Version 3.13 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,$0.00,3,0,1,1,1,1,20131001,00102,CPT,ANESTHESIA CLEFT LIP INVOLVING PLASTIC REPAIR,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00103,CPT,ANESTHESIA EYELID RECONSTRUCTIVE PROCEDURE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00104,CPT,ANESTHESIA ELECTROCONVULSIVE THERAPY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00120,CPT,ANESTHESIA EXTERNAL MIDDLE & INNER EAR W/BX NO,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00124,CPT,ANES EXTERNAL MIDDLE & INNER EAR W/BX OTOSCOPY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00126,CPT,ANES XTRNL MID & INNER EAR W/BX TYMPANOTOMY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00140,CPT,ANESTHESIA EYE NOT OTHERWISE SPECIFIED,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00142,CPT,ANESTHESIA EYE LENS SURGERY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00144,CPT,ANESTHESIA EYE CORNEAL TRANSPLANT,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00145,CPT,ANESTHESIA EYE VITREORETINAL SURGERY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00147,CPT,ANESTHESIA EYE IRIDECTOMY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00148,CPT,ANESTHESIA EYE OPHTHALMOSCOPY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00160,CPT,ANESTHESIA NOSE & ACCESSORY SINUSES NOS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00162,CPT,ANES NOSE & ACCESSORY SINUSES RADICAL SURGERY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00164,CPT,ANES NOSE & ACCESSORY SINUSES BIOPSY SOFT TISSUE,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00170,CPT,ANESTHESIA INTRAORAL WITH BIOPSY NOS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00172,CPT,ANES INTRAORAL W/BIOPSY REPAIR CLEFT PALATE,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00174,CPT,ANES INTRAORAL W/BX EXC RETROPHARYNGEAL TUMOR,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00176,CPT,ANESTHESIA INTRAORAL W/BIOPSY RADICAL SURGERY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00190,CPT,ANESTHESIA FACIAL BONES OR SKULL NOS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00192,CPT,ANES FACIAL BONES/SKULL RAD SURG W/PROGNATHISM,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20131001,0019T,CPT,EXTRACORPOREAL SHOCK WAVE MUSCSKEL NOS LOW ENRGY,,,21 ,,TotalUnits,,,,3.87 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,00210,CPT,ANESTHESIA INTRACRANIAL PROCEDURE NOS,,,3 ,,Anesth,,,,,11.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00211,CPT,ANES INTRACRANIAL CRANIOTOMY/CRANIECTOMY HMTMA,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00212,CPT,ANESTHESIA INTRACRANIAL PROCEDURE SUBDURAL TAPS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00214,CPT,ANES INTRACRANIAL BURR HOLES W/VENTRICULOGRAPHY,,,3 ,,Anesth,,,,,9.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00215,CPT,ANES INTRACRANIAL/ELEVATION DEPRSD SKULL FX XDRL,,,3 ,,Anesth,,,,,9.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00216,CPT,ANESTHESIA INTRACRANIAL VASCULAR PROCEDURE,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00218,CPT,ANES INTRACRANIAL PROCEDURE IN SITTING POSITION,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00220,CPT,ANES INTRACRANIAL CEREBROSPINAL FLUID SHUNTING,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00222,CPT,ANES INTRACRANIAL ELECTROCOAGULATION ICRA NERVE,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00300,CPT,ANES INTEG MUSC & NRV HEAD NECK&POSTERIOR TRUNK,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00320,CPT,ANES ESOPH THYRD LARYNX TRACH & LYMPH NECK 1YR,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00322,CPT,ANES ESOPH THYRD LARX TRACH & LYMPH NCK BX THYRD,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00326,CPT,ANESTHESIA LARYNX & TRACHEA CHILDREN <1 YEAR,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00350,CPT,ANESTHESIA MAJOR VESSELS NECK NOS,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00352,CPT,ANESTHESIA MAJOR VESSELS NECK SIMPLE LIGATION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00400,CPT,ANES INTEG EXTREMITIES ANT TRUNK & PERINEUM NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00402,CPT,ANESTHESIA RECONSTRUCTION BREAST,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00404,CPT,ANESTHESIA RADICAL/MODIFIED RADICAL BREAST,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00406,CPT,ANES RADICAL/MODIFIED RADICAL BREAST W/NODES,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00410,CPT,ANES INTEG SYS ELEC CONVERSION ARRHYTHMIAS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0042T,CPT,CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME,,,20 ,,TotalUnits,,,,2.75 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,00450,CPT,ANESTHESIA CLAVICLE AND SCAPULA NOS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00452,CPT,ANESTHESIA CLAVICLE & SCAPULA RADICAL SURGERY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00454,CPT,ANESTHESIA CLAVICLE & SCAPULA BIOPSY CLAVICLE,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00470,CPT,ANESTHESIA PARTIAL RIB RESECTION NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00472,CPT,ANESTHESIA PARTIAL RIB RESECTION THORACOPLASTY,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00474,CPT,ANESTHESIA PARTIAL RIB RESECTION RADICAL,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00500,CPT,ANESTHESIA ESOPHAGUS,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00520,CPT,ANESTHESIA CLOSED CHEST W/BRONCHOSCOPY NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00522,CPT,ANESTHESIA CLOSED CHEST NEEDLE BIOPSY PLEURA,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00524,CPT,ANESTHESIA CLOSED CHEST PNEUMOCENTESIS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00528,CPT,ANES MEDIASTINOSCOPY&THORACSCOPY W/O 1 LUNG VNTJ,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00529,CPT,ANES MEDIASTINOSCOPY&THORACOSCOPY W/1 LUNG VNT,,,3 ,,Anesth,,,,,11.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00530,CPT,ANES PERMANENT TRANSVENOUS PACEMAKER INSERTION,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00532,CPT,ANESTHESIA ACCESS CENTRAL VENOUS CIRCULATION,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00534,CPT,ANES TRANSVENOUS INSJ/REPLACEMENT PACING CVDFB,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00537,CPT,ANES CARDIAC ELECTROPHYSIOL STDY W/RF ABLATION,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00539,CPT,ANESTHESIA TRACHEOBRONCHIAL RECONSTRUCTION,,,3 ,,Anesth,,,,,18.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00540,CPT,ANES THORACOTOMY & THORACOSCOPY NOS,,,3 ,,Anesth,,,,,12.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00541,CPT,ANES THORACOTOMY & THORACOSCOPY W/1 LUNG VNTJ,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00542,CPT,ANES THORACOTOMY & THORACOSCOPY DECORTICATION,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00546,CPT,ANES THORACOTOMY & THORACOSCOPY PULMONARY RESC,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00548,CPT,ANES THORACOTOMY &THORACSCOPY TRACHEA & BRONCHI,,,3 ,,Anesth,,,,,17.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00550,CPT,ANESTHESIA FOR STERNAL DEBRIDEMENT,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0055T,CPT,CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI,,,21 ,,TotalUnits,,,,9.15 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,00560,CPT,ANES HRT PERICARDIAL SAC& GRT VESLS W/O PMP OXT,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00561,CPT,ANES HRT PERICARD SAC&GREAT VSLS W/PMP OXTJ <1YR,,,3 ,,Anesth,,,,,25.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00562,CPT,ANES HRT PERICRD SAC&GRT VSLS W/PMP OXTJ >1MO PO,,,3 ,,Anesth,,,,,20.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00563,CPT,ANES HRT PRCRD SAC & GREAT VSL W/PUMP OXTJ HYPTH,,,3 ,,Anesth,,,,,25.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00566,CPT,ANES DIRECT CABG W/O PUMP OXYGENATOR,,,3 ,,Anesth,,,,,25.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00567,CPT,ANES DIRECT CABG W/PUMP OXYGENATOR,,,3 ,,Anesth,,,,,18.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00580,CPT,ANES HEART TRANSPLANT/HEART/LUNG TRANSPLANT,,,3 ,,Anesth,,,,,20.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00600,CPT,ANESTHESIA CERVICAL SPINE & CORD NOS,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00604,CPT,ANES CERVICAL SPINE & CORD W/PATIENT SITTING,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00620,CPT,ANESTHESIA THORACIC SPINE & CORD NOS,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00622,CPT,ANES THORACIC SPINE & CORD THORACOLUMBAR SYMPTH,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00625,CPT,ANES THRC SPINE & CORD ANT APPR W/O 1 LUNG VENTJ,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00626,CPT,ANES THORACIC SPINE & CORD ANT APPR W/1 LNG VENT,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00630,CPT,ANESTHESIA LUMBAR REGION NOS,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00632,CPT,ANESTHESIA LUMBAR REGION LUMBAR SYMPATHECTOMY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00634,CPT,ANESTHESIA LUMBAR CHEMONUCLEOLYSIS,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00635,CPT,ANES DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00640,CPT,ANES MANIPULATE SPINE/CLSD CRV THORC/LUMBR SPINE,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00670,CPT,ANESTHESIA EXTENSIVE SPINE & SPINAL CORD,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00700,CPT,ANESTHESIA UPPER ANTERIOR ABDOMINAL WALL NOS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00702,CPT,ANES UPR ANT ABDL WALL PERCUTANEOUS LIVER BX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00730,CPT,ANESTHESIA UPPER POSTERIOR ABDOMINAL WALL,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0073T,CPT,COMPNSTR-BASED BEAM MODLJ TX DLVR INVERSE 3> FLD,,TC,20 ,,RBRVS,,13.97 ,13.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,00740,CPT,ANES UPPER GI ENDOSCOPY PROXIMAL TO DUODENUM,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00750,CPT,ANESTHESIA HERNIA REPAIR UPPER ABDOMEN NOS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00752,CPT,ANES HRNA RPR UPR ABD LMBR&VENTRAL HERNIA&DEHISC,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00754,CPT,ANES HERNIA REPAIR UPPER ABDOMEN OMPHALOCELE,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00756,CPT,ANES HRNA REPAIR UPR ABD TABDL RPR DIPHRG HRNA,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0075T,CPT,TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL,,,21 ,,TotalUnits,,,,14.77 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,0075T,CPT,TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL,26,,21 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,0075T,CPT,TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL,TC,,21 ,,TotalUnits,,,,13.85 ,,$0.00,$0.00,1,1,0,0,1,1,20131001,00770,CPT,ANESTHESIA MAJOR ABDOMINAL BLOOD VESSELS,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0078T,CPT,EVASC RPR AAA PSEUDOARYSM ABDL AORTA VISC,,,21 ,,TotalUnits,,,,26.80 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,00790,CPT,ANES INTRAPERITONEAL UPPER ABDOMEN W/LAPS NOS,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00792,CPT,ANES LAPS PARTIAL HEPATECTOMY W/MGMT LIVER HEMOR,,,3 ,,Anesth,,,,,13.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00794,CPT,ANES LAPAROSCOPIC PARTIAL/TOTAL PANCREATECTOMY,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00796,CPT,ANES LAPAROSCOPIC LIVER TRANSPLANT,,,3 ,,Anesth,,,,,30.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00797,CPT,ANES IPR UPPER ABDOMEN LAPS GASTRIC RSTCV MO,,,3 ,,Anesth,,,,,11.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0079T,CPT,PLMT VISC XTN PROSTH EVASC RPR AAA EA VISC,,,21 ,,TotalUnits,,,,38.75 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,00800,CPT,ANESTHESIA LOWER ANTERIOR ABDOMINAL WALL NOS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00802,CPT,ANES LOWER ANT ABDOMINAL WALL PANNICULECTOMY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,0,1,1,1,20131001,0080T,CPT,EVASC RPR AAA PSEUDOARYSM ABDL AORTA VISC RS&I,,,21 ,,TotalUnits,,,,4.20 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,00810,CPT,ANES LOWER INTESTINE ENDOSCOPY DISTAL DUODENUM,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0081T,CPT,PLMT VISC XTN PROSTH EVASC RPR AAA EA VISC RS&I,,,21 ,,TotalUnits,,,,6.43 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,00820,CPT,ANESTHESIA LOWER POSTERIOR ABDOMINAL WALL,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00830,CPT,ANESTHESIA HERNIA REPAIR LOWER ABDOMEN NOS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00832,CPT,ANES LWR ABD VENTRAL & INCISIONAL HERNIA REPAIR,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00834,CPT,ANES HERNIA REPAIR LOWER ABDOMEN NOS & 1YR AGE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00836,CPT,ANES HRNA RPR LWR ABD NOS INFTS <37WK BRTH/50WK,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00840,CPT,ANESTHESIA INTRAPERITONEAL LOWER ABD W/LAPS NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00842,CPT,ANES IPER LOWER ABDOMEN W/LAPS AMNIOCENTESIS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00844,CPT,ANES IPER LOWER ABD W/LAPS ABDOMINOPRNL RESCJ,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00846,CPT,ANES IPER LOWER ABD W/LAPS RAD HYSTERECTOMY,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00848,CPT,ANES IPER LOWER ABD W/LAPS PELVIC EXENTERATION,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00851,CPT,ANES IPER LWR ABD W/LAPS TUBAL LIGATION/TRANSECT,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00860,CPT,ANES EXTRAPERITONEAL LWR ABD W/URINARY TRACT NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00862,CPT,ANES XTRPRTL LOWER ABD UR TRACT RENAL DON NFRCT,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00864,CPT,ANES XTRPRTL LWER ABD W/URINARY TRACT TOT CYSTEC,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00865,CPT,ANES XTRPRTL LWR ABD W/URINARY TRACT RAD PRSTECT,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00866,CPT,ANES XTRPRTL LOWER ABD W/URIN TRACT ADRENLECTOMY,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00868,CPT,ANES XTRPRTL LWR ABD W/URIN TRACT RENAL TRANSPL,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00870,CPT,ANES XTRPRTL LWR ABD W/URIN TRACT CSTOLITHOTOMY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00872,CPT,ANES LITHOTRP XTRCORP SHOCK WAVE W/WATER BATH,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00873,CPT,ANES LITHOTRP XTRCORP SHOCK WAVE W/O WATER BATH,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00880,CPT,ANESTHESIA MAJOR LOWER ABDOMINAL VESSELS NOS,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00882,CPT,ANES MAJOR LOWER ABDOMINAL VESSELS IVC LIGATION,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00902,CPT,ANESTHESIA ANORECTAL PROCEDURE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00904,CPT,ANESTHESIA RADICAL PERINEAL PROCEDURE,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00906,CPT,ANESTHESIA VULVECTOMY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00908,CPT,ANESTHESIA PERINEAL PROSTATECTOMY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00910,CPT,ANES TRANSURETHRAL W/URETHROCYSTOSCOPY NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00912,CPT,ANES TRANSURETHRAL RESECTION OF BLADDER TUMOR,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00914,CPT,ANESTHESIA TRANSURETHRAL RESECTION OF PROSTATE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00916,CPT,ANES TRURL POST-TRURL RESECTION BLEEDING,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00918,CPT,ANES TRURL FRAGMNTJ MANJ&/RMVL URETERAL CALCULUS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00920,CPT,ANESTHESIA MALE GENITALIA INCL OPEN URETHRAL PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00921,CPT,ANES VASECTOMY UNI/BI INCL OPEN URETHRAL PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00922,CPT,ANES SEMINAL VESICLES INCL OPEN URETHRAL PX,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00924,CPT,ANES UNDSCND TESTIS UNI/BI INCL OPEN URTL PX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00926,CPT,ANES RAD ORCHIECTOMY INGUN INCL OPEN URTL PX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00928,CPT,ANES RAD ORCHIECTOMY ABDOMINAL INCL OPN URTL,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0092T,CPT,TOT DISC ARTHRP ANT APPR DSKC PREP CRV EA NTRSPC,,,21 ,,RBRVS,4.04 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,00930,CPT,ANES ORCHIOPEXY UNI/BI INCL OPEN URETHRAL PX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00932,CPT,ANES COMPLETE AMPUTATION PENIS INCL OPEN URTL,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00934,CPT,ANES RAD AMP PENIS W/BI INGUINAL LYMPH NODE RMVL,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00936,CPT,ANES RAD AMP PENIS W/BI INGUNL&ILIAC LYMPH RMOVL,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00938,CPT,ANES INSJ PENILE PROSTH PRNL INCL OPEN URTL,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00940,CPT,ANESTHESIA VAGINAL PROCEDURE W/BIOPSY NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00942,CPT,ANES COLPTMY VAGNC COLPRPHY INCL BX W/OPN URTL,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00944,CPT,ANESTHESIA VAGINAL HYSTERECTOMY INCL BIOPSY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20131001,00948,CPT,ANESTHESIA CERVICAL CERCLAGE INCLUDING BIOPSY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00950,CPT,ANESTHESIA CULDOSCOPY INCLUDING BIOPSY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,00952,CPT,ANES HYSTEROSCOPY&/HYSTEROSALPINGOGRAPHY W/BX,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0095T,CPT,RMVL TOT DISC ARTHRP ANT APPR CRV EA NTRSPC,,,21 ,,RBRVS,4.04 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,0098T,CPT,REVJ TOT DISC ARTHRP ANT APPR CRV EA NTRSPC,,,21 ,,RBRVS,4.04 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,0099T,CPT,IMPLTJ INTRASTROMAL CORNEAL RING SEGMENTS,,,21 ,,TotalUnits,,,,5.14 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0100T,CPT,PLMT SCJNCL RTA PROSTH&PLS&IMPLTJ INTRA-OC RTA,,,21 ,,TotalUnits,,,,12.92 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0101T,CPT,EXTRCORPL SHOCK WAVE MUSCSKELE NOS HIGH ENERGY,,,21 ,,TotalUnits,,,,5.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0102T,CPT,EXTRCRPL SHOCK WAVE W/ANES LAT HUMERL EPICONDYLE,,,21 ,,TotalUnits,,,,5.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0106T,CPT,QUANT SENSORY TEST&INTERPJ/XTR W/TOUCH STIMULI,,,14 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0107T,CPT,QUANT SENSORY TEST&INTERPJ/XTR W/VIBRJ STIMULI,,,14 ,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0108T,CPT,QUANT SENSORY TEST&INTERPJ/XTR W/COOL STIMULI,,,14 ,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,01112,CPT,ANES BONE MARROW ASPIR&/BX ANT/PST ILIAC CREST,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0111T,CPT,LONG-CHAIN OMEGA-3 FATTY ACIDS RBC MEMBS,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,01120,CPT,ANESTHESIA ON BONY PELVIS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01130,CPT,ANESTHESIA BODY CAST APPLICATION OR REVISION,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01140,CPT,ANESTHESIA INTERPELVI ABDOMINAL AMPUTATION,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01150,CPT,ANES RADICAL TUMOR PELVIS XCP HINDQUARTER AMP,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01160,CPT,ANES CLOSED SYMPHYSIS PUBIS/SACROILIAC JOINT,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01170,CPT,ANES OPEN SYMPHYSIS PUBIS/SACROILIAC JOINT,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01173,CPT,ANES OPN RPR DISRPJ PELVIS/COLUMN FX ACETABULUM,,,3 ,,Anesth,,,,,12.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01180,CPT,ANESTHESIA OBTURATOR NEURECTOMY EXTRAPELVIC,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01190,CPT,ANESTHESIA OBTURATOR NEURECTOMY INTRAPELVIC,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01200,CPT,ANESTHESIA CLOSED HIP JOINT PROCEDURE,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01202,CPT,ANESTHESIA ARTHROSCOPIC HIP JOINT PROCEDURE,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01210,CPT,ANESTHESIA OPEN HIP JOINT PROCEDURE NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01212,CPT,ANESTHESIA OPEN HIP JOINT DISARTICULATION,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01214,CPT,ANESTHESIA OPEN TOTAL HIP ARTHROPLASTY,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01215,CPT,ANESTHESIA OPEN REVISION TOTAL HIP ARTHROPLASTY,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01220,CPT,ANESTHESIA CLOSED PROCEDURES UPPER 2/3 FEMUR,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01230,CPT,ANESTHESIA OPEN PROCEDURES UPPER 2/3 FEMUR NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01232,CPT,ANESTHESIA UPPER 2/3 FEMUR AMPUTATION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01234,CPT,ANES UPPER 2/3 FEMUR RADICAL RESCECTION,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01250,CPT,ANES NERVE MUSC TENDON FASCIA & BURSAE UPPER LEG,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01260,CPT,ANES VEINS OF UPPER LEG INCLUDING EXPLORATION,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0126T,CPT,COMMON CAROTID INTIMA MEDIA THICKNESS STUDY,,,4 ,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,01270,CPT,ANESTHESIA ARTERIES UPPER LEG INCL BYPASS GRAFT,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01272,CPT,ANES ART UPPER LEG W/BYPASS GRAFT FEM ART LIG,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01274,CPT,ANES UPPER LEG W/BYPASS GRFT FEM ART EMBOLECTOMY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01320,CPT,ANES NERVE MUSC TENDON FASCIA&BURSA KNEE&/POPLT,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01340,CPT,ANESTHESIA CLOSED PROCEDURES LOWER 1/3 FEMUR,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01360,CPT,ANESTHESIA OPEN PROCEDURES LOWER 1/3 FEMUR,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01380,CPT,ANESTHESIA CLOSED PROCEDURES KNEE JOINT,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01382,CPT,ANESTH DIAGNOSTIC ARTHROSCOPIC PROC KNEE JOINT,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01390,CPT,ANES CLOSED PROC UPPER END TIBIA FIBULA&/PATELLA,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01392,CPT,ANES OPEN PROC UPPER ENDS TIBIA FIBULA&/PATELLA,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01400,CPT,ANES OPEN/SURG ARTHROSCOPIC PROC KNEE JOINT NOS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01402,CPT,ANESTH OPEN/SURG ARTHRS TOTAL KNEE ARTHROPLASTY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01404,CPT,ANESTH OPEN/SURG ARTHRS KNEE DISARTICULATION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01420,CPT,ANES CAST APPLICATION REMOVAL/REPAIR KNEE JOINT,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01430,CPT,ANESTHESIA VEINS KNEE & POPLITEAL AREA NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01432,CPT,ANES KNEE & POPLITEAL ARTERY VEIN FISTULA NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01440,CPT,ANES ARTERIES OF KNEE & POPLITEAL AREA NOS,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01442,CPT,ANES ART KNEE POPLITEAL TEAEC W/WO PATCH GRAFT,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01444,CPT,ANES ART KNEE POPLITEAL EXC&GRF/RPR OCCLS/ARYS,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01462,CPT,ANESTHESIA CLOSED PROC LOWER LEG ANKLE & FOOT,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01464,CPT,ANESTHESIA ARTHROSCOPIC PROCEDURE ANKLE & FOOT,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01470,CPT,ANES NRV/MUS/TND/FASC LOWER LEG/ANKLE/FOOT NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01472,CPT,ANES RPR RUPTURED ACHILLES TENDON W/WO GRAFT,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01474,CPT,ANESTHESIA GASTROCNEMIUS RECESSION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01480,CPT,ANES OPEN PROC BONES LOWER LEG/ANKLE/FOOT NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01482,CPT,ANES RADICAL RESECJ INCL BELOW KNEE AMPUTATION,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01484,CPT,ANES OPEN OSTEOTOMY/OSTEOPLASTY TIBIA&/FIBULA,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01486,CPT,ANESTHESIA OPEN TOTAL ANKLE REPLACEMENT,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01490,CPT,ANES LOWER LEG CAST APPLICATION REMOVAL/REPAIR,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01500,CPT,ANESTHESIA ARTERIES LOWER LEG W/BYPASS GRAFT NOS,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01502,CPT,ANES ART LOWER LEG W/BYP GRAFT EMBLC DIR/W/CATH,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01520,CPT,ANESTHESIA VEINS OF LOWER LEG NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01522,CPT,ANES VEINS LOWER LEG VENOUS THRMBC DIR/W/CATH,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0159T,CPT,COMPUTER AIDED DETECTION BREAST MRI,,,20 ,,TotalUnits,,,,1.81 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,0159T,CPT,COMPUTER AIDED DETECTION BREAST MRI,,PC,20 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,0159T,CPT,COMPUTER AIDED DETECTION BREAST MRI,,TC,20 ,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,01610,CPT,ANES NRV MUSC TNDN FSCIA BURSA SHOULDER & AXILLA,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01620,CPT,ANES CLOSED HUMRL H/N STRNCLAV JOINT& SHO JOINT,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01622,CPT,ANES DIAG ARTHROSCOPIC SHOULDER JOINT PROC NOS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01630,CPT,ANES ARTHRS HUMERAL H/N STRNCLAV & SHOULDER NOS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01634,CPT,ANESTHESIA ARTHROSCOPIC SHOULDER DISARTICULATION,,,3 ,,Anesth,,,,,9.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01636,CPT,ANES ARTHRS INTERTHORACOSCAPULAR AMPUTATION,,,3 ,,Anesth,,,,,15.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01638,CPT,ANES ARTHROSCOPIC TOTAL SHOULDER REPLACEMENT,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01650,CPT,ANESTHESIA ARTERIES SHOULDER & AXILLA NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01652,CPT,ANESTHESIA AXILLARY-BRACHIAL ANEURYSM,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01654,CPT,ANES ARTERIES SHOULDER & AXILLA BYPASS GRAFT,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01656,CPT,ANESTHESIA AXILLARY-FEMORAL BYPASS GRAFT,,,3 ,,Anesth,,,,,10.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01670,CPT,ANESTHESIA VEINS SHOULDER & AXILLA,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01680,CPT,ANES SHOULDER CAST APPL REMOVAL/REPAIR NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01682,CPT,ANES SHOULDER SPICA APPLICATION REMOVAL/REPAIR,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01710,CPT,ANES NRV MUSC TDN FSCA&BRS UPR ARM/ELBOW NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01712,CPT,ANESTHESIA OPEN TENOTOMY ELBOW TO SHOULDER,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01714,CPT,ANESTHESIA TENOPLASTY ELBOW TO SHOULDER,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01716,CPT,ANESTHESIA BICEPS TENODESIS RUPTURE LONG TENDON,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0171T,CPT,PST SPINOUS PROCESS DEVICE INSERT LMBR 1 LVL,,,21 ,,TotalUnits,,,,35.83 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0172T,CPT,PST SPINOUS PROCESS DEVICE INSERT LMBR EA LVL,,,21 ,,TotalUnits,,,,16.04 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,01730,CPT,ANESTHESIA CLOSED PROCEDURES HUMERUS & ELBOW,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01732,CPT,ANESTHESIA ELBOW JOINT DIAGNOSTIC ARTHROSCOPIC,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01740,CPT,ANES OPEN/SURG ARTHROSCOPIC ELBOW PROC NOS,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01742,CPT,ANESTHESIA OPEN/SURG ARTHRS OSTEOTOMY HUMERUS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01744,CPT,ANES OPEN/SURG ARTHRS REPRS NON/MALUNION HUMERUS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0174T,CPT,CAD CHEST RADIOGRAPH CONCURRENT W/INTERPRETATION,,,20 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,01756,CPT,ANESTHESIA OPEN/SURG ARTHRS RADICAL PROC ELBOW,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01758,CPT,ANESTH OPEN/SURG ARTHRS EXC CYST/TUMOR HUMERUS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01760,CPT,ANESTH OPEN/SURG ARTHRS TOTAL ELBOW REPLACEMENT,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01770,CPT,ANESTHESIA ARTERIES UPPER ARM & ELBOW NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01772,CPT,ANESTHESIA ARTERIES UPPER ARM&ELBOW EMBOLECTOM,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01780,CPT,ANESTH CLOSED PROC RADIUS ULNA WRIST/HAND BONES,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01782,CPT,ANESTHESIA VEINS UPPER ARM & ELBOW PHLEBORRHAPHY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01810,CPT,ANES NERVE MUSCLE TDN FASCIA&BURSA FOREARM WRIST,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0181T,CPT,CORNEAL HYSTERESIS AIR IMPULSE STIMJ BI W/I&R,,,14 ,,TotalUnits,,,,3.66 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,01820,CPT,ANES RADIUS ULNA WRIST/HAND BONES CLOSED PX,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01829,CPT,ANESTHESIA DIAGNOSTIC ARTHROSCOPIC PROC WRIST,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0182T,CPT,HDR ELECTRONIC BRACHYTHERAPY PER FRACTION,,,20 ,,TotalUnits,,,,43.09 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,0182T,CPT,HDR ELECTRONIC BRACHYTHERAPY PER FRACTION,26,,20 ,,TotalUnits,,,,4.31 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0182T,CPT,HDR ELECTRONIC BRACHYTHERAPY PER FRACTION,TC,,20 ,,TotalUnits,,,,38.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,01830,CPT,ANES ARTHRS/ENDSCPY DSTL RADIUS ULNA/WRIST/HAND,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01832,CPT,ANESTHESIA ARTHRS/ENDOSCPIC TOTAL WRIST REPLCMT,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0183T,CPT,LOW FREQUENCY WOUND ULTRASOUND,,,20 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,01840,CPT,ANESTHESIA ARTERIES FOREARM WRIST & HAND NOS,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01842,CPT,ANES ARTERIES FOREARM WRIST & HAND EMBOLECTOMY,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01844,CPT,ANESTHESIA VASCULAR SHUNT/SHUNT REVISION,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01850,CPT,ANESTHESIA VEINS FOREARM WRIST & HAND NOS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01852,CPT,ANES VEINS FOREARM WRIST & HAND PHLEBORRHAPHY,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01860,CPT,ANES FOREARM WRIST/HAND CAST APPL RMVL/REPAIR,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01916,CPT,ANESTHESIA DIAGNOSTIC ARTERIOGRAPHY/VENOGRAPH,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01920,CPT,ANES C-CATHJ W/C ANGIOGRAPHY & VENTRICULOGRAPHY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01922,CPT,ANES NON-INVASIVE IMAGING/RADIATION THERAPY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01924,CPT,ANESTHESIA THER IVNTL RADIOLOGICAL ARTERIAL,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01925,CPT,ANESTHESIA CAROTID/CORONARY THER IVNTL RAD,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01926,CPT,ANES ICRA ICAR/AORTIC THER IVNTL RAD ARTL,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0192T,CPT,ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR EXT,,,21 ,,TotalUnits,,,,28.81 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,01930,CPT,ANES VENOUS/LYMPHATIC NOS THER IVNTL RAD NOS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01931,CPT,ANESTHESIA INTRAHEPATIC/PORTAL THER IVNTL RAD,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01932,CPT,ANESTHESIA INTRATHORACIC/JUGULAR THER IVNTL RAD,,,3 ,,Anesth,,,,,6.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01933,CPT,ANES INTRACRANIAL THER IVNTL RAD VENS/LYMPHTC,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01935,CPT,ANESTHESIA PERQ IMAGE GUIDED SPINE DIAGNOSTIC,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01936,CPT,ANESTHESIA PERQ IMAGE GUIDED SPINE THERAPEUTIC,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01951,CPT,ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRFT 4 % TBSA,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01952,CPT,ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRFT 4-9 % TBSA,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01953,CPT,ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRF EA 9% TBS,,,3 ,,Anesth,,,,,1.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01958,CPT,ANESTHESIA EXTERNAL CEPHALIC VERSION,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01960,CPT,ANESTHESIA VAGINAL DELIVERY ONLY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01961,CPT,ANESTHESIA CESAREAN DELIVERY ONLY,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01962,CPT,ANES URGENT HYSTERECTOMY FOLLOWING DELIVERY,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01963,CPT,ANESTHESIA C HYST W/O ANY LABOR ANALG/ANES CARE,,,3 ,,Anesth,,,,,8.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01965,CPT,ANESTHESIA INCOMPLETE/MISSED ABORTION,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01966,CPT,ANESTHESIA INDUCED ABORTION,,,3 ,,Anesth,,,,,4.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01967,CPT,NEURAXIAL LABOR ANALG/ANES PLND VAGINAL DELIVERY,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01968,CPT,ANES CESARN DLVR FLWG NEURAXIAL LABOR ANALG/ANES,,,3 ,,Anesth,,,,,2.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01969,CPT,ANES CESARN HYST FLWG NEURAXIAL LABOR ANALG/ANES,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0197T,CPT,IFXJ LOCLZ&TRAKG TRGT/PT MTN DUR RADTX EA FXJ,,,20 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0198T,CPT,MEAS OCULAR BLOOD FLOW REPEAT IO PRES SAMP W/I&R,,,20 ,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,01990,CPT,PHYSIOL SUPPORT HARVEST ORGAN FROM BRAIN-DEAD PT,,,3 ,,Anesth,,,,,7.0,$1.00,$0.00,3,0,0,1,1,1,20131001,01991,CPT,ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS,,,3 ,,Anesth,,,,,3.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01992,CPT,ANES DX/THER NERVE BLOCK/INJECTION PRONE POS,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,01996,CPT,DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN,,,3 ,,TotalUnits,,,,2.74 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,01999,CPT,UNLISTED ANESTHESIA PROCEDURE,,,3 ,,Anesth,,,,,5.0,$1.00,$0.00,3,0,1,1,1,1,20131001,0201T,CPT,PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS,,,20 ,,TotalUnits,,,,22.87 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0206T,CPT,RMT ALGRTHMC ALYS ECG W/CPTR PRBLTY ASSMT,,TC,14 ,,TotalUnits,,,,3.86 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,0228T,CPT,NJX ANES/STEROID TFRML EDRL W/US CER/THOR 1 LVL,,,21 ,,TotalUnits,,,,7.09 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0229T,CPT,NJX ANES/STERD TFRML EDRL W/US CER/THOR EA ADDL,,,21 ,,TotalUnits,,,,3.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0230T,CPT,NJX ANES/STEROID TFRML EDRL W/US LUM/SAC 1 LVL,,,21 ,,TotalUnits,,,,6.90 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0231T,CPT,NJX ANES/STEROID TFRML EDRL W/US LUM/SAC EA ADDL,,,21 ,,TotalUnits,,,,3.48 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0232T,CPT,NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION,,,14 ,,TotalUnits,,,,16.34 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0234T,CPT,TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA,,,21 ,,RBRVS,5.53 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,0235T,CPT,TRLUML PERIPHERAL ATHERECTOMY VISCERAL ARTERY EA,,,21 ,,RBRVS,5.53 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,0236T,CPT,TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA,,,21 ,,RBRVS,7.60 ,3.18 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,0237T,CPT,TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL,,,21 ,,RBRVS,10.42 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,0238T,CPT,TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA,,,21 ,,RBRVS,6.64 ,3.19 ,3.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,0241T,CPT,ESOPH/GASTROESOPH MOTILITY W/STIM/PERFU W/I&R,,,14 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,0241T,CPT,ESOPH/GASTROESOPH MOTILITY W/STIM/PERFU W/I&R,26,,14 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,0241T,CPT,ESOPH/GASTROESOPH MOTILITY W/STIM/PERFU W/I&R,TC,,14 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,10021,CPT,FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE,,,21 ,,RBRVS,1.27 ,0.58 ,2.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10022,CPT,FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE,,,21 ,,RBRVS,1.27 ,0.49 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10040,CPT,ACNE SURGERY,,,21 ,,RBRVS,1.21 ,1.22 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10060,CPT,INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,,,21 ,,RBRVS,1.22 ,1.43 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10061,CPT,INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE,,,21 ,,RBRVS,2.45 ,2.34 ,3.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10080,CPT,INCISION & DRAINAGE PILONIDAL CYST SIMPLE,,,21 ,,RBRVS,1.22 ,1.55 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10081,CPT,INCISION & DRAINAGE PILONIDAL CYST COMPLICATED,,,21 ,,RBRVS,2.50 ,2.07 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10120,CPT,INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,,,21 ,,RBRVS,1.25 ,1.31 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10121,CPT,INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL,,,21 ,,RBRVS,2.74 ,2.29 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10140,CPT,I&D HEMATOMA SEROMA/FLUID COLLECTION,,,21 ,,RBRVS,1.58 ,1.67 ,2.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10160,CPT,PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,,,21 ,,RBRVS,1.25 ,1.39 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,10180,CPT,INCISION & DRAINAGE COMPLEX PO WOUND INFECTION,,,21 ,,RBRVS,2.30 ,2.47 ,4.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11000,CPT,DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF,,,21 ,,RBRVS,0.60 ,0.20 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11001,CPT,DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF,,,21 ,,RBRVS,0.30 ,0.09 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11004,CPT,DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR,,,21 ,,RBRVS,10.80 ,4.40 ,4.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,11005,CPT,DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL,,,21 ,,RBRVS,14.24 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,11006,CPT,DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL,,,21 ,,RBRVS,13.10 ,5.38 ,5.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,11008,CPT,REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION,,,21 ,,RBRVS,5.00 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,11010,CPT,DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS,,,21 ,,RBRVS,4.19 ,3.34 ,9.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11011,CPT,DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC,,,21 ,,RBRVS,4.94 ,2.94 ,9.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11012,CPT,DBRDMT FX&/DISLC SUBQ T/M/F BONE,,,21 ,,RBRVS,6.87 ,4.39 ,12.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11042,CPT,DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,,,21 ,,RBRVS,1.01 ,0.61 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11043,CPT,DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<,,,21 ,,RBRVS,2.70 ,1.50 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11044,CPT,DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<,,,21 ,,RBRVS,4.10 ,2.13 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11045,CPT,DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM,,,21 ,,RBRVS,0.50 ,0.18 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11046,CPT,DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM,,,21 ,,RBRVS,1.03 ,0.41 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11047,CPT,DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,,,21 ,,RBRVS,1.80 ,0.74 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11055,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,,,21 ,,RBRVS,0.43 ,0.13 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11056,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4,,,21 ,,RBRVS,0.50 ,0.15 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11057,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,,,21 ,,RBRVS,0.79 ,0.23 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11100,CPT,BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION,,,21 ,,RBRVS,0.81 ,0.53 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11101,CPT,BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN,,,21 ,,RBRVS,0.41 ,0.27 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11200,CPT,REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15,,,21 ,,RBRVS,0.82 ,1.19 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11201,CPT,REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10,,,21 ,,RBRVS,0.29 ,0.16 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11300,CPT,SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<,,,21 ,,RBRVS,0.51 ,0.30 ,1.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11301,CPT,SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,,,21 ,,RBRVS,0.85 ,0.53 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11302,CPT,SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,,,21 ,,RBRVS,1.05 ,0.66 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11303,CPT,SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,,,21 ,,RBRVS,1.24 ,0.77 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11305,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<,,,21 ,,RBRVS,0.67 ,0.25 ,1.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11306,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM,,,21 ,,RBRVS,0.99 ,0.47 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11307,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,,,21 ,,RBRVS,1.14 ,0.60 ,2.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11308,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM,,,21 ,,RBRVS,1.41 ,0.61 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11310,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<,,,21 ,,RBRVS,0.73 ,0.44 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11311,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,,,21 ,,RBRVS,1.05 ,0.67 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11312,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,,,21 ,,RBRVS,1.20 ,0.77 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11313,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,,,21 ,,RBRVS,1.62 ,1.01 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11400,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<,,,21 ,,RBRVS,0.90 ,1.30 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11401,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM,,,21 ,,RBRVS,1.28 ,1.56 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11402,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM,,,21 ,,RBRVS,1.45 ,1.65 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11403,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<,,,21 ,,RBRVS,1.84 ,2.14 ,3.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11404,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM,,,21 ,,RBRVS,2.11 ,2.24 ,3.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11406,CPT,EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM,,,21 ,,RBRVS,3.52 ,2.94 ,4.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11420,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,,,21 ,,RBRVS,1.03 ,1.24 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11421,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,,,21 ,,RBRVS,1.47 ,1.56 ,2.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11422,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,,,21 ,,RBRVS,1.68 ,2.02 ,3.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11423,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM,,,21 ,,RBRVS,2.06 ,2.22 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11424,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,,,21 ,,RBRVS,2.48 ,2.36 ,3.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11426,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM,,,21 ,,RBRVS,4.09 ,3.20 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11440,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<,,,21 ,,RBRVS,1.05 ,1.80 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11441,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,,,21 ,,RBRVS,1.53 ,2.09 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11442,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,,,21 ,,RBRVS,1.77 ,2.23 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11443,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM,,,21 ,,RBRVS,2.34 ,2.53 ,3.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11444,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM,,,21 ,,RBRVS,3.19 ,2.97 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11446,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM,,,21 ,,RBRVS,4.80 ,3.90 ,5.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11450,CPT,EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR,,,21 ,,RBRVS,3.22 ,3.40 ,7.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11451,CPT,EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR,,,21 ,,RBRVS,4.43 ,4.07 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11462,CPT,EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR,,,21 ,,RBRVS,3.00 ,3.43 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11463,CPT,EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR,,,21 ,,RBRVS,4.43 ,4.17 ,8.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11470,CPT,EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR,,,21 ,,RBRVS,3.74 ,3.71 ,7.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11471,CPT,EXCISION H/P/P/U COMPLEX REPAIR,,,21 ,,RBRVS,4.89 ,4.35 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11600,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<,,,21 ,,RBRVS,1.63 ,1.59 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11601,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,,21 ,,RBRVS,2.07 ,2.00 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11602,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM,,,21 ,,RBRVS,2.27 ,2.21 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11603,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<,,,21 ,,RBRVS,2.82 ,2.49 ,5.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11604,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM,,,21 ,,RBRVS,3.17 ,2.62 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11606,CPT,EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM,,,21 ,,RBRVS,5.02 ,3.43 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11620,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<,,,21 ,,RBRVS,1.64 ,1.63 ,3.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11621,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM,,,21 ,,RBRVS,2.08 ,2.03 ,4.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11622,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM,,,21 ,,RBRVS,2.41 ,2.29 ,4.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11623,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<,,,21 ,,RBRVS,3.11 ,2.65 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11624,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM,,,21 ,,RBRVS,3.62 ,2.86 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11626,CPT,EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM,,,21 ,,RBRVS,4.61 ,3.29 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11640,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<,,,21 ,,RBRVS,1.67 ,1.75 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11641,CPT,EXCISION MALIGNANT LES F/E/E/N/L 0.6-1.0 CM,,,21 ,,RBRVS,2.17 ,2.14 ,4.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11642,CPT,EXCISION MALIGNANT LES F/E/E/N/L 1.1-2.0 CM,,,21 ,,RBRVS,2.62 ,2.44 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11643,CPT,EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<,,,21 ,,RBRVS,3.42 ,2.87 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11644,CPT,EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM,,,21 ,,RBRVS,4.34 ,3.42 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11646,CPT,EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM,,,21 ,,RBRVS,6.26 ,4.44 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11719,CPT,TRIMMING NONDYSTROPHIC NAILS ANY NUMBER,,,21 ,,RBRVS,0.17 ,0.05 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11720,CPT,DEBRIDEMENT NAIL ANY METHOD 1-5,,,21 ,,RBRVS,0.32 ,0.09 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11721,CPT,DEBRIDEMENT NAIL ANY METHOD 6/>,,,21 ,,RBRVS,0.54 ,0.16 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11730,CPT,AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1,,,21 ,,RBRVS,1.10 ,0.32 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11732,CPT,AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,,,21 ,,RBRVS,0.44 ,0.14 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11740,CPT,EVACUATION SUBUNGUAL HEMATOMA,,,21 ,,RBRVS,0.37 ,0.54 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11750,CPT,EXCISION NAIL MATRIX PERMANENT REMOVAL,,,21 ,,RBRVS,2.50 ,2.34 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11752,CPT,EXC NAIL MATRIX PRM RMVL W/AMP TUFT DSTL PHALANX,,,21 ,,RBRVS,3.63 ,3.62 ,5.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11755,CPT,BIOPSY NAIL UNIT SEPARATE PROCEDURE,,,21 ,,RBRVS,1.31 ,0.91 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11760,CPT,REPAIR NAIL BED,,,21 ,,RBRVS,1.63 ,2.05 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11762,CPT,RECONSTRUCTION NAIL BED W/GRAFT,,,21 ,,RBRVS,2.94 ,2.23 ,4.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11765,CPT,WEDGE EXCISION SKIN NAIL FOLD,,,21 ,,RBRVS,1.22 ,1.35 ,3.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11770,CPT,EXCISION PILONIDAL CYST/SINUS SIMPLE,,,21 ,,RBRVS,2.66 ,2.16 ,4.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11771,CPT,EXCISION PILONIDAL CYST/SINUS EXTENSIVE,,,21 ,,RBRVS,6.09 ,5.25 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11772,CPT,EXCISION PILONIDAL CYST/SINUS COMPLICATED,,,21 ,,RBRVS,7.35 ,7.85 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11900,CPT,INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS,,,21 ,,RBRVS,0.52 ,0.34 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11901,CPT,INJECTION INTRALESIONAL >7 LESIONS,,,21 ,,RBRVS,0.80 ,0.53 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11920,CPT,TATTOOING INCL MICROPIGMENTATION 6.0 CM/<,,,21 ,,RBRVS,1.61 ,1.53 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11921,CPT,TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM,,,21 ,,RBRVS,1.93 ,1.74 ,3.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11922,CPT,TATTOOING INCL MICROPIGMENTATION EA 20.0 CM,,,21 ,,RBRVS,0.49 ,0.31 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11950,CPT,SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/<,,,21 ,,RBRVS,0.84 ,0.49 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11951,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC,,,21 ,,RBRVS,1.19 ,0.80 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11952,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC,,,21 ,,RBRVS,1.69 ,1.13 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11954,CPT,SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC,,,21 ,,RBRVS,1.85 ,1.25 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11960,CPT,INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ,,,21 ,,RBRVS,11.49 ,13.29 ,13.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11970,CPT,REPLACEMENT TISS EXPANDER PERMANENT PROSTHESIS,,,21 ,,RBRVS,8.01 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11971,CPT,REMOVAL TISS EXPANDER W/O INSERTION PROSTHESIS,,,21 ,,RBRVS,3.41 ,5.37 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11976,CPT,REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES,,,21 ,,RBRVS,1.78 ,0.76 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11980,CPT,SUBCUTANEOUS HORMONE PELLET IMPLANTATION,,,21 ,,RBRVS,1.48 ,0.67 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11981,CPT,INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,,21 ,,RBRVS,1.48 ,0.69 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11982,CPT,REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,,21 ,,RBRVS,1.78 ,0.85 ,2.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,11983,CPT,RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,,,21 ,,RBRVS,3.30 ,1.39 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12001,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<,,,21 ,,RBRVS,0.84 ,0.48 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12002,CPT,SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM,,,21 ,,RBRVS,1.14 ,0.57 ,1.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12004,CPT,SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM,,,21 ,,RBRVS,1.44 ,0.66 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12005,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM,,,21 ,,RBRVS,1.97 ,0.82 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12006,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM,,,21 ,,RBRVS,2.39 ,1.01 ,3.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12007,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM,,,21 ,,RBRVS,2.90 ,1.25 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12011,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<,,,21 ,,RBRVS,1.07 ,0.53 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12013,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,,,21 ,,RBRVS,1.22 ,0.59 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12014,CPT,SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM,,,21 ,,RBRVS,1.57 ,0.69 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12015,CPT,SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM,,,21 ,,RBRVS,1.98 ,0.80 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12016,CPT,SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM,,,21 ,,RBRVS,2.68 ,1.04 ,3.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12017,CPT,SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM,,,21 ,,RBRVS,3.18 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12018,CPT,SIMPLE REPAIR F/E/E/N/L/M >30.0 CM,,,21 ,,RBRVS,3.61 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12020,CPT,TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE,,,21 ,,RBRVS,2.67 ,2.40 ,4.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12021,CPT,TX SUPERFICIAL WOUND DEHISCENCE W/PACKING,,,21 ,,RBRVS,1.89 ,1.93 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12031,CPT,REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<,,,21 ,,RBRVS,2.00 ,2.18 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12032,CPT,REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM,,,21 ,,RBRVS,2.52 ,2.87 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12034,CPT,REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM,,,21 ,,RBRVS,2.97 ,2.59 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12035,CPT,REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM,,,21 ,,RBRVS,3.50 ,2.90 ,6.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12036,CPT,REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM,,,21 ,,RBRVS,4.23 ,3.22 ,7.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12037,CPT,REPAIR INTERMEDIATE S/A/T/E >30.0 CM,,,21 ,,RBRVS,5.00 ,3.68 ,7.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12041,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<,,,21 ,,RBRVS,2.10 ,2.19 ,4.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12042,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM,,,21 ,,RBRVS,2.79 ,2.70 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12044,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM,,,21 ,,RBRVS,3.19 ,2.59 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12045,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,,,21 ,,RBRVS,3.75 ,3.38 ,7.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12046,CPT,RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM,,,21 ,,RBRVS,4.30 ,3.74 ,8.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12047,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM,,,21 ,,RBRVS,4.95 ,4.07 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12051,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<,,,21 ,,RBRVS,2.33 ,2.40 ,4.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12052,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM,,,21 ,,RBRVS,2.87 ,2.81 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12053,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM,,,21 ,,RBRVS,3.17 ,2.74 ,6.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12054,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM,,,21 ,,RBRVS,3.50 ,2.65 ,6.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12055,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM,,,21 ,,RBRVS,4.50 ,3.49 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12056,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM,,,21 ,,RBRVS,5.30 ,4.92 ,9.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,12057,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM,,,21 ,,RBRVS,6.00 ,5.06 ,11.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13100,CPT,REPAIR COMPLEX TRUNK 1.1-2.5 CM,,,21 ,,RBRVS,3.17 ,3.24 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13101,CPT,REPAIR COMPLEX TRUNK 2.6-7.5 CM,,,21 ,,RBRVS,3.96 ,3.82 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13102,CPT,REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<,,,21 ,,RBRVS,1.24 ,0.75 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13120,CPT,REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM,,,21 ,,RBRVS,3.35 ,3.37 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13121,CPT,REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM,,,21 ,,RBRVS,4.42 ,4.58 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13122,CPT,REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<,,,21 ,,RBRVS,1.44 ,0.84 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13131,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM,,,21 ,,RBRVS,3.83 ,3.71 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13132,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM,,,21 ,,RBRVS,6.58 ,6.31 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13133,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<,,,21 ,,RBRVS,2.19 ,1.38 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13150,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.0 CM/<,,,21 ,,RBRVS,3.85 ,3.66 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13151,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM,,,21 ,,RBRVS,4.49 ,4.20 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13152,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM,,,21 ,,RBRVS,6.37 ,5.19 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13153,CPT,REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<,,,21 ,,RBRVS,2.38 ,1.47 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,13160,CPT,SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC,,,21 ,,RBRVS,12.04 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14000,CPT,ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<,,,21 ,,RBRVS,6.37 ,7.49 ,10.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14001,CPT,ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM,,,21 ,,RBRVS,8.78 ,9.23 ,13.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14020,CPT,ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<,,,21 ,,RBRVS,7.22 ,8.59 ,12.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14021,CPT,ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM,,,21 ,,RBRVS,9.72 ,10.30 ,14.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14040,CPT,ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<,,,21 ,,RBRVS,8.60 ,9.10 ,12.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14041,CPT,ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM,,,21 ,,RBRVS,10.83 ,10.89 ,15.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14060,CPT,ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<,,,21 ,,RBRVS,9.23 ,9.50 ,12.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14061,CPT,ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM,,,21 ,,RBRVS,11.48 ,11.73 ,16.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14301,CPT,ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM,,,21 ,,RBRVS,12.65 ,11.84 ,17.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14302,CPT,ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<,,,21 ,,RBRVS,3.73 ,2.29 ,2.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,14350,CPT,FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE,,,21 ,,RBRVS,11.05 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15002,CPT,PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT,,,21 ,,RBRVS,3.65 ,2.40 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15003,CPT,PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT,,,21 ,,RBRVS,0.80 ,0.39 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15004,CPT,PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT,,,21 ,,RBRVS,4.58 ,2.74 ,6.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15005,CPT,PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT,,,21 ,,RBRVS,1.60 ,0.79 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15040,CPT,HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<,,,21 ,,RBRVS,2.00 ,1.38 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15050,CPT,PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM,,,21 ,,RBRVS,5.57 ,6.78 ,10.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15100,CPT,SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD,,,21 ,,RBRVS,9.90 ,9.47 ,13.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15101,CPT,SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,,21 ,,RBRVS,1.72 ,1.22 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15110,CPT,EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHL,,,21 ,,RBRVS,10.97 ,9.05 ,12.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15111,CPT,EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,,21 ,,RBRVS,1.85 ,0.78 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15115,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<,,,21 ,,RBRVS,11.28 ,9.33 ,12.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15116,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/<,,,21 ,,RBRVS,2.50 ,1.58 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15120,CPT,SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %,,,21 ,,RBRVS,10.15 ,9.17 ,13.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15121,CPT,SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %,,,21 ,,RBRVS,2.00 ,1.63 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15130,CPT,DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM,,,21 ,,RBRVS,7.53 ,7.77 ,10.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15131,CPT,DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA,,,21 ,,RBRVS,1.50 ,0.93 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15135,CPT,DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100,,,21 ,,RBRVS,11.03 ,9.78 ,12.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15136,CPT,DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA,,,21 ,,RBRVS,1.50 ,0.76 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15150,CPT,CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<,,,21 ,,RBRVS,9.39 ,7.23 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15151,CPT,CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM,,,21 ,,RBRVS,2.00 ,0.84 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15152,CPT,CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA,,,21 ,,RBRVS,2.50 ,1.61 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15155,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<,,,21 ,,RBRVS,10.14 ,7.59 ,9.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15156,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM,,,21 ,,RBRVS,2.75 ,1.66 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15157,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA,,,21 ,,RBRVS,3.00 ,1.72 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15200,CPT,FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<,,,21 ,,RBRVS,9.15 ,9.04 ,13.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15201,CPT,FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 CM/<,,,21 ,,RBRVS,1.32 ,0.80 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15220,CPT,FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<,,,21 ,,RBRVS,8.09 ,8.90 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15221,CPT,FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM/<,,,21 ,,RBRVS,1.19 ,0.73 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15240,CPT,FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<,,,21 ,,RBRVS,10.41 ,11.75 ,15.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15241,CPT,FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<,,,21 ,,RBRVS,1.86 ,1.15 ,3.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15260,CPT,FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<,,,21 ,,RBRVS,11.64 ,12.22 ,16.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15261,CPT,FTH/GFT FREE W/DIR CLSR N/E/E/L EA 20 SQ CM/<,,,21 ,,RBRVS,2.23 ,1.63 ,3.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15271,CPT,APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25,,,21 ,,RBRVS,1.50 ,0.83 ,2.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15272,CPT,APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC,,,21 ,,RBRVS,0.33 ,0.14 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15273,CPT,APP SKN SUB GRFT T/A/L AREA/100SCM 1ST 100SCM,,,21 ,,RBRVS,3.50 ,2.03 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15274,CPT,APP SKN SUB GRFT T/A/L AREA/100SCM ADL 100SCM,,,21 ,,RBRVS,0.80 ,0.40 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15275,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,$0.00,1,0,1,1,1,1,20131001,15276,CPT,SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM,,,21 ,,RBRVS,0.50 ,0.17 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15277,CPT,SUB GRFT F/S/N/H/F/G/M/D </= 100SCM 1ST 100SCM,,,21 ,,RBRVS,4.00 ,1.76 ,4.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15278,CPT,SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SCM,,,21 ,,RBRVS,1.00 ,0.48 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15570,CPT,FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK,,,21 ,,RBRVS,10.21 ,9.47 ,14.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15572,CPT,FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS,,,21 ,,RBRVS,10.12 ,10.06 ,14.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15574,CPT,FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F,,,21 ,,RBRVS,10.70 ,10.24 ,14.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15576,CPT,FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL,,,21 ,,RBRVS,9.37 ,9.11 ,12.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15600,CPT,DELAY FLAP/SECTIONING FLAP TRUNK,,,21 ,,RBRVS,2.01 ,3.81 ,7.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15610,CPT,DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS,,,21 ,,RBRVS,2.52 ,4.23 ,7.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15620,CPT,DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F,,,21 ,,RBRVS,3.75 ,5.30 ,8.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15630,CPT,DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS,,,21 ,,RBRVS,4.08 ,5.63 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15650,CPT,TRANSFER ANY PEDICLE FLAP ANY LOCATION,,,21 ,,RBRVS,4.77 ,5.95 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15731,CPT,FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE,,,21 ,,RBRVS,14.38 ,13.61 ,16.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15732,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP HEAD&NC,,,21 ,,RBRVS,16.38 ,14.71 ,19.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15734,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK,,,21 ,,RBRVS,19.86 ,15.89 ,21.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15736,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR,,,21 ,,RBRVS,17.04 ,14.01 ,19.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15738,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR,,,21 ,,RBRVS,19.04 ,14.38 ,19.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15740,CPT,FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY,,,21 ,,RBRVS,11.80 ,11.97 ,16.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15750,CPT,FLAP NEUROVASCULAR PEDICLE,,,21 ,,RBRVS,12.96 ,11.92 ,11.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15756,CPT,FREE MUSCLE/MYOCUTANEOUS FLAP W/MVASC ANAST,,,21 ,,RBRVS,36.94 ,26.96 ,26.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,15757,CPT,FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS,,,21 ,,RBRVS,37.15 ,25.93 ,25.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,15758,CPT,FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS,,,21 ,,RBRVS,36.90 ,26.32 ,26.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,15760,CPT,GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA,,,21 ,,RBRVS,9.86 ,9.73 ,13.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15770,CPT,GRAFT DERMA-FAT-FASCIA,,,21 ,,RBRVS,8.96 ,9.37 ,9.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15775,CPT,PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS,,,21 ,,RBRVS,3.95 ,2.02 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15776,CPT,PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS,,,21 ,,RBRVS,5.53 ,2.75 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15777,CPT,IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT,,,21 ,,RBRVS,3.65 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15780,CPT,DERMABRASION TOTAL FACE,,,21 ,,RBRVS,8.73 ,8.73 ,14.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15781,CPT,DERMABRASION SEGMENTAL FACE,,,21 ,,RBRVS,5.02 ,7.01 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15782,CPT,DERMABRASION REGIONAL OTHER THAN FACE,,,21 ,,RBRVS,4.44 ,7.60 ,12.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15783,CPT,DERMABRASION SUPERFICIAL ANY SITE,,,21 ,,RBRVS,4.41 ,6.05 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15786,CPT,ABRASION 1 LESION,,,21 ,,RBRVS,2.08 ,1.67 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15787,CPT,ABRASION EACH ADDITIONAL 4 LESIONS OR LESS,,,21 ,,RBRVS,0.33 ,0.15 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15788,CPT,CHEMICAL PEEL FACIAL EPIDERMAL,,,21 ,,RBRVS,2.09 ,4.94 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15789,CPT,CHEMICAL PEEL FACIAL DERMAL,,,21 ,,RBRVS,4.91 ,6.92 ,10.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15792,CPT,CHEMICAL PEEL NONFACIAL EPIDERMAL,,,21 ,,RBRVS,1.86 ,5.66 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15793,CPT,CHEMICAL PEEL NONFACIAL DERMAL,,,21 ,,RBRVS,3.96 ,6.27 ,9.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15819,CPT,CERVICOPLASTY,,,21 ,,RBRVS,10.65 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15820,CPT,BLEPHAROPLASTY LOWER EYELID,,,21 ,,RBRVS,6.27 ,7.68 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15821,CPT,BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD,,,21 ,,RBRVS,6.84 ,7.98 ,9.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15822,CPT,BLEPHAROPLASTY UPPER EYELID,,,21 ,,RBRVS,4.62 ,6.08 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15823,CPT,BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN,,,21 ,,RBRVS,6.81 ,8.30 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15824,CPT,RHYTIDECTOMY FOREHEAD,,,21 ,,RBRVS,15.62 ,13.89 ,13.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15825,CPT,RHYTIDECTOMY NECK W/PLATYSMAL TIGHTENING,,,21 ,,RBRVS,17.57 ,15.63 ,15.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15826,CPT,RHYTIDECTOMY GLABELLAR FROWN LINES,,,21 ,,RBRVS,12.69 ,11.29 ,11.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15828,CPT,RHYTIDECTOMY CHEEK CHIN & NECK,,,21 ,,RBRVS,33.19 ,29.52 ,29.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15829,CPT,RHYTIDECTOMY SMAS FLAP,,,21 ,,RBRVS,37.09 ,32.99 ,32.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15830,CPT,EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY,,,21 ,,RBRVS,17.11 ,14.14 ,14.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15832,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE THIGH,,,21 ,,RBRVS,12.85 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15833,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE LEG,,,21 ,,RBRVS,11.90 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15834,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE HIP,,,21 ,,RBRVS,12.17 ,11.76 ,11.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15835,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE BUTTOCK,,,21 ,,RBRVS,12.99 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15836,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE ARM,,,21 ,,RBRVS,10.61 ,9.56 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15837,CPT,EXC EXCESSIVE SKIN &SUBQ TISSUE FOREARM/HAND,,,21 ,,RBRVS,9.55 ,9.40 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15838,CPT,EXC EXCSV SKIN & SUBQ TISSUE SUBMENTAL FAT PAD,,,21 ,,RBRVS,8.25 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15839,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA,,,21 ,,RBRVS,10.50 ,9.27 ,13.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15840,CPT,GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT,,,21 ,,RBRVS,14.99 ,12.93 ,12.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15841,CPT,GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT,,,21 ,,RBRVS,25.99 ,18.73 ,18.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15842,CPT,GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG,,,21 ,,RBRVS,41.01 ,27.42 ,27.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15845,CPT,GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR,,,21 ,,RBRVS,14.32 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15847,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN,,,21 ,,TotalUnits,,,,9.76 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,15850,CPT,REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON,,,21 ,,RBRVS,0.78 ,0.32 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15851,CPT,REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON,,,21 ,,RBRVS,0.86 ,0.38 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15852,CPT,DRESSING CHANGE UNDER ANESTHESIA,,,21 ,,RBRVS,0.86 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15860,CPT,IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT,,,21 ,,RBRVS,1.95 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15876,CPT,SUCTION ASSISTED LIPECTOMY HEAD & NECK,,,21 ,,TotalUnits,,,,21.15 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,15877,CPT,SUCTION ASSISTED LIPECTOMY TRUNK,,,21 ,,TotalUnits,,,,11.22 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,15878,CPT,SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY,,,21 ,,TotalUnits,,,,13.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,15879,CPT,SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY,,,21 ,,TotalUnits,,,,3.25 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,15920,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR,,,21 ,,RBRVS,8.29 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15922,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR,,,21 ,,RBRVS,10.38 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15931,CPT,EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE,,,21 ,,RBRVS,10.07 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15933,CPT,EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY,,,21 ,,RBRVS,11.77 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15934,CPT,EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR,,,21 ,,RBRVS,13.68 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15935,CPT,EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY,,,21 ,,RBRVS,15.78 ,13.78 ,13.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15936,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR,,,21 ,,RBRVS,13.16 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15937,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC,,,21 ,,RBRVS,15.14 ,12.64 ,12.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15940,CPT,EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE,,,21 ,,RBRVS,10.20 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15941,CPT,EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT,,,21 ,,RBRVS,12.41 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15944,CPT,EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE,,,21 ,,RBRVS,12.44 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15945,CPT,EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,,21 ,,RBRVS,13.75 ,12.94 ,12.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15946,CPT,EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN,,,21 ,,RBRVS,24.12 ,19.80 ,19.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15950,CPT,EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR,,,21 ,,RBRVS,8.03 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15951,CPT,EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY,,,21 ,,RBRVS,11.58 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15952,CPT,EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE,,,21 ,,RBRVS,12.31 ,12.03 ,12.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15953,CPT,EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,,21 ,,RBRVS,13.57 ,13.28 ,13.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15956,CPT,EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN,,,21 ,,RBRVS,16.79 ,14.05 ,14.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15958,CPT,EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC,,,21 ,,RBRVS,16.75 ,14.83 ,14.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,15999,CPT,UNLISTED PROCEDURE EXCISION PRESSURE ULCER,,,21 ,,TotalUnits,,,,24.09 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,16000,CPT,INITIAL TX 1ST DEGREE BURN LOCAL TX,,,21 ,,RBRVS,0.89 ,0.34 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,16020,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL,,,21 ,,RBRVS,0.71 ,0.77 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,16025,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM,,,21 ,,RBRVS,1.74 ,1.26 ,2.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,16030,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE,,,21 ,,RBRVS,2.08 ,1.45 ,2.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,16035,CPT,ESCHAROTOMY FIRST INCISION,,,21 ,,RBRVS,3.74 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,16036,CPT,ESCHAROTOMY EACH ADDITIONAL INCISION,,,21 ,,RBRVS,1.50 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,17000,CPT,DESTRUCTION PREMALIGNANT LESION 1ST,,,21 ,,RBRVS,0.65 ,0.92 ,1.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17003,CPT,DESTRUCTION PREMALIGNANT LESION 2-14 EA,,,21 ,,RBRVS,0.07 ,0.05 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17004,CPT,DESTRUCTION PREMALIGNANT LESION 15/>,,,21 ,,RBRVS,1.85 ,1.78 ,2.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17106,CPT,DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM,,,21 ,,RBRVS,3.69 ,3.90 ,5.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17107,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM,,,21 ,,RBRVS,4.79 ,4.89 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17108,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM,,,21 ,,RBRVS,7.49 ,6.74 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17110,CPT,DESTRUCTION BENIGN LESIONS UP TO 14,,,21 ,,RBRVS,0.70 ,1.27 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17111,CPT,DESTRUCTION BENIGN LESIONS 15/>,,,21 ,,RBRVS,0.97 ,1.43 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17250,CPT,CHEMICAL CAUTERIZATION GRANULATION TISSUE,,,21 ,,RBRVS,0.50 ,0.50 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17260,CPT,DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<,,,21 ,,RBRVS,0.96 ,0.96 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17261,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,,21 ,,RBRVS,1.22 ,1.32 ,2.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17262,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM,,,21 ,,RBRVS,1.63 ,1.59 ,3.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17263,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM,,,21 ,,RBRVS,1.84 ,1.73 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17264,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM,,,21 ,,RBRVS,1.99 ,1.81 ,3.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17266,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG < 4.0 CM,,,21 ,,RBRVS,2.39 ,2.03 ,4.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17270,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/>,,,21 ,,RBRVS,1.37 ,1.39 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17271,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM,,,21 ,,RBRVS,1.54 ,1.53 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17272,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM,,,21 ,,RBRVS,1.82 ,1.72 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17273,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM,,,21 ,,RBRVS,2.10 ,1.89 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17274,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM,,,21 ,,RBRVS,2.64 ,2.23 ,4.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17276,CPT,DSTRJ MAL LES S/N/H/F/G LES DIAM > 4.0 CM,,,21 ,,RBRVS,3.25 ,2.57 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17280,CPT,DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<,,,21 ,,RBRVS,1.22 ,1.29 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17281,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM,,,21 ,,RBRVS,1.77 ,1.68 ,3.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17282,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM,,,21 ,,RBRVS,2.09 ,1.89 ,3.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17283,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM,,,21 ,,RBRVS,2.69 ,2.27 ,4.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17284,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM,,,21 ,,RBRVS,3.20 ,2.57 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17286,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM,,,21 ,,RBRVS,4.48 ,3.35 ,5.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17311,CPT,MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS,,,21 ,,RBRVS,6.20 ,4.17 ,12.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17312,CPT,MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE,,,21 ,,RBRVS,3.30 ,2.22 ,7.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17313,CPT,MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS,,,21 ,,RBRVS,5.56 ,3.74 ,11.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17314,CPT,MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE,,,21 ,,RBRVS,3.06 ,2.06 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17315,CPT,MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE,,,21 ,,RBRVS,0.87 ,0.59 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17340,CPT,CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE,,,21 ,,RBRVS,0.77 ,0.54 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17360,CPT,CHEMICAL EXFOLIATION ACNE,,,21 ,,RBRVS,1.46 ,1.24 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17380,CPT,ELECTROLYSIS EPILATION EACH 30 MINUTES,,,21 ,,RBRVS,1.07 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,17999,CPT,UNLISTED PX SKIN MUC MEMBRANE & SUBQ TISSUE,,,21 ,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,19000,CPT,PUNCTURE ASPIRATION CYST BREAST,,,21 ,,RBRVS,0.84 ,0.33 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19001,CPT,PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST,,,21 ,,RBRVS,0.42 ,0.16 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19020,CPT,MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP,,,21 ,,RBRVS,3.83 ,4.24 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19030,CPT,INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM,,,21 ,,RBRVS,1.53 ,0.58 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19100,CPT,BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX,,,21 ,,RBRVS,1.27 ,0.50 ,2.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19101,CPT,BIOPSY BREAST OPEN INCISIONAL,,,21 ,,RBRVS,3.23 ,2.54 ,6.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19102,CPT,BIOPSY BREAST NEEDLE CORE W/IMAGING GUIDANCE,,,21 ,,RBRVS,2.00 ,0.76 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19103,CPT,BREAST BIOPSY VACUUM ASSISTED/ROTATING DEVICE,,,21 ,,RBRVS,3.69 ,1.40 ,11.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19105,CPT,ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA,,,21 ,,RBRVS,3.69 ,1.72 ,78.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19110,CPT,NIPPLE EXPLORATION,,,21 ,,RBRVS,4.44 ,4.52 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19112,CPT,EXCISION LACTIFEROUS DUCT FISTULA,,,21 ,,RBRVS,3.81 ,4.42 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19120,CPT,EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION,,,21 ,,RBRVS,5.92 ,4.77 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19125,CPT,EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,,,21 ,,RBRVS,6.69 ,5.15 ,7.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19126,CPT,EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL,,,21 ,,RBRVS,2.93 ,1.14 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19260,CPT,EXCISION CHEST WALL TUMOR INCLUDING RIBS,,,21 ,,RBRVS,17.78 ,13.73 ,13.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19271,CPT,EXC CHEST TUMOR W/RCNSTJ W/O MEDSTNL LMPHADEC,,,21 ,,RBRVS,22.19 ,21.13 ,21.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,19272,CPT,EXC CHEST TUMOR W/RCNSTJ W/MEDSTNL LMPHADEC,,,21 ,,RBRVS,25.17 ,22.19 ,22.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,19290,CPT,PREOP PLACEMENT LOCALIZATION WIRE BREAST,,,21 ,,RBRVS,1.27 ,0.48 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19291,CPT,PREOP PLMT LOCALIZATION WIRE BREAST EACH LESION,,,21 ,,RBRVS,0.63 ,0.24 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19295,CPT,IMG GID PLMT MTLC LOCLZJ CLIP PRQ BRST BX/ASPIR,,,21 ,,RBRVS,,2.67 ,2.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,19296,CPT,PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST,,,21 ,,RBRVS,3.63 ,1.76 ,116.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19297,CPT,PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST,,,21 ,,RBRVS,1.72 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19298,CPT,PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST,,,21 ,,RBRVS,6.00 ,2.62 ,27.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19300,CPT,MASTECTOMY GYNECOMASTIA,,,21 ,,RBRVS,5.31 ,5.43 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19301,CPT,MASTECTOMY PARTIAL,,,21 ,,RBRVS,10.13 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19302,CPT,MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY,,,21 ,,RBRVS,13.99 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19303,CPT,MASTECTOMY SIMPLE COMPLETE,,,21 ,,RBRVS,15.85 ,9.91 ,9.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19304,CPT,MASTECTOMY SUBCUTANEOUS,,,21 ,,RBRVS,7.95 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19305,CPT,MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES,,,21 ,,RBRVS,17.46 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,19306,CPT,MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES,,,21 ,,RBRVS,18.13 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,19307,CPT,MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN,,,21 ,,RBRVS,18.23 ,12.53 ,12.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19316,CPT,MASTOPEXY,,,21 ,,RBRVS,11.09 ,9.71 ,9.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19318,CPT,REDUCTION MAMMAPLASTY,,,21 ,,RBRVS,16.03 ,14.04 ,14.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19324,CPT,MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT,,,21 ,,RBRVS,6.80 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19325,CPT,MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT,,,21 ,,RBRVS,8.64 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19328,CPT,REMOVAL INTACT MAMMARY IMPLANT,,,21 ,,RBRVS,6.48 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19330,CPT,REMOVAL MAMMARY IMPLANT MATERIAL,,,21 ,,RBRVS,8.54 ,8.67 ,8.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19340,CPT,IMMT INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,,21 ,,RBRVS,13.99 ,11.36 ,11.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19342,CPT,DLYD INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,,21 ,,RBRVS,12.63 ,12.56 ,12.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19350,CPT,NIPPLE/AREOLA RECONSTRUCTION,,,21 ,,RBRVS,9.11 ,9.28 ,13.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19355,CPT,CORRECTION INVERTED NIPPLES,,,21 ,,RBRVS,8.52 ,6.35 ,10.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19357,CPT,BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ,,,21 ,,RBRVS,18.50 ,22.67 ,22.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19361,CPT,BRST RCNSTJ W/LATSMS D/SI FLAP WO PRSTHC IMPL,,,21 ,,RBRVS,23.36 ,19.98 ,19.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,19364,CPT,BREAST RECONSTRUCTION FREE FLAP,,,21 ,,RBRVS,42.58 ,32.09 ,32.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,19366,CPT,BREAST RECONSTRUCTION OTHER TECHNIQUE,,,21 ,,RBRVS,21.84 ,14.55 ,14.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19367,CPT,BREAST RECONSTRUCTION TRAM FLAP 1 PEDICLE,,,21 ,,RBRVS,26.80 ,21.78 ,21.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,19368,CPT,BREAST RECONSTRUCTION TRAM 1 PEDCL MVASC ANAST,,,21 ,,RBRVS,33.90 ,25.84 ,25.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,19369,CPT,BREAST RECONSTRUCTION TRAM FLAP DOUBLE PEDICLE,,,21 ,,RBRVS,31.31 ,24.02 ,24.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,19370,CPT,OPEN PERIPROSTHETIC CAPSULOTOMY BREAST,,,21 ,,RBRVS,9.17 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19371,CPT,PERIPROSTHETIC CAPSULECTOMY BREAST,,,21 ,,RBRVS,10.62 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19380,CPT,REVISION RECONSTRUCTED BREAST,,,21 ,,RBRVS,10.41 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19396,CPT,PREPARATION MOULAGE CUSTOM BREAST IMPLANT,,,21 ,,RBRVS,2.17 ,1.70 ,5.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,19499,CPT,UNLISTED PROCEDURE BREAST,,,21 ,,TotalUnits,,,,5.41 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,20005,CPT,I&D SOFT TISSUE ABSCESS SUBFASC,,,21 ,,RBRVS,3.58 ,2.62 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20100,CPT,EXPLORATION PENETRATING WOUND SPX NECK,,,21 ,,RBRVS,10.38 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20101,CPT,EXPLORATION PENETRATING WOUND SPX CHEST,,,21 ,,RBRVS,3.23 ,2.16 ,9.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20102,CPT,EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK,,,21 ,,RBRVS,3.98 ,2.61 ,9.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20103,CPT,EXPLORATION PENETRATING WOUND SPX EXTREMITY,,,21 ,,RBRVS,5.34 ,4.03 ,10.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20150,CPT,EXCISION EPIPHYSEAL BAR,,,21 ,,RBRVS,14.75 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20200,CPT,BIOPSY MUSCLE SUPERFICIAL,,,21 ,,RBRVS,1.46 ,1.00 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20205,CPT,BIOPSY MUSCLE DEEP,,,21 ,,RBRVS,2.35 ,1.58 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20206,CPT,BIOPSY MUSCLE PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,0.99 ,0.65 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20220,CPT,BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL,,,21 ,,RBRVS,1.27 ,0.76 ,3.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20225,CPT,BIOPSY BONE TROCAR/NEEDLE DEEP,,,21 ,,RBRVS,1.87 ,1.17 ,15.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20240,CPT,BIOPSY BONE OPEN SUPERFICIAL,,,21 ,,RBRVS,3.28 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20245,CPT,BIOPSY BONE OPEN DEEP,,,21 ,,RBRVS,8.95 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20250,CPT,BIOPSY VERTEBRAL BODY OPEN THORACIC,,,21 ,,RBRVS,5.19 ,4.84 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20251,CPT,BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL,,,21 ,,RBRVS,5.72 ,5.16 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20500,CPT,INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC,,,21 ,,RBRVS,1.28 ,1.17 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20501,CPT,INJECTION SINUS TRACT DIAGNOSTIC,,,21 ,,RBRVS,0.76 ,0.29 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20520,CPT,REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE,,,21 ,,RBRVS,1.90 ,2.09 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20525,CPT,RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP,,,21 ,,RBRVS,3.54 ,3.17 ,10.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20526,CPT,INJECTION THERAPEUTIC CARPAL TUNNEL,,,21 ,,RBRVS,0.94 ,0.58 ,1.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20527,CPT,INJECTION ENZYME PALMAR FASCIAL CORD,,,21 ,,RBRVS,1.00 ,0.60 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20550,CPT,INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,,,21 ,,RBRVS,0.75 ,0.37 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20551,CPT,INJECTION SINGLE TENDON ORIGIN/INSERTION,,,21 ,,RBRVS,0.75 ,0.41 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20552,CPT,INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,,,21 ,,RBRVS,0.66 ,0.36 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20553,CPT,INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,,,21 ,,RBRVS,0.75 ,0.41 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20555,CPT,PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT,,,21 ,,RBRVS,6.00 ,2.83 ,2.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20600,CPT,ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA,,,21 ,,RBRVS,0.66 ,0.40 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20605,CPT,ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS,,,21 ,,RBRVS,0.68 ,0.43 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20610,CPT,ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA,,,21 ,,RBRVS,0.79 ,0.55 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20612,CPT,ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ,,,21 ,,RBRVS,0.70 ,0.44 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20615,CPT,ASPIRATION & INJECTION TREATMENT BONE CYST,,,21 ,,RBRVS,2.33 ,2.06 ,4.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20650,CPT,INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX,,,21 ,,RBRVS,2.28 ,1.90 ,3.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20660,CPT,APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX,,,21 ,,RBRVS,4.00 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20661,CPT,APPLICATION HALO CRANIAL INCLUDING REMOVAL,,,21 ,,RBRVS,5.26 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20662,CPT,APPLICATION HALO PELVIC INCLUDING REMOVAL,,,21 ,,RBRVS,6.38 ,5.79 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20663,CPT,APPLICATION HALO FEMORAL INCLUDING REMOVAL,,,21 ,,RBRVS,5.74 ,5.10 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20664,CPT,APPL HALO 6/> PINS THIN SKULL OSTEOLOGY,,,21 ,,RBRVS,10.06 ,11.70 ,11.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20665,CPT,REMOVAL TONG/HALO APPLIED BY ANOTHER INDIVIDUAL,,,21 ,,RBRVS,1.36 ,1.15 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20670,CPT,REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE,,,21 ,,RBRVS,1.79 ,2.27 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20680,CPT,REMOVAL IMPLANT DEEP,,,21 ,,RBRVS,5.96 ,5.47 ,11.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20690,CPT,APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM,,,21 ,,RBRVS,8.78 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20692,CPT,APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM,,,21 ,,RBRVS,16.27 ,13.21 ,13.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20693,CPT,ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES,,,21 ,,RBRVS,6.06 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20694,CPT,REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,,,21 ,,RBRVS,4.28 ,4.86 ,7.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20696,CPT,XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST & SUBQ,,,21 ,,RBRVS,17.56 ,13.55 ,13.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20697,CPT,XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT,,,21 ,,RBRVS,,57.20 ,57.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,20802,CPT,REPLANTATION ARM COMPLETE AMPUTATION,,,21 ,,RBRVS,42.62 ,21.78 ,21.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20805,CPT,REPLANTATION FOREARM COMPLETE AMPUTATION,,,21 ,,RBRVS,51.46 ,23.16 ,23.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20808,CPT,REPLANTATION HAND COMPLETE AMPUTATION,,,21 ,,RBRVS,63.09 ,42.40 ,42.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20816,CPT,RPLJ DGT EXCEPT THMB MTCARPHLNGL JT COMPL AMP,,,21 ,,RBRVS,31.95 ,26.51 ,26.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20822,CPT,RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP,,,21 ,,RBRVS,26.66 ,21.32 ,21.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20824,CPT,RPLJ THMB CARP/MTCRPL JT MP JT COMPL AMPUTATION,,,21 ,,RBRVS,31.95 ,26.50 ,26.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20827,CPT,RPLJ THUMB DISTAL TIP MP JOINT COMPL AMPUTATION,,,21 ,,RBRVS,27.48 ,22.10 ,22.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20838,CPT,REPLANTATION FOOT COMPLETE AMPUTATION,,,21 ,,RBRVS,42.88 ,29.36 ,29.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20900,CPT,BONE GRAFT ANY DONOR AREA MINOR/SMALL,,,21 ,,RBRVS,3.00 ,2.94 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20902,CPT,BONE GRAFT ANY DONOR AREA MAJOR/LARGE,,,21 ,,RBRVS,4.58 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20910,CPT,CARTILAGE GRAFT COSTOCHONDRAL,,,21 ,,RBRVS,5.53 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20912,CPT,CARTILAGE GRAFT NASAL SEPTUM,,,21 ,,RBRVS,6.54 ,6.86 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20920,CPT,FASCIA LATA GRAFT BY STRIPPER,,,21 ,,RBRVS,5.51 ,5.64 ,5.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20922,CPT,FASCIA LATA GRAFT INCISION & AREA EXPOSURE,,,21 ,,RBRVS,6.93 ,6.38 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20924,CPT,TENDON GRAFT FROM A DISTANCE,,,21 ,,RBRVS,6.68 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20926,CPT,TISSUE GRAFTS OTHER,,,21 ,,RBRVS,5.79 ,5.93 ,5.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20930,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED,,,21 ,,TotalUnits,,,,4.82 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,20931,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL,,,21 ,,RBRVS,1.81 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20936,CPT,AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION,,,21 ,,TotalUnits,,,,5.95 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,20937,CPT,AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION,,,21 ,,RBRVS,2.79 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20938,CPT,AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC,,,21 ,,RBRVS,3.02 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20950,CPT,MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME,,,21 ,,RBRVS,1.26 ,1.18 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20955,CPT,BONE GRAFT MICROVASCULAR ANASTOMOSIS FIBULA,,,21 ,,RBRVS,40.26 ,28.12 ,28.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20956,CPT,BONE GRAFT MICROVASCULAR ANAST ILIAC CREST,,,21 ,,RBRVS,41.18 ,28.53 ,28.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20957,CPT,BONE GRAFT MICROVASCULAR ANAST METATARSAL,,,21 ,,RBRVS,42.61 ,28.22 ,28.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20962,CPT,BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR,,,21 ,,RBRVS,39.21 ,19.89 ,19.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20969,CPT,FREE OSTQ FLAP W/MVASC ANAST METAR/GREAT TOE,,,21 ,,RBRVS,45.43 ,31.03 ,31.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20970,CPT,FREE OSTQ FLAP W/MVASC ANASTOMOSIS ILIAC CREST,,,21 ,,RBRVS,44.58 ,29.05 ,29.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,20972,CPT,FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL,,,21 ,,RBRVS,44.51 ,17.72 ,17.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20973,CPT,FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE,,,21 ,,RBRVS,47.27 ,30.20 ,30.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20974,CPT,ELECTRICAL STIMULATION BONE HEALING NONINVASIVE,,,21 ,,RBRVS,0.62 ,0.71 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20975,CPT,ELECTRICAL STIMULATION BONE HEALING INVASIVE,,,21 ,,RBRVS,2.60 ,2.02 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20979,CPT,LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE,,,21 ,,RBRVS,0.62 ,0.28 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20982,CPT,ABLATION BONE TUMOR RF PERCUTANEOUS CT GUIDANCE,,,21 ,,RBRVS,7.27 ,3.13 ,103.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20985,CPT,CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS,,,21 ,,RBRVS,2.50 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,20999,CPT,UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL,,,21 ,,TotalUnits,,,,1.91 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,21010,CPT,ARTHROTOMY TEMPOROMANDIBULAR JOINT,,,21 ,,RBRVS,11.04 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21011,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM,,,21 ,,RBRVS,2.99 ,4.28 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21012,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>,,,21 ,,RBRVS,4.45 ,4.84 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21013,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM,,,21 ,,RBRVS,5.42 ,5.79 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21014,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>,,,21 ,,RBRVS,7.13 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21015,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM,,,21 ,,RBRVS,9.89 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21016,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/<,,,21 ,,RBRVS,15.26 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21025,CPT,EXCISION BONE MANDIBLE,,,21 ,,RBRVS,10.03 ,10.56 ,14.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21026,CPT,EXCISION FACIAL BONE,,,21 ,,RBRVS,5.70 ,8.12 ,11.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21029,CPT,REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE,,,21 ,,RBRVS,8.39 ,9.13 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21030,CPT,EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG,,,21 ,,RBRVS,4.91 ,6.54 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21031,CPT,EXCISION TORUS MANDIBULARIS,,,21 ,,RBRVS,3.30 ,4.82 ,7.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21032,CPT,EXCISION MAXILLARY TORUS PALATINUS,,,21 ,,RBRVS,3.34 ,4.68 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21034,CPT,EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA,,,21 ,,RBRVS,17.38 ,14.85 ,19.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21040,CPT,EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT,,,21 ,,RBRVS,4.91 ,6.55 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21044,CPT,EXCISION MALIGNANT TUMOR MANDIBLE,,,21 ,,RBRVS,12.80 ,11.61 ,11.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21045,CPT,EXCISION MALIGNANT TUMOR MANDIBLE RADICAL,,,21 ,,RBRVS,18.37 ,15.65 ,15.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21046,CPT,EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT,,,21 ,,RBRVS,14.21 ,16.32 ,16.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21047,CPT,EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDB,,,21 ,,RBRVS,20.07 ,15.72 ,15.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21048,CPT,EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT,,,21 ,,RBRVS,14.71 ,16.52 ,16.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21049,CPT,EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC,,,21 ,,RBRVS,19.32 ,14.79 ,14.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21050,CPT,CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX,,,21 ,,RBRVS,11.76 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21060,CPT,MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX,,,21 ,,RBRVS,11.07 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21070,CPT,CORONOIDECTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,8.62 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21073,CPT,MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA,,,21 ,,RBRVS,3.45 ,3.38 ,7.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21076,CPT,IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES,,,21 ,,RBRVS,13.40 ,9.11 ,13.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21077,CPT,IMPRESSION & PREPARATION ORBITAL PROSTHESIS,,,21 ,,RBRVS,33.70 ,23.10 ,33.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21079,CPT,IMPRESSION & PREPARATION INTERIM OBTURATOR PROST,,,21 ,,RBRVS,22.31 ,15.47 ,23.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21080,CPT,IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES,,,21 ,,RBRVS,25.06 ,16.98 ,26.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21081,CPT,IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES,,,21 ,,RBRVS,22.85 ,15.64 ,24.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21082,CPT,IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES,,,21 ,,RBRVS,20.84 ,15.31 ,24.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21083,CPT,IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS,,,21 ,,RBRVS,19.27 ,14.29 ,23.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21084,CPT,IMPRESSION & PREPARATION SPEECH AID PROSTHESIS,,,21 ,,RBRVS,22.48 ,16.44 ,26.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21085,CPT,IMPRESSION & PREPARATION ORAL SURGICAL SPLINT,,,21 ,,RBRVS,8.99 ,6.33 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21086,CPT,IMPRESSION & PREPARATION AURICULAR PROSTHESIS,,,21 ,,RBRVS,24.88 ,16.86 ,25.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21087,CPT,IMPRESSION & PREPARATION NASAL PROSTHESIS,,,21 ,,RBRVS,24.88 ,16.50 ,24.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21088,CPT,IMPRESSION & PREPARATION FACIAL PROSTHESIS,,,21 ,,TotalUnits,,,,37.96 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,21089,CPT,UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE,,,21 ,,TotalUnits,,,,46.92 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,21100,CPT,APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX,,,21 ,,RBRVS,4.73 ,6.07 ,15.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21110,CPT,APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC,,,21 ,,RBRVS,5.99 ,12.72 ,16.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21116,CPT,INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY,,,21 ,,RBRVS,0.81 ,0.37 ,3.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21120,CPT,GENIOPLASTY AUGMENTATION,,,21 ,,RBRVS,5.10 ,9.99 ,14.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21121,CPT,GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE,,,21 ,,RBRVS,7.81 ,10.26 ,14.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21122,CPT,GENIOPLASTY 2/> SLIDING OSTEOTOMIES,,,21 ,,RBRVS,8.71 ,9.71 ,9.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21123,CPT,GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS,,,21 ,,RBRVS,11.34 ,12.67 ,12.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21125,CPT,AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL,,,21 ,,RBRVS,10.80 ,10.41 ,77.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21127,CPT,AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL,,,21 ,,RBRVS,12.44 ,11.17 ,106.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21137,CPT,REDUCTION FOREHEAD CONTOURING ONLY,,,21 ,,RBRVS,10.24 ,10.22 ,10.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21138,CPT,RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT,,,21 ,,RBRVS,12.87 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21139,CPT,RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL,,,21 ,,RBRVS,15.02 ,15.31 ,15.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21141,CPT,RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT,,,21 ,,RBRVS,19.57 ,17.66 ,17.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21142,CPT,RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT,,,21 ,,RBRVS,20.28 ,17.59 ,17.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21143,CPT,RCNSTJ MIDFACE LEFORT I 3/> PIECE W/O BONE GRAFT,,,21 ,,RBRVS,21.05 ,17.89 ,17.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21145,CPT,RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS,,,21 ,,RBRVS,23.94 ,19.54 ,19.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21146,CPT,RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS,,,21 ,,RBRVS,24.87 ,21.88 ,21.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21147,CPT,RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS,,,21 ,,RBRVS,26.47 ,20.23 ,20.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21150,CPT,RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION,,,21 ,,RBRVS,25.96 ,20.89 ,20.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21151,CPT,RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS,,,21 ,,RBRVS,29.02 ,23.93 ,23.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21154,CPT,RCNSTJ MIDFACE LEFORT III W/O LEFORT I,,,21 ,,RBRVS,31.29 ,28.73 ,28.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21155,CPT,RCNSTJ MIDFACE LEFORT III W/LEFORT I,,,21 ,,RBRVS,35.22 ,26.27 ,26.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21159,CPT,RCNSTJ MIDFACE LEFORT III W/FHD W/O LEFORT I,,,21 ,,RBRVS,43.14 ,25.28 ,25.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21160,CPT,RCNSTJ MIDFACE LEFORT III W/FHD W/LEFORT I,,,21 ,,RBRVS,47.19 ,26.71 ,26.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21172,CPT,RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD,,,21 ,,RBRVS,28.20 ,21.65 ,21.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21175,CPT,RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD,,,21 ,,RBRVS,33.56 ,22.08 ,22.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21179,CPT,RCNSTJ FOREHEAD &/ SUPRAORB RIMS W/ALGRF/PROSTC,,,21 ,,RBRVS,22.65 ,15.70 ,15.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21180,CPT,RCNSTJ FOREHEAD &/ SUPRAORBITAL RIMS W/AUTOGRAFT,,,21 ,,RBRVS,25.58 ,17.50 ,17.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21181,CPT,RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC,,,21 ,,RBRVS,10.28 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21182,CPT,RCNSTJ ORBIT/FHD/NASETHMD EXCBONE TUM GRF<40SQCM,,,21 ,,RBRVS,32.58 ,21.06 ,21.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21183,CPT,RCNSTJ ORBIT/FHD/NASETHMD EXC BONE GRF>40 <80,,,21 ,,RBRVS,35.70 ,26.19 ,26.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21184,CPT,RCNSTJ ORBIT/FHD/NASETHMD EXC BONE TUM GRF>80SQ,,,21 ,,RBRVS,38.62 ,24.12 ,24.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21188,CPT,RCNSTJ MDFC OTH/THN LEFORT OSTEOT & BONE GRAFTS,,,21 ,,RBRVS,23.15 ,21.25 ,21.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21193,CPT,RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF,,,21 ,,RBRVS,18.90 ,15.91 ,15.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21194,CPT,RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT,,,21 ,,RBRVS,21.82 ,16.39 ,16.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21195,CPT,RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD,,,21 ,,RBRVS,19.16 ,18.30 ,18.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21196,CPT,RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI,,,21 ,,RBRVS,20.83 ,20.19 ,20.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21198,CPT,OSTEOTOMY MANDIBLE SEGMENTAL,,,21 ,,RBRVS,15.71 ,16.49 ,16.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21199,CPT,OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT,,,21 ,,RBRVS,16.73 ,11.23 ,11.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21206,CPT,OSTEOTOMY MAXILLA SEGMENTAL,,,21 ,,RBRVS,15.59 ,16.73 ,16.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21208,CPT,OSTEOPLASTY FACIAL BONES AUGMENTATION,,,21 ,,RBRVS,11.42 ,11.47 ,42.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21209,CPT,OSTEOPLASTY FACIAL BONES REDUCTION,,,21 ,,RBRVS,7.82 ,10.12 ,15.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21210,CPT,GRAFT BONE NASAL/MAXILLARY/MALAR AREAS,,,21 ,,RBRVS,11.69 ,11.75 ,52.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21215,CPT,GRAFT BONE MANDIBLE,,,21 ,,RBRVS,12.23 ,12.10 ,103.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21230,CPT,GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR,,,21 ,,RBRVS,11.17 ,9.66 ,9.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21235,CPT,GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR,,,21 ,,RBRVS,7.50 ,8.40 ,13.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21240,CPT,ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT,,,21 ,,RBRVS,16.07 ,14.18 ,14.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21242,CPT,ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT,,,21 ,,RBRVS,14.59 ,13.17 ,13.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21243,CPT,ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT,,,21 ,,RBRVS,24.53 ,21.50 ,21.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21244,CPT,RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE,,,21 ,,RBRVS,13.62 ,16.00 ,16.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21245,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL,,,21 ,,RBRVS,13.12 ,11.91 ,18.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21246,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE,,,21 ,,RBRVS,12.92 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21247,CPT,RCNSTJ MNDBLR CONDYLE W/BONE CARTLG AUTOGRAFTS,,,21 ,,RBRVS,24.37 ,20.48 ,20.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21248,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL,,,21 ,,RBRVS,12.74 ,11.78 ,17.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21249,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE,,,21 ,,RBRVS,18.77 ,14.99 ,22.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21255,CPT,RCNSTJ ZYGMTC ARCH/GLENOID FOSSA W/BONE CARTLG,,,21 ,,RBRVS,18.46 ,20.47 ,20.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21256,CPT,RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS,,,21 ,,RBRVS,17.66 ,15.39 ,15.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21260,CPT,PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL,,,21 ,,RBRVS,17.90 ,17.15 ,17.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21261,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR,,,21 ,,RBRVS,34.07 ,23.58 ,23.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21263,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD,,,21 ,,RBRVS,31.01 ,22.02 ,22.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21267,CPT,ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL,,,21 ,,RBRVS,20.69 ,21.33 ,21.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21268,CPT,ORBITAL REPOSITIONING W/BONE GRAFTS ICRA & XTRC,,,21 ,,RBRVS,27.07 ,20.92 ,20.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21270,CPT,MALAR AUGMENTATION PROSTHETIC MATERIAL,,,21 ,,RBRVS,10.63 ,9.55 ,16.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21275,CPT,SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ,,,21 ,,RBRVS,11.76 ,11.01 ,11.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21280,CPT,MEDIAL CANTHOPEXY SEPARATE PROCEDURE,,,21 ,,RBRVS,7.13 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21282,CPT,LATERAL CANTHOPEXY,,,21 ,,RBRVS,4.27 ,6.16 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21295,CPT,REDUCTION MASSETER MUSCLE & BONE EXTRAORAL,,,21 ,,RBRVS,1.90 ,3.18 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21296,CPT,REDUCTION MASSETER MUSCLE & BONE INTRAORAL,,,21 ,,RBRVS,4.78 ,7.30 ,7.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21299,CPT,UNLISTED CRANIOFACIAL & MAXILLOFACIAL PROCEDURE,,,21 ,,TotalUnits,,,,34.81 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,21310,CPT,CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,0.58 ,0.14 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21315,CPT,CLOSED TX NASAL FRACTURE W/O STABILIZATION,,,21 ,,RBRVS,1.83 ,2.44 ,6.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21320,CPT,CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION,,,21 ,,RBRVS,1.88 ,1.91 ,5.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21325,CPT,OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED,,,21 ,,RBRVS,4.18 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21330,CPT,OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI,,,21 ,,RBRVS,5.79 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21335,CPT,OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM,,,21 ,,RBRVS,9.02 ,11.59 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21336,CPT,OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION,,,21 ,,RBRVS,6.77 ,11.72 ,11.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21337,CPT,CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION,,,21 ,,RBRVS,3.39 ,4.90 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21338,CPT,OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION,,,21 ,,RBRVS,6.87 ,14.37 ,14.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21339,CPT,OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION,,,21 ,,RBRVS,8.50 ,13.53 ,13.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21340,CPT,PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE,,,21 ,,RBRVS,11.49 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21343,CPT,OPEN TX DEPRESSED FRONTAL SINUS FRACTURE,,,21 ,,RBRVS,14.32 ,19.20 ,19.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21344,CPT,OPEN TX COMPLICATED FRONTAL SINUS FRACTURE,,,21 ,,RBRVS,21.57 ,17.75 ,17.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21345,CPT,CLOSED TX NASOMAXILLARY COMPLEX FRACTURE,,,21 ,,RBRVS,9.06 ,8.74 ,13.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21346,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ,,,21 ,,RBRVS,11.45 ,14.57 ,14.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21347,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN,,,21 ,,RBRVS,13.53 ,17.92 ,17.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21348,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE W/BONE GRAFT,,,21 ,,RBRVS,17.52 ,12.90 ,12.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21355,CPT,PERCUTANEOUS TX MALAR AREA FRACTURE,,,21 ,,RBRVS,4.45 ,4.63 ,7.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21356,CPT,OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE,,,21 ,,RBRVS,4.83 ,5.68 ,9.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21360,CPT,OPEN TX DEPRESSED MALAR FRACTURE,,,21 ,,RBRVS,7.19 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21365,CPT,OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG,,,21 ,,RBRVS,16.77 ,13.55 ,13.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21366,CPT,OPEN TX COMP FRACTURE MALAR AREA W/BONE GRAFT,,,21 ,,RBRVS,18.60 ,13.47 ,13.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21385,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL,,,21 ,,RBRVS,9.57 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21386,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL,,,21 ,,RBRVS,9.57 ,8.07 ,8.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21387,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR,,,21 ,,RBRVS,10.11 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21390,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC,,,21 ,,RBRVS,11.23 ,10.56 ,10.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21395,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF,,,21 ,,RBRVS,14.70 ,12.59 ,12.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21400,CPT,CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION,,,21 ,,RBRVS,1.50 ,2.81 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21401,CPT,CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION,,,21 ,,RBRVS,3.68 ,4.65 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21406,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT,,,21 ,,RBRVS,7.42 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21407,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT,,,21 ,,RBRVS,9.02 ,8.70 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21408,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT,,,21 ,,RBRVS,12.78 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21421,CPT,CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT,,,21 ,,RBRVS,6.02 ,12.31 ,16.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21422,CPT,OPEN TREATMENT PALATAL/MAXILLARY FRACTURE,,,21 ,,RBRVS,8.73 ,9.91 ,9.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21423,CPT,OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR,,,21 ,,RBRVS,10.85 ,10.79 ,10.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21431,CPT,CLOSED TX CRANIOFACIAL SEPARATION,,,21 ,,RBRVS,7.90 ,10.71 ,10.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21432,CPT,OPEN TX CRANIOFACIAL SEP W/WIRING&/INT FIXJ,,,21 ,,RBRVS,8.82 ,10.73 ,10.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21433,CPT,OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR,,,21 ,,RBRVS,26.29 ,17.73 ,17.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21435,CPT,OPEN TX CRANIOFACIAL SEP COMP W/INT&/XTRNL FIX,,,21 ,,RBRVS,20.26 ,17.84 ,17.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21436,CPT,OPTX CRNFCL SEP LFT III TYP COMP INT FIXJ W/BONE,,,21 ,,RBRVS,30.30 ,25.06 ,25.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21440,CPT,CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,,21 ,,RBRVS,3.44 ,9.67 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21445,CPT,OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,,21 ,,RBRVS,6.26 ,11.21 ,15.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21450,CPT,CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,3.71 ,10.07 ,13.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21451,CPT,CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION,,,21 ,,RBRVS,5.65 ,12.25 ,15.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21452,CPT,PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ,,,21 ,,RBRVS,2.40 ,7.60 ,15.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21453,CPT,CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION,,,21 ,,RBRVS,6.64 ,15.34 ,18.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21454,CPT,OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION,,,21 ,,RBRVS,7.36 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21461,CPT,OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION,,,21 ,,RBRVS,9.31 ,17.28 ,52.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21462,CPT,OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION,,,21 ,,RBRVS,11.01 ,18.10 ,53.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21465,CPT,OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE,,,21 ,,RBRVS,13.12 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21470,CPT,OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION,,,21 ,,RBRVS,17.54 ,15.29 ,15.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21480,CPT,CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ,,,21 ,,RBRVS,0.61 ,0.24 ,2.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21485,CPT,CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ,,,21 ,,RBRVS,4.77 ,11.63 ,14.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21490,CPT,OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION,,,21 ,,RBRVS,12.95 ,11.94 ,11.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21495,CPT,OPEN TREATMENT HYOID FRACTURE,,,21 ,,RBRVS,6.79 ,13.61 ,13.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21497,CPT,INTERDENTAL WIRING OTHER THAN FRACTURE,,,21 ,,RBRVS,4.64 ,12.45 ,15.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21499,CPT,UNLISTED MUSCULOSKELETAL PROCEDURE HEAD,,,21 ,,TotalUnits,,,,19.30 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,21501,CPT,I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX,,,21 ,,RBRVS,3.98 ,4.77 ,8.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21502,CPT,I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI,,,21 ,,RBRVS,7.55 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21510,CPT,INCISION DEEP OPENING BONE CORTEX THORAX,,,21 ,,RBRVS,6.20 ,7.60 ,7.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21550,CPT,BIOPSY SOFT TISSUE NECK/THORAX,,,21 ,,RBRVS,2.11 ,2.25 ,5.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21552,CPT,EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>,,,21 ,,RBRVS,6.49 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21554,CPT,EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>,,,21 ,,RBRVS,11.13 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21555,CPT,EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM,,,21 ,,RBRVS,3.96 ,4.37 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21556,CPT,EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM,,,21 ,,RBRVS,7.66 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21557,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM,,,21 ,,RBRVS,14.75 ,9.86 ,9.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21558,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>,,,21 ,,RBRVS,21.58 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21600,CPT,EXCISION RIB PARTIAL,,,21 ,,RBRVS,7.26 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21610,CPT,COSTOTRANSVERSECTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,15.91 ,13.36 ,13.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21615,CPT,EXCISION 1ST &/ CERVICAL RIB,,,21 ,,RBRVS,10.45 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21616,CPT,EXCISION 1ST &/ CERVICAL RIB W/SYMPATHECTOMY,,,21 ,,RBRVS,12.69 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21620,CPT,OSTECTOMY STERNUM PARTIAL,,,21 ,,RBRVS,7.28 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21627,CPT,STERNAL DEBRIDEMENT,,,21 ,,RBRVS,7.30 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21630,CPT,RADICAL RESECTION STERNUM,,,21 ,,RBRVS,19.18 ,13.95 ,13.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21632,CPT,RADICAL RESECTION STERNUM W/MEDSTNL LMPHADEC,,,21 ,,RBRVS,19.68 ,11.99 ,11.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21685,CPT,HYOID MYOTOMY & SUSPENSION,,,21 ,,RBRVS,15.26 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21700,CPT,DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB,,,21 ,,RBRVS,6.31 ,3.76 ,3.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21705,CPT,DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB,,,21 ,,RBRVS,9.92 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21720,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST,,,21 ,,RBRVS,5.80 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21725,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/CAST,,,21 ,,RBRVS,7.19 ,5.49 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21740,CPT,REPAIR PECTUS EXCAVATUM/CARINATUM OPEN,,,21 ,,RBRVS,17.57 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21742,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC,,,21 ,,RBRVS,20.87 ,18.56 ,18.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21743,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC,,,21 ,,TotalUnits,,,,49.24 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,21750,CPT,CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX,,,21 ,,RBRVS,11.40 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21800,CPT,CLOSED TX RIB FRACTURE UNCOMPLICATED EACH,,,21 ,,RBRVS,1.01 ,2.09 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21805,CPT,OPEN TX RIB FRACTURE W/O FIXATION EACH,,,21 ,,RBRVS,2.88 ,4.34 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21810,CPT,TX RIB FRACTURE EXTERNAL FIXATION FLAIL CHEST,,,21 ,,RBRVS,7.03 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21820,CPT,CLOSED TREATMENT STERNUM FRACTURE,,,21 ,,RBRVS,1.36 ,2.56 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21825,CPT,OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION,,,21 ,,RBRVS,7.76 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,21899,CPT,UNLISTED PROCEDURE NECK/THORAX,,,21 ,,TotalUnits,,,,9.21 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,21920,CPT,BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL,,,21 ,,RBRVS,2.11 ,2.34 ,5.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21925,CPT,BIOPSY SOFT TISSUE BACK/FLANK DEEP,,,21 ,,RBRVS,4.63 ,4.74 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21930,CPT,EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM,,,21 ,,RBRVS,4.94 ,4.80 ,7.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21931,CPT,EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>,,,21 ,,RBRVS,6.88 ,5.59 ,5.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21932,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM,,,21 ,,RBRVS,9.82 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21933,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>,,,21 ,,RBRVS,11.13 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21935,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM,,,21 ,,RBRVS,15.72 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,21936,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>,,,21 ,,RBRVS,22.55 ,14.38 ,14.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22010,CPT,I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR,,,21 ,,RBRVS,12.75 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22015,CPT,I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC,,,21 ,,RBRVS,12.64 ,11.54 ,11.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22100,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV,,,21 ,,RBRVS,11.00 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22101,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC,,,21 ,,RBRVS,11.08 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22102,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR,,,21 ,,RBRVS,11.08 ,10.31 ,10.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22103,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA,,,21 ,,RBRVS,2.34 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22110,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV,,,21 ,,RBRVS,14.00 ,12.82 ,12.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22112,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM THRC,,,21 ,,RBRVS,14.07 ,12.16 ,12.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22114,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR,,,21 ,,RBRVS,14.07 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22116,CPT,PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA,,,21 ,,RBRVS,2.32 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22206,CPT,OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC,,,21 ,,RBRVS,37.18 ,24.83 ,24.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22207,CPT,OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR,,,21 ,,RBRVS,36.68 ,24.55 ,24.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22208,CPT,OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM,,,21 ,,RBRVS,9.66 ,5.16 ,5.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22210,CPT,OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM CRV,,,21 ,,RBRVS,25.38 ,20.03 ,20.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22212,CPT,OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC,,,21 ,,RBRVS,20.99 ,17.30 ,17.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22214,CPT,OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM LMBR,,,21 ,,RBRVS,21.02 ,17.45 ,17.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22216,CPT,OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM,,,21 ,,RBRVS,6.03 ,3.27 ,3.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22220,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM CRV,,,21 ,,RBRVS,22.94 ,18.33 ,18.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22222,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM THRC,,,21 ,,RBRVS,23.09 ,17.23 ,17.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22224,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM LMBR,,,21 ,,RBRVS,23.09 ,18.05 ,18.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22226,CPT,OSTEOT SPI W/DSKC ANT APPR 1 VRT SGM EA VRT SGM,,,21 ,,RBRVS,6.03 ,3.23 ,3.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22305,CPT,CLOSED TX VERTEBRAL PROCESS FRACTURE,,,21 ,,RBRVS,2.13 ,2.52 ,3.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22310,CPT,CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING,,,21 ,,RBRVS,3.89 ,3.54 ,4.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22315,CPT,CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ,,,21 ,,RBRVS,10.11 ,10.03 ,13.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22318,CPT,OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O G,,,21 ,,RBRVS,22.72 ,17.82 ,17.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22319,CPT,OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ,,,21 ,,RBRVS,25.33 ,19.40 ,19.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22325,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM,,,21 ,,RBRVS,19.87 ,16.80 ,16.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22326,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR,,,21 ,,RBRVS,20.84 ,16.69 ,16.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22327,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH,,,21 ,,RBRVS,20.77 ,17.23 ,17.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22328,CPT,OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA,,,21 ,,RBRVS,4.60 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22505,CPT,MANIPULATION SPINE REQUIRING ANESTHESIA,,,21 ,,RBRVS,1.87 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22520,CPT,PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX,,,21 ,,RBRVS,9.22 ,4.78 ,55.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22521,CPT,PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX,,,21 ,,RBRVS,8.65 ,4.67 ,56.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22522,CPT,PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR,,,21 ,,RBRVS,4.30 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22523,CPT,PERCUTANEOUS VERTEBRAL AUGMENTATION THORACIC,,,21 ,,RBRVS,9.04 ,5.97 ,214.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22524,CPT,PERCUTANEOUS VERTEBRAL AUGMENTATION LUMBAR,,,21 ,,RBRVS,8.54 ,5.73 ,213.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22525,CPT,PERQ VERTEBRAL AUGMENTATION EA ADDL THRC/LMBR,,,21 ,,RBRVS,4.47 ,2.23 ,134.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22526,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL,,,21 ,,RBRVS,6.10 ,3.10 ,59.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22527,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL,,,21 ,,RBRVS,3.03 ,1.10 ,50.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22532,CPT,ARTHRODESIS LATERAL EXTRACAVITARY THORACIC,,,21 ,,RBRVS,25.99 ,19.06 ,19.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22533,CPT,ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR,,,21 ,,RBRVS,24.79 ,18.39 ,18.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22534,CPT,ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR,,,21 ,,RBRVS,5.99 ,3.20 ,3.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22548,CPT,ARTHRD ANT TRANSORL/XTRORAL C1-C2 W/WO EXC ODNTD,,,21 ,,RBRVS,27.06 ,21.02 ,21.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22551,CPT,ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2,,,21 ,,RBRVS,25.00 ,18.46 ,18.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22552,CPT,ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC,,,21 ,,RBRVS,6.50 ,3.41 ,3.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22554,CPT,ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2,,,21 ,,RBRVS,17.69 ,14.58 ,14.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22556,CPT,ARTHRD ANT MIN DISCECTOMY INTERBODY THORACIC,,,21 ,,RBRVS,24.70 ,17.82 ,17.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22558,CPT,ARTHRODESIS ANTERIOR INTERBODY LUMBAR,,,21 ,,RBRVS,23.53 ,16.29 ,16.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22585,CPT,ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC,,,21 ,,RBRVS,5.52 ,2.90 ,2.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22586,CPT,ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5/S1,,,21 ,,RBRVS,28.12 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22590,CPT,ARTHRODESIS POSTERIOR CRANIOCERVICAL,,,21 ,,RBRVS,21.76 ,17.80 ,17.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22595,CPT,ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2,,,21 ,,RBRVS,20.64 ,17.18 ,17.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22600,CPT,ARTHRODESIS PST/PSTLAT CERVICAL BELW C2 SGM,,,21 ,,RBRVS,17.40 ,15.28 ,15.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22610,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL THORACIC,,,21 ,,RBRVS,17.28 ,14.98 ,14.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22612,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR,,,21 ,,RBRVS,23.53 ,17.38 ,17.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22614,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL,,,21 ,,RBRVS,6.43 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22630,CPT,ARTHRODESIS POSTERIOR INTERBODY LUMBAR,,,21 ,,RBRVS,22.09 ,17.26 ,17.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22632,CPT,ARTHRODESIS POSTERIOR INTERBODY EA ADDL,,,21 ,,RBRVS,5.22 ,2.79 ,2.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22633,CPT,ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR,,,21 ,,RBRVS,27.75 ,19.69 ,19.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22634,CPT,ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG,,,21 ,,RBRVS,8.16 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22800,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM UP 6 VRT SEG,,,21 ,,RBRVS,19.50 ,15.56 ,15.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22802,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SEG,,,21 ,,RBRVS,32.11 ,22.45 ,22.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22804,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM 13/> VRT SEG,,,21 ,,RBRVS,37.50 ,25.35 ,25.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22808,CPT,ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SEG,,,21 ,,RBRVS,27.51 ,19.06 ,19.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22810,CPT,ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SEG,,,21 ,,RBRVS,31.50 ,20.60 ,20.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22812,CPT,ARTHRODESIS POSTERIOR SPINAL DFRM 8/> VRT SEG,,,21 ,,RBRVS,34.25 ,24.02 ,24.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22818,CPT,KYPHECTOMY SINGLE OR TWO SEGMENTS,,,21 ,,RBRVS,34.33 ,22.89 ,22.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22819,CPT,KYPHECTOMY 3 OR MORE SEGMENTS,,,21 ,,RBRVS,39.38 ,27.46 ,27.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22830,CPT,EXPLORATION SPINAL FUSION,,,21 ,,RBRVS,11.22 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22840,CPT,POSTERIOR NON-SEGMENTAL INSTRUMENTATION,,,21 ,,RBRVS,12.52 ,6.70 ,6.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22841,CPT,INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS,,,21 ,,TotalUnits,,,,17.98 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,22842,CPT,POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG,,,21 ,,RBRVS,12.56 ,6.73 ,6.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22843,CPT,POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG,,,21 ,,RBRVS,13.44 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22844,CPT,POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE,,,21 ,,RBRVS,16.42 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22845,CPT,ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS,,,21 ,,RBRVS,11.94 ,6.33 ,6.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22846,CPT,ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS,,,21 ,,RBRVS,12.40 ,6.58 ,6.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22847,CPT,ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS,,,21 ,,RBRVS,13.78 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22848,CPT,PELVIC FIXATION OTHER THAN SACRUM,,,21 ,,RBRVS,5.99 ,3.27 ,3.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22849,CPT,REINSERTION SPINAL FIXATION DEVICE,,,21 ,,RBRVS,19.17 ,14.16 ,14.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22850,CPT,REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION,,,21 ,,RBRVS,9.82 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22851,CPT,APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE,,,21 ,,RBRVS,6.70 ,3.57 ,3.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22852,CPT,REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION,,,21 ,,RBRVS,9.37 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22855,CPT,REMOVAL ANTERIOR INSTRUMENTATION,,,21 ,,RBRVS,15.86 ,12.49 ,12.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22856,CPT,TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV,,,21 ,,RBRVS,24.05 ,17.87 ,17.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22857,CPT,TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC LMBR,,,21 ,,RBRVS,27.13 ,15.99 ,15.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22861,CPT,REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV,,,21 ,,RBRVS,33.36 ,16.55 ,16.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22862,CPT,REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC LMBR,,,21 ,,RBRVS,32.63 ,22.84 ,22.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22864,CPT,RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL,,,21 ,,RBRVS,29.40 ,19.28 ,19.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22865,CPT,RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE LUMBAR,,,21 ,,RBRVS,31.75 ,22.66 ,22.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,22899,CPT,UNLISTED PROCEDURE SPINE,,,21 ,,TotalUnits,,,,18.27 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,22900,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM,,,21 ,,RBRVS,8.32 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22901,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>,,,21 ,,RBRVS,10.11 ,7.45 ,7.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22902,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM,,,21 ,,RBRVS,4.42 ,4.47 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22903,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>,,,21 ,,RBRVS,6.39 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22904,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM,,,21 ,,RBRVS,16.69 ,10.84 ,10.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22905,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>,,,21 ,,RBRVS,21.58 ,13.25 ,13.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,22999,CPT,UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM,,,21 ,,TotalUnits,,,,12.10 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,23000,CPT,REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN,,,21 ,,RBRVS,4.48 ,5.40 ,11.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23020,CPT,CAPSULAR CONTRACTURE RELEASE,,,21 ,,RBRVS,9.36 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23030,CPT,I&D SHOULDER DEEP ABSCESS/HEMATOMA,,,21 ,,RBRVS,3.47 ,3.33 ,8.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23031,CPT,I&D SHOULDER INFECTED BURSA,,,21 ,,RBRVS,2.79 ,3.03 ,8.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23035,CPT,INCISION BONE CORTEX SHOULDER AREA,,,21 ,,RBRVS,9.16 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23040,CPT,ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB,,,21 ,,RBRVS,9.75 ,9.44 ,9.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23044,CPT,ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB,,,21 ,,RBRVS,7.59 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23065,CPT,BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL,,,21 ,,RBRVS,2.30 ,2.33 ,3.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23066,CPT,BIOPSY SOFT TISSUE SHOULDER DEEP,,,21 ,,RBRVS,4.30 ,5.09 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23071,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>,,,21 ,,RBRVS,5.91 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23073,CPT,EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>,,,21 ,,RBRVS,10.13 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23075,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM,,,21 ,,RBRVS,4.21 ,4.04 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23076,CPT,EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM,,,21 ,,RBRVS,7.41 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23077,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM,,,21 ,,RBRVS,17.66 ,12.67 ,12.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23078,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/>,,,21 ,,RBRVS,22.55 ,14.60 ,14.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23100,CPT,ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY,,,21 ,,RBRVS,6.20 ,7.14 ,7.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23101,CPT,ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG,,,21 ,,RBRVS,5.72 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23105,CPT,ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY,,,21 ,,RBRVS,8.48 ,8.55 ,8.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23106,CPT,ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX,,,21 ,,RBRVS,6.13 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23107,CPT,ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB,,,21 ,,RBRVS,8.87 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23120,CPT,CLAVICULECTOMY PARTIAL,,,21 ,,RBRVS,7.39 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23125,CPT,CLAVICULECTOMY TOTAL,,,21 ,,RBRVS,9.64 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23130,CPT,PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE,,,21 ,,RBRVS,7.77 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23140,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA,,,21 ,,RBRVS,7.12 ,6.96 ,6.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23145,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT,,,21 ,,RBRVS,9.40 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23146,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT,,,21 ,,RBRVS,8.08 ,8.36 ,8.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23150,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS,,,21 ,,RBRVS,8.91 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23155,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT,,,21 ,,RBRVS,10.86 ,10.20 ,10.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23156,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT,,,21 ,,RBRVS,9.11 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23170,CPT,SEQUESTRECTOMY CLAVICLE,,,21 ,,RBRVS,7.21 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23172,CPT,SEQUESTRECTOMY SCAPULA,,,21 ,,RBRVS,7.31 ,7.69 ,7.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23174,CPT,SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK,,,21 ,,RBRVS,10.05 ,10.14 ,10.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23180,CPT,PARTIAL EXCISION BONE CLAVICLE,,,21 ,,RBRVS,8.99 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23182,CPT,PARTIAL EXCISION BONE SCAPULA,,,21 ,,RBRVS,8.61 ,9.00 ,9.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23184,CPT,PARTIAL EXCISION BONE PROXIMAL HUMERUS,,,21 ,,RBRVS,9.90 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23190,CPT,OSTECTOMY SCAPULA PARTIAL,,,21 ,,RBRVS,7.47 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23195,CPT,RESECTION HUMERAL HEAD,,,21 ,,RBRVS,10.36 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23200,CPT,RADICAL RESECTION TUMOR CLAVICLE,,,21 ,,RBRVS,22.71 ,15.79 ,15.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,23210,CPT,RADICAL RESECTION TUMOR SCAPULA,,,21 ,,RBRVS,27.21 ,17.81 ,17.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,23220,CPT,RADICAL RESECTION BONE TUMOR PROXIMAL HUMERUS,,,21 ,,RBRVS,30.21 ,19.07 ,19.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,23330,CPT,REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS,,,21 ,,RBRVS,1.90 ,2.21 ,4.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23331,CPT,REMOVAL FOREIGN BODY SHOULDER DEEP,,,21 ,,RBRVS,7.63 ,8.22 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23332,CPT,REMOVAL FOREIGN BODY SHOULDER COMPLICATED,,,21 ,,RBRVS,12.37 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,23350,CPT,INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG,,,21 ,,RBRVS,1.00 ,0.39 ,3.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23395,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE,,,21 ,,RBRVS,18.54 ,15.70 ,15.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23397,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE,,,21 ,,RBRVS,16.76 ,13.44 ,13.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23400,CPT,SCAPULOPEXY,,,21 ,,RBRVS,13.87 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23405,CPT,TENOTOMY SHOULDER AREA 1 TENDON,,,21 ,,RBRVS,8.54 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23406,CPT,TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION,,,21 ,,RBRVS,11.01 ,9.67 ,9.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23410,CPT,OPEN REPAIR OF ROTATOR CUFF ACUTE,,,21 ,,RBRVS,11.39 ,10.56 ,10.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23412,CPT,OPEN REPAIR OF ROTATOR CUFF CHRONIC,,,21 ,,RBRVS,11.93 ,10.87 ,10.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23415,CPT,CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY,,,21 ,,RBRVS,9.23 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23420,CPT,RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,,,21 ,,RBRVS,13.54 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23430,CPT,TENODESIS LONG TENDON BICEPS,,,21 ,,RBRVS,10.17 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23440,CPT,RESECTION/TRANSPLANTATION LONG TENDON BICEPS,,,21 ,,RBRVS,10.64 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23450,CPT,CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON,,,21 ,,RBRVS,13.70 ,11.42 ,11.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23455,CPT,CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR,,,21 ,,RBRVS,14.67 ,11.97 ,11.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23460,CPT,CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK,,,21 ,,RBRVS,15.82 ,13.07 ,13.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23462,CPT,CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR,,,21 ,,RBRVS,15.72 ,12.66 ,12.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23465,CPT,CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK,,,21 ,,RBRVS,16.30 ,13.40 ,13.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23466,CPT,CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS,,,21 ,,RBRVS,15.80 ,14.07 ,14.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23470,CPT,ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY,,,21 ,,RBRVS,17.89 ,14.16 ,14.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23472,CPT,ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,,,21 ,,RBRVS,22.65 ,16.97 ,16.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,23473,CPT,REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT,,,21 ,,RBRVS,25.00 ,18.34 ,18.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23474,CPT,REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT,,,21 ,,RBRVS,27.21 ,19.52 ,19.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,23480,CPT,OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION,,,21 ,,RBRVS,11.54 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23485,CPT,OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL,,,21 ,,RBRVS,13.91 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23490,CPT,PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE,,,21 ,,RBRVS,12.16 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23491,CPT,PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS,,,21 ,,RBRVS,14.54 ,12.35 ,12.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23500,CPT,CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.21 ,3.80 ,3.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23505,CPT,CLSD TX CLAVICULAR FRACTURE W/MANIPULATION,,,21 ,,RBRVS,3.83 ,5.02 ,5.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23515,CPT,OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,,,21 ,,RBRVS,9.69 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23520,CPT,CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION,,,21 ,,RBRVS,2.29 ,4.00 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23525,CPT,CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION,,,21 ,,RBRVS,3.79 ,5.58 ,6.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23530,CPT,OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC,,,21 ,,RBRVS,7.48 ,7.56 ,7.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23532,CPT,OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,,21 ,,RBRVS,8.20 ,8.42 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23540,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION,,,21 ,,RBRVS,2.36 ,3.78 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23545,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION,,,21 ,,RBRVS,3.43 ,4.86 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23550,CPT,OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC,,,21 ,,RBRVS,7.59 ,7.64 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23552,CPT,OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,,21 ,,RBRVS,8.82 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23570,CPT,CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.36 ,4.10 ,3.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23575,CPT,CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION,,,21 ,,RBRVS,4.23 ,5.78 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23585,CPT,OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD,,,21 ,,RBRVS,14.23 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23600,CPT,CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,3.11 ,5.09 ,5.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23605,CPT,CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ,,,21 ,,RBRVS,5.06 ,6.40 ,7.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23615,CPT,OPEN TREATMENT PROXIMAL HUMERAL FRACTURE,,,21 ,,RBRVS,12.30 ,11.27 ,11.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23616,CPT,OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT,,,21 ,,RBRVS,18.37 ,14.77 ,14.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23620,CPT,CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ,,,21 ,,RBRVS,2.55 ,4.39 ,4.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23625,CPT,CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION,,,21 ,,RBRVS,4.10 ,5.36 ,6.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23630,CPT,OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE,,,21 ,,RBRVS,10.57 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23650,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES,,,21 ,,RBRVS,3.53 ,4.07 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23655,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES,,,21 ,,RBRVS,4.76 ,5.88 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23660,CPT,OPEN TX ACUTE SHOULDER DISLOCATION,,,21 ,,RBRVS,7.66 ,7.93 ,7.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23665,CPT,CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ,,,21 ,,RBRVS,4.66 ,5.95 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23670,CPT,OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX,,,21 ,,RBRVS,12.28 ,10.84 ,10.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23675,CPT,CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ,,,21 ,,RBRVS,6.27 ,7.10 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23680,CPT,OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE,,,21 ,,RBRVS,13.15 ,11.47 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23700,CPT,MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS,,,21 ,,RBRVS,2.57 ,2.65 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23800,CPT,ARTHRODESIS GLENOHUMERAL JOINT,,,21 ,,RBRVS,14.73 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23802,CPT,ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT,,,21 ,,RBRVS,18.42 ,15.41 ,15.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23900,CPT,INTERTHORACOSCAPULAR AMPUTATION,,,21 ,,RBRVS,20.72 ,15.46 ,15.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,23920,CPT,DISARTICULATION SHOULDER,,,21 ,,RBRVS,16.23 ,13.30 ,13.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,23921,CPT,DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION,,,21 ,,RBRVS,5.72 ,5.41 ,5.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23929,CPT,UNLISTED PROCEDURE SHOULDER,,,21 ,,TotalUnits,,,,15.67 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,23930,CPT,I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA,,,21 ,,RBRVS,2.99 ,2.74 ,6.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23931,CPT,INCISION&DRAINAGE UPPER ARM/ELBOW BURSA,,,21 ,,RBRVS,1.84 ,2.50 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,23935,CPT,INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW,,,21 ,,RBRVS,6.38 ,7.16 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24000,CPT,ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB,,,21 ,,RBRVS,6.08 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24006,CPT,ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX,,,21 ,,RBRVS,9.74 ,9.34 ,9.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24065,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL,,,21 ,,RBRVS,2.13 ,2.50 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24066,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP,,,21 ,,RBRVS,5.35 ,5.57 ,11.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24071,CPT,EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>,,,21 ,,RBRVS,5.70 ,5.15 ,5.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24073,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>,,,21 ,,RBRVS,10.13 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24075,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM,,,21 ,,RBRVS,4.24 ,4.57 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24076,CPT,EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM,,,21 ,,RBRVS,7.41 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24077,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM,,,21 ,,RBRVS,15.72 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24079,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/>,,,21 ,,RBRVS,20.61 ,14.32 ,14.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24100,CPT,ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY,,,21 ,,RBRVS,5.07 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24101,CPT,ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB,,,21 ,,RBRVS,6.30 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24102,CPT,ARTHROTOMY ELBOW W/SYNOVECTOMY,,,21 ,,RBRVS,8.26 ,8.22 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24105,CPT,EXCISION OLECRANON BURSA,,,21 ,,RBRVS,3.78 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24110,CPT,EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS,,,21 ,,RBRVS,7.58 ,8.07 ,8.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24115,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT,,,21 ,,RBRVS,10.12 ,9.42 ,9.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24116,CPT,EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT,,,21 ,,RBRVS,12.23 ,10.61 ,10.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24120,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN,,,21 ,,RBRVS,6.82 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24125,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT,,,21 ,,RBRVS,8.14 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24126,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT,,,21 ,,RBRVS,8.62 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24130,CPT,EXCISION RADIAL HEAD,,,21 ,,RBRVS,6.42 ,7.25 ,7.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24134,CPT,SEQUESTRECTOMY SHAFT/DISTAL HUMERUS,,,21 ,,RBRVS,10.22 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24136,CPT,SEQUESTRECTOMY RADIAL HEAD OR NECK,,,21 ,,RBRVS,8.40 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24138,CPT,SEQUESTRECTOMY OLECRANON PROCESS,,,21 ,,RBRVS,8.50 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24140,CPT,PARTIAL EXCISION BONE HUMERUS,,,21 ,,RBRVS,9.55 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24145,CPT,PARTIAL EXCISION BONE RADIAL HEAD/NECK,,,21 ,,RBRVS,7.81 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24147,CPT,PARTIAL EXCISION BONE OLECRANON PROCESS,,,21 ,,RBRVS,7.84 ,8.95 ,8.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24149,CPT,RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT,,,21 ,,RBRVS,16.22 ,15.19 ,15.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24150,CPT,RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS,,,21 ,,RBRVS,23.46 ,16.32 ,16.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24152,CPT,RADICAL RESECTION TUMOR RADIAL HEAD/NECK,,,21 ,,RBRVS,19.99 ,14.27 ,14.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24155,CPT,RESECTION ELBOW JOINT ARTHRECTOMY,,,21 ,,RBRVS,12.09 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24160,CPT,IMPLANT REMOVAL ELBOW JOINT,,,21 ,,RBRVS,8.00 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24164,CPT,IMPLANT REMOVAL RADIAL HEAD,,,21 ,,RBRVS,6.43 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24200,CPT,RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS,,,21 ,,RBRVS,1.81 ,1.95 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24201,CPT,REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP,,,21 ,,RBRVS,4.70 ,5.07 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24220,CPT,INJECTION ELBOW ARTHROGRAPHY,,,21 ,,RBRVS,1.31 ,0.55 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24300,CPT,MANIPULATION ELBOW UNDER ANESTHESIA,,,21 ,,RBRVS,4.04 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24301,CPT,MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE,,,21 ,,RBRVS,10.38 ,9.68 ,9.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24305,CPT,TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON,,,21 ,,RBRVS,7.62 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24310,CPT,TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON,,,21 ,,RBRVS,6.12 ,6.67 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24320,CPT,TENOPLASTY ELBOW TO SHOULDER SINGLE,,,21 ,,RBRVS,10.86 ,9.83 ,9.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24330,CPT,FLEXOR-PLASTY ELBOW,,,21 ,,RBRVS,9.79 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24331,CPT,FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT,,,21 ,,RBRVS,10.95 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24332,CPT,TENOLYSIS TRICEPS,,,21 ,,RBRVS,7.91 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24340,CPT,TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE,,,21 ,,RBRVS,8.08 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24341,CPT,REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA,,,21 ,,RBRVS,9.49 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24342,CPT,RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF,,,21 ,,RBRVS,10.86 ,9.92 ,9.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24343,CPT,REPAIR LATERAL COLLATERAL LIGAMENT ELBOW,,,21 ,,RBRVS,9.16 ,9.83 ,9.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24344,CPT,RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT,,,21 ,,RBRVS,15.21 ,14.10 ,14.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24345,CPT,REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW,,,21 ,,RBRVS,9.16 ,9.71 ,9.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24346,CPT,RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF,,,21 ,,RBRVS,15.21 ,13.96 ,13.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24357,CPT,TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS,,,21 ,,RBRVS,5.44 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24358,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN,,,21 ,,RBRVS,6.66 ,7.42 ,7.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24359,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR,,,21 ,,RBRVS,8.98 ,8.65 ,8.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24360,CPT,ARTHROPLASTY ELBOW W/MEMBRANE,,,21 ,,RBRVS,12.67 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24361,CPT,ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT,,,21 ,,RBRVS,14.41 ,12.28 ,12.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24362,CPT,ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ,,,21 ,,RBRVS,15.32 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24363,CPT,ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM,,,21 ,,RBRVS,22.65 ,17.16 ,17.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24365,CPT,ARTHROPLASTY RADIAL HEAD,,,21 ,,RBRVS,8.62 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24366,CPT,ARTHROPLASTY RADIAL HEAD W/IMPLANT,,,21 ,,RBRVS,9.36 ,8.86 ,8.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24370,CPT,REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT,,,21 ,,RBRVS,23.55 ,17.64 ,17.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24371,CPT,REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT,,,21 ,,RBRVS,27.50 ,19.90 ,19.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24400,CPT,OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION,,,21 ,,RBRVS,11.33 ,10.59 ,10.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24410,CPT,MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT,,,21 ,,RBRVS,15.11 ,9.92 ,9.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24420,CPT,OSTEOPLASTY HUMERUS,,,21 ,,RBRVS,13.73 ,12.60 ,12.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24430,CPT,REPAIR NON/MALUNION HUMERUS W/O GRAFT,,,21 ,,RBRVS,15.25 ,12.88 ,12.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24435,CPT,REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT,,,21 ,,RBRVS,14.99 ,13.72 ,13.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24470,CPT,HEMIEPIPHYSEAL ARREST,,,21 ,,RBRVS,8.93 ,8.65 ,8.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24495,CPT,DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL,,,21 ,,RBRVS,8.41 ,9.11 ,9.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24498,CPT,PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT,,,21 ,,RBRVS,12.28 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24500,CPT,CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,3.41 ,5.35 ,6.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24505,CPT,CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ,,,21 ,,RBRVS,5.39 ,6.78 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24515,CPT,OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE,,,21 ,,RBRVS,12.12 ,11.26 ,11.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24516,CPT,TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE,,,21 ,,RBRVS,12.19 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24530,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ,,,21 ,,RBRVS,3.69 ,5.60 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24535,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ,,,21 ,,RBRVS,7.11 ,8.12 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24538,CPT,PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX,,,21 ,,RBRVS,9.77 ,10.09 ,10.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24545,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN,,,21 ,,RBRVS,13.15 ,11.53 ,11.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24546,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN,,,21 ,,RBRVS,14.91 ,12.81 ,12.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24560,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ,,,21 ,,RBRVS,2.98 ,4.77 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24565,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ,,,21 ,,RBRVS,5.78 ,7.19 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24566,CPT,PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ,,,21 ,,RBRVS,9.06 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24575,CPT,OPEN TX HUMERAL EPICONDYLAR FRACTURE,,,21 ,,RBRVS,9.71 ,9.93 ,9.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24576,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ,,,21 ,,RBRVS,3.06 ,5.17 ,6.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24577,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ,,,21 ,,RBRVS,6.01 ,7.34 ,8.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24579,CPT,OPEN TREATMENT HUMERAL CONDYLAR FRACTURE,,,21 ,,RBRVS,11.44 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24582,CPT,PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ,,,21 ,,RBRVS,10.14 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24586,CPT,OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO,,,21 ,,RBRVS,15.78 ,13.12 ,13.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24587,CPT,OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR,,,21 ,,RBRVS,15.79 ,13.08 ,13.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24600,CPT,TREATMENT CLOSED ELBOW DISLOCATION W/O ANES,,,21 ,,RBRVS,4.37 ,4.54 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24605,CPT,TREATMENT CLOSED ELBOW DISLOCATION REQ ANES,,,21 ,,RBRVS,5.64 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24615,CPT,OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION,,,21 ,,RBRVS,9.83 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24620,CPT,CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ,,,21 ,,RBRVS,7.22 ,7.54 ,7.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24635,CPT,OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW,,,21 ,,RBRVS,8.80 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24640,CPT,CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ,,,21 ,,RBRVS,1.25 ,1.22 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24650,CPT,CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION,,,21 ,,RBRVS,2.31 ,4.20 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24655,CPT,CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION,,,21 ,,RBRVS,4.62 ,6.20 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24665,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE,,,21 ,,RBRVS,8.36 ,9.12 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24666,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC,,,21 ,,RBRVS,9.86 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24670,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ,,,21 ,,RBRVS,2.69 ,4.41 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24675,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ,,,21 ,,RBRVS,4.91 ,6.34 ,7.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24685,CPT,OPEN TREATMENT ULNAR FRACTURE PROXIMAL END,,,21 ,,RBRVS,8.37 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24800,CPT,ARTHRODESIS ELBOW JOINT LOCAL,,,21 ,,RBRVS,11.41 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24802,CPT,ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT,,,21 ,,RBRVS,14.32 ,12.19 ,12.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24900,CPT,AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE,,,21 ,,RBRVS,10.18 ,9.12 ,9.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,24920,CPT,AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR,,,21 ,,RBRVS,10.13 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,24925,CPT,AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ,,,21 ,,RBRVS,7.30 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24930,CPT,AMPUTATION ARM THRU HUMERUS RE-AMPUTATION,,,21 ,,RBRVS,10.83 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,24931,CPT,AMPUTATION ARM THRU HUMERUS W/IMPLANT,,,21 ,,RBRVS,13.44 ,8.09 ,8.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,24935,CPT,STUMP ELONGATION UPPER EXTREMITY,,,21 ,,RBRVS,16.45 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,24940,CPT,CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE,,,21 ,,RBRVS,14.77 ,13.13 ,13.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,24999,CPT,UNLISTED PROCEDURE HUMERUS/ELBOW,,,21 ,,TotalUnits,,,,14.08 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,25000,CPT,INCISION EXTENSOR TENDON SHEATH WRIST,,,21 ,,RBRVS,3.55 ,5.79 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25001,CPT,INCISION FLEXOR TENDON SHEATH WRIST,,,21 ,,RBRVS,3.79 ,5.54 ,5.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25020,CPT,DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT,,,21 ,,RBRVS,6.06 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25023,CPT,DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT,,,21 ,,RBRVS,13.83 ,15.97 ,15.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25024,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB,,,21 ,,RBRVS,10.79 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25025,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT,,,21 ,,RBRVS,17.94 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25028,CPT,I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA,,,21 ,,RBRVS,5.39 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25031,CPT,INCISION & DRAINAGE FOREARM&/WRIST BURSA,,,21 ,,RBRVS,4.26 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25035,CPT,INCISION DEEP BONE CORTEX FOREARM&/WRIST,,,21 ,,RBRVS,7.65 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25040,CPT,ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB,,,21 ,,RBRVS,7.50 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25065,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL,,,21 ,,RBRVS,2.04 ,2.50 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25066,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP,,,21 ,,RBRVS,4.27 ,5.60 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25071,CPT,EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>,,,21 ,,RBRVS,5.91 ,5.52 ,5.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25073,CPT,EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3CM/>,,,21 ,,RBRVS,7.13 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25075,CPT,EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM,,,21 ,,RBRVS,3.96 ,4.74 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25076,CPT,EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM,,,21 ,,RBRVS,6.74 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25077,CPT,RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM,,,21 ,,RBRVS,12.93 ,10.40 ,10.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25078,CPT,RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>,,,21 ,,RBRVS,17.69 ,13.23 ,13.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25085,CPT,CAPSULOTOMY WRIST,,,21 ,,RBRVS,5.64 ,6.58 ,6.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25100,CPT,ARTHROTOMY WRIST JOINT WITH BIOPSY,,,21 ,,RBRVS,4.02 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25101,CPT,ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB,,,21 ,,RBRVS,4.83 ,6.11 ,6.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25105,CPT,ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY,,,21 ,,RBRVS,6.02 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25107,CPT,ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE,,,21 ,,RBRVS,7.70 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25109,CPT,EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA,,,21 ,,RBRVS,6.94 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25110,CPT,EXCISION LESION TENDON SHEATH FOREARM&/WRIST,,,21 ,,RBRVS,4.04 ,5.35 ,5.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25111,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY,,,21 ,,RBRVS,3.53 ,5.17 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25112,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT,,,21 ,,RBRVS,4.67 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25115,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS,,,21 ,,RBRVS,10.09 ,10.82 ,10.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25116,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS,,,21 ,,RBRVS,7.56 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25118,CPT,SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT,,,21 ,,RBRVS,4.51 ,5.91 ,5.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25119,CPT,SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA,,,21 ,,RBRVS,6.21 ,7.33 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25120,CPT,EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA,,,21 ,,RBRVS,6.27 ,7.60 ,7.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25125,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT,,,21 ,,RBRVS,7.67 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25126,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT,,,21 ,,RBRVS,7.74 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25130,CPT,EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES,,,21 ,,RBRVS,5.43 ,6.74 ,6.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25135,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT,,,21 ,,RBRVS,7.08 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25136,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT,,,21 ,,RBRVS,6.14 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25145,CPT,SEQUESTRECTOMY FOREARM &/WRIST,,,21 ,,RBRVS,6.54 ,7.71 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25150,CPT,PARTIAL EXCISION BONE ULNA,,,21 ,,RBRVS,7.38 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25151,CPT,PARTIAL EXCISION BONE RADIUS,,,21 ,,RBRVS,7.68 ,8.43 ,8.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25170,CPT,RADICAL RESECTION TUMOR RADIUS OR ULNA,,,21 ,,RBRVS,22.21 ,15.85 ,15.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25210,CPT,CARPECTOMY 1 BONE,,,21 ,,RBRVS,6.12 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25215,CPT,CARPECTOMY ALL BONES PROXIMAL ROW,,,21 ,,RBRVS,8.14 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25230,CPT,RADICAL STYLOIDECTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,5.37 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25240,CPT,EXCISION DISTAL ULNA PARTIAL/COMPLETE,,,21 ,,RBRVS,5.31 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25246,CPT,INJECTION WRIST ARTHROGRAPHY,,,21 ,,RBRVS,1.45 ,0.59 ,3.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25248,CPT,EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,,,21 ,,RBRVS,5.31 ,6.09 ,6.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25250,CPT,REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE,,,21 ,,RBRVS,6.77 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25251,CPT,REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST,,,21 ,,RBRVS,9.82 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25259,CPT,MANIPULATION WRIST UNDER ANESTHESIA,,,21 ,,RBRVS,4.04 ,7.27 ,7.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25260,CPT,RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU,,,21 ,,RBRVS,8.04 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25263,CPT,RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS,,,21 ,,RBRVS,8.04 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25265,CPT,RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA,,,21 ,,RBRVS,10.10 ,10.27 ,10.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25270,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN,,,21 ,,RBRVS,6.17 ,7.60 ,7.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25272,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU,,,21 ,,RBRVS,7.21 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25274,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN,,,21 ,,RBRVS,8.94 ,9.48 ,9.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25275,CPT,RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT,,,21 ,,RBRVS,8.96 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25280,CPT,LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN,,,21 ,,RBRVS,7.39 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25290,CPT,TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,,21 ,,RBRVS,5.43 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25295,CPT,TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,,21 ,,RBRVS,6.72 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25300,CPT,TENODESIS WRIST FLEXORS FINGERS,,,21 ,,RBRVS,9.02 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25301,CPT,TENODESIS WRIST EXTENSORS FINGERS,,,21 ,,RBRVS,8.59 ,8.78 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25310,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN,,,21 ,,RBRVS,8.08 ,9.12 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25312,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR,,,21 ,,RBRVS,9.82 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25315,CPT,FLEXOR ORIGIN SLIDE FOREARM &/WRIST,,,21 ,,RBRVS,10.68 ,10.26 ,10.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25316,CPT,FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFE,,,21 ,,RBRVS,12.90 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25320,CPT,CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS,,,21 ,,RBRVS,12.75 ,13.99 ,13.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25332,CPT,ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ,,,21 ,,RBRVS,11.74 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25335,CPT,CENTRALIZATION WRST ULNA,,,21 ,,RBRVS,13.39 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25337,CPT,RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ,,,21 ,,RBRVS,11.73 ,12.39 ,12.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25350,CPT,OSTEOTOMY RADIUS DISTAL THIRD,,,21 ,,RBRVS,9.09 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25355,CPT,OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD,,,21 ,,RBRVS,10.53 ,10.30 ,10.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25360,CPT,OSTEOTOMY ULNA,,,21 ,,RBRVS,8.74 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25365,CPT,OSTEOTOMY RADIUS & ULNA,,,21 ,,RBRVS,12.91 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25370,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA,,,21 ,,RBRVS,14.10 ,10.23 ,10.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25375,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA,,,21 ,,RBRVS,13.55 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25390,CPT,OSTEOPLASTY RADIUS/ULNA SHORTENING,,,21 ,,RBRVS,10.70 ,10.46 ,10.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25391,CPT,OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT,,,21 ,,RBRVS,14.28 ,12.54 ,12.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25392,CPT,OSTEOPLASTY RADIUS & ULNA SHORTENING,,,21 ,,RBRVS,14.58 ,12.72 ,12.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25393,CPT,OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAF,,,21 ,,RBRVS,16.56 ,13.81 ,13.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25394,CPT,OSTEOPLASTY CARPAL BONE SHORTENING,,,21 ,,RBRVS,10.85 ,9.93 ,9.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25400,CPT,RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT,,,21 ,,RBRVS,11.28 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25405,CPT,RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT,,,21 ,,RBRVS,15.01 ,13.15 ,13.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25415,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF,,,21 ,,RBRVS,13.80 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25420,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT,,,21 ,,RBRVS,17.04 ,14.37 ,14.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25425,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA,,,21 ,,RBRVS,13.72 ,12.62 ,12.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25426,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA,,,21 ,,RBRVS,16.45 ,13.22 ,13.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25430,CPT,INSERTION VASCULAR PEDICLE CARPAL BONE,,,21 ,,RBRVS,9.71 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25431,CPT,REPAIR NONUNION CARPAL BONE EACH BONE,,,21 ,,RBRVS,10.89 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25440,CPT,RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC,,,21 ,,RBRVS,10.68 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25441,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS,,,21 ,,RBRVS,13.29 ,11.57 ,11.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25442,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA,,,21 ,,RBRVS,11.12 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25443,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL,,,21 ,,RBRVS,10.66 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25444,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE,,,21 ,,RBRVS,11.42 ,11.13 ,11.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25445,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM,,,21 ,,RBRVS,9.88 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25446,CPT,ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS,,,21 ,,RBRVS,17.30 ,14.15 ,14.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25447,CPT,ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS,,,21 ,,RBRVS,11.14 ,11.13 ,11.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25449,CPT,REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT,,,21 ,,RBRVS,14.94 ,12.73 ,12.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25450,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U,,,21 ,,RBRVS,8.06 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25455,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA,,,21 ,,RBRVS,9.71 ,9.48 ,9.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25490,CPT,PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS,,,21 ,,RBRVS,9.73 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25491,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA,,,21 ,,RBRVS,10.15 ,9.98 ,9.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25492,CPT,PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&UL,,,21 ,,RBRVS,12.66 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25500,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.60 ,4.13 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25505,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION,,,21 ,,RBRVS,5.45 ,6.96 ,8.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25515,CPT,OPEN TREATMENT RADIAL SHAFT FRACTURE,,,21 ,,RBRVS,8.80 ,9.11 ,9.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25520,CPT,CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT,,,21 ,,RBRVS,6.50 ,7.76 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25525,CPT,OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE,,,21 ,,RBRVS,10.55 ,10.52 ,10.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25526,CPT,OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE,,,21 ,,RBRVS,13.15 ,12.46 ,12.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25530,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.24 ,4.18 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25535,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION,,,21 ,,RBRVS,5.36 ,6.85 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25545,CPT,OPEN TREATMENT OF ULNAR SHAFT FRACTURE,,,21 ,,RBRVS,7.94 ,8.82 ,8.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25560,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN,,,21 ,,RBRVS,2.59 ,4.10 ,4.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25565,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ,,,21 ,,RBRVS,5.85 ,6.86 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25574,CPT,OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA,,,21 ,,RBRVS,8.80 ,9.14 ,9.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25575,CPT,OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA,,,21 ,,RBRVS,12.29 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25600,CPT,CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ,,,21 ,,RBRVS,2.78 ,5.40 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25605,CPT,CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF,,,21 ,,RBRVS,6.25 ,7.83 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25606,CPT,PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP,,,21 ,,RBRVS,8.31 ,9.51 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25607,CPT,OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP,,,21 ,,RBRVS,9.56 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25608,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG,,,21 ,,RBRVS,11.07 ,10.92 ,10.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25609,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG,,,21 ,,RBRVS,14.38 ,13.55 ,13.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25622,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ,,,21 ,,RBRVS,2.79 ,4.70 ,5.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25624,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ,,,21 ,,RBRVS,4.77 ,6.86 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25628,CPT,OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE,,,21 ,,RBRVS,9.67 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25630,CPT,CLTX CARPAL BONE FX W/O MANJ EACH BONE,,,21 ,,RBRVS,3.03 ,4.54 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25635,CPT,CLTX CARPAL BONE FX W/MANJ EACH BONE,,,21 ,,RBRVS,4.61 ,6.38 ,7.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25645,CPT,OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA,,,21 ,,RBRVS,7.42 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25650,CPT,CLOSED TREATMENT ULNAR STYLOID FRACTURE,,,21 ,,RBRVS,3.23 ,4.87 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25651,CPT,PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE,,,21 ,,RBRVS,5.82 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25652,CPT,OPEN TREATMENT ULNAR STYLOID FRACTURE,,,21 ,,RBRVS,8.06 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25660,CPT,CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ,,,21 ,,RBRVS,4.98 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25670,CPT,OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES,,,21 ,,RBRVS,8.09 ,8.11 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25671,CPT,PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION,,,21 ,,RBRVS,6.46 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25675,CPT,CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ,,,21 ,,RBRVS,4.89 ,5.90 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25676,CPT,OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC,,,21 ,,RBRVS,8.29 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25680,CPT,CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ,,,21 ,,RBRVS,6.23 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25685,CPT,OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC,,,21 ,,RBRVS,10.09 ,9.42 ,9.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25690,CPT,CLOSED TX LUNATE DISLOCATION W/MANIPULATION,,,21 ,,RBRVS,5.72 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25695,CPT,OPEN TREATMENT LUNATE DISLOCATION,,,21 ,,RBRVS,8.51 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25800,CPT,ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT,,,21 ,,RBRVS,10.07 ,9.65 ,9.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25805,CPT,ARTHRODESIS WRIST W/SLIDING GRAFT,,,21 ,,RBRVS,11.73 ,10.80 ,10.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25810,CPT,ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT,,,21 ,,RBRVS,11.95 ,11.45 ,11.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25820,CPT,ARTHRODESIS WRIST LIMITED W/O BONE GRAFT,,,21 ,,RBRVS,7.64 ,9.05 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25825,CPT,ARTHRODESIS WRIST LIMITED W/AUTOGRAFT,,,21 ,,RBRVS,9.69 ,10.85 ,10.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25830,CPT,ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE,,,21 ,,RBRVS,10.88 ,14.94 ,14.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25900,CPT,AMPUTATION FOREARM THROUGH RADIUS & ULNA,,,21 ,,RBRVS,9.61 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,25905,CPT,AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR,,,21 ,,RBRVS,9.59 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,25907,CPT,AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE,,,21 ,,RBRVS,8.09 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25909,CPT,AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION,,,21 ,,RBRVS,9.31 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25915,CPT,KRUKENBERG PROCEDURE,,,21 ,,RBRVS,17.52 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,25920,CPT,DISARTICULATION THROUGH WRIST,,,21 ,,RBRVS,9.03 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,25922,CPT,DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ,,,21 ,,RBRVS,7.65 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25924,CPT,DISARTICULATION THRU WRIST RE-AMPUTATION,,,21 ,,RBRVS,8.81 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,25927,CPT,TRANSMETACARPAL AMPUTATION,,,21 ,,RBRVS,9.09 ,12.71 ,12.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,25929,CPT,TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ,,,21 ,,RBRVS,7.82 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25931,CPT,TRANSMETACARPAL AMPUTATION RE-AMPUTATION,,,21 ,,RBRVS,8.04 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,25999,CPT,UNLISTED PROCEDURE FOREARM/WRIST,,,21 ,,TotalUnits,,,,15.23 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,26010,CPT,DRAINAGE FINGER ABSCESS SIMPLE,,,21 ,,RBRVS,1.59 ,2.15 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26011,CPT,DRAINAGE FINGER ABSCESS COMPLICATED,,,21 ,,RBRVS,2.24 ,2.79 ,8.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26020,CPT,DRAINAGE TENDON SHEATH DIGIT&/PALM EACH,,,21 ,,RBRVS,5.08 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26025,CPT,DRAINAGE OF PALMAR BURSA SINGLE BURSA,,,21 ,,RBRVS,5.08 ,6.34 ,6.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26030,CPT,DRAINAGE OF PALMAR BURSA MULTIPLE BURSA,,,21 ,,RBRVS,6.25 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26034,CPT,INCISION BONE CORTEX HAND/FINGER,,,21 ,,RBRVS,6.63 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26035,CPT,DECOMPRESSION FINGERS&/HAND INJECTION INJURY,,,21 ,,RBRVS,11.37 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26037,CPT,DECOMPRESSIVE FASCIOTOMY HAND,,,21 ,,RBRVS,7.57 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26040,CPT,FASCIOTOMY PALMAR PERCUTANEOUS,,,21 ,,RBRVS,3.46 ,5.06 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26045,CPT,FASCIOTOMY PALMAR OPEN PARTIAL,,,21 ,,RBRVS,5.73 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26055,CPT,TENDON SHEATH INCISION,,,21 ,,RBRVS,3.11 ,5.35 ,12.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26060,CPT,TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT,,,21 ,,RBRVS,2.91 ,4.35 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26070,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT,,,21 ,,RBRVS,3.81 ,4.64 ,4.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26075,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA,,,21 ,,RBRVS,3.91 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26080,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA,,,21 ,,RBRVS,4.47 ,6.11 ,6.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26100,CPT,ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH,,,21 ,,RBRVS,3.79 ,5.16 ,5.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26105,CPT,ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH,,,21 ,,RBRVS,3.83 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26110,CPT,ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH,,,21 ,,RBRVS,3.65 ,5.09 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26111,CPT,EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>,,,21 ,,RBRVS,5.42 ,5.99 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26113,CPT,EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>,,,21 ,,RBRVS,7.13 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26115,CPT,EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM,,,21 ,,RBRVS,3.96 ,5.25 ,10.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26116,CPT,EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM,,,21 ,,RBRVS,6.74 ,7.48 ,7.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26117,CPT,RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM,,,21 ,,RBRVS,10.13 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26118,CPT,RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/>,,,21 ,,RBRVS,14.81 ,13.76 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26121,CPT,FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT,,,21 ,,RBRVS,7.73 ,8.38 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26123,CPT,FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR,,,21 ,,RBRVS,10.88 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26125,CPT,FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR,,,21 ,,RBRVS,4.60 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26130,CPT,SYNOVECTOMY CARPOMETACARPAL JOINT,,,21 ,,RBRVS,5.59 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26135,CPT,SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD,,,21 ,,RBRVS,7.13 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26140,CPT,SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT,,,21 ,,RBRVS,6.34 ,7.31 ,7.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26145,CPT,SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN,,,21 ,,RBRVS,6.49 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26160,CPT,EXC LES TDN SHTH/JT CAPSL HAND/FNGR,,,21 ,,RBRVS,3.57 ,5.51 ,12.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26170,CPT,EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH,,,21 ,,RBRVS,4.91 ,6.12 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26180,CPT,EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH,,,21 ,,RBRVS,5.35 ,6.73 ,6.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26185,CPT,SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE,,,21 ,,RBRVS,6.52 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26200,CPT,EXCISION/CURETTAGE CYST/TUMOR METACARPAL,,,21 ,,RBRVS,5.65 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26205,CPT,EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT,,,21 ,,RBRVS,7.93 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26210,CPT,EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER,,,21 ,,RBRVS,5.32 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26215,CPT,EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT,,,21 ,,RBRVS,7.27 ,7.70 ,7.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26230,CPT,PARTIAL EXCISION BONE METACARPAL,,,21 ,,RBRVS,6.47 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26235,CPT,PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER,,,21 ,,RBRVS,6.33 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26236,CPT,PARTIAL EXCISION DISTAL PHALANX FINGER,,,21 ,,RBRVS,5.46 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26250,CPT,RADICAL RESECTION TUMOR METACARPAL,,,21 ,,RBRVS,15.21 ,11.97 ,11.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26260,CPT,RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER,,,21 ,,RBRVS,11.16 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26262,CPT,RADICAL RESECTION TUMOR DISTAL PHALANX FINGER,,,21 ,,RBRVS,8.29 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26320,CPT,REMOVAL IMPLANT FROM FINGER/HAND,,,21 ,,RBRVS,4.10 ,5.33 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26340,CPT,MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,,,21 ,,RBRVS,2.80 ,6.37 ,6.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26341,CPT,MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD,,,21 ,,RBRVS,0.91 ,1.14 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26350,CPT,RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON,,,21 ,,RBRVS,6.21 ,13.48 ,13.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26352,CPT,RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON,,,21 ,,RBRVS,7.87 ,14.30 ,14.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26356,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON,,,21 ,,RBRVS,10.62 ,19.40 ,19.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26357,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON,,,21 ,,RBRVS,8.77 ,14.80 ,14.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26358,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON,,,21 ,,RBRVS,9.36 ,15.50 ,15.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26370,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN,,,21 ,,RBRVS,7.28 ,13.64 ,13.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26372,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA,,,21 ,,RBRVS,9.01 ,14.99 ,14.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26373,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA,,,21 ,,RBRVS,8.41 ,14.63 ,14.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26390,CPT,EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F,,,21 ,,RBRVS,9.43 ,12.97 ,12.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26392,CPT,RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD,,,21 ,,RBRVS,10.50 ,16.08 ,16.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26410,CPT,REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH,,,21 ,,RBRVS,4.77 ,10.88 ,10.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26412,CPT,REPAIR EXTENSOR TENDON HAND W/GRAFT EACH,,,21 ,,RBRVS,6.48 ,12.33 ,12.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26415,CPT,EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA,,,21 ,,RBRVS,8.51 ,10.25 ,10.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26416,CPT,RMVL SYNTH ROD & INSJ XTNSR TDN GRF H/F EA ROD,,,21 ,,RBRVS,9.56 ,13.59 ,13.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26418,CPT,REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH,,,21 ,,RBRVS,4.47 ,11.59 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26420,CPT,REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH,,,21 ,,RBRVS,6.94 ,12.58 ,12.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26426,CPT,RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR,,,21 ,,RBRVS,6.32 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26428,CPT,RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER,,,21 ,,RBRVS,7.40 ,13.11 ,13.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26432,CPT,CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING,,,21 ,,RBRVS,4.16 ,9.65 ,9.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26433,CPT,REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF,,,21 ,,RBRVS,4.70 ,9.98 ,9.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26434,CPT,REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT,,,21 ,,RBRVS,6.26 ,11.26 ,11.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26437,CPT,REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,,,21 ,,RBRVS,5.99 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26440,CPT,TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON,,,21 ,,RBRVS,5.16 ,12.12 ,12.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26442,CPT,TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDO,,,21 ,,RBRVS,9.75 ,16.67 ,16.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26445,CPT,TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH,,,21 ,,RBRVS,4.45 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26449,CPT,TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA,,,21 ,,RBRVS,8.59 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26450,CPT,TENOTOMY FLEXOR PALM OPEN EACH TENDON,,,21 ,,RBRVS,3.79 ,7.31 ,7.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26455,CPT,TENOTOMY FLEXOR FINGER OPEN EACH TENDON,,,21 ,,RBRVS,3.76 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26460,CPT,TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON,,,21 ,,RBRVS,3.58 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26471,CPT,TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH,,,21 ,,RBRVS,5.90 ,10.99 ,10.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26474,CPT,TENODESIS DISTAL JOINT EACH,,,21 ,,RBRVS,5.49 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26476,CPT,LENGTHENING TENDON EXTENSOR HAND/FINGER EACH,,,21 ,,RBRVS,5.35 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26477,CPT,SHORTENING TENDON EXTENSOR HAND/FINGER EACH,,,21 ,,RBRVS,5.32 ,10.72 ,10.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26478,CPT,LENGTHENING TENDON FLEXOR HAND/FINGER EACH,,,21 ,,RBRVS,5.97 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26479,CPT,SHORTENING TENDON FLEXOR HAND/FINGER EACH,,,21 ,,RBRVS,5.91 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26480,CPT,TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN,,,21 ,,RBRVS,6.90 ,13.91 ,13.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26483,CPT,TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT,,,21 ,,RBRVS,8.48 ,14.71 ,14.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26485,CPT,TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH,,,21 ,,RBRVS,7.89 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26489,CPT,TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH,,,21 ,,RBRVS,9.86 ,15.03 ,15.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26490,CPT,OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN,,,21 ,,RBRVS,8.60 ,12.78 ,12.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26492,CPT,OPPONENSPLASTY TDN TR W/GRF EA TDN,,,21 ,,RBRVS,9.84 ,13.82 ,13.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26494,CPT,OPPONENSPLASTY HYPOTHENAR MUSC TR,,,21 ,,RBRVS,8.66 ,12.84 ,12.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26496,CPT,OPPONENSPLASTY OTHER METHODS,,,21 ,,RBRVS,9.78 ,13.57 ,13.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26497,CPT,TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR,,,21 ,,RBRVS,9.76 ,13.44 ,13.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26498,CPT,TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS,,,21 ,,RBRVS,14.21 ,16.23 ,16.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26499,CPT,CORRECTION CLAW FINGER OTHER METHODS,,,21 ,,RBRVS,9.17 ,13.11 ,13.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26500,CPT,RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX,,,21 ,,RBRVS,6.13 ,11.07 ,11.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26502,CPT,RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX,,,21 ,,RBRVS,7.31 ,11.84 ,11.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26508,CPT,RELEASE THENAR MUSCLE,,,21 ,,RBRVS,6.18 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26510,CPT,CROSS INTRINSIC TRANSFER EACH TENDON,,,21 ,,RBRVS,5.60 ,10.83 ,10.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26516,CPT,CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT,,,21 ,,RBRVS,7.32 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26517,CPT,CAPSULODESIS MTCARPHLNGL JOINT 2 DIGITS,,,21 ,,RBRVS,9.08 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26518,CPT,CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS,,,21 ,,RBRVS,9.27 ,13.19 ,13.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26520,CPT,CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH,,,21 ,,RBRVS,5.47 ,12.59 ,12.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26525,CPT,CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH,,,21 ,,RBRVS,5.50 ,12.63 ,12.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26530,CPT,ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH,,,21 ,,RBRVS,6.88 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26531,CPT,ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT,,,21 ,,RBRVS,8.13 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26535,CPT,ARTHROPLASTY INTERPHALANGEAL JOINT EACH,,,21 ,,RBRVS,5.41 ,5.79 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26536,CPT,ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA,,,21 ,,RBRVS,6.56 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26540,CPT,RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT,,,21 ,,RBRVS,6.60 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26541,CPT,RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF,,,21 ,,RBRVS,8.81 ,13.01 ,13.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26542,CPT,RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS,,,21 ,,RBRVS,6.95 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26545,CPT,RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT,,,21 ,,RBRVS,7.11 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26546,CPT,RPR NON-UNION MTCRPL/PHALANX,,,21 ,,RBRVS,10.83 ,16.23 ,16.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26548,CPT,RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL,,,21 ,,RBRVS,8.22 ,12.56 ,12.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26550,CPT,POLLICIZATION DIGIT,,,21 ,,RBRVS,21.68 ,20.90 ,20.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26551,CPT,TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND,,,21 ,,RBRVS,48.48 ,29.05 ,29.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,26553,CPT,TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 1,,,21 ,,RBRVS,48.17 ,27.07 ,27.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,26554,CPT,TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 2,,,21 ,,RBRVS,57.01 ,32.56 ,32.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,26555,CPT,TR FNGR AXH POS W/O MVASC ANAST,,,21 ,,RBRVS,17.08 ,19.46 ,19.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26556,CPT,TRANSFER FREE TOE JOINT W/MVASC ANASTOMOSIS,,,21 ,,RBRVS,49.75 ,30.51 ,30.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,26560,CPT,REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS,,,21 ,,RBRVS,5.52 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26561,CPT,REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT,,,21 ,,RBRVS,11.10 ,14.25 ,14.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26562,CPT,REPAIR SYNDACTYLY EACH SPACE COMPLEX,,,21 ,,RBRVS,16.68 ,19.75 ,19.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26565,CPT,OSTEOTOMY METACARPAL EACH,,,21 ,,RBRVS,6.91 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26567,CPT,OSTEOTOMY PHALANX FINGER EACH,,,21 ,,RBRVS,6.99 ,11.60 ,11.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26568,CPT,OSTEOPLASTY LENGTHENING METACARPAL/PHALANX,,,21 ,,RBRVS,9.27 ,15.05 ,15.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26580,CPT,REPAIR CLEFT HAND,,,21 ,,RBRVS,19.75 ,20.64 ,20.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26587,CPT,RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE,,,21 ,,RBRVS,14.50 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26590,CPT,REPAIR MACRODACTYLIA EACH DIGIT,,,21 ,,RBRVS,18.67 ,14.78 ,14.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26591,CPT,REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE,,,21 ,,RBRVS,3.38 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26593,CPT,RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE,,,21 ,,RBRVS,5.50 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26596,CPT,EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES,,,21 ,,RBRVS,9.14 ,11.00 ,11.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26600,CPT,CLTX METACARPAL FX W/O MANIPULATION EACH BONE,,,21 ,,RBRVS,2.60 ,4.86 ,5.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26605,CPT,CLTX METACARPAL FX W/MANIPULATION EACH BONE,,,21 ,,RBRVS,3.03 ,4.93 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26607,CPT,CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE,,,21 ,,RBRVS,5.48 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26608,CPT,PRQ SKELETAL FIXJ METACARPAL FX EACH BONE,,,21 ,,RBRVS,5.55 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26615,CPT,OPEN TX METACARPAL FRACTURE SINGLE EA BONE,,,21 ,,RBRVS,7.07 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26641,CPT,CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ,,,21 ,,RBRVS,4.13 ,4.80 ,5.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26645,CPT,CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ,,,21 ,,RBRVS,4.58 ,5.83 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26650,CPT,PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB,,,21 ,,RBRVS,5.35 ,7.62 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26665,CPT,OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB,,,21 ,,RBRVS,7.94 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26670,CPT,CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES,,,21 ,,RBRVS,3.83 ,4.24 ,5.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26675,CPT,CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES,,,21 ,,RBRVS,4.83 ,6.26 ,7.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26676,CPT,PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT,,,21 ,,RBRVS,5.74 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26685,CPT,OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB,,,21 ,,RBRVS,7.07 ,8.38 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26686,CPT,OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ,,,21 ,,RBRVS,8.17 ,8.42 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26700,CPT,CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES,,,21 ,,RBRVS,3.83 ,4.21 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26705,CPT,CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES,,,21 ,,RBRVS,4.38 ,5.74 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26706,CPT,PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ,,,21 ,,RBRVS,5.31 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26715,CPT,OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION,,,21 ,,RBRVS,7.03 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26720,CPT,CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA,,,21 ,,RBRVS,1.76 ,3.23 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26725,CPT,CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA,,,21 ,,RBRVS,3.48 ,4.76 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26727,CPT,PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T,,,21 ,,RBRVS,5.42 ,7.33 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26735,CPT,OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA,,,21 ,,RBRVS,7.42 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26740,CPT,CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ,,,21 ,,RBRVS,2.07 ,3.79 ,4.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26742,CPT,CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ,,,21 ,,RBRVS,3.99 ,5.05 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26746,CPT,OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA,,,21 ,,RBRVS,9.80 ,10.01 ,10.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26750,CPT,CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA,,,21 ,,RBRVS,1.80 ,3.18 ,3.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26755,CPT,CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA,,,21 ,,RBRVS,3.23 ,4.15 ,5.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26756,CPT,PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA,,,21 ,,RBRVS,4.58 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26765,CPT,OPEN TX DISTAL PHALANGEAL FRACTURE EACH,,,21 ,,RBRVS,5.86 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26770,CPT,CLTX IPHAL JT DISLC W/MANJ W/O ANES,,,21 ,,RBRVS,3.15 ,3.63 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26775,CPT,CLTX IPHAL JT DISLC W/MANJ REQ ANES,,,21 ,,RBRVS,3.90 ,5.48 ,6.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26776,CPT,PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ,,,21 ,,RBRVS,4.99 ,7.04 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26785,CPT,OPEN TX INTERPHALANGEAL JOINT DISLOCATION,,,21 ,,RBRVS,6.60 ,7.99 ,7.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26820,CPT,FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT,,,21 ,,RBRVS,8.45 ,12.76 ,12.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26841,CPT,ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ,,,21 ,,RBRVS,7.35 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26842,CPT,ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT,,,21 ,,RBRVS,8.49 ,12.85 ,12.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26843,CPT,ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH,,,21 ,,RBRVS,7.78 ,12.10 ,12.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26844,CPT,ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT,,,21 ,,RBRVS,8.98 ,13.36 ,13.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26850,CPT,ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ,,,21 ,,RBRVS,7.14 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26852,CPT,ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT,,,21 ,,RBRVS,8.71 ,12.96 ,12.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26860,CPT,ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ,,,21 ,,RBRVS,4.88 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26861,CPT,ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT,,,21 ,,RBRVS,1.74 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26862,CPT,ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT,,,21 ,,RBRVS,7.56 ,12.32 ,12.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26863,CPT,ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT,,,21 ,,RBRVS,3.89 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26910,CPT,AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER,,,21 ,,RBRVS,7.79 ,11.69 ,11.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26951,CPT,AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR,,,21 ,,RBRVS,6.04 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26952,CPT,AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP,,,21 ,,RBRVS,6.48 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26989,CPT,UNLISTED PROCEDURE HANDS/FINGERS,,,21 ,,TotalUnits,,,,11.76 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,26990,CPT,I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA,,,21 ,,RBRVS,7.95 ,8.74 ,8.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26991,CPT,I&D PELVIS/HIP JOINT AREA INFECTED BURSA,,,21 ,,RBRVS,7.06 ,6.95 ,12.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,26992,CPT,INCISION BONE CORTEX PELVIS&/HIP JOINT,,,21 ,,RBRVS,13.48 ,11.95 ,11.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27000,CPT,TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX,,,21 ,,RBRVS,5.74 ,5.98 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27001,CPT,TENOTOMY ADDUCTOR HIP OPEN,,,21 ,,RBRVS,7.14 ,7.33 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27003,CPT,TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY,,,21 ,,RBRVS,7.81 ,8.01 ,8.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27005,CPT,TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE,,,21 ,,RBRVS,10.07 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27006,CPT,TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX,,,21 ,,RBRVS,10.11 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27025,CPT,FASCIOTOMY HIP/THIGH ANY TYPE,,,21 ,,RBRVS,12.89 ,11.52 ,11.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27027,CPT,DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI,,,21 ,,RBRVS,13.04 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27030,CPT,ARTHROTOMY HIP W/DRAINAGE,,,21 ,,RBRVS,13.65 ,11.13 ,11.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27033,CPT,ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY,,,21 ,,RBRVS,14.11 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27035,CPT,DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH,,,21 ,,RBRVS,17.37 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27036,CPT,CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC,,,21 ,,RBRVS,14.38 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27040,CPT,BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL,,,21 ,,RBRVS,2.92 ,2.48 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27041,CPT,BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM,,,21 ,,RBRVS,10.18 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27043,CPT,EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/>,,,21 ,,RBRVS,6.88 ,5.60 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27045,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/>,,,21 ,,RBRVS,11.13 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27047,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM,,,21 ,,RBRVS,4.94 ,5.03 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27048,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM,,,21 ,,RBRVS,8.85 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27049,CPT,RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM,,,21 ,,RBRVS,21.55 ,13.58 ,13.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27050,CPT,ARTHROTOMY W/BIOPSY SACROILIAC JOINT,,,21 ,,RBRVS,4.74 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27052,CPT,ARTHROTOMY W/BIOPSY HIP JOINT,,,21 ,,RBRVS,7.42 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27054,CPT,ARTHROTOMY W/SYNOVECTOMY HIP JOINT,,,21 ,,RBRVS,9.21 ,9.03 ,9.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27057,CPT,DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI,,,21 ,,RBRVS,14.91 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27059,CPT,RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/>,,,21 ,,RBRVS,29.35 ,17.99 ,17.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27060,CPT,EXCISION ISCHIAL BURSA,,,21 ,,RBRVS,5.87 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27062,CPT,EXCISION TROCHANTERIC BURSA/CALCIFICATION,,,21 ,,RBRVS,5.75 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27065,CPT,EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL,,,21 ,,RBRVS,6.55 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27066,CPT,EXCISION BONE CYST/BENIGN TUMOR DEEP,,,21 ,,RBRVS,11.20 ,10.40 ,10.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27067,CPT,EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC,,,21 ,,RBRVS,14.72 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27070,CPT,PARTIAL EXCISION SUPERFICIAL PELVIS,,,21 ,,RBRVS,11.56 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27071,CPT,PARTIAL EXCISION DEEP PELVIS,,,21 ,,RBRVS,12.39 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27075,CPT,RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL,,,21 ,,RBRVS,32.71 ,22.77 ,22.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27076,CPT,RAD RESCT TUMOR ILIUM ACETABULUM BOTH PUBIC,,,21 ,,RBRVS,40.21 ,24.61 ,24.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27077,CPT,RADICAL RESCTION TUMOR INNOMINATE BONE TOTAL,,,21 ,,RBRVS,45.21 ,28.86 ,28.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27078,CPT,RAD RESCT TUMOR ISCHIAL TUBEROSITY&GRT TRCHNTR,,,21 ,,RBRVS,32.21 ,20.05 ,20.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27080,CPT,COCCYGECTOMY PRIMARY,,,21 ,,RBRVS,6.89 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27086,CPT,RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS,,,21 ,,RBRVS,1.92 ,2.14 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27087,CPT,REMOVAL FOREIGN BODY PELVIS/HIP DEEP,,,21 ,,RBRVS,8.83 ,8.01 ,8.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27090,CPT,REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE,,,21 ,,RBRVS,11.69 ,10.39 ,10.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27091,CPT,RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA,,,21 ,,RBRVS,24.35 ,17.90 ,17.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27093,CPT,INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA,,,21 ,,RBRVS,1.30 ,0.62 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27095,CPT,INJECTION HIP ARTHROGRAPHY W/ANESTHESIA,,,21 ,,RBRVS,1.50 ,0.72 ,5.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27096,CPT,INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA,,,21 ,,RBRVS,1.48 ,0.80 ,3.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27097,CPT,RELEASE/RECESSION HAMSTRING PROXIMAL,,,21 ,,RBRVS,9.27 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27098,CPT,TRANSFER ADDUCTOR ISCHIUM,,,21 ,,RBRVS,9.32 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27100,CPT,TR XTRNL OBLQ MUSC TRCHNTR W/FSCAL/TDN XTN GRF,,,21 ,,RBRVS,11.35 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27105,CPT,TR PARASPI MUSC HIP FASC/TDN XTN GRF,,,21 ,,RBRVS,12.04 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27110,CPT,TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR,,,21 ,,RBRVS,13.77 ,11.83 ,11.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27111,CPT,TRANSFER ILIOPSOAS FEMORAL NECK,,,21 ,,RBRVS,12.60 ,9.19 ,9.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27120,CPT,ACETABULOPLASTY,,,21 ,,RBRVS,19.25 ,14.91 ,14.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27122,CPT,ACETABULOPLASTY RESECTION FEMORAL HEAD,,,21 ,,RBRVS,16.09 ,13.15 ,13.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27125,CPT,HEMIARTHROPLASTY HIP PARTIAL,,,21 ,,RBRVS,16.64 ,13.37 ,13.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27130,CPT,ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT,,,21 ,,RBRVS,21.79 ,16.39 ,16.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27132,CPT,CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT,,,21 ,,RBRVS,25.69 ,18.72 ,18.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27134,CPT,REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT,,,21 ,,RBRVS,30.28 ,20.47 ,20.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27137,CPT,REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT,,,21 ,,RBRVS,22.70 ,16.35 ,16.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27138,CPT,REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT,,,21 ,,RBRVS,23.70 ,16.90 ,16.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27140,CPT,OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX,,,21 ,,RBRVS,12.78 ,11.00 ,11.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27146,CPT,OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE,,,21 ,,RBRVS,18.92 ,14.95 ,14.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27147,CPT,OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ,,,21 ,,RBRVS,22.07 ,16.78 ,16.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27151,CPT,OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT,,,21 ,,RBRVS,24.12 ,17.41 ,17.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27156,CPT,OSTEOT ILIAC ACTBLR/INNOMINATE BONE OSTEOT RDCTJ,,,21 ,,RBRVS,26.23 ,18.98 ,18.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27158,CPT,OSTEOTOMY PELVIS BILATERAL,,,21 ,,RBRVS,21.04 ,15.84 ,15.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27161,CPT,OSTEOTOMY FEMORAL NECK SEPARATE PROCEDURE,,,21 ,,RBRVS,17.89 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27165,CPT,OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL,,,21 ,,RBRVS,20.29 ,16.11 ,16.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27170,CPT,B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA,,,21 ,,RBRVS,17.61 ,13.55 ,13.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27175,CPT,TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION,,,21 ,,RBRVS,9.38 ,8.29 ,8.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27176,CPT,TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU,,,21 ,,RBRVS,12.92 ,11.41 ,11.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27177,CPT,OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT,,,21 ,,RBRVS,16.09 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27178,CPT,OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN,,,21 ,,RBRVS,12.92 ,11.36 ,11.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27179,CPT,OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX,,,21 ,,RBRVS,13.97 ,11.88 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27181,CPT,OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ,,,21 ,,RBRVS,16.18 ,13.52 ,13.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27185,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR,,,21 ,,RBRVS,9.79 ,8.95 ,8.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27187,CPT,PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR,,,21 ,,RBRVS,14.23 ,12.12 ,12.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27193,CPT,CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/O MANJ,,,21 ,,RBRVS,6.09 ,6.65 ,6.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27194,CPT,CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/MANJ ANES,,,21 ,,RBRVS,10.20 ,8.57 ,8.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27200,CPT,CLOSED TREATMENT COCCYGEAL FRACTURE,,,21 ,,RBRVS,1.92 ,3.13 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27202,CPT,OPEN TREATMENT COCCYGEAL FRACTURE,,,21 ,,RBRVS,7.31 ,7.65 ,7.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27215,CPT,OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD,,,21 ,,RBRVS,10.45 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27216,CPT,PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS,,,21 ,,RBRVS,15.73 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27217,CPT,OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR,,,21 ,,RBRVS,14.65 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27218,CPT,OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD,,,21 ,,RBRVS,20.93 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27220,CPT,CLTX ACETABULUM HIP/SOCKT FX W/O MANJ,,,21 ,,RBRVS,6.83 ,7.19 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27222,CPT,CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ,,,21 ,,RBRVS,14.11 ,11.85 ,11.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27226,CPT,OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ,,,21 ,,RBRVS,15.57 ,12.33 ,12.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27227,CPT,OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT,,,21 ,,RBRVS,25.41 ,18.50 ,18.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27228,CPT,OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT,,,21 ,,RBRVS,29.33 ,20.75 ,20.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27230,CPT,CLTX FEM FX PROX END NCK W/O MANJ,,,21 ,,RBRVS,5.81 ,6.80 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27232,CPT,CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ,,,21 ,,RBRVS,11.72 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27235,CPT,PRQ SKEL FIXJ FEMORAL FX PROX END NECK,,,21 ,,RBRVS,13.00 ,11.16 ,11.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27236,CPT,OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT,,,21 ,,RBRVS,17.61 ,14.10 ,14.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27238,CPT,CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ,,,21 ,,RBRVS,5.75 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27240,CPT,CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ,,,21 ,,RBRVS,13.81 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27244,CPT,TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT,,,21 ,,RBRVS,18.18 ,14.43 ,14.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27245,CPT,TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW,,,21 ,,RBRVS,18.18 ,14.63 ,14.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27246,CPT,CLTX GREATER TROCHANTERIC FX W/O MANJ,,,21 ,,RBRVS,4.83 ,5.53 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27248,CPT,OPEN TREATMENT GREATER TROCHANTERIC FRACTURE,,,21 ,,RBRVS,10.78 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27250,CPT,CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA,,,21 ,,RBRVS,3.82 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27252,CPT,CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA,,,21 ,,RBRVS,11.03 ,9.10 ,9.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27253,CPT,OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ,,,21 ,,RBRVS,13.58 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27254,CPT,OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD,,,21 ,,RBRVS,18.94 ,14.70 ,14.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27256,CPT,TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES,,,21 ,,RBRVS,4.28 ,1.91 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27257,CPT,TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES,,,21 ,,RBRVS,5.38 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27258,CPT,OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM,,,21 ,,RBRVS,16.18 ,13.19 ,13.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27259,CPT,OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM SHRT,,,21 ,,RBRVS,23.26 ,17.76 ,17.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27265,CPT,CLTX POST HIP ARTHRP DISLC W/O ANES,,,21 ,,RBRVS,5.24 ,5.51 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27266,CPT,CLTX POST HIP ARTHRP DISLC REQ ANES,,,21 ,,RBRVS,7.78 ,7.71 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27267,CPT,CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ,,,21 ,,RBRVS,5.50 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27268,CPT,CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ,,,21 ,,RBRVS,7.12 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27269,CPT,OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD,,,21 ,,RBRVS,18.89 ,13.72 ,13.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27275,CPT,MANIPULATION HIP JOINT GENERAL ANESTHESIA,,,21 ,,RBRVS,2.32 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27280,CPT,ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT,,,21 ,,RBRVS,14.64 ,12.68 ,12.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27282,CPT,ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT,,,21 ,,RBRVS,11.85 ,10.55 ,10.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27284,CPT,ARTHRODESIS HIP JOINT W/OBTAINING GRAFT,,,21 ,,RBRVS,25.06 ,17.07 ,17.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27286,CPT,ARTHRD HIP JT W/OBTG GRF W/SUBTRCHNTRIC OSTEOT,,,21 ,,RBRVS,25.17 ,18.54 ,18.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27290,CPT,INTERPELVIABDOMINAL AMPUTATION,,,21 ,,RBRVS,24.55 ,18.01 ,18.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27295,CPT,DISARTICULATION HIP,,,21 ,,RBRVS,19.66 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27299,CPT,UNLISTED PROCEDURE PELVIS/HIP JOINT,,,21 ,,TotalUnits,,,,3.81 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,27301,CPT,I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION,,,21 ,,RBRVS,6.78 ,6.54 ,11.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27303,CPT,INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE,,,21 ,,RBRVS,8.63 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27305,CPT,FASCIOTOMY ILIOTIBIAL OPEN,,,21 ,,RBRVS,6.18 ,6.59 ,6.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27306,CPT,TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX,,,21 ,,RBRVS,4.74 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27307,CPT,TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON,,,21 ,,RBRVS,6.06 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27310,CPT,ARTHRT KNE W/EXPL DRG/RMVL FB,,,21 ,,RBRVS,10.00 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27323,CPT,BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL,,,21 ,,RBRVS,2.33 ,2.52 ,5.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27324,CPT,BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP,,,21 ,,RBRVS,5.04 ,5.37 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27325,CPT,NEURECTOMY HAMSTRING MUSCLE,,,21 ,,RBRVS,7.20 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27326,CPT,NEURECTOMY POPLITEAL,,,21 ,,RBRVS,6.47 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27327,CPT,EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM,,,21 ,,RBRVS,3.96 ,4.51 ,8.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27328,CPT,EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM,,,21 ,,RBRVS,8.85 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27329,CPT,RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM,,,21 ,,RBRVS,15.72 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27330,CPT,ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY,,,21 ,,RBRVS,5.11 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27331,CPT,ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB,,,21 ,,RBRVS,6.02 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27332,CPT,ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT,,,21 ,,RBRVS,8.46 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27333,CPT,ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL&LAT,,,21 ,,RBRVS,7.55 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27334,CPT,ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR,,,21 ,,RBRVS,9.19 ,9.03 ,9.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27335,CPT,ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA,,,21 ,,RBRVS,10.55 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27337,CPT,EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>,,,21 ,,RBRVS,5.91 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27339,CPT,EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/>,,,21 ,,RBRVS,11.13 ,8.76 ,8.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27340,CPT,EXCISION PREPATELLAR BURSA,,,21 ,,RBRVS,4.32 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27345,CPT,EXCISION SYNOVIAL CYST POPLITEAL SPACE,,,21 ,,RBRVS,6.09 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27347,CPT,EXCISION LESION MENISCUS/CAPSULE KNEE,,,21 ,,RBRVS,6.73 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27350,CPT,PATELLECTOMY/HEMIPATELLECTOMY,,,21 ,,RBRVS,8.66 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27355,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR,,,21 ,,RBRVS,8.00 ,8.09 ,8.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27356,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT,,,21 ,,RBRVS,10.09 ,9.55 ,9.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27357,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT,,,21 ,,RBRVS,11.16 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27358,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION,,,21 ,,RBRVS,4.73 ,2.61 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27360,CPT,PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA,,,21 ,,RBRVS,11.46 ,11.32 ,11.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27364,CPT,RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>,,,21 ,,RBRVS,24.49 ,16.62 ,16.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27365,CPT,RADICAL RESECTION TUMOR FEMOR OR KNEE,,,21 ,,RBRVS,32.21 ,20.50 ,20.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27370,CPT,INJECTION KNEE ARTHROGRAPHY,,,21 ,,RBRVS,0.96 ,0.46 ,3.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27372,CPT,REMOVAL FOREIGN BODY DEEP THIGH/KNEE,,,21 ,,RBRVS,5.21 ,5.61 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27380,CPT,SUTURE INFRAPATELLAR TENDON PRIMARY,,,21 ,,RBRVS,7.45 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27381,CPT,SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF,,,21 ,,RBRVS,10.76 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27385,CPT,SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY,,,21 ,,RBRVS,6.93 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27386,CPT,SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ,,,21 ,,RBRVS,11.13 ,11.07 ,11.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27390,CPT,TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON,,,21 ,,RBRVS,5.53 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27391,CPT,TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG,,,21 ,,RBRVS,7.49 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27392,CPT,TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI,,,21 ,,RBRVS,9.63 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27393,CPT,LENGTHENING HAMSTRING TENDON SINGLE,,,21 ,,RBRVS,6.59 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27394,CPT,LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG,,,21 ,,RBRVS,8.79 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27395,CPT,LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL,,,21 ,,RBRVS,12.24 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27396,CPT,TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON,,,21 ,,RBRVS,8.15 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27397,CPT,TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN,,,21 ,,RBRVS,12.66 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27400,CPT,TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR,,,21 ,,RBRVS,9.33 ,9.12 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27403,CPT,ARTHROTOMY W/MENISCUS REPAIR KNEE,,,21 ,,RBRVS,8.62 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27405,CPT,RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL,,,21 ,,RBRVS,9.08 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27407,CPT,REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT,,,21 ,,RBRVS,10.85 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27409,CPT,RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE,,,21 ,,RBRVS,13.71 ,11.87 ,11.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27412,CPT,AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE,,,21 ,,RBRVS,24.74 ,18.94 ,18.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27415,CPT,OSTEOCHONDRAL ALLOGRAFT KNEE OPEN,,,21 ,,RBRVS,20.00 ,16.35 ,16.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27416,CPT,OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY,,,21 ,,RBRVS,14.16 ,11.69 ,11.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27418,CPT,ANTERIOR TIBIAL TUBERCLEPLASTY,,,21 ,,RBRVS,11.60 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27420,CPT,RCNSTJ DISLOCATING PATELLA,,,21 ,,RBRVS,10.26 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27422,CPT,RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL,,,21 ,,RBRVS,10.21 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27424,CPT,RCNSTJ DISLC PATELLA W/PATELLECTOMY,,,21 ,,RBRVS,10.24 ,9.65 ,9.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27425,CPT,LATERAL RETINACULAR RELEASE OPEN,,,21 ,,RBRVS,5.39 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27427,CPT,LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR,,,21 ,,RBRVS,9.79 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27428,CPT,LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR,,,21 ,,RBRVS,15.58 ,14.03 ,14.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27429,CPT,LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR,,,21 ,,RBRVS,17.54 ,15.68 ,15.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27430,CPT,QUADRICEPSPLASTY,,,21 ,,RBRVS,10.16 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27435,CPT,CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE,,,21 ,,RBRVS,10.88 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27437,CPT,ARTHROPLASTY PATELLA W/O PROSTHESIS,,,21 ,,RBRVS,8.93 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27438,CPT,ARTHROPLASTY PATELLA W/PROSTHESIS,,,21 ,,RBRVS,11.89 ,10.48 ,10.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27440,CPT,ARTHROPLASTY KNEE TIBIAL PLATEAU,,,21 ,,RBRVS,11.09 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27441,CPT,ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT,,,21 ,,RBRVS,11.54 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27442,CPT,ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE,,,21 ,,RBRVS,12.37 ,10.73 ,10.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27443,CPT,ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDMT&PRTL,,,21 ,,RBRVS,11.41 ,10.27 ,10.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27445,CPT,ARTHROPLASTY KNEE HINGE PROSTHESIS,,,21 ,,RBRVS,18.66 ,14.50 ,14.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27446,CPT,ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT,,,21 ,,RBRVS,16.38 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27447,CPT,ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS,,,21 ,,RBRVS,23.25 ,17.55 ,17.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27448,CPT,OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION,,,21 ,,RBRVS,11.60 ,10.17 ,10.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27450,CPT,OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION,,,21 ,,RBRVS,14.61 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27454,CPT,OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT,,,21 ,,RBRVS,19.17 ,15.10 ,15.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27455,CPT,OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL,,,21 ,,RBRVS,13.36 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27457,CPT,OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL,,,21 ,,RBRVS,14.03 ,11.48 ,11.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27465,CPT,OSTEOPLASTY FEMUR SHORTENING EXCLUDING 64876,,,21 ,,RBRVS,18.60 ,14.30 ,14.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27466,CPT,OSTEOPLASTY FEMUR LENGTHENING,,,21 ,,RBRVS,17.28 ,14.03 ,14.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27468,CPT,OSTPL FEMUR CMBN LNGTH&SHRT W/FEMORAL SGM TRNSFR,,,21 ,,RBRVS,19.97 ,15.48 ,15.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27470,CPT,RPR NON/MAL FEMUR DSTL H/N W/O GRF,,,21 ,,RBRVS,17.14 ,14.16 ,14.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27472,CPT,RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE,,,21 ,,RBRVS,18.72 ,14.88 ,14.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27475,CPT,ARREST EPIPHYSEAL DISTAL FEMUR,,,21 ,,RBRVS,8.93 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27477,CPT,ARREST EPIPHYSEAL TIBIA & FIBULA PROXIMAL,,,21 ,,RBRVS,10.14 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27479,CPT,ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB,,,21 ,,RBRVS,13.16 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27485,CPT,ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA,,,21 ,,RBRVS,9.13 ,8.70 ,8.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27486,CPT,REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT,,,21 ,,RBRVS,21.12 ,16.22 ,16.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27487,CPT,REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE,,,21 ,,RBRVS,27.11 ,19.50 ,19.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27488,CPT,RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER,,,21 ,,RBRVS,17.60 ,14.30 ,14.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27495,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR,,,21 ,,RBRVS,16.54 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27496,CPT,DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT,,,21 ,,RBRVS,6.78 ,7.54 ,7.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27497,CPT,DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE,,,21 ,,RBRVS,7.79 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27498,CPT,DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS,,,21 ,,RBRVS,8.66 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27499,CPT,DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&am,,,21 ,,RBRVS,9.43 ,7.52 ,7.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27500,CPT,CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION,,,21 ,,RBRVS,6.30 ,6.45 ,7.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27501,CPT,CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ,,,21 ,,RBRVS,6.45 ,6.87 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27502,CPT,CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ,,,21 ,,RBRVS,11.36 ,9.30 ,9.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27503,CPT,CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ,,,21 ,,RBRVS,11.27 ,10.03 ,10.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27506,CPT,OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW,,,21 ,,RBRVS,19.65 ,15.86 ,15.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27507,CPT,OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE,,,21 ,,RBRVS,14.48 ,11.36 ,11.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27508,CPT,CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ,,,21 ,,RBRVS,6.20 ,7.02 ,7.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27509,CPT,PRQ SKELETAL FIXJ FEMORAL FX DISTAL END,,,21 ,,RBRVS,8.14 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27510,CPT,CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ,,,21 ,,RBRVS,9.80 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27511,CPT,OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN,,,21 ,,RBRVS,15.11 ,11.44 ,11.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27513,CPT,OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN,,,21 ,,RBRVS,19.25 ,13.76 ,13.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27514,CPT,OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE,,,21 ,,RBRVS,14.60 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27516,CPT,CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,,,21 ,,RBRVS,5.59 ,7.14 ,8.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27517,CPT,CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL,,,21 ,,RBRVS,9.12 ,9.13 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27519,CPT,OPEN TX DISTAL FEMORAL EPIPHYSEAL SEPARATION,,,21 ,,RBRVS,13.25 ,10.55 ,10.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27520,CPT,CLOSED TX PATELLAR FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,3.04 ,4.93 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27524,CPT,OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR,,,21 ,,RBRVS,10.37 ,9.71 ,9.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27530,CPT,CLTX TIBIAL FX PROXIMAL W/O MANIPULATION,,,21 ,,RBRVS,2.65 ,5.19 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27532,CPT,CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ,,,21 ,,RBRVS,7.55 ,7.88 ,8.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27535,CPT,OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR,,,21 ,,RBRVS,13.41 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27536,CPT,OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ,,,21 ,,RBRVS,17.39 ,14.21 ,14.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27538,CPT,CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN,,,21 ,,RBRVS,5.09 ,6.84 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27540,CPT,OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE,,,21 ,,RBRVS,11.30 ,10.45 ,10.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27550,CPT,CLOSED TX KNEE DISLOCATION W/O ANESTHESIA,,,21 ,,RBRVS,5.98 ,6.34 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27552,CPT,CLOSED TX KNEE DISLOCATION W/ANESTHESIA,,,21 ,,RBRVS,8.18 ,8.54 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27556,CPT,OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR,,,21 ,,RBRVS,13.00 ,10.41 ,10.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27557,CPT,OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR,,,21 ,,RBRVS,15.90 ,12.02 ,12.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27558,CPT,OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION,,,21 ,,RBRVS,18.39 ,13.30 ,13.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27560,CPT,CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA,,,21 ,,RBRVS,3.99 ,5.43 ,6.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27562,CPT,CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA,,,21 ,,RBRVS,5.98 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27566,CPT,OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY,,,21 ,,RBRVS,12.71 ,10.98 ,10.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27570,CPT,MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,,,21 ,,RBRVS,1.79 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27580,CPT,ARTHRODESIS KNEE ANY TECHNIQUE,,,21 ,,RBRVS,21.10 ,17.12 ,17.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27590,CPT,AMPUTATION THIGH THROUGH FEMUR ANY LEVEL,,,21 ,,RBRVS,13.47 ,7.98 ,7.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27591,CPT,AMP THI THRU FEMUR LVL IMMT FITG TQ W/1ST CST,,,21 ,,RBRVS,13.94 ,9.10 ,9.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27592,CPT,AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR,,,21 ,,RBRVS,10.98 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27594,CPT,AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION,,,21 ,,RBRVS,7.29 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27596,CPT,AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION,,,21 ,,RBRVS,11.29 ,8.01 ,8.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27598,CPT,DISARTICULATION KNEE,,,21 ,,RBRVS,11.22 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27599,CPT,UNLISTED PROCEDURE FEMUR/KNEE,,,21 ,,TotalUnits,,,,22.37 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,27600,CPT,DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY,,,21 ,,RBRVS,6.03 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27601,CPT,DCMPRN FASCT LEG POST COMPARTMENT ONLY,,,21 ,,RBRVS,6.05 ,5.65 ,5.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27602,CPT,DCMPRN FASCT LEG ANT&/LAT&PST CMPRT,,,21 ,,RBRVS,7.82 ,5.50 ,5.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27603,CPT,INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA,,,21 ,,RBRVS,5.23 ,5.33 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27604,CPT,INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA,,,21 ,,RBRVS,4.59 ,4.54 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27605,CPT,TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES,,,21 ,,RBRVS,2.92 ,2.25 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27606,CPT,TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES,,,21 ,,RBRVS,4.18 ,3.56 ,3.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27607,CPT,INCISION LEG/ANKLE,,,21 ,,RBRVS,8.62 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27610,CPT,ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB,,,21 ,,RBRVS,9.13 ,8.43 ,8.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27612,CPT,ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH,,,21 ,,RBRVS,8.15 ,7.11 ,7.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27613,CPT,BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL,,,21 ,,RBRVS,2.22 ,2.34 ,4.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27614,CPT,BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP,,,21 ,,RBRVS,5.80 ,5.21 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27615,CPT,RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM,,,21 ,,RBRVS,15.72 ,11.28 ,11.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27616,CPT,RAD RESCJ TUM SOFT TISSUE LEG/ANKLE 5 CM/>,,,21 ,,RBRVS,19.63 ,14.05 ,14.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27618,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM,,,21 ,,RBRVS,3.96 ,4.45 ,8.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27619,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM,,,21 ,,RBRVS,6.91 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27620,CPT,ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB,,,21 ,,RBRVS,6.15 ,6.22 ,6.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27625,CPT,ARTHROTOMY W/SYNOVECTOMY ANKLE,,,21 ,,RBRVS,8.49 ,7.12 ,7.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27626,CPT,ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY,,,21 ,,RBRVS,9.10 ,8.04 ,8.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27630,CPT,EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK,,,21 ,,RBRVS,4.94 ,5.14 ,10.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27632,CPT,EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>,,,21 ,,RBRVS,5.91 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27634,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/>,,,21 ,,RBRVS,10.13 ,8.42 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27635,CPT,EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA,,,21 ,,RBRVS,8.03 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27637,CPT,EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT,,,21 ,,RBRVS,10.31 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27638,CPT,EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT,,,21 ,,RBRVS,10.99 ,9.61 ,9.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27640,CPT,PARTIAL EXCISION BONE TIBIA,,,21 ,,RBRVS,12.24 ,10.32 ,10.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27641,CPT,PARTIAL EXCISION BONE FIBULA,,,21 ,,RBRVS,9.84 ,8.29 ,8.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27645,CPT,RADICAL RESECTION OF TUMOR TIBIA,,,21 ,,RBRVS,27.21 ,18.23 ,18.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27646,CPT,RADICAL RESECTION TUMOR BONE FIBULA,,,21 ,,RBRVS,23.21 ,16.20 ,16.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27647,CPT,RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS,,,21 ,,RBRVS,20.26 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27648,CPT,INJECTION ANKLE ARTHROGRAPHY,,,21 ,,RBRVS,0.96 ,0.44 ,3.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27650,CPT,REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON,,,21 ,,RBRVS,9.21 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27652,CPT,RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT,,,21 ,,RBRVS,10.78 ,8.25 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27654,CPT,REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT,,,21 ,,RBRVS,10.53 ,8.82 ,8.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27656,CPT,REPAIR FASCIAL DEFECT LEG,,,21 ,,RBRVS,4.71 ,5.71 ,12.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27658,CPT,REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH,,,21 ,,RBRVS,5.12 ,5.12 ,5.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27659,CPT,RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH,,,21 ,,RBRVS,7.10 ,6.34 ,6.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27664,CPT,RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH,,,21 ,,RBRVS,4.73 ,5.21 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27665,CPT,RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH,,,21 ,,RBRVS,5.57 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27675,CPT,RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY,,,21 ,,RBRVS,7.35 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27676,CPT,REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT,,,21 ,,RBRVS,8.73 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27680,CPT,TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH,,,21 ,,RBRVS,5.88 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27681,CPT,TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN,,,21 ,,RBRVS,7.05 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27685,CPT,LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX,,,21 ,,RBRVS,6.69 ,6.07 ,11.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27686,CPT,LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA,,,21 ,,RBRVS,7.75 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27687,CPT,GASTROCNEMIUS RECESSION,,,21 ,,RBRVS,6.41 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27690,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC,,,21 ,,RBRVS,9.17 ,8.11 ,8.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27691,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP,,,21 ,,RBRVS,10.49 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27692,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN,,,21 ,,RBRVS,1.87 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27695,CPT,RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL,,,21 ,,RBRVS,6.70 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27696,CPT,RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS,,,21 ,,RBRVS,8.58 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27698,CPT,REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL,,,21 ,,RBRVS,9.61 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27700,CPT,ARTHROPLASTY ANKLE,,,21 ,,RBRVS,9.66 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27702,CPT,ARTHROPLASTY ANKLE W/IMPLANT,,,21 ,,RBRVS,14.42 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27703,CPT,ARTHROPLASTY ANKLE REVISION TOTAL ANKLE,,,21 ,,RBRVS,16.94 ,13.39 ,13.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27704,CPT,REMOVAL ANKLE IMPLANT,,,21 ,,RBRVS,7.81 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27705,CPT,OSTEOTOMY TIBIA,,,21 ,,RBRVS,10.86 ,9.58 ,9.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27707,CPT,OSTEOTOMY FIBULA,,,21 ,,RBRVS,4.78 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27709,CPT,OSTEOTOMY TIBIA & FIBULA,,,21 ,,RBRVS,17.48 ,13.59 ,13.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27712,CPT,OSTEOT MLT W/RELIGNMT IMED ROD,,,21 ,,RBRVS,15.87 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27715,CPT,OSTEOPLASTY TIBIA & FIBULA LENGTHENING/SHORTENIN,,,21 ,,RBRVS,15.50 ,12.68 ,12.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27720,CPT,REPAIR NONUNION/MALUNION TIBIA W/O GRAFT,,,21 ,,RBRVS,12.36 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27722,CPT,REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT,,,21 ,,RBRVS,12.45 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27724,CPT,RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT,,,21 ,,RBRVS,19.31 ,14.34 ,14.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27725,CPT,RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH,,,21 ,,RBRVS,17.41 ,14.91 ,14.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27726,CPT,REPAIR FIBULA NONUNION/MALUNION W INT FIXATION,,,21 ,,RBRVS,14.34 ,11.18 ,11.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27727,CPT,REPAIR CONGENITAL PSEUDARTHROSIS TIBIA,,,21 ,,RBRVS,14.84 ,12.20 ,12.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27730,CPT,ARREST EPIPHYSEAL OPEN DISTAL TIBIA,,,21 ,,RBRVS,7.70 ,7.90 ,7.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27732,CPT,ARREST EPIPHYSEAL OPEN DISTAL FIBULA,,,21 ,,RBRVS,5.46 ,4.73 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27734,CPT,ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA,,,21 ,,RBRVS,8.83 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27740,CPT,ARREST EPIPHYSEAL ANY METHOD TIBIA & FIBULA,,,21 ,,RBRVS,9.61 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27742,CPT,ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR,,,21 ,,RBRVS,10.63 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27745,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA,,,21 ,,RBRVS,10.49 ,9.71 ,9.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27750,CPT,CLTX TIBIAL SHAFT FX W/O MANIPULATION,,,21 ,,RBRVS,3.37 ,5.22 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27752,CPT,CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ,,,21 ,,RBRVS,6.27 ,7.09 ,8.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27756,CPT,PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE,,,21 ,,RBRVS,7.45 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27758,CPT,OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE,,,21 ,,RBRVS,12.54 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27759,CPT,TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA,,,21 ,,RBRVS,14.45 ,12.13 ,12.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27760,CPT,CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION,,,21 ,,RBRVS,3.21 ,5.07 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27762,CPT,CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ,,,21 ,,RBRVS,5.47 ,6.41 ,7.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27766,CPT,OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE,,,21 ,,RBRVS,7.89 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27767,CPT,CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ,,,21 ,,RBRVS,2.64 ,5.06 ,5.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27768,CPT,CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,,,21 ,,RBRVS,5.14 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27769,CPT,OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE,,,21 ,,RBRVS,10.14 ,9.20 ,9.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27780,CPT,CLTX PROX FIBULA/SHFT FX W/O MANJ,,,21 ,,RBRVS,2.83 ,4.71 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27781,CPT,CLTX PROX FIBULA/SHFT FX W/MANJ,,,21 ,,RBRVS,4.59 ,6.08 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27784,CPT,OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE,,,21 ,,RBRVS,9.67 ,9.45 ,9.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27786,CPT,CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ,,,21 ,,RBRVS,3.02 ,4.76 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27788,CPT,CLTX DSTL FIBULAR FX LAT MALLS W/MANJ,,,21 ,,RBRVS,4.64 ,5.85 ,6.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27792,CPT,OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS,,,21 ,,RBRVS,8.75 ,8.88 ,8.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27808,CPT,CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ,,,21 ,,RBRVS,3.03 ,5.14 ,6.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27810,CPT,CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ,,,21 ,,RBRVS,5.32 ,6.26 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27814,CPT,OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,,,21 ,,RBRVS,10.62 ,10.09 ,10.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27816,CPT,CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION,,,21 ,,RBRVS,3.07 ,4.69 ,5.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27818,CPT,CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION,,,21 ,,RBRVS,5.69 ,6.06 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27822,CPT,OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP,,,21 ,,RBRVS,11.21 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27823,CPT,OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP,,,21 ,,RBRVS,13.16 ,12.48 ,12.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27824,CPT,CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ,,,21 ,,RBRVS,3.31 ,4.91 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27825,CPT,CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ,,,21 ,,RBRVS,6.69 ,6.58 ,8.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27826,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA,,,21 ,,RBRVS,11.10 ,11.24 ,11.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27827,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY,,,21 ,,RBRVS,14.79 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27828,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA,,,21 ,,RBRVS,18.43 ,16.20 ,16.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27829,CPT,OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION,,,21 ,,RBRVS,8.80 ,9.60 ,9.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27830,CPT,CLTX PROX TIBFIB JT DISLC W/O ANES,,,21 ,,RBRVS,3.96 ,5.47 ,6.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27831,CPT,CLTX PROX TIBFIB JT DISLC REQ ANES,,,21 ,,RBRVS,4.73 ,5.91 ,5.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27832,CPT,OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB,,,21 ,,RBRVS,10.17 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27840,CPT,CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA,,,21 ,,RBRVS,4.77 ,5.09 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27842,CPT,CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ,,,21 ,,RBRVS,6.46 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27846,CPT,OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ,,,21 ,,RBRVS,10.28 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27848,CPT,OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ,,,21 ,,RBRVS,11.68 ,10.16 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27860,CPT,MANIPULATION ANKLE UNDER GENERAL ANESTHESIA,,,21 ,,RBRVS,2.39 ,2.42 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27870,CPT,ARTHRODESIS ANKLE OPEN,,,21 ,,RBRVS,15.41 ,12.42 ,12.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27871,CPT,ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL,,,21 ,,RBRVS,9.54 ,9.02 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27880,CPT,AMPUTATION LEG THROUGH TIBIA&FIBULA,,,21 ,,RBRVS,15.37 ,8.89 ,8.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27881,CPT,AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST,,,21 ,,RBRVS,13.47 ,9.91 ,9.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27882,CPT,AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR,,,21 ,,RBRVS,9.79 ,6.41 ,6.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27884,CPT,AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV,,,21 ,,RBRVS,8.76 ,6.73 ,6.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27886,CPT,AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION,,,21 ,,RBRVS,10.02 ,7.77 ,7.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27888,CPT,AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV,,,21 ,,RBRVS,10.37 ,8.02 ,8.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,27889,CPT,ANKLE DISARTICULATION,,,21 ,,RBRVS,10.86 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27892,CPT,DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE,,,21 ,,RBRVS,7.94 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27893,CPT,DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV,,,21 ,,RBRVS,7.90 ,8.07 ,8.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27894,CPT,DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS,,,21 ,,RBRVS,12.67 ,10.23 ,10.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,27899,CPT,UNLISTED PROCEDURE LEG/ANKLE,,,21 ,,TotalUnits,,,,17.45 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,28001,CPT,INCISION&DRAINAGE BURSA FOOT,,,21 ,,RBRVS,2.78 ,1.97 ,4.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28002,CPT,I&D BELOW FASCIA FOOT 1 BURSAL SPACE,,,21 ,,RBRVS,5.34 ,3.76 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28003,CPT,I&D BELOW FASCIA FOOT MULTIPLE AREAS,,,21 ,,RBRVS,9.06 ,6.49 ,10.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28005,CPT,INCISION BONE CORTEX FOOT,,,21 ,,RBRVS,9.44 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28008,CPT,FASCIOTOMY FOOT&/TOE,,,21 ,,RBRVS,4.59 ,3.66 ,7.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28010,CPT,TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,,,21 ,,RBRVS,2.97 ,2.94 ,3.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28011,CPT,TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON,,,21 ,,RBRVS,4.28 ,3.92 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28020,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT,,,21 ,,RBRVS,5.15 ,4.65 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28022,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT,,,21 ,,RBRVS,4.81 ,4.18 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28024,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT,,,21 ,,RBRVS,4.52 ,3.95 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28035,CPT,RELEASE TARSAL TUNNEL,,,21 ,,RBRVS,5.23 ,4.62 ,9.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28039,CPT,EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>,,,21 ,,RBRVS,5.42 ,4.61 ,9.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28041,CPT,EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>,,,21 ,,RBRVS,7.13 ,6.05 ,6.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28043,CPT,EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM,,,21 ,,RBRVS,3.96 ,3.44 ,7.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28045,CPT,EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM,,,21 ,,RBRVS,5.45 ,4.35 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28046,CPT,RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM,,,21 ,,RBRVS,12.38 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28047,CPT,RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/>,,,21 ,,RBRVS,17.45 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28050,CPT,ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT,,,21 ,,RBRVS,4.39 ,4.16 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28052,CPT,ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT,,,21 ,,RBRVS,4.06 ,3.69 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28054,CPT,ARTHRTOMY W/BX INTERPHALANGEAL JOINT,,,21 ,,RBRVS,3.57 ,3.19 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28055,CPT,NEURECTOMY INTRINSIC MUSCULATURE OF FOOT,,,21 ,,RBRVS,6.29 ,4.27 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28060,CPT,FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,,,21 ,,RBRVS,5.40 ,4.47 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28062,CPT,FASCIOTOMY PLANTAR FASCIA RADICAL SPX,,,21 ,,RBRVS,6.69 ,4.69 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28070,CPT,SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX,,,21 ,,RBRVS,5.24 ,4.60 ,9.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28072,CPT,SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH,,,21 ,,RBRVS,4.72 ,4.66 ,9.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28080,CPT,EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH,,,21 ,,RBRVS,4.86 ,5.32 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28086,CPT,SYNOVECTOMY TENDON SHEATH FOOT FLEXOR,,,21 ,,RBRVS,4.92 ,4.93 ,10.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28088,CPT,SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR,,,21 ,,RBRVS,3.98 ,4.25 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28090,CPT,EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT,,,21 ,,RBRVS,4.55 ,4.03 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28092,CPT,EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA,,,21 ,,RBRVS,3.78 ,3.79 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28100,CPT,EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS,,,21 ,,RBRVS,5.83 ,5.35 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28102,CPT,EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT,,,21 ,,RBRVS,7.92 ,5.39 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28103,CPT,EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT,,,21 ,,RBRVS,6.67 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28104,CPT,EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL,,,21 ,,RBRVS,5.26 ,4.39 ,9.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28106,CPT,EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT,,,21 ,,RBRVS,7.35 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28107,CPT,EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT,,,21 ,,RBRVS,5.73 ,4.26 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28108,CPT,EXC/CURTG CST/B9 TUM PHALANGES FOOT,,,21 ,,RBRVS,4.30 ,3.72 ,7.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28110,CPT,OSTECTOMY PRTL 5TH METAR HEAD SPX,,,21 ,,RBRVS,4.22 ,3.87 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28111,CPT,OSTECTOMY COMPLETE 1ST METATARSAL HEAD,,,21 ,,RBRVS,5.15 ,4.06 ,9.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28112,CPT,OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4,,,21 ,,RBRVS,4.63 ,4.12 ,9.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28113,CPT,OSTECTOMY COMPLETE 5TH METATARSAL HEAD,,,21 ,,RBRVS,6.11 ,5.81 ,10.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28114,CPT,OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC,,,21 ,,RBRVS,12.00 ,10.99 ,17.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28116,CPT,OSTECTOMY TARSAL COALITION,,,21 ,,RBRVS,9.14 ,6.75 ,12.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28118,CPT,OSTECTOMY CALCANEUS,,,21 ,,RBRVS,6.13 ,5.24 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28119,CPT,OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS,,,21 ,,RBRVS,5.56 ,4.53 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28120,CPT,PARTIAL EXCISION BONE TALUS/CALCANEUS,,,21 ,,RBRVS,7.31 ,6.09 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28122,CPT,PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS,,,21 ,,RBRVS,6.76 ,5.69 ,10.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28124,CPT,PARTICAL EXCISION BONE PHALANX TOE,,,21 ,,RBRVS,5.00 ,4.28 ,8.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28126,CPT,RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH,,,21 ,,RBRVS,3.64 ,3.36 ,7.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28130,CPT,TALECTOMY ASTRAGALECTOMY,,,21 ,,RBRVS,9.50 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28140,CPT,METATARSECTOMY,,,21 ,,RBRVS,7.14 ,5.12 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28150,CPT,PHALANGECTOMY TOE EACH TOE,,,21 ,,RBRVS,4.23 ,3.71 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28153,CPT,RESECTION CONDYLE DISTAL END PHALANX EACH TOE,,,21 ,,RBRVS,3.80 ,3.63 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28160,CPT,HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE,,,21 ,,RBRVS,3.88 ,3.74 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28171,CPT,RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS,,,21 ,,RBRVS,16.41 ,7.06 ,7.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28173,CPT,RADICAL RESECTION TUMOR METATARSAL,,,21 ,,RBRVS,14.16 ,6.74 ,6.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28175,CPT,RADICAL RESECTION TUMOR PHALANX OR TOE,,,21 ,,RBRVS,8.29 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28190,CPT,REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,,,21 ,,RBRVS,2.01 ,1.73 ,5.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28192,CPT,REMOVAL FOREIGN BODY FOOT DEEP,,,21 ,,RBRVS,4.78 ,4.04 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28193,CPT,REMOVAL FOREIGN BODY FOOT COMPLICATED,,,21 ,,RBRVS,5.90 ,4.52 ,9.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28200,CPT,RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON,,,21 ,,RBRVS,4.74 ,4.11 ,8.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28202,CPT,RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON,,,21 ,,RBRVS,7.07 ,4.75 ,9.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28208,CPT,REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,,,21 ,,RBRVS,4.51 ,4.04 ,8.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28210,CPT,RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON,,,21 ,,RBRVS,6.52 ,4.81 ,9.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28220,CPT,TENOLYSIS FLEXOR FOOT SINGLE TENDON,,,21 ,,RBRVS,4.67 ,3.81 ,7.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28222,CPT,TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS,,,21 ,,RBRVS,5.76 ,4.10 ,8.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28225,CPT,TENOLYSIS EXTENSOR FOOT SINGLE TENDON,,,21 ,,RBRVS,3.78 ,3.47 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28226,CPT,TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON,,,21 ,,RBRVS,4.67 ,4.12 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28230,CPT,TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX,,,21 ,,RBRVS,4.36 ,3.59 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28232,CPT,TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,,,21 ,,RBRVS,3.51 ,3.44 ,7.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28234,CPT,TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON,,,21 ,,RBRVS,3.54 ,3.95 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28238,CPT,RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR,,,21 ,,RBRVS,7.96 ,5.71 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28240,CPT,TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC,,,21 ,,RBRVS,4.48 ,3.66 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28250,CPT,DIVISION PLANTAR FASCIA & MUSCLE SPX,,,21 ,,RBRVS,6.06 ,4.94 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28260,CPT,CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX,,,21 ,,RBRVS,8.19 ,6.08 ,11.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28261,CPT,CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING,,,21 ,,RBRVS,13.11 ,8.29 ,14.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28262,CPT,CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH,,,21 ,,RBRVS,17.21 ,13.93 ,21.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28264,CPT,CAPSULOTOMY MIDTARSAL,,,21 ,,RBRVS,10.65 ,9.52 ,16.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28270,CPT,CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX,,,21 ,,RBRVS,4.93 ,4.42 ,8.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28272,CPT,CAPSULOTOMY IPHAL JOINT EACH JOINT SPX,,,21 ,,RBRVS,3.92 ,3.25 ,7.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28280,CPT,SYNDACTYLIZATION TOES,,,21 ,,RBRVS,5.33 ,4.62 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28285,CPT,CORRECTION HAMMERTOE,,,21 ,,RBRVS,5.62 ,4.73 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28286,CPT,CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE,,,21 ,,RBRVS,4.70 ,3.78 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28288,CPT,OSTC PRTL EXOSTC/CONDYLC METAR HEAD,,,21 ,,RBRVS,6.02 ,6.03 ,11.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28289,CPT,HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT,,,21 ,,RBRVS,8.31 ,6.87 ,12.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28290,CPT,CORRJ HALLUX VALGUS W/WO SESMDC SMPL EXOSTECTOMY,,,21 ,,RBRVS,5.83 ,5.18 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28292,CPT,KELLER/MCBRIDE/MAYO PROCEDURE,,,21 ,,RBRVS,9.05 ,7.73 ,13.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28293,CPT,CORRJ HALLUX VALGUS W/WO SESMDC RESCJ JT W/IMPLT,,,21 ,,RBRVS,11.48 ,8.40 ,17.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28294,CPT,CORRJ HALLUX VALGUS W/WO SESMDC W/TDN TRNSPLS,,,21 ,,RBRVS,8.75 ,6.00 ,12.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28296,CPT,CORRJ HALLUX VALGUS W/WO SESMDC W/METAR OSTEOT,,,21 ,,RBRVS,8.35 ,6.26 ,11.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28297,CPT,CORRJ HALLUX VALGUS W/WO SESMDC LAPIDUS-TYP PX,,,21 ,,RBRVS,9.43 ,6.77 ,13.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28298,CPT,CORRJ HALLUX VALGUS W/WO SESMDC PHALANX OSTEOT,,,21 ,,RBRVS,8.13 ,5.83 ,11.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28299,CPT,CORRJ HALLUX VALGUS W/WO SESMDC 2 OSTEOT,,,21 ,,RBRVS,11.57 ,7.18 ,13.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28300,CPT,OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION,,,21 ,,RBRVS,9.73 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28302,CPT,OSTEOTOMY TALUS,,,21 ,,RBRVS,9.74 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28304,CPT,OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS,,,21 ,,RBRVS,9.41 ,6.90 ,12.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28305,CPT,OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT,,,21 ,,RBRVS,10.77 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28306,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR,,,21 ,,RBRVS,6.00 ,5.14 ,11.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28307,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE,,,21 ,,RBRVS,6.50 ,5.88 ,12.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28308,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA,,,21 ,,RBRVS,5.48 ,4.91 ,10.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28309,CPT,OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT,,,21 ,,RBRVS,14.16 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28310,CPT,OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE,,,21 ,,RBRVS,5.57 ,4.28 ,9.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28312,CPT,OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE,,,21 ,,RBRVS,4.69 ,4.21 ,9.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28313,CPT,RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY,,,21 ,,RBRVS,5.15 ,4.72 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28315,CPT,SESAMOIDECTOMY FIRST TOE SPX,,,21 ,,RBRVS,5.00 ,4.05 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28320,CPT,REPAIR NONUNION/MALUNION TARSAL BONES,,,21 ,,RBRVS,9.37 ,7.41 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28322,CPT,RPR NON/MALUNION METARSAL W/WO BONE GRAFT,,,21 ,,RBRVS,8.53 ,7.18 ,13.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28340,CPT,RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION,,,21 ,,RBRVS,7.15 ,4.57 ,9.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28341,CPT,RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION,,,21 ,,RBRVS,8.72 ,5.17 ,10.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28344,CPT,RECONSTRUCTION TOE POLYDACTYLY,,,21 ,,RBRVS,4.40 ,4.50 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28345,CPT,RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB,,,21 ,,RBRVS,6.09 ,4.40 ,8.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28360,CPT,RECONSTRUCTION CLEFT FOOT,,,21 ,,RBRVS,14.92 ,13.33 ,13.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28400,CPT,CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.31 ,3.96 ,4.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28405,CPT,CLOSED TX CALCANEAL FRACTURE W/MANIPULATION,,,21 ,,RBRVS,4.74 ,4.87 ,5.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28406,CPT,PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ,,,21 ,,RBRVS,6.56 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28415,CPT,OPEN TREATMENT CALCANEAL FRACTURE,,,21 ,,RBRVS,16.19 ,13.85 ,13.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28420,CPT,OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT,,,21 ,,RBRVS,17.52 ,15.56 ,15.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28430,CPT,CLOSED TX TALUS FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.22 ,3.52 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28435,CPT,CLOSED TX TALUS FRACTURE W/MANIPULATION,,,21 ,,RBRVS,3.54 ,3.42 ,4.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28436,CPT,PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ,,,21 ,,RBRVS,4.90 ,7.18 ,7.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28445,CPT,OPEN TREATMENT TALUS FRACTURE,,,21 ,,RBRVS,15.76 ,12.99 ,12.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28446,CPT,OPEN OSTEOCHONDRAL AUTOGRAFT TALUS,,,21 ,,RBRVS,17.71 ,14.56 ,14.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28450,CPT,TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ,,,21 ,,RBRVS,2.03 ,3.30 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28455,CPT,TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ,,,21 ,,RBRVS,3.24 ,3.98 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28456,CPT,PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ,,,21 ,,RBRVS,2.86 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28465,CPT,OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA,,,21 ,,RBRVS,8.80 ,8.12 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28470,CPT,CLOSED TX METATARSAL FRACTURE W/O MANIPULATION,,,21 ,,RBRVS,2.03 ,3.23 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28475,CPT,CLTX METAR FX W/MANJ,,,21 ,,RBRVS,3.01 ,3.38 ,4.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28476,CPT,PRQ SKEL FIXJ METAR FX W/MANJ,,,21 ,,RBRVS,3.60 ,6.08 ,6.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28485,CPT,OPEN TREATMENT METATARSAL FRACTURE EACH,,,21 ,,RBRVS,7.44 ,7.13 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28490,CPT,CLTX FX GRT TOE PHLX/PHLG W/O MANJ,,,21 ,,RBRVS,1.17 ,2.30 ,2.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28495,CPT,CLTX FX GRT TOE PHLX/PHLG W/MANJ,,,21 ,,RBRVS,1.68 ,2.54 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28496,CPT,PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ,,,21 ,,RBRVS,2.48 ,3.90 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28505,CPT,OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES,,,21 ,,RBRVS,7.44 ,6.25 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28510,CPT,CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ,,,21 ,,RBRVS,1.17 ,2.16 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28515,CPT,CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ,,,21 ,,RBRVS,1.56 ,2.40 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28525,CPT,OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE,,,21 ,,RBRVS,5.62 ,5.44 ,10.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28530,CPT,CLOSED TREATMENT SESAMOID FRACTURE,,,21 ,,RBRVS,1.11 ,1.75 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28531,CPT,OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION,,,21 ,,RBRVS,2.57 ,2.60 ,7.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28540,CPT,CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES,,,21 ,,RBRVS,2.19 ,2.97 ,3.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28545,CPT,CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES,,,21 ,,RBRVS,2.60 ,4.34 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28546,CPT,PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ,,,21 ,,RBRVS,3.40 ,5.67 ,12.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28555,CPT,OPEN TREATMENT TARSAL BONE DISLOCATION,,,21 ,,RBRVS,9.65 ,8.55 ,14.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28570,CPT,CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,,,21 ,,RBRVS,1.76 ,2.24 ,2.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28575,CPT,CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES,,,21 ,,RBRVS,3.49 ,5.35 ,6.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28576,CPT,PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ,,,21 ,,RBRVS,4.60 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28585,CPT,OPEN TREATMENT TALOTARSAL JOINT DISLOCATION,,,21 ,,RBRVS,11.13 ,7.86 ,13.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28600,CPT,CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES,,,21 ,,RBRVS,2.02 ,3.17 ,4.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28605,CPT,CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES,,,21 ,,RBRVS,2.89 ,4.90 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28606,CPT,PRQ SKEL FIXJ TARS JT DISLC W/MANJ,,,21 ,,RBRVS,5.09 ,5.63 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28615,CPT,OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,,,21 ,,RBRVS,10.70 ,10.87 ,10.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28630,CPT,CLTX METATARSOPHLNGL JT DISLC W/O ANES,,,21 ,,RBRVS,1.75 ,1.23 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28635,CPT,CLTX METATARSOPHLNGL JT DISLC REQ ANES,,,21 ,,RBRVS,1.96 ,1.81 ,3.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28636,CPT,PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ,,,21 ,,RBRVS,2.77 ,2.63 ,5.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28645,CPT,OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION,,,21 ,,RBRVS,7.44 ,5.88 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28660,CPT,CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES,,,21 ,,RBRVS,1.28 ,1.11 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28665,CPT,CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES,,,21 ,,RBRVS,1.97 ,1.68 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28666,CPT,PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ,,,21 ,,RBRVS,2.66 ,2.43 ,2.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28675,CPT,OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION,,,21 ,,RBRVS,5.62 ,5.71 ,10.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28705,CPT,ARTHRODESIS PANTALAR,,,21 ,,RBRVS,20.33 ,14.11 ,14.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28715,CPT,ARTHRODESIS TRIPLE,,,21 ,,RBRVS,13.42 ,11.91 ,11.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28725,CPT,ARTHRODESIS SUBTALAR,,,21 ,,RBRVS,11.22 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28730,CPT,ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS,,,21 ,,RBRVS,10.70 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28735,CPT,ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT,,,21 ,,RBRVS,12.23 ,9.31 ,9.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28737,CPT,ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR,,,21 ,,RBRVS,11.03 ,7.78 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28740,CPT,ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,,,21 ,,RBRVS,9.29 ,7.86 ,14.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28750,CPT,ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT,,,21 ,,RBRVS,8.57 ,7.79 ,14.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28755,CPT,ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT,,,21 ,,RBRVS,4.88 ,4.30 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28760,CPT,ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK,,,21 ,,RBRVS,9.14 ,6.78 ,12.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28800,CPT,AMPUTATION FOOT MIDTARSAL,,,21 ,,RBRVS,8.79 ,6.26 ,6.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,28805,CPT,AMPUTATION FOOT TRANSMETARSAL,,,21 ,,RBRVS,12.71 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28810,CPT,AMPUTATION METATARSAL W/TOE SINGLE,,,21 ,,RBRVS,6.64 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28820,CPT,AMPUTATION TOE METATARSOPHALANGEAL JOINT,,,21 ,,RBRVS,5.82 ,5.04 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28825,CPT,AMPUTATION TOE INTERPHALANGEAL JOINT,,,21 ,,RBRVS,5.37 ,5.00 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28890,CPT,ESWT HI NRG PHYS/QHP W/US GDN INVG PLNTAR FASCIA,,,21 ,,RBRVS,3.45 ,2.83 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,28899,CPT,UNLISTED PROCEDURE FOOT/TOES,,,21 ,,TotalUnits,,,,11.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,29000,CPT,APPLICATION HALO TYPE BODY CAST,,,21 ,,RBRVS,2.25 ,2.70 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29010,CPT,APPLICATION RISSER JACKET LOCALIZER BODY ONLY,,,21 ,,RBRVS,2.06 ,1.70 ,3.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29015,CPT,APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD,,,21 ,,RBRVS,2.41 ,2.33 ,5.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29020,CPT,APPLICATION TURNBUCKLE JACKET BODY ONLY,,,21 ,,RBRVS,2.11 ,1.85 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29025,CPT,APPLICATION TURNBUCKLE JACKET BODY W/HEAD,,,21 ,,RBRVS,2.40 ,2.41 ,5.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29035,CPT,APPLICATION BODY CAST SHOULDER HIPS,,,21 ,,RBRVS,1.77 ,2.10 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29040,CPT,APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA,,,21 ,,RBRVS,2.22 ,1.76 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29044,CPT,APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH,,,21 ,,RBRVS,2.12 ,2.37 ,5.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29046,CPT,APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS,,,21 ,,RBRVS,2.41 ,2.41 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29049,CPT,APPLICATION CAST FIGURE-OF-8,,,21 ,,RBRVS,0.89 ,0.93 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29055,CPT,APPLICATION CAST SHOULDER SPICA,,,21 ,,RBRVS,1.78 ,1.91 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29058,CPT,APPLICATION CAST PLASTER VELPEAU,,,21 ,,RBRVS,1.31 ,0.78 ,1.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29065,CPT,APPLICATION CAST SHOULDER HAND LONG ARM,,,21 ,,RBRVS,0.87 ,0.98 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29075,CPT,APPLICATION CAST ELBOW FINGER SHORT ARM,,,21 ,,RBRVS,0.77 ,0.92 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29085,CPT,APPLICATION CAST HAND & LOWER FOREARM GAUNTLET,,,21 ,,RBRVS,0.87 ,0.95 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29086,CPT,APPLICATION CAST FINGER,,,21 ,,RBRVS,0.62 ,0.79 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29105,CPT,APPLICATION LONG ARM SPLINT SHOULDER HAND,,,21 ,,RBRVS,0.87 ,0.73 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29125,CPT,APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,,,21 ,,RBRVS,0.50 ,0.57 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29126,CPT,APPLICATION SHORT ARM SPLINT DYNAMIC,,,21 ,,RBRVS,0.68 ,0.65 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29130,CPT,APPLICATION FINGER SPLINT STATIC,,,21 ,,RBRVS,0.50 ,0.26 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29131,CPT,APPLICATION FINGER SPLINT DYNAMIC,,,21 ,,RBRVS,0.55 ,0.36 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29200,CPT,STRAPPING THORAX,,,21 ,,RBRVS,0.65 ,0.45 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29240,CPT,STRAPPING SHOULDER,,,21 ,,RBRVS,0.71 ,0.50 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29260,CPT,STRAPPING ELBOW/WRIST,,,21 ,,RBRVS,0.55 ,0.49 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29280,CPT,STRAPPING HAND/FINGER,,,21 ,,RBRVS,0.51 ,0.50 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29305,CPT,APPLICATION HIP SPICA CAST 1 LEG,,,21 ,,RBRVS,2.03 ,2.24 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29325,CPT,APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS,,,21 ,,RBRVS,2.32 ,2.47 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29345,CPT,APPLICATION LONG LEG CAST THIGH-TOE,,,21 ,,RBRVS,1.40 ,1.31 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29355,CPT,APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE,,,21 ,,RBRVS,1.53 ,1.35 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29358,CPT,APPLICATION LONG LEG CAST BRACE,,,21 ,,RBRVS,1.43 ,1.33 ,2.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29365,CPT,APPLICATION CYLINDER CAST THIGH ANKLE,,,21 ,,RBRVS,1.18 ,1.18 ,2.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29405,CPT,APPLICATION SHORT LEG CAST BELOW KNEE-TOE,,,21 ,,RBRVS,0.80 ,0.85 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29425,CPT,APPLICATION SHORT LEG CAST WALKING/AMBULATORY,,,21 ,,RBRVS,0.80 ,0.79 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29435,CPT,APPLICATION PATELLAR TENDON BEARING CAST,,,21 ,,RBRVS,1.18 ,1.11 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29440,CPT,ADDING WALKER PREVIOUSLY APPLIED CAST,,,21 ,,RBRVS,0.57 ,0.40 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29445,CPT,APPLICATION RIGID TOTAL CONTACT LEG CAST,,,21 ,,RBRVS,1.78 ,1.11 ,2.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29450,CPT,APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG,,,21 ,,RBRVS,2.08 ,1.07 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29505,CPT,APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES,,,21 ,,RBRVS,0.69 ,0.63 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29515,CPT,APPLICATION SHORT LEG SPLINT CALF FOOT,,,21 ,,RBRVS,0.73 ,0.62 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29520,CPT,STRAPPING HIP,,,21 ,,RBRVS,0.54 ,0.47 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29530,CPT,STRAPPING KNEE,,,21 ,,RBRVS,0.57 ,0.48 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29540,CPT,STRAPPING ANKLE &/FOOT,,,21 ,,RBRVS,0.39 ,0.35 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29550,CPT,STRAPPING TOES,,,21 ,,RBRVS,0.25 ,0.32 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29580,CPT,STRAPPING UNNA BOOT,,,21 ,,RBRVS,0.55 ,0.43 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29581,CPT,APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT,,,21 ,,RBRVS,0.25 ,0.11 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29582,CPT,APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE,,,21 ,,RBRVS,0.35 ,0.09 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29583,CPT,APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM,,,21 ,,RBRVS,0.25 ,0.07 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29584,CPT,APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING,,,21 ,,RBRVS,0.35 ,0.09 ,1.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29700,CPT,REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST,,,21 ,,RBRVS,0.57 ,0.34 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29705,CPT,REMOVAL/BIVALVING FULL ARM/FULL LEG CAST,,,21 ,,RBRVS,0.76 ,0.50 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29710,CPT,RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET,,,21 ,,RBRVS,1.34 ,0.71 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29715,CPT,REMOVAL/BIVALVING TURNBUCKLE JACKET,,,21 ,,RBRVS,0.94 ,0.55 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29720,CPT,REPAIR SPICA BODY CAST/JACKET,,,21 ,,RBRVS,0.68 ,0.48 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29730,CPT,WINDOWING CAST,,,21 ,,RBRVS,0.75 ,0.46 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29740,CPT,WEDGING CAST EXCEPT CLUBFOOT CASTS,,,21 ,,RBRVS,1.12 ,0.61 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29750,CPT,WEDGING CLUBFOOT CAST,,,21 ,,RBRVS,1.26 ,0.75 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29799,CPT,UNLISTED PROCEDURE CASTING/STRAPPING,,,21 ,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,29800,CPT,ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX,,,21 ,,RBRVS,6.84 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29804,CPT,ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL,,,21 ,,RBRVS,8.87 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29805,CPT,ARTHROSCOPY SHOULDER DX W/WO SYNOVIAL BIOPSY SPX,,,21 ,,RBRVS,6.03 ,6.63 ,6.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29806,CPT,ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY,,,21 ,,RBRVS,15.14 ,13.13 ,13.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29807,CPT,ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION,,,21 ,,RBRVS,14.67 ,12.90 ,12.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29819,CPT,ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB,,,21 ,,RBRVS,7.79 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29820,CPT,ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL,,,21 ,,RBRVS,7.21 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29821,CPT,ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE,,,21 ,,RBRVS,7.89 ,7.96 ,7.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29822,CPT,ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED,,,21 ,,RBRVS,7.60 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29823,CPT,ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE,,,21 ,,RBRVS,8.36 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29824,CPT,ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY,,,21 ,,RBRVS,8.98 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29825,CPT,ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MANIPJ,,,21 ,,RBRVS,7.79 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29826,CPT,ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE,,,21 ,,RBRVS,3.00 ,1.65 ,1.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29827,CPT,ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR,,,21 ,,RBRVS,15.59 ,13.06 ,13.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29828,CPT,ARTHROSCOPY SHOULDER BICEPS TENODESIS,,,21 ,,RBRVS,13.16 ,11.38 ,11.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29830,CPT,ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX,,,21 ,,RBRVS,5.88 ,6.29 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29834,CPT,ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB,,,21 ,,RBRVS,6.42 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29835,CPT,ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL,,,21 ,,RBRVS,6.62 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29836,CPT,ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE,,,21 ,,RBRVS,7.72 ,7.90 ,7.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29837,CPT,ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED,,,21 ,,RBRVS,7.01 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29838,CPT,ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE,,,21 ,,RBRVS,7.88 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29840,CPT,ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX,,,21 ,,RBRVS,5.68 ,6.55 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29843,CPT,ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE,,,21 ,,RBRVS,6.15 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29844,CPT,ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL,,,21 ,,RBRVS,6.51 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29845,CPT,ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE,,,21 ,,RBRVS,7.69 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29846,CPT,ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT,,,21 ,,RBRVS,6.89 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29847,CPT,ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY,,,21 ,,RBRVS,7.22 ,7.29 ,7.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29848,CPT,NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM,,,21 ,,RBRVS,6.39 ,7.41 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29850,CPT,ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ,,,21 ,,RBRVS,8.27 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29851,CPT,ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ,,,21 ,,RBRVS,13.26 ,11.51 ,11.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29855,CPT,ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR,,,21 ,,RBRVS,10.76 ,10.23 ,10.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29856,CPT,ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR,,,21 ,,RBRVS,14.28 ,12.20 ,12.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29860,CPT,ARTHROSCOPY HIP DIAGNOSTIC W/WO SYNOVIAL BYP SPX,,,21 ,,RBRVS,9.00 ,8.71 ,8.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29861,CPT,ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB,,,21 ,,RBRVS,10.10 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29862,CPT,ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG,,,21 ,,RBRVS,11.17 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29863,CPT,ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY,,,21 ,,RBRVS,11.17 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29866,CPT,ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST,,,21 ,,RBRVS,14.67 ,13.23 ,13.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29867,CPT,ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT,,,21 ,,RBRVS,18.39 ,15.48 ,15.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29868,CPT,ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED/LAT,,,21 ,,RBRVS,25.10 ,19.16 ,19.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29870,CPT,ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX,,,21 ,,RBRVS,5.19 ,5.88 ,11.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29871,CPT,ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE,,,21 ,,RBRVS,6.69 ,7.08 ,7.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29873,CPT,ARTHROSCOPY KNEE LATERAL RELEASE,,,21 ,,RBRVS,6.24 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29874,CPT,ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY,,,21 ,,RBRVS,7.19 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29875,CPT,ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,,,21 ,,RBRVS,6.45 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29876,CPT,ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS,,,21 ,,RBRVS,8.87 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29877,CPT,ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG,,,21 ,,RBRVS,8.30 ,8.37 ,8.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29879,CPT,ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX,,,21 ,,RBRVS,8.99 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29880,CPT,ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING,,,21 ,,RBRVS,7.39 ,8.01 ,8.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29881,CPT,ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG,,,21 ,,RBRVS,7.03 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29882,CPT,ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL,,,21 ,,RBRVS,9.60 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29883,CPT,ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL,,,21 ,,RBRVS,11.77 ,10.68 ,10.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29884,CPT,ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX,,,21 ,,RBRVS,8.28 ,8.35 ,8.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29885,CPT,ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG,,,21 ,,RBRVS,10.21 ,9.84 ,9.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29886,CPT,ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION,,,21 ,,RBRVS,8.49 ,8.48 ,8.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29887,CPT,ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ,,,21 ,,RBRVS,10.16 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29888,CPT,ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ,,,21 ,,RBRVS,14.30 ,12.03 ,12.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29889,CPT,ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ,,,21 ,,RBRVS,17.41 ,14.80 ,14.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29891,CPT,ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT,,,21 ,,RBRVS,9.67 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29892,CPT,ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX,,,21 ,,RBRVS,10.27 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29893,CPT,ENDOSCOPIC PLANTAR FASCIOTOMY,,,21 ,,RBRVS,6.32 ,5.69 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29894,CPT,ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY,,,21 ,,RBRVS,7.35 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29895,CPT,ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL,,,21 ,,RBRVS,7.13 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29897,CPT,ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED,,,21 ,,RBRVS,7.32 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29898,CPT,ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE,,,21 ,,RBRVS,8.49 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29899,CPT,ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS,,,21 ,,RBRVS,15.41 ,12.40 ,12.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29900,CPT,ARTHROSCOPY METACARPOPHALANGEAL SYNOVIAL BIOPSY,,,21 ,,RBRVS,5.88 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29901,CPT,ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT,,,21 ,,RBRVS,6.59 ,7.84 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29902,CPT,ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM,,,21 ,,RBRVS,7.16 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29904,CPT,ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY,,,21 ,,RBRVS,8.65 ,8.27 ,8.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29905,CPT,ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY,,,21 ,,RBRVS,9.18 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29906,CPT,ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT,,,21 ,,RBRVS,9.65 ,9.66 ,9.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29907,CPT,ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS,,,21 ,,RBRVS,12.18 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29914,CPT,ARTHROSCOPY HIP W/FEMOROPLASTY,,,21 ,,RBRVS,14.67 ,12.49 ,12.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29915,CPT,ARTHROSCOPY HIP W/ACETABULOPLASTY,,,21 ,,RBRVS,15.00 ,12.68 ,12.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29916,CPT,ARTHROSCOPY HIP W/LABRAL REPAIR,,,21 ,,RBRVS,15.00 ,12.68 ,12.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,29999,CPT,UNLISTED PROCEDURE ARTHROSCOPY,,,21 ,,TotalUnits,,,,15.40 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,30000,CPT,DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH,,,21 ,,RBRVS,1.48 ,1.86 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30020,CPT,DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM,,,21 ,,RBRVS,1.48 ,1.88 ,5.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30100,CPT,BIOPSY INTRANASAL,,,21 ,,RBRVS,0.94 ,1.01 ,3.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30110,CPT,EXCISION NASAL POLYP SIMPLE,,,21 ,,RBRVS,1.68 ,1.99 ,5.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30115,CPT,EXCISION NASAL POLYP EXTENSIVE,,,21 ,,RBRVS,4.44 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30117,CPT,EXCISION/DESTRUCTION INTRANASAL LESION INT APPR,,,21 ,,RBRVS,3.26 ,6.43 ,22.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30118,CPT,EXCISION/DESTRUCTION INTRANASAL LESION XTRNL,,,21 ,,RBRVS,9.92 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30120,CPT,EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA,,,21 ,,RBRVS,5.39 ,6.89 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30124,CPT,EXCISION DERMOID CYST NOSE SIMPLE SUBCUTANEOUS,,,21 ,,RBRVS,3.20 ,4.84 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30125,CPT,EXC DERMOID CYST NOSE COMPLEX UNDER BONE/CRTLG,,,21 ,,RBRVS,7.30 ,9.98 ,9.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30130,CPT,EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE,,,21 ,,RBRVS,3.47 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30140,CPT,SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL,,,21 ,,RBRVS,3.57 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30150,CPT,RHINECTOMY PARTIAL,,,21 ,,RBRVS,9.55 ,12.11 ,12.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30160,CPT,RHINECTOMY TOTAL,,,21 ,,RBRVS,9.99 ,11.92 ,11.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30200,CPT,INJECTION TURBINATE THERAPEUTIC,,,21 ,,RBRVS,0.78 ,0.91 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30210,CPT,DISPLACEMENT THERAPY PROETZ TYPE,,,21 ,,RBRVS,1.13 ,1.71 ,3.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30220,CPT,INSERTION NASAL SEPTAL PROSTHESIS BUTTON,,,21 ,,RBRVS,1.59 ,1.95 ,7.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30300,CPT,REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE,,,21 ,,RBRVS,1.09 ,2.54 ,5.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30310,CPT,REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES,,,21 ,,RBRVS,2.01 ,3.91 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30320,CPT,RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY,,,21 ,,RBRVS,4.64 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30400,CPT,RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI,,,21 ,,RBRVS,10.86 ,18.16 ,18.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30410,CPT,RHINP PRIM COMPLETE XTRNL PARTS,,,21 ,,RBRVS,14.00 ,22.54 ,22.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30420,CPT,RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR,,,21 ,,RBRVS,16.90 ,21.63 ,21.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30430,CPT,RHINOPLASTY SECONDARY MINOR REVISION,,,21 ,,RBRVS,8.24 ,18.06 ,18.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30435,CPT,RHINOPLASTY SECONDARY INTERMEDIATE REVISION,,,21 ,,RBRVS,12.73 ,19.50 ,19.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30450,CPT,RHINOPLASTY SECONDARY MAJOR REVISION,,,21 ,,RBRVS,19.66 ,22.98 ,22.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30460,CPT,RHINP DFRM W/COLUM LNGTH TIP ONLY,,,21 ,,RBRVS,10.32 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30462,CPT,RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT,,,21 ,,RBRVS,20.28 ,22.48 ,22.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30465,CPT,REPAIR NASAL VESTIBULAR STENOSIS,,,21 ,,RBRVS,12.36 ,15.21 ,15.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30520,CPT,SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF,,,21 ,,RBRVS,7.01 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30540,CPT,REPAIR CHOANAL ATRESIA INTRANASAL,,,21 ,,RBRVS,7.92 ,11.50 ,11.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30545,CPT,REPAIR CHOANAL ATRESIA TRANSPALATINE,,,21 ,,RBRVS,11.62 ,15.03 ,15.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30560,CPT,LYSIS INTRANASAL SYNECHIA,,,21 ,,RBRVS,1.31 ,2.67 ,6.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30580,CPT,REPAIR FISTULA OROMAXILLARY,,,21 ,,RBRVS,6.88 ,6.99 ,11.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30600,CPT,REPAIR FISTULA ORONASAL,,,21 ,,RBRVS,6.16 ,5.88 ,10.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30620,CPT,SEPTAL/OTHER INTRANASAL DERMATOPLASTY,,,21 ,,RBRVS,6.16 ,11.59 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30630,CPT,REPAIR NASAL SEPTAL PERFORATIONS,,,21 ,,RBRVS,7.29 ,10.39 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30801,CPT,ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC,,,21 ,,RBRVS,1.14 ,2.81 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30802,CPT,ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL,,,21 ,,RBRVS,2.08 ,3.34 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30901,CPT,CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,,,21 ,,RBRVS,1.10 ,0.42 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30903,CPT,CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX,,,21 ,,RBRVS,1.54 ,0.61 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30905,CPT,CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST,,,21 ,,RBRVS,1.97 ,0.74 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30906,CPT,CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ,,,21 ,,RBRVS,2.45 ,1.15 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30915,CPT,LIGATION ARTERIES ETHMOIDAL,,,21 ,,RBRVS,7.44 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30920,CPT,LIGATION ARTERIES INT MAXILLARY TRANSANTRAL,,,21 ,,RBRVS,11.14 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30930,CPT,FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC,,,21 ,,RBRVS,1.31 ,2.21 ,2.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,30999,CPT,UNLISTED PROCEDURE NOSE,,,21 ,,TotalUnits,,,,9.45 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,31000,CPT,LAVAGE CANNULATION MAXILLARY SINUS,,,21 ,,RBRVS,1.20 ,1.77 ,4.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31002,CPT,LAVAGE CANNULATION SPHENOID SINUS,,,21 ,,RBRVS,1.96 ,3.77 ,3.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31020,CPT,SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL,,,21 ,,RBRVS,3.07 ,7.24 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31030,CPT,SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS,,,21 ,,RBRVS,6.01 ,8.75 ,13.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31032,CPT,SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS,,,21 ,,RBRVS,6.69 ,9.48 ,9.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31040,CPT,PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH,,,21 ,,RBRVS,9.77 ,11.46 ,11.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31050,CPT,SINUSOTOMY SPHENOID W/WO BIOPSY,,,21 ,,RBRVS,5.37 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31051,CPT,SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP,,,21 ,,RBRVS,7.25 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31070,CPT,SINUSOTOMY FRONTAL EXTERNAL SIMPLE,,,21 ,,RBRVS,4.40 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31075,CPT,SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL,,,21 ,,RBRVS,9.51 ,12.61 ,12.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31080,CPT,SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC,,,21 ,,RBRVS,12.74 ,16.21 ,16.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31081,CPT,SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC,,,21 ,,RBRVS,14.19 ,23.84 ,23.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31084,CPT,SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC,,,21 ,,RBRVS,14.95 ,17.71 ,17.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31085,CPT,SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC,,,21 ,,RBRVS,15.64 ,18.18 ,18.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31086,CPT,SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC,,,21 ,,RBRVS,14.36 ,17.20 ,17.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31087,CPT,SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC,,,21 ,,RBRVS,14.57 ,15.87 ,15.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31090,CPT,SINUSOT UNI 3/> PARANSL SINUSES,,,21 ,,RBRVS,11.17 ,17.78 ,17.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31200,CPT,ETHMOIDECTOMY INTRANASAL ANTERIOR,,,21 ,,RBRVS,5.14 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31201,CPT,ETHMOIDECTOMY INTRANASAL TOTAL,,,21 ,,RBRVS,8.60 ,12.28 ,12.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31205,CPT,ETHMOIDECTOMY EXTRANASAL TOTAL,,,21 ,,RBRVS,10.58 ,14.22 ,14.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31225,CPT,MAXILLECTOMY W/O ORBITAL EXENTERATION,,,21 ,,RBRVS,26.70 ,25.12 ,25.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31230,CPT,MAXILLECTOMY W/ORBITAL EXENTERATION,,,21 ,,RBRVS,30.82 ,26.88 ,26.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31231,CPT,NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX,,,21 ,,RBRVS,1.10 ,1.07 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31233,CPT,NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY,,,21 ,,RBRVS,2.18 ,1.64 ,5.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31235,CPT,NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY,,,21 ,,RBRVS,2.64 ,1.86 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31237,CPT,NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX,,,21 ,,RBRVS,2.98 ,2.06 ,6.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31238,CPT,NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG,,,21 ,,RBRVS,3.26 ,2.21 ,6.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31239,CPT,NASAL/SINUS NDSC SURG W/DACRYOCSTORHINOSTOMY,,,21 ,,RBRVS,9.33 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31240,CPT,NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION,,,21 ,,RBRVS,2.61 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31254,CPT,NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY PARTIAL,,,21 ,,RBRVS,4.64 ,2.94 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31255,CPT,NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL,,,21 ,,RBRVS,6.95 ,4.15 ,4.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31256,CPT,NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY,,,21 ,,RBRVS,3.29 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31267,CPT,NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS,,,21 ,,RBRVS,5.45 ,3.36 ,3.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31276,CPT,NASAL/SINUS NDSC W/FRONTAL SINUS EXPLORATION,,,21 ,,RBRVS,8.84 ,5.14 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31287,CPT,NASAL/SINUS ENDOSCOPY W/SPHENOIDECTOMY,,,21 ,,RBRVS,3.91 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31288,CPT,NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS,,,21 ,,RBRVS,4.57 ,2.90 ,2.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31290,CPT,NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID,,,21 ,,RBRVS,18.61 ,13.35 ,13.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31291,CPT,NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID,,,21 ,,RBRVS,19.56 ,14.07 ,14.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31292,CPT,NSL/SINUS NDSC SURG W/MEDIAL/INF ORB WALL DCMPRN,,,21 ,,RBRVS,15.90 ,11.97 ,11.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31293,CPT,NASAL/SINUS NDSC MEDIAL ORB&NF ORB WALL DCMPR,,,21 ,,RBRVS,17.47 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31294,CPT,NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN,,,21 ,,RBRVS,20.31 ,14.24 ,14.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31295,CPT,NASAL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS,,,21 ,,RBRVS,2.70 ,2.00 ,60.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31296,CPT,NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS,,,21 ,,RBRVS,3.29 ,2.31 ,60.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31297,CPT,NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS,,,21 ,,RBRVS,2.64 ,1.97 ,60.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31299,CPT,UNLISTED PROCEDURE ACCESSORY SINUSES,,,21 ,,TotalUnits,,,,5.55 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,31300,CPT,LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY,,,21 ,,RBRVS,15.91 ,19.77 ,19.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31320,CPT,LARYNGOTOMY THYROTOMY LARYNGOFISSURE DX,,,21 ,,RBRVS,5.73 ,13.27 ,13.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31360,CPT,LARYNGECTOMY TOTAL W/O RADICAL NECK DISSECTION,,,21 ,,RBRVS,29.91 ,27.89 ,27.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31365,CPT,LARYNGECTOMY TOTAL W/RADICAL NECK DISSECTION,,,21 ,,RBRVS,38.81 ,32.39 ,32.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31367,CPT,LARYNGECTOMY STOT SUPRAGLOTTIC W/O RAD NECK DSJ,,,21 ,,RBRVS,30.57 ,31.08 ,31.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31368,CPT,LARYNGECTOMY STOT SUPRAGLOTTIC W/RAD NCK DSJ,,,21 ,,RBRVS,34.19 ,34.20 ,34.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31370,CPT,PARTIAL LARYNGECTOMY HEMILARYGECTOMY HORIZONTAL,,,21 ,,RBRVS,27.57 ,30.61 ,30.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31375,CPT,PARTIAL LARYNGECTOMY HEMILARYNG LATEROVERTICAL,,,21 ,,RBRVS,26.07 ,29.13 ,29.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31380,CPT,PARTIAL LARYNGECTOMY HEMILARYNG ANTEROVERTICAL,,,21 ,,RBRVS,25.57 ,28.85 ,28.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31382,CPT,PARTIAL LARYNG HEMILARYNG ANTERO-LATERO-VERTICAL,,,21 ,,RBRVS,28.57 ,31.04 ,31.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31390,CPT,PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ,,,21 ,,RBRVS,42.51 ,36.72 ,36.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31395,CPT,PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ,,,21 ,,RBRVS,43.80 ,39.94 ,39.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31400,CPT,ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH,,,21 ,,RBRVS,11.60 ,16.86 ,16.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31420,CPT,EPIGLOTTIDECTOMY,,,21 ,,RBRVS,11.43 ,12.06 ,12.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31500,CPT,INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,,,21 ,,RBRVS,2.33 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31502,CPT,TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT,,,21 ,,RBRVS,0.65 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31505,CPT,LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX,,,21 ,,RBRVS,0.61 ,0.79 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31510,CPT,LARYNGOSCOPY INDIRECT W/BIOPSY,,,21 ,,RBRVS,1.92 ,1.45 ,4.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31511,CPT,LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY,,,21 ,,RBRVS,2.16 ,1.40 ,3.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31512,CPT,LARYNGOSCOPY INDIRECT W/REMOVAL LESION,,,21 ,,RBRVS,2.07 ,1.58 ,3.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31513,CPT,LARYNGOSCOPY INDIRECT W/VOCAL CORD INJECTION,,,21 ,,RBRVS,2.10 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31515,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION,,,21 ,,RBRVS,1.80 ,1.26 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31520,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DX NEWBORN,,,21 ,,RBRVS,2.56 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31525,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN,,,21 ,,RBRVS,2.63 ,1.82 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31526,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE,,,21 ,,RBRVS,2.57 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31527,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY INSERT OBTURATOR,,,21 ,,RBRVS,3.27 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31528,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN,,,21 ,,RBRVS,2.37 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31529,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ,,,21 ,,RBRVS,2.68 ,1.85 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31530,CPT,LARYNGOSCOPY W/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,3.38 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31531,CPT,LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE,,,21 ,,RBRVS,3.58 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31535,CPT,LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY,,,21 ,,RBRVS,3.16 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31536,CPT,LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE,,,21 ,,RBRVS,3.55 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31540,CPT,LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT,,,21 ,,RBRVS,4.12 ,2.65 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31541,CPT,LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP,,,21 ,,RBRVS,4.52 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31545,CPT,LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP,,,21 ,,RBRVS,6.30 ,3.82 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31546,CPT,LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD GRAFT,,,21 ,,RBRVS,9.73 ,5.58 ,5.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31560,CPT,LARYNGOSCOPY DIRECT OPERATIVE W/ARYTENOIDECTOMY,,,21 ,,RBRVS,5.45 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31561,CPT,LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE,,,21 ,,RBRVS,5.99 ,3.57 ,3.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31570,CPT,LARYNGOSCOPE INJECTION VOCAL CORD THERAPEUTIC,,,21 ,,RBRVS,3.86 ,2.49 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31571,CPT,LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE,,,21 ,,RBRVS,4.26 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31575,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC,,,21 ,,RBRVS,1.10 ,1.06 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31576,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY,,,21 ,,RBRVS,1.97 ,1.49 ,4.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31577,CPT,LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY,,,21 ,,RBRVS,2.47 ,1.65 ,4.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31578,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION,,,21 ,,RBRVS,2.84 ,1.95 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31579,CPT,LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY,,,21 ,,RBRVS,2.26 ,1.68 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31580,CPT,LARYNGOPLASTY LARYN WEB 2 STG W/KEEL INSJ&RMVL,,,21 ,,RBRVS,14.66 ,19.97 ,19.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31582,CPT,LARYNGP LARYN STENOSIS GRF/CORE MOLD W/TRACHT,,,21 ,,RBRVS,23.22 ,30.71 ,30.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31584,CPT,LARYNGOPLASTY W/OPEN REDUCTION FRACTURE,,,21 ,,RBRVS,20.47 ,22.03 ,22.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31587,CPT,LARYNGOPLASTY CRICOID SPLIT,,,21 ,,RBRVS,15.27 ,12.60 ,12.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31588,CPT,LARYNGOPLASTY NOT OTHERWISE SPECIFIED,,,21 ,,RBRVS,14.99 ,17.23 ,17.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31590,CPT,LARYNGEAL REINNERVATION NEUROMUSCULAR PEDICLE,,,21 ,,RBRVS,7.85 ,18.02 ,18.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31595,CPT,SECTION RECURRENT LARYNGEAL NERVE THER UNI SPX,,,21 ,,RBRVS,8.84 ,12.97 ,12.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31599,CPT,UNLISTED PROCEDURE LARYNX,,,21 ,,TotalUnits,,,,3.26 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,31600,CPT,TRACHEOSTOMY PLANNED SEPARATE PROCEDURE,,,21 ,,RBRVS,7.17 ,3.37 ,3.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31601,CPT,TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX,,,21 ,,RBRVS,4.44 ,2.78 ,2.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31603,CPT,TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL,,,21 ,,RBRVS,4.14 ,1.80 ,1.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31605,CPT,TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE,,,21 ,,RBRVS,3.57 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31610,CPT,TRACHEOSTOMY FENESTRATION W/SKIN FLAPS,,,21 ,,RBRVS,9.38 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31611,CPT,CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH,,,21 ,,RBRVS,6.00 ,9.45 ,9.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31612,CPT,TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX,,,21 ,,RBRVS,0.91 ,0.39 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31613,CPT,TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION,,,21 ,,RBRVS,4.71 ,8.13 ,8.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31614,CPT,TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION,,,21 ,,RBRVS,8.63 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31615,CPT,TRACHEOBRNCHSC THRU EST TRACHS INC,,,21 ,,RBRVS,2.09 ,1.48 ,3.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31620,CPT,ENDOBRNCL US BRONCHOSCOPIC DX/THER IVNTJ,,,21 ,,RBRVS,1.40 ,0.48 ,6.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31622,CPT,BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX,,,21 ,,RBRVS,2.78 ,1.22 ,6.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31623,CPT,BRNCHSC BRUSHING/PROTECTED BRUSHINGS,,,21 ,,RBRVS,2.88 ,1.19 ,6.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31624,CPT,BRNCHSC W/BRNCL ALVEOLAR LAVAGE,,,21 ,,RBRVS,2.88 ,1.21 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31625,CPT,BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES,,,21 ,,RBRVS,3.36 ,1.37 ,6.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31626,CPT,BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT,,,21 ,,RBRVS,4.16 ,1.61 ,8.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31627,CPT,BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION,,,21 ,,RBRVS,2.00 ,0.66 ,36.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,31628,CPT,BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE,,,21 ,,RBRVS,3.80 ,1.49 ,7.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31629,CPT,BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON,,,21 ,,RBRVS,4.09 ,1.59 ,13.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31630,CPT,BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX,,,21 ,,RBRVS,3.81 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31631,CPT,BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT,,,21 ,,RBRVS,4.36 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31632,CPT,BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE,,,21 ,,RBRVS,1.03 ,0.35 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31633,CPT,BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE,,,21 ,,RBRVS,1.32 ,0.44 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31634,CPT,BRONCHOSCOPY BALLOON OCCLUSION,,,21 ,,RBRVS,4.00 ,2.00 ,60.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31635,CPT,BRONCHOSCOPY W/REMOVAL FOREIGN BODY,,,21 ,,RBRVS,3.67 ,1.53 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31636,CPT,BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS,,,21 ,,RBRVS,4.30 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31637,CPT,BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED,,,21 ,,RBRVS,1.58 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31638,CPT,BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS,,,21 ,,RBRVS,4.88 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31640,CPT,BRONCHOSCOPY W/EXCISION TUMOR,,,21 ,,RBRVS,4.93 ,2.10 ,2.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31641,CPT,BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC,,,21 ,,RBRVS,5.02 ,2.05 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31643,CPT,BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL,,,21 ,,RBRVS,3.49 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31645,CPT,BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST,,,21 ,,RBRVS,3.16 ,1.30 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31646,CPT,BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ,,,21 ,,RBRVS,2.72 ,1.15 ,5.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31647,CPT,BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE,,,21 ,,RBRVS,4.40 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31648,CPT,BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL,,,21 ,,RBRVS,4.20 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31649,CPT,BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE,,,21 ,,RBRVS,1.44 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31651,CPT,BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL,,,21 ,,RBRVS,1.58 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31660,CPT,BRONCHOSCOPIC THERMOPLASTY ONE LOBE,,,21 ,,RBRVS,4.25 ,1.85 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31661,CPT,BRONCHOSCOPIC THERMOPLASTY 2/> LOBES,,,21 ,,RBRVS,4.50 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31717,CPT,CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY,,,21 ,,RBRVS,2.12 ,0.95 ,5.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31720,CPT,CATHETER ASPIRATION NASOTRACHEAL SPX,,,21 ,,RBRVS,1.06 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31725,CPT,CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,,,21 ,,RBRVS,1.96 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31730,CPT,TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER,,,21 ,,RBRVS,2.85 ,1.05 ,29.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31750,CPT,TRACHEOPLASTY CERVICAL,,,21 ,,RBRVS,15.39 ,23.16 ,23.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31755,CPT,TRACHEOPLASTY TRACHEOPHARYNGEAL FSTLJ EA STG,,,21 ,,RBRVS,17.54 ,32.09 ,32.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31760,CPT,TRACHEOPLASTY INTRATHORACIC,,,21 ,,RBRVS,23.48 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31766,CPT,CARINAL RECONSTRUCTION,,,21 ,,RBRVS,31.67 ,16.57 ,16.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31770,CPT,BRONCHOPLASTY GRAFT REPAIR,,,21 ,,RBRVS,23.54 ,11.07 ,11.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31775,CPT,BRONCHOPLASTY EXCISION STENOSIS & ANASTOMOSIS,,,21 ,,RBRVS,24.59 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31780,CPT,EXCISION TRACHEAL STENOSIS&ANASTOMOSIS CERVICA,,,21 ,,RBRVS,19.84 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31781,CPT,EXC TRACHEAL STENOSIS&ANAST CERVICOTHORACIC,,,21 ,,RBRVS,24.85 ,11.39 ,11.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31785,CPT,EXCISION TRACHEAL TUMOR/CARCINOMA CERVICAL,,,21 ,,RBRVS,18.35 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31786,CPT,EXCISION TRACHEAL TUMOR/CARCINOMA THORACIC,,,21 ,,RBRVS,25.42 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31800,CPT,SUTURE TRACHEAL WOUND/INJURY CERVICAL,,,21 ,,RBRVS,8.18 ,12.09 ,12.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31805,CPT,SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC,,,21 ,,RBRVS,13.42 ,8.02 ,8.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,31820,CPT,SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR,,,21 ,,RBRVS,4.64 ,4.55 ,7.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31825,CPT,SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR,,,21 ,,RBRVS,7.07 ,6.37 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31830,CPT,REVISION TRACHEOSTOMY SCAR,,,21 ,,RBRVS,4.62 ,4.91 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,31899,CPT,UNLISTED PROCEDURE TRACHEA BRONCHI,,,21 ,,TotalUnits,,,,4.19 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,32035,CPT,THORACOSTOMY W/RIB RESECTION EMPYEMA,,,21 ,,RBRVS,11.29 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32036,CPT,THORACOSTOMY OPEN FLAP DRAINAGE EMPYEMA,,,21 ,,RBRVS,12.30 ,8.20 ,8.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32096,CPT,THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL,,,21 ,,RBRVS,13.75 ,7.28 ,7.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32097,CPT,THORACTOMY W/DX BX LUNG NODULE/MASS UNILATERAL,,,21 ,,RBRVS,13.75 ,7.28 ,7.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32098,CPT,THORACOTOMY W/BIOPSY OF PLEURA,,,21 ,,RBRVS,12.91 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32100,CPT,THORACOTOMY WITH EXPLORATION,,,21 ,,RBRVS,13.75 ,7.77 ,7.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32110,CPT,THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR,,,21 ,,RBRVS,25.28 ,12.94 ,12.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32120,CPT,THORACOTOMY POSTOPERATIVE COMPLICATIONS,,,21 ,,RBRVS,14.39 ,8.55 ,8.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32124,CPT,THORACOTOMY OPN INTRAPLEURAL PNEUMONOLYSIS,,,21 ,,RBRVS,15.45 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32140,CPT,THORCOM W/REMOVAL OF CYST,,,21 ,,RBRVS,16.66 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32141,CPT,THORACOTOMY W/RESECTION BULLAE,,,21 ,,RBRVS,27.18 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32150,CPT,THORCOM W/RMVL INTRAPLEURAL FB/FIBRIN DEP,,,21 ,,RBRVS,16.82 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32151,CPT,THORCOM W/RMVL IPUL FB,,,21 ,,RBRVS,16.94 ,9.50 ,9.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32160,CPT,THORACOTOMY W/CARDIAC MASSAGE,,,21 ,,RBRVS,13.10 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32200,CPT,PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST,,,21 ,,RBRVS,18.68 ,11.24 ,11.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32201,CPT,PNEUMONOSTOMY PERCUTANEOUS DRAINAGE ABSCESS/CYST,,,21 ,,RBRVS,3.99 ,1.48 ,22.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32215,CPT,PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX,,,21 ,,RBRVS,13.05 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32220,CPT,DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE,,,21 ,,RBRVS,26.65 ,14.98 ,14.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32225,CPT,DECORTICATION PULMONARY PARTIAL SEPARATE PROC,,,21 ,,RBRVS,16.75 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32310,CPT,PLEURECTOMY PARIETAL SEPARATE PROCEDURE,,,21 ,,RBRVS,15.28 ,8.86 ,8.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32320,CPT,DECORTICATION & PARIETAL PLEURECTOMY,,,21 ,,RBRVS,27.25 ,14.55 ,14.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32400,CPT,BIOPSY PLEURA PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,1.76 ,0.64 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32405,CPT,BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,1.93 ,0.89 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32440,CPT,REMOVAL OF LUNG PNEUMONECTOMY,,,21 ,,RBRVS,27.28 ,13.68 ,13.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32442,CPT,REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA,,,21 ,,RBRVS,56.47 ,22.21 ,22.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32445,CPT,REMOVAL LUNG PNEUMONECTOMY EXTRAPLEURAL,,,21 ,,RBRVS,63.84 ,27.03 ,27.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32480,CPT,RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT,,,21 ,,RBRVS,25.82 ,12.87 ,12.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32482,CPT,RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC,,,21 ,,RBRVS,27.44 ,14.02 ,14.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32484,CPT,RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY,,,21 ,,RBRVS,25.38 ,12.11 ,12.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32486,CPT,RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY,,,21 ,,RBRVS,42.88 ,18.00 ,18.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32488,CPT,RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC,,,21 ,,RBRVS,42.99 ,18.78 ,18.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32491,CPT,RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG,,,21 ,,RBRVS,25.24 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32501,CPT,RESCJ&BRONCHOPLASTY PFRMD TM LOBEC/SGMECTOMY,,,21 ,,RBRVS,4.68 ,1.65 ,1.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32503,CPT,RESCJ APICAL LUNG TUMOR W/O CHEST WALL RCNSTJ,,,21 ,,RBRVS,31.74 ,15.73 ,15.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32504,CPT,RESCJ APICAL LUNG TUMOR W/CHEST WALL RCNSTJ,,,21 ,,RBRVS,36.54 ,16.90 ,16.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32505,CPT,THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL,,,21 ,,RBRVS,15.75 ,8.61 ,8.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32506,CPT,THORACOTOMY W/THERAP WEDGE RESEXN ADDL IPSILATRL,,,21 ,,RBRVS,3.00 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32507,CPT,THORACOTOMY W/DX WEDGE RESEXN & ANTOM LUNG RESE,,,21 ,,RBRVS,3.00 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32540,CPT,EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY,,,21 ,,RBRVS,30.35 ,14.36 ,14.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32550,CPT,INSERTION INDWELLING TUNNELED PLEURAL CATHETER,,,21 ,,RBRVS,4.17 ,1.82 ,18.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32551,CPT,TUBE THORACOSTOMY INCLUDES WATER SEAL,,,21 ,,RBRVS,3.29 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32552,CPT,RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF,,,21 ,,RBRVS,2.53 ,1.81 ,2.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32553,CPT,PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT,,,21 ,,RBRVS,3.80 ,1.47 ,12.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32554,CPT,THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING,,,21 ,,RBRVS,1.82 ,0.65 ,24.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32555,CPT,THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,,,21 ,,RBRVS,2.27 ,0.81 ,14.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32556,CPT,PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING,,,21 ,,RBRVS,2.50 ,0.88 ,15.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32557,CPT,PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING,,,21 ,,RBRVS,3.12 ,1.07 ,28.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32560,CPT,INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS,,,21 ,,RBRVS,1.54 ,0.60 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32561,CPT,INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY,,,21 ,,RBRVS,1.39 ,0.47 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32562,CPT,INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY,,,21 ,,RBRVS,1.24 ,0.41 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32601,CPT,THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX,,,21 ,,RBRVS,5.50 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32604,CPT,THORACOSCOPY DX PERICARDIAL SAC W/BIOPSY SPX,,,21 ,,RBRVS,8.77 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32606,CPT,THORACOSCOPY DX MEDIASTINAL SPACE W/BIOPSY SPX,,,21 ,,RBRVS,8.39 ,3.64 ,3.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32607,CPT,THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL,,,21 ,,RBRVS,5.50 ,2.51 ,2.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32608,CPT,THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL,,,21 ,,RBRVS,6.84 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32609,CPT,THORACOSCOPY WITH BIOPSYIES OF PLEURA,,,21 ,,RBRVS,4.58 ,2.20 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32650,CPT,THORACOSCOPY W/PLEURODESIS,,,21 ,,RBRVS,10.83 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32651,CPT,THORACOSCOPY W/PARTIAL PULMONARY DECORTICATION,,,21 ,,RBRVS,18.78 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32652,CPT,THRSC TOT PULM DCRTCTJ INTRAPLEURAL PNEUMONOLSS,,,21 ,,RBRVS,29.13 ,13.91 ,13.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32653,CPT,THORACOSCOPY RMVL INTRAPLEURAL FB/FIBRIN DEPOSIT,,,21 ,,RBRVS,18.17 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32654,CPT,THORACOSCOPY CONTROL TRAUMATIC HEMORRHAGE,,,21 ,,RBRVS,20.52 ,10.15 ,10.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32655,CPT,THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX,,,21 ,,RBRVS,16.17 ,8.82 ,8.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32656,CPT,THORACOSCOPY W/PARIETAL PLEURECTOMY,,,21 ,,RBRVS,13.26 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32658,CPT,THORACOSCOPY W/RMVL CLOT/FB FROM PERICARDIAL SAC,,,21 ,,RBRVS,11.71 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32659,CPT,THRSC CRTJ PRCRD WINDOW/PRTL RESCJ PRCRD SAC,,,21 ,,RBRVS,11.94 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32661,CPT,THORACOSCOPY W/EXC PERICARDIAL CYST TUMOR/MASS,,,21 ,,RBRVS,13.33 ,7.69 ,7.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32662,CPT,THORACOSCOPY W/EXC MEDIASTINAL CYST TUMOR/MASS,,,21 ,,RBRVS,14.99 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32663,CPT,THORACOSCOPY W/LOBECTOMY SINGLE LOBE,,,21 ,,RBRVS,24.64 ,11.90 ,11.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32664,CPT,THORACOSCOPY W/THORACIC SYMPATHECTOMY,,,21 ,,RBRVS,14.28 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32665,CPT,THORACOSCOPY W/ESOPHAGOMYOTOMY HELLER TYPE,,,21 ,,RBRVS,21.53 ,10.52 ,10.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32666,CPT,THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT,,,21 ,,RBRVS,14.50 ,8.27 ,8.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32667,CPT,THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL,,,21 ,,RBRVS,3.00 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32668,CPT,THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG RESEXN,,,21 ,,RBRVS,3.00 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32669,CPT,THORACOSCOPY W/SEGMENTECTOMY,,,21 ,,RBRVS,23.53 ,11.29 ,11.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32670,CPT,THORACOSCOPY W/BILOBECTOMY,,,21 ,,RBRVS,28.52 ,12.99 ,12.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32671,CPT,THORACOSCOPY W/PNEUMONECTOMY,,,21 ,,RBRVS,31.92 ,13.93 ,13.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32672,CPT,THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG UNIL,,,21 ,,RBRVS,27.00 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32673,CPT,THORACOSCOPY RESEXN THYMUS UNI/BILATERAL,,,21 ,,RBRVS,21.13 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32674,CPT,THORCOSCPY W/MEDIASTINL & REGIONL LYMPHDENECTOMY,,,21 ,,RBRVS,4.12 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32701,CPT,THORAX STEREOTACTIC RADIATION TARGET W/TX COURSE,,,21 ,,RBRVS,4.18 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32800,CPT,REPAIR LUNG HERNIA THROUGH CHEST WALL,,,21 ,,RBRVS,15.71 ,8.97 ,8.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32810,CPT,CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA,,,21 ,,RBRVS,14.95 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32815,CPT,OPEN CLOSURE MAJOR BRONCHIAL FISTULA,,,21 ,,RBRVS,50.03 ,22.06 ,22.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32820,CPT,MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC,,,21 ,,RBRVS,22.51 ,12.49 ,12.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32851,CPT,LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,59.64 ,25.84 ,25.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32852,CPT,LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,65.50 ,28.24 ,28.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32853,CPT,LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,84.48 ,33.07 ,33.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32854,CPT,LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,90.00 ,35.30 ,35.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32855,CPT,BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT UNI,,,21 ,,TotalUnits,,,,11.48 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,32900,CPT,RESECTION RIBS EXTRAPLEURAL ALL STAGES,,,21 ,,RBRVS,23.81 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32905,CPT,THORACOPLASTY SCHEDE TYPE/EXTRAPLEURAL,,,21 ,,RBRVS,23.29 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32906,CPT,THORACOP SCHEDE TYP/XTRPLEURAL CLSR BRNCPLR FSTL,,,21 ,,RBRVS,29.30 ,13.67 ,13.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32940,CPT,PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX,,,21 ,,RBRVS,21.34 ,10.82 ,10.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32960,CPT,PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR,,,21 ,,RBRVS,1.84 ,0.82 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32997,CPT,TOTAL LUNG LAVAGE UNILATERAL,,,21 ,,RBRVS,7.31 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,32998,CPT,ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI,,,21 ,,RBRVS,5.68 ,2.28 ,80.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,32999,CPT,UNLISTED PROCEDURE LUNGS & PLEURA,,,21 ,,TotalUnits,,,,2.98 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,33010,CPT,PERICARDIOCENTESIS INITIAL,,,21 ,,RBRVS,2.24 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33011,CPT,PERICARDIOCENTESIS SUBSEQUENT,,,21 ,,RBRVS,2.24 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33015,CPT,TUBE PERICARDIOSTOMY,,,21 ,,RBRVS,8.52 ,5.16 ,5.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33020,CPT,PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY,,,21 ,,RBRVS,14.95 ,8.01 ,8.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33025,CPT,CRTJ PERICARDIAL WINDOW/PRTL RESECJ W/DRG/BX,,,21 ,,RBRVS,13.70 ,7.25 ,7.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33030,CPT,PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS,,,21 ,,RBRVS,36.00 ,14.93 ,14.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33031,CPT,PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS,,,21 ,,RBRVS,45.00 ,17.32 ,17.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33050,CPT,RESECTION PERICARDIAL CYST/TUMOR,,,21 ,,RBRVS,16.97 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33120,CPT,EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP,,,21 ,,RBRVS,38.45 ,15.30 ,15.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33130,CPT,RESECTION EXTERNAL CARDIAC TUMOR,,,21 ,,RBRVS,24.17 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33140,CPT,TRANSMYOCARDIAL LASER REVASCULAR THORACOTOMY SPX,,,21 ,,RBRVS,28.34 ,12.66 ,12.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33141,CPT,TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX,,,21 ,,RBRVS,2.54 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33202,CPT,INSERTION EPICARDIAL ELECTRODE OPEN,,,21 ,,RBRVS,13.20 ,7.14 ,7.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33203,CPT,INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC,,,21 ,,RBRVS,13.97 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33206,CPT,INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL,,,21 ,,RBRVS,7.39 ,4.73 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33207,CPT,INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR,,,21 ,,RBRVS,8.05 ,4.77 ,4.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33208,CPT,INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT,,,21 ,,RBRVS,8.77 ,5.07 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33210,CPT,INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH,,,21 ,,RBRVS,3.30 ,1.38 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33211,CPT,INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX,,,21 ,,RBRVS,3.39 ,1.36 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33212,CPT,INS PM PLS GEN W/EXIST SINGLE LEAD,,,21 ,,RBRVS,5.26 ,3.56 ,3.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33213,CPT,INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS,,,21 ,,RBRVS,5.53 ,3.76 ,3.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33214,CPT,UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS,,,21 ,,RBRVS,7.84 ,4.94 ,4.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33215,CPT,RPSG PREV IMPLTED PM/CVDFB R ATR/R VENTR ELTRD,,,21 ,,RBRVS,4.92 ,3.15 ,3.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33216,CPT,INSJ 1 TRANSVNS ELTRD PERM PACEMAKER OR CVDFB,,,21 ,,RBRVS,5.87 ,4.13 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33217,CPT,INSJ 2 TRANSVNS ELTRD PERM PACEMAKER OR CVDFB,,,21 ,,RBRVS,5.84 ,4.11 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33218,CPT,RPR 1 ELTRD PRM PM/PACING CVDFB,,,21 ,,RBRVS,6.07 ,4.40 ,4.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33220,CPT,RPR 2 ELTRDS PRM PM/PACING CVDFB,,,21 ,,RBRVS,6.15 ,4.41 ,4.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33221,CPT,INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS,,,21 ,,RBRVS,5.80 ,3.43 ,3.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33222,CPT,REVISION/RELOCATION SKIN POCKET PACEMAKER,,,21 ,,RBRVS,5.10 ,4.16 ,4.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33223,CPT,REVJ SKN POCKET FOR CARDIOVERTER-DEFIBRILLATOR,,,21 ,,RBRVS,6.55 ,4.43 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33224,CPT,INSJ ELTRD CAR VEN SYS ATTCH PM/CVDFB PLS GEN,,,21 ,,RBRVS,9.04 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33225,CPT,INSJ ELTRD CAR VEN SYS TM INSJ CVDFB/PM PLS GEN,,,21 ,,RBRVS,8.33 ,3.54 ,3.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33226,CPT,RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD,,,21 ,,RBRVS,8.68 ,4.07 ,4.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33227,CPT,REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD,,,21 ,,RBRVS,5.50 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33228,CPT,REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS,,,21 ,,RBRVS,5.77 ,3.41 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33229,CPT,REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD,,,21 ,,RBRVS,6.04 ,3.51 ,3.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33230,CPT,INS PACNG CVDFB PLS GEN ONLY W/EXIST DUAL LEADS,,,21 ,,RBRVS,6.32 ,3.59 ,3.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33231,CPT,INS PACNG CVDFB PLS GEN ONLY W/EXIST MULTI LEADS,,,21 ,,RBRVS,6.59 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33233,CPT,REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY,,,21 ,,RBRVS,3.39 ,3.03 ,3.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33234,CPT,RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR,,,21 ,,RBRVS,7.91 ,4.96 ,4.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33235,CPT,RMVL TRANSVNS PM ELTRD DUAL LEAD SYS,,,21 ,,RBRVS,10.15 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33236,CPT,RMVL PRM EPICAR PM&ELTRDS THORCOM 1 LEAD SYS,,,21 ,,RBRVS,12.73 ,8.04 ,8.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33237,CPT,RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY,,,21 ,,RBRVS,13.84 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33238,CPT,RMVL PRM TRANSVENOUS ELECTRODE THORACOTOMY,,,21 ,,RBRVS,15.40 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33240,CPT,INSJ 1/2 CHMBR PACING CARDIOVERTERDEFIB PLS GEN,,,21 ,,RBRVS,6.05 ,4.17 ,4.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33241,CPT,REMVL PAC CVDFB PLS GEN ONLY,,,21 ,,RBRVS,3.29 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33243,CPT,RMVL 1/2CHMBR PACG CARDIOVTERDEFIB ELTRD THORCOM,,,21 ,,RBRVS,23.57 ,12.28 ,12.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33244,CPT,RMVL 1/2CHMBR PACG CVDFB ELTRD TRANSVNS XTRJ,,,21 ,,RBRVS,13.99 ,8.54 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33249,CPT,INS/REP PAC PERM CVDFB TRNSVEN LEADS 1/2 CHAMBER,,,21 ,,RBRVS,15.17 ,8.70 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33250,CPT,ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/O BYPASS,,,21 ,,RBRVS,25.90 ,12.14 ,12.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33251,CPT,ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/BYPASS,,,21 ,,RBRVS,28.92 ,13.50 ,13.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33254,CPT,ABLATION & RECONSTRUCTION ATRIA LIMITED,,,21 ,,RBRVS,23.71 ,11.98 ,11.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33255,CPT,ABLATION & RCNSTJ ATRIA X10SV W/O BYPASS,,,21 ,,RBRVS,29.04 ,13.79 ,13.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33256,CPT,ABLATION & RCNSTJ ATRIA X10SV W/BYPASS,,,21 ,,RBRVS,34.90 ,16.12 ,16.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33257,CPT,ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE,,,21 ,,RBRVS,9.63 ,5.82 ,5.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33258,CPT,ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTENSIV W/O BYP,,,21 ,,RBRVS,11.00 ,6.30 ,6.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33259,CPT,ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS,,,21 ,,RBRVS,14.14 ,8.22 ,8.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33261,CPT,OPRATIVE ABLTJ VENTR ARRHYTHMOGENIC FOC W/BYPASS,,,21 ,,RBRVS,28.92 ,13.50 ,13.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33262,CPT,REM PAC CVDFB PLSE GEN &REPL PLSE GEN SNGL LEA,,,21 ,,RBRVS,6.06 ,3.50 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33263,CPT,REM PAC CVDFB PLSE GEN &REPL PLSE GEN DUAL LEA,,,21 ,,RBRVS,6.33 ,3.60 ,3.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33264,CPT,REM PAC CVDFB PLS GEN &REPL PLSE GEN MULTI LEA,,,21 ,,RBRVS,6.60 ,3.70 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33265,CPT,NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPAS,,,21 ,,RBRVS,23.71 ,11.80 ,11.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33266,CPT,NDSC ABLATION & RCNSTJ ATRIA EXTEN W/O BYPASS,,,21 ,,RBRVS,33.04 ,15.17 ,15.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33282,CPT,IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER,,,21 ,,RBRVS,4.80 ,3.82 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33284,CPT,RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER,,,21 ,,RBRVS,3.14 ,3.13 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33300,CPT,REPAIR CARDIAC WOUND W/O BYPASS,,,21 ,,RBRVS,44.97 ,18.14 ,18.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33305,CPT,REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,76.93 ,28.55 ,28.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33310,CPT,CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP,,,21 ,,RBRVS,20.34 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33315,CPT,CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP,,,21 ,,RBRVS,35.00 ,14.30 ,14.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33320,CPT,SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP,,,21 ,,RBRVS,18.54 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33321,CPT,SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS,,,21 ,,RBRVS,20.81 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33322,CPT,SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS,,,21 ,,RBRVS,24.42 ,11.95 ,11.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33330,CPT,INSJ GRAFT AORTA/GREAT VESSEL W/O SHUNT/BYPASS,,,21 ,,RBRVS,25.29 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33332,CPT,INSJ GRAFT AORTA/GREAT VESSEL W/SHUN,,,21 ,,RBRVS,24.56 ,11.94 ,11.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33335,CPT,INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS,,,21 ,,RBRVS,33.91 ,15.26 ,15.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33361,CPT,REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH,,,21 ,,RBRVS,25.13 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33362,CPT,REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH,,,21 ,,RBRVS,27.52 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33363,CPT,REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH,,,21 ,,RBRVS,28.50 ,10.14 ,10.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33364,CPT,REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH,,,21 ,,RBRVS,30.00 ,11.18 ,11.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33365,CPT,REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH,,,21 ,,RBRVS,33.12 ,11.46 ,11.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33367,CPT,REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH,,,21 ,,RBRVS,11.88 ,3.72 ,3.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33368,CPT,REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH,,,21 ,,RBRVS,14.39 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33369,CPT,REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH,,,21 ,,RBRVS,19.00 ,5.96 ,5.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33400,CPT,VALVULOPLASTY AORTIC VALVE OPEN W/BYPASS,,,21 ,,RBRVS,41.50 ,17.94 ,17.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33401,CPT,VALVULOPLASTY AORTIC VALVE OPEN W/INFLOW OCCLUS,,,21 ,,RBRVS,24.63 ,12.95 ,12.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33403,CPT,VLVP AORTIC VALVE W/TRANSVENTR DILAT W/CARD BYP,,,21 ,,RBRVS,25.61 ,13.57 ,13.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33404,CPT,CONSTRUCTION APICAL-AORTIC CONDUIT,,,21 ,,RBRVS,31.37 ,14.77 ,14.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33405,CPT,RPLCMT PROST AORTIC VALVE XCP HOMOGRF/STENT,,,21 ,,RBRVS,41.32 ,18.47 ,18.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33406,CPT,RPLCMT AORTIC VALVE ALLOGRAFT VALVE FREEHAND,,,21 ,,RBRVS,52.68 ,22.07 ,22.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33410,CPT,RPLCMT AORTIC VALVE W/STENTLESS TISSUE VALVE,,,21 ,,RBRVS,46.41 ,19.83 ,19.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33411,CPT,RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS,,,21 ,,RBRVS,62.07 ,25.17 ,25.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33412,CPT,REPLACEMENT AORTIC VALVE KONNO PROCEDURE,,,21 ,,RBRVS,59.00 ,22.78 ,22.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33413,CPT,REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDUR,,,21 ,,RBRVS,59.87 ,24.60 ,24.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33414,CPT,RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC,,,21 ,,RBRVS,39.37 ,16.59 ,16.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33415,CPT,RESECTION/INCISION SUBVALVULAR TISSUE,,,21 ,,RBRVS,37.27 ,16.58 ,16.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33416,CPT,VENTRICULOMYOTOMY-MYECTOMY,,,21 ,,RBRVS,36.56 ,16.46 ,16.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33417,CPT,AORTOPLASTY SUPRAVALVULAR STENOSIS,,,21 ,,RBRVS,29.33 ,14.28 ,14.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33420,CPT,VALVOTOMY MITRAL VALVE CLOSED HEART,,,21 ,,RBRVS,25.79 ,14.54 ,14.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33422,CPT,VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS,,,21 ,,RBRVS,29.73 ,14.19 ,14.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33425,CPT,VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS,,,21 ,,RBRVS,49.96 ,20.85 ,20.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33426,CPT,VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING,,,21 ,,RBRVS,43.28 ,19.03 ,19.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33427,CPT,VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING,,,21 ,,RBRVS,44.83 ,19.16 ,19.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33430,CPT,REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP,,,21 ,,RBRVS,50.93 ,22.27 ,22.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33460,CPT,VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP,,,21 ,,RBRVS,44.70 ,17.93 ,17.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33463,CPT,VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION,,,21 ,,RBRVS,57.08 ,22.83 ,22.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33464,CPT,VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION,,,21 ,,RBRVS,44.62 ,18.94 ,18.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33465,CPT,REPLACEMENT TRICUSPID VALVE W/CARD BYPASS,,,21 ,,RBRVS,50.72 ,20.73 ,20.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33468,CPT,TRICUSPID VALVE RPSG&PLCTJ EBSTEIN ANOMALY,,,21 ,,RBRVS,45.13 ,17.97 ,17.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33470,CPT,VALVOTOMY PULMONARY VALVE CLSD HEART TRANSVENTR,,,21 ,,RBRVS,21.54 ,10.87 ,10.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33471,CPT,VALVOTOMY PULM VALVE CLSD HEART VIA PULM ARTERY,,,21 ,,RBRVS,22.96 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33472,CPT,VALVOTOMY PULM VALVE OPEN HRT W/INFLOW OCCLUSION,,,21 ,,RBRVS,23.06 ,12.15 ,12.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33474,CPT,VALVOTOMY PULMONARY VALVE OPEN HEART W/BYPASS,,,21 ,,RBRVS,39.40 ,16.60 ,16.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33475,CPT,REPLACEMENT PULMONARY VALVE,,,21 ,,RBRVS,42.40 ,18.23 ,18.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33476,CPT,R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY,,,21 ,,RBRVS,26.57 ,13.04 ,13.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33478,CPT,OUTFLOW TRACT AGMNTJ W/WO COMMISSUR/INFUND RESCJ,,,21 ,,RBRVS,27.54 ,13.58 ,13.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33496,CPT,RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS,,,21 ,,RBRVS,29.84 ,13.99 ,13.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33500,CPT,RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS,,,21 ,,RBRVS,27.94 ,13.16 ,13.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33501,CPT,RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/O BYPASS,,,21 ,,RBRVS,19.51 ,9.89 ,9.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33502,CPT,RPR ANOM CORONARY ART PULM ART ORIGIN LIGATION,,,21 ,,RBRVS,21.85 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33503,CPT,RPR ANOM CORONARY ARTERY PULM ART ORIGIN GRAFT,,,21 ,,RBRVS,22.51 ,12.25 ,12.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33504,CPT,RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP,,,21 ,,RBRVS,25.46 ,12.89 ,12.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33505,CPT,RPR ANOM CORON ART W/CONSTJ INTRAPULM ART TUNNEL,,,21 ,,RBRVS,38.40 ,14.88 ,14.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33506,CPT,RPR ANOM CORONARY ART FROM PULM ART TO AORTA,,,21 ,,RBRVS,37.85 ,15.57 ,15.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33507,CPT,RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ,,,21 ,,RBRVS,31.40 ,13.52 ,13.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33508,CPT,NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG,,,21 ,,RBRVS,0.31 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,33510,CPT,CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT,,,21 ,,RBRVS,34.98 ,15.80 ,15.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33511,CPT,CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS,,,21 ,,RBRVS,38.45 ,17.27 ,17.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33512,CPT,CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS,,,21 ,,RBRVS,43.98 ,19.17 ,19.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33513,CPT,CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS,,,21 ,,RBRVS,45.37 ,19.39 ,19.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33514,CPT,CORONARY ARTERY BYPASS 5 CORONARY VENOUS GRAFTS,,,21 ,,RBRVS,48.08 ,20.43 ,20.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33516,CPT,CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT,,,21 ,,RBRVS,49.76 ,21.27 ,21.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33517,CPT,CORONARY ARTERY BYP W VEIN & ARTERY GRAFT 1 VEI,,,21 ,,RBRVS,3.61 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33518,CPT,CORONARY ARTERY BYP W VEIN & ARTERY GRAFT 2 VEI,,,21 ,,RBRVS,7.93 ,2.69 ,2.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33519,CPT,CORONARY ARTERY BYP W VEIN & ARTERY GRAFT 3 VEI,,,21 ,,RBRVS,10.49 ,3.58 ,3.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33521,CPT,CORONARY ARTERY BYP W VEIN & ARTERY GRAFT 4 VEI,,,21 ,,RBRVS,12.59 ,4.31 ,4.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33522,CPT,CORONARY ARTERY BYP W VEIN & ARTERY GRAFT 5 VEI,,,21 ,,RBRVS,14.14 ,4.87 ,4.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33523,CPT,CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 6 VEI,,,21 ,,RBRVS,16.08 ,5.54 ,5.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33530,CPT,ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ,,,21 ,,RBRVS,10.13 ,3.42 ,3.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33533,CPT,CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT,,,21 ,,RBRVS,33.75 ,15.42 ,15.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33534,CPT,CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS,,,21 ,,RBRVS,39.88 ,17.79 ,17.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33535,CPT,CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS,,,21 ,,RBRVS,44.75 ,19.42 ,19.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33536,CPT,CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS,,,21 ,,RBRVS,48.43 ,20.59 ,20.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33542,CPT,MYOCARDIAL RESECTION,,,21 ,,RBRVS,48.21 ,19.98 ,19.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33545,CPT,RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT,,,21 ,,RBRVS,57.06 ,23.20 ,23.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33548,CPT,SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD,,,21 ,,RBRVS,54.14 ,23.45 ,23.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33572,CPT,CORONARY ENDARTERCOMY OPEN ANY METHOD,,,21 ,,RBRVS,4.44 ,1.54 ,1.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33600,CPT,CLOSURE ATRIOVENTRICULAR VALVE SUTURE/PATCH,,,21 ,,RBRVS,30.31 ,14.56 ,14.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33602,CPT,CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH,,,21 ,,RBRVS,29.34 ,14.08 ,14.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33606,CPT,ANAST PULMONARY ART AORTA DAMUS-KAYE-STANSEL PX,,,21 ,,RBRVS,31.53 ,17.03 ,17.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33608,CPT,RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT,,,21 ,,RBRVS,31.88 ,15.23 ,15.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33610,CPT,RPR CAR ANOMAL SURG ENLGMENT VENTR SEPTL DFCT,,,21 ,,RBRVS,31.40 ,15.03 ,15.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33611,CPT,RPR 2 OUTLET R VNTRC W/INTRAVENTR TUNNEL RPR,,,21 ,,RBRVS,35.57 ,16.94 ,16.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33612,CPT,RPR 2 OUTLET R VNTRC RPR R VENTR O/F TRC OBSTRCJ,,,21 ,,RBRVS,36.57 ,15.48 ,15.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33615,CPT,RPR CAR ANOMAL CLSR SEPTL DFCT SMPL FONTAN PX,,,21 ,,RBRVS,35.89 ,16.42 ,16.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33617,CPT,RPR COMPLEX CARDIAC ANOMALY MODIFIED FONTAN PX,,,21 ,,RBRVS,39.09 ,17.15 ,17.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33619,CPT,RPR 1 VNTRC W/O/F OBSTRCJ&AORTIC ARCH HYPOPLAS,,,21 ,,RBRVS,48.76 ,21.63 ,21.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33620,CPT,APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND,,,21 ,,RBRVS,30.00 ,12.53 ,12.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33621,CPT,TRANSTHORACIC CATHETER INSERTION FOR STENT PLMT,,,21 ,,RBRVS,16.18 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33622,CPT,RECONSTRUCTION COMPLEX CARDIAC ANOMALY,,,21 ,,RBRVS,64.00 ,26.31 ,26.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33641,CPT,RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH,,,21 ,,RBRVS,29.58 ,13.03 ,13.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33645,CPT,DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG,,,21 ,,RBRVS,31.30 ,13.58 ,13.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33647,CPT,RPR ATRIAL & VENTRIC SEPTAL DFCT DIR/PATCH CLS,,,21 ,,RBRVS,33.00 ,14.46 ,14.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33660,CPT,RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR,,,21 ,,RBRVS,31.83 ,13.85 ,13.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33665,CPT,RPR INTRM/TRANSJ AV CANAL W/WO AV VALVE RPR,,,21 ,,RBRVS,34.85 ,14.95 ,14.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33670,CPT,RPR COMPL AV CANAL W/WO PROSTC VALVE,,,21 ,,RBRVS,36.63 ,14.64 ,14.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33675,CPT,CLOSURE MULTIPLE VENTRICULAR SEPTAL DEFECTS,,,21 ,,RBRVS,35.95 ,15.31 ,15.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33676,CPT,CLOSURE MULTIPLE VSD W/RESECTION,,,21 ,,RBRVS,36.95 ,17.62 ,17.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33677,CPT,CLOSURE MULTIPLE VSD W/REMOVAL ARTERY BAND,,,21 ,,RBRVS,38.45 ,18.23 ,18.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33681,CPT,CLSR 1 VENTRICULAR SEPTAL DEFECT W/WO PATCH,,,21 ,,RBRVS,32.34 ,15.66 ,15.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33684,CPT,CLSR V-SEPTL DFCT W/PULM VLVT/INFUND RESCJ,,,21 ,,RBRVS,34.37 ,14.88 ,14.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33688,CPT,CLSR V-SEPTAL DFCT W/RMVL P-ART BAND W/WO GUSSET,,,21 ,,RBRVS,34.75 ,14.08 ,14.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33690,CPT,BANDING PULMONARY ARTERY,,,21 ,,RBRVS,20.36 ,11.04 ,11.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33692,CPT,COMPL RPR TETRALOGY FALLOT W/O PULM ATRESIA,,,21 ,,RBRVS,36.15 ,14.58 ,14.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33694,CPT,COMPL RPR T-FALLOT W/O PULM ATRESIA TANULR PATCH,,,21 ,,RBRVS,35.57 ,15.32 ,15.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33697,CPT,COMPL RPR T-FALLOT W/PULM ATRESIA,,,21 ,,RBRVS,37.57 ,16.88 ,16.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33702,CPT,RPR SINUS VALSALVA FISTULA,,,21 ,,RBRVS,27.24 ,13.16 ,13.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33710,CPT,RPR SINUS VALSALVA FISTULA W/RPR V-SEPTAL DEFECT,,,21 ,,RBRVS,37.50 ,16.48 ,16.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33720,CPT,RPR SINUS VALSALVA ANEURYSM,,,21 ,,RBRVS,27.26 ,13.29 ,13.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33722,CPT,CLOSURE AORTICO-LEFT VENTRICULAR TUNNEL,,,21 ,,RBRVS,29.21 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33724,CPT,REPAIR ISOLATED PARTIAL PULM VENOUS RETURN,,,21 ,,RBRVS,27.63 ,12.80 ,12.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33726,CPT,REPAIR PULMONARY VENOUS STENOSIS,,,21 ,,RBRVS,37.12 ,16.04 ,16.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33730,CPT,COMPLETE RPR ANOMALOUS PULMONARY VENOUS RETURN,,,21 ,,RBRVS,36.14 ,18.10 ,18.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33732,CPT,RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB,,,21 ,,RBRVS,28.96 ,14.21 ,14.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33735,CPT,ATRIAL SEPTECTOMY/SEPTOSTOMY CLOSED HEART,,,21 ,,RBRVS,22.20 ,11.14 ,11.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33736,CPT,ATRIAL SEPTECTOMY/SEPTOSTOMY OPEN HEART W/BYPASS,,,21 ,,RBRVS,24.32 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33737,CPT,ATRIAL SEPTECT/SEPTOST OPN HRT W/INFL OCCLUSION,,,21 ,,RBRVS,22.47 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33750,CPT,SHUNT SUBCLAVIAN PULMONARY ARTERY,,,21 ,,RBRVS,22.22 ,11.50 ,11.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33755,CPT,SHUNT ASCENDING AORTA PULMONARY ARTERY,,,21 ,,RBRVS,22.60 ,12.54 ,12.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33762,CPT,SHUNT DESCENDING AORTA PULMONARY ARTERY,,,21 ,,RBRVS,22.60 ,12.55 ,12.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33764,CPT,SHUNT CENTRAL W/PROSTHETIC GRAFT,,,21 ,,RBRVS,22.60 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33766,CPT,SHUNT SUPERIOR VENA CAVA PULMONARY ART 1 LUNG,,,21 ,,RBRVS,23.57 ,12.66 ,12.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33767,CPT,SHUNT SUPERIOR VENA CAVA PULM ARTERY BOTH LUNGS,,,21 ,,RBRVS,25.30 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33768,CPT,ANASTOMOSIS CAVOPULMARY 2ND SUPRIOR VENA CAVA,,,21 ,,RBRVS,8.00 ,3.27 ,3.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33770,CPT,RPR TRPOS GREAT VSLS W/O ENLGMNT V-SEPTL DFCT,,,21 ,,RBRVS,39.07 ,17.92 ,17.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33771,CPT,RPR TRPOS GREAT VSLS W/ENLGMNT V-SEPTL DFCT,,,21 ,,RBRVS,40.63 ,16.38 ,16.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33774,CPT,RPR TRPOS GREAT VSLS ATRIAL BAFFLE PX W/BYPASS,,,21 ,,RBRVS,31.73 ,15.41 ,15.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33775,CPT,RPR TRPOS GREAT VSLS ATR BAFFLE W/RMVL PULM BAND,,,21 ,,RBRVS,32.99 ,16.95 ,16.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33776,CPT,RPR TRPOS GRT VSL ATR BAFFLE W/CLSR V-SEPTL DFCT,,,21 ,,RBRVS,34.75 ,18.02 ,18.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33777,CPT,RPR TRPOS GRT VSL ATR BAFFLE W/BYP SBPULM OBSTRC,,,21 ,,RBRVS,34.17 ,16.89 ,16.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33778,CPT,RPR TRPOS GRT VESSEL AORTIC PULMONARY ART RCNSTJ,,,21 ,,RBRVS,42.75 ,18.48 ,18.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33779,CPT,RPR TGV AORTIC PULM ART RCNSTJ W/RMVL PULM BAND,,,21 ,,RBRVS,43.23 ,19.49 ,19.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33780,CPT,RPR TGV AORTIC P-ART RCNSTJ W/CLSR V-SEPTL DFCT,,,21 ,,RBRVS,43.90 ,20.22 ,20.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33781,CPT,RPR TGV AORTIC P-ART RCNSTJ RPR SBPULMC OBSTRCJ,,,21 ,,RBRVS,43.21 ,16.70 ,16.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33782,CPT,A-ROOT TLCJ VSD PULM STNS RPR W/O C OST RIMPLTJ,,,21 ,,RBRVS,60.08 ,22.71 ,22.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33783,CPT,A-ROOT TLCJ VSD PULM STNS RPR W/RIMPLTJ C OSTIA,,,21 ,,RBRVS,65.08 ,24.57 ,24.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33786,CPT,TOTAL REPAIR TRUNCUS ARTERIOSUS,,,21 ,,RBRVS,41.87 ,17.30 ,17.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33788,CPT,REIMPLANTATION ANOMALOUS PULMONARY ARTERY,,,21 ,,RBRVS,27.42 ,12.64 ,12.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33800,CPT,AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX,,,21 ,,RBRVS,17.28 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33802,CPT,DIVISION ABERRANT VESSEL VASCULAR RING,,,21 ,,RBRVS,18.37 ,10.01 ,10.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33803,CPT,DIVISION ABERRANT VESSEL W/REANASTOMOSIS,,,21 ,,RBRVS,20.31 ,10.87 ,10.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33813,CPT,OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS,,,21 ,,RBRVS,21.36 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33814,CPT,OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS,,,21 ,,RBRVS,26.57 ,15.22 ,15.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33820,CPT,REPAIR PATENT DUCTUS ARTERIOSUS LIGATION,,,21 ,,RBRVS,16.69 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33822,CPT,RPR PATENT DUXUS ARTERIOSUS DIV UNDER 18 YR,,,21 ,,RBRVS,17.71 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33824,CPT,RPR PATENT DUXUS ARTERIOSUS DIV 18 YR & OLDER,,,21 ,,RBRVS,20.23 ,10.68 ,10.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33840,CPT,EXC COARCJ AORTA W/WO PDA W/DIRECT ANASTOMOSIS,,,21 ,,RBRVS,21.34 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33845,CPT,EXCISION COARCTATION AORTA W/WO PDA W/GRAFT,,,21 ,,RBRVS,22.93 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33851,CPT,EXC COARCJ AORTA W/L SUBCLAV ART/PROSTC GUSSET,,,21 ,,RBRVS,21.98 ,12.86 ,12.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33852,CPT,RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/O BYPASS,,,21 ,,RBRVS,24.41 ,11.78 ,11.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33853,CPT,RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/BYPASS,,,21 ,,RBRVS,32.51 ,15.73 ,15.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33860,CPT,ASCENDING AORTA GRF W/CARD BYP & VALVE SSP,,,21 ,,RBRVS,59.46 ,23.83 ,23.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33863,CPT,AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT,,,21 ,,RBRVS,58.79 ,23.06 ,23.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33864,CPT,ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL,,,21 ,,RBRVS,60.08 ,23.74 ,23.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33870,CPT,TRANSVERSE ARCH GRAFT W/CARDIOPULMONARY BYPASS,,,21 ,,RBRVS,46.06 ,19.77 ,19.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33875,CPT,DESCENDING THORACIC AORTA GRAFT W/WO BYPASS,,,21 ,,RBRVS,50.72 ,20.40 ,20.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33877,CPT,RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS,,,21 ,,RBRVS,69.03 ,24.69 ,24.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33880,CPT,EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH,,,21 ,,RBRVS,34.58 ,13.15 ,13.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33881,CPT,EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN,,,21 ,,RBRVS,29.58 ,11.56 ,11.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33883,CPT,PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN,,,21 ,,RBRVS,21.09 ,8.81 ,8.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33884,CPT,PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN,,,21 ,,RBRVS,8.20 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33886,CPT,PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA,,,21 ,,RBRVS,18.09 ,7.65 ,7.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33889,CPT,OPN SUBCLA CRTD ART TRPOS NCK INC ULAT,,,21 ,,RBRVS,15.92 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33891,CPT,BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC,,,21 ,,RBRVS,20.00 ,5.54 ,5.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33910,CPT,PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS,,,21 ,,RBRVS,48.21 ,18.55 ,18.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33915,CPT,PULMONARY ARTERY EMBOLECTOMY W/O CARD BYPASS,,,21 ,,RBRVS,24.95 ,11.18 ,11.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33916,CPT,PULMONARY ENDARTERCOMY W/WO EMBOLECTOMY W/BYPASS,,,21 ,,RBRVS,78.00 ,26.52 ,26.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33917,CPT,RPR PULMONARY ART STENOSIS RCNSTJ W/PATCH/GRAFT,,,21 ,,RBRVS,25.30 ,13.25 ,13.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33920,CPT,RPR PULMONARY ATRESIA W/CONSTJ/RPLCMT CONDUIT,,,21 ,,RBRVS,32.74 ,14.39 ,14.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33922,CPT,TRANSECTION PULMONARY ARTERY W/CARD BYPASS,,,21 ,,RBRVS,24.22 ,13.83 ,13.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33924,CPT,LIG&TKDN SYSIC-TO-PULM ART SHUNT W/CGEN HEART,,,21 ,,RBRVS,5.49 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33925,CPT,RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS,,,21 ,,RBRVS,31.30 ,13.63 ,13.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33926,CPT,RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/BYPASS,,,21 ,,RBRVS,44.73 ,17.74 ,17.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33935,CPT,HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC,,,21 ,,RBRVS,91.78 ,34.81 ,34.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33940,CPT,DONOR CARDIECTOMY,,,21 ,,TotalUnits,,,,39.56 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,33944,CPT,BKBENCH PREPJ CADAVER DONOR HEART ALLOGRAFT,,,21 ,,TotalUnits,,,,27.63 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,33945,CPT,HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY,,,21 ,,RBRVS,89.50 ,36.14 ,36.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33960,CPT,PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY,,,21 ,,RBRVS,19.33 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33961,CPT,PROLONGED EXTRACORPOREAL CIRCULATION EA ADDL DAY,,,21 ,,RBRVS,10.91 ,3.95 ,3.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33967,CPT,INSERTION INTRA-AORTIC BALLOON ASSIST DEV PRQ,,,21 ,,RBRVS,4.84 ,2.02 ,2.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33968,CPT,REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ,,,21 ,,RBRVS,0.64 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33970,CPT,INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN,,,21 ,,RBRVS,6.74 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33971,CPT,RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF,,,21 ,,RBRVS,11.99 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33973,CPT,INSJ I-AORT BALO ASSIST DEV VIA ASCENDING AORTA,,,21 ,,RBRVS,9.75 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33974,CPT,RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA,,,21 ,,RBRVS,15.03 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33975,CPT,INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE,,,21 ,,RBRVS,25.00 ,8.69 ,8.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33976,CPT,INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR,,,21 ,,RBRVS,30.75 ,10.08 ,10.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33977,CPT,REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE,,,21 ,,RBRVS,20.86 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33978,CPT,REMOVAL VENTR ASSIST DEVICE XTRCORP BIVENTR,,,21 ,,RBRVS,25.00 ,10.37 ,10.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33979,CPT,INSJ VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC,,,21 ,,RBRVS,37.50 ,13.86 ,13.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33980,CPT,RMVL VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC,,,21 ,,RBRVS,33.50 ,17.07 ,17.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33981,CPT,RPLCMT XTRCORP VAD 1/BIVENTR PUMP 1/EA PUMP,,,21 ,,RBRVS,16.11 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33982,CPT,PLCMT VAD PMP IMPLTBL ICORP 1 VENTR W/O BYPASS,,,21 ,,RBRVS,37.86 ,12.48 ,12.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33983,CPT,RPLCMT VAD PMP IMPLTBL ICORP 1 VNTR W/BYPASS,,,21 ,,RBRVS,44.54 ,14.54 ,14.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33990,CPT,INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY,,,21 ,,RBRVS,8.15 ,2.95 ,2.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33991,CPT,INSJ PERQ VAD TRNSPTAL W/IMAGE ART&VENOUS ACCESS,,,21 ,,RBRVS,11.88 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33992,CPT,REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION,,,21 ,,RBRVS,4.00 ,1.26 ,1.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33993,CPT,REPOSITION VAD W/IMAGING DIFFERENT SESSION,,,21 ,,RBRVS,3.51 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,33999,CPT,UNLISTED CARDIAC SURGERY,,,21 ,,TotalUnits,,,,10.22 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,34001,CPT,EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART,,,21 ,,RBRVS,17.88 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34051,CPT,EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY,,,21 ,,RBRVS,16.99 ,7.24 ,7.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34101,CPT,EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART,,,21 ,,RBRVS,10.93 ,5.40 ,5.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34111,CPT,EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC,,,21 ,,RBRVS,10.93 ,5.44 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34151,CPT,EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART,,,21 ,,RBRVS,26.52 ,10.89 ,10.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34201,CPT,EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART,,,21 ,,RBRVS,19.48 ,8.02 ,8.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34203,CPT,EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC,,,21 ,,RBRVS,17.86 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34401,CPT,THRMBC DIR/W/CATH VENA CAVA ILIAC VEIN ABDL INC,,,21 ,,RBRVS,26.52 ,12.23 ,12.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34421,CPT,THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN LEG INC,,,21 ,,RBRVS,13.37 ,6.42 ,6.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34451,CPT,THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN ABDL&LEG,,,21 ,,RBRVS,28.52 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34471,CPT,THRMBC DIR/W/CATH SUBCLAVIAN VEIN NECK INC,,,21 ,,RBRVS,21.11 ,11.04 ,11.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34490,CPT,THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM IN,,,21 ,,RBRVS,10.91 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34501,CPT,VALVULOPLASTY FEMORAL VEIN,,,21 ,,RBRVS,16.85 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34502,CPT,RECONSTRUCTION VENA CAVA ANY METHOD,,,21 ,,RBRVS,28.07 ,12.84 ,12.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34510,CPT,VENOUS VALVE TRANSPOSITION ANY VEIN DONOR,,,21 ,,RBRVS,19.91 ,10.92 ,10.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34520,CPT,CROSS-OVER VEIN GRAFT VENOUS SYSTEM,,,21 ,,RBRVS,19.18 ,7.47 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34530,CPT,SAPHENOPOPLITEAL VEIN ANASTOMOSIS,,,21 ,,RBRVS,17.93 ,7.46 ,7.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,34800,CPT,EVASC RPR AAA W/AORTO-AORTIC TUBE PROSTH,,,21 ,,RBRVS,21.54 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34802,CPT,EVASC RPR AAA W/MDLR BFRC PROSTH 1 LIMB,,,21 ,,RBRVS,23.79 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34803,CPT,EVASC RPR AAA W/MDLR BFRC PROSTH 2 LIMBS,,,21 ,,RBRVS,24.82 ,9.60 ,9.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34804,CPT,EVASC RPR AAA W/UNIBDY BFRC PROSTH,,,21 ,,RBRVS,23.79 ,9.66 ,9.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34805,CPT,EVASC RPR AAA AORTO-UNIILIAC/AORTO-UNIFEM PROSTH,,,21 ,,RBRVS,22.67 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34806,CPT,TCAT PLACEMENT PHYSIOLOGIC SENSOR ANEURYSMAL SAC,,,21 ,,RBRVS,2.06 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34808,CPT,EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE,,,21 ,,RBRVS,4.12 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34812,CPT,OPN FEM ART EXPOS DLVR EVASC PROSTH UNI,,,21 ,,RBRVS,6.74 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34813,CPT,PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR,,,21 ,,RBRVS,4.79 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34820,CPT,ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI,,,21 ,,RBRVS,9.74 ,3.07 ,3.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34825,CPT,PLMT XTN PROSTH EVASC RPR ARYSM/DSJ 1ST VSL,,,21 ,,RBRVS,12.80 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34826,CPT,PLMT XTN PROSTH EVASC RPR ARYSM/DSJ EA VSL,,,21 ,,RBRVS,4.12 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34830,CPT,OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH,,,21 ,,RBRVS,35.23 ,11.91 ,11.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34831,CPT,OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH,,,21 ,,RBRVS,37.98 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34832,CPT,OPN RPR ARYSM RPR ARTL TRMA AORTO-BIFEM PROSTH,,,21 ,,RBRVS,37.98 ,12.67 ,12.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34833,CPT,ILIAC ART EXPOS W/CRTJ CONDUIT UNI,,,21 ,,RBRVS,11.98 ,4.08 ,4.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34834,CPT,BRACH ART EXPOS DPLMNT AORTIC/ILIAC PROSTH UNI,,,21 ,,RBRVS,5.34 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,34900,CPT,EVASC RPR ILIAC ART ILIO-ILIAC PROSTHESIS,,,21 ,,RBRVS,16.85 ,7.20 ,7.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35001,CPT,DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY,,,21 ,,RBRVS,20.81 ,9.59 ,9.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35002,CPT,DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY,,,21 ,,RBRVS,22.23 ,11.97 ,11.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35005,CPT,DIR RPR ANEURYSM VERTEBRAL ARTERY,,,21 ,,RBRVS,19.29 ,9.22 ,9.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35011,CPT,DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION,,,21 ,,RBRVS,18.58 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35013,CPT,DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS,,,21 ,,RBRVS,23.23 ,9.94 ,9.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35021,CPT,DIR RPR ANEURYSM INNOMINATE/SUBCLAVIAN ARTERY,,,21 ,,RBRVS,22.17 ,10.38 ,10.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35022,CPT,DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN,,,21 ,,RBRVS,25.70 ,11.94 ,11.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35045,CPT,DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY,,,21 ,,RBRVS,18.01 ,8.32 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35081,CPT,DIR RPR ANEURYSM ABDOMINAL AORTA,,,21 ,,RBRVS,33.53 ,13.20 ,13.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35082,CPT,DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA,,,21 ,,RBRVS,42.09 ,16.25 ,16.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35091,CPT,DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS,,,21 ,,RBRVS,35.35 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35092,CPT,DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS,,,21 ,,RBRVS,50.97 ,18.20 ,18.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35102,CPT,DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS,,,21 ,,RBRVS,36.53 ,13.82 ,13.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35103,CPT,DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS,,,21 ,,RBRVS,43.62 ,16.08 ,16.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35111,CPT,DIR RPR ANEURYSM SPLENIC ARTERY,,,21 ,,RBRVS,26.28 ,9.37 ,9.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35112,CPT,DIR RPR RUPTD ANEURYSM SPLENIC ARTERY,,,21 ,,RBRVS,32.57 ,15.96 ,15.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35121,CPT,DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC,,,21 ,,RBRVS,31.52 ,12.04 ,12.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35122,CPT,DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN,,,21 ,,RBRVS,37.89 ,18.09 ,18.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35131,CPT,DIR RPR ANEURYSM & GRAFT ILIAC ARTERY,,,21 ,,RBRVS,26.40 ,10.90 ,10.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35132,CPT,DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY,,,21 ,,RBRVS,32.57 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35141,CPT,DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY,,,21 ,,RBRVS,20.91 ,8.78 ,8.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35142,CPT,DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART,,,21 ,,RBRVS,25.16 ,10.45 ,10.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35151,CPT,DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY,,,21 ,,RBRVS,23.72 ,9.75 ,9.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35152,CPT,DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY,,,21 ,,RBRVS,27.66 ,9.86 ,9.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35180,CPT,REPAIR CONGENITAL AV FISTULA HEAD & NECK,,,21 ,,RBRVS,15.10 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35182,CPT,RPR CONGENITAL AV FISTULA THORAX & ABDOMEN,,,21 ,,RBRVS,31.71 ,14.77 ,14.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35184,CPT,RPR CONGENITAL AV FISTULA EXTREMITIES,,,21 ,,RBRVS,18.82 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35188,CPT,RPR/TRAUMATIC AV FISTULA HEAD & NECK,,,21 ,,RBRVS,18.00 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35189,CPT,RPR/TRAUMATIC AV FISTULA THORAX & ABDOMEN,,,21 ,,RBRVS,29.98 ,10.55 ,10.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35190,CPT,RPR/TRAUMATIC AV FISTULA EXTREMITIES,,,21 ,,RBRVS,13.42 ,6.90 ,6.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35201,CPT,REPAIR BLOOD VESSEL DIRECT NECK,,,21 ,,RBRVS,16.93 ,8.22 ,8.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35206,CPT,REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY,,,21 ,,RBRVS,13.84 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35207,CPT,REPAIR BLOOD VESSEL DIRECT HAND FINGER,,,21 ,,RBRVS,10.94 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35211,CPT,RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS,,,21 ,,RBRVS,24.58 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35216,CPT,RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS,,,21 ,,RBRVS,36.61 ,16.37 ,16.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35221,CPT,RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL,,,21 ,,RBRVS,26.62 ,11.44 ,11.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35226,CPT,RPR BLOOD VESSEL DIRECT LOWER EXTREMITY,,,21 ,,RBRVS,15.30 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35231,CPT,REPAIR BLOOD VESSEL W/VEIN GRAFT NECK,,,21 ,,RBRVS,21.16 ,12.02 ,12.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35236,CPT,REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY,,,21 ,,RBRVS,18.02 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35241,CPT,RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP,,,21 ,,RBRVS,25.58 ,12.31 ,12.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35246,CPT,RPR BLOOD VESSEL VEIN GRF INTRATHORACIC W/O BYP,,,21 ,,RBRVS,28.23 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35251,CPT,REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL,,,21 ,,RBRVS,31.91 ,12.91 ,12.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35256,CPT,REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY,,,21 ,,RBRVS,19.06 ,8.17 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35261,CPT,REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK,,,21 ,,RBRVS,18.96 ,9.03 ,9.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35266,CPT,RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY,,,21 ,,RBRVS,15.83 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35271,CPT,RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP,,,21 ,,RBRVS,24.58 ,11.67 ,11.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35276,CPT,RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/O BYP,,,21 ,,RBRVS,25.83 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35281,CPT,RPR BLVSL W/GRFT OTHER/THAN VEIN INTRA-ABDOMINAL,,,21 ,,RBRVS,30.06 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35286,CPT,RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY,,,21 ,,RBRVS,17.19 ,7.93 ,7.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35301,CPT,TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC,,,21 ,,RBRVS,19.61 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35302,CPT,TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY,,,21 ,,RBRVS,21.35 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35303,CPT,TEAEC W/GRAFT POPLITEAL ARTERY,,,21 ,,RBRVS,23.60 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35304,CPT,TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY,,,21 ,,RBRVS,24.60 ,9.48 ,9.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35305,CPT,TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL,,,21 ,,RBRVS,23.60 ,9.30 ,9.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35306,CPT,TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART,,,21 ,,RBRVS,9.25 ,2.52 ,2.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35311,CPT,TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC,,,21 ,,RBRVS,28.60 ,12.15 ,12.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35321,CPT,TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL,,,21 ,,RBRVS,16.59 ,7.44 ,7.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35331,CPT,TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA,,,21 ,,RBRVS,27.72 ,11.24 ,11.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35341,CPT,TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL,,,21 ,,RBRVS,26.21 ,10.55 ,10.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35351,CPT,TEAEC W/WO PATCH GRAFT ILIAC,,,21 ,,RBRVS,24.61 ,9.68 ,9.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35355,CPT,TEAEC W/WO PATCH GRAFT ILIOFEMORAL,,,21 ,,RBRVS,19.86 ,8.03 ,8.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35361,CPT,TEAEC W/WO PATCH GRAFT COMBINED AORTOILIAC,,,21 ,,RBRVS,30.24 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35363,CPT,TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL,,,21 ,,RBRVS,32.35 ,14.08 ,14.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35371,CPT,TEAEC W/WO PATCH GRAFT COMMON FEMORAL,,,21 ,,RBRVS,15.31 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35372,CPT,TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL,,,21 ,,RBRVS,18.58 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35390,CPT,ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO,,,21 ,,RBRVS,3.19 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35400,CPT,ANGIOSCOPY NON-CORONARY VESSEL/GRAFTS THER IVNTJ,,,21 ,,RBRVS,3.00 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35450,CPT,TRLUML BALOON ANGIOPL OPN RENAL/OTH VISCERAL ART,,,21 ,,RBRVS,10.05 ,3.59 ,3.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35452,CPT,TRLUML BALLOON ANGIOPLASTY OPEN AORTIC,,,21 ,,RBRVS,6.90 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35458,CPT,TRLUML BALO ANGIOP OPN BRCH/CPHLC TRNK/BRNCH EA,,,21 ,,RBRVS,9.48 ,3.54 ,3.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35460,CPT,TRLUML BALLOON ANGIOPLASTY OPEN VENOUS,,,21 ,,RBRVS,6.03 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35471,CPT,TRLUML BALLOON ANGIOP PRQ RENAL/VISCERAL ART,,,21 ,,RBRVS,10.05 ,4.17 ,70.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35472,CPT,TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS AORTIC,,,21 ,,RBRVS,6.90 ,2.79 ,52.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35475,CPT,TRLUML BALO ANGIOP PRQ BRCH/CPHLC TRNK/BRNCH EA,,,21 ,,RBRVS,9.48 ,3.74 ,57.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35476,CPT,TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS VENOUS,,,21 ,,RBRVS,6.03 ,2.49 ,45.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35500,CPT,HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX,,,21 ,,RBRVS,6.44 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35501,CPT,BYPASS W/VEIN COMMON-IPSILATERAL CAROTID,,,21 ,,RBRVS,29.09 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35506,CPT,BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID,,,21 ,,RBRVS,25.33 ,10.32 ,10.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35508,CPT,BYPASS W/VEIN CAROTID-VERTEBRAL,,,21 ,,RBRVS,26.09 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35509,CPT,BYPASS W/VEIN CAROTID-CONTRALATERAL CAROTID,,,21 ,,RBRVS,28.09 ,10.04 ,10.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35510,CPT,BYPASS W/VEIN CAROTID-BRACHIAL,,,21 ,,RBRVS,24.39 ,8.67 ,8.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35511,CPT,BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN,,,21 ,,RBRVS,22.20 ,11.38 ,11.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35512,CPT,BYPASS W/VEIN SUBCLAVIAN-BRACHIAL,,,21 ,,RBRVS,23.89 ,8.47 ,8.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35515,CPT,BYPASS W/VEIN SUBCLAVIAN-VERTEBRAL,,,21 ,,RBRVS,26.09 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35516,CPT,BYPASS W/VEIN SUBCLAVIAN-AXILLARY,,,21 ,,RBRVS,24.21 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35518,CPT,BYPASS W/VEIN AXILLARY-AXILLARY,,,21 ,,RBRVS,22.65 ,8.13 ,8.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35521,CPT,BYPASS W/VEIN AXILLARY-FEMORAL,,,21 ,,RBRVS,24.13 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35522,CPT,BYPASS W/VEIN AXILLARY-BRACHIAL,,,21 ,,RBRVS,23.15 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35523,CPT,BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL,,,21 ,,RBRVS,24.13 ,10.29 ,10.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35525,CPT,BYPASS W/VEIN BRACHIAL-BRACHIAL,,,21 ,,RBRVS,21.69 ,9.07 ,9.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35526,CPT,BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE,,,21 ,,RBRVS,31.55 ,13.66 ,13.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35531,CPT,BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC,,,21 ,,RBRVS,39.11 ,14.61 ,14.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35533,CPT,BYPASS W/VEIN AXILLARY-FEMORAL-FEMORAL,,,21 ,,RBRVS,29.92 ,10.50 ,10.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35535,CPT,BYPASS W/VEIN HEPATORENAL,,,21 ,,RBRVS,38.13 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35536,CPT,BYPASS W/VEIN SPLENORENAL,,,21 ,,RBRVS,33.73 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35537,CPT,BYPASS W/VEIN AORTOILIAC,,,21 ,,RBRVS,41.88 ,13.83 ,13.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35538,CPT,BYPASS W/VEIN AORTOBI-ILIAC,,,21 ,,RBRVS,47.03 ,15.38 ,15.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35539,CPT,BYPASS W/VEIN AORTOFEMORAL,,,21 ,,RBRVS,44.11 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35540,CPT,BYPASS W/VEIN AORTOBIFEMORAL,,,21 ,,RBRVS,49.33 ,18.73 ,18.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35556,CPT,BYPASS W/VEIN FEMORAL-POPLITEAL,,,21 ,,RBRVS,26.75 ,10.81 ,10.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35558,CPT,BYPASS W/VEIN FEMORAL-FEMORAL,,,21 ,,RBRVS,23.13 ,10.12 ,10.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35560,CPT,BYPASS W/VEIN AORTORENAL,,,21 ,,RBRVS,34.03 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35563,CPT,BYPASS W/VEIN ILIOILIAC,,,21 ,,RBRVS,26.12 ,13.33 ,13.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35565,CPT,BYPASS W/VEIN ILIOFEMORAL,,,21 ,,RBRVS,25.13 ,10.40 ,10.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35566,CPT,BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL,,,21 ,,RBRVS,32.35 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35570,CPT,BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL,,,21 ,,RBRVS,29.15 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35571,CPT,BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL,,,21 ,,RBRVS,25.52 ,10.25 ,10.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35572,CPT,HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX,,,21 ,,RBRVS,6.81 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35583,CPT,IN-SITU VEIN BYPASS FEMORAL-POPLITEAL,,,21 ,,RBRVS,27.75 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35585,CPT,IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART,,,21 ,,RBRVS,32.35 ,12.67 ,12.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35587,CPT,IN-SITU VEIN BYP POP-TIBL PRONEAL,,,21 ,,RBRVS,26.21 ,10.71 ,10.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35600,CPT,HARVEST UPPER EXTREMITY ARTERY 1 SEGMENT CABG,,,21 ,,RBRVS,4.94 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35601,CPT,BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID,,,21 ,,RBRVS,27.09 ,10.73 ,10.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35606,CPT,BYP OTH/THN VEIN CAROTID-SUBCLAVIAN,,,21 ,,RBRVS,22.46 ,8.96 ,8.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35612,CPT,BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN,,,21 ,,RBRVS,20.35 ,7.59 ,7.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35616,CPT,BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY,,,21 ,,RBRVS,21.82 ,7.71 ,7.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35621,CPT,BYP OTH/THN VEIN AXILLARY-FEMORAL,,,21 ,,RBRVS,21.03 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35623,CPT,BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL,,,21 ,,RBRVS,25.92 ,9.31 ,9.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35626,CPT,BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE,,,21 ,,RBRVS,29.14 ,12.23 ,12.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35631,CPT,BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL,,,21 ,,RBRVS,36.03 ,13.10 ,13.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35632,CPT,BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC,,,21 ,,RBRVS,36.13 ,12.45 ,12.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35633,CPT,BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC,,,21 ,,RBRVS,39.11 ,14.35 ,14.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35634,CPT,BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL,,,21 ,,RBRVS,35.33 ,13.40 ,13.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35636,CPT,BYP OTH/THN VEIN SPLENORENAL,,,21 ,,RBRVS,31.75 ,10.96 ,10.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35637,CPT,BYP OTH/THN VEIN AORTOILIAC,,,21 ,,RBRVS,33.05 ,13.17 ,13.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35638,CPT,BYP OTH/THN VEIN AORTOBI-ILIAC,,,21 ,,RBRVS,33.60 ,13.52 ,13.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35642,CPT,BYP OTH/THN VEIN CAROTID-VERTEBRAL,,,21 ,,RBRVS,18.94 ,11.22 ,11.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35645,CPT,BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL,,,21 ,,RBRVS,18.43 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35646,CPT,BYP OTH/THN VEIN AORTOBIFEMORAL,,,21 ,,RBRVS,32.98 ,13.08 ,13.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35647,CPT,BYP OTH/THN VEIN AORTOFEMORAL,,,21 ,,RBRVS,29.73 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35650,CPT,BYP OTH/THN VEIN AXILLARY-AXILLARY,,,21 ,,RBRVS,20.16 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35654,CPT,BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL,,,21 ,,RBRVS,26.28 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35656,CPT,BYP OTH/THN VEIN FEMORAL-POPLITEAL,,,21 ,,RBRVS,20.47 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35661,CPT,BYP OTH/THN VEIN FEMORAL-FEMORAL,,,21 ,,RBRVS,20.35 ,8.93 ,8.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35663,CPT,BYP OTH/THN VEIN ILIOILIAC,,,21 ,,RBRVS,23.93 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35665,CPT,BYP OTH/THN VEIN ILIOFEMORAL,,,21 ,,RBRVS,22.35 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35666,CPT,BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL,,,21 ,,RBRVS,23.66 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35671,CPT,BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART,,,21 ,,RBRVS,20.77 ,9.52 ,9.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35681,CPT,BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN,,,21 ,,RBRVS,1.60 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35682,CPT,BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS,,,21 ,,RBRVS,7.19 ,2.20 ,2.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35683,CPT,BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATION,,,21 ,,RBRVS,8.49 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35685,CPT,PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT,,,21 ,,RBRVS,4.04 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35686,CPT,CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO,,,21 ,,RBRVS,3.34 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35691,CPT,TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART,,,21 ,,RBRVS,18.41 ,7.07 ,7.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35693,CPT,TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART,,,21 ,,RBRVS,15.73 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35694,CPT,TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART,,,21 ,,RBRVS,19.28 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35695,CPT,TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART,,,21 ,,RBRVS,20.06 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35697,CPT,RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART,,,21 ,,RBRVS,3.00 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35700,CPT,ROPRTJ > 1 MO AFTER ORIGINAL OPRATION,,,21 ,,RBRVS,3.08 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35701,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS CAROTID ARTERY,,,21 ,,RBRVS,9.19 ,6.30 ,6.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35721,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS FEMORAL ARTERY,,,21 ,,RBRVS,7.72 ,4.61 ,4.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35741,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS POPLITEAL ARTERY,,,21 ,,RBRVS,8.69 ,5.22 ,5.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35761,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS OTHER ARTERY,,,21 ,,RBRVS,5.93 ,4.66 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35800,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK,,,21 ,,RBRVS,12.00 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35820,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ CH,,,21 ,,RBRVS,36.89 ,15.05 ,15.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35840,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD,,,21 ,,RBRVS,20.75 ,9.34 ,9.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35860,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR,,,21 ,,RBRVS,15.25 ,6.56 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35870,CPT,RPR GRF-ENTERIC FSTL,,,21 ,,RBRVS,24.50 ,8.88 ,8.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35875,CPT,THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL,,,21 ,,RBRVS,10.72 ,5.43 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35876,CPT,THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF,,,21 ,,RBRVS,17.82 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35879,CPT,REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP,,,21 ,,RBRVS,17.41 ,7.55 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35881,CPT,REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS,,,21 ,,RBRVS,19.35 ,8.17 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35883,CPT,REVISION FEMORAL ANAST OPEN NONAUTOG GRAFT,,,21 ,,RBRVS,23.15 ,9.11 ,9.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35884,CPT,REVISION FEMORAL ANAST OPEN W/AUTOG GRAFT,,,21 ,,RBRVS,24.65 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35901,CPT,EXCISION INFECTED NECK GRAFT,,,21 ,,RBRVS,8.38 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35903,CPT,EXCISION INFECTED GRAFT EXTREMITY,,,21 ,,RBRVS,9.53 ,5.95 ,5.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,35905,CPT,EXCISION INFECTED GRAFT THORAX,,,21 ,,RBRVS,33.52 ,11.44 ,11.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,35907,CPT,EXCISION INFECTED GRAFT ABDOMEN,,,21 ,,RBRVS,37.27 ,13.75 ,13.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,36000,CPT,INTRODUCTION NEEDLE/INTRACATHETER VEIN,,,21 ,,RBRVS,0.18 ,0.08 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36002,CPT,INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM,,,21 ,,RBRVS,1.96 ,0.96 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36005,CPT,NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH,,,21 ,,RBRVS,0.95 ,0.36 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36010,CPT,INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA,,,21 ,,RBRVS,2.43 ,0.87 ,13.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36011,CPT,SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH,,,21 ,,RBRVS,3.14 ,1.15 ,23.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36012,CPT,SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC,,,21 ,,RBRVS,3.51 ,1.30 ,22.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36013,CPT,INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY,,,21 ,,RBRVS,2.52 ,0.94 ,21.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36014,CPT,SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY,,,21 ,,RBRVS,3.02 ,1.14 ,22.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36015,CPT,SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART,,,21 ,,RBRVS,3.51 ,1.31 ,23.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36100,CPT,INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY,,,21 ,,RBRVS,3.02 ,1.18 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36120,CPT,INTRO NEEDLE/INTRACATH RETROGRADE BRACHIAL ART,,,21 ,,RBRVS,2.01 ,0.69 ,11.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36140,CPT,INTRO NEEDLE/INTRACATH EXTREMITY ARTERY,,,21 ,,RBRVS,2.01 ,0.72 ,11.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36147,CPT,INTRO NDL/CATH AV SHUNT IST ACCESS W/ RAD EVAL,,,21 ,,RBRVS,3.72 ,1.33 ,21.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36148,CPT,INTRO NDL/CATH AV SHUNT ADDL ACCESS THER IVNTJ,,,21 ,,RBRVS,1.00 ,0.34 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36160,CPT,INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR,,,21 ,,RBRVS,2.52 ,0.97 ,12.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36200,CPT,INTRODUCTION CATHETER AORTA,,,21 ,,RBRVS,3.02 ,1.05 ,16.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36215,CPT,SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH,,,21 ,,RBRVS,4.67 ,1.84 ,29.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36216,CPT,SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH,,,21 ,,RBRVS,5.27 ,2.12 ,32.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36217,CPT,SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH,,,21 ,,RBRVS,6.29 ,2.55 ,56.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36218,CPT,SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH,,,21 ,,RBRVS,1.01 ,0.41 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36221,CPT,NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART,,,21 ,,RBRVS,4.17 ,1.39 ,29.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36222,CPT,SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART,,,21 ,,RBRVS,5.53 ,2.13 ,36.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36223,CPT,SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART,,,21 ,,RBRVS,6.00 ,2.28 ,39.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36224,CPT,SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART,,,21 ,,RBRVS,6.50 ,2.58 ,42.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36225,CPT,SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY,,,21 ,,RBRVS,6.00 ,2.25 ,39.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36226,CPT,SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY,,,21 ,,RBRVS,6.50 ,2.60 ,43.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36227,CPT,SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC,,,21 ,,RBRVS,2.09 ,0.80 ,5.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36228,CPT,SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT,,,21 ,,RBRVS,4.25 ,1.65 ,30.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36245,CPT,SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH,,,21 ,,RBRVS,4.67 ,1.87 ,27.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36246,CPT,SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH,,,21 ,,RBRVS,5.27 ,1.95 ,24.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36247,CPT,SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH,,,21 ,,RBRVS,6.29 ,2.30 ,44.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36248,CPT,SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH,,,21 ,,RBRVS,1.01 ,0.37 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36251,CPT,SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN,,,21 ,,RBRVS,5.35 ,1.95 ,36.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36252,CPT,SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL,,,21 ,,RBRVS,6.99 ,2.52 ,39.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36253,CPT,SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I,,,21 ,,RBRVS,7.55 ,2.59 ,57.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36254,CPT,SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I,,,21 ,,RBRVS,8.15 ,2.79 ,59.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36260,CPT,INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM,,,21 ,,RBRVS,9.91 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36261,CPT,REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP,,,21 ,,RBRVS,5.63 ,4.84 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36262,CPT,REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP,,,21 ,,RBRVS,4.11 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36299,CPT,UNLISTED PROCEDURE VASCULAR INJECTION,,,21 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,36400,CPT,VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN,,,21 ,,RBRVS,0.38 ,0.14 ,0.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36405,CPT,VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN,,,21 ,,RBRVS,0.31 ,0.13 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36406,CPT,VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN,,,21 ,,RBRVS,0.18 ,0.05 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36410,CPT,VNPNXR 3 YEARS/> PHYS/QHP SKILL,,,21 ,,RBRVS,0.18 ,0.07 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36415,CPT,COLLECTION VENOUS BLOOD VENIPUNCTURE,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,36416,CPT,COLLECTION CAPILLARY BLOOD SPECIMEN,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,36420,CPT,VENIPUNCTURE CUTDOWN UNDER AGE 1 YR,,,21 ,,RBRVS,1.01 ,0.39 ,0.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36425,CPT,VENIPUNCTURE CUTDOWN AGE 1 YR/>,,,21 ,,RBRVS,0.76 ,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36430,CPT,TRANSFUSION BLOOD/BLOOD COMPONENTS,,,21 ,,RBRVS,,1.00 ,1.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36440,CPT,PUSH TRANSFUSION BLOOD 2 YR/UNDER,,,21 ,,RBRVS,1.03 ,0.40 ,0.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36450,CPT,EXCHNG TRANSFUSION BLOOD NEWBORN,,,21 ,,RBRVS,2.23 ,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36455,CPT,EXCHNG TRANSFUSION BLOOD OTHER/THAN NEW BORN,,,21 ,,RBRVS,2.43 ,0.88 ,0.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36460,CPT,TRANSFUSION INTRAUTERINE FETAL,,,21 ,,RBRVS,6.58 ,2.59 ,2.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36468,CPT,1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRUNK,,,21 ,,TotalUnits,,,,2.24 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,36469,CPT,1/MLT NJXS SCLRSG SLNS SPIDER VEINS FACE,,,21 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,36470,CPT,NJX SCLEROSING SOLUTION SINGLE VEIN,,,21 ,,RBRVS,1.10 ,1.13 ,3.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36471,CPT,NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG,,,21 ,,RBRVS,1.65 ,1.05 ,3.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36475,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN,,,21 ,,RBRVS,6.72 ,2.55 ,45.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36476,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS,,,21 ,,RBRVS,3.38 ,1.15 ,7.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36478,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,,,21 ,,RBRVS,6.72 ,2.61 ,34.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36479,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS,,,21 ,,RBRVS,3.38 ,1.22 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36481,CPT,PRQ PORTAL VEIN CATHETERIZATION ANY METHOD,,,21 ,,RBRVS,6.98 ,2.80 ,42.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36500,CPT,VEN CATHJ SLCTV ORGAN BLD SAMPLING,,,21 ,,RBRVS,3.51 ,1.35 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36510,CPT,CATHJ UMBILICAL VEIN DX/THER NB,,,21 ,,RBRVS,1.09 ,0.48 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36511,CPT,THERAPEUTIC APHERESIS WHITE BLOOD CELLS,,,21 ,,RBRVS,1.74 ,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36512,CPT,THERAPEUTIC APHERESIS RED BLOOD CELLS,,,21 ,,RBRVS,1.74 ,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36513,CPT,THERAPEUTIC APHERESIS PLATELETS,,,21 ,,RBRVS,1.74 ,0.88 ,0.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36514,CPT,THERAPEUTIC APHERESIS PLASMA PHERESIS,,,21 ,,RBRVS,1.74 ,0.74 ,13.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36515,CPT,THER APHERESIS W/XTRCORP IMMUNODSPTJ& PLSM RENFJ,,,21 ,,RBRVS,1.74 ,0.78 ,62.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36516,CPT,THER APHRS XTRCORP SLCTV ADSRPJ/FILTRJ & REINFSJ,,,21 ,,RBRVS,1.22 ,0.51 ,60.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36522,CPT,PHOTOPHERESIS EXTRACORPOREAL,,,21 ,,RBRVS,1.67 ,1.17 ,39.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36555,CPT,INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y,,,21 ,,RBRVS,2.68 ,0.70 ,5.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36556,CPT,INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>,,,21 ,,RBRVS,2.50 ,0.79 ,4.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36557,CPT,INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR,,,21 ,,RBRVS,5.14 ,3.45 ,23.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36558,CPT,INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>,,,21 ,,RBRVS,4.84 ,2.79 ,18.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36560,CPT,INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR,,,21 ,,RBRVS,6.29 ,3.89 ,32.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36561,CPT,INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>,,,21 ,,RBRVS,6.04 ,3.47 ,28.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36563,CPT,INSJ TUNNELED CTR VAD W/SUBQ PUMP,,,21 ,,RBRVS,6.24 ,3.73 ,31.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36565,CPT,INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP,,,21 ,,RBRVS,6.04 ,3.25 ,22.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36566,CPT,INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT,,,21 ,,RBRVS,6.54 ,3.58 ,142.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36568,CPT,INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR,,,21 ,,RBRVS,1.92 ,0.73 ,6.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36569,CPT,INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>,,,21 ,,RBRVS,1.82 ,0.71 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36570,CPT,INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR,,,21 ,,RBRVS,5.36 ,3.32 ,29.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36571,CPT,INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>,,,21 ,,RBRVS,5.34 ,3.24 ,32.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36575,CPT,RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP,,,21 ,,RBRVS,0.67 ,0.29 ,4.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36576,CPT,RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT,,,21 ,,RBRVS,3.24 ,2.02 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36578,CPT,RPLCMT CATH CTR VAD SUBQ PORT/PMP,,,21 ,,RBRVS,3.54 ,2.41 ,11.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36580,CPT,RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP,,,21 ,,RBRVS,1.31 ,0.51 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36581,CPT,RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP,,,21 ,,RBRVS,3.48 ,1.99 ,18.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36582,CPT,RPLCMT COMPL TUN CTR VAD W/SUBQ PORT,,,21 ,,RBRVS,5.24 ,3.07 ,27.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36583,CPT,RPLCMT COMPL TUN CTR VAD W/SUBQ PMP,,,21 ,,RBRVS,5.29 ,3.21 ,28.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36584,CPT,RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP,,,21 ,,RBRVS,1.20 ,0.65 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36585,CPT,RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT,,,21 ,,RBRVS,4.84 ,2.87 ,28.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36589,CPT,RMVL TUN CVC W/O SUBQ PORT/PMP,,,21 ,,RBRVS,2.28 ,1.53 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36590,CPT,RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ,,,21 ,,RBRVS,3.35 ,2.14 ,4.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36591,CPT,COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,,,21 ,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36592,CPT,COLLECT BLOOD FROM CATHETER VENOUS NOS,,,21 ,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36593,CPT,DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH,,,21 ,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,36595,CPT,MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS,,,21 ,,RBRVS,3.59 ,1.55 ,13.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36596,CPT,MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN,,,21 ,,RBRVS,0.75 ,0.50 ,3.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36597,CPT,RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDN,,,21 ,,RBRVS,1.21 ,0.49 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36598,CPT,CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT,,,21 ,,RBRVS,0.74 ,0.45 ,2.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36600,CPT,ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,,,21 ,,RBRVS,0.32 ,0.10 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36620,CPT,ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ,,,21 ,,RBRVS,1.15 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36625,CPT,ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN,,,21 ,,RBRVS,2.11 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36640,CPT,ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN,,,21 ,,RBRVS,2.10 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36660,CPT,CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY,,,21 ,,RBRVS,1.40 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,36680,CPT,PLACEMENT NEEDLE INTRAOSSEOUS INFUSION,,,21 ,,RBRVS,1.20 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36800,CPT,INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN,,,21 ,,RBRVS,2.43 ,2.02 ,2.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36810,CPT,INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL,,,21 ,,RBRVS,3.96 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36815,CPT,INSJ CANNULA HEMO OTH SPX ARVEN XTRNL REVJ/CLSR,,,21 ,,RBRVS,2.62 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36818,CPT,ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS,,,21 ,,RBRVS,11.89 ,6.03 ,6.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36819,CPT,ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS,,,21 ,,RBRVS,13.29 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36820,CPT,ARVEN ANAST OPN F/ARM VEIN TRPOS,,,21 ,,RBRVS,14.47 ,6.98 ,6.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36821,CPT,ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT,,,21 ,,RBRVS,12.11 ,6.37 ,6.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36822,CPT,INSJ CANNULA PROLNG XC-CIRCJ ECMO SPX,,,21 ,,RBRVS,5.57 ,4.82 ,4.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,36823,CPT,INSJ CNULA ISLTD XC-CIRCJ REG CHEMOTX XTR RMVL,,,21 ,,RBRVS,22.98 ,11.82 ,11.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,36825,CPT,CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF,,,21 ,,RBRVS,14.17 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36830,CPT,CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF,,,21 ,,RBRVS,12.03 ,5.45 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36831,CPT,THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF,,,21 ,,RBRVS,8.04 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36832,CPT,REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF,,,21 ,,RBRVS,10.53 ,4.94 ,4.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36833,CPT,REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF,,,21 ,,RBRVS,11.98 ,5.46 ,5.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36835,CPT,INSERTION THOMAS SHUNT SEPARATE PROCEDURE,,,21 ,,RBRVS,7.51 ,5.72 ,5.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36838,CPT,DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS,,,21 ,,RBRVS,21.69 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36860,CPT,XTRNL CANNULA DECLTNG SPX W/O BALO CATH,,,21 ,,RBRVS,2.01 ,0.97 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36861,CPT,XTRNL CANNULA DECLTNG SPX W/BALO CATH,,,21 ,,RBRVS,2.52 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,36870,CPT,THRMBC PRQ ARVEN FSTL AUTOG/NONAUTOG GRF,,,21 ,,RBRVS,5.20 ,3.19 ,51.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37140,CPT,VENOUS ANASTOMOSIS OPEN PORTOCAVAL,,,21 ,,RBRVS,40.00 ,17.84 ,17.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37145,CPT,VENOUS ANASTOMOSIS OPEN RENOPORTAL,,,21 ,,RBRVS,37.00 ,17.15 ,17.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37160,CPT,VENOUS ANASTOMOSIS OPEN CAVAL-MESENTERIC,,,21 ,,RBRVS,38.00 ,17.01 ,17.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37180,CPT,VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL,,,21 ,,RBRVS,36.50 ,16.72 ,16.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37181,CPT,VENOUS ANASTOMOSIS OPEN SPLENORENAL DISTAL,,,21 ,,RBRVS,40.00 ,18.10 ,18.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37182,CPT,INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT,,,21 ,,RBRVS,16.97 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37183,CPT,REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT,,,21 ,,RBRVS,7.99 ,3.13 ,160.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37184,CPT,PRIM PRQ TRLUML MCHNL THRMBC 1ST VSL,,,21 ,,RBRVS,8.66 ,3.55 ,59.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37185,CPT,PRIM PRQ TRLUML MCHNL THRMBC SBSQ VSL,,,21 ,,RBRVS,3.28 ,1.18 ,19.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37186,CPT,SEC PRQ TRANSLUMINAL THROMBECTOMY NONCORONARY,,,21 ,,RBRVS,4.92 ,1.85 ,39.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37187,CPT,PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN,,,21 ,,RBRVS,8.03 ,3.19 ,57.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37188,CPT,PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX,,,21 ,,RBRVS,5.71 ,2.39 ,49.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37191,CPT,INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I,,,21 ,,RBRVS,4.71 ,1.68 ,73.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37192,CPT,REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&,,,21 ,,RBRVS,7.35 ,2.53 ,44.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37193,CPT,RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I,,,21 ,,RBRVS,7.35 ,2.52 ,41.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37195,CPT,THROMBOLYSIS CEREBRAL IV INFUSION,,,21 ,,TotalUnits,,,,10.78 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,37197,CPT,PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING,,,21 ,,RBRVS,6.29 ,2.17 ,42.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37200,CPT,TRANSCATHETER BIOPSY,,,21 ,,RBRVS,4.55 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37202,CPT,TCAT THER INFUSION OTH/THN THROMBOLYSIS ANY TYPE,,,21 ,,RBRVS,5.67 ,3.13 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37204,CPT,TCAT OCCLS/EMBOLJ PRQ NON-CNS NON-HEAD/NCK,,,21 ,,RBRVS,18.11 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37205,CPT,TCAT PLMT IV STENT PERCUTANEOUS 1ST VESSEL,,,21 ,,RBRVS,8.27 ,3.15 ,117.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37206,CPT,TCAT PLMT IV STENT PERCUTANEOUS EACH ADDL VESSEL,,,21 ,,RBRVS,4.12 ,1.49 ,71.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37207,CPT,TCAT PLMT IV STENT OPEN 1ST VESSEL,,,21 ,,RBRVS,8.27 ,2.98 ,2.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37208,CPT,TCAT PLMT IV STENT OPEN EACH ADDL VESSEL,,,21 ,,RBRVS,4.12 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37210,CPT,UTERINE FIBROID EMBOLIZATION PERQ W/RAD GID,,,21 ,,RBRVS,10.60 ,4.12 ,96.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37211,CPT,THROMBOLYSIS ARTERIAL INFUSION W/IMAGING INIT TX,,,21 ,,RBRVS,8.00 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37212,CPT,THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX,,,21 ,,RBRVS,7.06 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37213,CPT,THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX,,,21 ,,RBRVS,5.00 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37214,CPT,CESSATION THROMBOLYTIC THRPY W/CATHETER REMOVAL,,,21 ,,RBRVS,2.74 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37215,CPT,TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ,,,21 ,,RBRVS,19.68 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37216,CPT,TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ,,,21 ,,RBRVS,18.95 ,9.69 ,9.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37220,CPT,REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL,,,21 ,,RBRVS,8.15 ,2.75 ,87.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37221,CPT,REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY,,,21 ,,RBRVS,10.00 ,3.42 ,132.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37222,CPT,REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL,,,21 ,,RBRVS,3.73 ,1.21 ,23.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37223,CPT,REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL,,,21 ,,RBRVS,4.25 ,1.38 ,74.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37224,CPT,REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI,,,21 ,,RBRVS,9.00 ,3.03 ,105.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37225,CPT,REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL,,,21 ,,RBRVS,12.00 ,4.18 ,316.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37226,CPT,REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL,,,21 ,,RBRVS,10.49 ,3.59 ,267.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37227,CPT,REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL,,,21 ,,RBRVS,14.50 ,5.03 ,430.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37228,CPT,REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI,,,21 ,,RBRVS,11.00 ,3.67 ,153.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37229,CPT,REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL,,,21 ,,RBRVS,14.05 ,4.85 ,310.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37230,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL,,,21 ,,RBRVS,13.80 ,4.69 ,243.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37231,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL,,,21 ,,RBRVS,15.00 ,5.09 ,399.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37232,CPT,REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL,,,21 ,,RBRVS,4.00 ,1.30 ,32.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37233,CPT,REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL,,,21 ,,RBRVS,6.50 ,2.20 ,37.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37234,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL,,,21 ,,RBRVS,5.50 ,1.79 ,112.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37235,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL,,,21 ,,RBRVS,7.80 ,2.54 ,117.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37250,CPT,IV US NON-C VSL DX EVAL&/THER IVNTJ 1ST VSL,,,21 ,,RBRVS,2.10 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37251,CPT,IV US NON-C VSL DX EVAL&/THER IVNTJ EA VSL,,,21 ,,RBRVS,1.60 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37500,CPT,VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX,,,21 ,,RBRVS,11.67 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37501,CPT,UNLISTED VASCULAR ENDOSCOPY PROCEDURE,,,21 ,,TotalUnits,,,,18.58 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,37565,CPT,LIGATION INTERNAL JUGULAR VEIN,,,21 ,,RBRVS,12.05 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37600,CPT,LIGATION EXTERNAL CAROTID ARTERY,,,21 ,,RBRVS,12.42 ,6.56 ,6.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37605,CPT,LIGATION INTERNAL/COMMON CAROTID ARTERY,,,21 ,,RBRVS,14.28 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37606,CPT,LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION,,,21 ,,RBRVS,8.81 ,6.29 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37607,CPT,LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA,,,21 ,,RBRVS,6.25 ,3.95 ,3.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37609,CPT,LIGATION/BIOPSY TEMPORAL ARTERY,,,21 ,,RBRVS,3.05 ,2.56 ,5.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37615,CPT,LIGATION MAJOR ARTERY NECK,,,21 ,,RBRVS,7.80 ,5.81 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37616,CPT,LIGATION MAJOR ARTERY CHEST,,,21 ,,RBRVS,18.97 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37617,CPT,LIGATION MAJOR ARTERY ABDOMEN,,,21 ,,RBRVS,23.79 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37618,CPT,LIGAMENT MAJOR ARTERY EXTREMITY,,,21 ,,RBRVS,6.03 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37619,CPT,INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I,,,21 ,,RBRVS,30.00 ,11.90 ,11.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37650,CPT,REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&,,,21 ,,RBRVS,8.49 ,5.98 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37660,CPT,RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I,,,21 ,,RBRVS,22.28 ,11.34 ,11.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37700,CPT,LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ,,,21 ,,RBRVS,3.82 ,3.10 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37718,CPT,LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN,,,21 ,,RBRVS,7.13 ,4.70 ,4.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37722,CPT,LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW,,,21 ,,RBRVS,8.16 ,4.88 ,4.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37735,CPT,LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS,,,21 ,,RBRVS,10.90 ,5.98 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37760,CPT,LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG,,,21 ,,RBRVS,10.78 ,6.11 ,6.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37761,CPT,LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG,,,21 ,,RBRVS,9.13 ,5.79 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37765,CPT,STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS,,,21 ,,RBRVS,7.71 ,4.60 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37766,CPT,STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS,,,21 ,,RBRVS,9.66 ,5.28 ,12.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37780,CPT,LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX,,,21 ,,RBRVS,3.93 ,3.12 ,3.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37785,CPT,LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG,,,21 ,,RBRVS,3.93 ,3.23 ,6.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37788,CPT,PENILE REVASCULARIZATION ARTERY W/WO VEIN GRAFT,,,21 ,,RBRVS,23.33 ,12.84 ,12.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,37790,CPT,PENILE VENOUS OCCLUSIVE PROCEDURE,,,21 ,,RBRVS,8.43 ,5.03 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,37799,CPT,UNLISTED PROCEDURE VASCULAR SURGERY,,,21 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,38100,CPT,SPLENECTOMY TOTAL SEPARATE PROCEDURE,,,21 ,,RBRVS,19.55 ,9.93 ,9.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38101,CPT,SPLENECTOMY TOTAL EN BLOC W/OTHER PROCEDURE,,,21 ,,RBRVS,19.55 ,10.16 ,10.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38102,CPT,SPLENC TOT EN BLOC X10SV DS CONJUNCT W/OTH PX,,,21 ,,RBRVS,4.79 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38115,CPT,RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT,,,21 ,,RBRVS,21.88 ,10.85 ,10.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38120,CPT,LAPAROSCOPIC SURGICAL SPLENECTOMY,,,21 ,,RBRVS,17.07 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38129,CPT,UNLISTED LAPAROSCOPY PROCEDURE SPLEEN,,,21 ,,TotalUnits,,,,27.14 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,38200,CPT,INJECTION PROCEDURE SPLENOPORTOGRAPY,,,21 ,,RBRVS,2.64 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38204,CPT,MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ,,,21 ,,RBRVS,2.00 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38205,CPT,BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC,,,21 ,,RBRVS,1.50 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38206,CPT,BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL,,,21 ,,RBRVS,1.50 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38207,CPT,TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR,,,21 ,,RBRVS,0.89 ,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38208,CPT,TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR,,,21 ,,RBRVS,0.56 ,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38209,CPT,TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR,,,21 ,,RBRVS,0.24 ,0.11 ,0.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38210,CPT,TRNSPL PREPJ HEMATOP PROGEN DEPLJ IN HRV T-CELL,,,21 ,,RBRVS,1.57 ,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38211,CPT,TRNSPL PREPJ HEMATOP PROGEN TUM CELL DEPLJ,,,21 ,,RBRVS,1.42 ,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38212,CPT,TRNSPL PREPJ HEMATOP PROGEN RED BLD CELL RMVL,,,21 ,,RBRVS,0.94 ,0.43 ,0.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38213,CPT,TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ,,,21 ,,RBRVS,0.24 ,0.11 ,0.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38214,CPT,TRNSPL PREPJ HEMATOP PROGEN PLSM VOL DEPLJ,,,21 ,,RBRVS,0.81 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38215,CPT,TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM,,,21 ,,RBRVS,0.94 ,0.43 ,0.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38220,CPT,MARROW ASPIRATION ONLY,,,21 ,,RBRVS,1.08 ,0.59 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38221,CPT,BONE MARROW BIOPSY NEEDLE/TROCAR,,,21 ,,RBRVS,1.37 ,0.74 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38230,CPT,BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC,,,21 ,,RBRVS,3.09 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38232,CPT,BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS,,,21 ,,RBRVS,3.09 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38240,CPT,TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR,,,21 ,,RBRVS,2.24 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38241,CPT,TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR,,,21 ,,RBRVS,2.24 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38242,CPT,ALLOGENEIC LYMPHOCYTE INFUSIONS,,,21 ,,RBRVS,1.71 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38243,CPT,TRNSPLJ HEMATOPOIETIC CELL BOOST,,,21 ,,RBRVS,2.13 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38300,CPT,DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL,,,21 ,,RBRVS,2.36 ,2.72 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38305,CPT,DRG LYMPH NODE ABSC/LYMPHADENITIS X10SV,,,21 ,,RBRVS,6.68 ,5.53 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38308,CPT,LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS,,,21 ,,RBRVS,6.81 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38380,CPT,SUTR&/LIG THORACIC DUCT CERVICAL APPROACH,,,21 ,,RBRVS,8.46 ,7.48 ,7.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38381,CPT,SUTR&/LIG THORACIC DUCT THORACIC APPROACH,,,21 ,,RBRVS,13.38 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38382,CPT,SUTR&/LIG THORACIC DUCT ABDOMINAL APPROACH,,,21 ,,RBRVS,10.65 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38500,CPT,BX/EXC LYMPH NODE OPEN SUPERFICIAL,,,21 ,,RBRVS,3.79 ,2.85 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38505,CPT,BX/EXC LYMPH NODE NEEDLE SUPERFICIAL,,,21 ,,RBRVS,1.14 ,0.85 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38510,CPT,BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE,,,21 ,,RBRVS,6.74 ,4.47 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38520,CPT,BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD,,,21 ,,RBRVS,7.03 ,5.26 ,5.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38525,CPT,BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE,,,21 ,,RBRVS,6.43 ,4.89 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38530,CPT,BX/EXC LYMPH NODE OPEN INT MAMMARY NODE,,,21 ,,RBRVS,8.34 ,5.97 ,5.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38542,CPT,DISSECTION DEEP JUGULAR NODE,,,21 ,,RBRVS,7.95 ,6.09 ,6.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38550,CPT,EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ,,,21 ,,RBRVS,7.11 ,6.13 ,6.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38555,CPT,EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ,,,21 ,,RBRVS,15.59 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38562,CPT,LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC,,,21 ,,RBRVS,11.06 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38564,CPT,LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC,,,21 ,,RBRVS,11.38 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38570,CPT,LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT,,,21 ,,RBRVS,9.34 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38571,CPT,LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY,,,21 ,,RBRVS,14.76 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38572,CPT,LAPS BI TOT PEL LMPHADEC&PRI-AORTIC LYMPH BX 1,,,21 ,,RBRVS,16.94 ,8.54 ,8.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38589,CPT,UNLISTED LAPAROSCOPY PX LYMPHATIC SYSTEM,,,21 ,,TotalUnits,,,,21.91 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,38700,CPT,SUPRAHYOID LYMPHADENECTOMY,,,21 ,,RBRVS,12.81 ,9.37 ,9.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38720,CPT,CERVICAL LYMPHADENECTOMY,,,21 ,,RBRVS,21.95 ,14.66 ,14.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38724,CPT,CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ,,,21 ,,RBRVS,23.95 ,15.92 ,15.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38740,CPT,AXILLARY LYMPHADENECTOMY SUPERFICIAL,,,21 ,,RBRVS,10.70 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38745,CPT,AXILLARY LYMPHADENECTOMY COMPLETE,,,21 ,,RBRVS,13.87 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38746,CPT,THORCOM THRC W/MEDSTNL & REGIONAL LMPHADEC,,,21 ,,RBRVS,4.12 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38747,CPT,ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC,,,21 ,,RBRVS,4.88 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38760,CPT,INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX,,,21 ,,RBRVS,13.62 ,8.24 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38765,CPT,INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC,,,21 ,,RBRVS,21.91 ,11.52 ,11.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38770,CPT,PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR,,,21 ,,RBRVS,14.06 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38780,CPT,RPR TABDL LMPHADEC X10SV W/PEL AORTIC&RNL,,,21 ,,RBRVS,17.70 ,10.01 ,10.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,38790,CPT,INJECTION PROCEDURE LYMPHANGIOGRAPHY,,,21 ,,RBRVS,1.29 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38792,CPT,INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE,,,21 ,,RBRVS,0.52 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38794,CPT,CANNULATION THORACIC DUCT,,,21 ,,RBRVS,4.62 ,3.62 ,3.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,38900,CPT,INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION,,,21 ,,RBRVS,2.50 ,0.94 ,0.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,38999,CPT,UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEM,,,21 ,,TotalUnits,,,,3.46 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,39000,CPT,MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR,,,21 ,,RBRVS,7.57 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39010,CPT,MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR,,,21 ,,RBRVS,13.19 ,7.65 ,7.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39200,CPT,RESECTION OF MEDIASTINAL CYST,,,21 ,,RBRVS,15.09 ,7.93 ,7.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39220,CPT,RESECTION MEDIASTINAL TUMOR,,,21 ,,RBRVS,19.55 ,10.28 ,10.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39400,CPT,MEDIASTINOSCOPY INCL BIOPSIES WHEN PERFORMED,,,21 ,,RBRVS,8.05 ,5.36 ,5.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,39499,CPT,UNLISTED PROCEDURE MEDIASTINUM,,,21 ,,TotalUnits,,,,13.41 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,39501,CPT,REPAIR LACERATION DIAPHRAGM ANY APPROACH,,,21 ,,RBRVS,13.98 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39503,CPT,RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ,,,21 ,,RBRVS,108.91 ,46.83 ,46.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39540,CPT,RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT,,,21 ,,RBRVS,14.57 ,7.90 ,7.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39541,CPT,RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC,,,21 ,,RBRVS,15.75 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39545,CPT,IMBRICATION DIAPHRAGM EVENTRATION,,,21 ,,RBRVS,14.67 ,8.87 ,8.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39560,CPT,RESCJ DIAPHRAGM W/SIMPLE REPAIR,,,21 ,,RBRVS,13.06 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39561,CPT,RESCJ DIAPHRAGM W/COMPLEX REPAIR,,,21 ,,RBRVS,19.99 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,39599,CPT,UNLISTED PROCEDURE DIAPHRAGM,,,21 ,,TotalUnits,,,,22.12 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,40490,CPT,BIOPSY OF LIP,,,21 ,,RBRVS,1.22 ,0.80 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40500,CPT,VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT,,,21 ,,RBRVS,4.47 ,5.78 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40510,CPT,EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR,,,21 ,,RBRVS,4.82 ,5.12 ,8.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40520,CPT,EXC LIP V-EXC W/PRIM DIR LINR CLSR,,,21 ,,RBRVS,4.79 ,5.24 ,9.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40525,CPT,EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP,,,21 ,,RBRVS,7.72 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40527,CPT,EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP,,,21 ,,RBRVS,9.32 ,8.28 ,8.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40530,CPT,RESCJ LIP > ONE-FOURTH W/O RCNSTJ,,,21 ,,RBRVS,5.54 ,5.76 ,9.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40650,CPT,RPR LIP FULL THICKNESS VERMILION ONLY,,,21 ,,RBRVS,3.78 ,4.39 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40652,CPT,RPR LIP FULL THICKNESS HALF/< VERTICAL HEIGHT,,,21 ,,RBRVS,4.43 ,5.46 ,9.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40654,CPT,RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE,,,21 ,,RBRVS,5.48 ,6.37 ,10.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40700,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI,,,21 ,,RBRVS,14.17 ,12.40 ,12.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40701,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX,,,21 ,,RBRVS,17.23 ,15.40 ,15.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40702,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS,,,21 ,,RBRVS,14.27 ,8.95 ,8.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40720,CPT,PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL,,,21 ,,RBRVS,14.72 ,13.31 ,13.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40761,CPT,PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP,,,21 ,,RBRVS,15.84 ,11.86 ,11.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40799,CPT,UNLISTED PROCEDURE LIPS,,,21 ,,TotalUnits,,,,3.60 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,40800,CPT,DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL,,,21 ,,RBRVS,1.23 ,2.50 ,4.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40801,CPT,DRG ABSC CST HMTMA VESTIBULE MOUTH COMP,,,21 ,,RBRVS,2.63 ,3.58 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40804,CPT,RMVL EMBEDDED FB VESTIBULE MOUTH SMPL,,,21 ,,RBRVS,1.30 ,2.54 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40805,CPT,RMVL EMBEDDED FB VESTIBULE MOUTH COMP,,,21 ,,RBRVS,2.79 ,3.57 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40806,CPT,INCISION LABIAL FRENUM FRENOTOMY,,,21 ,,RBRVS,0.31 ,0.78 ,4.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40808,CPT,BIOPSY VESTIBULE MOUTH,,,21 ,,RBRVS,1.01 ,2.11 ,4.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40810,CPT,EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR,,,21 ,,RBRVS,1.36 ,2.30 ,4.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40812,CPT,EXC LES MUCOSA & SBMCSL VESTIBULE SMPL RPR,,,21 ,,RBRVS,2.37 ,3.17 ,5.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40814,CPT,EXC LES MUCOSA & SBMCSL VESTIBULE CPLX RPR,,,21 ,,RBRVS,3.52 ,5.08 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40816,CPT,EXC LES MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC,,,21 ,,RBRVS,3.77 ,5.21 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40818,CPT,EXC MUCOSA VESTIBULE MOUTH AS DON GRF,,,21 ,,RBRVS,2.83 ,4.89 ,7.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40819,CPT,EXC FRENUM LABIAL/BUCCAL,,,21 ,,RBRVS,2.51 ,4.17 ,6.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40820,CPT,DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS,,,21 ,,RBRVS,1.34 ,3.69 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40830,CPT,CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<,,,21 ,,RBRVS,1.82 ,2.82 ,5.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40831,CPT,CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL,,,21 ,,RBRVS,2.57 ,3.74 ,6.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40840,CPT,VESTIBULOPLASTY ANTERIOR,,,21 ,,RBRVS,9.15 ,7.92 ,13.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40842,CPT,VESTIBULOPLASTY POSTERIOR UNILATERAL,,,21 ,,RBRVS,9.15 ,8.46 ,13.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40843,CPT,VESTIBULOPLASTY POSTERIOR BILATERAL,,,21 ,,RBRVS,12.79 ,10.23 ,16.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40844,CPT,VESTIBULOPLASTY ENTIRE ARCH,,,21 ,,RBRVS,16.80 ,13.09 ,20.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40845,CPT,VESTIBULOPLASTY CPLX W/RIDGE XTN MUSC RPSG,,,21 ,,RBRVS,19.36 ,14.81 ,21.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,40899,CPT,UNLISTED PROCEDURE VESTIBULE MOUTH,,,21 ,,TotalUnits,,,,5.30 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,41000,CPT,INTRAORAL I&D TONGUE/FLOOR LINGUAL,,,21 ,,RBRVS,1.35 ,1.82 ,3.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41005,CPT,INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC,,,21 ,,RBRVS,1.31 ,2.34 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41006,CPT,INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD,,,21 ,,RBRVS,3.34 ,4.03 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41007,CPT,INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE,,,21 ,,RBRVS,3.20 ,3.84 ,7.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41008,CPT,INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE,,,21 ,,RBRVS,3.46 ,4.07 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41009,CPT,INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE,,,21 ,,RBRVS,3.71 ,4.48 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41010,CPT,INCISION LINGUAL FRENUM FRENOTOMY,,,21 ,,RBRVS,1.11 ,2.08 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41015,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL,,,21 ,,RBRVS,4.08 ,5.51 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41016,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT,,,21 ,,RBRVS,4.19 ,5.67 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41017,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB,,,21 ,,RBRVS,4.19 ,5.70 ,8.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41018,CPT,XTRORAL I&D FLOOR MASTICATOR SPACE,,,21 ,,RBRVS,5.22 ,6.31 ,8.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41019,CPT,PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT,,,21 ,,RBRVS,8.84 ,3.90 ,3.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41100,CPT,BIOPSY TONGUE ANTERIOR TWO-THIRDS,,,21 ,,RBRVS,1.42 ,1.64 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41105,CPT,BIOPSY TONGUE POSTERIOR ONE-THIRD,,,21 ,,RBRVS,1.47 ,1.68 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41108,CPT,BIOPSY FLOOR MOUTH,,,21 ,,RBRVS,1.10 ,1.48 ,3.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41110,CPT,EXCISION LESION TONGUE W/O CLOSURE,,,21 ,,RBRVS,1.56 ,2.22 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41112,CPT,EXC LES TONGUE W/CLSR ANTERIOR TWO-THIRDS,,,21 ,,RBRVS,2.83 ,4.38 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41113,CPT,EXC LES TONGUE W/CLSR POSTERIOR ONE-THIRD,,,21 ,,RBRVS,3.29 ,4.65 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41114,CPT,EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP,,,21 ,,RBRVS,8.82 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41115,CPT,EXCIISION LINGUAL FRENUM FRENECTOMY,,,21 ,,RBRVS,1.79 ,2.42 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41116,CPT,EXCISION LESION FLOOR MOUTH,,,21 ,,RBRVS,2.52 ,3.77 ,7.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41120,CPT,GLOSSECTOMY <ONE-HALF TONGUE,,,21 ,,RBRVS,11.14 ,19.16 ,19.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41130,CPT,GLOSSECTOMY HEMIGLOSSECTOMY,,,21 ,,RBRVS,15.74 ,21.46 ,21.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,41135,CPT,GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ,,,21 ,,RBRVS,30.14 ,30.25 ,30.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,41140,CPT,GLSSC COMPL/TOT W/WOTRACHS W/O RAD NECK DSJ,,,21 ,,RBRVS,29.15 ,32.85 ,32.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,41145,CPT,GLSSC COMPL/TOT W/WO TRACHS W/UNI RAD NECK DSJ,,,21 ,,RBRVS,37.93 ,40.10 ,40.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,41150,CPT,GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ,,,21 ,,RBRVS,29.86 ,32.00 ,32.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,41153,CPT,GLSSC COMPOSIT RESCJ FLOOR SUPRAHYOID NCK DSJ,,,21 ,,RBRVS,33.59 ,33.20 ,33.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,41155,CPT,GLSSC COMPOSIT RESCJ FLR MNDBLR RESCJ & RAD NECK,,,21 ,,RBRVS,44.30 ,39.05 ,39.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,41250,CPT,RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG,,,21 ,,RBRVS,1.96 ,2.22 ,5.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41251,CPT,RPR LAC 2.5 CM/< PST ONE-THIRD TONGUE,,,21 ,,RBRVS,2.32 ,2.62 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41252,CPT,RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX,,,21 ,,RBRVS,3.02 ,2.86 ,5.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41500,CPT,FIXJ TONGUE MECHANICAL OTHER/THAN SUTURE,,,21 ,,RBRVS,3.80 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41510,CPT,SUTURE TONGUE LIP MICROGNATHIA,,,21 ,,RBRVS,3.51 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41512,CPT,TONGUE BASE SUSPENSION PERMANENT SUTURE TQ,,,21 ,,RBRVS,6.86 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41520,CPT,FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY,,,21 ,,RBRVS,2.83 ,4.41 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41530,CPT,SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION,,,21 ,,RBRVS,4.51 ,7.47 ,94.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41599,CPT,UNLISTED PROCEDURE TONGUE FLOOR MOUTH,,,21 ,,TotalUnits,,,,4.74 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,41800,CPT,DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS,,,21 ,,RBRVS,1.27 ,2.81 ,6.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41805,CPT,RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS,,,21 ,,RBRVS,1.34 ,3.53 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41806,CPT,RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE,,,21 ,,RBRVS,2.79 ,4.53 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41820,CPT,GINGIVECTOMY EXC GINGIVA EACH QUADRANT,,,21 ,,TotalUnits,,,,6.12 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,41821,CPT,OPRCULECTOMY EXC PRICORONAL TISSUE,,,21 ,,TotalUnits,,,,1.38 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,41822,CPT,EXC FIBROUS TUBEROSITIES DENTOALVEOLAR STRUXS,,,21 ,,RBRVS,2.41 ,2.63 ,5.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41823,CPT,EXC OSS TUBEROSITIES DENTOALVEOLAR STRUXS,,,21 ,,RBRVS,3.77 ,5.30 ,8.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41825,CPT,EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR,,,21 ,,RBRVS,1.41 ,2.08 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41826,CPT,EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR,,,21 ,,RBRVS,2.41 ,3.52 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41827,CPT,EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR,,,21 ,,RBRVS,3.83 ,4.82 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41828,CPT,EXC HYPRPLSTC ALVEOLAR MUCOSA EA QUADRANT SPEC,,,21 ,,RBRVS,3.14 ,2.75 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41830,CPT,ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY,,,21 ,,RBRVS,3.45 ,4.46 ,7.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41850,CPT,DESTRUCTION LESION DENTOALVEOLAR STRUCTURES,,,21 ,,RBRVS,1.78 ,1.59 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41870,CPT,PERIODONTAL MUCOSAL GRAFTING,,,21 ,,TotalUnits,,,,7.65 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,41872,CPT,GINGIVOPLASTY EACH QUADRANT SPECIFY,,,21 ,,RBRVS,3.01 ,5.09 ,8.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41874,CPT,ALVEOLOPLASTY EACH QUADRANT SPECIFY,,,21 ,,RBRVS,3.19 ,3.93 ,7.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,41899,CPT,UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES,,,21 ,,TotalUnits,,,,10.29 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,42000,CPT,DRAINAGE ABSCESS PALATE UVULA,,,21 ,,RBRVS,1.28 ,1.69 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42100,CPT,BIOPSY PALATE UVULA,,,21 ,,RBRVS,1.36 ,1.75 ,2.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42104,CPT,EXC LESION PALATE UVULA W/O CLOSURE,,,21 ,,RBRVS,1.69 ,2.27 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42106,CPT,EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE,,,21 ,,RBRVS,2.15 ,2.89 ,5.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42107,CPT,EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE,,,21 ,,RBRVS,4.56 ,5.23 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42120,CPT,RESCJ PALATE/EXTENSIVE RESCJ LESION,,,21 ,,RBRVS,11.86 ,16.56 ,16.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42140,CPT,UVULECTOMY EXCISION UVULA,,,21 ,,RBRVS,1.70 ,2.81 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42145,CPT,PALATOPHARYNGOPLASTY,,,21 ,,RBRVS,9.78 ,10.24 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42160,CPT,DSTRJ LES PALATE/UVULA THERMAL CRYO/CHEM,,,21 ,,RBRVS,1.85 ,2.39 ,4.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42180,CPT,REPAIR LACERATION PALATE </2 CM,,,21 ,,RBRVS,2.55 ,2.68 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42182,CPT,REPAIR LACERATION PALATE >2 CM/COMPLEX,,,21 ,,RBRVS,3.87 ,3.42 ,5.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42200,CPT,PALATOP CL PALATE SOFT&/HARD PALATE ONLY,,,21 ,,RBRVS,12.53 ,11.70 ,11.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42205,CPT,PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE,,,21 ,,RBRVS,13.66 ,10.70 ,10.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42210,CPT,PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE,,,21 ,,RBRVS,15.03 ,15.24 ,15.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42215,CPT,PALATOPLASTY CLEFT PALATE MAJOR REVJ,,,21 ,,RBRVS,8.99 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42220,CPT,PALATOPLASTY CLEFT PALATE SEC LNGTH PX,,,21 ,,RBRVS,7.16 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42225,CPT,PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP,,,21 ,,RBRVS,9.77 ,16.12 ,16.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42226,CPT,LENGTHENING PALATE & PHARYNGEAL FLAP,,,21 ,,RBRVS,10.35 ,15.71 ,15.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42227,CPT,LENGTHENING PALATE W/ISLAND FLAP,,,21 ,,RBRVS,9.90 ,14.73 ,14.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42235,CPT,REPAIR ANTERIOR PALATE W/VOMER FLAP,,,21 ,,RBRVS,8.01 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42260,CPT,REPAIR NASOLABIAL FISTULA,,,21 ,,RBRVS,10.22 ,8.40 ,13.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42280,CPT,MAXILLARY IMPRESJ PALATAL PROSTHESIS,,,21 ,,RBRVS,1.59 ,1.38 ,2.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42281,CPT,INSJ PIN-RETAINED PALATAL PROSTHESIS,,,21 ,,RBRVS,1.98 ,2.36 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42299,CPT,UNLISTED PROCEDURE PALATE UVULA,,,21 ,,TotalUnits,,,,5.86 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,42300,CPT,DRAINAGE ABSCESS PAROTID SIMPLE,,,21 ,,RBRVS,1.98 ,2.38 ,4.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42305,CPT,DRAINAGE ABSCESS PAROTID COMPLICATED,,,21 ,,RBRVS,6.31 ,5.74 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42310,CPT,DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL,,,21 ,,RBRVS,1.61 ,1.96 ,3.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42320,CPT,DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL,,,21 ,,RBRVS,2.40 ,2.62 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42330,CPT,SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL,,,21 ,,RBRVS,2.26 ,2.42 ,4.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42335,CPT,SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL,,,21 ,,RBRVS,3.41 ,3.95 ,7.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42340,CPT,SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL,,,21 ,,RBRVS,4.72 ,4.86 ,8.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42400,CPT,BIOPSY SALIVARY GLAND NEEDLE,,,21 ,,RBRVS,0.78 ,0.81 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42405,CPT,BIOPSY SALIVARY GLAND INCISIONAL,,,21 ,,RBRVS,3.34 ,3.02 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42408,CPT,EXC SUBLINGUAL SALIVARY CYST RANULA,,,21 ,,RBRVS,4.66 ,4.61 ,8.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42409,CPT,MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA,,,21 ,,RBRVS,2.91 ,3.47 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42410,CPT,EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ,,,21 ,,RBRVS,9.57 ,7.68 ,7.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42415,CPT,EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR,,,21 ,,RBRVS,17.16 ,12.43 ,12.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42420,CPT,EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR,,,21 ,,RBRVS,19.53 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42425,CPT,EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL,,,21 ,,RBRVS,13.42 ,9.92 ,9.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42426,CPT,EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ,,,21 ,,RBRVS,22.66 ,14.85 ,14.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,42440,CPT,EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND,,,21 ,,RBRVS,6.14 ,5.56 ,5.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42450,CPT,EXISION OF SUBLINGUAL GLAND,,,21 ,,RBRVS,4.74 ,5.46 ,8.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42500,CPT,PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM,,,21 ,,RBRVS,4.42 ,5.31 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42505,CPT,PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP,,,21 ,,RBRVS,6.32 ,6.52 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42507,CPT,PAROTID DUCT DIVERSION BILATERAL WILKE PX,,,21 ,,RBRVS,6.25 ,8.55 ,8.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42508,CPT,PAROTID DUCT DIVERSION BI W/EXC 1 SUBMNDBLR GLND,,,21 ,,RBRVS,9.33 ,11.13 ,11.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42509,CPT,PAROTID DUCT DVRJ BI W/EXC BOTH SUBMNDBLR GLANDS,,,21 ,,RBRVS,11.76 ,12.21 ,12.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42510,CPT,PAROTID DUCT DVRJ BILATERAL WITH LIG BOTH DUCTS,,,21 ,,RBRVS,8.35 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42550,CPT,INJECTION PROCEDURE SIALOGRAPHY,,,21 ,,RBRVS,1.25 ,0.48 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42600,CPT,CLOSURE SALIVARY FISTULA,,,21 ,,RBRVS,4.94 ,5.00 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42650,CPT,DILATION SALIVARY DUCT,,,21 ,,RBRVS,0.77 ,0.90 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42660,CPT,DILAT&CATHJ SALIVARY DUCT W/WO INJECTION,,,21 ,,RBRVS,1.13 ,1.05 ,1.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42665,CPT,LIGATION SALIVARY DUCT INTRAORAL,,,21 ,,RBRVS,2.63 ,3.32 ,6.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42699,CPT,UNLISTED PX SALIVARY GLANDS/DUCTS,,,21 ,,TotalUnits,,,,14.97 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,42700,CPT,I&D ABSCESS PERITONSILLAR,,,21 ,,RBRVS,1.67 ,2.24 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42720,CPT,I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL,,,21 ,,RBRVS,6.31 ,4.67 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42725,CPT,I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR,,,21 ,,RBRVS,12.41 ,10.33 ,10.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42800,CPT,BIOPSY OROPHARYNX,,,21 ,,RBRVS,1.44 ,1.77 ,3.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42802,CPT,BIOPSY HYPOPHARYNX,,,21 ,,RBRVS,1.59 ,2.28 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42804,CPT,BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE,,,21 ,,RBRVS,1.29 ,2.02 ,4.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42806,CPT,BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION,,,21 ,,RBRVS,1.63 ,2.20 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42808,CPT,EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD,,,21 ,,RBRVS,2.35 ,2.26 ,4.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42809,CPT,REMOVAL FOREIGN BODY PHARYNX,,,21 ,,RBRVS,1.86 ,1.83 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42810,CPT,EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS,,,21 ,,RBRVS,3.38 ,4.98 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42815,CPT,EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX,,,21 ,,RBRVS,7.31 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42820,CPT,TONSILLECTOMY & ADENOIDECTOMY <AGE 12,,,21 ,,RBRVS,4.22 ,4.02 ,4.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42821,CPT,TONSILLECTOMY & ADENOIDECTOMY AGE 12/>,,,21 ,,RBRVS,4.36 ,4.19 ,4.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42825,CPT,TONSILLECTOMY ONE-HALF <AGE 12,,,21 ,,RBRVS,3.51 ,3.38 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42826,CPT,TONSILLECTOMY ONE-HALF AGE 12/>,,,21 ,,RBRVS,3.45 ,3.73 ,3.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42830,CPT,ADENOIDECTOMY PRIMARY <AGE 12,,,21 ,,RBRVS,2.65 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42831,CPT,ADENOIDECTOMY PRIMARY AGE 12/>,,,21 ,,RBRVS,2.81 ,3.62 ,3.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42835,CPT,ADENOIDECTOMY SECONDARY<AGE 12,,,21 ,,RBRVS,2.38 ,3.12 ,3.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42836,CPT,ADENOIDECTOMY SECONDARY AGE 12/>,,,21 ,,RBRVS,3.26 ,3.63 ,3.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42842,CPT,RADICAL RESECTION TONSIL W/O CLOSURE,,,21 ,,RBRVS,12.23 ,16.16 ,16.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42844,CPT,RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP,,,21 ,,RBRVS,17.78 ,21.24 ,21.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42845,CPT,RADICAL RESCJ TONSIL CLOSURE W/OTHER FLAP,,,21 ,,RBRVS,32.56 ,30.02 ,30.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,42860,CPT,EXCISION TONSIL TAGS,,,21 ,,RBRVS,2.30 ,3.13 ,3.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42870,CPT,EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX,,,21 ,,RBRVS,5.52 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42890,CPT,LIMITED PHARYNGECTOMY,,,21 ,,RBRVS,19.13 ,20.88 ,20.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42892,CPT,RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR,,,21 ,,RBRVS,26.03 ,26.97 ,26.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42894,CPT,RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS,,,21 ,,RBRVS,33.92 ,32.73 ,32.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,42900,CPT,SUTURE PHARYNX WOUND/INJURY,,,21 ,,RBRVS,5.29 ,4.27 ,4.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42950,CPT,PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX,,,21 ,,RBRVS,8.27 ,14.70 ,14.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42953,CPT,PHARYNGOESOPHAGEAL REPAIR,,,21 ,,RBRVS,9.45 ,18.46 ,18.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,42955,CPT,PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING,,,21 ,,RBRVS,8.01 ,13.78 ,13.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42960,CPT,CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE,,,21 ,,RBRVS,2.38 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42961,CPT,CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ,,,21 ,,RBRVS,5.77 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,42962,CPT,CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ,,,21 ,,RBRVS,7.40 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42970,CPT,CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS,,,21 ,,RBRVS,5.82 ,5.44 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42971,CPT,CTRL NASOPHARYNGEAL HEMRRG COMP REQ HOSPIZATION,,,21 ,,RBRVS,6.60 ,6.38 ,6.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,42972,CPT,CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ,,,21 ,,RBRVS,7.59 ,6.89 ,6.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,42999,CPT,UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS,,,21 ,,TotalUnits,,,,7.18 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,43020,CPT,ESOPHAGOTOMY CERVICAL APPR W/RMVL FB,,,21 ,,RBRVS,8.23 ,6.84 ,6.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43030,CPT,CRICOPHARYNGEAL MYOTOMY,,,21 ,,RBRVS,7.99 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43045,CPT,ESOPHAGOTOMY THORACIC APPR W/RMVL FB,,,21 ,,RBRVS,21.88 ,12.21 ,12.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43100,CPT,EXC LESION ESOPHOGUS W/PRIM RPR CERVICAL APPR,,,21 ,,RBRVS,9.66 ,7.93 ,7.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43101,CPT,EXC LESION ESOPHAGUS W/PRIM RPR THRC/ABDL APPR,,,21 ,,RBRVS,17.07 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43107,CPT,TOT ESOPHAGECTOMY W/O THORCOM W/WO PYLOROPLASTY,,,21 ,,RBRVS,44.18 ,21.63 ,21.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43108,CPT,TOT ESOPHG W/O THORCOM COLON NTRPSTJ/INT RCNSTJ,,,21 ,,RBRVS,82.87 ,30.75 ,30.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43112,CPT,TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY,,,21 ,,RBRVS,47.48 ,22.24 ,22.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43113,CPT,TOT ESOPHG W/THORCOM W/COLON NTRPSTJ/INT RCNSTJ,,,21 ,,RBRVS,80.06 ,37.01 ,37.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43116,CPT,PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF,,,21 ,,RBRVS,92.99 ,49.40 ,49.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43117,CPT,PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY,,,21 ,,RBRVS,43.65 ,20.04 ,20.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43118,CPT,PRTL ESOPH DSTL W/WO PROX GASTRC W/COLON NTRPSTJ,,,21 ,,RBRVS,67.07 ,30.09 ,30.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43121,CPT,PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY,,,21 ,,RBRVS,51.43 ,22.24 ,22.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43122,CPT,PRTL ESOPHG THORACOABD W/WO PROXGASTREC/PYLOROPL,,,21 ,,RBRVS,44.18 ,21.75 ,21.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43123,CPT,PRTL ESPHG THORACOABDL/ABDL APPR NTRPSTJ/RCNSTJ,,,21 ,,RBRVS,83.12 ,37.28 ,37.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43124,CPT,TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY,,,21 ,,RBRVS,69.09 ,28.81 ,28.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43130,CPT,DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR,,,21 ,,RBRVS,12.53 ,9.12 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43135,CPT,DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR,,,21 ,,RBRVS,26.17 ,12.21 ,12.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43200,CPT,ESPHGSC RGD/FLX DX W/WO COLLJ SPEC BR/WA SPX,,,21 ,,RBRVS,1.59 ,1.32 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43201,CPT,ESPHGSC RGD/FLX W/SUBMUCOSAL INJ ANY SBST,,,21 ,,RBRVS,2.09 ,1.45 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43202,CPT,ESPHGSC RGD/FLX W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,1.89 ,1.28 ,6.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43204,CPT,ESPHGSC RGD/FLX W/NJX SCLEROSIS ESOPHGL VARC,,,21 ,,RBRVS,3.76 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43205,CPT,ESPHGSC RGD/FLX W/BAND LIGATION ESOPHGL VARICES,,,21 ,,RBRVS,3.78 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43215,CPT,ESPHGSC RGD/FLX W/RMVL FOREIGN BODY,,,21 ,,RBRVS,2.60 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43216,CPT,ESPHGSC RGD/FLX RMVL TUM HOT BX FORCEPS/CAUT,,,21 ,,RBRVS,2.40 ,1.57 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43217,CPT,ESPHGSC RGD/FLX W/RMVL TUMOR SNARE TECHNIQUE,,,21 ,,RBRVS,2.90 ,1.72 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43219,CPT,ESPHGSC RGD/FLX W/INSJ PLSTC TUBE/STENT,,,21 ,,RBRVS,2.80 ,1.85 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43220,CPT,ESPHGSC RGD/FLX W/BALLOON DILAT <30 MM DIAM,,,21 ,,RBRVS,2.10 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43226,CPT,ESPHGSC RGD/FLX W/INSJ GUIDE WIRE DILATION,,,21 ,,RBRVS,2.34 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43227,CPT,ESPHGSC RGD/FLX W/CTRL BLEEDING,,,21 ,,RBRVS,3.59 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43228,CPT,ESPHGSC RGD/FLX ABLTJ TUM XCP HOT BX/CAUT/SNARE,,,21 ,,RBRVS,3.76 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43231,CPT,ESPHGSC RGD/FLX W/NDSC ULTRASOUND EXAMINATION,,,21 ,,RBRVS,3.19 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43232,CPT,ESPHGSC RGD/FLX W/TNDSC US-GID FINE NDL ASPIR/BX,,,21 ,,RBRVS,4.47 ,2.63 ,2.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43235,CPT,UPPER GI NDSC DX W/WO COLLECTION SPECIMEN,,,21 ,,RBRVS,2.39 ,1.59 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43236,CPT,UPPER GI NDSC W/SUBMUCOSAL INJECTION,,,21 ,,RBRVS,2.92 ,1.90 ,8.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43237,CPT,UPR GI NDSC & US NDSC EXAM LMTD ESOPHAGUS,,,21 ,,RBRVS,3.98 ,2.42 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43238,CPT,UPR GI NDSC TNDSC US FINE NDL ASPIR/BX ESOPH,,,21 ,,RBRVS,5.02 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43239,CPT,UPPER NDSC BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,2.87 ,1.84 ,7.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43240,CPT,UPR GI NDSC TRANSMURAL DRAINAGE PSEUDOCYST,,,21 ,,RBRVS,6.85 ,3.96 ,3.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43241,CPT,UPR GI NDSC TNDSC INTRALUMINAL TUBE/CATH PLMT,,,21 ,,RBRVS,2.59 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43242,CPT,UPPER GI NDSC ULTRASOUND GUIDED BIOPSY,,,21 ,,RBRVS,7.30 ,4.25 ,4.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43243,CPT,UPR GI NDSC NJX SCLEROSIS ESOPHGL&/GSTR VARICE,,,21 ,,RBRVS,4.56 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43244,CPT,UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARICES,,,21 ,,RBRVS,5.04 ,3.04 ,3.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43245,CPT,UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ,,,21 ,,RBRVS,3.18 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43246,CPT,UPR GI NDSC PLMT PRQ GASTROSTOMY TUBE,,,21 ,,RBRVS,4.32 ,2.51 ,2.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43247,CPT,UPPER GI NDSC W/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,3.38 ,2.09 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43248,CPT,UPR GI NDSC INSJ GUIDE WIRE DILAT ESOPHAGUS,,,21 ,,RBRVS,3.15 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43249,CPT,UPR GI NDSC BALLOON DILAT ESOPH <30 MM DIAM,,,21 ,,RBRVS,2.90 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43250,CPT,UPR GI NDSC RMVL LESION HOT BX/BIPOLAR CAUTERY,,,21 ,,RBRVS,3.20 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43251,CPT,UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ,,,21 ,,RBRVS,3.69 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43255,CPT,UPR GI NDSC CONTROL BLEEDING ANY METHOD,,,21 ,,RBRVS,4.81 ,2.91 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43256,CPT,UPR GI NDSC TNDSC STENT PLMT W/PREDILAT,,,21 ,,RBRVS,4.34 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43257,CPT,UPR GI NDSC DLVR THERMAL NRG SPHNCTR/CARDIA,,,21 ,,RBRVS,5.50 ,3.28 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43258,CPT,UPR GI NDSC ABLTJ LES X RMVL FORCEPS/CAUT/SNARE,,,21 ,,RBRVS,4.54 ,2.75 ,2.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43259,CPT,UPPER GI NDSC W/NDSC ULTRASOUND EXAM,,,21 ,,RBRVS,5.19 ,3.12 ,3.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43260,CPT,ERCP DX W/WO COLLJ SPEC BRUSHING/WASHING SPX,,,21 ,,RBRVS,5.95 ,3.52 ,3.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43261,CPT,ERCP W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,6.26 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43262,CPT,ERCP W/SPHINCTEROTOMY/PAPILLOTOMY,,,21 ,,RBRVS,7.38 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43263,CPT,ERCP W/PRESSURE MEAS SPHINCTER ODDI,,,21 ,,RBRVS,7.28 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43264,CPT,ERCP W/RMVCALCULI BILIARY&/PANCREATIC DUCTS,,,21 ,,RBRVS,8.89 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43265,CPT,ERCP W/DSTRJ LITHOTRIPSY CALCULI ANY METHOD,,,21 ,,RBRVS,10.00 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43267,CPT,ERCP W/INSJ NASOBILIARY/NASOPNCRTC DRAINAGE TUBE,,,21 ,,RBRVS,7.38 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43268,CPT,ERCP W/INSJ TUBE/STENT BILE/PANCREATIC DUCT,,,21 ,,RBRVS,7.38 ,4.47 ,4.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43269,CPT,ERCP W/RTRGR RMVL FB&/CHNG TUBE/STENT,,,21 ,,RBRVS,8.20 ,4.73 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43271,CPT,ERCP W/BALO DILAT AMPULLA BILIARY&/PNCRTC DUX,,,21 ,,RBRVS,7.38 ,4.28 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43272,CPT,ERCP W/ABLTJ LES X RMVL FORCEPS/CAUT/SNARE,,,21 ,,RBRVS,7.38 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43273,CPT,ENDOSCOPIC PAPILLA CANNULATION BILE PANCREATIC,,,21 ,,RBRVS,2.24 ,1.22 ,1.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43279,CPT,LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED,,,21 ,,RBRVS,22.10 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43280,CPT,LAPS SURG ESOPG/GSTR FUNDOPLASTY,,,21 ,,RBRVS,18.10 ,9.73 ,9.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43281,CPT,LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH,,,21 ,,RBRVS,26.60 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43282,CPT,LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH,,,21 ,,RBRVS,30.10 ,14.88 ,14.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43283,CPT,LAPS ESOPHAGEAL LENGTHENING ADDL,,,21 ,,RBRVS,2.95 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43289,CPT,UNLISTED LAPAROSCOPIC PROCEDURE ESOPHAGUS,,,21 ,,TotalUnits,,,,27.83 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,43300,CPT,ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL,,,21 ,,RBRVS,9.33 ,7.99 ,7.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43305,CPT,ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL,,,21 ,,RBRVS,18.10 ,12.43 ,12.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43310,CPT,ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL,,,21 ,,RBRVS,26.26 ,12.39 ,12.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43312,CPT,ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL,,,21 ,,RBRVS,29.25 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43313,CPT,ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL,,,21 ,,RBRVS,48.45 ,25.24 ,25.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43314,CPT,ESPHGP CGEN DFCT THRC APPR W/RPR FSTL,,,21 ,,RBRVS,53.43 ,25.81 ,25.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43320,CPT,EGST W/WO VAGOTOMY&PYLOROPLASTY TABDL/TTHRC AP,,,21 ,,RBRVS,23.31 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43325,CPT,ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH,,,21 ,,RBRVS,22.60 ,12.19 ,12.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43327,CPT,ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY,,,21 ,,RBRVS,13.35 ,7.98 ,7.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43328,CPT,ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY,,,21 ,,RBRVS,19.91 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43330,CPT,ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH,,,21 ,,RBRVS,22.19 ,11.45 ,11.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43331,CPT,ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH,,,21 ,,RBRVS,23.06 ,12.00 ,12.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43332,CPT,RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH,,,21 ,,RBRVS,19.62 ,10.61 ,10.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43333,CPT,LAPT RPR PARAESOPH HIATAL HERNIA W/MESH,,,21 ,,RBRVS,21.46 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43334,CPT,RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH,,,21 ,,RBRVS,22.12 ,10.82 ,10.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43335,CPT,RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH,,,21 ,,RBRVS,23.97 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43336,CPT,RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH,,,21 ,,RBRVS,25.81 ,12.83 ,12.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43337,CPT,RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH,,,21 ,,RBRVS,27.65 ,14.78 ,14.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43338,CPT,ESOPHAGUS LENGTHENING,,,21 ,,RBRVS,2.21 ,1.18 ,1.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43340,CPT,ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT ABDL APPR,,,21 ,,RBRVS,22.99 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43341,CPT,ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT THRC APPR,,,21 ,,RBRVS,24.23 ,12.52 ,12.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43350,CPT,ESOPHAGOSTOMY FSTLJ ESOPH XTRNL ABDL APPR,,,21 ,,RBRVS,19.49 ,13.30 ,13.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43351,CPT,ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR,,,21 ,,RBRVS,22.05 ,12.38 ,12.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43352,CPT,ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR,,,21 ,,RBRVS,17.81 ,10.18 ,10.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43360,CPT,GI RCNSTJ PREV ESPHG/EXCLUSION W/STOMACH,,,21 ,,RBRVS,40.11 ,21.13 ,21.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43361,CPT,GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT,,,21 ,,RBRVS,45.68 ,23.39 ,23.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43400,CPT,LIGATION DIRECT ESOPHAGEAL VARICES,,,21 ,,RBRVS,25.60 ,14.63 ,14.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43401,CPT,TRNSXJ ESOPH W/RPR ESOPHAGEAL VARICES,,,21 ,,RBRVS,26.49 ,13.08 ,13.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43405,CPT,LIG/STAPLING G-ESOP JUNCT PRE-ESOPHGL PRF8J,,,21 ,,RBRVS,24.73 ,13.22 ,13.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43410,CPT,SUTR ESOPHGL WND/INJ CRV APPR,,,21 ,,RBRVS,16.41 ,12.13 ,12.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43415,CPT,SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR,,,21 ,,RBRVS,44.88 ,20.10 ,20.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43420,CPT,CLSR ESOPHAGOSTOMY/FSTL CRV APPR,,,21 ,,RBRVS,16.78 ,11.47 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43425,CPT,CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR,,,21 ,,RBRVS,25.04 ,12.77 ,12.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43450,CPT,DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS,,,21 ,,RBRVS,1.38 ,1.07 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43453,CPT,DILATION ESOPHAGUS GUIDE WIRE,,,21 ,,RBRVS,1.51 ,1.14 ,7.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43456,CPT,DILAT ESOPHAGUS BALLOON/DILATOR RETROGRADE,,,21 ,,RBRVS,2.57 ,1.68 ,15.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43458,CPT,DILAT ESOPH BALLOON 30 MM DIAM/> ACHALASIA,,,21 ,,RBRVS,3.06 ,1.90 ,8.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43460,CPT,ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE,,,21 ,,RBRVS,3.79 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43496,CPT,FREE JEJUNUM TRSF W/MICROVASC ANASTOMOSIS,,,21 ,,TotalUnits,,,,3.93 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,43499,CPT,UNLISTED PROCEDURE ESOPHAGUS,,,21 ,,TotalUnits,,,,5.12 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,43500,CPT,GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,12.79 ,7.44 ,7.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43501,CPT,GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER,,,21 ,,RBRVS,22.60 ,11.95 ,11.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43502,CPT,GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC,,,21 ,,RBRVS,25.69 ,13.28 ,13.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43510,CPT,GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE,,,21 ,,RBRVS,15.14 ,10.75 ,10.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43520,CPT,PYLOROMYOTOMY CUTTING PYLORIC MUSC,,,21 ,,RBRVS,11.29 ,6.52 ,6.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43605,CPT,BIOPSY STOMACH LAPAROTOMY,,,21 ,,RBRVS,13.72 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43610,CPT,EXC LOCAL ULCER/BENIGN TUMOR STOMACH,,,21 ,,RBRVS,16.34 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43611,CPT,EXC LOCAL MALIGNANT TUMOR STOMACH,,,21 ,,RBRVS,20.38 ,10.82 ,10.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43620,CPT,GSTRCT TOT W/ESOPHAGOENTEROSTOMY,,,21 ,,RBRVS,34.04 ,16.13 ,16.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43621,CPT,GSTRCT TOT W/ROUX-EN-Y RCNSTJ,,,21 ,,RBRVS,39.53 ,18.05 ,18.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43622,CPT,GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE,,,21 ,,RBRVS,40.03 ,18.46 ,18.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43631,CPT,GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY,,,21 ,,RBRVS,24.51 ,12.63 ,12.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43632,CPT,GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY,,,21 ,,RBRVS,35.14 ,16.44 ,16.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43633,CPT,GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ,,,21 ,,RBRVS,33.14 ,15.72 ,15.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43634,CPT,GSTRCT PRTL DSTL W/FRMJ INTSTINAL POUCH,,,21 ,,RBRVS,36.64 ,17.41 ,17.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43635,CPT,VAGOTOMY PFRMD W/PRTL DSTL GSTRCT,,,21 ,,RBRVS,2.06 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43640,CPT,VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV,,,21 ,,RBRVS,19.56 ,10.67 ,10.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43641,CPT,VGTMY W/PYLOROPLASTY W/WO GASTROST PARIETAL CELL,,,21 ,,RBRVS,19.81 ,10.93 ,10.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43644,CPT,LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM,,,21 ,,RBRVS,29.40 ,14.98 ,14.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43645,CPT,LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ,,,21 ,,RBRVS,31.53 ,15.87 ,15.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43651,CPT,LAPS SURG TRNSXJ VAGUS NRV TRUNCAL,,,21 ,,RBRVS,10.13 ,6.80 ,6.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43652,CPT,LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV,,,21 ,,RBRVS,12.13 ,7.58 ,7.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43653,CPT,LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX,,,21 ,,RBRVS,8.48 ,6.39 ,6.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43659,CPT,UNLISTED LAPAROSCOPIC PROCEDURE STOMACH,,,21 ,,TotalUnits,,,,44.38 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,43752,CPT,NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE,,,21 ,,RBRVS,0.81 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43753,CPT,GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE,,,21 ,,RBRVS,0.45 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43754,CPT,GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN,,,21 ,,RBRVS,0.45 ,0.45 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43755,CPT,GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC,,,21 ,,RBRVS,0.94 ,0.68 ,2.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43756,CPT,DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN,,,21 ,,RBRVS,0.77 ,0.71 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43757,CPT,DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN,,,21 ,,RBRVS,1.26 ,0.98 ,8.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43760,CPT,CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE,,,21 ,,RBRVS,0.90 ,0.41 ,12.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43761,CPT,REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO,,,21 ,,RBRVS,2.01 ,0.80 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43770,CPT,LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE,,,21 ,,RBRVS,18.00 ,10.82 ,10.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43771,CPT,LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE,,,21 ,,RBRVS,20.79 ,11.86 ,11.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43772,CPT,LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE,,,21 ,,RBRVS,15.70 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43773,CPT,LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE,,,21 ,,RBRVS,20.79 ,11.84 ,11.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43774,CPT,LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT,,,21 ,,RBRVS,15.76 ,8.95 ,8.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43775,CPT,LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY,,,21 ,,TotalUnits,,,,40.38 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,43800,CPT,PYLOROPLASTY,,,21 ,,RBRVS,15.43 ,8.40 ,8.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43810,CPT,GASTRODUODENOSTOMY,,,21 ,,RBRVS,16.88 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43820,CPT,GASTROJEJUNOSTOMY W/O VAGOTOMY,,,21 ,,RBRVS,22.53 ,11.64 ,11.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43825,CPT,GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE,,,21 ,,RBRVS,21.76 ,11.62 ,11.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43830,CPT,GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX,,,21 ,,RBRVS,10.85 ,7.31 ,7.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43831,CPT,GASTROSTOMY OPN NEONATAL FEEDING,,,21 ,,RBRVS,8.49 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43832,CPT,GASTROSTOMY OPN W/CONSTJ GSTR TUBE,,,21 ,,RBRVS,17.34 ,9.85 ,9.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43840,CPT,GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ,,,21 ,,RBRVS,22.83 ,11.87 ,11.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43842,CPT,GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY,,,21 ,,RBRVS,21.03 ,11.07 ,11.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43843,CPT,GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP,,,21 ,,RBRVS,21.21 ,11.54 ,11.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43845,CPT,GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM,,,21 ,,RBRVS,33.30 ,16.68 ,16.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43846,CPT,GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/<,,,21 ,,RBRVS,27.41 ,14.29 ,14.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43847,CPT,GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ,,,21 ,,RBRVS,30.28 ,15.71 ,15.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43848,CPT,REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE,,,21 ,,RBRVS,32.75 ,16.59 ,16.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43850,CPT,REVJ GASTRODUOL ANAST W/RCNSTJ W/O VAGOTOMY,,,21 ,,RBRVS,27.58 ,13.96 ,13.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43855,CPT,REVJ GASTRODUOL ANAST W/RCNSTJ W/VGTMY,,,21 ,,RBRVS,28.69 ,14.46 ,14.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43860,CPT,REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY,,,21 ,,RBRVS,27.89 ,13.86 ,13.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43865,CPT,REVJ GSTR/JJ ANAST W/RCNSTJ W/VGTMY,,,21 ,,RBRVS,29.05 ,14.59 ,14.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43870,CPT,CLOSURE GASTROSTOMY SURG,,,21 ,,RBRVS,11.44 ,6.98 ,6.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43880,CPT,CLOSURE GASTROCOLIC FISTULA,,,21 ,,RBRVS,27.18 ,13.67 ,13.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,43886,CPT,GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY,,,21 ,,RBRVS,4.64 ,4.89 ,4.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43887,CPT,GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY,,,21 ,,RBRVS,4.32 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43888,CPT,GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT,,,21 ,,RBRVS,6.44 ,5.56 ,5.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,43999,CPT,UNLISTED PROCEDURE STOMACH,,,21 ,,TotalUnits,,,,4.58 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,44005,CPT,ENTEROLSS FRING INTSTINAL ADHESION SPX,,,21 ,,RBRVS,18.46 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44010,CPT,DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,14.26 ,8.01 ,8.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44015,CPT,TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD,,,21 ,,RBRVS,2.62 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44020,CPT,ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL,,,21 ,,RBRVS,16.22 ,8.79 ,8.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44021,CPT,ENTEROTOMY SM INT OTH/THN DUO DCMPRN,,,21 ,,RBRVS,16.31 ,8.90 ,8.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44025,CPT,COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL,,,21 ,,RBRVS,16.51 ,8.92 ,8.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44050,CPT,RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT,,,21 ,,RBRVS,15.52 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44055,CPT,CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS,,,21 ,,RBRVS,25.63 ,12.64 ,12.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44100,CPT,BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS,,,21 ,,RBRVS,2.01 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44110,CPT,EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM,,,21 ,,RBRVS,14.04 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44111,CPT,EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE,,,21 ,,RBRVS,16.52 ,8.75 ,8.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44120,CPT,ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST,,,21 ,,RBRVS,20.82 ,10.52 ,10.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44121,CPT,ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA,,,21 ,,RBRVS,4.44 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44125,CPT,ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY,,,21 ,,RBRVS,20.03 ,10.38 ,10.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44126,CPT,ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING,,,21 ,,RBRVS,42.23 ,20.59 ,20.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44127,CPT,ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING,,,21 ,,RBRVS,49.30 ,23.27 ,23.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44128,CPT,ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS,,,21 ,,RBRVS,4.44 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44130,CPT,ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX,,,21 ,,RBRVS,22.11 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44139,CPT,MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT,,,21 ,,RBRVS,2.23 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44140,CPT,COLECTOMY PARTIAL W/ANASTOMOSIS,,,21 ,,RBRVS,22.59 ,11.95 ,11.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44141,CPT,COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY,,,21 ,,RBRVS,29.91 ,17.09 ,17.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44143,CPT,COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT,,,21 ,,RBRVS,27.79 ,15.12 ,15.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44144,CPT,COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA,,,21 ,,RBRVS,29.91 ,15.55 ,15.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44145,CPT,COLECTOMY PRTL W/COLOPROCTOSTOMY,,,21 ,,RBRVS,28.58 ,14.30 ,14.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44146,CPT,COLECTOMY PRTL W/COLOPROCTOSTOMY & COLOSTOMY,,,21 ,,RBRVS,35.30 ,19.69 ,19.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44147,CPT,COLECTOMY PRTL ABDOMINAL & TRANSANAL APPROACH,,,21 ,,RBRVS,33.69 ,15.98 ,15.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44150,CPT,COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS,,,21 ,,RBRVS,30.18 ,18.36 ,18.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44151,CPT,COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST,,,21 ,,RBRVS,34.92 ,20.12 ,20.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44155,CPT,COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY,,,21 ,,RBRVS,34.42 ,20.02 ,20.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44156,CPT,COLECTOMY TOT ABDL W/PROCTECTOMY W/CONTNT ILEOST,,,21 ,,RBRVS,37.42 ,22.01 ,22.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44157,CPT,COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST,,,21 ,,RBRVS,35.70 ,20.26 ,20.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44158,CPT,COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR,,,21 ,,RBRVS,36.70 ,20.67 ,20.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44160,CPT,COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS,,,21 ,,RBRVS,20.89 ,11.12 ,11.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44180,CPT,LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE,,,21 ,,RBRVS,15.27 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44186,CPT,LAPAROSCOPY SURGICAL JEJUNOSTOMY,,,21 ,,RBRVS,10.38 ,6.49 ,6.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44187,CPT,LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE,,,21 ,,RBRVS,17.40 ,11.68 ,11.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44188,CPT,LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY,,,21 ,,RBRVS,19.35 ,12.67 ,12.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44202,CPT,LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA,,,21 ,,RBRVS,23.39 ,12.30 ,12.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44203,CPT,LAPAROSCOPY SMALL INTESTINE RESCJ & ANASTOMOSIS,,,21 ,,RBRVS,4.44 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44204,CPT,LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS,,,21 ,,RBRVS,26.42 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44205,CPT,LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM,,,21 ,,RBRVS,22.95 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44206,CPT,LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM,,,21 ,,RBRVS,29.79 ,15.56 ,15.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44207,CPT,LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST,,,21 ,,RBRVS,31.92 ,15.43 ,15.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44208,CPT,LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST,,,21 ,,RBRVS,33.99 ,17.86 ,17.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44210,CPT,LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS,,,21 ,,RBRVS,30.09 ,16.69 ,16.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44211,CPT,LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS,,,21 ,,RBRVS,37.08 ,20.75 ,20.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44212,CPT,LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY,,,21 ,,RBRVS,34.58 ,19.52 ,19.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44213,CPT,LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY,,,21 ,,RBRVS,3.50 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44227,CPT,LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS,,,21 ,,RBRVS,28.62 ,14.41 ,14.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44238,CPT,UNLISTED LAPAROSCOPY PX INTESTINE XCP RECTUM,,,21 ,,TotalUnits,,,,39.83 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,44300,CPT,PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN,,,21 ,,RBRVS,13.75 ,7.96 ,7.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44310,CPT,ILEOSTOMY/JEJUNOSTOMY NON-TUBE,,,21 ,,RBRVS,17.59 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44312,CPT,REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX,,,21 ,,RBRVS,9.43 ,6.19 ,6.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44314,CPT,REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX,,,21 ,,RBRVS,16.74 ,9.60 ,9.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44316,CPT,CONTINENT ILEOSTOMY KOCK PROCEDURE SPX,,,21 ,,RBRVS,23.59 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44320,CPT,COLOSTOMY/SKIN LEVEL CECOSTOMY,,,21 ,,RBRVS,19.91 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44322,CPT,COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX,,,21 ,,RBRVS,13.32 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44340,CPT,REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX,,,21 ,,RBRVS,9.28 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44345,CPT,REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX,,,21 ,,RBRVS,17.22 ,10.11 ,10.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44346,CPT,REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX,,,21 ,,RBRVS,19.63 ,11.04 ,11.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44360,CPT,ENDOSCOPY UPPER SMALL INTESTINE,,,21 ,,RBRVS,2.59 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44361,CPT,ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY,,,21 ,,RBRVS,2.87 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44363,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY,,,21 ,,RBRVS,3.49 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44364,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE,,,21 ,,RBRVS,3.73 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44365,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY,,,21 ,,RBRVS,3.31 ,2.11 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44366,CPT,ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING,,,21 ,,RBRVS,4.40 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44369,CPT,ENTEROSCOPY > 2ND PRTN ABLTJ LESION,,,21 ,,RBRVS,4.51 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44370,CPT,ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT,,,21 ,,RBRVS,4.79 ,3.07 ,3.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44372,CPT,ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE,,,21 ,,RBRVS,4.40 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44373,CPT,ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE,,,21 ,,RBRVS,3.49 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44376,CPT,ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX,,,21 ,,RBRVS,5.25 ,3.00 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44377,CPT,ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,5.52 ,3.25 ,3.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44378,CPT,ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING,,,21 ,,RBRVS,7.12 ,4.13 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44379,CPT,ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT,,,21 ,,RBRVS,7.46 ,4.53 ,4.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44380,CPT,ILEOSCOPY STOMA DX W/WO COLLJ SPEC BR/WA SPX,,,21 ,,RBRVS,1.05 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44382,CPT,ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,1.27 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44383,CPT,ILEOSCOPY STOMA W/TNDSC STENT PLMT,,,21 ,,RBRVS,2.94 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44385,CPT,NDSC EVAL INTSTINAL POUCH DX W/WO COLLJ SPEC SPX,,,21 ,,RBRVS,1.82 ,1.08 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44386,CPT,NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,2.12 ,1.33 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44388,CPT,COLONOSCOPY STOMA DX W/WO COLLJ SPEC SPX,,,21 ,,RBRVS,2.82 ,1.69 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44389,CPT,COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,3.13 ,1.91 ,8.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44390,CPT,COLONOSCOPY STOMA W/RMVL FOREIGN BODY,,,21 ,,RBRVS,3.82 ,2.13 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44391,CPT,COLONOSCOPY STOMA CONTROL BLEEDING,,,21 ,,RBRVS,4.31 ,2.53 ,10.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44392,CPT,COLONOSCOPY STOMA RMVL LESION CAUTERY,,,21 ,,RBRVS,3.81 ,2.11 ,8.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44393,CPT,COLONOSCOPY STOMA ABLATION LESION,,,21 ,,RBRVS,4.83 ,2.70 ,9.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44394,CPT,COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE,,,21 ,,RBRVS,4.42 ,2.53 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44397,CPT,COLONOSCOPY STOMA W/TNDSC STENT PLMT,,,21 ,,RBRVS,4.70 ,2.84 ,2.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44500,CPT,INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE,,,21 ,,RBRVS,0.49 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44602,CPT,ENTERORRHAPHY 1PERFORATION,,,21 ,,RBRVS,24.72 ,11.19 ,11.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44603,CPT,ENTERORRHAPHY MULTIPLE PERFORATIONS,,,21 ,,RBRVS,28.16 ,13.19 ,13.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44604,CPT,SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY,,,21 ,,RBRVS,18.16 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44605,CPT,SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY,,,21 ,,RBRVS,22.08 ,11.65 ,11.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44615,CPT,INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ,,,21 ,,RBRVS,18.16 ,9.56 ,9.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44620,CPT,CLOSURE ENTEROSTOMY LG/SMALL INTESTINE,,,21 ,,RBRVS,14.43 ,8.08 ,8.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44625,CPT,CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT,,,21 ,,RBRVS,17.28 ,9.20 ,9.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44626,CPT,CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS,,,21 ,,RBRVS,27.90 ,13.35 ,13.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44640,CPT,CLOSURE INTESTINAL CUTANEOUS FISTULA,,,21 ,,RBRVS,24.20 ,11.94 ,11.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44650,CPT,CLSR ENTEROENTERIC/ENTEROCOLIC FSTL,,,21 ,,RBRVS,25.12 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44660,CPT,CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ,,,21 ,,RBRVS,23.91 ,11.48 ,11.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44661,CPT,CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ,,,21 ,,RBRVS,27.35 ,13.04 ,13.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44680,CPT,INTESTINAL PLICATION SEPARATE PROCEDURE,,,21 ,,RBRVS,17.96 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44700,CPT,EXCLUSION SM INT FROM PELVIS MESH/PROSTH/TISS,,,21 ,,RBRVS,17.48 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44701,CPT,INTRAOPERATIVE COLONIC LAVAGE,,,21 ,,RBRVS,3.10 ,1.22 ,1.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44720,CPT,BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA,,,21 ,,RBRVS,5.00 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44721,CPT,BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA,,,21 ,,RBRVS,7.00 ,2.78 ,2.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44799,CPT,UNLISTED PROCEDURE INTESTINE,,,21 ,,TotalUnits,,,,21.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,44800,CPT,EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT,,,21 ,,RBRVS,12.05 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44820,CPT,EXCISION LESION MESENTERY SEPARATE PROCEDURE,,,21 ,,RBRVS,13.73 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44850,CPT,SUTURE MESENTERY SEPARATE PROCEDURE,,,21 ,,RBRVS,12.11 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44899,CPT,UNLISTED PX MECKEL'S DIVERTICULUM & MESENTERY,,,21 ,,TotalUnits,,,,19.87 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,44900,CPT,I&D APPENDICEAL ABSC OPN,,,21 ,,RBRVS,12.57 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44901,CPT,I&D APPENDICEAL ABSC PRQ,,,21 ,,RBRVS,3.37 ,1.27 ,23.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44950,CPT,APPENDECTOMY,,,21 ,,RBRVS,10.60 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44955,CPT,APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX,,,21 ,,RBRVS,1.53 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44960,CPT,APPENDEC RPTD APPENDIX ABSC/PRITONITIS,,,21 ,,RBRVS,14.50 ,7.92 ,7.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,44970,CPT,LAPAROSCOPIC APPENDECTOMY,,,21 ,,RBRVS,9.45 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,44979,CPT,UNLISTED LAPAROSCOPY PROCEDURE APPENDIX,,,21 ,,TotalUnits,,,,15.51 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,45000,CPT,TRANSRECTAL DRAINAGE OF PELVIC ABSCESS,,,21 ,,RBRVS,6.30 ,4.95 ,4.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45005,CPT,I&D SUBMUCOSAL ABSCESS RECTUM,,,21 ,,RBRVS,2.02 ,2.24 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45020,CPT,I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC,,,21 ,,RBRVS,8.56 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45100,CPT,BX ANORECTAL WALL ANAL APPROACH,,,21 ,,RBRVS,4.04 ,3.96 ,3.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45108,CPT,ANORECTAL MYOMECTOMY,,,21 ,,RBRVS,5.12 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45110,CPT,PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST,,,21 ,,RBRVS,30.76 ,17.61 ,17.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45111,CPT,PRCTECT PRTL RESCJ RECTUM TABDL APPR,,,21 ,,RBRVS,18.01 ,10.31 ,10.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45112,CPT,PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX,,,21 ,,RBRVS,33.18 ,15.91 ,15.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45113,CPT,PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR,,,21 ,,RBRVS,33.22 ,17.68 ,17.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45114,CPT,PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH,,,21 ,,RBRVS,30.79 ,15.53 ,15.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45116,CPT,PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY,,,21 ,,RBRVS,27.72 ,14.27 ,14.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45119,CPT,PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM,,,21 ,,RBRVS,33.48 ,17.73 ,17.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45120,CPT,PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS,,,21 ,,RBRVS,26.40 ,14.11 ,14.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45121,CPT,PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS,,,21 ,,RBRVS,29.08 ,15.34 ,15.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45123,CPT,PRCTECT PRTL W/O ANAST PRNL APPR,,,21 ,,RBRVS,18.86 ,10.59 ,10.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45126,CPT,PELVIC EXENTERATION COLORECTAL MALIGNANCY,,,21 ,,RBRVS,49.10 ,24.48 ,24.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45130,CPT,EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH,,,21 ,,RBRVS,18.50 ,10.26 ,10.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45135,CPT,EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH,,,21 ,,RBRVS,22.36 ,12.66 ,12.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45136,CPT,EXC ILEOANAL RSVR W/ILEOSTOMY,,,21 ,,RBRVS,30.82 ,17.90 ,17.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45150,CPT,DIVISION STRICTURE RECTUM,,,21 ,,RBRVS,5.85 ,4.82 ,4.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45160,CPT,EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL,,,21 ,,RBRVS,16.33 ,9.79 ,9.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45171,CPT,EXC RCT TUM NOT INCL MUSCULARIS PROPRIA,,,21 ,,RBRVS,8.13 ,8.21 ,8.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45172,CPT,EXC RCT TUM INCL MUSCULARIS PROPRIA,,,21 ,,RBRVS,12.13 ,9.77 ,9.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45190,CPT,DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH,,,21 ,,RBRVS,10.42 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45300,CPT,PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX,,,21 ,,RBRVS,0.80 ,0.65 ,2.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45303,CPT,PROCTOSGMDSC RIGID W/DILATION,,,21 ,,RBRVS,1.50 ,0.92 ,25.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45305,CPT,PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,1.25 ,0.85 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45307,CPT,PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY,,,21 ,,RBRVS,1.70 ,1.01 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45308,CPT,PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY,,,21 ,,RBRVS,1.40 ,0.90 ,4.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45309,CPT,PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ,,,21 ,,RBRVS,1.50 ,0.97 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45315,CPT,PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE,,,21 ,,RBRVS,1.80 ,1.11 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45317,CPT,PROCTOSGMDSC RIGID CONTROL BLEEDING,,,21 ,,RBRVS,2.00 ,1.14 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45320,CPT,PROCTOSGMDSC RIGID ABLATION LESION,,,21 ,,RBRVS,1.78 ,1.09 ,4.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45321,CPT,PROCTOSGMDSC RIGID DCMPRN VOLVULUS,,,21 ,,RBRVS,1.75 ,1.10 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45327,CPT,PROCTOSGMDSC RIGID TNDSC STENT PLMT,,,21 ,,RBRVS,2.00 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45330,CPT,SIGMOIDOSCOPY FLX DX W/WO COLLJ SPECIMENS,,,21 ,,RBRVS,0.96 ,0.79 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45331,CPT,SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,1.15 ,0.94 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45332,CPT,SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY,,,21 ,,RBRVS,1.79 ,1.24 ,6.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45333,CPT,SIGMOIDOSCOPY FLX W/RMVL TUMOR CAUTERY,,,21 ,,RBRVS,1.79 ,1.21 ,6.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45334,CPT,SIGMOIDOSCOPY FLX CONTROL BLEEDING,,,21 ,,RBRVS,2.73 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45335,CPT,SGMDSC FLX DIRED SBMCSL NJX ANY SBST,,,21 ,,RBRVS,1.46 ,1.07 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45337,CPT,SGMDSC FLX DCMPRN VOLVULUS ANY METHOD,,,21 ,,RBRVS,2.36 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45338,CPT,SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ,,,21 ,,RBRVS,2.34 ,1.53 ,6.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45339,CPT,SIGMOIDOSCOPY FLX ABLTJ LESION,,,21 ,,RBRVS,3.14 ,1.94 ,6.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45340,CPT,SIGMOIDOSCOPY FLX DILAT BALO 1/MORE STRIXS,,,21 ,,RBRVS,1.89 ,1.28 ,12.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45341,CPT,SIGMOIDOSCOPY FLX NDSC US XM,,,21 ,,RBRVS,2.60 ,1.70 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45342,CPT,SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX,,,21 ,,RBRVS,4.05 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45345,CPT,SIGMOIDOSCOPY FLX TNDSC STENT PLMT,,,21 ,,RBRVS,2.92 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45355,CPT,COLSC RGD/FLX TABDL VIA COLOTOMY 1/MLT,,,21 ,,RBRVS,3.51 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45378,CPT,COLONOSCOPY FLX DX W/WO COLLJ SPECIMENS,,,21 ,,RBRVS,3.69 ,2.20 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45379,CPT,COLSC FLX PROX SPLENIC FLXR RMVL FB,,,21 ,,RBRVS,4.68 ,2.70 ,9.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45380,CPT,COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,,,21 ,,RBRVS,4.43 ,2.65 ,9.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45381,CPT,COLSC FLX PROX SPLENIC FLXR SBMCSL NJX,,,21 ,,RBRVS,4.19 ,2.53 ,9.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45382,CPT,COLSC FLX PROX SPLENIC FLXR CTRL BLD,,,21 ,,RBRVS,5.68 ,3.35 ,11.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45383,CPT,COLSC FLX PROX SPLENIC FLXR ABLTJ LES,,,21 ,,RBRVS,5.86 ,3.25 ,10.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45384,CPT,COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT,,,21 ,,RBRVS,4.69 ,2.66 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45385,CPT,COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ,,,21 ,,RBRVS,5.30 ,3.09 ,9.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45386,CPT,COLSC FLX PROX SPLENIC FLXR DILAT BALO 1/> STRI,,,21 ,,RBRVS,4.57 ,2.65 ,14.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45387,CPT,COLSC FLX PROX SPLENIC FLXR TNDSC STENT PLMT,,,21 ,,RBRVS,5.90 ,3.52 ,3.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45391,CPT,COLSC FLX PROX SPLENIC FLXR NDSC US XM,,,21 ,,RBRVS,5.09 ,2.99 ,2.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45392,CPT,COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX,,,21 ,,RBRVS,6.54 ,3.78 ,3.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45395,CPT,LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY,,,21 ,,RBRVS,33.00 ,19.26 ,19.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45397,CPT,LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR,,,21 ,,RBRVS,36.50 ,20.34 ,20.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45400,CPT,LAPAROSCOPY PROCTOPEXY PROLAPSE,,,21 ,,RBRVS,19.44 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45402,CPT,LAPAROSCOPY PROCTOPEXY PROLAPSE SIGMOID RESCJ,,,21 ,,RBRVS,26.51 ,13.46 ,13.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45499,CPT,UNLISTED LAPAROSCOPY PROCEDURE RECTUM,,,21 ,,TotalUnits,,,,52.26 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,45500,CPT,PROCTOPLASTY STENOSIS,,,21 ,,RBRVS,7.73 ,6.36 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45505,CPT,PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE,,,21 ,,RBRVS,8.36 ,7.29 ,7.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45520,CPT,PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE,,,21 ,,RBRVS,0.55 ,0.55 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45540,CPT,PROCTOPEXY ABDOMINAL APPROACH,,,21 ,,RBRVS,18.12 ,9.73 ,9.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45541,CPT,PROCTOPEXY PERINEAL APPROACH,,,21 ,,RBRVS,14.85 ,9.64 ,9.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45550,CPT,PROCTOPEXY W/SIGMOID RESCJ ABDL APPR,,,21 ,,RBRVS,24.80 ,13.55 ,13.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45560,CPT,REPAIR RECTOCELE SEPARATE PROCEDURE,,,21 ,,RBRVS,11.50 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45562,CPT,EXPL RPR & PRESACRAL DRG RECTAL INJURY,,,21 ,,RBRVS,17.98 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45563,CPT,EXPL RPR & PRESACRAL DRG RECTAL INJ W/COLOSTOMY,,,21 ,,RBRVS,26.38 ,15.90 ,15.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45800,CPT,CLOSURE RECTOVESICAL FISTULA,,,21 ,,RBRVS,20.31 ,11.43 ,11.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45805,CPT,CLSR RECTOVESICAL FISTULA W/COLOSTOMY,,,21 ,,RBRVS,23.32 ,14.22 ,14.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45820,CPT,CLOSURE RECTOURETHRAL FISTULA,,,21 ,,RBRVS,20.37 ,11.96 ,11.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45825,CPT,CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY,,,21 ,,RBRVS,24.17 ,15.19 ,15.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,45900,CPT,RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE,,,21 ,,RBRVS,2.99 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45905,CPT,DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL,,,21 ,,RBRVS,2.35 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45910,CPT,DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL,,,21 ,,RBRVS,2.85 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45915,CPT,RMVL FECAL IMPACTION/FB SPX UNDER ANES,,,21 ,,RBRVS,3.19 ,2.87 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45990,CPT,ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX,,,21 ,,RBRVS,1.80 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,45999,CPT,UNLISTED PROCEDURE RECTUM,,,21 ,,TotalUnits,,,,7.57 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,46020,CPT,PLACEMENT SETON,,,21 ,,RBRVS,3.00 ,3.26 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46030,CPT,REMOVAL ANAL SETON OTHER MARKER,,,21 ,,RBRVS,1.26 ,1.15 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46040,CPT,I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX,,,21 ,,RBRVS,5.37 ,5.59 ,8.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46045,CPT,I&D INTRAMURAL IM/ABSC TRANSANAL ANES,,,21 ,,RBRVS,5.87 ,5.47 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46050,CPT,I&D PERIANAL ABSCESS SUPERFICIAL,,,21 ,,RBRVS,1.24 ,1.37 ,4.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46060,CPT,I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON,,,21 ,,RBRVS,6.37 ,6.23 ,6.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46070,CPT,INCISION ANAL SEPTUM INFANT,,,21 ,,RBRVS,2.79 ,3.96 ,3.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46080,CPT,SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX,,,21 ,,RBRVS,2.52 ,1.65 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46083,CPT,INCISION THROMBOSED HEMORRHOID EXTERNAL,,,21 ,,RBRVS,1.45 ,1.44 ,3.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46200,CPT,FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED,,,21 ,,RBRVS,3.59 ,5.17 ,8.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46220,CPT,EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS,,,21 ,,RBRVS,1.61 ,1.56 ,4.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46221,CPT,HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS,,,21 ,,RBRVS,2.36 ,2.80 ,5.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46230,CPT,EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS,,,21 ,,RBRVS,2.62 ,1.95 ,4.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46250,CPT,HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP,,,21 ,,RBRVS,4.25 ,4.05 ,8.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46255,CPT,HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP,,,21 ,,RBRVS,4.96 ,4.37 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46257,CPT,HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTO,,,21 ,,RBRVS,5.76 ,5.38 ,5.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46258,CPT,HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY,,,21 ,,RBRVS,6.41 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46260,CPT,HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO,,,21 ,,RBRVS,6.73 ,5.76 ,5.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46261,CPT,HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU,,,21 ,,RBRVS,7.76 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46262,CPT,HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY,,,21 ,,RBRVS,7.91 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46270,CPT,SURG TX ANAL FISTULA SUBQ,,,21 ,,RBRVS,4.92 ,5.42 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46275,CPT,SURG TX ANAL FISTULA INTERSPHINCTERIC,,,21 ,,RBRVS,5.42 ,5.58 ,9.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46280,CPT,TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON,,,21 ,,RBRVS,6.39 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46285,CPT,SURG TX ANAL FISTULA 2ND STAGE,,,21 ,,RBRVS,5.42 ,5.58 ,8.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46288,CPT,CLSR ANAL FSTL W/RCT ADVMNT FLAP,,,21 ,,RBRVS,7.81 ,6.73 ,6.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46320,CPT,EXC THROMBOSED HEMORRHOID XTRNL,,,21 ,,RBRVS,1.64 ,1.30 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46500,CPT,INJECTION SCLEROSING SOLUTION HEMORRHOIDS,,,21 ,,RBRVS,1.69 ,1.79 ,4.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46505,CPT,CHEMODENERVATION INTERNAL ANAL SPHINCTER,,,21 ,,RBRVS,3.18 ,3.23 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46600,CPT,ANOSCOPY DX W/WO COLLJ SPEC BR/WA SPX,,,21 ,,RBRVS,0.55 ,0.55 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46604,CPT,ANOSCOPY W/DILATION,,,21 ,,RBRVS,1.03 ,0.75 ,16.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46606,CPT,ANOSCOPY W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,1.20 ,0.82 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46608,CPT,ANOSCOPY W/RMVL FOREIGN BODY,,,21 ,,RBRVS,1.30 ,0.82 ,5.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46610,CPT,ANOSCOPY W/RMVL LESION CAUTERY,,,21 ,,RBRVS,1.28 ,0.86 ,5.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46611,CPT,ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ,,,21 ,,RBRVS,1.30 ,0.89 ,3.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46612,CPT,ANOSC RMVL MULT TUMORS CAUTERY/SNARE,,,21 ,,RBRVS,1.50 ,0.97 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46614,CPT,ANOSCOPY CONTROL BLEEDING,,,21 ,,RBRVS,1.00 ,0.77 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46615,CPT,ANOSCOPY ABLATION LESION,,,21 ,,RBRVS,1.50 ,0.98 ,2.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46700,CPT,ANOPLASTY PLASTIC OPERATION STRICTURE ADULT,,,21 ,,RBRVS,9.81 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46705,CPT,ANOPLASTY PLASTIC OPERATION STRICTURE INFANT,,,21 ,,RBRVS,7.43 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46706,CPT,REPAIR ANAL FISTULA W/FIBRIN GLUE,,,21 ,,RBRVS,2.44 ,2.00 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46707,CPT,REPAIR ANORECTAL FISTULA PLUG,,,21 ,,RBRVS,6.39 ,6.41 ,6.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46710,CPT,RPR ILEOANAL POUCH FSTL/POUCH ADVMNT TPRNL APPR,,,21 ,,RBRVS,17.14 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46712,CPT,RPR ILEOANAL POUCH FSTL/POUCH ADVMNT CMBN APPR,,,21 ,,RBRVS,36.45 ,20.30 ,20.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46715,CPT,RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK,,,21 ,,RBRVS,7.62 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46716,CPT,RPR LW IMPERFORATE ANUS W/TRPOS FISTULA,,,21 ,,RBRVS,17.54 ,14.62 ,14.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46730,CPT,RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR,,,21 ,,RBRVS,30.65 ,19.57 ,19.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46735,CPT,RPR HI IMPRF ANUS W/O FISTULA CMBN APPR,,,21 ,,RBRVS,36.14 ,20.63 ,20.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46740,CPT,RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR,,,21 ,,RBRVS,33.90 ,21.13 ,21.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46742,CPT,RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL,,,21 ,,RBRVS,40.14 ,22.05 ,22.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46744,CPT,RPR CLOACAL ANOMALY SACROPERINEAL,,,21 ,,RBRVS,58.94 ,30.30 ,30.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46746,CPT,RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL,,,21 ,,RBRVS,65.44 ,32.86 ,32.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46748,CPT,RPR CLOACAL ANOMALY CMBN ABDL & SACROPRNL W/GRF,,,21 ,,RBRVS,71.42 ,35.04 ,35.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46750,CPT,SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT,,,21 ,,RBRVS,12.15 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46751,CPT,SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD,,,21 ,,RBRVS,9.30 ,6.86 ,6.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,46753,CPT,GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE,,,21 ,,RBRVS,8.89 ,6.66 ,6.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46754,CPT,RMVL THIERSCH WIRE/SUTURE ANAL CANAL,,,21 ,,RBRVS,3.01 ,3.30 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46760,CPT,SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT,,,21 ,,RBRVS,17.45 ,11.85 ,11.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46761,CPT,SPHNCTROP ANAL LEVATOR MUSC IMBRCJ,,,21 ,,RBRVS,15.29 ,9.53 ,9.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46762,CPT,SPHNCTROP ANAL IMPLTJ ARTIF SPHNCTR,,,21 ,,RBRVS,14.82 ,9.96 ,9.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46900,CPT,DSTRJ LESION ANUS SIMPLE CHEMICAL,,,21 ,,RBRVS,1.91 ,1.84 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46910,CPT,DSTRJ LESION ANUS SMPL ELTRDSICCATION,,,21 ,,RBRVS,1.91 ,1.70 ,5.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46916,CPT,DSTRJ LESION ANUS SIMPLE CRYOSURGERY,,,21 ,,RBRVS,1.91 ,2.09 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46917,CPT,DSTRJ LESION ANUS SIMPLE LASER SURG,,,21 ,,RBRVS,1.91 ,1.68 ,11.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46922,CPT,DSTRJ LESION ANUS SIMPLE SURG EXCISION,,,21 ,,RBRVS,1.91 ,1.69 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46924,CPT,DSTRJ LESION ANUS EXTENSIVE,,,21 ,,RBRVS,2.81 ,2.15 ,12.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46930,CPT,DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY,,,21 ,,RBRVS,1.61 ,2.53 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46940,CPT,CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST,,,21 ,,RBRVS,2.35 ,1.57 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46942,CPT,CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ,,,21 ,,RBRVS,2.07 ,1.44 ,3.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46945,CPT,HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP,,,21 ,,RBRVS,2.21 ,3.98 ,6.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46946,CPT,HRHC NTRNL LIG OTH THAN RBBR BAND 2/> COL/GRP,,,21 ,,RBRVS,2.63 ,3.51 ,6.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46947,CPT,HEMORRHOIDOPEXY STAPLING,,,21 ,,RBRVS,5.57 ,4.47 ,4.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,46999,CPT,UNLISTED PROCEDURE ANUS,,,21 ,,TotalUnits,,,,5.84 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,47000,CPT,BIOPSY LIVER NEEDLE PERCUTANEOUS,,,21 ,,RBRVS,1.90 ,0.91 ,5.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47001,CPT,BX LVR NDL DONE PURPOSE TM OTH MAJOR PX,,,21 ,,RBRVS,1.90 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47010,CPT,HEPATOTOMY OPN DRG ABSCESS/CYST 1/2 STAGES,,,21 ,,RBRVS,19.40 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47011,CPT,HEPATOTOMY PRQ DRG ABSCESS/CYST 1/2 STAGES,,,21 ,,RBRVS,3.69 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47015,CPT,LAPT W/ASPIR &/NJX HEPATC PARASITIC CYST/ABSCESS,,,21 ,,RBRVS,18.50 ,11.40 ,11.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47100,CPT,BIOPSY LIVER WEDGE,,,21 ,,RBRVS,12.91 ,8.97 ,8.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47120,CPT,HEPATECTOMY RESCJ PARTIAL LOBECTOMY,,,21 ,,RBRVS,39.01 ,20.40 ,20.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47122,CPT,HEPATECTOMY RESCJ TRISEGMENTECTOMY,,,21 ,,RBRVS,59.48 ,27.60 ,27.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47125,CPT,HEPATECTOMY RESCJ TOTAL LEFT LOBECTOMY,,,21 ,,RBRVS,53.04 ,25.04 ,25.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47130,CPT,HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY,,,21 ,,RBRVS,57.19 ,26.74 ,26.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47135,CPT,LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE,,,21 ,,RBRVS,83.64 ,41.48 ,41.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47136,CPT,LVR ALTRNSPLJ HTRTPC PRTL/WHL DON ANY AGE,,,21 ,,RBRVS,70.74 ,34.81 ,34.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47140,CPT,DONOR HEPATECTOMY LIVING DONOR SEG II & III,,,21 ,,RBRVS,59.40 ,30.18 ,30.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47141,CPT,DONOR HEPATECTOMY LIVING DONOR SEG II III & IV,,,21 ,,RBRVS,71.50 ,37.57 ,37.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47142,CPT,DONOR HEPATECTOMY LIVING DONOR SEG V VI VII &VI,,,21 ,,RBRVS,79.44 ,40.69 ,40.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47143,CPT,BKBENCH PREP CADAVER DONOR,,,21 ,,TotalUnits,,,,15.66 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,47146,CPT,BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA,,,21 ,,RBRVS,6.00 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47147,CPT,BKBENCH RCNSTJ LVR GRF ARTL ANAST EA,,,21 ,,RBRVS,7.00 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47300,CPT,MARSUPIALIZATION CST/ABSC LVR,,,21 ,,RBRVS,18.14 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47350,CPT,MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ,,,21 ,,RBRVS,22.49 ,12.83 ,12.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47360,CPT,MGMT LVR HEMRRG CPLX SUTR WND/INJ,,,21 ,,RBRVS,31.31 ,16.30 ,16.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47361,CPT,MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR,,,21 ,,RBRVS,52.60 ,24.56 ,24.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47362,CPT,MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING,,,21 ,,RBRVS,23.54 ,13.62 ,13.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47370,CPT,LAPS SURG ABLTJ 1/> LVR TUM RF,,,21 ,,RBRVS,20.80 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47371,CPT,LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG,,,21 ,,RBRVS,20.80 ,11.53 ,11.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47379,CPT,UNLIS LAPAROSCOPIC PROCEDURE LIVER,,,21 ,,TotalUnits,,,,31.74 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,47380,CPT,ABLTJ OPN 1/> LVR TUM RF,,,21 ,,RBRVS,24.56 ,12.21 ,12.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47381,CPT,ABLTJ OPN 1/> LVR TUM CRYOSURG,,,21 ,,RBRVS,24.88 ,13.09 ,13.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47382,CPT,ABLTJ 1/> LVR TUM PRQ RF,,,21 ,,RBRVS,15.22 ,6.40 ,127.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47399,CPT,UNLISTED PROCEDURE LIVER,,,21 ,,TotalUnits,,,,3.12 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,47400,CPT,HEPATCOTOMY/HEPATCOSTOMY W/EXPL DRG/RMVL ST1,,,21 ,,RBRVS,36.36 ,18.71 ,18.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47420,CPT,CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP,,,21 ,,RBRVS,22.03 ,12.42 ,12.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47425,CPT,CHOLEDOCHOT/OST W/SPHNCTROTOMY/SPHNCTROP,,,21 ,,RBRVS,22.31 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47460,CPT,TRANSDUOL SPHINCTEROT/PLASTY W/WO RMVL CALCULUS,,,21 ,,RBRVS,20.52 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47480,CPT,CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX,,,21 ,,RBRVS,13.25 ,9.42 ,9.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47490,CPT,CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT,,,21 ,,RBRVS,4.76 ,4.97 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47500,CPT,INJECTION PX PRQ TRANSHEPATIC CHOLANGIOGRAPHY,,,21 ,,RBRVS,1.96 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47505,CPT,INJ PX CHOLANGIOGRAPHY VIA CATHETER/T-TUBE,,,21 ,,RBRVS,0.76 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47510,CPT,INTRO PRQ TRANSHEPATC CATH BILIARY DRG,,,21 ,,RBRVS,8.03 ,5.10 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47511,CPT,INTRODUCJ PERCUT TRANSHEPATC STENT BILIARY DRG,,,21 ,,RBRVS,10.77 ,5.37 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47525,CPT,CHANGE PERCUTANEOUS BILIARY DRAINAGE CATHETER,,,21 ,,RBRVS,1.54 ,0.99 ,13.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47530,CPT,REVISION &/REINSERTION TRANSHEPATC TUBE,,,21 ,,RBRVS,6.05 ,3.79 ,35.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47550,CPT,BILIARY NDSC INTRAOPERATIVE,,,21 ,,RBRVS,3.02 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47552,CPT,BILIARY NDSC PRQ T-TUBE DX W/WO COLLJ SPEC SPX,,,21 ,,RBRVS,6.03 ,2.67 ,2.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47553,CPT,BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,6.34 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47554,CPT,BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS,,,21 ,,RBRVS,9.05 ,3.90 ,3.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47555,CPT,BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT,,,21 ,,RBRVS,7.55 ,2.79 ,2.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47556,CPT,BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT,,,21 ,,RBRVS,8.55 ,3.17 ,3.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47560,CPT,LAPS SURG W/GID TRANSHEPATC CHOLANGRPH W/O BX,,,21 ,,RBRVS,4.88 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47561,CPT,LAPS SURG W/GID TRANSHEPATC CHOLANGRPH W/BX,,,21 ,,RBRVS,5.17 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47562,CPT,LAPAROSCOPY SURG CHOLECYSTECTOMY,,,21 ,,RBRVS,11.76 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47563,CPT,LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,,,21 ,,RBRVS,11.47 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47564,CPT,LAPS SURG CHOLECSTC W/EXPL COMMON DUCT,,,21 ,,RBRVS,18.00 ,10.06 ,10.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47570,CPT,LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY,,,21 ,,RBRVS,12.56 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47579,CPT,UNLISTED LAPAROSCOPY PROCEDURE BILIARY TRACT,,,21 ,,TotalUnits,,,,19.37 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,47600,CPT,CHOLECYSTECTOMY,,,21 ,,RBRVS,17.48 ,10.36 ,10.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47605,CPT,CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,,,21 ,,RBRVS,15.98 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47610,CPT,CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT,,,21 ,,RBRVS,20.92 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47612,CPT,CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY,,,21 ,,RBRVS,21.21 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47620,CPT,CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP,,,21 ,,RBRVS,23.07 ,11.95 ,11.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47630,CPT,BILIARY DUCT STONE XTRJ PRQ VIA BASKET/SNARE,,,21 ,,RBRVS,9.65 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,47700,CPT,EXPL CONGENITAL ATRESIA BILE DUCTS,,,21 ,,RBRVS,16.50 ,10.68 ,10.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47701,CPT,PORTOENETEROSTOMY,,,21 ,,RBRVS,28.73 ,16.15 ,16.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47711,CPT,EXC BILE DUX TUM W/WO PRIM RPR XTRHEPATC,,,21 ,,RBRVS,25.90 ,13.99 ,13.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47712,CPT,EXC BILE DUX TUM W/WO PRIM RPR INTRAHEPATC,,,21 ,,RBRVS,33.72 ,17.36 ,17.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47715,CPT,EXCISION CHOLEDOCHAL CYST,,,21 ,,RBRVS,21.55 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47720,CPT,CHOLECYSTOENTEROSTOMY DIRECT,,,21 ,,RBRVS,18.34 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47721,CPT,CHOLECYSTOENTEROSTOMY W/GASTROENTEROSTOMY,,,21 ,,RBRVS,21.99 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47740,CPT,CHOLECYSTOENTEROSTOMY ROUX-EN-Y,,,21 ,,RBRVS,21.23 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47741,CPT,CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM,,,21 ,,RBRVS,24.21 ,13.63 ,13.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47760,CPT,ANAST XTRHEPATC BILIARY DUCTS & GI TRACT,,,21 ,,RBRVS,38.32 ,18.94 ,18.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47765,CPT,ANAST INTRAHEPATC DUCTS & GI TRACT,,,21 ,,RBRVS,52.19 ,24.81 ,24.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47780,CPT,ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI,,,21 ,,RBRVS,42.32 ,20.38 ,20.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47785,CPT,ANAST ROUX-EN-Y INTRAHEPATC BILIARY DUCTS & GI,,,21 ,,RBRVS,56.19 ,25.92 ,25.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47800,CPT,RCNSTJ PLSTC BILIARY DUCTS W/END-TO-END ANAST,,,21 ,,RBRVS,26.17 ,14.30 ,14.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47801,CPT,PLACEMENT CHOLEDOCHAL STENT,,,21 ,,RBRVS,17.60 ,9.99 ,9.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47802,CPT,U-TUBE HEPATICOENTEROSTOMY,,,21 ,,RBRVS,24.93 ,14.22 ,14.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47900,CPT,SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY,,,21 ,,RBRVS,22.44 ,12.54 ,12.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,47999,CPT,UNLISTED PROCEDURE BILIARY TRACT,,,21 ,,TotalUnits,,,,19.37 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,48000,CPT,PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS,,,21 ,,RBRVS,31.95 ,15.79 ,15.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48001,CPT,PLACE DRAIN PERIPANCREATIC W/CHOLECYSTOSTOMY,,,21 ,,RBRVS,39.69 ,19.19 ,19.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48020,CPT,REMOVAL PANCREATIC CALCULUS,,,21 ,,RBRVS,19.09 ,11.16 ,11.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48100,CPT,BIOPSY PANCREAS OPEN,,,21 ,,RBRVS,14.46 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48102,CPT,BIOPSY PANCREA PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,4.70 ,2.03 ,10.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,48105,CPT,RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS,,,21 ,,RBRVS,49.26 ,23.64 ,23.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48120,CPT,EXCISION LESION PANCREAS,,,21 ,,RBRVS,18.41 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48140,CPT,PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY,,,21 ,,RBRVS,26.32 ,13.51 ,13.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48145,CPT,PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY,,,21 ,,RBRVS,27.39 ,14.34 ,14.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48146,CPT,PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX,,,21 ,,RBRVS,30.60 ,17.59 ,17.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48148,CPT,EXCISION AMPULLA VATER,,,21 ,,RBRVS,20.39 ,11.61 ,11.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48150,CPT,PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY,,,21 ,,RBRVS,52.84 ,26.16 ,26.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48152,CPT,PNCRTECT WHIPPLE W/O PANCREATOJEJUNOSTOMY,,,21 ,,RBRVS,48.65 ,25.16 ,25.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48153,CPT,PNCRTECT W/PANCREATOJEJUNOSTOMY,,,21 ,,RBRVS,52.79 ,26.10 ,26.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48154,CPT,PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY,,,21 ,,RBRVS,48.88 ,25.21 ,25.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48155,CPT,PANCREATECTOMY TOTAL,,,21 ,,RBRVS,29.45 ,17.13 ,17.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48160,CPT,PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS,,,21 ,,RBRVS,43.71 ,38.87 ,38.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,48400,CPT,INJECTION INTRAOPERATIVE PANCREATOGRAPHY,,,21 ,,RBRVS,1.95 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48500,CPT,MARSUPIALIZATION PANCREATIC CYST,,,21 ,,RBRVS,18.16 ,11.47 ,11.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48510,CPT,XTRNL DRG PSEUDOCYST PANCREAS OPEN,,,21 ,,RBRVS,17.19 ,10.74 ,10.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48511,CPT,XTRNL DRG PSEUDOCYST PANCREAS PRQ,,,21 ,,RBRVS,3.99 ,1.49 ,23.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,48520,CPT,INT ANAST PANCREATIC CYST GI TRACT DIRECT,,,21 ,,RBRVS,18.15 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48540,CPT,INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y,,,21 ,,RBRVS,21.94 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48545,CPT,PANCREATORRHAPHY INJURY,,,21 ,,RBRVS,22.23 ,12.16 ,12.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48547,CPT,DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ,,,21 ,,RBRVS,30.38 ,15.36 ,15.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48548,CPT,PANCREATICOJEJUNOSTOMY SIDE-TO-SIDE ANAST,,,21 ,,RBRVS,28.09 ,14.46 ,14.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48552,CPT,BKBENCH RCNSTJ CDVR PNCRS ALGRFT VEN ANAST EA,,,21 ,,RBRVS,4.30 ,1.70 ,1.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48554,CPT,TRANSPLANTATION PANCREATIC ALLOGRAFT,,,21 ,,RBRVS,37.80 ,28.90 ,28.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48556,CPT,RMVL TRANSPLANTED PANCREATIC ALLOGRAFT,,,21 ,,RBRVS,19.47 ,13.48 ,13.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,48999,CPT,UNLISTED PROCEDURE PANCREAS,,,21 ,,TotalUnits,,,,7.28 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,49000,CPT,EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX,,,21 ,,RBRVS,12.54 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49002,CPT,REOPENING RECENT LAPAROTOMY,,,21 ,,RBRVS,17.63 ,9.14 ,9.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49010,CPT,EXPL RETROPERITONEUM W/WO BX SPX,,,21 ,,RBRVS,16.06 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49020,CPT,DRG PERITONEAL ABSCESS/LOCAL PERITONITIS OPEN,,,21 ,,RBRVS,26.67 ,14.30 ,14.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49021,CPT,DRG PERITONEAL ABSCESS/LOCAL PERITONITIS PRQ,,,21 ,,RBRVS,3.37 ,1.26 ,22.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49040,CPT,DRG SUBDIAPHRAGMATIC/SUBPHRENIC ABSCESS OPEN,,,21 ,,RBRVS,16.52 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49041,CPT,DRG SUBDIAPHRAGMATIC/SUBPHRENIC ABSCESS PRQ,,,21 ,,RBRVS,3.99 ,1.48 ,23.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49060,CPT,DRG RETROPERITONEAL ABSCESS OPEN,,,21 ,,RBRVS,18.53 ,10.01 ,10.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49061,CPT,DRG RETROPERITONEAL ABSCESS PERCUTANEOUS,,,21 ,,RBRVS,3.69 ,1.37 ,22.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49062,CPT,DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN,,,21 ,,RBRVS,12.22 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49082,CPT,ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE,,,21 ,,RBRVS,1.24 ,0.70 ,3.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49083,CPT,ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE,,,21 ,,RBRVS,2.00 ,0.98 ,6.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49084,CPT,PERITONEAL LAVAGE W/WO IMAGING GUIDANCE,,,21 ,,RBRVS,2.00 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49180,CPT,BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE,,,21 ,,RBRVS,1.73 ,0.65 ,2.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49203,CPT,EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<,,,21 ,,RBRVS,20.13 ,10.84 ,10.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49204,CPT,EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM,,,21 ,,RBRVS,26.13 ,13.24 ,13.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49205,CPT,EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM,,,21 ,,RBRVS,30.13 ,14.85 ,14.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49215,CPT,EXC PRESAC/SACROCOCCYGEAL TUMOR,,,21 ,,RBRVS,37.81 ,18.95 ,18.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49220,CPT,STAGING LAPAROTOMY HODGKINS DISEASE/LYMPHOMA,,,21 ,,RBRVS,15.79 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49250,CPT,UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX,,,21 ,,RBRVS,9.01 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49255,CPT,OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX,,,21 ,,RBRVS,12.56 ,8.00 ,8.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49320,CPT,LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX,,,21 ,,RBRVS,5.14 ,3.42 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49321,CPT,LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE,,,21 ,,RBRVS,5.44 ,3.58 ,3.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49322,CPT,LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE,,,21 ,,RBRVS,6.01 ,3.72 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49323,CPT,LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY,,,21 ,,RBRVS,10.23 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49324,CPT,LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER,,,21 ,,RBRVS,6.32 ,3.90 ,3.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49325,CPT,LAPS W/REVISION INTRAPERITONEAL CATHETER,,,21 ,,RBRVS,6.82 ,4.04 ,4.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49326,CPT,LAPAROSCOPY W/OMENTOPEXY,,,21 ,,RBRVS,3.50 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49327,CPT,LAPS W/INSERTION NTRSTL DEV W/IMG GID 1/MLT,,,21 ,,RBRVS,2.38 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49329,CPT,UNLISTED LAPAROSCOPIC PX ABD PERTONEUM & OMENTUM,,,21 ,,TotalUnits,,,,9.02 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,49400,CPT,INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX,,,21 ,,RBRVS,1.88 ,0.70 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49402,CPT,REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY,,,21 ,,RBRVS,14.09 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49411,CPT,INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT,,,21 ,,RBRVS,3.82 ,1.53 ,12.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49412,CPT,PLMT INTRSTL DEV OPN W/IMG GID 1/MLT,,,21 ,,RBRVS,1.50 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49418,CPT,INSJ INTRAPERITONEAL CATHETER W/IMG GID,,,21 ,,RBRVS,4.21 ,1.93 ,41.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49419,CPT,INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT,,,21 ,,RBRVS,7.08 ,4.66 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49421,CPT,INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN,,,21 ,,RBRVS,4.21 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49422,CPT,REMOVAL TUNNELED INTRAPERITONEAL CATHETER,,,21 ,,RBRVS,6.29 ,3.65 ,3.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49423,CPT,EXCHNG ABSC/CST DRG CATH RAD GID SPX,,,21 ,,RBRVS,1.46 ,0.58 ,15.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49424,CPT,CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX,,,21 ,,RBRVS,0.76 ,0.32 ,3.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49425,CPT,INSERTION PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,12.22 ,7.23 ,7.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49426,CPT,REVIS PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,10.41 ,6.11 ,6.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49427,CPT,INJECT EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,0.89 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49428,CPT,LIGATION PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,6.87 ,5.77 ,5.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49429,CPT,RMVL PERITONEAL-VENOUS SHUNT,,,21 ,,RBRVS,7.44 ,4.04 ,4.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49435,CPT,INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER,,,21 ,,RBRVS,2.25 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49436,CPT,DELAYED CREATION EXIT SITE EMBEDDED CATHETER,,,21 ,,RBRVS,2.72 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49440,CPT,INSERT GASTROSTOMY TUBE PERCUTANEOUS,,,21 ,,RBRVS,4.18 ,2.01 ,27.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49441,CPT,INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ,,,21 ,,RBRVS,4.77 ,2.28 ,30.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49442,CPT,INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS,,,21 ,,RBRVS,4.00 ,2.00 ,24.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49446,CPT,CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ,,,21 ,,RBRVS,3.31 ,1.24 ,26.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49450,CPT,REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS,,,21 ,,RBRVS,1.36 ,0.50 ,19.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49451,CPT,REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ,,,21 ,,RBRVS,1.84 ,0.69 ,19.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49452,CPT,REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS,,,21 ,,RBRVS,2.86 ,1.07 ,23.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49460,CPT,OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE,,,21 ,,RBRVS,0.96 ,0.37 ,21.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49465,CPT,CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE,,,21 ,,RBRVS,0.62 ,0.23 ,4.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49491,CPT,RPR 1ST INGUN HRNA PRETERM INFT RDC,,,21 ,,RBRVS,12.53 ,7.26 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49492,CPT,RPR 1ST INGUN HRNA PRETERM INFT INCARCERATED,,,21 ,,RBRVS,15.43 ,9.13 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49495,CPT,RPR 1ST INGUN HRNA FULL TERM INFT <6 MO RDC,,,21 ,,RBRVS,6.20 ,4.36 ,4.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49496,CPT,RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER,,,21 ,,RBRVS,9.42 ,5.87 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49500,CPT,RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE,,,21 ,,RBRVS,5.84 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49501,CPT,RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED,,,21 ,,RBRVS,9.36 ,6.26 ,6.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49505,CPT,RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE,,,21 ,,RBRVS,7.96 ,5.53 ,5.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49507,CPT,RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED,,,21 ,,RBRVS,9.09 ,6.13 ,6.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49520,CPT,RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE,,,21 ,,RBRVS,9.99 ,6.32 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49521,CPT,RPR RECRT INGUN HERNIA ANY AGE INCARCERATED,,,21 ,,RBRVS,11.48 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49525,CPT,RPR INGUN HERNIA SLIDING ANY AGE,,,21 ,,RBRVS,8.93 ,5.91 ,5.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49540,CPT,REPAIR LUMBAR HERNIA,,,21 ,,RBRVS,10.74 ,6.59 ,6.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49550,CPT,RPR 1ST FEM HRNA ANY AGE REDUCIBLE,,,21 ,,RBRVS,8.99 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49553,CPT,RPR 1ST FEM HERNIA ANY AGE INCARCERATED,,,21 ,,RBRVS,9.92 ,6.38 ,6.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49555,CPT,RPR RECRT FEM HERNIA REDUCIBLE,,,21 ,,RBRVS,9.39 ,6.10 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49557,CPT,RPR RECRT FEM HRNA INCARCERATED,,,21 ,,RBRVS,11.62 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49560,CPT,REPAIR FIRST ABDOMINAL WALL HERNIA,,,21 ,,RBRVS,11.92 ,7.09 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49561,CPT,RPR 1ST INCAL/VNT HERNIA INCARCERATED,,,21 ,,RBRVS,15.38 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49565,CPT,RPR RECRT INCAL/VNT HERNIA REDUCIBLE,,,21 ,,RBRVS,12.37 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49566,CPT,RPR RECRT INCAL/VNT HERNIA INCARCERATED,,,21 ,,RBRVS,15.53 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49568,CPT,IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE,,,21 ,,RBRVS,4.88 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49570,CPT,RPR EPIGASTRIC HERNIA REDUCIBLE SPX,,,21 ,,RBRVS,6.05 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49572,CPT,RPR EPIGASTRIC HERNIA INCARCERATED,,,21 ,,RBRVS,7.87 ,5.47 ,5.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49580,CPT,RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE,,,21 ,,RBRVS,4.47 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49582,CPT,RPR UMBILICAL HERNIA < 5 YRS INCARCERATED,,,21 ,,RBRVS,7.13 ,5.38 ,5.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49585,CPT,RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE,,,21 ,,RBRVS,6.59 ,4.98 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49587,CPT,RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED,,,21 ,,RBRVS,7.08 ,5.33 ,5.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49590,CPT,RPR SPIGELIAN HERNIA,,,21 ,,RBRVS,8.90 ,5.88 ,5.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49600,CPT,RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE,,,21 ,,RBRVS,11.55 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49605,CPT,RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH,,,21 ,,RBRVS,87.09 ,38.90 ,38.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49606,CPT,RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH,,,21 ,,RBRVS,19.00 ,9.98 ,9.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49610,CPT,RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG,,,21 ,,RBRVS,10.91 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49611,CPT,RPR OMPHALOCELE GROSS TYP OPRATION 2ND STG,,,21 ,,RBRVS,9.34 ,5.95 ,5.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49650,CPT,LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA,,,21 ,,RBRVS,6.36 ,4.77 ,4.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49651,CPT,LAPS SURG RPR RECURRENT INGUINAL HERNIA,,,21 ,,RBRVS,8.38 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49652,CPT,LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE,,,21 ,,RBRVS,11.92 ,7.34 ,7.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49653,CPT,LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED,,,21 ,,RBRVS,14.94 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49654,CPT,LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE,,,21 ,,RBRVS,13.76 ,8.09 ,8.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49655,CPT,LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED,,,21 ,,RBRVS,16.84 ,9.83 ,9.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49656,CPT,LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE,,,21 ,,RBRVS,15.08 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49657,CPT,LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED,,,21 ,,RBRVS,22.11 ,11.75 ,11.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,49659,CPT,UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY,,,21 ,,TotalUnits,,,,12.84 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,49900,CPT,SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN,,,21 ,,RBRVS,12.41 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49904,CPT,OMENTAL FLAP EXTRA-ABDOMINAL,,,21 ,,RBRVS,22.35 ,15.88 ,15.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49905,CPT,OMENTAL FLAP INTRA-ABDOMINAL,,,21 ,,RBRVS,6.54 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,49999,CPT,UNLISTED PROCEDURE ABDOMEN PERITONEUM & OMENTUM,,,21 ,,TotalUnits,,,,13.49 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,50010,CPT,RNL EXPL X NECESSITATING OTH SPEC PX,,,21 ,,RBRVS,12.28 ,7.59 ,7.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50020,CPT,DRAINAGE PERIRENAL/RENAL ABSCESS OPEN,,,21 ,,RBRVS,18.08 ,10.46 ,10.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50021,CPT,DRAINAGE PERIRENAL/RENAL ABSCESS PRW,,,21 ,,RBRVS,3.37 ,1.25 ,24.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50040,CPT,NEPHROSTOMY/NEPHROTOMY W/DRAINAGE,,,21 ,,RBRVS,16.68 ,9.03 ,9.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50045,CPT,NEPHROTOMY W/EXPLORATION,,,21 ,,RBRVS,16.82 ,9.08 ,9.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50060,CPT,NEPHROLITHOTOMY REMOVAL STAGE 1,,,21 ,,RBRVS,20.95 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50065,CPT,NEPHROLITHOTOMY SECONDARY FOR CALCULUS,,,21 ,,RBRVS,22.32 ,11.18 ,11.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50070,CPT,NEPHROLITHOTOMY COMP CGEN KDN ABNORMALITY,,,21 ,,RBRVS,21.85 ,12.07 ,12.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50075,CPT,NEPHROLITHOTOMY RMVL LG STAGHORN STAGE 1,,,21 ,,RBRVS,27.09 ,13.46 ,13.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50080,CPT,PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY </2 CM,,,21 ,,RBRVS,15.74 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50081,CPT,PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY > 2 CM,,,21 ,,RBRVS,23.50 ,12.03 ,12.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50100,CPT,TRNSXJ/REPOSITIONING ABERRANT RENAL VESSEL SPX,,,21 ,,RBRVS,17.45 ,5.31 ,5.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50120,CPT,PYELOTOMY W/EXPLORATION,,,21 ,,RBRVS,17.21 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50125,CPT,PYELOTOMY W/DRAINAGE PYELOSTOMY,,,21 ,,RBRVS,17.82 ,10.89 ,10.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50130,CPT,PYELOTOMY W/REMOVAL CALCULUS,,,21 ,,RBRVS,18.82 ,9.94 ,9.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50135,CPT,PYELOTOMY COMPLICATED,,,21 ,,RBRVS,20.59 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50200,CPT,RENAL BIOPSY PRQ TROCAR/NEEDLE,,,21 ,,RBRVS,2.63 ,1.32 ,14.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50205,CPT,RENAL BIOPSY SURG EXPOSURE KIDNEY,,,21 ,,RBRVS,12.29 ,7.33 ,7.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50220,CPT,NEPHRECTOMY W/PRTL URETERECTOMY W/OPEN RIB RESCJ,,,21 ,,RBRVS,18.68 ,9.96 ,9.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50225,CPT,NEPHRECTOMY W/PRTL URETERECT OPN RIB RESCJ COMPL,,,21 ,,RBRVS,21.88 ,11.12 ,11.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50230,CPT,NEPHRECTOMY W/PRTL URETERECT OPEN RIB RESCJ RAD,,,21 ,,RBRVS,23.81 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50234,CPT,NEPHRECTOMY W/TOT URETERECT&BLDR CUFF SAME INC,,,21 ,,RBRVS,24.05 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50236,CPT,NEPHRECTOMY TOT URETEREC&BLDR CUFF SEPAR INCISN,,,21 ,,RBRVS,26.94 ,13.83 ,13.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50240,CPT,NEPHRECTOMY PARTIAL,,,21 ,,RBRVS,24.21 ,12.56 ,12.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50250,CPT,OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND,,,21 ,,RBRVS,22.22 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50280,CPT,EXCISION/UNROOFING CYST KIDNEY,,,21 ,,RBRVS,17.09 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50290,CPT,EXCISION PERINEPHRIC CYST,,,21 ,,RBRVS,16.15 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50300,CPT,DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL,,,21 ,,TotalUnits,,,,23.05 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,50320,CPT,DONOR NEPHRECTOMY OPEN LIVING DONOR,,,21 ,,RBRVS,22.43 ,15.72 ,15.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50323,CPT,BKBENCH PREPJ CADAVER DONOR RENAL ALLOGRAFT,,,21 ,,TotalUnits,,,,14.33 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,50325,CPT,BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT,,,21 ,,TotalUnits,,,,9.48 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,50327,CPT,BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA,,,21 ,,RBRVS,4.00 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50328,CPT,BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA,,,21 ,,RBRVS,3.50 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50329,CPT,BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA,,,21 ,,RBRVS,3.34 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50340,CPT,RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,14.04 ,10.55 ,10.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50360,CPT,RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY,,,21 ,,RBRVS,40.90 ,25.68 ,25.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50365,CPT,RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY,,,21 ,,RBRVS,46.13 ,28.03 ,28.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50370,CPT,RMVL TRNSPLED RENAL ALLOGRAFT,,,21 ,,RBRVS,18.88 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50380,CPT,RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY,,,21 ,,RBRVS,30.11 ,22.33 ,22.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50382,CPT,RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ,,,21 ,,RBRVS,5.50 ,2.09 ,30.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50384,CPT,REMOVAL INDWELLING URETERAL STENT PRQ,,,21 ,,RBRVS,5.00 ,1.90 ,24.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50385,CPT,REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL,,,21 ,,RBRVS,4.44 ,2.06 ,31.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50386,CPT,REMOVE INT DWELL URETERAL STENT TRANSURETHRAL,,,21 ,,RBRVS,3.30 ,1.62 ,19.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50387,CPT,RMVL & RPLCMT XTRNLLY ACCESSIBLE URETERAL STENT,,,21 ,,RBRVS,2.00 ,0.74 ,14.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50389,CPT,RMVL NFROS TUBE REQ FLUORO GUIDANCE,,,21 ,,RBRVS,1.10 ,0.41 ,8.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50390,CPT,ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ,,,21 ,,RBRVS,1.96 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50391,CPT,INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUB,,,21 ,,RBRVS,1.96 ,0.77 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50392,CPT,INTRO INTRACATH/CATH IN RNL PELVIS DRG&/NJX PRQ,,,21 ,,RBRVS,3.37 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50393,CPT,INTRO URETER CATH/STNT RENAL PELVIS DRG&/NJX,,,21 ,,RBRVS,4.15 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50394,CPT,INJECTION PROCEDURE PYELOGRAPHY VIA TUBE/CATH,,,21 ,,RBRVS,0.76 ,0.64 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50395,CPT,INTRO GUIDE PELVIS&/URETER W/DILAT NFROS TRACT,,,21 ,,RBRVS,3.37 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50396,CPT,MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH,,,21 ,,RBRVS,2.09 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50398,CPT,CHANGE NEPHROSTOMY/PYELOSTOMY TUBE,,,21 ,,RBRVS,1.46 ,0.58 ,13.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50400,CPT,PYELOPLASTY SIMPLE,,,21 ,,RBRVS,21.27 ,10.88 ,10.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50405,CPT,PYELOPLASTY COMPLICATED,,,21 ,,RBRVS,25.86 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50500,CPT,NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY,,,21 ,,RBRVS,21.22 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50520,CPT,CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA,,,21 ,,RBRVS,18.88 ,9.88 ,9.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50525,CPT,CLSR NEPHROVISCERAL FISTULA W/VISC RPR ABDL APPR,,,21 ,,RBRVS,24.39 ,11.99 ,11.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50526,CPT,CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR,,,21 ,,RBRVS,26.31 ,13.49 ,13.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50540,CPT,SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI,,,21 ,,RBRVS,21.10 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50541,CPT,LAPAROSCOPY SURG ABLATION RENAL CYSTS,,,21 ,,RBRVS,16.86 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50542,CPT,LAPS ABLTJ RENAL MASS LESION W/INTRAOP US,,,21 ,,RBRVS,21.36 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50543,CPT,LAPAROSCOPY SURG PARTIAL NEPHRECTOMY,,,21 ,,RBRVS,27.41 ,13.99 ,13.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50544,CPT,LAPAROSCOPY SURG PYELOPLASTY,,,21 ,,RBRVS,23.37 ,11.28 ,11.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50545,CPT,LAPAROSCOPY RADICAL NEPHRECTOMY,,,21 ,,RBRVS,25.06 ,12.16 ,12.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50546,CPT,LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT,,,21 ,,RBRVS,21.87 ,11.41 ,11.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50547,CPT,LAPAROSCOPY DONOR NEPHRECTOMY LIVING DONOR,,,21 ,,RBRVS,26.34 ,15.91 ,15.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50548,CPT,LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY,,,21 ,,RBRVS,25.36 ,12.05 ,12.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50549,CPT,UNLISTED LAPAROSCOPY PROCEDURE RENAL,,,21 ,,TotalUnits,,,,37.22 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,50551,CPT,RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION,,,21 ,,RBRVS,5.59 ,2.61 ,4.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50553,CPT,RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA,,,21 ,,RBRVS,5.98 ,2.73 ,4.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50555,CPT,RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY,,,21 ,,RBRVS,6.52 ,2.98 ,5.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50557,CPT,RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI,,,21 ,,RBRVS,6.61 ,3.02 ,5.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50561,CPT,RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS,,,21 ,,RBRVS,7.58 ,3.39 ,5.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50562,CPT,RENAL NDSC NEPHROS/PYELOSTOMY RESCJ TUMOR,,,21 ,,RBRVS,10.90 ,5.31 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50570,CPT,RENAL NDSC NEPHROTOMY W/WO IRRIGATION,,,21 ,,RBRVS,9.53 ,4.14 ,4.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50572,CPT,RNL NDSC NFROT W/URTRL CATHJ W/WO DILAT URETER,,,21 ,,RBRVS,10.33 ,4.46 ,4.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50574,CPT,RENAL NDSC NEPHROTOMY W/BIOPSY,,,21 ,,RBRVS,11.00 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50575,CPT,RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY,,,21 ,,RBRVS,13.96 ,5.90 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50576,CPT,RNL NDSC NFROT FULGURATION &/INCISION W/WO BX,,,21 ,,RBRVS,10.97 ,4.71 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50580,CPT,RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS,,,21 ,,RBRVS,11.84 ,5.03 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50590,CPT,LITHOTRIPSY XTRCORP SHOCK WAVE,,,21 ,,RBRVS,9.77 ,6.02 ,13.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50592,CPT,ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY,,,21 ,,RBRVS,6.80 ,3.26 ,89.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50593,CPT,ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY,,,21 ,,RBRVS,9.13 ,4.11 ,127.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50600,CPT,URTROTOMY W/EXPL/DRG SEPARATE PROCEDURE,,,21 ,,RBRVS,17.17 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50605,CPT,URETEROTOMY INSERTION INDWELLING STENT ALL TYPES,,,21 ,,RBRVS,16.79 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50610,CPT,URTROLITHOTOMY UPPER ONE-THIRD URETER,,,21 ,,RBRVS,17.25 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50620,CPT,URTROLITHOTOMY MIDDLE ONE-THIRD URETER,,,21 ,,RBRVS,16.43 ,8.74 ,8.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50630,CPT,URTROLITHOTOMY LOWER ONE-THIRD URETER,,,21 ,,RBRVS,16.21 ,8.55 ,8.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50650,CPT,URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE,,,21 ,,RBRVS,18.82 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50660,CPT,URETERECTOMY TOT ECTOPIC URETER CMBN APPR,,,21 ,,RBRVS,21.02 ,10.74 ,10.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50684,CPT,INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH,,,21 ,,RBRVS,0.76 ,0.65 ,2.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50686,CPT,MANOMETRIC STDS THRU URTROST/NDWELLG URTRL CATH,,,21 ,,RBRVS,1.51 ,0.98 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50688,CPT,CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL,,,21 ,,RBRVS,1.20 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50690,CPT,NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG,,,21 ,,RBRVS,1.16 ,0.80 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50700,CPT,URETEROPLASTY PLASTIC OPERATION URETER,,,21 ,,RBRVS,16.69 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50715,CPT,URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS,,,21 ,,RBRVS,20.64 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50722,CPT,URETEROLYSIS FOR OVARIAN VEIN SYNDROME,,,21 ,,RBRVS,17.95 ,10.11 ,10.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50725,CPT,URTROLSS RETROCAVAL URTR W/REANAST,,,21 ,,RBRVS,20.20 ,10.27 ,10.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50727,CPT,REVJ URINARY-CUTANEOUS ANASTAMOSIS,,,21 ,,RBRVS,8.28 ,5.89 ,5.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50728,CPT,REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA,,,21 ,,RBRVS,12.18 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50740,CPT,EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR,,,21 ,,RBRVS,20.07 ,11.57 ,11.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50750,CPT,URETEROCALYCOSTOMY ANAST URETER RENAL CALYX,,,21 ,,RBRVS,21.22 ,10.91 ,10.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50760,CPT,URETEROURETEROSTOMY,,,21 ,,RBRVS,20.07 ,10.59 ,10.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50770,CPT,TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR,,,21 ,,RBRVS,21.22 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50780,CPT,URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER,,,21 ,,RBRVS,19.95 ,10.47 ,10.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50782,CPT,URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR,,,21 ,,RBRVS,19.66 ,10.10 ,10.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50783,CPT,URETERONEOCYSTOSTOMY W/URETERAL TAILORING,,,21 ,,RBRVS,20.70 ,10.34 ,10.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50785,CPT,URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP,,,21 ,,RBRVS,22.23 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50800,CPT,URETEROENTEROSTOMY ANAST URETER INTESTINE,,,21 ,,RBRVS,16.41 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50810,CPT,URETEROSIGMOIDOSTOMY W/SIGMOID BLADDER & COLOSTO,,,21 ,,RBRVS,22.61 ,13.48 ,13.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50815,CPT,URETEROCOLON CONDUIT INTESTINE ANASTOMOSIS,,,21 ,,RBRVS,22.26 ,11.73 ,11.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50820,CPT,URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS,,,21 ,,RBRVS,24.07 ,12.23 ,12.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50825,CPT,CONTINENT DVRJ W/INT ANAST ANY SGM SM&/LG INTSTN,,,21 ,,RBRVS,30.68 ,15.24 ,15.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50830,CPT,URINARY UNIDIVERSION,,,21 ,,RBRVS,33.77 ,16.10 ,16.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50840,CPT,RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST,,,21 ,,RBRVS,22.39 ,11.81 ,11.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50845,CPT,CUTANANEOUS APPENDICO-VESICOSTOMY,,,21 ,,RBRVS,22.46 ,12.34 ,12.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50860,CPT,URETEROSTOMY TRANSPLANTATION URETER SKIN,,,21 ,,RBRVS,17.08 ,9.20 ,9.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50900,CPT,URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE,,,21 ,,RBRVS,15.04 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50920,CPT,CLOSURE URETEROCUTANEOUS FISTULA,,,21 ,,RBRVS,15.81 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50930,CPT,CLOSURE URETEROCUTANEOUS FISTULA W/VISC RPR,,,21 ,,RBRVS,20.19 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50940,CPT,DELIGATION URETER,,,21 ,,RBRVS,15.93 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,50945,CPT,LAPAROSCOPY URTROLITHOTOMY,,,21 ,,RBRVS,17.97 ,9.09 ,9.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50947,CPT,LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT,,,21 ,,RBRVS,25.78 ,12.58 ,12.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50948,CPT,LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT,,,21 ,,RBRVS,23.82 ,11.67 ,11.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50949,CPT,UNLISTED LAPAROSCOPY PROCEDURE URETER,,,21 ,,TotalUnits,,,,38.36 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,50951,CPT,URETERAL ENDOSCOPY VIA URETEROSTOMY,,,21 ,,RBRVS,5.83 ,2.72 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50953,CPT,URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER,,,21 ,,RBRVS,6.23 ,3.24 ,5.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50955,CPT,URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY,,,21 ,,RBRVS,6.74 ,3.46 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50957,CPT,URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY,,,21 ,,RBRVS,6.78 ,3.08 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50961,CPT,URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE,,,21 ,,RBRVS,6.04 ,2.80 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50970,CPT,URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING,,,21 ,,RBRVS,7.13 ,3.19 ,3.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50972,CPT,NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER,,,21 ,,RBRVS,6.88 ,3.08 ,3.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50974,CPT,URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX,,,21 ,,RBRVS,9.16 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50976,CPT,URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO,,,21 ,,RBRVS,9.03 ,3.93 ,3.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,50980,CPT,NDSC URETEROTOMY RMVL FB/CALCULUS,,,21 ,,RBRVS,6.84 ,3.08 ,3.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51020,CPT,CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL,,,21 ,,RBRVS,7.69 ,5.45 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51030,CPT,CSTOTOMY/CSTOST CRYOSURG DSTRJ INTRAVESICAL LES,,,21 ,,RBRVS,7.81 ,5.19 ,5.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51040,CPT,CYSTOSTOMY CYSTOTOMY W/DRAINAGE,,,21 ,,RBRVS,4.49 ,3.67 ,3.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51045,CPT,CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX,,,21 ,,RBRVS,7.81 ,5.63 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51050,CPT,CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS,,,21 ,,RBRVS,7.97 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51060,CPT,TRANSVESICAL URETROLITHOTOMY,,,21 ,,RBRVS,9.95 ,6.30 ,6.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51065,CPT,CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO,,,21 ,,RBRVS,9.95 ,6.20 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51080,CPT,DRG PRIVESICAL/PREVESICAL SPACE ABSC,,,21 ,,RBRVS,6.71 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51100,CPT,ASPIRATION BLADDER NEEDLE,,,21 ,,RBRVS,0.78 ,0.29 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51101,CPT,ASPIRATION BLADDER TROCAR/INTRACATHETER,,,21 ,,RBRVS,1.02 ,0.42 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51102,CPT,ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER,,,21 ,,RBRVS,2.70 ,1.35 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51500,CPT,EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR,,,21 ,,RBRVS,11.05 ,7.71 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51520,CPT,CYSTOTOMY SIMPLE EXCISION VESICAL NECK,,,21 ,,RBRVS,10.21 ,6.31 ,6.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51525,CPT,CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE,,,21 ,,RBRVS,15.42 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51530,CPT,CYSTOTOMY EXCISION BLADDER TUMOR,,,21 ,,RBRVS,13.71 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51535,CPT,CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE,,,21 ,,RBRVS,13.90 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51550,CPT,CYSTECTOMY PARTIAL SIMPLE,,,21 ,,RBRVS,17.23 ,9.25 ,9.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51555,CPT,CYSTECTOMY PARTIAL COMPLICATED,,,21 ,,RBRVS,23.18 ,11.81 ,11.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51565,CPT,CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST,,,21 ,,RBRVS,23.68 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51570,CPT,CYSTECTOMY COMPLETE SEPARATE PROCEDURE,,,21 ,,RBRVS,27.46 ,13.41 ,13.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51575,CPT,CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY,,,21 ,,RBRVS,34.18 ,16.38 ,16.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51580,CPT,CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES,,,21 ,,RBRVS,35.37 ,17.34 ,17.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51585,CPT,CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES,,,21 ,,RBRVS,39.64 ,19.02 ,19.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51590,CPT,CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST,,,21 ,,RBRVS,36.33 ,17.22 ,17.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51595,CPT,CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC,,,21 ,,RBRVS,41.32 ,19.42 ,19.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51596,CPT,CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR,,,21 ,,RBRVS,44.26 ,21.05 ,21.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51597,CPT,PELVIC EXENTERATION COMPLETE MALIGNANCY,,,21 ,,RBRVS,42.86 ,20.52 ,20.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51600,CPT,NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY,,,21 ,,RBRVS,0.88 ,0.34 ,4.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51605,CPT,NJX & PLMT CHAIN CONTRAST&/URETHROCSTOGRAPY,,,21 ,,RBRVS,0.64 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51610,CPT,NJX RETROGRADE URETHROCSTOGRAPY,,,21 ,,RBRVS,1.05 ,0.74 ,2.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51700,CPT,BLDR IRRIGATION SMPL LAVAGE &/INSTLJ,,,21 ,,RBRVS,0.88 ,0.35 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51701,CPT,INSJ NON-NDWELLG BLADDER CATHETER,,,21 ,,RBRVS,0.50 ,0.26 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51702,CPT,INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,,,21 ,,RBRVS,0.50 ,0.34 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51703,CPT,INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED,,,21 ,,RBRVS,1.47 ,0.80 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51705,CPT,CHANGE CYSTOSTOMY TUBE SIMPLE,,,21 ,,RBRVS,0.90 ,0.52 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51710,CPT,CHANGE CYSTOSTOMY TUBE COMPLICATED,,,21 ,,RBRVS,1.35 ,0.84 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51715,CPT,NDSC NJX IMPLT MATRL URT&/BLDR NCK,,,21 ,,RBRVS,3.73 ,1.81 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51720,CPT,BLADDER INSTILLATION ANTICARCINOGENIC AGENT,,,21 ,,RBRVS,1.50 ,0.74 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51725,CPT,SIMPLE CYSTOMETROGRAM,,,21 ,,RBRVS,1.51 ,4.23 ,4.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51725,CPT,SIMPLE CYSTOMETROGRAM,26,,21 ,,RBRVS,1.51 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51725,CPT,SIMPLE CYSTOMETROGRAM,TC,,21 ,,RBRVS,,3.61 ,3.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,,,21 ,,RBRVS,1.71 ,6.73 ,6.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,26,,21 ,,RBRVS,1.71 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,TC,,21 ,,RBRVS,,6.04 ,6.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,,,21 ,,RBRVS,2.11 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,26,,21 ,,RBRVS,2.11 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,TC,,21 ,,RBRVS,,6.08 ,6.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,,,21 ,,RBRVS,2.11 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,26,,21 ,,RBRVS,2.11 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,TC,,21 ,,RBRVS,,6.16 ,6.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL,,,21 ,,RBRVS,2.51 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL,26,,21 ,,RBRVS,2.51 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL,TC,,21 ,,RBRVS,,6.33 ,6.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51736,CPT,SIMPLE UROFLOMETRY,,,21 ,,RBRVS,0.17 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51736,CPT,SIMPLE UROFLOMETRY,26,,21 ,,RBRVS,0.17 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51736,CPT,SIMPLE UROFLOMETRY,TC,,21 ,,RBRVS,,0.33 ,0.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51741,CPT,COMPLEX UROFLOMETRY,,,21 ,,RBRVS,0.17 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51741,CPT,COMPLEX UROFLOMETRY,26,,21 ,,RBRVS,0.17 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51741,CPT,COMPLEX UROFLOMETRY,TC,,21 ,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,,,21 ,,RBRVS,1.53 ,4.26 ,4.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,26,,21 ,,RBRVS,1.53 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,TC,,21 ,,RBRVS,,3.64 ,3.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,,,21 ,,RBRVS,1.53 ,5.35 ,5.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,26,,21 ,,RBRVS,1.53 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,TC,,21 ,,RBRVS,,4.70 ,4.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51792,CPT,STIMULUS EVOKED RESPONSE,,,21 ,,RBRVS,1.10 ,5.39 ,5.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51792,CPT,STIMULUS EVOKED RESPONSE,26,,21 ,,RBRVS,1.10 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51792,CPT,STIMULUS EVOKED RESPONSE,TC,,21 ,,RBRVS,,4.94 ,4.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,,,21 ,,RBRVS,0.80 ,2.77 ,2.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,26,,21 ,,RBRVS,0.80 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,TC,,21 ,,RBRVS,,2.43 ,2.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51798,CPT,MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP,,,21 ,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,51800,CPT,CSTOPLASTY/CSTOURTP PLSTC ANY,,,21 ,,RBRVS,18.89 ,10.09 ,10.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51820,CPT,CSTOURTP W/UNI/BI URTRONEOCSTOST,,,21 ,,RBRVS,19.59 ,10.29 ,10.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51840,CPT,ANT VESICOURETHROPEXY/URETHROPEXY SMPL,,,21 ,,RBRVS,11.36 ,6.81 ,6.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51841,CPT,ANT VESICOURETHROPEXY/URETHROPEXY COMP,,,21 ,,RBRVS,13.68 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51845,CPT,ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL,,,21 ,,RBRVS,10.15 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51860,CPT,CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE,,,21 ,,RBRVS,12.60 ,7.71 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51865,CPT,CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED,,,21 ,,RBRVS,15.80 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51880,CPT,CLOSURE CYSTOSTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,7.87 ,5.06 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51900,CPT,CLSR VESICOVAGINAL FISTUL AABDL APPROACH,,,21 ,,RBRVS,14.63 ,8.46 ,8.46 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51920,CPT,CLOSURE VESICOUTERINE FISTULA,,,21 ,,RBRVS,13.41 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51925,CPT,CLSR VESICOUTERINE FISTULA W/HYSTERECTOMY,,,21 ,,RBRVS,17.53 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51940,CPT,CLOSURE EXSTROPHY BLADDER,,,21 ,,RBRVS,30.66 ,14.52 ,14.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51960,CPT,ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS,,,21 ,,RBRVS,25.40 ,13.15 ,13.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51980,CPT,CUTANEOUS VESICOSTOMY,,,21 ,,RBRVS,12.57 ,7.29 ,7.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,51990,CPT,LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT,,,21 ,,RBRVS,13.36 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51992,CPT,LAPAROSCOPY SLING OPERATION STRESS INCONT,,,21 ,,RBRVS,14.87 ,8.29 ,8.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,51999,CPT,UNLISTED LAPAROSCOPY PROCEDURE BLADDER,,,21 ,,TotalUnits,,,,23.16 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,52000,CPT,CYSTOURETHROSCOPY,,,21 ,,RBRVS,2.23 ,1.28 ,3.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52001,CPT,CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS,,,21 ,,RBRVS,5.44 ,2.55 ,5.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52005,CPT,CYSTO BLADDER W/URETERAL CATHETERIZATION,,,21 ,,RBRVS,2.37 ,1.34 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52007,CPT,CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS,,,21 ,,RBRVS,3.02 ,1.60 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52010,CPT,CYSTO W/EJACULATORY DUCT CATHETERIZATION,,,21 ,,RBRVS,3.02 ,1.56 ,8.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52204,CPT,CYSTOURETHROSCOPY WITH BIOPSY,,,21 ,,RBRVS,2.59 ,1.35 ,8.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52214,CPT,CYSTO W/DESTRUCTION OF LESIONS,,,21 ,,RBRVS,3.70 ,1.96 ,14.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52224,CPT,CYSTO W/REMOVAL OF LESIONS SMALL,,,21 ,,RBRVS,3.14 ,1.57 ,16.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52234,CPT,CYSTO W/REMOVAL OF TUMORS SMALL,,,21 ,,RBRVS,4.62 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52235,CPT,CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM,,,21 ,,RBRVS,5.44 ,2.59 ,2.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52240,CPT,CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE,,,21 ,,RBRVS,9.71 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52250,CPT,CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG,,,21 ,,RBRVS,4.49 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52260,CPT,CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH,,,21 ,,RBRVS,3.91 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52265,CPT,CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA,,,21 ,,RBRVS,2.94 ,1.57 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52270,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE,,,21 ,,RBRVS,3.36 ,1.71 ,7.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52275,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE,,,21 ,,RBRVS,4.69 ,2.23 ,9.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52276,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE,,,21 ,,RBRVS,4.99 ,2.41 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52277,CPT,CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER,,,21 ,,RBRVS,6.16 ,2.91 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52281,CPT,CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS,,,21 ,,RBRVS,2.75 ,1.50 ,5.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52282,CPT,CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT,,,21 ,,RBRVS,6.39 ,2.99 ,2.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52283,CPT,CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE,,,21 ,,RBRVS,3.73 ,1.87 ,4.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52285,CPT,CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME,,,21 ,,RBRVS,3.60 ,1.85 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52287,CPT,CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER,,,21 ,,RBRVS,3.20 ,1.37 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52290,CPT,CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI,,,21 ,,RBRVS,4.58 ,2.23 ,2.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52300,CPT,CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI,,,21 ,,RBRVS,5.30 ,2.59 ,2.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52301,CPT,CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI,,,21 ,,RBRVS,5.50 ,2.66 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52305,CPT,CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT,,,21 ,,RBRVS,5.30 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52310,CPT,CYSTO W/SIMPLE REMOVAL STONE & STENT,,,21 ,,RBRVS,2.81 ,1.41 ,4.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52315,CPT,CYSTO W/COMPLEX REMOVAL STONE & STENT,,,21 ,,RBRVS,5.20 ,2.44 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52317,CPT,LITHOLAPAXY SMPL/SM <2.5 CM,,,21 ,,RBRVS,6.71 ,2.95 ,17.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52318,CPT,LITHOLAPAXY COMP/LG > 2.5 CM,,,21 ,,RBRVS,9.18 ,3.99 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52320,CPT,CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS,,,21 ,,RBRVS,4.69 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52325,CPT,CYSTO FRAGMENTATION URETERAL STONE,,,21 ,,RBRVS,6.15 ,2.78 ,2.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52327,CPT,CYSTO W/SUBURTRIC NJX IMPLT MATRL,,,21 ,,RBRVS,5.18 ,2.10 ,2.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52330,CPT,CYSTO MANJ W/O RMVL URETERAL STONE,,,21 ,,RBRVS,5.03 ,2.31 ,11.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52332,CPT,CYSTO W/INSERT URETERAL STENT,,,21 ,,RBRVS,2.82 ,1.52 ,11.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52334,CPT,CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR,,,21 ,,RBRVS,4.82 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52341,CPT,CYSTO W/TX URETERAL STRICTURE,,,21 ,,RBRVS,5.35 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52342,CPT,CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE,,,21 ,,RBRVS,5.85 ,2.92 ,2.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52343,CPT,CYSTO W/TX INTRA-RENAL STRICTURE,,,21 ,,RBRVS,6.55 ,3.20 ,3.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52344,CPT,CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE,,,21 ,,RBRVS,7.05 ,3.56 ,3.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52345,CPT,CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX,,,21 ,,RBRVS,7.55 ,3.76 ,3.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52346,CPT,CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE,,,21 ,,RBRVS,8.58 ,4.19 ,4.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52351,CPT,CYSTO W/URTROSCOPY&/PYELOSCOPY DX,,,21 ,,RBRVS,5.85 ,2.91 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52352,CPT,CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES,,,21 ,,RBRVS,6.87 ,3.41 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52353,CPT,CYSTO W/URETEROSCOPY W/LITHOTRIPSY,,,21 ,,RBRVS,7.96 ,3.84 ,3.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52354,CPT,CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION,,,21 ,,RBRVS,7.33 ,3.59 ,3.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52355,CPT,CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR,,,21 ,,RBRVS,8.81 ,4.18 ,4.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52400,CPT,CYSTO INC FULG/RESCJ URTL VALVES/FOLDS,,,21 ,,RBRVS,8.69 ,4.67 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52402,CPT,CSTO W/TRURL RESCJ/INC EJACULATORY DUXS,,,21 ,,RBRVS,5.27 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52450,CPT,TRANSURETHRAL INCISION PROSTATE,,,21 ,,RBRVS,7.78 ,5.39 ,5.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52500,CPT,TRANSURETHRAL RESECTION PROSTATE,,,21 ,,RBRVS,8.14 ,5.55 ,5.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52601,CPT,TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE,,,21 ,,RBRVS,15.26 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52630,CPT,TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS,,,21 ,,RBRVS,6.55 ,4.68 ,4.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52640,CPT,TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE,,,21 ,,RBRVS,4.79 ,3.98 ,3.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52647,CPT,LASER COAGULATION OF PROSTATE FOR URINE FLOW,,,21 ,,RBRVS,11.30 ,6.76 ,44.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52648,CPT,LASER VAPORIZATION OF PROSTATE FOR URINE FLOW,,,21 ,,RBRVS,12.15 ,7.10 ,44.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52649,CPT,LASER ENUCLEATION PROSTATE W/MORCELLATION,,,21 ,,RBRVS,14.56 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,52700,CPT,TRURL DRAINAGE PROSTATIC ABSCESS,,,21 ,,RBRVS,7.49 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53000,CPT,URTT/URTS XTRNL SPX PENDULOUS URETHRA,,,21 ,,RBRVS,2.33 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53010,CPT,URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA,,,21 ,,RBRVS,4.45 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53020,CPT,MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT,,,21 ,,RBRVS,1.77 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53025,CPT,MEATOTOMY CUTTING MEATUS SPX INFANT,,,21 ,,RBRVS,1.13 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53040,CPT,DRAINAGE DEEP PERIURETHRAL ABSCESS,,,21 ,,RBRVS,6.55 ,4.43 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53060,CPT,DRG OF SKENE'S GLAND ABSCESS OR CYST,,,21 ,,RBRVS,2.68 ,1.87 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53080,CPT,DRG PERINEAL URINARY XTRVASATION UNCOMP SPX,,,21 ,,RBRVS,6.92 ,4.98 ,4.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53085,CPT,DRG PERINEAL URINARY XTRVASATION COMPLIC,,,21 ,,RBRVS,11.18 ,6.63 ,6.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53200,CPT,BIOPSY URETHRA,,,21 ,,RBRVS,2.59 ,1.34 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53210,CPT,URETHRECTOMY TOT W/CYSTOST FEMALE,,,21 ,,RBRVS,13.72 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53215,CPT,URETHRECTOMY TOT W/CYSTOST MALE,,,21 ,,RBRVS,16.85 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53220,CPT,EXC/FULGURATION CARCINOMA URETHRA,,,21 ,,RBRVS,7.63 ,5.13 ,5.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53230,CPT,EXC URETHRAL DIVERTICULUM SPX FEMALE,,,21 ,,RBRVS,10.44 ,6.47 ,6.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53235,CPT,EXC URETHRAL DIVERTICULUM SPX MALE,,,21 ,,RBRVS,10.99 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53240,CPT,MARSUPIALIZATION URTL DIVERTICULUM MALE/FEMALE,,,21 ,,RBRVS,7.08 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53250,CPT,EXCISION OF BULBOURETHRAL GLAND,,,21 ,,RBRVS,6.52 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53260,CPT,EXC/FULGURATION URETHRAL POLYP DSTL URETHRA,,,21 ,,RBRVS,3.03 ,1.98 ,2.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53265,CPT,EXC/FULGURATION URETHRAL CARUNCLE,,,21 ,,RBRVS,3.17 ,2.01 ,2.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53270,CPT,EXCISION OR FULGURATION SKENES GLANDS,,,21 ,,RBRVS,3.14 ,1.94 ,2.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53275,CPT,EXCISION/FULGURATION URETHRAL PROLAPSE,,,21 ,,RBRVS,4.57 ,2.78 ,2.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53400,CPT,URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX,,,21 ,,RBRVS,14.13 ,8.26 ,8.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53405,CPT,URETHROPLASTY 2ND STAGE W/URINARY DIVERSION,,,21 ,,RBRVS,15.66 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53410,CPT,URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA,,,21 ,,RBRVS,17.68 ,9.57 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53415,CPT,URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT,,,21 ,,RBRVS,20.70 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,53420,CPT,URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE,,,21 ,,RBRVS,15.17 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53425,CPT,URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE,,,21 ,,RBRVS,17.07 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53430,CPT,URETHROPLASTY RCNSTJ FEMALE URETHRA,,,21 ,,RBRVS,17.43 ,9.24 ,9.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53431,CPT,URTP W/TUBULARIZATION POST URT&/LWR BLDR,,,21 ,,RBRVS,21.18 ,10.92 ,10.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53440,CPT,SLING OPRATION CORRJ MALE URINARY INCONTINENCE,,,21 ,,RBRVS,13.36 ,8.03 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53442,CPT,RMVL/REVJ SLING MALE URINARY INCONTINENCE,,,21 ,,RBRVS,13.49 ,8.33 ,8.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53444,CPT,INSERTION TANDEM CUFF,,,21 ,,RBRVS,14.19 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53445,CPT,INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER,,,21 ,,RBRVS,13.00 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53446,CPT,REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER,,,21 ,,RBRVS,11.02 ,6.95 ,6.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53447,CPT,RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC,,,21 ,,RBRVS,14.28 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53448,CPT,RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD,,,21 ,,RBRVS,23.44 ,12.21 ,12.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,53449,CPT,RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER,,,21 ,,RBRVS,10.56 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53450,CPT,URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT,,,21 ,,RBRVS,6.77 ,4.70 ,4.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53460,CPT,URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM,,,21 ,,RBRVS,7.75 ,5.07 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53500,CPT,URETHROLSS TRVG SEC OPN W/CSTO,,,21 ,,RBRVS,13.00 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53502,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE,,,21 ,,RBRVS,8.26 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53505,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE,,,21 ,,RBRVS,8.26 ,5.35 ,5.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53510,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL,,,21 ,,RBRVS,10.96 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53515,CPT,URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS,,,21 ,,RBRVS,14.22 ,7.93 ,7.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53520,CPT,CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX,,,21 ,,RBRVS,9.48 ,6.09 ,6.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53600,CPT,DILAT URETHRAL STRIX DILATOR MALE 1ST,,,21 ,,RBRVS,1.21 ,0.57 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53601,CPT,DILAT URETHRAL STRIX DILATOR MALE SBSQ,,,21 ,,RBRVS,0.98 ,0.51 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53605,CPT,DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES,,,21 ,,RBRVS,1.28 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53620,CPT,DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST,,,21 ,,RBRVS,1.62 ,0.81 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53621,CPT,DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ,,,21 ,,RBRVS,1.35 ,0.66 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53660,CPT,DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI,,,21 ,,RBRVS,0.71 ,0.45 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53661,CPT,DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ,,,21 ,,RBRVS,0.72 ,0.41 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53665,CPT,DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES,,,21 ,,RBRVS,0.76 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53850,CPT,TRURL DSTRJ PRSTATE TISS MICROWAVE THERMOTH,,,21 ,,RBRVS,10.08 ,5.77 ,52.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53852,CPT,TRURL DSTRJ PRSTATE TISS RF THERMOTH,,,21 ,,RBRVS,10.83 ,6.54 ,49.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53855,CPT,INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT,,,21 ,,RBRVS,1.64 ,0.59 ,20.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53860,CPT,TRURL RF FEMALE BLADDER NECK STRS URIN INCONT,,,21 ,,RBRVS,3.97 ,2.23 ,40.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,53899,CPT,UNLISTED PROCEDURE URINARY SYSTEM,,,21 ,,TotalUnits,,,,2.79 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,54000,CPT,SLITTING PREPUCE DORSAL/LATERAL SPX NEWBORN,,,21 ,,RBRVS,1.59 ,1.46 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54001,CPT,SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN,,,21 ,,RBRVS,2.24 ,1.65 ,3.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54015,CPT,I&D PENIS DEEP,,,21 ,,RBRVS,5.36 ,3.20 ,3.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54050,CPT,DSTRJ LESION PENIS SIMPLE CHEMICAL,,,21 ,,RBRVS,1.29 ,1.63 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54055,CPT,DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION,,,21 ,,RBRVS,1.25 ,1.33 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54056,CPT,DSTRJ LESION PENIS SIMPLE CRYOSURGERY,,,21 ,,RBRVS,1.29 ,1.81 ,2.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54057,CPT,DSTRJ LESION PENIS SIMPLE LASER,,,21 ,,RBRVS,1.29 ,1.37 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54060,CPT,DSTRJ LESION PENIS SIMPLE SURG EXCISION,,,21 ,,RBRVS,1.98 ,1.67 ,3.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54065,CPT,DSTRJ LESION PENIS EXTENSIVE,,,21 ,,RBRVS,2.47 ,2.31 ,3.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54100,CPT,BIOPSY PENIS SEPARATE PROCEDURE,,,21 ,,RBRVS,1.90 ,1.60 ,3.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54105,CPT,BIOPSY PENIS DEEP STRUCTURES,,,21 ,,RBRVS,3.54 ,2.42 ,4.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54110,CPT,EXCISION OF PENILE PLAQUE,,,21 ,,RBRVS,10.92 ,6.50 ,6.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54111,CPT,EXC PENILE PLAQUE GRAFT &/5 CM LENGTH,,,21 ,,RBRVS,14.42 ,7.90 ,7.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54112,CPT,EXC PENILE PLAQUE GRAFT > 5 CM LENGTH,,,21 ,,RBRVS,16.98 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54115,CPT,REMOVAL FOREIGN BODY DEEP PENILE TISSUE,,,21 ,,RBRVS,6.95 ,4.94 ,5.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54120,CPT,AMPUTATION PENIS PARTIAL,,,21 ,,RBRVS,11.01 ,6.63 ,6.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54125,CPT,AMPUTATION PENIS COMPLETE,,,21 ,,RBRVS,14.56 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,54130,CPT,AMPUTAION PENIS RADW/BI INGUINOFEMORAL LMPHADE,,,21 ,,RBRVS,21.84 ,11.39 ,11.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,54135,CPT,AMPUTATION PENIS RADICAL W/LYMPH NODES,,,21 ,,RBRVS,28.17 ,15.03 ,15.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,54150,CPT,CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,,,21 ,,RBRVS,1.90 ,0.79 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54160,CPT,CIRCUMCISION NEONATE,,,21 ,,RBRVS,2.53 ,1.49 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54161,CPT,CIRCUMCISION AGE >28 DAYS,,,21 ,,RBRVS,3.32 ,2.19 ,2.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54162,CPT,LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS,,,21 ,,RBRVS,3.32 ,2.24 ,4.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54163,CPT,REPAIR INCOMPLETE CIRCUMCISION,,,21 ,,RBRVS,3.32 ,2.85 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54164,CPT,FRENULOTOMY PENIS,,,21 ,,RBRVS,2.82 ,2.63 ,2.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54200,CPT,INJECTION PEYRONIE DISEASE,,,21 ,,RBRVS,1.11 ,1.29 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54205,CPT,NJX PEYRONIE W/SURG EXPOS PLAQUE,,,21 ,,RBRVS,8.97 ,5.99 ,5.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54220,CPT,IRRIGATION CORPORA CAVERNOSA PRIAPISM,,,21 ,,RBRVS,2.42 ,1.32 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54230,CPT,INJECTION CORPORA CAVERNOSOGRAPY,,,21 ,,RBRVS,1.34 ,0.90 ,1.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54231,CPT,DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS,,,21 ,,RBRVS,2.04 ,1.22 ,1.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54235,CPT,NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT,,,21 ,,RBRVS,1.19 ,0.88 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54240,CPT,PENILE PLETHYSMOGRAPY,,,21 ,,RBRVS,1.31 ,1.54 ,1.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,54240,CPT,PENILE PLETHYSMOGRAPY,26,,21 ,,RBRVS,1.31 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54240,CPT,PENILE PLETHYSMOGRAPY,TC,,21 ,,RBRVS,,1.03 ,1.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,54250,CPT,NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST,,,21 ,,RBRVS,2.22 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,54250,CPT,NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST,26,,21 ,,RBRVS,2.22 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54250,CPT,NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST,TC,,21 ,,RBRVS,,0.33 ,0.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,54300,CPT,PENIS STRAIGHTENING CHORDEE,,,21 ,,RBRVS,11.20 ,6.78 ,6.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54304,CPT,PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR,,,21 ,,RBRVS,13.28 ,7.72 ,7.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54308,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR <3 CM,,,21 ,,RBRVS,12.62 ,7.99 ,7.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54312,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR > 3 CM,,,21 ,,RBRVS,14.51 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54316,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF,,,21 ,,RBRVS,18.05 ,10.63 ,10.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54318,CPT,URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS,,,21 ,,RBRVS,12.43 ,7.48 ,7.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54322,CPT,1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT,,,21 ,,RBRVS,13.98 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54324,CPT,1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS,,,21 ,,RBRVS,17.55 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54326,CPT,1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS,,,21 ,,RBRVS,17.02 ,9.14 ,9.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54328,CPT,1 STAGE DSTL HYPOSPADIAS RPR W/EXTENSIVE DSJ,,,21 ,,RBRVS,16.89 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54332,CPT,1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR,,,21 ,,RBRVS,18.37 ,9.95 ,9.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54336,CPT,1 STG PERINEAL HYPOSPADIAS RPR W/GRF&/FLAP,,,21 ,,RBRVS,21.62 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54340,CPT,RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE,,,21 ,,RBRVS,9.71 ,6.20 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54344,CPT,RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP,,,21 ,,RBRVS,17.06 ,9.45 ,9.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54348,CPT,RPR HYPOSPADIAS COMPLCTJS DSJ & URTP FLAP/GRF,,,21 ,,RBRVS,18.32 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54352,CPT,RPR HYPOSPADIAS CRIPPLE W/DSJ & EXC & GRFS/FLAP,,,21 ,,RBRVS,26.13 ,13.43 ,13.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54360,CPT,PLASTIC RPR PENIS CORRECT ANGULATION,,,21 ,,RBRVS,12.78 ,7.41 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54380,CPT,PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR,,,21 ,,RBRVS,14.18 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54385,CPT,PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT,,,21 ,,RBRVS,16.56 ,10.53 ,10.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54390,CPT,PLASTIC RPR PENIS EPISPADIAS W/EXSTROPHY BLADDER,,,21 ,,RBRVS,22.77 ,12.20 ,12.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,54400,CPT,INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID,,,21 ,,RBRVS,9.17 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54401,CPT,INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED,,,21 ,,RBRVS,10.44 ,8.02 ,8.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54405,CPT,INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH,,,21 ,,RBRVS,14.52 ,8.03 ,8.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54406,CPT,RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH,,,21 ,,RBRVS,12.89 ,7.50 ,7.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54408,CPT,RPR COMPONENT INFLATABLE PENILE PROSTHESIS,,,21 ,,RBRVS,13.91 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54410,CPT,RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS,,,21 ,,RBRVS,15.18 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54411,CPT,RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL,,,21 ,,RBRVS,18.35 ,10.23 ,10.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,54415,CPT,RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT,,,21 ,,RBRVS,8.88 ,5.93 ,5.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54416,CPT,RMVL & RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESI,,,21 ,,RBRVS,12.08 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54417,CPT,RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD,,,21 ,,RBRVS,16.10 ,8.95 ,8.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,54420,CPT,CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI,,,21 ,,RBRVS,12.39 ,7.33 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54430,CPT,CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI,,,21 ,,RBRVS,11.06 ,6.87 ,6.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,54435,CPT,CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM,,,21 ,,RBRVS,6.81 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54440,CPT,PLASTIC OPERATION PENIS INJURY,,,21 ,,TotalUnits,,,,19.66 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,54450,CPT,FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING,,,21 ,,RBRVS,1.12 ,0.48 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54500,CPT,BIOPSY TESTIS NEEDLE SEPARATE PROCEDURE,,,21 ,,RBRVS,1.31 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54505,CPT,BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE,,,21 ,,RBRVS,3.50 ,2.40 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54512,CPT,EXC XTRPARENCHYMAL LESION TESTIS,,,21 ,,RBRVS,9.33 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54520,CPT,ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH,,,21 ,,RBRVS,5.30 ,3.80 ,3.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54522,CPT,ORCHIECTOMY PARTIAL,,,21 ,,RBRVS,10.25 ,6.11 ,6.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54530,CPT,ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH,,,21 ,,RBRVS,8.46 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54535,CPT,ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL,,,21 ,,RBRVS,13.19 ,7.47 ,7.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54550,CPT,EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA,,,21 ,,RBRVS,8.41 ,5.32 ,5.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54560,CPT,EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL,,,21 ,,RBRVS,12.10 ,8.05 ,8.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54600,CPT,RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS,,,21 ,,RBRVS,7.64 ,5.04 ,5.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54620,CPT,FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE,,,21 ,,RBRVS,5.21 ,3.19 ,3.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54640,CPT,ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR,,,21 ,,RBRVS,7.73 ,5.57 ,5.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54650,CPT,ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS,,,21 ,,RBRVS,12.39 ,7.41 ,7.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54660,CPT,INSJ TESTICULAR PROSTH SEPARATE PROCEDURE,,,21 ,,RBRVS,5.74 ,4.28 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54670,CPT,SUTURE/REPAIR TESTICULAR INJURY,,,21 ,,RBRVS,6.65 ,4.71 ,4.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54680,CPT,TRANSPLANTATION TESTIS TO THIGH,,,21 ,,RBRVS,14.04 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54690,CPT,LAPAROSCOPY SURGICAL ORCHIECTOMY,,,21 ,,RBRVS,11.70 ,7.45 ,7.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54692,CPT,LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS,,,21 ,,RBRVS,13.74 ,7.43 ,7.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54699,CPT,UNLISTED LAPAROSCOPY PROCEDURE TESTIS,,,21 ,,TotalUnits,,,,19.15 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,54700,CPT,I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE,,,21 ,,RBRVS,3.47 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54800,CPT,BIOPSY EPIDIDYMIS NEEDLE,,,21 ,,RBRVS,2.33 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54830,CPT,EXCISION LOCAL LESION EPIDIDYMIS,,,21 ,,RBRVS,6.01 ,4.42 ,4.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54840,CPT,EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY,,,21 ,,RBRVS,5.27 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54860,CPT,EPIDIDYMECTOMY UNILATERAL,,,21 ,,RBRVS,6.95 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54861,CPT,EPIDIDYMECTOMY BILATERAL,,,21 ,,RBRVS,9.70 ,6.12 ,6.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54865,CPT,EXPLORATION EPIDIDYMIS W/WO BIOPSY,,,21 ,,RBRVS,5.77 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54900,CPT,EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI,,,21 ,,RBRVS,14.20 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,54901,CPT,EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS BI,,,21 ,,RBRVS,19.10 ,10.35 ,10.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55000,CPT,PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED,,,21 ,,RBRVS,1.43 ,0.94 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55040,CPT,EXCISION HYDROCELE UNILATERAL,,,21 ,,RBRVS,5.45 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55041,CPT,EXCISION HYDROCELE BILATERAL,,,21 ,,RBRVS,8.54 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55060,CPT,RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE,,,21 ,,RBRVS,6.15 ,4.47 ,4.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55100,CPT,DRAINAGE SCROTAL WALL ABSCESS,,,21 ,,RBRVS,2.45 ,2.19 ,3.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55110,CPT,SCROTAL EXPLORATION,,,21 ,,RBRVS,6.33 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55120,CPT,REMOVAL FOREIGN BODY SCROTUM,,,21 ,,RBRVS,5.72 ,4.33 ,4.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55150,CPT,RESECTION SCROTUM,,,21 ,,RBRVS,8.14 ,5.57 ,5.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55175,CPT,SCROTOPLASTY SIMPLE,,,21 ,,RBRVS,5.87 ,4.31 ,4.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55180,CPT,SCROTOPLASTY COMPLICATED,,,21 ,,RBRVS,11.78 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55200,CPT,VASOTOMY CANNULIZATION W/WO VAS INC UNI/BI SPX,,,21 ,,RBRVS,4.55 ,3.23 ,8.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55250,CPT,VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS,,,21 ,,RBRVS,3.37 ,3.04 ,8.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55300,CPT,VASOTOMY VASOGRAMS UNI/BI,,,21 ,,RBRVS,3.50 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55400,CPT,VASOVASOSTOMY VASOVASORRHAPHY,,,21 ,,RBRVS,8.61 ,5.35 ,5.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55450,CPT,LIGATION PRQ VAS DEFERENS UNI/BI SPX,,,21 ,,RBRVS,4.43 ,2.74 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55500,CPT,EXC HYDROCELE SPRMATIC CORD UNI SPX,,,21 ,,RBRVS,6.22 ,4.63 ,4.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55520,CPT,EXC LESION SPERMATIC CORD SEPARATE PROCEDURE,,,21 ,,RBRVS,6.66 ,5.19 ,5.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55530,CPT,EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX,,,21 ,,RBRVS,5.75 ,4.13 ,4.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55535,CPT,EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL,,,21 ,,RBRVS,7.19 ,4.84 ,4.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55540,CPT,EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR,,,21 ,,RBRVS,8.30 ,5.79 ,5.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55550,CPT,LAPS LIGATION SPERMATIC VEINS VARICOCELE,,,21 ,,RBRVS,7.20 ,4.73 ,4.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55559,CPT,UNLISTED LAPROSCOPY PROCEDURE SPERMATIC CORD,,,21 ,,TotalUnits,,,,11.93 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,55600,CPT,VESICULOTOMY,,,21 ,,RBRVS,7.01 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55605,CPT,VESICULOTOMY COMPLICATED,,,21 ,,RBRVS,8.76 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55650,CPT,VESICULECTOMY ANY APPROACH,,,21 ,,RBRVS,12.65 ,7.33 ,7.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55680,CPT,EXCISION MULLERIAN DUCT CYST,,,21 ,,RBRVS,5.67 ,3.97 ,3.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55700,CPT,PROSTATE NEEDLE BIOPSY ANY APPROACH,,,21 ,,RBRVS,2.58 ,1.28 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55705,CPT,BIOPSY PROSTATE INCISIONAL ANY APPROACH,,,21 ,,RBRVS,4.61 ,2.85 ,2.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55706,CPT,BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID,,,21 ,,RBRVS,6.28 ,4.26 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55720,CPT,PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE,,,21 ,,RBRVS,7.73 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55725,CPT,PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED,,,21 ,,RBRVS,10.05 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55801,CPT,PROSTATECTOMY PERINEAL SUBTOTAL,,,21 ,,RBRVS,19.80 ,10.59 ,10.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55810,CPT,PROSTATECTOMY PERINEAL RADICAL,,,21 ,,RBRVS,24.29 ,12.23 ,12.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55812,CPT,PROSTATECTOMY PERINEAL RADICAL W/LYMPH NODE BX,,,21 ,,RBRVS,29.89 ,14.84 ,14.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55815,CPT,PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC,,,21 ,,RBRVS,32.95 ,16.07 ,16.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55821,CPT,PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES,,,21 ,,RBRVS,15.76 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55831,CPT,PROSTATECTOMY RETROPUBIC SUBTOTAL,,,21 ,,RBRVS,17.19 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55840,CPT,PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING,,,21 ,,RBRVS,24.63 ,12.58 ,12.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55842,CPT,PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX,,,21 ,,RBRVS,26.49 ,13.36 ,13.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55845,CPT,PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM,,,21 ,,RBRVS,30.67 ,14.74 ,14.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55860,CPT,EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST,,,21 ,,RBRVS,15.84 ,8.53 ,8.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55862,CPT,EXPOS PROSTATE INSJ RADIOACT SBST W/LYMPH BX,,,21 ,,RBRVS,20.04 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55865,CPT,EXPOS PROSTATE INSJ RADIOAC SBST W/BI PELV LYMPH,,,21 ,,RBRVS,24.57 ,12.59 ,12.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55866,CPT,LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT,,,21 ,,RBRVS,32.06 ,16.13 ,16.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,55870,CPT,ELECTROEJACULATION,,,21 ,,RBRVS,2.58 ,1.40 ,2.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55873,CPT,CRYOSURGICAL ABLATION PROSTATE W/US & MONITORI,,,21 ,,RBRVS,13.60 ,8.81 ,182.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55875,CPT,TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ,,,21 ,,RBRVS,13.46 ,7.81 ,7.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55876,CPT,PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT,,,21 ,,RBRVS,1.73 ,1.09 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,55899,CPT,UNLISTED PROCEDURE MALE GENITAL SYSTEM,,,21 ,,TotalUnits,,,,5.83 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,55920,CPT,PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL,,,21 ,,RBRVS,8.31 ,3.70 ,3.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56405,CPT,I&D VULVA/PERINEAL ABSCESS,,,21 ,,RBRVS,1.49 ,1.48 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56420,CPT,I&D OF BARTHOLINS GLAND ABSCESS,,,21 ,,RBRVS,1.44 ,1.05 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56440,CPT,MARSUPIALIZATION BARTHOLINS GLAND CYST,,,21 ,,RBRVS,2.89 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56441,CPT,LYSIS LABIAL ADHESIONS,,,21 ,,RBRVS,2.02 ,1.81 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56442,CPT,HYMENOTOMY SIMPLE INCISION,,,21 ,,RBRVS,0.68 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56501,CPT,DESTRUCTION LESIONS VULVA SIMPLE,,,21 ,,RBRVS,1.58 ,1.57 ,2.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56515,CPT,DESTRUCTION LESIONS VULVA EXTENSIVE,,,21 ,,RBRVS,3.08 ,2.35 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56605,CPT,BIOPSY VULVA/PERINEUM 1 LESION SPX,,,21 ,,RBRVS,1.10 ,0.52 ,1.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56606,CPT,BIOPSY VULVA/PERINEUM EACH ADDL LESION,,,21 ,,RBRVS,0.55 ,0.24 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56620,CPT,VULVECTOMY SIMPLE PARTIAL,,,21 ,,RBRVS,7.53 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56625,CPT,VULVECTOMY SIMPLE COMPLETE,,,21 ,,RBRVS,9.68 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56630,CPT,VULVECTOMY RADICAL PARTIAL,,,21 ,,RBRVS,14.80 ,9.13 ,9.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,56631,CPT,VULVECTOMY RAD PRTL UNI INGUINOFEM LMPHADECTOMY,,,21 ,,RBRVS,18.99 ,11.39 ,11.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,56632,CPT,VULVECTOMY RAD PRTL BI INGUINOFEM LMPHADECTOMY,,,21 ,,RBRVS,21.86 ,13.48 ,13.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,56633,CPT,VULVECTOMY RADICAL COMPLETE,,,21 ,,RBRVS,19.62 ,11.48 ,11.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,56634,CPT,VULVECTOMY RAD COMPL UNI INGUINOFEM LMPHADECTOMY,,,21 ,,RBRVS,20.66 ,12.35 ,12.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,56637,CPT,VULVECTOMY RAD COMPL BI INGUINOFEM LMPHADECTOMY,,,21 ,,RBRVS,24.75 ,13.85 ,13.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,56640,CPT,VULVECTOMY RAD COMPL ILIAC & PELVIC LMPHADECTOMY,,,21 ,,RBRVS,24.78 ,13.70 ,13.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,56700,CPT,PRTL HYMENECTOMY/REVJ HYMENAL RING,,,21 ,,RBRVS,2.84 ,2.28 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56740,CPT,EXC BARTHOLINS GLAND/CYST,,,21 ,,RBRVS,4.88 ,3.17 ,3.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56800,CPT,PLASTIC REPAIR INTROITUS,,,21 ,,RBRVS,3.93 ,2.61 ,2.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56805,CPT,CLITOROPLASTY INTERSEX STATE,,,21 ,,RBRVS,19.88 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56810,CPT,PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX,,,21 ,,RBRVS,4.29 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56820,CPT,COLPOSCOPY VULVA,,,21 ,,RBRVS,1.50 ,0.79 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,56821,CPT,COLPOSCOPY VULVA W/BIOPSY,,,21 ,,RBRVS,2.05 ,1.03 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57000,CPT,COLPOTOMY W/EXPLORATION,,,21 ,,RBRVS,3.02 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57010,CPT,COLPOTOMY W/DRAINAGE PELVIC ABSCESS,,,21 ,,RBRVS,6.84 ,4.97 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57020,CPT,COLPOCENTESIS SEPARATE PROCEDURE,,,21 ,,RBRVS,1.50 ,0.68 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57022,CPT,I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM,,,21 ,,RBRVS,2.73 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57023,CPT,I&D VAGINAL HEMATOMA NON-OBSTETRICAL,,,21 ,,RBRVS,5.18 ,3.24 ,3.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57061,CPT,DESTRUCTION VAGINAL LESIONS SIMPLE,,,21 ,,RBRVS,1.30 ,1.41 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57065,CPT,DESTRUCTION VAGINAL LESIONS EXTENSIVE,,,21 ,,RBRVS,2.66 ,2.01 ,2.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57100,CPT,BIOPSY VAGINAL MUCOSA SIMPLE,,,21 ,,RBRVS,1.20 ,0.56 ,1.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57105,CPT,BIOPSY VAGINAL MUCOSA EXTENSIVE,,,21 ,,RBRVS,1.74 ,1.70 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57106,CPT,VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL,,,21 ,,RBRVS,7.50 ,5.66 ,5.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57107,CPT,VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T,,,21 ,,RBRVS,24.56 ,13.16 ,13.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57109,CPT,VAGNC PRTL RMVL VAG WALL W/BI TOT PEL LMPHADEC,,,21 ,,RBRVS,28.40 ,14.68 ,14.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57110,CPT,VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL,,,21 ,,RBRVS,15.48 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57111,CPT,VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS,,,21 ,,RBRVS,28.40 ,14.82 ,14.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57112,CPT,VAGNC COMPL RMVL VAG WALL TOT PEL LMPHADEC BX,,,21 ,,RBRVS,30.52 ,15.68 ,15.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57120,CPT,COLPOCLEISIS LE FORT TYPE,,,21 ,,RBRVS,8.28 ,5.60 ,5.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57130,CPT,EXCISION VAGINAL SEPTUM,,,21 ,,RBRVS,2.46 ,1.90 ,2.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57135,CPT,EXCISION VAGINAL CYST/TUMOR,,,21 ,,RBRVS,2.70 ,2.00 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57150,CPT,IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE,,,21 ,,RBRVS,0.55 ,0.24 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57155,CPT,INSERTION UTERINE TANDEM&/VAGINAL OVOIDS,,,21 ,,RBRVS,5.40 ,2.32 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57156,CPT,INSERTION VAGINAL RADIATION DEVICE,,,21 ,,RBRVS,2.69 ,1.24 ,2.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57160,CPT,FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI,,,21 ,,RBRVS,0.89 ,0.38 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57170,CPT,DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS,,,21 ,,RBRVS,0.91 ,0.39 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57180,CPT,INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX,,,21 ,,RBRVS,1.63 ,1.26 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57200,CPT,COLPORRHAPHY SUTURE INJURY VAGINA,,,21 ,,RBRVS,4.42 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57210,CPT,COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU,,,21 ,,RBRVS,5.71 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57220,CPT,PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH,,,21 ,,RBRVS,4.85 ,3.88 ,3.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57230,CPT,PLASTIC REPAIR URETHROCELE,,,21 ,,RBRVS,6.30 ,4.52 ,4.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57240,CPT,ANT COLPORRHAPHY CYSTOCELE W/WO RPR URETHROCELE,,,21 ,,RBRVS,11.50 ,6.67 ,6.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57250,CPT,POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY,,,21 ,,RBRVS,11.50 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57260,CPT,COMBINED ANTEROPOSTERIOR COLPORRHAPHY,,,21 ,,RBRVS,14.44 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57265,CPT,CMBND ANTEROPOST COLPORRHAPHY W/ENTEROCELE RPR,,,21 ,,RBRVS,15.94 ,8.64 ,8.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57267,CPT,INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE,,,21 ,,RBRVS,4.88 ,2.07 ,2.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57268,CPT,REPAIR ENTEROCELE VAGINAL APPROACH SPX,,,21 ,,RBRVS,7.57 ,5.59 ,5.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57270,CPT,REPAIR ENTEROCELE ABDOMINAL APPROACH SPX,,,21 ,,RBRVS,13.67 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57280,CPT,COLPOPEXY ABDOMINAL APPROACH,,,21 ,,RBRVS,16.72 ,9.11 ,9.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57282,CPT,COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH,,,21 ,,RBRVS,7.97 ,5.72 ,5.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57283,CPT,COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH,,,21 ,,RBRVS,11.66 ,7.01 ,7.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57284,CPT,PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPR,,,21 ,,RBRVS,14.33 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57285,CPT,PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH,,,21 ,,RBRVS,11.60 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57287,CPT,RMVL/REVJ SLING STRESS INCONTINENCE,,,21 ,,RBRVS,11.15 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57288,CPT,SLING OPERATION STRESS INCONTINENCE,,,21 ,,RBRVS,12.13 ,7.44 ,7.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57289,CPT,PEREYRA PX W/ANTERIOR COLPORRHAPHY,,,21 ,,RBRVS,12.80 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57291,CPT,CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT,,,21 ,,RBRVS,8.64 ,8.19 ,8.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57292,CPT,CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT,,,21 ,,RBRVS,14.01 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57295,CPT,REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP,,,21 ,,RBRVS,7.82 ,5.27 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57296,CPT,REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR,,,21 ,,RBRVS,16.56 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57300,CPT,CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR,,,21 ,,RBRVS,8.71 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57305,CPT,CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH,,,21 ,,RBRVS,15.35 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57307,CPT,CLSR RECTOVAG FSTL ABDL APPR W/CONCOMITANT CLST,,,21 ,,RBRVS,17.17 ,10.31 ,10.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57308,CPT,CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ,,,21 ,,RBRVS,10.59 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57310,CPT,CLOSURE URETHROVAGINAL FISTULA,,,21 ,,RBRVS,7.65 ,5.19 ,5.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57311,CPT,CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL,,,21 ,,RBRVS,8.91 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57320,CPT,CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH,,,21 ,,RBRVS,8.88 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57330,CPT,CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR,,,21 ,,RBRVS,13.21 ,7.25 ,7.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57335,CPT,VAGINOPLASTY INTERSEX STATE,,,21 ,,RBRVS,20.02 ,10.16 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57400,CPT,DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL,,,21 ,,RBRVS,2.27 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57410,CPT,PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL,,,21 ,,RBRVS,1.75 ,1.15 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57415,CPT,REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL,,,21 ,,RBRVS,2.49 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57420,CPT,COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT,,,21 ,,RBRVS,1.60 ,0.82 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57421,CPT,COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX,,,21 ,,RBRVS,2.20 ,1.09 ,2.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57423,CPT,PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH,,,21 ,,RBRVS,16.08 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57425,CPT,LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX,,,21 ,,RBRVS,17.03 ,9.21 ,9.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57426,CPT,REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC,,,21 ,,RBRVS,14.30 ,8.73 ,8.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57452,CPT,COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA,,,21 ,,RBRVS,1.50 ,0.99 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57454,CPT,COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE,,,21 ,,RBRVS,2.33 ,1.35 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57455,CPT,COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX,,,21 ,,RBRVS,1.99 ,0.99 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57456,CPT,COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE,,,21 ,,RBRVS,1.85 ,0.93 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57460,CPT,COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX,,,21 ,,RBRVS,2.83 ,1.57 ,5.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57461,CPT,COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX,,,21 ,,RBRVS,3.43 ,1.61 ,5.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57500,CPT,BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX,,,21 ,,RBRVS,1.20 ,0.86 ,2.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57505,CPT,ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE,,,21 ,,RBRVS,1.19 ,1.35 ,1.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57510,CPT,CAUTERY CERVIX ELECTRO/THERMAL,,,21 ,,RBRVS,1.90 ,1.23 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57511,CPT,CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT,,,21 ,,RBRVS,1.95 ,1.67 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57513,CPT,CAUTERY CERVIX LASER ABLATION,,,21 ,,RBRVS,1.95 ,1.69 ,2.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57520,CPT,CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER,,,21 ,,RBRVS,4.11 ,3.34 ,4.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57522,CPT,CONIZATION CERVIX W/WO D&C RPR ELTRD EXC,,,21 ,,RBRVS,3.67 ,2.97 ,3.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57530,CPT,TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX,,,21 ,,RBRVS,5.27 ,4.14 ,4.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57531,CPT,RAD TRACHELECTOMY W/BI PEL LMPHADEC,,,21 ,,RBRVS,29.95 ,16.56 ,16.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57540,CPT,EXCISION CERVICAL STUMP ABDOMINAL APPROACH,,,21 ,,RBRVS,13.29 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57545,CPT,EXC CERVICAL STUMP ABDL APPR W/PELVIC FLOOR RPR,,,21 ,,RBRVS,14.10 ,8.09 ,8.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,57550,CPT,EXCISION CERVICAL STUMP VAGINAL APPROACH,,,21 ,,RBRVS,6.34 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57555,CPT,EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR,,,21 ,,RBRVS,9.94 ,6.34 ,6.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57556,CPT,EXC CRV STUMP VAG APPR W/RPR NTRCL,,,21 ,,RBRVS,9.36 ,6.04 ,6.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57558,CPT,DILATION & CURETTAGE CERVICAL STUMP,,,21 ,,RBRVS,1.72 ,1.39 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57700,CPT,CERCLAGE UTERINE CERVIX NONOBSTETRICAL,,,21 ,,RBRVS,4.35 ,4.22 ,4.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57720,CPT,TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG,,,21 ,,RBRVS,4.61 ,3.81 ,3.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,57800,CPT,DILATION CERVICAL CANAL INSTRUMENTAL SPX,,,21 ,,RBRVS,0.77 ,0.55 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58100,CPT,ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX,,,21 ,,RBRVS,1.53 ,0.83 ,1.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58110,CPT,ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY,,,21 ,,RBRVS,0.77 ,0.33 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58120,CPT,DILATION & CURETTAGE DX&/THER NONOBSTETRIC,,,21 ,,RBRVS,3.59 ,2.30 ,3.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58140,CPT,MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR,,,21 ,,RBRVS,15.79 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58145,CPT,MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR,,,21 ,,RBRVS,8.91 ,5.83 ,5.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58146,CPT,MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA,,,21 ,,RBRVS,20.34 ,10.72 ,10.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58150,CPT,TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY,,,21 ,,RBRVS,17.31 ,9.48 ,9.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58152,CPT,TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY,,,21 ,,RBRVS,21.86 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58180,CPT,SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY,,,21 ,,RBRVS,16.60 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58200,CPT,TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM,,,21 ,,RBRVS,23.10 ,12.24 ,12.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58210,CPT,RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY,,,21 ,,RBRVS,30.91 ,16.37 ,16.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58240,CPT,PEL EXNTJ GYNECOLOGIC MAL,,,21 ,,RBRVS,49.33 ,25.71 ,25.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58260,CPT,VAGINAL HYSTERECTOMY UTERUS 250 GM/<,,,21 ,,RBRVS,14.15 ,8.16 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58262,CPT,VAG HYST 250 GM/< W/RMVL TUBE&/OVARY,,,21 ,,RBRVS,15.94 ,8.91 ,8.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58263,CPT,VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL,,,21 ,,RBRVS,17.23 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58267,CPT,VAG HYST 250 GM/< W/COLPO-URTCSTOPEXY,,,21 ,,RBRVS,18.36 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58270,CPT,VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE,,,21 ,,RBRVS,15.30 ,8.45 ,8.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58275,CPT,VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY,,,21 ,,RBRVS,17.03 ,9.47 ,9.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58280,CPT,VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE,,,21 ,,RBRVS,18.33 ,10.04 ,10.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58285,CPT,VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION,,,21 ,,RBRVS,23.38 ,11.86 ,11.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58290,CPT,VAGINAL HYSTERECTOMY UTERUS > 250 GM,,,21 ,,RBRVS,20.27 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58291,CPT,VAG HYST > 250 GM RMVL TUBE&/OVARY,,,21 ,,RBRVS,22.06 ,11.44 ,11.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58292,CPT,VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE,,,21 ,,RBRVS,23.35 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58293,CPT,VAG HYST >250 GM COLPOURTCSTOPEXY W/WO NDSC CTR,,,21 ,,RBRVS,24.33 ,12.41 ,12.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58294,CPT,VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE,,,21 ,,RBRVS,21.55 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58300,CPT,INSERTION INTRAUTERINE DEVICE IUD,,,21 ,,RBRVS,1.01 ,0.42 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58301,CPT,REMOVAL INTRAUTERINE DEVICE IUD,,,21 ,,RBRVS,1.27 ,0.54 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58321,CPT,ARTIFICIAL INSEMINATION INTRA-CERVICAL,,,21 ,,RBRVS,0.92 ,0.40 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58322,CPT,ARTIFICIAL INSEMINATION INTRA-UTERINE,,,21 ,,RBRVS,1.10 ,0.47 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58323,CPT,SPERM WASHING ARTIFICIAL INSEMINATION,,,21 ,,RBRVS,0.23 ,0.10 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58340,CPT,CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI,,,21 ,,RBRVS,0.88 ,0.72 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58345,CPT,TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING,,,21 ,,RBRVS,4.70 ,2.87 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58346,CPT,INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY,,,21 ,,RBRVS,7.56 ,5.02 ,5.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58350,CPT,CHROMOTUBATION OVIDUCT W/MATERIALS,,,21 ,,RBRVS,1.06 ,1.12 ,1.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58353,CPT,ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GID,,,21 ,,RBRVS,3.60 ,2.35 ,26.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58356,CPT,ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR,,,21 ,,RBRVS,6.41 ,2.87 ,50.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58400,CPT,UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX,,,21 ,,RBRVS,7.14 ,4.87 ,4.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58410,CPT,UTERINE SUSP W/WO SHORT LIGAMNTS W/SYMPATHECTOMY,,,21 ,,RBRVS,13.80 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58520,CPT,HYSTERORRHAPHY REPAIR RUPT UTERUS NONOBSTETRICAL,,,21 ,,RBRVS,13.48 ,7.73 ,7.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58540,CPT,HYSTEROPLASTY RPR UTERINE ANOMALY,,,21 ,,RBRVS,15.71 ,8.77 ,8.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58541,CPT,LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/<,,,21 ,,RBRVS,14.70 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58542,CPT,LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR,,,21 ,,RBRVS,16.56 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58543,CPT,LAPS SUPRACERVICAL HYSTERECTOMY >250,,,21 ,,RBRVS,16.87 ,9.50 ,9.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58544,CPT,LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY,,,21 ,,RBRVS,18.37 ,10.15 ,10.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58545,CPT,LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<,,,21 ,,RBRVS,15.55 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58546,CPT,LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS,,,21 ,,RBRVS,19.94 ,10.34 ,10.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58548,CPT,LAPS W/RAD HYST W/BILAT LMPHADEC RMVL TUBE/OVARY,,,21 ,,RBRVS,31.63 ,16.85 ,16.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58550,CPT,LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<,,,21 ,,RBRVS,15.10 ,8.70 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58552,CPT,LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES,,,21 ,,RBRVS,16.91 ,9.50 ,9.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58553,CPT,LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS,,,21 ,,RBRVS,20.06 ,10.44 ,10.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58554,CPT,LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR,,,21 ,,RBRVS,23.11 ,12.17 ,12.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58555,CPT,HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE,,,21 ,,RBRVS,3.33 ,1.78 ,4.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58558,CPT,HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C,,,21 ,,RBRVS,4.74 ,2.43 ,5.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58559,CPT,HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS,,,21 ,,RBRVS,6.16 ,3.05 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58560,CPT,HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM,,,21 ,,RBRVS,6.99 ,3.40 ,3.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58561,CPT,HYSTEROSCOPY REMOVAL LEIOMYOMATA,,,21 ,,RBRVS,9.99 ,4.70 ,4.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58562,CPT,HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY,,,21 ,,RBRVS,5.20 ,2.59 ,5.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58563,CPT,HYSTEROSCOPY ENDOMETRIAL ABLATION,,,21 ,,RBRVS,6.16 ,3.04 ,43.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58565,CPT,HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS,,,21 ,,RBRVS,7.12 ,4.64 ,48.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58570,CPT,LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/>,,,21 ,,RBRVS,15.88 ,9.11 ,9.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58571,CPT,LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY,,,21 ,,RBRVS,17.69 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58572,CPT,LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM,,,21 ,,RBRVS,20.09 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58573,CPT,LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR,,,21 ,,RBRVS,23.11 ,12.40 ,12.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58578,CPT,UNLISTED LAPAROSCOPY PROCEDURE UTERUS,,,21 ,,TotalUnits,,,,26.37 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,58579,CPT,UNLISTED HYSTEROSCOPY PROCEDURE UTERUS,,,21 ,,TotalUnits,,,,7.56 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,58600,CPT,LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI,,,21 ,,RBRVS,5.91 ,3.97 ,3.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58605,CPT,LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX,,,21 ,,RBRVS,5.28 ,3.67 ,3.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58611,CPT,LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG,,,21 ,,RBRVS,1.45 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58615,CPT,OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR,,,21 ,,RBRVS,3.94 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58660,CPT,LAPAROSCOPY W/LYSIS OF ADHESIONS,,,21 ,,RBRVS,11.59 ,6.43 ,6.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58661,CPT,LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES,,,21 ,,RBRVS,11.35 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58662,CPT,LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE,,,21 ,,RBRVS,12.15 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58670,CPT,LAPAROSCOPY FULGURATION OVIDUCTS,,,21 ,,RBRVS,5.91 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58671,CPT,LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS,,,21 ,,RBRVS,5.91 ,3.99 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58672,CPT,LAPAROSCOPY FIMBRIOPLASTY,,,21 ,,RBRVS,12.91 ,6.89 ,6.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58673,CPT,LAPAROSCOPY SALPINGOSTOMY,,,21 ,,RBRVS,14.04 ,7.50 ,7.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58679,CPT,UNLISTED LAPAROSCOPY PROCEDURE OVIDUCT/OVARY,,,21 ,,TotalUnits,,,,17.27 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,58700,CPT,SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX,,,21 ,,RBRVS,12.95 ,7.74 ,7.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58720,CPT,SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX,,,21 ,,RBRVS,12.16 ,7.22 ,7.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58740,CPT,LYSIS OF ADHESIONS SALPINX/OVARY,,,21 ,,RBRVS,14.90 ,8.60 ,8.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58750,CPT,TUBOTUBAL ANASTATOMOSIS,,,21 ,,RBRVS,15.64 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58752,CPT,TUBOUTERINE IMPLANTATION,,,21 ,,RBRVS,15.64 ,8.67 ,8.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58760,CPT,FIMBRIOPLASTY,,,21 ,,RBRVS,13.93 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58770,CPT,SALPINGOSTOMY,,,21 ,,RBRVS,14.77 ,8.10 ,8.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58800,CPT,DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR,,,21 ,,RBRVS,4.62 ,3.54 ,4.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58805,CPT,DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL,,,21 ,,RBRVS,6.42 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58820,CPT,DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN,,,21 ,,RBRVS,4.70 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58822,CPT,DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH,,,21 ,,RBRVS,11.81 ,7.67 ,7.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58823,CPT,DRG PELVIC ABSCESS TRANSVAG/TRANSRECTAL APPR,,,21 ,,RBRVS,3.37 ,1.27 ,23.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58825,CPT,TRANSPOSITION OVARY,,,21 ,,RBRVS,11.78 ,7.38 ,7.38 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58900,CPT,BIOPSY OVARY UNI/BI SEPARATE PROCEDURE,,,21 ,,RBRVS,6.59 ,5.21 ,5.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58920,CPT,WEDGE RESCJ/BISCTJ OVARY UNI/BI,,,21 ,,RBRVS,11.95 ,6.93 ,6.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58925,CPT,OVARIAN CYSTECTOMY UNI/BI,,,21 ,,RBRVS,12.43 ,7.39 ,7.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58940,CPT,OOPHORECTOMY PARTIAL/TOTAL UNI/BI,,,21 ,,RBRVS,8.22 ,5.66 ,5.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58943,CPT,OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY,,,21 ,,RBRVS,19.52 ,10.71 ,10.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58950,CPT,RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO,,,21 ,,RBRVS,18.37 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58951,CPT,RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD,,,21 ,,RBRVS,24.26 ,13.01 ,13.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58952,CPT,RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING,,,21 ,,RBRVS,27.29 ,14.81 ,14.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58953,CPT,BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION,,,21 ,,RBRVS,34.13 ,17.92 ,17.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58954,CPT,BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY,,,21 ,,RBRVS,37.13 ,19.29 ,19.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58956,CPT,BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC,,,21 ,,RBRVS,22.80 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58957,CPT,RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY,,,21 ,,RBRVS,26.22 ,14.20 ,14.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58958,CPT,RESECTION RECRT MAL W/OMENTECTOMY PEL LMPHADEC,,,21 ,,RBRVS,29.22 ,15.53 ,15.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58960,CPT,LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK,,,21 ,,RBRVS,15.79 ,9.13 ,9.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,58970,CPT,FOLLICLE PUNCTURE OOCYTE RETRIEVAL ANY METHOD,,,21 ,,RBRVS,3.52 ,1.87 ,2.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58974,CPT,EMBRYO TRANSFER INTRAUTERINE,,,21 ,,TotalUnits,,,,4.89 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,58976,CPT,GAMETE ZYGOTE/EMBRYO FALLOPIAN TRANSFER ANY METH,,,21 ,,RBRVS,3.82 ,2.00 ,3.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,58999,CPT,UNLISTED PX FEMALE GENITAL SYSTEM NONOBSTETRICAL,,,21 ,,TotalUnits,,,,3.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,59000,CPT,AMNIOCENTESIS DIAGNOSIC,,,12 ,,RBRVS,1.30 ,0.77 ,2.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59001,CPT,AMNIOCENTESISS THER AMNIOTIC FLUID RDCTJ US GID,,,12 ,,RBRVS,3.00 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59012,CPT,CORDOCENTESIS INTRAUTERINE,,,12 ,,RBRVS,3.44 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59015,CPT,CHORIONIC VILLUS SAMPLING,,,12 ,,RBRVS,2.20 ,1.16 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59020,CPT,FETAL CONTRACTION STRESS TEST,,,12 ,,RBRVS,0.66 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,59020,CPT,FETAL CONTRACTION STRESS TEST,26,,12 ,,RBRVS,0.66 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59020,CPT,FETAL CONTRACTION STRESS TEST,TC,,12 ,,RBRVS,,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,59025,CPT,FETAL NONSTRESS TEST,,,12 ,,RBRVS,0.53 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,59025,CPT,FETAL NONSTRESS TEST,26,,12 ,,RBRVS,0.53 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59025,CPT,FETAL NONSTRESS TEST,TC,,12 ,,RBRVS,,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,59030,CPT,FETAL SCALP BLOOD SAMPLING,,,12 ,,RBRVS,1.99 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59050,CPT,FETAL MONITORING LABOR PHYS WRITTEN REPORT,,,12 ,,RBRVS,0.89 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59051,CPT,FETAL MONITR LABOR PHYS WRTTN REPRT INTERPJ ONLY,,,12 ,,RBRVS,0.74 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59070,CPT,TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE,,,12 ,,RBRVS,5.24 ,2.67 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59072,CPT,FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE,,,12 ,,RBRVS,8.99 ,4.08 ,4.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59074,CPT,FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE,,,12 ,,RBRVS,5.24 ,2.83 ,5.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59076,CPT,FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE,,,12 ,,RBRVS,8.99 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59100,CPT,HYSTEROTOMY ABDOMINAL,,,12 ,,RBRVS,13.37 ,7.85 ,7.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59120,CPT,TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR,,,12 ,,RBRVS,12.67 ,7.59 ,7.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59121,CPT,TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY,,,12 ,,RBRVS,12.74 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59130,CPT,TX ECTOPIC PREGNANCY ABDL PREGNANCY,,,12 ,,RBRVS,15.08 ,8.30 ,8.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59135,CPT,TX ECTOPIC PREGNANCY NTRSTL REQ TOT HYST,,,12 ,,RBRVS,14.92 ,8.89 ,8.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59136,CPT,TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER,,,12 ,,RBRVS,14.25 ,7.91 ,7.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59140,CPT,TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION,,,12 ,,RBRVS,5.94 ,4.37 ,4.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59150,CPT,LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY,,,12 ,,RBRVS,12.29 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59151,CPT,LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY,,,12 ,,RBRVS,12.11 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59160,CPT,CURETTAGE POSTPARTUM,,,12 ,,RBRVS,2.76 ,1.72 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59200,CPT,INSERTION CERVICAL DILATOR SEPARATE PROCEDURE,,,12 ,,RBRVS,0.79 ,0.34 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59300,CPT,EPISIOTOMY/VAG RPR OTH/THN ATTENDING,,,12 ,,RBRVS,2.41 ,1.36 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59320,CPT,CERCLAGE CERVIX PREGNANCY VAGINAL,,,12 ,,RBRVS,2.48 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59325,CPT,CERCLAGE CERVIX PREGNANCY ABDOMINAL,,,12 ,,RBRVS,4.06 ,2.10 ,2.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59350,CPT,HYSTERORRHAPHY RUPTURED UTERUS,,,12 ,,RBRVS,4.94 ,2.09 ,2.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59400,CPT,OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM,,,13 ,,RBRVS,32.16 ,21.18 ,21.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59409,CPT,VAGINAL DELIVERY ONLY,,,13 ,,RBRVS,14.37 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59410,CPT,VAGINAL DELIVERY ONLY W/POSTPARTUM CARE,,,13 ,,RBRVS,18.01 ,8.14 ,8.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59412,CPT,EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS,,,13 ,,RBRVS,1.71 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59414,CPT,DELIVERY PLACENTA SEPARATE PROCEDURE,,,13 ,,RBRVS,1.61 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59425,CPT,ANTEPARTUM CARE ONLY 4-6 VISITS,,,13 ,,RBRVS,6.31 ,2.66 ,5.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59426,CPT,ANTEPARTUM CARE ONLY 7/> VISITS,,,13 ,,RBRVS,11.16 ,4.72 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59430,CPT,POSTPARTUM CARE ONLY SEPARATE PROCEDURE,,,13 ,,RBRVS,2.47 ,1.07 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59510,CPT,OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM,,,11 ,,RBRVS,35.64 ,23.29 ,23.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59514,CPT,CESAREAN DELIVERY ONLY,,,11 ,,RBRVS,16.13 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59515,CPT,CESAREAN DELIVERY ONLY W/POSTPARTUM CARE,,,11 ,,RBRVS,21.47 ,10.16 ,10.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59525,CPT,STOT/TOT HYSTERECTOMY AFTER CESAREN DELIVERY,,,21 ,,RBRVS,8.53 ,3.67 ,3.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59610,CPT,ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB,,,13 ,,RBRVS,33.87 ,21.84 ,21.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59612,CPT,VAGINAL DELIVERY AFTER CESAREAN DELIVERY,,,13 ,,RBRVS,16.09 ,6.86 ,6.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59614,CPT,VAGINAL DELIVERY & POSTPARTUM CARE VBAC,,,13 ,,RBRVS,19.73 ,8.72 ,8.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59618,CPT,ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC,,,11 ,,RBRVS,36.16 ,23.63 ,23.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59620,CPT,CESAREAN DELIVERY ATTEMPTED VBAC,,,11 ,,RBRVS,16.66 ,7.27 ,7.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59622,CPT,CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA,,,11 ,,RBRVS,22.00 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59812,CPT,TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL,,,12 ,,RBRVS,4.44 ,3.17 ,3.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59820,CPT,TX MISSED ABORTION FIRST TRIMESTER SURGICAL,,,12 ,,RBRVS,4.84 ,4.47 ,5.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59821,CPT,TX MISSED ABORTION SECOND TRIMESTER SURGICAL,,,12 ,,RBRVS,5.09 ,4.18 ,4.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59830,CPT,TX SEPTIC ABORTION SURGICAL,,,12 ,,RBRVS,6.59 ,4.65 ,4.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59840,CPT,INDUCED ABORTION DILATION AND CURETTAGE,,,12 ,,RBRVS,3.01 ,2.40 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59841,CPT,INDUCED ABORTION DILATION & EVAUCATION,,,12 ,,RBRVS,5.65 ,3.57 ,4.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59850,CPT,INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVACJ,,,12 ,,RBRVS,5.90 ,3.88 ,3.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59851,CPT,INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C,,,12 ,,RBRVS,5.92 ,4.40 ,4.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59852,CPT,INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTM,,,12 ,,RBRVS,8.23 ,5.94 ,5.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59855,CPT,INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS,,,12 ,,RBRVS,6.43 ,4.21 ,4.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59856,CPT,INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC,,,12 ,,RBRVS,7.79 ,4.66 ,4.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59857,CPT,INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT,,,12 ,,RBRVS,9.33 ,5.18 ,5.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,59866,CPT,MULTIFETAL PREGNANCY REDUCTION,,,12 ,,RBRVS,3.99 ,2.04 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59870,CPT,UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE,,,12 ,,RBRVS,6.57 ,5.76 ,5.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59871,CPT,REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA,,,12 ,,RBRVS,2.13 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,59897,CPT,UNLISTED FETAL INVASIVE PX W/ULTRASOUND,,,12 ,,TotalUnits,,,,3.04 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,59898,CPT,UNLISTED LAPAROSCOPY PX MATERNITY CARE&DELIVERY,,,12 ,,TotalUnits,,,,19.05 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,59899,CPT,UNLISTED PROCEDURE MATERNITY CARE & DELIVERY,,,12 ,,TotalUnits,,,,13.52 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,60000,CPT,I&D THYROGLOSSAL DUCT CYST INFECTED,,,21 ,,RBRVS,1.81 ,2.31 ,2.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60100,CPT,BIOPSY THYROID PERCUTANEOUS CORE NEEDLE,,,21 ,,RBRVS,1.56 ,0.60 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60200,CPT,EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS,,,21 ,,RBRVS,10.02 ,7.82 ,7.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60210,CPT,PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY,,,21 ,,RBRVS,11.23 ,7.61 ,7.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60212,CPT,PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC,,,21 ,,RBRVS,16.43 ,10.39 ,10.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60220,CPT,TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY,,,21 ,,RBRVS,11.19 ,7.89 ,7.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60225,CPT,TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC,,,21 ,,RBRVS,14.79 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60240,CPT,THYROIDECTOMY TOTAL/COMPLETE,,,21 ,,RBRVS,15.04 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60252,CPT,THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT,,,21 ,,RBRVS,22.01 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60254,CPT,THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT,,,21 ,,RBRVS,28.42 ,16.48 ,16.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60260,CPT,THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL,,,21 ,,RBRVS,18.26 ,11.00 ,11.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60270,CPT,THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC,,,21 ,,RBRVS,23.20 ,12.88 ,12.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60271,CPT,THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH,,,21 ,,RBRVS,17.62 ,10.61 ,10.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60280,CPT,EXCISION THYROGLOSSAL DUCT CYST/SINUS,,,21 ,,RBRVS,6.16 ,6.23 ,6.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60281,CPT,EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT,,,21 ,,RBRVS,8.82 ,7.63 ,7.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60300,CPT,ASPIRATION AND/OR INJECTION THYROID CYST,,,21 ,,RBRVS,0.97 ,0.37 ,2.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60500,CPT,PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS,,,21 ,,RBRVS,15.60 ,9.79 ,9.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60502,CPT,PARATHYROIDECTOMY/EXPLOR PARATHYROIDS RE-EXPLOR,,,21 ,,RBRVS,21.15 ,12.34 ,12.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60505,CPT,PARATHYRDEC/EXPL PARATHYR MEDSTNL STERNAL/TTHRC,,,21 ,,RBRVS,23.06 ,13.94 ,13.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60512,CPT,PARATHYROID AUTOTRANSPLANTATION ADD-ON,,,21 ,,RBRVS,4.44 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60520,CPT,THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX,,,21 ,,RBRVS,17.16 ,9.82 ,9.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,60521,CPT,THYMECTOMY PRTL/TOT W/O RAD MEDSTNL DSJ SPX,,,21 ,,RBRVS,19.18 ,10.20 ,10.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60522,CPT,THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX,,,21 ,,RBRVS,23.48 ,12.29 ,12.29 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60540,CPT,ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX,,,21 ,,RBRVS,18.02 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60545,CPT,ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR,,,21 ,,RBRVS,20.93 ,11.02 ,11.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60600,CPT,EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY,,,21 ,,RBRVS,25.09 ,12.06 ,12.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60605,CPT,EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY,,,21 ,,RBRVS,31.96 ,12.13 ,12.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60650,CPT,LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL,,,21 ,,RBRVS,20.73 ,10.52 ,10.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,60659,CPT,UNLISTED LAPAROSCOPY PROCEDURE ENDOCRINE SYSTEM,,,21 ,,TotalUnits,,,,31.25 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,60699,CPT,UNLISTED PROCEDURE ENDOCRINE SYSTEM,,,21 ,,TotalUnits,,,,9.47 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,61000,CPT,SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT,,,21 ,,RBRVS,1.58 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61001,CPT,SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ,,,21 ,,RBRVS,1.49 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61020,CPT,VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX,,,21 ,,RBRVS,1.51 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61026,CPT,VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ,,,21 ,,RBRVS,1.69 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61050,CPT,CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX,,,21 ,,RBRVS,1.51 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61055,CPT,CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION,,,21 ,,RBRVS,2.10 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61070,CPT,PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX,,,21 ,,RBRVS,0.89 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61105,CPT,TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE,,,21 ,,RBRVS,5.45 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61107,CPT,TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE,,,21 ,,RBRVS,4.99 ,2.60 ,2.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61108,CPT,TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA,,,21 ,,RBRVS,11.64 ,10.97 ,10.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61120,CPT,BURR HOLE VENTRICULAR PUNCTURE,,,21 ,,RBRVS,9.60 ,8.94 ,8.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61140,CPT,BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION,,,21 ,,RBRVS,17.23 ,13.96 ,13.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61150,CPT,BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST,,,21 ,,RBRVS,18.90 ,14.39 ,14.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61151,CPT,BURR HOLE/TREPHINE W/SBSQ TAPPING ICRA ABSC/CST,,,21 ,,RBRVS,13.49 ,11.03 ,11.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61154,CPT,BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDRL,,,21 ,,RBRVS,17.07 ,14.39 ,14.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61156,CPT,BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL,,,21 ,,RBRVS,17.45 ,13.13 ,13.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61210,CPT,BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE,,,21 ,,RBRVS,5.83 ,3.04 ,3.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61215,CPT,INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH,,,21 ,,RBRVS,5.85 ,7.05 ,7.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61250,CPT,BURR HOLE/TREPHINE SUPRATENTORIAL W/O OTH SURG,,,21 ,,RBRVS,11.49 ,9.97 ,9.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61253,CPT,BURR HOLE/TREPHINE INFRATENTORIAL UNI/BI,,,21 ,,RBRVS,13.49 ,9.42 ,9.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61304,CPT,CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL,,,21 ,,RBRVS,23.41 ,17.02 ,17.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61305,CPT,CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL,,,21 ,,RBRVS,28.64 ,20.58 ,20.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61312,CPT,CRANIECTOMY HMTMA SUPRATENTORIAL EXTRA/SUBDURAL,,,21 ,,RBRVS,30.17 ,20.62 ,20.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61313,CPT,CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL,,,21 ,,RBRVS,28.09 ,20.63 ,20.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61314,CPT,CRANIECTOMY HMTMA INFRATENTORIAL EXTRA/SUBDURAL,,,21 ,,RBRVS,25.90 ,18.92 ,18.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61315,CPT,CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL,,,21 ,,RBRVS,29.65 ,20.99 ,20.99 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61316,CPT,INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAF,,,21 ,,RBRVS,1.39 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61320,CPT,CRANIECTOMY/CRANIOTMY DRG ABSCESS SUPRATENTORIAL,,,21 ,,RBRVS,27.42 ,19.26 ,19.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61321,CPT,CRANIECTOMY/CRANIOTMY DRG ABSCESS INFRATENTORIAL,,,21 ,,RBRVS,30.53 ,21.41 ,21.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61322,CPT,CRANIECT/CRANIOT W/WO DURAPLASTY W/O LOBECTOMY,,,21 ,,RBRVS,34.26 ,23.64 ,23.64 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61323,CPT,CRANIECT/CRANIOT W/WO DURAPLASTY W/LOBECTOMY,,,21 ,,RBRVS,35.06 ,23.06 ,23.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61330,CPT,DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH,,,21 ,,RBRVS,25.30 ,18.80 ,18.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61332,CPT,EXPLORATION ORBIT TRANSCRANIAL APPROACH W/BIOPSY,,,21 ,,RBRVS,28.60 ,20.56 ,20.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61333,CPT,EXPL ORBIT TRANSCRANIAL APPROACH W/RMVL LESION,,,21 ,,RBRVS,29.27 ,21.02 ,21.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61334,CPT,EXPL ORBIT TRANSCRANIAL W/RMVL FOREIGN BODY,,,21 ,,RBRVS,19.60 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61340,CPT,SUBTEMPORAL CRANIAL DECOMPRESSION,,,21 ,,RBRVS,20.11 ,15.40 ,15.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61343,CPT,CRNEC SUBOCCIPITAL CRV LAM DCMPRN MEDULLA & CORD,,,21 ,,RBRVS,31.86 ,21.77 ,21.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61345,CPT,OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA,,,21 ,,RBRVS,29.23 ,20.70 ,20.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61440,CPT,CRANIOTOMY SECTION TENTORIUM CEREBELLI SPX,,,21 ,,RBRVS,28.66 ,20.35 ,20.35 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61450,CPT,CRNEC STPL SCTJ COMPRESSION/DCMPRN GANGLION,,,21 ,,RBRVS,27.69 ,19.25 ,19.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61458,CPT,CRNEC SOPL EXPL/DCMPRN CRNL NRV,,,21 ,,RBRVS,28.84 ,20.33 ,20.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61460,CPT,CRANIECTOMY SUBOCCIPITAL SECTION 1/> CRANIAL NR,,,21 ,,RBRVS,30.24 ,21.03 ,21.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61470,CPT,CRANIECTOMY SUBOCCIPITAL MEDULLARY TRACTOTOMY,,,21 ,,RBRVS,27.62 ,15.24 ,15.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61480,CPT,CRNEC SUBOCPTL MESENCEPHAL TRCOTOMY/PEDUNCULOTMY,,,21 ,,RBRVS,28.05 ,18.62 ,18.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61490,CPT,CRANIOTOMY LOBOTOMY W/CINGULOTOMY,,,21 ,,RBRVS,27.22 ,19.10 ,19.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61500,CPT,CRANIECTOMY W/EXCISION TUMOR/LESION SKULL,,,21 ,,RBRVS,19.18 ,14.61 ,14.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61501,CPT,CRANIECTOMY OSTEOMYELITIS,,,21 ,,RBRVS,16.35 ,13.22 ,13.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61510,CPT,CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR,,,21 ,,RBRVS,30.83 ,22.88 ,22.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61512,CPT,CRNEC TREPHINE BONE FLAP MENINGIOMA SUPRATENTOR,,,21 ,,RBRVS,37.14 ,25.19 ,25.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61514,CPT,CRNEC TREPHINE BONE FLAP BRAIN ABSC SUPRATENTOR,,,21 ,,RBRVS,27.23 ,19.48 ,19.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61516,CPT,CRNEC TREPHINE BONE FLAP FENEST CYST SUPRATENTOR,,,21 ,,RBRVS,26.58 ,19.15 ,19.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61517,CPT,IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT,,,21 ,,RBRVS,1.38 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61518,CPT,CRNEC EXC BRAIN TUMOR INFRATENTORIAL/POST FOSSA,,,21 ,,RBRVS,39.89 ,27.55 ,27.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61519,CPT,CRNEC EXC TUM INFRATENTOR/POST FOSSA MENINGIOMA,,,21 ,,RBRVS,43.43 ,28.43 ,28.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61520,CPT,CRNEC TUM INFRATTL/POSTFOSSA CRBLOPNT ANGLE TUM,,,21 ,,RBRVS,57.09 ,36.15 ,36.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61521,CPT,CRNEC TUM INFRATTL/PFOSSA MIDLINE TUM BASE SKULL,,,21 ,,RBRVS,46.99 ,30.41 ,30.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61522,CPT,CRNEC INFRATNTORIAL/POST FOSSA EXC BRAIN ABSCESS,,,21 ,,RBRVS,31.54 ,21.93 ,21.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61524,CPT,CRNEC INFRATNTOR/POSTFOSSA EXC/FENESTRATION CYST,,,21 ,,RBRVS,29.89 ,20.96 ,20.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61526,CPT,CRNEC TRANSTEMPOR EXC CEREBELLOPONTINE ANGLE TUM,,,21 ,,RBRVS,54.08 ,34.22 ,34.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61530,CPT,CRNEC EXC CEREBELLOPNTIN ANGLE TUM MID/POSTFOSSA,,,21 ,,RBRVS,45.56 ,27.26 ,27.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61531,CPT,SUBDURAL IMPLTJ ELECTRODES SEIZURE MONITORING,,,21 ,,RBRVS,16.41 ,13.87 ,13.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61533,CPT,CRANIOT SUBDURAL IMPLT ELCTRD SEIZURE MONITORING,,,21 ,,RBRVS,21.46 ,15.94 ,15.94 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61534,CPT,CRANIOT EPILEPTOGENIC FOC W/O ELECTRCORTICOGRPHY,,,21 ,,RBRVS,23.01 ,17.43 ,17.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61535,CPT,CRANIOT RMVL EPID/SUBDURL ELCTRD W/O EXC TIS SPX,,,21 ,,RBRVS,13.15 ,11.70 ,11.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61536,CPT,CRANIOT EPILEPTOGENIC FOCUS W/ELECTROCORTCOGRPHY,,,21 ,,RBRVS,37.72 ,25.20 ,25.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61537,CPT,CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY,,,21 ,,RBRVS,36.45 ,23.21 ,23.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61538,CPT,CRANIOT LOBEC TEMPORAL LOBE W/ELECTROCORTCOGRPHY,,,21 ,,RBRVS,39.45 ,25.13 ,25.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61539,CPT,CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/ECOG,,,21 ,,RBRVS,34.28 ,23.24 ,23.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61540,CPT,CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG,,,21 ,,RBRVS,31.43 ,21.98 ,21.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61541,CPT,CRANIOTOMY TRANSECTION CORPUS CALLOSUM,,,21 ,,RBRVS,30.94 ,21.55 ,21.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61542,CPT,CRANIOTOMY TOTAL HEMISPHERECTOMY,,,21 ,,RBRVS,33.16 ,19.95 ,19.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61543,CPT,CRANIOTOMY PARTIAL/SUBTOTAL HEMISPHERECTOMY,,,21 ,,RBRVS,31.31 ,21.60 ,21.60 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61544,CPT,CRANIOTOMY EXCISION/COAGULATION CHOROID PLEXUS,,,21 ,,RBRVS,27.36 ,18.33 ,18.33 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61545,CPT,CRANIOTOMY EXCISION CRANIOPHARYNGIOMA,,,21 ,,RBRVS,46.43 ,31.15 ,31.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61546,CPT,CRANIOT HYPOPHYSEC/EXC PITUITARY TUMOR ICRL APPR,,,21 ,,RBRVS,33.44 ,22.85 ,22.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61548,CPT,HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL,,,21 ,,RBRVS,23.37 ,16.12 ,16.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61550,CPT,CRANIECTOMY CRANIOSYNOSTOSIS 1 CRANIAL SUTURE,,,21 ,,RBRVS,15.59 ,13.40 ,13.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61552,CPT,CRANIECT CRANIOSYNOSTOSIS MULT CRANIAL SUTURES,,,21 ,,RBRVS,20.40 ,15.93 ,15.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61556,CPT,CRANIEC CRANIOSYNOSTOSIS FRONT/PARIET BONE FLAP,,,21 ,,RBRVS,24.09 ,17.48 ,17.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61557,CPT,CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP,,,21 ,,RBRVS,23.31 ,18.17 ,18.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61558,CPT,XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS,,,21 ,,RBRVS,26.50 ,19.61 ,19.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61559,CPT,XTN CRNEC MLT SUTR CRANIOSYNOSTOSIS W/BONE GRAFT,,,21 ,,RBRVS,34.02 ,18.66 ,18.66 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61563,CPT,EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN,,,21 ,,RBRVS,28.44 ,20.00 ,20.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61564,CPT,EXC BENIGN TUM CRANIAL BONE W/OPTIC NRV DCMPRN,,,21 ,,RBRVS,34.74 ,24.11 ,24.11 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61566,CPT,CRANIOTOMY SELECTIVE AMYGDALOHIPPOCAMPECTOMY,,,21 ,,RBRVS,32.45 ,22.57 ,22.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61567,CPT,CRANIOTOMY MULTIPLE SUBPIAL TRANSECTIONS W/ECOG,,,21 ,,RBRVS,37.00 ,25.76 ,25.76 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61570,CPT,CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN,,,21 ,,RBRVS,26.51 ,19.15 ,19.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61571,CPT,CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN,,,21 ,,RBRVS,28.42 ,20.31 ,20.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61575,CPT,TRNSRAL SKULL BSE/BR STEM/CORD BX/DCOMPR/EXC LES,,,21 ,,RBRVS,36.56 ,24.18 ,24.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61576,CPT,TRNSRL SKUL BSE/BR STM/CORD BX/DCMP/ SPLT TONGUE,,,21 ,,RBRVS,55.31 ,48.18 ,48.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61580,CPT,CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ,,,21 ,,RBRVS,34.51 ,33.20 ,33.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61581,CPT,CRANIOFACIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ,,,21 ,,RBRVS,39.13 ,36.16 ,36.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61582,CPT,CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT,,,21 ,,RBRVS,35.14 ,42.32 ,42.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61583,CPT,CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE,,,21 ,,RBRVS,38.50 ,34.49 ,34.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61584,CPT,ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ,,,21 ,,RBRVS,37.70 ,34.24 ,34.24 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61585,CPT,ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ,,,21 ,,RBRVS,42.57 ,37.30 ,37.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61586,CPT,BICORONAL TRANSZYGMTC&/LEFORT I W/O BONE GRFT,,,21 ,,RBRVS,27.48 ,34.25 ,34.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61590,CPT,INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN,,,21 ,,RBRVS,47.04 ,35.49 ,35.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61591,CPT,INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI,,,21 ,,RBRVS,47.02 ,35.62 ,35.62 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61592,CPT,ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE,,,21 ,,RBRVS,43.08 ,36.36 ,36.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61595,CPT,TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV,,,21 ,,RBRVS,33.74 ,29.39 ,29.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61596,CPT,TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART,,,21 ,,RBRVS,39.43 ,29.34 ,29.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61597,CPT,TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL,,,21 ,,RBRVS,40.82 ,30.68 ,30.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61598,CPT,TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM,,,21 ,,RBRVS,36.53 ,33.28 ,33.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61600,CPT,RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL,,,21 ,,RBRVS,30.01 ,27.31 ,27.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61601,CPT,RESCJ/EXC LES BASE ANT CRNL FOSSA INDRL W/WO GRF,,,21 ,,RBRVS,31.14 ,29.79 ,29.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61605,CPT,RESCJ/EXC LES INFRATEMPOR FOSSA SPACE APEX XDRL,,,21 ,,RBRVS,32.57 ,27.73 ,27.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61606,CPT,RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR,,,21 ,,RBRVS,42.05 ,33.18 ,33.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61607,CPT,RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL,,,21 ,,RBRVS,40.93 ,29.82 ,29.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61608,CPT,RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL,,,21 ,,RBRVS,45.54 ,35.19 ,35.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61609,CPT,TRNSXJ/LIGATION CAROTID ARTERY SINUS W/O REPAIR,,,21 ,,RBRVS,9.88 ,4.15 ,4.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61610,CPT,TRNSXJ/LIG CAROTID ARTERY SINUS W/RPR ANAST/GRFT,,,21 ,,RBRVS,29.63 ,12.75 ,12.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61611,CPT,TRNSXJ/LIG CAROTID ARTERY PETROUS CANAL W/O RPR,,,21 ,,RBRVS,7.41 ,3.23 ,3.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61612,CPT,TRNSXJ/LIG CRTD ART PETROUS CANAL RPR ANAST/GRF,,,21 ,,RBRVS,27.84 ,11.85 ,11.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61613,CPT,OBLTRJ CAROTID ARYSM ARTVEN CAROTID FISTULA DSJ,,,21 ,,RBRVS,45.03 ,35.87 ,35.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61615,CPT,RESCJ/EXC LES BASE POST CRNL FOSSA JUG FRMN XDRL,,,21 ,,RBRVS,35.77 ,27.90 ,27.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61616,CPT,RESCJ/EXC LES BASE PCF FORAMEN VRT BODIES IDRL,,,21 ,,RBRVS,46.74 ,37.30 ,37.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61618,CPT,SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT,,,21 ,,RBRVS,18.69 ,14.10 ,14.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61619,CPT,SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP,,,21 ,,RBRVS,22.10 ,15.50 ,15.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61623,CPT,EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK,,,21 ,,RBRVS,9.95 ,4.61 ,4.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61624,CPT,TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS,,,21 ,,RBRVS,20.12 ,8.63 ,8.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61626,CPT,TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS,,,21 ,,RBRVS,16.60 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61630,CPT,BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS,,,21 ,,RBRVS,22.07 ,10.79 ,10.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61635,CPT,TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD,,,21 ,,RBRVS,24.28 ,12.23 ,12.23 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61640,CPT,BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL,,,21 ,,RBRVS,12.32 ,5.03 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61641,CPT,BALLOON DILAT INCRNL VASOSPSM PRQ EA VESSEL,,,21 ,,RBRVS,4.33 ,1.77 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61642,CPT,BALLOON DILAT INCRNL VASOSPSM PRQ EA VESSEL,,,21 ,,RBRVS,8.66 ,3.54 ,3.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61680,CPT,INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL,,,21 ,,RBRVS,32.55 ,22.77 ,22.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61682,CPT,INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL,,,21 ,,RBRVS,63.41 ,38.06 ,38.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61684,CPT,INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL,,,21 ,,RBRVS,41.64 ,27.51 ,27.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61686,CPT,INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL,,,21 ,,RBRVS,67.50 ,41.77 ,41.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61690,CPT,INTRACRANIAL ARVEN MALFRMJ DURAL SMPL,,,21 ,,RBRVS,31.34 ,22.10 ,22.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61692,CPT,INTRACRANIAL ARVEN MALFRMJ DURAL CMPL,,,21 ,,RBRVS,54.59 ,34.26 ,34.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61697,CPT,COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION,,,21 ,,RBRVS,63.40 ,39.06 ,39.06 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61698,CPT,CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ,,,21 ,,RBRVS,69.63 ,42.25 ,42.25 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61700,CPT,SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION,,,21 ,,RBRVS,50.62 ,32.72 ,32.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61702,CPT,SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ,,,21 ,,RBRVS,60.04 ,37.40 ,37.40 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61703,CPT,ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART,,,21 ,,RBRVS,18.80 ,14.70 ,14.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61705,CPT,ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART,,,21 ,,RBRVS,38.10 ,25.07 ,25.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61708,CPT,ARYSM VASC MALFRMJ/ICRA ELECTROTHROMBOSIS,,,21 ,,RBRVS,37.20 ,20.75 ,20.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61710,CPT,ARYSM VASC MALFRMJ IA EMBOLIZATION,,,21 ,,RBRVS,31.29 ,20.82 ,20.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61711,CPT,ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES,,,21 ,,RBRVS,38.23 ,25.30 ,25.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61720,CPT,CRTJ LES STRTCTC BURR GLOBUS PALLIDUS/THALAMUS,,,21 ,,RBRVS,17.62 ,13.27 ,13.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61735,CPT,CRTJ LES STRTCTC BURR SUBCORTICAL STRUX OTH/THN,,,21 ,,RBRVS,22.35 ,16.16 ,16.16 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61750,CPT,STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES,,,21 ,,RBRVS,19.83 ,14.70 ,14.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61751,CPT,STRTCTC BX ASPIR/EXC BURR ICRA LES W/CT&L5178/MR,,,21 ,,RBRVS,18.79 ,15.20 ,15.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61760,CPT,STRTCTC IMPLTJ ELTRD CEREBRUM SEIZURE MONITORING,,,21 ,,RBRVS,22.39 ,16.12 ,16.12 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61770,CPT,STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC,,,21 ,,RBRVS,23.19 ,16.24 ,16.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61781,CPT,STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL,,,21 ,,RBRVS,3.75 ,1.98 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,61782,CPT,STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL,,,21 ,,RBRVS,3.18 ,1.68 ,1.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,61783,CPT,STEREOTACTIC COMPUTER ASSISTED PX SPINAL,,,21 ,,RBRVS,3.75 ,1.98 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,61790,CPT,CREATE LES STRTCTC PRQ NEUROLYTIC GASSERIAN,,,21 ,,RBRVS,11.60 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61791,CPT,CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC,,,21 ,,RBRVS,15.41 ,12.29 ,12.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61796,CPT,STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES,,,21 ,,RBRVS,13.93 ,10.69 ,10.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61797,CPT,STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE,,,21 ,,RBRVS,3.48 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61798,CPT,STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES,,,21 ,,RBRVS,19.85 ,12.98 ,12.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61799,CPT,STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX,,,21 ,,RBRVS,4.81 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61800,CPT,APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY,,,21 ,,RBRVS,2.25 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61850,CPT,TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL,,,21 ,,RBRVS,13.34 ,10.95 ,10.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61860,CPT,CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL,,,21 ,,RBRVS,22.26 ,16.10 ,16.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61863,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY,,,21 ,,RBRVS,20.71 ,16.41 ,16.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61864,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY,,,21 ,,RBRVS,4.49 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61867,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY,,,21 ,,RBRVS,33.03 ,22.80 ,22.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61868,CPT,STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY,,,21 ,,RBRVS,7.91 ,4.14 ,4.14 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61870,CPT,CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR CORTICAL,,,21 ,,RBRVS,16.34 ,12.89 ,12.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61875,CPT,CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR SUBCORTICAL,,,21 ,,RBRVS,16.46 ,12.86 ,12.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,61880,CPT,REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS,,,21 ,,RBRVS,6.95 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61885,CPT,INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR,,,21 ,,RBRVS,6.05 ,7.57 ,7.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61886,CPT,INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS,,,21 ,,RBRVS,9.93 ,11.55 ,11.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,61888,CPT,REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR,,,21 ,,RBRVS,5.23 ,4.57 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62000,CPT,ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL,,,21 ,,RBRVS,13.93 ,7.28 ,7.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62005,CPT,ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL,,,21 ,,RBRVS,17.63 ,13.55 ,13.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62010,CPT,ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN,,,21 ,,RBRVS,21.43 ,16.13 ,16.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62100,CPT,CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA,,,21 ,,RBRVS,23.53 ,16.50 ,16.50 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62115,CPT,RDCTJ CRANIOMEGALIC SKULL W/O GRAFT/CRANIOPLASTY,,,21 ,,RBRVS,22.91 ,11.89 ,11.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62116,CPT,RDCTJ CRANIOMEGALIC SKULL W/SIMPLE CRANIOPLASTY,,,21 ,,RBRVS,25.02 ,18.52 ,18.52 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62117,CPT,RDCTJ CRANIOMEGALIC CRANIO&RECNSTJ W/WO GRAFT,,,21 ,,RBRVS,28.35 ,15.01 ,15.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62120,CPT,RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY,,,21 ,,RBRVS,24.59 ,22.67 ,22.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62121,CPT,CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE,,,21 ,,RBRVS,23.03 ,18.51 ,18.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62140,CPT,CRANIOPLASTY SKULL DEFECT </5 CM DIAMETER,,,21 ,,RBRVS,14.55 ,11.57 ,11.57 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62141,CPT,CRANIOPLASTY SKULL DEFECT >5 CM DIAMETER,,,21 ,,RBRVS,16.07 ,12.48 ,12.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62142,CPT,RMVL BONE FLAP/PROSTHETIC PLATE SKULL,,,21 ,,RBRVS,11.83 ,10.42 ,10.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62143,CPT,RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL,,,21 ,,RBRVS,14.15 ,11.69 ,11.69 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62145,CPT,CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG,,,21 ,,RBRVS,20.09 ,14.58 ,14.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62146,CPT,CRANIOPLASTY W/AUTOGRAFT </ 5 CM DIAMETER,,,21 ,,RBRVS,17.28 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62147,CPT,CRANIOPLASTY W/AUTOGRAFT > 5 CM DIAMETER,,,21 ,,RBRVS,20.67 ,15.18 ,15.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62148,CPT,INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT,,,21 ,,RBRVS,2.00 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62160,CPT,NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS,,,21 ,,RBRVS,3.00 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62161,CPT,NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS,,,21 ,,RBRVS,21.23 ,16.00 ,16.00 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62162,CPT,NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG,,,21 ,,RBRVS,26.80 ,19.61 ,19.61 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62163,CPT,NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY,,,21 ,,RBRVS,16.53 ,13.83 ,13.83 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62164,CPT,NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY,,,21 ,,RBRVS,29.43 ,21.65 ,21.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62165,CPT,NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID,,,21 ,,RBRVS,23.23 ,16.41 ,16.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62180,CPT,VENTRICULOCISTERNOSTOMY,,,21 ,,RBRVS,22.58 ,16.72 ,16.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62190,CPT,CRTJ SHUNT SARACH/SDRL-ATR-JUG-AUR,,,21 ,,RBRVS,12.17 ,10.78 ,10.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62192,CPT,CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH,,,21 ,,RBRVS,13.35 ,10.91 ,10.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62194,CPT,RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER,,,21 ,,RBRVS,5.78 ,6.07 ,6.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62200,CPT,VENTRICULOCISTERNOSTOMY 3RD VENTRICLE,,,21 ,,RBRVS,19.29 ,14.53 ,14.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62201,CPT,VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC,,,21 ,,RBRVS,16.04 ,13.81 ,13.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62220,CPT,CRTJ SHUNT VENTRICULO-ATR-JUG-AUR,,,21 ,,RBRVS,14.10 ,11.31 ,11.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62223,CPT,CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS,,,21 ,,RBRVS,14.05 ,12.36 ,12.36 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62225,CPT,RPLCMT/IRRIGATION VENTRICULAR CATHETER,,,21 ,,RBRVS,6.19 ,7.03 ,7.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62230,CPT,RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS,,,21 ,,RBRVS,11.43 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,,,21 ,,RBRVS,0.74 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,26,,21 ,,RBRVS,0.74 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,TC,,21 ,,RBRVS,,1.29 ,1.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,62256,CPT,RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT,,,21 ,,RBRVS,7.38 ,7.70 ,7.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62258,CPT,RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT,,,21 ,,RBRVS,15.64 ,12.26 ,12.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,62263,CPT,PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS,,,21 ,,RBRVS,5.00 ,4.61 ,14.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62264,CPT,PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY,,,21 ,,RBRVS,4.42 ,2.25 ,7.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62267,CPT,PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS,,,21 ,,RBRVS,3.00 ,1.34 ,3.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62268,CPT,PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX,,,21 ,,RBRVS,4.73 ,2.46 ,3.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62269,CPT,BIOPSY SPINAL CORD PERCUTANEOUS NEEDLE,,,21 ,,RBRVS,5.01 ,2.21 ,3.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62270,CPT,SPINAL PUNCTURE LUMBAR DIAGNOSTIC,,,21 ,,RBRVS,1.37 ,0.70 ,3.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62272,CPT,SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID,,,21 ,,RBRVS,1.35 ,0.82 ,4.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62273,CPT,INJECTION EPIDURAL BLOOD/CLOT PATCH,,,21 ,,RBRVS,2.15 ,0.98 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62280,CPT,INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID,,,21 ,,RBRVS,2.63 ,1.80 ,6.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62281,CPT,INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC,,,21 ,,RBRVS,2.66 ,1.56 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62282,CPT,INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL,,,21 ,,RBRVS,2.33 ,1.56 ,6.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62284,CPT,INJECTION PROCEDURE MYELOGRAPHY/CT SPINAL,,,21 ,,RBRVS,1.54 ,0.80 ,4.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62287,CPT,DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR,,,21 ,,RBRVS,9.03 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62290,CPT,INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR,,,21 ,,RBRVS,3.00 ,1.78 ,6.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62291,CPT,INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC,,,21 ,,RBRVS,2.91 ,1.71 ,6.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62292,CPT,INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC,,,21 ,,RBRVS,9.24 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62294,CPT,NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL,,,21 ,,RBRVS,12.87 ,9.93 ,9.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62310,CPT,NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC,,,21 ,,RBRVS,1.91 ,1.08 ,5.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62311,CPT,NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL,,,21 ,,RBRVS,1.54 ,0.92 ,4.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62318,CPT,NJXS INFUS/BOLUS DX/SBST EDRL/SUBARACH CRV/THRC,,,21 ,,RBRVS,2.04 ,0.79 ,5.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62319,CPT,NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL,,,21 ,,RBRVS,1.87 ,0.82 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62350,CPT,IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM,,,21 ,,RBRVS,6.05 ,4.63 ,4.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62351,CPT,IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM,,,21 ,,RBRVS,11.66 ,10.73 ,10.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62355,CPT,RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH,,,21 ,,RBRVS,3.55 ,3.52 ,3.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62360,CPT,IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR,,,21 ,,RBRVS,4.33 ,3.89 ,3.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62361,CPT,IMPLTJ/RPLCMT FS NON-PRGRBL PUMP,,,21 ,,RBRVS,5.00 ,4.32 ,4.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62362,CPT,IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP,,,21 ,,RBRVS,5.60 ,4.72 ,4.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62365,CPT,RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS,,,21 ,,RBRVS,3.93 ,3.98 ,3.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62367,CPT,ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL,,,21 ,,RBRVS,0.48 ,0.20 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62368,CPT,ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG,,,21 ,,RBRVS,0.67 ,0.29 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62369,CPT,ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL,,,21 ,,RBRVS,0.67 ,0.32 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,62370,CPT,ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP,,,21 ,,RBRVS,0.90 ,0.42 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63001,CPT,LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG CRV,,,21 ,,RBRVS,17.61 ,13.28 ,13.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63003,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC,,,21 ,,RBRVS,17.74 ,13.26 ,13.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63005,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR,,,21 ,,RBRVS,16.43 ,13.32 ,13.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63011,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL,,,21 ,,RBRVS,15.91 ,12.12 ,12.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63012,CPT,LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR,,,21 ,,RBRVS,16.85 ,13.30 ,13.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63015,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL,,,21 ,,RBRVS,20.85 ,16.07 ,16.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63016,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC,,,21 ,,RBRVS,22.03 ,16.02 ,16.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63017,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR,,,21 ,,RBRVS,17.33 ,14.05 ,14.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63020,CPT,LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC,,,21 ,,RBRVS,16.20 ,13.35 ,13.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63030,CPT,LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR,,,21 ,,RBRVS,13.18 ,11.58 ,11.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63035,CPT,LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR,,,21 ,,RBRVS,3.15 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63040,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL,,,21 ,,RBRVS,20.31 ,15.04 ,15.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63042,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR,,,21 ,,RBRVS,18.76 ,14.52 ,14.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63043,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC EA CRV,,,21 ,,TotalUnits,,,,20.96 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,63044,CPT,LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC EA LMBR,,,21 ,,TotalUnits,,,,19.91 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,63045,CPT,LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT CERVICAL,,,21 ,,RBRVS,17.95 ,14.01 ,14.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63046,CPT,LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT THORACIC,,,21 ,,RBRVS,17.25 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63047,CPT,LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR,,,21 ,,RBRVS,15.37 ,12.83 ,12.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63048,CPT,LAM FACETECTOMY&FORAMTOMY 1 SGM EA CRV THRC/LMBR,,,21 ,,RBRVS,3.47 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63050,CPT,LAMOP CERVICAL W/DCMPRN SPI CORD 2/> VERT SEG,,,21 ,,RBRVS,22.01 ,16.01 ,16.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63051,CPT,LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ,,,21 ,,RBRVS,25.51 ,17.93 ,17.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63055,CPT,TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC,,,21 ,,RBRVS,23.55 ,16.92 ,16.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63056,CPT,TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR,,,21 ,,RBRVS,21.86 ,15.75 ,15.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63057,CPT,TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR,,,21 ,,RBRVS,5.25 ,2.80 ,2.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63064,CPT,COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG,,,21 ,,RBRVS,26.22 ,18.18 ,18.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63066,CPT,COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG,,,21 ,,RBRVS,3.26 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63075,CPT,DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC,,,21 ,,RBRVS,19.60 ,15.02 ,15.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63076,CPT,DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC,,,21 ,,RBRVS,4.04 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63077,CPT,DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC,,,21 ,,RBRVS,22.88 ,15.48 ,15.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63078,CPT,DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC,,,21 ,,RBRVS,3.28 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63081,CPT,VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG,,,21 ,,RBRVS,26.10 ,18.42 ,18.42 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63082,CPT,VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG,,,21 ,,RBRVS,4.36 ,2.32 ,2.32 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63085,CPT,VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG,,,21 ,,RBRVS,29.47 ,18.68 ,18.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63086,CPT,VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG,,,21 ,,RBRVS,3.19 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63087,CPT,VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG,,,21 ,,RBRVS,37.53 ,23.30 ,23.30 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63088,CPT,VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG,,,21 ,,RBRVS,4.32 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63090,CPT,VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG,,,21 ,,RBRVS,30.93 ,19.90 ,19.90 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63091,CPT,VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG,,,21 ,,RBRVS,3.03 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63101,CPT,VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG,,,21 ,,RBRVS,34.10 ,23.96 ,23.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63102,CPT,VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG,,,21 ,,RBRVS,34.10 ,23.51 ,23.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63103,CPT,VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG,,,21 ,,RBRVS,4.82 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63170,CPT,LAM W/MYELOTOMY CERVICAL/THORACIC/THORACOLUMBAR,,,21 ,,RBRVS,22.21 ,16.79 ,16.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63172,CPT,LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID,,,21 ,,RBRVS,19.76 ,14.84 ,14.84 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63173,CPT,LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL,,,21 ,,RBRVS,24.31 ,18.07 ,18.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63180,CPT,LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV 1/2 SEG,,,21 ,,RBRVS,20.53 ,15.73 ,15.73 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63182,CPT,LAM&SCTJ DENTATE LIG W/WO DURAL GRF CRV >2 SEG,,,21 ,,RBRVS,22.82 ,16.41 ,16.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63185,CPT,LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS,,,21 ,,RBRVS,16.49 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63190,CPT,LAMINECTOMY W/RHIZOTOMY > 2 SEGMENTS,,,21 ,,RBRVS,18.89 ,14.15 ,14.15 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63191,CPT,LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE,,,21 ,,RBRVS,18.92 ,13.86 ,13.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63194,CPT,LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT CERVICAL,,,21 ,,RBRVS,22.10 ,12.47 ,12.47 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63195,CPT,LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT THORACIC,,,21 ,,RBRVS,21.64 ,15.97 ,15.97 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63196,CPT,LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACTS CRV,,,21 ,,RBRVS,25.27 ,13.87 ,13.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63197,CPT,LAM CORDOTOMY SCTJ BOTH SPINOTHALMIC TRACT THRC,,,21 ,,RBRVS,24.08 ,17.91 ,17.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63198,CPT,LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES CERVICAL,,,21 ,,RBRVS,29.90 ,14.68 ,14.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63199,CPT,LAM CORDOTOMY SCTJ BOTH TRACTS 2 STAGES THORACIC,,,21 ,,RBRVS,31.47 ,21.87 ,21.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63200,CPT,LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR,,,21 ,,RBRVS,21.44 ,16.19 ,16.19 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63250,CPT,LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL,,,21 ,,RBRVS,43.86 ,28.22 ,28.22 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63251,CPT,LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC,,,21 ,,RBRVS,44.64 ,29.21 ,29.21 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63252,CPT,LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR,,,21 ,,RBRVS,44.63 ,29.18 ,29.18 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63265,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL,,,21 ,,RBRVS,23.82 ,17.53 ,17.53 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63266,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC,,,21 ,,RBRVS,24.68 ,17.87 ,17.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63267,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL LUMBAR,,,21 ,,RBRVS,19.45 ,15.08 ,15.08 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63268,CPT,LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL,,,21 ,,RBRVS,20.02 ,15.72 ,15.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63270,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL,,,21 ,,RBRVS,29.80 ,20.92 ,20.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63271,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC,,,21 ,,RBRVS,29.92 ,20.79 ,20.79 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63272,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR,,,21 ,,RBRVS,27.50 ,19.43 ,19.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63273,CPT,LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL,,,21 ,,RBRVS,26.47 ,18.93 ,18.93 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63275,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL,,,21 ,,RBRVS,25.86 ,18.55 ,18.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63276,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC,,,21 ,,RBRVS,25.69 ,18.44 ,18.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63277,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR,,,21 ,,RBRVS,22.39 ,16.58 ,16.58 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63278,CPT,LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL,,,21 ,,RBRVS,22.12 ,16.82 ,16.82 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63280,CPT,LAM BX/EXC ISPI NEO IDRL XMED CERVICAL,,,21 ,,RBRVS,30.29 ,21.43 ,21.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63281,CPT,LAM BX/EXC ISPI NEO IDRL XMED THORACIC,,,21 ,,RBRVS,29.99 ,21.41 ,21.41 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63282,CPT,LAM BX/EXC ISPI NEO IDRL XMED LUMBAR,,,21 ,,RBRVS,28.15 ,20.31 ,20.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63283,CPT,LAM BX/EXC ISPI NEO IDRL SACRAL,,,21 ,,RBRVS,26.76 ,19.81 ,19.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63285,CPT,LAM BX/EXC ISPI NEO IDRL IMED CERVICAL,,,21 ,,RBRVS,38.05 ,25.65 ,25.65 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63286,CPT,LAM BX/EXC ISPI NEO IDRL IMED THORACIC,,,21 ,,RBRVS,37.62 ,25.13 ,25.13 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63287,CPT,LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR,,,21 ,,RBRVS,40.08 ,26.78 ,26.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63290,CPT,LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL,,,21 ,,RBRVS,40.82 ,27.17 ,27.17 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63295,CPT,OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX,,,21 ,,RBRVS,5.25 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63300,CPT,VCRPEC LES 1 SGM XDRL CERVICAL,,,21 ,,RBRVS,26.80 ,18.88 ,18.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63301,CPT,VCRPEC LES 1 SGM XDRL THORACIC TTHRC,,,21 ,,RBRVS,31.57 ,21.91 ,21.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63302,CPT,VCRPEC LES 1 SEG XDRL THRC THORACOLMBR,,,21 ,,RBRVS,31.15 ,21.74 ,21.74 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63303,CPT,VCRPEC LES 1 SEG XDRL LMBR/SAC TRANSPRTL/RPR,,,21 ,,RBRVS,33.55 ,20.04 ,20.04 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63304,CPT,VERTEBRAL CORPECTOMY EXC LES 1 SEG IDRL CERVICAL,,,21 ,,RBRVS,33.85 ,23.49 ,23.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63305,CPT,VERTEBRAL CORPECTOMY LES 1 SEG IDRL THRC TTHRC,,,21 ,,RBRVS,36.24 ,24.20 ,24.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63306,CPT,VERTEBRL CORPECT LES 1 SEG IDRL THRC THORACOLMBR,,,21 ,,RBRVS,35.55 ,17.01 ,17.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63307,CPT,VCRPEC LES 1 SEG IDRL LMBR/SAC TRANSPRTL/RPR,,,21 ,,RBRVS,34.96 ,23.55 ,23.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63308,CPT,VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG,,,21 ,,RBRVS,5.24 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63600,CPT,CREATION LES SPINAL CORD STEREOTACTIC METHOD PRQ,,,21 ,,RBRVS,15.12 ,10.49 ,10.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63610,CPT,STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG,,,21 ,,RBRVS,8.72 ,3.37 ,9.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63615,CPT,STRTCTC BX ASPIRAT/EXC LESION SPINAL CORD,,,21 ,,RBRVS,17.32 ,12.80 ,12.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63620,CPT,STEREOTACTIC RADIOSURGERY 1 SPINAL LESION,,,21 ,,RBRVS,15.60 ,11.32 ,11.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63621,CPT,STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION,,,21 ,,RBRVS,4.00 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63650,CPT,PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL,,,21 ,,RBRVS,7.15 ,4.76 ,4.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63655,CPT,LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL,,,21 ,,RBRVS,10.92 ,10.15 ,10.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63661,CPT,RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR,,,21 ,,RBRVS,5.08 ,3.77 ,11.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63662,CPT,RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR,,,21 ,,RBRVS,11.00 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63663,CPT,REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR,,,21 ,,RBRVS,7.75 ,5.11 ,16.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63664,CPT,REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR,,,21 ,,RBRVS,11.52 ,10.54 ,10.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63685,CPT,INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING,,,21 ,,RBRVS,5.19 ,4.54 ,4.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63688,CPT,REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR,,,21 ,,RBRVS,5.30 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63700,CPT,REPAIR MENINGOCELE </5 CM DIAMETER,,,21 ,,RBRVS,17.47 ,14.48 ,14.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63702,CPT,REPAIR MENINGOCELE > 5 CM DIAMETER,,,21 ,,RBRVS,19.41 ,15.68 ,15.68 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63704,CPT,REPAIR MYELOMENINGOCELE </5 CM DIAMETER,,,21 ,,RBRVS,22.43 ,17.89 ,17.89 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63706,CPT,REPAIR MYELOMENINGOCELE > 5 CM DIAMETER,,,21 ,,RBRVS,25.35 ,19.71 ,19.71 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63707,CPT,RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM,,,21 ,,RBRVS,12.65 ,10.81 ,10.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63709,CPT,RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM,,,21 ,,RBRVS,15.65 ,12.37 ,12.37 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63710,CPT,DURAL GRAFT SPINAL,,,21 ,,RBRVS,15.40 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63740,CPT,CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM,,,21 ,,RBRVS,12.63 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,63741,CPT,CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM,,,21 ,,RBRVS,9.12 ,7.33 ,7.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63744,CPT,RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT,,,21 ,,RBRVS,8.94 ,7.94 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,63746,CPT,RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT,,,21 ,,RBRVS,7.33 ,7.67 ,7.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64400,CPT,NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH,,,21 ,,RBRVS,1.11 ,0.71 ,2.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64402,CPT,INJECTION ANESTHETIC AGENT FACIAL NERVE,,,21 ,,RBRVS,1.25 ,0.77 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64405,CPT,INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV,,,21 ,,RBRVS,0.94 ,0.69 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64408,CPT,INJECTION ANESTHETIC AGENT VAGUS NERVE,,,21 ,,RBRVS,1.41 ,0.74 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64410,CPT,INJECTION ANESTHETIC AGENT PHRENIC NERVE,,,21 ,,RBRVS,1.43 ,0.81 ,2.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64412,CPT,INJECTION ANESTHETIC AGENT SPINAL ACCESSORY NRV,,,21 ,,RBRVS,1.18 ,0.80 ,2.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64413,CPT,INJECTION ANESTHETIC AGENT CERVICAL PLEXUS,,,21 ,,RBRVS,1.40 ,0.76 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64415,CPT,SINGLE NERVE BLOCK INJECTION ARM NERVE,,,21 ,,RBRVS,1.48 ,0.37 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64416,CPT,INJECTION ANES BRACHIAL PLEXUS CONT NFS CATH,,,21 ,,RBRVS,1.81 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64417,CPT,INJECTION ANESTHETIC AGENT AXILLARY NERVE,,,21 ,,RBRVS,1.44 ,0.54 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64418,CPT,INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE,,,21 ,,RBRVS,1.32 ,0.74 ,2.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64420,CPT,INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE,,,21 ,,RBRVS,1.18 ,0.70 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64421,CPT,MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES,,,21 ,,RBRVS,1.68 ,0.89 ,3.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64425,CPT,INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS,,,21 ,,RBRVS,1.75 ,0.85 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64430,CPT,INJECTION ANESTHETIC AGENT PUDENDAL NERVE,,,21 ,,RBRVS,1.46 ,0.83 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64435,CPT,INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE,,,21 ,,RBRVS,1.45 ,0.78 ,2.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64445,CPT,INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE,,,21 ,,RBRVS,1.48 ,0.54 ,2.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64446,CPT,INJECTION ANES SCIATIC NERVE CONT INFUSION CATH,,,21 ,,RBRVS,1.81 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64447,CPT,INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE,,,21 ,,RBRVS,1.50 ,0.34 ,2.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64448,CPT,INJECTION ANES FEMORAL NERVE CONT INFUSION CATH,,,21 ,,RBRVS,1.63 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64449,CPT,INJECTION ANES LUMBAR PLEXUS POST CONT NFS CATH,,,21 ,,RBRVS,1.81 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64450,CPT,INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,,,21 ,,RBRVS,1.27 ,0.65 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64455,CPT,NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE,,,21 ,,RBRVS,0.75 ,0.23 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64479,CPT,NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL,,,21 ,,RBRVS,2.29 ,1.38 ,5.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64480,CPT,NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LV,,,21 ,,RBRVS,1.20 ,0.58 ,2.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64483,CPT,NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,,,21 ,,RBRVS,1.90 ,1.23 ,5.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64484,CPT,NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV,,,21 ,,RBRVS,1.00 ,0.47 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64490,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,,,21 ,,RBRVS,1.82 ,1.24 ,3.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64491,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL,,,21 ,,RBRVS,1.16 ,0.55 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64492,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL,,,21 ,,RBRVS,1.16 ,0.57 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64493,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL,,,21 ,,RBRVS,1.52 ,1.08 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64494,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL,,,21 ,,RBRVS,1.00 ,0.46 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64495,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL,,,21 ,,RBRVS,1.00 ,0.49 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64505,CPT,INJECTION ANES AGENT SPHENOPALATINE GANGLION,,,21 ,,RBRVS,1.36 ,1.00 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64508,CPT,INJECTION ANESTHETIC AGENT CAROTID SINUS SPX,,,21 ,,RBRVS,1.12 ,0.90 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64510,CPT,NJX ANES STELLATE GANGLION CRV SYMPATHETIC,,,21 ,,RBRVS,1.22 ,0.81 ,2.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64517,CPT,INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS,,,21 ,,RBRVS,2.20 ,1.31 ,3.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64520,CPT,INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC,,,21 ,,RBRVS,1.35 ,0.90 ,4.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64530,CPT,INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG,,,21 ,,RBRVS,1.58 ,1.01 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64550,CPT,APPLICATION SURFACE NEUROSTIMULATOR,,,21 ,,RBRVS,0.18 ,0.07 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64553,CPT,PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE,,,21 ,,RBRVS,2.36 ,2.16 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64555,CPT,PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV,,,21 ,,RBRVS,2.32 ,1.75 ,3.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64561,CPT,PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING,,,21 ,,RBRVS,7.15 ,3.90 ,18.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64565,CPT,PRQ IMPLTJ NSTIM ELTRD NEUROMUSCULAR,,,21 ,,RBRVS,1.81 ,1.67 ,3.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64566,CPT,POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE,,,21 ,,RBRVS,0.60 ,0.22 ,3.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64568,CPT,INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER,,,21 ,,RBRVS,9.00 ,8.50 ,8.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64569,CPT,REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV,,,21 ,,RBRVS,11.00 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64570,CPT,REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO,,,21 ,,RBRVS,9.10 ,4.22 ,4.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64575,CPT,INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD,,,21 ,,RBRVS,4.42 ,3.95 ,3.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64580,CPT,INC IMPLTJ NSTIM ELTRD NEUROMUSCULAR,,,21 ,,RBRVS,4.19 ,3.90 ,3.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64581,CPT,INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE,,,21 ,,RBRVS,12.20 ,6.32 ,6.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64585,CPT,REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE,,,21 ,,RBRVS,2.11 ,1.99 ,5.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64590,CPT,INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR,,,21 ,,RBRVS,2.45 ,2.09 ,5.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64595,CPT,REVISION/RMVL PERIPHERAL/GASTRIC NPGR,,,21 ,,RBRVS,1.78 ,1.83 ,5.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64600,CPT,DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH,,,21 ,,RBRVS,3.49 ,2.44 ,8.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64605,CPT,DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH,,,21 ,,RBRVS,5.65 ,3.80 ,11.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64610,CPT,DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR,,,21 ,,RBRVS,7.20 ,5.02 ,12.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64611,CPT,CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS,,,21 ,,RBRVS,1.03 ,1.36 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64612,CPT,CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL,,,21 ,,RBRVS,2.01 ,2.05 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64613,CPT,CHEMODENERVATION NECK MUSCLE,,,21 ,,RBRVS,2.01 ,1.80 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64614,CPT,CHEMODENERVATION EXTREMITY&/TRUNK MUSCLE,,,21 ,,RBRVS,2.20 ,1.97 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64615,CPT,CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE,,,21 ,,RBRVS,1.85 ,1.36 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64620,CPT,DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE,,,21 ,,RBRVS,2.89 ,1.91 ,3.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64630,CPT,DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE,,,21 ,,RBRVS,3.05 ,2.21 ,3.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64632,CPT,DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE,,,21 ,,RBRVS,1.23 ,0.71 ,1.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64633,CPT,DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA,,,21 ,,RBRVS,3.84 ,2.75 ,9.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64634,CPT,DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA,,,21 ,,RBRVS,1.32 ,0.64 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64635,CPT,DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL,,,21 ,,RBRVS,3.78 ,2.68 ,8.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64636,CPT,DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL,,,21 ,,RBRVS,1.16 ,0.55 ,4.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64640,CPT,DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE,,,21 ,,RBRVS,2.81 ,1.94 ,3.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64650,CPT,CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE,,,21 ,,RBRVS,0.70 ,0.37 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64653,CPT,CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY,,,21 ,,RBRVS,0.88 ,0.43 ,2.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64680,CPT,DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS,,,21 ,,RBRVS,2.67 ,1.92 ,6.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64681,CPT,DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS,,,21 ,,RBRVS,3.78 ,1.78 ,7.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64702,CPT,NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT,,,21 ,,RBRVS,6.26 ,7.29 ,7.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64704,CPT,NEUROPLASTY NERVE HAND/FOOT,,,21 ,,RBRVS,4.69 ,4.06 ,4.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64708,CPT,NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC,,,21 ,,RBRVS,6.36 ,7.02 ,7.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64712,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV,,,21 ,,RBRVS,8.07 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64713,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS,,,21 ,,RBRVS,11.40 ,8.66 ,8.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64714,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS,,,21 ,,RBRVS,10.55 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64716,CPT,NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE,,,21 ,,RBRVS,6.99 ,7.75 ,7.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64718,CPT,NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW,,,21 ,,RBRVS,7.26 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64719,CPT,NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST,,,21 ,,RBRVS,4.97 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64721,CPT,NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE,,,21 ,,RBRVS,4.97 ,6.54 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64722,CPT,DECOMPRESSION UNSPECIFIED NERVE,,,21 ,,RBRVS,4.82 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64726,CPT,DECOMPRESSION PLANTAR DIGITAL NERVE,,,21 ,,RBRVS,4.27 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64727,CPT,INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE,,,21 ,,RBRVS,3.10 ,1.76 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64732,CPT,TRANSECTION/AVULSION SUPRAORBITAL NERVE,,,21 ,,RBRVS,4.89 ,6.18 ,6.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64734,CPT,TRANSECTION/AVULSION INFRAORBITAL NERVE,,,21 ,,RBRVS,5.55 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64736,CPT,TRANSECTION/AVULSION MENTAL NERVE,,,21 ,,RBRVS,5.23 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64738,CPT,TRANSECTION/AVULSION INF ALVEOLAR NRV W/OSTEO,,,21 ,,RBRVS,6.36 ,6.20 ,6.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64740,CPT,TRANSECTION/AVULSION LINGUAL NERVE,,,21 ,,RBRVS,6.22 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64742,CPT,TRANSECTION/AVULSION FACIAL NRV DIFFERENT/CMPL,,,21 ,,RBRVS,6.85 ,5.98 ,5.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64744,CPT,TRANSECTION/AVULSION GREATER OCCIPITAL NERVE,,,21 ,,RBRVS,5.72 ,6.46 ,6.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64746,CPT,TRANSECTION/AVULSION PHRENIC NERVE,,,21 ,,RBRVS,6.56 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64752,CPT,TRANSECTION/AVULSION VAGUS NRV TRANSTHORACIC,,,21 ,,RBRVS,7.69 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,64755,CPT,TRANSECTION/AVULSION VAGUS NERVES,,,21 ,,RBRVS,15.05 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,64760,CPT,TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL,,,21 ,,RBRVS,7.59 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,64761,CPT,TRANSECTION/AVULSION PUDENDAL NERVE,,,21 ,,RBRVS,7.04 ,5.45 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64763,CPT,TRNSXJ/AVLSN OBTURAT NRV XPELV W/WO TENOTOMY,,,21 ,,RBRVS,7.56 ,6.08 ,6.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64766,CPT,TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY,,,21 ,,RBRVS,9.47 ,6.98 ,6.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64771,CPT,TRANSECTION/AVULSION OTH CRANIAL NRV XDRL,,,21 ,,RBRVS,8.15 ,8.38 ,8.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64772,CPT,TRANSECTION/AVULSION OTH SPINAL NRV XDRL,,,21 ,,RBRVS,7.84 ,7.45 ,7.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64774,CPT,EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE,,,21 ,,RBRVS,5.80 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64776,CPT,EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT,,,21 ,,RBRVS,5.60 ,5.06 ,5.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64778,CPT,EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT,,,21 ,,RBRVS,3.11 ,1.68 ,1.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64782,CPT,EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE,,,21 ,,RBRVS,6.86 ,5.51 ,5.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64783,CPT,EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT,,,21 ,,RBRVS,3.71 ,2.27 ,2.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64784,CPT,EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC,,,21 ,,RBRVS,10.62 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64786,CPT,EXCISION NEUROMA SCIATIC NERVE,,,21 ,,RBRVS,16.25 ,12.18 ,12.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64787,CPT,IMPLANTATION NERVE END BONE/MUSCLE,,,21 ,,RBRVS,4.29 ,2.25 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64788,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV,,,21 ,,RBRVS,5.24 ,5.35 ,5.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64790,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV,,,21 ,,RBRVS,12.10 ,9.62 ,9.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64792,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA X10SV,,,21 ,,RBRVS,15.86 ,13.34 ,13.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64795,CPT,BIOPSY NERVE,,,21 ,,RBRVS,3.01 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64802,CPT,SYMPATHECTOMY CERVICAL,,,21 ,,RBRVS,10.37 ,4.74 ,4.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64804,CPT,SYMPATHECTOMY CERVICOTHORACIC,,,21 ,,RBRVS,15.91 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64809,CPT,SYMPATHECTOMY THORACOLUMBAR,,,21 ,,RBRVS,14.71 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,64818,CPT,SYMPATHECTOMY LUMBAR,,,21 ,,RBRVS,11.34 ,6.39 ,6.39 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,64820,CPT,SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT,,,21 ,,RBRVS,10.74 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64821,CPT,SYMPATHECTOMY ULNAR ARTERY,,,21 ,,RBRVS,9.33 ,9.59 ,9.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64822,CPT,SYMPATHECTOMY ULNAR ARTERY,,,21 ,,RBRVS,9.33 ,9.03 ,9.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64823,CPT,SYMPATHECTOMY SUPERFICIAL PALMAR ARCH,,,21 ,,RBRVS,10.94 ,9.85 ,9.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64831,CPT,SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE,,,21 ,,RBRVS,9.16 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64832,CPT,SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV,,,21 ,,RBRVS,5.65 ,3.44 ,3.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64834,CPT,SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE,,,21 ,,RBRVS,10.81 ,9.13 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64835,CPT,SUTURE 1 NERVE MEDIAN MOTOR THENAR,,,21 ,,RBRVS,11.73 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64836,CPT,SUTURE 1 NERVE ULNAR MOTOR,,,21 ,,RBRVS,11.73 ,9.81 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64837,CPT,SUTURE EACH ADDITIONAL NERVE HAND/FOOT,,,21 ,,RBRVS,6.25 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64840,CPT,SUTURE POSTERIOR TIBIAL NERVE,,,21 ,,RBRVS,14.02 ,10.74 ,10.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64856,CPT,SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS,,,21 ,,RBRVS,15.07 ,12.03 ,12.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64857,CPT,SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS,,,21 ,,RBRVS,15.82 ,12.40 ,12.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64858,CPT,SUTURE SCIATIC NERVE,,,21 ,,RBRVS,17.82 ,10.76 ,10.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64859,CPT,SUTURE EACH ADDITIONAL PERIPHERAL NERVE,,,21 ,,RBRVS,4.25 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64861,CPT,SUTURE BRACHIAL PLEXUS,,,21 ,,RBRVS,20.89 ,14.13 ,14.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64862,CPT,SUTURE LUMBAR PLEXUS,,,21 ,,RBRVS,21.09 ,16.34 ,16.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64864,CPT,SUTURE FACIAL NERVE EXTRACRANIAL,,,21 ,,RBRVS,13.41 ,10.86 ,10.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64865,CPT,SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT,,,21 ,,RBRVS,16.09 ,15.43 ,15.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64866,CPT,ANASTOMOSIS FACIAL-SPINAL ACCESSORY,,,21 ,,RBRVS,16.83 ,14.81 ,14.81 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,64868,CPT,ANASTOMOSIS FACIAL HYPOGLOSSAL,,,21 ,,RBRVS,14.90 ,13.86 ,13.86 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,64870,CPT,ANASTOMOSIS FACIAL-PHRENIC,,,21 ,,RBRVS,17.08 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64872,CPT,SUTURE NERVE REQ SECONDARY/DELAYED SUTURE,,,21 ,,RBRVS,1.99 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64874,CPT,SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE,,,21 ,,RBRVS,2.98 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64876,CPT,SUTURE NERVE REQ SHORTENING BONE EXTREMITY,,,21 ,,RBRVS,3.37 ,1.42 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64885,CPT,NERVE GRAFT HEAD/NECK </ 4 CM,,,21 ,,RBRVS,17.60 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64886,CPT,NERVE GRAFT HEAD/NECK >4 CM,,,21 ,,RBRVS,20.82 ,14.80 ,14.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64890,CPT,NERVE GRAFT 1 STRAND HAND/FOOT </4 CM,,,21 ,,RBRVS,16.24 ,13.56 ,13.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64891,CPT,NRV GRF 1 STRAND HAND/FOOT >4 CM,,,21 ,,RBRVS,17.35 ,12.15 ,12.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64892,CPT,NERVE GRAFT 1 STRAND ARM/LEG <4 CM,,,21 ,,RBRVS,15.74 ,13.19 ,13.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64893,CPT,NERVE GRAFT 1 STRAND ARM/LEG >4 CM,,,21 ,,RBRVS,16.87 ,13.90 ,13.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64895,CPT,NERVE GRAFT MLT STRANDS HAND/FOOT </4 CM,,,21 ,,RBRVS,20.39 ,16.09 ,16.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64896,CPT,NERVE GRAFT MLT STRANDS HAND/FOOT > 4 CM,,,21 ,,RBRVS,21.96 ,17.56 ,17.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64897,CPT,NERVE GRAFT MLT STRANDS ARM/LEG </4 CM,,,21 ,,RBRVS,19.38 ,15.57 ,15.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64898,CPT,NERVE GRAFT MLT STRANDS ARM/LEG >4 CM,,,21 ,,RBRVS,20.97 ,16.97 ,16.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64901,CPT,NERVE GRAFT EACH NERVE 1 STRAND,,,21 ,,RBRVS,10.20 ,6.51 ,6.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64902,CPT,NERVE GRAFT EACH NERVE MULTIPLE STRANDS,,,21 ,,RBRVS,11.81 ,7.51 ,7.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64905,CPT,NERVE PEDICLE TRANSFER FIRST STAGE,,,21 ,,RBRVS,15.11 ,12.61 ,12.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64907,CPT,NERVE PEDICAL TRANSFER SECOND STAGE,,,21 ,,RBRVS,20.03 ,11.33 ,11.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64910,CPT,NERVE REPAIR W/CONDUIT EACH NERVE,,,21 ,,RBRVS,11.39 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64911,CPT,NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE,,,21 ,,RBRVS,14.39 ,13.26 ,13.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,64999,CPT,UNLISTED PROCEDURE NERVOUS SYSTEM,,,21 ,,TotalUnits,,,,3.60 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,65091,CPT,EVISCERATION OCULAR CONTENTS W/O IMPLANT,,,21 ,,RBRVS,7.26 ,10.07 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65093,CPT,EVISCERATION OCULAR CONTENTS W/IMPLANT,,,21 ,,RBRVS,7.04 ,10.21 ,10.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65101,CPT,ENUCLEATION OF EYE W/O IMPLANT,,,21 ,,RBRVS,8.30 ,11.91 ,11.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65103,CPT,ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT,,,21 ,,RBRVS,8.84 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65105,CPT,ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT,,,21 ,,RBRVS,9.93 ,13.28 ,13.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65110,CPT,EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY,,,21 ,,RBRVS,15.70 ,17.50 ,17.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65112,CPT,EXENTERATION ORBIT RMVL ORBIT CONTENTS & BONE,,,21 ,,RBRVS,18.51 ,20.16 ,20.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65114,CPT,EXNTJ ORBIT RMVL ORB CNTS W/MUSC/MYOQ FLAP,,,21 ,,RBRVS,19.65 ,20.84 ,20.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65125,CPT,MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX,,,21 ,,RBRVS,3.27 ,4.74 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65130,CPT,INSJ OC IMPLT SEC AFTER EVSC SCLL SHELL,,,21 ,,RBRVS,8.42 ,11.59 ,11.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65135,CPT,INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED,,,21 ,,RBRVS,8.60 ,11.71 ,11.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65140,CPT,INSJ OC IMPLT AFTER ENCL MUSC ATTACHED,,,21 ,,RBRVS,9.46 ,12.63 ,12.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65150,CPT,REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT,,,21 ,,RBRVS,6.43 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65155,CPT,REINSERTION OCULAR IMPLT RNFCMT &/ ATTACH MUSCLE,,,21 ,,RBRVS,10.10 ,13.04 ,13.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65175,CPT,REMOVAL OCULAR IMPLANT,,,21 ,,RBRVS,7.40 ,10.60 ,10.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65205,CPT,REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,,,21 ,,RBRVS,0.71 ,0.46 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65210,CPT,RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR,,,21 ,,RBRVS,0.84 ,0.61 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65220,CPT,RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP,,,21 ,,RBRVS,0.71 ,0.42 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65222,CPT,RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP,,,21 ,,RBRVS,0.93 ,0.64 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65235,CPT,RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS,,,21 ,,RBRVS,9.01 ,10.29 ,10.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65260,CPT,RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE,,,21 ,,RBRVS,12.54 ,13.53 ,13.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65265,CPT,RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ,,,21 ,,RBRVS,14.34 ,15.01 ,15.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65270,CPT,RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR,,,21 ,,RBRVS,1.95 ,1.88 ,5.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65272,CPT,RPR LAC CJNC MOBLJ& REARGMT W/O HOSPITALIZATION,,,21 ,,RBRVS,4.62 ,4.93 ,9.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65273,CPT,RPR LAC CJNC MOBLJ & REARGMT W/HOSPIZATION,,,21 ,,RBRVS,5.16 ,5.20 ,5.20 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,65275,CPT,RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY,,,21 ,,RBRVS,6.29 ,6.22 ,9.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65280,CPT,RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TIS,,,21 ,,RBRVS,9.10 ,9.10 ,9.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65285,CPT,RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T,,,21 ,,RBRVS,15.36 ,14.48 ,14.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65286,CPT,RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA,,,21 ,,RBRVS,6.63 ,6.85 ,12.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65290,CPT,RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU,,,21 ,,RBRVS,6.53 ,6.83 ,6.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65400,CPT,EXCISION LESION CORNEA XCP PTERYGIUM,,,21 ,,RBRVS,7.50 ,8.94 ,11.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65410,CPT,BIOPSY CORNEA,,,21 ,,RBRVS,1.47 ,1.36 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65420,CPT,EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT,,,21 ,,RBRVS,4.36 ,5.95 ,9.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65426,CPT,EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG,,,21 ,,RBRVS,6.05 ,7.00 ,11.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65430,CPT,CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE,,,21 ,,RBRVS,1.47 ,1.35 ,1.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65435,CPT,RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION,,,21 ,,RBRVS,0.92 ,0.98 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65436,CPT,RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT,,,21 ,,RBRVS,4.82 ,5.30 ,5.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65450,CPT,DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION,,,21 ,,RBRVS,3.47 ,5.34 ,5.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65600,CPT,MULTIPLE PUNCTURES ANTERIOR CORNEA,,,21 ,,RBRVS,4.20 ,5.18 ,6.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65710,CPT,KERATOPLASTY ANTERIOR LAMELLAR,,,21 ,,RBRVS,14.45 ,15.72 ,15.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65730,CPT,KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA,,,21 ,,RBRVS,16.35 ,17.08 ,17.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65750,CPT,KERATOPLASTY PENETRAING APHAKIA,,,21 ,,RBRVS,16.90 ,16.69 ,16.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65755,CPT,KERATOPLASTY PENETRATING PSEUDOPHAKIA,,,21 ,,RBRVS,16.79 ,16.63 ,16.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65756,CPT,KERATOPLASTY ENDOTHELIAL,,,21 ,,RBRVS,16.84 ,15.28 ,15.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65757,CPT,BACKBENCH PREPJ CORNEAL ENDOTHELIAL ALLOGRAFT,,,21 ,,TotalUnits,,,,5.93 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,65760,CPT,KERATOMILEUSIS,,,21 ,,TotalUnits,,,,23.02 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,65765,CPT,KERATOPHAKIA,,,21 ,,RBRVS,23.90 ,21.25 ,21.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65767,CPT,EPIKERATOPLASTY,,,21 ,,RBRVS,22.25 ,19.79 ,19.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65770,CPT,KERATOPROSTHESIS,,,21 ,,RBRVS,19.74 ,18.48 ,18.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65771,CPT,RADIAL KERATOTOMY,,,21 ,,RBRVS,9.06 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65772,CPT,CRNL RELAXING INC CORRJ INDUCED ASTIGMATISM,,,21 ,,RBRVS,5.09 ,5.98 ,7.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65775,CPT,CRNL WEDGE RESCJ CORRJ INDUCED ASTIGMATISM,,,21 ,,RBRVS,6.91 ,8.15 ,8.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65778,CPT,PLACE AMNIOTIC MEMB OCULAR SURFACE SELF RETAIN,,,21 ,,RBRVS,1.19 ,0.78 ,38.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65779,CPT,PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED,,,21 ,,RBRVS,3.92 ,4.00 ,30.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65780,CPT,OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE,,,21 ,,RBRVS,10.73 ,13.59 ,13.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65781,CPT,OCULAR SURFACE RECONSTRUCTION LIMBAL ALLOGRAFT,,,21 ,,RBRVS,18.14 ,18.21 ,18.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65782,CPT,OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT,,,21 ,,RBRVS,15.43 ,15.95 ,15.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65800,CPT,PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX,,,21 ,,RBRVS,1.91 ,1.64 ,2.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65810,CPT,PARACENTSIS ANT CHAM RMVL VITREOUS W/WO AIR INJX,,,21 ,,RBRVS,5.82 ,6.88 ,6.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65815,CPT,PARACEN ANT CHAM RMVL BLOOD W/WO IRRIG&/AIR IN,,,21 ,,RBRVS,6.00 ,7.01 ,11.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65820,CPT,GONIOTOMY,,,21 ,,RBRVS,8.91 ,11.56 ,11.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65850,CPT,TRABECULOTOMY AB EXTERNO,,,21 ,,RBRVS,11.39 ,11.47 ,11.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65855,CPT,TRABECULOPLASTY LASER SURG 1/> SESSIONS,,,21 ,,RBRVS,3.99 ,4.12 ,5.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65860,CPT,SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX,,,21 ,,RBRVS,3.59 ,3.31 ,4.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65865,CPT,SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE,,,21 ,,RBRVS,5.77 ,7.17 ,7.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65870,CPT,SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE,,,21 ,,RBRVS,7.39 ,8.74 ,8.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65875,CPT,SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE,,,21 ,,RBRVS,7.81 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65880,CPT,SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL,,,21 ,,RBRVS,8.36 ,9.72 ,9.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65900,CPT,RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE,,,21 ,,RBRVS,12.51 ,13.77 ,13.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65920,CPT,RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE,,,21 ,,RBRVS,9.99 ,11.49 ,11.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,65930,CPT,RMVL BLOOD CLOT ANTERIOR SEGMENT EYE,,,21 ,,RBRVS,8.39 ,8.99 ,8.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66020,CPT,INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX,,,21 ,,RBRVS,1.64 ,1.95 ,3.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66030,CPT,INJX ANTERIOR CHAMBER EYE MEDICATION SPX,,,21 ,,RBRVS,1.30 ,1.73 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66130,CPT,EXCISION LESION SCLERA,,,21 ,,RBRVS,7.83 ,7.66 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66150,CPT,FSTLJ SCLERA GLAUCOMA TREPHIN W/IRIDECTOMY,,,21 ,,RBRVS,10.53 ,13.38 ,13.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66155,CPT,FSTLJ SCLERA GLAUCOMA THERMOCAUT IRRIDEC,,,21 ,,RBRVS,10.52 ,13.37 ,13.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66160,CPT,FSTLJ SCLERA SCLERECTOMY PUNCH/SCISSORS IRIDECT,,,21 ,,RBRVS,12.39 ,14.53 ,14.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66165,CPT,FSTLJ SCLERA GLAUCOMA IRIDENCLEISIS/IRIDOTASIS,,,21 ,,RBRVS,10.24 ,13.20 ,13.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66170,CPT,FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO,,,21 ,,RBRVS,15.02 ,17.69 ,17.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66172,CPT,FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING,,,21 ,,RBRVS,18.86 ,22.40 ,22.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66174,CPT,TRLUML DILAT AQUEOUS CANAL W/O DEVICE/STENT,,,21 ,,RBRVS,12.85 ,13.59 ,13.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66175,CPT,TRLUML DILAT AQUEOUS CANAL W/DEVICE/STENT,,,21 ,,RBRVS,13.60 ,14.09 ,14.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66180,CPT,AQUEOUS SHUNT EXTRAOCULAR RESERVOIR,,,21 ,,RBRVS,16.30 ,15.35 ,15.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66185,CPT,REVISION AQUEOUS SHUNT EXTRAOCULAR RESERVOIR,,,21 ,,RBRVS,9.58 ,10.83 ,10.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66220,CPT,REPAIR SCLERAL STAPHYLOMA W/O GRAFT,,,21 ,,RBRVS,9.21 ,10.99 ,10.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66225,CPT,REPAIR SCLERAL STAPHYLOMA W/GRAFT,,,21 ,,RBRVS,12.63 ,12.70 ,12.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66250,CPT,REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT,,,21 ,,RBRVS,7.10 ,8.06 ,13.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66500,CPT,IRIDOTOMY STAB INC SPX XCP TRANSFIXION,,,21 ,,RBRVS,3.83 ,5.87 ,5.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66505,CPT,IRIDOTOMY STAB INC SPX TRANSFIXION,,,21 ,,RBRVS,4.22 ,6.41 ,6.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66600,CPT,IRDEC CRNLSCLRL/CRNL SCTJ RMVL LES,,,21 ,,RBRVS,10.12 ,12.52 ,12.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66605,CPT,IRDEC CRNLSCLRL/CRNL SCTJ CYCLECTOMY,,,21 ,,RBRVS,14.22 ,14.49 ,14.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66625,CPT,IRDEC CRNLSCLRL/CRNL SCTJ PRPH GLC SPX,,,21 ,,RBRVS,5.30 ,6.42 ,6.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66630,CPT,IRDEC CRNLSCLRL/CRNL SCTJ SECTOR GLC SPX,,,21 ,,RBRVS,7.28 ,8.23 ,8.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66635,CPT,IRDEC CRNLSCLRL/CRNL SCTJ OPTICAL SPX,,,21 ,,RBRVS,7.37 ,8.27 ,8.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66680,CPT,REPAIR IRIS CILIARY BODY,,,21 ,,RBRVS,6.39 ,7.70 ,7.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66682,CPT,SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE,,,21 ,,RBRVS,7.33 ,10.02 ,10.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66700,CPT,CILIARY BODY DESTRUCTION DIATHERMY,,,21 ,,RBRVS,5.14 ,5.57 ,7.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66710,CPT,CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL,,,21 ,,RBRVS,5.14 ,5.56 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66711,CPT,CILIARY BODY DSTRJ CYCLOPHOTOCOAG ENDOSCOPIC,,,21 ,,RBRVS,7.93 ,9.46 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66720,CPT,CILIARY BODY DESTRUCTION CRYOTHERAPY,,,21 ,,RBRVS,5.00 ,6.52 ,7.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66740,CPT,CILIARY BODY DESTRUCTION CYCLODIAL,,,21 ,,RBRVS,5.14 ,5.57 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66761,CPT,IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION,,,21 ,,RBRVS,3.00 ,4.03 ,5.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66762,CPT,IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS,,,21 ,,RBRVS,5.38 ,6.23 ,7.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66770,CPT,DSTRJ CYST/LESION IRIS/CILIARY BODY,,,21 ,,RBRVS,6.13 ,7.02 ,8.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66820,CPT,DISCISSION SECONDARY MEMBRANOUS CATARACT,,,21 ,,RBRVS,4.01 ,6.82 ,6.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66821,CPT,POST-CATARACT LASER SURGERY,,,21 ,,RBRVS,3.42 ,5.09 ,5.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66825,CPT,REPOSITIONING IO LENS PROSTHESIS REQ INC SPX,,,21 ,,RBRVS,9.01 ,11.77 ,11.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66830,CPT,RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ,,,21 ,,RBRVS,9.47 ,9.92 ,9.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66840,CPT,RMVL LENS MATERIAL ASPIR TQ 1/> STAGES,,,21 ,,RBRVS,9.18 ,9.76 ,9.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66850,CPT,RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR,,,21 ,,RBRVS,10.55 ,11.01 ,11.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66852,CPT,RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY,,,21 ,,RBRVS,11.41 ,11.56 ,11.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66920,CPT,RMVL LENS MATERIAL INTRACAPSULAR,,,21 ,,RBRVS,10.13 ,10.38 ,10.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66930,CPT,REMOVAL LENS MATRL INTRACAPSULAR DISLOCATED LENS,,,21 ,,RBRVS,11.61 ,11.69 ,11.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66940,CPT,REMOVAL LENS MATERIAL EXTRACAPSULAR,,,21 ,,RBRVS,10.37 ,10.90 ,10.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66982,CPT,XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG,,,21 ,,RBRVS,15.02 ,13.63 ,13.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66983,CPT,ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG,,,21 ,,RBRVS,10.43 ,9.80 ,9.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66984,CPT,CATARACT REMOVAL INSERTION OF LENS,,,21 ,,RBRVS,10.52 ,10.18 ,10.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66985,CPT,INSJ IO LENS PROSTHESIS NOT W/CONCURRENT RMVL,,,21 ,,RBRVS,9.98 ,11.00 ,11.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66986,CPT,EXCHANGE INTRAOCULAR LENS,,,21 ,,RBRVS,12.26 ,12.51 ,12.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66990,CPT,USE OPHTHALMIC ENDOSCOPE,,,21 ,,RBRVS,1.51 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,66999,CPT,UNLISTED PROCEDURE ANTERIOR SEGMENT EYE,,,21 ,,TotalUnits,,,,20.70 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,67005,CPT,RMVL VITREOUS ANT APPR PARTIAL REMOVAL,,,21 ,,RBRVS,5.89 ,6.98 ,6.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67010,CPT,RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT,,,21 ,,RBRVS,7.06 ,7.71 ,7.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67015,CPT,ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL,,,21 ,,RBRVS,7.14 ,8.70 ,8.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67025,CPT,INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX,,,21 ,,RBRVS,8.11 ,9.10 ,11.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67027,CPT,IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS,,,21 ,,RBRVS,11.62 ,11.53 ,11.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67028,CPT,INTRAVITREAL NJX PHARMACOLOGIC AGT SPX,,,21 ,,RBRVS,1.44 ,1.42 ,1.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67030,CPT,DISCISSION VITREOUS STRANS PARS PLANA APPROACH,,,21 ,,RBRVS,6.11 ,8.41 ,8.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67031,CPT,SEVERING VITREOUS STRANS LASER 1/> STAGES,,,21 ,,RBRVS,4.47 ,5.25 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67036,CPT,VITRECTOMY MECHANICAL PARS PLANA,,,21 ,,RBRVS,13.32 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67039,CPT,VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC,,,21 ,,RBRVS,16.74 ,16.83 ,16.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67040,CPT,VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC,,,21 ,,RBRVS,19.61 ,18.99 ,18.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67041,CPT,VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE,,,21 ,,RBRVS,19.25 ,16.62 ,16.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67042,CPT,VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA,,,21 ,,RBRVS,22.38 ,18.55 ,18.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67043,CPT,VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE,,,21 ,,RBRVS,23.24 ,19.82 ,19.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67101,CPT,RPR RETINAL DTCHMNT 1/>SES CRYOTX/DTHRM W/WO DR,,,21 ,,RBRVS,8.80 ,9.54 ,12.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67105,CPT,RPR RETINAL DTCHMNT 1/> SES PC W/WO DRG SUBRETI,,,21 ,,RBRVS,8.53 ,8.99 ,11.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67107,CPT,RPR RETINAL DTCHMNT SCLERAL BUCKLING W/WO IMPLT,,,21 ,,RBRVS,16.71 ,16.31 ,16.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67108,CPT,RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH,,,21 ,,RBRVS,22.89 ,20.67 ,20.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67110,CPT,RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS,,,21 ,,RBRVS,10.25 ,10.82 ,13.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67112,CPT,RPR RETINAL DTCHMNT SCLERAL BUCKLING/VITRECTOMY,,,21 ,,RBRVS,18.75 ,17.23 ,17.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67113,CPT,RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL,,,21 ,,RBRVS,25.35 ,21.90 ,21.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67115,CPT,RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT,,,21 ,,RBRVS,6.11 ,7.50 ,7.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67120,CPT,RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR,,,21 ,,RBRVS,7.10 ,8.10 ,10.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67121,CPT,RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR,,,21 ,,RBRVS,12.25 ,12.44 ,12.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67141,CPT,PROPH RTA DTCHMNT W/O DRG 1/> SESS CRTX DTHRM,,,21 ,,RBRVS,6.15 ,7.13 ,8.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67145,CPT,PROPH RTA DTCHMNT W/O DRG 1/> SESS,,,21 ,,RBRVS,6.32 ,7.23 ,8.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67208,CPT,DSTRJ LOCLZD LES RETINA 1/> SESS CRTX DTHRM,,,21 ,,RBRVS,7.65 ,8.07 ,8.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67210,CPT,DSTRJ LOCLZD LES RETINA 1/> SESS PC,,,21 ,,RBRVS,6.36 ,7.51 ,8.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67218,CPT,DSTRJ LES RETINA 1/> SESS RADJ IMPLTJ,,,21 ,,RBRVS,20.36 ,17.11 ,17.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67220,CPT,DSTRJ LES CHOROID PC 1/> SESS,,,21 ,,RBRVS,6.36 ,8.40 ,9.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67221,CPT,DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY,,,21 ,,RBRVS,3.45 ,2.34 ,4.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67225,CPT,DSTRJ LESION CHOROID PDT 2ND EYE 1 SESSION,,,21 ,,RBRVS,0.47 ,0.29 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67227,CPT,DESTRUCTION RETINOPATHY 1/> SESS DIATHERMY,,,21 ,,RBRVS,7.53 ,7.99 ,9.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67228,CPT,EXTENSIVE RETINOPATHY 1/> SESS PHOTOCOAGULATION,,,21 ,,RBRVS,13.82 ,12.51 ,14.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67229,CPT,EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT,,,21 ,,RBRVS,16.30 ,14.06 ,14.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67250,CPT,SCLERAL REINFORCEMENT SPX W/O GRAFT,,,21 ,,RBRVS,9.61 ,11.72 ,11.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67255,CPT,SCLERAL REINFORCEMENT SPX W/GRAFT,,,21 ,,RBRVS,10.17 ,12.82 ,12.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67299,CPT,UNLISTED PROCEDURE POSTERIOR SEGMENT,,,21 ,,TotalUnits,,,,6.06 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,67311,CPT,STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC,,,21 ,,RBRVS,7.77 ,8.51 ,8.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67312,CPT,STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC,,,21 ,,RBRVS,9.66 ,9.70 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67314,CPT,STRABISMUS RECESSION/RESCJ 1 VER MUSC,,,21 ,,RBRVS,8.79 ,9.53 ,9.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67316,CPT,STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC,,,21 ,,RBRVS,10.93 ,10.85 ,10.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67318,CPT,STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE,,,21 ,,RBRVS,9.12 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67320,CPT,TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC,,,21 ,,RBRVS,5.40 ,3.31 ,3.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67331,CPT,STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC,,,21 ,,RBRVS,5.13 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67332,CPT,STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY,,,21 ,,RBRVS,5.56 ,3.40 ,3.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67334,CPT,STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION,,,21 ,,RBRVS,5.05 ,3.09 ,3.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67335,CPT,PLACEMENT ADJUSTABLE SUTURE STRABISMUS,,,21 ,,RBRVS,2.49 ,1.54 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67340,CPT,STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC,,,21 ,,RBRVS,6.00 ,3.68 ,3.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67343,CPT,RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX,,,21 ,,RBRVS,8.47 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67345,CPT,CHEMODENERVATION EXTRAOCULAR MUSCLE,,,21 ,,RBRVS,3.01 ,2.72 ,3.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67346,CPT,BIOPSY EXTRAOCULAR MUSCLE,,,21 ,,RBRVS,2.87 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67399,CPT,UNLISTED PROCEDURE OCULAR MUSCLE,,,21 ,,TotalUnits,,,,16.28 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,67400,CPT,ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY,,,21 ,,RBRVS,11.20 ,14.26 ,14.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67405,CPT,ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY,,,21 ,,RBRVS,9.20 ,12.56 ,12.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67412,CPT,ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION,,,21 ,,RBRVS,10.30 ,13.02 ,13.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67413,CPT,ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY,,,21 ,,RBRVS,10.24 ,13.20 ,13.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67414,CPT,ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN,,,21 ,,RBRVS,17.94 ,18.02 ,18.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67415,CPT,FINE NEEDLE ASPIRATION ORBITAL CONTENTS,,,21 ,,RBRVS,1.76 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67420,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION,,,21 ,,RBRVS,21.87 ,22.08 ,22.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67430,CPT,ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB,,,21 ,,RBRVS,15.29 ,18.79 ,18.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67440,CPT,ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG,,,21 ,,RBRVS,14.84 ,18.11 ,18.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67445,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN,,,21 ,,RBRVS,19.12 ,18.93 ,18.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67450,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX,,,21 ,,RBRVS,15.41 ,18.85 ,18.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67500,CPT,RETROBULBAR INJECTION MEDICATION SPX,,,21 ,,RBRVS,1.44 ,0.63 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67505,CPT,RETROBULBAR INJECTION ALCOHOL,,,21 ,,RBRVS,1.27 ,0.91 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67515,CPT,INJECTION MEDICATION/OTHER SUBST TENON CAPSULE,,,21 ,,RBRVS,1.40 ,0.99 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67550,CPT,ORBITAL IMPLANT INSERTION,,,21 ,,RBRVS,11.77 ,14.66 ,14.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67560,CPT,ORBITAL IMPLANT REMOVAL/REVISION,,,21 ,,RBRVS,12.18 ,14.80 ,14.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67570,CPT,OPTIC NERVE DECOMPRESSION,,,21 ,,RBRVS,14.40 ,16.75 ,16.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67599,CPT,UNLISTED PROCEDURE ORBIT,,,21 ,,TotalUnits,,,,2.59 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,67700,CPT,BLEPHAROTOMY DRAINAGE ABSCESS EYELID,,,21 ,,RBRVS,1.40 ,1.77 ,6.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67710,CPT,SEVERING TARSORRHAPHY,,,21 ,,RBRVS,1.07 ,1.60 ,5.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67715,CPT,CANTHOTOMY SEPARATE PROCEDURE,,,21 ,,RBRVS,1.27 ,1.72 ,5.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67800,CPT,EXCISION CHALAZION SINGLE,,,21 ,,RBRVS,1.41 ,1.41 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67801,CPT,EXCISION CHALAZION MULTIPLE SAME LID,,,21 ,,RBRVS,1.91 ,1.72 ,2.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67805,CPT,EXCISION CHALAZION MULTIPLE DIFFERENT LIDS,,,21 ,,RBRVS,2.27 ,2.22 ,3.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67808,CPT,EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT,,,21 ,,RBRVS,4.60 ,5.43 ,5.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67810,CPT,INCISIONAL BIOPSY EYELID SKIN & LID MARGIN,,,21 ,,RBRVS,1.48 ,0.97 ,4.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67820,CPT,CORRECTION TRICHIASIS EPILATION FORCEPS ONLY,,,21 ,,RBRVS,0.71 ,0.75 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67825,CPT,CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS,,,21 ,,RBRVS,1.43 ,1.90 ,2.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67830,CPT,CORRECTION TRICHIASIS INCCISION LID MARGIN,,,21 ,,RBRVS,1.75 ,2.02 ,5.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67835,CPT,CORRJ TRICHIASIS INC LID MRGN W/FR MUC MEMB GRF,,,21 ,,RBRVS,5.70 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67840,CPT,EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE,,,21 ,,RBRVS,2.09 ,2.23 ,5.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67850,CPT,DESTRUCTION LESION LID MARGIN </ 1 CM,,,21 ,,RBRVS,1.74 ,2.03 ,4.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67875,CPT,TEMPORARY CLOSURE EYELIDS SUTURE,,,21 ,,RBRVS,1.35 ,1.30 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67880,CPT,CONSTJ INTERMARGIN ADHES/TARSORRH/CANTHORRHAPY,,,21 ,,RBRVS,4.60 ,5.45 ,8.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67882,CPT,CONSTJ INTERMARGIN ADHES/TARSOR/CANTHOR W/TRPOS,,,21 ,,RBRVS,6.02 ,6.85 ,9.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67900,CPT,REPAIR BROW PTOSIS,,,21 ,,RBRVS,6.82 ,7.07 ,10.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67901,CPT,RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL,,,21 ,,RBRVS,7.59 ,8.08 ,12.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67902,CPT,RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING,,,21 ,,RBRVS,9.82 ,9.78 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67903,CPT,RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL,,,21 ,,RBRVS,6.51 ,6.72 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67904,CPT,RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL,,,21 ,,RBRVS,7.97 ,8.25 ,12.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67906,CPT,RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING,,,21 ,,RBRVS,6.93 ,6.92 ,6.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67908,CPT,RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ,,,21 ,,RBRVS,5.30 ,6.35 ,8.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67909,CPT,REDUCTION OVERCORRECTION PTOSIS,,,21 ,,RBRVS,5.57 ,6.42 ,9.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67911,CPT,CORRECTION LID RETRACTION,,,21 ,,RBRVS,7.50 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67912,CPT,CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD,,,21 ,,RBRVS,6.36 ,7.11 ,18.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67914,CPT,REPAIR ECTROPION SUTURE,,,21 ,,RBRVS,3.75 ,4.12 ,6.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67915,CPT,REPAIR ECTROPION THERMOCAUTERIZATION,,,21 ,,RBRVS,3.26 ,3.71 ,6.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67916,CPT,REPAIR ECTROPION EXCISION TARSAL WEDGE,,,21 ,,RBRVS,5.48 ,6.33 ,9.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67917,CPT,REPAIR ECTROPION EXTENSIVE,,,21 ,,RBRVS,6.19 ,6.77 ,9.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67921,CPT,REPAIR ENTROPION SUTURE,,,21 ,,RBRVS,3.47 ,3.93 ,6.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67922,CPT,REPAIR ENTROPION THERMOCAUTERIZATION,,,21 ,,RBRVS,3.14 ,3.57 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67923,CPT,REPAIR ENTROPION EXCISION TARSAL WEDGE,,,21 ,,RBRVS,6.05 ,6.67 ,9.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67924,CPT,REPAIR ENTROPION EXTENSIVE,,,21 ,,RBRVS,5.93 ,6.30 ,10.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67930,CPT,SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK,,,21 ,,RBRVS,3.65 ,2.90 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67935,CPT,SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK,,,21 ,,RBRVS,6.36 ,5.69 ,10.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67938,CPT,REMOVAL EMBEDDED FOREIGN BODY EYELID,,,21 ,,RBRVS,1.38 ,1.80 ,5.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67950,CPT,CANTHOPLASTY,,,21 ,,RBRVS,5.99 ,6.69 ,9.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67961,CPT,EXCISION & REPAIR EYELID > ONE-FOURTH LID MARGIN,,,21 ,,RBRVS,5.86 ,6.58 ,10.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67966,CPT,EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN,,,21 ,,RBRVS,8.97 ,8.87 ,12.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67971,CPT,RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG,,,21 ,,RBRVS,10.01 ,9.71 ,9.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67973,CPT,RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG,,,21 ,,RBRVS,13.13 ,12.25 ,12.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67974,CPT,RCNSTJ EYELID FULL THICKNESS UPPER EYELID 1 STG,,,21 ,,RBRVS,13.10 ,12.21 ,12.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67975,CPT,RCNSTJ EYELID FULL THICKNESS SECOND STAGE,,,21 ,,RBRVS,9.35 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,67999,CPT,UNLISTED PROCEDURE EYELIDS,,,21 ,,TotalUnits,,,,6.02 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,68020,CPT,INCISION CONJUNCTIVA DRAINAGE OF CYST,,,21 ,,RBRVS,1.42 ,1.61 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68040,CPT,EXPRESSION CONJUNCTIVAL FOLLICLES,,,21 ,,RBRVS,0.85 ,0.58 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68100,CPT,BIOPSY CONJUNCTIVA,,,21 ,,RBRVS,1.35 ,1.32 ,3.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68110,CPT,EXCISION LESION CONJUNCTIVA </1 CM,,,21 ,,RBRVS,1.82 ,2.24 ,4.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68115,CPT,EXCISION LESION CONJUNCTIVA > 1 CM,,,21 ,,RBRVS,2.41 ,2.60 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68130,CPT,EXCISION LESION CONJUNCTIVA ADJACENT SCLERA,,,21 ,,RBRVS,5.10 ,6.16 ,9.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68135,CPT,DESTRUCTION LESION CONJUNCTIVA,,,21 ,,RBRVS,1.89 ,2.24 ,2.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68200,CPT,SUBCONJUNCTIVAL INJECTION,,,21 ,,RBRVS,0.49 ,0.46 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68320,CPT,CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT,,,21 ,,RBRVS,6.64 ,8.06 ,13.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68325,CPT,CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT,,,21 ,,RBRVS,8.63 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68326,CPT,CJP RCNSTJ CUL-DE-SAC BUCCAL GRF/XTNSV REARRGMT,,,21 ,,RBRVS,8.42 ,9.17 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68328,CPT,CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT,,,21 ,,RBRVS,9.45 ,9.90 ,9.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68330,CPT,RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT,,,21 ,,RBRVS,5.78 ,6.79 ,10.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68335,CPT,RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB,,,21 ,,RBRVS,8.46 ,9.18 ,9.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68340,CPT,RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LE,,,21 ,,RBRVS,4.97 ,5.91 ,10.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68360,CPT,CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX,,,21 ,,RBRVS,5.17 ,6.05 ,9.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68362,CPT,CONJUNCTIVAL FLAP TOTAL,,,21 ,,RBRVS,8.61 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68371,CPT,HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR,,,21 ,,RBRVS,5.09 ,6.21 ,6.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68399,CPT,UNLISTED PROCEDURE CONJUNCTIVA,,,21 ,,TotalUnits,,,,1.90 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,68400,CPT,INCISION DRAINAGE LACRIMAL GLAND,,,21 ,,RBRVS,1.74 ,1.88 ,6.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68420,CPT,INCISION DRAINAGE LACRIMAL SAC,,,21 ,,RBRVS,2.35 ,2.27 ,6.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68440,CPT,SNIP INCISION LACRIMAL PUNCTUM,,,21 ,,RBRVS,0.99 ,1.73 ,1.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68500,CPT,EXCISION LACRIMAL GLAND XCPT TUMOR TOTAL,,,21 ,,RBRVS,12.77 ,13.78 ,13.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68505,CPT,EXCISION LACRIMAL GLAND XCPT TUMOR PRTL,,,21 ,,RBRVS,12.69 ,13.81 ,13.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68510,CPT,BIOPSY LACRIMAL GLAND,,,21 ,,RBRVS,4.60 ,3.32 ,7.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68520,CPT,EXCISION LACRIMAL SAC,,,21 ,,RBRVS,8.78 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68525,CPT,BIOPSY LACRIMAL SAC,,,21 ,,RBRVS,4.42 ,2.73 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68530,CPT,RMVL FB/DACRYOLITH LACRIMAL PASSAGES,,,21 ,,RBRVS,3.70 ,3.31 ,8.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68540,CPT,EXC LACRIMAL GLAND TUMOR FRONTAL APPROACH,,,21 ,,RBRVS,12.18 ,13.13 ,13.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68550,CPT,EXC LACRIMAL GLAND TUMOR W/OSTEOTOMY,,,21 ,,RBRVS,15.16 ,11.07 ,11.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68700,CPT,PLASTIC REPAIR CANALICULI,,,21 ,,RBRVS,7.87 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68705,CPT,CORRECTION EVERTED PUNCTUM CAUTERY,,,21 ,,RBRVS,2.11 ,2.42 ,4.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68720,CPT,DACRYOCSTORHINOSTOMY,,,21 ,,RBRVS,9.96 ,10.66 ,10.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68745,CPT,CONJUNCTIVORHINOSTOMY W/O TUBE,,,21 ,,RBRVS,9.90 ,10.82 ,10.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68750,CPT,CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT,,,21 ,,RBRVS,10.10 ,11.38 ,11.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68760,CPT,CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER,,,21 ,,RBRVS,1.78 ,2.21 ,3.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68761,CPT,CLSR LACRIMAL PUNCTUM PLUG EACH,,,21 ,,RBRVS,1.41 ,1.86 ,2.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68770,CPT,CLOSURE LACRIMAL FISTULA SPX,,,21 ,,RBRVS,8.29 ,8.61 ,8.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68801,CPT,DILATION LACRIMAL PUNCTUM W/WO IRRGATION,,,21 ,,RBRVS,1.00 ,1.98 ,2.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68810,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRIGATION,,,21 ,,RBRVS,2.15 ,3.02 ,4.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68811,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES,,,21 ,,RBRVS,2.45 ,3.21 ,3.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68815,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT,,,21 ,,RBRVS,3.30 ,3.73 ,9.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68816,CPT,PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION,,,21 ,,RBRVS,3.06 ,3.80 ,17.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68840,CPT,PROBE LACRIMAL CANALICULI W/WO IRRIGATION,,,21 ,,RBRVS,1.30 ,1.88 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68850,CPT,INJECTION CONTRAST MEDIUM DACRYOCYSTOGRAPY,,,21 ,,RBRVS,0.80 ,0.71 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,68899,CPT,UNLISTED PROCEDURE LACRIMAL SYSTEM,,,21 ,,TotalUnits,,,,4.07 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,69000,CPT,DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE,,,21 ,,RBRVS,1.50 ,1.85 ,3.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69005,CPT,DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX,,,21 ,,RBRVS,2.16 ,2.27 ,3.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69020,CPT,DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS,,,21 ,,RBRVS,1.53 ,2.59 ,5.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69090,CPT,EAR PIERCING,,,14 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,69100,CPT,BIOPSY EXTERNAL EAR,,,21 ,,RBRVS,0.81 ,0.54 ,2.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69105,CPT,BIOPSY EXTERNAL AUDITORY CANAL,,,21 ,,RBRVS,0.85 ,0.96 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69110,CPT,EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR,,,21 ,,RBRVS,3.53 ,5.72 ,9.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69120,CPT,EXCISION EXTERNAL EAR COMPLETE AMPUTATION,,,21 ,,RBRVS,4.14 ,7.37 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69140,CPT,EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL,,,21 ,,RBRVS,8.14 ,17.35 ,17.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69145,CPT,EXCISION SOFT TIS LES EXTERNAL AUDITORY CANAL,,,21 ,,RBRVS,2.70 ,4.48 ,8.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69150,CPT,RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ,,,21 ,,RBRVS,13.61 ,15.92 ,15.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69155,CPT,RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ,,,21 ,,RBRVS,23.35 ,23.85 ,23.85 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,69200,CPT,RMVL FB XTRNL AUDITORY CANAL W/O ANES,,,21 ,,RBRVS,0.77 ,0.85 ,2.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69205,CPT,RMVL FB XTRNL AUDITORY CANAL ANES,,,21 ,,RBRVS,1.21 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69210,CPT,RMVL IMPACTED CERUMEN SPX 1/BOTH EARS,,,21 ,,RBRVS,0.61 ,0.28 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69220,CPT,DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE,,,21 ,,RBRVS,0.83 ,0.93 ,3.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69222,CPT,DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX,,,21 ,,RBRVS,1.45 ,2.52 ,5.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69300,CPT,OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ,,,21 ,,RBRVS,6.69 ,6.71 ,13.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69310,CPT,RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX,,,21 ,,RBRVS,10.97 ,20.42 ,20.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69320,CPT,RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG,,,21 ,,RBRVS,17.18 ,26.84 ,26.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69399,CPT,UNLISTED PROCEDURE EXTERNAL EAR,,,21 ,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,69400,CPT,EUSTACHIAN TUBE NFLTJ TRANSNSL CATHJ,,,21 ,,RBRVS,0.83 ,0.93 ,3.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69401,CPT,EUSTACHIAN TUBE NFLTJ TRANSNSL W/O CATHJ,,,21 ,,RBRVS,0.63 ,0.79 ,1.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69405,CPT,EUSTACHIAN TUBE CATHJ TRANSTYMPANIC,,,21 ,,RBRVS,2.68 ,2.77 ,4.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69420,CPT,MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ,,,21 ,,RBRVS,1.38 ,2.08 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69421,CPT,MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES,,,21 ,,RBRVS,1.78 ,2.51 ,2.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69424,CPT,VENTILATING TUBE RMVL REQUIRING GENERAL ANES,,,21 ,,RBRVS,0.85 ,0.92 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69433,CPT,TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA,,,21 ,,RBRVS,1.57 ,2.15 ,4.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69436,CPT,TYMPANOSTOMY GENERAL ANESTHESIA,,,21 ,,RBRVS,2.01 ,2.60 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69440,CPT,MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC,,,21 ,,RBRVS,7.71 ,12.10 ,12.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69450,CPT,TYMPANOLYSIS TRANSCANAL,,,21 ,,RBRVS,5.69 ,10.04 ,10.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69501,CPT,TRANSMASTOID ANTROTOMY,,,21 ,,RBRVS,9.21 ,11.66 ,11.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69502,CPT,MASTOIDECTOMY COMPLETE,,,21 ,,RBRVS,12.56 ,15.00 ,15.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69505,CPT,MASTOIDECTOMY MODIFIED RADICAL,,,21 ,,RBRVS,13.17 ,21.51 ,21.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69511,CPT,MASTOIDECTOMY RADICAL,,,21 ,,RBRVS,13.70 ,21.81 ,21.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69530,CPT,PETROUS APICECTOMY RADICAL MASTOIDECTOMY,,,21 ,,RBRVS,20.38 ,26.87 ,26.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69535,CPT,RESCJ TEMPORAL BONE EXTERNAL APPROACH,,,21 ,,RBRVS,37.42 ,37.56 ,37.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,69540,CPT,EXCISION AURAL POLYP,,,21 ,,RBRVS,1.25 ,2.46 ,4.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69550,CPT,EXCISION AURAL GLOMUS TUMOR TRANSCANAL,,,21 ,,RBRVS,11.15 ,18.90 ,18.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69552,CPT,EXCISION AURAL GLOMUS TUMOR TRANSMASTOID,,,21 ,,RBRVS,19.81 ,24.97 ,24.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69554,CPT,EXCISION AURAL GLOMUS TUMOR EXTENDED,,,21 ,,RBRVS,35.97 ,34.88 ,34.88 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,69601,CPT,REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY,,,21 ,,RBRVS,13.45 ,16.37 ,16.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69602,CPT,REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC,,,21 ,,RBRVS,13.76 ,17.30 ,17.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69603,CPT,REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY,,,21 ,,RBRVS,14.20 ,22.12 ,22.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69604,CPT,REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY,,,21 ,,RBRVS,14.20 ,17.59 ,17.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69605,CPT,REVJ MASTOIDECTOMY W/APICECTOMY,,,21 ,,RBRVS,18.69 ,26.00 ,26.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69610,CPT,TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH,,,21 ,,RBRVS,4.47 ,3.72 ,6.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69620,CPT,MYRINGOPLASTY,,,21 ,,RBRVS,6.03 ,7.92 ,14.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69631,CPT,TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ,,,21 ,,RBRVS,10.05 ,15.35 ,15.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69632,CPT,TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ,,,21 ,,RBRVS,12.96 ,17.91 ,17.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69633,CPT,TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP,,,21 ,,RBRVS,12.31 ,17.55 ,17.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69635,CPT,TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ,,,21 ,,RBRVS,13.51 ,21.66 ,21.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69636,CPT,TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ,,,21 ,,RBRVS,15.43 ,24.29 ,24.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69637,CPT,TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP,,,21 ,,RBRVS,15.32 ,24.24 ,24.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69641,CPT,TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ,,,21 ,,RBRVS,12.89 ,16.86 ,16.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69642,CPT,TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ,,,21 ,,RBRVS,17.06 ,21.05 ,21.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69643,CPT,TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR,,,21 ,,RBRVS,15.59 ,19.27 ,19.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69644,CPT,TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR,,,21 ,,RBRVS,17.23 ,25.23 ,25.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69645,CPT,TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR,,,21 ,,RBRVS,16.71 ,24.98 ,24.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69646,CPT,TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR,,,21 ,,RBRVS,18.37 ,25.79 ,25.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69650,CPT,STAPES MOBILIZATION,,,21 ,,RBRVS,9.80 ,13.13 ,13.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69660,CPT,STAPEDECTOMY/STAPEDOTOMY,,,21 ,,RBRVS,12.03 ,14.37 ,14.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69661,CPT,STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT,,,21 ,,RBRVS,15.92 ,18.45 ,18.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69662,CPT,REVISION STAPEDECTOMY/STAPEDOTOMY,,,21 ,,RBRVS,15.60 ,17.22 ,17.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69666,CPT,REPAIR OVAL WINDOW FISTULA,,,21 ,,RBRVS,9.89 ,13.11 ,13.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69667,CPT,REPAIR ROUND WINDOW FISTULA,,,21 ,,RBRVS,9.90 ,13.16 ,13.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69670,CPT,MASTOID OBLITERATION SEPARATE PROCEDURE,,,21 ,,RBRVS,11.73 ,15.22 ,15.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69676,CPT,TYMPANIC NEURECTOMY,,,21 ,,RBRVS,9.69 ,14.19 ,14.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69700,CPT,CLOSURE POSTAURICULAR FISTULA MASTOID SPX,,,21 ,,RBRVS,8.37 ,11.30 ,11.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69710,CPT,IMPLTJ/RPLCMT EMGNT BONE CNDJ DEV TEMPORAL BONE,,,21 ,,TotalUnits,,,,19.59 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,69711,CPT,RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE,,,21 ,,RBRVS,10.62 ,14.08 ,14.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69714,CPT,IMPLTJ OSSEOINTEGRATED TEMPORAL BONE W/MASTOID,,,21 ,,RBRVS,14.45 ,16.05 ,16.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69715,CPT,IMPLJ OSSEOINTEGRATED TEMPORAL BONE W/O MASTOID,,,21 ,,RBRVS,18.96 ,18.62 ,18.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69717,CPT,RPLMCT OSSEOINTEGRATE IMPLNT W/O MASTOIDECTOMY,,,21 ,,RBRVS,15.43 ,16.72 ,16.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69718,CPT,RPLMCT OSSEOINTEGRATE IMPLNT W/MASTOIDECTOMY,,,21 ,,RBRVS,19.21 ,18.77 ,18.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69720,CPT,DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION,,,21 ,,RBRVS,14.71 ,19.14 ,19.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69725,CPT,DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE,,,21 ,,RBRVS,27.64 ,25.37 ,25.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69740,CPT,SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE,,,21 ,,RBRVS,16.27 ,16.81 ,16.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69745,CPT,SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE,,,21 ,,RBRVS,17.02 ,18.27 ,18.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69799,CPT,UNLISTED PROCEDURE MIDDLE EAR,,,21 ,,TotalUnits,,,,5.73 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,69801,CPT,LABYRINTHOTOMY TRANSCANAL,,,21 ,,RBRVS,2.06 ,4.00 ,3.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69805,CPT,ENDOLYMPHATIC SAC W/O SHUNT,,,21 ,,RBRVS,14.71 ,15.13 ,15.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69806,CPT,ENDOLYMPHATIC SAC SHUNT,,,21 ,,RBRVS,12.63 ,14.20 ,14.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69820,CPT,FENESTRATION SEMICIRCULAR CANAL,,,21 ,,RBRVS,10.52 ,14.04 ,14.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69840,CPT,REVISION FENESTRATION OPERATION,,,21 ,,RBRVS,10.44 ,15.64 ,15.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69905,CPT,LABYRINTHECTOMY TRANSCANAL,,,21 ,,RBRVS,11.26 ,15.02 ,15.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69910,CPT,LABYRINTHECTOMY W/MASTOIDECTOMY,,,21 ,,RBRVS,13.91 ,14.97 ,14.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69915,CPT,VESTIBULAR NRV SECTION TRANSLABYRINTHINE APPR,,,21 ,,RBRVS,22.77 ,20.55 ,20.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69930,CPT,COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY,,,21 ,,RBRVS,17.73 ,16.91 ,16.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69949,CPT,UNLISTED PROCEDURE INNER EAR,,,21 ,,TotalUnits,,,,34.64 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,69950,CPT,VESTIBULAR NRV SECTION TRANSCRANIAL APPROACH,,,21 ,,RBRVS,27.63 ,22.56 ,22.56 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,69955,CPT,TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR,,,21 ,,RBRVS,29.42 ,26.34 ,26.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69960,CPT,DECOMPRESSION INTERNAL AUDITORY CANAL,,,21 ,,RBRVS,29.42 ,24.66 ,24.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69970,CPT,REMOVAL TUMOR TEMPORAL BONE,,,21 ,,RBRVS,32.41 ,27.90 ,27.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,69979,CPT,UNLISTED PROCEDURE TEMPORAL BONE MIDDLE FOSSA,,,21 ,,TotalUnits,,,,55.76 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,69990,CPT,MICROSURG TQS REQ USE OPERATING MICROSCOPE,,,21 ,,RBRVS,3.46 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70010,CPT,MYELOGRAPY POST FOSSA RS&I,,,20 ,,RBRVS,1.19 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70010,CPT,MYELOGRAPY POST FOSSA RS&I,26,,20 ,,RBRVS,0.31 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70010,CPT,MYELOGRAPY POST FOSSA RS&I,TC,,20 ,,RBRVS,0.88 ,1.02 ,1.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,,,20 ,,RBRVS,1.19 ,3.33 ,3.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,26,,20 ,,RBRVS,1.19 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,TC,,20 ,,RBRVS,,2.85 ,2.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,,,20 ,,RBRVS,0.17 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,26,,20 ,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,TC,,20 ,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS,,,20 ,,RBRVS,0.18 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS,26,,20 ,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS,TC,,20 ,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.25 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.25 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,0.82 ,0.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,,,20 ,,RBRVS,0.18 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,26,,20 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,TC,,20 ,,RBRVS,,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,,,20 ,,RBRVS,0.34 ,1.35 ,1.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,26,,20 ,,RBRVS,0.34 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,TC,,20 ,,RBRVS,,1.21 ,1.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,,,20 ,,RBRVS,0.34 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,26,,20 ,,RBRVS,0.34 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,TC,,20 ,,RBRVS,,1.15 ,1.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70140,CPT,RADEX FACIAL BONES < 3 VIEWS,,,20 ,,RBRVS,0.19 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70140,CPT,RADEX FACIAL BONES < 3 VIEWS,26,,20 ,,RBRVS,0.19 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70140,CPT,RADEX FACIAL BONES < 3 VIEWS,TC,,20 ,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.26 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.26 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.90 ,0.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,,,20 ,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,26,,20 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,TC,,20 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,70190,CPT,RADEX OPTIC FORAMINA,,,20 ,,RBRVS,0.21 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70190,CPT,RADEX OPTIC FORAMINA,26,,20 ,,RBRVS,0.21 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70190,CPT,RADEX OPTIC FORAMINA,TC,,20 ,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.28 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.28 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,0.90 ,0.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70210,CPT,RADEX SINUSES PARANASAL <3 VIEWS,,,20 ,,RBRVS,0.17 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70210,CPT,RADEX SINUSES PARANASAL <3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70210,CPT,RADEX SINUSES PARANASAL <3 VIEWS,TC,,20 ,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.25 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.25 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,,,20 ,,RBRVS,0.19 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,26,,20 ,,RBRVS,0.19 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,TC,,20 ,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70250,CPT,RADIOLOGIC EXAMINATION SKULL 4/> VIEWS,,,20 ,,RBRVS,0.24 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70250,CPT,RADIOLOGIC EXAMINATION SKULL 4/> VIEWS,26,,20 ,,RBRVS,0.24 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70250,CPT,RADIOLOGIC EXAMINATION SKULL 4/> VIEWS,TC,,20 ,,RBRVS,,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.34 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.34 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,0.92 ,0.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,,,20 ,,RBRVS,0.10 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,26,,20 ,,RBRVS,0.10 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,TC,,20 ,,RBRVS,,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,,,20 ,,RBRVS,0.16 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,TC,,20 ,,RBRVS,,0.88 ,0.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,,,20 ,,RBRVS,0.22 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,26,,20 ,,RBRVS,0.22 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,TC,,20 ,,RBRVS,,1.19 ,1.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70328,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT,,,20 ,,RBRVS,0.18 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70328,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT,26,,20 ,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70328,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT,TC,,20 ,,RBRVS,,0.66 ,0.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70330,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT,,,20 ,,RBRVS,0.24 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70330,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT,26,,20 ,,RBRVS,0.24 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70330,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT,TC,,20 ,,RBRVS,,1.09 ,1.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,1.47 ,1.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70336,CPT,MRI TEMPOROMANDIBULAR JOINT,,,20 ,,RBRVS,1.48 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70336,CPT,MRI TEMPOROMANDIBULAR JOINT,26,,20 ,,RBRVS,1.48 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70336,CPT,MRI TEMPOROMANDIBULAR JOINT,TC,,20 ,,RBRVS,,10.08 ,10.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70350,CPT,CEPHALOGRAM ORTHODONTIC,,,20 ,,RBRVS,0.17 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70350,CPT,CEPHALOGRAM ORTHODONTIC,26,,20 ,,RBRVS,0.17 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70350,CPT,CEPHALOGRAM ORTHODONTIC,TC,,20 ,,RBRVS,,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70355,CPT,ORTHOPANTOGRAM,,,20 ,,RBRVS,0.20 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70355,CPT,ORTHOPANTOGRAM,26,,20 ,,RBRVS,0.20 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70355,CPT,ORTHOPANTOGRAM,TC,,20 ,,RBRVS,,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,,,20 ,,RBRVS,0.17 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,26,,20 ,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,TC,,20 ,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,,,20 ,,RBRVS,0.32 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,26,,20 ,,RBRVS,0.32 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,TC,,20 ,,RBRVS,,2.11 ,2.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,,,20 ,,RBRVS,0.84 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,26,,20 ,,RBRVS,0.84 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,TC,,20 ,,RBRVS,,1.59 ,1.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70373,CPT,LARYNGOGRAPY CONTRAST RS&I,,,20 ,,RBRVS,0.44 ,1.93 ,1.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70373,CPT,LARYNGOGRAPY CONTRAST RS&I,26,,20 ,,RBRVS,0.44 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70373,CPT,LARYNGOGRAPY CONTRAST RS&I,TC,,20 ,,RBRVS,,1.77 ,1.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,,,20 ,,RBRVS,0.17 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,26,,20 ,,RBRVS,0.17 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,TC,,20 ,,RBRVS,,0.93 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70390,CPT,SIALOGRAPY RS&I,,,20 ,,RBRVS,0.38 ,2.65 ,2.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70390,CPT,SIALOGRAPY RS&I,26,,20 ,,RBRVS,0.38 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70390,CPT,SIALOGRAPY RS&I,TC,,20 ,,RBRVS,,2.51 ,2.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,,,20 ,,RBRVS,0.85 ,4.52 ,4.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,0.85 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,4.20 ,4.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.13 ,5.89 ,5.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.13 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.46 ,5.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70470,CPT,CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,6.22 ,6.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70470,CPT,CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70470,CPT,CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.74 ,5.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,,,20 ,,RBRVS,1.28 ,7.54 ,7.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.28 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,7.05 ,7.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,,,20 ,,RBRVS,1.38 ,8.85 ,8.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,26,,20 ,,RBRVS,1.38 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,TC,,20 ,,RBRVS,,8.33 ,8.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR,,,20 ,,RBRVS,1.45 ,10.01 ,10.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR,26,,20 ,,RBRVS,1.45 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR,TC,,20 ,,RBRVS,,9.47 ,9.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.14 ,6.17 ,6.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.14 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.73 ,5.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.30 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.30 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.00 ,7.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70488,CPT,CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.42 ,9.22 ,9.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70488,CPT,CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.42 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70488,CPT,CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,8.69 ,8.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.28 ,5.83 ,5.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.28 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.34 ,5.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.38 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.38 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.68 ,6.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70492,CPT,CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.45 ,8.88 ,8.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70492,CPT,CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.45 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70492,CPT,CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,8.34 ,8.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.75 ,14.65 ,14.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.75 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,13.99 ,13.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.75 ,15.09 ,15.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.75 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,14.43 ,14.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,,,20 ,,RBRVS,1.35 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,26,,20 ,,RBRVS,1.35 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,TC,,20 ,,RBRVS,,11.72 ,11.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.62 ,13.61 ,13.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.62 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.01 ,13.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70543,CPT,MRI ORBIT FACE & NCK W/O & W/CONTRAST MATRL,,,20 ,,RBRVS,2.15 ,17.12 ,17.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70543,CPT,MRI ORBIT FACE & NCK W/O & W/CONTRAST MATRL,26,,20 ,,RBRVS,2.15 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70543,CPT,MRI ORBIT FACE & NCK W/O & W/CONTRAST MATRL,TC,,20 ,,RBRVS,,16.33 ,16.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70544,CPT,MRA HEAD W/O CONTRST MATERIAL,,,20 ,,RBRVS,1.20 ,13.92 ,13.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70544,CPT,MRA HEAD W/O CONTRST MATERIAL,26,,20 ,,RBRVS,1.20 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70544,CPT,MRA HEAD W/O CONTRST MATERIAL,TC,,20 ,,RBRVS,,13.47 ,13.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70545,CPT,MRA HEAD W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.20 ,13.66 ,13.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70545,CPT,MRA HEAD W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.20 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70545,CPT,MRA HEAD W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.22 ,13.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70546,CPT,MRA HEAD W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,21.42 ,21.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70546,CPT,MRA HEAD W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70546,CPT,MRA HEAD W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,20.75 ,20.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70547,CPT,MRA NECK W/O CONTRST MATERIAL,,,20 ,,RBRVS,1.20 ,13.89 ,13.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70547,CPT,MRA NECK W/O CONTRST MATERIAL,26,,20 ,,RBRVS,1.20 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70547,CPT,MRA NECK W/O CONTRST MATERIAL,TC,,20 ,,RBRVS,,13.44 ,13.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70548,CPT,MRA NECK W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.20 ,14.75 ,14.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70548,CPT,MRA NECK W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.20 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70548,CPT,MRA NECK W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,14.30 ,14.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,21.49 ,21.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,20.82 ,20.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.48 ,12.68 ,12.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.48 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,12.13 ,12.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.78 ,14.02 ,14.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.78 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.35 ,13.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70553,CPT,MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL,,,20 ,,RBRVS,2.36 ,16.83 ,16.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70553,CPT,MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL,26,,20 ,,RBRVS,2.36 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70553,CPT,MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,15.95 ,15.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,,,20 ,,RBRVS,2.11 ,13.67 ,13.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,26,,20 ,,RBRVS,2.11 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,TC,,20 ,,RBRVS,,12.86 ,12.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,,,20 ,,TotalUnits,,,,21.60 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,26,,20 ,,TotalUnits,,,,3.52 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,TC,,20 ,,TotalUnits,,,,18.08 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,,,20 ,,TotalUnits,,,,37.33 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,26,,20 ,,TotalUnits,,,,4.02 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,TC,,20 ,,TotalUnits,,,,33.31 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,,,20 ,,RBRVS,3.20 ,37.41 ,37.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,26,,20 ,,RBRVS,3.20 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,TC,,20 ,,RBRVS,,36.20 ,36.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST,,,20 ,,TotalUnits,,,,52.27 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST,26,,20 ,,TotalUnits,,,,4.45 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST,TC,,20 ,,TotalUnits,,,,47.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,,,20 ,,RBRVS,0.18 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,26,,20 ,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,TC,,20 ,,RBRVS,,0.43 ,0.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,,,20 ,,RBRVS,0.21 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,26,,20 ,,RBRVS,0.21 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,TC,,20 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,,,20 ,,RBRVS,0.22 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,26,,20 ,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71021,CPT,RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX,,,20 ,,RBRVS,0.27 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71021,CPT,RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX,26,,20 ,,RBRVS,0.27 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71021,CPT,RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX,TC,,20 ,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71022,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ,,,20 ,,RBRVS,0.31 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71022,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ,26,,20 ,,RBRVS,0.31 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71022,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ,TC,,20 ,,RBRVS,,0.96 ,0.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71023,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO,,,20 ,,RBRVS,0.38 ,1.63 ,1.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71023,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO,26,,20 ,,RBRVS,0.38 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71023,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO,TC,,20 ,,RBRVS,,1.48 ,1.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.31 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.31 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,0.93 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,,,20 ,,RBRVS,0.46 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,26,,20 ,,RBRVS,0.46 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,TC,,20 ,,RBRVS,,1.94 ,1.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71035,CPT,RADEX CHEST SPECIAL VIEWS,,,20 ,,RBRVS,0.18 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71035,CPT,RADEX CHEST SPECIAL VIEWS,26,,20 ,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71035,CPT,RADEX CHEST SPECIAL VIEWS,TC,,20 ,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,,,20 ,,RBRVS,0.22 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,TC,,20 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.27 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.27 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.79 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,,,20 ,,RBRVS,0.27 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,26,,20 ,,RBRVS,0.27 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,TC,,20 ,,RBRVS,,0.82 ,0.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.32 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.32 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.20 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.22 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.79 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71250,CPT,CT THORAX W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.02 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71250,CPT,CT THORAX W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.02 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71250,CPT,CT THORAX W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.45 ,5.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71260,CPT,CT THORAX W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.24 ,7.28 ,7.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71260,CPT,CT THORAX W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.24 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71260,CPT,CT THORAX W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.81 ,6.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71270,CPT,CT THORAX W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.38 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71270,CPT,CT THORAX W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.38 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71270,CPT,CT THORAX W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,8.54 ,8.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.92 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.92 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,10.36 ,10.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.46 ,14.14 ,14.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.46 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.60 ,13.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71551,CPT,MRI CHEST W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.73 ,15.72 ,15.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71551,CPT,MRI CHEST W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.73 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71551,CPT,MRI CHEST W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,15.07 ,15.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71552,CPT,MRI CHEST W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,2.26 ,20.16 ,20.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71552,CPT,MRI CHEST W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,2.26 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71552,CPT,MRI CHEST W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,19.31 ,19.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,71555,CPT,MRA CHEST W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.81 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,71555,CPT,MRA CHEST W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.81 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,71555,CPT,MRA CHEST W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,12.73 ,12.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72010,CPT,RADEX SPINE ENTIRE SURVEY STD ANTEROPOST & LAT,,,20 ,,RBRVS,0.45 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72010,CPT,RADEX SPINE ENTIRE SURVEY STD ANTEROPOST & LAT,26,,20 ,,RBRVS,0.45 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72010,CPT,RADEX SPINE ENTIRE SURVEY STD ANTEROPOST & LAT,TC,,20 ,,RBRVS,,1.64 ,1.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,,,20 ,,RBRVS,0.15 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,26,,20 ,,RBRVS,0.15 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,TC,,20 ,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72040,CPT,RADEX SPINE CERVICAL 3 VIEWS OR LESS,,,20 ,,RBRVS,0.22 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72040,CPT,RADEX SPINE CERVICAL 3 VIEWS OR LESS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72040,CPT,RADEX SPINE CERVICAL 3 VIEWS OR LESS,TC,,20 ,,RBRVS,,0.84 ,0.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72050,CPT,RADEX SPINE CERVICAL 4 OR 5 VIEWS,,,20 ,,RBRVS,0.31 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72050,CPT,RADEX SPINE CERVICAL 4 OR 5 VIEWS,26,,20 ,,RBRVS,0.31 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72050,CPT,RADEX SPINE CERVICAL 4 OR 5 VIEWS,TC,,20 ,,RBRVS,,1.13 ,1.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72052,CPT,RADEX SPINE CERVICAL 6 OR MORE VIEWS,,,20 ,,RBRVS,0.36 ,1.65 ,1.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72052,CPT,RADEX SPINE CERVICAL 6 OR MORE VIEWS,26,,20 ,,RBRVS,0.36 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72052,CPT,RADEX SPINE CERVICAL 6 OR MORE VIEWS,TC,,20 ,,RBRVS,,1.50 ,1.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72069,CPT,RADEX SPINE THORACOLMBR STANDING SCOLIOSIS,,,20 ,,RBRVS,0.22 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72069,CPT,RADEX SPINE THORACOLMBR STANDING SCOLIOSIS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72069,CPT,RADEX SPINE THORACOLMBR STANDING SCOLIOSIS,TC,,20 ,,RBRVS,,0.79 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72070,CPT,RADEX SPINE THORACIC 2 VIEWS,,,20 ,,RBRVS,0.22 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72070,CPT,RADEX SPINE THORACIC 2 VIEWS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72070,CPT,RADEX SPINE THORACIC 2 VIEWS,TC,,20 ,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72072,CPT,RADEX SPINE THORACIC 3 VIEWS,,,20 ,,RBRVS,0.22 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72072,CPT,RADEX SPINE THORACIC 3 VIEWS,26,,20 ,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72072,CPT,RADEX SPINE THORACIC 3 VIEWS,TC,,20 ,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.22 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.22 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,1.01 ,1.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72080,CPT,RADEX SPINE THORACOLUMBAR 2 VIEWS,,,20 ,,RBRVS,0.22 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72080,CPT,RADEX SPINE THORACOLUMBAR 2 VIEWS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72080,CPT,RADEX SPINE THORACOLUMBAR 2 VIEWS,TC,,20 ,,RBRVS,,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72090,CPT,RADEX SPINE SCOLIOS STUDY W/SUPINE & ERECT STUDY,,,20 ,,RBRVS,0.28 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72090,CPT,RADEX SPINE SCOLIOS STUDY W/SUPINE & ERECT STUDY,26,,20 ,,RBRVS,0.28 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72090,CPT,RADEX SPINE SCOLIOS STUDY W/SUPINE & ERECT STUDY,TC,,20 ,,RBRVS,,1.07 ,1.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,,,20 ,,RBRVS,0.22 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,TC,,20 ,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,,,20 ,,RBRVS,0.31 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,26,,20 ,,RBRVS,0.31 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,TC,,20 ,,RBRVS,,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,,,20 ,,RBRVS,0.32 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,26,,20 ,,RBRVS,0.32 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,TC,,20 ,,RBRVS,,1.47 ,1.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,,,20 ,,RBRVS,0.22 ,1.06 ,1.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,26,,20 ,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,TC,,20 ,,RBRVS,,0.96 ,0.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.07 ,5.91 ,5.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.07 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.50 ,5.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,7.31 ,7.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.85 ,6.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,8.98 ,8.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,8.51 ,8.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,5.87 ,5.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.48 ,5.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,7.31 ,7.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.85 ,6.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,9.06 ,9.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,8.58 ,8.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,5.85 ,5.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.46 ,5.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,7.29 ,7.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.83 ,6.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,9.04 ,9.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,8.56 ,8.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,,,20 ,,RBRVS,1.60 ,11.05 ,11.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.60 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,10.45 ,10.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,,,20 ,,RBRVS,1.92 ,14.13 ,14.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,26,,20 ,,RBRVS,1.92 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,TC,,20 ,,RBRVS,,13.40 ,13.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,,,20 ,,RBRVS,1.60 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.60 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,10.55 ,10.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,,,20 ,,RBRVS,1.92 ,12.39 ,12.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,26,,20 ,,RBRVS,1.92 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,TC,,20 ,,RBRVS,,11.66 ,11.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.48 ,11.10 ,11.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.48 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,10.54 ,10.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.78 ,13.88 ,13.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.78 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.20 ,13.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,,,20 ,,RBRVS,2.57 ,16.58 ,16.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,26,,20 ,,RBRVS,2.57 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,TC,,20 ,,RBRVS,,15.62 ,15.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,,,20 ,,RBRVS,2.57 ,15.36 ,15.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,26,,20 ,,RBRVS,2.57 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,TC,,20 ,,RBRVS,,14.40 ,14.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72158,CPT,MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL,,,20 ,,RBRVS,2.36 ,16.48 ,16.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72158,CPT,MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL,26,,20 ,,RBRVS,2.36 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72158,CPT,MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL,TC,,20 ,,RBRVS,,15.59 ,15.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,14.07 ,14.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.40 ,13.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,,,20 ,,RBRVS,0.17 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,TC,,20 ,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.21 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.21 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.81 ,11.57 ,11.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.81 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,10.89 ,10.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.09 ,5.54 ,5.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.09 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.13 ,5.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72193,CPT,CT PELVIS W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.16 ,6.90 ,6.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72193,CPT,CT PELVIS W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.16 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72193,CPT,CT PELVIS W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.46 ,6.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,9.14 ,9.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,8.68 ,8.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.46 ,12.59 ,12.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.46 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,12.04 ,12.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.73 ,13.89 ,13.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.73 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,13.23 ,13.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,2.26 ,17.43 ,17.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,2.26 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,16.59 ,16.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,13.44 ,13.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,12.77 ,12.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS,,,20 ,,RBRVS,0.17 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS,TC,,20 ,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,,,20 ,,RBRVS,0.19 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,26,,20 ,,RBRVS,0.19 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,TC,,20 ,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.17 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72240,CPT,MYELOGRAPY CERVICAL RS&I,,,20 ,,RBRVS,0.91 ,3.14 ,3.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72240,CPT,MYELOGRAPY CERVICAL RS&I,26,,20 ,,RBRVS,0.91 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72240,CPT,MYELOGRAPY CERVICAL RS&I,TC,,20 ,,RBRVS,,2.79 ,2.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72255,CPT,MYELOGRAPY THORACIC RS&I,,,20 ,,RBRVS,0.91 ,2.94 ,2.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72255,CPT,MYELOGRAPY THORACIC RS&I,26,,20 ,,RBRVS,0.91 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72255,CPT,MYELOGRAPY THORACIC RS&I,TC,,20 ,,RBRVS,,2.59 ,2.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,,,20 ,,RBRVS,0.83 ,3.07 ,3.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,26,,20 ,,RBRVS,0.83 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,TC,,20 ,,RBRVS,,2.75 ,2.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,,,20 ,,RBRVS,1.33 ,4.77 ,4.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,26,,20 ,,RBRVS,1.33 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,TC,,20 ,,RBRVS,,4.26 ,4.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72275,CPT,EPIDUROGRAPY RS&I,,,20 ,,RBRVS,0.76 ,2.73 ,2.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72275,CPT,EPIDUROGRAPY RS&I,26,,20 ,,RBRVS,0.76 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72275,CPT,EPIDUROGRAPY RS&I,TC,,20 ,,RBRVS,,2.40 ,2.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,,,20 ,,RBRVS,1.16 ,2.75 ,2.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,26,,20 ,,RBRVS,1.16 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,TC,,20 ,,RBRVS,,2.24 ,2.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,72291,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PR VRT BODY FLUO,,,20 ,,TotalUnits,,,,8.29 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,72291,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PR VRT BODY FLUO,26,,20 ,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,72291,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PR VRT BODY FLUO,TC,,20 ,,TotalUnits,,,,6.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,72292,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PER VRT BODY CT,,,20 ,,TotalUnits,,,,8.44 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,72292,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PER VRT BODY CT,26,,20 ,,TotalUnits,,,,1.94 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,72292,CPT,RAD S&I PERQ VRTPLS/SACRPLSTY PER VRT BODY CT,TC,,20 ,,TotalUnits,,,,6.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,72295,CPT,DISKOGRAPY LUMBAR RS&I,,,20 ,,RBRVS,0.83 ,2.63 ,2.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,72295,CPT,DISKOGRAPY LUMBAR RS&I,26,,20 ,,RBRVS,0.83 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,72295,CPT,DISKOGRAPY LUMBAR RS&I,TC,,20 ,,RBRVS,,2.25 ,2.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73000,CPT,RADEX CLAVICLE COMPLETE,,,20 ,,RBRVS,0.16 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73000,CPT,RADEX CLAVICLE COMPLETE,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73000,CPT,RADEX CLAVICLE COMPLETE,TC,,20 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73010,CPT,RADEX SCAPULA COMPLETE,,,20 ,,RBRVS,0.17 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73010,CPT,RADEX SCAPULA COMPLETE,26,,20 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73010,CPT,RADEX SCAPULA COMPLETE,TC,,20 ,,RBRVS,,0.66 ,0.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73020,CPT,RADEX SHOULDER 1 VIEW,,,20 ,,RBRVS,0.15 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73020,CPT,RADEX SHOULDER 1 VIEW,26,,20 ,,RBRVS,0.15 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73020,CPT,RADEX SHOULDER 1 VIEW,TC,,20 ,,RBRVS,,0.49 ,0.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.18 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.66 ,2.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,2.44 ,2.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,,,20 ,,RBRVS,0.20 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,26,,20 ,,RBRVS,0.20 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,TC,,20 ,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.17 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73070,CPT,RADEX ELBOW 2 VIEWS,,,20 ,,RBRVS,0.15 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73070,CPT,RADEX ELBOW 2 VIEWS,26,,20 ,,RBRVS,0.15 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73070,CPT,RADEX ELBOW 2 VIEWS,TC,,20 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.76 ,0.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.45 ,2.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,2.21 ,2.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73090,CPT,RADEX FOREARM 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73090,CPT,RADEX FOREARM 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73090,CPT,RADEX FOREARM 2 VIEWS,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73100,CPT,RADEX WRIST 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73100,CPT,RADEX WRIST 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73100,CPT,RADEX WRIST 2 VIEWS,TC,,20 ,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.81 ,2.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,2.57 ,2.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73120,CPT,RADEX HAND 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73120,CPT,RADEX HAND 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73120,CPT,RADEX HAND 2 VIEWS,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73130,CPT,RADEX HAND MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73130,CPT,RADEX HAND MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73130,CPT,RADEX HAND MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.13 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.13 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.78 ,0.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,5.74 ,5.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.35 ,5.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73201,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.16 ,7.12 ,7.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73201,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.16 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73201,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.68 ,6.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.22 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.22 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,8.97 ,8.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,,,20 ,,RBRVS,1.81 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,26,,20 ,,RBRVS,1.81 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,TC,,20 ,,RBRVS,,9.36 ,9.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,,,20 ,,RBRVS,1.35 ,12.61 ,12.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,26,,20 ,,RBRVS,1.35 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,TC,,20 ,,RBRVS,,12.10 ,12.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,,,20 ,,RBRVS,1.62 ,13.76 ,13.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,26,,20 ,,RBRVS,1.62 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,TC,,20 ,,RBRVS,,13.15 ,13.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS,,,20 ,,RBRVS,2.15 ,17.43 ,17.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS,26,,20 ,,RBRVS,2.15 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS,TC,,20 ,,RBRVS,,16.62 ,16.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,,,20 ,,RBRVS,1.35 ,11.92 ,11.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.35 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,11.40 ,11.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,,,20 ,,RBRVS,1.62 ,12.78 ,12.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,26,,20 ,,RBRVS,1.62 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,TC,,20 ,,RBRVS,,12.17 ,12.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,,,20 ,,RBRVS,2.15 ,16.33 ,16.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,26,,20 ,,RBRVS,2.15 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,TC,,20 ,,RBRVS,,15.52 ,15.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.73 ,13.53 ,13.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.73 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,12.90 ,12.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73500,CPT,RADEX HIP UNILATERAL 1 VIEW,,,20 ,,RBRVS,0.17 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73500,CPT,RADEX HIP UNILATERAL 1 VIEW,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73500,CPT,RADEX HIP UNILATERAL 1 VIEW,TC,,20 ,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73510,CPT,RADEX HIP UNILATERAL COMPLETE MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.21 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73510,CPT,RADEX HIP UNILATERAL COMPLETE MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.21 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73510,CPT,RADEX HIP UNILATERAL COMPLETE MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.84 ,0.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73520,CPT,RADEX HIPS BILATERAL 2 VIEWS ANTEROPOST PELVIS,,,20 ,,RBRVS,0.26 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73520,CPT,RADEX HIPS BILATERAL 2 VIEWS ANTEROPOST PELVIS,26,,20 ,,RBRVS,0.26 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73520,CPT,RADEX HIPS BILATERAL 2 VIEWS ANTEROPOST PELVIS,TC,,20 ,,RBRVS,,0.83 ,0.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.54 ,2.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,2.29 ,2.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73530,CPT,RADEX HIP OPERATIVE PROCEDURE,,,20 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,73530,CPT,RADEX HIP OPERATIVE PROCEDURE,26,,20 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,73530,CPT,RADEX HIP OPERATIVE PROCEDURE,TC,,20 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,73540,CPT,RADEX PELVIS&HIPS INFT/CHLD MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.20 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73540,CPT,RADEX PELVIS&HIPS INFT/CHLD MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.20 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73540,CPT,RADEX PELVIS&HIPS INFT/CHLD MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73550,CPT,RADIOLOGIC EXAMINATION FEMUR 2 VIEWS,,,20 ,,RBRVS,0.17 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73550,CPT,RADIOLOGIC EXAMINATION FEMUR 2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73550,CPT,RADIOLOGIC EXAMINATION FEMUR 2 VIEWS,TC,,20 ,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,,,20 ,,RBRVS,0.17 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,TC,,20 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,,,20 ,,RBRVS,0.18 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,26,,20 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,TC,,20 ,,RBRVS,,0.82 ,0.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,,,20 ,,RBRVS,0.22 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,26,,20 ,,RBRVS,0.22 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,TC,,20 ,,RBRVS,,0.95 ,0.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,,,20 ,,RBRVS,0.17 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,26,,20 ,,RBRVS,0.17 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,TC,,20 ,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,3.47 ,3.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,TC,,20 ,,RBRVS,,3.21 ,3.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,,,20 ,,RBRVS,0.17 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,TC,,20 ,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,TC,,20 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73615,CPT,RADEX ANKLE ARTHROGGRAPHY RS&I,,,20 ,,RBRVS,0.54 ,2.67 ,2.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73615,CPT,RADEX ANKLE ARTHROGGRAPHY RS&I,26,,20 ,,RBRVS,0.54 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73615,CPT,RADEX ANKLE ARTHROGGRAPHY RS&I,TC,,20 ,,RBRVS,,2.42 ,2.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,,,20 ,,RBRVS,0.17 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,26,,20 ,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,TC,,20 ,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.16 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73660,CPT,RADEX TOE MINIMUM 2 VIEWS,,,20 ,,RBRVS,0.13 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73660,CPT,RADEX TOE MINIMUM 2 VIEWS,26,,20 ,,RBRVS,0.13 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73660,CPT,RADEX TOE MINIMUM 2 VIEWS,TC,,20 ,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.00 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.00 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.37 ,5.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.16 ,7.21 ,7.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.16 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,6.77 ,6.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,,,20 ,,RBRVS,1.22 ,9.43 ,9.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,26,,20 ,,RBRVS,1.22 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,TC,,20 ,,RBRVS,,8.97 ,8.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,,,20 ,,RBRVS,1.90 ,11.22 ,11.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,26,,20 ,,RBRVS,1.90 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,TC,,20 ,,RBRVS,,10.50 ,10.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,,,20 ,,RBRVS,1.35 ,12.42 ,12.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,26,,20 ,,RBRVS,1.35 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,TC,,20 ,,RBRVS,,11.92 ,11.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,,,20 ,,RBRVS,1.62 ,13.80 ,13.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,26,,20 ,,RBRVS,1.62 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,TC,,20 ,,RBRVS,,13.19 ,13.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR,,,20 ,,RBRVS,2.15 ,17.52 ,17.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR,26,,20 ,,RBRVS,2.15 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR,TC,,20 ,,RBRVS,,16.72 ,16.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,,,20 ,,RBRVS,1.35 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,26,,20 ,,RBRVS,1.35 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,TC,,20 ,,RBRVS,,11.70 ,11.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.62 ,13.10 ,13.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.62 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,12.48 ,12.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,,,20 ,,RBRVS,2.15 ,16.35 ,16.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,26,,20 ,,RBRVS,2.15 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,TC,,20 ,,RBRVS,,15.55 ,15.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.82 ,13.46 ,13.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.82 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,12.78 ,12.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,,,20 ,,RBRVS,0.18 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,26,,20 ,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,TC,,20 ,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,,,20 ,,RBRVS,0.23 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,26,,20 ,,RBRVS,0.23 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,TC,,20 ,,RBRVS,,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,,,20 ,,RBRVS,0.27 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,26,,20 ,,RBRVS,0.27 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,TC,,20 ,,RBRVS,,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,,,20 ,,RBRVS,0.32 ,1.10 ,1.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,26,,20 ,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,TC,,20 ,,RBRVS,,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.19 ,5.56 ,5.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.19 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,5.11 ,5.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.27 ,7.95 ,7.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.27 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.47 ,7.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74170,CPT,CT ABDOMEN W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.40 ,10.83 ,10.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74170,CPT,CT ABDOMEN W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.40 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74170,CPT,CT ABDOMEN W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,10.30 ,10.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG,,,20 ,,RBRVS,2.20 ,14.17 ,14.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG,26,,20 ,,RBRVS,2.20 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG,TC,,20 ,,RBRVS,,13.41 ,13.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,,,20 ,,RBRVS,1.90 ,12.33 ,12.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,26,,20 ,,RBRVS,1.90 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,TC,,20 ,,RBRVS,,11.62 ,11.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.74 ,4.80 ,4.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.74 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,4.19 ,4.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74177,CPT,CT ABDOEN & PELVIS W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.82 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74177,CPT,CT ABDOEN & PELVIS W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.82 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74177,CPT,CT ABDOEN & PELVIS W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,7.94 ,7.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE,,,20 ,,RBRVS,2.01 ,11.21 ,11.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE,26,,20 ,,RBRVS,2.01 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE,TC,,20 ,,RBRVS,,10.50 ,10.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,,,20 ,,RBRVS,1.46 ,11.06 ,11.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,26,,20 ,,RBRVS,1.46 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,TC,,20 ,,RBRVS,,10.51 ,10.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,,,20 ,,RBRVS,1.73 ,15.34 ,15.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,26,,20 ,,RBRVS,1.73 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,14.69 ,14.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74183,CPT,MRI ABDOMEN W/O & W/CONTRAST MATERIAL,,,20 ,,RBRVS,2.26 ,17.48 ,17.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74183,CPT,MRI ABDOMEN W/O & W/CONTRAST MATERIAL,26,,20 ,,RBRVS,2.26 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74183,CPT,MRI ABDOMEN W/O & W/CONTRAST MATERIAL,TC,,20 ,,RBRVS,,16.64 ,16.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,,,20 ,,RBRVS,1.80 ,13.42 ,13.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,26,,20 ,,RBRVS,1.80 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,TC,,20 ,,RBRVS,,12.75 ,12.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74190,CPT,PERITONEOGRAM RS&I,,,20 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74190,CPT,PERITONEOGRAM RS&I,26,,20 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74190,CPT,PERITONEOGRAM RS&I,TC,,20 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,,,20 ,,RBRVS,0.36 ,1.99 ,1.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,26,,20 ,,RBRVS,0.36 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,TC,,20 ,,RBRVS,,1.85 ,1.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74220,CPT,RADEX ESOPHAGUS,,,20 ,,RBRVS,0.46 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74220,CPT,RADEX ESOPHAGUS,26,,20 ,,RBRVS,0.46 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74220,CPT,RADEX ESOPHAGUS,TC,,20 ,,RBRVS,,2.05 ,2.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,,,20 ,,RBRVS,0.53 ,2.19 ,2.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,26,,20 ,,RBRVS,0.53 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,TC,,20 ,,RBRVS,,1.99 ,1.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,,,20 ,,RBRVS,1.19 ,3.99 ,3.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,26,,20 ,,RBRVS,1.19 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,TC,,20 ,,RBRVS,,3.37 ,3.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/O KUB,,,20 ,,RBRVS,0.69 ,2.69 ,2.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/O KUB,26,,20 ,,RBRVS,0.69 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/O KUB,TC,,20 ,,RBRVS,,2.42 ,2.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/KUB,,,20 ,,RBRVS,0.69 ,2.86 ,2.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/KUB,26,,20 ,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED FILMS W/KUB,TC,,20 ,,RBRVS,,2.60 ,2.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL FLMS,,,20 ,,RBRVS,0.91 ,4.38 ,4.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL FLMS,26,,20 ,,RBRVS,0.91 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL FLMS,TC,,20 ,,RBRVS,,4.04 ,4.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FILMS W/O KUB,,,20 ,,RBRVS,0.69 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FILMS W/O KUB,26,,20 ,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FILMS W/O KUB,TC,,20 ,,RBRVS,,2.85 ,2.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FLMS W/KUB,,,20 ,,RBRVS,0.69 ,3.54 ,3.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FLMS W/KUB,26,,20 ,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY FLMS W/KUB,TC,,20 ,,RBRVS,,3.28 ,3.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,,,20 ,,RBRVS,0.91 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,26,,20 ,,RBRVS,0.91 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,TC,,20 ,,RBRVS,,4.47 ,4.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL FILMS,,,20 ,,RBRVS,0.47 ,2.74 ,2.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL FILMS,26,,20 ,,RBRVS,0.47 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL FILMS,TC,,20 ,,RBRVS,,2.56 ,2.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74251,CPT,RADEX SM INT W/MLT SRL FLMS VIA ENTEROCLSS TUBE,,,20 ,,RBRVS,0.69 ,10.85 ,10.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74251,CPT,RADEX SM INT W/MLT SRL FLMS VIA ENTEROCLSS TUBE,26,,20 ,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74251,CPT,RADEX SM INT W/MLT SRL FLMS VIA ENTEROCLSS TUBE,TC,,20 ,,RBRVS,,10.59 ,10.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74260,CPT,DUODENOGRAPY HYPOTONIC,,,20 ,,RBRVS,0.50 ,9.10 ,9.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74260,CPT,DUODENOGRAPY HYPOTONIC,26,,20 ,,RBRVS,0.50 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74260,CPT,DUODENOGRAPY HYPOTONIC,TC,,20 ,,RBRVS,,8.91 ,8.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,,,20 ,,RBRVS,2.40 ,13.37 ,13.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,26,,20 ,,RBRVS,2.40 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,TC,,20 ,,RBRVS,,12.52 ,12.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,,,20 ,,RBRVS,2.50 ,15.90 ,15.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,26,,20 ,,RBRVS,2.50 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,TC,,20 ,,RBRVS,,14.96 ,14.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,,,20 ,,RBRVS,2.28 ,21.36 ,21.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,26,,20 ,,RBRVS,2.28 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,TC,,20 ,,RBRVS,,20.43 ,20.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74270,CPT,RADEX COLON BARIUM ENEMA W/WOKUB,,,20 ,,RBRVS,0.69 ,3.94 ,3.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74270,CPT,RADEX COLON BARIUM ENEMA W/WOKUB,26,,20 ,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74270,CPT,RADEX COLON BARIUM ENEMA W/WOKUB,TC,,20 ,,RBRVS,,3.68 ,3.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,,,20 ,,RBRVS,0.99 ,5.43 ,5.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,26,,20 ,,RBRVS,0.99 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,TC,,20 ,,RBRVS,,5.06 ,5.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,,,20 ,,RBRVS,2.02 ,4.00 ,4.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,26,,20 ,,RBRVS,2.02 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,TC,,20 ,,RBRVS,,3.23 ,3.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,,,20 ,,RBRVS,0.32 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,26,,20 ,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,TC,,20 ,,RBRVS,,1.63 ,1.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74291,CPT,CHOLECYST ORAL CNTRST ADDL/REPEAT XM/MULT DAY XM,,,20 ,,RBRVS,0.20 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74291,CPT,CHOLECYST ORAL CNTRST ADDL/REPEAT XM/MULT DAY XM,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74291,CPT,CHOLECYST ORAL CNTRST ADDL/REPEAT XM/MULT DAY XM,TC,,20 ,,RBRVS,,1.71 ,1.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,,,20 ,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,26,,20 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,TC,,20 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS,,,20 ,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS,26,,20 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS,TC,,20 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74305,CPT,CHOLANGIO&/PANCREATOGRAPHY THRU CATH RS&I,,,20 ,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74305,CPT,CHOLANGIO&/PANCREATOGRAPHY THRU CATH RS&I,26,,20 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74305,CPT,CHOLANGIO&/PANCREATOGRAPHY THRU CATH RS&I,TC,,20 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74320,CPT,CHOLANGIO&/PANCREATOGRAPHY TRANSHEPATC RS&I,,,20 ,,RBRVS,0.54 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74320,CPT,CHOLANGIO&/PANCREATOGRAPHY TRANSHEPATC RS&I,26,,20 ,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74320,CPT,CHOLANGIO&/PANCREATOGRAPHY TRANSHEPATC RS&I,TC,,20 ,,RBRVS,,2.33 ,2.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74327,CPT,POSTOP BILIARY STONE RMVL PRQ T-TUBE RS&I,,,20 ,,RBRVS,0.70 ,3.33 ,3.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74327,CPT,POSTOP BILIARY STONE RMVL PRQ T-TUBE RS&I,26,,20 ,,RBRVS,0.70 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74327,CPT,POSTOP BILIARY STONE RMVL PRQ T-TUBE RS&I,TC,,20 ,,RBRVS,,3.07 ,3.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,,,20 ,,TotalUnits,,,,3.70 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,26,,20 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,TC,,20 ,,TotalUnits,,,,2.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,,,20 ,,TotalUnits,,,,3.01 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,26,,20 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,TC,,20 ,,TotalUnits,,,,2.02 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,,,20 ,,TotalUnits,,,,4.51 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,26,,20 ,,TotalUnits,,,,1.26 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,TC,,20 ,,TotalUnits,,,,3.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO&FILMS RS&,,,20 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO&FILMS RS&,26,,20 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO&FILMS RS&,TC,,20 ,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,,,20 ,,RBRVS,0.76 ,3.27 ,3.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,26,,20 ,,RBRVS,0.76 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,TC,,20 ,,RBRVS,,2.95 ,2.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,,,20 ,,TotalUnits,,,,3.54 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,26,,20 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,TC,,20 ,,TotalUnits,,,,2.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,,,20 ,,TotalUnits,,,,3.28 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,26,,20 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,TC,,20 ,,TotalUnits,,,,2.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,,,20 ,,RBRVS,0.49 ,2.84 ,2.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,26,,20 ,,RBRVS,0.49 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,TC,,20 ,,RBRVS,,2.66 ,2.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,,,20 ,,RBRVS,0.49 ,2.88 ,2.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,26,,20 ,,RBRVS,0.49 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,TC,,20 ,,RBRVS,,2.69 ,2.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,,,20 ,,RBRVS,0.49 ,3.59 ,3.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,26,,20 ,,RBRVS,0.49 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,TC,,20 ,,RBRVS,,3.41 ,3.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,,,20 ,,TotalUnits,,,,2.58 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,26,,20 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,TC,,20 ,,TotalUnits,,,,2.08 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74425,CPT,UROGRAPHY ANTEGRADE RS&I,,,20 ,,TotalUnits,,,,1.87 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74425,CPT,UROGRAPHY ANTEGRADE RS&I,26,,20 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74425,CPT,UROGRAPHY ANTEGRADE RS&I,TC,,20 ,,TotalUnits,,,,1.38 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,,,20 ,,RBRVS,0.32 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,26,,20 ,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,TC,,20 ,,RBRVS,,1.05 ,1.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,,,20 ,,RBRVS,0.38 ,2.07 ,2.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,26,,20 ,,RBRVS,0.38 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,TC,,20 ,,RBRVS,,1.93 ,1.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,,,20 ,,TotalUnits,,,,3.45 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,26,,20 ,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,TC,,20 ,,TotalUnits,,,,1.86 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,,,20 ,,TotalUnits,,,,2.11 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,26,,20 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,TC,,20 ,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,,,20 ,,RBRVS,0.33 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,26,,20 ,,RBRVS,0.33 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,TC,,20 ,,RBRVS,,2.17 ,2.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,,,20 ,,RBRVS,0.54 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,26,,20 ,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,TC,,20 ,,RBRVS,,1.32 ,1.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74475,CPT,INTRO CATH IN RENAL PELVIS DRG&/NJX PRQ RS&I,,,20 ,,RBRVS,0.54 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74475,CPT,INTRO CATH IN RENAL PELVIS DRG&/NJX PRQ RS&I,26,,20 ,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74475,CPT,INTRO CATH IN RENAL PELVIS DRG&/NJX PRQ RS&I,TC,,20 ,,RBRVS,,2.37 ,2.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74480,CPT,INTRO URETERAL CATH/STENT PRQ RS&I,,,20 ,,RBRVS,0.54 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74480,CPT,INTRO URETERAL CATH/STENT PRQ RS&I,26,,20 ,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74480,CPT,INTRO URETERAL CATH/STENT PRQ RS&I,TC,,20 ,,RBRVS,,2.38 ,2.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,,,20 ,,RBRVS,0.54 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,26,,20 ,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,TC,,20 ,,RBRVS,,2.37 ,2.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,,,20 ,,RBRVS,0.34 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,26,,20 ,,RBRVS,0.34 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,TC,,20 ,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,,,20 ,,RBRVS,0.38 ,1.98 ,1.98 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,26,,20 ,,RBRVS,0.38 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,TC,,20 ,,RBRVS,,1.83 ,1.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,,,20 ,,TotalUnits,,,,3.18 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,26,,20 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,TC,,20 ,,TotalUnits,,,,2.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,74775,CPT,PERINEOGRAM,,,20 ,,TotalUnits,,,,3.52 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,74775,CPT,PERINEOGRAM,26,,20 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,74775,CPT,PERINEOGRAM,TC,,20 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,,,20 ,,RBRVS,2.35 ,9.73 ,9.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,26,,20 ,,RBRVS,2.35 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,TC,,20 ,,RBRVS,,8.79 ,8.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75559,CPT,CARDIAC MRI W/O CONTRAST W STRESS IMAGING,,,20 ,,RBRVS,2.95 ,14.19 ,14.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75559,CPT,CARDIAC MRI W/O CONTRAST W STRESS IMAGING,26,,20 ,,RBRVS,2.95 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75559,CPT,CARDIAC MRI W/O CONTRAST W STRESS IMAGING,TC,,20 ,,RBRVS,,12.99 ,12.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75561,CPT,CARDIAC MRI W/WO CONTRAST & FURTHER SEQ,,,20 ,,RBRVS,2.60 ,13.71 ,13.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75561,CPT,CARDIAC MRI W/WO CONTRAST & FURTHER SEQ,26,,20 ,,RBRVS,2.60 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75561,CPT,CARDIAC MRI W/WO CONTRAST & FURTHER SEQ,TC,,20 ,,RBRVS,,12.67 ,12.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75563,CPT,CARDIAC MRI W/W/O CONTRAST W STRESS,,,20 ,,RBRVS,3.00 ,16.63 ,16.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75563,CPT,CARDIAC MRI W/W/O CONTRAST W STRESS,26,,20 ,,RBRVS,3.00 ,1.26 ,1.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75563,CPT,CARDIAC MRI W/W/O CONTRAST W STRESS,TC,,20 ,,RBRVS,,15.37 ,15.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,,,20 ,,RBRVS,0.25 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,26,,20 ,,RBRVS,0.25 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,TC,,20 ,,RBRVS,,1.58 ,1.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,,,20 ,,RBRVS,0.58 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,26,,20 ,,RBRVS,0.58 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,TC,,20 ,,RBRVS,,2.55 ,2.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,,,20 ,,RBRVS,1.75 ,7.40 ,7.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,26,,20 ,,RBRVS,1.75 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,TC,,20 ,,RBRVS,,6.77 ,6.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D,,,20 ,,RBRVS,2.55 ,10.00 ,10.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D,26,,20 ,,RBRVS,2.55 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D,TC,,20 ,,RBRVS,,9.08 ,9.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,,,20 ,,RBRVS,2.40 ,11.15 ,11.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,26,,20 ,,RBRVS,2.40 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,TC,,20 ,,RBRVS,,10.29 ,10.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,,,20 ,,RBRVS,0.49 ,6.68 ,6.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,0.49 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,6.48 ,6.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,,,20 ,,RBRVS,1.14 ,4.26 ,4.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,1.14 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,3.82 ,3.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,,,20 ,,RBRVS,1.14 ,4.28 ,4.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,1.14 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,3.87 ,3.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,,,20 ,,RBRVS,1.79 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,26,,20 ,,RBRVS,1.79 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,TC,,20 ,,RBRVS,,3.92 ,3.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP,,,20 ,,RBRVS,2.40 ,12.22 ,12.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP,26,,20 ,,RBRVS,2.40 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP,TC,,20 ,,RBRVS,,11.30 ,11.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,,,20 ,,RBRVS,1.31 ,4.87 ,4.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,26,,20 ,,RBRVS,1.31 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,TC,,20 ,,RBRVS,,4.42 ,4.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75676,CPT,ARTERY X-RAYS NECK,,,20 ,,RBRVS,1.31 ,5.10 ,5.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75676,CPT,ARTERY X-RAYS NECK,26,,20 ,,RBRVS,1.31 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75676,CPT,ARTERY X-RAYS NECK,TC,,20 ,,RBRVS,,4.59 ,4.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,,,20 ,,RBRVS,2.18 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,26,,20 ,,RBRVS,2.18 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,4.82 ,4.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,,,20 ,,RBRVS,1.14 ,4.93 ,4.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,26,,20 ,,RBRVS,1.14 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,TC,,20 ,,RBRVS,,4.51 ,4.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,,,20 ,,RBRVS,1.31 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,26,,20 ,,RBRVS,1.31 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,TC,,20 ,,RBRVS,,5.30 ,5.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,,,20 ,,RBRVS,1.14 ,4.88 ,4.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,26,,20 ,,RBRVS,1.14 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,TC,,20 ,,RBRVS,,4.46 ,4.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,,,20 ,,RBRVS,1.14 ,4.71 ,4.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,26,,20 ,,RBRVS,1.14 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,TC,,20 ,,RBRVS,,4.24 ,4.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,,,20 ,,RBRVS,1.31 ,5.70 ,5.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,26,,20 ,,RBRVS,1.31 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,TC,,20 ,,RBRVS,,5.15 ,5.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,,,20 ,,RBRVS,1.14 ,4.82 ,4.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,26,,20 ,,RBRVS,1.14 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,TC,,20 ,,RBRVS,,4.40 ,4.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,,,20 ,,RBRVS,1.31 ,4.26 ,4.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,26,,20 ,,RBRVS,1.31 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,TC,,20 ,,RBRVS,,3.78 ,3.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,,,20 ,,RBRVS,1.66 ,4.68 ,4.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,26,,20 ,,RBRVS,1.66 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,TC,,20 ,,RBRVS,,4.06 ,4.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,,,20 ,,RBRVS,1.14 ,4.67 ,4.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,26,,20 ,,RBRVS,1.14 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,TC,,20 ,,RBRVS,,4.24 ,4.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,,,20 ,,RBRVS,1.14 ,5.09 ,5.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,26,,20 ,,RBRVS,1.14 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,TC,,20 ,,RBRVS,,4.64 ,4.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,,,20 ,,RBRVS,0.36 ,3.49 ,3.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,26,,20 ,,RBRVS,0.36 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,TC,,20 ,,RBRVS,,3.36 ,3.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75791,CPT,ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR S&I,,,20 ,,RBRVS,1.71 ,8.18 ,8.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75791,CPT,ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR S&I,26,,20 ,,RBRVS,1.71 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75791,CPT,ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR S&I,TC,,20 ,,RBRVS,,7.62 ,7.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,,,20 ,,RBRVS,0.81 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,26,,20 ,,RBRVS,0.81 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,TC,,20 ,,RBRVS,,6.08 ,6.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,,,20 ,,RBRVS,1.17 ,6.25 ,6.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,26,,20 ,,RBRVS,1.17 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,TC,,20 ,,RBRVS,,5.80 ,5.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75805,CPT,ANGRPH CATH F/U STUDY THER/EMBOLIZATION/INFUSION,,,20 ,,RBRVS,0.81 ,6.71 ,6.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75805,CPT,ANGRPH CATH F/U STUDY THER/EMBOLIZATION/INFUSION,26,,20 ,,RBRVS,0.81 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75805,CPT,ANGRPH CATH F/U STUDY THER/EMBOLIZATION/INFUSION,TC,,20 ,,RBRVS,,6.40 ,6.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,,,20 ,,RBRVS,1.17 ,6.99 ,6.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,26,,20 ,,RBRVS,1.17 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,TC,,20 ,,RBRVS,,6.54 ,6.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,,,20 ,,RBRVS,0.47 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,26,,20 ,,RBRVS,0.47 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,TC,,20 ,,RBRVS,,2.39 ,2.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75810,CPT,SPLENOPORTOGRAPY RS&I,,,20 ,,RBRVS,1.14 ,13.35 ,13.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75810,CPT,SPLENOPORTOGRAPY RS&I,26,,20 ,,RBRVS,1.14 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75810,CPT,SPLENOPORTOGRAPY RS&I,TC,,20 ,,RBRVS,,12.91 ,12.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,,,20 ,,RBRVS,0.70 ,3.03 ,3.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,26,,20 ,,RBRVS,0.70 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,TC,,20 ,,RBRVS,,2.76 ,2.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,,,20 ,,RBRVS,1.06 ,3.51 ,3.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,26,,20 ,,RBRVS,1.06 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,TC,,20 ,,RBRVS,,3.12 ,3.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,,,20 ,,RBRVS,1.14 ,4.08 ,4.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,1.14 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,3.67 ,3.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,,,20 ,,RBRVS,1.14 ,4.19 ,4.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,26,,20 ,,RBRVS,1.14 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,TC,,20 ,,RBRVS,,3.79 ,3.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,,,20 ,,RBRVS,1.14 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,26,,20 ,,RBRVS,1.14 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,3.79 ,3.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,,,20 ,,RBRVS,1.49 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,26,,20 ,,RBRVS,1.49 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,4.27 ,4.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,,,20 ,,RBRVS,1.14 ,4.16 ,4.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,26,,20 ,,RBRVS,1.14 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,3.74 ,3.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,,,20 ,,RBRVS,1.49 ,4.87 ,4.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,26,,20 ,,RBRVS,1.49 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,TC,,20 ,,RBRVS,,4.30 ,4.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,,,20 ,,RBRVS,1.14 ,4.25 ,4.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,26,,20 ,,RBRVS,1.14 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,TC,,20 ,,RBRVS,,3.81 ,3.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,,,20 ,,RBRVS,1.14 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,26,,20 ,,RBRVS,1.14 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,TC,,20 ,,RBRVS,,3.77 ,3.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75872,CPT,VENOGRAPHY EPIDURAL RS&I,,,20 ,,RBRVS,1.14 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75872,CPT,VENOGRAPHY EPIDURAL RS&I,26,,20 ,,RBRVS,1.14 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75872,CPT,VENOGRAPHY EPIDURAL RS&I,TC,,20 ,,RBRVS,,6.40 ,6.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75880,CPT,VENOGRAPHY ORBITAL RS&I,,,20 ,,RBRVS,0.70 ,3.19 ,3.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75880,CPT,VENOGRAPHY ORBITAL RS&I,26,,20 ,,RBRVS,0.70 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75880,CPT,VENOGRAPHY ORBITAL RS&I,TC,,20 ,,RBRVS,,2.93 ,2.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,,,20 ,,RBRVS,1.44 ,4.31 ,4.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,26,,20 ,,RBRVS,1.44 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,TC,,20 ,,RBRVS,,3.77 ,3.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP,,,20 ,,RBRVS,1.44 ,4.34 ,4.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP,26,,20 ,,RBRVS,1.44 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP,TC,,20 ,,RBRVS,,3.81 ,3.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,,,20 ,,RBRVS,1.14 ,4.21 ,4.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,26,,20 ,,RBRVS,1.14 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,TC,,20 ,,RBRVS,,3.79 ,3.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,,,20 ,,RBRVS,1.14 ,4.22 ,4.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,26,,20 ,,RBRVS,1.14 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,TC,,20 ,,RBRVS,,3.80 ,3.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&,,,20 ,,RBRVS,0.54 ,3.97 ,3.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&,26,,20 ,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&,TC,,20 ,,RBRVS,,3.77 ,3.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,,,20 ,,TotalUnits,,,,27.12 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,26,,20 ,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,TC,,20 ,,TotalUnits,,,,25.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,75896,CPT,TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS,,,20 ,,TotalUnits,,,,26.27 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75896,CPT,TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS,26,,20 ,,TotalUnits,,,,1.80 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,75896,CPT,TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS,TC,,20 ,,TotalUnits,,,,24.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,75898,CPT,ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS,,,20 ,,TotalUnits,,,,3.68 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75898,CPT,ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS,26,,20 ,,TotalUnits,,,,2.28 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,75898,CPT,ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS,TC,,20 ,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,,,20 ,,RBRVS,0.49 ,4.65 ,4.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,26,,20 ,,RBRVS,0.49 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,TC,,20 ,,RBRVS,,4.47 ,4.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,,,20 ,,RBRVS,0.39 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,26,,20 ,,RBRVS,0.39 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,TC,,20 ,,RBRVS,,1.73 ,1.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75945,CPT,IV ULTRASOUND RS&I INITIAL VESSEL,,,20 ,,TotalUnits,,,,8.00 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75945,CPT,IV ULTRASOUND RS&I INITIAL VESSEL,26,,20 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,75945,CPT,IV ULTRASOUND RS&I INITIAL VESSEL,TC,,20 ,,TotalUnits,,,,7.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,75946,CPT,IV ULTRASOUND RS&I EACH NON-CORONARY VESSEL,,,20 ,,TotalUnits,,,,4.36 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75946,CPT,IV ULTRASOUND RS&I EACH NON-CORONARY VESSEL,26,,20 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,75946,CPT,IV ULTRASOUND RS&I EACH NON-CORONARY VESSEL,TC,,20 ,,TotalUnits,,,,3.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,75952,CPT,EVASC RPR INFRARENAL AAA/DISSECTION RS&I,,,20 ,,TotalUnits,,,,11.52 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75952,CPT,EVASC RPR INFRARENAL AAA/DISSECTION RS&I,26,,20 ,,TotalUnits,,,,5.96 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,75952,CPT,EVASC RPR INFRARENAL AAA/DISSECTION RS&I,TC,,20 ,,TotalUnits,,,,5.56 ,,$0.00,$0.00,1,1,0,0,1,1,20131001,75953,CPT,PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I,,,20 ,,TotalUnits,,,,3.25 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75953,CPT,PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I,26,,20 ,,TotalUnits,,,,1.81 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,75953,CPT,PLMT XTN PROSTH EVASC RPR INFRARENAL RS&I,TC,,20 ,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,0,0,1,1,20131001,75954,CPT,EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I,,,20 ,,TotalUnits,,,,7.58 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75954,CPT,EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I,26,,20 ,,TotalUnits,,,,3.08 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,75954,CPT,EVASC RPR ILIAC ART W/ILIO-ILIAC PROSTH RS&I,TC,,20 ,,TotalUnits,,,,4.50 ,,$0.00,$0.00,1,1,0,0,1,1,20131001,75956,CPT,EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&i,,,20 ,,RBRVS,7.00 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75956,CPT,EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&i,26,,20 ,,RBRVS,7.00 ,2.26 ,2.26 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,75957,CPT,EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&i,,,20 ,,RBRVS,6.00 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75957,CPT,EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&i,26,,20 ,,RBRVS,6.00 ,1.95 ,1.95 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,75958,CPT,PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&i,,,20 ,,RBRVS,4.00 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75958,CPT,PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&i,26,,20 ,,RBRVS,4.00 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,75959,CPT,PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&i,,,20 ,,RBRVS,3.50 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75959,CPT,PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&i,26,,20 ,,RBRVS,3.50 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,75960,CPT,TCAT STENT ILIAC/LOW EXT ART PRQ/OPN RSI EA VSL,,,20 ,,RBRVS,0.82 ,3.85 ,3.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75960,CPT,TCAT STENT ILIAC/LOW EXT ART PRQ/OPN RSI EA VSL,26,,20 ,,RBRVS,0.82 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75960,CPT,TCAT STENT ILIAC/LOW EXT ART PRQ/OPN RSI EA VSL,TC,,20 ,,RBRVS,,3.55 ,3.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75962,CPT,TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI,,,20 ,,RBRVS,0.54 ,4.69 ,4.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75962,CPT,TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI,26,,20 ,,RBRVS,0.54 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75962,CPT,TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI,TC,,20 ,,RBRVS,,4.50 ,4.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75964,CPT,TRLUML BALOON ANGIOP PERIPHER EA ADDL ARTERY RSI,,,20 ,,RBRVS,0.36 ,3.00 ,3.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75964,CPT,TRLUML BALOON ANGIOP PERIPHER EA ADDL ARTERY RSI,26,,20 ,,RBRVS,0.36 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75964,CPT,TRLUML BALOON ANGIOP PERIPHER EA ADDL ARTERY RSI,TC,,20 ,,RBRVS,,2.87 ,2.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75966,CPT,TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&,,,20 ,,RBRVS,1.31 ,5.04 ,5.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75966,CPT,TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&,26,,20 ,,RBRVS,1.31 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75966,CPT,TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&,TC,,20 ,,RBRVS,,4.54 ,4.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75968,CPT,TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I,,,20 ,,RBRVS,0.36 ,2.91 ,2.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75968,CPT,TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I,26,,20 ,,RBRVS,0.36 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75968,CPT,TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I,TC,,20 ,,RBRVS,,2.77 ,2.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75970,CPT,TRANSCATHETER BIOPSY RS&I,,,20 ,,TotalUnits,,,,14.43 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75970,CPT,TRANSCATHETER BIOPSY RS&I,26,,20 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,75970,CPT,TRANSCATHETER BIOPSY RS&I,TC,,20 ,,TotalUnits,,,,13.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,75978,CPT,TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I,,,20 ,,RBRVS,0.54 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75978,CPT,TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I,26,,20 ,,RBRVS,0.54 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75978,CPT,TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I,TC,,20 ,,RBRVS,,4.62 ,4.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75980,CPT,PRQ TRANSHEPATC BILIARY DRG W/CONTRAST MNTR RS&I,,,20 ,,TotalUnits,,,,9.26 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75980,CPT,PRQ TRANSHEPATC BILIARY DRG W/CONTRAST MNTR RS&I,26,,20 ,,TotalUnits,,,,1.97 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,75980,CPT,PRQ TRANSHEPATC BILIARY DRG W/CONTRAST MNTR RS&I,TC,,20 ,,TotalUnits,,,,7.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,75982,CPT,PRQ PLMT INT/EXT BILIARY DRNG CATH/STENT RS&I,,,20 ,,TotalUnits,,,,9.79 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,75982,CPT,PRQ PLMT INT/EXT BILIARY DRNG CATH/STENT RS&I,26,,20 ,,TotalUnits,,,,1.97 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,75982,CPT,PRQ PLMT INT/EXT BILIARY DRNG CATH/STENT RS&I,TC,,20 ,,TotalUnits,,,,7.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,,,20 ,,RBRVS,0.72 ,2.63 ,2.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,26,,20 ,,RBRVS,0.72 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,TC,,20 ,,RBRVS,,2.36 ,2.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,,,20 ,,RBRVS,1.19 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,26,,20 ,,RBRVS,1.19 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,TC,,20 ,,RBRVS,,2.20 ,2.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76000,CPT,FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME,,,20 ,,RBRVS,0.17 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76000,CPT,FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76000,CPT,FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME,TC,,20 ,,RBRVS,,1.67 ,1.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76001,CPT,FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME,,,20 ,,RBRVS,0.67 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76001,CPT,FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME,26,,20 ,,RBRVS,0.67 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76001,CPT,FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME,TC,,20 ,,RBRVS,,2.94 ,2.94 ,,,$0.00,$0.00,1,1,0,0,1,1,20131001,76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,,20 ,,RBRVS,0.18 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,PC,20 ,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,TC,20 ,,RBRVS,,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,,20 ,,RBRVS,0.54 ,1.24 ,1.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,PC,20 ,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,TC,20 ,,RBRVS,,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,,20 ,,RBRVS,0.16 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,PC,20 ,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,TC,20 ,,RBRVS,,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,,20 ,,RBRVS,0.58 ,2.71 ,2.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,PC,20 ,,RBRVS,0.58 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,TC,20 ,,RBRVS,,2.43 ,2.43 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,,20 ,,RBRVS,0.58 ,4.25 ,4.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,PC,20 ,,RBRVS,0.58 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,TC,20 ,,RBRVS,,3.90 ,3.90 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,,20 ,,RBRVS,0.58 ,5.95 ,5.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,PC,20 ,,RBRVS,0.58 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,TC,20 ,,RBRVS,,5.61 ,5.61 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,,20 ,,RBRVS,0.38 ,1.87 ,1.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,PC,20 ,,RBRVS,0.38 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,TC,20 ,,RBRVS,,1.73 ,1.73 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,,20 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,PC,20 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,TC,20 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,76140,CPT,CONSLTJ X-RAY XM MADE ELSEWHERE WRTTN REPRT,,,20 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76376,CPT,3D RENDERING W/INTERP & POSTPROCESS SUPERVISION,,,20 ,,RBRVS,0.20 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76376,CPT,3D RENDERING W/INTERP & POSTPROCESS SUPERVISION,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76376,CPT,3D RENDERING W/INTERP & POSTPROCESS SUPERVISION,TC,,20 ,,RBRVS,,1.66 ,1.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76377,CPT,3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION,,,20 ,,RBRVS,0.79 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76377,CPT,3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION,26,,20 ,,RBRVS,0.79 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76377,CPT,3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION,TC,,20 ,,RBRVS,,1.43 ,1.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,,,20 ,,RBRVS,0.98 ,4.29 ,4.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,26,,20 ,,RBRVS,0.98 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,TC,,20 ,,RBRVS,,3.91 ,3.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76390,CPT,MRI SPECTROSCOPY,,,20 ,,RBRVS,1.40 ,12.79 ,12.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76390,CPT,MRI SPECTROSCOPY,26,,20 ,,RBRVS,1.40 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76390,CPT,MRI SPECTROSCOPY,TC,,20 ,,RBRVS,,12.22 ,12.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,,,20 ,,TotalUnits,,,,1.91 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,26,,20 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,TC,,20 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,,,20 ,,TotalUnits,,,,6.56 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,26,,20 ,,TotalUnits,,,,1.58 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,TC,,20 ,,TotalUnits,,,,4.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,,,20 ,,TotalUnits,,,,11.10 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,26,,20 ,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,TC,,20 ,,TotalUnits,,,,9.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,,,20 ,,TotalUnits,,,,2.71 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,26,,20 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,TC,,20 ,,TotalUnits,,,,2.02 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76506,CPT,ECHOENCEPHALOGRAPY REAL TIME IMAGING,,,20 ,,RBRVS,0.63 ,3.03 ,3.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76506,CPT,ECHOENCEPHALOGRAPY REAL TIME IMAGING,26,,20 ,,RBRVS,0.63 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76506,CPT,ECHOENCEPHALOGRAPY REAL TIME IMAGING,TC,,20 ,,RBRVS,,2.79 ,2.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,,,20 ,,RBRVS,1.55 ,3.25 ,3.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,26,,20 ,,RBRVS,1.55 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,TC,,20 ,,RBRVS,,2.31 ,2.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,,,20 ,,RBRVS,0.94 ,2.01 ,2.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,26,,20 ,,RBRVS,0.94 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,TC,,20 ,,RBRVS,,1.45 ,1.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,,,20 ,,RBRVS,0.94 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,26,,20 ,,RBRVS,0.94 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,TC,,20 ,,RBRVS,,1.18 ,1.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,,,20 ,,RBRVS,0.66 ,2.02 ,2.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,26,,20 ,,RBRVS,0.66 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,TC,,20 ,,RBRVS,,1.68 ,1.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,,,20 ,,RBRVS,0.17 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,26,,20 ,,RBRVS,0.17 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,TC,,20 ,,RBRVS,,0.14 ,0.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,,,20 ,,RBRVS,0.54 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,26,,20 ,,RBRVS,0.54 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,TC,,20 ,,RBRVS,,1.34 ,1.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,,,20 ,,RBRVS,0.54 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,26,,20 ,,RBRVS,0.54 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,TC,,20 ,,RBRVS,,1.49 ,1.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,,,20 ,,RBRVS,0.57 ,1.66 ,1.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,26,,20 ,,RBRVS,0.57 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,TC,,20 ,,RBRVS,,1.31 ,1.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,,,20 ,,RBRVS,0.56 ,3.02 ,3.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,26,,20 ,,RBRVS,0.56 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,TC,,20 ,,RBRVS,,2.81 ,2.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,,,20 ,,RBRVS,0.55 ,2.04 ,2.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,26,,20 ,,RBRVS,0.55 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,TC,,20 ,,RBRVS,,1.84 ,1.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76645,CPT,US BREAST REAL TIME W/IMAGE DOCUMENTATION,,,20 ,,RBRVS,0.54 ,2.33 ,2.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76645,CPT,US BREAST REAL TIME W/IMAGE DOCUMENTATION,26,,20 ,,RBRVS,0.54 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76645,CPT,US BREAST REAL TIME W/IMAGE DOCUMENTATION,TC,,20 ,,RBRVS,,2.13 ,2.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,,,20 ,,RBRVS,0.81 ,3.36 ,3.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,26,,20 ,,RBRVS,0.81 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,TC,,20 ,,RBRVS,,3.05 ,3.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76705,CPT,ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED,,,20 ,,RBRVS,0.59 ,2.60 ,2.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76705,CPT,ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED,26,,20 ,,RBRVS,0.59 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76705,CPT,ULTRASOUND ABDOMINAL REAL TIME W/IMAGE LIMITED,TC,,20 ,,RBRVS,,2.38 ,2.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,,,20 ,,RBRVS,0.74 ,3.21 ,3.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,26,,20 ,,RBRVS,0.74 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,TC,,20 ,,RBRVS,,2.93 ,2.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,,,20 ,,RBRVS,0.58 ,2.68 ,2.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,26,,20 ,,RBRVS,0.58 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,TC,,20 ,,RBRVS,,2.46 ,2.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,,,20 ,,RBRVS,0.76 ,3.78 ,3.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,26,,20 ,,RBRVS,0.76 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,TC,,20 ,,RBRVS,,3.50 ,3.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,,,20 ,,RBRVS,1.13 ,2.76 ,2.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,26,,20 ,,RBRVS,1.13 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,TC,,20 ,,RBRVS,,2.34 ,2.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,,,20 ,,RBRVS,0.99 ,2.84 ,2.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,26,,20 ,,RBRVS,0.99 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,TC,,20 ,,RBRVS,,2.44 ,2.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,,,20 ,,RBRVS,0.83 ,1.17 ,1.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,26,,20 ,,RBRVS,0.83 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,TC,,20 ,,RBRVS,,0.84 ,0.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,,,20 ,,RBRVS,0.99 ,3.45 ,3.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,26,,20 ,,RBRVS,0.99 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,TC,,20 ,,RBRVS,,3.05 ,3.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO,,,20 ,,RBRVS,0.98 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO,26,,20 ,,RBRVS,0.98 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO,TC,,20 ,,RBRVS,,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,,,20 ,,RBRVS,1.90 ,3.72 ,3.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,26,,20 ,,RBRVS,1.90 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,TC,,20 ,,RBRVS,,2.91 ,2.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,,,20 ,,RBRVS,1.78 ,4.42 ,4.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,26,,20 ,,RBRVS,1.78 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,TC,,20 ,,RBRVS,,3.67 ,3.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,,,20 ,,RBRVS,1.18 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,26,,20 ,,RBRVS,1.18 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,TC,,20 ,,RBRVS,,2.04 ,2.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,,,20 ,,RBRVS,0.99 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,26,,20 ,,RBRVS,0.99 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,TC,,20 ,,RBRVS,,0.97 ,0.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,,,20 ,,RBRVS,0.65 ,2.07 ,2.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,26,,20 ,,RBRVS,0.65 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,TC,,20 ,,RBRVS,,1.81 ,1.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,,,20 ,,RBRVS,0.85 ,2.69 ,2.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,26,,20 ,,RBRVS,0.85 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,TC,,20 ,,RBRVS,,2.33 ,2.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,,,20 ,,RBRVS,0.75 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,26,,20 ,,RBRVS,0.75 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,TC,,20 ,,RBRVS,,2.00 ,2.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,,,20 ,,RBRVS,1.05 ,2.60 ,2.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,26,,20 ,,RBRVS,1.05 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,TC,,20 ,,RBRVS,,2.15 ,2.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,,,20 ,,RBRVS,0.77 ,1.92 ,1.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,26,,20 ,,RBRVS,0.77 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,TC,,20 ,,RBRVS,,1.60 ,1.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,,,20 ,,RBRVS,0.50 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,26,,20 ,,RBRVS,0.50 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,TC,,20 ,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,,,20 ,,RBRVS,0.70 ,2.18 ,2.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,26,,20 ,,RBRVS,0.70 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,TC,,20 ,,RBRVS,,1.88 ,1.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,,,20 ,,RBRVS,1.67 ,4.86 ,4.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,26,,20 ,,RBRVS,1.67 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,TC,,20 ,,RBRVS,,4.17 ,4.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,,,20 ,,RBRVS,0.83 ,3.00 ,3.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,26,,20 ,,RBRVS,0.83 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,TC,,20 ,,RBRVS,,2.66 ,2.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,,,20 ,,RBRVS,0.58 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,26,,20 ,,RBRVS,0.58 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,TC,,20 ,,RBRVS,,1.07 ,1.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,,,20 ,,RBRVS,0.56 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,26,,20 ,,RBRVS,0.56 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,TC,,20 ,,RBRVS,,0.58 ,0.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76830,CPT,ULTRASOUND TRANSVAGINAL,,,20 ,,RBRVS,0.69 ,3.06 ,3.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76830,CPT,ULTRASOUND TRANSVAGINAL,26,,20 ,,RBRVS,0.69 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76830,CPT,ULTRASOUND TRANSVAGINAL,TC,,20 ,,RBRVS,,2.79 ,2.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,,,20 ,,RBRVS,0.72 ,3.07 ,3.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,26,,20 ,,RBRVS,0.72 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,TC,,20 ,,RBRVS,,2.77 ,2.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,,,20 ,,RBRVS,0.69 ,3.02 ,3.02 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,26,,20 ,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,TC,,20 ,,RBRVS,,2.76 ,2.76 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,,,20 ,,RBRVS,0.38 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,26,,20 ,,RBRVS,0.38 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,TC,,20 ,,RBRVS,,2.40 ,2.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76870,CPT,ULTRASOUND SCROTUM & CONTENTS,,,20 ,,RBRVS,0.64 ,3.04 ,3.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76870,CPT,ULTRASOUND SCROTUM & CONTENTS,26,,20 ,,RBRVS,0.64 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76870,CPT,ULTRASOUND SCROTUM & CONTENTS,TC,,20 ,,RBRVS,,2.80 ,2.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76872,CPT,ULTRASOUND TRANSRECTAL,,,20 ,,RBRVS,0.69 ,3.35 ,3.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76872,CPT,ULTRASOUND TRANSRECTAL,26,,20 ,,RBRVS,0.69 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76872,CPT,ULTRASOUND TRANSRECTAL,TC,,20 ,,RBRVS,,3.08 ,3.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,,,20 ,,RBRVS,1.55 ,3.55 ,3.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,26,,20 ,,RBRVS,1.55 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,TC,,20 ,,RBRVS,,2.94 ,2.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,,,20 ,,RBRVS,0.63 ,2.94 ,2.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,26,,20 ,,RBRVS,0.63 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,TC,,20 ,,RBRVS,,2.72 ,2.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,,,20 ,,RBRVS,0.49 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,26,,20 ,,RBRVS,0.49 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,TC,,20 ,,RBRVS,,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ,,,20 ,,RBRVS,0.74 ,3.67 ,3.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ,26,,20 ,,RBRVS,0.74 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ,TC,,20 ,,RBRVS,,3.38 ,3.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76886,CPT,US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ,,,20 ,,RBRVS,0.62 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76886,CPT,US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ,26,,20 ,,RBRVS,0.62 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76886,CPT,US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ,TC,,20 ,,RBRVS,,2.25 ,2.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,,,20 ,,RBRVS,0.67 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,26,,20 ,,RBRVS,0.67 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,TC,,20 ,,RBRVS,,1.60 ,1.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,,,20 ,,TotalUnits,,,,2.60 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,26,,20 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,TC,,20 ,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,,,20 ,,RBRVS,1.99 ,6.69 ,6.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,26,,20 ,,RBRVS,1.99 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,TC,,20 ,,RBRVS,,5.99 ,5.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,,,20 ,,RBRVS,0.30 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,26,,20 ,,RBRVS,0.30 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,,,20 ,,TotalUnits,,,,4.42 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,26,,20 ,,TotalUnits,,,,2.76 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,TC,,20 ,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,,,20 ,,TotalUnits,,,,2.85 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,26,,20 ,,TotalUnits,,,,1.84 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,TC,,20 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76942,CPT,US GUIDANCE NEEDLE PLACEMENT RS&I,,,20 ,,RBRVS,0.67 ,5.35 ,5.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76942,CPT,US GUIDANCE NEEDLE PLACEMENT RS&I,26,,20 ,,RBRVS,0.67 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76942,CPT,US GUIDANCE NEEDLE PLACEMENT RS&I,TC,,20 ,,RBRVS,,5.09 ,5.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I,,,20 ,,TotalUnits,,,,2.71 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I,26,,20 ,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING RS&I,TC,,20 ,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76946,CPT,US GUIDANCE AMNIOCENTESIS RS&I,,,20 ,,RBRVS,0.38 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76946,CPT,US GUIDANCE AMNIOCENTESIS RS&I,26,,20 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76946,CPT,US GUIDANCE AMNIOCENTESIS RS&I,TC,,20 ,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76948,CPT,US GUIDANCE ASPIRATION OVA RS&I,,,20 ,,RBRVS,0.38 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76948,CPT,US GUIDANCE ASPIRATION OVA RS&I,26,,20 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76948,CPT,US GUIDANCE ASPIRATION OVA RS&I,TC,,20 ,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76950,CPT,US GUIDANCE PLACEMENT RADIATION THERAPY FIELDS,,,20 ,,RBRVS,0.58 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76950,CPT,US GUIDANCE PLACEMENT RADIATION THERAPY FIELDS,26,,20 ,,RBRVS,0.58 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76950,CPT,US GUIDANCE PLACEMENT RADIATION THERAPY FIELDS,TC,,20 ,,RBRVS,,0.77 ,0.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,,,20 ,,RBRVS,1.34 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,26,,20 ,,RBRVS,1.34 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,TC,,20 ,,RBRVS,,1.08 ,1.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76970,CPT,US STUDY FOLLOW UP,,,20 ,,RBRVS,0.40 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76970,CPT,US STUDY FOLLOW UP,26,,20 ,,RBRVS,0.40 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76970,CPT,US STUDY FOLLOW UP,TC,,20 ,,RBRVS,,2.43 ,2.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76975,CPT,GI ENDOSCOPIC ULTRASOUND RS&I,,,20 ,,TotalUnits,,,,4.50 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76975,CPT,GI ENDOSCOPIC ULTRASOUND RS&I,26,,20 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76975,CPT,GI ENDOSCOPIC ULTRASOUND RS&I,TC,,20 ,,TotalUnits,,,,3.31 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHO,,,20 ,,RBRVS,0.05 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHO,26,,20 ,,RBRVS,0.05 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHO,TC,,20 ,,RBRVS,,0.17 ,0.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,76998,CPT,ULTRASONIC GUIDANCE INTRAOPERATIVE,,,20 ,,TotalUnits,,,,6.78 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76998,CPT,ULTRASONIC GUIDANCE INTRAOPERATIVE,26,,20 ,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,76998,CPT,ULTRASONIC GUIDANCE INTRAOPERATIVE,TC,,20 ,,TotalUnits,,,,5.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,76999,CPT,UNLISTED ULTRASOUND PROCEDURE,,,20 ,,TotalUnits,,,,2.74 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,76999,CPT,UNLISTED ULTRASOUND PROCEDURE,,PC,20 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,76999,CPT,UNLISTED ULTRASOUND PROCEDURE,,TC,20 ,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,,,20 ,,RBRVS,0.38 ,3.09 ,3.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,26,,20 ,,RBRVS,0.38 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,TC,,20 ,,RBRVS,,2.95 ,2.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,,,20 ,,RBRVS,0.54 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,26,,20 ,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,TC,,20 ,,RBRVS,,1.49 ,1.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,,,20 ,,RBRVS,0.60 ,1.26 ,1.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,26,,20 ,,RBRVS,0.60 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,TC,,20 ,,RBRVS,,1.01 ,1.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,,20 ,,RBRVS,1.21 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,PC,20 ,,RBRVS,1.21 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,TC,20 ,,RBRVS,,8.84 ,8.84 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,,20 ,,RBRVS,1.16 ,3.11 ,3.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,PC,20 ,,RBRVS,1.16 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,TC,20 ,,RBRVS,,2.68 ,2.68 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,,20 ,,TotalUnits,,,,23.76 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,PC,20 ,,TotalUnits,,,,5.47 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,TC,20 ,,TotalUnits,,,,18.29 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,,20 ,,RBRVS,0.85 ,3.32 ,3.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,PC,20 ,,RBRVS,0.85 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,TC,20 ,,RBRVS,,2.98 ,2.98 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,,,20 ,,RBRVS,1.50 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,26,,20 ,,RBRVS,1.50 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,TC,,20 ,,RBRVS,,10.06 ,10.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,,,20 ,,TotalUnits,,,,28.62 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,26,,20 ,,TotalUnits,,,,5.76 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,TC,,20 ,,TotalUnits,,,,22.86 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,77031,CPT,STRTCTC LOCLZJ GID BREAST BX/NEEDLE PLACEMENT,,,20 ,,RBRVS,1.59 ,2.57 ,2.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77031,CPT,STRTCTC LOCLZJ GID BREAST BX/NEEDLE PLACEMENT,26,,20 ,,RBRVS,1.59 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77031,CPT,STRTCTC LOCLZJ GID BREAST BX/NEEDLE PLACEMENT,TC,,20 ,,RBRVS,,1.97 ,1.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77032,CPT,MAMMOGRAPHIC GID NEEDLE PLACEMENTT BREAST,,,20 ,,RBRVS,0.56 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77032,CPT,MAMMOGRAPHIC GID NEEDLE PLACEMENTT BREAST,26,,20 ,,RBRVS,0.56 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77032,CPT,MAMMOGRAPHIC GID NEEDLE PLACEMENTT BREAST,TC,,20 ,,RBRVS,,0.78 ,0.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77051,CPT,COMPUTER-AIDED DETECTION DX MAMMOGRAPHY,,,20 ,,RBRVS,0.06 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77051,CPT,COMPUTER-AIDED DETECTION DX MAMMOGRAPHY,26,,20 ,,RBRVS,0.06 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77051,CPT,COMPUTER-AIDED DETECTION DX MAMMOGRAPHY,TC,,20 ,,RBRVS,,0.22 ,0.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77052,CPT,COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY,,,20 ,,RBRVS,0.06 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77052,CPT,COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY,26,,20 ,,RBRVS,0.06 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77052,CPT,COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY,TC,,20 ,,RBRVS,,0.22 ,0.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,,,20 ,,RBRVS,0.36 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,26,,20 ,,RBRVS,0.36 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,TC,,20 ,,RBRVS,,1.36 ,1.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,,,20 ,,RBRVS,0.45 ,2.06 ,2.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,26,,20 ,,RBRVS,0.45 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,TC,,20 ,,RBRVS,,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77055,CPT,MAMMOGRAPHY UNILATERAL,,,20 ,,RBRVS,0.70 ,1.83 ,1.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77055,CPT,MAMMOGRAPHY UNILATERAL,26,,20 ,,RBRVS,0.70 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77055,CPT,MAMMOGRAPHY UNILATERAL,TC,,20 ,,RBRVS,,1.56 ,1.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77056,CPT,MAMMOGRAPHY BILATERAL,,,20 ,,RBRVS,0.87 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77056,CPT,MAMMOGRAPHY BILATERAL,26,,20 ,,RBRVS,0.87 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77056,CPT,MAMMOGRAPHY BILATERAL,TC,,20 ,,RBRVS,,2.04 ,2.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77057,CPT,SCREENING MAMMOGRAPHY BILATERAL,,,20 ,,RBRVS,0.70 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77057,CPT,SCREENING MAMMOGRAPHY BILATERAL,26,,20 ,,RBRVS,0.70 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77057,CPT,SCREENING MAMMOGRAPHY BILATERAL,TC,,20 ,,RBRVS,,1.37 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77058,CPT,MRI BREAST UNILATERAL,,,20 ,,RBRVS,1.63 ,18.93 ,18.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77058,CPT,MRI BREAST UNILATERAL,26,,20 ,,RBRVS,1.63 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77058,CPT,MRI BREAST UNILATERAL,TC,,20 ,,RBRVS,,18.32 ,18.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77059,CPT,MRI BREAST BILATERAL,,,20 ,,RBRVS,1.63 ,19.32 ,19.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77059,CPT,MRI BREAST BILATERAL,26,,20 ,,RBRVS,1.63 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77059,CPT,MRI BREAST BILATERAL,TC,,20 ,,RBRVS,,18.72 ,18.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77071,CPT,MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS,,PC,20 ,,RBRVS,0.41 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77072,CPT,BONE AGE STUDIES,,,20 ,,RBRVS,0.19 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77072,CPT,BONE AGE STUDIES,26,,20 ,,RBRVS,0.19 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77072,CPT,BONE AGE STUDIES,TC,,20 ,,RBRVS,,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77073,CPT,BONE LENGTH STUDIES,,,20 ,,RBRVS,0.27 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77073,CPT,BONE LENGTH STUDIES,26,,20 ,,RBRVS,0.27 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77073,CPT,BONE LENGTH STUDIES,TC,,20 ,,RBRVS,,0.72 ,0.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,,,20 ,,RBRVS,0.45 ,1.59 ,1.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,26,,20 ,,RBRVS,0.45 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,TC,,20 ,,RBRVS,,1.42 ,1.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,,,20 ,,RBRVS,0.54 ,2.53 ,2.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,26,,20 ,,RBRVS,0.54 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,TC,,20 ,,RBRVS,,2.32 ,2.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,,,20 ,,RBRVS,0.70 ,2.47 ,2.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,26,,20 ,,RBRVS,0.70 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,TC,,20 ,,RBRVS,,2.20 ,2.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,,,20 ,,RBRVS,0.31 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,26,,20 ,,RBRVS,0.31 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,TC,,20 ,,RBRVS,,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,,,20 ,,RBRVS,0.25 ,4.12 ,4.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,26,,20 ,,RBRVS,0.25 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,TC,,20 ,,RBRVS,,4.03 ,4.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,,,20 ,,RBRVS,0.20 ,1.45 ,1.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,TC,,20 ,,RBRVS,,1.37 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,,,20 ,,RBRVS,0.22 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,TC,,20 ,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77082,CPT,DXA BONE DENSITY STUDY VERTEBRAL FRACTURE,,,20 ,,RBRVS,0.17 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77082,CPT,DXA BONE DENSITY STUDY VERTEBRAL FRACTURE,26,,20 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77082,CPT,DXA BONE DENSITY STUDY VERTEBRAL FRACTURE,TC,,20 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77084,CPT,BONE MARROW BLOOD SUPPLY,,,20 ,,RBRVS,1.60 ,12.74 ,12.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77084,CPT,BONE MARROW BLOOD SUPPLY,26,,20 ,,RBRVS,1.60 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77084,CPT,BONE MARROW BLOOD SUPPLY,TC,,20 ,,RBRVS,,12.14 ,12.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77261,CPT,THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE,,PC,20 ,,RBRVS,1.39 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77262,CPT,THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE,,PC,20 ,,RBRVS,2.11 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77263,CPT,THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX,,PC,20 ,,RBRVS,3.14 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,,,20 ,,RBRVS,0.70 ,4.77 ,4.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,26,,20 ,,RBRVS,0.70 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,TC,,20 ,,RBRVS,,4.49 ,4.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,,,20 ,,RBRVS,1.05 ,8.62 ,8.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,26,,20 ,,RBRVS,1.05 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,TC,,20 ,,RBRVS,,8.20 ,8.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,,,20 ,,RBRVS,1.56 ,14.11 ,14.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,26,,20 ,,RBRVS,1.56 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,TC,,20 ,,RBRVS,,13.49 ,13.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77295,CPT,THER RAD SIMULAJ-AIDED FLD SETTING 3-DIMENSIONAL,,,20 ,,RBRVS,4.56 ,9.85 ,9.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77295,CPT,THER RAD SIMULAJ-AIDED FLD SETTING 3-DIMENSIONAL,26,,20 ,,RBRVS,4.56 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77295,CPT,THER RAD SIMULAJ-AIDED FLD SETTING 3-DIMENSIONAL,TC,,20 ,,RBRVS,,8.04 ,8.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,,,20 ,,TotalUnits,,,,10.22 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,26,,20 ,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,TC,,20 ,,TotalUnits,,,,8.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,,,20 ,,RBRVS,0.62 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,26,,20 ,,RBRVS,0.62 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,TC,,20 ,,RBRVS,,1.08 ,1.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,,,20 ,,RBRVS,7.99 ,49.69 ,49.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,26,,20 ,,RBRVS,7.99 ,3.17 ,3.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,TC,,20 ,,RBRVS,,46.52 ,46.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77305,CPT,TELETHERAPY ISODOSE PLAN SIMPLE,,,20 ,,RBRVS,0.70 ,1.09 ,1.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77305,CPT,TELETHERAPY ISODOSE PLAN SIMPLE,26,,20 ,,RBRVS,0.70 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77305,CPT,TELETHERAPY ISODOSE PLAN SIMPLE,TC,,20 ,,RBRVS,,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77310,CPT,TELETHERAPY ISODOSE PLAN INTERMEDIATE,,,20 ,,RBRVS,1.05 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77310,CPT,TELETHERAPY ISODOSE PLAN INTERMEDIATE,26,,20 ,,RBRVS,1.05 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77310,CPT,TELETHERAPY ISODOSE PLAN INTERMEDIATE,TC,,20 ,,RBRVS,,1.08 ,1.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77315,CPT,TELETHERAPY ISODOSE PLAN COMPLETE,,,20 ,,RBRVS,1.56 ,2.40 ,2.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77315,CPT,TELETHERAPY ISODOSE PLAN COMPLETE,26,,20 ,,RBRVS,1.56 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77315,CPT,TELETHERAPY ISODOSE PLAN COMPLETE,TC,,20 ,,RBRVS,,1.78 ,1.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,,,20 ,,RBRVS,0.95 ,1.89 ,1.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,26,,20 ,,RBRVS,0.95 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,TC,,20 ,,RBRVS,,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77326,CPT,BRACHYTHERAPY ISODOSE PLAN SIMPLE,,,20 ,,RBRVS,0.93 ,3.23 ,3.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77326,CPT,BRACHYTHERAPY ISODOSE PLAN SIMPLE,26,,20 ,,RBRVS,0.93 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77326,CPT,BRACHYTHERAPY ISODOSE PLAN SIMPLE,TC,,20 ,,RBRVS,,2.86 ,2.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77327,CPT,BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE,,,20 ,,RBRVS,1.39 ,4.46 ,4.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77327,CPT,BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE,26,,20 ,,RBRVS,1.39 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77327,CPT,BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE,TC,,20 ,,RBRVS,,3.91 ,3.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77328,CPT,BRACHYTHERAPY ISODOSE PLAN COMPLEX,,,20 ,,RBRVS,2.09 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77328,CPT,BRACHYTHERAPY ISODOSE PLAN COMPLEX,26,,20 ,,RBRVS,2.09 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77328,CPT,BRACHYTHERAPY ISODOSE PLAN COMPLEX,TC,,20 ,,RBRVS,,4.92 ,4.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,,,20 ,,RBRVS,0.87 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,26,,20 ,,RBRVS,0.87 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,TC,,20 ,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,,,20 ,,RBRVS,0.54 ,1.69 ,1.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,26,,20 ,,RBRVS,0.54 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,TC,,20 ,,RBRVS,,1.48 ,1.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,,,20 ,,RBRVS,0.84 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,26,,20 ,,RBRVS,0.84 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,TC,,20 ,,RBRVS,,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,,,20 ,,RBRVS,1.24 ,3.06 ,3.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,26,,20 ,,RBRVS,1.24 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,TC,,20 ,,RBRVS,,2.57 ,2.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77336,CPT,CONTINUING MEDICAL PHYSICS CONSLTJ PR WK,,TC,20 ,,RBRVS,,1.36 ,1.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,,20 ,,RBRVS,4.29 ,9.88 ,9.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,PC,20 ,,RBRVS,4.29 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,TC,20 ,,RBRVS,,8.21 ,8.21 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,77370,CPT,SPEC MEDICAL RADJ PHYSICS CONSLTJ,,TC,20 ,,RBRVS,,3.29 ,3.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77371,CPT,RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT,,TC,20 ,,RBRVS,6.73 ,33.56 ,33.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77372,CPT,RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR,,TC,20 ,,RBRVS,,24.56 ,24.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77373,CPT,STEREOTACTIC BODY RADIATION DELIVERY,,TC,20 ,,RBRVS,,46.82 ,46.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,,20 ,,TotalUnits,,,,6.39 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,PC,20 ,,TotalUnits,,,,2.55 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,TC,20 ,,TotalUnits,,,,3.84 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,77401,CPT,RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA,,TC,20 ,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77402,CPT,RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL <5MEV,,TC,20 ,,RBRVS,,5.37 ,5.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77403,CPT,RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 6-10MEV,,TC,20 ,,RBRVS,,3.92 ,3.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77404,CPT,RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 11-19MEV,,TC,20 ,,RBRVS,,4.38 ,4.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77406,CPT,RADJ DLVR 1 AREA 1/PRLL OPSD PORTS SMPL 20MEV/<,,TC,20 ,,RBRVS,,4.46 ,4.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77407,CPT,RADJ DLVR 2 AREAS 3/>PORTS 1 MLT BLKS <5MEV,,TC,20 ,,RBRVS,,7.42 ,7.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77408,CPT,RADJ DLVR 2 AREAS 3/>PORTS 1 MLT BLKS 6-1MEV,,TC,20 ,,RBRVS,,5.37 ,5.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77409,CPT,RADJ DLVR 2 AREAS 3/>PORTS 1 MLT BLKS 11-19MEV,,TC,20 ,,RBRVS,,5.98 ,5.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77411,CPT,RADJ DLVR 2 AREAS 3/> PORTS 1 TX AREA 20 MEV/<,,TC,20 ,,RBRVS,,5.95 ,5.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77412,CPT,RADJ DLVR 3/> AREAS CUSTOM BLKING <5MEV,,TC,20 ,,RBRVS,,7.14 ,7.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77413,CPT,RADJ DLVR 3/> AREAS CUSTOM BLKING 6-10MEV,,TC,20 ,,RBRVS,,7.07 ,7.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77414,CPT,RADJ DLVR 3/> AREAS CUSTOM BLKING 11-19MEV,,TC,20 ,,RBRVS,,7.94 ,7.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77416,CPT,RADJ DLVR 3/> AREAS CUSTOM BLKING 20MEV/<,,TC,20 ,,RBRVS,,7.97 ,7.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77417,CPT,THERAPEUTIC RADIOLOGY PORT FILMS,,TC,20 ,,RBRVS,,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,0,1,1,20131001,77418,CPT,NTSTY MODUL DLVR 1/MLT FLDS/ARCS PR TX SESSION,,TC,20 ,,RBRVS,,13.97 ,13.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77421,CPT,STRSC X-RAY GDN LOCLZJ TARGET VOL DLVR RADJ THER,,,20 ,,RBRVS,0.39 ,2.13 ,2.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77421,CPT,STRSC X-RAY GDN LOCLZJ TARGET VOL DLVR RADJ THER,26,,20 ,,RBRVS,0.39 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77421,CPT,STRSC X-RAY GDN LOCLZJ TARGET VOL DLVR RADJ THER,TC,,20 ,,RBRVS,,1.98 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77422,CPT,HIGH ENERGY NEUTRON RADJ TX DLVR 1 TX AREA,,TC,20 ,,RBRVS,,7.42 ,7.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77423,CPT,HIGH ENERGY NEUTRON RADJ TX DLVR 1/> ISOCENTER,,TC,20 ,,RBRVS,,7.68 ,7.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77427,CPT,RADIATION TREATMENT MANAGEMENT 5 TREATMENTS,,PC,20 ,,RBRVS,3.37 ,1.56 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77431,CPT,RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY,,PC,20 ,,RBRVS,1.81 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77432,CPT,STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION,,PC,20 ,,RBRVS,7.92 ,3.18 ,3.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77435,CPT,STEREOTACTIC BODY RADIATION MANAGEMENT,,PC,20 ,,RBRVS,11.87 ,4.76 ,5.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77469,CPT,INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT,,,20 ,,RBRVS,5.75 ,2.52 ,2.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77470,CPT,SPECIAL TREATMENT PROCEDURE,,,20 ,,RBRVS,2.09 ,2.90 ,2.90 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77470,CPT,SPECIAL TREATMENT PROCEDURE,26,,20 ,,RBRVS,2.09 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77470,CPT,SPECIAL TREATMENT PROCEDURE,TC,,20 ,,RBRVS,,2.07 ,2.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,,20 ,,TotalUnits,,,,7.94 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,PC,20 ,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,TC,20 ,,TotalUnits,,,,6.58 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,77520,CPT,PROTON TX DELIVERY SIMPLE W/O COMPENSATION,,TC,20 ,,TotalUnits,,,,17.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,77522,CPT,PROTON TX DELIVERY SIMPLE W/COMPENSATION,,TC,20 ,,TotalUnits,,,,22.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,77523,CPT,PROTON TX DELIVERY INTERMEDIATE,,TC,20 ,,TotalUnits,,,,23.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,77525,CPT,PROTON TX DELIVERY COMPLEX,,TC,20 ,,TotalUnits,,,,28.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,,,20 ,,RBRVS,1.56 ,10.58 ,10.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,26,,20 ,,RBRVS,1.56 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,TC,,20 ,,RBRVS,,9.96 ,9.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,,,20 ,,RBRVS,2.09 ,18.21 ,18.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,26,,20 ,,RBRVS,2.09 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,TC,,20 ,,RBRVS,,17.41 ,17.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,,,20 ,,RBRVS,1.56 ,17.82 ,17.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,26,,20 ,,RBRVS,1.56 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,TC,,20 ,,RBRVS,,17.22 ,17.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,,,20 ,,RBRVS,2.09 ,26.83 ,26.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,26,,20 ,,RBRVS,2.09 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,TC,,20 ,,RBRVS,,26.00 ,26.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,,,20 ,,RBRVS,1.56 ,14.46 ,14.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,26,,20 ,,RBRVS,1.56 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,TC,,20 ,,RBRVS,,13.84 ,13.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,,,20 ,,RBRVS,5.00 ,5.00 ,5.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,26,,20 ,,RBRVS,5.00 ,1.98 ,1.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,TC,,20 ,,RBRVS,,3.02 ,3.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,,,20 ,,RBRVS,3.85 ,6.73 ,6.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,26,,20 ,,RBRVS,3.85 ,1.50 ,1.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,TC,,20 ,,RBRVS,,5.23 ,5.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,,,20 ,,RBRVS,5.76 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,26,,20 ,,RBRVS,5.76 ,2.28 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,TC,,20 ,,RBRVS,,6.03 ,6.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,,,20 ,,RBRVS,8.66 ,11.25 ,11.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,26,,20 ,,RBRVS,8.66 ,3.42 ,3.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,TC,,20 ,,RBRVS,,7.83 ,7.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77776,CPT,INTERSTITIAL RADIATION SOURCE APPLIC SIMPLE,,,20 ,,RBRVS,4.70 ,7.19 ,7.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77776,CPT,INTERSTITIAL RADIATION SOURCE APPLIC SIMPLE,26,,20 ,,RBRVS,4.70 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77776,CPT,INTERSTITIAL RADIATION SOURCE APPLIC SIMPLE,TC,,20 ,,RBRVS,,5.33 ,5.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77777,CPT,INTERSTITIAL RADIATION SOURCE APPLIC INTERMED,,,20 ,,RBRVS,7.52 ,8.59 ,8.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77777,CPT,INTERSTITIAL RADIATION SOURCE APPLIC INTERMED,26,,20 ,,RBRVS,7.52 ,3.03 ,3.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77777,CPT,INTERSTITIAL RADIATION SOURCE APPLIC INTERMED,TC,,20 ,,RBRVS,,5.56 ,5.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,,,20 ,,RBRVS,11.32 ,12.46 ,12.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,26,,20 ,,RBRVS,11.32 ,4.45 ,4.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,TC,,20 ,,RBRVS,,8.01 ,8.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77785,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 1 CHANNEL,,,20 ,,RBRVS,1.42 ,5.34 ,5.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77785,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 1 CHANNEL,26,,20 ,,RBRVS,1.42 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77785,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 1 CHANNEL,TC,,20 ,,RBRVS,,4.77 ,4.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77786,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 2-12 CHANNEL,,,20 ,,RBRVS,3.25 ,13.04 ,13.04 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77786,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 2-12 CHANNEL,26,,20 ,,RBRVS,3.25 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77786,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX 2-12 CHANNEL,TC,,20 ,,RBRVS,,11.77 ,11.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77787,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX > 12 CHANNEL,,,20 ,,RBRVS,4.89 ,22.12 ,22.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77787,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX > 12 CHANNEL,26,,20 ,,RBRVS,4.89 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77787,CPT,REMOTE AFTLD RADIONUCLIDE BRACHYTX > 12 CHANNEL,TC,,20 ,,RBRVS,,20.15 ,20.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77789,CPT,SURFACE APPLICATION RADIATION SOURCE,,,20 ,,RBRVS,1.14 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77789,CPT,SURFACE APPLICATION RADIATION SOURCE,26,,20 ,,RBRVS,1.14 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77789,CPT,SURFACE APPLICATION RADIATION SOURCE,TC,,20 ,,RBRVS,,1.62 ,1.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,,,20 ,,RBRVS,1.05 ,1.57 ,1.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,26,,20 ,,RBRVS,1.05 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,TC,,20 ,,RBRVS,,1.16 ,1.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,,,20 ,,TotalUnits,,,,11.32 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,26,,20 ,,TotalUnits,,,,5.25 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,TC,,20 ,,TotalUnits,,,,6.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78012,CPT,THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT,,,20 ,,RBRVS,0.19 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78012,CPT,THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT,26,,20 ,,RBRVS,0.19 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78012,CPT,THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT,TC,,20 ,,RBRVS,,2.17 ,2.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78013,CPT,THYROID IMAGING WITH VASCULAR FLOW,,,20 ,,RBRVS,0.37 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78013,CPT,THYROID IMAGING WITH VASCULAR FLOW,26,,20 ,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78013,CPT,THYROID IMAGING WITH VASCULAR FLOW,TC,,20 ,,RBRVS,,5.64 ,5.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78014,CPT,THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS,,,20 ,,RBRVS,0.50 ,6.61 ,6.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78014,CPT,THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS,26,,20 ,,RBRVS,0.50 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78014,CPT,THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS,TC,,20 ,,RBRVS,,6.44 ,6.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,,,20 ,,RBRVS,0.67 ,5.77 ,5.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,26,,20 ,,RBRVS,0.67 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,TC,,20 ,,RBRVS,,5.54 ,5.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,,,20 ,,RBRVS,0.82 ,8.03 ,8.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,26,,20 ,,RBRVS,0.82 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,TC,,20 ,,RBRVS,,7.83 ,7.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,,,20 ,,RBRVS,0.86 ,8.56 ,8.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,26,,20 ,,RBRVS,0.86 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,TC,,20 ,,RBRVS,,8.27 ,8.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,,,20 ,,RBRVS,0.60 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,26,,20 ,,RBRVS,0.60 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,TC,,20 ,,RBRVS,,1.67 ,1.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78070,CPT,PARATHYROID PLANAR IMAGING,,,20 ,,RBRVS,0.82 ,3.85 ,3.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78070,CPT,PARATHYROID PLANAR IMAGING,26,,20 ,,RBRVS,0.82 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78070,CPT,PARATHYROID PLANAR IMAGING,TC,,20 ,,RBRVS,,3.56 ,3.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78071,CPT,PARATHYROID PLANAR IMAGING W/WO SUBTRACTION,,,20 ,,RBRVS,1.20 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78071,CPT,PARATHYROID PLANAR IMAGING W/WO SUBTRACTION,26,,20 ,,RBRVS,1.20 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78071,CPT,PARATHYROID PLANAR IMAGING W/WO SUBTRACTION,TC,,20 ,,RBRVS,,8.99 ,8.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78072,CPT,PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT,26,,20 ,,RBRVS,1.60 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,,,20 ,,RBRVS,0.74 ,11.92 ,11.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,26,,20 ,,RBRVS,0.74 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,TC,,20 ,,RBRVS,,11.68 ,11.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,4.80 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,4.02 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78102,CPT,BONE MARROW IMAGING LIMITED AREA,,,20 ,,RBRVS,0.55 ,4.41 ,4.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78102,CPT,BONE MARROW IMAGING LIMITED AREA,26,,20 ,,RBRVS,0.55 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78102,CPT,BONE MARROW IMAGING LIMITED AREA,TC,,20 ,,RBRVS,,4.22 ,4.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,,,20 ,,RBRVS,0.75 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,26,,20 ,,RBRVS,0.75 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,TC,,20 ,,RBRVS,,5.55 ,5.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78104,CPT,BONE MARROW IMAGING WHOLE BODY,,,20 ,,RBRVS,0.80 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78104,CPT,BONE MARROW IMAGING WHOLE BODY,26,,20 ,,RBRVS,0.80 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78104,CPT,BONE MARROW IMAGING WHOLE BODY,TC,,20 ,,RBRVS,,6.26 ,6.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,,,20 ,,RBRVS,0.19 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,26,,20 ,,RBRVS,0.19 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,TC,,20 ,,RBRVS,,2.23 ,2.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,,,20 ,,RBRVS,0.22 ,2.22 ,2.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,26,,20 ,,RBRVS,0.22 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,TC,,20 ,,RBRVS,,2.16 ,2.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,,,20 ,,RBRVS,0.23 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,26,,20 ,,RBRVS,0.23 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,TC,,20 ,,RBRVS,,2.26 ,2.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,,,20 ,,RBRVS,0.32 ,2.56 ,2.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,26,,20 ,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,TC,,20 ,,RBRVS,,2.44 ,2.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU,,,20 ,,RBRVS,0.45 ,2.56 ,2.56 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU,26,,20 ,,RBRVS,0.45 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU,TC,,20 ,,RBRVS,,2.41 ,2.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78130,CPT,RED CELL SURVIVAL STUDY,,,20 ,,RBRVS,0.61 ,3.94 ,3.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78130,CPT,RED CELL SURVIVAL STUDY,26,,20 ,,RBRVS,0.61 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78130,CPT,RED CELL SURVIVAL STUDY,TC,,20 ,,RBRVS,,3.70 ,3.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,,,20 ,,RBRVS,0.64 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,26,,20 ,,RBRVS,0.64 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,TC,,20 ,,RBRVS,,9.80 ,9.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,,,20 ,,RBRVS,0.61 ,3.35 ,3.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,26,,20 ,,RBRVS,0.61 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,TC,,20 ,,RBRVS,,3.12 ,3.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,,,20 ,,RBRVS,0.40 ,5.78 ,5.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,26,,20 ,,RBRVS,0.40 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,TC,,20 ,,RBRVS,,5.63 ,5.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,,,20 ,,RBRVS,1.09 ,11.09 ,11.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,26,,20 ,,RBRVS,1.09 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,TC,,20 ,,RBRVS,,10.64 ,10.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78191,CPT,PLATELET SURVIVAL STUDY,,,20 ,,RBRVS,0.61 ,4.26 ,4.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78191,CPT,PLATELET SURVIVAL STUDY,26,,20 ,,RBRVS,0.61 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78191,CPT,PLATELET SURVIVAL STUDY,TC,,20 ,,RBRVS,,4.03 ,4.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,,,20 ,,RBRVS,1.20 ,9.40 ,9.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,26,,20 ,,RBRVS,1.20 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,TC,,20 ,,RBRVS,,8.97 ,8.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,,,20 ,,TotalUnits,,,,7.32 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,26,,20 ,,TotalUnits,,,,1.37 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,TC,,20 ,,TotalUnits,,,,5.95 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78201,CPT,LIVER IMAGING STATIC ONLY,,,20 ,,RBRVS,0.44 ,5.03 ,5.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78201,CPT,LIVER IMAGING STATIC ONLY,26,,20 ,,RBRVS,0.44 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78201,CPT,LIVER IMAGING STATIC ONLY,TC,,20 ,,RBRVS,,4.89 ,4.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78202,CPT,LIVER IMAGING W/VASCULAR FLOW,,,20 ,,RBRVS,0.51 ,5.61 ,5.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78202,CPT,LIVER IMAGING W/VASCULAR FLOW,26,,20 ,,RBRVS,0.51 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78202,CPT,LIVER IMAGING W/VASCULAR FLOW,TC,,20 ,,RBRVS,,5.45 ,5.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78205,CPT,LIVER IMAGING SPECT,,,20 ,,RBRVS,0.71 ,5.80 ,5.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78205,CPT,LIVER IMAGING SPECT,26,,20 ,,RBRVS,0.71 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78205,CPT,LIVER IMAGING SPECT,TC,,20 ,,RBRVS,,5.56 ,5.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,,,20 ,,RBRVS,0.96 ,9.35 ,9.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,26,,20 ,,RBRVS,0.96 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,TC,,20 ,,RBRVS,,9.01 ,9.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,,,20 ,,RBRVS,0.49 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,26,,20 ,,RBRVS,0.49 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,TC,,20 ,,RBRVS,,5.07 ,5.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,,,20 ,,RBRVS,0.57 ,3.10 ,3.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,26,,20 ,,RBRVS,0.57 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,TC,,20 ,,RBRVS,,2.91 ,2.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,,,20 ,,RBRVS,0.74 ,8.84 ,8.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,26,,20 ,,RBRVS,0.74 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,TC,,20 ,,RBRVS,,8.59 ,8.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,,,20 ,,RBRVS,0.90 ,12.23 ,12.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,26,,20 ,,RBRVS,0.90 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,TC,,20 ,,RBRVS,,11.93 ,11.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78230,CPT,SALIVARY GLAND IMAGING,,,20 ,,RBRVS,0.45 ,4.58 ,4.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78230,CPT,SALIVARY GLAND IMAGING,26,,20 ,,RBRVS,0.45 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78230,CPT,SALIVARY GLAND IMAGING,TC,,20 ,,RBRVS,,4.41 ,4.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,,,20 ,,RBRVS,0.52 ,3.20 ,3.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,26,,20 ,,RBRVS,0.52 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,TC,,20 ,,RBRVS,,3.00 ,3.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78232,CPT,SALIVARY GLAND FUNCTION STUDY,,,20 ,,RBRVS,0.47 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78232,CPT,SALIVARY GLAND FUNCTION STUDY,26,,20 ,,RBRVS,0.47 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78232,CPT,SALIVARY GLAND FUNCTION STUDY,TC,,20 ,,RBRVS,,2.53 ,2.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78258,CPT,ESOPHAGEAL MOTILITY,,,20 ,,RBRVS,0.74 ,6.15 ,6.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78258,CPT,ESOPHAGEAL MOTILITY,26,,20 ,,RBRVS,0.74 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78258,CPT,ESOPHAGEAL MOTILITY,TC,,20 ,,RBRVS,,5.87 ,5.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78261,CPT,GASTRIC MUCOSA IMAGING,,,20 ,,RBRVS,0.69 ,6.79 ,6.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78261,CPT,GASTRIC MUCOSA IMAGING,26,,20 ,,RBRVS,0.69 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78261,CPT,GASTRIC MUCOSA IMAGING,TC,,20 ,,RBRVS,,6.53 ,6.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,,,20 ,,RBRVS,0.68 ,6.77 ,6.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,26,,20 ,,RBRVS,0.68 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,TC,,20 ,,RBRVS,,6.52 ,6.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78264,CPT,GASTRIC EMPTYING STUDY,,,20 ,,RBRVS,0.80 ,7.80 ,7.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78264,CPT,GASTRIC EMPTYING STUDY,26,,20 ,,RBRVS,0.80 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78264,CPT,GASTRIC EMPTYING STUDY,TC,,20 ,,RBRVS,,7.51 ,7.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78267,CPT,UREA BREATH TEST C-14 ISOTOPIC ACQUISJ ANALYSIS,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78268,CPT,UREA BREATH TEST C-14 ISOTOPIC ANALYSIS,,,17 ,,TotalUnits,,,,2.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,,,20 ,,RBRVS,0.20 ,2.24 ,2.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,TC,,20 ,,RBRVS,,2.16 ,2.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,,,20 ,,RBRVS,0.20 ,2.42 ,2.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,26,,20 ,,RBRVS,0.20 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,TC,,20 ,,RBRVS,,2.34 ,2.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78272,CPT,VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT,,,20 ,,RBRVS,0.27 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78272,CPT,VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT,26,,20 ,,RBRVS,0.27 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78272,CPT,VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT,TC,,20 ,,RBRVS,,2.27 ,2.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,,,20 ,,RBRVS,0.99 ,9.38 ,9.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,26,,20 ,,RBRVS,0.99 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,TC,,20 ,,RBRVS,,9.02 ,9.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78282,CPT,GASTROINTESTINAL PROTEIN LOSS,,,20 ,,RBRVS,0.38 ,1.71 ,1.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78282,CPT,GASTROINTESTINAL PROTEIN LOSS,26,,20 ,,RBRVS,0.38 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78282,CPT,GASTROINTESTINAL PROTEIN LOSS,TC,,20 ,,RBRVS,,1.57 ,1.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78290,CPT,INTESTINE IMAGING,,,20 ,,RBRVS,0.68 ,9.15 ,9.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78290,CPT,INTESTINE IMAGING,26,,20 ,,RBRVS,0.68 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78290,CPT,INTESTINE IMAGING,TC,,20 ,,RBRVS,,8.90 ,8.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,,,20 ,,RBRVS,0.88 ,6.65 ,6.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,26,,20 ,,RBRVS,0.88 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,TC,,20 ,,RBRVS,,6.34 ,6.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,,,20 ,,RBRVS,0.62 ,4.65 ,4.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,26,,20 ,,RBRVS,0.62 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,TC,,20 ,,RBRVS,,4.42 ,4.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,,,20 ,,RBRVS,0.83 ,6.13 ,6.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,26,,20 ,,RBRVS,0.83 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,TC,,20 ,,RBRVS,,5.83 ,5.83 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,,,20 ,,RBRVS,0.86 ,6.64 ,6.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,26,,20 ,,RBRVS,0.86 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,TC,,20 ,,RBRVS,,6.33 ,6.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,,,20 ,,RBRVS,1.02 ,9.34 ,9.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,26,,20 ,,RBRVS,1.02 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,TC,,20 ,,RBRVS,,8.97 ,8.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,,,20 ,,RBRVS,1.04 ,5.92 ,5.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,26,,20 ,,RBRVS,1.04 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,TC,,20 ,,RBRVS,,5.56 ,5.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,,,20 ,,RBRVS,0.22 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,TC,,20 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78351,CPT,BONE DENSTY 1/> SITES DUAL PHOTON ABSORPTIOMETR,,,20 ,,RBRVS,0.30 ,0.13 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,8.91 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,PC,20 ,,TotalUnits,,,,1.39 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,TC,20 ,,TotalUnits,,,,7.52 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,,,20 ,,TotalUnits,,,,1.84 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,26,,20 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,TC,,20 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78428,CPT,CARDIAC SHUNT DETECTION,,,20 ,,RBRVS,0.78 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78428,CPT,CARDIAC SHUNT DETECTION,26,,20 ,,RBRVS,0.78 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78428,CPT,CARDIAC SHUNT DETECTION,TC,,20 ,,RBRVS,,4.51 ,4.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,,,20 ,,RBRVS,0.49 ,4.66 ,4.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,26,,20 ,,RBRVS,0.49 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,TC,,20 ,,RBRVS,,4.50 ,4.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,,,20 ,,RBRVS,1.38 ,9.14 ,9.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,26,,20 ,,RBRVS,1.38 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,TC,,20 ,,RBRVS,,8.65 ,8.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,,,20 ,,RBRVS,1.62 ,13.08 ,13.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,26,,20 ,,RBRVS,1.62 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,TC,,20 ,,RBRVS,,12.50 ,12.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,,,20 ,,RBRVS,1.00 ,8.06 ,8.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,26,,20 ,,RBRVS,1.00 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,TC,,20 ,,RBRVS,,7.72 ,7.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,,,20 ,,RBRVS,1.34 ,11.63 ,11.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,26,,20 ,,RBRVS,1.34 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,TC,,20 ,,RBRVS,,11.17 ,11.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,,,20 ,,RBRVS,1.00 ,10.27 ,10.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,26,,20 ,,RBRVS,1.00 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,TC,,20 ,,RBRVS,,9.84 ,9.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,,,20 ,,RBRVS,0.77 ,5.23 ,5.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,26,,20 ,,RBRVS,0.77 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,TC,,20 ,,RBRVS,,4.95 ,4.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,,,20 ,,RBRVS,0.90 ,4.69 ,4.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,26,,20 ,,RBRVS,0.90 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,TC,,20 ,,RBRVS,,4.43 ,4.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,,,20 ,,TotalUnits,,,,9.95 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,26,,20 ,,TotalUnits,,,,2.03 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,TC,,20 ,,TotalUnits,,,,7.92 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,,,20 ,,RBRVS,0.69 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,26,,20 ,,RBRVS,0.69 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,TC,,20 ,,RBRVS,,4.24 ,4.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,,,20 ,,RBRVS,0.80 ,5.52 ,5.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,26,,20 ,,RBRVS,0.80 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,TC,,20 ,,RBRVS,,5.19 ,5.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,,,20 ,,RBRVS,0.92 ,6.26 ,6.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,26,,20 ,,RBRVS,0.92 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,TC,,20 ,,RBRVS,,5.89 ,5.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,,,20 ,,RBRVS,0.98 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,26,,20 ,,RBRVS,0.98 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,TC,,20 ,,RBRVS,,5.86 ,5.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,,,20 ,,RBRVS,1.47 ,7.86 ,7.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,26,,20 ,,RBRVS,1.47 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,TC,,20 ,,RBRVS,,7.27 ,7.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,,,20 ,,RBRVS,0.98 ,4.92 ,4.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,26,,20 ,,RBRVS,0.98 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,TC,,20 ,,RBRVS,,4.51 ,4.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,,,20 ,,RBRVS,1.47 ,6.54 ,6.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,26,,20 ,,RBRVS,1.47 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,TC,,20 ,,RBRVS,,5.93 ,5.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,,,20 ,,TotalUnits,,,,10.38 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,26,,20 ,,TotalUnits,,,,2.06 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,TC,,20 ,,TotalUnits,,,,8.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,,,20 ,,TotalUnits,,,,13.17 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,26,,20 ,,TotalUnits,,,,2.61 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,TC,,20 ,,TotalUnits,,,,10.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,,,20 ,,RBRVS,1.19 ,6.12 ,6.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,26,,20 ,,RBRVS,1.19 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,TC,,20 ,,RBRVS,,5.65 ,5.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,,,20 ,,RBRVS,0.50 ,1.35 ,1.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,26,,20 ,,RBRVS,0.50 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,TC,,20 ,,RBRVS,,1.14 ,1.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,5.57 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,3.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78579,CPT,PULMONARY VENTILATION IMAGING,,,20 ,,RBRVS,0.49 ,4.59 ,4.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78579,CPT,PULMONARY VENTILATION IMAGING,26,,20 ,,RBRVS,0.49 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78579,CPT,PULMONARY VENTILATION IMAGING,TC,,20 ,,RBRVS,,4.43 ,4.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,,,20 ,,RBRVS,0.74 ,5.82 ,5.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,26,,20 ,,RBRVS,0.74 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,TC,,20 ,,RBRVS,,5.55 ,5.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,,,20 ,,RBRVS,1.07 ,8.31 ,8.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,26,,20 ,,RBRVS,1.07 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,TC,,20 ,,RBRVS,,7.96 ,7.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,,,20 ,,RBRVS,0.75 ,4.99 ,4.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,26,,20 ,,RBRVS,0.75 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,TC,,20 ,,RBRVS,,4.75 ,4.75 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN,,,20 ,,RBRVS,0.85 ,7.97 ,7.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN,26,,20 ,,RBRVS,0.85 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN,TC,,20 ,,RBRVS,,7.70 ,7.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,6.56 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,5.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,,,20 ,,RBRVS,0.44 ,4.95 ,4.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,26,,20 ,,RBRVS,0.44 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,TC,,20 ,,RBRVS,,4.78 ,4.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,,,20 ,,RBRVS,0.51 ,5.84 ,5.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,26,,20 ,,RBRVS,0.51 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,TC,,20 ,,RBRVS,,5.66 ,5.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,,,20 ,,RBRVS,0.53 ,5.35 ,5.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,26,,20 ,,RBRVS,0.53 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,TC,,20 ,,RBRVS,,5.15 ,5.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,,,20 ,,RBRVS,0.64 ,9.29 ,9.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,26,,20 ,,RBRVS,0.64 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,TC,,20 ,,RBRVS,,9.05 ,9.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,,,20 ,,RBRVS,1.23 ,9.60 ,9.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,26,,20 ,,RBRVS,1.23 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,TC,,20 ,,RBRVS,,9.18 ,9.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,,20 ,,TotalUnits,,,,12.67 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,PC,20 ,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,TC,20 ,,TotalUnits,,,,10.67 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,,20 ,,TotalUnits,,,,8.44 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,PC,20 ,,TotalUnits,,,,2.11 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,TC,20 ,,TotalUnits,,,,6.33 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,,,20 ,,RBRVS,0.30 ,4.97 ,4.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,26,,20 ,,RBRVS,0.30 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,TC,,20 ,,RBRVS,,4.85 ,4.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,,,20 ,,RBRVS,0.68 ,9.53 ,9.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,26,,20 ,,RBRVS,0.68 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,TC,,20 ,,RBRVS,,9.28 ,9.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,,,20 ,,RBRVS,0.61 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,26,,20 ,,RBRVS,0.61 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,TC,,20 ,,RBRVS,,9.09 ,9.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,,,20 ,,RBRVS,0.57 ,9.01 ,9.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,26,,20 ,,RBRVS,0.57 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,TC,,20 ,,RBRVS,,8.81 ,8.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,,,20 ,,RBRVS,0.90 ,9.33 ,9.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,26,,20 ,,RBRVS,0.90 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,TC,,20 ,,RBRVS,,9.03 ,9.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO,,,20 ,,RBRVS,0.61 ,9.28 ,9.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO,26,,20 ,,RBRVS,0.61 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO,TC,,20 ,,RBRVS,,9.07 ,9.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,,,20 ,,RBRVS,0.53 ,4.97 ,4.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,26,,20 ,,RBRVS,0.53 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,TC,,20 ,,RBRVS,,4.74 ,4.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,8.43 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,7.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78700,CPT,KIDNEY IMAGING MORPHOLOGY,,,20 ,,RBRVS,0.45 ,4.79 ,4.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78700,CPT,KIDNEY IMAGING MORPHOLOGY,26,,20 ,,RBRVS,0.45 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78700,CPT,KIDNEY IMAGING MORPHOLOGY,TC,,20 ,,RBRVS,,4.62 ,4.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,,,20 ,,RBRVS,0.49 ,5.87 ,5.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,26,,20 ,,RBRVS,0.49 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,TC,,20 ,,RBRVS,,5.69 ,5.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,,,20 ,,RBRVS,0.96 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,26,,20 ,,RBRVS,0.96 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,TC,,20 ,,RBRVS,,5.67 ,5.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX,,,20 ,,RBRVS,1.21 ,3.85 ,3.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX,26,,20 ,,RBRVS,1.21 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX,TC,,20 ,,RBRVS,,3.42 ,3.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,,,20 ,,RBRVS,1.41 ,9.54 ,9.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,26,,20 ,,RBRVS,1.41 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,TC,,20 ,,RBRVS,,9.04 ,9.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,,,20 ,,RBRVS,0.66 ,5.67 ,5.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,26,,20 ,,RBRVS,0.66 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,TC,,20 ,,RBRVS,,5.46 ,5.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,,,20 ,,RBRVS,0.38 ,2.70 ,2.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,26,,20 ,,RBRVS,0.38 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,TC,,20 ,,RBRVS,,2.57 ,2.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78730,CPT,URINARY BLADDER RESIDUAL STUDY,,,20 ,,RBRVS,0.15 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78730,CPT,URINARY BLADDER RESIDUAL STUDY,26,,20 ,,RBRVS,0.15 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78730,CPT,URINARY BLADDER RESIDUAL STUDY,TC,,20 ,,RBRVS,,2.05 ,2.05 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,,,20 ,,RBRVS,0.57 ,6.27 ,6.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,26,,20 ,,RBRVS,0.57 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,TC,,20 ,,RBRVS,,6.04 ,6.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,,,20 ,,RBRVS,0.71 ,5.60 ,5.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,26,,20 ,,RBRVS,0.71 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,TC,,20 ,,RBRVS,,5.33 ,5.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,6.97 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,1.30 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,5.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,,,20 ,,RBRVS,0.66 ,4.94 ,4.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,26,,20 ,,RBRVS,0.66 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,TC,,20 ,,RBRVS,,4.69 ,4.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,,,20 ,,RBRVS,0.79 ,6.53 ,6.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,26,,20 ,,RBRVS,0.79 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,TC,,20 ,,RBRVS,,6.24 ,6.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,,,20 ,,RBRVS,0.86 ,8.83 ,8.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,26,,20 ,,RBRVS,0.86 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,TC,,20 ,,RBRVS,,8.53 ,8.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,,,20 ,,RBRVS,1.09 ,9.22 ,9.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,26,,20 ,,RBRVS,1.09 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,TC,,20 ,,RBRVS,,8.86 ,8.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY,,,20 ,,RBRVS,1.07 ,16.17 ,16.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY,26,,20 ,,RBRVS,1.07 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY,TC,,20 ,,RBRVS,,15.80 ,15.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,,,20 ,,RBRVS,0.73 ,4.68 ,4.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,26,,20 ,,RBRVS,0.73 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,TC,,20 ,,RBRVS,,4.42 ,4.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,,,20 ,,RBRVS,0.86 ,9.16 ,9.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,26,,20 ,,RBRVS,0.86 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,TC,,20 ,,RBRVS,,8.86 ,8.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,,,20 ,,RBRVS,1.09 ,9.26 ,9.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,26,,20 ,,RBRVS,1.09 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,TC,,20 ,,RBRVS,,8.90 ,8.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,78808,CPT,NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS,,,20 ,,RBRVS,0.18 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,,,20 ,,TotalUnits,,,,16.87 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,26,,20 ,,TotalUnits,,,,2.10 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,TC,,20 ,,TotalUnits,,,,14.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,,,20 ,,TotalUnits,,,,20.87 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,26,,20 ,,TotalUnits,,,,2.62 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,TC,,20 ,,TotalUnits,,,,18.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78813,CPT,PET IMAGING WHOLE BODY,,,20 ,,TotalUnits,,,,21.66 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78813,CPT,PET IMAGING WHOLE BODY,26,,20 ,,TotalUnits,,,,2.73 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78813,CPT,PET IMAGING WHOLE BODY,TC,,20 ,,TotalUnits,,,,18.93 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,,,20 ,,TotalUnits,,,,23.81 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,26,,20 ,,TotalUnits,,,,2.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,TC,,20 ,,TotalUnits,,,,20.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,,,20 ,,TotalUnits,,,,26.05 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,26,,20 ,,TotalUnits,,,,3.31 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,TC,,20 ,,TotalUnits,,,,22.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,,,20 ,,TotalUnits,,,,26.54 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,26,,20 ,,TotalUnits,,,,3.34 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,TC,,20 ,,TotalUnits,,,,23.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,,,20 ,,TotalUnits,,,,14.67 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,26,,20 ,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,TC,,20 ,,TotalUnits,,,,12.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,79005,CPT,RP THERAPY ORAL ADMINISTRATION,,,20 ,,RBRVS,1.80 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,79005,CPT,RP THERAPY ORAL ADMINISTRATION,26,,20 ,,RBRVS,1.80 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,79005,CPT,RP THERAPY ORAL ADMINISTRATION,TC,,20 ,,RBRVS,,1.50 ,1.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,,,20 ,,RBRVS,1.96 ,2.52 ,2.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,26,,20 ,,RBRVS,1.96 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,TC,,20 ,,RBRVS,,1.62 ,1.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,,,20 ,,RBRVS,1.99 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,26,,20 ,,RBRVS,1.99 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,TC,,20 ,,RBRVS,,1.95 ,1.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,,,20 ,,RBRVS,1.60 ,2.30 ,2.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,26,,20 ,,RBRVS,1.60 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,TC,,20 ,,RBRVS,,1.57 ,1.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,,,20 ,,RBRVS,2.25 ,3.28 ,3.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,26,,20 ,,RBRVS,2.25 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,TC,,20 ,,RBRVS,,2.47 ,2.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,,,20 ,,RBRVS,1.99 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,26,,20 ,,RBRVS,1.99 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,TC,,20 ,,RBRVS,,1.67 ,1.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,,,20 ,,TotalUnits,,,,9.73 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,26,,20 ,,TotalUnits,,,,3.22 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,TC,,20 ,,TotalUnits,,,,6.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,79999,CPT,RP THERAPY UNLISTED PROCEDURE,,,20 ,,TotalUnits,,,,3.95 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,79999,CPT,RP THERAPY UNLISTED PROCEDURE,,PC,20 ,,TotalUnits,,,,2.38 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,79999,CPT,RP THERAPY UNLISTED PROCEDURE,,TC,20 ,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,80047,CPT,BASIC METABOLIC PANEL CALCIUM IONIZED,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80048,CPT,BASIC METABOLIC PANEL CALCIUM TOTAL,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80050,CPT,GENERAL HEALTH PANEL,,,17 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80051,CPT,ELECTROLYTE PANEL,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80053,CPT,COMPREHENSIVE METABOLIC PANEL,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80055,CPT,OBSTETRIC PANEL,,,17 ,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80061,CPT,LIPID PANEL,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80069,CPT,RENAL FUNCTION PANEL,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80074,CPT,ACUTE HEPATITIS PANEL,,,17 ,,TotalUnits,,,,1.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80076,CPT,HEPATIC FUNCTION PANEL,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80100,CPT,DRUG SCR QUAL MLT DRUG CLASSES CHROM EA PX,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80101,CPT,DRUG SCR QUAL 1 DRUG CLASS METH EA DRUG CLASS,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80102,CPT,DRUG CONFIRMATION EACH PROCEDURE,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80103,CPT,TISSUE PREPARATION DRUG ANALYSIS,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80104,CPT,DRUG SCRN QUAL MLT CLASS NONCHROMOTOGRAPHIC EACH,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80150,CPT,DRUG SCREEN QUALITATIVE AMIKACIN,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80152,CPT,DRUG SCREEN QUALITATIVE AMITRIPTYLINE,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80154,CPT,DRUG SCREEN QUALITATIVE BENZODIAZEPINES,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80156,CPT,DRUG SCREEN QUALITATIVE CARBAMAZEPINE TOTAL,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80157,CPT,DRUG SCREEN QUALITATIVE CARBAMAZEPINE FREE,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80158,CPT,DRUG SCREEN QUALITATIVE CYCLOSPORINE,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80160,CPT,DRUG SCREEN QUALITATIVE DESIPRAMINE,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80162,CPT,DRUG SCREEN QUALITATIVE DIGOXIN,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80164,CPT,DRUG SCREEN QUALITATIVE DIPROPYLACETIC ACID,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80166,CPT,DRUG SCREEN QUALITATIVE DOXEPIN,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80168,CPT,DRUG SCREEN QUALITATIVE ETHOSUXIMIDE,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80170,CPT,DRUG SCREEN QUALITATIVE GENTAMICIN,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80172,CPT,DRUG SCREEN QUALITATIVE GOLD,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80173,CPT,DRUG SCREEN QUALITATIVE HALOPRIDOL,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80174,CPT,DRUG SCREEN QUALITATIVE IMIPRAMINE,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80176,CPT,DRUG SCREEN QUALITATIVE LIDOCAINE,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80178,CPT,DRUG SCREEN QUALITATIVE LITHIUM,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80182,CPT,DRUG SCREEN QUALITATIVE NORTRIPTYLINE,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80184,CPT,DRUG SCREEN QUALITATIVE PHENOBARBITAL,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80185,CPT,DRUG SCREEN QUALITATIVE PHENYTOIN TOTAL,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80186,CPT,DRUG SCREEN QUALITATIVE PHENYTOIN FREE,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80188,CPT,DRUG SCREEN QUALITATIVE PRIMIDONE,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80190,CPT,DRUG SCREEN QUALITATIVE PROCAINAMIDE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80192,CPT,DRUG SCREEN QUALITATIVE PROCAINAMIDE METABOLITES,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80194,CPT,DRUG SCREEN QUALITATIVE QUINIDINE,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80195,CPT,DRUG SCREEN QUALITATIVE SIROLIMUS,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80196,CPT,DRUG SCREEN QUALITATIVE SALICYLATE,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80197,CPT,DRUG SCREEN QUALITATIVE TACROLIMUS,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80198,CPT,DRUG SCREEN QUALITATIVE THEOPHYLLINE,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80200,CPT,DRUG SCREEN QUALITATIVE TOBRAMYCIN,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80201,CPT,DRUG SCREEN QUALITATIVE TOPIRAMATE,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80202,CPT,DRUG SCREEN QUALITATIVE VANCOMYCIN,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80299,CPT,QUANTITATION DRUG NOT ELSEWHERE SPECIFIED,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80400,CPT,ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY,,,17 ,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80402,CPT,ACTH STIMULATION PANEL 21 HYDROXYLASE DEFICIENCY,,,17 ,,TotalUnits,,,,3.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80406,CPT,ACTH STIMJ PANEL 3 BETA-HYDROXYDEHYD DEFNCY,,,17 ,,TotalUnits,,,,3.26 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80408,CPT,ALDOSTERONE SUPPRESSION EVALUATION PANEL,,,17 ,,TotalUnits,,,,5.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80410,CPT,CALCITONIN STIMULATION PANEL,,,17 ,,TotalUnits,,,,3.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80412,CPT,CORTICOTROPIC RELEASING HORM STIMJ PANEL,,,17 ,,TotalUnits,,,,13.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80414,CPT,CHORNC GONAD STIMJ PANEL TSTOSTERONE RESPONSE,,,17 ,,TotalUnits,,,,2.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80415,CPT,CHORNC GONAD STIMJ PANEL ESTRADIOL RESPONSE,,,17 ,,TotalUnits,,,,2.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80416,CPT,RENAL VEIN RENIN STIMULATION PANEL,,,17 ,,TotalUnits,,,,5.49 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80417,CPT,PERIPHERAL VEIN RENIN STIMULATION PANEL,,,17 ,,TotalUnits,,,,1.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80418,CPT,COMBINED RAPID ANT PITUITARY EVALUATION PANEL,,,17 ,,TotalUnits,,,,24.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80420,CPT,DEXMETHASONE SUPPRESSION PANEL 48 HR,,,17 ,,TotalUnits,,,,3.00 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80422,CPT,GLUCOSE TOLERANCE PANEL INSULINOMA,,,17 ,,TotalUnits,,,,1.92 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80424,CPT,GLUCOSE TOLERANCE PANEL PHEOCHROMOCYTOMA,,,17 ,,TotalUnits,,,,2.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80426,CPT,GONADOTROPIN RELEASING HORMONE STIMJ PANEL,,,17 ,,TotalUnits,,,,6.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80428,CPT,GROWTH HORMONE STIMULATION PANEL,,,17 ,,TotalUnits,,,,2.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80430,CPT,GROWTH HORMONE SUPRJ PANEL GLUCOSE ADMN,,,17 ,,TotalUnits,,,,3.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80432,CPT,INSULIN-INDUCED C-PEPTIDE SUPRESSION PANEL,,,17 ,,TotalUnits,,,,5.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80434,CPT,INSULIN TOLERANCE PANEL ACTH INSUFFICIENCY,,,17 ,,TotalUnits,,,,4.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80435,CPT,INSULIN TOLERANCE PANEL GROWTH HORM DEFNCY,,,17 ,,TotalUnits,,,,4.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80436,CPT,METYRAPONE PANEL,,,17 ,,TotalUnits,,,,3.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80438,CPT,THYROTROPIN RELEASING HORMONE STMLJ PANEL 1 HR,,,17 ,,TotalUnits,,,,2.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80439,CPT,THYROTROPIN RELEASING HORMONE STMLJ PANEL 2 HR,,,17 ,,TotalUnits,,,,2.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80440,CPT,THYROTROPIN RELEAS HORMONE HYPRPROLACTINEMIA,,,17 ,,TotalUnits,,,,2.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,80500,CPT,CLINICAL PATHOLOGY CONSULTATION LIMITED,,,17 ,,RBRVS,0.37 ,0.12 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,80502,CPT,CLINICAL PATHOLOGY CONSULTATION COMPREHENSIVE,,,17 ,,RBRVS,1.33 ,0.40 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,81000,CPT,URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81001,CPT,URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81002,CPT,URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP,,,17 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81003,CPT,URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81005,CPT,URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81007,CPT,URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK,,,17 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81015,CPT,URINALYSIS MICROSCOPIC ONLY,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81020,CPT,URINALYSIS 2/3 GLASS TEST,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81025,CPT,URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,,,17 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81050,CPT,VOLUME MEASUREMENT TIMED COLLECTION EACH,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,81099,CPT,UNLISTED URINALYSIS PROCEDURE,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82000,CPT,ASSAY ACETALDEHYDE BLOOD,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82003,CPT,ASSAY OF ACETAMINOPHEN,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82009,CPT,KETONE BODIES SERUM QUALITATIVE,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82010,CPT,KETONE BODIES SERUM QUANTITATIVE,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82013,CPT,ASSAY OF ACETYLCHOLINESTERASE,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82016,CPT,ACYLCARNITINES QUALITATIVE EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82017,CPT,ACYLCARNITINES QUANTIATIVE EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82024,CPT,ADRENOCORTICOTROPIC HORMONE ACTH,,,17 ,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82030,CPT,ADENOSINE 5-MONOPHOSPHATE CYCLIC,,,17 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82040,CPT,ALBUMIN SERUM PLASMA/WHOLE BLOOD,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82042,CPT,ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82043,CPT,ALBUMIN URINE MICROALBUMIN QUANTIATIVE,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82044,CPT,ALBUMIN URINE MICROALBUMIN SEMIQUANTITATIVE,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82045,CPT,ALBUMIN ISCHEMIA MODIFIED,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82055,CPT,ALCOHOL ANY SPECIMEN EXCEPT BREATH,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82075,CPT,ASSAY OF ALCOHOL BREATH,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82085,CPT,ASSAY OF ALDOLASE,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82088,CPT,ASSAY OF ALDOSTERONE,,,17 ,,TotalUnits,,,,1.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82101,CPT,ALKALOIDS URINE QUANTITATIVE,,,17 ,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82103,CPT,ALPHA-1-ANTITRYPSIN TOTAL,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82104,CPT,ALPHA-1-ANTITRYPSIN PHENOTYPE,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82105,CPT,ALPHA-FETOPROTEIN SERUM,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82106,CPT,ALPHA-FETOPROTEIN AMNIOTIC FLUID,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82107,CPT,AFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIO,,,17 ,,TotalUnits,,,,2.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82108,CPT,ASSAY OF ALUMINUM,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82120,CPT,AMINES VAGINAL FLUID QUALITATIVE,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82127,CPT,AMINO ACIDS 1 QUALITATIVE EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82128,CPT,AMINO ACIDS MULTIPLE QUALITATIVE EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82131,CPT,AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82135,CPT,AMINOLEVULINIC ACID DELTA,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82136,CPT,AMINO ACIDS 2-5 AMINO ACIDS QUANTITATIVE EA SPEC,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82139,CPT,AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82140,CPT,ASSAY OF AMMONIA,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82143,CPT,AMNIOTIC FLU SCAN,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82145,CPT,AMPHETAMINE/METHAMPHETAMINE,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82150,CPT,ASSAY OF AMYLASE,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82154,CPT,ANDROSTANEDIOL GLUCURONIDE,,,17 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82157,CPT,ANDROSTENEDIONE,,,17 ,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82160,CPT,ANDROSTERONE,,,17 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82163,CPT,ANGIOTENSIN II,,,17 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82164,CPT,ANGIOTENSIN I-CONVERTING ENZYME,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82172,CPT,APOLIPOPROTEIN EACH,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82175,CPT,ASSAY OF ARSENIC,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82180,CPT,ASSAY OF ASCORBIC ACID BLOOD,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82190,CPT,ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82205,CPT,BARBITURATES NOT ELSEWHERE SPECIFIED,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82232,CPT,BETA-2 MICROGLOBULIN,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82239,CPT,BILE ACIDS TOTAL,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82240,CPT,BILE ACIDS CHOLYLGLYCINE,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82247,CPT,BILIRUBIN TOTAL,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82248,CPT,BILIRUBIN DIRECT,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82252,CPT,BILIRUBIN FECES QUALITATIVE,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82261,CPT,BIOTINIDASE EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82270,CPT,BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER,,,17 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82271,CPT,BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES,,,17 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82272,CPT,BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC,,,17 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82274,CPT,BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82286,CPT,BRADYKININ,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82300,CPT,CADMIUM,,,17 ,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82306,CPT,25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,,,17 ,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82308,CPT,CALCITONIN,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82310,CPT,CALCIUM TOTAL,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82330,CPT,CALCIUM IONIZED,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82331,CPT,CALCIUM AFTER CALCIUM INFUSION TEST,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82340,CPT,CALCIUM URINE QUANTITATIVE TIMED SPECIMEN,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82355,CPT,CALCULUS QUALITATIVE ANALYSIS,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82360,CPT,CALCULUS QUANTITATIVE CHEMICAL,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82365,CPT,CALCULUS INFRARED SPECTROSCOPY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82370,CPT,CALCULUS XRAY DIFFRACTION,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82373,CPT,CARBOHYDRATE DEFICIENT TRANSFERRIN,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82374,CPT,CARBON DIOXIDE BICARBONATE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82375,CPT,CARBOXYHEMOGLOBIN QUANTITATIVE,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82376,CPT,CARBOXYHEMOGLOBIN QUALITATIVE,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82378,CPT,CARCINOEMBRYONIC ANTIGEN CEA,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82379,CPT,CARNITINE QUANTITATIVE EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82380,CPT,CAROTENE,,,17 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82382,CPT,CATECHOLAMINES TOTAL URINE,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82383,CPT,CATECHOLAMINES BLOOD,,,17 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82384,CPT,CATECHOLAMINES FRACTIONATED,,,17 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82387,CPT,CATHEPSIN-D,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82390,CPT,CERULOPLASMIN,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82397,CPT,CHEMILUMINESCENT ASSAY,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82415,CPT,CHLORAMPHENICOL,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82435,CPT,CHLORIDE BLD,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82436,CPT,CHLORIDE URINE,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82438,CPT,CHLORIDE OTHER SOURCE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82441,CPT,CHLORINATED HYDROCARBONS SCREEN,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82465,CPT,CHOLESTEROL SERUM/WHOLE BLOOD TOTAL,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82480,CPT,CHOLINESTERASE SERUM,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82482,CPT,CHOLINESTERASE RBC,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82485,CPT,CHONDROITIN B SULFATE QUANTITATIVE,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82486,CPT,CHROMATOGRAPHY QUAL COLUMN ANALYTE NES,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82487,CPT,CHROMATOGRAPHY QUAL PAPR 1-DIMENSNL ANALYTE NES,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82488,CPT,CHROMATOGRAPHY QUAL PAPR 2-DIMENSIONAL ANAL NES,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82489,CPT,CHROMATOGRAPHY QUAL THIN LAYER ANALYTE NES,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82491,CPT,CHROMATOGRAPHY QUAN COLUMN 1 ANALYTE NES,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82492,CPT,CHROMATOGRAPHY QUAN COLUMN MULTIPLE ANALYTES,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82495,CPT,ASSAY OF CHROMIUM,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82507,CPT,ASSAY OF CITRATE,,,17 ,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82520,CPT,COCAINE/METABOLITE,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82523,CPT,COLLAGEN CROSS LINKS ANY METHOD,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82525,CPT,ASSAY OF COPPER,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82528,CPT,CORTICOSTERONE,,,17 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82530,CPT,CORTISOL FREE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82533,CPT,CORTISOL TOTAL,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82540,CPT,ASSAY OF CREATINE,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82541,CPT,COL-CHR/MS QUAL 1 STATIONARY&MOBILE PHASE NES,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82542,CPT,COL-CHR/MS QUAN 1 STATIONARY&MOBILE PHASE NES,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82543,CPT,COL-CHR/MS STABLE ISOTOPE DIL 1 ANALYTE NES,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82544,CPT,COL-CHR/MS STABLE ISOTOPE DIL MLT ANALYTES NES,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82550,CPT,CREATINE KINASE TOTAL,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82552,CPT,CREATINE KINASE ISOENZYMES,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82553,CPT,CREATINE KINASE MB FRACTION ONLY,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82554,CPT,CREATINE KINASE ISOFORMS,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82565,CPT,CREATININE BLOOD,,,17 ,,TotalUnits,,,,0.21 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EACH,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82785,CPT,ASSAY OF GAMMAGLOBULIN IGE,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82787,CPT,GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82800,CPT,GASES BLOOD PH ONLY,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82803,CPT,BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82805,CPT,GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY,,,17 ,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82810,CPT,GASES BLOOD O2 SATURATION ONLY DIRECT MEAS,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82820,CPT,HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82930,CPT,GASTRIC ACID ANALYIS W/PH EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82938,CPT,GASTRIN AFTER SECRETIN STIMULATION,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82941,CPT,ASSAY OF GASTRIN,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82943,CPT,ASSAY OF GLUCAGON,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82945,CPT,GLUCOSE BODY FLUID OTHER THAN BLOOD,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82946,CPT,GLUCOSE TOLERANCE TEST,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82947,CPT,GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82948,CPT,GLUCOSE BLOOD REAGENT STRIP,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82950,CPT,GLUCOSE POST GLUCOSE DOSE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82951,CPT,GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82952,CPT,GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82953,CPT,GLUC TOLBUTAMIDE TOLERANCE TST,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82955,CPT,GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82960,CPT,GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82962,CPT,GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82963,CPT,ASSAY OF GLUCOSIDASE BETA,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82965,CPT,ASSAY OF GLUTAMATE DEHYDROGENASE,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82975,CPT,ASSAY OF GLUTAMINE,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82977,CPT,ASSAY OF GLUTAMYLTRASE GAMMA,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82978,CPT,ASSAY OF GLUTATHIONE,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82979,CPT,ASSAY OF GLUTATHIONE REDUCTASE RBC,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82980,CPT,ASSAY OF GLUTETHIMIDE,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,82985,CPT,ASSAY OF GLYCATED PROTEIN,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83001,CPT,GONADOTROPIN FOLLICLE STIMULATING HORMONE,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83002,CPT,GONADOTROPIN LUTEINIZING HORMONE,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83003,CPT,ASSAY OF GROWTH HORMONE HUMAN,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83008,CPT,ASSAY OF GUANOSINE MONOPHOSPHATE CYCLIC,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83009,CPT,HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE,,,17 ,,TotalUnits,,,,2.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83010,CPT,ASSAY OF HAPTOGLOBIN QUANTITATIVE,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83012,CPT,ASSAY OF HAPTOGLOBIN PHENOTYPES,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83013,CPT,HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE,,,17 ,,TotalUnits,,,,2.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83014,CPT,HPYLORI DRUG ADMINISTRATION,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83015,CPT,HEAVY METAL SCREEN,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83018,CPT,HEAVY METAL QUANTIATIVE EACH,,,17 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83020,CPT,HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,83020,CPT,HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,83021,CPT,HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83026,CPT,HEMOGLOBIN COPPER SULFATE METHOD NON-AUTOMATED,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83030,CPT,HEMOGLOBIN F FETAL CHEMICAL,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83033,CPT,HEMOGLOBIN F FETAL QUALITATIVE,,,17 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,,$0.00,$0.00,1,1,1,0,1,1,20131001,83069,CPT,ASSAY OF HEMOGLOBIN URINE,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83070,CPT,ASSAY OF HEMOSIDERIN QUALITATIVE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83071,CPT,ASSAY OF HEMOSIDERIN QUANTITATIVE,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83080,CPT,ASSAY OF B-HEXOSAMINIDASE EACH ASSAY,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83088,CPT,ASSAY OF HISTAMINE,,,17 ,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83090,CPT,ASSAY OF HOMOCYSTEINE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83150,CPT,ASSAY OF HOMOVANILLIC ACID,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83491,CPT,HYDROXYCORTICOSTEROIDS 17,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83497,CPT,ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83498,CPT,ASSAY OF HYDROXYPROGESTERONE 17-D,,,17 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83499,CPT,ASSAY OF HYDROXYPROGESTERONE 20-,,,17 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83500,CPT,ASSAY OF HYDROXYPROLINE FREE,,,17 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83505,CPT,ASSAY OF HYDROXYPROLINE TOTAL,,,17 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83516,CPT,IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83518,CPT,IMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE STEP,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83519,CPT,IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83520,CPT,IMMUNOASSAY ANALYTE QUANTITATIVE NOS,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83525,CPT,ASSAY OF INSULIN TOTAL,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83527,CPT,ASSAY OF INSULIN FREE,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83528,CPT,ASSAY OF INTRINSIC FACTOR,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83540,CPT,ASSAY OF IRON,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83550,CPT,IRON BINDING CAPACITY,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83570,CPT,ISOCITRIC DEHYDROGENASE,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83582,CPT,ASSAY OF KETOGENIC STEROIDS FRACTIONATION,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83586,CPT,ASSAY OF KETOSTEROIDS 17- TOTAL,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83593,CPT,KETOSTEROIDS 17- FRACTIONATION,,,17 ,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83605,CPT,ASSAY OF LACTATE,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83615,CPT,LACTATE DEHYDROGENASE LDH,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83625,CPT,LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83630,CPT,LACTOFERRIN FECAL QUALITATIVE,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83631,CPT,LACTOFERRIN FECAL QUANTITATIVE,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83632,CPT,LACTOGEN HPL HUMAN CHORIONIC SOMATOMAMMOTROPIN,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83633,CPT,LACTOSE URINE QUALITATIVE,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83634,CPT,LACTOSE URINE QUANTITATIVE,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83655,CPT,ASSAY OF LEAD,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83661,CPT,FETAL LUNG MATURITY LECITHIN SPHINGOMYELIN RATIO,,,17 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83662,CPT,FETAL LUNG MATURITY FOAM STABILITY TEST,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83663,CPT,FETAL LUNG MATURITY FLUORESCENCE POLARIZATION,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83664,CPT,FETAL LUNG MATURITY LAMELLAR BODY DENSITY,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83670,CPT,LEUCINE AMINOPEPTIDASE LAP,,,17 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83690,CPT,ASSAY OF LIPASE,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83695,CPT,LIPOPROTEIN A,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83698,CPT,LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83700,CPT,LIPOPROTEIN BLOOD ELECTROPHORECTIC SEP&QUAN,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83701,CPT,LIPOPROTEIN BLOOD HIGH RESOLTJ&QUANTJ SUBCLASS,,,17 ,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83704,CPT,LIPOPROTEIN BLOOD QUAN NUMBERS&SUBCLASSES,,,17 ,,TotalUnits,,,,1.31 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83718,CPT,LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83719,CPT,LIPOPROTEIN DIRECT MEASSUREMENT VLDL CHOLESTEROL,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83721,CPT,LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83727,CPT,LUTEINIZING RELEASING FACTOR,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83735,CPT,ASSAY OF MAGNESIUM,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83775,CPT,ASSAY OF MALATE DEHYDROGENASE,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83785,CPT,ASSAY OF MANGANESE,,,17 ,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83788,CPT,MASS SPECT&TANDEM MASS SPECT ANAL QUAL EA SPEC,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83789,CPT,MASS SPECT&TANDEM MASS SPECT ANAL QUAN EA SPEC,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83805,CPT,ASSAY OF MEPROBAMATE,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83825,CPT,ASSAY OF MERCURY QUANTITATIVE,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83835,CPT,METANEPHRINES,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83840,CPT,METHADONE,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83857,CPT,METHEMALBUMIN,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83858,CPT,METHSUXIMIDE,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83861,CPT,MICROFLUIDIC ANALYSIS TEAR OSMOLARITY,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83864,CPT,MUCOPOLYSACCHARIDES ACID QUANTITATIVE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83866,CPT,MUCOPOLYSACCHARIDES ACID SCREEN,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83872,CPT,MUCIN SYNOVIAL FLUID ROPES TEST,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83873,CPT,MYELIN BASIC PROTEIN CEREBROSPINAL FLUID,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83874,CPT,MYOGLOBIN,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83876,CPT,MYELOPEROXIDASE MPO,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83880,CPT,NATRIURETIC PEPTIDE,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83883,CPT,ASSAY OF NEPHELOMETRY EACH ANALYTE NES,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83885,CPT,ASSAY OF NICKEL,,,17 ,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83887,CPT,ASSAY OF NICOTINE,,,17 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83915,CPT,ASSAY OF NUCLEOTIDASE 5'-,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83916,CPT,OLIGOCLONAL IMMUNE,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83918,CPT,ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83919,CPT,ORGANIC ACIDS QUALITATIVE EACH SPECIMEN,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83921,CPT,ORGANIC ACID 1 QUANTITATIVE,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83925,CPT,OPIATE(S) DRUG AND METABOLITES EACH PROCEDURE,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83930,CPT,ASSAY OF OSMOLALITY BLOOD,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83935,CPT,ASSAY OF OSMOLALITY URINE,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83937,CPT,ASSAY OF OSTEOCALCIN,,,17 ,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83945,CPT,ASSAY OF OXALATE,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83950,CPT,ONCOPROTEIN HER-2/NEU,,,17 ,,TotalUnits,,,,2.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83951,CPT,ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP,,,17 ,,TotalUnits,,,,2.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83970,CPT,ASSAY OF PARATHORMONE,,,17 ,,TotalUnits,,,,1.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83986,CPT,PH BODY FLUID NOT ELSEWHERE SPECIFIED,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83987,CPT,PH EXHALED BREATH CONDENSATE,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83992,CPT,ASSAY OF PHENCYCLIDINE,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,83993,CPT,ASSAY OF CALPROTECTIN FECAL,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84022,CPT,ASSAY OF PHENOTHIAZINE,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84030,CPT,ASSAY OF PHENYLALANINE BLOOD,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84035,CPT,ASSAY OF PHENYLKETONES QUALITATIVE,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84060,CPT,ASSAY OF PHOSPHATASE ACID TOTAL,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84061,CPT,PHOSPHATASE ACID FORENSIC EXAMINATION,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84066,CPT,ASSAY OF PHOSPHATASE ACID PROSTATIC,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84075,CPT,ASSAY OF PHOSPHATASE ALKALINE,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84078,CPT,ASSAY OF PHOSPHATASE ALKALINE HEAT STABLE,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84080,CPT,ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84081,CPT,PHOSPHATIDYLGLYCEROL,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84085,CPT,PHOSPHOGLUCONATE 6-DEHYD RBC,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84087,CPT,ASSAY OF PHOSPHOHEXOSE ISOMERASE,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84100,CPT,ASSAY OF PHOSPHORUS INORGANIC,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84105,CPT,ASSAY OF PHOSPHORUS INORGANIC URINE,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84106,CPT,PORPHOBILINOGEN URINE QUALITATIVE,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84110,CPT,ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84112,CPT,PLACENTAL ALPHA MICROGLOBULIN C/V QUAL,,,17 ,,TotalUnits,,,,2.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84119,CPT,PORPHYRINS URINE QUALITATAIVE,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84120,CPT,PORPHYRINS URINE QUANTITATION & FRACTIONATION,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84126,CPT,PORPHYRINS FECES QUANTITATIVE,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84127,CPT,PORPHYRINS FECES QUALITATIVE,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84132,CPT,POTASSIUM SERUM PLASMA/WHOLE BLOOD,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84133,CPT,POTASSIUM URINE,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84134,CPT,PREALBUMIN,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84135,CPT,PREGNANEDIOL,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84138,CPT,PREGNANETRIOL,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84140,CPT,PREGNENOLONE,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84143,CPT,17-HYDROXYPREGNENOLONE,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84144,CPT,ASSAY OF PROGESTERONE,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84145,CPT,PROCALCITONIN (PCT),,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84146,CPT,ASSAY OF PROLACTIN,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84150,CPT,ASSAY OF PROSTAGLNDIN EACH,,,17 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84152,CPT,ASSAY OF PROSTATE SPECIFIC ANTIGEN COMPLEXED,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84153,CPT,ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84154,CPT,ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84155,CPT,PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84156,CPT,PROTEIN TOTAL XCPT REFRACTOMETRY URINE,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84157,CPT,PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84160,CPT,PROTEIN TOTAL REFRACTOMETRY ANY SRC,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84163,CPT,PREGNANCY-ASSOCIATED PLASMA PROTEIN-A,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84165,CPT,PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,84165,CPT,PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,84166,CPT,PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,84166,CPT,PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,84181,CPT,PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,84181,CPT,PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,84182,CPT,PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL,26,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,84182,CPT,PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,84202,CPT,PROTOPORPHYRIN RBC QUANTITATIVE,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84203,CPT,PROTOPORPHYRIN RBC SCREEN,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84206,CPT,ASSAY OF PROINSULIN,,,17 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84207,CPT,ASSAY OF PYRIDOXAL PHOSPHATE,,,17 ,,TotalUnits,,,,1.17 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84210,CPT,ASSAY OF PYRUVATE,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84220,CPT,ASSAY OF PYRUVATE KINASE,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84228,CPT,ASSAY OF QUININE,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84233,CPT,ASSAY OF RECEPTOR ASSAY ESTROGEN,,,17 ,,TotalUnits,,,,2.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84234,CPT,ASSAY OF RECEPTOR ASSAY PROGESTERONE,,,17 ,,TotalUnits,,,,2.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84235,CPT,RECEPTOR ASSAY ENDOCRINE OTH/THN ESTRGN/PROGST,,,17 ,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84238,CPT,RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR,,,17 ,,TotalUnits,,,,1.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84244,CPT,ASSAY OF RENIN,,,17 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84252,CPT,ASSAY OF RIBOFLAVIN-VITAMIN B-2,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84255,CPT,ASSAY OF SELENIUM,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84260,CPT,ASSAY OF SEROTONIN,,,17 ,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84270,CPT,ASSAY OF SEX HORMONE BINDING GLOBULIN,,,17 ,,TotalUnits,,,,0.90 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84275,CPT,ASSAY OF SIALIC ACID,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84285,CPT,ASSAY OF SILICA,,,17 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84295,CPT,SODIUM SERUM PLASMA OR WHOLE BLOOD,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84300,CPT,ASSAY OF URINE SODIUM,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84302,CPT,ASSAY OF SODIUM OTHER SOURCE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84305,CPT,ASSAY OF SOMATOMEDIN,,,17 ,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84307,CPT,ASSAY OF SOMATOSTATIN,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84311,CPT,SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84315,CPT,SPECIFIC GRAVITY EXCEPT URINE,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84375,CPT,SUGARS CHROMATOGRAPHIC TLC/PAPER CHROMATOGRAPHY,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84376,CPT,SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84377,CPT,SUGARS MONO DI&OLIGOS MLT QUALITATIVE EACH SPE,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84378,CPT,SUGARS MONO DI&OLIGOS 1 QUANTITATIVE EACH SPEC,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84379,CPT,SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84392,CPT,ASSAY OF SULFATE URINE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84402,CPT,ASSAY OF TESTOSTERONE FREE,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84403,CPT,ASSAY OF TESTOSTERONE TOTAL,,,17 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84425,CPT,ASSAY OF THIAMINE-VITAMIN B-1,,,17 ,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84430,CPT,ASSAY OF THIOCYANATE,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84431,CPT,THROMBOXANE METABOLITE W/WO THROMBOXANE URINE,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84432,CPT,ASSAY OF THYROGLOBULIN,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84436,CPT,ASSAY OF THYROXINE TOTAL,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84437,CPT,ASSAY OF THYROXINE REQUIRING ELUTION,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84439,CPT,ASSAY OF FREE THYROXINE,,,17 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84442,CPT,ASSAY OF THYROXINE BINDING GLOBULIN,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84443,CPT,ASSAY OF THYROID STIMULATING HORMONE TSH,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84445,CPT,THYROID STIMULATING IMMUNE GLOBULINS TSI,,,17 ,,TotalUnits,,,,2.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84446,CPT,ASSAY OF TOCOPHEROL ALPHA VITAMIN E,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84449,CPT,ASSAY OF TRANSCORTIN CORTISOL BINDING GLOBULIN,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84450,CPT,TRANSFERASE ASPARTATE AMINO AST SGOT,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84460,CPT,TRANSFERASE ALANINE AMINO ALT SGPT,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84466,CPT,ASSAY OF L7383TRANSFERRIN,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84478,CPT,ASSAY OF TRIGLYCERIDES,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84479,CPT,THYROID HORM UPTK/THYROID HORMONE BINDING RATIO,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84480,CPT,ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84481,CPT,ASSAY OF TRIIODOTHYRONINE T3 FREE,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84482,CPT,TRIIODOTHYRONINE T3 REVERSE,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84484,CPT,ASSAY OF TROPONIN QUANTITATIVE,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84485,CPT,ASSAY OF TRYPSIN DUODENAL FLUID,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84488,CPT,ASSAY OF TRYPSIN FECES QUALITATIVE,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84490,CPT,TRYPSIN FECES QUANTITATIVE 24-HR COLLECTION,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84510,CPT,ASSAY OF TYROSINE,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84512,CPT,ASSAY OF TROPONIN QUALITATIVE,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84520,CPT,ASSAY OF UREA NITROGEN QUANTITATIVE,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84525,CPT,ASSAY OF UREA NITROGEN SEMIQUANTITATIVE,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84540,CPT,ASSAY OF UREA NITROGEN URINE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84545,CPT,UREA NITROGEN CLEARANCE,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84550,CPT,ASSAY OF BLOOD/URIC ACID,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84560,CPT,ASSAY OF URIC ACID OTHER SOURCE,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84577,CPT,ASSAY OF UROBILINOGEN FECES QUANTITATIVE,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84578,CPT,ASSAY OF UROBILINOGEN URINE QUALITATIVE,,,17 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84580,CPT,UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84583,CPT,ASSAY OF UROBILINOGEN URINE SEMIQUANTITATIVE,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84585,CPT,ASSAY OF VANILLYLMANDELIC ACID URINE,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84586,CPT,ASSAY OF VASOACTIVE INTESTINAL PEPTIDE,,,17 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84588,CPT,ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84590,CPT,ASSAY OF VITAMIN A,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84591,CPT,ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84597,CPT,ASSAY OF VITAMIN K,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84600,CPT,ASSAY OF VOLATILES,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84620,CPT,XYLOSE ABSORPTION TEST BLOOD &/URINE,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84630,CPT,ASSAY OF ZINC,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84681,CPT,ASSAY OF C-PEPTIDE,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84702,CPT,GONADOTROPIN CHORIONIC QUANTITATIVE,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84703,CPT,GONADOTROPIN CHORIONIC QUALITATIVE,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84704,CPT,GONADOTROPIN CHORIONIC HCG FREE BETA CHAIN,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84830,CPT,OVULATION TEST VISUAL COLOR COMPARISON HLH,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,84999,CPT,UNLISTED CHEMISTRY PROCEDURE,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85002,CPT,BLEEDING TIME TEST,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85004,CPT,BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85007,CPT,BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT,,,17 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85008,CPT,BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT,,,17 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85009,CPT,BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85013,CPT,BLOOD COUNT SPUN MICROHEMATOCRIT,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85014,CPT,BLOOD COUNT HEMATOCRIT,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85018,CPT,BLOOD COUNT HEMOGLOBIN,,,17 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85025,CPT,BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85027,CPT,BLOOD COUNT COMPLETE AUTOMATED,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85032,CPT,BLOOD COUNT MANUAL CELL COUNT EACH,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85041,CPT,BLOOD COUNT RED BLOOD CELL AUTOMATED,,,17 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85044,CPT,BLOOD COUNT RETICULOCYTE AUTOMATED,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85045,CPT,BLOOD COUNT RETICULOCYTE AUTOMATED,,,17 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85046,CPT,BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85048,CPT,BLOOD COUNT LEUKOCYTE WBC AUTOMATED,,,17 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85049,CPT,BLOOD COUNT PLATELET AUTOMATED,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85055,CPT,RETICULATED PLATELET ASSAY,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85060,CPT,BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT,,,17 ,,RBRVS,0.45 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,85097,CPT,BONE MARROW SMEAR INTERPRETATION,,,17 ,,RBRVS,0.94 ,0.37 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,85130,CPT,CHROMOGENIC SUBSTRATE ASSAY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85170,CPT,BLOOD CLOT RETRACTION,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85175,CPT,CLOT LYSIS TIME WHOLE BLOOD DILUTION,,,17 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85210,CPT,CLOTTING FACTOR II PROTHROMBIN SPECIFIC,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85220,CPT,CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85230,CPT,CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85240,CPT,CLOTTING FACTOR VIII AHG 1 STAGE,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85244,CPT,CLOTTING FACTOR VIII RELATED ANTIGEN,,,17 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85245,CPT,CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85246,CPT,CLOTTING FACTOR VIII VW FACTOR ANTIGEN,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85247,CPT,CLOTTING FACTOR VIII MULTIMETRIC ANALYSIS,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85250,CPT,CLOTTING FACTOR IX PTC/CHRISTMAS,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85260,CPT,CLOTTING FACTOR X STUART-PROWER,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85270,CPT,CLOTTING FACTOR XI PTA,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85280,CPT,CLOTTING FACTOR XII HAGEMAN,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85290,CPT,CLOTTING FACTOR XIII FIBRIN STABILIZING,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85291,CPT,CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85292,CPT,CLOTTING PREKALLIKREIN ASSAY FLETCHER FACT ASSAY,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85293,CPT,CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85300,CPT,CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85301,CPT,CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85302,CPT,CLOTTING INHIBITORS PROTEIN C ANTIGEN,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85303,CPT,CLOTTING INHIBITORS PROTEIN C ACTIVITY,,,17 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85305,CPT,CLOTTING INHIBITORS PROTEIN S TOTAL,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85306,CPT,CLOTTING INHIBITORS PROTEIN S FREE,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85307,CPT,ACTIVATED PROTEIN C APC RESISTANCE ASSAY,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85335,CPT,FACTOR INHIBITOR TEST,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85337,CPT,THROMBOMODULIN,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85345,CPT,COAGULATION TIME LEE AND WHITE,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85347,CPT,COAGULATION TIME ACTIVATED,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85348,CPT,COAGULATION TIME OTHER METHODS,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85360,CPT,EUGLOBULIN LYSIS,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85362,CPT,FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85366,CPT,FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85370,CPT,FIBRIN DGRADJ SPLT PRODUCTS QUANTITATIVE,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85378,CPT,FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85379,CPT,FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85380,CPT,FIBRIN DGRADJ PRODUCTS D-DIMER ULTRASENSITIVE,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85384,CPT,FIBRINOGEN ACTIVITY,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85385,CPT,FIBRINOGEN ANTIGEN,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85390,CPT,FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,85390,CPT,FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,85396,CPT,COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY,,,17 ,,RBRVS,0.37 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,85397,CPT,COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV NOS EA ANAL,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85400,CPT,FIBRINOLYTIC FACTORS & INHIBITORS PLASMIN,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85410,CPT,FBRNLYC FACTORS&INHIBITORS ALPHA-2 ANTIPLASMIN,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85415,CPT,FBRNLYC FACTORS&INHIBITORS PLSMNG ACTIVATOR,,,17 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85420,CPT,FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85421,CPT,FBRNLYC FACTORS&INHIBITORS PLSMNG AGIC ASSAY,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85441,CPT,HEINZ BODIES DIRECT,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85445,CPT,HEINZ BODIES INDUCED ACETYL PHENYLHYDRAZINE,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85460,CPT,HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85461,CPT,HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85475,CPT,HEMOLYSIN ACID,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85520,CPT,HEPARIN ASSAY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85525,CPT,HEPARIN NEUTRALIZATION,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85530,CPT,HEPARIN-PROTAMINE TOLERANCE TST,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85536,CPT,IRON STAIN PERIPHERAL BLOOD,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85540,CPT,WBC ALKALINE PHOSPHATASE COUNT,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85547,CPT,MECHANICAL FRAGILITY RBC,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85549,CPT,MURAMIDASE,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85555,CPT,OSMOTIC FRAGILITY RBC UNINCUBATED,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85557,CPT,OSMOTIC FRAGILITY RBC INCUBATED,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85576,CPT,PLATELET AGGREGATION IN VITRO EACH AGENT,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,85576,CPT,PLATELET AGGREGATION IN VITRO EACH AGENT,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,85597,CPT,PHOSPHOLIPID NEUTRALIZATION PLATELET,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85598,CPT,PHOSPHOLIPID NEUTRALIZATION HEXAGONAL,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85610,CPT,PROTHROMBIN TIME,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85611,CPT,PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85612,CPT,RUSSELL VIPER VENON TIME UNDILUTED,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85613,CPT,RUSSELL VIPER VENOM TIME DILUTED,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85635,CPT,REPTILASE TEST,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85651,CPT,SEDIMENTATION RATE RBC NON-AUTOMATED,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85652,CPT,SEDIMENTATION RATE RBC AUTOMATED,,,17 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85660,CPT,SICKLING RBC REDUCTION,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85670,CPT,THROMBIN TIME PLASMA,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85675,CPT,THROMBIN TIME TITER,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85705,CPT,THROMBOPLASTIN INHIBITION TISSUE,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85730,CPT,THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85732,CPT,THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85810,CPT,VISCOSITY,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,85999,CPT,UNLISTED HEMATOLOGY & COAGULATION PROCEDURE,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86000,CPT,AGGLUTININS FEBRILE EACH ANTIGEN,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86001,CPT,ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86003,CPT,ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86005,CPT,ALLERGEN SPECIFIC IGE QUAL MULTIALLERGEN SCREEN,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86021,CPT,ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86022,CPT,ANTIBODY IDENTIFICATION PLATELET ANTIBODIES,,,17 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86023,CPT,ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86038,CPT,ANTINUCLEAR ANTIBODIES ANA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86039,CPT,ANTINUCLEAR ANTIBODIES ANA TITER,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86060,CPT,ANTISTREPTOLYSIN O TITER,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86063,CPT,ANTISTREPTOLYSIN O SCREEN,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86077,CPT,BLD BANK PHYS SVCS DIFFC CROSS MATCH&/EVAL REP,,,17 ,,RBRVS,0.94 ,0.41 ,0.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,86078,CPT,BLD BANK PHYS SVCS INVSTGJ TFUJ RXN REPRT,,,17 ,,RBRVS,0.94 ,0.42 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,86079,CPT,BLD BANK PHYS SVCS AUTHJ DEVIJ STANDARD REPRT,,,17 ,,RBRVS,0.94 ,0.42 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,86140,CPT,C-REACTIVE PROTEIN,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86141,CPT,C-REACTIVE PROTEIN HIGH SENSITIVITY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86146,CPT,BETA 2 GLYCOPROTEIN I ANTIBODY EACH,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86147,CPT,CARDIOLIPIN ANTIBODY EACH IG CLASS,,,17 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86148,CPT,ANTI-PHOSPHATIDYLSERINE ANTIBODY,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86153,CPT,CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP,26,,17 ,,RBRVS,0.69 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,86155,CPT,CHEMOTAXIS ASSAY SPECIFY METHOD,,,17 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86156,CPT,COLD AGGLUTININ SCREEN,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86157,CPT,COLD AGGLUTININ TITER,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86160,CPT,COMPLEMENT ANTIGEN EACH COMPONENT,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86161,CPT,COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86162,CPT,COMPLEMENT TOTAL HEMOLYTIC,,,17 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86171,CPT,COMPLEMENT FIXATION TESTS EACH ANTIGEN,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86185,CPT,CNTERIMMUNOELECTROPHORESIS EACH ANTIGEN,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86200,CPT,CYCLIC CITRULLINATED PEPTIDE ANTIBODY,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86215,CPT,DEOXYRIBONUCLEASE ANTIBODY,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86225,CPT,DNA ANTIBODY NATIVE/DOUBLE STRANDED,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86226,CPT,DNA ANTIBODY SINGLE STRANDED,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86235,CPT,EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86243,CPT,FC RECEPTOR,,,17 ,,TotalUnits,,,,0.85 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86255,CPT,FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,86255,CPT,FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,86256,CPT,FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,86256,CPT,FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,86277,CPT,GROWTH HORMONE HUMAN ANTIBODY,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86280,CPT,HEMAGGLUTINATION INHIBITION TEST HAI,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86294,CPT,IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86300,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86301,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86304,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86305,CPT,HUMAN EPIDIDYMIS PROTEIN 4 (HE4),,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86308,CPT,HETEROPHILE ANTIBODIES SCREEN,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86309,CPT,HETEROPHILE ANTIBODIES TITER,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86310,CPT,HETEROPHILE ANTIBODIES TITER AFTER ABSORPTION,,,17 ,,TotalUnits,,,,0.31 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86316,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86317,CPT,IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86318,CPT,IMMUNOASSAY NFCT AGT ANTB QUAL/SEMIQUAN 1 STEP,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86320,CPT,IMMUNOELECTROPHORESIS SERUM,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,86320,CPT,IMMUNOELECTROPHORESIS SERUM,,,17 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,86325,CPT,IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,86325,CPT,IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION,,,17 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,86327,CPT,IMMUNOELECTROPHORESIS CROSSED,26,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,86327,CPT,IMMUNOELECTROPHORESIS CROSSED,,,17 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,86329,CPT,IMMUNODIFFUSION NOT ELSEWHERE SPECIFIED,,,17 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86331,CPT,IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86332,CPT,IMMUNE COMPLEX ASSAY,,,17 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86334,CPT,IMMUNOFIXJ ELECTROPHORESIS SERUM,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,86334,CPT,IMMUNOFIXJ ELECTROPHORESIS SERUM,,,17 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,86335,CPT,IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,86335,CPT,IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS,,,17 ,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,86336,CPT,INHIBIN A,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86337,CPT,INSULIN ANTIBODIES,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86340,CPT,INTRINSIC FACTOR ANTIBODIES,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86341,CPT,ISLET CELL ANTIBODY,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86343,CPT,LEUKOCYTE HISTAMINE RELEASE TEST LHR,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86344,CPT,LEUKOCYTE PHAGOCYTOSIS,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86352,CPT,CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKE,,,17 ,,TotalUnits,,,,5.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86353,CPT,LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS,,,17 ,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86355,CPT,B CELLS TOTAL COUNT,,,17 ,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86356,CPT,MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86357,CPT,NATURAL KILLER CELLS TOTAL COUNT,,,17 ,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86359,CPT,T CELLS TOTAL COUNT,,,17 ,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86360,CPT,T CELLS ABSOLUTE CD4&CD8 COUNT RATIO,,,17 ,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86361,CPT,T CELLS ABSOLUTE CD4 COUNT,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86367,CPT,STEM CELLS TOTAL COUNT,,,17 ,,TotalUnits,,,,1.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86376,CPT,MICROSOMAL ANTIBODIES EACH,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86378,CPT,MIGRATION INHIBITORY FACTOR TEST MIF,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86382,CPT,NEUTRALIZATION TEST VIRAL,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86384,CPT,NITROBLUE TETRAZOLIUM DYE TEST NTD,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86386,CPT,NUCLEAR MATRIX PROTEIN 22 NMP22 QUALITATIVE,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86403,CPT,PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86406,CPT,PARTICLE AGGLUTINATION TITER EACH ANTIBODY,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86430,CPT,RHEUMATOID FACTOR QUALITATIVE,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86431,CPT,RHEUMATOID FACTOR QUANTITATIVE,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86480,CPT,TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON,,,17 ,,TotalUnits,,,,2.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86481,CPT,TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP,,,17 ,,TotalUnits,,,,3.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86485,CPT,SKIN TEST CANDIDA,,TC,17 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86486,CPT,SKIN TEST UNLISTED ANTIGEN EACH,,TC,17 ,,RBRVS,,0.15 ,0.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,86490,CPT,SKIN TEST COCCIDIOIDOMYCOSIS,,TC,17 ,,RBRVS,,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,86510,CPT,SKIN TEST HISTOPLASMOSIS,,TC,17 ,,RBRVS,,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,86580,CPT,SKIN TEST TUBERCULOSIS INTRADERMAL,,TC,17 ,,RBRVS,,0.22 ,0.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,86590,CPT,STREPTOKINASE ANTIBODY,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86592,CPT,SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86593,CPT,SYPHILIS TEST QUANTITATIVE,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86602,CPT,ANTIBODY ACTINOMYCES,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86603,CPT,ANTIBODY ADENOVIRUS,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86606,CPT,ANTIBODY ASPERGILLUS,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86609,CPT,ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86611,CPT,ANTIBODY BARTONELLA,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86612,CPT,ANTIBODY BLASTOMYCES,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86615,CPT,ANTIBODY BORDETELLA,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86617,CPT,ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86618,CPT,ANTIBODY BORRELIA BURGDORFERI LYME DISEASE,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86619,CPT,ANTIBODY BORRELIA RELAPSING FEVER,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86622,CPT,ANTIBODY BRUCELLA,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86625,CPT,ANTIBODY CAMPYLOBACTER,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86628,CPT,ANTIBODY CANDIDA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86631,CPT,ANTIBODY CHLAMYDIA,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86632,CPT,ANTIBODY CHLAMYDIA IGM,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86635,CPT,ANTIBODY COCCIDIOIDES,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86638,CPT,ANTIBODY COXIELLA BURNETII Q FEVER,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86641,CPT,ANTIBODY CRYPTOCOCCUS,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86644,CPT,ANTIBODY CYTOMEGALOVIRUS CMV,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86645,CPT,ANTIBODY CYTOMEGALOVIRUS CMV IGM,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86648,CPT,ANTIBODY DIPHTHERIA,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86651,CPT,ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86652,CPT,ANTIBODY ENCEPHALITIS EASTERN EQUINE,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86653,CPT,ANTIBODY ENCEPHALITIS ST. LOUIS,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86654,CPT,ANTIBODY ENCEPHALITIS WESTRN EQUINE,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86658,CPT,ANTIBODY ENTEROVIRUS,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86663,CPT,ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86664,CPT,ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86665,CPT,ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86666,CPT,ANTIBODY EHRLICHIA,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86668,CPT,ANTIBODY FRANCISELLA TULARENSIS,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86671,CPT,ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86674,CPT,ANTIBODY GIARDIA LAMBLIA,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86677,CPT,ANTIBODY HELICOBACTER PYLORI,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86682,CPT,ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86684,CPT,ANTIBODY HAEMOPHILUS INFLUENZA,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86687,CPT,ANTIBODY HTLV-I,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86688,CPT,ANTIBODY HTLV-II,,,17 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86689,CPT,ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86692,CPT,ANTIBODY HEP DELTA AGENT,,,17 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86694,CPT,ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86695,CPT,ANTIBODY HERPES SMPLX TYPE 1,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86696,CPT,ANTIBODY HERPES SMPLX TYPE 2,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86698,CPT,ANTIBODY HISTOPLASMA,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86701,CPT,ANTIBODY HIV-1,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86702,CPT,ANTIBODY HIV-2,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86703,CPT,ANTIBODY HIV-1&HIV-2 SINGLE RESULT,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86704,CPT,HEPATITIS B CORE ANTIBODY HBCAB TOTAL,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86705,CPT,HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY,,,17 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86706,CPT,HEPATITIS B SURF ANTIBODY HBSAB,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86707,CPT,HEPATITIS BE ANTIBODY HBEAB,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86708,CPT,HEPATITIS ANTIBODY HAAB TOTAL,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86709,CPT,HEPATITIS ANTIBODY HAAB IGM ANTIBODY,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86710,CPT,ANTIBODY INFLUENZA VIRUS,,,17 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86713,CPT,ANTIBODY LEGIONELLA,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86717,CPT,ANTIBODY LEISHMANIA,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86720,CPT,ANTIBODY LEPTOSPIRA,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86723,CPT,ANTIBODY LISTERIA MONOCYTOGENES,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86727,CPT,ANTIBODY LYMPHOCYTIC CHORIOMENINGITIS,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86729,CPT,ANTIBODY LYMPHOGRANULOMA VENEREUM,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86732,CPT,ANTIBODY MUCORMYCOSIS,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86735,CPT,ANTIBODY MUMPS,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86738,CPT,ANTIBODY MYCOPLSM,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86741,CPT,ANTIBODY NEISSERIA MENINGITIDIS,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86744,CPT,ANTIBODY NOCARDIA,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86747,CPT,ANTIBODY PARVOVIRUS,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86750,CPT,ANTIBODY PLASMODIUM MALARIA,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86753,CPT,ANTIBODY PROTOZOA NES,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86756,CPT,ANTIBODY RESPIRATORY SYNCTIAL VIRUS,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86757,CPT,ANTIBODY RICKETTSIA,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86759,CPT,ANTIBODY ROTAVIRUS,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86762,CPT,ANTIBODY RUBELLA,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86765,CPT,ANTIBODY RUBEOLA,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86768,CPT,ANTIBODY SALMONELLA,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86771,CPT,ANTIBODY SHIGELLA,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86774,CPT,ANTIBODY TETANUS,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86777,CPT,ANTIBODY TOXOPLASMA,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86778,CPT,ANTIBODY TOXOPLASMA IGM,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86780,CPT,ANTIBODY TREPONEMA PALLIDUM,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86784,CPT,ANTIBODY TRICHINELLA,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86787,CPT,ANTIBODY VARICELLA-ZOSTER,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86788,CPT,ANTIBODY WEST NILE VIRUS IGM,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86789,CPT,ANTIBODY WEST NILE VIRUS,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86790,CPT,ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED,,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86793,CPT,ANTIBODY YERSINIA,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86800,CPT,THYROGLOBULIN ANTIBODY,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86803,CPT,HEPATITIS C ANTIBODY,,,17 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86804,CPT,HEPATITIS C ANTIBODY CONFIRMATORY TEST,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86805,CPT,LYMPHOCYTOTOXICITY ASSAY VIS CROSSMATCH TITRATJ,,,17 ,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86806,CPT,LMPHOCYTOTOXICITY ASSAY VIS CROSSMTCH W/O TITRAT,,,17 ,,TotalUnits,,,,1.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86807,CPT,SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH,,,17 ,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86808,CPT,SERUM SCREENING % REACTIVE ANTIBODY QUICK METH,,,17 ,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86812,CPT,HLA TYPING A/B/C SINGLE ANTIGEN,,,17 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86813,CPT,HLA TYPING A/B/C MULTIPLE ANTIGENS,,,17 ,,TotalUnits,,,,2.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86816,CPT,HLA TYPING DR/DQ SINGLE ANTIGEN,,,17 ,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86817,CPT,HLA TYPING DR/DQ MULTIPLE ANTIGENS,,,17 ,,TotalUnits,,,,2.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86821,CPT,HLA TYPING LYMPHOCYTE CULTURE MIXED,,,17 ,,TotalUnits,,,,2.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86822,CPT,HLA TYPING LYMPHOCYTE CULTURE PRIMED,,,17 ,,TotalUnits,,,,1.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86825,CPT,HLA CROSSMATCH NONCYTOTOXIC 1ST SERUM/DILUTION,,,17 ,,TotalUnits,,,,3.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86826,CPT,HLA CROSSMATCH NONCYTOTOXIC ADDL SERUM/DILUTION,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86849,CPT,UNLISTED IMMUNOLOGY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86850,CPT,ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86860,CPT,ANTIBODY ELUTION RBC EACH ELUTION,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86870,CPT,ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86880,CPT,ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86885,CPT,ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86886,CPT,ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86890,CPT,AUTOL BLD/COMPONENT COLLJ STORAGE PREDEPOSITED,,,17 ,,TotalUnits,,,,1.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86891,CPT,AUTOL BLD/COMPONENT COLLJ STORAGE SALVAGE,,,17 ,,TotalUnits,,,,2.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86900,CPT,BLOOD TYPING ABO,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86901,CPT,BLOOD TYPING RH D,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86902,CPT,BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86904,CPT,BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86905,CPT,BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH,,,17 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86906,CPT,BLOOD TYPING RH PHENOTYPING COMPLETE,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86910,CPT,BLOOD TYPING PATERNITY PR INDIV ABO RH&MN,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86911,CPT,BLOOD TYPING PATERNITY INDIV ADDL ANTIGEN SYS,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86920,CPT,COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86921,CPT,COMPATIBILITY EACH UNIT INCUBATION,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86922,CPT,COMPATIBILITY EACH UNIT ANTIGLOBULIN,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86923,CPT,COMPATIBILITY EACH UNIT ELECTRONIC,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86927,CPT,FRESH FROZEN PLASMA THAWING EACH UNIT,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86930,CPT,FROZEN BLOOD EACH UNIT FREEZING,,,17 ,,TotalUnits,,,,2.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86931,CPT,FROZEN BLOOD EACH UNIT THAWING,,,17 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86932,CPT,FROZEN BLOOD EACH UNIT FREEZING & THAWING,,,17 ,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86940,CPT,HEMOLYSINS&AGGLUTININS AUTO SCREEN EACH,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86941,CPT,HEMOLYSINS&AGGLUTININS INCUBATED,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86945,CPT,IRRADIATION BLOOD PRODUCT EACH UNIT,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86950,CPT,LEUKOCYTE TRANSFUSION,,,17 ,,TotalUnits,,,,1.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86960,CPT,VOLUME REDUCTION BLOOD/BLOOD PRODUCT EACH UNIT,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86965,CPT,POOLING PLATELETS/OTHER BLOOD PRODUCTS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86970,CPT,PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86971,CPT,PRETX RBC ANTIBODY INCUBAT W/ENZYMES EACH,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86972,CPT,PRETX RBC ANTIBODY INCUBAT W/DENSITY GRAD SEP,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86975,CPT,PRETX SERUM RBC ANTIBODY INCUBATION DRUGS EACH,,,17 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86976,CPT,PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86977,CPT,PRETX SERUM RBC ANTB ID INCUBATION INHIBITORS EA,,,17 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86978,CPT,PRETX SERUM RBC ANTIBODY ID DIFFIAL EACH ABSRPJ,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86985,CPT,SPLITTING BLOOD/BLOOD PRODUCTS EACH UNIT,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,86999,CPT,UNLISTED TRANSFUSION MEDICINE PROCEDURE,,,17 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87001,CPT,ANIMAL INOCULATION SMALL ANIMAL W/OBSERVATION,,,17 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87003,CPT,ANIMAL INOCULATION SMALL ANIMAL W/OBS&DSJ,,,17 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87015,CPT,CONCENTRATION INFECTIOUS AGENTS,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87040,CPT,CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87045,CPT,CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87046,CPT,CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87070,CPT,CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87071,CPT,CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87073,CPT,CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87075,CPT,CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87076,CPT,CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87077,CPT,CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87081,CPT,CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87084,CPT,CUL PRSMPTV PTHGNC ORGANISMS SCR DNS CHART,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87086,CPT,CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87088,CPT,CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE,,,17 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87101,CPT,CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87102,CPT,CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87103,CPT,CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD,,,17 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87106,CPT,CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87107,CPT,CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87109,CPT,CULTURE MYCOPLASMA ANY SOURCE,,,17 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87110,CPT,CULTURE CHLAMYDIA ANY SOURCE,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87116,CPT,CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87118,CPT,CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL,,,17 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87140,CPT,CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87143,CPT,CULTURE TYPING GAS/HIGH PRES LIQ CHROMATOGRAPHY,,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87147,CPT,CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87149,CPT,CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87150,CPT,CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87152,CPT,CULTURE TYPING IDENTIFJ PULSE FIELD GEL TYPING,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87153,CPT,CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE,,,17 ,,TotalUnits,,,,4.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87158,CPT,CULTURE TYPING OTHER METHODS,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87164,CPT,DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,87164,CPT,DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION,,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,87166,CPT,DARK FIELD EXAM ANY SOURCE W/O SPECIMEN COLLECT,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87168,CPT,MACROSCOPIC EXAMINATION ARTHROPOD,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87169,CPT,MACROSCOPIC EXAMINATION PARASITE,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87172,CPT,PINWORM EXAMINATION,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87176,CPT,HOMOGENIZATION TISSUE CULTURE,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87177,CPT,OVA&PARASITES DIRECT SMEARS CONCENTRATION&,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87181,CPT,SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87184,CPT,SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD,,,17 ,,TotalUnits,,,,0.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87185,CPT,SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87186,CPT,SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87187,CPT,SUSCEPTIBLTY STDY ANTMCRB MICRO/AGAR DILUTJ EA,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87188,CPT,SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,,,17 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87190,CPT,SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD,,,17 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87197,CPT,SERUM BACTERICIDAL TITER,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87205,CPT,SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87206,CPT,SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT,,,17 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87207,CPT,SMR PRIM SRC SPEC STAIN BODIES/PARASITS,26,,17 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,87207,CPT,SMR PRIM SRC SPEC STAIN BODIES/PARASITS,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,87209,CPT,SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS,,,17 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87210,CPT,SMR PRIM SRC WET MOUNT NFCT AGT,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87220,CPT,TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87230,CPT,TOXIN/ANTITOXIN ASSAY TISSUE CULTURE,,,17 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87250,CPT,VIRUS INOCULATION EGGS/SM ANIMAL OBS&DSJ,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87252,CPT,VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT,,,17 ,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87253,CPT,VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87254,CPT,VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87255,CPT,VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC,,,17 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87260,CPT,IAADI ADENOVIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87265,CPT,IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87267,CPT,IAADI ENTEROVIRUS DIRECT FLUORESCENT ANTIBODY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87269,CPT,IAADI GIARDIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87270,CPT,IAADI CHLAMYDIA TRACHOMATIS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87271,CPT,IAADI CYTOMEGALOVIRUS DIR FLUORESCENT ANTIBODY,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87272,CPT,IAADI CRYPTOSPORIDIUM,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87273,CPT,IAADI HERPES SMPLX VIRUS TYPE 2,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87274,CPT,IAADI HERPES SMPLX VIRUS TYPE 1,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87275,CPT,IAADI INFLUENZA B VIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87276,CPT,IAADI INFFLUENZA A VIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87277,CPT,IAADI LEGIONELLA MICDADEI,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87278,CPT,IAADI LEGIONELLA PNEUMOPHILA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87279,CPT,IAADI PARAINFLUENZA VIRUS EACH TYPE,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87280,CPT,IAADI RESPIRATORY SYNCTIAL VIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87281,CPT,IAADI PNEUMOCUSTIS CARINII,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87283,CPT,IAADI RUBEOLA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87285,CPT,IAADI TREPONEMA PALLIDUM,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87290,CPT,IAADI VARICELLA ZOSTER VIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87299,CPT,IAADI NOT OTHERWISE SPECIFIED EACH ORGANISM,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87300,CPT,IAADI POLYV MLT ORGANISMS EA POLYV ANTISERUM,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87301,CPT,IAAD EIA ADENOVIRUS ENTERIC TYP 40/41,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87305,CPT,IAAD EIA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87320,CPT,IAAD EIA CHLAMYDIA TRACHOMATIS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87324,CPT,IAAD EIA CLOSTRIDIUM DIFFICILE TOXIN,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87327,CPT,IAAD EIA CRYPTOCOCCUS NEOFORMANS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87328,CPT,IAAD EIA CRYPTOSPORIDIUM,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87329,CPT,IAAD EIA GIARDIA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87332,CPT,IAAD EIA CYTOMEGALOVIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87335,CPT,IAAD EIA ESCHERICHIA COLI 0157,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87336,CPT,IAAD EIA ENTAMOEBA HISTOLYTICA DISPAR GRP,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87337,CPT,IAAD EIA ENTAMOEBA HISTOLYTICA GRP,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87338,CPT,IAAD EIA HPYLORI STOOL,,,17 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87339,CPT,IAAD EIA HPYLORI,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87340,CPT,IAAD EIA HEPATITIS B SURFACE ANTIGEN,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87341,CPT,IAAD EIA HEPATITIS B SURFACE AG NEUTRALIZATION,,,17 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87350,CPT,IAAD EIA HEPATITIS BE ANTIGEN,,,17 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87380,CPT,IAAD EIA HEPATITIS DELTA ANTIGEN,,,17 ,,TotalUnits,,,,0.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87385,CPT,IAAD EIA HISTOPLASM CAPSULATUM,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87389,CPT,IAAD EIA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE,,,17 ,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87390,CPT,IAAD EIA HIV-1,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87391,CPT,IAAD EIA HIV-2,,,17 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87400,CPT,IAAD EIA INFLUENZA A/B EACH,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87420,CPT,IAAD EIA RESPIRATORY SYNCTIAL VIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87425,CPT,IAAD EIA ROTAVIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87427,CPT,IAAD EIA SHIGA-LIKE TOXIN,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87430,CPT,IAAD EIA STREPTOCOCCUS GROUP A,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87449,CPT,IAAD EIA MULT STEP METHOD NOS EACH ORGANISM,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87450,CPT,IAAD EIA SINGLE STEP METHOD NOS EA ORGANISM,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87451,CPT,IAAD EIA POLYV MLT ORGANISMS EA POLYV ANTISERUM,,,17 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87470,CPT,IADNA BARTONELLA DIRECT PROBE TECHNIQUE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87471,CPT,IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87472,CPT,IADNA BARTONELLA HENSELAE&QUINTANA QUANTJ,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87475,CPT,IADNA BORRELIA BURGDORFERI DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87476,CPT,IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87477,CPT,IADNA BORRELIA BURGDORFERI QUANTIFICATION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87480,CPT,IADNA CANDIDA SPECIES DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87481,CPT,IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87482,CPT,IADNA CANDIDA SPECIES QUANTIFICATION,,,17 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87485,CPT,IADNA CHLAMYDIA PNEUMONIAE DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87486,CPT,IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87487,CPT,IADNA CHLAMYDIA PNEUMONIAE QUANTIFICATION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87490,CPT,IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87491,CPT,IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87492,CPT,IADNA CHLAMYDIA TRACHOMATIS QUANTIFICATION,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87493,CPT,INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87495,CPT,IADNA CYTOMEGALOVIRUS DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87496,CPT,IADNA CYTOMEGALOVIRUS AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87497,CPT,IADNA CYTOMEGALOVIRUS QUANTIFICATION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87498,CPT,IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87500,CPT,INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87501,CPT,INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE,,,17 ,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87502,CPT,INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES,,,17 ,,TotalUnits,,,,3.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87503,CPT,NFCT AGENT DNA/RNA INFLUENZA 1/> TYPES EA ADDL,,,17 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87510,CPT,IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87511,CPT,IADNA GARDNERELLA VAGINALIS AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87512,CPT,IADNA GARDNERELLA VAGINALIS QUANTIFICATION,,,17 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87515,CPT,IADNA HEPATITIS B VIRUS DIRECT PROBE TECHNIQUE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87516,CPT,IADNA HEPATITIS B VIRUS AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87517,CPT,IADNA HEPATITIS B VIRUS QUANTIFICATION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87520,CPT,IADNA HEPATITIS C DIRECT PROBE TECHNIQUE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87521,CPT,IADNA HEPATITIS C AMPLIFIED PROBE&REVRSE TRANSCR,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87522,CPT,IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87525,CPT,IADNA HEPATITIS G DIRECT PROBE TECHNIQUE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87526,CPT,IADNA HEPATITIS G AMPLIFIED PROBE TECHNIQUE,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87527,CPT,IADNA HEPATITIS G QUANTIFICATION,,,17 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87528,CPT,IADNA HERPES SIMPLX VIRUS DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87529,CPT,IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87530,CPT,IADNA HERPES SOMPLX VIRUS QUANTIFICATION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87531,CPT,IADNA HERPES VIRUS-6 DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87532,CPT,IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87533,CPT,IADNA HERPES VIRUS-6 QUANTIFICATION,,,17 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87534,CPT,IADNA HIV-1 DIRECT PROBE TECHNIQUE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87535,CPT,IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87536,CPT,IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION,,,17 ,,TotalUnits,,,,3.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87537,CPT,IADNA HIV-2 DIRECT PROBE TECHNIQUE,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87538,CPT,IADNA HIV-2 AMPLIFIED PROBE & REVERSE TRANSCRIPJ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87539,CPT,IADNA HIV-2 QUANT & REVERSE TRANSCRIPTION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87540,CPT,IADNA LEGIONELLA PNEUMOPHILA DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87541,CPT,IADNA LEGIONELLA PNEUMOPHILA AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87542,CPT,IADNA LEGIONELLA PNEUMOPHILA QUANTIFICATION,,,17 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87550,CPT,IADNA MYCOBACTERIA SPECIES DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87551,CPT,IADNA MYCOBACTERIA SPECIES AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87552,CPT,IADNA MYCOBACTERIA SPECIES QUANTIFICATION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87555,CPT,IADNA MYCOBACTERIA TUBERCULOSIS DIR PRB,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87556,CPT,IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87557,CPT,IADNA MYCOBACTERIA TUBERCULOSIS QUANTIFICATION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87560,CPT,IADNA MYCOBACTERIA AVIUM-INTRACLRE DIR PRB,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87561,CPT,IADNA MYCOBACTERIA AVIUM-INTRACLRE AMP PRB,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87562,CPT,IADNA MYCOBACTERIA AVIUM-INTRACELLULARE QUANT,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87580,CPT,IADNA MYCOPLSM PNEUMONIAE DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87581,CPT,IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87582,CPT,IADNA MYCOPLSM PNEUMONIAE QUANTIFICATION,,,17 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87590,CPT,IADNA NEISSERIA GONORRHOEAE DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87591,CPT,IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87592,CPT,IADNA NEISSERIA GONORRHOEAE QUANTIFICATION,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87620,CPT,IADNA PAPILLOMAVIRUS HUMAN DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87621,CPT,IADNA PAPILLOMAVIRUS HUMAN AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87622,CPT,IADNA PAPILLOMAVIRUS HUMAN QUANTIFICATION,,,17 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87640,CPT,IADNA S AUREUS AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87641,CPT,IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87650,CPT,IADNA STREPTOCOCCUS GROUP A DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87651,CPT,IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87652,CPT,IADNA STREPTOCOCCUS GROUP A QUANTIFICATION,,,17 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87653,CPT,IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87660,CPT,IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87797,CPT,IADNA NOS DIRECT PROBE TQ EACH ORGANISM,,,17 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87798,CPT,IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM,,,17 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87799,CPT,IADNA NOS QUANTIFICATION EACH ORGANISM,,,17 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87800,CPT,IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ,,,17 ,,TotalUnits,,,,1.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87801,CPT,IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ,,,17 ,,TotalUnits,,,,2.92 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87802,CPT,IAADIADOO STREPTOCOCCUS GROUP B,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87803,CPT,IAADIADOO CLOSTRIDIUM DIFFICILE TOXIN,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87804,CPT,IAADIADOO INFLUENZA,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87807,CPT,IAADIADOO RESPIRATORY SYNCTIAL VIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87808,CPT,IAADIADOO TRICHOMONAS VAGINALIS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87809,CPT,INFECTIOUS AGENT IMMUNOASSAY OPTICAL ADENOVIRUS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87810,CPT,CHLAMYDIA TRACHOMATIS,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87850,CPT,IAADIADOO NEISSERIA GONORRHOEAE,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87880,CPT,IAADIADOO STREPTOCOCCUS GROUP A,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87899,CPT,IAADIADOO NOT OTHERWISE SPECIFIED,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87900,CPT,NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION,,,17 ,,TotalUnits,,,,5.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87901,CPT,NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS,,,17 ,,TotalUnits,,,,10.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87902,CPT,NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS,,,17 ,,TotalUnits,,,,10.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87903,CPT,NFCT PHEXYP RESIST TISS CUL HIV FIRST 1-10 DRUGS,,,17 ,,TotalUnits,,,,20.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87904,CPT,NFCT PHEXYP RESIST TISS CUL HIV EA ADDL DRUG,,,17 ,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87905,CPT,INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87906,CPT,NFCT GEXYP DNA/RNA HIV 1 OTHER REGION,,,17 ,,TotalUnits,,,,5.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,87999,CPT,UNLISTED MICROBIOLOGY,,,17 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88000,CPT,NECROPSY GROSS EXAMINATION ONLY W/O CNS,,,17 ,,TotalUnits,,,,5.76 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88005,CPT,NECROPSY GROSS EXAMINATION W/BRAIN,,,17 ,,TotalUnits,,,,6.72 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88007,CPT,NECROPSY GROSS EXAMINATION W/BRAIN&SPINAL CORD,,,17 ,,TotalUnits,,,,7.04 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88012,CPT,NECROPSY GROSS EXAMINATION INFANT W/BRAIN,,,17 ,,TotalUnits,,,,5.76 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88014,CPT,NECROPSY GROSS EXAM STILLBORN/NEWBORN W/BRAIN,,,17 ,,TotalUnits,,,,5.28 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88016,CPT,NECROPSY GROSS EXAM MACERATED STILLBORN,,,17 ,,TotalUnits,,,,7.36 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88020,CPT,NECROPSY GROSS & MICROSCOPIC W/O CNS,,,17 ,,TotalUnits,,,,9.92 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88025,CPT,NECROPSY GROSS & MICROSCOPIC W/BRAIN,,,17 ,,TotalUnits,,,,9.60 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88027,CPT,NECROPSY GROSS&MCRSCP BRAIN & SPINAL CORD,,,17 ,,TotalUnits,,,,10.24 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88028,CPT,NECROPSY GROSS & MICROSCOPIC INFANT W/BRAIN,,,17 ,,TotalUnits,,,,5.76 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88029,CPT,NECROPSY GROSS&MCRSCP STILLBORN/NEWBORN BRAIN,,,17 ,,TotalUnits,,,,5.76 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88036,CPT,NECROPSY LIMITED GROSS&/MCRSCP REGIONAL,,,17 ,,TotalUnits,,,,2.88 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88037,CPT,NECROPSY LIMITD GROSS&/MCRSCP SINGLE ORGAN,,,17 ,,TotalUnits,,,,2.56 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88040,CPT,NECROPSY FORENSIC EXAMINATION,,,17 ,,TotalUnits,,,,16.00 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88045,CPT,NECROPSY CORONER CALL,,,17 ,,TotalUnits,,,,1.60 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88099,CPT,UNLISTED NECROPSY PROCEDURE,,,17 ,,TotalUnits,,,,9.60 ,,$0.00,$0.00,1,0,1,0,1,1,20131001,88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,,,17 ,,RBRVS,0.56 ,1.41 ,1.41 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,26,,17 ,,RBRVS,0.56 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,TC,,17 ,,RBRVS,,1.18 ,1.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,,,17 ,,RBRVS,0.37 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,26,,17 ,,RBRVS,0.37 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,TC,,17 ,,RBRVS,,1.58 ,1.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,,,17 ,,RBRVS,0.44 ,1.62 ,1.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,26,,17 ,,RBRVS,0.44 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,TC,,17 ,,RBRVS,,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,,,17 ,,RBRVS,1.18 ,1.78 ,1.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,26,,17 ,,RBRVS,1.18 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,TC,,17 ,,RBRVS,,1.35 ,1.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,,,17 ,,RBRVS,1.20 ,12.65 ,12.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,26,,17 ,,RBRVS,1.20 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,TC,,17 ,,RBRVS,,12.36 ,12.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,,,17 ,,RBRVS,1.00 ,10.95 ,10.95 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,26,,17 ,,RBRVS,1.00 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,TC,,17 ,,RBRVS,,10.63 ,10.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88125,CPT,CYTOPATHOLOGY FORENSIC,,,17 ,,RBRVS,0.26 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88125,CPT,CYTOPATHOLOGY FORENSIC,26,,17 ,,RBRVS,0.26 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88125,CPT,CYTOPATHOLOGY FORENSIC,TC,,17 ,,RBRVS,,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88130,CPT,SEX CHROMATIN IDENTIFICATION BARR BODIES,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88140,CPT,SEX CHROMATIN IDENTJ PERIPHERAL BLOOD SMEAR,,,17 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88141,CPT,CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN,,PC,17 ,,RBRVS,0.42 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88142,CPT,CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88143,CPT,CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88147,CPT,CYTP SMRS C/V SCR AUTOMATED SYSTEM PHYS SUPV,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88148,CPT,CYTP SMRS C/V SCR AUTO SYS MNL RESCR PHYS,,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88150,CPT,CYTP SLIDES C/V MNL SCR UNDER PHYS,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88152,CPT,CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88153,CPT,CYTP SLIDES C/V MNL SCR&RESCR PHYS,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88154,CPT,CYTP SLIDES C/V MNL SCR&CPTR-RESCR CELL S&i,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88155,CPT,CYTP SLIDES C/V DEFINITIVE HORMONAL EVAL,,,17 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,,,17 ,,RBRVS,0.50 ,1.12 ,1.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,26,,17 ,,RBRVS,0.50 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,TC,,17 ,,RBRVS,,0.92 ,0.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,,,17 ,,RBRVS,0.50 ,1.16 ,1.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,26,,17 ,,RBRVS,0.50 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,TC,,17 ,,RBRVS,,0.97 ,0.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,,,17 ,,RBRVS,0.76 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,26,,17 ,,RBRVS,0.76 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,TC,,17 ,,RBRVS,,1.40 ,1.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88164,CPT,CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88165,CPT,CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88166,CPT,CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS SUPV,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88167,CPT,CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&i,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,,,17 ,,RBRVS,0.69 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,26,,17 ,,RBRVS,0.69 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,TC,,17 ,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,,,17 ,,RBRVS,1.39 ,2.64 ,2.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,26,,17 ,,RBRVS,1.39 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,TC,,17 ,,RBRVS,,2.08 ,2.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88174,CPT,CYTP C/V AUTO THIN LYR PREPJ SCR SYS PHYS,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88175,CPT,CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS,,,17 ,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,,,17 ,,RBRVS,0.42 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,26,,17 ,,RBRVS,0.42 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,TC,,17 ,,RBRVS,,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,,,17 ,,RBRVS,0.77 ,2.17 ,2.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,26,,17 ,,RBRVS,0.77 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,TC,,17 ,,RBRVS,,1.97 ,1.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88184,CPT,FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST,,TC,17 ,,RBRVS,,2.42 ,2.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88185,CPT,FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA,,TC,17 ,,RBRVS,,1.46 ,1.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88187,CPT,FLOW CYTOMETRY INTERPJ 2-8 MARKERS,,PC,17 ,,RBRVS,1.36 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88188,CPT,FLOW CYTOMETRY INTERPJ 9-15 MARKERS,,PC,17 ,,RBRVS,1.69 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88189,CPT,FLOW CYTOMETRY INTERPJ 16/> MARKERS,,PC,17 ,,RBRVS,2.23 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88199,CPT,UNLISTED CYTOPATHOLOGY PROCEDURE,,PC,17 ,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,88199,CPT,UNLISTED CYTOPATHOLOGY PROCEDURE,,TC,17 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,88199,CPT,UNLISTED CYTOPATHOLOGY PROCEDURE,,,17 ,,TotalUnits,,,,2.96 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,88230,CPT,TISS CUL NON-NEO DISORDERS LYMPHOCYTE,,,17 ,,TotalUnits,,,,4.85 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88233,CPT,TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX,,,17 ,,TotalUnits,,,,5.86 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88235,CPT,TISS CUL NON-NEO DISORDERS AMNIOTIC/CHORNC CELLS,,,17 ,,TotalUnits,,,,6.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88237,CPT,TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS,,,17 ,,TotalUnits,,,,5.26 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88239,CPT,TISS CUL NEO DISORDERS SOLID TUMOR,,,17 ,,TotalUnits,,,,6.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88240,CPT,CRYOPRSRV FRZING&STORAGE CELLS EA CELL LINE,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88241,CPT,THAWING&EXPANSION FROZEN CELLS EACH ALIQUOT,,,17 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88245,CPT,CHRMSM BREAKAGE BASELINE SISTER 20-25 CLL,,,17 ,,TotalUnits,,,,6.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88248,CPT,CHRMSM BREAKAGE BASELINE BREAKAGE 50-100 CLL,,,17 ,,TotalUnits,,,,7.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88249,CPT,CHRMSM BREAKAGE SYNDS SCORE 100 CLL,,,17 ,,TotalUnits,,,,7.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88261,CPT,CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING,,,17 ,,TotalUnits,,,,7.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88262,CPT,CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING,,,17 ,,TotalUnits,,,,5.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88263,CPT,CHRMSM COUNT 45 CELL MOSAICISM 2KARYOTYPE,,,17 ,,TotalUnits,,,,6.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88264,CPT,CHRMSM ANALYZE 20-25 CELLS,,,17 ,,TotalUnits,,,,5.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88267,CPT,CHRMSM ALYS AMNIOTIC/VILLUS 15 CELL 1KARYOTYPE,,,17 ,,TotalUnits,,,,7.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88269,CPT,CHRMSM SITU AMNIOTIC CLL 6-12 COLONIES 1KARYOTYP,,,17 ,,TotalUnits,,,,6.92 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88271,CPT,MOLECULAR CYTOGENETICS DNA PROBE EACH,,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88272,CPT,MOLECULAR CYTOGENETICS CHRMOML ISH 3-5 CELLS,,,17 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88273,CPT,MOLECULAR CYTOGENETICS CHRMOML ISH 10-30 CLL,,,17 ,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88274,CPT,MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL,,,17 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88275,CPT,MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL,,,17 ,,TotalUnits,,,,1.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88280,CPT,CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY,,,17 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88283,CPT,CHRMSM ANALYSIS ADDL SPECIALIZED BANDING,,,17 ,,TotalUnits,,,,2.85 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88285,CPT,CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY,,,17 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88289,CPT,CHRMSM ANALYSIS ADDL HIGH RESOLUTION STUDY,,,17 ,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88291,CPT,CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP,,PC,17 ,,RBRVS,0.52 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88299,CPT,UNLISTED CYTOGENETIC STUDY,,,17 ,,TotalUnits,,,,1.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,,,17 ,,RBRVS,0.08 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,26,,17 ,,RBRVS,0.08 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,TC,,17 ,,RBRVS,,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17 ,,RBRVS,0.13 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17 ,,RBRVS,0.13 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17 ,,RBRVS,,1.44 ,1.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXA,,,17 ,,RBRVS,0.22 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXA,26,,17 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXA,TC,,17 ,,RBRVS,,1.49 ,1.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17 ,,RBRVS,0.75 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17 ,,RBRVS,0.75 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17 ,,RBRVS,,2.04 ,2.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17 ,,RBRVS,1.59 ,5.25 ,5.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17 ,,RBRVS,1.59 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17 ,,RBRVS,,4.56 ,4.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,,17 ,,RBRVS,2.80 ,7.53 ,7.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,26,,17 ,,RBRVS,2.80 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,TC,,17 ,,RBRVS,,6.33 ,6.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88311,CPT,DECALCIFICATION PROCEDURE,,,17 ,,RBRVS,0.24 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88311,CPT,DECALCIFICATION PROCEDURE,26,,17 ,,RBRVS,0.24 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88311,CPT,DECALCIFICATION PROCEDURE,TC,,17 ,,RBRVS,,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,,,17 ,,RBRVS,0.54 ,2.19 ,2.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,26,,17 ,,RBRVS,0.54 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,TC,,17 ,,RBRVS,,1.98 ,1.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT,,,17 ,,RBRVS,0.24 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT,26,,17 ,,RBRVS,0.24 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT,TC,,17 ,,RBRVS,,1.58 ,1.58 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU,,,17 ,,RBRVS,0.45 ,1.88 ,1.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU,26,,17 ,,RBRVS,0.45 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU,TC,,17 ,,RBRVS,,1.70 ,1.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,,,17 ,,RBRVS,0.53 ,2.31 ,2.31 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,26,,17 ,,RBRVS,0.53 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,TC,,17 ,,RBRVS,,2.10 ,2.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88321,CPT,CONSLTJ&REPRT SLIDES PREPARED ELSEWHERE,,,17 ,,RBRVS,1.63 ,0.64 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,,,17 ,,RBRVS,1.83 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,26,,17 ,,RBRVS,1.83 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,TC,,17 ,,RBRVS,,1.63 ,1.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88325,CPT,CONSLTJ COMPRE REVIEW REPRT REFERRED MATRL,,,17 ,,RBRVS,2.50 ,1.04 ,3.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88329,CPT,PATHOLOGY CONSULTATION DURING SURGERY,,,17 ,,RBRVS,0.67 ,0.30 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,,,17 ,,RBRVS,1.19 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,26,,17 ,,RBRVS,1.19 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,TC,,17 ,,RBRVS,,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,,,17 ,,RBRVS,0.59 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,26,,17 ,,RBRVS,0.59 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,TC,,17 ,,RBRVS,,0.33 ,0.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,,,17 ,,RBRVS,1.20 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,26,,17 ,,RBRVS,1.20 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,TC,,17 ,,RBRVS,,1.08 ,1.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,,,17 ,,RBRVS,0.73 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,26,,17 ,,RBRVS,0.73 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,TC,,17 ,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88342,CPT,IMCYTCHM TISS IMMUNOPROXIDASE EA ANTIBODY,,,17 ,,RBRVS,0.85 ,2.21 ,2.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88342,CPT,IMCYTCHM TISS IMMUNOPROXIDASE EA ANTIBODY,26,,17 ,,RBRVS,0.85 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88342,CPT,IMCYTCHM TISS IMMUNOPROXIDASE EA ANTIBODY,TC,,17 ,,RBRVS,,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88346,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY DIR METHOD,,,17 ,,RBRVS,0.86 ,2.16 ,2.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88346,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY DIR METHOD,26,,17 ,,RBRVS,0.86 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88346,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY DIR METHOD,TC,,17 ,,RBRVS,,1.82 ,1.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88347,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY INDIR METHOD,,,17 ,,RBRVS,0.86 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88347,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY INDIR METHOD,26,,17 ,,RBRVS,0.86 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88347,CPT,IMMUNOFLUORESCENT STUDY EA ANTIBODY INDIR METHOD,TC,,17 ,,RBRVS,,1.08 ,1.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,,,17 ,,RBRVS,1.51 ,19.03 ,19.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,26,,17 ,,RBRVS,1.51 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,TC,,17 ,,RBRVS,,18.46 ,18.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88349,CPT,ELECTRON MICROSCOPY SCANNING,,,17 ,,RBRVS,0.76 ,10.71 ,10.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88349,CPT,ELECTRON MICROSCOPY SCANNING,26,,17 ,,RBRVS,0.76 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88349,CPT,ELECTRON MICROSCOPY SCANNING,TC,,17 ,,RBRVS,,10.37 ,10.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,,,17 ,,RBRVS,1.85 ,3.79 ,3.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,26,,17 ,,RBRVS,1.85 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,TC,,17 ,,RBRVS,,3.28 ,3.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88356,CPT,MORPHOMETRIC ANALYSIS NERVE,,,17 ,,RBRVS,3.02 ,4.81 ,4.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88356,CPT,MORPHOMETRIC ANALYSIS NERVE,26,,17 ,,RBRVS,3.02 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88356,CPT,MORPHOMETRIC ANALYSIS NERVE,TC,,17 ,,RBRVS,,4.24 ,4.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,,,17 ,,RBRVS,0.95 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,26,,17 ,,RBRVS,0.95 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,TC,,17 ,,RBRVS,,0.98 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,,,17 ,,RBRVS,1.10 ,2.40 ,2.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,26,,17 ,,RBRVS,1.10 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,TC,,17 ,,RBRVS,,2.03 ,2.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,,,17 ,,RBRVS,1.18 ,3.22 ,3.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,26,,17 ,,RBRVS,1.18 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,TC,,17 ,,RBRVS,,2.80 ,2.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88362,CPT,NERVE TEASING PREPARATIONS,,,17 ,,RBRVS,2.17 ,6.57 ,6.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88362,CPT,NERVE TEASING PREPARATIONS,26,,17 ,,RBRVS,2.17 ,0.88 ,0.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88362,CPT,NERVE TEASING PREPARATIONS,TC,,17 ,,RBRVS,,5.69 ,5.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88363,CPT,EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI,,,17 ,,RBRVS,0.37 ,0.06 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88365,CPT,IN SITU HYBRIDIZATION EACH PROBE,,,17 ,,RBRVS,1.20 ,3.63 ,3.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88365,CPT,IN SITU HYBRIDIZATION EACH PROBE,26,,17 ,,RBRVS,1.20 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88365,CPT,IN SITU HYBRIDIZATION EACH PROBE,TC,,17 ,,RBRVS,,3.20 ,3.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88367,CPT,M/PHMTRC ALYS ISH EA PRB CPTR-ASST TECHNOLOGY,,,17 ,,RBRVS,1.30 ,6.40 ,6.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88367,CPT,M/PHMTRC ALYS ISH EA PRB CPTR-ASST TECHNOLOGY,26,,17 ,,RBRVS,1.30 ,0.42 ,0.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88367,CPT,M/PHMTRC ALYS ISH EA PRB CPTR-ASST TECHNOLOGY,TC,,17 ,,RBRVS,,5.98 ,5.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,,,17 ,,RBRVS,1.40 ,5.05 ,5.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,26,,17 ,,RBRVS,1.40 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,TC,,17 ,,RBRVS,,4.69 ,4.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88371,CPT,PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPO,26,,17 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,88371,CPT,PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPO,,,17 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,88372,CPT,PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA,26,,17 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,88372,CPT,PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA,,,17 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,,,17 ,,RBRVS,1.56 ,3.75 ,3.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,26,,17 ,,RBRVS,1.56 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,TC,,17 ,,RBRVS,,3.16 ,3.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,,,17 ,,RBRVS,1.18 ,3.52 ,3.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,26,,17 ,,RBRVS,1.18 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,TC,,17 ,,RBRVS,,3.24 ,3.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,,17 ,,RBRVS,0.62 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,PC,17 ,,RBRVS,0.62 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,TC,17 ,,RBRVS,,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE,,,17 ,,RBRVS,0.45 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE,,PC,17 ,,RBRVS,0.45 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE,,TC,17 ,,RBRVS,,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,88399,CPT,UNLISTED SURGICAL PATHOLOGY PROCEDURE,,PC,17 ,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,88399,CPT,UNLISTED SURGICAL PATHOLOGY PROCEDURE,,TC,17 ,,TotalUnits,,,,2.34 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,88399,CPT,UNLISTED SURGICAL PATHOLOGY PROCEDURE,,,17 ,,TotalUnits,,,,3.58 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,88720,CPT,BILIRUBIN TOTAL TRANSCUTANEOUS,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88738,CPT,HGB QUANTITATIVE TRANSCUTANEOUS,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88740,CPT,HEMOGLOBIN QUAN TC PER DAY CARBOXYHEMOGLOBIN,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88741,CPT,HEMOGLOBIN QUANTITATIVE TC PER DAY METHEMOGLOBIN,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,88749,CPT,UNLISTED IN VIVO LABORTORY SERVICE,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89049,CPT,CAFFEINE HALOTHANE CONTRACTURE TEST,,,17 ,,RBRVS,1.40 ,0.41 ,6.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,89050,CPT,CELL COUNT MISCELLANEOUS BODY FLUIDS,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89051,CPT,CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89055,CPT,LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89060,CPT,CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID,26,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,89060,CPT,CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,89125,CPT,FAT STAIN FECES URINE/RESPIR SECRETIONS,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89160,CPT,MEAT FIBERS FECES,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89190,CPT,NASAL SMEAR EOSINOPHILS,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89220,CPT,SPUTUM OBTAINING SPEC AEROSOL INDUCED TX SPX,,TC,17 ,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,89230,CPT,SWEAT COLLECTION IONTOPHORESIS,,TC,17 ,,RBRVS,,0.07 ,0.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,89240,CPT,UNLIS MISC PATH,,,17 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89250,CPT,CUL OOCYTE/EMBRYO <4 DAYS,,,17 ,,TotalUnits,,,,13.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89251,CPT,CUL OOCYTE/EMBRYO < 4 D CO-CULT OCYTE/EMBRY,,,17 ,,TotalUnits,,,,13.93 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89253,CPT,ASSTD EMBRYO HATCHING MICROTQS ANY METH,,,17 ,,TotalUnits,,,,5.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89254,CPT,OOCYTE ID FROM FOLLICULAR FLU,,,17 ,,TotalUnits,,,,6.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89255,CPT,PREPJ EMBRYO TR,,,17 ,,TotalUnits,,,,4.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89257,CPT,SPRM ID FROM ASPIR OTH/THN SEMINAL,,,17 ,,TotalUnits,,,,5.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89258,CPT,CRYOPRSRV EMBRYO,,,17 ,,TotalUnits,,,,5.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89259,CPT,CRYOPRSRV SPRM,,,17 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89260,CPT,SPRM ISOL SMPL PREP INSEMINATION/DX SEMEN ALYS,,,17 ,,TotalUnits,,,,1.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89261,CPT,SPRM ISOL CPLX PREP INSEMINATION/DX SEMEN ALYS,,,17 ,,TotalUnits,,,,2.02 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89264,CPT,SPRM ID FROM TSTIS TISS FRSH/CRYOPRSRVD,,,17 ,,TotalUnits,,,,5.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89268,CPT,INSEMINATION OOCYTES,,,17 ,,TotalUnits,,,,4.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89272,CPT,EXTND CUL OOCYTE/EMBRYO 4-7 DAYS,,,17 ,,TotalUnits,,,,8.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89280,CPT,ASSTD FERTILIZATION MICROTQ </EQUAL 10 OOCYTES,,,17 ,,TotalUnits,,,,12.96 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89281,CPT,ASSTD FERTILIZATION MICROTQ > 10 OOCYTES,,,17 ,,TotalUnits,,,,14.91 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89290,CPT,BX OOCYTE MICROTQ >/EQUAL 5 EMBRY,,,17 ,,TotalUnits,,,,22.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89291,CPT,BX OOCYTE MICROTQ >5 EMBRY,,,17 ,,TotalUnits,,,,14.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89300,CPT,SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER,,,17 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89310,CPT,SEMEN ALYS MOTILITY&CNT X W/HUHNER TST,,,17 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89320,CPT,SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89321,CPT,SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89322,CPT,SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA,,,17 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89325,CPT,SPERM ANTIBODIES,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89329,CPT,SPERM EVALUATION HAMSTER PENETRATION TEST,,,17 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89330,CPT,SPERM EVALUATION CERVICAL MUCOUS PENETRATION,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89331,CPT,SPERM EVALUATION RETROGRADE EJACULATION URINE,,,17 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89342,CPT,STORAGE PER YEAR EMBRYO,,,17 ,,TotalUnits,,,,2.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89343,CPT,STORAGE PER YEAR SPERM/SEMEN,,,17 ,,TotalUnits,,,,1.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89352,CPT,THAWING CRYOPRESERVED EMBRYO,,,17 ,,TotalUnits,,,,5.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89353,CPT,THAWING CRYOPRESERVED SPERM/SEMEN EACH ALIQUOT,,,17 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,89398,CPT,UNLISTED REPRODUCTIVE MEDICINE LAB PROCEDURE,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90281,CPT,IMMUNE GLOBULIN IG HUMAN IM USE,,,22 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90283,CPT,IMMUNE GLOBULIN IGIV HUMAN IV USE,,,22 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90284,CPT,IMMUNE GLOBULIN HUMAN SUBQ INFUSION 100 MG EA,,,22 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90287,CPT,BOTULINUM ANTITOXIN EQUINE ANY ROUTE,,,22 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90296,CPT,DIPHTHERIA ANTITOXIN EQUINE ANY ROUTE,,,22 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90371,CPT,HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM,,,22 ,,TotalUnits,,,,3.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90375,CPT,RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ,,,22 ,,TotalUnits,,,,3.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90376,CPT,RABIES IG HEAT-TREATED HUMAN IM/SUBQ,,,22 ,,TotalUnits,,,,3.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90378,CPT,RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E,,,22 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90384,CPT,RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM,,,22 ,,TotalUnits,,,,2.38 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90385,CPT,RHO(D) IMMUNE GLOBULIN HUMAN MINI-DOSE IM,,,22 ,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90386,CPT,RHO(D) IMMUNE GLOBULIN HUMAN IV,,,22 ,,RBRVS,,2.56 ,2.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,90389,CPT,TETANUS IMMUNE GLOBULIN TIG HUMAN IM,,,22 ,,TotalUnits,,,,2.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90396,CPT,VARICELLA-ZOSTER IMMUNE GLOBULIN HUMAN IM,,,22 ,,TotalUnits,,,,2.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90399,CPT,UNLISTED IMMUNE GLOBULIN,,,22 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90460,CPT,IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX,,,9 ,,RBRVS,0.17 ,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,90461,CPT,IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT,,,9 ,,RBRVS,0.15 ,0.21 ,0.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,90471,CPT,IMADM PRQ ID SUBQ/IM NJXS 1 VACCINE,,,9 ,,RBRVS,0.17 ,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,90472,CPT,IMADM PRQ ID SUBQ/IM NJXS EA VACCINE,,,9 ,,RBRVS,0.15 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,90473,CPT,IMADM INTRANSL/ORAL 1 VACCINE,,,9 ,,RBRVS,0.17 ,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,90474,CPT,IMADM INTRANSL/ORAL EA VACCINE,,,9 ,,RBRVS,0.15 ,0.18 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,90476,CPT,ADENOVIRUS VACCINE TYPE 4 LIVE ORAL,,,9 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90477,CPT,ADENOVIRUS VACCINE TYPE 7 LIVE FOR ORAL,,,9 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90581,CPT,ANTHRAX VACCINE SUBCUTANEOUS/IM USE,,,9 ,,RBRVS,,2.84 ,2.84 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,90585,CPT,BACILLUS CALMETTE-GUERIN VACC FOR TB LIVE PERQ,,,9 ,,TotalUnits,,,,4.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90586,CPT,BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL,,,9 ,,TotalUnits,,,,7.03 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90632,CPT,HEPATITIS A VACCINE ADULT FOR INTRAMUSCULAR USE,,,9 ,,TotalUnits,,,,2.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90633,CPT,HEPATITIS A VACCINE PEDIATRIC 2 DOSE SCHEDULE IM,,,9 ,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90634,CPT,HEPATITIS A VACCINE PEDIATRIC 3 DOSE SCHEDULE IM,,,9 ,,TotalUnits,,,,1.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90636,CPT,HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM,,,9 ,,TotalUnits,,,,3.36 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90644,CPT,MENINGOCOCCAL & HIB-MENCY VACCINE 4 DOSE IM,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90645,CPT,HEMOPHILUS INFLUENZA B VACC HBOC CONJ 4 DOSE IM,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90646,CPT,HEMOPHILUS INFLUENZA B VACCINE PRP-D BOOSTER IM,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90647,CPT,HEMOPHILUS INFLUENZA B VACCINE PRP-OMP 3 DOSE IM,,,9 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90648,CPT,HEMOPHILUS INFLUENZA B VACCINE PRP-T 4 DOSE IM,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90649,CPT,HUMAN PAPILLOMA VIRUS VACCINE QUADRIV 3 DOSE IM,,,9 ,,TotalUnits,,,,4.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90650,CPT,HUMAN PAPILLOMA VIRUS BIVALENT VACCINE 3 DOSE IM,,,9 ,,TotalUnits,,,,2.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90654,CPT,INFLUENZA VACCINE SPLIT VIRUS PRSRV FREE ID,,,9 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90655,CPT,INFLUENZA VACC TRIVALENT PRSRV FREE 6-35 MO IM,,,9 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90656,CPT,INFLUENZA VIRUS VACC SPLIT PRSRV FREE 3 YRS/> IM,,,9 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90657,CPT,INFLUENZA VIRUS VACCINE SPLIT VIRUS 6-35 MO IM,,,9 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90658,CPT,INFLUENZA VIRUS VACCINE SPLIT VIRUS 3/> YRS IM,,,9 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90660,CPT,INFLUENZA VIRUS VACCINE LIVE INTRANASAL,,,9 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90661,CPT,INFLUENZA VACCINE CELL CULT PRSRV FREE IM,,,9 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90662,CPT,INFLUENZA VACCINE SPLT PRSRV FREE INC ANTIGEN IM,,,9 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90664,CPT,INFLUENZA VAC PANDEMIC FORMULA LIVE INTRANASAL,,,9 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90666,CPT,INFLUENZA VACCINE PANDEMIC SPLT PRSRV FREE IM,,,9 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90667,CPT,INFLUENZA VACCINE PANDEMIC SPLT ADJUVANT IM,,,9 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90668,CPT,INFLUENZA VACCINE PANDEMIC SPLT IM,,,9 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90669,CPT,PNEUMOCOCCAL CONJ VACCINE 7 VALENT IM,,,9 ,,TotalUnits,,,,2.90 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90670,CPT,PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,,,9 ,,TotalUnits,,,,2.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90675,CPT,RABIES VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,6.97 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90676,CPT,RABIES VACCINE INTRADERMAL,,,9 ,,TotalUnits,,,,2.94 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90680,CPT,ROTAVIRUS VACCINE PENTAVALENT 3 DOSE LIVE ORAL,,,9 ,,TotalUnits,,,,2.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90681,CPT,ROTAVIRUS VACC HUMAN ATTENUATED 2 DOSE LIVE ORAL,,,9 ,,TotalUnits,,,,2.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90690,CPT,TYPHOID VACCINE LIVE ORAL,,,9 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90691,CPT,TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM,,,9 ,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90692,CPT,TYPHOID VACC H-P INACTIVATED SUBQ/INTRADERMAL,,,9 ,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90693,CPT,TYPHOID VACCINE AKD SUBQ U.S. MILITARY,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90696,CPT,DTAP-IPV INACTIVATED ADMIN PTS AGE 4-6 YRS IM,,,9 ,,TotalUnits,,,,1.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90698,CPT,DTAP-HIB-IPV INACTIVATED VACCINE IM,,,9 ,,TotalUnits,,,,2.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90700,CPT,DIPHTH TETANUS TOX ACELL PERTUSSIS VACC>7 YR IM,,,9 ,,TotalUnits,,,,0.92 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90702,CPT,DIPHTHERIA TETANUS TOXOID ADSORBED >7 YR IM,,,9 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90703,CPT,TETANUS TOXOID ADSORBED INTRAMUSCULAR,,,9 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90704,CPT,MUMPS VIRUS VACCINE LIVE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,0.95 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90705,CPT,MEASLES VIRUS VACCINE LIVE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90706,CPT,RUBELLA VIRUS VACCINE LIVE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90707,CPT,MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ,,,9 ,,TotalUnits,,,,1.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90708,CPT,MEASLES & RUBELLA VIRUS VACCINE LIVE SUBQ,,,9 ,,TotalUnits,,,,1.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90710,CPT,MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ,,,9 ,,TotalUnits,,,,4.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90712,CPT,POLIOVIRUS VACCINE ANY LIVE ORAL,,,9 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90713,CPT,POLIOVIRUS VACCINE INACTIVATED SUBQ/IM,,,9 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90714,CPT,TD TOXOIDS ADSORBED PRSRV FR 7 YR/> IM,,,9 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90715,CPT,TDAP VACCINE 7 YRS/> IM,,,9 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90716,CPT,VARICELLA VIRUS VACCINE LIVE SUBQ,,,9 ,,TotalUnits,,,,2.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90717,CPT,YELLOW FEVER VACCINE LIVE SUBQ,,,9 ,,TotalUnits,,,,3.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90719,CPT,DIPHTHERIA TOXOID INTRAMUSCULAR,,,9 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90720,CPT,DTP-HIB VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90721,CPT,DTAP-HIB VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,1.17 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90723,CPT,DTAP-HEPB-IPV VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,2.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90725,CPT,CHOLERA VACCINE INJECTABLE,,,9 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90727,CPT,PLAGUE VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90732,CPT,PNEUMOCOCCAL POLYSAC VACCINE 23-V 2 YRS/>SUBQ/IM,,,9 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90733,CPT,MENINGOCOCCAL POLYSAC VACCINE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,3.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90734,CPT,MENINGOCOCCAL CONJ VACCINE TETRAVALENT IM,,,9 ,,TotalUnits,,,,3.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90735,CPT,JAPANESE ENCEPHALITIS VIRUS VACCINE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,3.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90736,CPT,ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS,,,9 ,,TotalUnits,,,,5.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90738,CPT,JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM,,,9 ,,TotalUnits,,,,2.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90740,CPT,HEPATITIS B VACCINE DIALYSIS DOSAGE 3 DOSE IM,,,9 ,,TotalUnits,,,,7.03 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90743,CPT,HEPATITIS B VACCINE ADOLESCENT 2 DOSE IM,,,9 ,,TotalUnits,,,,1.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90744,CPT,HEPATITIS B VACCINE PEDIATRIC3 DOSE IM,,,9 ,,TotalUnits,,,,1.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90746,CPT,HEPATITIS B VACCINE ADULT 3 DOSE IM,,,9 ,,TotalUnits,,,,2.48 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90747,CPT,HEPATITIS B VACCINE DIALYSIS DOSAGE 4 DOSE IM,,,9 ,,TotalUnits,,,,7.91 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90748,CPT,HEPB-HIB VACCINE INTRAMUSCULAR,,,9 ,,TotalUnits,,,,2.05 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90749,CPT,UNLISTED VACCINE/TOXOID,,,9 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,90785,CPT,PSYCHOTHERAPY COMPLEX INTERACTIVE,,,16 ,,RBRVS,0.11 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90791,CPT,PSYCHIATRIC DIAGNOSTIC EVALUATION,,,16 ,,RBRVS,2.80 ,0.53 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90792,CPT,PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES,,,16 ,,RBRVS,2.96 ,0.48 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90832,CPT,PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES,,,16 ,,RBRVS,1.25 ,0.14 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90833,CPT,PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN,,,16 ,,RBRVS,0.98 ,0.19 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90834,CPT,PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES,,,16 ,,RBRVS,1.89 ,0.20 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90836,CPT,PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN,,,16 ,,RBRVS,1.60 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90837,CPT,PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES,,,16 ,,RBRVS,2.83 ,0.32 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90838,CPT,PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN,,,16 ,,RBRVS,2.56 ,0.52 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90845,CPT,PSYCHOANALYSIS,,,16 ,,RBRVS,1.79 ,0.36 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90846,CPT,FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT,,,16 ,,RBRVS,1.83 ,0.41 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90847,CPT,FAMILY PSYCHOTHERAPY W/PATIENT PRESENT,,,16 ,,RBRVS,2.21 ,0.46 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90849,CPT,MULTIPLE FAMILY GROUP PSYCHOTHERAPY,,,16 ,,RBRVS,0.59 ,0.20 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90853,CPT,GROUP PSYCHOTHERAPY,,,16 ,,RBRVS,0.59 ,0.22 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90865,CPT,NARCOSYNTHESIS PSYC DX&THER PURPOSES,,,16 ,,RBRVS,2.84 ,0.70 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90867,CPT,REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M,,,16 ,,RBRVS,3.52 ,1.43 ,7.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90868,CPT,THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG,,,16 ,,RBRVS,0.48 ,0.20 ,4.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90869,CPT,REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN,,,16 ,,RBRVS,3.00 ,0.27 ,10.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90870,CPT,ELECTROCONVULSIVE THERAPY,,,16 ,,RBRVS,2.50 ,0.52 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90875,CPT,INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN,,,16 ,,RBRVS,1.20 ,0.50 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90876,CPT,INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN,,,16 ,,RBRVS,1.90 ,0.78 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90880,CPT,HYPNOTHERAPY,,,16 ,,RBRVS,2.19 ,0.38 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90882,CPT,ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT,,,16 ,,TotalUnits,,,,2.26 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,90885,CPT,PSYCHIATRIC EVAL HOSPITAL RECORDS DX PURPOSES,,,16 ,,RBRVS,0.97 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90887,CPT,INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY,,,16 ,,RBRVS,1.48 ,0.61 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90889,CPT,PREP REPORT PT PSYCH STATUS AGENCY/PAYER,,,16 ,,TotalUnits,,,,1.91 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,90899,CPT,UNLISTED PSYCHIATRIC SERVICE/PROCEDURE,,,16 ,,TotalUnits,,,,1.71 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,90901,CPT,BIOFEEDBACK TRAINING ANY MODALITY,,,14 ,,RBRVS,0.41 ,0.18 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90911,CPT,BIOFDBK TRNG PERINL MUSC ANORECT/URO SPHX W/EMG,,,14 ,,RBRVS,0.89 ,0.35 ,1.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90935,CPT,HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION,,,14 ,,RBRVS,1.48 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90937,CPT,HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX,,,14 ,,RBRVS,2.11 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90940,CPT,HEMODIALYSIS ACCESS FLOW STUDY,,,14 ,,TotalUnits,,,,1.37 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,90945,CPT,DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL,,,14 ,,RBRVS,1.56 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90947,CPT,DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS,,,14 ,,RBRVS,2.52 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90951,CPT,ESRD RELATED SVC MONTHLY & <2 YR OLD 4/> VISITS,,,14 ,,RBRVS,18.46 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90952,CPT,ESRD RELATED SVC MONTHLY <2 YR OLD 2/3 VISITS,,,14 ,,RBRVS,6.29 ,14.08 ,14.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90953,CPT,ESRD RELATED SVC MONTHLY <2 YR OLD 1 VISIT,,,14 ,,RBRVS,4.19 ,9.39 ,9.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90954,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS,,,14 ,,RBRVS,15.98 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90955,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS,,,14 ,,RBRVS,8.79 ,3.91 ,3.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90956,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT,,,14 ,,RBRVS,5.95 ,2.83 ,2.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90957,CPT,ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/> VISITS,,,14 ,,RBRVS,12.52 ,5.41 ,5.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90958,CPT,ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS,,,14 ,,RBRVS,8.34 ,3.82 ,3.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90959,CPT,ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT,,,14 ,,RBRVS,5.50 ,2.68 ,2.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90960,CPT,ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS,,,14 ,,RBRVS,5.18 ,2.80 ,2.80 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90961,CPT,ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS,,,14 ,,RBRVS,4.26 ,2.38 ,2.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90962,CPT,ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT,,,14 ,,RBRVS,3.15 ,1.90 ,1.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90963,CPT,ESRD SVC HOME DIALYSIS FULL MONTH <2YR OLD,,,14 ,,RBRVS,10.56 ,4.66 ,4.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90964,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD,,,14 ,,RBRVS,9.14 ,3.95 ,3.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90965,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD,,,14 ,,RBRVS,8.69 ,3.79 ,3.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90966,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD,,,14 ,,RBRVS,4.26 ,2.35 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90967,CPT,ESRD RELATED SVC <FULL MONTH <2 YR OLD,,,14 ,,RBRVS,0.35 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90968,CPT,ESRD RELATED SVC <FULL MONTH 2-11 YR OLD,,,14 ,,RBRVS,0.30 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90969,CPT,ESRD RELATED SVC <FULL MONTH 12-19 YR OLD,,,14 ,,RBRVS,0.29 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90970,CPT,ESRD RELATED SVC <FULL MONTH 20/>YR OLD,,,14 ,,RBRVS,0.14 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90989,CPT,DIALYSIS TRAINING PATIENT COMPLETED COURSE,,,14 ,,TotalUnits,,,,8.56 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,90993,CPT,DIALYSIS TRAINING PATIENT PER TRAINING SESSION,,,14 ,,TotalUnits,,,,2.27 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,90997,CPT,HEMOPERFUSION,,,14 ,,RBRVS,1.84 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,90999,CPT,UNLISTED DIALYSIS PROCEDURE INPATIENT/OUTPATIENT,,,14 ,,TotalUnits,,,,2.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,,,14 ,,RBRVS,1.28 ,4.14 ,4.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,26,,14 ,,RBRVS,1.28 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,TC,,14 ,,RBRVS,,3.48 ,3.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,,,14 ,,RBRVS,0.18 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,26,,14 ,,RBRVS,0.18 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,TC,,14 ,,RBRVS,,0.42 ,0.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,,,14 ,,RBRVS,1.44 ,5.69 ,5.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,26,,14 ,,RBRVS,1.44 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,TC,,14 ,,RBRVS,,4.94 ,4.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,,,14 ,,RBRVS,1.44 ,3.86 ,3.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,26,,14 ,,RBRVS,1.44 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,TC,,14 ,,RBRVS,,3.08 ,3.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,,,14 ,,RBRVS,0.91 ,3.27 ,3.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,26,,14 ,,RBRVS,0.91 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,TC,,14 ,,RBRVS,,2.78 ,2.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,,,14 ,,RBRVS,0.97 ,4.85 ,4.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,26,,14 ,,RBRVS,0.97 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,TC,,14 ,,RBRVS,,4.35 ,4.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,,,14 ,,RBRVS,1.59 ,13.12 ,13.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,26,,14 ,,RBRVS,1.59 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,TC,,14 ,,RBRVS,,12.30 ,12.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,,,14 ,,RBRVS,0.97 ,3.89 ,3.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,26,,14 ,,RBRVS,0.97 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,TC,,14 ,,RBRVS,,3.38 ,3.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,,,14 ,,RBRVS,1.10 ,10.62 ,10.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,26,,14 ,,RBRVS,1.10 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,TC,,14 ,,RBRVS,,10.04 ,10.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91040,CPT,ESOPHGL BALO DISTENSION PROVOCATION STD,,,14 ,,RBRVS,0.97 ,8.39 ,8.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91040,CPT,ESOPHGL BALO DISTENSION PROVOCATION STD,26,,14 ,,RBRVS,0.97 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91040,CPT,ESOPHGL BALO DISTENSION PROVOCATION STD,TC,,14 ,,RBRVS,,7.98 ,7.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91065,CPT,BREATH HYDROGEN TEST,,,14 ,,RBRVS,0.20 ,2.40 ,2.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91065,CPT,BREATH HYDROGEN TEST,26,,14 ,,RBRVS,0.20 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91065,CPT,BREATH HYDROGEN TEST,TC,,14 ,,RBRVS,,2.30 ,2.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91110,CPT,GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R,,,14 ,,RBRVS,3.64 ,23.81 ,23.81 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91110,CPT,GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R,26,,14 ,,RBRVS,3.64 ,1.94 ,1.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91110,CPT,GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R,TC,,14 ,,RBRVS,,21.87 ,21.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R,,,14 ,,RBRVS,1.00 ,21.45 ,21.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R,26,,14 ,,RBRVS,1.00 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R,TC,,14 ,,RBRVS,,20.91 ,20.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91112,CPT,GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP,,,14 ,,RBRVS,2.10 ,32.73 ,32.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91112,CPT,GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP,26,,14 ,,RBRVS,2.10 ,1.10 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91112,CPT,GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP,TC,,14 ,,RBRVS,,31.63 ,31.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91117,CPT,COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R,,,14 ,,RBRVS,2.45 ,1.61 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,,,14 ,,RBRVS,0.97 ,10.94 ,10.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,26,,14 ,,RBRVS,0.97 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,TC,,14 ,,RBRVS,,10.51 ,10.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91122,CPT,ANORECTAL MANOMETRY,,,14 ,,RBRVS,1.77 ,4.78 ,4.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91122,CPT,ANORECTAL MANOMETRY,26,,14 ,,RBRVS,1.77 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91122,CPT,ANORECTAL MANOMETRY,TC,,14 ,,RBRVS,,4.04 ,4.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,,,14 ,,RBRVS,0.52 ,4.14 ,4.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,26,,14 ,,RBRVS,0.52 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,TC,,14 ,,RBRVS,,3.86 ,3.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,,,14 ,,RBRVS,0.66 ,4.75 ,4.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,26,,14 ,,RBRVS,0.66 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,TC,,14 ,,RBRVS,,4.39 ,4.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,,14 ,,TotalUnits,,,,21.26 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,PC,14 ,,TotalUnits,,,,6.67 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,TC,14 ,,TotalUnits,,,,14.59 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,92002,CPT,OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT,,,23 ,,RBRVS,0.88 ,0.44 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92004,CPT,OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST,,,23 ,,RBRVS,1.82 ,0.94 ,2.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92012,CPT,OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT,,,23 ,,RBRVS,0.92 ,0.52 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92014,CPT,OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>,,,23 ,,RBRVS,1.42 ,0.78 ,2.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92015,CPT,DETERMINATION REFRACTIVE STATE,,,23 ,,RBRVS,0.38 ,0.16 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92018,CPT,OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL,,,14 ,,RBRVS,2.50 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92019,CPT,OPHTH XM&EVAL ANES W/WO MANJ GLOBE LMTD,,,14 ,,RBRVS,1.31 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92020,CPT,GONIOSCOPY SEPARATE PROCEDURE,,,14 ,,RBRVS,0.37 ,0.21 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,,,14 ,,RBRVS,0.35 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,26,,14 ,,RBRVS,0.35 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,TC,,14 ,,RBRVS,,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,,,14 ,,RBRVS,0.69 ,1.11 ,1.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,26,,14 ,,RBRVS,0.69 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,TC,,14 ,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ,,,14 ,,RBRVS,0.37 ,1.13 ,1.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ,26,,14 ,,RBRVS,0.37 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ,TC,,14 ,,RBRVS,,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92071,CPT,FIT CONTACT LENS TX OCULAR SURFACE DISEASE,,,14 ,,RBRVS,0.61 ,0.34 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92072,CPT,FITTING CONTACT LENS FOR MNGT OF KERATOCONUS,,,14 ,,RBRVS,1.97 ,0.73 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,,,14 ,,RBRVS,0.30 ,1.10 ,1.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,26,,14 ,,RBRVS,0.30 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,TC,,14 ,,RBRVS,,0.94 ,0.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,,,14 ,,RBRVS,0.40 ,1.60 ,1.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,26,,14 ,,RBRVS,0.40 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,TC,,14 ,,RBRVS,,1.39 ,1.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,,,14 ,,RBRVS,0.50 ,2.09 ,2.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,26,,14 ,,RBRVS,0.50 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,TC,,14 ,,RBRVS,,1.81 ,1.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92100,CPT,SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRES,,,14 ,,RBRVS,0.92 ,0.48 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,,,14 ,,RBRVS,0.35 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,26,,14 ,,RBRVS,0.35 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,TC,,14 ,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,,,14 ,,RBRVS,0.50 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,26,,14 ,,RBRVS,0.50 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,TC,,14 ,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,,,14 ,,RBRVS,0.50 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,26,,14 ,,RBRVS,0.50 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,TC,,14 ,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,,,14 ,,RBRVS,0.54 ,2.00 ,2.00 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,26,,14 ,,RBRVS,0.54 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,TC,,14 ,,RBRVS,,1.67 ,1.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92140,CPT,PROVOCATIVE TESTS GLAUCOMA I&R W/O TONOGRAPHY,,,14 ,,RBRVS,0.50 ,0.24 ,1.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92225,CPT,OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST,,,14 ,,RBRVS,0.38 ,0.21 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92226,CPT,OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS,,,14 ,,RBRVS,0.33 ,0.20 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92227,CPT,REMOTE IMG DX RETINL DIS W/ALYS & REPORT UNI/B,,,14 ,,RBRVS,,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B,,,14 ,,RBRVS,0.37 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B,26,,14 ,,RBRVS,0.37 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B,TC,,14 ,,RBRVS,,0.39 ,0.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92230,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,,,14 ,,RBRVS,0.60 ,0.31 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,,,14 ,,RBRVS,0.81 ,3.18 ,3.18 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,26,,14 ,,RBRVS,0.81 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,2.68 ,2.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR,,,14 ,,RBRVS,1.10 ,6.16 ,6.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR,26,,14 ,,RBRVS,1.10 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR,TC,,14 ,,RBRVS,,5.48 ,5.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,,,14 ,,RBRVS,0.44 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,26,,14 ,,RBRVS,0.44 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,1.56 ,1.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92260,CPT,OPHTHALMODYNAMOMETRY,,,14 ,,RBRVS,0.20 ,0.11 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92265,CPT,NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R,,,14 ,,RBRVS,0.81 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92265,CPT,NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R,26,,14 ,,RBRVS,0.81 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92265,CPT,NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R,TC,,14 ,,RBRVS,,1.10 ,1.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,,,14 ,,RBRVS,0.81 ,1.85 ,1.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,26,,14 ,,RBRVS,0.81 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,1.49 ,1.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,,,14 ,,RBRVS,1.01 ,3.39 ,3.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,26,,14 ,,RBRVS,1.01 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,2.78 ,2.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,,,14 ,,RBRVS,0.17 ,1.35 ,1.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,26,,14 ,,RBRVS,0.17 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,TC,,14 ,,RBRVS,,1.27 ,1.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,,,14 ,,RBRVS,0.24 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,26,,14 ,,RBRVS,0.24 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,TC,,14 ,,RBRVS,,1.43 ,1.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE,,,14 ,,RBRVS,0.05 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE,26,,14 ,,RBRVS,0.05 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE,TC,,14 ,,RBRVS,,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92286,CPT,ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY,,,14 ,,RBRVS,0.66 ,2.92 ,2.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92286,CPT,ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY,26,,14 ,,RBRVS,0.66 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92286,CPT,ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY,TC,,14 ,,RBRVS,,2.56 ,2.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92287,CPT,ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R,,,14 ,,RBRVS,0.81 ,0.49 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92310,CPT,RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK,,,23 ,,RBRVS,1.17 ,0.48 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92311,CPT,RX&FITG CONTACT CORNEAL LENS APHAKIA 1 EYE,,,14 ,,RBRVS,1.08 ,0.49 ,1.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92312,CPT,RX&FITG CONTACT CORNEAL LENS APHAKIA BOTH EYES,,,14 ,,RBRVS,1.26 ,0.56 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92313,CPT,RX&FITG CORNEOSCLERAL LENS,,,14 ,,RBRVS,0.92 ,0.50 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92314,CPT,RX&FTG CONTACT CORNEAL LENS EYES XCPT APHAKIA,,,23 ,,RBRVS,0.69 ,0.28 ,1.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92315,CPT,RX CONTACT CORNEAL LENS APHAKIA 1 EYE,,,14 ,,RBRVS,0.45 ,0.20 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92316,CPT,RX CONTACT CORNEAL LENS APHAKIA BOTH EYES,,,14 ,,RBRVS,0.68 ,0.41 ,2.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92317,CPT,RX CONTACT CORNEOSCLERAL LENS,,,14 ,,RBRVS,0.45 ,0.16 ,1.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92325,CPT,MODIFICAJ CONTACT LENX SPX SUPVJ ADAPTATION,,,14 ,,RBRVS,,1.09 ,1.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92326,CPT,REPLACEMENT CONTACT LENS,,,14 ,,RBRVS,,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92340,CPT,FITTING SPECTACLES XCPT APHAKIA MONOFOCAL,,,14 ,,RBRVS,0.37 ,0.15 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92341,CPT,FITTING SPECTACLES XCPT APHAKIA BIFOCAL,,,14 ,,RBRVS,0.47 ,0.19 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92342,CPT,FITTING SPECTACLES XCPT APHAKIA MULTIFOCAL,,,14 ,,RBRVS,0.53 ,0.22 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92352,CPT,FITTING SPECTACLE PROSTH APHAKIA MONOFOCAL,,,14 ,,RBRVS,0.37 ,0.15 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92353,CPT,FITTING SPECTACLE PROSTH APHAKIA MULTIFOCAL,,,14 ,,RBRVS,0.50 ,0.20 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92354,CPT,FITTING SPECTACLE MOUNTED LW VIS AID 1 ELMNT,,,14 ,,RBRVS,,1.02 ,1.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92355,CPT,FITTING SPECTACLE MOUNTED LW VIS AID TLSCP,,,14 ,,RBRVS,,0.89 ,0.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92358,CPT,PROSTHESIS SERVICE APHAKIA TEMPORARY,,,14 ,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92370,CPT,RPR&REFITG SPECTACLES EXCEPT APHAKIA,,,14 ,,RBRVS,0.32 ,0.13 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92371,CPT,RPR&REFITG SPECTACLE PROSTHESIS APHAKIA,,,14 ,,RBRVS,,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,,14 ,,TotalUnits,,,,1.12 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,PC,14 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,TC,14 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,92502,CPT,OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA,,,14 ,,RBRVS,1.51 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92504,CPT,BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE,,,14 ,,RBRVS,0.18 ,0.09 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92506,CPT,EVAL SPEECH LANG VOICE COMMUNJ &/AUDITORY PROC,,,8 ,,RBRVS,0.86 ,3.95 ,3.95 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92507,CPT,TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND,,,8 ,,RBRVS,1.30 ,0.83 ,0.83 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92508,CPT,TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV,,,8 ,,RBRVS,0.33 ,0.32 ,0.32 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92511,CPT,NASOPHARYNGOSCOPY W/ENDOSCOPE SPX,,,14 ,,RBRVS,0.61 ,0.82 ,3.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92512,CPT,NASAL FUNCTION STUDIES,,,14 ,,RBRVS,0.55 ,0.25 ,1.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92516,CPT,FACIAL NERVE FUNCTION STUDIES,,,14 ,,RBRVS,0.43 ,0.22 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92520,CPT,LARYNGEAL FUNCTION STUDIES,,,14 ,,RBRVS,0.75 ,0.40 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92526,CPT,TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING,,,14 ,,RBRVS,1.34 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92531,CPT,SPONTANEOUS NYSTAGMUS W/GAZE,,,14 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,92532,CPT,POSITIONAL NYSTAGMUS TEST,,,14 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,92533,CPT,CALORIC VESTIBULAR TEST EACH IRRIGATION,,,14 ,,RBRVS,0.25 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92534,CPT,OPTOKINETIC NYSTAGMUS TEST,,,14 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK,,,14 ,,RBRVS,1.50 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK,,PC,14 ,,RBRVS,1.50 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK,,TC,14 ,,RBRVS,,0.64 ,0.64 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,92541,CPT,SPONTANEOUS NYSTAGMUS TEST,,,14 ,,RBRVS,0.40 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92541,CPT,SPONTANEOUS NYSTAGMUS TEST,26,,14 ,,RBRVS,0.40 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92541,CPT,SPONTANEOUS NYSTAGMUS TEST,TC,,14 ,,RBRVS,,0.50 ,0.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92542,CPT,POSITIONAL NYSTAGMUS TEST,,,14 ,,RBRVS,0.33 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92542,CPT,POSITIONAL NYSTAGMUS TEST,26,,14 ,,RBRVS,0.33 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92542,CPT,POSITIONAL NYSTAGMUS TEST,TC,,14 ,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92543,CPT,CALORIC VESTIBULAR TEST EA IRRIGATION W/RECORD,,,14 ,,RBRVS,0.10 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92543,CPT,CALORIC VESTIBULAR TEST EA IRRIGATION W/RECORD,26,,14 ,,RBRVS,0.10 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92543,CPT,CALORIC VESTIBULAR TEST EA IRRIGATION W/RECORD,TC,,14 ,,RBRVS,,0.40 ,0.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,,,14 ,,RBRVS,0.26 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,26,,14 ,,RBRVS,0.26 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,TC,,14 ,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,,,14 ,,RBRVS,0.23 ,0.57 ,0.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,26,,14 ,,RBRVS,0.23 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,TC,,14 ,,RBRVS,,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,,,14 ,,RBRVS,0.29 ,2.67 ,2.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,26,,14 ,,RBRVS,0.29 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,TC,,14 ,,RBRVS,,2.54 ,2.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92547,CPT,USE VERTICAL ELECTRODES,,TC,14 ,,RBRVS,,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,0,1,1,20131001,92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,,,14 ,,RBRVS,0.50 ,2.58 ,2.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,26,,14 ,,RBRVS,0.50 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,TC,,14 ,,RBRVS,,2.35 ,2.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92550,CPT,TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS,,,8 ,,RBRVS,0.35 ,0.25 ,0.25 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92551,CPT,SCREENING TEST PURE TONE AIR ONLY,,,8 ,,RBRVS,,0.34 ,0.34 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92552,CPT,PURE TONE AUDIOMETRY AIR ONLY,,TC,8 ,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92553,CPT,PURE TONE AUDIOMETRY AIR & BONE,,TC,8 ,,RBRVS,,1.05 ,1.05 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92555,CPT,SPEECH AUDIOMETRY THRESHOLD,,TC,8 ,,RBRVS,,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92556,CPT,SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ,,TC,8 ,,RBRVS,,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92557,CPT,COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ,,,8 ,,RBRVS,0.60 ,0.38 ,0.52 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92558,CPT,EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS,,,8 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,92559,CPT,AUDIOMETRIC TESTING GROUPS,,,8 ,,RBRVS,0.25 ,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92560,CPT,BEKESY AUDIOMETRY SCREENING,,,8 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,92561,CPT,BEKESY AUDIOMETRY DIAGNOSTIC,,TC,8 ,,RBRVS,,1.05 ,1.05 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92562,CPT,LOUDNESS BALANCE BINAURAL/MONAURAL,,TC,8 ,,RBRVS,,1.13 ,1.13 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92563,CPT,TONE DECAY TEST,,TC,8 ,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92564,CPT,SHORT INCREMENT SENSITIVITY INDEX,,TC,8 ,,RBRVS,,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92565,CPT,STENGER TEST PURE TONE,,TC,8 ,,RBRVS,,0.45 ,0.45 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92567,CPT,TYMPANOMETRY,,,8 ,,RBRVS,0.20 ,0.13 ,0.23 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92568,CPT,ACOUSTIC REFLEX THRESHOLD,,,8 ,,RBRVS,0.29 ,0.17 ,0.17 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92570,CPT,ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY,,,8 ,,RBRVS,0.55 ,0.29 ,0.36 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92571,CPT,FILTERED SPEECH TEST,,TC,8 ,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92572,CPT,STAGGERED SPONDAIC WORD,,TC,8 ,,RBRVS,,0.92 ,0.92 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92575,CPT,SENSORINEURAL ACUITY LEVEL,,TC,8 ,,RBRVS,,1.91 ,1.91 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92576,CPT,SYNTHETIC SENTENCE IDENTIFICATION TEST,,TC,8 ,,RBRVS,,0.99 ,0.99 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92577,CPT,STENGER TEST SPEECH,,TC,8 ,,RBRVS,,0.51 ,0.51 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92579,CPT,VISUAL REINFORCEMENT AUDIOMETRY,,,8 ,,RBRVS,0.70 ,0.39 ,0.53 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92582,CPT,CONDITIONING PLAY AUDIOMETRY,,TC,8 ,,RBRVS,,1.86 ,1.86 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92583,CPT,SELECT PICTURE AUDIOMETRY,,TC,8 ,,RBRVS,,1.36 ,1.36 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92584,CPT,ELECTROCOCHLEOGRAPY,,TC,8 ,,RBRVS,,2.08 ,2.08 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,,,8 ,,RBRVS,0.50 ,3.13 ,3.13 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,26,,8 ,,RBRVS,0.50 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,TC,,8 ,,RBRVS,,2.89 ,2.89 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92586,CPT,AUDITORY EVOKED POTENTIALS LIMITED,,TC,8 ,,RBRVS,,2.35 ,2.35 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,,,8 ,,RBRVS,0.35 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,26,,8 ,,RBRVS,0.35 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,TC,,8 ,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,,,8 ,,RBRVS,0.55 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,26,,8 ,,RBRVS,0.55 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,TC,,8 ,,RBRVS,,0.42 ,0.42 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92590,CPT,HEARING AID EXAMINATION & SELECTION MONAURAL,,,8 ,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,92591,CPT,HEARING AID EXAMINATION & SELECTION BINAURAL,,,8 ,,TotalUnits,,,,1.92 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,92592,CPT,HEARING AID CHECK MONAURAL,,,8 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,92593,CPT,HEARING AID CHECK BINAURAL,,,8 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,92594,CPT,ELECTROACOUS EVAL HEARING AID MONAURAL,,,8 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,92595,CPT,ELECTROACOUS EVAL HEARING AID BINAURAL,,,8 ,,TotalUnits,,,,1.24 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,92596,CPT,EAR PROTECTOR ATTENUATION MEASUREMENTS,,TC,8 ,,RBRVS,,1.26 ,1.26 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92597,CPT,EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC,,,8 ,,RBRVS,1.26 ,1.11 ,1.11 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92601,CPT,ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG,,,14 ,,RBRVS,2.30 ,1.26 ,1.82 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92602,CPT,ANALYSIS COCHLEAR IMPLT PT <7 YR SBSQ REPRGRMG,,,14 ,,RBRVS,1.30 ,0.74 ,1.32 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92603,CPT,ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG,,,14 ,,RBRVS,2.25 ,1.25 ,1.92 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92604,CPT,ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG,,,14 ,,RBRVS,1.25 ,0.70 ,1.26 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92605,CPT,EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR,,,14 ,,RBRVS,1.75 ,0.71 ,0.83 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92606,CPT,THER SVC N-SP-GENRATJ DEV PRGRMG&MODIFICAJ,,,14 ,,RBRVS,1.40 ,0.57 ,0.91 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92607,CPT,RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR,,,14 ,,RBRVS,1.85 ,2.24 ,2.24 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92608,CPT,RX SP-GENRATJ AUGMNT&COMUNICAJ DEV EA 30 MIN,,,14 ,,RBRVS,0.70 ,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92609,CPT,THER SP-GENRATJ DEV PRGRMG&MODIFICAJ,,,14 ,,RBRVS,1.50 ,1.40 ,1.40 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92610,CPT,EVAL ORAL&PHARYNGEAL SWLNG FUNCJ,,,14 ,,RBRVS,1.30 ,0.60 ,1.26 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92611,CPT,MOTION FLUOR EVAL SWLNG FUNCJ C/V REC,,,14 ,,RBRVS,1.34 ,1.47 ,1.47 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92612,CPT,FLX FIBOPT NDSC EVAL SWLNG C/V REC,,,14 ,,RBRVS,1.27 ,0.64 ,3.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92613,CPT,FLX FIBOPT NDSC EVAL SWLNG C/V REC PHYS I&R,,,14 ,,RBRVS,0.71 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92614,CPT,FLX FIBOPT NDSC EVAL LARYN SENS C/V REC,,,14 ,,RBRVS,1.27 ,0.66 ,3.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92615,CPT,FLX FIBOPT NDSC EVAL LARYN SENS PHYS I&R,,,14 ,,RBRVS,0.63 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92616,CPT,FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS C/V REC,,,14 ,,RBRVS,1.88 ,0.94 ,4.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,92617,CPT,FLX FIBOPT NDSC EVAL SWLNG&LARYN SENS PHYS I&R,,,14 ,,RBRVS,0.79 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92618,CPT,EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV ADD 30 MIN,,,14 ,,RBRVS,0.65 ,0.26 ,0.28 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,92620,CPT,EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN,,,14 ,,RBRVS,1.50 ,0.77 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92621,CPT,EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN,,,14 ,,RBRVS,0.35 ,0.17 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92625,CPT,ASSESSMENT TINNITUS,,,14 ,,RBRVS,1.15 ,0.58 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92626,CPT,EVALUATION AUDITORY REHAB STATUS 1ST HR,,,14 ,,RBRVS,1.40 ,0.78 ,1.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92627,CPT,EVALUATION AUDITORY REHAB STATUS EA 15 MIN,,,14 ,,RBRVS,0.33 ,0.19 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92630,CPT,AUDITORY REHABILITATION PRELINGUAL HEARING LOSS,,,14 ,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,92633,CPT,AUDITORY REHABILITATION POSTLINGUAL HEARING LOSS,,,14 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,92640,CPT,ANALYSIS W/PRGRMG AUD BRAINSTEM IMPLANT PR HR,,,14 ,,RBRVS,1.76 ,0.78 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92700,CPT,UNLISTED OTORHINOLARYNGOLOGICAL SERVICE,,,14 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,92920,CPT,PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH,,,21 ,,RBRVS,10.10 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92924,CPT,PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH,,,21 ,,RBRVS,11.99 ,4.39 ,4.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92928,CPT,PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH,,,21 ,,RBRVS,11.21 ,4.08 ,4.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92933,CPT,PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH,,,21 ,,RBRVS,12.54 ,4.57 ,4.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92937,CPT,PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,,,21 ,,RBRVS,11.20 ,4.08 ,4.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92941,CPT,PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL,,,21 ,,RBRVS,12.56 ,4.58 ,4.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92943,CPT,PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,,,21 ,,RBRVS,12.56 ,4.58 ,4.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92950,CPT,CARDIOPULMONARY RESUSCITATION,,,4 ,,RBRVS,4.00 ,1.07 ,4.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92953,CPT,TEMPORARY TRANSCUTANEOUS PACING,,,4 ,,RBRVS,0.23 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92960,CPT,CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,,,4 ,,RBRVS,2.25 ,1.24 ,4.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92961,CPT,CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX,,,4 ,,RBRVS,4.59 ,2.20 ,2.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92970,CPT,CARDIOASSIST-METH CIRCULATORY ASSIST INTERNAL,,,4 ,,RBRVS,3.51 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,92971,CPT,CARDIOASSIST-METH CIRCULATORY ASSIST EXTERNAL,,,4 ,,RBRVS,1.77 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,92973,CPT,PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY,,,21 ,,RBRVS,3.28 ,1.40 ,1.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92974,CPT,TCAT PLMT RADJ DLVR DEV SBSQ C IV BRACHYTX,,,21 ,,RBRVS,3.00 ,1.28 ,1.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92975,CPT,THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH,,,4 ,,RBRVS,7.24 ,3.10 ,3.10 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,92977,CPT,THROMBOLYSIS CORONARY INTRAVENOUS INFUSION,,,4 ,,RBRVS,,3.56 ,3.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE,,,4 ,,TotalUnits,,,,7.91 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE,26,,4 ,,TotalUnits,,,,2.57 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE,TC,,4 ,,TotalUnits,,,,5.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,,,4 ,,TotalUnits,,,,4.23 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,26,,4 ,,TotalUnits,,,,2.06 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,TC,,4 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,92986,CPT,PRQ BALLOON VALVULOPLASTY AORTIC VALVE,,,21 ,,RBRVS,22.85 ,12.91 ,12.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92987,CPT,PRQ BALLOON VALVULOPLASTY MITRAL VALVE,,,21 ,,RBRVS,23.63 ,13.21 ,13.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92990,CPT,PRQ BALLOON VALVULOPLASTY PULMONARY VALVE,,,21 ,,RBRVS,18.27 ,10.57 ,10.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92992,CPT,ATRIAL SEPTECT/SEPTOST TRANSVENOUS BALLOON,,,21 ,,TotalUnits,,,,35.08 ,,$0.00,$0.00,1,0,0,1,1,1,20131001,92993,CPT,ATRIAL SEPTECT/SEPTOSTOMY BLADE METHOD,,,21 ,,RBRVS,6.96 ,15.59 ,15.59 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,92997,CPT,PRQ TRLUML PULMONARY ART BALLOON ANGIOP 1 VSL,,,21 ,,RBRVS,11.98 ,5.01 ,5.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,92998,CPT,PRQ TRLUML PULMONARY ART BALLOON ANGIOP EA VSL,,,21 ,,RBRVS,5.99 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93000,CPT,ECG ROUTINE ECG W/LEAST 12 LDS W/I&R,,,4 ,,RBRVS,0.17 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93005,CPT,ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R,,TC,4 ,,RBRVS,,0.30 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93010,CPT,ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY,,PC,4 ,,RBRVS,0.17 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93015,CPT,CV STRS TST XERS&/OR RX CONT ECG W/SI&R,,,4 ,,RBRVS,0.75 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93016,CPT,CV STRS TST XERS&/OR RX CONT ECG W/O I&R,,PC,4 ,,RBRVS,0.45 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93017,CPT,CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY,,TC,4 ,,RBRVS,,1.50 ,1.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93018,CPT,CV STRS TST XERS&/OR RX CONT ECG I&R ONLY,,PC,4 ,,RBRVS,0.30 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93024,CPT,ERGONOVINE PROVOCATION TST,,,4 ,,RBRVS,1.17 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93024,CPT,ERGONOVINE PROVOCATION TST,26,,4 ,,RBRVS,1.17 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93024,CPT,ERGONOVINE PROVOCATION TST,TC,,4 ,,RBRVS,,1.65 ,1.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,,,4 ,,RBRVS,0.75 ,4.52 ,4.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,26,,4 ,,RBRVS,0.75 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,TC,,4 ,,RBRVS,,4.20 ,4.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93040,CPT,RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT,,,4 ,,RBRVS,0.15 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93041,CPT,RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R,,TC,4 ,,RBRVS,,0.16 ,0.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93042,CPT,RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON,,PC,4 ,,RBRVS,0.15 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93224,CPT,XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I,,,4 ,,RBRVS,0.52 ,2.36 ,2.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93225,CPT,XTRNL ECG & 48 HR RECORDING,,TC,4 ,,RBRVS,,0.85 ,0.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93226,CPT,EXTERNAL ECG SCANNING ANALYSIS REPORT,,TC,4 ,,RBRVS,,1.26 ,1.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93227,CPT,XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS,,PC,4 ,,RBRVS,0.52 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93228,CPT,XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS,,PC,4 ,,RBRVS,0.52 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93229,CPT,XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT,,TC,4 ,,RBRVS,,20.38 ,20.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93268,CPT,XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS,,,4 ,,RBRVS,0.52 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93270,CPT,XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS,,TC,4 ,,RBRVS,,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93271,CPT,XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS,,TC,4 ,,RBRVS,,5.90 ,5.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93272,CPT,XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS,,PC,4 ,,RBRVS,0.52 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93278,CPT,SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG,,,4 ,,RBRVS,0.25 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93278,CPT,SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG,26,,4 ,,RBRVS,0.25 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93278,CPT,SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG,TC,,4 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93279,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER,,,4 ,,RBRVS,0.65 ,0.80 ,0.80 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93279,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER,26,,4 ,,RBRVS,0.65 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93279,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER,TC,,4 ,,RBRVS,,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93280,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER,,,4 ,,RBRVS,0.77 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93280,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER,26,,4 ,,RBRVS,0.77 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93280,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER,TC,,4 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93281,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER,,,4 ,,RBRVS,0.90 ,1.07 ,1.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93281,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER,26,,4 ,,RBRVS,0.90 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93281,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER,TC,,4 ,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93282,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB,,,4 ,,RBRVS,0.85 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93282,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB,26,,4 ,,RBRVS,0.85 ,0.36 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93282,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN 1 LD CARD/DFB,TC,,4 ,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93283,CPT,PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB,,,4 ,,RBRVS,1.15 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93283,CPT,PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB,26,,4 ,,RBRVS,1.15 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93283,CPT,PROGRM EVAL IMPLANTABLE IN PRSN DUAL L CARD/DFB,TC,,4 ,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93284,CPT,PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB,,,4 ,,RBRVS,1.25 ,1.35 ,1.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93284,CPT,PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB,26,,4 ,,RBRVS,1.25 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93284,CPT,PROGRM EVAL IMPLANTABLE IN PRSN MLT LD CARD/DFB,TC,,4 ,,RBRVS,,0.80 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93285,CPT,PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM,,,4 ,,RBRVS,0.52 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93285,CPT,PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM,26,,4 ,,RBRVS,0.52 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93285,CPT,PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM,TC,,4 ,,RBRVS,,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93286,CPT,PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM,,,4 ,,RBRVS,0.30 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93286,CPT,PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM,26,,4 ,,RBRVS,0.30 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93286,CPT,PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM,TC,,4 ,,RBRVS,,0.33 ,0.33 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93287,CPT,PERI-PX EVAL&PROGRAM CARDIOVERTER/DEFIBRILLATOR,,,4 ,,RBRVS,0.45 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93287,CPT,PERI-PX EVAL&PROGRAM CARDIOVERTER/DEFIBRILLATOR,26,,4 ,,RBRVS,0.45 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93287,CPT,PERI-PX EVAL&PROGRAM CARDIOVERTER/DEFIBRILLATOR,TC,,4 ,,RBRVS,,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93288,CPT,INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM,,,4 ,,RBRVS,0.43 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93288,CPT,INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM,26,,4 ,,RBRVS,0.43 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93288,CPT,INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM,TC,,4 ,,RBRVS,,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93289,CPT,INTERROGATION EVAL F2F 1/DUAL/MLT LEADS CVDFB,,,4 ,,RBRVS,0.92 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93289,CPT,INTERROGATION EVAL F2F 1/DUAL/MLT LEADS CVDFB,26,,4 ,,RBRVS,0.92 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93289,CPT,INTERROGATION EVAL F2F 1/DUAL/MLT LEADS CVDFB,TC,,4 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93290,CPT,INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS,,,4 ,,RBRVS,0.43 ,0.43 ,0.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93290,CPT,INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS,26,,4 ,,RBRVS,0.43 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93290,CPT,INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS,TC,,4 ,,RBRVS,,0.27 ,0.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93291,CPT,INTERROGATION EVALUATION IN PERSON ILR SYSTEM,,,4 ,,RBRVS,0.43 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93291,CPT,INTERROGATION EVALUATION IN PERSON ILR SYSTEM,26,,4 ,,RBRVS,0.43 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93291,CPT,INTERROGATION EVALUATION IN PERSON ILR SYSTEM,TC,,4 ,,RBRVS,,0.43 ,0.43 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93292,CPT,INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR,,,4 ,,RBRVS,0.43 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93292,CPT,INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR,26,,4 ,,RBRVS,0.43 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93292,CPT,INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR,TC,,4 ,,RBRVS,,0.32 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93293,CPT,TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL,,,4 ,,RBRVS,0.32 ,1.26 ,1.26 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93293,CPT,TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL,26,,4 ,,RBRVS,0.32 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93293,CPT,TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL,TC,,4 ,,RBRVS,,1.14 ,1.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93294,CPT,INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM,,PC,4 ,,RBRVS,0.65 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93295,CPT,INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD ICD,,PC,4 ,,RBRVS,1.29 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93296,CPT,INTERROGATION REMOTE </90 D TECHNICIAN REVIEW,,TC,4 ,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93297,CPT,INTERROGATION EVAL REMOTE </30 D CV MNTR SYS,,PC,4 ,,RBRVS,0.52 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93298,CPT,INTERROGATION EVALUATION REMOTE </30 D ILR SYS,,PC,4 ,,RBRVS,0.52 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93299,CPT,INTERROGATION EVAL REMOTE </30 D TECH REVIEW,,TC,4 ,,TotalUnits,,,,1.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93303,CPT,COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY,,,4 ,,RBRVS,1.30 ,4.76 ,4.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93303,CPT,COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY,26,,4 ,,RBRVS,1.30 ,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93303,CPT,COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY,TC,,4 ,,RBRVS,,4.21 ,4.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93304,CPT,F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY,,,4 ,,RBRVS,0.75 ,3.17 ,3.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93304,CPT,F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY,26,,4 ,,RBRVS,0.75 ,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93304,CPT,F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY,TC,,4 ,,RBRVS,,2.87 ,2.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93306,CPT,ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D,,,4 ,,RBRVS,1.30 ,4.91 ,4.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93306,CPT,ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D,26,,4 ,,RBRVS,1.30 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93306,CPT,ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D,TC,,4 ,,RBRVS,,4.35 ,4.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93307,CPT,ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP,,,4 ,,RBRVS,0.92 ,2.93 ,2.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93307,CPT,ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP,26,,4 ,,RBRVS,0.92 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93307,CPT,ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP,TC,,4 ,,RBRVS,,2.53 ,2.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93308,CPT,ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD,,,4 ,,RBRVS,0.53 ,2.44 ,2.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93308,CPT,ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD,26,,4 ,,RBRVS,0.53 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93308,CPT,ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD,TC,,4 ,,RBRVS,,2.22 ,2.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93312,CPT,ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R,,,4 ,,RBRVS,2.20 ,6.97 ,6.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93312,CPT,ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R,26,,4 ,,RBRVS,2.20 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93312,CPT,ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R,TC,,4 ,,RBRVS,,6.12 ,6.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93313,CPT,ECHO R-T 2D W/PROBE PLACEMENT ONLY,,,4 ,,RBRVS,0.95 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93314,CPT,ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY,,,4 ,,RBRVS,1.25 ,7.10 ,7.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93314,CPT,ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY,26,,4 ,,RBRVS,1.25 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93314,CPT,ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY,TC,,4 ,,RBRVS,,6.61 ,6.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93315,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R,,,4 ,,TotalUnits,,,,6.75 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93315,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R,26,,4 ,,TotalUnits,,,,3.91 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93315,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R,TC,,4 ,,TotalUnits,,,,2.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93316,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY,,,4 ,,RBRVS,0.95 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93317,CPT,ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT,,,4 ,,TotalUnits,,,,4.37 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93317,CPT,ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT,26,,4 ,,TotalUnits,,,,2.49 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93317,CPT,ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT,TC,,4 ,,TotalUnits,,,,1.88 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93318,CPT,ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ,,,4 ,,TotalUnits,,,,5.16 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93318,CPT,ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ,26,,4 ,,TotalUnits,,,,2.98 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93318,CPT,ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ,TC,,4 ,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93320,CPT,DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY,,,4 ,,RBRVS,0.38 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93320,CPT,DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY,26,,4 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93320,CPT,DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY,TC,,4 ,,RBRVS,,1.03 ,1.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93321,CPT,DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD,,,4 ,,RBRVS,0.15 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93321,CPT,DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD,26,,4 ,,RBRVS,0.15 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93321,CPT,DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD,TC,,4 ,,RBRVS,,0.56 ,0.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93325,CPT,DOP ECHOCARD COLOR FLOW VELOCITY MAPPING,,,4 ,,RBRVS,0.07 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93325,CPT,DOP ECHOCARD COLOR FLOW VELOCITY MAPPING,26,,4 ,,RBRVS,0.07 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93325,CPT,DOP ECHOCARD COLOR FLOW VELOCITY MAPPING,TC,,4 ,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93350,CPT,ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST,,,4 ,,RBRVS,1.46 ,4.58 ,4.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93350,CPT,ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST,26,,4 ,,RBRVS,1.46 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93350,CPT,ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST,TC,,4 ,,RBRVS,,3.95 ,3.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93351,CPT,ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG,,,4 ,,RBRVS,1.75 ,5.30 ,5.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93351,CPT,ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG,26,,4 ,,RBRVS,1.75 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93351,CPT,ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG,TC,,4 ,,RBRVS,,4.53 ,4.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93352,CPT,USE OF ECHO CONTRAST AGENT DURING STRESS ECHO,,,4 ,,RBRVS,0.19 ,0.83 ,0.83 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93451,CPT,RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPU,,,21 ,,RBRVS,2.72 ,20.22 ,20.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93451,CPT,RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPU,26,,21 ,,RBRVS,2.72 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93451,CPT,RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPU,TC,,21 ,,RBRVS,,19.22 ,19.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93452,CPT,L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I,,,21 ,,RBRVS,4.75 ,20.09 ,20.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93452,CPT,L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I,26,,21 ,,RBRVS,4.75 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93452,CPT,L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I,TC,,21 ,,RBRVS,,18.35 ,18.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93453,CPT,R & L HRT CATH W/NJX L VENTRICULOG IMG S&I,,,21 ,,RBRVS,6.24 ,26.30 ,26.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93453,CPT,R & L HRT CATH W/NJX L VENTRICULOG IMG S&I,26,,21 ,,RBRVS,6.24 ,2.28 ,2.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93453,CPT,R & L HRT CATH W/NJX L VENTRICULOG IMG S&I,TC,,21 ,,RBRVS,,24.02 ,24.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93454,CPT,CATH PLMT & NJX CORONARY ART ANGIO IMG S&I,,,21 ,,RBRVS,4.79 ,20.85 ,20.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93454,CPT,CATH PLMT & NJX CORONARY ART ANGIO IMG S&I,26,,21 ,,RBRVS,4.79 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93454,CPT,CATH PLMT & NJX CORONARY ART ANGIO IMG S&I,TC,,21 ,,RBRVS,,19.10 ,19.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93455,CPT,CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I,,,21 ,,RBRVS,5.54 ,24.42 ,24.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93455,CPT,CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I,26,,21 ,,RBRVS,5.54 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93455,CPT,CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I,TC,,21 ,,RBRVS,,22.39 ,22.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93456,CPT,CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I,,,21 ,,RBRVS,6.15 ,25.92 ,25.92 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93456,CPT,CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I,26,,21 ,,RBRVS,6.15 ,2.25 ,2.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93456,CPT,CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I,TC,,21 ,,RBRVS,,23.67 ,23.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93457,CPT,CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I,,,21 ,,RBRVS,6.89 ,29.48 ,29.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93457,CPT,CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I,26,,21 ,,RBRVS,6.89 ,2.52 ,2.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93457,CPT,CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I,TC,,21 ,,RBRVS,,26.96 ,26.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93458,CPT,CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I,,,21 ,,RBRVS,5.85 ,25.08 ,25.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93458,CPT,CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I,26,,21 ,,RBRVS,5.85 ,2.14 ,2.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93458,CPT,CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I,TC,,21 ,,RBRVS,,22.94 ,22.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93459,CPT,CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&i,,,21 ,,RBRVS,6.60 ,27.55 ,27.55 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93459,CPT,CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&i,26,,21 ,,RBRVS,6.60 ,2.42 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93459,CPT,CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&i,TC,,21 ,,RBRVS,,25.13 ,25.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93460,CPT,R & L HRT CATH WINJX HRT ART& L VENTR IMG,,,21 ,,RBRVS,7.35 ,29.10 ,29.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93460,CPT,R & L HRT CATH WINJX HRT ART& L VENTR IMG,26,,21 ,,RBRVS,7.35 ,2.69 ,2.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93460,CPT,R & L HRT CATH WINJX HRT ART& L VENTR IMG,TC,,21 ,,RBRVS,,26.41 ,26.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93461,CPT,R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I,,,21 ,,RBRVS,8.10 ,33.76 ,33.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93461,CPT,R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I,26,,21 ,,RBRVS,8.10 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93461,CPT,R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I,TC,,21 ,,RBRVS,,30.79 ,30.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93462,CPT,LEFT HEART CATH BY TRANSEPTAL PUNCTURE,,,21 ,,RBRVS,3.73 ,1.39 ,1.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93463,CPT,MEDICATION ADMIN & HEMODYNAMIC MEASURMENT,,,21 ,,RBRVS,2.00 ,0.74 ,0.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93464,CPT,PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU,,,21 ,,RBRVS,1.80 ,5.68 ,5.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93464,CPT,PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU,26,,21 ,,RBRVS,1.80 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93464,CPT,PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU,TC,,21 ,,RBRVS,,5.08 ,5.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93503,CPT,INSERTION FLOW DIRECTED CATHETER FOR MONITORING,,,21 ,,RBRVS,2.91 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93505,CPT,ENDOMYOCARDIAL BIOPSY,,,21 ,,RBRVS,4.37 ,18.53 ,18.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93505,CPT,ENDOMYOCARDIAL BIOPSY,26,,21 ,,RBRVS,4.37 ,1.85 ,1.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93505,CPT,ENDOMYOCARDIAL BIOPSY,TC,,21 ,,RBRVS,,16.68 ,16.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93530,CPT,R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY,,,21 ,,TotalUnits,,,,36.09 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93530,CPT,R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY,26,,21 ,,TotalUnits,,,,6.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93530,CPT,R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY,TC,,21 ,,TotalUnits,,,,30.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93531,CPT,CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMA,,,21 ,,TotalUnits,,,,94.49 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93531,CPT,CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMA,26,,21 ,,TotalUnits,,,,11.78 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93531,CPT,CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMA,TC,,21 ,,TotalUnits,,,,82.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93532,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN,,,21 ,,TotalUnits,,,,101.20 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93532,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN,26,,21 ,,TotalUnits,,,,14.07 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93532,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN,TC,,21 ,,TotalUnits,,,,87.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93533,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN,,,21 ,,TotalUnits,,,,95.40 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93533,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN,26,,21 ,,TotalUnits,,,,9.43 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93533,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN,TC,,21 ,,TotalUnits,,,,85.97 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93561,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS,,,4 ,,TotalUnits,,,,2.37 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93561,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS,26,,4 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93561,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS,TC,,4 ,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93562,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEA,,,4 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93562,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEA,26,,4 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93562,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEA,TC,,4 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93563,CPT,NJX SEL HRT ART CONGENITAL HRT CATH W/S&I,,,4 ,,RBRVS,1.11 ,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93564,CPT,NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I,,,4 ,,RBRVS,1.13 ,0.42 ,0.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93565,CPT,NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I,,,4 ,,RBRVS,0.86 ,0.32 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93566,CPT,NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I,,,4 ,,RBRVS,0.86 ,0.31 ,4.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93567,CPT,NJX SUPRAVALV AORTOG HRT CATH W/S&I,,,4 ,,RBRVS,0.97 ,0.36 ,3.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93568,CPT,NJX PULMONARY ANGIO HRT CATH W/S&I,,,4 ,,RBRVS,0.88 ,0.33 ,3.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93571,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL,,,4 ,,TotalUnits,,,,8.78 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93571,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL,26,,4 ,,TotalUnits,,,,2.57 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93571,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL,TC,,4 ,,TotalUnits,,,,6.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93572,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL,,,4 ,,TotalUnits,,,,5.39 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93572,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL,26,,4 ,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93572,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL,TC,,4 ,,TotalUnits,,,,3.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93580,CPT,PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT,,,21 ,,RBRVS,17.97 ,7.99 ,7.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93581,CPT,PRQ TCAT CLSR CGEN VENTR SEPTAL DFCT W/IMPLT,,,21 ,,RBRVS,24.39 ,10.26 ,10.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93600,CPT,BUNDLE OF HIS RECORDING,,,4 ,,TotalUnits,,,,4.40 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93600,CPT,BUNDLE OF HIS RECORDING,26,,4 ,,TotalUnits,,,,3.01 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93600,CPT,BUNDLE OF HIS RECORDING,TC,,4 ,,TotalUnits,,,,1.39 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93602,CPT,INTRA-ATRIAL RECORDING,,,4 ,,TotalUnits,,,,4.18 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93602,CPT,INTRA-ATRIAL RECORDING,26,,4 ,,TotalUnits,,,,3.01 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93602,CPT,INTRA-ATRIAL RECORDING,TC,,4 ,,TotalUnits,,,,1.17 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93603,CPT,RIGHT VENTRICULAR RECORDING,,,4 ,,TotalUnits,,,,4.78 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93603,CPT,RIGHT VENTRICULAR RECORDING,26,,4 ,,TotalUnits,,,,3.01 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93603,CPT,RIGHT VENTRICULAR RECORDING,TC,,4 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93609,CPT,INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA,,,4 ,,TotalUnits,,,,9.29 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93609,CPT,INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA,26,,4 ,,TotalUnits,,,,7.11 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93609,CPT,INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA,TC,,4 ,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93610,CPT,INTRA-ATRIAL PACING,,,4 ,,TotalUnits,,,,4.34 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93610,CPT,INTRA-ATRIAL PACING,26,,4 ,,TotalUnits,,,,4.28 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93610,CPT,INTRA-ATRIAL PACING,TC,,4 ,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93612,CPT,INTRAVENTRICULAR PACING,,,4 ,,TotalUnits,,,,5.92 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93612,CPT,INTRAVENTRICULAR PACING,26,,4 ,,TotalUnits,,,,4.26 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93612,CPT,INTRAVENTRICULAR PACING,TC,,4 ,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93613,CPT,INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING,,,4 ,,RBRVS,6.99 ,2.98 ,2.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93615,CPT,ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS,,,4 ,,TotalUnits,,,,1.77 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93615,CPT,ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS,26,,4 ,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93615,CPT,ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS,TC,,4 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93616,CPT,ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG,,,4 ,,TotalUnits,,,,2.47 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93616,CPT,ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG,26,,4 ,,TotalUnits,,,,1.85 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93616,CPT,ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG,TC,,4 ,,TotalUnits,,,,0.62 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93618,CPT,INDUCTION ARRHYTHMIA ELECTRICAL PACING,,,4 ,,TotalUnits,,,,10.31 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93618,CPT,INDUCTION ARRHYTHMIA ELECTRICAL PACING,26,,4 ,,TotalUnits,,,,6.07 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93618,CPT,INDUCTION ARRHYTHMIA ELECTRICAL PACING,TC,,4 ,,TotalUnits,,,,4.24 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93619,CPT,COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION,,,4 ,,TotalUnits,,,,16.79 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93619,CPT,COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION,26,,4 ,,TotalUnits,,,,10.47 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93619,CPT,COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION,TC,,4 ,,TotalUnits,,,,6.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93620,CPT,COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION,,,4 ,,TotalUnits,,,,19.79 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93620,CPT,COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION,26,,4 ,,TotalUnits,,,,16.52 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93620,CPT,COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION,TC,,4 ,,TotalUnits,,,,3.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93621,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC,,,4 ,,TotalUnits,,,,4.88 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93621,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC,26,,4 ,,TotalUnits,,,,2.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93621,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC,TC,,4 ,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93622,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC,,,4 ,,TotalUnits,,,,5.88 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93622,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC,26,,4 ,,TotalUnits,,,,4.41 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93622,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC,TC,,4 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93623,CPT,PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS,,,4 ,,TotalUnits,,,,5.41 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93623,CPT,PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS,26,,4 ,,TotalUnits,,,,4.06 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93623,CPT,PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS,TC,,4 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93624,CPT,ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT,,,4 ,,TotalUnits,,,,8.50 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93624,CPT,ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT,26,,4 ,,TotalUnits,,,,6.86 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93624,CPT,ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT,TC,,4 ,,TotalUnits,,,,1.64 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93631,CPT,INTRAOP EPICAR& ENDOCAR PACG& MAPG,,,4 ,,TotalUnits,,,,13.66 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93631,CPT,INTRAOP EPICAR& ENDOCAR PACG& MAPG,26,,4 ,,TotalUnits,,,,10.36 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93631,CPT,INTRAOP EPICAR& ENDOCAR PACG& MAPG,TC,,4 ,,TotalUnits,,,,3.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93640,CPT,EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE,,,4 ,,TotalUnits,,,,12.22 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93640,CPT,EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE,26,,4 ,,TotalUnits,,,,5.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93640,CPT,EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE,TC,,4 ,,TotalUnits,,,,7.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93641,CPT,EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN,,,4 ,,TotalUnits,,,,14.05 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93641,CPT,EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN,26,,4 ,,TotalUnits,,,,8.44 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93641,CPT,EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN,TC,,4 ,,TotalUnits,,,,5.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93642,CPT,EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS,,,4 ,,RBRVS,4.88 ,6.72 ,6.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93642,CPT,EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS,26,,4 ,,RBRVS,4.88 ,2.11 ,2.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93642,CPT,EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS,TC,,4 ,,RBRVS,,4.61 ,4.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93650,CPT,ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION,,,4 ,,RBRVS,10.49 ,4.76 ,4.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93653,CPT,EPHYS EVAL W/ ABLATION SUPRAVENT ARRHYTHMIA,,,4 ,,RBRVS,15.00 ,5.89 ,5.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93654,CPT,EPHYS EVAL W/ ABLATION VENTRICULAR TACHYCARDIA,,,4 ,,RBRVS,20.00 ,7.88 ,7.88 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93655,CPT,ICAR CATHETER ABLATION ARRHYTHMIA ADD ON,,,4 ,,RBRVS,7.50 ,2.95 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93656,CPT,EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN,,,4 ,,RBRVS,20.02 ,7.87 ,7.87 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93657,CPT,ABLATE L/R ATRIAL FIBRIL W/ ISOLATED PULM VEIN,,,4 ,,RBRVS,7.50 ,2.95 ,2.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93660,CPT,CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR,,,4 ,,RBRVS,1.89 ,2.67 ,2.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93660,CPT,CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR,26,,4 ,,RBRVS,1.89 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93660,CPT,CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR,TC,,4 ,,RBRVS,,1.86 ,1.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93662,CPT,INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I,,,4 ,,TotalUnits,,,,5.42 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93662,CPT,INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I,26,,4 ,,TotalUnits,,,,3.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93662,CPT,INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I,TC,,4 ,,TotalUnits,,,,1.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93668,CPT,PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION,,,4 ,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93701,CPT,BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS,,TC,4 ,,TotalUnits,,,,0.75 ,,$0.00,$0.00,1,1,0,0,0,1,20131001,93701,CPT,BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS,26,,4 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,93701,CPT,BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS,TC,,4 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,93724,CPT,ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM,,,4 ,,RBRVS,4.88 ,3.16 ,3.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93724,CPT,ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM,26,,4 ,,RBRVS,4.88 ,2.08 ,2.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93724,CPT,ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM,TC,,4 ,,RBRVS,,1.08 ,1.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93740,CPT,TEMPRATURE GRADIENT STUDY,,,4 ,,RBRVS,0.16 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93740,CPT,TEMPRATURE GRADIENT STUDY,26,,4 ,,RBRVS,0.16 ,0.05 ,0.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93740,CPT,TEMPRATURE GRADIENT STUDY,TC,,4 ,,RBRVS,,0.03 ,0.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93750,CPT,INTERROGATION VAD IN PRSON W/PHYS/QHP ANALYSIS,,,4 ,,RBRVS,0.92 ,0.33 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93770,CPT,DERMINATION OF VENOUS PRESSUE,,,4 ,,RBRVS,0.16 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93770,CPT,DERMINATION OF VENOUS PRESSUE,26,,4 ,,RBRVS,0.16 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93770,CPT,DERMINATION OF VENOUS PRESSUE,TC,,4 ,,RBRVS,,0.01 ,0.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93784,CPT,AMBL BLD PRESS W/TAPE&/DISK 24/> HR ALYS I&R,,,4 ,,RBRVS,0.38 ,1.32 ,1.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93786,CPT,BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL,,TC,4 ,,RBRVS,,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93788,CPT,AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT,,TC,4 ,,RBRVS,,0.25 ,0.25 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93790,CPT,AMBL BLD PRESS TAPE&/DISK 24/> HR REVIEW,,PC,4 ,,RBRVS,0.38 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93797,CPT,OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR,,,4 ,,RBRVS,0.18 ,0.08 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93798,CPT,OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING,,,4 ,,RBRVS,0.28 ,0.12 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,,4 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,PC,4 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,TC,4 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,,,14 ,,RBRVS,0.60 ,6.76 ,6.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,26,,14 ,,RBRVS,0.60 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,TC,,14 ,,RBRVS,,6.53 ,6.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,,,14 ,,RBRVS,0.40 ,4.79 ,4.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,26,,14 ,,RBRVS,0.40 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,TC,,14 ,,RBRVS,,4.65 ,4.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,,,14 ,,RBRVS,0.94 ,9.48 ,9.48 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,26,,14 ,,RBRVS,0.94 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,TC,,14 ,,RBRVS,,9.10 ,9.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,,,14 ,,RBRVS,0.62 ,5.73 ,5.73 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,26,,14 ,,RBRVS,0.62 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,TC,,14 ,,RBRVS,,5.48 ,5.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,,,14 ,,RBRVS,1.00 ,7.32 ,7.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,26,,14 ,,RBRVS,1.00 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,TC,,14 ,,RBRVS,,6.92 ,6.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,,,14 ,,RBRVS,1.15 ,8.40 ,8.40 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,26,,14 ,,RBRVS,1.15 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,TC,,14 ,,RBRVS,,7.94 ,7.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,,,14 ,,RBRVS,1.15 ,8.49 ,8.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,26,,14 ,,RBRVS,1.15 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,TC,,14 ,,RBRVS,,8.02 ,8.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,,,14 ,,RBRVS,0.25 ,2.79 ,2.79 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,26,,14 ,,RBRVS,0.25 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,TC,,14 ,,RBRVS,,2.70 ,2.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,,,14 ,,RBRVS,0.45 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,26,,14 ,,RBRVS,0.45 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,TC,,14 ,,RBRVS,,4.08 ,4.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,,,14 ,,RBRVS,0.50 ,5.42 ,5.42 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,26,,14 ,,RBRVS,0.50 ,0.19 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,TC,,14 ,,RBRVS,,5.23 ,5.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,,,14 ,,RBRVS,0.58 ,8.68 ,8.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,26,,14 ,,RBRVS,0.58 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,TC,,14 ,,RBRVS,,8.47 ,8.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,,,14 ,,RBRVS,0.39 ,5.64 ,5.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,26,,14 ,,RBRVS,0.39 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,TC,,14 ,,RBRVS,,5.51 ,5.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,,,14 ,,RBRVS,0.46 ,6.94 ,6.94 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,26,,14 ,,RBRVS,0.46 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,TC,,14 ,,RBRVS,,6.77 ,6.77 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,,,14 ,,RBRVS,0.31 ,4.60 ,4.60 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,26,,14 ,,RBRVS,0.31 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,TC,,14 ,,RBRVS,,4.49 ,4.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93965,CPT,N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD,,,14 ,,RBRVS,0.35 ,3.35 ,3.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93965,CPT,N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD,26,,14 ,,RBRVS,0.35 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93965,CPT,N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD,TC,,14 ,,RBRVS,,3.22 ,3.22 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,,,14 ,,RBRVS,0.68 ,6.91 ,6.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,26,,14 ,,RBRVS,0.68 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,TC,,14 ,,RBRVS,,6.67 ,6.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,,,14 ,,RBRVS,0.45 ,4.06 ,4.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,26,,14 ,,RBRVS,0.45 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,TC,,14 ,,RBRVS,,3.90 ,3.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM,,,14 ,,RBRVS,1.80 ,9.23 ,9.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM,26,,14 ,,RBRVS,1.80 ,0.67 ,0.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM,TC,,14 ,,RBRVS,,8.56 ,8.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT,,,14 ,,RBRVS,1.21 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT,26,,14 ,,RBRVS,1.21 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT,TC,,14 ,,RBRVS,,4.66 ,4.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,,,14 ,,RBRVS,0.65 ,6.44 ,6.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,26,,14 ,,RBRVS,0.65 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,TC,,14 ,,RBRVS,,6.21 ,6.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,,,14 ,,RBRVS,0.44 ,4.51 ,4.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,26,,14 ,,RBRVS,0.44 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,TC,,14 ,,RBRVS,,4.35 ,4.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,,,14 ,,RBRVS,1.25 ,3.77 ,3.77 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,26,,14 ,,RBRVS,1.25 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,TC,,14 ,,RBRVS,,3.28 ,3.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD S,,,14 ,,RBRVS,0.44 ,2.97 ,2.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD S,26,,14 ,,RBRVS,0.44 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD S,TC,,14 ,,RBRVS,,2.80 ,2.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93982,CPT,IMPLANT WIRELESS PRESS SENSOR STUDY ANEURYSM SAC,,,14 ,,RBRVS,0.30 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,,,14 ,,RBRVS,0.25 ,6.06 ,6.06 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,26,,14 ,,RBRVS,0.25 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,TC,,14 ,,RBRVS,,5.98 ,5.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,93998,CPT,UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY,,,14 ,,TotalUnits,,,,4.68 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,94002,CPT,VENTILATION ASSIST & MGMT INPATIENT 1ST DAY,,,14 ,,RBRVS,1.99 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94003,CPT,VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA,,,14 ,,RBRVS,1.37 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94004,CPT,VENTILATION ASSIST & MGMT NURSING FAC PR DAY,,,14 ,,RBRVS,1.00 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94005,CPT,HOME VENTILATOR MGMT CARE OVERSIGHT 30 MIN/>,,,14 ,,RBRVS,1.50 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94010,CPT,SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,,,14 ,,RBRVS,0.17 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94010,CPT,SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,26,,14 ,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94010,CPT,SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,TC,,14 ,,RBRVS,,0.81 ,0.81 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94011,CPT,MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANT&/2 Y,,,14 ,,RBRVS,2.00 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94012,CPT,MEAS SPIRO FRCD EXP FLO PRE&POST BRONCH INF/2YRS,,,14 ,,RBRVS,3.10 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94013,CPT,MEASUREMENT LUNG VOLUMES INFANT/CHILD/2 YRS,,,14 ,,RBRVS,0.66 ,0.27 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94014,CPT,PT-INITIATE SPIROMETRIC RECORDING PHYS/QHP R&I,,,14 ,,RBRVS,0.52 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94015,CPT,PATIENT-INITIATED SPIROMETRIC RECORDING,,TC,14 ,,RBRVS,,0.68 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94016,CPT,PATIENT-INITIATED SPIROMETRIC PHYS/QHP R&I ONLY,,PC,14 ,,RBRVS,0.52 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,,,14 ,,RBRVS,0.26 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,26,,14 ,,RBRVS,0.26 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,TC,,14 ,,RBRVS,,1.41 ,1.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,,,14 ,,RBRVS,0.60 ,1.15 ,1.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,26,,14 ,,RBRVS,0.60 ,0.21 ,0.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,TC,,14 ,,RBRVS,,0.94 ,0.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,,,14 ,,RBRVS,0.07 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,26,,14 ,,RBRVS,0.07 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,TC,,14 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,,,14 ,,RBRVS,0.11 ,0.61 ,0.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,26,,14 ,,RBRVS,0.11 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,TC,,14 ,,RBRVS,,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,,,14 ,,RBRVS,0.11 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,26,,14 ,,RBRVS,0.11 ,0.04 ,0.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,TC,,14 ,,RBRVS,,0.61 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94375,CPT,RESPIRATORY FLOW VOLUME LOOP,,,14 ,,RBRVS,0.31 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94375,CPT,RESPIRATORY FLOW VOLUME LOOP,26,,14 ,,RBRVS,0.31 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94375,CPT,RESPIRATORY FLOW VOLUME LOOP,TC,,14 ,,RBRVS,,0.71 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94400,CPT,BREATHING RESPONSE TO CO2,,,14 ,,RBRVS,0.40 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94400,CPT,BREATHING RESPONSE TO CO2,26,,14 ,,RBRVS,0.40 ,0.14 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94400,CPT,BREATHING RESPONSE TO CO2,TC,,14 ,,RBRVS,,1.11 ,1.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94450,CPT,BREATHING RESPONSE TO HYPOXIA,,,14 ,,RBRVS,0.40 ,1.46 ,1.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94450,CPT,BREATHING RESPONSE TO HYPOXIA,26,,14 ,,RBRVS,0.40 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94450,CPT,BREATHING RESPONSE TO HYPOXIA,TC,,14 ,,RBRVS,,1.31 ,1.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,,,14 ,,RBRVS,0.31 ,1.38 ,1.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,26,,14 ,,RBRVS,0.31 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,TC,,14 ,,RBRVS,,1.28 ,1.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,,,14 ,,RBRVS,0.40 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,26,,14 ,,RBRVS,0.40 ,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,TC,,14 ,,RBRVS,,1.78 ,1.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94610,CPT,INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP,,,14 ,,RBRVS,1.16 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94620,CPT,PULMONARY STRESS TESTING SIMPLE,,,14 ,,RBRVS,0.64 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94620,CPT,PULMONARY STRESS TESTING SIMPLE,26,,14 ,,RBRVS,0.64 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94620,CPT,PULMONARY STRESS TESTING SIMPLE,TC,,14 ,,RBRVS,,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94621,CPT,PULMONARY STRESS TESTING COMPLEX,,,14 ,,RBRVS,1.42 ,3.33 ,3.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94621,CPT,PULMONARY STRESS TESTING COMPLEX,26,,14 ,,RBRVS,1.42 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94621,CPT,PULMONARY STRESS TESTING COMPLEX,TC,,14 ,,RBRVS,,2.80 ,2.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94640,CPT,PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT,,,14 ,,RBRVS,,0.51 ,0.51 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,94642,CPT,PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH,,,14 ,,TotalUnits,,,,1.41 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,94644,CPT,CONTINUOUS INHALATION TREATMENT 1ST HR,,,14 ,,RBRVS,,1.27 ,1.27 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,94645,CPT,CONTINUOUS INHALATION TREATMENT EA ADDL HR,,,14 ,,RBRVS,,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,94660,CPT,CPAP VENTILATION CPAP INITIATION&MGMT,,,14 ,,RBRVS,0.76 ,0.28 ,0.98 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94662,CPT,CONTINUOUS NEGATIVE PRESSURE VENTJ INITIAT&MGM,,,14 ,,RBRVS,0.76 ,0.25 ,0.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94664,CPT,DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP,,,14 ,,RBRVS,,0.49 ,0.49 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,94667,CPT,MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL,,,14 ,,RBRVS,,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,94668,CPT,MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ,,,14 ,,RBRVS,,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP,,,14 ,,RBRVS,0.26 ,1.47 ,1.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP,26,,14 ,,RBRVS,0.26 ,0.10 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP,TC,,14 ,,RBRVS,,1.37 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,,,14 ,,RBRVS,0.20 ,1.37 ,1.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,26,,14 ,,RBRVS,0.20 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,TC,,14 ,,RBRVS,,1.30 ,1.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,,,14 ,,RBRVS,0.07 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,26,,14 ,,RBRVS,0.07 ,0.03 ,0.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,TC,,14 ,,RBRVS,,1.41 ,1.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,,,14 ,,RBRVS,0.26 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,26,,14 ,,RBRVS,0.26 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,TC,,14 ,,RBRVS,,1.20 ,1.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V,,,14 ,,RBRVS,0.26 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V,26,,14 ,,RBRVS,0.26 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V,TC,,14 ,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,,,14 ,,RBRVS,0.26 ,0.96 ,0.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,26,,14 ,,RBRVS,0.26 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,TC,,14 ,,RBRVS,,0.87 ,0.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94729,CPT,CO DIFFUSING CAPACITY,,,14 ,,RBRVS,0.17 ,1.38 ,1.38 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94729,CPT,CO DIFFUSING CAPACITY,26,,14 ,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94729,CPT,CO DIFFUSING CAPACITY,TC,,14 ,,RBRVS,,1.32 ,1.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94750,CPT,PULMONARY COMPLIANCE STUDY,,,14 ,,RBRVS,0.23 ,2.10 ,2.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94750,CPT,PULMONARY COMPLIANCE STUDY,26,,14 ,,RBRVS,0.23 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94750,CPT,PULMONARY COMPLIANCE STUDY,TC,,14 ,,RBRVS,,2.02 ,2.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94760,CPT,NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER,,TC,14 ,,RBRVS,,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,0,1,1,20131001,94761,CPT,NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER,,TC,14 ,,RBRVS,,0.13 ,0.13 ,,,$0.00,$0.00,1,0,1,0,1,1,20131001,94762,CPT,NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR,,TC,14 ,,RBRVS,,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,,,14 ,,RBRVS,0.15 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,26,,14 ,,RBRVS,0.15 ,0.01 ,0.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,TC,,14 ,,RBRVS,,0.27 ,0.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,,,14 ,,TotalUnits,,,,3.43 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,26,,14 ,,TotalUnits,,,,1.37 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,TC,,14 ,,TotalUnits,,,,2.06 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,94774,CPT,PEDIATRIC APNEA MONITOR ATTACHMENT PHYS I&R,,,14 ,,TotalUnits,,,,2.71 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,94776,CPT,PEDIATRIC APNEA MONITOR ANALYSES COMPUTER,,TC,14 ,,TotalUnits,,,,1.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,94777,CPT,PEDIATRIC APNEA MONITOR PHYS/QHP REVIEW,,PC,14 ,,TotalUnits,,,,1.50 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,94780,CPT,CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN,,,14 ,,RBRVS,0.48 ,0.18 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94781,CPT,CAR SEAT/BED TESTNG W/INTERP & REPORT ADDL 30MIN,,,14 ,,RBRVS,0.17 ,0.06 ,0.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,,14 ,,TotalUnits,,,,1.17 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,PC,14 ,,TotalUnits,,,,0.36 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,TC,14 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,95004,CPT,PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,,2 ,,RBRVS,0.01 ,0.17 ,0.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95012,CPT,NITRIC OXIDE EXPIRED GAS DETERMINATION,,,2 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95017,CPT,ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R,,,2 ,,RBRVS,0.07 ,0.03 ,2.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95018,CPT,ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R,,,2 ,,RBRVS,0.14 ,0.06 ,0.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95024,CPT,INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,,2 ,,RBRVS,0.01 ,0.01 ,0.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95027,CPT,INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE,,,2 ,,RBRVS,0.01 ,0.13 ,0.13 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95028,CPT,IQ TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING,,TC,2 ,,RBRVS,,0.39 ,0.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95044,CPT,PATCH/APPLICATION TEST SPECIFY NUMBER TESTS,,,2 ,,RBRVS,,0.17 ,0.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95052,CPT,PHOTO PATCH TEST SPECIFY NUMBER TSTS,,,2 ,,RBRVS,,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95056,CPT,PHOTO TESTS,,,2 ,,RBRVS,,1.28 ,1.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95060,CPT,OPHTHALMIC MUCOUS MEMBRANE TESTS,,TC,2 ,,RBRVS,,0.93 ,0.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95065,CPT,DIRECT NASAL MUCOUS MEMBRANE TEST,,TC,2 ,,RBRVS,,0.73 ,0.73 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95070,CPT,INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL,,TC,2 ,,RBRVS,,1.00 ,1.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95071,CPT,INHLJ BRNCL CHALLENGE TSTG W/AGS/GASES,,TC,2 ,,RBRVS,,1.99 ,1.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95076,CPT,INGESTION CHALLENGE TEST INITIAL 120 MINUTES,,,2 ,,RBRVS,1.50 ,0.55 ,1.87 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95079,CPT,INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES,,,2 ,,RBRVS,1.38 ,0.51 ,0.98 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95115,CPT,PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX,,,1 ,,RBRVS,,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95117,CPT,PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS,,,1 ,,RBRVS,,0.34 ,0.34 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95120,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX,,,1 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,95125,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX,,,1 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,95130,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 1 STING INSECT,,,1 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,95131,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 2 STING INSECT,,,1 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,95132,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 3 STING INSECT,,,1 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,95133,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 4 STING INSECT,,,1 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,95134,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 5 STING INSECT,,,1 ,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,95144,CPT,PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO,,,1 ,,RBRVS,0.06 ,0.02 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95145,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT,,,1 ,,RBRVS,0.06 ,0.02 ,0.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95146,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT,,,1 ,,RBRVS,0.06 ,0.02 ,0.99 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95147,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 3 INSECT,,,1 ,,RBRVS,0.06 ,0.02 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95148,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT,,,1 ,,RBRVS,0.06 ,0.02 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95149,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT,,,1 ,,RBRVS,0.06 ,0.02 ,1.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95165,CPT,PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN,,,1 ,,RBRVS,0.06 ,0.03 ,0.31 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95170,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE,,,1 ,,RBRVS,0.06 ,0.02 ,0.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95180,CPT,RAPID DESENSITIZATION PROCEDURE EACH HOUR,,,1 ,,RBRVS,2.01 ,0.91 ,1.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95199,CPT,UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SRVC/PX,,,1 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,95250,CPT,GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID,,TC,14 ,,RBRVS,,4.63 ,4.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95251,CPT,GLUC MNTR CONT REC FROM NTRSTL TISS FLU I&R,,PC,14 ,,RBRVS,0.85 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95782,CPT,POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND,,,14 ,,RBRVS,2.60 ,28.46 ,28.46 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95782,CPT,POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND,26,,14 ,,RBRVS,2.60 ,1.05 ,1.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95782,CPT,POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND,TC,,14 ,,RBRVS,,27.41 ,27.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95783,CPT,POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM,,,14 ,,RBRVS,2.83 ,29.67 ,29.67 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95783,CPT,POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM,26,,14 ,,RBRVS,2.83 ,1.14 ,1.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95783,CPT,POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM,TC,,14 ,,RBRVS,,28.53 ,28.53 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,,,14 ,,RBRVS,1.05 ,3.63 ,3.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,26,,14 ,,RBRVS,1.05 ,0.39 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,TC,,14 ,,RBRVS,,3.24 ,3.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,,,14 ,,RBRVS,1.00 ,1.49 ,1.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,26,,14 ,,RBRVS,1.00 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,TC,,14 ,,RBRVS,,1.12 ,1.12 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,,,14 ,,RBRVS,0.90 ,3.91 ,3.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,26,,14 ,,RBRVS,0.90 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,TC,,14 ,,RBRVS,,3.56 ,3.56 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,,,14 ,,RBRVS,1.20 ,10.99 ,10.99 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,26,,14 ,,RBRVS,1.20 ,0.50 ,0.50 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,TC,,14 ,,RBRVS,,10.49 ,10.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT,,,14 ,,RBRVS,1.25 ,4.07 ,4.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT,26,,14 ,,RBRVS,1.25 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT,TC,,14 ,,RBRVS,,3.55 ,3.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,,,14 ,,RBRVS,1.28 ,13.21 ,13.21 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,26,,14 ,,RBRVS,1.28 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,TC,,14 ,,RBRVS,,12.72 ,12.72 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95808,CPT,POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND,,,14 ,,RBRVS,1.74 ,17.82 ,17.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95808,CPT,POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND,26,,14 ,,RBRVS,1.74 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95808,CPT,POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND,TC,,14 ,,RBRVS,,17.07 ,17.07 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95810,CPT,POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,,,14 ,,RBRVS,2.50 ,16.76 ,16.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95810,CPT,POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,26,,14 ,,RBRVS,2.50 ,0.97 ,0.97 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95810,CPT,POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,TC,,14 ,,RBRVS,,15.79 ,15.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95811,CPT,POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND,,,14 ,,RBRVS,2.60 ,17.93 ,17.93 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95811,CPT,POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND,26,,14 ,,RBRVS,2.60 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95811,CPT,POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND,TC,,14 ,,RBRVS,,16.92 ,16.92 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95812,CPT,ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN,,,14 ,,RBRVS,1.08 ,9.63 ,9.63 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95812,CPT,ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN,26,,14 ,,RBRVS,1.08 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95812,CPT,ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN,TC,,14 ,,RBRVS,,9.16 ,9.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR >1 HR,,,14 ,,RBRVS,1.73 ,10.65 ,10.65 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR >1 HR,26,,14 ,,RBRVS,1.73 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR >1 HR,TC,,14 ,,RBRVS,,9.91 ,9.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,,,14 ,,RBRVS,1.08 ,8.74 ,8.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,26,,14 ,,RBRVS,1.08 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,TC,,14 ,,RBRVS,,8.27 ,8.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,,,14 ,,RBRVS,1.08 ,10.09 ,10.09 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,26,,14 ,,RBRVS,1.08 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,TC,,14 ,,RBRVS,,9.62 ,9.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,,,14 ,,RBRVS,1.08 ,9.10 ,9.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,26,,14 ,,RBRVS,1.08 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,TC,,14 ,,RBRVS,,8.63 ,8.63 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,,,14 ,,RBRVS,0.74 ,1.97 ,1.97 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,26,,14 ,,RBRVS,0.74 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,TC,,14 ,,RBRVS,,1.65 ,1.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,,,14 ,,RBRVS,1.08 ,18.51 ,18.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,26,,14 ,,RBRVS,1.08 ,0.47 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,TC,,14 ,,RBRVS,,18.04 ,18.04 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95829,CPT,ELECTROCORTICOGRAM SURGERY SPX,,,14 ,,RBRVS,6.20 ,42.74 ,42.74 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95829,CPT,ELECTROCORTICOGRAM SURGERY SPX,26,,14 ,,RBRVS,6.20 ,2.72 ,2.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95829,CPT,ELECTROCORTICOGRAM SURGERY SPX,TC,,14 ,,RBRVS,,40.02 ,40.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95830,CPT,INSERTION SPHENOIDAL ELECTRODES EEG PHYS/QHP,,,14 ,,RBRVS,1.70 ,0.70 ,4.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95831,CPT,MUSC TSTG MNL W/REPRT XTR EX HAND/TRNK,,,14 ,,RBRVS,0.28 ,0.12 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95832,CPT,MUSC TSTG MNL W/REPRT HAND W/WO CMPRSN NRML SIDE,,,14 ,,RBRVS,0.29 ,0.13 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95833,CPT,MUSC TSTG MNL W/REPRT TOTAL EVAL BODY EX HANDS,,,14 ,,RBRVS,0.47 ,0.15 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95834,CPT,MUSC TSTG MNL W/REPRT TOTAL EVAL BODY W/HANDS,,,14 ,,RBRVS,0.60 ,0.24 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95851,CPT,ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPI,,,14 ,,RBRVS,0.16 ,0.05 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95852,CPT,ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID,,,14 ,,RBRVS,0.11 ,0.05 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95857,CPT,CHOLINESTERASE INHIBITOR CHALLENGE TEST,,,14 ,,RBRVS,0.53 ,0.26 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,,,14 ,,RBRVS,0.96 ,1.82 ,1.82 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,26,,14 ,,RBRVS,0.96 ,0.46 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,TC,,14 ,,RBRVS,,1.36 ,1.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,,,14 ,,RBRVS,1.54 ,2.50 ,2.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,26,,14 ,,RBRVS,1.54 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,TC,,14 ,,RBRVS,,1.78 ,1.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,,,14 ,,RBRVS,1.87 ,3.01 ,3.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,26,,14 ,,RBRVS,1.87 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,TC,,14 ,,RBRVS,,2.16 ,2.16 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,,,14 ,,RBRVS,1.99 ,3.30 ,3.30 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,26,,14 ,,RBRVS,1.99 ,0.91 ,0.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,TC,,14 ,,RBRVS,,2.39 ,2.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,,,14 ,,RBRVS,1.57 ,2.03 ,2.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,26,,14 ,,RBRVS,1.57 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,TC,,14 ,,RBRVS,,1.28 ,1.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,,,14 ,,RBRVS,1.25 ,1.96 ,1.96 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,26,,14 ,,RBRVS,1.25 ,0.56 ,0.56 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,TC,,14 ,,RBRVS,,1.40 ,1.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,,,14 ,,RBRVS,0.79 ,1.86 ,1.86 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,26,,14 ,,RBRVS,0.79 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,TC,,14 ,,RBRVS,,1.51 ,1.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,,,14 ,,RBRVS,1.18 ,2.37 ,2.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,26,,14 ,,RBRVS,1.18 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,TC,,14 ,,RBRVS,,1.85 ,1.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,,,14 ,,RBRVS,0.37 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,26,,14 ,,RBRVS,0.37 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,TC,,14 ,,RBRVS,,1.45 ,1.45 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,,,14 ,,RBRVS,0.37 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,26,,14 ,,RBRVS,0.37 ,0.17 ,0.17 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,TC,,14 ,,RBRVS,,1.36 ,1.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,,,14 ,,RBRVS,2.88 ,2.44 ,2.44 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,26,,14 ,,RBRVS,2.88 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,TC,,14 ,,RBRVS,,1.21 ,1.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,,,14 ,,RBRVS,0.37 ,1.57 ,1.57 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,26,,14 ,,RBRVS,0.37 ,0.20 ,0.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,TC,,14 ,,RBRVS,,1.37 ,1.37 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,,,14 ,,RBRVS,0.37 ,1.47 ,1.47 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,26,,14 ,,RBRVS,0.37 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,TC,,14 ,,RBRVS,,1.29 ,1.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,,,14 ,,RBRVS,1.10 ,2.12 ,2.12 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,26,,14 ,,RBRVS,1.10 ,0.48 ,0.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,TC,,14 ,,RBRVS,,1.64 ,1.64 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,,,14 ,,RBRVS,0.35 ,1.27 ,1.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,26,,14 ,,RBRVS,0.35 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,TC,,14 ,,RBRVS,,1.11 ,1.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,,,14 ,,RBRVS,0.92 ,1.61 ,1.61 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,26,,14 ,,RBRVS,0.92 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,TC,,14 ,,RBRVS,,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,,,14 ,,RBRVS,0.73 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,26,,14 ,,RBRVS,0.73 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,TC,,14 ,,RBRVS,,1.19 ,1.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,,,14 ,,RBRVS,0.05 ,1.91 ,1.91 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,26,,14 ,,RBRVS,0.05 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,TC,,14 ,,RBRVS,,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95907,CPT,MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB,,,14 ,,RBRVS,1.00 ,1.72 ,1.72 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95907,CPT,MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB,26,,14 ,,RBRVS,1.00 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95907,CPT,MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB,TC,,14 ,,RBRVS,,1.23 ,1.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95908,CPT,MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB,,,14 ,,RBRVS,1.25 ,2.11 ,2.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95908,CPT,MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB,26,,14 ,,RBRVS,1.25 ,0.62 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95908,CPT,MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB,TC,,14 ,,RBRVS,,1.49 ,1.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95909,CPT,MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB,,,14 ,,RBRVS,1.50 ,2.52 ,2.52 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95909,CPT,MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB,26,,14 ,,RBRVS,1.50 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95909,CPT,MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB,TC,,14 ,,RBRVS,,1.78 ,1.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95910,CPT,MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB,,,14 ,,RBRVS,2.00 ,3.29 ,3.29 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95910,CPT,MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB,26,,14 ,,RBRVS,2.00 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95910,CPT,MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB,TC,,14 ,,RBRVS,,2.30 ,2.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95911,CPT,MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB,,,14 ,,RBRVS,2.50 ,3.89 ,3.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95911,CPT,MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB,26,,14 ,,RBRVS,2.50 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95911,CPT,MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB,TC,,14 ,,RBRVS,,2.66 ,2.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95912,CPT,MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB,,,14 ,,RBRVS,3.00 ,4.49 ,4.49 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95912,CPT,MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB,26,,14 ,,RBRVS,3.00 ,1.48 ,1.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95912,CPT,MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB,TC,,14 ,,RBRVS,,3.01 ,3.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95913,CPT,MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB,,,14 ,,RBRVS,3.56 ,5.11 ,5.11 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95913,CPT,MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB,26,,14 ,,RBRVS,3.56 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95913,CPT,MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB,TC,,14 ,,RBRVS,,3.36 ,3.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,,,14 ,,RBRVS,0.90 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,26,,14 ,,RBRVS,0.90 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,TC,,14 ,,RBRVS,,1.15 ,1.15 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,,,14 ,,RBRVS,0.96 ,2.10 ,2.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,26,,14 ,,RBRVS,0.96 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,TC,,14 ,,RBRVS,,1.69 ,1.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,,,14 ,,RBRVS,0.90 ,3.69 ,3.69 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,26,,14 ,,RBRVS,0.90 ,0.40 ,0.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,TC,,14 ,,RBRVS,,3.29 ,3.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95924,CPT,TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT,,,14 ,,RBRVS,1.73 ,2.51 ,2.51 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95924,CPT,TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT,26,,14 ,,RBRVS,1.73 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95924,CPT,TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT,TC,,14 ,,RBRVS,,1.78 ,1.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,,,14 ,,RBRVS,0.54 ,4.33 ,4.33 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,26,,14 ,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,TC,,14 ,,RBRVS,,4.09 ,4.09 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,,,14 ,,RBRVS,0.54 ,4.16 ,4.16 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,26,,14 ,,RBRVS,0.54 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,TC,,14 ,,RBRVS,,3.93 ,3.93 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,,,14 ,,RBRVS,0.54 ,4.24 ,4.24 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,26,,14 ,,RBRVS,0.54 ,0.24 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,TC,,14 ,,RBRVS,,4.00 ,4.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,,,14 ,,RBRVS,1.50 ,5.89 ,5.89 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,26,,14 ,,RBRVS,1.50 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,TC,,14 ,,RBRVS,,5.23 ,5.23 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,,,14 ,,RBRVS,1.50 ,6.01 ,6.01 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,26,,14 ,,RBRVS,1.50 ,0.66 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,TC,,14 ,,RBRVS,,5.35 ,5.35 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,,,14 ,,RBRVS,0.35 ,4.07 ,4.07 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,26,,14 ,,RBRVS,0.35 ,0.16 ,0.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,TC,,14 ,,RBRVS,,3.91 ,3.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,,,14 ,,RBRVS,0.59 ,1.75 ,1.75 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,26,,14 ,,RBRVS,0.59 ,0.26 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,TC,,14 ,,RBRVS,,1.49 ,1.49 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,,,14 ,,RBRVS,0.65 ,1.34 ,1.34 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,26,,14 ,,RBRVS,0.65 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,TC,,14 ,,RBRVS,,1.06 ,1.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB,,,14 ,,RBRVS,0.86 ,7.76 ,7.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB,26,,14 ,,RBRVS,0.86 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB,TC,,14 ,,RBRVS,,7.38 ,7.38 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI,,,14 ,,RBRVS,2.25 ,11.20 ,11.20 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI,26,,14 ,,RBRVS,2.25 ,1.01 ,1.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI,TC,,14 ,,RBRVS,,10.19 ,10.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95940,CPT,IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES,,,14 ,,RBRVS,0.60 ,0.30 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,,,14 ,,RBRVS,1.51 ,7.15 ,7.15 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,26,,14 ,,RBRVS,1.51 ,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,TC,,14 ,,RBRVS,,6.50 ,6.50 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,,,14 ,,TotalUnits,,,,15.35 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,26,,14 ,,TotalUnits,,,,8.60 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,TC,,14 ,,TotalUnits,,,,6.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,,,14 ,,RBRVS,3.08 ,9.36 ,9.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,26,,14 ,,RBRVS,3.08 ,1.35 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,TC,,14 ,,RBRVS,,8.01 ,8.01 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95954,CPT,RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE,,,14 ,,RBRVS,2.45 ,9.32 ,9.32 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95954,CPT,RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE,26,,14 ,,RBRVS,2.45 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95954,CPT,RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE,TC,,14 ,,RBRVS,,8.42 ,8.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95955,CPT,EEG NONINTRACRANIAL SURGERY,,,14 ,,RBRVS,1.01 ,4.64 ,4.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95955,CPT,EEG NONINTRACRANIAL SURGERY,26,,14 ,,RBRVS,1.01 ,0.44 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95955,CPT,EEG NONINTRACRANIAL SURGERY,TC,,14 ,,RBRVS,,4.20 ,4.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95956,CPT,MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR,,,14 ,,RBRVS,3.61 ,30.71 ,30.71 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95956,CPT,MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR,26,,14 ,,RBRVS,3.61 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95956,CPT,MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR,TC,,14 ,,RBRVS,,29.27 ,29.27 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,,,14 ,,RBRVS,1.98 ,9.27 ,9.27 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,26,,14 ,,RBRVS,1.98 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,TC,,14 ,,RBRVS,,8.42 ,8.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,,,14 ,,RBRVS,4.24 ,10.05 ,10.05 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,26,,14 ,,RBRVS,4.24 ,1.81 ,1.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,TC,,14 ,,RBRVS,,8.24 ,8.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95961,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR,,,14 ,,RBRVS,2.97 ,4.84 ,4.84 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95961,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR,26,,14 ,,RBRVS,2.97 ,1.33 ,1.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95961,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR,TC,,14 ,,RBRVS,,3.51 ,3.51 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95962,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR,,,14 ,,RBRVS,3.21 ,3.58 ,3.58 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95962,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR,26,,14 ,,RBRVS,3.21 ,1.40 ,1.40 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95962,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR,TC,,14 ,,RBRVS,,2.18 ,2.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,,,14 ,,RBRVS,7.99 ,49.83 ,49.83 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,26,,14 ,,RBRVS,7.99 ,3.55 ,3.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,TC,,14 ,,RBRVS,,46.28 ,46.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,,,14 ,,RBRVS,3.99 ,24.88 ,24.88 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,26,,14 ,,RBRVS,3.99 ,1.78 ,1.78 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,TC,,14 ,,RBRVS,,23.10 ,23.10 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,,,14 ,,RBRVS,3.49 ,21.66 ,21.66 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,26,,14 ,,RBRVS,3.49 ,1.52 ,1.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,TC,,14 ,,RBRVS,,20.14 ,20.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,95970,CPT,ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM,,,14 ,,RBRVS,0.45 ,0.19 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95971,CPT,ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG,,,14 ,,RBRVS,0.78 ,0.32 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95972,CPT,ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH 1ST HR,,,14 ,,RBRVS,1.50 ,0.64 ,1.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95973,CPT,ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN,,,14 ,,RBRVS,0.92 ,0.41 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95974,CPT,ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR,,,14 ,,RBRVS,3.00 ,1.26 ,2.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95975,CPT,ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN,,,14 ,,RBRVS,1.70 ,0.74 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95978,CPT,ELEC ALYS NSTIM PLS GEN CPLX DP BRN 1ST HR,,,14 ,,RBRVS,3.50 ,1.53 ,2.91 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95979,CPT,ELEC ALYS NSTIM PLS GEN CPLX DP BRN EA 30 MIN,,,14 ,,RBRVS,1.64 ,0.72 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95980,CPT,ELEC ALYS NSTIM PLS GEN GASTRIC INTRAOP W/PRGRMG,,,14 ,,RBRVS,0.80 ,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95981,CPT,ELEC ALYS NSTIM GEN GASTRIC SBSQ W/O REPRGRMG,,,14 ,,RBRVS,0.30 ,0.18 ,0.61 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95982,CPT,ELEC ALYS NSTIM PLS GEN GASTRIC SBSQ W/REPRGRMG,,,14 ,,RBRVS,0.65 ,0.33 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95990,CPT,REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN,,,14 ,,RBRVS,,2.49 ,2.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95991,CPT,RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP,,,14 ,,RBRVS,0.77 ,0.32 ,2.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95992,CPT,CANALITH REPOSITIONING PROCEDURE,,,14 ,,RBRVS,0.75 ,0.31 ,0.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,95999,CPT,UNLIS NEUROLOGICAL/NEUROMUSCULAR DX PX,,,14 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,96000,CPT,COMPRE CPTR MTN ALYS VIDEO TAPING 3-D KINEMATICS,,,14 ,,RBRVS,1.80 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96001,CPT,COMPRE CPTR MTN ALYS W/DYN PLNTR PRES MEAS WALKG,,,14 ,,RBRVS,2.15 ,0.63 ,0.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96002,CPT,DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC,,,14 ,,RBRVS,0.41 ,0.18 ,0.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96003,CPT,DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC,,,14 ,,RBRVS,0.37 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96004,CPT,PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR,,PC,14 ,,RBRVS,2.14 ,0.99 ,0.99 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96020,CPT,TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP,26,,14 ,,RBRVS,3.43 ,1.31 ,1.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96040,CPT,MEDICAL GENETICS COUNSELING EACH 30 MINUTES,,,14 ,,RBRVS,,1.33 ,1.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96101,CPT,PSYCHOLOGICAL TESTING PR HR WITH PATIENT,,,16 ,,RBRVS,1.86 ,0.31 ,0.47 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96102,CPT,PSYCHOLOGICAL TESTING ADMN BY TECH PR HR,,,16 ,,RBRVS,0.50 ,0.13 ,1.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96103,CPT,PSYCHOLOGICAL TESTING COMPUTER W/PROF I&R,,,16 ,,RBRVS,0.51 ,0.17 ,1.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96105,CPT,ASSESSMENT PHASIA W/INTERP & REPORT PER HOUR,,,16 ,,RBRVS,1.75 ,1.20 ,1.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96110,CPT,DEVELOPMENTAL SCREENING W/INTERP&REPRT STD FOR,,,16 ,,RBRVS,,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96111,CPT,DEVELOPMENTAL TESTING W/INTERP & REPORT,,,16 ,,RBRVS,2.60 ,0.73 ,0.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96116,CPT,NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ,,,16 ,,RBRVS,1.86 ,0.49 ,0.66 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96118,CPT,NUROPSYC TESTING PR HR W/PT & INTERPJ TIME,,,16 ,,RBRVS,1.86 ,0.29 ,0.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96119,CPT,NUROPSYC TSTG WPROF I&R ADMN BY TECH PR HR,,,16 ,,RBRVS,0.55 ,0.10 ,1.48 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96120,CPT,NEUROPSYCHOLOG TESTING COMPUTER W/PROF I&R,,,16 ,,RBRVS,0.51 ,0.17 ,2.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96125,CPT,STANDARDIZED COGNITIVE PERFORMANCE TESTING,,,16 ,,RBRVS,1.70 ,1.14 ,1.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96150,CPT,HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST ASSMT,,,16 ,,RBRVS,0.50 ,0.08 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96151,CPT,HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT RE-ASSMT,,,16 ,,RBRVS,0.48 ,0.08 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96152,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN INDIV,,,16 ,,RBRVS,0.46 ,0.07 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96153,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN GRP 2/>PTS,,,16 ,,RBRVS,0.10 ,0.02 ,0.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96154,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/PT,,,16 ,,RBRVS,0.45 ,0.07 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96155,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/O PT,,,16 ,,RBRVS,0.44 ,0.18 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,96360,CPT,IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,,,22 ,,RBRVS,0.17 ,1.48 ,1.48 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96361,CPT,IV INFUSION HYDRATION EACH ADDITIONAL HOUR,,,22 ,,RBRVS,0.09 ,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96365,CPT,IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR,,,22 ,,RBRVS,0.21 ,1.89 ,1.89 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96366,CPT,IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR,,,22 ,,RBRVS,0.18 ,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96367,CPT,IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR,,,22 ,,RBRVS,0.19 ,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96368,CPT,IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS,,,22 ,,RBRVS,0.17 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96369,CPT,SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP,,,22 ,,RBRVS,0.21 ,5.26 ,5.26 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96370,CPT,SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR,,,22 ,,RBRVS,0.18 ,0.27 ,0.27 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96371,CPT,SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE,,,22 ,,RBRVS,,2.52 ,2.52 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96372,CPT,THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM,,,22 ,,RBRVS,0.17 ,0.53 ,0.53 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96373,CPT,THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL,,,22 ,,RBRVS,0.17 ,0.40 ,0.40 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96374,CPT,THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,,,22 ,,RBRVS,0.18 ,1.43 ,1.43 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96375,CPT,THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,,,22 ,,RBRVS,0.10 ,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,96376,CPT,THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC,,,22 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,96379,CPT,UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,,,22 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,96401,CPT,CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO,,,14 ,,RBRVS,0.21 ,1.90 ,1.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96402,CPT,CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO,,,14 ,,RBRVS,0.19 ,0.79 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96405,CPT,CHEMOTHERAPY ADMINISTRATION INTRALESIONAL </7,,,14 ,,RBRVS,0.52 ,0.34 ,1.94 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96406,CPT,CHEMOTHERAPY ADMINISTRATION INTRALESIONAL >7,,,14 ,,RBRVS,0.80 ,0.46 ,2.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96409,CPT,CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG,,,14 ,,RBRVS,0.24 ,2.97 ,2.97 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96411,CPT,CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG,,,14 ,,RBRVS,0.20 ,1.60 ,1.60 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96413,CPT,CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG,,,14 ,,RBRVS,0.28 ,3.74 ,3.74 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96415,CPT,CHEMOTHERAPY ADMN IV INFUSION TQ EA HR,,,14 ,,RBRVS,0.19 ,0.70 ,0.70 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96416,CPT,CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP,,,14 ,,RBRVS,0.21 ,3.78 ,3.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96417,CPT,CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR,,,14 ,,RBRVS,0.21 ,1.85 ,1.85 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96420,CPT,CHEMOTHERAPY ADMIN INTRA-ARTERIAL PUSH TQ,,,14 ,,RBRVS,0.17 ,2.90 ,2.90 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96422,CPT,CHEMOTHERAPY ADMIN INTRA-ARTERIAL INFUS </1 HR,,,14 ,,RBRVS,0.17 ,4.80 ,4.80 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96423,CPT,CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR,,,14 ,,RBRVS,0.17 ,2.11 ,2.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96425,CPT,CHEMOTX ADMN IA NFS >8 HR PRTBLE IMPLTBL PMP,,,14 ,,RBRVS,0.17 ,5.03 ,5.03 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96440,CPT,CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS,,,14 ,,RBRVS,2.37 ,1.24 ,21.40 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96446,CPT,CHEMOTX ADMN PRTL CAVITY PORT/CATH,,,14 ,,RBRVS,0.37 ,0.18 ,5.21 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96450,CPT,CHEMOTX ADMN CNS REQ SPINAL PUNCTURE,,,14 ,,RBRVS,1.53 ,0.76 ,3.86 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96521,CPT,REFILLING & MAINTENANCE PORTABLE PUMP,,,14 ,,RBRVS,0.21 ,3.76 ,3.76 ,,,$0.00,$0.00,1,1,1,1,1,1,20131001,96522,CPT,REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC,,,14 ,,RBRVS,0.21 ,3.00 ,3.00 ,,,$0.00,$0.00,1,1,1,1,1,1,20131001,96523,CPT,IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST,,,14 ,,RBRVS,0.04 ,0.69 ,0.69 ,,,$0.00,$0.00,1,1,1,1,1,1,20131001,96542,CPT,CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT,,,14 ,,RBRVS,0.75 ,0.44 ,2.82 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96549,CPT,UNLISTED CHEMOTHERAPY PROCEDURE,,,14 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,96567,CPT,PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX,,,14 ,,RBRVS,,4.00 ,4.00 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96570,CPT,PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN,,,14 ,,RBRVS,1.10 ,0.42 ,0.42 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96571,CPT,PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX A 15 MIN,,,14 ,,RBRVS,0.55 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96900,CPT,ACTINOTHERAPY ULTRAVIOLET LIGHT,,,14 ,,RBRVS,,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96902,CPT,MCRSCP XM HAIR PLUCK/CLIP FOR CNTS/STRUCT ABNORM,,,14 ,,RBRVS,0.41 ,0.17 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96904,CPT,WHOLE BODY INTEGUMENTARY PHOTOGRAPHY,,,14 ,,RBRVS,,2.08 ,2.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96910,CPT,PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB,,,14 ,,RBRVS,,2.11 ,2.11 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96912,CPT,PHOTOCHEMOTX PSORALENS&ULTRAVIOLET PUVA,,,14 ,,RBRVS,,2.71 ,2.71 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96913,CPT,PHOTOCHEMOTHERAPY DERMATOSES 4-8 HRS SUPERVISION,,,14 ,,RBRVS,,3.78 ,3.78 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96920,CPT,LASER SKIN DISEASE PSORIASIS TOT AREA <250 SQ C,,,14 ,,RBRVS,1.15 ,0.77 ,3.96 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96921,CPT,LASER SKIN DISEASE PSORIASIS 250-500 SQ CM,,,14 ,,RBRVS,1.17 ,0.76 ,4.02 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96922,CPT,LASER SKIN DISEASE PSORIASIS >500 SQ CM,,,14 ,,RBRVS,2.10 ,1.36 ,5.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,96999,CPT,UNLISTED SPECIAL DERMATOLOGICAL SERVICE/PROCED,,,14 ,,TotalUnits,,,,2.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,97001,CPT,PHYSICAL THERAPY EVALUATION,,,19 ,,RBRVS,1.20 ,0.91 ,0.91 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97002,CPT,PHYSICAL THERAPY RE-EVALUATION,,,19 ,,RBRVS,0.60 ,0.57 ,0.57 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97003,CPT,OCCUPATIONAL THERAPY EVALUATION,,,19 ,,RBRVS,1.20 ,1.17 ,1.17 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97004,CPT,OCCUPATIONAL THERAPY RE-EVALUATION,,,19 ,,RBRVS,0.60 ,0.86 ,0.86 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97005,CPT,ATHLETIC TRAINING EVALUATION,,,19 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,97006,CPT,ATHLETIC TRAINING RE-EVALUATION,,,19 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,97010,CPT,APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS,,,19 ,,RBRVS,0.06 ,0.10 ,0.10 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97012,CPT,APPL MODALITY 1/> AREAS TRACTION MECHANICAL,,,19 ,,RBRVS,0.25 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97014,CPT,APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED,,,19 ,,RBRVS,0.18 ,0.26 ,0.26 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97016,CPT,APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES,,,19 ,,RBRVS,0.18 ,0.35 ,0.35 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97018,CPT,APPL MODALITY 1/> AREAS PARAFFIN BATH,,,19 ,,RBRVS,0.06 ,0.23 ,0.23 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97022,CPT,APPLICATION MODALITY 1/> AREAS WHIRLPOOL,,,19 ,,RBRVS,0.17 ,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97024,CPT,APPLICATION MODALITY 1/> AREAS DIATHERMY,,,19 ,,RBRVS,0.06 ,0.12 ,0.12 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97026,CPT,APPLICATION MODALITY 1/> AREAS INFRARED,,,19 ,,RBRVS,0.06 ,0.10 ,0.10 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97028,CPT,APPL MODALITY 1/> AREAS ULTRAVIOLET,,,19 ,,RBRVS,0.08 ,0.12 ,0.12 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97032,CPT,APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN,,,19 ,,RBRVS,0.25 ,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97033,CPT,APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN,,,19 ,,RBRVS,0.26 ,0.63 ,0.63 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97034,CPT,APPL MODALITY 1/> AREAS CONTRAST BATHS EA 15 MI,,,19 ,,RBRVS,0.21 ,0.28 ,0.28 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97035,CPT,APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN,,,19 ,,RBRVS,0.21 ,0.14 ,0.14 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97036,CPT,APPL MODALITY 1/> AREAS HUBBARD TANK EA 15 MIN,,,19 ,,RBRVS,0.28 ,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97039,CPT,UNLIST MODALITY SPEC TYPE&TIME CONSTANT ATTEND,,,19 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,97110,CPT,THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES,,,19 ,,RBRVS,0.45 ,0.44 ,0.44 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97112,CPT,THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA,,,19 ,,RBRVS,0.45 ,0.48 ,0.48 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97113,CPT,THER PX 1/> AREAS EACH 15 MIN AQUA THER W/XERSS,,,19 ,,RBRVS,0.44 ,0.75 ,0.75 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97116,CPT,THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR,,,19 ,,RBRVS,0.40 ,0.39 ,0.39 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97124,CPT,THER PX 1/> AREAS EACH 15 MINUTES MASSAGE,,,19 ,,RBRVS,0.35 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97139,CPT,UNLISTED THERAPEUTIC PROCEDURE SPECIFY,,,19 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,97140,CPT,MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES,,,19 ,,RBRVS,0.43 ,0.40 ,0.40 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97150,CPT,THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS,,,19 ,,RBRVS,0.27 ,0.30 ,0.30 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97530,CPT,THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,,,19 ,,RBRVS,0.44 ,0.54 ,0.54 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97532,CPT,DEVELOPMENT OF COGNITIVE SKILLS EACH 15 MINUTES,,,19 ,,RBRVS,0.44 ,0.30 ,0.30 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97533,CPT,SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES,,,19 ,,RBRVS,0.44 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97535,CPT,SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES,,,19 ,,RBRVS,0.45 ,0.52 ,0.52 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97537,CPT,COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN,,,19 ,,RBRVS,0.45 ,0.39 ,0.39 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97542,CPT,WHEELCHAIR MGMT EA 15 MIN,,,19 ,,RBRVS,0.45 ,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97545,CPT,WORK HARDENING/CONDITIONING 1ST 2 HR,,,19 ,,TotalUnits,,,,3.17 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,97546,CPT,WORK HARDENING/CONDITIONING EACH HOUR,,,19 ,,TotalUnits,,,,1.27 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,97597,CPT,DEBRIDEMENT OPEN WOUND 20 SQ CM/<,,,14 ,,RBRVS,0.51 ,0.14 ,1.65 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,97598,CPT,DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,,,14 ,,RBRVS,0.24 ,0.06 ,0.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,97602,CPT,RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS,,,14 ,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,97605,CPT,NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM,,,14 ,,RBRVS,0.55 ,0.16 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,97606,CPT,NEGATIVE PRESSURE WOUND THERAPY >50 SQ CM,,,14 ,,RBRVS,0.60 ,0.17 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,97750,CPT,PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN,,,19 ,,RBRVS,0.45 ,0.47 ,0.47 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97755,CPT,ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN,,,19 ,,RBRVS,0.62 ,0.38 ,0.38 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97760,CPT,ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15,,,19 ,,RBRVS,0.45 ,0.60 ,0.60 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97761,CPT,PROSTHETIC TRAINING UPPR&/LOWER EXTREM EA 15 M,,,19 ,,RBRVS,0.45 ,0.46 ,0.46 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97762,CPT,CHECKOUT ORTHOTIC/PROSTHETIC ESTAB PT EA 15 MIN,,,19 ,,RBRVS,0.25 ,1.04 ,1.04 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,97799,CPT,UNLISTED PHYSICAL MEDICINE/REHAB SERVICE/PROC,,,19 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,97802,CPT,MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI,,,14 ,,RBRVS,0.53 ,0.37 ,0.44 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,97803,CPT,MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M,,,14 ,,RBRVS,0.45 ,0.32 ,0.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,97804,CPT,MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI,,,14 ,,RBRVS,0.25 ,0.17 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,97810,CPT,ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MI,,,14 ,,RBRVS,0.60 ,0.25 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,97811,CPT,ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN,,,14 ,,RBRVS,0.50 ,0.20 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,97813,CPT,ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN,,,14 ,,RBRVS,0.65 ,0.27 ,0.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,97814,CPT,ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ,,,14 ,,RBRVS,0.55 ,0.23 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98925,CPT,OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS,,,19 ,,RBRVS,0.46 ,0.19 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,98926,CPT,OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS,,,19 ,,RBRVS,0.71 ,0.28 ,0.54 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,98927,CPT,OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS,,,19 ,,RBRVS,0.96 ,0.35 ,0.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,98928,CPT,OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS,,,19 ,,RBRVS,1.21 ,0.44 ,0.79 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,98929,CPT,OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS,,,19 ,,RBRVS,1.46 ,0.50 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,98940,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS,,,5 ,,RBRVS,0.45 ,0.15 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98941,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS,,,5 ,,RBRVS,0.65 ,0.22 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98942,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS,,,5 ,,RBRVS,0.87 ,0.29 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98943,CPT,CHIROPRACTIC MANIPLTV TX EXTRASPINAL 1/> REGION,,,5 ,,RBRVS,0.40 ,0.17 ,0.27 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98960,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT,,,14 ,,RBRVS,,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98961,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS,,,14 ,,RBRVS,,0.38 ,0.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98962,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS,,,14 ,,RBRVS,,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98966,CPT,NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN,,,15 ,,RBRVS,0.25 ,0.10 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98967,CPT,NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN,,,15 ,,RBRVS,0.50 ,0.20 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98968,CPT,NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN,,,15 ,,RBRVS,0.75 ,0.31 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,98969,CPT,NONPHYSICIAN ONLINE ASSESSMENT AND MANAGEMENT,,,15 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99000,CPT,HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB,,,14 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,99001,CPT,HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB,,,14 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,99002,CPT,HANDLE/CONVEY/ANY OTH SVC DEVICE FIT PHYS/QHP,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,99024,CPT,POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX,,,14 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99026,CPT,HOSPITAL MANDATED CALL SERVICE IN-HOSPITAL EA HR,,,14 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99027,CPT,HOSPITAL MANDATED CALL SVC OUT-OF-HOSPITAL EA HR,,,14 ,,TotalUnits,,,,0.19 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99050,CPT,SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS,,,15 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99051,CPT,SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS,,,15 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99053,CPT,SERVICES PROVIDED BTW 10 PM&8 AM AT 24-HR FACI,,,15 ,,TotalUnits,,,,1.26 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99056,CPT,SVC TYPICAL PRV OFFICE PRV OUT OFFICE REQUEST PT,,,15 ,,TotalUnits,,,,0.94 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99058,CPT,SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS,,,15 ,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99060,CPT,SVC PRV EMER OUT OFFICE DISRUPTS OFFICE SVC,,,15 ,,TotalUnits,,,,1.32 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99070,CPT,SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP,,,14 ,,TotalUnits,,,,0.45 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,99071,CPT,EDUCATIONAL SUPPLIES PRV BY THE PHYS AT COST,,,14 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,99075,CPT,MEDICAL TESTIMONY,,,14 ,,TotalUnits,,,,1.91 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99078,CPT,PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING,,,14 ,,TotalUnits,,,,1.09 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99080,CPT,SPEC REPORTS > USUAL MED COMUNICAJ/STAND RPRTG,,,14 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99082,CPT,UNUSUAL TRAVEL,,,14 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99090,CPT,ANALYSIS CLINICAL DATA STORED IN COMPUTERS,,,14 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99091,CPT,COLLJ&INTERPJ PHYS/QHP PHYSIO COMPUTR DATA 30 MI,,,14 ,,RBRVS,1.10 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99100,CPT,ANESTHESIA EXTREME AGE PATIENT UNDER 1 YR/<,,,14 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99116,CPT,ANES COMPLICJ UTILIZATION TOTAL BODY HYPOTHERMIA,,,14 ,,TotalUnits,,,,3.48 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99135,CPT,ANES COMPLICJ UTILIZATION CONTROLLED HYPOTENSION,,,14 ,,TotalUnits,,,,3.16 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99140,CPT,ANES COMPLICJ EMERGENCY CONDITIONS SPECIFY,,,14 ,,TotalUnits,,,,2.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99143,CPT,MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN,,,14 ,,TotalUnits,,,,1.62 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99144,CPT,MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN,,,14 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99145,CPT,MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN,,,14 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99148,CPT,MOD SEDATJ DIFF PHYS/QHP <5 YRS INIT 30 MIN,,,14 ,,TotalUnits,,,,1.49 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99149,CPT,MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN,,,14 ,,TotalUnits,,,,1.22 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99150,CPT,MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN,,,14 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99170,CPT,ANOGENITAL XM W/COLPOSCOPY CHILD/SUSPECT TRAUMA,,,14 ,,RBRVS,1.75 ,0.74 ,2.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,,23 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,PC,23 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,TC,23 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,99173,CPT,SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT,,,23 ,,RBRVS,,0.08 ,0.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,99174,CPT,INSTRUMENT BASED OCULAR SCREENING BILATERAL,,,23 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,99174,CPT,INSTRUMENT BASED OCULAR SCREENING BILATERAL,,PC,23 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,99174,CPT,INSTRUMENT BASED OCULAR SCREENING BILATERAL,,TC,23 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,99175,CPT,IPECAC/SIMILAR ADMN EMESIS&OBS STOMACH EMPTIED,,,14 ,,RBRVS,,0.55 ,0.55 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,99183,CPT,PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX /SESSION,,,14 ,,RBRVS,2.34 ,0.91 ,3.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99190,CPT,ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH EA HR,,,14 ,,TotalUnits,,,,13.51 ,,$0.00,$0.00,1,1,0,0,1,1,20131001,99191,CPT,ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 45 MI,,,14 ,,TotalUnits,,,,9.45 ,,$0.00,$0.00,1,1,0,0,1,1,20131001,99192,CPT,ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 30 MI,,,14 ,,TotalUnits,,,,6.75 ,,$0.00,$0.00,1,1,0,0,1,1,20131001,99195,CPT,PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE,,,14 ,,RBRVS,,2.69 ,2.69 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,99199,CPT,UNLISTED SPECIAL SERVICE PROCEDURE/REPORT,,,14 ,,TotalUnits,,,,2.69 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,99201,CPT,OFFICE OUTPATIENT NEW 10 MINUTES,,,15 ,,RBRVS,0.48 ,0.24 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99202,CPT,OFFICE OUTPATIENT NEW 20 MINUTES,,,15 ,,RBRVS,0.93 ,0.44 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99203,CPT,OFFICE OUTPATIENT NEW 30 MINUTES,,,15 ,,RBRVS,1.42 ,0.64 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99204,CPT,OFFICE OUTPATIENT NEW 45 MINUTES,,,15 ,,RBRVS,2.43 ,1.07 ,2.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99205,CPT,OFFICE OUTPATIENT NEW 60 MINUTES,,,15 ,,RBRVS,3.17 ,1.34 ,2.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99211,CPT,OFFICE OUTPATIENT VISIT 5 MINUTES,,,15 ,,RBRVS,0.18 ,0.08 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99212,CPT,OFFICE OUTPATIENT VISIT 10 MINUTES,,,15 ,,RBRVS,0.48 ,0.22 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99213,CPT,OFFICE OUTPATIENT VISIT 15 MINUTES,,,15 ,,RBRVS,0.97 ,0.42 ,1.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99214,CPT,OFFICE OUTPATIENT VISIT 25 MINUTES,,,15 ,,RBRVS,1.50 ,0.64 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99215,CPT,OFFICE OUTPATIENT VISIT 40 MINUTES,,,15 ,,RBRVS,2.11 ,0.90 ,1.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99217,CPT,OBSERVATION CARE DISCHARGE MANAGEMENT,,,10 ,,RBRVS,1.28 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99218,CPT,INITIAL OBSERVATION CARE/DAY 30 MINUTES,,,10 ,,RBRVS,1.92 ,0.73 ,0.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99219,CPT,INITIAL OBSERVATION CARE/DAY 50 MINUTES,,,10 ,,RBRVS,2.60 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99220,CPT,INITIAL OBSERVATION CARE/DAY 70 MINUTES,,,10 ,,RBRVS,3.56 ,1.43 ,1.43 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99221,CPT,INITIAL HOSPITAL CARE/DAY 30 MINUTES,,,10 ,,RBRVS,1.92 ,0.79 ,0.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99222,CPT,INITIAL HOSPITAL CARE/DAY 50 MINUTES,,,10 ,,RBRVS,2.61 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99223,CPT,INITIAL HOSPITAL CARE/DAY 70 MINUTES,,,10 ,,RBRVS,3.86 ,1.59 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99224,CPT,SBSQ OBSERVATION CARE/DAY 15 MINUTES,,,10 ,,RBRVS,0.76 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99225,CPT,SBSQ OBSERVATION CARE/DAY 25 MINUTES,,,10 ,,RBRVS,1.39 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99226,CPT,SBSQ OBSERVATION CARE/DAY 35 MINUTES,,,10 ,,RBRVS,2.00 ,0.85 ,0.85 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99231,CPT,SBSQ HOSPITAL CARE/DAY 15 MINUTES,,,10 ,,RBRVS,0.76 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99232,CPT,SBSQ HOSPITAL CARE/DAY 25 MINUTES,,,10 ,,RBRVS,1.39 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99233,CPT,SBSQ HOSPITAL CARE/DAY 35 MINUTES,,,10 ,,RBRVS,2.00 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99234,CPT,OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES,,,10 ,,RBRVS,2.56 ,1.08 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99235,CPT,OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES,,,10 ,,RBRVS,3.24 ,1.38 ,1.38 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99236,CPT,OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES,,,10 ,,RBRVS,4.20 ,1.74 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99238,CPT,HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/<,,,10 ,,RBRVS,1.28 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99239,CPT,HOSPITAL DISCHARGE DAY MANAGEMENT > 30 MIN,,,10 ,,RBRVS,1.90 ,1.02 ,1.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99241,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN,,,6 ,,RBRVS,0.64 ,0.24 ,0.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99242,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN,,,6 ,,RBRVS,1.34 ,0.51 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99243,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN,,,6 ,,RBRVS,1.88 ,0.71 ,1.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99244,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN,,,6 ,,RBRVS,3.02 ,1.14 ,1.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99245,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN,,,6 ,,RBRVS,3.77 ,1.38 ,2.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99251,CPT,INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN,,,6 ,,RBRVS,1.00 ,0.32 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99252,CPT,INITL INPATIENT CONSULT NEW/ESTAB PT 40 MIN,,,6 ,,RBRVS,1.50 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99253,CPT,INITL INPATIENT CONSULT NEW/ESTAB PT 55 MIN,,,6 ,,RBRVS,2.27 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99254,CPT,INITL INPATIENT CONSULT NEW/ESTAB PT 80 MIN,,,6 ,,RBRVS,3.29 ,1.23 ,1.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99255,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN,,,6 ,,RBRVS,4.00 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99281,CPT,EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB,,,7 ,,RBRVS,0.45 ,0.12 ,0.12 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99282,CPT,EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY,,,7 ,,RBRVS,0.88 ,0.23 ,0.23 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99283,CPT,EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY,,,7 ,,RBRVS,1.34 ,0.33 ,0.33 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99284,CPT,EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY,,,7 ,,RBRVS,2.56 ,0.59 ,0.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99285,CPT,EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ,,,7 ,,RBRVS,3.80 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99288,CPT,PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS,,,7 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99291,CPT,CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN,,,10 ,,RBRVS,4.50 ,1.54 ,3.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99292,CPT,CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN,,,10 ,,RBRVS,2.25 ,0.77 ,1.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99304,CPT,INITIAL NURSING FACILITY CARE/DAY 25 MINUTES,,,10 ,,RBRVS,1.64 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99305,CPT,INITIAL NURSING FACILITY CARE/DAY 35 MINUTES,,,10 ,,RBRVS,2.35 ,1.18 ,1.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99306,CPT,INITIAL NURSING FACILITY CARE/DAY 45 MINUTES,,,10 ,,RBRVS,3.06 ,1.44 ,1.44 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99307,CPT,SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN,,,10 ,,RBRVS,0.76 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99308,CPT,SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN,,,10 ,,RBRVS,1.16 ,0.71 ,0.71 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99309,CPT,SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN,,,10 ,,RBRVS,1.55 ,0.92 ,0.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99310,CPT,SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN,,,10 ,,RBRVS,2.35 ,1.30 ,1.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99315,CPT,NURSING FACILITY DISCHARGE MANAGEMENT 30 MINUTES,,,10 ,,RBRVS,1.28 ,0.69 ,0.69 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99316,CPT,NURSING FACILITY DISCHARGE MANAGEMENT 30 MINUTES,,,10 ,,RBRVS,1.90 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99318,CPT,E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN,,,10 ,,RBRVS,1.71 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99324,CPT,DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN,,,15 ,,RBRVS,1.01 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99325,CPT,DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN,,,15 ,,RBRVS,1.52 ,0.70 ,0.70 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99326,CPT,DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES,,,15 ,,RBRVS,2.63 ,1.18 ,1.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99327,CPT,DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN,,,15 ,,RBRVS,3.46 ,1.59 ,1.59 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99328,CPT,DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 MINUTES,,,15 ,,RBRVS,4.09 ,1.79 ,1.79 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99334,CPT,DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES,,,15 ,,RBRVS,1.07 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99335,CPT,DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES,,,15 ,,RBRVS,1.72 ,0.86 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99336,CPT,DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES,,,15 ,,RBRVS,2.46 ,1.19 ,1.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99337,CPT,DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES,,,15 ,,RBRVS,3.58 ,1.64 ,1.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99339,CPT,INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 15-29 MIN,,,15 ,,RBRVS,1.25 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99340,CPT,INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/>,,,15 ,,RBRVS,1.80 ,1.20 ,1.20 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99341,CPT,HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES,,,15 ,,RBRVS,1.01 ,0.51 ,0.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99342,CPT,HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES,,,15 ,,RBRVS,1.52 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99343,CPT,HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES,,,15 ,,RBRVS,2.53 ,1.07 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99344,CPT,HOME VISIT NEW PATIENT HI SEVERITY 60 MINUTES,,,15 ,,RBRVS,3.38 ,1.58 ,1.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99345,CPT,HOME VISIT NEW PT UNSTABL/SIGNIF NEW PROB 75 MIN,,,15 ,,RBRVS,4.09 ,1.84 ,1.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99347,CPT,HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES,,,15 ,,RBRVS,1.00 ,0.53 ,0.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99348,CPT,HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES,,,15 ,,RBRVS,1.56 ,0.75 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99349,CPT,HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES,,,15 ,,RBRVS,2.33 ,1.15 ,1.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99350,CPT,HOME VST EST PT UNSTABLE/SIGNIF NEW PROB 60 MINS,,,15 ,,RBRVS,3.28 ,1.53 ,1.53 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99354,CPT,PROLNG SVC OFFICE O/P DIR CONTACT 1ST HR,,,15 ,,RBRVS,1.77 ,0.75 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99355,CPT,PROLNG SVC OFFICE O/P DIR CONTACT EA 30 MINUTES,,,15 ,,RBRVS,1.77 ,0.70 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99356,CPT,PROLONGED SERVICE I/P REQ UNIT/FLOOR TIME 1ST HR,,,10 ,,RBRVS,1.71 ,0.78 ,0.78 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99357,CPT,PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN,,,10 ,,RBRVS,1.71 ,0.77 ,0.77 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99358,CPT,PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR,,,15 ,,RBRVS,2.10 ,0.90 ,0.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99359,CPT,PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES,,,15 ,,RBRVS,1.00 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99360,CPT,PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES,,,14 ,,RBRVS,1.20 ,0.49 ,0.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99363,CPT,ANTICOAGULANT MGMT OUTPATIENT INIT 90 DAYS,,,14 ,,RBRVS,1.65 ,0.67 ,1.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99364,CPT,ANTICOAGULANT MGMT OUTPATIENT EA SBSQ 90 DAYS,,,14 ,,RBRVS,0.63 ,0.26 ,0.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99366,CPT,TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN,,,15 ,,RBRVS,0.82 ,0.33 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99367,CPT,TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN,,,15 ,,RBRVS,1.10 ,0.45 ,0.45 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99368,CPT,TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN,,,15 ,,RBRVS,0.72 ,0.29 ,0.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99374,CPT,SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES,,,15 ,,RBRVS,1.10 ,0.45 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99375,CPT,SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>,,,15 ,,RBRVS,1.73 ,0.78 ,1.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99377,CPT,SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN,,,15 ,,RBRVS,1.10 ,0.45 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99378,CPT,SUPERVISION HOSPICE PATIENT/MONTH 30 MINUTES/>,,,15 ,,RBRVS,1.73 ,0.81 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99379,CPT,SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN,,,15 ,,RBRVS,1.10 ,0.45 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99380,CPT,SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>,,,15 ,,RBRVS,1.73 ,0.71 ,1.18 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99381,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR,,,24 ,,RBRVS,1.50 ,0.58 ,1.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99382,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS,,,24 ,,RBRVS,1.60 ,0.63 ,1.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99383,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS,,,18 ,,RBRVS,1.70 ,0.66 ,1.63 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99384,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR,,,18 ,,RBRVS,2.00 ,0.77 ,1.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99385,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS,,,18 ,,RBRVS,1.92 ,0.75 ,1.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99386,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS,,,18 ,,RBRVS,2.33 ,0.91 ,1.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99387,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>,,,18 ,,RBRVS,2.50 ,0.99 ,2.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99391,CPT,PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y,,,24 ,,RBRVS,1.37 ,0.53 ,1.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99392,CPT,PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS,,,24 ,,RBRVS,1.50 ,0.58 ,1.42 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99393,CPT,PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS,,,18 ,,RBRVS,1.50 ,0.58 ,1.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99394,CPT,PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS,,,18 ,,RBRVS,1.70 ,0.66 ,1.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99395,CPT,PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS,,,18 ,,RBRVS,1.75 ,0.68 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99396,CPT,PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS,,,18 ,,RBRVS,1.90 ,0.74 ,1.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99397,CPT,PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER,,,18 ,,RBRVS,2.00 ,0.80 ,1.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99401,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 M,,,18 ,,RBRVS,0.48 ,0.20 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99402,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 M,,,18 ,,RBRVS,0.98 ,0.40 ,0.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99403,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 M,,,18 ,,RBRVS,1.46 ,0.60 ,0.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99404,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN,,,18 ,,RBRVS,1.95 ,0.80 ,1.16 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99406,CPT,TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES,,,14 ,,RBRVS,0.24 ,0.09 ,0.15 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,99407,CPT,TOBACCO USE CESSATION INTENSIVE >10 MINUTES,,,14 ,,RBRVS,0.50 ,0.20 ,0.25 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,99408,CPT,ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN,,,16 ,,RBRVS,0.65 ,0.27 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,99409,CPT,ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN,,,16 ,,RBRVS,1.30 ,0.53 ,0.59 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,99411,CPT,PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M,,,18 ,,RBRVS,0.15 ,0.06 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99412,CPT,PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M,,,18 ,,RBRVS,0.25 ,0.10 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99420,CPT,ADMN & INTERPJ HEALTH RISK ASSESSMENT INSTRUMENT,,,18 ,,RBRVS,,0.30 ,0.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99429,CPT,UNLISTED PREVENTIVE MEDICINE SERVICE,,,18 ,,TotalUnits,,,,0.98 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99441,CPT,PHYS/QHP TELEPHONE EVALUATION 5-10 MIN,,,15 ,,RBRVS,0.25 ,0.10 ,0.14 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99442,CPT,PHYS/QHP TELEPHONE EVALUATION 11-20 MIN,,,15 ,,RBRVS,0.50 ,0.20 ,0.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99443,CPT,PHYS/QHP TELEPHONE EVALUATION 21-30 MIN,,,15 ,,RBRVS,0.75 ,0.31 ,0.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99444,CPT,PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE,,,15 ,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99450,CPT,BASIC LIFE AND/OR DISABILITY EXAMINATION,,,14 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99455,CPT,WORK RELATED/MED DBLT XM TREATING PHYS,,,14 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99456,CPT,WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,,,14 ,,TotalUnits,,,,5.02 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99460,CPT,1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB,,,10 ,,RBRVS,1.92 ,0.74 ,0.74 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99461,CPT,1ST CARE PR DAY NML NB XCPT HOSP/BIRTHING CENTER,,,24 ,,RBRVS,1.26 ,0.51 ,1.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99462,CPT,SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN,,,10 ,,RBRVS,0.84 ,0.34 ,0.34 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99463,CPT,1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT,,,10 ,,RBRVS,2.13 ,1.00 ,1.00 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99464,CPT,ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN,,,10 ,,RBRVS,1.50 ,0.54 ,0.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99465,CPT,DELIVERY/BIRTHING ROOM RESUSCITATION,,,10 ,,RBRVS,2.93 ,1.10 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99466,CPT,CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN,,,10 ,,RBRVS,4.79 ,2.01 ,2.01 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99467,CPT,CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN,,,10 ,,RBRVS,2.40 ,0.95 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99468,CPT,1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<,,,10 ,,RBRVS,18.46 ,6.45 ,6.45 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99469,CPT,SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<,,,10 ,,RBRVS,7.99 ,3.49 ,3.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99471,CPT,INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS,,,10 ,,RBRVS,15.98 ,5.75 ,5.75 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99472,CPT,SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO,,,10 ,,RBRVS,7.99 ,3.02 ,3.02 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99475,CPT,INITIAL PED CRITICAL CARE 2 THRU 5 YEARS,,,10 ,,RBRVS,11.25 ,3.96 ,3.96 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99476,CPT,SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS,,,10 ,,RBRVS,6.75 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99477,CPT,INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL,,,10 ,,RBRVS,7.00 ,2.55 ,2.55 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99478,CPT,SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS,,,10 ,,RBRVS,2.75 ,1.03 ,1.03 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99479,CPT,SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS,,,10 ,,RBRVS,2.50 ,0.98 ,0.98 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99480,CPT,SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS,,,10 ,,RBRVS,2.40 ,0.87 ,0.87 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,99485,CPT,SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN,,,10 ,,RBRVS,1.50 ,0.60 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99486,CPT,SUPERVISION INTERFACILITY TRANSPORT ADDL 30 MIN,,,10 ,,RBRVS,1.30 ,0.52 ,0.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99487,CPT,COMPLX CHRON CARE COORD W/O PT VST 1ST HR PER MO,,,10 ,,RBRVS,1.00 ,1.35 ,1.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99488,CPT,COMPLX CHRON CARE COORD W/ PT VST 1ST HR PER MO,,,10 ,,RBRVS,2.50 ,2.73 ,2.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99489,CPT,COMPLX CHRON CARE COORD EA ADDL 30 MIN PER MONTH,,,10 ,,RBRVS,0.50 ,0.68 ,0.68 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99495,CPT,TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE,,,10 ,,RBRVS,2.11 ,1.71 ,2.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99496,CPT,TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE,,,10 ,,RBRVS,3.05 ,2.56 ,3.54 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,99499,CPT,UNLISTED EVALUATION AND MANAGEMENT SERVICE,,,15 ,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,99500,CPT,HOME VISIT PRENATAL MONITORING & ASSESSMENT,,,14 ,,TotalUnits,,,,1.66 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99501,CPT,HOME VISIT POSTNATAL ASSMT&F-UP CARE,,,14 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99502,CPT,HOME VISIT NEWBORN CARE & ASSESSMENT,,,14 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99503,CPT,HOME VISIT RESPIRATORY THERAPY CARE,,,14 ,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99504,CPT,HOME VISIT MECHANICAL VENTILATION CARE,,,14 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99505,CPT,HOME VISIT STOMA CARE&MAINT CLST&CSTOST,,,14 ,,TotalUnits,,,,0.73 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99506,CPT,HOME VISIT INTRAMUSCULAR INJECTIONS,,,14 ,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99507,CPT,HOME VISIT CARE&MAINT CATH,,,14 ,,TotalUnits,,,,0.88 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99509,CPT,HOME VISIT ASSISTANCE DAILY LIV&PRSONAL CARE,,,14 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99510,CPT,HOME VISIT INDIV FAM/MARRIAGE COUNSELING,,,14 ,,TotalUnits,,,,1.27 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99511,CPT,HOME VISIT FECAL IMPACTION MGMT&ENEMA ADMN,,,14 ,,TotalUnits,,,,0.99 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99512,CPT,HOME VISIT HEMODIALYSIS,,,14 ,,TotalUnits,,,,5.35 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99600,CPT,UNLISTED HOME VISIT SERVICE/PROCEDURE,,,14 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99601,CPT,HOME NFS/SPECTY DRUG ADMN PR VST </2 HR,,,14 ,,TotalUnits,,,,2.72 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99602,CPT,HOME NFS/SPECTY DRUG ADMN PR VST </2 HR EA HR,,,14 ,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,99605,CPT,MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT,,,14 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,99606,CPT,MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT,,,14 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,99607,CPT,MEDICATION THERAPY EACH ADDITIONAL 15 MIN,,,14 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,A4206,HCPCS,1 CC STERILE SYRINGE&NEEDLE,,,28 ,,NW,,,,,,$0.95,$0.00,1,1,1,0,0,1,20131001,A4207,HCPCS,2 CC STERILE SYRINGE&NEEDLE,,,28 ,,NW,,,,,,$0.95,$0.00,1,1,1,0,0,1,20131001,A4208,HCPCS,3 CC STERILE SYRINGE&NEEDLE,,,28 ,,NW,,,,,,$0.95,$0.00,1,1,1,0,0,1,20131001,A4209,HCPCS,5+ CC STERILE SYRINGE&NEEDLE,,,28 ,,NW,,,,,,$0.95,$0.00,1,1,1,0,0,1,20131001,A4210,HCPCS,NONNEEDLE INJECTION DEVICE,,,28 ,,NW,,,,,,$987.00,$0.00,1,1,1,0,0,1,20131001,A4211,HCPCS,SUPP FOR SELF-ADM INJECTIONS,,,28 ,,NW,,,,,,$44.42,$0.00,1,1,1,0,0,1,20131001,A4212,HCPCS,NON CORING NEEDLE OR STYLET,,,28 ,,NW,,,,,,$16.61,$0.00,1,1,1,0,0,1,20131001,A4213,HCPCS,20+ CC SYRINGE ONLY,,,28 ,,NW,,,,,,$1.91,$0.00,1,1,1,0,0,1,20131001,A4215,HCPCS,STERILE NEEDLE,,,28 ,,NW,,,,,,$1.01,$0.00,1,1,1,0,0,1,20131001,A4216,HCPCS,"STERILE WATER/SALINE, 10 ML",,,28 ,,NW,,,,,,$0.77,$0.00,1,1,1,0,0,1,20131001,A4217,HCPCS,"STERILE WATER/SALINE, 500 ML",AU,,28 ,,NW,,,,,,$5.42,$0.00,1,1,1,0,0,1,20131001,A4217,HCPCS,"STERILE WATER/SALINE, 500 ML",,,28 ,,NW,,,,,,$5.42,$0.00,1,1,1,0,0,1,20131001,A4218,HCPCS,STERILE SALINE OR WATER,,,28 ,,NW,,,,,,$2.91,$0.00,1,1,1,0,0,1,20131001,A4220,HCPCS,INFUSION PUMP REFILL KIT,,,28 ,,NW,,,,,,$86.77,$0.00,1,1,1,0,0,1,20131001,A4221,HCPCS,MAINT DRUG INFUS CATH PER WK,,,28 ,,NW,,,,,,$44.90,$0.00,1,1,1,0,0,1,20131001,A4222,HCPCS,INFUSION SUPPLIES WITH PUMP,,,28 ,,NW,,,,,,$82.07,$0.00,1,1,1,0,0,1,20131001,A4223,HCPCS,INFUSION SUPPLIES W/O PUMP,,,28 ,,NW,,,,,,$128.15,$0.00,1,1,1,0,0,1,20131001,A4230,HCPCS,INFUS INSULIN PUMP NON NEEDL,,,28 ,,NW,,,,,,$22.59,$0.00,1,1,1,0,0,1,20131001,A4231,HCPCS,INFUSION INSULIN PUMP NEEDLE,,,28 ,,NW,,,,,,$11.07,$0.00,1,1,1,0,0,1,20131001,A4232,HCPCS,SYRINGE W/NEEDLE INSULIN 3CC,,,28 ,,NW,,,,,,$5.03,$0.00,1,1,1,0,0,1,20131001,A4233,HCPCS,ALKALIN BATT FOR GLUCOSE MON,NU,,28 ,,NW,,,,,,$5.12,$0.00,1,1,1,1,1,1,20131001,A4233,HCPCS,ALKALIN BATT FOR GLUCOSE MON,,,28 ,,NW,,,,,,$5.12,$0.00,1,1,1,1,1,1,20131001,A4234,HCPCS,J-CELL BATT FOR GLUCOSE MON,NU,,28 ,,NW,,,,,,$19.42,$0.00,1,1,1,1,1,1,20131001,A4234,HCPCS,J-CELL BATT FOR GLUCOSE MON,,,28 ,,NW,,,,,,$19.42,$0.00,1,1,1,1,1,1,20131001,A4235,HCPCS,LITHIUM BATT FOR GLUCOSE MON,NU,,28 ,,NW,,,,,,$15.02,$0.00,1,1,1,1,1,1,20131001,A4235,HCPCS,LITHIUM BATT FOR GLUCOSE MON,,,28 ,,NW,,,,,,$15.02,$0.00,1,1,1,1,1,1,20131001,A4236,HCPCS,SILVR OXIDE BATT GLUCOSE MON,NU,,28 ,,NW,,,,,,$10.76,$0.00,1,1,1,1,1,1,20131001,A4236,HCPCS,SILVR OXIDE BATT GLUCOSE MON,,,28 ,,NW,,,,,,$10.76,$0.00,1,1,1,1,1,1,20131001,A4244,HCPCS,ALCOHOL OR PEROXIDE PER PINT,,,28 ,,NW,,,,,,$1.91,$0.00,1,1,1,0,0,1,20131001,A4245,HCPCS,ALCOHOL WIPES PER BOX,,,28 ,,NW,,,,,,$5.83,$0.00,1,1,1,0,0,1,20131001,A4246,HCPCS,BETADINE/PHISOHEX SOLUTION,,,28 ,,NW,,,,,,$5.83,$0.00,1,1,1,0,0,1,20131001,A4247,HCPCS,BETADINE/IODINE SWABS/WIPES,,,28 ,,NW,,,,,,$8.77,$0.00,1,1,1,0,0,1,20131001,A4248,HCPCS,CHLORHEXIDINE ANTISEPT,,,28 ,,NW,,,,,,$7.54,$0.00,1,1,1,0,0,1,20131001,A4250,HCPCS,URINE REAGENT STRIPS/TABLETS,,,28 ,,NW,,,,,,$27.82,$0.00,1,1,1,0,0,1,20131001,A4252,HCPCS,BLOOD KETONE TEST OR STRIP,,,28 ,,NW,,,,,,$11.68,$0.00,1,1,1,0,0,1,20131001,A4253,HCPCS,BLOOD GLUCOSE/REAGENT STRIPS,NU,,28 ,,NW,,,,,,$81.89,$0.00,1,1,1,0,0,1,20131001,A4253,HCPCS,BLOOD GLUCOSE/REAGENT STRIPS,,,28 ,,NW,,,,,,$81.89,$0.00,1,1,1,0,0,1,20131001,A4255,HCPCS,GLUCOSE MONITOR PLATFORMS,,,28 ,,NW,,,,,,$13.83,$0.00,1,1,1,0,0,1,20131001,A4256,HCPCS,CALIBRATOR SOLUTION/CHIPS,KL,,28 ,,NW,,,,,,$23.25,$0.00,1,1,1,0,0,1,20131001,A4256,HCPCS,CALIBRATOR SOLUTION/CHIPS,,,28 ,,NW,,,,,,$25.62,$0.00,1,1,1,0,0,1,20131001,A4257,HCPCS,REPLACE LENSSHIELD CARTRIDGE,,,28 ,,NW,,,,,,$29.09,$0.00,1,1,1,0,0,1,20131001,A4258,HCPCS,LANCET DEVICE EACH,KL,,28 ,,NW,,,,,,$33.51,$0.00,1,1,1,0,0,1,20131001,A4258,HCPCS,LANCET DEVICE EACH,,,28 ,,NW,,,,,,$37.52,$0.00,1,1,1,0,0,1,20131001,A4259,HCPCS,LANCETS PER BOX,KL,,28 ,,NW,,,,,,$24.89,$0.00,1,1,1,0,0,1,20131001,A4259,HCPCS,LANCETS PER BOX,,,28 ,,NW,,,,,,$27.52,$0.00,1,1,1,0,0,1,20131001,A4261,HCPCS,CERVICAL CAP CONTRACEPTIVE,,,28 ,,NW,,,,,,$67.53,$0.00,1,1,1,1,1,1,20131001,A4262,HCPCS,TEMPORARY TEAR DUCT PLUG,,,28 ,,NW,,,,,,$0.95,$0.00,1,1,1,0,0,1,20131001,A4263,HCPCS,PERMANENT TEAR DUCT PLUG,,,28 ,,NW,,,,,,$55.20,$0.00,1,1,1,0,0,1,20131001,A4264,HCPCS,INTRATUBAL OCCLUSION DEVICE,,,28 ,,NW,,,,,,"$1,802.34",$0.00,1,1,1,1,1,1,20131001,A4265,HCPCS,PARAFFIN,,,28 ,,NW,,,,,,$11.69,$0.00,1,1,1,0,0,1,20131001,A4266,HCPCS,DIAPHRAGM,,,28 ,,NW,,,,,,$39.79,$0.00,1,1,1,1,1,1,20131001,A4267,HCPCS,MALE CONDOM,,,28 ,,NW,,,,,,$0.95,$0.00,1,1,1,1,1,1,20131001,A4268,HCPCS,FEMALE CONDOM,,,28 ,,NW,,,,,,$1.98,$0.00,1,1,1,1,1,1,20131001,A4269,HCPCS,SPERMICIDE,,,28 ,,NW,,,,,,$1.91,$0.00,1,1,1,1,1,1,20131001,A4270,HCPCS,DISPOSABLE ENDOSCOPE SHEATH,,,28 ,,NW,,,,,,$36.04,$0.00,1,1,1,0,0,1,20131001,A4280,HCPCS,BRST PRSTHS ADHSV ATTCHMNT,,,28 ,,NW,,,,,,$9.67,$0.00,1,1,1,0,0,1,20131001,A4281,HCPCS,REPLACEMENT BREASTPUMP TUBE,,,28 ,,NW,,,,,,$22.96,$0.00,1,1,1,1,1,1,20131001,A4282,HCPCS,REPLACEMENT BREASTPUMP ADPT,,,28 ,,NW,,,,,,$4.05,$0.00,1,1,1,1,1,1,20131001,A4284,HCPCS,REPLCMNT BREAST PUMP SHIELD,,,28 ,,NW,,,,,,$27.82,$0.00,1,1,1,1,1,1,20131001,A4285,HCPCS,REPLCMNT BREAST PUMP BOTTLE,,,28 ,,NW,,,,,,$9.70,$0.00,1,1,1,1,1,1,20131001,A4286,HCPCS,REPLCMNT BREASTPUMP LOK RING,,,28 ,,NW,,,,,,$146.54,$0.00,1,1,1,1,1,1,20131001,A4290,HCPCS,SACRAL NERVE STIM TEST LEAD,,,28 ,,NW,,,,,,$699.44,$0.00,1,1,1,0,0,1,20131001,A4300,HCPCS,CATH IMPL VASC ACCESS PORTAL,,,28 ,,NW,,,,,,$18.69,$0.00,1,1,1,0,0,1,20131001,A4301,HCPCS,IMPLANTABLE ACCESS SYST PERC,,,28 ,,NW,,,,,,$22.34,$0.00,1,1,1,0,0,1,20131001,A4305,HCPCS,DRUG DELIVERY SYSTEM >=50 ML,,,28 ,,NW,,,,,,$22.34,$0.00,1,1,1,0,0,1,20131001,A4306,HCPCS,DRUG DELIVERY SYSTEM <=50 ML,,,28 ,,NW,,,,,,$28.43,$0.00,1,1,1,0,0,1,20131001,A4310,HCPCS,INSERT TRAY W/O BAG/CATH,,,28 ,,NW,,,,,,$13.64,$0.00,1,1,1,0,0,1,20131001,A4311,HCPCS,CATHETER W/O BAG 2-WAY LATEX,,,28 ,,NW,,,,,,$22.71,$0.00,1,1,1,0,0,1,20131001,A4312,HCPCS,CATH W/O BAG 2-WAY SILICONE,,,28 ,,NW,,,,,,$26.41,$0.00,1,1,1,0,0,1,20131001,A4313,HCPCS,CATHETER W/BAG 3-WAY,,,28 ,,NW,,,,,,$27.12,$0.00,1,1,1,0,0,1,20131001,A4314,HCPCS,CATH W/DRAINAGE 2-WAY LATEX,,,28 ,,NW,,,,,,$34.57,$0.00,1,1,1,0,0,1,20131001,A4315,HCPCS,CATH W/DRAINAGE 2-WAY SILCNE,,,28 ,,NW,,,,,,$35.90,$0.00,1,1,1,0,0,1,20131001,A4316,HCPCS,CATH W/DRAINAGE 3-WAY,,,28 ,,NW,,,,,,$38.32,$0.00,1,1,1,0,0,1,20131001,A4320,HCPCS,IRRIGATION TRAY,,,28 ,,NW,,,,,,$9.20,$0.00,1,1,1,0,0,1,20131001,A4321,HCPCS,CATH THERAPEUTIC IRRIG AGENT,,,28 ,,NW,,,,,,$7.02,$0.00,1,1,1,0,0,1,20131001,A4322,HCPCS,IRRIGATION SYRINGE,,,28 ,,NW,,,,,,$5.48,$0.00,1,1,1,0,0,1,20131001,A4326,HCPCS,MALE EXTERNAL CATHETER,,,28 ,,NW,,,,,,$18.39,$0.00,1,1,1,0,0,1,20131001,A4327,HCPCS,FEM URINARY COLLECT DEV CUP,,,28 ,,NW,,,,,,$57.13,$0.00,1,1,1,0,0,1,20131001,A4328,HCPCS,FEM URINARY COLLECT POUCH,,,28 ,,NW,,,,,,$18.21,$0.00,1,1,1,0,0,1,20131001,A4330,HCPCS,STOOL COLLECTION POUCH,,,28 ,,NW,,,,,,$12.70,$0.00,1,1,1,0,0,1,20131001,A4331,HCPCS,EXTENSION DRAINAGE TUBING,,,28 ,,NW,,,,,,$5.88,$0.00,1,1,1,0,0,1,20131001,A4332,HCPCS,LUBE STERILE PACKET,,,28 ,,NW,,,,,,$0.22,$0.00,1,1,1,0,0,1,20131001,A4333,HCPCS,URINARY CATH ANCHOR DEVICE,,,28 ,,NW,,,,,,$4.05,$0.00,1,1,1,0,0,1,20131001,A4334,HCPCS,URINARY CATH LEG STRAP,,,28 ,,NW,,,,,,$8.99,$0.00,1,1,1,0,0,1,20131001,A4335,HCPCS,INCONTINENCE SUPPLY,,,28 ,,NW,,,,,,$5.88,$0.00,1,1,1,0,0,1,20131001,A4336,HCPCS,URETHRAL INSERT,,,28 ,,NW,,,,,,$2.64,$0.00,1,1,1,0,0,1,20131001,A4338,HCPCS,INDWELLING CATHETER LATEX,,,28 ,,NW,,,,,,$20.19,$0.00,1,1,1,0,0,1,20131001,A4340,HCPCS,INDWELLING CATHETER SPECIAL,,,28 ,,NW,,,,,,$40.94,$0.00,1,1,1,0,0,1,20131001,A4344,HCPCS,CATH INDW FOLEY 2 WAY SILICN,,,28 ,,NW,,,,,,$24.12,$0.00,1,1,1,0,0,1,20131001,A4346,HCPCS,CATH INDW FOLEY 3 WAY,,,28 ,,NW,,,,,,$27.92,$0.00,1,1,1,0,0,1,20131001,A4349,HCPCS,DISPOSABLE MALE EXTERNAL CAT,,,28 ,,NW,,,,,,$3.72,$0.00,1,1,1,0,0,1,20131001,A4351,HCPCS,STRAIGHT TIP URINE CATHETER,,,28 ,,NW,,,,,,$3.13,$0.00,1,1,1,0,0,1,20131001,A4352,HCPCS,COUDE TIP URINARY CATHETER,,,28 ,,NW,,,,,,$11.31,$0.00,1,1,1,0,0,1,20131001,A4353,HCPCS,INTERMITTENT URINARY CATH,,,28 ,,NW,,,,,,$12.99,$0.00,1,1,1,0,0,1,20131001,A4354,HCPCS,CATH INSERTION TRAY W/BAG,,,28 ,,NW,,,,,,$19.61,$0.00,1,1,1,0,0,1,20131001,A4355,HCPCS,BLADDER IRRIGATION TUBING,,,28 ,,NW,,,,,,$16.08,$0.00,1,1,1,0,0,1,20131001,A4356,HCPCS,EXT URETH CLMP OR COMPR DVC,,,28 ,,NW,,,,,,$56.92,$0.00,1,1,1,0,0,1,20131001,A4357,HCPCS,BEDSIDE DRAINAGE BAG,,,28 ,,NW,,,,,,$17.28,$0.00,1,1,1,0,0,1,20131001,A4358,HCPCS,URINARY LEG OR ABDOMEN BAG,,,28 ,,NW,,,,,,$11.74,$0.00,1,1,1,0,0,1,20131001,A4360,HCPCS,DISPOSABLE EXT URETHRAL DEV,,,28 ,,NW,,,,,,$0.84,$0.00,1,1,1,0,0,1,20131001,A4361,HCPCS,OSTOMY FACE PLATE,,,28 ,,NW,,,,,,$27.10,$0.00,1,1,1,0,0,1,20131001,A4362,HCPCS,SOLID SKIN BARRIER,,,28 ,,NW,,,,,,$6.07,$0.00,1,1,1,0,0,1,20131001,A4363,HCPCS,"OSTOMY CLAMP, REPLACEMENT",,,28 ,,NW,,,,,,$4.18,$0.00,1,1,1,0,0,1,20131001,A4364,HCPCS,"ADHESIVE, LIQUID OR EQUAL",,,28 ,,NW,,,,,,$5.01,$0.00,1,1,1,0,0,1,20131001,A4366,HCPCS,OSTOMY VENT,,,28 ,,NW,,,,,,$2.39,$0.00,1,1,1,0,0,1,20131001,A4367,HCPCS,OSTOMY BELT,,,28 ,,NW,,,,,,$13.03,$0.00,1,1,1,0,0,1,20131001,A4368,HCPCS,OSTOMY FILTER,,,28 ,,NW,,,,,,$0.47,$0.00,1,1,1,0,0,1,20131001,A4369,HCPCS,SKIN BARRIER LIQUID PER OZ,,,28 ,,NW,,,,,,$4.28,$0.00,1,1,1,0,0,1,20131001,A4371,HCPCS,SKIN BARRIER POWDER PER OZ,,,28 ,,NW,,,,,,$6.73,$0.00,1,1,1,0,0,1,20131001,A4372,HCPCS,SKIN BARRIER SOLID 4X4 EQUIV,,,28 ,,NW,,,,,,$7.76,$0.00,1,1,1,0,0,1,20131001,A4373,HCPCS,SKIN BARRIER WITH FLANGE,,,28 ,,NW,,,,,,$11.64,$0.00,1,1,1,0,0,1,20131001,A4375,HCPCS,DRAINABLE PLASTIC PCH W FCPL,,,28 ,,NW,,,,,,$26.39,$0.00,1,1,1,0,0,1,20131001,A4376,HCPCS,DRAINABLE RUBBER PCH W FCPLT,,,28 ,,NW,,,,,,$61.56,$0.00,1,1,1,0,0,1,20131001,A4377,HCPCS,DRAINABLE PLSTIC PCH W/O FP,,,28 ,,NW,,,,,,$7.95,$0.00,1,1,1,0,0,1,20131001,A4378,HCPCS,DRAINABLE RUBBER PCH W/O FP,,,28 ,,NW,,,,,,$42.09,$0.00,1,1,1,0,0,1,20131001,A4379,HCPCS,URINARY PLASTIC POUCH W FCPL,,,28 ,,NW,,,,,,$23.89,$0.00,1,1,1,0,0,1,20131001,A4380,HCPCS,URINARY RUBBER POUCH W FCPLT,,,28 ,,NW,,,,,,$49.71,$0.00,1,1,1,0,0,1,20131001,A4381,HCPCS,URINARY PLASTIC POUCH W/O FP,,,28 ,,NW,,,,,,$8.55,$0.00,1,1,1,0,0,1,20131001,A4382,HCPCS,URINARY HVY PLSTC PCH W/O FP,,,28 ,,NW,,,,,,$35.00,$0.00,1,1,1,0,0,1,20131001,A4383,HCPCS,URINARY RUBBER POUCH W/O FP,,,28 ,,NW,,,,,,$39.13,$0.00,1,1,1,0,0,1,20131001,A4384,HCPCS,OSTOMY FACEPLT/SILICONE RING,,,28 ,,NW,,,,,,$17.65,$0.00,1,1,1,0,0,1,20131001,A4385,HCPCS,OST SKN BARRIER SLD EXT WEAR,,,28 ,,NW,,,,,,$9.46,$0.00,1,1,1,0,0,1,20131001,A4387,HCPCS,OST CLSD POUCH W ATT ST BARR,,,28 ,,NW,,,,,,$6.12,$0.00,1,1,1,0,0,1,20131001,A4388,HCPCS,DRAINABLE PCH W EX WEAR BARR,,,28 ,,NW,,,,,,$8.09,$0.00,1,1,1,0,0,1,20131001,A4389,HCPCS,DRAINABLE PCH W ST WEAR BARR,,,28 ,,NW,,,,,,$11.54,$0.00,1,1,1,0,0,1,20131001,A4390,HCPCS,DRAINABLE PCH EX WEAR CONVEX,,,28 ,,NW,,,,,,$17.64,$0.00,1,1,1,0,0,1,20131001,A4391,HCPCS,URINARY POUCH W EX WEAR BARR,,,28 ,,NW,,,,,,$13.12,$0.00,1,1,1,0,0,1,20131001,A4392,HCPCS,URINARY POUCH W ST WEAR BARR,,,28 ,,NW,,,,,,$15.19,$0.00,1,1,1,0,0,1,20131001,A4393,HCPCS,URINE PCH W EX WEAR BAR CONV,,,28 ,,NW,,,,,,$16.79,$0.00,1,1,1,0,0,1,20131001,A4394,HCPCS,OSTOMY POUCH LIQ DEODORANT,,,28 ,,NW,,,,,,$4.77,$0.00,1,1,1,0,0,1,20131001,A4395,HCPCS,OSTOMY POUCH SOLID DEODORANT,,,28 ,,NW,,,,,,$0.08,$0.00,1,1,1,0,0,1,20131001,A4396,HCPCS,PERISTOMAL HERNIA SUPPRT BLT,,,28 ,,NW,,,,,,$53.33,$0.00,1,1,1,0,0,1,20131001,A4397,HCPCS,IRRIGATION SUPPLY SLEEVE,,,28 ,,NW,,,,,,$8.19,$0.00,1,1,1,0,0,1,20131001,A4398,HCPCS,OSTOMY IRRIGATION BAG,,,28 ,,NW,,,,,,$22.18,$0.00,1,1,1,0,0,1,20131001,A4399,HCPCS,OSTOMY IRRIG CONE/CATH W BRS,,,28 ,,NW,,,,,,$19.88,$0.00,1,1,1,0,0,1,20131001,A4400,HCPCS,OSTOMY IRRIGATION SET,,,28 ,,NW,,,,,,$59.51,$0.00,1,1,1,0,0,1,20131001,A4402,HCPCS,LUBRICANT PER OUNCE,,,28 ,,NW,,,,,,$2.81,$0.00,1,1,1,0,0,1,20131001,A4404,HCPCS,OSTOMY RING EACH,,,28 ,,NW,,,,,,$3.00,$0.00,1,1,1,0,0,1,20131001,A4405,HCPCS,NONPECTIN BASED OSTOMY PASTE,,,28 ,,NW,,,,,,$6.30,$0.00,1,1,1,0,0,1,20131001,A4406,HCPCS,PECTIN BASED OSTOMY PASTE,,,28 ,,NW,,,,,,$10.63,$0.00,1,1,1,0,0,1,20131001,A4407,HCPCS,"EXT WEAR OST SKN BARR <=4SQ""",,,28 ,,NW,,,,,,$16.27,$0.00,1,1,1,0,0,1,20131001,A4408,HCPCS,"EXT WEAR OST SKN BARR >4SQ""",,,28 ,,NW,,,,,,$17.93,$0.00,1,1,1,0,0,1,20131001,A4409,HCPCS,OST SKN BARR CONVEX <=4 SQ I,,,28 ,,NW,,,,,,$11.53,$0.00,1,1,1,0,0,1,20131001,A4410,HCPCS,OST SKN BARR EXTND >4 SQ,,,28 ,,NW,,,,,,$16.79,$0.00,1,1,1,0,0,1,20131001,A4411,HCPCS,OST SKN BARR EXTND =4SQ,,,28 ,,NW,,,,,,$9.45,$0.00,1,1,1,0,0,1,20131001,A4412,HCPCS,OST POUCH DRAIN HIGH OUTPUT,,,28 ,,NW,,,,,,$5.00,$0.00,1,1,1,0,0,1,20131001,A4413,HCPCS,2 PC DRAINABLE OST POUCH,,,28 ,,NW,,,,,,$10.20,$0.00,1,1,1,0,0,1,20131001,A4414,HCPCS,OST SKNBAR W/O CONV<=4 SQ IN,,,28 ,,NW,,,,,,$9.12,$0.00,1,1,1,0,0,1,20131001,A4415,HCPCS,OST SKN BARR W/O CONV >4 SQI,,,28 ,,NW,,,,,,$11.12,$0.00,1,1,1,0,0,1,20131001,A4416,HCPCS,OST PCH CLSD W BARRIER/FILTR,,,28 ,,NW,,,,,,$5.05,$0.00,1,1,1,0,0,1,20131001,A4417,HCPCS,OST PCH W BAR/BLTINCONV/FLTR,,,28 ,,NW,,,,,,$6.82,$0.00,1,1,1,0,0,1,20131001,A4418,HCPCS,OST PCH CLSD W/O BAR W FILTR,,,28 ,,NW,,,,,,$3.33,$0.00,1,1,1,0,0,1,20131001,A4419,HCPCS,OST PCH FOR BAR W FLANGE/FLT,,,28 ,,NW,,,,,,$3.19,$0.00,1,1,1,0,0,1,20131001,A4420,HCPCS,OST PCH CLSD FOR BAR W LK FL,,,28 ,,NW,,,,,,$3.37,$0.00,1,1,1,0,0,1,20131001,A4421,HCPCS,OSTOMY SUPPLY MISC,,,28 ,,NW,,,,,,$4.99,$0.00,1,1,1,0,0,1,20131001,A4422,HCPCS,OST POUCH ABSORBENT MATERIAL,,,28 ,,NW,,,,,,$0.22,$0.00,1,1,1,0,0,1,20131001,A4423,HCPCS,OST PCH FOR BAR W LK FL/FLTR,,,28 ,,NW,,,,,,$3.41,$0.00,1,1,1,0,0,1,20131001,A4424,HCPCS,OST PCH DRAIN W BAR & FILTER,,,28 ,,NW,,,,,,$8.71,$0.00,1,1,1,0,0,1,20131001,A4425,HCPCS,OST PCH DRAIN FOR BARRIER FL,,,28 ,,NW,,,,,,$6.56,$0.00,1,1,1,0,0,1,20131001,A4426,HCPCS,OST PCH DRAIN 2 PIECE SYSTEM,,,28 ,,NW,,,,,,$5.01,$0.00,1,1,1,0,0,1,20131001,A4427,HCPCS,OST PCH DRAIN/BARR LK FLNG/F,,,28 ,,NW,,,,,,$5.10,$0.00,1,1,1,0,0,1,20131001,A4428,HCPCS,URINE OST POUCH W FAUCET/TAP,,,28 ,,NW,,,,,,$11.92,$0.00,1,1,1,0,0,1,20131001,A4429,HCPCS,URINE OST POUCH W BLTINCONV,,,28 ,,NW,,,,,,$14.83,$0.00,1,1,1,0,0,1,20131001,A4430,HCPCS,OST URINE PCH W B/BLTIN CONV,,,28 ,,NW,,,,,,$15.23,$0.00,1,1,1,0,0,1,20131001,A4431,HCPCS,OST PCH URINE W BARRIER/TAPV,,,28 ,,NW,,,,,,$11.39,$0.00,1,1,1,0,0,1,20131001,A4432,HCPCS,OS PCH URINE W BAR/FANGE/TAP,,,28 ,,NW,,,,,,$6.58,$0.00,1,1,1,0,0,1,20131001,A4433,HCPCS,URINE OST PCH BAR W LOCK FLN,,,28 ,,NW,,,,,,$6.12,$0.00,1,1,1,0,0,1,20131001,A4434,HCPCS,OST PCH URINE W LOCK FLNG/FT,,,28 ,,NW,,,,,,$6.89,$0.00,1,1,1,0,0,1,20131001,A4450,HCPCS,NON-WATERPROOF TAPE,AU,,28 ,,NW,,,,,,$0.15,$0.00,1,1,1,0,0,1,20131001,A4450,HCPCS,NON-WATERPROOF TAPE,AV,,28 ,,NW,,,,,,$0.15,$0.00,1,1,1,0,0,1,20131001,A4450,HCPCS,NON-WATERPROOF TAPE,AW,,28 ,,NW,,,,,,$0.20,$0.00,1,1,1,0,0,1,20131001,A4450,HCPCS,NON-WATERPROOF TAPE,,,28 ,,NW,,,,,,$0.15,$0.00,1,1,1,0,0,1,20131001,A4452,HCPCS,WATERPROOF TAPE,AU,,28 ,,NW,,,,,,$0.66,$0.00,1,1,1,0,0,1,20131001,A4452,HCPCS,WATERPROOF TAPE,AV,,28 ,,NW,,,,,,$0.66,$0.00,1,1,1,0,0,1,20131001,A4452,HCPCS,WATERPROOF TAPE,AW,,28 ,,NW,,,,,,$0.72,$0.00,1,1,1,0,0,1,20131001,A4452,HCPCS,WATERPROOF TAPE,,,28 ,,NW,,,,,,$0.66,$0.00,1,1,1,0,0,1,20131001,A4455,HCPCS,ADHESIVE REMOVER PER OUNCE,,,28 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,A4456,HCPCS,"ADHESIVE REMOVER, WIPES",,,28 ,,NW,,,,,,$0.46,$0.00,1,1,1,0,0,1,20131001,A4458,HCPCS,REUSABLE ENEMA BAG,,,28 ,,NW,,,,,,$21.22,$0.00,1,1,1,0,0,1,20131001,A4461,HCPCS,SURGICL DRESS HOLD NON-REUSE,,,28 ,,NW,,,,,,$6.07,$0.00,1,1,1,0,0,1,20131001,A4463,HCPCS,SURGICAL DRESS HOLDER REUSE,,,28 ,,NW,,,,,,$21.93,$0.00,1,1,1,0,0,1,20131001,A4465,HCPCS,NON-ELASTIC EXTREMITY BINDER,,,28 ,,NW,,,,,,$17.48,$0.00,1,1,1,0,0,1,20131001,A4466,HCPCS,ELASTIC GARMENT/COVERING,,,28 ,,NW,,,,,,$56.06,$0.00,1,1,1,0,0,1,20131001,A4470,HCPCS,GRAVLEE JET WASHER,,,28 ,,NW,,,,,,$12.69,$0.00,1,1,1,0,0,1,20131001,A4480,HCPCS,VABRA ASPIRATOR,,,28 ,,NW,,,,,,$9.75,$0.00,1,1,1,0,0,1,20131001,A4481,HCPCS,TRACHEOSTOMA FILTER,,,28 ,,NW,,,,,,$1.30,$0.00,1,1,1,0,0,1,20131001,A4483,HCPCS,MOISTURE EXCHANGER,,,28 ,,NW,,,,,,$8.44,$0.00,1,1,1,0,0,1,20131001,A4490,HCPCS,ABOVE KNEE SURGICAL STOCKING,,,28 ,,NW,,,,,,$12.69,$0.00,1,1,1,0,0,1,20131001,A4495,HCPCS,THIGH LENGTH SURG STOCKING,,,28 ,,NW,,,,,,$12.69,$0.00,1,1,1,0,0,1,20131001,A4500,HCPCS,BELOW KNEE SURGICAL STOCKING,,,28 ,,NW,,,,,,$9.75,$0.00,1,1,1,0,0,1,20131001,A4510,HCPCS,FULL LENGTH SURG STOCKING,,,28 ,,NW,,,,,,$21.13,$0.00,1,1,1,0,0,1,20131001,A4520,HCPCS,INCONTINENCE GARMENT ANYTYPE,,,28 ,,NW,,,,,,$1.21,$0.00,1,1,1,0,0,1,20131001,A4550,HCPCS,SURGICAL TRAYS,,,28 ,,NW,,,,,,$42.42,$0.00,1,1,1,0,0,1,20131001,A4554,HCPCS,DISPOSABLE UNDERPADS,,,28 ,,NW,,,,,,$5.83,$0.00,1,1,1,0,0,1,20131001,A4556,HCPCS,"ELECTRODES, PAIR",,,28 ,,NW,,,,,,$26.69,$0.00,1,1,1,0,0,1,20131001,A4557,HCPCS,"LEAD WIRES, PAIR",,,28 ,,NW,,,,,,$39.82,$0.00,1,1,1,0,0,1,20131001,A4558,HCPCS,CONDUCTIVE GEL OR PASTE,,,28 ,,NW,,,,,,$16.79,$0.00,1,1,1,0,0,1,20131001,A4559,HCPCS,COUPLING GEL OR PASTE,,,28 ,,NW,,,,,,$0.35,$0.00,1,1,1,0,0,1,20131001,A4561,HCPCS,"PESSARY RUBBER, ANY TYPE",,,28 ,,NW,,,,,,$29.83,$0.00,1,1,1,0,0,1,20131001,A4562,HCPCS,"PESSARY, NON RUBBER,ANY TYPE",,,28 ,,NW,,,,,,$64.50,$0.00,1,1,1,0,0,1,20131001,A4565,HCPCS,SLINGS,,,28 ,,NW,,,,,,$13.67,$0.00,1,1,1,0,0,1,20131001,A4570,HCPCS,SPLINT,,,28 ,,NW,,,,,,$27.82,$0.00,1,1,1,0,0,1,20131001,A4575,HCPCS,HYPERBARIC O2 CHAMBER DISPS,,,28 ,,NW,,,,,,"$1,046.59",$0.00,1,1,1,0,0,1,20131001,A4580,HCPCS,CAST SUPPLIES (PLASTER),,,28 ,,NW,,,,,,$80.09,$0.00,1,1,1,0,0,1,20131001,A4590,HCPCS,SPECIAL CASTING MATERIAL,,,28 ,,NW,,,,,,$53.98,$0.00,1,1,1,0,0,1,20131001,A4595,HCPCS,TENS SUPPL 2 LEAD PER MONTH,,,28 ,,NW,,,,,,$54.85,$0.00,1,1,1,0,0,1,20131001,A4600,HCPCS,"SLEEVE, INTER LIMB COMP DEV",,,28 ,,NW,,,,,,$203.09,$0.00,1,1,1,1,1,1,20131001,A4601,HCPCS,"LITH ION BATT, NON-PROS USE",,,28 ,,NW,,,,,,$2.73,$0.00,1,1,1,1,1,1,20131001,A4604,HCPCS,TUBING WITH HEATING ELEMENT,NU,,28 ,,NW,,,,,,$110.99,$0.00,1,1,1,1,1,1,20131001,A4604,HCPCS,TUBING WITH HEATING ELEMENT,,,28 ,,NW,,,,,,$110.99,$0.00,1,1,1,1,1,1,20131001,A4605,HCPCS,TRACH SUCTION CATH CLOSE SYS,NU,,28 ,,NW,,,,,,$34.96,$0.00,1,1,1,1,1,1,20131001,A4605,HCPCS,TRACH SUCTION CATH CLOSE SYS,,,28 ,,NW,,,,,,$34.96,$0.00,1,1,1,1,1,1,20131001,A4606,HCPCS,OXYGEN PROBE USED W OXIMETER,,,28 ,,NW,,,,,,$50.63,$0.00,1,1,1,1,1,1,20131001,A4608,HCPCS,TRANSTRACHEAL OXYGEN CATH,,,28 ,,NW,,,,,,$91.59,$0.00,1,1,1,1,1,1,20131001,A4611,HCPCS,HEAVY DUTY BATTERY,NU,,28 ,,NW,,,,,,$432.51,$0.00,1,1,1,1,1,1,20131001,A4611,HCPCS,HEAVY DUTY BATTERY,RR,,28 ,,NW,,,,,,$38.75,$0.00,1,1,1,1,1,1,20131001,A4611,HCPCS,HEAVY DUTY BATTERY,UE,,28 ,,NW,,,,,,$314.68,$0.00,1,1,1,1,1,1,20131001,A4611,HCPCS,HEAVY DUTY BATTERY,,,28 ,,NW,,,,,,$432.51,$0.00,1,1,1,1,1,1,20131001,A4612,HCPCS,BATTERY CABLES,NU,,28 ,,NW,,,,,,$157.41,$0.00,1,1,1,1,1,1,20131001,A4612,HCPCS,BATTERY CABLES,RR,,28 ,,NW,,,,,,$20.86,$0.00,1,1,1,1,1,1,20131001,A4612,HCPCS,BATTERY CABLES,UE,,28 ,,NW,,,,,,$110.38,$0.00,1,1,1,1,1,1,20131001,A4612,HCPCS,BATTERY CABLES,,,28 ,,NW,,,,,,$157.41,$0.00,1,1,1,1,1,1,20131001,A4613,HCPCS,BATTERY CHARGER,NU,,28 ,,NW,,,,,,$309.58,$0.00,1,1,1,1,1,1,20131001,A4613,HCPCS,BATTERY CHARGER,RR,,28 ,,NW,,,,,,$30.11,$0.00,1,1,1,1,1,1,20131001,A4613,HCPCS,BATTERY CHARGER,UE,,28 ,,NW,,,,,,$213.29,$0.00,1,1,1,1,1,1,20131001,A4613,HCPCS,BATTERY CHARGER,,,28 ,,NW,,,,,,$309.58,$0.00,1,1,1,1,1,1,20131001,A4614,HCPCS,HAND-HELD PEFR METER,,,28 ,,NW,,,,,,$34.03,$0.00,1,1,1,1,1,1,20131001,A4615,HCPCS,CANNULA NASAL,,,28 ,,NW,,,,,,$1.98,$0.00,1,1,1,1,1,1,20131001,A4616,HCPCS,TUBING (OXYGEN) PER FOOT,,,28 ,,NW,,,,,,$1.66,$0.00,1,1,1,1,1,1,20131001,A4617,HCPCS,MOUTH PIECE,,,28 ,,NW,,,,,,$3.17,$0.00,1,1,1,1,1,1,20131001,A4618,HCPCS,BREATHING CIRCUITS,NU,,28 ,,NW,,,,,,$15.65,$0.00,1,1,1,1,1,1,20131001,A4618,HCPCS,BREATHING CIRCUITS,RR,,28 ,,NW,,,,,,$1.74,$0.00,1,1,1,1,1,1,20131001,A4618,HCPCS,BREATHING CIRCUITS,UE,,28 ,,NW,,,,,,$11.74,$0.00,1,1,1,1,1,1,20131001,A4618,HCPCS,BREATHING CIRCUITS,,,28 ,,NW,,,,,,$15.65,$0.00,1,1,1,1,1,1,20131001,A4619,HCPCS,FACE TENT,NU,,28 ,,NW,,,,,,$2.55,$0.00,1,1,1,1,1,1,20131001,A4619,HCPCS,FACE TENT,,,28 ,,NW,,,,,,$2.55,$0.00,1,1,1,1,1,1,20131001,A4620,HCPCS,VARIABLE CONCENTRATION MASK,,,28 ,,NW,,,,,,$1.93,$0.00,1,1,1,1,1,1,20131001,A4623,HCPCS,TRACHEOSTOMY INNER CANNULA,,,28 ,,NW,,,,,,$11.16,$0.00,1,1,1,1,1,1,20131001,A4624,HCPCS,TRACHEAL SUCTION TUBE,NU,,28 ,,NW,,,,,,$8.59,$0.00,1,1,1,1,1,1,20131001,A4624,HCPCS,TRACHEAL SUCTION TUBE,,,28 ,,NW,,,,,,$8.59,$0.00,1,1,1,1,1,1,20131001,A4625,HCPCS,TRACH CARE KIT FOR NEW TRACH,,,28 ,,NW,,,,,,$12.23,$0.00,1,1,1,1,1,1,20131001,A4626,HCPCS,TRACHEOSTOMY CLEANING BRUSH,,,28 ,,NW,,,,,,$5.42,$0.00,1,1,1,1,1,1,20131001,A4627,HCPCS,SPACER BAG/RESERVOIR,,,28 ,,NW,,,,,,$27.21,$0.00,1,1,1,1,1,1,20131001,A4628,HCPCS,OROPHARYNGEAL SUCTION CATH,NU,,28 ,,NW,,,,,,$6.84,$0.00,1,1,1,1,1,1,20131001,A4628,HCPCS,OROPHARYNGEAL SUCTION CATH,,,28 ,,NW,,,,,,$6.84,$0.00,1,1,1,1,1,1,20131001,A4629,HCPCS,TRACHEOSTOMY CARE KIT,,,28 ,,NW,,,,,,$8.58,$0.00,1,1,1,1,1,1,20131001,A4630,HCPCS,REPL BAT T.E.N.S. OWN BY PT,NU,,28 ,,NW,,,,,,$17.78,$0.00,1,1,1,1,1,1,20131001,A4630,HCPCS,REPL BAT T.E.N.S. OWN BY PT,,,28 ,,NW,,,,,,$17.78,$0.00,1,1,1,1,1,1,20131001,A4633,HCPCS,UVL REPLACEMENT BULB,NU,,28 ,,NW,,,,,,$74.74,$0.00,1,1,1,1,1,1,20131001,A4633,HCPCS,UVL REPLACEMENT BULB,,,28 ,,NW,,,,,,$74.74,$0.00,1,1,1,1,1,1,20131001,A4634,HCPCS,REPLACEMENT BULB TH LIGHTBOX,,,28 ,,NW,,,,,,$111.49,$0.00,1,1,1,1,1,1,20131001,A4635,HCPCS,UNDERARM CRUTCH PAD,NU,,28 ,,NW,,,,,,$16.19,$0.00,1,1,1,1,1,1,20131001,A4635,HCPCS,UNDERARM CRUTCH PAD,RR,,28 ,,NW,,,,,,$2.22,$0.00,1,1,1,1,1,1,20131001,A4635,HCPCS,UNDERARM CRUTCH PAD,UE,,28 ,,NW,,,,,,$10.96,$0.00,1,1,1,1,1,1,20131001,A4635,HCPCS,UNDERARM CRUTCH PAD,,,28 ,,NW,,,,,,$16.19,$0.00,1,1,1,1,1,1,20131001,A4636,HCPCS,HANDGRIP FOR CANE ETC,NU,,28 ,,NW,,,,,,$20.26,$0.00,1,1,1,1,1,1,20131001,A4636,HCPCS,HANDGRIP FOR CANE ETC,RR,,28 ,,NW,,,,,,$2.53,$0.00,1,1,1,1,1,1,20131001,A4636,HCPCS,HANDGRIP FOR CANE ETC,UE,,28 ,,NW,,,,,,$17.11,$0.00,1,1,1,1,1,1,20131001,A4636,HCPCS,HANDGRIP FOR CANE ETC,,,28 ,,NW,,,,,,$20.26,$0.00,1,1,1,1,1,1,20131001,A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,NU,,28 ,,NW,,,,,,$12.85,$0.00,1,1,1,1,1,1,20131001,A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,RR,,28 ,,NW,,,,,,$1.82,$0.00,1,1,1,1,1,1,20131001,A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,UE,,28 ,,NW,,,,,,$9.72,$0.00,1,1,1,1,1,1,20131001,A4637,HCPCS,REPL TIP CANE/CRUTCH/WALKER,,,28 ,,NW,,,,,,$12.85,$0.00,1,1,1,1,1,1,20131001,A4638,HCPCS,REPL BATT PULSE GEN SYS,NU,,28 ,,NW,,,,,,"$14,951.27",$0.00,1,1,1,1,1,1,20131001,A4638,HCPCS,REPL BATT PULSE GEN SYS,RR,,28 ,,NW,,,,,,"$1,569.06",$0.00,1,1,1,1,1,1,20131001,A4638,HCPCS,REPL BATT PULSE GEN SYS,UE,,28 ,,NW,,,,,,"$11,235.01",$0.00,1,1,1,1,1,1,20131001,A4638,HCPCS,REPL BATT PULSE GEN SYS,,,28 ,,NW,,,,,,"$14,951.27",$0.00,1,1,1,1,1,1,20131001,A4639,HCPCS,INFRARED HT SYS REPLCMNT PAD,NU,,28 ,,NW,,,,,,$708.58,$0.00,1,1,1,1,1,1,20131001,A4639,HCPCS,INFRARED HT SYS REPLCMNT PAD,,,28 ,,NW,,,,,,$708.58,$0.00,1,1,1,1,1,1,20131001,A4640,HCPCS,ALTERNATING PRESSURE PAD,NU,,28 ,,NW,,,,,,$111.93,$0.00,1,1,1,1,1,1,20131001,A4640,HCPCS,ALTERNATING PRESSURE PAD,RR,,28 ,,NW,,,,,,$17.99,$0.00,1,1,1,1,1,1,20131001,A4640,HCPCS,ALTERNATING PRESSURE PAD,UE,,28 ,,NW,,,,,,$75.92,$0.00,1,1,1,1,1,1,20131001,A4640,HCPCS,ALTERNATING PRESSURE PAD,,,28 ,,NW,,,,,,$111.93,$0.00,1,1,1,1,1,1,20131001,A4641,HCPCS,RADIOPHARM DX AGENT NOC,,,28 ,,NW,,,,,,$30.00,$0.00,1,1,1,0,0,1,20131001,A4642,HCPCS,IN111 SATUMOMAB,,,28 ,,NW,,,,,,$26.13,$0.00,1,1,1,0,0,1,20131001,A4648,HCPCS,IMPLANTABLE TISSUE MARKER,,,28 ,,NW,,,,,,$279.02,$0.00,1,1,1,0,0,1,20131001,A4649,HCPCS,SURGICAL SUPPLIES,,,28 ,,NW,,,,,,$0.83,$0.00,1,1,1,0,0,1,20131001,A4651,HCPCS,CALIBRATED MICROCAP TUBE,,,28 ,,NW,,,,,,$4.26,$0.00,1,1,1,0,0,1,20131001,A4652,HCPCS,MICROCAPILLARY TUBE SEALANT,,,28 ,,NW,,,,,,$1.43,$0.00,1,1,1,0,0,1,20131001,A4653,HCPCS,PD CATHETER ANCHOR BELT,,,28 ,,NW,,,,,,$69.55,$0.00,1,1,1,0,0,1,20131001,A4657,HCPCS,SYRINGE W/WO NEEDLE,,,28 ,,NW,,,,,,$1.30,$0.00,1,1,1,0,0,1,20131001,A4660,HCPCS,SPHYG/BP APP W CUFF AND STET,,,28 ,,NW,,,,,,$50.57,$0.00,1,1,1,0,0,1,20131001,A4663,HCPCS,DIALYSIS BLOOD PRESSURE CUFF,,,28 ,,NW,,,,,,$48.92,$0.00,1,1,1,0,0,1,20131001,A4670,HCPCS,"AUTOMATIC BP MONITOR, DIAL",,,28 ,,NW,,,,,,$139.43,$0.00,1,1,1,0,0,1,20131001,A4671,HCPCS,DISPOSABLE CYCLER SET,,,28 ,,NW,,,,,,$55.07,$0.00,1,1,1,0,0,1,20131001,A4672,HCPCS,"DRAINAGE EXT LINE, DIALYSIS",,,28 ,,NW,,,,,,$20.79,$0.00,1,1,1,0,0,1,20131001,A4673,HCPCS,EXT LINE W EASY LOCK CONNECT,,,28 ,,NW,,,,,,$14.68,$0.00,1,1,1,0,0,1,20131001,A4674,HCPCS,"CHEM/ANTISEPT SOLUTION, 8OZ",,,28 ,,NW,,,,,,$2.78,$0.00,1,1,1,0,0,1,20131001,A4680,HCPCS,"ACTIVATED CARBON FILTER, EA",,,28 ,,NW,,,,,,$161.41,$0.00,1,1,1,0,0,1,20131001,A4690,HCPCS,"DIALYZER, EACH",,,28 ,,NW,,,,,,"$1,106.94",$0.00,1,1,1,0,0,1,20131001,A4706,HCPCS,BICARBONATE CONC SOL PER GAL,,,28 ,,NW,,,,,,$26.73,$0.00,1,1,1,0,0,1,20131001,A4707,HCPCS,BICARBONATE CONC POW PER PAC,,,28 ,,NW,,,,,,$16.54,$0.00,1,1,1,0,0,1,20131001,A4708,HCPCS,ACETATE CONC SOL PER GALLON,,,28 ,,NW,,,,,,$20.51,$0.00,1,1,1,0,0,1,20131001,A4709,HCPCS,ACID CONC SOL PER GALLON,,,28 ,,NW,,,,,,$31.95,$0.00,1,1,1,0,0,1,20131001,A4714,HCPCS,TREATED WATER PER GALLON,,,28 ,,NW,,,,,,$7.14,$0.00,1,1,1,0,0,1,20131001,A4719,HCPCS,"""Y SET"" TUBING",,,28 ,,NW,,,,,,$34.72,$0.00,1,1,1,0,0,1,20131001,A4720,HCPCS,DIALYSAT SOL FLD VOL > 249CC,,,28 ,,NW,,,,,,$29.08,$0.00,1,1,1,0,0,1,20131001,A4721,HCPCS,DIALYSAT SOL FLD VOL > 999CC,,,28 ,,NW,,,,,,$38.39,$0.00,1,1,1,0,0,1,20131001,A4722,HCPCS,DIALYS SOL FLD VOL > 1999CC,,,28 ,,NW,,,,,,$42.52,$0.00,1,1,1,0,0,1,20131001,A4723,HCPCS,DIALYS SOL FLD VOL > 2999CC,,,28 ,,NW,,,,,,$49.23,$0.00,1,1,1,0,0,1,20131001,A4724,HCPCS,DIALYS SOL FLD VOL > 3999CC,,,28 ,,NW,,,,,,$55.96,$0.00,1,1,1,0,0,1,20131001,A4725,HCPCS,DIALYS SOL FLD VOL > 4999CC,,,28 ,,NW,,,,,,$62.67,$0.00,1,1,1,0,0,1,20131001,A4726,HCPCS,DIALYS SOL FLD VOL > 5999CC,,,28 ,,NW,,,,,,$69.66,$0.00,1,1,1,0,0,1,20131001,A4728,HCPCS,"DIALYSATE SOLUTION, NON-DEX",,,28 ,,NW,,,,,,$17.97,$0.00,1,1,1,0,0,1,20131001,A4730,HCPCS,"FISTULA CANNULATION SET, EA",,,28 ,,NW,,,,,,$3.51,$0.00,1,1,1,0,0,1,20131001,A4736,HCPCS,"TOPICAL ANESTHETIC, PER GRAM",,,28 ,,NW,,,,,,$40.74,$0.00,1,1,1,0,0,1,20131001,A4737,HCPCS,INJ ANESTHETIC PER 10 ML,,,28 ,,NW,,,,,,$4.05,$0.00,1,1,1,0,0,1,20131001,A4740,HCPCS,SHUNT ACCESSORY,,,28 ,,NW,,,,,,$46.36,$0.00,1,1,1,0,0,1,20131001,A4750,HCPCS,ART OR VENOUS BLOOD TUBING,,,28 ,,NW,,,,,,$33.61,$0.00,1,1,1,0,0,1,20131001,A4755,HCPCS,COMB ART/VENOUS BLOOD TUBING,,,28 ,,NW,,,,,,$34.01,$0.00,1,1,1,0,0,1,20131001,A4760,HCPCS,"DIALYSATE SOL TEST KIT, EACH",,,28 ,,NW,,,,,,$166.41,$0.00,1,1,1,0,0,1,20131001,A4765,HCPCS,DIALYSATE CONC POW PER PACK,,,28 ,,NW,,,,,,$37.33,$0.00,1,1,1,0,0,1,20131001,A4766,HCPCS,DIALYSATE CONC SOL ADD 10 ML,,,28 ,,NW,,,,,,$35.79,$0.00,1,1,1,0,0,1,20131001,A4770,HCPCS,BLOOD COLLECTION TUBE/VACUUM,,,28 ,,NW,,,,,,$38.82,$0.00,1,1,1,0,0,1,20131001,A4771,HCPCS,SERUM CLOTTING TIME TUBE,,,28 ,,NW,,,,,,$11.13,$0.00,1,1,1,0,0,1,20131001,A4772,HCPCS,BLOOD GLUCOSE TEST STRIPS,,,28 ,,NW,,,,,,$64.56,$0.00,1,1,1,0,0,1,20131001,A4773,HCPCS,OCCULT BLOOD TEST STRIPS,,,28 ,,NW,,,,,,$40.95,$0.00,1,1,1,0,0,1,20131001,A4774,HCPCS,AMMONIA TEST STRIPS,,,28 ,,NW,,,,,,$13.90,$0.00,1,1,1,0,0,1,20131001,A4802,HCPCS,PROTAMINE SULFATE PER 50 MG,,,28 ,,NW,,,,,,$11.64,$0.00,1,1,1,0,0,1,20131001,A4860,HCPCS,DISPOSABLE CATHETER TIPS,,,28 ,,NW,,,,,,$9.30,$0.00,1,1,1,0,0,1,20131001,A4870,HCPCS,PLUMB/ELEC WK HM HEMO EQUIP,,,28 ,,NW,,,,,,$224.55,$0.00,1,1,1,0,0,1,20131001,A4890,HCPCS,REPAIR/MAINT CONT HEMO EQUIP,,,28 ,,NW,,,,,,$28.51,$0.00,1,1,1,0,0,1,20131001,A4911,HCPCS,DRAIN BAG/BOTTLE,,,28 ,,NW,,,,,,$17.69,$0.00,1,1,1,0,0,1,20131001,A4913,HCPCS,MISC DIALYSIS SUPPLIES NOC,,,28 ,,NW,,,,,,$120.44,$0.00,1,1,1,0,0,1,20131001,A4918,HCPCS,VENOUS PRESSURE CLAMP,,,28 ,,NW,,,,,,$7.14,$0.00,1,1,1,0,0,1,20131001,A4927,HCPCS,NON-STERILE GLOVES,,,28 ,,NW,,,,,,$7.83,$0.00,1,1,1,0,0,1,20131001,A4928,HCPCS,SURGICAL MASK,,,28 ,,NW,,,,,,$0.81,$0.00,1,1,1,0,0,1,20131001,A4929,HCPCS,"TOURNIQUET FOR DIALYSIS, EA",,,28 ,,NW,,,,,,$0.34,$0.00,1,1,1,0,0,1,20131001,A4930,HCPCS,"STERILE, GLOVES PER PAIR",,,28 ,,NW,,,,,,$1.81,$0.00,1,1,1,0,0,1,20131001,A4931,HCPCS,REUSABLE ORAL THERMOMETER,,,28 ,,NW,,,,,,$8.55,$0.00,1,1,1,0,0,1,20131001,A5051,HCPCS,POUCH CLSD W BARR ATTACHED,,,28 ,,NW,,,,,,$3.80,$0.00,1,1,1,0,0,1,20131001,A5052,HCPCS,CLSD OSTOMY POUCH W/O BARR,,,28 ,,NW,,,,,,$2.73,$0.00,1,1,1,0,0,1,20131001,A5053,HCPCS,CLSD OSTOMY POUCH FACEPLATE,,,28 ,,NW,,,,,,$3.03,$0.00,1,1,1,0,0,1,20131001,A5054,HCPCS,CLSD OSTOMY POUCH W/FLANGE,,,28 ,,NW,,,,,,$3.30,$0.00,1,1,1,0,0,1,20131001,A5055,HCPCS,STOMA CAP,,,28 ,,NW,,,,,,$2.57,$0.00,1,1,1,0,0,1,20131001,A5056,HCPCS,1 PC OST POUCH W FILTER,,,28 ,,NW,,,,,,$8.64,$0.00,1,1,1,0,0,1,20131001,A5057,HCPCS,1 PC OST POU W BUILT-IN CONV,,,28 ,,NW,,,,,,$17.64,$0.00,1,1,1,0,0,1,20131001,A5061,HCPCS,POUCH DRAINABLE W BARRIER AT,,,28 ,,NW,,,,,,$6.52,$0.00,1,1,1,0,0,1,20131001,A5062,HCPCS,DRNBLE OSTOMY POUCH W/O BARR,,,28 ,,NW,,,,,,$3.97,$0.00,1,1,1,0,0,1,20131001,A5063,HCPCS,DRAIN OSTOMY POUCH W/FLANGE,,,28 ,,NW,,,,,,$5.00,$0.00,1,1,1,0,0,1,20131001,A5071,HCPCS,URINARY POUCH W/BARRIER,,,28 ,,NW,,,,,,$11.13,$0.00,1,1,1,0,0,1,20131001,A5072,HCPCS,URINARY POUCH W/O BARRIER,,,28 ,,NW,,,,,,$6.29,$0.00,1,1,1,0,0,1,20131001,A5073,HCPCS,URINARY POUCH ON BARR W/FLNG,,,28 ,,NW,,,,,,$5.76,$0.00,1,1,1,0,0,1,20131001,A5081,HCPCS,CONTINENT STOMA PLUG,,,28 ,,NW,,,,,,$5.76,$0.00,1,1,1,0,0,1,20131001,A5082,HCPCS,CONTINENT STOMA CATHETER,,,28 ,,NW,,,,,,$19.28,$0.00,1,1,1,0,0,1,20131001,A5083,HCPCS,STOMA ABSORPTIVE COVER,,,28 ,,NW,,,,,,$1.15,$0.00,1,1,1,0,0,1,20131001,A5093,HCPCS,OSTOMY ACCESSORY CONVEX INSE,,,28 ,,NW,,,,,,$3.47,$0.00,1,1,1,0,0,1,20131001,A5102,HCPCS,BEDSIDE DRAIN BTL W/WO TUBE,,,28 ,,NW,,,,,,$32.47,$0.00,1,1,1,0,0,1,20131001,A5105,HCPCS,URINARY SUSPENSORY,,,28 ,,NW,,,,,,$52.24,$0.00,1,1,1,0,0,1,20131001,A5112,HCPCS,URINARY LEG BAG,,,28 ,,NW,,,,,,$44.72,$0.00,1,1,1,0,0,1,20131001,A5113,HCPCS,LATEX LEG STRAP,,,28 ,,NW,,,,,,$8.15,$0.00,1,1,1,0,0,1,20131001,A5114,HCPCS,FOAM/FABRIC LEG STRAP,,,28 ,,NW,,,,,,$15.71,$0.00,1,1,1,0,0,1,20131001,A5120,HCPCS,"SKIN BARRIER, WIPE OR SWAB",AU,,28 ,,NW,,,,,,$0.44,$0.00,1,1,1,0,0,1,20131001,A5120,HCPCS,"SKIN BARRIER, WIPE OR SWAB",AV,,28 ,,NW,,,,,,$0.44,$0.00,1,1,1,0,0,1,20131001,A5120,HCPCS,"SKIN BARRIER, WIPE OR SWAB",,,28 ,,NW,,,,,,$0.44,$0.00,1,1,1,0,0,1,20131001,A5121,HCPCS,SOLID SKIN BARRIER 6X6,,,28 ,,NW,,,,,,$13.12,$0.00,1,1,1,0,0,1,20131001,A5122,HCPCS,SOLID SKIN BARRIER 8X8,,,28 ,,NW,,,,,,$20.62,$0.00,1,1,1,0,0,1,20131001,A5126,HCPCS,DISK/FOAM PAD +OR- ADHESIVE,,,28 ,,NW,,,,,,$2.21,$0.00,1,1,1,0,0,1,20131001,A5131,HCPCS,APPLIANCE CLEANER,,,28 ,,NW,,,,,,$23.78,$0.00,1,1,1,0,0,1,20131001,A5200,HCPCS,PERCUTANEOUS CATHETER ANCHOR,,,28 ,,NW,,,,,,$19.58,$0.00,1,1,1,0,0,1,20131001,A5500,HCPCS,DIAB SHOE FOR DENSITY INSERT,,,28 ,,NW,,,,,,$96.79,$0.00,1,1,1,0,0,1,20131001,A5501,HCPCS,DIABETIC CUSTOM MOLDED SHOE,,,28 ,,NW,,,,,,$291.82,$0.00,1,1,1,0,0,1,20131001,A5503,HCPCS,DIABETIC SHOE W/ROLLER/ROCKR,,,28 ,,NW,,,,,,$48.85,$0.00,1,1,1,0,0,1,20131001,A5504,HCPCS,DIABETIC SHOE WITH WEDGE,,,28 ,,NW,,,,,,$48.85,$0.00,1,1,1,0,0,1,20131001,A5505,HCPCS,DIAB SHOE W/METATARSAL BAR,,,28 ,,NW,,,,,,$48.85,$0.00,1,1,1,0,0,1,20131001,A5506,HCPCS,DIABETIC SHOE W/OFF SET HEEL,,,28 ,,NW,,,,,,$48.85,$0.00,1,1,1,0,0,1,20131001,A5507,HCPCS,MODIFICATION DIABETIC SHOE,,,28 ,,NW,,,,,,$48.85,$0.00,1,1,1,0,0,1,20131001,A5508,HCPCS,DIABETIC DELUXE SHOE,,,28 ,,NW,,,,,,$48.85,$0.00,1,1,1,0,0,1,20131001,A5510,HCPCS,COMPRESSION FORM SHOE INSERT,,,28 ,,NW,,,,,,$51.95,$0.00,1,1,1,0,0,1,20131001,A5512,HCPCS,MULTI DEN INSERT DIRECT FORM,,,28 ,,NW,,,,,,$41.03,$0.00,1,1,1,0,0,1,20131001,A5513,HCPCS,MULTI DEN INSERT CUSTOM MOLD,,,28 ,,NW,,,,,,$59.95,$0.00,1,1,1,0,0,1,20131001,A6000,HCPCS,WOUND WARMING WOUND COVER,,,28 ,,NW,,,,,,$105.28,$0.00,1,1,1,0,0,1,20131001,A6010,HCPCS,COLLAGEN BASED WOUND FILLER,,,28 ,,NW,,,,,,$42.33,$0.00,1,1,1,0,0,1,20131001,A6011,HCPCS,COLLAGEN GEL/PASTE WOUND FIL,,,28 ,,NW,,,,,,$4.20,$0.00,1,1,1,0,0,1,20131001,A6021,HCPCS,COLLAGEN DRESSING <=16 SQ IN,,,28 ,,NW,,,,,,$30.83,$0.00,1,1,1,0,0,1,20131001,A6022,HCPCS,COLLAGEN DRSG>16<=48 SQ IN,,,28 ,,NW,,,,,,$30.83,$0.00,1,1,1,0,0,1,20131001,A6023,HCPCS,COLLAGEN DRESSING >48 SQ IN,,,28 ,,NW,,,,,,$226.56,$0.00,1,1,1,0,0,1,20131001,A6024,HCPCS,COLLAGEN DSG WOUND FILLER,,,28 ,,NW,,,,,,$11.48,$0.00,1,1,1,0,0,1,20131001,A6025,HCPCS,"SILICONE GEL SHEET, EACH",,,28 ,,NW,,,,,,$36.34,$0.00,1,1,1,0,0,1,20131001,A6154,HCPCS,WOUND POUCH EACH,,,28 ,,NW,,,,,,$23.01,$0.00,1,1,1,0,0,1,20131001,A6196,HCPCS,ALGINATE DRESSING <=16 SQ IN,,,28 ,,NW,,,,,,$13.65,$0.00,1,1,1,0,0,1,20131001,A6197,HCPCS,ALGINATE DRSG >16 <=48 SQ IN,,,28 ,,NW,,,,,,$25.53,$0.00,1,1,1,0,0,1,20131001,A6198,HCPCS,ALGINATE DRESSING > 48 SQ IN,,,28 ,,NW,,,,,,$34.08,$0.00,1,1,1,0,0,1,20131001,A6199,HCPCS,ALGINATE DRSG WOUND FILLER,,,28 ,,NW,,,,,,$9.79,$0.00,1,1,1,0,0,1,20131001,A6203,HCPCS,COMPOSITE DRSG <= 16 SQ IN,,,28 ,,NW,,,,,,$6.20,$0.00,1,1,1,0,0,1,20131001,A6204,HCPCS,COMPOSITE DRSG >16<=48 SQ IN,,,28 ,,NW,,,,,,$11.56,$0.00,1,1,1,0,0,1,20131001,A6205,HCPCS,COMPOSITE DRSG > 48 SQ IN,,,28 ,,NW,,,,,,$17.22,$0.00,1,1,1,0,0,1,20131001,A6206,HCPCS,CONTACT LAYER <= 16 SQ IN,,,28 ,,NW,,,,,,$8.77,$0.00,1,1,1,0,0,1,20131001,A6207,HCPCS,CONTACT LAYER >16<= 48 SQ IN,,,28 ,,NW,,,,,,$13.62,$0.00,1,1,1,0,0,1,20131001,A6208,HCPCS,CONTACT LAYER > 48 SQ IN,,,28 ,,NW,,,,,,$20.28,$0.00,1,1,1,0,0,1,20131001,A6209,HCPCS,FOAM DRSG <=16 SQ IN W/O BDR,,,28 ,,NW,,,,,,$13.88,$0.00,1,1,1,0,0,1,20131001,A6210,HCPCS,FOAM DRG >16<=48 SQ IN W/O B,,,28 ,,NW,,,,,,$29.57,$0.00,1,1,1,0,0,1,20131001,A6211,HCPCS,FOAM DRG > 48 SQ IN W/O BRDR,,,28 ,,NW,,,,,,$40.50,$0.00,1,1,1,0,0,1,20131001,A6212,HCPCS,FOAM DRG <=16 SQ IN W/BORDER,,,28 ,,NW,,,,,,$17.74,$0.00,1,1,1,0,0,1,20131001,A6213,HCPCS,FOAM DRG >16<=48 SQ IN W/BDR,,,28 ,,NW,,,,,,$32.69,$0.00,1,1,1,0,0,1,20131001,A6214,HCPCS,FOAM DRG > 48 SQ IN W/BORDER,,,28 ,,NW,,,,,,$44.77,$0.00,1,1,1,0,0,1,20131001,A6215,HCPCS,FOAM DRESSING WOUND FILLER,,,28 ,,NW,,,,,,$5.95,$0.00,1,1,1,0,0,1,20131001,A6216,HCPCS,NON-STERILE GAUZE<=16 SQ IN,,,28 ,,NW,,,,,,$0.08,$0.00,1,1,1,0,0,1,20131001,A6217,HCPCS,NON-STERILE GAUZE>16<=48 SQ,,,28 ,,NW,,,,,,$0.31,$0.00,1,1,1,0,0,1,20131001,A6218,HCPCS,NON-STERILE GAUZE > 48 SQ IN,,,28 ,,NW,,,,,,$0.95,$0.00,1,1,1,0,0,1,20131001,A6219,HCPCS,GAUZE <= 16 SQ IN W/BORDER,,,28 ,,NW,,,,,,$1.72,$0.00,1,1,1,0,0,1,20131001,A6220,HCPCS,GAUZE >16 <=48 SQ IN W/BORDR,,,28 ,,NW,,,,,,$4.77,$0.00,1,1,1,0,0,1,20131001,A6221,HCPCS,GAUZE > 48 SQ IN W/BORDER,,,28 ,,NW,,,,,,$7.31,$0.00,1,1,1,0,0,1,20131001,A6222,HCPCS,GAUZE <=16 IN NO W/SAL W/O B,,,28 ,,NW,,,,,,$3.92,$0.00,1,1,1,0,0,1,20131001,A6223,HCPCS,GAUZE >16<=48 NO W/SAL W/O B,,,28 ,,NW,,,,,,$4.46,$0.00,1,1,1,0,0,1,20131001,A6224,HCPCS,GAUZE > 48 IN NO W/SAL W/O B,,,28 ,,NW,,,,,,$6.68,$0.00,1,1,1,0,0,1,20131001,A6228,HCPCS,GAUZE <= 16 SQ IN WATER/SAL,,,28 ,,NW,,,,,,$3.87,$0.00,1,1,1,0,0,1,20131001,A6229,HCPCS,GAUZE >16<=48 SQ IN WATR/SAL,,,28 ,,NW,,,,,,$6.68,$0.00,1,1,1,0,0,1,20131001,A6230,HCPCS,GAUZE > 48 SQ IN WATER/SALNE,,,28 ,,NW,,,,,,$5.83,$0.00,1,1,1,0,0,1,20131001,A6231,HCPCS,HYDROGEL DSG<=16 SQ IN,,,28 ,,NW,,,,,,$8.66,$0.00,1,1,1,0,0,1,20131001,A6232,HCPCS,HYDROGEL DSG>16<=48 SQ IN,,,28 ,,NW,,,,,,$12.75,$0.00,1,1,1,0,0,1,20131001,A6233,HCPCS,HYDROGEL DRESSING >48 SQ IN,,,28 ,,NW,,,,,,$28.71,$0.00,1,1,1,0,0,1,20131001,A6234,HCPCS,HYDROCOLLD DRG <=16 W/O BDR,,,28 ,,NW,,,,,,$12.13,$0.00,1,1,1,0,0,1,20131001,A6235,HCPCS,HYDROCOLLD DRG >16<=48 W/O B,,,28 ,,NW,,,,,,$25.97,$0.00,1,1,1,0,0,1,20131001,A6236,HCPCS,HYDROCOLLD DRG > 48 IN W/O B,,,28 ,,NW,,,,,,$38.04,$0.00,1,1,1,0,0,1,20131001,A6237,HCPCS,HYDROCOLLD DRG <=16 IN W/BDR,,,28 ,,NW,,,,,,$14.69,$0.00,1,1,1,0,0,1,20131001,A6238,HCPCS,HYDROCOLLD DRG >16<=48 W/BDR,,,28 ,,NW,,,,,,$32.89,$0.00,1,1,1,0,0,1,20131001,A6239,HCPCS,HYDROCOLLD DRG > 48 IN W/BDR,,,28 ,,NW,,,,,,$41.22,$0.00,1,1,1,0,0,1,20131001,A6240,HCPCS,HYDROCOLLD DRG FILLER PASTE,,,28 ,,NW,,,,,,$20.68,$0.00,1,1,1,0,0,1,20131001,A6241,HCPCS,HYDROCOLLOID DRG FILLER DRY,,,28 ,,NW,,,,,,$4.74,$0.00,1,1,1,0,0,1,20131001,A6242,HCPCS,HYDROGEL DRG <=16 IN W/O BDR,,,28 ,,NW,,,,,,$11.24,$0.00,1,1,1,0,0,1,20131001,A6243,HCPCS,HYDROGEL DRG >16<=48 W/O BDR,,,28 ,,NW,,,,,,$20.77,$0.00,1,1,1,0,0,1,20131001,A6244,HCPCS,HYDROGEL DRG >48 IN W/O BDR,,,28 ,,NW,,,,,,$51.96,$0.00,1,1,1,0,0,1,20131001,A6245,HCPCS,HYDROGEL DRG <= 16 IN W/BDR,,,28 ,,NW,,,,,,$13.48,$0.00,1,1,1,0,0,1,20131001,A6246,HCPCS,HYDROGEL DRG >16<=48 IN W/B,,,28 ,,NW,,,,,,$18.00,$0.00,1,1,1,0,0,1,20131001,A6247,HCPCS,HYDROGEL DRG > 48 SQ IN W/B,,,28 ,,NW,,,,,,$34.04,$0.00,1,1,1,0,0,1,20131001,A6248,HCPCS,HYDROGEL DRSG GEL FILLER,,,28 ,,NW,,,,,,$25.30,$0.00,1,1,1,0,0,1,20131001,A6250,HCPCS,SKIN SEAL PROTECT MOISTURIZR,,,28 ,,NW,,,,,,$3.22,$0.00,1,1,1,0,0,1,20131001,A6251,HCPCS,ABSORPT DRG <=16 SQ IN W/O B,,,28 ,,NW,,,,,,$3.66,$0.00,1,1,1,0,0,1,20131001,A6252,HCPCS,ABSORPT DRG >16 <=48 W/O BDR,,,28 ,,NW,,,,,,$6.01,$0.00,1,1,1,0,0,1,20131001,A6253,HCPCS,ABSORPT DRG > 48 SQ IN W/O B,,,28 ,,NW,,,,,,$11.78,$0.00,1,1,1,0,0,1,20131001,A6254,HCPCS,ABSORPT DRG <=16 SQ IN W/BDR,,,28 ,,NW,,,,,,$2.21,$0.00,1,1,1,0,0,1,20131001,A6255,HCPCS,ABSORPT DRG >16<=48 IN W/BDR,,,28 ,,NW,,,,,,$5.61,$0.00,1,1,1,0,0,1,20131001,A6256,HCPCS,ABSORPT DRG > 48 SQ IN W/BDR,,,28 ,,NW,,,,,,$13.04,$0.00,1,1,1,0,0,1,20131001,A6257,HCPCS,TRANSPARENT FILM <= 16 SQ IN,,,28 ,,NW,,,,,,$2.81,$0.00,1,1,1,0,0,1,20131001,A6258,HCPCS,TRANSPARENT FILM >16<=48 IN,,,28 ,,NW,,,,,,$7.98,$0.00,1,1,1,0,0,1,20131001,A6259,HCPCS,TRANSPARENT FILM > 48 SQ IN,,,28 ,,NW,,,,,,$19.19,$0.00,1,1,1,0,0,1,20131001,A6260,HCPCS,WOUND CLEANSER ANY TYPE/SIZE,,,28 ,,NW,,,,,,$1.91,$0.00,1,1,1,0,0,1,20131001,A6261,HCPCS,WOUND FILLER GEL/PASTE /OZ,,,28 ,,NW,,,,,,$7.79,$0.00,1,1,1,0,0,1,20131001,A6262,HCPCS,WOUND FILLER DRY FORM / GRAM,,,28 ,,NW,,,,,,$1.91,$0.00,1,1,1,0,0,1,20131001,A6266,HCPCS,IMPREG GAUZE NO H20/SAL/YARD,,,28 ,,NW,,,,,,$3.54,$0.00,1,1,1,0,0,1,20131001,A6402,HCPCS,STERILE GAUZE <= 16 SQ IN,,,28 ,,NW,,,,,,$0.22,$0.00,1,1,1,0,0,1,20131001,A6403,HCPCS,STERILE GAUZE>16 <= 48 SQ IN,,,28 ,,NW,,,,,,$0.78,$0.00,1,1,1,0,0,1,20131001,A6404,HCPCS,STERILE GAUZE > 48 SQ IN,,,28 ,,NW,,,,,,$0.95,$0.00,1,1,1,0,0,1,20131001,A6407,HCPCS,"PACKING STRIPS, NON-IMPREG",,,28 ,,NW,,,,,,$3.45,$0.00,1,1,1,0,0,1,20131001,A6410,HCPCS,STERILE EYE PAD,,,28 ,,NW,,,,,,$0.71,$0.00,1,1,1,0,0,1,20131001,A6411,HCPCS,NON-STERILE EYE PAD,,,28 ,,NW,,,,,,$0.68,$0.00,1,1,1,0,0,1,20131001,A6412,HCPCS,OCCLUSIVE EYE PATCH,,,28 ,,NW,,,,,,$0.95,$0.00,1,1,1,0,0,1,20131001,A6413,HCPCS,"ADHESIVE BANDAGE, FIRST-AID",,,28 ,,NW,,,,,,$1.66,$0.00,1,1,1,0,0,1,20131001,A6441,HCPCS,"PAD BAND W>=3"" <5""/YD",,,28 ,,NW,,,,,,$1.21,$0.00,1,1,1,0,0,1,20131001,A6442,HCPCS,"CONFORM BAND N/S W<3""/YD",,,28 ,,NW,,,,,,$0.30,$0.00,1,1,1,0,0,1,20131001,A6443,HCPCS,"CONFORM BAND N/S W>=3""<5""/YD",,,28 ,,NW,,,,,,$0.52,$0.00,1,1,1,0,0,1,20131001,A6444,HCPCS,"CONFORM BAND N/S W>=5""/YD",,,28 ,,NW,,,,,,$1.01,$0.00,1,1,1,0,0,1,20131001,A6445,HCPCS,"CONFORM BAND S W <3""/YD",,,28 ,,NW,,,,,,$0.59,$0.00,1,1,1,0,0,1,20131001,A6446,HCPCS,"CONFORM BAND S W>=3"" <5""/YD",,,28 ,,NW,,,,,,$0.74,$0.00,1,1,1,0,0,1,20131001,A6447,HCPCS,"CONFORM BAND S W >=5""/YD",,,28 ,,NW,,,,,,$1.21,$0.00,1,1,1,0,0,1,20131001,A6448,HCPCS,"LT COMPRES BAND <3""/YD",,,28 ,,NW,,,,,,$2.12,$0.00,1,1,1,0,0,1,20131001,A6449,HCPCS,"LT COMPRES BAND >=3"" <5""/YD",,,28 ,,NW,,,,,,$3.21,$0.00,1,1,1,0,0,1,20131001,A6450,HCPCS,"LT COMPRES BAND >=5""/YD",,,28 ,,NW,,,,,,$4.10,$0.00,1,1,1,0,0,1,20131001,A6451,HCPCS,"MOD COMPRES BAND W>=3""<5""/YD",,,28 ,,NW,,,,,,$5.44,$0.00,1,1,1,0,0,1,20131001,A6452,HCPCS,"HIGH COMPRES BAND W>=3""<5""YD",,,28 ,,NW,,,,,,$10.96,$0.00,1,1,1,0,0,1,20131001,A6453,HCPCS,"SELF-ADHER BAND W <3""/YD",,,28 ,,NW,,,,,,$1.11,$0.00,1,1,1,0,0,1,20131001,A6454,HCPCS,"SELF-ADHER BAND W>=3"" <5""/YD",,,28 ,,NW,,,,,,$1.40,$0.00,1,1,1,0,0,1,20131001,A6455,HCPCS,"SELF-ADHER BAND >=5""/YD",,,28 ,,NW,,,,,,$2.55,$0.00,1,1,1,0,0,1,20131001,A6456,HCPCS,"ZINC PASTE BAND W >=3""<5""/YD",,,28 ,,NW,,,,,,$2.33,$0.00,1,1,1,0,0,1,20131001,A6457,HCPCS,TUBULAR DRESSING,,,28 ,,NW,,,,,,$2.08,$0.00,1,1,1,0,0,1,20131001,A6504,HCPCS,CMPRSBURNGARMENT GLOVE-WRIST,,,28 ,,NW,,,,,,$364.60,$0.00,1,1,1,0,0,1,20131001,A6505,HCPCS,CMPRSBURNGARMENT GLOVE-ELBOW,,,28 ,,NW,,,,,,$190.21,$0.00,1,1,1,0,0,1,20131001,A6506,HCPCS,CMPRSBURNGRMNT GLOVE-AXILLA,,,28 ,,NW,,,,,,$108.03,$0.00,1,1,1,0,0,1,20131001,A6507,HCPCS,CMPRS BURNGARMENT FOOT-KNEE,,,28 ,,NW,,,,,,$148.03,$0.00,1,1,1,0,0,1,20131001,A6509,HCPCS,COMPRES BURN GARMENT JACKET,,,28 ,,NW,,,,,,$697.13,$0.00,1,1,1,0,0,1,20131001,A6510,HCPCS,COMPRES BURN GARMENT LEOTARD,,,28 ,,NW,,,,,,$299.48,$0.00,1,1,1,0,0,1,20131001,A6511,HCPCS,COMPRES BURN GARMENT PANTY,,,28 ,,NW,,,,,,$646.63,$0.00,1,1,1,0,0,1,20131001,A6512,HCPCS,"COMPRES BURN GARMENT, NOC",,,28 ,,NW,,,,,,$46.72,$0.00,1,1,1,0,0,1,20131001,A6530,HCPCS,COMPRESSION STOCKING BK18-30,,,28 ,,NW,,,,,,$46.72,$0.00,1,1,1,0,0,1,20131001,A6531,HCPCS,COMPRESSION STOCKING BK30-40,AW,,28 ,,NW,,,,,,$56.55,$0.00,1,1,1,0,0,1,20131001,A6531,HCPCS,COMPRESSION STOCKING BK30-40,,,28 ,,NW,,,,,,$56.55,$0.00,1,1,1,0,0,1,20131001,A6532,HCPCS,COMPRESSION STOCKING BK40-50,AW,,28 ,,NW,,,,,,$77.01,$0.00,1,1,1,0,0,1,20131001,A6532,HCPCS,COMPRESSION STOCKING BK40-50,,,28 ,,NW,,,,,,$77.01,$0.00,1,1,1,0,0,1,20131001,A6533,HCPCS,GC STOCKING THIGHLNGTH 18-30,,,28 ,,NW,,,,,,$66.74,$0.00,1,1,1,0,0,1,20131001,A6534,HCPCS,GC STOCKING THIGHLNGTH 30-40,,,28 ,,NW,,,,,,$73.42,$0.00,1,1,1,0,0,1,20131001,A6535,HCPCS,GC STOCKING THIGHLNGTH 40-50,,,28 ,,NW,,,,,,$91.31,$0.00,1,1,1,0,0,1,20131001,A6536,HCPCS,GC STOCKING FULL LNGTH 18-30,,,28 ,,NW,,,,,,$70.01,$0.00,1,1,1,0,0,1,20131001,A6537,HCPCS,GC STOCKING FULL LNGTH 30-40,,,28 ,,NW,,,,,,$86.83,$0.00,1,1,1,0,0,1,20131001,A6538,HCPCS,GC STOCKING FULL LNGTH 40-50,,,28 ,,NW,,,,,,$117.15,$0.00,1,1,1,0,0,1,20131001,A6539,HCPCS,GC STOCKING WAISTLNGTH 18-30,,,28 ,,NW,,,,,,$145.66,$0.00,1,1,1,0,0,1,20131001,A6540,HCPCS,GC STOCKING WAISTLNGTH 30-40,,,28 ,,NW,,,,,,$166.71,$0.00,1,1,1,0,0,1,20131001,A6541,HCPCS,GC STOCKING WAISTLNGTH 40-50,,,28 ,,NW,,,,,,$192.74,$0.00,1,1,1,0,0,1,20131001,A6544,HCPCS,GC STOCKING GARTER BELT,,,28 ,,NW,,,,,,$86.72,$0.00,1,1,1,0,0,1,20131001,A6545,HCPCS,GRAD COMP NON-ELASTIC BK,AW,,28 ,,NW,,,,,,$105.02,$0.00,1,1,1,0,0,1,20131001,A6545,HCPCS,GRAD COMP NON-ELASTIC BK,,,28 ,,NW,,,,,,$105.02,$0.00,1,1,1,0,0,1,20131001,A6549,HCPCS,G COMPRESSION STOCKING,,,28 ,,NW,,,,,,$141.22,$0.00,1,1,1,0,0,1,20131001,A6550,HCPCS,NEG PRES WOUND THER DRSG SET,,,28 ,,NW,,,,,,$46.67,$0.00,1,1,1,0,0,1,20131001,A7000,HCPCS,DISPOSABLE CANISTER FOR PUMP,NU,,28 ,,NW,,,,,,$35.77,$0.00,1,1,1,0,0,1,20131001,A7000,HCPCS,DISPOSABLE CANISTER FOR PUMP,,,28 ,,NW,,,,,,$35.77,$0.00,1,1,1,0,0,1,20131001,A7001,HCPCS,NONDISPOSABLE PUMP CANISTER,NU,,28 ,,NW,,,,,,$58.76,$0.00,1,1,1,0,0,1,20131001,A7001,HCPCS,NONDISPOSABLE PUMP CANISTER,,,28 ,,NW,,,,,,$58.76,$0.00,1,1,1,0,0,1,20131001,A7002,HCPCS,TUBING USED W SUCTION PUMP,NU,,28 ,,NW,,,,,,$12.32,$0.00,1,1,1,0,0,1,20131001,A7002,HCPCS,TUBING USED W SUCTION PUMP,,,28 ,,NW,,,,,,$12.32,$0.00,1,1,1,0,0,1,20131001,A7003,HCPCS,NEBULIZER ADMINISTRATION SET,NU,,28 ,,NW,,,,,,$9.05,$0.00,1,1,1,0,0,1,20131001,A7003,HCPCS,NEBULIZER ADMINISTRATION SET,,,28 ,,NW,,,,,,$9.05,$0.00,1,1,1,0,0,1,20131001,A7004,HCPCS,DISPOSABLE NEBULIZER SML VOL,NU,,28 ,,NW,,,,,,$5.74,$0.00,1,1,1,0,0,1,20131001,A7004,HCPCS,DISPOSABLE NEBULIZER SML VOL,,,28 ,,NW,,,,,,$5.74,$0.00,1,1,1,0,0,1,20131001,A7005,HCPCS,NONDISPOSABLE NEBULIZER SET,NU,,28 ,,NW,,,,,,$54.97,$0.00,1,1,1,0,0,1,20131001,A7005,HCPCS,NONDISPOSABLE NEBULIZER SET,,,28 ,,NW,,,,,,$54.97,$0.00,1,1,1,0,0,1,20131001,A7006,HCPCS,FILTERED NEBULIZER ADMIN SET,NU,,28 ,,NW,,,,,,$23.54,$0.00,1,1,1,0,0,1,20131001,A7006,HCPCS,FILTERED NEBULIZER ADMIN SET,,,28 ,,NW,,,,,,$23.54,$0.00,1,1,1,0,0,1,20131001,A7007,HCPCS,LG VOL NEBULIZER DISPOSABLE,NU,,28 ,,NW,,,,,,$15.14,$0.00,1,1,1,0,0,1,20131001,A7007,HCPCS,LG VOL NEBULIZER DISPOSABLE,,,28 ,,NW,,,,,,$15.14,$0.00,1,1,1,0,0,1,20131001,A7008,HCPCS,DISPOSABLE NEBULIZER PREFILL,NU,,28 ,,NW,,,,,,$25.39,$0.00,1,1,1,0,0,1,20131001,A7008,HCPCS,DISPOSABLE NEBULIZER PREFILL,,,28 ,,NW,,,,,,$25.39,$0.00,1,1,1,0,0,1,20131001,A7009,HCPCS,NEBULIZER RESERVOIR BOTTLE,NU,,28 ,,NW,,,,,,$74.30,$0.00,1,1,1,0,0,1,20131001,A7009,HCPCS,NEBULIZER RESERVOIR BOTTLE,,,28 ,,NW,,,,,,$74.30,$0.00,1,1,1,0,0,1,20131001,A7010,HCPCS,DISPOSABLE CORRUGATED TUBING,NU,,28 ,,NW,,,,,,$44.61,$0.00,1,1,1,0,0,1,20131001,A7010,HCPCS,DISPOSABLE CORRUGATED TUBING,,,28 ,,NW,,,,,,$44.61,$0.00,1,1,1,0,0,1,20131001,A7011,HCPCS,NONDISPOS CORRUGATED TUBING,,,28 ,,NW,,,,,,$37.11,$0.00,1,1,1,0,0,1,20131001,A7012,HCPCS,NEBULIZER WATER COLLEC DEVIC,NU,,28 ,,NW,,,,,,$12.38,$0.00,1,1,1,0,0,1,20131001,A7012,HCPCS,NEBULIZER WATER COLLEC DEVIC,,,28 ,,NW,,,,,,$12.38,$0.00,1,1,1,0,0,1,20131001,A7013,HCPCS,DISPOSABLE COMPRESSOR FILTER,NU,,28 ,,NW,,,,,,$2.67,$0.00,1,1,1,0,0,1,20131001,A7013,HCPCS,DISPOSABLE COMPRESSOR FILTER,,,28 ,,NW,,,,,,$2.67,$0.00,1,1,1,0,0,1,20131001,A7014,HCPCS,COMPRESSOR NONDISPOS FILTER,NU,,28 ,,NW,,,,,,$15.11,$0.00,1,1,1,0,0,1,20131001,A7014,HCPCS,COMPRESSOR NONDISPOS FILTER,,,28 ,,NW,,,,,,$15.11,$0.00,1,1,1,0,0,1,20131001,A7015,HCPCS,AEROSOL MASK USED W NEBULIZE,NU,,28 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20131001,A7015,HCPCS,AEROSOL MASK USED W NEBULIZE,,,28 ,,NW,,,,,,$6.16,$0.00,1,1,1,0,0,1,20131001,A7016,HCPCS,NEBULIZER DOME & MOUTHPIECE,NU,,28 ,,NW,,,,,,$19.77,$0.00,1,1,1,0,0,1,20131001,A7016,HCPCS,NEBULIZER DOME & MOUTHPIECE,,,28 ,,NW,,,,,,$19.77,$0.00,1,1,1,0,0,1,20131001,A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,NU,,28 ,,NW,,,,,,$309.95,$0.00,1,1,1,0,0,1,20131001,A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,RR,,28 ,,NW,,,,,,$30.14,$0.00,1,1,1,0,0,1,20131001,A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,UE,,28 ,,NW,,,,,,$222.73,$0.00,1,1,1,0,0,1,20131001,A7017,HCPCS,NEBULIZER NOT USED W OXYGEN,,,28 ,,NW,,,,,,$309.95,$0.00,1,1,1,0,0,1,20131001,A7018,HCPCS,WATER DISTILLED W/NEBULIZER,,,28 ,,NW,,,,,,$1.25,$0.00,1,1,1,0,0,1,20131001,A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",NU,,28 ,,NW,,,,,,$31.49,$0.00,1,1,1,0,0,1,20131001,A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",RR,,28 ,,NW,,,,,,$3.27,$0.00,1,1,1,0,0,1,20131001,A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",UE,,28 ,,NW,,,,,,$23.64,$0.00,1,1,1,0,0,1,20131001,A7020,HCPCS,"INTERFACE, COUGH STIM DEVICE",,,28 ,,NW,,,,,,$31.49,$0.00,1,1,1,0,0,1,20131001,A7025,HCPCS,REPLACE CHEST COMPRESS VEST,NU,,28 ,,NW,,,,,,"$1,093.03",$0.00,1,1,1,0,0,1,20131001,A7025,HCPCS,REPLACE CHEST COMPRESS VEST,,,28 ,,NW,,,,,,"$1,093.03",$0.00,1,1,1,0,0,1,20131001,A7026,HCPCS,REPLACE CHST CMPRSS SYS HOSE,NU,,28 ,,NW,,,,,,$54.90,$0.00,1,1,1,0,0,1,20131001,A7026,HCPCS,REPLACE CHST CMPRSS SYS HOSE,,,28 ,,NW,,,,,,$54.90,$0.00,1,1,1,0,0,1,20131001,A7027,HCPCS,COMBINATION ORAL/NASAL MASK,NU,,28 ,,NW,,,,,,$438.34,$0.00,1,1,1,0,0,1,20131001,A7027,HCPCS,COMBINATION ORAL/NASAL MASK,,,28 ,,NW,,,,,,$438.34,$0.00,1,1,1,0,0,1,20131001,A7028,HCPCS,REPL ORAL CUSHION COMBO MASK,NU,,28 ,,NW,,,,,,$90.08,$0.00,1,1,1,0,0,1,20131001,A7028,HCPCS,REPL ORAL CUSHION COMBO MASK,,,28 ,,NW,,,,,,$90.08,$0.00,1,1,1,0,0,1,20131001,A7029,HCPCS,REPL NASAL PILLOW COMB MASK,NU,,28 ,,NW,,,,,,$41.17,$0.00,1,1,1,0,0,1,20131001,A7029,HCPCS,REPL NASAL PILLOW COMB MASK,,,28 ,,NW,,,,,,$41.17,$0.00,1,1,1,0,0,1,20131001,A7030,HCPCS,CPAP FULL FACE MASK,NU,,28 ,,NW,,,,,,$384.26,$0.00,1,1,1,0,0,1,20131001,A7030,HCPCS,CPAP FULL FACE MASK,,,28 ,,NW,,,,,,$384.26,$0.00,1,1,1,0,0,1,20131001,A7031,HCPCS,REPLACEMENT FACEMASK INTERFA,NU,,28 ,,NW,,,,,,$117.63,$0.00,1,1,1,0,0,1,20131001,A7031,HCPCS,REPLACEMENT FACEMASK INTERFA,,,28 ,,NW,,,,,,$117.63,$0.00,1,1,1,0,0,1,20131001,A7032,HCPCS,REPLACEMENT NASAL CUSHION,NU,,28 ,,NW,,,,,,$64.88,$0.00,1,1,1,0,0,1,20131001,A7032,HCPCS,REPLACEMENT NASAL CUSHION,,,28 ,,NW,,,,,,$64.88,$0.00,1,1,1,0,0,1,20131001,A7033,HCPCS,REPLACEMENT NASAL PILLOWS,NU,,28 ,,NW,,,,,,$48.02,$0.00,1,1,1,0,0,1,20131001,A7033,HCPCS,REPLACEMENT NASAL PILLOWS,,,28 ,,NW,,,,,,$48.02,$0.00,1,1,1,0,0,1,20131001,A7034,HCPCS,NASAL APPLICATION DEVICE,NU,,28 ,,NW,,,,,,$224.99,$0.00,1,1,1,0,0,1,20131001,A7034,HCPCS,NASAL APPLICATION DEVICE,,,28 ,,NW,,,,,,$224.99,$0.00,1,1,1,0,0,1,20131001,A7035,HCPCS,POS AIRWAY PRESS HEADGEAR,NU,,28 ,,NW,,,,,,$60.99,$0.00,1,1,1,0,0,1,20131001,A7035,HCPCS,POS AIRWAY PRESS HEADGEAR,,,28 ,,NW,,,,,,$60.99,$0.00,1,1,1,0,0,1,20131001,A7036,HCPCS,POS AIRWAY PRESS CHINSTRAP,NU,,28 ,,NW,,,,,,$31.73,$0.00,1,1,1,0,0,1,20131001,A7036,HCPCS,POS AIRWAY PRESS CHINSTRAP,,,28 ,,NW,,,,,,$31.73,$0.00,1,1,1,0,0,1,20131001,A7037,HCPCS,POS AIRWAY PRESSURE TUBING,NU,,28 ,,NW,,,,,,$64.45,$0.00,1,1,1,0,0,1,20131001,A7037,HCPCS,POS AIRWAY PRESSURE TUBING,,,28 ,,NW,,,,,,$64.45,$0.00,1,1,1,0,0,1,20131001,A7038,HCPCS,POS AIRWAY PRESSURE FILTER,NU,,28 ,,NW,,,,,,$14.87,$0.00,1,1,1,0,0,1,20131001,A7038,HCPCS,POS AIRWAY PRESSURE FILTER,,,28 ,,NW,,,,,,$14.87,$0.00,1,1,1,0,0,1,20131001,A7039,HCPCS,"FILTER, NON DISPOSABLE W PAP",NU,,28 ,,NW,,,,,,$28.41,$0.00,1,1,1,0,0,1,20131001,A7039,HCPCS,"FILTER, NON DISPOSABLE W PAP",,,28 ,,NW,,,,,,$28.41,$0.00,1,1,1,0,0,1,20131001,A7040,HCPCS,ONE WAY CHEST DRAIN VALVE,,,28 ,,NW,,,,,,$52.59,$0.00,1,1,1,0,0,1,20131001,A7041,HCPCS,WATER SEAL DRAIN CONTAINER,,,28 ,,NW,,,,,,$93.10,$0.00,1,1,1,0,0,1,20131001,A7042,HCPCS,IMPLANTED PLEURAL CATHETER,,,28 ,,NW,,,,,,$214.95,$0.00,1,1,1,0,0,1,20131001,A7043,HCPCS,VACUUM DRAINAGEBOTTLE/TUBING,,,28 ,,NW,,,,,,$39.53,$0.00,1,1,1,0,0,1,20131001,A7044,HCPCS,PAP ORAL INTERFACE,NU,,28 ,,NW,,,,,,$232.33,$0.00,1,1,1,0,0,1,20131001,A7044,HCPCS,PAP ORAL INTERFACE,,,28 ,,NW,,,,,,$232.33,$0.00,1,1,1,0,0,1,20131001,A7045,HCPCS,REPL EXHALATION PORT FOR PAP,NU,,28 ,,NW,,,,,,$35.58,$0.00,1,1,1,0,0,1,20131001,A7045,HCPCS,REPL EXHALATION PORT FOR PAP,RR,,28 ,,NW,,,,,,$5.76,$0.00,1,1,1,0,0,1,20131001,A7045,HCPCS,REPL EXHALATION PORT FOR PAP,UE,,28 ,,NW,,,,,,$28.82,$0.00,1,1,1,0,0,1,20131001,A7045,HCPCS,REPL EXHALATION PORT FOR PAP,,,28 ,,NW,,,,,,$35.58,$0.00,1,1,1,0,0,1,20131001,A7046,HCPCS,"REPL WATER CHAMBER, PAP DEV",NU,,28 ,,NW,,,,,,$35.64,$0.00,1,1,1,0,0,1,20131001,A7046,HCPCS,"REPL WATER CHAMBER, PAP DEV",,,28 ,,NW,,,,,,$35.64,$0.00,1,1,1,0,0,1,20131001,A7501,HCPCS,TRACHEOSTOMA VALVE W DIAPHRA,,,28 ,,NW,,,,,,$127.96,$0.00,1,1,1,0,0,1,20131001,A7502,HCPCS,REPLACEMENT DIAPHRAGM/FPLATE,,,28 ,,NW,,,,,,$64.24,$0.00,1,1,1,0,0,1,20131001,A7503,HCPCS,HMES FILTER HOLDER OR CAP,,,28 ,,NW,,,,,,$19.63,$0.00,1,1,1,0,0,1,20131001,A7504,HCPCS,TRACHEOSTOMA HMES FILTER,,,28 ,,NW,,,,,,$1.21,$0.00,1,1,1,0,0,1,20131001,A7505,HCPCS,HMES OR TRACH VALVE HOUSING,,,28 ,,NW,,,,,,$8.67,$0.00,1,1,1,0,0,1,20131001,A7506,HCPCS,HMES/TRACHVALVE ADHESIVEDISK,,,28 ,,NW,,,,,,$0.61,$0.00,1,1,1,0,0,1,20131001,A7507,HCPCS,INTEGRATED FILTER & HOLDER,,,28 ,,NW,,,,,,$4.58,$0.00,1,1,1,0,0,1,20131001,A7508,HCPCS,HOUSING & INTEGRATED ADHESIV,,,28 ,,NW,,,,,,$5.29,$0.00,1,1,1,0,0,1,20131001,A7509,HCPCS,HEAT & MOISTURE EXCHANGE SYS,,,28 ,,NW,,,,,,$2.59,$0.00,1,1,1,0,0,1,20131001,A7520,HCPCS,TRACH/LARYN TUBE NON-CUFFED,,,28 ,,NW,,,,,,$72.95,$0.00,1,1,1,0,0,1,20131001,A7521,HCPCS,TRACH/LARYN TUBE CUFFED,,,28 ,,NW,,,,,,$72.30,$0.00,1,1,1,0,0,1,20131001,A7522,HCPCS,TRACH/LARYN TUBE STAINLESS,,,28 ,,NW,,,,,,$69.51,$0.00,1,1,1,0,0,1,20131001,A7523,HCPCS,TRACHEOSTOMY SHOWER PROTECT,,,28 ,,NW,,,,,,$17.88,$0.00,1,1,1,0,0,1,20131001,A7524,HCPCS,TRACHEOSTOMA STENT/STUD/BTTN,,,28 ,,NW,,,,,,$117.27,$0.00,1,1,1,0,0,1,20131001,A7525,HCPCS,TRACHEOSTOMY MASK,,,28 ,,NW,,,,,,$3.79,$0.00,1,1,1,0,0,1,20131001,A7526,HCPCS,TRACHEOSTOMY TUBE COLLAR,,,28 ,,NW,,,,,,$6.17,$0.00,1,1,1,0,0,1,20131001,A7527,HCPCS,TRACH/LARYN TUBE PLUG/STOP,,,28 ,,NW,,,,,,$6.63,$0.00,1,1,1,0,0,1,20131001,A8000,HCPCS,SOFT PROTECT HELMET PREFAB,NU,,28 ,,NW,,,,,,$360.23,$0.00,1,1,1,1,1,1,20131001,A8000,HCPCS,SOFT PROTECT HELMET PREFAB,RR,,28 ,,NW,,,,,,$33.25,$0.00,1,1,1,1,1,1,20131001,A8000,HCPCS,SOFT PROTECT HELMET PREFAB,UE,,28 ,,NW,,,,,,$260.50,$0.00,1,1,1,1,1,1,20131001,A8000,HCPCS,SOFT PROTECT HELMET PREFAB,,,28 ,,NW,,,,,,$360.23,$0.00,1,1,1,1,1,1,20131001,A8001,HCPCS,HARD PROTECT HELMET PREFAB,NU,,28 ,,NW,,,,,,$360.23,$0.00,1,1,1,1,1,1,20131001,A8001,HCPCS,HARD PROTECT HELMET PREFAB,RR,,28 ,,NW,,,,,,$33.25,$0.00,1,1,1,1,1,1,20131001,A8001,HCPCS,HARD PROTECT HELMET PREFAB,UE,,28 ,,NW,,,,,,$260.50,$0.00,1,1,1,1,1,1,20131001,A8001,HCPCS,HARD PROTECT HELMET PREFAB,,,28 ,,NW,,,,,,$360.23,$0.00,1,1,1,1,1,1,20131001,A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,NU,,28 ,,NW,,,,,,$934.19,$0.00,1,1,1,1,1,1,20131001,A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,RR,,28 ,,NW,,,,,,$97.63,$0.00,1,1,1,1,1,1,20131001,A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,UE,,28 ,,NW,,,,,,$701.79,$0.00,1,1,1,1,1,1,20131001,A8002,HCPCS,SOFT PROTECT HELMET CUSTOM,,,28 ,,NW,,,,,,$934.19,$0.00,1,1,1,1,1,1,20131001,A8003,HCPCS,HARD PROTECT HELMET CUSTOM,NU,,28 ,,NW,,,,,,$792.22,$0.00,1,1,1,1,1,1,20131001,A8003,HCPCS,HARD PROTECT HELMET CUSTOM,RR,,28 ,,NW,,,,,,$82.17,$0.00,1,1,1,1,1,1,20131001,A8003,HCPCS,HARD PROTECT HELMET CUSTOM,UE,,28 ,,NW,,,,,,$594.77,$0.00,1,1,1,1,1,1,20131001,A8003,HCPCS,HARD PROTECT HELMET CUSTOM,,,28 ,,NW,,,,,,$792.22,$0.00,1,1,1,1,1,1,20131001,A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",NU,,28 ,,NW,,,,,,$153.66,$0.00,1,1,1,1,1,1,20131001,A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",RR,,28 ,,NW,,,,,,$16.03,$0.00,1,1,1,1,1,1,20131001,A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",UE,,28 ,,NW,,,,,,$115.42,$0.00,1,1,1,1,1,1,20131001,A8004,HCPCS,"REPL SOFT INTERFACE, HELMET",,,28 ,,NW,,,,,,$153.66,$0.00,1,1,1,1,1,1,20131001,A9150,HCPCS,MISC/EXPER NON-PRESCRIPT DRU,,,29 ,,NW,,,,,,$14.10,$0.00,1,1,1,0,0,1,20131001,A9152,HCPCS,SINGLE VITAMIN NOS,,,29 ,,NW,,,,,,$37.85,$0.00,1,1,1,0,0,1,20131001,A9153,HCPCS,MULTI-VITAMIN NOS,,,29 ,,NW,,,,,,$31.34,$0.00,1,1,1,0,0,1,20131001,A9155,HCPCS,ARTIFICIAL SALIVA,,,29 ,,NW,,,,,,$7.45,$0.00,1,1,1,0,0,1,20131001,A9180,HCPCS,"LICE TREATMENT, TOPICAL",,,29 ,,NW,,,,,,$170.78,$0.00,1,1,1,0,0,1,20131001,A9270,HCPCS,NON-COVERED ITEM OR SERVICE,,,28 ,,NW,,,,,,$58.67,$0.00,1,1,1,0,0,1,20131001,A9273,HCPCS,HOT/COLD H2OBOT/CAP/COL/WRAP,,,28 ,,NW,,,,,,$20.28,$0.00,1,1,1,1,1,1,20131001,A9274,HCPCS,EXT AMB INSULIN DELIVERY SYS,,,28 ,,NW,,,,,,$53.39,$0.00,1,1,1,1,1,1,20131001,A9275,HCPCS,DISP HOME GLUCOSE MONITOR,,,28 ,,NW,,,,,,$17.73,$0.00,1,1,1,1,1,1,20131001,A9276,HCPCS,"DISPOSABLE SENSOR, CGM SYS",,,28 ,,NW,,,,,,$18.62,$0.00,1,1,1,1,1,1,20131001,A9277,HCPCS,"EXTERNAL TRANSMITTER, CGM",,,28 ,,NW,,,,,,$843.75,$0.00,1,1,1,1,1,1,20131001,A9278,HCPCS,"EXTERNAL RECEIVER, CGM SYS",,,28 ,,NW,,,,,,"$1,239.15",$0.00,1,1,1,1,1,1,20131001,A9279,HCPCS,MONITORING FEATURE/DEVICENOC,,,28 ,,NW,,,,,,$47.78,$0.00,1,1,1,1,1,1,20131001,A9280,HCPCS,"ALERT DEVICE, NOC",,,28 ,,NW,,,,,,$47.78,$0.00,1,1,1,1,1,1,20131001,A9281,HCPCS,REACHING/GRABBING DEVICE,,,28 ,,NW,,,,,,$46.07,$0.00,1,1,1,1,1,1,20131001,A9282,HCPCS,WIG ANY TYPE,,,28 ,,NW,,,,,,$381.67,$0.00,1,1,1,1,1,1,20131001,A9283,HCPCS,FOOT PRESS OFF LOAD SUPP DEV,,,28 ,,NW,,,,,,$112.28,$0.00,1,1,1,1,1,1,20131001,A9284,HCPCS,NON-ELECTRONIC SPIROMETER,,,28 ,,NW,,,,,,$86.84,$0.00,1,1,1,1,1,1,20131001,A9300,HCPCS,EXERCISE EQUIPMENT,,,28 ,,NW,,,,,,$12.98,$0.00,1,1,1,1,1,1,20131001,A9500,HCPCS,TC99M SESTAMIBI,,,28 ,,NW,,,,,,$228.37,$0.00,1,1,1,0,0,1,20131001,A9501,HCPCS,TECHNETIUM TC-99M TEBOROXIME,,,28 ,,NW,,,,,,$411.53,$0.00,1,1,1,0,0,1,20131001,A9502,HCPCS,TC99M TETROFOSMIN,,,28 ,,NW,,,,,,$259.41,$0.00,1,1,1,0,0,1,20131001,A9503,HCPCS,TC99M MEDRONATE,,,28 ,,NW,,,,,,$64.85,$0.00,1,1,1,0,0,1,20131001,A9504,HCPCS,TC99M APCITIDE,,,28 ,,NW,,,,,,$294.20,$0.00,1,1,1,0,0,1,20131001,A9505,HCPCS,TL201 THALLIUM,,,28 ,,NW,,,,,,$106.84,$0.00,1,1,1,0,0,1,20131001,A9507,HCPCS,IN111 CAPROMAB,,,28 ,,NW,,,,,,"$5,470.33",$0.00,1,1,1,0,0,1,20131001,A9508,HCPCS,"I131 IODOBENGUATE, DX",,,28 ,,NW,,,,,,$44.31,$0.00,1,1,1,0,0,1,20131001,A9509,HCPCS,IODINE I-123 SOD IODIDE MIL,,,28 ,,NW,,,,,,$101.54,$0.00,1,1,1,0,0,1,20131001,A9510,HCPCS,TC99M DISOFENIN,,,28 ,,NW,,,,,,$99.11,$0.00,1,1,1,0,0,1,20131001,A9512,HCPCS,TC99M PERTECHNETATE,,,28 ,,NW,,,,,,$5.21,$0.00,1,1,1,0,0,1,20131001,A9516,HCPCS,IODINE I-123 SOD IODIDE MIC,,,28 ,,NW,,,,,,$1.28,$0.00,1,1,1,0,0,1,20131001,A9517,HCPCS,"I131 IODIDE CAP, RX",,,28 ,,NW,,,,,,$46.08,$0.00,1,1,1,0,0,1,20131001,A9521,HCPCS,TC99M EXAMETAZIME,,,28 ,,NW,,,,,,"$1,124.01",$0.00,1,1,1,0,0,1,20131001,A9524,HCPCS,"I131 SERUM ALBUMIN, DX",,,28 ,,NW,,,,,,$226.34,$0.00,1,1,1,0,0,1,20131001,A9526,HCPCS,NITROGEN N-13 AMMONIA,,,28 ,,NW,,,,,,$421.04,$0.00,1,1,1,0,0,1,20131001,A9527,HCPCS,IODINE I-125 SODIUM IODIDE,,,28 ,,NW,,,,,,$137.17,$0.00,1,1,1,0,0,1,20131001,A9528,HCPCS,"IODINE I-131 IODIDE CAP, DX",,,28 ,,NW,,,,,,$223.16,$0.00,1,1,1,0,0,1,20131001,A9529,HCPCS,"I131 IODIDE SOL, DX",,,28 ,,NW,,,,,,$69.97,$0.00,1,1,1,0,0,1,20131001,A9530,HCPCS,"I131 IODIDE SOL, RX",,,28 ,,NW,,,,,,$38.62,$0.00,1,1,1,0,0,1,20131001,A9531,HCPCS,I131 MAX 100UCI,,,28 ,,NW,,,,,,$16.18,$0.00,1,1,1,0,0,1,20131001,A9532,HCPCS,"I125 SERUM ALBUMIN, DX",,,28 ,,NW,,,,,,$709.61,$0.00,1,1,1,0,0,1,20131001,A9536,HCPCS,TC99M DEPREOTIDE,,,28 ,,NW,,,,,,$754.46,$0.00,1,1,1,0,0,1,20131001,A9537,HCPCS,TC99M MEBROFENIN,,,28 ,,NW,,,,,,$98.22,$0.00,1,1,1,0,0,1,20131001,A9538,HCPCS,TC99M PYROPHOSPHATE,,,28 ,,NW,,,,,,$67.69,$0.00,1,1,1,0,0,1,20131001,A9539,HCPCS,TC99M PENTETATE,,,28 ,,NW,,,,,,$57.27,$0.00,1,1,1,0,0,1,20131001,A9540,HCPCS,TC99M MAA,,,28 ,,NW,,,,,,$63.11,$0.00,1,1,1,0,0,1,20131001,A9541,HCPCS,TC99M SULFUR COLLOID,,,28 ,,NW,,,,,,$81.77,$0.00,1,1,1,0,0,1,20131001,A9546,HCPCS,CO57/58,,,28 ,,NW,,,,,,$28.43,$0.00,1,1,1,0,0,1,20131001,A9547,HCPCS,IN111 OXYQUINOLINE,,,28 ,,NW,,,,,,"$1,023.20",$0.00,1,1,1,0,0,1,20131001,A9548,HCPCS,IN111 PENTETATE,,,28 ,,NW,,,,,,$613.92,$0.00,1,1,1,0,0,1,20131001,A9550,HCPCS,TC99M GLUCEPTATE,,,28 ,,NW,,,,,,$46.64,$0.00,1,1,1,0,0,1,20131001,A9551,HCPCS,TC99M SUCCIMER,,,28 ,,NW,,,,,,$384.09,$0.00,1,1,1,0,0,1,20131001,A9552,HCPCS,F18 FDG,,,28 ,,NW,,,,,,$734.25,$0.00,1,1,1,0,0,1,20131001,A9554,HCPCS,"I125 IOTHALAMATE, DX",,,28 ,,NW,,,,,,"$1,101.37",$0.00,1,1,1,0,0,1,20131001,A9555,HCPCS,RB82 RUBIDIUM,,,28 ,,NW,,,,,,$699.48,$0.00,1,1,1,0,0,1,20131001,A9556,HCPCS,GA67 GALLIUM,,,28 ,,NW,,,,,,$76.70,$0.00,1,1,1,0,0,1,20131001,A9557,HCPCS,TC99M BICISATE,,,28 ,,NW,,,,,,$342.94,$0.00,1,1,1,0,0,1,20131001,A9558,HCPCS,XE133 XENON 10MCI,,,28 ,,NW,,,,,,$134.75,$0.00,1,1,1,0,0,1,20131001,A9560,HCPCS,TC99M LABELED RBC,,,28 ,,NW,,,,,,$143.49,$0.00,1,1,1,0,0,1,20131001,A9561,HCPCS,TC99M OXIDRONATE,,,28 ,,NW,,,,,,$72.11,$0.00,1,1,1,0,0,1,20131001,A9562,HCPCS,TC99M MERTIATIDE,,,28 ,,NW,,,,,,$447.20,$0.00,1,1,1,0,0,1,20131001,A9564,HCPCS,P32 CHROMIC PHOSPHATE,,,28 ,,NW,,,,,,$523.88,$0.00,1,1,1,0,0,1,20131001,A9567,HCPCS,TECHNETIUM TC-99M AEROSOL,,,28 ,,NW,,,,,,$64.27,$0.00,1,1,1,0,0,1,20131001,A9569,HCPCS,TECHNETIUM TC-99M AUTO WBC,,,28 ,,NW,,,,,,$3.24,$0.00,1,1,1,0,0,1,20131001,A9570,HCPCS,INDIUM IN-111 AUTO WBC,,,28 ,,NW,,,,,,$317.79,$0.00,1,1,1,0,0,1,20131001,A9571,HCPCS,INDIUM IN-111 AUTO PLATELET,,,28 ,,NW,,,,,,$14.20,$0.00,1,1,1,0,0,1,20131001,A9572,HCPCS,INDIUM IN-111 PENTETREOTIDE,,,28 ,,NW,,,,,,"$2,951.31",$0.00,1,1,1,0,0,1,20131001,A9576,HCPCS,INJ PROHANCE MULTIPACK,,,28 ,,NW,,,,,,$7.84,$0.00,1,1,1,0,0,1,20131001,A9577,HCPCS,INJ MULTIHANCE,,,28 ,,NW,,,,,,$7.65,$0.00,1,1,1,0,0,1,20131001,A9578,HCPCS,INJ MULTIHANCE MULTIPACK,,,28 ,,NW,,,,,,$11.33,$0.00,1,1,1,0,0,1,20131001,A9579,HCPCS,"GAD-BASE MR CONTRAST NOS,1ML",,,28 ,,NW,,,,,,$12.98,$0.00,1,1,1,0,0,1,20131001,A9580,HCPCS,SODIUM FLUORIDE F-18,,,28 ,,NW,,,,,,$514.57,$0.00,1,1,1,0,0,1,20131001,A9581,HCPCS,GADOXETATE DISODIUM INJ,,,28 ,,NW,,,,,,$42.47,$0.00,1,1,1,0,0,1,20131001,A9582,HCPCS,IODINE I-123 IOBENGUANE,,,28 ,,NW,,,,,,$3.55,$0.00,1,1,1,0,0,1,20131001,A9583,HCPCS,GADOFOSVESET TRISODIUM INJ,,,28 ,,NW,,,,,,"$7,503.50",$0.00,1,1,1,0,0,1,20131001,A9600,HCPCS,SR89 STRONTIUM,,,28 ,,NW,,,,,,"$1,324.03",$0.00,1,1,1,0,0,1,20131001,A9604,HCPCS,SM 153 LEXIDRONAM,,,28 ,,NW,,,,,,"$13,322.09",$0.00,1,1,1,0,0,1,20131001,A9698,HCPCS,NON-RAD CONTRAST MATERIALNOC,,,28 ,,NW,,,,,,$30.44,$0.00,1,1,1,0,0,1,20131001,A9699,HCPCS,RADIOPHARM RX AGENT NOC,,,28 ,,NW,,,,,,$30.44,$0.00,1,1,1,0,0,1,20131001,A9700,HCPCS,ECHOCARDIOGRAPHY CONTRAST,,,28 ,,NW,,,,,,$239.91,$0.00,1,1,1,0,0,1,20131001,A9900,HCPCS,SUPPLY/ACCESSORY/SERVICE,,,28 ,,NW,,,,,,$58.13,$0.00,1,1,1,0,0,1,20131001,A9999,HCPCS,"DME SUPPLY OR ACCESSORY, NOS",,,28 ,,NW,,,,,,$20.41,$0.00,1,1,1,0,0,1,20131001,B4034,HCPCS,ENTER FEED SUPKIT SYR BY DAY,,,28 ,,NW,,,,,,$13.69,$0.00,1,1,1,0,0,1,20131001,B4035,HCPCS,ENTERAL FEED SUPP PUMP PER D,,,28 ,,NW,,,,,,$26.44,$0.00,1,1,1,0,0,1,20131001,B4036,HCPCS,ENTERAL FEED SUP KIT GRAV BY,,,28 ,,NW,,,,,,$18.05,$0.00,1,1,1,0,0,1,20131001,B4081,HCPCS,ENTERAL NG TUBING W/ STYLET,,,28 ,,NW,,,,,,$49.60,$0.00,1,1,1,0,0,1,20131001,B4082,HCPCS,ENTERAL NG TUBING W/O STYLET,,,28 ,,NW,,,,,,$36.60,$0.00,1,1,1,0,0,1,20131001,B4083,HCPCS,ENTERAL STOMACH TUBE LEVINE,,,28 ,,NW,,,,,,$5.32,$0.00,1,1,1,0,0,1,20131001,B4087,HCPCS,"GASTRO/JEJUNO TUBE, STD",,,28 ,,NW,,,,,,$82.56,$0.00,1,1,1,0,0,1,20131001,B4088,HCPCS,"GASTRO/JEJUNO TUBE, LOW-PRO",,,28 ,,NW,,,,,,$82.56,$0.00,1,1,1,0,0,1,20131001,B4100,HCPCS,FOOD THICKENER ORAL,,,28 ,,NW,,,,,,$0.97,$0.00,1,1,1,0,0,1,20131001,B4102,HCPCS,EF ADULT FLUIDS AND ELECTRO,,,28 ,,NW,,,,,,$11.04,$0.00,1,1,1,0,0,1,20131001,B4103,HCPCS,EF PED FLUID AND ELECTROLYTE,,,28 ,,NW,,,,,,$12.16,$0.00,1,1,1,0,0,1,20131001,B4104,HCPCS,ADDITIVE FOR ENTERAL FORMULA,,,28 ,,NW,,,,,,$9.42,$0.00,1,1,1,0,0,1,20131001,B4149,HCPCS,EF BLENDERIZED FOODS,,,28 ,,NW,,,,,,$3.26,$0.00,1,1,1,0,0,1,20131001,B4150,HCPCS,EF COMPLET W/INTACT NUTRIENT,,,28 ,,NW,,,,,,$1.19,$0.00,1,1,1,0,0,1,20131001,B4152,HCPCS,EF CALORIE DENSE>/=1.5KCAL,,,28 ,,NW,,,,,,$0.91,$0.00,1,1,1,0,0,1,20131001,B4153,HCPCS,EF HYDROLYZED/AMINO ACIDS,,,28 ,,NW,,,,,,$4.02,$0.00,1,1,1,0,0,1,20131001,B4154,HCPCS,EF SPEC METABOLIC NONINHERIT,,,28 ,,NW,,,,,,$2.44,$0.00,1,1,1,0,0,1,20131001,B4155,HCPCS,EF INCOMPLETE/MODULAR,,,28 ,,NW,,,,,,$1.82,$0.00,1,1,1,0,0,1,20131001,B4157,HCPCS,EF SPECIAL METABOLIC INHERIT,,,28 ,,NW,,,,,,$9.51,$0.00,1,1,1,0,0,1,20131001,B4158,HCPCS,EF PED COMPLETE INTACT NUT,,,28 ,,NW,,,,,,$4.19,$0.00,1,1,1,0,0,1,20131001,B4159,HCPCS,EF PED COMPLETE SOY BASED,,,28 ,,NW,,,,,,$4.66,$0.00,1,1,1,0,0,1,20131001,B4160,HCPCS,EF PED CALORIC DENSE>/=0.7KC,,,28 ,,NW,,,,,,$3.93,$0.00,1,1,1,0,0,1,20131001,B4161,HCPCS,EF PED HYDROLYZED/AMINO ACID,,,28 ,,NW,,,,,,$10.24,$0.00,1,1,1,0,0,1,20131001,B4162,HCPCS,EF PED SPECMETABOLIC INHERIT,,,28 ,,NW,,,,,,$14.48,$0.00,1,1,1,0,0,1,20131001,B4164,HCPCS,PARENTERAL 50% DEXTROSE SOLU,,,28 ,,NW,,,,,,$43.72,$0.00,1,1,1,0,0,1,20131001,B4168,HCPCS,PARENTERAL SOL AMINO ACID 3.,,,28 ,,NW,,,,,,$64.23,$0.00,1,1,1,0,0,1,20131001,B4172,HCPCS,PARENTERAL SOL AMINO ACID 5.,,,28 ,,NW,,,,,,$114.45,$0.00,1,1,1,0,0,1,20131001,B4176,HCPCS,PARENTERAL SOL AMINO ACID 7-,,,28 ,,NW,,,,,,$125.26,$0.00,1,1,1,0,0,1,20131001,B4178,HCPCS,PARENTERAL SOL AMINO ACID >,,,28 ,,NW,,,,,,$150.59,$0.00,1,1,1,0,0,1,20131001,B4180,HCPCS,PARENTERAL SOL CARB > 50%,,,28 ,,NW,,,,,,$63.21,$0.00,1,1,1,0,0,1,20131001,B4185,HCPCS,PARENTERAL SOL 10 GM LIPIDS,,,28 ,,NW,,,,,,$28.69,$0.00,1,1,1,0,0,1,20131001,B4189,HCPCS,PARENTERAL SOL AMINO ACID &,,,28 ,,NW,,,,,,$467.40,$0.00,1,1,1,0,0,1,20131001,B4193,HCPCS,PARENTERAL SOL 52-73 GM PROT,,,28 ,,NW,,,,,,$604.29,$0.00,1,1,1,0,0,1,20131001,B4197,HCPCS,PARENTERAL SOL 74-100 GM PRO,,,28 ,,NW,,,,,,$735.92,$0.00,1,1,1,0,0,1,20131001,B4199,HCPCS,PARENTERAL SOL > 100GM PROTE,,,28 ,,NW,,,,,,$841.07,$0.00,1,1,1,0,0,1,20131001,B4216,HCPCS,PARENTERAL NUTRITION ADDITIV,,,28 ,,NW,,,,,,$19.60,$0.00,1,1,1,0,0,1,20131001,B4220,HCPCS,PARENTERAL SUPPLY KIT PREMIX,,,28 ,,NW,,,,,,$20.34,$0.00,1,1,1,0,0,1,20131001,B4222,HCPCS,PARENTERAL SUPPLY KIT HOMEMI,,,28 ,,NW,,,,,,$25.17,$0.00,1,1,1,0,0,1,20131001,B4224,HCPCS,PARENTERAL ADMINISTRATION KI,,,28 ,,NW,,,,,,$64.84,$0.00,1,1,1,0,0,1,20131001,B5000,HCPCS,PARENTERAL SOL RENAL-AMIROSY,,,28 ,,NW,,,,,,$30.38,$0.00,1,1,1,0,0,1,20131001,B5100,HCPCS,PARENTERAL SOL HEPATIC-FREAM,,,28 ,,NW,,,,,,$11.65,$0.00,1,1,1,0,0,1,20131001,B5200,HCPCS,PARENTERAL SOL STRES-BRNCH C,,,28 ,,NW,,,,,,$567.14,$0.00,1,1,1,0,0,1,20131001,B9000,HCPCS,ENTER INFUSION PUMP W/O ALRM,NU,,28 ,,NW,,,,,,"$2,872.31",$0.00,1,1,1,0,0,1,20131001,B9000,HCPCS,ENTER INFUSION PUMP W/O ALRM,RR,,28 ,,NW,,,,,,$262.97,$0.00,1,1,1,0,0,1,20131001,B9000,HCPCS,ENTER INFUSION PUMP W/O ALRM,UE,,28 ,,NW,,,,,,"$2,153.98",$0.00,1,1,1,0,0,1,20131001,B9000,HCPCS,ENTER INFUSION PUMP W/O ALRM,,,28 ,,NW,,,,,,"$2,872.31",$0.00,1,1,1,0,0,1,20131001,B9002,HCPCS,ENTERAL INFUSION PUMP W/ ALA,NU,,28 ,,NW,,,,,,"$2,872.31",$0.00,1,1,1,0,0,1,20131001,B9002,HCPCS,ENTERAL INFUSION PUMP W/ ALA,RR,,28 ,,NW,,,,,,$277.22,$0.00,1,1,1,0,0,1,20131001,B9002,HCPCS,ENTERAL INFUSION PUMP W/ ALA,UE,,28 ,,NW,,,,,,"$2,153.98",$0.00,1,1,1,0,0,1,20131001,B9002,HCPCS,ENTERAL INFUSION PUMP W/ ALA,,,28 ,,NW,,,,,,"$2,872.31",$0.00,1,1,1,0,0,1,20131001,B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,NU,,28 ,,NW,,,,,,"$6,648.83",$0.00,1,1,1,0,0,1,20131001,B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,RR,,28 ,,NW,,,,,,"$1,051.65",$0.00,1,1,1,0,0,1,20131001,B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,UE,,28 ,,NW,,,,,,"$4,986.33",$0.00,1,1,1,0,0,1,20131001,B9004,HCPCS,PARENTERAL INFUS PUMP PORTAB,,,28 ,,NW,,,,,,"$6,648.83",$0.00,1,1,1,0,0,1,20131001,B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,NU,,28 ,,NW,,,,,,"$6,648.83",$0.00,1,1,1,0,0,1,20131001,B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,RR,,28 ,,NW,,,,,,"$1,051.65",$0.00,1,1,1,0,0,1,20131001,B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,UE,,28 ,,NW,,,,,,"$4,986.33",$0.00,1,1,1,0,0,1,20131001,B9006,HCPCS,PARENTERAL INFUS PUMP STATIO,,,28 ,,NW,,,,,,"$6,648.83",$0.00,1,1,1,0,0,1,20131001,B9998,HCPCS,ENTERAL SUPP NOT OTHERWISE C,,,28 ,,NW,,,,,,$270.01,$0.00,1,1,1,0,0,1,20131001,B9999,HCPCS,PARENTERAL SUPP NOT OTHRWS C,,,28 ,,NW,,,,,,$270.01,$0.00,1,1,1,0,0,1,20131001,C1300,HCPCS,HYPERBARIC OXYGEN,,,28 ,,NW,,,,,,$612.08,$0.00,1,1,1,1,1,1,20131001,C1713,HCPCS,"ANCHOR/SCREW BN/BN,TIS/BN",,,28 ,,NW,,,,,,"$1,183.79",$0.00,1,1,1,1,1,1,20131001,C1714,HCPCS,"CATH, TRANS ATHERECTOMY, DIR",,,28 ,,NW,,,,,,$251.38,$0.00,1,1,1,1,1,1,20131001,C1715,HCPCS,BRACHYTHERAPY NEEDLE,,,28 ,,NW,,,,,,$42.63,$0.00,1,1,1,1,1,1,20131001,C1717,HCPCS,"BRACHYTX, NON-STR,HDR IR-192",,,28 ,,NW,,,,,,$945.32,$0.00,1,1,1,1,1,1,20131001,C1721,HCPCS,"AICD, DUAL CHAMBER",,,28 ,,NW,,,,,,"$27,974.03",$0.00,1,1,1,1,1,1,20131001,C1722,HCPCS,"AICD, SINGLE CHAMBER",,,28 ,,NW,,,,,,"$22,654.39",$0.00,1,1,1,1,1,1,20131001,C1724,HCPCS,"CATH, TRANS ATHEREC,ROTATION",,,28 ,,NW,,,,,,"$2,809.19",$0.00,1,1,1,1,1,1,20131001,C1725,HCPCS,"CATH, TRANSLUMIN NON-LASER",,,28 ,,NW,,,,,,"$1,345.17",$0.00,1,1,1,1,1,1,20131001,C1726,HCPCS,"CATH, BAL DIL, NON-VASCULAR",,,28 ,,NW,,,,,,$458.34,$0.00,1,1,1,1,1,1,20131001,C1727,HCPCS,"CATH, BAL TIS DIS, NON-VAS",,,28 ,,NW,,,,,,$846.68,$0.00,1,1,1,1,1,1,20131001,C1729,HCPCS,"CATH, DRAINAGE",,,28 ,,NW,,,,,,$239.70,$0.00,1,1,1,1,1,1,20131001,C1730,HCPCS,"CATH, EP, 19 OR FEW ELECT",,,28 ,,NW,,,,,,"$1,717.43",$0.00,1,1,1,1,1,1,20131001,C1731,HCPCS,"CATH, EP, 20 OR MORE ELEC",,,28 ,,NW,,,,,,"$4,736.73",$0.00,1,1,1,1,1,1,20131001,C1732,HCPCS,"CATH, EP, DIAG/ABL, 3D/VECT",,,28 ,,NW,,,,,,"$4,736.73",$0.00,1,1,1,1,1,1,20131001,C1733,HCPCS,"CATH, EP, OTHR THAN COOL-TIP",,,28 ,,NW,,,,,,"$1,717.43",$0.00,1,1,1,1,1,1,20131001,C1750,HCPCS,"CATH, HEMODIALYSIS,LONG-TERM",,,28 ,,NW,,,,,,$653.97,$0.00,1,1,1,1,1,1,20131001,C1751,HCPCS,"CATH, INF, PER/CENT/MIDLINE",,,28 ,,NW,,,,,,$369.83,$0.00,1,1,1,1,1,1,20131001,C1752,HCPCS,"CATH,HEMODIALYSIS,SHORT-TERM",,,28 ,,NW,,,,,,$688.73,$0.00,1,1,1,1,1,1,20131001,C1753,HCPCS,"CATH, INTRAVAS ULTRASOUND",,,28 ,,NW,,,,,,"$1,332.15",$0.00,1,1,1,1,1,1,20131001,C1754,HCPCS,"CATHETER, INTRADISCAL",,,28 ,,NW,,,,,,$862.64,$0.00,1,1,1,1,1,1,20131001,C1755,HCPCS,"CATHETER, INTRASPINAL",,,28 ,,NW,,,,,,$780.35,$0.00,1,1,1,1,1,1,20131001,C1756,HCPCS,"CATH, PACING, TRANSESOPH",,,28 ,,NW,,,,,,"$1,133.11",$0.00,1,1,1,1,1,1,20131001,C1757,HCPCS,"CATH, THROMBECTOMY/EMBOLECT",,,28 ,,NW,,,,,,"$2,802.14",$0.00,1,1,1,1,1,1,20131001,C1758,HCPCS,"CATHETER, URETERAL",,,28 ,,NW,,,,,,$491.36,$0.00,1,1,1,1,1,1,20131001,C1759,HCPCS,"CATH, INTRA ECHOCARDIOGRAPHY",,,28 ,,NW,,,,,,"$3,760.29",$0.00,1,1,1,1,1,1,20131001,C1760,HCPCS,"CLOSURE DEV, VASC",,,28 ,,NW,,,,,,"$1,136.41",$0.00,1,1,1,1,1,1,20131001,C1762,HCPCS,"CONN TISS, HUMAN(INC FASCIA)",,,28 ,,NW,,,,,,"$2,602.89",$0.00,1,1,1,1,1,1,20131001,C1763,HCPCS,"CONN TISS, NON-HUMAN",,,28 ,,NW,,,,,,"$2,111.60",$0.00,1,1,1,1,1,1,20131001,C1764,HCPCS,"EVENT RECORDER, CARDIAC",,,28 ,,NW,,,,,,"$3,226.94",$0.00,1,1,1,1,1,1,20131001,C1765,HCPCS,ADHESION BARRIER,,,28 ,,NW,,,,,,$401.07,$0.00,1,1,1,1,1,1,20131001,C1766,HCPCS,"INTRO/SHEATH,STRBLE,NON-PEEL",,,28 ,,NW,,,,,,$561.44,$0.00,1,1,1,1,1,1,20131001,C1767,HCPCS,"GENERATOR, NEURO NON-RECHARG",,,28 ,,NW,,,,,,"$16,538.73",$0.00,1,1,1,1,1,1,20131001,C1768,HCPCS,"GRAFT, VASCULAR",,,28 ,,NW,,,,,,"$2,647.05",$0.00,1,1,1,1,1,1,20131001,C1769,HCPCS,GUIDE WIRE,,,28 ,,NW,,,,,,$422.22,$0.00,1,1,1,1,1,1,20131001,C1770,HCPCS,"IMAGING COIL, MR, INSERTABLE",,,28 ,,NW,,,,,,$326.86,$0.00,1,1,1,1,1,1,20131001,C1771,HCPCS,"REP DEV, URINARY, W/SLING",,,28 ,,NW,,,,,,"$3,496.27",$0.00,1,1,1,1,1,1,20131001,C1772,HCPCS,"INFUSION PUMP, PROGRAMMABLE",,,28 ,,NW,,,,,,$259.80,$0.00,1,1,1,1,1,1,20131001,C1776,HCPCS,JOINT DEVICE (IMPLANTABLE),,,28 ,,NW,,,,,,"$4,379.23",$0.00,1,1,1,1,1,1,20131001,C1777,HCPCS,"LEAD, AICD, ENDO SINGLE COIL",,,28 ,,NW,,,,,,"$6,655.68",$0.00,1,1,1,1,1,1,20131001,C1778,HCPCS,"LEAD, NEUROSTIMULATOR",,,28 ,,NW,,,,,,"$3,624.91",$0.00,1,1,1,1,1,1,20131001,C1779,HCPCS,"LEAD, PMKR, TRANSVENOUS VDD",,,28 ,,NW,,,,,,"$3,146.43",$0.00,1,1,1,1,1,1,20131001,C1780,HCPCS,"LENS, INTRAOCULAR (NEW TECH)",,,28 ,,NW,,,,,,$471.21,$0.00,1,1,1,1,1,1,20131001,C1781,HCPCS,MESH (IMPLANTABLE),,,28 ,,NW,,,,,,$543.10,$0.00,1,1,1,1,1,1,20131001,C1782,HCPCS,MORCELLATOR,,,28 ,,NW,,,,,,$366.66,$0.00,1,1,1,1,1,1,20131001,C1783,HCPCS,"OCULAR IMP, AQUEOUS DRAIN DE",,,28 ,,NW,,,,,,"$1,282.74",$0.00,1,1,1,1,1,1,20131001,C1784,HCPCS,"OCULAR DEV, INTRAOP, DET RET",,,28 ,,NW,,,,,,"$1,341.34",$0.00,1,1,1,1,1,1,20131001,C1785,HCPCS,"PMKR, DUAL, RATE-RESP",,,28 ,,NW,,,,,,"$8,038.54",$0.00,1,1,1,1,1,1,20131001,C1786,HCPCS,"PMKR, SINGLE, RATE-RESP",,,28 ,,NW,,,,,,"$7,037.37",$0.00,1,1,1,1,1,1,20131001,C1787,HCPCS,"PATIENT PROGR, NEUROSTIM",,,28 ,,NW,,,,,,"$5,056.62",$0.00,1,1,1,1,1,1,20131001,C1788,HCPCS,"PORT, INDWELLING, IMP",,,28 ,,NW,,,,,,$918.07,$0.00,1,1,1,1,1,1,20131001,C1789,HCPCS,"PROSTHESIS, BREAST, IMP",,,28 ,,NW,,,,,,"$1,203.57",$0.00,1,1,1,1,1,1,20131001,C1813,HCPCS,"PROSTHESIS, PENILE, INFLATAB",,,28 ,,NW,,,,,,"$4,473.65",$0.00,1,1,1,1,1,1,20131001,C1815,HCPCS,"PROS, URINARY SPH, IMP",,,28 ,,NW,,,,,,"$3,898.23",$0.00,1,1,1,1,1,1,20131001,C1816,HCPCS,"RECEIVER/TRANSMITTER, NEURO",,,28 ,,NW,,,,,,"$1,421.16",$0.00,1,1,1,1,1,1,20131001,C1817,HCPCS,SEPTAL DEFECT IMP SYS,,,28 ,,NW,,,,,,"$4,624.83",$0.00,1,1,1,1,1,1,20131001,C1818,HCPCS,INTEGRATED KERATOPROSTHESIS,,,28 ,,NW,,,,,,"$3,555.97",$0.00,1,1,1,1,1,1,20131001,C1820,HCPCS,GENERATOR NEURO RECHG BAT SY,,,28 ,,NW,,,,,,"$14,340.49",$0.00,1,1,1,1,1,1,20131001,C1821,HCPCS,INTERSPINOUS IMPLANT,,,28 ,,NW,,,,,,"$2,239.07",$0.00,1,1,1,1,1,1,20131001,C1874,HCPCS,"STENT, COATED/COV W/DEL SYS",,,28 ,,NW,,,,,,"$3,215.55",$0.00,1,1,1,1,1,1,20131001,C1875,HCPCS,"STENT, COATED/COV W/O DEL SY",,,28 ,,NW,,,,,,"$3,092.92",$0.00,1,1,1,1,1,1,20131001,C1876,HCPCS,"STENT, NON-COA/NON-COV W/DEL",,,28 ,,NW,,,,,,"$2,802.60",$0.00,1,1,1,1,1,1,20131001,C1877,HCPCS,"STENT, NON-COAT/COV W/O DEL",,,28 ,,NW,,,,,,"$2,504.45",$0.00,1,1,1,1,1,1,20131001,C1878,HCPCS,MATRL FOR VOCAL CORD,,,28 ,,NW,,,,,,$676.44,$0.00,1,1,1,1,1,1,20131001,C1879,HCPCS,"TISSUE MARKER, IMPLANTABLE",,,28 ,,NW,,,,,,$189.79,$0.00,1,1,1,1,1,1,20131001,C1880,HCPCS,VENA CAVA FILTER,,,28 ,,NW,,,,,,"$2,113.84",$0.00,1,1,1,1,1,1,20131001,C1881,HCPCS,DIALYSIS ACCESS SYSTEM,,,28 ,,NW,,,,,,$467.24,$0.00,1,1,1,1,1,1,20131001,C1882,HCPCS,"AICD, OTHER THAN SING/DUAL",,,28 ,,NW,,,,,,"$43,122.34",$0.00,1,1,1,1,1,1,20131001,C1883,HCPCS,"ADAPT/EXT, PACING/NEURO LEAD",,,28 ,,NW,,,,,,"$1,888.87",$0.00,1,1,1,1,1,1,20131001,C1884,HCPCS,EMBOLIZATION PROTECT SYST,,,28 ,,NW,,,,,,$274.32,$0.00,1,1,1,1,1,1,20131001,C1885,HCPCS,"CATH, TRANSLUMIN ANGIO LASER",,,28 ,,NW,,,,,,$312.65,$0.00,1,1,1,1,1,1,20131001,C1887,HCPCS,"CATHETER, GUIDING",,,28 ,,NW,,,,,,$59.80,$0.00,1,1,1,1,1,1,20131001,C1888,HCPCS,ENDOVAS NON-CARDIAC ABL CATH,,,28 ,,NW,,,,,,$632.69,$0.00,1,1,1,1,1,1,20131001,C1891,HCPCS,"INFUSION PUMP,NON-PROG, PERM",,,28 ,,NW,,,,,,"$5,386.31",$0.00,1,1,1,1,1,1,20131001,C1892,HCPCS,"INTRO/SHEATH,FIXED,PEEL-AWAY",,,28 ,,NW,,,,,,"$1,083.92",$0.00,1,1,1,1,1,1,20131001,C1893,HCPCS,"INTRO/SHEATH, FIXED,NON-PEEL",,,28 ,,NW,,,,,,$578.84,$0.00,1,1,1,1,1,1,20131001,C1894,HCPCS,"INTRO/SHEATH, NON-LASER",,,28 ,,NW,,,,,,$150.62,$0.00,1,1,1,1,1,1,20131001,C1895,HCPCS,"LEAD, AICD, ENDO DUAL COIL",,,28 ,,NW,,,,,,"$6,987.41",$0.00,1,1,1,1,1,1,20131001,C1896,HCPCS,"LEAD, AICD, NON SING/DUAL",,,28 ,,NW,,,,,,"$3,554.47",$0.00,1,1,1,1,1,1,20131001,C1897,HCPCS,"LEAD, NEUROSTIM TEST KIT",,,28 ,,NW,,,,,,"$3,661.16",$0.00,1,1,1,1,1,1,20131001,C1898,HCPCS,"LEAD, PMKR, OTHER THAN TRANS",,,28 ,,NW,,,,,,"$1,033.34",$0.00,1,1,1,1,1,1,20131001,C1899,HCPCS,"LEAD, PMKR/AICD COMBINATION",,,28 ,,NW,,,,,,"$7,980.64",$0.00,1,1,1,1,1,1,20131001,C1900,HCPCS,"LEAD, CORONARY VENOUS",,,28 ,,NW,,,,,,"$5,395.90",$0.00,1,1,1,1,1,1,20131001,C2614,HCPCS,"PROBE, PERC LUMB DISC",,,28 ,,NW,,,,,,$765.70,$0.00,1,1,1,1,1,1,20131001,C2615,HCPCS,"SEALANT, PULMONARY, LIQUID",,,28 ,,NW,,,,,,$851.70,$0.00,1,1,1,1,1,1,20131001,C2617,HCPCS,"STENT, NON-COR, TEM W/O DEL",,,28 ,,NW,,,,,,"$2,621.98",$0.00,1,1,1,1,1,1,20131001,C2618,HCPCS,"PROBE, CRYOABLATION",,,28 ,,NW,,,,,,"$2,392.06",$0.00,1,1,1,1,1,1,20131001,C2619,HCPCS,"PMKR, DUAL, NON RATE-RESP",,,28 ,,NW,,,,,,"$7,105.06",$0.00,1,1,1,1,1,1,20131001,C2620,HCPCS,"PMKR, SINGLE, NON RATE-RESP",,,28 ,,NW,,,,,,"$10,767.76",$0.00,1,1,1,1,1,1,20131001,C2621,HCPCS,"PMKR, OTHER THAN SING/DUAL",,,28 ,,NW,,,,,,"$17,718.89",$0.00,1,1,1,1,1,1,20131001,C2622,HCPCS,"PROSTHESIS, PENILE, NON-INF",,,28 ,,NW,,,,,,"$4,590.86",$0.00,1,1,1,1,1,1,20131001,C2625,HCPCS,"STENT, NON-COR, TEM W/DEL SY",,,28 ,,NW,,,,,,"$1,893.67",$0.00,1,1,1,1,1,1,20131001,C2626,HCPCS,"INFUSION PUMP, NON-PROG,TEMP",,,28 ,,NW,,,,,,"$1,112.96",$0.00,1,1,1,1,1,1,20131001,C2627,HCPCS,"CATH, SUPRAPUBIC/CYSTOSCOPIC",,,28 ,,NW,,,,,,$922.60,$0.00,1,1,1,1,1,1,20131001,C2628,HCPCS,"CATHETER, OCCLUSION",,,28 ,,NW,,,,,,"$1,038.36",$0.00,1,1,1,1,1,1,20131001,C2631,HCPCS,"REP DEV, URINARY, W/O SLING",,,28 ,,NW,,,,,,"$3,021.38",$0.00,1,1,1,1,1,1,20131001,C2638,HCPCS,"BRACHYTX, STRANDED, I-125",,,28 ,,NW,,,,,,$72.00,$0.00,1,1,1,1,1,1,20131001,C2639,HCPCS,"BRACHYTX, NON-STRANDED,I-125",,,28 ,,NW,,,,,,$36.86,$0.00,1,1,1,1,1,1,20131001,C2640,HCPCS,"BRACHYTX, STRANDED, P-103",,,28 ,,NW,,,,,,$135.72,$0.00,1,1,1,1,1,1,20131001,C2641,HCPCS,"BRACHYTX, NON-STRANDED,P-103",,,28 ,,NW,,,,,,$69.48,$0.00,1,1,1,1,1,1,20131001,C2698,HCPCS,"BRACHYTX, STRANDED, NOS",,,28 ,,NW,,,,,,"$2,357.14",$0.00,1,1,1,1,1,1,20131001,C2699,HCPCS,"BRACHYTX, NON-STRANDED, NOS",,,28 ,,NW,,,,,,"$2,357.14",$0.00,1,1,1,1,1,1,20131001,C8908,HCPCS,"MRI W/O FOL W/CONT, BREAST,",,,20 ,,TotalUnits,,,,16.38 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,C9113,HCPCS,"INJ PANTOPRAZOLE SODIUM, VIA",,,29 ,,NW,,,,,,$172.55,$0.00,1,1,1,0,0,1,20131001,C9121,HCPCS,"INJECTION, ARGATROBAN",,,29 ,,NW,,,,,,$199.84,$0.00,1,1,1,0,0,1,20131001,C9248,HCPCS,"INJ, CLEVIDIPINE BUTYRATE",,,29 ,,NW,,,,,,$10.59,$0.00,1,1,1,0,0,1,20131001,C9250,HCPCS,ARTISS FIBRIN SEALANT,,,29 ,,NW,,,,,,$727.58,$0.00,1,1,1,0,0,1,20131001,C9254,HCPCS,"INJECTION, LACOSAMIDE",,,29 ,,NW,,,,,,$1.14,$0.00,1,1,1,0,0,1,20131001,C9257,HCPCS,BEVACIZUMAB INJECTION,,,29 ,,NW,,,,,,$72.57,$0.00,1,1,1,0,0,1,20131001,C9285,HCPCS,"PATCH, LIDOCAINE/TETRACAINE",,,29 ,,NW,,,,,,$93.94,$0.00,1,1,1,0,0,1,20131001,C9288,HCPCS,"INJ, CENTRUROIDES (SCORPION)",,,29 ,,NW,,,,,,"$19,905.43",$0.00,1,1,1,0,0,1,20131001,C9289,HCPCS,"INJ, ERWINIA CHRYSANTHEMI",,,29 ,,NW,,,,,,"$2,147.11",$0.00,1,1,1,0,0,1,20131001,C9290,HCPCS,"INJ, BUPIVACAINE LIPOSOME",,,29 ,,NW,,,,,,$7.26,$0.00,1,1,1,0,0,1,20131001,C9358,HCPCS,"SURGIMEND, FETAL",,,28 ,,NW,,,,,,"$1,187.96",$0.00,1,1,1,1,1,1,20131001,C9359,HCPCS,"IMPLNT,BON VOID FILLER-PUTTY",,,28 ,,NW,,,,,,"$1,513.56",$0.00,1,1,1,1,1,1,20131001,C9360,HCPCS,"SURGIMEND, NEONATAL",,,28 ,,NW,,,,,,$60.42,$0.00,1,1,1,1,1,1,20131001,C9361,HCPCS,NEUROMEND NERVE WRAP,,,28 ,,NW,,,,,,"$1,075.85",$0.00,1,1,1,1,1,1,20131001,C9362,HCPCS,"IMPLNT,BON VOID FILLER-STRIP",,,28 ,,NW,,,,,,$268.85,$0.00,1,1,1,1,1,1,20131001,C9363,HCPCS,INTEGRA MESHED BIL WOUND MAT,,,28 ,,NW,,,,,,$106.14,$0.00,1,1,1,1,1,1,20131001,C9364,HCPCS,"PORCINE IMPLANT, PERMACOL",,,28 ,,NW,,,,,,$93.37,$0.00,1,1,1,1,1,1,20131001,C9367,HCPCS,ENDOFORM DERMAL TEMPLATE,,,28 ,,NW,,,,,,$23.24,$0.00,1,1,1,0,0,1,20131001,C9368,HCPCS,GRAFIX CORE,,,29 ,,NW,,,,,,$50.67,$0.00,1,1,1,1,1,1,20131001,C9369,HCPCS,GRAFIX PRIME,,,29 ,,NW,,,,,,$3.88,$0.00,1,1,1,1,1,1,20131001,C9800,HCPCS,DERMAL FILLER INJ PX/SUPPL,,,28 ,,NW,,,,,,"$1,609.10",$0.00,1,1,1,0,0,1,20131001,D0120,HCPCS,PERIODIC ORAL EVALUATION,,,25 ,,NW,,,,,,$55.34,$0.00,1,0,1,1,1,1,20131001,D0140,HCPCS,LIMIT ORAL EVAL PROBLM FOCUS,,,25 ,,NW,,,,,,$84.36,$0.00,1,0,1,1,1,1,20131001,D0145,HCPCS,"ORAL EVALUATION, PT < 3YRS",,,25 ,,NW,,,,,,$80.37,$0.00,1,0,1,1,1,1,20131001,D0150,HCPCS,COMPREHENSVE ORAL EVALUATION,,,25 ,,NW,,,,,,$94.21,$0.00,1,0,1,1,1,1,20131001,D0160,HCPCS,EXTENSV ORAL EVAL PROB FOCUS,,,25 ,,NW,,,,,,$182.73,$0.00,1,0,1,1,1,1,20131001,D0170,HCPCS,"RE-EVAL,EST PT,PROBLEM FOCUS",,,25 ,,NW,,,,,,$72.07,$0.00,1,0,1,1,1,1,20131001,D0180,HCPCS,COMP PERIODONTAL EVALUATION,,,25 ,,NW,,,,,,$104.36,$0.00,1,0,1,1,1,1,20131001,D0190,HCPCS,SCREENING OF A PATIENT,,,25 ,,NW,,,,,,$44.27,$0.00,1,0,1,1,1,1,20131001,D0191,HCPCS,ASSESSMENT OF A PATIENT,,,25 ,,NW,,,,,,$44.27,$0.00,1,0,1,1,1,1,20131001,D0210,HCPCS,INTRAOR COMPLETE FILM SERIES,,,25 ,,NW,,,,,,$142.22,$0.00,1,0,1,1,1,1,20131001,D0220,HCPCS,INTRAORAL PERIAPICAL FIRST,,,25 ,,NW,,,,,,$30.78,$0.00,1,0,1,1,1,1,20131001,D0230,HCPCS,INTRAORAL PERIAPICAL EA ADD,,,25 ,,NW,,,,,,$26.22,$0.00,1,0,1,1,1,1,20131001,D0240,HCPCS,INTRAORAL OCCLUSAL FILM,,,25 ,,NW,,,,,,$46.07,$0.00,1,0,1,1,1,1,20131001,D0250,HCPCS,EXTRAORAL FIRST FILM,,,25 ,,NW,,,,,,$65.14,$0.00,1,0,1,1,1,1,20131001,D0260,HCPCS,EXTRAORAL EA ADDITIONAL FILM,,,25 ,,NW,,,,,,$57.26,$0.00,1,0,1,1,1,1,20131001,D0270,HCPCS,DENTAL BITEWING SINGLE IMAGE,,,25 ,,NW,,,,,,$30.43,$0.00,1,0,1,1,1,1,20131001,D0272,HCPCS,DENTAL BITEWINGS TWO IMAGES,,,25 ,,NW,,,,,,$48.76,$0.00,1,0,1,1,1,1,20131001,D0273,HCPCS,BITEWINGS - THREE IMAGES,,,25 ,,NW,,,,,,$60.62,$0.00,1,0,1,1,1,1,20131001,D0274,HCPCS,BITEWINGS FOUR IMAGES,,,25 ,,NW,,,,,,$70.26,$0.00,1,0,1,1,1,1,20131001,D0277,HCPCS,VERT BITEWINGS 7 TO 8 IMAGES,,,25 ,,NW,,,,,,$106.54,$0.00,1,0,1,1,1,1,20131001,D0290,HCPCS,SKULL/FACIAL BONE IMAGE,,,25 ,,NW,,,,,,$155.48,$0.00,1,0,1,1,1,1,20131001,D0310,HCPCS,DENTAL SALIOGRAPHY,,,25 ,,NW,,,,,,$394.06,$0.00,1,0,1,1,1,1,20131001,D0320,HCPCS,DENTAL TMJ ARTHROGRAM INCL I,,,25 ,,NW,,,,,,$672.76,$0.00,1,0,1,1,1,1,20131001,D0321,HCPCS,OTHER TMJ IMAGES BY REPORT,,,25 ,,NW,,,,,,$227.62,$0.00,1,0,1,1,1,1,20131001,D0322,HCPCS,DENTAL TOMOGRAPHIC SURVEY,,,25 ,,NW,,,,,,$571.60,$0.00,1,0,1,1,1,1,20131001,D0330,HCPCS,PANORAMIC IMAGE,,,25 ,,NW,,,,,,$120.97,$0.00,1,0,1,1,1,1,20131001,D0340,HCPCS,CEPHALOMETRIC IMAGE,,,25 ,,NW,,,,,,$136.37,$0.00,1,0,1,1,1,1,20131001,D0350,HCPCS,ORAL/FACIAL PHOTO IMAGES,,,25 ,,NW,,,,,,$73.50,$0.00,1,0,1,1,1,1,20131001,D0363,HCPCS,"CONE BEAM, THREE DIMENSIONAL",,,25 ,,NW,,,,,,$549.05,$0.00,1,0,1,1,1,1,20131001,D0364,HCPCS,CONE BEAM CT CAPT & INTERP,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0365,HCPCS,CONE BEAM CT INTERPRETE MAN,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0366,HCPCS,CONE BEAM CT INTERPRETE MAX,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0367,HCPCS,CONE BEAM CT INTERP BOTH JAW,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0368,HCPCS,CONE BEAM CT INTERPRETE TMJ,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0369,HCPCS,MAX MRI CAPTURE & INTERPRETE,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0370,HCPCS,MAX ULTRASOUND CAPT & INTERP,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0371,HCPCS,SIALOENDOSCOPY CAPT & INTERP,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0380,HCPCS,CONE BEAM CT CAPTURE LIMITED,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0381,HCPCS,CONE BEAM CT CAPT MANDIBLE,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0382,HCPCS,CONE BEAM CT CAPT MAXILLA,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0383,HCPCS,CONE BEAM CT BOTH JAWS,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0384,HCPCS,CONE BEAM CT CAPTURE TMJ,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0385,HCPCS,MAX MRI IMAGE CAPTURE,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0386,HCPCS,MAX ULTRASOUND IMAGE CAPTURE,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0391,HCPCS,IMTERPRETE DIAGNOSTIC IMAGE,,,25 ,,NW,,,,,,$714.06,$0.00,1,0,1,1,1,1,20131001,D0415,HCPCS,COLLECTION OF MICROORGANISMS,,,25 ,,NW,,,,,,$98.78,$0.00,1,0,1,1,1,1,20131001,D0416,HCPCS,VIRAL CULTURE,,,25 ,,NW,,,,,,$104.77,$0.00,1,0,1,1,1,1,20131001,D0417,HCPCS,COLLECT & PREP SALIVA SAMPLE,,,25 ,,NW,,,,,,$120.37,$0.00,1,0,1,1,1,1,20131001,D0418,HCPCS,ANALYSIS OF SALIVA SAMPLE,,,25 ,,NW,,,,,,$120.32,$0.00,1,0,1,1,1,1,20131001,D0421,HCPCS,GEN TST SUSCEPT ORAL DISEASE,,,25 ,,NW,,,,,,$88.73,$0.00,1,0,1,1,1,1,20131001,D0425,HCPCS,CARIES SUSCEPTIBILITY TEST,,,25 ,,NW,,,,,,$59.23,$0.00,1,0,1,1,1,1,20131001,D0431,HCPCS,DIAG TST DETECT MUCOS ABNORM,,,25 ,,NW,,,,,,$69.85,$0.00,1,0,1,1,1,1,20131001,D0460,HCPCS,PULP VITALITY TEST,,,25 ,,NW,,,,,,$61.61,$0.00,1,0,1,1,1,1,20131001,D0470,HCPCS,DIAGNOSTIC CASTS,,,25 ,,NW,,,,,,$129.77,$0.00,1,0,1,1,1,1,20131001,D0472,HCPCS,"GROSS EXAM, PREP & REPORT",,,25 ,,NW,,,,,,$109.50,$0.00,1,0,1,1,1,1,20131001,D0473,HCPCS,"MICRO EXAM, PREP & REPORT",,,25 ,,NW,,,,,,$179.75,$0.00,1,0,1,1,1,1,20131001,D0474,HCPCS,MICRO W EXAM OF SURG MARGINS,,,25 ,,NW,,,,,,$203.19,$0.00,1,0,1,1,1,1,20131001,D0475,HCPCS,DECALCIFICATION PROCEDURE,,,25 ,,NW,,,,,,$141.33,$0.00,1,0,1,1,1,1,20131001,D0476,HCPCS,SPEC STAINS FOR MICROORGANIS,,,25 ,,NW,,,,,,$171.66,$0.00,1,0,1,1,1,1,20131001,D0477,HCPCS,SPEC STAINS NOT FOR MICROORG,,,25 ,,NW,,,,,,$237.57,$0.00,1,0,1,1,1,1,20131001,D0478,HCPCS,IMMUNOHISTOCHEMICAL STAINS,,,25 ,,NW,,,,,,$156.86,$0.00,1,0,1,1,1,1,20131001,D0479,HCPCS,TISSUE IN-SITU HYBRIDIZATION,,,25 ,,NW,,,,,,$228.42,$0.00,1,0,1,1,1,1,20131001,D0480,HCPCS,CYTOPATH SMEAR PREP & REPORT,,,25 ,,NW,,,,,,$156.18,$0.00,1,0,1,1,1,1,20131001,D0481,HCPCS,ELECTRON MICROSCOPY DIAGNOST,,,25 ,,NW,,,,,,$273.29,$0.00,1,0,1,1,1,1,20131001,D0482,HCPCS,DIRECT IMMUNOFLUORESCENCE,,,25 ,,NW,,,,,,$134.71,$0.00,1,0,1,1,1,1,20131001,D0483,HCPCS,INDIRECT IMMUNOFLUORESCENCE,,,25 ,,NW,,,,,,$143.98,$0.00,1,0,1,1,1,1,20131001,D0484,HCPCS,CONSULT SLIDES PREP ELSEWHER,,,25 ,,NW,,,,,,$206.96,$0.00,1,0,1,1,1,1,20131001,D0485,HCPCS,CONSULT INC PREP OF SLIDES,,,25 ,,NW,,,,,,$255.65,$0.00,1,0,1,1,1,1,20131001,D0486,HCPCS,ACCESS OF TRANSEP CYTOL SAMP,,,25 ,,NW,,,,,,$157.96,$0.00,1,0,1,1,1,1,20131001,D0502,HCPCS,OTHER ORAL PATHOLOGY PROCEDU,,,25 ,,NW,,,,,,$185.39,$0.00,1,0,1,1,1,1,20131001,D0999,HCPCS,UNSPECIFIED DIAGNOSTIC PROCE,,,25 ,,NW,,,,,,$84.36,$0.00,1,0,1,1,1,1,20131001,D1110,HCPCS,DENTAL PROPHYLAXIS ADULT,,,25 ,,NW,,,,,,$98.41,$0.00,1,0,1,1,1,1,20131001,D1120,HCPCS,DENTAL PROPHYLAXIS CHILD,,,25 ,,NW,,,,,,$73.52,$0.00,1,0,1,1,1,1,20131001,D1206,HCPCS,TOPICAL FLUORIDE VARNISH,,,25 ,,NW,,,,,,$48.29,$0.00,1,0,1,1,1,1,20131001,D1208,HCPCS,TOPICAL APP OF FLUORIDE,,,25 ,,NW,,,,,,$40.83,$0.00,1,0,1,1,1,1,20131001,D1310,HCPCS,NUTRI COUNSEL-CONTROL CARIES,,,25 ,,NW,,,,,,$65.46,$0.00,1,0,1,1,1,1,20131001,D1320,HCPCS,TOBACCO COUNSELING,,,25 ,,NW,,,,,,$73.89,$0.00,1,0,1,1,1,1,20131001,D1330,HCPCS,ORAL HYGIENE INSTRUCTION,,,25 ,,NW,,,,,,$67.51,$0.00,1,0,1,1,1,1,20131001,D1351,HCPCS,DENTAL SEALANT PER TOOTH,,,25 ,,NW,,,,,,$60.57,$0.00,1,0,1,1,1,1,20131001,D1352,HCPCS,"PREV RESIN REST, PERM TOOTH",,,25 ,,NW,,,,,,$79.98,$0.00,1,0,1,1,1,1,20131001,D1510,HCPCS,SPACE MAINTAINER FXD UNILAT,,,26 ,,NW,,,,,,$360.87,$0.00,1,0,1,1,1,1,20131001,D1515,HCPCS,FIXED BILAT SPACE MAINTAINER,,,26 ,,NW,,,,,,$496.26,$0.00,1,0,1,1,1,1,20131001,D1520,HCPCS,REMOVE UNILAT SPACE MAINTAIN,,,26 ,,NW,,,,,,$419.05,$0.00,1,0,1,1,1,1,20131001,D1525,HCPCS,REMOVE BILAT SPACE MAINTAIN,,,26 ,,NW,,,,,,$585.31,$0.00,1,0,1,1,1,1,20131001,D1550,HCPCS,RECEMENT SPACE MAINTAINER,,,26 ,,NW,,,,,,$88.42,$0.00,1,0,1,1,1,1,20131001,D1555,HCPCS,REMOVE FIX SPACE MAINTAINER,,,26 ,,NW,,,,,,$82.31,$0.00,1,0,1,1,1,1,20131001,D2140,HCPCS,AMALGAM ONE SURFACE PERMANEN,,,26 ,,NW,,,,,,$148.49,$0.00,1,0,1,1,1,1,20131001,D2150,HCPCS,AMALGAM TWO SURFACES PERMANE,,,26 ,,NW,,,,,,$189.38,$0.00,1,0,1,1,1,1,20131001,D2160,HCPCS,AMALGAM THREE SURFACES PERMA,,,26 ,,NW,,,,,,$233.23,$0.00,1,0,1,1,1,1,20131001,D2161,HCPCS,AMALGAM 4 OR > SURFACES PERM,,,26 ,,NW,,,,,,$277.96,$0.00,1,0,1,1,1,1,20131001,D2330,HCPCS,RESIN ONE SURFACE-ANTERIOR,,,26 ,,NW,,,,,,$174.68,$0.00,1,0,1,1,1,1,20131001,D2331,HCPCS,RESIN TWO SURFACES-ANTERIOR,,,26 ,,NW,,,,,,$212.20,$0.00,1,0,1,1,1,1,20131001,D2332,HCPCS,RESIN THREE SURFACES-ANTERIO,,,26 ,,NW,,,,,,$262.49,$0.00,1,0,1,1,1,1,20131001,D2335,HCPCS,RESIN 4/> SURF OR W INCIS AN,,,26 ,,NW,,,,,,$318.97,$0.00,1,0,1,1,1,1,20131001,D2390,HCPCS,ANT RESIN-BASED CMPST CROWN,,,26 ,,NW,,,,,,$414.02,$0.00,1,0,1,1,1,1,20131001,D2391,HCPCS,POST 1 SRFC RESINBASED CMPST,,,26 ,,NW,,,,,,$192.28,$0.00,1,0,1,1,1,1,20131001,D2392,HCPCS,POST 2 SRFC RESINBASED CMPST,,,26 ,,NW,,,,,,$247.67,$0.00,1,0,1,1,1,1,20131001,D2393,HCPCS,POST 3 SRFC RESINBASED CMPST,,,26 ,,NW,,,,,,$306.05,$0.00,1,0,1,1,1,1,20131001,D2394,HCPCS,POST >=4SRFC RESINBASE CMPST,,,26 ,,NW,,,,,,$375.23,$0.00,1,0,1,1,1,1,20131001,D2410,HCPCS,DENTAL GOLD FOIL ONE SURFACE,,,27 ,,NW,,,,,,$478.06,$0.00,1,0,1,1,1,1,20131001,D2420,HCPCS,DENTAL GOLD FOIL TWO SURFACE,,,27 ,,NW,,,,,,$692.97,$0.00,1,0,1,1,1,1,20131001,D2430,HCPCS,DENTAL GOLD FOIL THREE SURFA,,,27 ,,NW,,,,,,$970.57,$0.00,1,0,1,1,1,1,20131001,D2510,HCPCS,DENTAL INLAY METALIC 1 SURF,,,27 ,,NW,,,,,,$901.45,$0.00,1,0,1,1,1,1,20131001,D2520,HCPCS,DENTAL INLAY METALLIC 2 SURF,,,27 ,,NW,,,,,,$973.99,$0.00,1,0,1,1,1,1,20131001,D2530,HCPCS,DENTAL INLAY METL 3/MORE SUR,,,27 ,,NW,,,,,,"$1,087.15",$0.00,1,0,1,1,1,1,20131001,D2542,HCPCS,DENTAL ONLAY METALLIC 2 SURF,,,27 ,,NW,,,,,,"$1,101.67",$0.00,1,0,1,1,1,1,20131001,D2543,HCPCS,DENTAL ONLAY METALLIC 3 SURF,,,27 ,,NW,,,,,,"$1,131.80",$0.00,1,0,1,1,1,1,20131001,D2544,HCPCS,DENTAL ONLAY METL 4/MORE SUR,,,27 ,,NW,,,,,,"$1,169.05",$0.00,1,0,1,1,1,1,20131001,D2610,HCPCS,INLAY PORCELAIN/CERAMIC 1 SU,,,27 ,,NW,,,,,,"$1,010.37",$0.00,1,0,1,1,1,1,20131001,D2620,HCPCS,INLAY PORCELAIN/CERAMIC 2 SU,,,27 ,,NW,,,,,,"$1,056.74",$0.00,1,0,1,1,1,1,20131001,D2630,HCPCS,DENTAL ONLAY PORC 3/MORE SUR,,,27 ,,NW,,,,,,"$1,123.44",$0.00,1,0,1,1,1,1,20131001,D2642,HCPCS,DENTAL ONLAY PORCELIN 2 SURF,,,27 ,,NW,,,,,,"$1,109.80",$0.00,1,0,1,1,1,1,20131001,D2643,HCPCS,DENTAL ONLAY PORCELIN 3 SURF,,,27 ,,NW,,,,,,"$1,170.12",$0.00,1,0,1,1,1,1,20131001,D2644,HCPCS,DENTAL ONLAY PORC 4/MORE SUR,,,27 ,,NW,,,,,,"$1,226.92",$0.00,1,0,1,1,1,1,20131001,D2650,HCPCS,INLAY COMPOSITE/RESIN ONE SU,,,27 ,,NW,,,,,,$815.42,$0.00,1,0,1,1,1,1,20131001,D2651,HCPCS,INLAY COMPOSITE/RESIN TWO SU,,,27 ,,NW,,,,,,$887.48,$0.00,1,0,1,1,1,1,20131001,D2652,HCPCS,DENTAL INLAY RESIN 3/MRE SUR,,,27 ,,NW,,,,,,$928.06,$0.00,1,0,1,1,1,1,20131001,D2662,HCPCS,DENTAL ONLAY RESIN 2 SURFACE,,,27 ,,NW,,,,,,$885.16,$0.00,1,0,1,1,1,1,20131001,D2663,HCPCS,DENTAL ONLAY RESIN 3 SURFACE,,,27 ,,NW,,,,,,$968.04,$0.00,1,0,1,1,1,1,20131001,D2664,HCPCS,DENTAL ONLAY RESIN 4/MRE SUR,,,27 ,,NW,,,,,,"$1,016.04",$0.00,1,0,1,1,1,1,20131001,D2710,HCPCS,CROWN RESIN-BASED INDIRECT,,,27 ,,NW,,,,,,$713.50,$0.00,1,0,1,1,1,1,20131001,D2712,HCPCS,CROWN 3/4 RESIN-BASED COMPOS,,,27 ,,NW,,,,,,$807.75,$0.00,1,0,1,1,1,1,20131001,D2720,HCPCS,CROWN RESIN W/ HIGH NOBLE ME,,,27 ,,NW,,,,,,"$1,168.61",$0.00,1,0,1,1,1,1,20131001,D2721,HCPCS,CROWN RESIN W/ BASE METAL,,,27 ,,NW,,,,,,"$1,105.41",$0.00,1,0,1,1,1,1,20131001,D2722,HCPCS,CROWN RESIN W/ NOBLE METAL,,,27 ,,NW,,,,,,"$1,126.60",$0.00,1,0,1,1,1,1,20131001,D2740,HCPCS,CROWN PORCELAIN/CERAMIC SUBS,,,27 ,,NW,,,,,,"$1,232.77",$0.00,1,0,1,1,1,1,20131001,D2750,HCPCS,CROWN PORCELAIN W/ H NOBLE M,,,27 ,,NW,,,,,,"$1,207.31",$0.00,1,0,1,1,1,1,20131001,D2751,HCPCS,CROWN PORCELAIN FUSED BASE M,,,27 ,,NW,,,,,,"$1,117.99",$0.00,1,0,1,1,1,1,20131001,D2752,HCPCS,CROWN PORCELAIN W/ NOBLE MET,,,27 ,,NW,,,,,,"$1,144.11",$0.00,1,0,1,1,1,1,20131001,D2780,HCPCS,CROWN 3/4 CAST HI NOBLE MET,,,27 ,,NW,,,,,,"$1,152.57",$0.00,1,0,1,1,1,1,20131001,D2781,HCPCS,CROWN 3/4 CAST BASE METAL,,,27 ,,NW,,,,,,"$1,101.43",$0.00,1,0,1,1,1,1,20131001,D2782,HCPCS,CROWN 3/4 CAST NOBLE METAL,,,27 ,,NW,,,,,,"$1,122.77",$0.00,1,0,1,1,1,1,20131001,D2783,HCPCS,CROWN 3/4 PORCELAIN/CERAMIC,,,27 ,,NW,,,,,,"$1,184.94",$0.00,1,0,1,1,1,1,20131001,D2790,HCPCS,CROWN FULL CAST HIGH NOBLE M,,,27 ,,NW,,,,,,"$1,189.87",$0.00,1,0,1,1,1,1,20131001,D2791,HCPCS,CROWN FULL CAST BASE METAL,,,27 ,,NW,,,,,,"$1,087.46",$0.00,1,0,1,1,1,1,20131001,D2792,HCPCS,CROWN FULL CAST NOBLE METAL,,,27 ,,NW,,,,,,"$1,117.99",$0.00,1,0,1,1,1,1,20131001,D2794,HCPCS,CROWN-TITANIUM,,,27 ,,NW,,,,,,"$1,182.00",$0.00,1,0,1,1,1,1,20131001,D2799,HCPCS,PROVISIONAL CROWN,,,27 ,,NW,,,,,,$481.78,$0.00,1,0,1,1,1,1,20131001,D2910,HCPCS,RECEMENT INLAY ONLAY OR PART,,,27 ,,NW,,,,,,$115.48,$0.00,1,0,1,1,1,1,20131001,D2915,HCPCS,RECEMENT CAST OR PREFAB POST,,,27 ,,NW,,,,,,$118.05,$0.00,1,0,1,1,1,1,20131001,D2920,HCPCS,DENTAL RECEMENT CROWN,,,27 ,,NW,,,,,,$116.22,$0.00,1,0,1,1,1,1,20131001,D2929,HCPCS,PREFAB PORC/CERAM CROWN PRI,,,27 ,,NW,,,,,,$645.48,$0.00,1,0,1,1,1,1,20131001,D2930,HCPCS,PREFAB STNLSS STEEL CRWN PRI,,,27 ,,NW,,,,,,$296.67,$0.00,1,0,1,1,1,1,20131001,D2931,HCPCS,PREFAB STNLSS STEEL CROWN PE,,,27 ,,NW,,,,,,$347.99,$0.00,1,0,1,1,1,1,20131001,D2932,HCPCS,PREFABRICATED RESIN CROWN,,,27 ,,NW,,,,,,$373.59,$0.00,1,0,1,1,1,1,20131001,D2933,HCPCS,PREFAB STAINLESS STEEL CROWN,,,27 ,,NW,,,,,,$407.92,$0.00,1,0,1,1,1,1,20131001,D2934,HCPCS,PREFAB STEEL CROWN PRIMARY,,,27 ,,NW,,,,,,$408.44,$0.00,1,0,1,1,1,1,20131001,D2940,HCPCS,PROTECTIVE RESTORATION,,,27 ,,NW,,,,,,$124.64,$0.00,1,0,1,1,1,1,20131001,D2950,HCPCS,CORE BUILD-UP INCL ANY PINS,,,27 ,,NW,,,,,,$290.95,$0.00,1,0,1,1,1,1,20131001,D2951,HCPCS,TOOTH PIN RETENTION,,,27 ,,NW,,,,,,$73.26,$0.00,1,0,1,1,1,1,20131001,D2952,HCPCS,POST AND CORE CAST + CROWN,,,27 ,,NW,,,,,,$455.40,$0.00,1,0,1,1,1,1,20131001,D2953,HCPCS,EACH ADDTNL CAST POST,,,27 ,,NW,,,,,,$291.56,$0.00,1,0,1,1,1,1,20131001,D2954,HCPCS,PREFAB POST/CORE + CROWN,,,27 ,,NW,,,,,,$363.80,$0.00,1,0,1,1,1,1,20131001,D2955,HCPCS,POST REMOVAL,,,27 ,,NW,,,,,,$301.68,$0.00,1,0,1,1,1,1,20131001,D2957,HCPCS,EACH ADDTNL PREFAB POST,,,27 ,,NW,,,,,,$205.33,$0.00,1,0,1,1,1,1,20131001,D2960,HCPCS,LAMINATE LABIAL VENEER,,,27 ,,NW,,,,,,$802.67,$0.00,1,0,1,1,1,1,20131001,D2961,HCPCS,LAB LABIAL VENEER RESIN,,,27 ,,NW,,,,,,"$1,049.31",$0.00,1,0,1,1,1,1,20131001,D2962,HCPCS,LAB LABIAL VENEER PORCELAIN,,,27 ,,NW,,,,,,"$1,175.74",$0.00,1,0,1,1,1,1,20131001,D2970,HCPCS,TEMP CROWN (FRACTURED TOOTH),,,27 ,,NW,,,,,,$349.97,$0.00,1,0,1,1,1,1,20131001,D2971,HCPCS,ADD PROC CONSTRUCT NEW CROWN,,,27 ,,NW,,,,,,$210.87,$0.00,1,0,1,1,1,1,20131001,D2975,HCPCS,COPING,,,27 ,,NW,,,,,,$595.15,$0.00,1,0,1,1,1,1,20131001,D2980,HCPCS,CROWN REPAIR,,,27 ,,NW,,,,,,$330.61,$0.00,1,0,1,1,1,1,20131001,D2981,HCPCS,INLAY REPAIR,,,27 ,,NW,,,,,,$330.61,$0.00,1,0,1,1,1,1,20131001,D2982,HCPCS,ONLAY REPAIR,,,27 ,,NW,,,,,,$330.61,$0.00,1,0,1,1,1,1,20131001,D2983,HCPCS,VENEER REPAIR,,,27 ,,NW,,,,,,$330.61,$0.00,1,0,1,1,1,1,20131001,D2990,HCPCS,RESIN INFILTRATION OF LESION,,,27 ,,NW,,,,,,$212.20,$0.00,1,0,1,1,1,1,20131001,D2999,HCPCS,DENTAL UNSPEC RESTORATIVE PR,,,27 ,,NW,,,,,,$212.20,$0.00,1,0,1,1,1,1,20131001,D3110,HCPCS,PULP CAP DIRECT,,,26 ,,NW,,,,,,$94.94,$0.00,1,0,1,1,1,1,20131001,D3120,HCPCS,PULP CAP INDIRECT,,,26 ,,NW,,,,,,$86.15,$0.00,1,0,1,1,1,1,20131001,D3220,HCPCS,THERAPEUTIC PULPOTOMY,,,26 ,,NW,,,,,,$210.36,$0.00,1,0,1,1,1,1,20131001,D3221,HCPCS,GROSS PULPAL DEBRIDEMENT,,,26 ,,NW,,,,,,$240.26,$0.00,1,0,1,1,1,1,20131001,D3222,HCPCS,PART PULP FOR APEXOGENESIS,,,26 ,,NW,,,,,,$268.13,$0.00,1,0,1,1,1,1,20131001,D3230,HCPCS,PULPAL THERAPY ANTERIOR PRIM,,,26 ,,NW,,,,,,$256.62,$0.00,1,0,1,1,1,1,20131001,D3240,HCPCS,PULPAL THERAPY POSTERIOR PRI,,,26 ,,NW,,,,,,$300.43,$0.00,1,0,1,1,1,1,20131001,D3310,HCPCS,"END THXPY, ANTERIOR TOOTH",,,26 ,,NW,,,,,,$796.80,$0.00,1,0,1,1,1,1,20131001,D3320,HCPCS,"END THXPY, BICUSPID TOOTH",,,26 ,,NW,,,,,,$947.57,$0.00,1,0,1,1,1,1,20131001,D3330,HCPCS,"END THXPY, MOLAR",,,26 ,,NW,,,,,,"$1,161.99",$0.00,1,0,1,1,1,1,20131001,D3331,HCPCS,NON-SURG TX ROOT CANAL OBS,,,26 ,,NW,,,,,,$503.90,$0.00,1,0,1,1,1,1,20131001,D3332,HCPCS,INCOMPLETE ENDODONTIC TX,,,26 ,,NW,,,,,,$542.75,$0.00,1,0,1,1,1,1,20131001,D3333,HCPCS,INTERNAL ROOT REPAIR,,,26 ,,NW,,,,,,$332.12,$0.00,1,0,1,1,1,1,20131001,D3346,HCPCS,RETREAT ROOT CANAL ANTERIOR,,,26 ,,NW,,,,,,"$1,003.52",$0.00,1,0,1,1,1,1,20131001,D3347,HCPCS,RETREAT ROOT CANAL BICUSPID,,,26 ,,NW,,,,,,"$1,157.13",$0.00,1,0,1,1,1,1,20131001,D3348,HCPCS,RETREAT ROOT CANAL MOLAR,,,26 ,,NW,,,,,,"$1,410.74",$0.00,1,0,1,1,1,1,20131001,D3351,HCPCS,APEXIFICATION/RECALC INITIAL,,,26 ,,NW,,,,,,$431.12,$0.00,1,0,1,1,1,1,20131001,D3352,HCPCS,APEXIFICATION/RECALC INTERIM,,,26 ,,NW,,,,,,$250.05,$0.00,1,0,1,1,1,1,20131001,D3353,HCPCS,APEXIFICATION/RECALC FINAL,,,26 ,,NW,,,,,,$622.10,$0.00,1,0,1,1,1,1,20131001,D3354,HCPCS,PULPAL REGENERATION,,,26 ,,NW,,,,,,$546.20,$0.00,1,0,1,1,1,1,20131001,D3410,HCPCS,APICOECT/PERIRAD SURG ANTER,,,26 ,,NW,,,,,,$844.38,$0.00,1,0,1,1,1,1,20131001,D3421,HCPCS,ROOT SURGERY BICUSPID,,,26 ,,NW,,,,,,$939.02,$0.00,1,0,1,1,1,1,20131001,D3425,HCPCS,ROOT SURGERY MOLAR,,,26 ,,NW,,,,,,"$1,066.47",$0.00,1,0,1,1,1,1,20131001,D3426,HCPCS,ROOT SURGERY EA ADD ROOT,,,26 ,,NW,,,,,,$430.56,$0.00,1,0,1,1,1,1,20131001,D3430,HCPCS,RETROGRADE FILLING,,,26 ,,NW,,,,,,$298.33,$0.00,1,0,1,1,1,1,20131001,D3450,HCPCS,ROOT AMPUTATION,,,26 ,,NW,,,,,,$570.93,$0.00,1,0,1,1,1,1,20131001,D3460,HCPCS,ENDODONTIC ENDOSSEOUS IMPLAN,,,26 ,,NW,,,,,,"$1,976.52",$0.00,1,0,1,1,1,1,20131001,D3470,HCPCS,INTENTIONAL REPLANTATION,,,26 ,,NW,,,,,,"$1,013.76",$0.00,1,0,1,1,1,1,20131001,D3910,HCPCS,ISOLATION- TOOTH W RUBB DAM,,,26 ,,NW,,,,,,$212.43,$0.00,1,0,1,1,1,1,20131001,D3920,HCPCS,TOOTH SPLITTING,,,26 ,,NW,,,,,,$484.84,$0.00,1,0,1,1,1,1,20131001,D3950,HCPCS,CANAL PREP/FITTING OF DOWEL,,,26 ,,NW,,,,,,$252.62,$0.00,1,0,1,1,1,1,20131001,D3999,HCPCS,ENDODONTIC PROCEDURE,,,26 ,,NW,,,,,,$939.02,$0.00,1,0,1,1,1,1,20131001,D4210,HCPCS,GINGIVECTOMY/PLASTY 4 OR MOR,,,26 ,,NW,,,,,,$718.83,$0.00,1,0,1,1,1,1,20131001,D4211,HCPCS,GINGIVECTOMY/PLASTY 1 TO 3,,,26 ,,NW,,,,,,$336.13,$0.00,1,0,1,1,1,1,20131001,D4212,HCPCS,GINGIVECTOMY/PLASTY REST,,,26 ,,NW,,,,,,$336.13,$0.00,1,0,1,1,1,1,20131001,D4230,HCPCS,ANA CROWN EXP 4 OR> PER QUAD,,,26 ,,NW,,,,,,$930.97,$0.00,1,0,1,1,1,1,20131001,D4231,HCPCS,ANA CROWN EXP 1-3 PER QUAD,,,26 ,,NW,,,,,,$578.09,$0.00,1,0,1,1,1,1,20131001,D4240,HCPCS,GINGIVAL FLAP PROC W/ PLANIN,,,26 ,,NW,,,,,,$881.89,$0.00,1,0,1,1,1,1,20131001,D4241,HCPCS,GNGVL FLAP W ROOTPLAN 1-3 TH,,,26 ,,NW,,,,,,$620.66,$0.00,1,0,1,1,1,1,20131001,D4245,HCPCS,APICALLY POSITIONED FLAP,,,26 ,,NW,,,,,,$802.43,$0.00,1,0,1,1,1,1,20131001,D4249,HCPCS,CROWN LENGTHEN HARD TISSUE,,,26 ,,NW,,,,,,$941.81,$0.00,1,0,1,1,1,1,20131001,D4260,HCPCS,OSSEOUS SURGERY 4 OR MORE,,,26 ,,NW,,,,,,"$1,398.74",$0.00,1,0,1,1,1,1,20131001,D4261,HCPCS,OSSEOUS SURG 1 TO 3 TEETH,,,26 ,,NW,,,,,,$913.14,$0.00,1,0,1,1,1,1,20131001,D4263,HCPCS,BONE REPLCE GRAFT FIRST SITE,,,26 ,,NW,,,,,,$676.73,$0.00,1,0,1,1,1,1,20131001,D4264,HCPCS,BONE REPLCE GRAFT EACH ADD,,,26 ,,NW,,,,,,$553.95,$0.00,1,0,1,1,1,1,20131001,D4265,HCPCS,BIO MTRLS TO AID SOFT/OS REG,,,26 ,,NW,,,,,,$627.24,$0.00,1,0,1,1,1,1,20131001,D4266,HCPCS,GUIDED TISS REGEN RESORBLE,,,26 ,,NW,,,,,,$753.41,$0.00,1,0,1,1,1,1,20131001,D4267,HCPCS,GUIDED TISS REGEN NONRESORB,,,26 ,,NW,,,,,,$907.31,$0.00,1,0,1,1,1,1,20131001,D4268,HCPCS,SURGICAL REVISION PROCEDURE,,,26 ,,NW,,,,,,$841.80,$0.00,1,0,1,1,1,1,20131001,D4270,HCPCS,PEDICLE SOFT TISSUE GRAFT PR,,,26 ,,NW,,,,,,"$1,019.80",$0.00,1,0,1,1,1,1,20131001,D4273,HCPCS,SUBEPITHELIAL TISSUE GRAFT,,,26 ,,NW,,,,,,"$1,300.60",$0.00,1,0,1,1,1,1,20131001,D4274,HCPCS,DISTAL/PROXIMAL WEDGE PROC,,,26 ,,NW,,,,,,$753.64,$0.00,1,0,1,1,1,1,20131001,D4275,HCPCS,SOFT TISSUE ALLOGRAFT,,,26 ,,NW,,,,,,"$1,074.71",$0.00,1,0,1,1,1,1,20131001,D4276,HCPCS,CON TISSUE W DBLE PED GRAFT,,,26 ,,NW,,,,,,"$1,365.42",$0.00,1,0,1,1,1,1,20131001,D4277,HCPCS,SOFT TISSUE GRAFT FIRSTTOOTH,,,26 ,,NW,,,,,,"$1,084.53",$0.00,1,0,1,1,1,1,20131001,D4278,HCPCS,SOFT TISSUE GRAFT ADDL TOOTH,,,26 ,,NW,,,,,,"$1,084.53",$0.00,1,0,1,1,1,1,20131001,D4320,HCPCS,PROVISION SPLNT INTRACORONAL,,,26 ,,NW,,,,,,$508.22,$0.00,1,0,1,1,1,1,20131001,D4321,HCPCS,PROVISIONAL SPLINT EXTRACORO,,,26 ,,NW,,,,,,$464.07,$0.00,1,0,1,1,1,1,20131001,D4341,HCPCS,PERIODONTAL SCALING & ROOT,,,26 ,,NW,,,,,,$276.10,$0.00,1,0,1,1,1,1,20131001,D4342,HCPCS,PERIODONTAL SCALING 1-3TEETH,,,26 ,,NW,,,,,,$179.02,$0.00,1,0,1,1,1,1,20131001,D4355,HCPCS,FULL MOUTH DEBRIDEMENT,,,26 ,,NW,,,,,,$190.08,$0.00,1,0,1,1,1,1,20131001,D4381,HCPCS,LOCALIZED DELIVERY ANTIMICRO,,,26 ,,NW,,,,,,$140.63,$0.00,1,0,1,1,1,1,20131001,D4910,HCPCS,PERIODONTAL MAINT PROCEDURES,,,26 ,,NW,,,,,,$151.55,$0.00,1,0,1,1,1,1,20131001,D4920,HCPCS,UNSCHEDULED DRESSING CHANGE,,,26 ,,NW,,,,,,$114.60,$0.00,1,0,1,1,1,1,20131001,D4999,HCPCS,UNSPECIFIED PERIODONTAL PROC,,,26 ,,NW,,,,,,$179.02,$0.00,1,0,1,1,1,1,20131001,D5110,HCPCS,DENTURES COMPLETE MAXILLARY,,,27 ,,NW,,,,,,"$1,764.99",$0.00,1,0,1,1,1,1,20131001,D5120,HCPCS,DENTURES COMPLETE MANDIBLE,,,27 ,,NW,,,,,,"$1,764.99",$0.00,1,0,1,1,1,1,20131001,D5130,HCPCS,DENTURES IMMEDIAT MAXILLARY,,,27 ,,NW,,,,,,"$1,903.67",$0.00,1,0,1,1,1,1,20131001,D5140,HCPCS,DENTURES IMMEDIAT MANDIBLE,,,27 ,,NW,,,,,,"$1,904.18",$0.00,1,0,1,1,1,1,20131001,D5211,HCPCS,DENTURES MAXILL PART RESIN,,,27 ,,NW,,,,,,"$1,441.33",$0.00,1,0,1,1,1,1,20131001,D5212,HCPCS,DENTURES MAND PART RESIN,,,27 ,,NW,,,,,,"$1,554.68",$0.00,1,0,1,1,1,1,20131001,D5213,HCPCS,DENTURES MAXILL PART METAL,,,27 ,,NW,,,,,,"$1,888.82",$0.00,1,0,1,1,1,1,20131001,D5214,HCPCS,DENTURES MANDIBL PART METAL,,,27 ,,NW,,,,,,"$1,889.85",$0.00,1,0,1,1,1,1,20131001,D5225,HCPCS,MAXILLARY PART DENTURE FLEX,,,27 ,,NW,,,,,,"$1,570.07",$0.00,1,0,1,1,1,1,20131001,D5226,HCPCS,MANDIBULAR PART DENTURE FLEX,,,27 ,,NW,,,,,,"$1,665.40",$0.00,1,0,1,1,1,1,20131001,D5281,HCPCS,REMOVABLE PARTIAL DENTURE,,,27 ,,NW,,,,,,"$1,082.92",$0.00,1,0,1,1,1,1,20131001,D5410,HCPCS,DENTURES ADJUST CMPLT MAXIL,,,27 ,,NW,,,,,,$94.16,$0.00,1,0,1,1,1,1,20131001,D5411,HCPCS,DENTURES ADJUST CMPLT MAND,,,27 ,,NW,,,,,,$94.16,$0.00,1,0,1,1,1,1,20131001,D5421,HCPCS,DENTURES ADJUST PART MAXILL,,,27 ,,NW,,,,,,$94.16,$0.00,1,0,1,1,1,1,20131001,D5422,HCPCS,DENTURES ADJUST PART MANDBL,,,27 ,,NW,,,,,,$94.16,$0.00,1,0,1,1,1,1,20131001,D5510,HCPCS,DENTUR REPR BROKEN COMPL BAS,,,27 ,,NW,,,,,,$206.34,$0.00,1,0,1,1,1,1,20131001,D5520,HCPCS,REPLACE DENTURE TEETH COMPLT,,,27 ,,NW,,,,,,$178.56,$0.00,1,0,1,1,1,1,20131001,D5610,HCPCS,DENTURES REPAIR RESIN BASE,,,27 ,,NW,,,,,,$209.68,$0.00,1,0,1,1,1,1,20131001,D5620,HCPCS,REP PART DENTURE CAST FRAME,,,27 ,,NW,,,,,,$262.96,$0.00,1,0,1,1,1,1,20131001,D5630,HCPCS,REP PARTIAL DENTURE CLASP,,,27 ,,NW,,,,,,$271.94,$0.00,1,0,1,1,1,1,20131001,D5640,HCPCS,REPLACE PART DENTURE TEETH,,,27 ,,NW,,,,,,$186.02,$0.00,1,0,1,1,1,1,20131001,D5650,HCPCS,ADD TOOTH TO PARTIAL DENTURE,,,27 ,,NW,,,,,,$234.88,$0.00,1,0,1,1,1,1,20131001,D5660,HCPCS,ADD CLASP TO PARTIAL DENTURE,,,27 ,,NW,,,,,,$284.54,$0.00,1,0,1,1,1,1,20131001,D5670,HCPCS,REPLC TTH&ACRLC ON MTL FRMWK,,,27 ,,NW,,,,,,$742.52,$0.00,1,0,1,1,1,1,20131001,D5671,HCPCS,REPLC TTH&ACRLC MANDIBULAR,,,27 ,,NW,,,,,,$748.70,$0.00,1,0,1,1,1,1,20131001,D5710,HCPCS,DENTURES REBASE CMPLT MAXIL,,,27 ,,NW,,,,,,$659.21,$0.00,1,0,1,1,1,1,20131001,D5711,HCPCS,DENTURES REBASE CMPLT MAND,,,27 ,,NW,,,,,,$641.73,$0.00,1,0,1,1,1,1,20131001,D5720,HCPCS,DENTURES REBASE PART MAXILL,,,27 ,,NW,,,,,,$623.07,$0.00,1,0,1,1,1,1,20131001,D5721,HCPCS,DENTURES REBASE PART MANDBL,,,27 ,,NW,,,,,,$622.04,$0.00,1,0,1,1,1,1,20131001,D5730,HCPCS,DENTURE RELN CMPLT MAXIL CH,,,27 ,,NW,,,,,,$394.11,$0.00,1,0,1,1,1,1,20131001,D5731,HCPCS,DENTURE RELN CMPLT MAND CHR,,,27 ,,NW,,,,,,$392.05,$0.00,1,0,1,1,1,1,20131001,D5740,HCPCS,DENTURE RELN PART MAXIL CHR,,,27 ,,NW,,,,,,$373.82,$0.00,1,0,1,1,1,1,20131001,D5741,HCPCS,DENTURE RELN PART MAND CHR,,,27 ,,NW,,,,,,$376.39,$0.00,1,0,1,1,1,1,20131001,D5750,HCPCS,DENTURE RELN CMPLT MAX LAB,,,27 ,,NW,,,,,,$513.88,$0.00,1,0,1,1,1,1,20131001,D5751,HCPCS,DENTURE RELN CMPLT MAND LAB,,,27 ,,NW,,,,,,$513.88,$0.00,1,0,1,1,1,1,20131001,D5760,HCPCS,DENTURE RELN PART MAXIL LAB,,,27 ,,NW,,,,,,$505.52,$0.00,1,0,1,1,1,1,20131001,D5761,HCPCS,DENTURE RELN PART MAND LAB,,,27 ,,NW,,,,,,$505.52,$0.00,1,0,1,1,1,1,20131001,D5810,HCPCS,DENTURE INTERM CMPLT MAXILL,,,27 ,,NW,,,,,,$880.67,$0.00,1,0,1,1,1,1,20131001,D5811,HCPCS,DENTURE INTERM CMPLT MANDBL,,,27 ,,NW,,,,,,$909.97,$0.00,1,0,1,1,1,1,20131001,D5820,HCPCS,DENTURE INTERM PART MAXILL,,,27 ,,NW,,,,,,$695.44,$0.00,1,0,1,1,1,1,20131001,D5821,HCPCS,DENTURE INTERM PART MANDBL,,,27 ,,NW,,,,,,$714.07,$0.00,1,0,1,1,1,1,20131001,D5850,HCPCS,DENTURE TISS CONDITN MAXILL,,,27 ,,NW,,,,,,$194.65,$0.00,1,0,1,1,1,1,20131001,D5851,HCPCS,DENTURE TISS CONDTIN MANDBL,,,27 ,,NW,,,,,,$193.62,$0.00,1,0,1,1,1,1,20131001,D5860,HCPCS,OVERDENTURE COMPLETE,,,27 ,,NW,,,,,,"$2,429.64",$0.00,1,0,1,1,1,1,20131001,D5861,HCPCS,OVERDENTURE PARTIAL,,,27 ,,NW,,,,,,"$2,310.16",$0.00,1,0,1,1,1,1,20131001,D5862,HCPCS,PRECISION ATTACHMENT,,,27 ,,NW,,,,,,$794.09,$0.00,1,0,1,1,1,1,20131001,D5867,HCPCS,REPLACEMENT OF PRECISION ATT,,,27 ,,NW,,,,,,$365.30,$0.00,1,0,1,1,1,1,20131001,D5875,HCPCS,PROSTHESIS MODIFICATION,,,27 ,,NW,,,,,,$429.49,$0.00,1,0,1,1,1,1,20131001,D5899,HCPCS,REMOVABLE PROSTHODONTIC PROC,,,27 ,,NW,,,,,,$513.88,$0.00,1,0,1,1,1,1,20131001,D5911,HCPCS,FACIAL MOULAGE SECTIONAL,,,27 ,,NW,,,,,,$414.43,$0.00,1,0,1,1,1,1,20131001,D5912,HCPCS,FACIAL MOULAGE COMPLETE,,,27 ,,NW,,,,,,$414.43,$0.00,1,0,1,1,1,1,20131001,D5913,HCPCS,NASAL PROSTHESIS,,,27 ,,NW,,,,,,"$8,726.81",$0.00,1,0,1,1,1,1,20131001,D5914,HCPCS,AURICULAR PROSTHESIS,,,27 ,,NW,,,,,,"$8,726.81",$0.00,1,0,1,1,1,1,20131001,D5915,HCPCS,ORBITAL PROSTHESIS,,,27 ,,NW,,,,,,"$11,809.67",$0.00,1,0,1,1,1,1,20131001,D5916,HCPCS,OCULAR PROSTHESIS,,,27 ,,NW,,,,,,"$3,149.94",$0.00,1,0,1,1,1,1,20131001,D5919,HCPCS,FACIAL PROSTHESIS,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D5922,HCPCS,NASAL SEPTAL PROSTHESIS,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D5923,HCPCS,OCULAR PROSTHESIS INTERIM,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D5924,HCPCS,CRANIAL PROSTHESIS,,,27 ,,NW,,,,,,"$1,048.16",$0.00,1,0,1,1,1,1,20131001,D5925,HCPCS,FACIAL AUGMENTATION IMPLANT,,,27 ,,NW,,,,,,$337.18,$0.00,1,0,1,1,1,1,20131001,D5926,HCPCS,REPLACEMENT NASAL PROSTHESIS,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D5927,HCPCS,AURICULAR REPLACEMENT,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D5928,HCPCS,ORBITAL REPLACEMENT,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D5929,HCPCS,FACIAL REPLACEMENT,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D5931,HCPCS,SURGICAL OBTURATOR,,,27 ,,NW,,,,,,"$4,297.56",$0.00,1,0,1,1,1,1,20131001,D5932,HCPCS,POSTSURGICAL OBTURATOR,,,27 ,,NW,,,,,,"$7,869.28",$0.00,1,0,1,1,1,1,20131001,D5933,HCPCS,REFITTING OF OBTURATOR,,,27 ,,NW,,,,,,$274.60,$0.00,1,0,1,1,1,1,20131001,D5934,HCPCS,MANDIBULAR FLANGE PROSTHESIS,,,27 ,,NW,,,,,,"$8,009.77",$0.00,1,0,1,1,1,1,20131001,D5935,HCPCS,MANDIBULAR DENTURE PROSTH,,,27 ,,NW,,,,,,"$6,969.23",$0.00,1,0,1,1,1,1,20131001,D5936,HCPCS,TEMP OBTURATOR PROSTHESIS,,,27 ,,NW,,,,,,"$7,827.90",$0.00,1,0,1,1,1,1,20131001,D5937,HCPCS,TRISMUS APPLIANCE,,,27 ,,NW,,,,,,$885.38,$0.00,1,0,1,1,1,1,20131001,D5951,HCPCS,FEEDING AID,,,27 ,,NW,,,,,,"$1,147.29",$0.00,1,0,1,1,1,1,20131001,D5952,HCPCS,PEDIATRIC SPEECH AID,,,27 ,,NW,,,,,,"$4,153.21",$0.00,1,0,1,1,1,1,20131001,D5953,HCPCS,ADULT SPEECH AID,,,27 ,,NW,,,,,,"$7,887.52",$0.00,1,0,1,1,1,1,20131001,D5954,HCPCS,SUPERIMPOSED PROSTHESIS,,,27 ,,NW,,,,,,"$7,309.12",$0.00,1,0,1,1,1,1,20131001,D5955,HCPCS,PALATAL LIFT PROSTHESIS,,,27 ,,NW,,,,,,"$6,760.52",$0.00,1,0,1,1,1,1,20131001,D5958,HCPCS,INTRAORAL CON DEF INTER PLT,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D5959,HCPCS,INTRAORAL CON DEF MOD PALAT,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D5960,HCPCS,MODIFY SPEECH AID PROSTHESIS,,,27 ,,NW,,,,,,$496.31,$0.00,1,0,1,1,1,1,20131001,D5982,HCPCS,SURGICAL STENT,,,27 ,,NW,,,,,,$583.51,$0.00,1,0,1,1,1,1,20131001,D5983,HCPCS,RADIATION APPLICATOR,,,27 ,,NW,,,,,,"$1,344.72",$0.00,1,0,1,1,1,1,20131001,D5984,HCPCS,RADIATION SHIELD,,,27 ,,NW,,,,,,"$1,490.74",$0.00,1,0,1,1,1,1,20131001,D5985,HCPCS,RADIATION CONE LOCATOR,,,27 ,,NW,,,,,,"$1,490.74",$0.00,1,0,1,1,1,1,20131001,D5986,HCPCS,FLUORIDE APPLICATOR,,,27 ,,NW,,,,,,$195.56,$0.00,1,0,1,1,1,1,20131001,D5987,HCPCS,COMMISSURE SPLINT,,,27 ,,NW,,,,,,"$2,043.20",$0.00,1,0,1,1,1,1,20131001,D5988,HCPCS,SURGICAL SPLINT,,,27 ,,NW,,,,,,$617.24,$0.00,1,0,1,1,1,1,20131001,D5991,HCPCS,TOPICAL MEDICAMENT CARRIER,,,27 ,,NW,,,,,,$206.22,$0.00,1,0,1,1,1,1,20131001,D5992,HCPCS,ADJUST MAX PROST APPLIANCE,,,27 ,,NW,,,,,,$529.50,$0.00,1,0,1,1,1,1,20131001,D5993,HCPCS,MAIN/CLEAN MAX PROSTHESIS,,,27 ,,NW,,,,,,$529.50,$0.00,1,0,1,1,1,1,20131001,D5999,HCPCS,MAXILLOFACIAL PROSTHESIS,,,27 ,,NW,,,,,,"$1,375.99",$0.00,1,0,1,1,1,1,20131001,D6010,HCPCS,ODONTICS ENDOSTEAL IMPLANT,,,27 ,,NW,,,,,,"$2,473.51",$0.00,1,0,1,1,1,1,20131001,D6012,HCPCS,ENDOSTEAL IMPLANT,,,27 ,,NW,,,,,,"$2,171.64",$0.00,1,0,1,1,1,1,20131001,D6040,HCPCS,ODONTICS EPOSTEAL IMPLANT,,,27 ,,NW,,,,,,"$9,205.97",$0.00,1,0,1,1,1,1,20131001,D6050,HCPCS,ODONTICS TRANSOSTEAL IMPLNT,,,27 ,,NW,,,,,,"$6,621.92",$0.00,1,0,1,1,1,1,20131001,D6051,HCPCS,INTERIM ABUTMENT,,,27 ,,NW,,,,,,$724.57,$0.00,1,0,1,1,1,1,20131001,D6053,HCPCS,IMPLNT/ABTMNT SPPRT REMV DNT,,,27 ,,NW,,,,,,"$2,595.77",$0.00,1,0,1,1,1,1,20131001,D6054,HCPCS,IMPLNT/ABTMNT SPPRT REMVPRTL,,,27 ,,NW,,,,,,"$2,536.03",$0.00,1,0,1,1,1,1,20131001,D6055,HCPCS,IMPLANT CONNECTING BAR,,,27 ,,NW,,,,,,"$1,711.58",$0.00,1,0,1,1,1,1,20131001,D6056,HCPCS,PREFABRICATED ABUTMENT,,,27 ,,NW,,,,,,$724.57,$0.00,1,0,1,1,1,1,20131001,D6057,HCPCS,CUSTOM ABUTMENT,,,27 ,,NW,,,,,,$875.08,$0.00,1,0,1,1,1,1,20131001,D6058,HCPCS,ABUTMENT SUPPORTED CROWN,,,27 ,,NW,,,,,,"$1,591.04",$0.00,1,0,1,1,1,1,20131001,D6059,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,585.24",$0.00,1,0,1,1,1,1,20131001,D6060,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,512.88",$0.00,1,0,1,1,1,1,20131001,D6061,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,523.16",$0.00,1,0,1,1,1,1,20131001,D6062,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,550.04",$0.00,1,0,1,1,1,1,20131001,D6063,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,414.24",$0.00,1,0,1,1,1,1,20131001,D6064,HCPCS,ABUTMENT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,447.66",$0.00,1,0,1,1,1,1,20131001,D6065,HCPCS,IMPLANT SUPPORTED CROWN,,,27 ,,NW,,,,,,"$1,636.56",$0.00,1,0,1,1,1,1,20131001,D6066,HCPCS,IMPLANT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,617.98",$0.00,1,0,1,1,1,1,20131001,D6067,HCPCS,IMPLANT SUPPORTED MTL CROWN,,,27 ,,NW,,,,,,"$1,606.95",$0.00,1,0,1,1,1,1,20131001,D6068,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,584.33",$0.00,1,0,1,1,1,1,20131001,D6069,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,585.24",$0.00,1,0,1,1,1,1,20131001,D6070,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,489.71",$0.00,1,0,1,1,1,1,20131001,D6071,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,531.91",$0.00,1,0,1,1,1,1,20131001,D6072,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,581.02",$0.00,1,0,1,1,1,1,20131001,D6073,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,456.72",$0.00,1,0,1,1,1,1,20131001,D6074,HCPCS,ABUTMENT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,499.95",$0.00,1,0,1,1,1,1,20131001,D6075,HCPCS,IMPLANT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,630.89",$0.00,1,0,1,1,1,1,20131001,D6076,HCPCS,IMPLANT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,634.46",$0.00,1,0,1,1,1,1,20131001,D6077,HCPCS,IMPLANT SUPPORTED RETAINER,,,27 ,,NW,,,,,,"$1,618.28",$0.00,1,0,1,1,1,1,20131001,D6078,HCPCS,IMPLNT/ABUT SUPRTD FIXD DENT,,,27 ,,NW,,,,,,"$6,413.46",$0.00,1,0,1,1,1,1,20131001,D6079,HCPCS,IMPLNT/ABUT SUPRTD FIXD DENT,,,27 ,,NW,,,,,,"$4,390.65",$0.00,1,0,1,1,1,1,20131001,D6080,HCPCS,IMPLANT MAINTENANCE,,,27 ,,NW,,,,,,$203.37,$0.00,1,0,1,1,1,1,20131001,D6090,HCPCS,REPAIR IMPLANT,,,27 ,,NW,,,,,,$709.10,$0.00,1,0,1,1,1,1,20131001,D6091,HCPCS,REPL SEMI/PRECISION ATTACH,,,27 ,,NW,,,,,,$650.24,$0.00,1,0,1,1,1,1,20131001,D6092,HCPCS,RECEMENT SUPP CROWN,,,27 ,,NW,,,,,,$147.92,$0.00,1,0,1,1,1,1,20131001,D6093,HCPCS,RECEMENT SUPP PART DENTURE,,,27 ,,NW,,,,,,$194.05,$0.00,1,0,1,1,1,1,20131001,D6094,HCPCS,ABUT SUPPORT CROWN TITANIUM,,,27 ,,NW,,,,,,"$1,330.23",$0.00,1,0,1,1,1,1,20131001,D6095,HCPCS,ODONTICS REPR ABUTMENT,,,27 ,,NW,,,,,,$695.30,$0.00,1,0,1,1,1,1,20131001,D6100,HCPCS,REMOVAL OF IMPLANT,,,27 ,,NW,,,,,,$840.43,$0.00,1,0,1,1,1,1,20131001,D6101,HCPCS,DEBRIDEMENT OF A PERIIMPLANT,,,27 ,,NW,,,,,,$875.08,$0.00,1,0,1,1,1,1,20131001,D6102,HCPCS,DEBRIDEMENT & CONTOURING,,,27 ,,NW,,,,,,$875.08,$0.00,1,0,1,1,1,1,20131001,D6103,HCPCS,BONE GRAFT REPAIR PERIMPLANT,,,27 ,,NW,,,,,,$875.08,$0.00,1,0,1,1,1,1,20131001,D6104,HCPCS,BONE GRAFT TIME OF IMPLANT,,,27 ,,NW,,,,,,$875.08,$0.00,1,0,1,1,1,1,20131001,D6190,HCPCS,RADIO/SURGICAL IMPLANT INDEX,,,27 ,,NW,,,,,,$371.69,$0.00,1,0,1,1,1,1,20131001,D6194,HCPCS,ABUT SUPPORT RETAINER TITANI,,,27 ,,NW,,,,,,"$1,415.81",$0.00,1,0,1,1,1,1,20131001,D6199,HCPCS,IMPLANT PROCEDURE,,,27 ,,NW,,,,,,$875.08,$0.00,1,0,1,1,1,1,20131001,D6205,HCPCS,PONTIC-INDIRECT RESIN BASED,,,27 ,,NW,,,,,,$922.00,$0.00,1,0,1,1,1,1,20131001,D6210,HCPCS,PROSTHODONT HIGH NOBLE METAL,,,27 ,,NW,,,,,,"$1,177.84",$0.00,1,0,1,1,1,1,20131001,D6211,HCPCS,BRIDGE BASE METAL CAST,,,27 ,,NW,,,,,,"$1,101.97",$0.00,1,0,1,1,1,1,20131001,D6212,HCPCS,BRIDGE NOBLE METAL CAST,,,27 ,,NW,,,,,,"$1,132.97",$0.00,1,0,1,1,1,1,20131001,D6214,HCPCS,PONTIC TITANIUM,,,27 ,,NW,,,,,,"$1,196.91",$0.00,1,0,1,1,1,1,20131001,D6240,HCPCS,BRIDGE PORCELAIN HIGH NOBLE,,,27 ,,NW,,,,,,"$1,186.56",$0.00,1,0,1,1,1,1,20131001,D6241,HCPCS,BRIDGE PORCELAIN BASE METAL,,,27 ,,NW,,,,,,"$1,096.75",$0.00,1,0,1,1,1,1,20131001,D6242,HCPCS,BRIDGE PORCELAIN NOBEL METAL,,,27 ,,NW,,,,,,"$1,140.66",$0.00,1,0,1,1,1,1,20131001,D6245,HCPCS,BRIDGE PORCELAIN/CERAMIC,,,27 ,,NW,,,,,,"$1,216.51",$0.00,1,0,1,1,1,1,20131001,D6250,HCPCS,BRIDGE RESIN W/HIGH NOBLE,,,27 ,,NW,,,,,,"$1,156.14",$0.00,1,0,1,1,1,1,20131001,D6251,HCPCS,BRIDGE RESIN BASE METAL,,,27 ,,NW,,,,,,"$1,102.38",$0.00,1,0,1,1,1,1,20131001,D6252,HCPCS,BRIDGE RESIN W/NOBLE METAL,,,27 ,,NW,,,,,,"$1,119.04",$0.00,1,0,1,1,1,1,20131001,D6253,HCPCS,PROVISIONAL PONTIC,,,27 ,,NW,,,,,,$683.77,$0.00,1,0,1,1,1,1,20131001,D6545,HCPCS,DENTAL RETAINR CAST METL,,,27 ,,NW,,,,,,$686.05,$0.00,1,0,1,1,1,1,20131001,D6548,HCPCS,PORCELAIN/CERAMIC RETAINER,,,27 ,,NW,,,,,,$758.83,$0.00,1,0,1,1,1,1,20131001,D6600,HCPCS,PORCELAIN/CERAMIC INLAY 2SRF,,,27 ,,NW,,,,,,$975.96,$0.00,1,0,1,1,1,1,20131001,D6601,HCPCS,PORC/CERAM INLAY >= 3 SURFAC,,,27 ,,NW,,,,,,"$1,032.13",$0.00,1,0,1,1,1,1,20131001,D6602,HCPCS,CST HGH NBLE MTL INLAY 2 SRF,,,27 ,,NW,,,,,,"$1,010.64",$0.00,1,0,1,1,1,1,20131001,D6603,HCPCS,CST HGH NBLE MTL INLAY >=3SR,,,27 ,,NW,,,,,,"$1,078.95",$0.00,1,0,1,1,1,1,20131001,D6604,HCPCS,CST BSE MTL INLAY 2 SURFACES,,,27 ,,NW,,,,,,$989.77,$0.00,1,0,1,1,1,1,20131001,D6605,HCPCS,CST BSE MTL INLAY >= 3 SURFA,,,27 ,,NW,,,,,,"$1,047.62",$0.00,1,0,1,1,1,1,20131001,D6606,HCPCS,CAST NOBLE METAL INLAY 2 SUR,,,27 ,,NW,,,,,,$984.74,$0.00,1,0,1,1,1,1,20131001,D6607,HCPCS,CST NOBLE MTL INLAY >=3 SURF,,,27 ,,NW,,,,,,"$1,065.93",$0.00,1,0,1,1,1,1,20131001,D6608,HCPCS,ONLAY PORC/CRMC 2 SURFACES,,,27 ,,NW,,,,,,"$1,033.31",$0.00,1,0,1,1,1,1,20131001,D6609,HCPCS,ONLAY PORC/CRMC >=3 SURFACES,,,27 ,,NW,,,,,,"$1,123.34",$0.00,1,0,1,1,1,1,20131001,D6610,HCPCS,ONLAY CST HGH NBL MTL 2 SRFC,,,27 ,,NW,,,,,,"$1,089.36",$0.00,1,0,1,1,1,1,20131001,D6611,HCPCS,ONLAY CST HGH NBL MTL >=3SRF,,,27 ,,NW,,,,,,"$1,184.07",$0.00,1,0,1,1,1,1,20131001,D6612,HCPCS,ONLAY CST BASE MTL 2 SURFACE,,,27 ,,NW,,,,,,"$1,054.34",$0.00,1,0,1,1,1,1,20131001,D6613,HCPCS,ONLAY CST BASE MTL >=3 SURFA,,,27 ,,NW,,,,,,"$1,132.91",$0.00,1,0,1,1,1,1,20131001,D6614,HCPCS,ONLAY CST NBL MTL 2 SURFACES,,,27 ,,NW,,,,,,"$1,062.56",$0.00,1,0,1,1,1,1,20131001,D6615,HCPCS,ONLAY CST NBL MTL >=3 SURFAC,,,27 ,,NW,,,,,,"$1,137.91",$0.00,1,0,1,1,1,1,20131001,D6624,HCPCS,INLAY TITANIUM,,,27 ,,NW,,,,,,"$1,051.84",$0.00,1,0,1,1,1,1,20131001,D6634,HCPCS,ONLAY TITANIUM,,,27 ,,NW,,,,,,"$1,097.07",$0.00,1,0,1,1,1,1,20131001,D6710,HCPCS,CROWN-INDIRECT RESIN BASED,,,27 ,,NW,,,,,,"$1,031.04",$0.00,1,0,1,1,1,1,20131001,D6720,HCPCS,RETAIN CROWN RESIN W HI NBLE,,,27 ,,NW,,,,,,"$1,150.27",$0.00,1,0,1,1,1,1,20131001,D6721,HCPCS,CROWN RESIN W/BASE METAL,,,27 ,,NW,,,,,,"$1,106.83",$0.00,1,0,1,1,1,1,20131001,D6722,HCPCS,CROWN RESIN W/NOBLE METAL,,,27 ,,NW,,,,,,"$1,125.26",$0.00,1,0,1,1,1,1,20131001,D6740,HCPCS,CROWN PORCELAIN/CERAMIC,,,27 ,,NW,,,,,,"$1,232.32",$0.00,1,0,1,1,1,1,20131001,D6750,HCPCS,CROWN PORCELAIN HIGH NOBLE,,,27 ,,NW,,,,,,"$1,198.82",$0.00,1,0,1,1,1,1,20131001,D6751,HCPCS,CROWN PORCELAIN BASE METAL,,,27 ,,NW,,,,,,"$1,101.43",$0.00,1,0,1,1,1,1,20131001,D6752,HCPCS,CROWN PORCELAIN NOBLE METAL,,,27 ,,NW,,,,,,"$1,132.86",$0.00,1,0,1,1,1,1,20131001,D6780,HCPCS,CROWN 3/4 HIGH NOBLE METAL,,,27 ,,NW,,,,,,"$1,139.67",$0.00,1,0,1,1,1,1,20131001,D6781,HCPCS,CROWN 3/4 CAST BASED METAL,,,27 ,,NW,,,,,,"$1,115.99",$0.00,1,0,1,1,1,1,20131001,D6782,HCPCS,CROWN 3/4 CAST NOBLE METAL,,,27 ,,NW,,,,,,"$1,090.69",$0.00,1,0,1,1,1,1,20131001,D6783,HCPCS,CROWN 3/4 PORCELAIN/CERAMIC,,,27 ,,NW,,,,,,"$1,172.27",$0.00,1,0,1,1,1,1,20131001,D6790,HCPCS,CROWN FULL HIGH NOBLE METAL,,,27 ,,NW,,,,,,"$1,169.05",$0.00,1,0,1,1,1,1,20131001,D6791,HCPCS,CROWN FULL BASE METAL CAST,,,27 ,,NW,,,,,,"$1,091.11",$0.00,1,0,1,1,1,1,20131001,D6792,HCPCS,CROWN FULL NOBLE METAL CAST,,,27 ,,NW,,,,,,"$1,128.99",$0.00,1,0,1,1,1,1,20131001,D6793,HCPCS,PROVISIONAL RETAINER CROWN,,,27 ,,NW,,,,,,$532.75,$0.00,1,0,1,1,1,1,20131001,D6794,HCPCS,CROWN TITANIUM,,,27 ,,NW,,,,,,"$1,136.20",$0.00,1,0,1,1,1,1,20131001,D6920,HCPCS,DENTAL CONNECTOR BAR,,,27 ,,NW,,,,,,$558.50,$0.00,1,0,1,1,1,1,20131001,D6930,HCPCS,DENTAL RECEMENT BRIDGE,,,27 ,,NW,,,,,,$175.62,$0.00,1,0,1,1,1,1,20131001,D6940,HCPCS,STRESS BREAKER,,,27 ,,NW,,,,,,$422.99,$0.00,1,0,1,1,1,1,20131001,D6950,HCPCS,PRECISION ATTACHMENT,,,27 ,,NW,,,,,,$712.79,$0.00,1,0,1,1,1,1,20131001,D6975,HCPCS,COPING,,,27 ,,NW,,,,,,$778.10,$0.00,1,0,1,1,1,1,20131001,D6980,HCPCS,FIXED PARTIAL REPAIR,,,27 ,,NW,,,,,,$437.73,$0.00,1,0,1,1,1,1,20131001,D6985,HCPCS,PEDIATRIC PARTIAL DENTURE FX,,,27 ,,NW,,,,,,$803.12,$0.00,1,0,1,1,1,1,20131001,D6999,HCPCS,FIXED PROSTHODONTIC PROC,,,27 ,,NW,,,,,,"$1,186.56",$0.00,1,0,1,1,1,1,20131001,D7111,HCPCS,EXTRACTION CORONAL REMNANTS,,,26 ,,NW,,,,,,$141.45,$0.00,1,0,1,1,1,1,20131001,D7140,HCPCS,EXTRACTION ERUPTED TOOTH/EXR,,,26 ,,NW,,,,,,$184.84,$0.00,1,0,1,1,1,1,20131001,D7210,HCPCS,REM IMP TOOTH W MUCOPER FLP,,,26 ,,NW,,,,,,$302.26,$0.00,1,0,1,1,1,1,20131001,D7220,HCPCS,IMPACT TOOTH REMOV SOFT TISS,,,26 ,,NW,,,,,,$352.25,$0.00,1,0,1,1,1,1,20131001,D7230,HCPCS,IMPACT TOOTH REMOV PART BONY,,,26 ,,NW,,,,,,$457.84,$0.00,1,0,1,1,1,1,20131001,D7240,HCPCS,IMPACT TOOTH REMOV COMP BONY,,,26 ,,NW,,,,,,$547.72,$0.00,1,0,1,1,1,1,20131001,D7241,HCPCS,IMPACT TOOTH REM BONY W/COMP,,,26 ,,NW,,,,,,$671.06,$0.00,1,0,1,1,1,1,20131001,D7250,HCPCS,TOOTH ROOT REMOVAL,,,26 ,,NW,,,,,,$324.11,$0.00,1,0,1,1,1,1,20131001,D7251,HCPCS,CORONECTOMY,,,26 ,,NW,,,,,,$519.35,$0.00,1,0,1,1,1,1,20131001,D7260,HCPCS,ORAL ANTRAL FISTULA CLOSURE,,,26 ,,NW,,,,,,"$1,622.54",$0.00,1,0,1,1,1,1,20131001,D7261,HCPCS,PRIMARY CLOSURE SINUS PERF,,,26 ,,NW,,,,,,$850.46,$0.00,1,0,1,1,1,1,20131001,D7270,HCPCS,TOOTH REIMPLANTATION,,,26 ,,NW,,,,,,$612.61,$0.00,1,0,1,1,1,1,20131001,D7272,HCPCS,TOOTH TRANSPLANTATION,,,26 ,,NW,,,,,,$829.86,$0.00,1,0,1,1,1,1,20131001,D7280,HCPCS,EXPOSURE IMPACT TOOTH ORTHOD,,,26 ,,NW,,,,,,$543.11,$0.00,1,0,1,1,1,1,20131001,D7282,HCPCS,MOBILIZE ERUPTED/MALPOS TOOT,,,26 ,,NW,,,,,,$435.57,$0.00,1,0,1,1,1,1,20131001,D7283,HCPCS,PLACE DEVICE IMPACTED TOOTH,,,26 ,,NW,,,,,,$349.98,$0.00,1,0,1,1,1,1,20131001,D7285,HCPCS,BIOPSY OF ORAL TISSUE HARD,,,26 ,,NW,,,,,,$814.82,$0.00,1,0,1,1,1,1,20131001,D7286,HCPCS,BIOPSY OF ORAL TISSUE SOFT,,,26 ,,NW,,,,,,$421.08,$0.00,1,0,1,1,1,1,20131001,D7287,HCPCS,EXFOLIATIVE CYTOLOG COLLECT,,,26 ,,NW,,,,,,$200.36,$0.00,1,0,1,1,1,1,20131001,D7288,HCPCS,BRUSH BIOPSY,,,26 ,,NW,,,,,,$204.48,$0.00,1,0,1,1,1,1,20131001,D7290,HCPCS,REPOSITIONING OF TEETH,,,26 ,,NW,,,,,,$529.23,$0.00,1,0,1,1,1,1,20131001,D7291,HCPCS,TRANSSEPTAL FIBEROTOMY,,,26 ,,NW,,,,,,$311.07,$0.00,1,0,1,1,1,1,20131001,D7292,HCPCS,SCREW RETAINED PLATE,,,26 ,,NW,,,,,,"$1,704.87",$0.00,1,0,1,1,1,1,20131001,D7293,HCPCS,TEMP ANCHORAGE DEV W FLAP,,,26 ,,NW,,,,,,"$1,342.51",$0.00,1,0,1,1,1,1,20131001,D7294,HCPCS,TEMP ANCHORAGE DEV W/O FLAP,,,26 ,,NW,,,,,,$893.01,$0.00,1,0,1,1,1,1,20131001,D7295,HCPCS,"BONE HARVEST,AUTO GRAFT PROC",,,26 ,,NW,,,,,,$659.60,$0.00,1,0,1,1,1,1,20131001,D7310,HCPCS,ALVEOPLASTY W/ EXTRACTION,,,26 ,,NW,,,,,,$391.20,$0.00,1,0,1,1,1,1,20131001,D7311,HCPCS,ALVEOLOPLASTY W/EXTRACT 1-3,,,26 ,,NW,,,,,,$367.51,$0.00,1,0,1,1,1,1,20131001,D7320,HCPCS,ALVEOPLASTY W/O EXTRACTION,,,26 ,,NW,,,,,,$607.15,$0.00,1,0,1,1,1,1,20131001,D7321,HCPCS,ALVEOLOPLASTY NOT W/EXTRACTS,,,26 ,,NW,,,,,,$540.51,$0.00,1,0,1,1,1,1,20131001,D7340,HCPCS,VESTIBULOPLASTY RIDGE EXTENS,,,26 ,,NW,,,,,,"$2,136.21",$0.00,1,0,1,1,1,1,20131001,D7350,HCPCS,VESTIBULOPLASTY EXTEN GRAFT,,,26 ,,NW,,,,,,"$5,108.33",$0.00,1,0,1,1,1,1,20131001,D7410,HCPCS,RAD EXC LESION UP TO 1.25 CM,,,26 ,,NW,,,,,,$828.50,$0.00,1,0,1,1,1,1,20131001,D7411,HCPCS,EXCISION BENIGN LESION>1.25C,,,26 ,,NW,,,,,,"$1,292.24",$0.00,1,0,1,1,1,1,20131001,D7412,HCPCS,EXCISION BENIGN LESION COMPL,,,26 ,,NW,,,,,,"$1,683.60",$0.00,1,0,1,1,1,1,20131001,D7413,HCPCS,EXCISION MALIG LESION<=1.25C,,,26 ,,NW,,,,,,"$1,194.35",$0.00,1,0,1,1,1,1,20131001,D7414,HCPCS,EXCISION MALIG LESION>1.25CM,,,26 ,,NW,,,,,,"$1,810.20",$0.00,1,0,1,1,1,1,20131001,D7415,HCPCS,EXCISION MALIG LES COMPLICAT,,,26 ,,NW,,,,,,"$1,968.04",$0.00,1,0,1,1,1,1,20131001,D7440,HCPCS,MALIG TUMOR EXC TO 1.25 CM,,,26 ,,NW,,,,,,"$1,338.60",$0.00,1,0,1,1,1,1,20131001,D7441,HCPCS,MALIG TUMOR > 1.25 CM,,,26 ,,NW,,,,,,"$2,264.88",$0.00,1,0,1,1,1,1,20131001,D7450,HCPCS,REM ODONTOGEN CYST TO 1.25CM,,,26 ,,NW,,,,,,"$1,010.70",$0.00,1,0,1,1,1,1,20131001,D7451,HCPCS,REM ODONTOGEN CYST > 1.25 CM,,,26 ,,NW,,,,,,"$1,394.21",$0.00,1,0,1,1,1,1,20131001,D7460,HCPCS,REM NONODONTO CYST TO 1.25CM,,,26 ,,NW,,,,,,$984.62,$0.00,1,0,1,1,1,1,20131001,D7461,HCPCS,REM NONODONTO CYST > 1.25 CM,,,26 ,,NW,,,,,,"$1,445.99",$0.00,1,0,1,1,1,1,20131001,D7465,HCPCS,LESION DESTRUCTION,,,26 ,,NW,,,,,,$615.90,$0.00,1,0,1,1,1,1,20131001,D7471,HCPCS,REM EXOSTOSIS ANY SITE,,,26 ,,NW,,,,,,"$1,205.95",$0.00,1,0,1,1,1,1,20131001,D7472,HCPCS,REMOVAL OF TORUS PALATINUS,,,26 ,,NW,,,,,,"$1,462.67",$0.00,1,0,1,1,1,1,20131001,D7473,HCPCS,REMOVE TORUS MANDIBULARIS,,,26 ,,NW,,,,,,"$1,356.88",$0.00,1,0,1,1,1,1,20131001,D7485,HCPCS,SURG REDUCT OSSEOUSTUBEROSIT,,,26 ,,NW,,,,,,"$1,232.83",$0.00,1,0,1,1,1,1,20131001,D7490,HCPCS,MAXILLA OR MANDIBLE RESECTIO,,,26 ,,NW,,,,,,"$11,127.93",$0.00,1,0,1,1,1,1,20131001,D7510,HCPCS,I&D ABSC INTRAORAL SOFT TISS,,,26 ,,NW,,,,,,$370.38,$0.00,1,0,1,1,1,1,20131001,D7511,HCPCS,INCISION/DRAIN ABSCESS INTRA,,,26 ,,NW,,,,,,$567.19,$0.00,1,0,1,1,1,1,20131001,D7520,HCPCS,I&D ABSCESS EXTRAORAL,,,26 ,,NW,,,,,,"$1,283.00",$0.00,1,0,1,1,1,1,20131001,D7521,HCPCS,INCISION/DRAIN ABSCESS EXTRA,,,26 ,,NW,,,,,,"$1,462.44",$0.00,1,0,1,1,1,1,20131001,D7530,HCPCS,REMOVAL FB SKIN/AREOLAR TISS,,,26 ,,NW,,,,,,$606.66,$0.00,1,0,1,1,1,1,20131001,D7540,HCPCS,REMOVAL OF FB REACTION,,,26 ,,NW,,,,,,$834.21,$0.00,1,0,1,1,1,1,20131001,D7550,HCPCS,REMOVAL OF SLOUGHED OFF BONE,,,26 ,,NW,,,,,,$613.00,$0.00,1,0,1,1,1,1,20131001,D7560,HCPCS,MAXILLARY SINUSOTOMY,,,26 ,,NW,,,,,,"$3,085.51",$0.00,1,0,1,1,1,1,20131001,D7610,HCPCS,MAXILLA OPEN REDUCT SIMPLE,,,26 ,,NW,,,,,,"$6,160.83",$0.00,1,0,1,1,1,1,20131001,D7620,HCPCS,CLSD REDUCT SIMPL MAXILLA FX,,,26 ,,NW,,,,,,"$4,935.67",$0.00,1,0,1,1,1,1,20131001,D7630,HCPCS,OPEN RED SIMPL MANDIBLE FX,,,26 ,,NW,,,,,,"$7,114.22",$0.00,1,0,1,1,1,1,20131001,D7640,HCPCS,CLSD RED SIMPL MANDIBLE FX,,,26 ,,NW,,,,,,"$4,867.44",$0.00,1,0,1,1,1,1,20131001,D7650,HCPCS,OPEN RED SIMP MALAR/ZYGOM FX,,,26 ,,NW,,,,,,"$4,691.87",$0.00,1,0,1,1,1,1,20131001,D7660,HCPCS,CLSD RED SIMP MALAR/ZYGOM FX,,,26 ,,NW,,,,,,"$3,281.20",$0.00,1,0,1,1,1,1,20131001,D7670,HCPCS,CLOSD RDUCTN SPLINT ALVEOLUS,,,26 ,,NW,,,,,,"$2,078.80",$0.00,1,0,1,1,1,1,20131001,D7671,HCPCS,ALVEOLUS OPEN REDUCTION,,,26 ,,NW,,,,,,"$2,456.78",$0.00,1,0,1,1,1,1,20131001,D7680,HCPCS,REDUCT SIMPLE FACIAL BONE FX,,,26 ,,NW,,,,,,"$10,716.82",$0.00,1,0,1,1,1,1,20131001,D7710,HCPCS,MAXILLA OPEN REDUCT COMPOUND,,,26 ,,NW,,,,,,"$6,920.75",$0.00,1,0,1,1,1,1,20131001,D7720,HCPCS,CLSD REDUCT COMPD MAXILLA FX,,,26 ,,NW,,,,,,"$4,814.17",$0.00,1,0,1,1,1,1,20131001,D7730,HCPCS,OPEN REDUCT COMPD MANDBLE FX,,,26 ,,NW,,,,,,"$8,728.73",$0.00,1,0,1,1,1,1,20131001,D7740,HCPCS,CLSD REDUCT COMPD MANDBLE FX,,,26 ,,NW,,,,,,"$5,052.07",$0.00,1,0,1,1,1,1,20131001,D7750,HCPCS,OPEN RED COMP MALAR/ZYGMA FX,,,26 ,,NW,,,,,,"$6,098.01",$0.00,1,0,1,1,1,1,20131001,D7760,HCPCS,CLSD RED COMP MALAR/ZYGMA FX,,,26 ,,NW,,,,,,"$4,261.84",$0.00,1,0,1,1,1,1,20131001,D7770,HCPCS,OPEN REDUC COMPD ALVEOLUS FX,,,26 ,,NW,,,,,,"$3,589.23",$0.00,1,0,1,1,1,1,20131001,D7771,HCPCS,ALVEOLUS CLSD REDUC STBLZ TE,,,26 ,,NW,,,,,,"$2,689.28",$0.00,1,0,1,1,1,1,20131001,D7780,HCPCS,REDUCT COMPND FACIAL BONE FX,,,26 ,,NW,,,,,,"$14,086.60",$0.00,1,0,1,1,1,1,20131001,D7810,HCPCS,TMJ OPEN REDUCT-DISLOCATION,,,26 ,,NW,,,,,,"$6,437.64",$0.00,1,0,1,1,1,1,20131001,D7820,HCPCS,CLOSED TMP MANIPULATION,,,26 ,,NW,,,,,,"$1,027.78",$0.00,1,0,1,1,1,1,20131001,D7830,HCPCS,TMJ MANIPULATION UNDER ANEST,,,26 ,,NW,,,,,,$901.77,$0.00,1,0,1,1,1,1,20131001,D7840,HCPCS,REMOVAL OF TMJ CONDYLE,,,26 ,,NW,,,,,,"$9,091.23",$0.00,1,0,1,1,1,1,20131001,D7850,HCPCS,TMJ MENISCECTOMY,,,26 ,,NW,,,,,,"$8,202.90",$0.00,1,0,1,1,1,1,20131001,D7852,HCPCS,TMJ REPAIR OF JOINT DISC,,,26 ,,NW,,,,,,"$8,627.88",$0.00,1,0,1,1,1,1,20131001,D7854,HCPCS,TMJ EXCISN OF JOINT MEMBRANE,,,26 ,,NW,,,,,,"$8,636.49",$0.00,1,0,1,1,1,1,20131001,D7856,HCPCS,TMJ CUTTING OF A MUSCLE,,,26 ,,NW,,,,,,"$6,384.30",$0.00,1,0,1,1,1,1,20131001,D7858,HCPCS,TMJ RECONSTRUCTION,,,26 ,,NW,,,,,,"$21,265.51",$0.00,1,0,1,1,1,1,20131001,D7860,HCPCS,TMJ CUTTING INTO JOINT,,,26 ,,NW,,,,,,"$9,412.57",$0.00,1,0,1,1,1,1,20131001,D7865,HCPCS,TMJ RESHAPING COMPONENTS,,,26 ,,NW,,,,,,"$14,295.18",$0.00,1,0,1,1,1,1,20131001,D7870,HCPCS,TMJ ASPIRATION JOINT FLUID,,,26 ,,NW,,,,,,$562.76,$0.00,1,0,1,1,1,1,20131001,D7871,HCPCS,LYSIS + LAVAGE W CATHETERS,,,26 ,,NW,,,,,,$995.18,$0.00,1,0,1,1,1,1,20131001,D7872,HCPCS,TMJ DIAGNOSTIC ARTHROSCOPY,,,26 ,,NW,,,,,,"$5,152.16",$0.00,1,0,1,1,1,1,20131001,D7873,HCPCS,TMJ ARTHROSCOPY LYSIS ADHESN,,,26 ,,NW,,,,,,"$6,442.13",$0.00,1,0,1,1,1,1,20131001,D7874,HCPCS,TMJ ARTHROSCOPY DISC REPOSIT,,,26 ,,NW,,,,,,"$8,898.23",$0.00,1,0,1,1,1,1,20131001,D7875,HCPCS,TMJ ARTHROSCOPY SYNOVECTOMY,,,26 ,,NW,,,,,,"$9,748.18",$0.00,1,0,1,1,1,1,20131001,D7876,HCPCS,TMJ ARTHROSCOPY DISCECTOMY,,,26 ,,NW,,,,,,"$10,509.98",$0.00,1,0,1,1,1,1,20131001,D7877,HCPCS,TMJ ARTHROSCOPY DEBRIDEMENT,,,26 ,,NW,,,,,,"$9,275.99",$0.00,1,0,1,1,1,1,20131001,D7880,HCPCS,OCCLUSAL ORTHOTIC APPLIANCE,,,26 ,,NW,,,,,,"$1,252.46",$0.00,1,0,1,1,1,1,20131001,D7899,HCPCS,TMJ UNSPECIFIED THERAPY,,,26 ,,NW,,,,,,"$1,252.46",$0.00,1,0,1,1,1,1,20131001,D7910,HCPCS,DENT SUTUR RECENT WND TO 5CM,,,26 ,,NW,,,,,,$528.50,$0.00,1,0,1,1,1,1,20131001,D7911,HCPCS,DENTAL SUTURE WOUND TO 5 CM,,,26 ,,NW,,,,,,"$1,047.21",$0.00,1,0,1,1,1,1,20131001,D7912,HCPCS,SUTURE COMPLICATE WND > 5 CM,,,26 ,,NW,,,,,,"$1,872.16",$0.00,1,0,1,1,1,1,20131001,D7920,HCPCS,DENTAL SKIN GRAFT,,,26 ,,NW,,,,,,"$4,208.54",$0.00,1,0,1,1,1,1,20131001,D7921,HCPCS,COLLECT & APPL BLOOD PRODUCT,,,26 ,,NW,,,,,,$644.40,$0.00,1,0,1,1,1,1,20131001,D7940,HCPCS,RESHAPING BONE ORTHOGNATHIC,,,26 ,,NW,,,,,,"$3,562.18",$0.00,1,0,1,1,1,1,20131001,D7941,HCPCS,BONE CUTTING RAMUS CLOSED,,,26 ,,NW,,,,,,"$11,687.77",$0.00,1,0,1,1,1,1,20131001,D7943,HCPCS,CUTTING RAMUS OPEN W/GRAFT,,,26 ,,NW,,,,,,"$10,652.82",$0.00,1,0,1,1,1,1,20131001,D7944,HCPCS,BONE CUTTING SEGMENTED,,,26 ,,NW,,,,,,"$9,121.60",$0.00,1,0,1,1,1,1,20131001,D7945,HCPCS,BONE CUTTING BODY MANDIBLE,,,26 ,,NW,,,,,,"$11,321.35",$0.00,1,0,1,1,1,1,20131001,D7946,HCPCS,RECONSTRUCTION MAXILLA TOTAL,,,26 ,,NW,,,,,,"$13,610.44",$0.00,1,0,1,1,1,1,20131001,D7947,HCPCS,RECONSTRUCT MAXILLA SEGMENT,,,26 ,,NW,,,,,,"$12,496.43",$0.00,1,0,1,1,1,1,20131001,D7948,HCPCS,RECONSTRUCT MIDFACE NO GRAFT,,,26 ,,NW,,,,,,"$15,707.10",$0.00,1,0,1,1,1,1,20131001,D7949,HCPCS,RECONSTRUCT MIDFACE W/GRAFT,,,26 ,,NW,,,,,,"$19,969.27",$0.00,1,0,1,1,1,1,20131001,D7950,HCPCS,MANDIBLE GRAFT,,,26 ,,NW,,,,,,"$3,079.26",$0.00,1,0,1,1,1,1,20131001,D7951,HCPCS,SINUS AUG W BONE OR BONE SUB,,,26 ,,NW,,,,,,"$3,627.46",$0.00,1,0,1,1,1,1,20131001,D7952,HCPCS,SINUS AUGMENTATION VERTICAL,,,26 ,,NW,,,,,,"$3,627.46",$0.00,1,0,1,1,1,1,20131001,D7953,HCPCS,BONE REPLACEMENT GRAFT,,,26 ,,NW,,,,,,$644.40,$0.00,1,0,1,1,1,1,20131001,D7955,HCPCS,REPAIR MAXILLOFACIAL DEFECTS,,,26 ,,NW,,,,,,"$3,485.75",$0.00,1,0,1,1,1,1,20131001,D7960,HCPCS,FRENULECTOMY/FRENECTOMY,,,26 ,,NW,,,,,,$591.50,$0.00,1,0,1,1,1,1,20131001,D7963,HCPCS,FRENULOPLASTY,,,26 ,,NW,,,,,,$777.76,$0.00,1,0,1,1,1,1,20131001,D7970,HCPCS,EXCISION HYPERPLASTIC TISSUE,,,26 ,,NW,,,,,,$726.28,$0.00,1,0,1,1,1,1,20131001,D7971,HCPCS,EXCISION PERICORONAL GINGIVA,,,26 ,,NW,,,,,,$334.58,$0.00,1,0,1,1,1,1,20131001,D7972,HCPCS,SURG REDCT FIBROUS TUBEROSIT,,,26 ,,NW,,,,,,"$1,037.82",$0.00,1,0,1,1,1,1,20131001,D7980,HCPCS,SIALOLITHOTOMY,,,26 ,,NW,,,,,,"$1,156.28",$0.00,1,0,1,1,1,1,20131001,D7981,HCPCS,EXCISION OF SALIVARY GLAND,,,26 ,,NW,,,,,,$642.57,$0.00,1,0,1,1,1,1,20131001,D7982,HCPCS,SIALODOCHOPLASTY,,,26 ,,NW,,,,,,"$2,521.12",$0.00,1,0,1,1,1,1,20131001,D7983,HCPCS,CLOSURE OF SALIVARY FISTULA,,,26 ,,NW,,,,,,"$2,480.19",$0.00,1,0,1,1,1,1,20131001,D7990,HCPCS,EMERGENCY TRACHEOTOMY,,,26 ,,NW,,,,,,"$2,215.36",$0.00,1,0,1,1,1,1,20131001,D7991,HCPCS,DENTAL CORONOIDECTOMY,,,26 ,,NW,,,,,,"$6,007.14",$0.00,1,0,1,1,1,1,20131001,D7995,HCPCS,SYNTHETIC GRAFT FACIAL BONES,,,26 ,,NW,,,,,,$483.30,$0.00,1,0,1,1,1,1,20131001,D7996,HCPCS,IMPLANT MANDIBLE FOR AUGMENT,,,26 ,,NW,,,,,,"$2,032.07",$0.00,1,0,1,1,1,1,20131001,D7997,HCPCS,APPLIANCE REMOVAL,,,26 ,,NW,,,,,,$449.39,$0.00,1,0,1,1,1,1,20131001,D7998,HCPCS,INTRAORAL PLACE OF FIX DEV,,,26 ,,NW,,,,,,"$2,657.43",$0.00,1,0,1,1,1,1,20131001,D7999,HCPCS,ORAL SURGERY PROCEDURE,,,26 ,,NW,,,,,,$644.40,$0.00,1,0,1,1,1,1,20131001,D8010,HCPCS,LIMITED DENTAL TX PRIMARY,,,27 ,,NW,,,,,,"$2,438.91",$0.00,1,0,1,1,1,1,20131001,D8020,HCPCS,LIMITED DENTAL TX TRANSITION,,,27 ,,NW,,,,,,"$2,904.44",$0.00,1,0,1,1,1,1,20131001,D8030,HCPCS,LIMITED DENTAL TX ADOLESCENT,,,27 ,,NW,,,,,,"$3,431.77",$0.00,1,0,1,1,1,1,20131001,D8040,HCPCS,LIMITED DENTAL TX ADULT,,,27 ,,NW,,,,,,"$3,704.71",$0.00,1,0,1,1,1,1,20131001,D8050,HCPCS,INTERCEP DENTAL TX PRIMARY,,,27 ,,NW,,,,,,"$2,913.71",$0.00,1,0,1,1,1,1,20131001,D8060,HCPCS,INTERCEP DENTAL TX TRANSITN,,,27 ,,NW,,,,,,"$3,071.29",$0.00,1,0,1,1,1,1,20131001,D8070,HCPCS,COMPRE DENTAL TX TRANSITION,,,27 ,,NW,,,,,,"$5,691.47",$0.00,1,0,1,1,1,1,20131001,D8080,HCPCS,COMPRE DENTAL TX ADOLESCENT,,,27 ,,NW,,,,,,"$5,750.18",$0.00,1,0,1,1,1,1,20131001,D8090,HCPCS,COMPRE DENTAL TX ADULT,,,27 ,,NW,,,,,,"$5,777.98",$0.00,1,0,1,1,1,1,20131001,D8210,HCPCS,ORTHODONTIC REM APPLIANCE TX,,,27 ,,NW,,,,,,$953.73,$0.00,1,0,1,1,1,1,20131001,D8220,HCPCS,FIXED APPLIANCE THERAPY HABT,,,27 ,,NW,,,,,,"$1,127.79",$0.00,1,0,1,1,1,1,20131001,D8660,HCPCS,PREORTHODONTIC TX VISIT,,,27 ,,NW,,,,,,$451.12,$0.00,1,0,1,1,1,1,20131001,D8670,HCPCS,PERIODIC ORTHODONTC TX VISIT,,,27 ,,NW,,,,,,$294.56,$0.00,1,0,1,1,1,1,20131001,D8680,HCPCS,ORTHODONTIC RETENTION,,,27 ,,NW,,,,,,$603.55,$0.00,1,0,1,1,1,1,20131001,D8690,HCPCS,ORTHODONTIC TREATMENT,,,27 ,,NW,,,,,,$304.86,$0.00,1,0,1,1,1,1,20131001,D8691,HCPCS,REPAIR ORTHO APPLIANCE,,,27 ,,NW,,,,,,$233.80,$0.00,1,0,1,1,1,1,20131001,D8692,HCPCS,REPLACEMENT RETAINER,,,27 ,,NW,,,,,,$377.99,$0.00,1,0,1,1,1,1,20131001,D8693,HCPCS,REBOND/CEMENT/REPAIR RETAIN,,,27 ,,NW,,,,,,$369.75,$0.00,1,0,1,1,1,1,20131001,D8999,HCPCS,ORTHODONTIC PROCEDURE,,,27 ,,NW,,,,,,$294.56,$0.00,1,0,1,1,1,1,20131001,D9110,HCPCS,TX DENTAL PAIN MINOR PROC,,,26 ,,NW,,,,,,$135.90,$0.00,1,0,1,1,1,1,20131001,D9120,HCPCS,FIX PARTIAL DENTURE SECTION,,,27 ,,NW,,,,,,$207.60,$0.00,1,0,1,1,1,1,20131001,D9210,HCPCS,DENT ANESTHESIA W/O SURGERY,,,26 ,,NW,,,,,,$64.64,$0.00,1,0,1,1,1,1,20131001,D9211,HCPCS,REGIONAL BLOCK ANESTHESIA,,,26 ,,NW,,,,,,$67.39,$0.00,1,0,1,1,1,1,20131001,D9212,HCPCS,TRIGEMINAL BLOCK ANESTHESIA,,,26 ,,NW,,,,,,$152.20,$0.00,1,0,1,1,1,1,20131001,D9215,HCPCS,LOCAL ANESTHESIA,,,26 ,,NW,,,,,,$55.54,$0.00,1,0,1,1,1,1,20131001,D9220,HCPCS,GENERAL ANESTHESIA,,,26 ,,NW,,,,,,$445.55,$0.00,1,0,1,1,1,1,20131001,D9221,HCPCS,GENERAL ANESTHESIA EA AD 15M,,,26 ,,NW,,,,,,$193.92,$0.00,1,0,1,1,1,1,20131001,D9230,HCPCS,ANALGESIA,,,26 ,,NW,,,,,,$82.23,$0.00,1,0,1,1,1,1,20131001,D9241,HCPCS,INTRAVENOUS SEDATION,,,26 ,,NW,,,,,,$410.13,$0.00,1,0,1,1,1,1,20131001,D9242,HCPCS,IV SEDATION EA AD 30 M,,,26 ,,NW,,,,,,$177.60,$0.00,1,0,1,1,1,1,20131001,D9248,HCPCS,SEDATION (NON-IV),,,26 ,,NW,,,,,,$205.96,$0.00,1,0,1,1,1,1,20131001,D9310,HCPCS,DENTAL CONSULTATION,,,25 ,,NW,,,,,,$146.40,$0.00,1,0,1,1,1,1,20131001,D9410,HCPCS,DENTAL HOUSE CALL,,,25 ,,NW,,,,,,$184.84,$0.00,1,0,1,1,1,1,20131001,D9420,HCPCS,HOSPITAL/ASC CALL,,,25 ,,NW,,,,,,$303.52,$0.00,1,0,1,1,1,1,20131001,D9430,HCPCS,OFFICE VISIT DURING HOURS,,,25 ,,NW,,,,,,$87.55,$0.00,1,0,1,1,1,1,20131001,D9440,HCPCS,OFFICE VISIT AFTER HOURS,,,25 ,,NW,,,,,,$145.38,$0.00,1,0,1,1,1,1,20131001,D9450,HCPCS,CASE PRESENTATION TX PLAN,,,25 ,,NW,,,,,,$88.58,$0.00,1,0,1,1,1,1,20131001,D9610,HCPCS,DENT THERAPEUTIC DRUG INJECT,,,27 ,,NW,,,,,,$109.83,$0.00,1,0,1,1,1,1,20131001,D9612,HCPCS,THERA PAR DRUGS 2 OR > ADMIN,,,27 ,,NW,,,,,,$187.95,$0.00,1,0,1,1,1,1,20131001,D9630,HCPCS,OTHER DRUGS/MEDICAMENTS,,,27 ,,NW,,,,,,$57.68,$0.00,1,0,1,1,1,1,20131001,D9910,HCPCS,DENT APPL DESENSITIZING MED,,,27 ,,NW,,,,,,$70.28,$0.00,1,0,1,1,1,1,20131001,D9911,HCPCS,APPL DESENSITIZING RESIN,,,27 ,,NW,,,,,,$90.56,$0.00,1,0,1,1,1,1,20131001,D9920,HCPCS,BEHAVIOR MANAGEMENT,,,27 ,,NW,,,,,,$191.57,$0.00,1,0,1,1,1,1,20131001,D9930,HCPCS,TREATMENT OF COMPLICATIONS,,,27 ,,NW,,,,,,$146.25,$0.00,1,0,1,1,1,1,20131001,D9940,HCPCS,DENTAL OCCLUSAL GUARD,,,27 ,,NW,,,,,,$608.65,$0.00,1,0,1,1,1,1,20131001,D9941,HCPCS,FABRICATION ATHLETIC GUARD,,,27 ,,NW,,,,,,$241.70,$0.00,1,0,1,1,1,1,20131001,D9942,HCPCS,REPAIR/RELINE OCCLUSAL GUARD,,,27 ,,NW,,,,,,$256.77,$0.00,1,0,1,1,1,1,20131001,D9950,HCPCS,OCCLUSION ANALYSIS,,,27 ,,NW,,,,,,$377.25,$0.00,1,0,1,1,1,1,20131001,D9951,HCPCS,LIMITED OCCLUSAL ADJUSTMENT,,,27 ,,NW,,,,,,$183.41,$0.00,1,0,1,1,1,1,20131001,D9952,HCPCS,COMPLETE OCCLUSAL ADJUSTMENT,,,27 ,,NW,,,,,,$761.85,$0.00,1,0,1,1,1,1,20131001,D9970,HCPCS,ENAMEL MICROABRASION,,,27 ,,NW,,,,,,$133.39,$0.00,1,0,1,1,1,1,20131001,D9971,HCPCS,ODONTOPLASTY 1-2 TEETH,,,27 ,,NW,,,,,,$137.68,$0.00,1,0,1,1,1,1,20131001,D9972,HCPCS,EXTRNL BLEACHING PER ARCH,,,27 ,,NW,,,,,,$370.62,$0.00,1,0,1,1,1,1,20131001,D9973,HCPCS,EXTRNL BLEACHING PER TOOTH,,,27 ,,NW,,,,,,$131.26,$0.00,1,0,1,1,1,1,20131001,D9974,HCPCS,INTRNL BLEACHING PER TOOTH,,,27 ,,NW,,,,,,$325.13,$0.00,1,0,1,1,1,1,20131001,D9975,HCPCS,EXTERNAL BLEACHING HOME APP,,,27 ,,NW,,,,,,$370.62,$0.00,1,0,1,1,1,1,20131001,D9999,HCPCS,ADJUNCTIVE PROCEDURE,,,27 ,,NW,,,,,,$146.40,$0.00,1,0,1,1,1,1,20131001,E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,NU,,28 ,,NW,,,,,,$41.05,$0.00,1,1,1,1,1,1,20131001,E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,RR,,28 ,,NW,,,,,,$17.61,$0.00,1,1,1,1,1,1,20131001,E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,UE,,28 ,,NW,,,,,,$33.99,$0.00,1,1,1,1,1,1,20131001,E0100,HCPCS,CANE ADJUST/FIXED WITH TIP,,,28 ,,NW,,,,,,$41.05,$0.00,1,1,1,1,1,1,20131001,E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,NU,,28 ,,NW,,,,,,$86.54,$0.00,1,1,1,1,1,1,20131001,E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,RR,,28 ,,NW,,,,,,$21.99,$0.00,1,1,1,1,1,1,20131001,E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,UE,,28 ,,NW,,,,,,$67.57,$0.00,1,1,1,1,1,1,20131001,E0105,HCPCS,CANE ADJUST/FIXED QUAD/3 PRO,,,28 ,,NW,,,,,,$86.54,$0.00,1,1,1,1,1,1,20131001,E0110,HCPCS,CRUTCH FOREARM PAIR,NU,,28 ,,NW,,,,,,$152.24,$0.00,1,1,1,1,1,1,20131001,E0110,HCPCS,CRUTCH FOREARM PAIR,RR,,28 ,,NW,,,,,,$32.76,$0.00,1,1,1,1,1,1,20131001,E0110,HCPCS,CRUTCH FOREARM PAIR,UE,,28 ,,NW,,,,,,$104.36,$0.00,1,1,1,1,1,1,20131001,E0110,HCPCS,CRUTCH FOREARM PAIR,,,28 ,,NW,,,,,,$152.24,$0.00,1,1,1,1,1,1,20131001,E0111,HCPCS,CRUTCH FOREARM EACH,NU,,28 ,,NW,,,,,,$91.84,$0.00,1,1,1,1,1,1,20131001,E0111,HCPCS,CRUTCH FOREARM EACH,RR,,28 ,,NW,,,,,,$21.23,$0.00,1,1,1,1,1,1,20131001,E0111,HCPCS,CRUTCH FOREARM EACH,UE,,28 ,,NW,,,,,,$70.73,$0.00,1,1,1,1,1,1,20131001,E0111,HCPCS,CRUTCH FOREARM EACH,,,28 ,,NW,,,,,,$91.84,$0.00,1,1,1,1,1,1,20131001,E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,NU,,28 ,,NW,,,,,,$65.17,$0.00,1,1,1,1,1,1,20131001,E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,RR,,28 ,,NW,,,,,,$23.48,$0.00,1,1,1,1,1,1,20131001,E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,UE,,28 ,,NW,,,,,,$51.95,$0.00,1,1,1,1,1,1,20131001,E0112,HCPCS,CRUTCH UNDERARM PAIR WOOD,,,28 ,,NW,,,,,,$65.17,$0.00,1,1,1,1,1,1,20131001,E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,NU,,28 ,,NW,,,,,,$40.62,$0.00,1,1,1,1,1,1,20131001,E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,RR,,28 ,,NW,,,,,,$16.32,$0.00,1,1,1,1,1,1,20131001,E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,UE,,28 ,,NW,,,,,,$32.59,$0.00,1,1,1,1,1,1,20131001,E0113,HCPCS,CRUTCH UNDERARM EACH WOOD,,,28 ,,NW,,,,,,$40.62,$0.00,1,1,1,1,1,1,20131001,E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,NU,,28 ,,NW,,,,,,$80.05,$0.00,1,1,1,1,1,1,20131001,E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,RR,,28 ,,NW,,,,,,$21.46,$0.00,1,1,1,1,1,1,20131001,E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,UE,,28 ,,NW,,,,,,$62.46,$0.00,1,1,1,1,1,1,20131001,E0114,HCPCS,CRUTCH UNDERARM PAIR NO WOOD,,,28 ,,NW,,,,,,$80.05,$0.00,1,1,1,1,1,1,20131001,E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,NU,,28 ,,NW,,,,,,$48.98,$0.00,1,1,1,1,1,1,20131001,E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,RR,,28 ,,NW,,,,,,$16.53,$0.00,1,1,1,1,1,1,20131001,E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,UE,,28 ,,NW,,,,,,$38.97,$0.00,1,1,1,1,1,1,20131001,E0116,HCPCS,CRUTCH UNDERARM EACH NO WOOD,,,28 ,,NW,,,,,,$48.98,$0.00,1,1,1,1,1,1,20131001,E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,NU,,28 ,,NW,,,,,,$462.66,$0.00,1,1,1,1,1,1,20131001,E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,RR,,28 ,,NW,,,,,,$39.58,$0.00,1,1,1,1,1,1,20131001,E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,UE,,28 ,,NW,,,,,,$337.33,$0.00,1,1,1,1,1,1,20131001,E0117,HCPCS,UNDERARM SPRINGASSIST CRUTCH,,,28 ,,NW,,,,,,$462.66,$0.00,1,1,1,1,1,1,20131001,E0118,HCPCS,CRUTCH SUBSTITUTE,RR,,28 ,,NW,,,,,,$38.91,$0.00,1,1,1,1,1,1,20131001,E0118,HCPCS,CRUTCH SUBSTITUTE,,,28 ,,NW,,,,,,$394.71,$0.00,1,1,1,1,1,1,20131001,E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,NU,,28 ,,NW,,,,,,$112.92,$0.00,1,1,1,1,1,1,20131001,E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,RR,,28 ,,NW,,,,,,$30.72,$0.00,1,1,1,1,1,1,20131001,E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,UE,,28 ,,NW,,,,,,$82.08,$0.00,1,1,1,1,1,1,20131001,E0130,HCPCS,WALKER RIGID ADJUST/FIXED HT,,,28 ,,NW,,,,,,$112.92,$0.00,1,1,1,1,1,1,20131001,E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,NU,,28 ,,NW,,,,,,$144.04,$0.00,1,1,1,1,1,1,20131001,E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,RR,,28 ,,NW,,,,,,$31.63,$0.00,1,1,1,1,1,1,20131001,E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,UE,,28 ,,NW,,,,,,$99.39,$0.00,1,1,1,1,1,1,20131001,E0135,HCPCS,WALKER FOLDING ADJUST/FIXED,,,28 ,,NW,,,,,,$144.04,$0.00,1,1,1,1,1,1,20131001,E0140,HCPCS,WALKER W TRUNK SUPPORT,NU,,28 ,,NW,,,,,,$770.21,$0.00,1,1,1,1,1,1,20131001,E0140,HCPCS,WALKER W TRUNK SUPPORT,RR,,28 ,,NW,,,,,,$58.69,$0.00,1,1,1,1,1,1,20131001,E0140,HCPCS,WALKER W TRUNK SUPPORT,UE,,28 ,,NW,,,,,,$567.98,$0.00,1,1,1,1,1,1,20131001,E0140,HCPCS,WALKER W TRUNK SUPPORT,,,28 ,,NW,,,,,,$770.21,$0.00,1,1,1,1,1,1,20131001,E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,NU,,28 ,,NW,,,,,,$211.90,$0.00,1,1,1,1,1,1,20131001,E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,RR,,28 ,,NW,,,,,,$37.69,$0.00,1,1,1,1,1,1,20131001,E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,UE,,28 ,,NW,,,,,,$147.35,$0.00,1,1,1,1,1,1,20131001,E0141,HCPCS,RIGID WHEELED WALKER ADJ/FIX,,,28 ,,NW,,,,,,$211.90,$0.00,1,1,1,1,1,1,20131001,E0143,HCPCS,WALKER FOLDING WHEELED W/O S,NU,,28 ,,NW,,,,,,$220.13,$0.00,1,1,1,1,1,1,20131001,E0143,HCPCS,WALKER FOLDING WHEELED W/O S,RR,,28 ,,NW,,,,,,$37.13,$0.00,1,1,1,1,1,1,20131001,E0143,HCPCS,WALKER FOLDING WHEELED W/O S,UE,,28 ,,NW,,,,,,$151.92,$0.00,1,1,1,1,1,1,20131001,E0143,HCPCS,WALKER FOLDING WHEELED W/O S,,,28 ,,NW,,,,,,$220.13,$0.00,1,1,1,1,1,1,20131001,E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,NU,,28 ,,NW,,,,,,$675.43,$0.00,1,1,1,1,1,1,20131001,E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,RR,,28 ,,NW,,,,,,$51.60,$0.00,1,1,1,1,1,1,20131001,E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,UE,,28 ,,NW,,,,,,$482.14,$0.00,1,1,1,1,1,1,20131001,E0144,HCPCS,ENCLOSED WALKER W REAR SEAT,,,28 ,,NW,,,,,,$675.43,$0.00,1,1,1,1,1,1,20131001,E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,NU,,28 ,,NW,,,,,,"$1,250.44",$0.00,1,1,1,1,1,1,20131001,E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,RR,,28 ,,NW,,,,,,$90.08,$0.00,1,1,1,1,1,1,20131001,E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,UE,,28 ,,NW,,,,,,$928.16,$0.00,1,1,1,1,1,1,20131001,E0147,HCPCS,WALKER VARIABLE WHEEL RESIST,,,28 ,,NW,,,,,,"$1,250.44",$0.00,1,1,1,1,1,1,20131001,E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,NU,,28 ,,NW,,,,,,$246.14,$0.00,1,1,1,1,1,1,20131001,E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,RR,,28 ,,NW,,,,,,$26.20,$0.00,1,1,1,1,1,1,20131001,E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,UE,,28 ,,NW,,,,,,$174.86,$0.00,1,1,1,1,1,1,20131001,E0148,HCPCS,HEAVYDUTY WALKER NO WHEELS,,,28 ,,NW,,,,,,$246.14,$0.00,1,1,1,1,1,1,20131001,E0149,HCPCS,HEAVY DUTY WHEELED WALKER,NU,,28 ,,NW,,,,,,$461.79,$0.00,1,1,1,1,1,1,20131001,E0149,HCPCS,HEAVY DUTY WHEELED WALKER,RR,,28 ,,NW,,,,,,$39.55,$0.00,1,1,1,1,1,1,20131001,E0149,HCPCS,HEAVY DUTY WHEELED WALKER,UE,,28 ,,NW,,,,,,$336.60,$0.00,1,1,1,1,1,1,20131001,E0149,HCPCS,HEAVY DUTY WHEELED WALKER,,,28 ,,NW,,,,,,$461.79,$0.00,1,1,1,1,1,1,20131001,E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,NU,,28 ,,NW,,,,,,$132.36,$0.00,1,1,1,1,1,1,20131001,E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,RR,,28 ,,NW,,,,,,$20.67,$0.00,1,1,1,1,1,1,20131001,E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,UE,,28 ,,NW,,,,,,$89.54,$0.00,1,1,1,1,1,1,20131001,E0153,HCPCS,FOREARM CRUTCH PLATFORM ATTA,,,28 ,,NW,,,,,,$132.36,$0.00,1,1,1,1,1,1,20131001,E0154,HCPCS,WALKER PLATFORM ATTACHMENT,NU,,28 ,,NW,,,,,,$112.14,$0.00,1,1,1,1,1,1,20131001,E0154,HCPCS,WALKER PLATFORM ATTACHMENT,RR,,28 ,,NW,,,,,,$19.84,$0.00,1,1,1,1,1,1,20131001,E0154,HCPCS,WALKER PLATFORM ATTACHMENT,UE,,28 ,,NW,,,,,,$79.46,$0.00,1,1,1,1,1,1,20131001,E0154,HCPCS,WALKER PLATFORM ATTACHMENT,,,28 ,,NW,,,,,,$112.14,$0.00,1,1,1,1,1,1,20131001,E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",NU,,28 ,,NW,,,,,,$50.01,$0.00,1,1,1,1,1,1,20131001,E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",RR,,28 ,,NW,,,,,,$10.79,$0.00,1,1,1,1,1,1,20131001,E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",UE,,28 ,,NW,,,,,,$40.08,$0.00,1,1,1,1,1,1,20131001,E0155,HCPCS,"WALKER WHEEL ATTACHMENT,PAIR",,,28 ,,NW,,,,,,$50.01,$0.00,1,1,1,1,1,1,20131001,E0156,HCPCS,WALKER SEAT ATTACHMENT,NU,,28 ,,NW,,,,,,$43.24,$0.00,1,1,1,1,1,1,20131001,E0156,HCPCS,WALKER SEAT ATTACHMENT,RR,,28 ,,NW,,,,,,$9.19,$0.00,1,1,1,1,1,1,20131001,E0156,HCPCS,WALKER SEAT ATTACHMENT,UE,,28 ,,NW,,,,,,$34.57,$0.00,1,1,1,1,1,1,20131001,E0156,HCPCS,WALKER SEAT ATTACHMENT,,,28 ,,NW,,,,,,$43.24,$0.00,1,1,1,1,1,1,20131001,E0157,HCPCS,WALKER CRUTCH ATTACHMENT,NU,,28 ,,NW,,,,,,$128.28,$0.00,1,1,1,1,1,1,20131001,E0157,HCPCS,WALKER CRUTCH ATTACHMENT,RR,,28 ,,NW,,,,,,$19.94,$0.00,1,1,1,1,1,1,20131001,E0157,HCPCS,WALKER CRUTCH ATTACHMENT,UE,,28 ,,NW,,,,,,$86.49,$0.00,1,1,1,1,1,1,20131001,E0157,HCPCS,WALKER CRUTCH ATTACHMENT,,,28 ,,NW,,,,,,$128.28,$0.00,1,1,1,1,1,1,20131001,E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,NU,,28 ,,NW,,,,,,$50.64,$0.00,1,1,1,1,1,1,20131001,E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,RR,,28 ,,NW,,,,,,$9.88,$0.00,1,1,1,1,1,1,20131001,E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,UE,,28 ,,NW,,,,,,$40.30,$0.00,1,1,1,1,1,1,20131001,E0158,HCPCS,WALKER LEG EXTENDERS SET OF4,,,28 ,,NW,,,,,,$50.64,$0.00,1,1,1,1,1,1,20131001,E0159,HCPCS,BRAKE FOR WHEELED WALKER,NU,,28 ,,NW,,,,,,$33.35,$0.00,1,1,1,1,1,1,20131001,E0159,HCPCS,BRAKE FOR WHEELED WALKER,RR,,28 ,,NW,,,,,,$5.41,$0.00,1,1,1,1,1,1,20131001,E0159,HCPCS,BRAKE FOR WHEELED WALKER,UE,,28 ,,NW,,,,,,$27.15,$0.00,1,1,1,1,1,1,20131001,E0159,HCPCS,BRAKE FOR WHEELED WALKER,,,28 ,,NW,,,,,,$33.35,$0.00,1,1,1,1,1,1,20131001,E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,NU,,28 ,,NW,,,,,,$58.19,$0.00,1,1,1,1,1,1,20131001,E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,RR,,28 ,,NW,,,,,,$14.23,$0.00,1,1,1,1,1,1,20131001,E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,UE,,28 ,,NW,,,,,,$46.09,$0.00,1,1,1,1,1,1,20131001,E0160,HCPCS,SITZ TYPE BATH OR EQUIPMENT,,,28 ,,NW,,,,,,$58.19,$0.00,1,1,1,1,1,1,20131001,E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,NU,,28 ,,NW,,,,,,$48.20,$0.00,1,1,1,1,1,1,20131001,E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,RR,,28 ,,NW,,,,,,$11.26,$0.00,1,1,1,1,1,1,20131001,E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,UE,,28 ,,NW,,,,,,$38.21,$0.00,1,1,1,1,1,1,20131001,E0161,HCPCS,SITZ BATH/EQUIPMENT W/FAUCET,,,28 ,,NW,,,,,,$48.20,$0.00,1,1,1,1,1,1,20131001,E0162,HCPCS,SITZ BATH CHAIR,NU,,28 ,,NW,,,,,,$309.38,$0.00,1,1,1,1,1,1,20131001,E0162,HCPCS,SITZ BATH CHAIR,RR,,28 ,,NW,,,,,,$31.13,$0.00,1,1,1,1,1,1,20131001,E0162,HCPCS,SITZ BATH CHAIR,UE,,28 ,,NW,,,,,,$229.82,$0.00,1,1,1,1,1,1,20131001,E0162,HCPCS,SITZ BATH CHAIR,,,28 ,,NW,,,,,,$309.38,$0.00,1,1,1,1,1,1,20131001,E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,NU,,28 ,,NW,,,,,,$241.11,$0.00,1,1,1,1,1,1,20131001,E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,RR,,28 ,,NW,,,,,,$46.34,$0.00,1,1,1,1,1,1,20131001,E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,UE,,28 ,,NW,,,,,,$172.27,$0.00,1,1,1,1,1,1,20131001,E0163,HCPCS,COMMODE CHAIR WITH FIXED ARM,,,28 ,,NW,,,,,,$241.11,$0.00,1,1,1,1,1,1,20131001,E0165,HCPCS,COMMODE CHAIR WITH DETACHARM,RR,,28 ,,NW,,,,,,$36.87,$0.00,1,1,1,1,1,1,20131001,E0165,HCPCS,COMMODE CHAIR WITH DETACHARM,,,28 ,,NW,,,,,,$355.47,$0.00,1,1,1,1,1,1,20131001,E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,NU,,28 ,,NW,,,,,,$27.07,$0.00,1,1,1,1,1,1,20131001,E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,RR,,28 ,,NW,,,,,,$4.11,$0.00,1,1,1,1,1,1,20131001,E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,UE,,28 ,,NW,,,,,,$22.64,$0.00,1,1,1,1,1,1,20131001,E0167,HCPCS,COMMODE CHAIR PAIL OR PAN,,,28 ,,NW,,,,,,$27.07,$0.00,1,1,1,1,1,1,20131001,E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,NU,,28 ,,NW,,,,,,$353.90,$0.00,1,1,1,1,1,1,20131001,E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,RR,,28 ,,NW,,,,,,$32.91,$0.00,1,1,1,1,1,1,20131001,E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,UE,,28 ,,NW,,,,,,$255.68,$0.00,1,1,1,1,1,1,20131001,E0168,HCPCS,HEAVYDUTY/WIDE COMMODE CHAIR,,,28 ,,NW,,,,,,$353.90,$0.00,1,1,1,1,1,1,20131001,E0170,HCPCS,COMMODE CHAIR ELECTRIC,RR,,28 ,,NW,,,,,,$379.41,$0.00,1,1,1,1,1,1,20131001,E0170,HCPCS,COMMODE CHAIR ELECTRIC,,,28 ,,NW,,,,,,"$3,657.95",$0.00,1,1,1,1,1,1,20131001,E0171,HCPCS,COMMODE CHAIR NON-ELECTRIC,RR,,28 ,,NW,,,,,,$55.19,$0.00,1,1,1,1,1,1,20131001,E0171,HCPCS,COMMODE CHAIR NON-ELECTRIC,,,28 ,,NW,,,,,,$532.09,$0.00,1,1,1,1,1,1,20131001,E0172,HCPCS,SEAT LIFT MECHANISM TOILET,,,28 ,,NW,,,,,,$418.49,$0.00,1,1,1,1,1,1,20131001,E0175,HCPCS,COMMODE CHAIR FOOT REST,NU,,28 ,,NW,,,,,,$122.62,$0.00,1,1,1,1,1,1,20131001,E0175,HCPCS,COMMODE CHAIR FOOT REST,RR,,28 ,,NW,,,,,,$18.47,$0.00,1,1,1,1,1,1,20131001,E0175,HCPCS,COMMODE CHAIR FOOT REST,UE,,28 ,,NW,,,,,,$82.16,$0.00,1,1,1,1,1,1,20131001,E0175,HCPCS,COMMODE CHAIR FOOT REST,,,28 ,,NW,,,,,,$122.62,$0.00,1,1,1,1,1,1,20131001,E0181,HCPCS,PRESS PAD ALTERNATING W/ PUM,RR,,28 ,,NW,,,,,,$50.55,$0.00,1,1,1,1,1,1,20131001,E0181,HCPCS,PRESS PAD ALTERNATING W/ PUM,,,28 ,,NW,,,,,,$487.33,$0.00,1,1,1,1,1,1,20131001,E0182,HCPCS,"REPLACE PUMP, ALT PRESS PAD",RR,,28 ,,NW,,,,,,$47.65,$0.00,1,1,1,1,1,1,20131001,E0182,HCPCS,"REPLACE PUMP, ALT PRESS PAD",,,28 ,,NW,,,,,,$459.38,$0.00,1,1,1,1,1,1,20131001,E0184,HCPCS,DRY PRESSURE MATTRESS,NU,,28 ,,NW,,,,,,$428.29,$0.00,1,1,1,1,1,1,20131001,E0184,HCPCS,DRY PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,$46.96,$0.00,1,1,1,1,1,1,20131001,E0184,HCPCS,DRY PRESSURE MATTRESS,UE,,28 ,,NW,,,,,,$319.33,$0.00,1,1,1,1,1,1,20131001,E0184,HCPCS,DRY PRESSURE MATTRESS,,,28 ,,NW,,,,,,$428.29,$0.00,1,1,1,1,1,1,20131001,E0185,HCPCS,GEL PRESSURE MATTRESS PAD,NU,,28 ,,NW,,,,,,$741.01,$0.00,1,1,1,1,1,1,20131001,E0185,HCPCS,GEL PRESSURE MATTRESS PAD,RR,,28 ,,NW,,,,,,$78.15,$0.00,1,1,1,1,1,1,20131001,E0185,HCPCS,GEL PRESSURE MATTRESS PAD,UE,,28 ,,NW,,,,,,$563.08,$0.00,1,1,1,1,1,1,20131001,E0185,HCPCS,GEL PRESSURE MATTRESS PAD,,,28 ,,NW,,,,,,$741.01,$0.00,1,1,1,1,1,1,20131001,E0186,HCPCS,AIR PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,$39.91,$0.00,1,1,1,1,1,1,20131001,E0186,HCPCS,AIR PRESSURE MATTRESS,,,28 ,,NW,,,,,,$384.75,$0.00,1,1,1,1,1,1,20131001,E0187,HCPCS,WATER PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,$44.17,$0.00,1,1,1,1,1,1,20131001,E0187,HCPCS,WATER PRESSURE MATTRESS,,,28 ,,NW,,,,,,$425.85,$0.00,1,1,1,1,1,1,20131001,E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,NU,,28 ,,NW,,,,,,$49.09,$0.00,1,1,1,1,1,1,20131001,E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,RR,,28 ,,NW,,,,,,$10.10,$0.00,1,1,1,1,1,1,20131001,E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,UE,,28 ,,NW,,,,,,$38.93,$0.00,1,1,1,1,1,1,20131001,E0188,HCPCS,SYNTHETIC SHEEPSKIN PAD,,,28 ,,NW,,,,,,$49.09,$0.00,1,1,1,1,1,1,20131001,E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,NU,,28 ,,NW,,,,,,$90.17,$0.00,1,1,1,1,1,1,20131001,E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,RR,,28 ,,NW,,,,,,$17.25,$0.00,1,1,1,1,1,1,20131001,E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,UE,,28 ,,NW,,,,,,$68.53,$0.00,1,1,1,1,1,1,20131001,E0189,HCPCS,LAMBSWOOL SHEEPSKIN PAD,,,28 ,,NW,,,,,,$90.17,$0.00,1,1,1,1,1,1,20131001,E0190,HCPCS,POSITIONING CUSHION,,,28 ,,NW,,,,,,$49.35,$0.00,1,1,1,1,1,1,20131001,E0191,HCPCS,PROTECTOR HEEL OR ELBOW,NU,,28 ,,NW,,,,,,$23.45,$0.00,1,1,1,1,1,1,20131001,E0191,HCPCS,PROTECTOR HEEL OR ELBOW,RR,,28 ,,NW,,,,,,$3.23,$0.00,1,1,1,1,1,1,20131001,E0191,HCPCS,PROTECTOR HEEL OR ELBOW,UE,,28 ,,NW,,,,,,$19.68,$0.00,1,1,1,1,1,1,20131001,E0191,HCPCS,PROTECTOR HEEL OR ELBOW,,,28 ,,NW,,,,,,$23.45,$0.00,1,1,1,1,1,1,20131001,E0193,HCPCS,POWERED AIR FLOTATION BED,RR,,28 ,,NW,,,,,,"$1,319.32",$0.00,1,1,1,1,1,1,20131001,E0193,HCPCS,POWERED AIR FLOTATION BED,,,28 ,,NW,,,,,,"$12,719.64",$0.00,1,1,1,1,1,1,20131001,E0194,HCPCS,AIR FLUIDIZED BED,RR,,28 ,,NW,,,,,,"$5,153.61",$0.00,1,1,1,1,1,1,20131001,E0194,HCPCS,AIR FLUIDIZED BED,UE,,28 ,,NW,,,,,,"$39,122.30",$0.00,1,1,1,1,1,1,20131001,E0194,HCPCS,AIR FLUIDIZED BED,,,28 ,,NW,,,,,,"$49,686.18",$0.00,1,1,1,1,1,1,20131001,E0196,HCPCS,GEL PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,$64.48,$0.00,1,1,1,1,1,1,20131001,E0196,HCPCS,GEL PRESSURE MATTRESS,UE,,28 ,,NW,,,,,,$427.53,$0.00,1,1,1,1,1,1,20131001,E0196,HCPCS,GEL PRESSURE MATTRESS,,,28 ,,NW,,,,,,$621.68,$0.00,1,1,1,1,1,1,20131001,E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,NU,,28 ,,NW,,,,,,$498.89,$0.00,1,1,1,1,1,1,20131001,E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,RR,,28 ,,NW,,,,,,$54.53,$0.00,1,1,1,1,1,1,20131001,E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,UE,,28 ,,NW,,,,,,$429.88,$0.00,1,1,1,1,1,1,20131001,E0197,HCPCS,AIR PRESSURE PAD FOR MATTRES,,,28 ,,NW,,,,,,$498.89,$0.00,1,1,1,1,1,1,20131001,E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,NU,,28 ,,NW,,,,,,$504.27,$0.00,1,1,1,1,1,1,20131001,E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,RR,,28 ,,NW,,,,,,$43.87,$0.00,1,1,1,1,1,1,20131001,E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,UE,,28 ,,NW,,,,,,$374.40,$0.00,1,1,1,1,1,1,20131001,E0198,HCPCS,WATER PRESSURE PAD FOR MATTR,,,28 ,,NW,,,,,,$504.27,$0.00,1,1,1,1,1,1,20131001,E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,NU,,28 ,,NW,,,,,,$58.41,$0.00,1,1,1,1,1,1,20131001,E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,RR,,28 ,,NW,,,,,,$11.39,$0.00,1,1,1,1,1,1,20131001,E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,UE,,28 ,,NW,,,,,,$46.95,$0.00,1,1,1,1,1,1,20131001,E0199,HCPCS,DRY PRESSURE PAD FOR MATTRES,,,28 ,,NW,,,,,,$58.41,$0.00,1,1,1,1,1,1,20131001,E0200,HCPCS,HEAT LAMP WITHOUT STAND,NU,,28 ,,NW,,,,,,$159.49,$0.00,1,1,1,1,1,1,20131001,E0200,HCPCS,HEAT LAMP WITHOUT STAND,RR,,28 ,,NW,,,,,,$25.38,$0.00,1,1,1,1,1,1,20131001,E0200,HCPCS,HEAT LAMP WITHOUT STAND,UE,,28 ,,NW,,,,,,$109.98,$0.00,1,1,1,1,1,1,20131001,E0200,HCPCS,HEAT LAMP WITHOUT STAND,,,28 ,,NW,,,,,,$159.49,$0.00,1,1,1,1,1,1,20131001,E0202,HCPCS,PHOTOTHERAPY LIGHT W/ PHOTOM,RR,,28 ,,NW,,,,,,$114.47,$0.00,1,1,1,1,1,1,20131001,E0202,HCPCS,PHOTOTHERAPY LIGHT W/ PHOTOM,,,28 ,,NW,,,,,,"$1,103.58",$0.00,1,1,1,1,1,1,20131001,E0203,HCPCS,THERAPEUTIC LIGHTBOX TABLETP,,,28 ,,NW,,,,,,$327.73,$0.00,1,1,1,1,1,1,20131001,E0205,HCPCS,HEAT LAMP WITH STAND,NU,,28 ,,NW,,,,,,$430.18,$0.00,1,1,1,1,1,1,20131001,E0205,HCPCS,HEAT LAMP WITH STAND,RR,,28 ,,NW,,,,,,$41.95,$0.00,1,1,1,1,1,1,20131001,E0205,HCPCS,HEAT LAMP WITH STAND,UE,,28 ,,NW,,,,,,$312.91,$0.00,1,1,1,1,1,1,20131001,E0205,HCPCS,HEAT LAMP WITH STAND,,,28 ,,NW,,,,,,$430.18,$0.00,1,1,1,1,1,1,20131001,E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,NU,,28 ,,NW,,,,,,$58.00,$0.00,1,1,1,1,1,1,20131001,E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,RR,,28 ,,NW,,,,,,$11.03,$0.00,1,1,1,1,1,1,20131001,E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,UE,,28 ,,NW,,,,,,$45.60,$0.00,1,1,1,1,1,1,20131001,E0210,HCPCS,ELECTRIC HEAT PAD STANDARD,,,28 ,,NW,,,,,,$58.00,$0.00,1,1,1,1,1,1,20131001,E0215,HCPCS,ELECTRIC HEAT PAD MOIST,NU,,28 ,,NW,,,,,,$133.39,$0.00,1,1,1,1,1,1,20131001,E0215,HCPCS,ELECTRIC HEAT PAD MOIST,RR,,28 ,,NW,,,,,,$20.24,$0.00,1,1,1,1,1,1,20131001,E0215,HCPCS,ELECTRIC HEAT PAD MOIST,UE,,28 ,,NW,,,,,,$90.55,$0.00,1,1,1,1,1,1,20131001,E0215,HCPCS,ELECTRIC HEAT PAD MOIST,,,28 ,,NW,,,,,,$133.39,$0.00,1,1,1,1,1,1,20131001,E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,NU,,28 ,,NW,,,,,,"$1,168.69",$0.00,1,1,1,1,1,1,20131001,E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,RR,,28 ,,NW,,,,,,$95.26,$0.00,1,1,1,1,1,1,20131001,E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,UE,,28 ,,NW,,,,,,$866.73,$0.00,1,1,1,1,1,1,20131001,E0217,HCPCS,WATER CIRC HEAT PAD W PUMP,,,28 ,,NW,,,,,,"$1,168.69",$0.00,1,1,1,1,1,1,20131001,E0218,HCPCS,WATER CIRC COLD PAD W PUMP,,,28 ,,NW,,,,,,"$1,168.69",$0.00,1,1,1,1,1,1,20131001,E0221,HCPCS,INFRARED HEATING PAD SYSTEM,,,28 ,,NW,,,,,,$480.61,$0.00,1,1,1,1,1,1,20131001,E0225,HCPCS,HYDROCOLLATOR UNIT,NU,,28 ,,NW,,,,,,$904.68,$0.00,1,1,1,1,1,1,20131001,E0225,HCPCS,HYDROCOLLATOR UNIT,RR,,28 ,,NW,,,,,,$66.09,$0.00,1,1,1,1,1,1,20131001,E0225,HCPCS,HYDROCOLLATOR UNIT,UE,,28 ,,NW,,,,,,$668.17,$0.00,1,1,1,1,1,1,20131001,E0225,HCPCS,HYDROCOLLATOR UNIT,,,28 ,,NW,,,,,,$904.68,$0.00,1,1,1,1,1,1,20131001,E0231,HCPCS,WOUND WARMING DEVICE,RR,,28 ,,NW,,,,,,$49.22,$0.00,1,1,1,1,1,1,20131001,E0231,HCPCS,WOUND WARMING DEVICE,,,28 ,,NW,,,,,,$449.78,$0.00,1,1,1,1,1,1,20131001,E0232,HCPCS,WARMING CARD FOR NWT,,,28 ,,NW,,,,,,$141.87,$0.00,1,1,1,1,1,1,20131001,E0235,HCPCS,PARAFFIN BATH UNIT PORTABLE,RR,,28 ,,NW,,,,,,$35.75,$0.00,1,1,1,1,1,1,20131001,E0235,HCPCS,PARAFFIN BATH UNIT PORTABLE,UE,,28 ,,NW,,,,,,$296.41,$0.00,1,1,1,1,1,1,20131001,E0235,HCPCS,PARAFFIN BATH UNIT PORTABLE,,,28 ,,NW,,,,,,$344.66,$0.00,1,1,1,1,1,1,20131001,E0236,HCPCS,PUMP FOR WATER CIRCULATING P,RR,,28 ,,NW,,,,,,$75.74,$0.00,1,1,1,1,1,1,20131001,E0236,HCPCS,PUMP FOR WATER CIRCULATING P,UE,,28 ,,NW,,,,,,$548.22,$0.00,1,1,1,1,1,1,20131001,E0236,HCPCS,PUMP FOR WATER CIRCULATING P,,,28 ,,NW,,,,,,$730.21,$0.00,1,1,1,1,1,1,20131001,E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,NU,,28 ,,NW,,,,,,"$1,081.17",$0.00,1,1,1,1,1,1,20131001,E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,RR,,28 ,,NW,,,,,,$78.10,$0.00,1,1,1,1,1,1,20131001,E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,UE,,28 ,,NW,,,,,,$801.22,$0.00,1,1,1,1,1,1,20131001,E0239,HCPCS,HYDROCOLLATOR UNIT PORTABLE,,,28 ,,NW,,,,,,"$1,081.17",$0.00,1,1,1,1,1,1,20131001,E0240,HCPCS,BATH/SHOWER CHAIR,,,28 ,,NW,,,,,,$75.83,$0.00,1,1,1,1,1,1,20131001,E0241,HCPCS,BATH TUB WALL RAIL,,,28 ,,NW,,,,,,$51.07,$0.00,1,1,1,1,1,1,20131001,E0242,HCPCS,BATH TUB RAIL FLOOR,,,28 ,,NW,,,,,,$115.28,$0.00,1,1,1,1,1,1,20131001,E0243,HCPCS,TOILET RAIL,,,28 ,,NW,,,,,,$84.56,$0.00,1,1,1,1,1,1,20131001,E0244,HCPCS,TOILET SEAT RAISED,,,28 ,,NW,,,,,,$66.42,$0.00,1,1,1,1,1,1,20131001,E0245,HCPCS,TUB STOOL OR BENCH,,,28 ,,NW,,,,,,$114.15,$0.00,1,1,1,1,1,1,20131001,E0246,HCPCS,TRANSFER TUB RAIL ATTACHMENT,,,28 ,,NW,,,,,,$170.41,$0.00,1,1,1,1,1,1,20131001,E0247,HCPCS,TRANS BENCH W/WO COMM OPEN,,,28 ,,NW,,,,,,$139.20,$0.00,1,1,1,1,1,1,20131001,E0248,HCPCS,HDTRANS BENCH W/WO COMM OPEN,,,28 ,,NW,,,,,,$190.75,$0.00,1,1,1,1,1,1,20131001,E0249,HCPCS,PAD WATER CIRCULATING HEAT U,NU,,28 ,,NW,,,,,,$204.39,$0.00,1,1,1,1,1,1,20131001,E0249,HCPCS,PAD WATER CIRCULATING HEAT U,RR,,28 ,,NW,,,,,,$25.06,$0.00,1,1,1,1,1,1,20131001,E0249,HCPCS,PAD WATER CIRCULATING HEAT U,UE,,28 ,,NW,,,,,,$143.57,$0.00,1,1,1,1,1,1,20131001,E0249,HCPCS,PAD WATER CIRCULATING HEAT U,,,28 ,,NW,,,,,,$204.39,$0.00,1,1,1,1,1,1,20131001,E0250,HCPCS,HOSP BED FIXED HT W/ MATTRES,RR,,28 ,,NW,,,,,,$162.88,$0.00,1,1,1,1,1,1,20131001,E0250,HCPCS,HOSP BED FIXED HT W/ MATTRES,UE,,28 ,,NW,,,,,,"$1,049.25",$0.00,1,1,1,1,1,1,20131001,E0250,HCPCS,HOSP BED FIXED HT W/ MATTRES,,,28 ,,NW,,,,,,"$1,570.37",$0.00,1,1,1,1,1,1,20131001,E0251,HCPCS,HOSP BED FIXD HT W/O MATTRES,RR,,28 ,,NW,,,,,,$125.18,$0.00,1,1,1,1,1,1,20131001,E0251,HCPCS,HOSP BED FIXD HT W/O MATTRES,UE,,28 ,,NW,,,,,,$804.46,$0.00,1,1,1,1,1,1,20131001,E0251,HCPCS,HOSP BED FIXD HT W/O MATTRES,,,28 ,,NW,,,,,,"$1,206.90",$0.00,1,1,1,1,1,1,20131001,E0255,HCPCS,HOSPITAL BED VAR HT W/ MATTR,RR,,28 ,,NW,,,,,,$195.45,$0.00,1,1,1,1,1,1,20131001,E0255,HCPCS,HOSPITAL BED VAR HT W/ MATTR,UE,,28 ,,NW,,,,,,"$1,253.71",$0.00,1,1,1,1,1,1,20131001,E0255,HCPCS,HOSPITAL BED VAR HT W/ MATTR,,,28 ,,NW,,,,,,"$1,884.38",$0.00,1,1,1,1,1,1,20131001,E0256,HCPCS,HOSPITAL BED VAR HT W/O MATT,RR,,28 ,,NW,,,,,,$137.02,$0.00,1,1,1,1,1,1,20131001,E0256,HCPCS,HOSPITAL BED VAR HT W/O MATT,UE,,28 ,,NW,,,,,,$900.43,$0.00,1,1,1,1,1,1,20131001,E0256,HCPCS,HOSPITAL BED VAR HT W/O MATT,,,28 ,,NW,,,,,,"$1,321.01",$0.00,1,1,1,1,1,1,20131001,E0260,HCPCS,HOSP BED SEMI-ELECTR W/ MATT,RR,,28 ,,NW,,,,,,$241.43,$0.00,1,1,1,1,1,1,20131001,E0260,HCPCS,HOSP BED SEMI-ELECTR W/ MATT,UE,,28 ,,NW,,,,,,"$1,747.51",$0.00,1,1,1,1,1,1,20131001,E0260,HCPCS,HOSP BED SEMI-ELECTR W/ MATT,,,28 ,,NW,,,,,,"$2,327.64",$0.00,1,1,1,1,1,1,20131001,E0261,HCPCS,HOSP BED SEMI-ELECTR W/O MAT,RR,,28 ,,NW,,,,,,$223.54,$0.00,1,1,1,1,1,1,20131001,E0261,HCPCS,HOSP BED SEMI-ELECTR W/O MAT,UE,,28 ,,NW,,,,,,"$1,454.69",$0.00,1,1,1,1,1,1,20131001,E0261,HCPCS,HOSP BED SEMI-ELECTR W/O MAT,,,28 ,,NW,,,,,,"$2,155.20",$0.00,1,1,1,1,1,1,20131001,E0265,HCPCS,HOSP BED TOTAL ELECTR W/ MAT,RR,,28 ,,NW,,,,,,$317.02,$0.00,1,1,1,1,1,1,20131001,E0265,HCPCS,HOSP BED TOTAL ELECTR W/ MAT,UE,,28 ,,NW,,,,,,"$2,106.32",$0.00,1,1,1,1,1,1,20131001,E0265,HCPCS,HOSP BED TOTAL ELECTR W/ MAT,,,28 ,,NW,,,,,,"$3,056.44",$0.00,1,1,1,1,1,1,20131001,E0266,HCPCS,HOSP BED TOTAL ELEC W/O MATT,RR,,28 ,,NW,,,,,,$286.55,$0.00,1,1,1,1,1,1,20131001,E0266,HCPCS,HOSP BED TOTAL ELEC W/O MATT,UE,,28 ,,NW,,,,,,"$1,875.43",$0.00,1,1,1,1,1,1,20131001,E0266,HCPCS,HOSP BED TOTAL ELEC W/O MATT,,,28 ,,NW,,,,,,"$2,762.65",$0.00,1,1,1,1,1,1,20131001,E0270,HCPCS,HOSPITAL BED INSTITUTIONAL T,RR,,28 ,,NW,,,,,,$46.69,$0.00,1,1,1,1,1,1,20131001,E0270,HCPCS,HOSPITAL BED INSTITUTIONAL T,UE,,28 ,,NW,,,,,,$333.13,$0.00,1,1,1,1,1,1,20131001,E0270,HCPCS,HOSPITAL BED INSTITUTIONAL T,,,28 ,,NW,,,,,,$443.21,$0.00,1,1,1,1,1,1,20131001,E0271,HCPCS,MATTRESS INNERSPRING,NU,,28 ,,NW,,,,,,$336.27,$0.00,1,1,1,1,1,1,20131001,E0271,HCPCS,MATTRESS INNERSPRING,RR,,28 ,,NW,,,,,,$39.09,$0.00,1,1,1,1,1,1,20131001,E0271,HCPCS,MATTRESS INNERSPRING,UE,,28 ,,NW,,,,,,$268.49,$0.00,1,1,1,1,1,1,20131001,E0271,HCPCS,MATTRESS INNERSPRING,,,28 ,,NW,,,,,,$336.27,$0.00,1,1,1,1,1,1,20131001,E0272,HCPCS,MATTRESS FOAM RUBBER,NU,,28 ,,NW,,,,,,$318.02,$0.00,1,1,1,1,1,1,20131001,E0272,HCPCS,MATTRESS FOAM RUBBER,RR,,28 ,,NW,,,,,,$35.98,$0.00,1,1,1,1,1,1,20131001,E0272,HCPCS,MATTRESS FOAM RUBBER,UE,,28 ,,NW,,,,,,$242.47,$0.00,1,1,1,1,1,1,20131001,E0272,HCPCS,MATTRESS FOAM RUBBER,,,28 ,,NW,,,,,,$318.02,$0.00,1,1,1,1,1,1,20131001,E0273,HCPCS,BED BOARD,RR,,28 ,,NW,,,,,,$22.99,$0.00,1,1,1,1,1,1,20131001,E0273,HCPCS,BED BOARD,UE,,28 ,,NW,,,,,,$44.63,$0.00,1,1,1,1,1,1,20131001,E0273,HCPCS,BED BOARD,,,28 ,,NW,,,,,,$59.45,$0.00,1,1,1,1,1,1,20131001,E0274,HCPCS,OVER-BED TABLE,RR,,28 ,,NW,,,,,,$39.64,$0.00,1,1,1,1,1,1,20131001,E0274,HCPCS,OVER-BED TABLE,UE,,28 ,,NW,,,,,,$72.11,$0.00,1,1,1,1,1,1,20131001,E0274,HCPCS,OVER-BED TABLE,,,28 ,,NW,,,,,,$96.05,$0.00,1,1,1,1,1,1,20131001,E0275,HCPCS,BED PAN STANDARD,NU,,28 ,,NW,,,,,,$31.97,$0.00,1,1,1,1,1,1,20131001,E0275,HCPCS,BED PAN STANDARD,RR,,28 ,,NW,,,,,,$5.21,$0.00,1,1,1,1,1,1,20131001,E0275,HCPCS,BED PAN STANDARD,UE,,28 ,,NW,,,,,,$26.10,$0.00,1,1,1,1,1,1,20131001,E0275,HCPCS,BED PAN STANDARD,,,28 ,,NW,,,,,,$31.97,$0.00,1,1,1,1,1,1,20131001,E0276,HCPCS,BED PAN FRACTURE,NU,,28 ,,NW,,,,,,$28.93,$0.00,1,1,1,1,1,1,20131001,E0276,HCPCS,BED PAN FRACTURE,RR,,28 ,,NW,,,,,,$5.14,$0.00,1,1,1,1,1,1,20131001,E0276,HCPCS,BED PAN FRACTURE,UE,,28 ,,NW,,,,,,$24.62,$0.00,1,1,1,1,1,1,20131001,E0276,HCPCS,BED PAN FRACTURE,,,28 ,,NW,,,,,,$28.93,$0.00,1,1,1,1,1,1,20131001,E0277,HCPCS,POWERED PRES-REDU AIR MATTRS,RR,,28 ,,NW,,,,,,"$1,046.05",$0.00,1,1,1,1,1,1,20131001,E0277,HCPCS,POWERED PRES-REDU AIR MATTRS,UE,,28 ,,NW,,,,,,"$7,571.47",$0.00,1,1,1,1,1,1,20131001,E0277,HCPCS,POWERED PRES-REDU AIR MATTRS,,,28 ,,NW,,,,,,"$10,085.02",$0.00,1,1,1,1,1,1,20131001,E0280,HCPCS,BED CRADLE,NU,,28 ,,NW,,,,,,$65.24,$0.00,1,1,1,1,1,1,20131001,E0280,HCPCS,BED CRADLE,RR,,28 ,,NW,,,,,,$8.24,$0.00,1,1,1,1,1,1,20131001,E0280,HCPCS,BED CRADLE,UE,,28 ,,NW,,,,,,$49.25,$0.00,1,1,1,1,1,1,20131001,E0280,HCPCS,BED CRADLE,,,28 ,,NW,,,,,,$65.24,$0.00,1,1,1,1,1,1,20131001,E0290,HCPCS,HOSP BED FX HT W/O RAILS W/M,RR,,28 ,,NW,,,,,,$122.46,$0.00,1,1,1,1,1,1,20131001,E0290,HCPCS,HOSP BED FX HT W/O RAILS W/M,UE,,28 ,,NW,,,,,,$810.72,$0.00,1,1,1,1,1,1,20131001,E0290,HCPCS,HOSP BED FX HT W/O RAILS W/M,,,28 ,,NW,,,,,,"$1,180.61",$0.00,1,1,1,1,1,1,20131001,E0291,HCPCS,HOSP BED FX HT W/O RAIL W/O,RR,,28 ,,NW,,,,,,$88.52,$0.00,1,1,1,1,1,1,20131001,E0291,HCPCS,HOSP BED FX HT W/O RAIL W/O,UE,,28 ,,NW,,,,,,$599.31,$0.00,1,1,1,1,1,1,20131001,E0291,HCPCS,HOSP BED FX HT W/O RAIL W/O,,,28 ,,NW,,,,,,$853.44,$0.00,1,1,1,1,1,1,20131001,E0292,HCPCS,HOSP BED VAR HT W/O RAIL W/O,RR,,28 ,,NW,,,,,,$137.78,$0.00,1,1,1,1,1,1,20131001,E0292,HCPCS,HOSP BED VAR HT W/O RAIL W/O,UE,,28 ,,NW,,,,,,$907.38,$0.00,1,1,1,1,1,1,20131001,E0292,HCPCS,HOSP BED VAR HT W/O RAIL W/O,,,28 ,,NW,,,,,,"$1,328.36",$0.00,1,1,1,1,1,1,20131001,E0293,HCPCS,HOSP BED VAR HT W/O RAIL W/,RR,,28 ,,NW,,,,,,$117.78,$0.00,1,1,1,1,1,1,20131001,E0293,HCPCS,HOSP BED VAR HT W/O RAIL W/,UE,,28 ,,NW,,,,,,$777.34,$0.00,1,1,1,1,1,1,20131001,E0293,HCPCS,HOSP BED VAR HT W/O RAIL W/,,,28 ,,NW,,,,,,"$1,135.57",$0.00,1,1,1,1,1,1,20131001,E0294,HCPCS,HOSP BED SEMI-ELECT W/ MATTR,RR,,28 ,,NW,,,,,,$216.40,$0.00,1,1,1,1,1,1,20131001,E0294,HCPCS,HOSP BED SEMI-ELECT W/ MATTR,UE,,28 ,,NW,,,,,,"$1,390.02",$0.00,1,1,1,1,1,1,20131001,E0294,HCPCS,HOSP BED SEMI-ELECT W/ MATTR,,,28 ,,NW,,,,,,"$2,086.28",$0.00,1,1,1,1,1,1,20131001,E0295,HCPCS,HOSP BED SEMI-ELECT W/O MATT,RR,,28 ,,NW,,,,,,$210.03,$0.00,1,1,1,1,1,1,20131001,E0295,HCPCS,HOSP BED SEMI-ELECT W/O MATT,UE,,28 ,,NW,,,,,,"$1,355.94",$0.00,1,1,1,1,1,1,20131001,E0295,HCPCS,HOSP BED SEMI-ELECT W/O MATT,,,28 ,,NW,,,,,,"$2,024.92",$0.00,1,1,1,1,1,1,20131001,E0296,HCPCS,HOSP BED TOTAL ELECT W/ MATT,RR,,28 ,,NW,,,,,,$258.45,$0.00,1,1,1,1,1,1,20131001,E0296,HCPCS,HOSP BED TOTAL ELECT W/ MATT,UE,,28 ,,NW,,,,,,"$1,737.04",$0.00,1,1,1,1,1,1,20131001,E0296,HCPCS,HOSP BED TOTAL ELECT W/ MATT,,,28 ,,NW,,,,,,"$2,491.74",$0.00,1,1,1,1,1,1,20131001,E0297,HCPCS,HOSP BED TOTAL ELECT W/O MAT,RR,,28 ,,NW,,,,,,$232.18,$0.00,1,1,1,1,1,1,20131001,E0297,HCPCS,HOSP BED TOTAL ELECT W/O MAT,UE,,28 ,,NW,,,,,,"$1,493.64",$0.00,1,1,1,1,1,1,20131001,E0297,HCPCS,HOSP BED TOTAL ELECT W/O MAT,,,28 ,,NW,,,,,,"$2,238.48",$0.00,1,1,1,1,1,1,20131001,E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,NU,,28 ,,NW,,,,,,"$4,160.80",$0.00,1,1,1,1,1,1,20131001,E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,RR,,28 ,,NW,,,,,,$449.72,$0.00,1,1,1,1,1,1,20131001,E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,UE,,28 ,,NW,,,,,,"$3,129.94",$0.00,1,1,1,1,1,1,20131001,E0300,HCPCS,ENCLOSED PED CRIB HOSP GRADE,,,28 ,,NW,,,,,,"$4,160.80",$0.00,1,1,1,1,1,1,20131001,E0301,HCPCS,"HD HOSP BED, 350-600 LBS",RR,,28 ,,NW,,,,,,$419.31,$0.00,1,1,1,1,1,1,20131001,E0301,HCPCS,"HD HOSP BED, 350-600 LBS",,,28 ,,NW,,,,,,"$4,042.54",$0.00,1,1,1,1,1,1,20131001,E0302,HCPCS,EX HD HOSP BED > 600 LBS,RR,,28 ,,NW,,,,,,"$1,075.21",$0.00,1,1,1,1,1,1,20131001,E0302,HCPCS,EX HD HOSP BED > 600 LBS,,,28 ,,NW,,,,,,"$10,366.13",$0.00,1,1,1,1,1,1,20131001,E0303,HCPCS,HOSP BED HVY DTY XTRA WIDE,RR,,28 ,,NW,,,,,,$467.57,$0.00,1,1,1,1,1,1,20131001,E0303,HCPCS,HOSP BED HVY DTY XTRA WIDE,,,28 ,,NW,,,,,,"$4,507.86",$0.00,1,1,1,1,1,1,20131001,E0304,HCPCS,HOSP BED XTRA HVY DTY X WIDE,RR,,28 ,,NW,,,,,,"$1,155.34",$0.00,1,1,1,1,1,1,20131001,E0304,HCPCS,HOSP BED XTRA HVY DTY X WIDE,,,28 ,,NW,,,,,,"$11,138.68",$0.00,1,1,1,1,1,1,20131001,E0305,HCPCS,RAILS BED SIDE HALF LENGTH,RR,,28 ,,NW,,,,,,$30.44,$0.00,1,1,1,1,1,1,20131001,E0305,HCPCS,RAILS BED SIDE HALF LENGTH,UE,,28 ,,NW,,,,,,$221.68,$0.00,1,1,1,1,1,1,20131001,E0305,HCPCS,RAILS BED SIDE HALF LENGTH,,,28 ,,NW,,,,,,$293.49,$0.00,1,1,1,1,1,1,20131001,E0310,HCPCS,RAILS BED SIDE FULL LENGTH,NU,,28 ,,NW,,,,,,$305.64,$0.00,1,1,1,1,1,1,20131001,E0310,HCPCS,RAILS BED SIDE FULL LENGTH,RR,,28 ,,NW,,,,,,$38.97,$0.00,1,1,1,1,1,1,20131001,E0310,HCPCS,RAILS BED SIDE FULL LENGTH,UE,,28 ,,NW,,,,,,$242.63,$0.00,1,1,1,1,1,1,20131001,E0310,HCPCS,RAILS BED SIDE FULL LENGTH,,,28 ,,NW,,,,,,$305.64,$0.00,1,1,1,1,1,1,20131001,E0315,HCPCS,BED ACCESSORY BRD/TBL/SUPPRT,,,28 ,,NW,,,,,,$127.55,$0.00,1,1,1,1,1,1,20131001,E0316,HCPCS,BED SAFETY ENCLOSURE,RR,,28 ,,NW,,,,,,$334.30,$0.00,1,1,1,1,1,1,20131001,E0316,HCPCS,BED SAFETY ENCLOSURE,,,28 ,,NW,,,,,,"$3,223.01",$0.00,1,1,1,1,1,1,20131001,E0325,HCPCS,URINAL MALE JUG-TYPE,NU,,28 ,,NW,,,,,,$23.35,$0.00,1,1,1,1,1,1,20131001,E0325,HCPCS,URINAL MALE JUG-TYPE,RR,,28 ,,NW,,,,,,$4.96,$0.00,1,1,1,1,1,1,20131001,E0325,HCPCS,URINAL MALE JUG-TYPE,UE,,28 ,,NW,,,,,,$18.50,$0.00,1,1,1,1,1,1,20131001,E0325,HCPCS,URINAL MALE JUG-TYPE,,,28 ,,NW,,,,,,$23.35,$0.00,1,1,1,1,1,1,20131001,E0326,HCPCS,URINAL FEMALE JUG-TYPE,NU,,28 ,,NW,,,,,,$24.64,$0.00,1,1,1,1,1,1,20131001,E0326,HCPCS,URINAL FEMALE JUG-TYPE,RR,,28 ,,NW,,,,,,$3.98,$0.00,1,1,1,1,1,1,20131001,E0326,HCPCS,URINAL FEMALE JUG-TYPE,UE,,28 ,,NW,,,,,,$20.60,$0.00,1,1,1,1,1,1,20131001,E0326,HCPCS,URINAL FEMALE JUG-TYPE,,,28 ,,NW,,,,,,$24.64,$0.00,1,1,1,1,1,1,20131001,E0328,HCPCS,"PED HOSPITAL BED, MANUAL",,,28 ,,NW,,,,,,$128.52,$0.00,1,1,1,1,1,1,20131001,E0329,HCPCS,PED HOSPITAL BED SEMI/ELECT,,,28 ,,NW,,,,,,$582.28,$0.00,1,1,1,1,1,1,20131001,E0352,HCPCS,DISPOSABLE PACK W/BOWEL SYST,,,28 ,,NW,,,,,,$68.87,$0.00,1,1,1,1,1,1,20131001,E0370,HCPCS,AIR ELEVATOR FOR HEEL,,,28 ,,NW,,,,,,$69.35,$0.00,1,1,1,1,1,1,20131001,E0371,HCPCS,NONPOWER MATTRESS OVERLAY,RR,,28 ,,NW,,,,,,$929.98,$0.00,1,1,1,1,1,1,20131001,E0371,HCPCS,NONPOWER MATTRESS OVERLAY,,,28 ,,NW,,,,,,"$8,965.99",$0.00,1,1,1,1,1,1,20131001,E0372,HCPCS,POWERED AIR MATTRESS OVERLAY,RR,,28 ,,NW,,,,,,"$1,136.75",$0.00,1,1,1,1,1,1,20131001,E0372,HCPCS,POWERED AIR MATTRESS OVERLAY,,,28 ,,NW,,,,,,"$10,959.42",$0.00,1,1,1,1,1,1,20131001,E0373,HCPCS,NONPOWERED PRESSURE MATTRESS,RR,,28 ,,NW,,,,,,"$1,304.06",$0.00,1,1,1,1,1,1,20131001,E0373,HCPCS,NONPOWERED PRESSURE MATTRESS,,,28 ,,NW,,,,,,"$12,572.51",$0.00,1,1,1,1,1,1,20131001,E0424,HCPCS,STATIONARY COMPRESSED GAS 02,RR,,28 ,,NW,,,,,,$577.63,$0.00,1,1,1,1,1,1,20131001,E0424,HCPCS,STATIONARY COMPRESSED GAS 02,,,28 ,,NW,,,,,,"$5,569.00",$0.00,1,1,1,1,1,1,20131001,E0425,HCPCS,GAS SYSTEM STATIONARY COMPRE,NU,,28 ,,NW,,,,,,"$13,227.04",$0.00,1,1,1,1,1,1,20131001,E0425,HCPCS,GAS SYSTEM STATIONARY COMPRE,,,28 ,,NW,,,,,,"$13,227.04",$0.00,1,1,1,1,1,1,20131001,E0430,HCPCS,OXYGEN SYSTEM GAS PORTABLE,NU,,28 ,,NW,,,,,,"$5,965.26",$0.00,1,1,1,1,1,1,20131001,E0430,HCPCS,OXYGEN SYSTEM GAS PORTABLE,UE,,28 ,,NW,,,,,,"$4,462.43",$0.00,1,1,1,1,1,1,20131001,E0430,HCPCS,OXYGEN SYSTEM GAS PORTABLE,,,28 ,,NW,,,,,,"$5,965.26",$0.00,1,1,1,1,1,1,20131001,E0431,HCPCS,PORTABLE GASEOUS 02,RR,,28 ,,NW,,,,,,$59.55,$0.00,1,1,1,1,1,1,20131001,E0431,HCPCS,PORTABLE GASEOUS 02,,,28 ,,NW,,,,,,$574.15,$0.00,1,1,1,1,1,1,20131001,E0433,HCPCS,PORTABLE LIQUID OXYGEN SYS,RR,,28 ,,NW,,,,,,$137.99,$0.00,1,1,1,1,1,1,20131001,E0433,HCPCS,PORTABLE LIQUID OXYGEN SYS,,,28 ,,NW,,,,,,"$1,330.37",$0.00,1,1,1,1,1,1,20131001,E0434,HCPCS,PORTABLE LIQUID 02,RR,,28 ,,NW,,,,,,$59.55,$0.00,1,1,1,1,1,1,20131001,E0434,HCPCS,PORTABLE LIQUID 02,,,28 ,,NW,,,,,,$574.15,$0.00,1,1,1,1,1,1,20131001,E0435,HCPCS,OXYGEN SYSTEM LIQUID PORTABL,NU,,28 ,,NW,,,,,,"$4,087.13",$0.00,1,1,1,1,1,1,20131001,E0435,HCPCS,OXYGEN SYSTEM LIQUID PORTABL,UE,,28 ,,NW,,,,,,"$3,055.05",$0.00,1,1,1,1,1,1,20131001,E0435,HCPCS,OXYGEN SYSTEM LIQUID PORTABL,,,28 ,,NW,,,,,,"$4,087.13",$0.00,1,1,1,1,1,1,20131001,E0439,HCPCS,STATIONARY LIQUID 02,RR,,28 ,,NW,,,,,,$577.63,$0.00,1,1,1,1,1,1,20131001,E0439,HCPCS,STATIONARY LIQUID 02,,,28 ,,NW,,,,,,"$5,569.00",$0.00,1,1,1,1,1,1,20131001,E0440,HCPCS,OXYGEN SYSTEM LIQUID STATION,NU,,28 ,,NW,,,,,,"$8,344.87",$0.00,1,1,1,1,1,1,20131001,E0440,HCPCS,OXYGEN SYSTEM LIQUID STATION,UE,,28 ,,NW,,,,,,"$6,246.74",$0.00,1,1,1,1,1,1,20131001,E0440,HCPCS,OXYGEN SYSTEM LIQUID STATION,,,28 ,,NW,,,,,,"$8,344.87",$0.00,1,1,1,1,1,1,20131001,E0441,HCPCS,"STATIONARY O2 CONTENTS, GAS",,,28 ,,NW,,,,,,$229.22,$0.00,1,1,1,1,1,1,20131001,E0442,HCPCS,"STATIONARY O2 CONTENTS, LIQ",,,28 ,,NW,,,,,,$229.22,$0.00,1,1,1,1,1,1,20131001,E0443,HCPCS,"PORTABLE 02 CONTENTS, GAS",,,28 ,,NW,,,,,,$229.22,$0.00,1,1,1,1,1,1,20131001,E0444,HCPCS,"PORTABLE 02 CONTENTS, LIQUID",,,28 ,,NW,,,,,,$229.22,$0.00,1,1,1,1,1,1,20131001,E0445,HCPCS,OXIMETER NON-INVASIVE,,,28 ,,NW,,,,,,$259.62,$0.00,1,1,1,1,1,1,20131001,E0446,HCPCS,"TOPICAL OX DELIVER SYS, NOS",,,28 ,,NW,,,,,,$819.61,$0.00,1,1,1,1,1,1,20131001,E0450,HCPCS,VOL CONTROL VENT INVASIV INT,NU,,28 ,,NW,,,,,,"$22,438.28",$0.00,1,1,1,1,1,1,20131001,E0450,HCPCS,VOL CONTROL VENT INVASIV INT,RR,,28 ,,NW,,,,,,"$2,327.37",$0.00,1,1,1,1,1,1,20131001,E0450,HCPCS,VOL CONTROL VENT INVASIV INT,UE,,28 ,,NW,,,,,,"$16,845.85",$0.00,1,1,1,1,1,1,20131001,E0450,HCPCS,VOL CONTROL VENT INVASIV INT,,,28 ,,NW,,,,,,"$22,438.28",$0.00,1,1,1,1,1,1,20131001,E0455,HCPCS,OXYGEN TENT EXCL CROUP/PED T,,,28 ,,NW,,,,,,$39.74,$0.00,1,1,1,1,1,1,20131001,E0457,HCPCS,CHEST SHELL,NU,,28 ,,NW,,,,,,"$1,560.34",$0.00,1,1,1,1,1,1,20131001,E0457,HCPCS,CHEST SHELL,RR,,28 ,,NW,,,,,,$121.07,$0.00,1,1,1,1,1,1,20131001,E0457,HCPCS,CHEST SHELL,UE,,28 ,,NW,,,,,,"$1,160.45",$0.00,1,1,1,1,1,1,20131001,E0457,HCPCS,CHEST SHELL,,,28 ,,NW,,,,,,"$1,560.34",$0.00,1,1,1,1,1,1,20131001,E0459,HCPCS,CHEST WRAP,NU,,28 ,,NW,,,,,,"$1,279.72",$0.00,1,1,1,1,1,1,20131001,E0459,HCPCS,CHEST WRAP,RR,,28 ,,NW,,,,,,$88.52,$0.00,1,1,1,1,1,1,20131001,E0459,HCPCS,CHEST WRAP,UE,,28 ,,NW,,,,,,$950.08,$0.00,1,1,1,1,1,1,20131001,E0459,HCPCS,CHEST WRAP,,,28 ,,NW,,,,,,"$1,279.72",$0.00,1,1,1,1,1,1,20131001,E0460,HCPCS,NEG PRESS VENT PORTABL/STATN,NU,,28 ,,NW,,,,,,"$18,965.71",$0.00,1,1,1,1,1,1,20131001,E0460,HCPCS,NEG PRESS VENT PORTABL/STATN,RR,,28 ,,NW,,,,,,"$1,744.17",$0.00,1,1,1,1,1,1,20131001,E0460,HCPCS,NEG PRESS VENT PORTABL/STATN,UE,,28 ,,NW,,,,,,"$14,214.57",$0.00,1,1,1,1,1,1,20131001,E0460,HCPCS,NEG PRESS VENT PORTABL/STATN,,,28 ,,NW,,,,,,"$18,965.71",$0.00,1,1,1,1,1,1,20131001,E0461,HCPCS,VOL CONTROL VENT NONINV INT,RR,,28 ,,NW,,,,,,"$2,327.37",$0.00,1,1,1,1,1,1,20131001,E0461,HCPCS,VOL CONTROL VENT NONINV INT,,,28 ,,NW,,,,,,"$22,438.31",$0.00,1,1,1,1,1,1,20131001,E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,NU,,28 ,,NW,,,,,,"$4,703.77",$0.00,1,1,1,1,1,1,20131001,E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,RR,,28 ,,NW,,,,,,$508.23,$0.00,1,1,1,1,1,1,20131001,E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,UE,,28 ,,NW,,,,,,"$3,536.83",$0.00,1,1,1,1,1,1,20131001,E0462,HCPCS,ROCKING BED W/ OR W/O SIDE R,,,28 ,,NW,,,,,,"$4,703.77",$0.00,1,1,1,1,1,1,20131001,E0463,HCPCS,PRESS SUPP VENT INVASIVE INT,RR,,28 ,,NW,,,,,,"$3,621.10",$0.00,1,1,1,1,1,1,20131001,E0463,HCPCS,PRESS SUPP VENT INVASIVE INT,,,28 ,,NW,,,,,,"$34,911.21",$0.00,1,1,1,1,1,1,20131001,E0464,HCPCS,PRESS SUPP VENT NONINV INT,RR,,28 ,,NW,,,,,,"$3,621.10",$0.00,1,1,1,1,1,1,20131001,E0464,HCPCS,PRESS SUPP VENT NONINV INT,,,28 ,,NW,,,,,,"$34,911.21",$0.00,1,1,1,1,1,1,20131001,E0470,HCPCS,RAD W/O BACKUP NON-INV INTFC,RR,,28 ,,NW,,,,,,$511.61,$0.00,1,1,1,1,1,1,20131001,E0470,HCPCS,RAD W/O BACKUP NON-INV INTFC,,,28 ,,NW,,,,,,"$4,932.49",$0.00,1,1,1,1,1,1,20131001,E0471,HCPCS,RAD W/BACKUP NON INV INTRFC,RR,,28 ,,NW,,,,,,"$1,316.31",$0.00,1,1,1,1,1,1,20131001,E0471,HCPCS,RAD W/BACKUP NON INV INTRFC,,,28 ,,NW,,,,,,"$12,690.60",$0.00,1,1,1,1,1,1,20131001,E0472,HCPCS,RAD W BACKUP INVASIVE INTRFC,RR,,28 ,,NW,,,,,,"$1,316.31",$0.00,1,1,1,1,1,1,20131001,E0472,HCPCS,RAD W BACKUP INVASIVE INTRFC,,,28 ,,NW,,,,,,"$12,690.60",$0.00,1,1,1,1,1,1,20131001,E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,NU,,28 ,,NW,,,,,,$727.22,$0.00,1,1,1,1,1,1,20131001,E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,RR,,28 ,,NW,,,,,,$75.43,$0.00,1,1,1,1,1,1,20131001,E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,UE,,28 ,,NW,,,,,,$545.97,$0.00,1,1,1,1,1,1,20131001,E0480,HCPCS,PERCUSSOR ELECT/PNEUM HOME M,,,28 ,,NW,,,,,,$727.22,$0.00,1,1,1,1,1,1,20131001,E0481,HCPCS,INTRPULMNRY PERCUSS VENT SYS,,,28 ,,NW,,,,,,$602.37,$0.00,1,1,1,1,1,1,20131001,E0482,HCPCS,COUGH STIMULATING DEVICE,RR,,28 ,,NW,,,,,,"$1,048.28",$0.00,1,1,1,1,1,1,20131001,E0482,HCPCS,COUGH STIMULATING DEVICE,,,28 ,,NW,,,,,,"$10,106.53",$0.00,1,1,1,1,1,1,20131001,E0483,HCPCS,CHEST COMPRESSION GEN SYSTEM,RR,,28 ,,NW,,,,,,"$2,727.81",$0.00,1,1,1,1,1,1,20131001,E0483,HCPCS,CHEST COMPRESSION GEN SYSTEM,,,28 ,,NW,,,,,,"$26,298.98",$0.00,1,1,1,1,1,1,20131001,E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,NU,,28 ,,NW,,,,,,$68.10,$0.00,1,1,1,1,1,1,20131001,E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,RR,,28 ,,NW,,,,,,$12.68,$0.00,1,1,1,1,1,1,20131001,E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,UE,,28 ,,NW,,,,,,$53.22,$0.00,1,1,1,1,1,1,20131001,E0484,HCPCS,NON-ELEC OSCILLATORY PEP DVC,,,28 ,,NW,,,,,,$68.10,$0.00,1,1,1,1,1,1,20131001,E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,NU,,28 ,,NW,,,,,,"$3,074.28",$0.00,1,1,1,1,1,1,20131001,E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,RR,,28 ,,NW,,,,,,$336.45,$0.00,1,1,1,1,1,1,20131001,E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,UE,,28 ,,NW,,,,,,"$2,315.13",$0.00,1,1,1,1,1,1,20131001,E0485,HCPCS,ORAL DEVICE/APPLIANCE PREFAB,,,28 ,,NW,,,,,,"$3,074.28",$0.00,1,1,1,1,1,1,20131001,E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,NU,,28 ,,NW,,,,,,"$3,495.10",$0.00,1,1,1,1,1,1,20131001,E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,RR,,28 ,,NW,,,,,,$352.71,$0.00,1,1,1,1,1,1,20131001,E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,UE,,28 ,,NW,,,,,,"$2,427.00",$0.00,1,1,1,1,1,1,20131001,E0486,HCPCS,ORAL DEVICE/APPLIANCE CUSFAB,,,28 ,,NW,,,,,,"$3,495.10",$0.00,1,1,1,1,1,1,20131001,E0487,HCPCS,ELECTRONIC SPIROMETER,,,28 ,,NW,,,,,,$382.51,$0.00,1,1,1,1,1,1,20131001,E0500,HCPCS,IPPB ALL TYPES,NU,,28 ,,NW,,,,,,"$2,805.30",$0.00,1,1,1,1,1,1,20131001,E0500,HCPCS,IPPB ALL TYPES,RR,,28 ,,NW,,,,,,$238.07,$0.00,1,1,1,1,1,1,20131001,E0500,HCPCS,IPPB ALL TYPES,UE,,28 ,,NW,,,,,,"$2,094.26",$0.00,1,1,1,1,1,1,20131001,E0500,HCPCS,IPPB ALL TYPES,,,28 ,,NW,,,,,,"$2,805.30",$0.00,1,1,1,1,1,1,20131001,E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,NU,,28 ,,NW,,,,,,"$1,259.47",$0.00,1,1,1,1,1,1,20131001,E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,RR,,28 ,,NW,,,,,,$85.43,$0.00,1,1,1,1,1,1,20131001,E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,UE,,28 ,,NW,,,,,,$935.45,$0.00,1,1,1,1,1,1,20131001,E0550,HCPCS,HUMIDIF EXTENS SUPPLE W IPPB,,,28 ,,NW,,,,,,"$1,259.47",$0.00,1,1,1,1,1,1,20131001,E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,NU,,28 ,,NW,,,,,,$5.44,$0.00,1,1,1,1,1,1,20131001,E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,RR,,28 ,,NW,,,,,,$0.56,$0.00,1,1,1,1,1,1,20131001,E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,UE,,28 ,,NW,,,,,,$4.08,$0.00,1,1,1,1,1,1,20131001,E0555,HCPCS,HUMIDIFIER FOR USE W/ REGULA,,,28 ,,NW,,,,,,$5.44,$0.00,1,1,1,1,1,1,20131001,E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,NU,,28 ,,NW,,,,,,$318.74,$0.00,1,1,1,1,1,1,20131001,E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,RR,,28 ,,NW,,,,,,$35.13,$0.00,1,1,1,1,1,1,20131001,E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,UE,,28 ,,NW,,,,,,$229.34,$0.00,1,1,1,1,1,1,20131001,E0560,HCPCS,HUMIDIFIER SUPPLEMENTAL W/ I,,,28 ,,NW,,,,,,$318.74,$0.00,1,1,1,1,1,1,20131001,E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,NU,,28 ,,NW,,,,,,$201.23,$0.00,1,1,1,1,1,1,20131001,E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,RR,,28 ,,NW,,,,,,$23.37,$0.00,1,1,1,1,1,1,20131001,E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,UE,,28 ,,NW,,,,,,$141.22,$0.00,1,1,1,1,1,1,20131001,E0561,HCPCS,HUMIDIFIER NONHEATED W PAP,,,28 ,,NW,,,,,,$201.23,$0.00,1,1,1,1,1,1,20131001,E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,NU,,28 ,,NW,,,,,,$636.79,$0.00,1,1,1,1,1,1,20131001,E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,RR,,28 ,,NW,,,,,,$50.38,$0.00,1,1,1,1,1,1,20131001,E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,UE,,28 ,,NW,,,,,,$467.87,$0.00,1,1,1,1,1,1,20131001,E0562,HCPCS,HUMIDIFIER HEATED USED W PAP,,,28 ,,NW,,,,,,$636.79,$0.00,1,1,1,1,1,1,20131001,E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,NU,,28 ,,NW,,,,,,"$1,541.86",$0.00,1,1,1,1,1,1,20131001,E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,RR,,28 ,,NW,,,,,,$111.78,$0.00,1,1,1,1,1,1,20131001,E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,UE,,28 ,,NW,,,,,,"$1,146.96",$0.00,1,1,1,1,1,1,20131001,E0565,HCPCS,COMPRESSOR AIR POWER SOURCE,,,28 ,,NW,,,,,,"$1,541.86",$0.00,1,1,1,1,1,1,20131001,E0570,HCPCS,NEBULIZER WITH COMPRESSION,NU,,28 ,,NW,,,,,,$332.62,$0.00,1,1,1,1,1,1,20131001,E0570,HCPCS,NEBULIZER WITH COMPRESSION,RR,,28 ,,NW,,,,,,$34.50,$0.00,1,1,1,1,1,1,20131001,E0570,HCPCS,NEBULIZER WITH COMPRESSION,UE,,28 ,,NW,,,,,,$249.72,$0.00,1,1,1,1,1,1,20131001,E0570,HCPCS,NEBULIZER WITH COMPRESSION,,,28 ,,NW,,,,,,$332.62,$0.00,1,1,1,1,1,1,20131001,E0572,HCPCS,AEROSOL COMPRESSOR ADJUST PR,RR,,28 ,,NW,,,,,,$96.42,$0.00,1,1,1,1,1,1,20131001,E0572,HCPCS,AEROSOL COMPRESSOR ADJUST PR,,,28 ,,NW,,,,,,$929.61,$0.00,1,1,1,1,1,1,20131001,E0574,HCPCS,ULTRASONIC GENERATOR W SVNEB,RR,,28 ,,NW,,,,,,$104.45,$0.00,1,1,1,1,1,1,20131001,E0574,HCPCS,ULTRASONIC GENERATOR W SVNEB,,,28 ,,NW,,,,,,"$1,007.00",$0.00,1,1,1,1,1,1,20131001,E0575,HCPCS,NEBULIZER ULTRASONIC,NU,,28 ,,NW,,,,,,"$2,624.17",$0.00,1,1,1,1,1,1,20131001,E0575,HCPCS,NEBULIZER ULTRASONIC,RR,,28 ,,NW,,,,,,$218.94,$0.00,1,1,1,1,1,1,20131001,E0575,HCPCS,NEBULIZER ULTRASONIC,UE,,28 ,,NW,,,,,,"$1,958.13",$0.00,1,1,1,1,1,1,20131001,E0575,HCPCS,NEBULIZER ULTRASONIC,,,28 ,,NW,,,,,,"$2,624.17",$0.00,1,1,1,1,1,1,20131001,E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,NU,,28 ,,NW,,,,,,$261.81,$0.00,1,1,1,1,1,1,20131001,E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,RR,,28 ,,NW,,,,,,$27.15,$0.00,1,1,1,1,1,1,20131001,E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,UE,,28 ,,NW,,,,,,$186.61,$0.00,1,1,1,1,1,1,20131001,E0580,HCPCS,NEBULIZER FOR USE W/ REGULAT,,,28 ,,NW,,,,,,$261.81,$0.00,1,1,1,1,1,1,20131001,E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,NU,,28 ,,NW,,,,,,$870.20,$0.00,1,1,1,1,1,1,20131001,E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,RR,,28 ,,NW,,,,,,$62.51,$0.00,1,1,1,1,1,1,20131001,E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,UE,,28 ,,NW,,,,,,$642.93,$0.00,1,1,1,1,1,1,20131001,E0585,HCPCS,NEBULIZER W/ COMPRESSOR & HE,,,28 ,,NW,,,,,,$870.20,$0.00,1,1,1,1,1,1,20131001,E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,NU,,28 ,,NW,,,,,,"$1,146.96",$0.00,1,1,1,1,1,1,20131001,E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,RR,,28 ,,NW,,,,,,$79.17,$0.00,1,1,1,1,1,1,20131001,E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,UE,,28 ,,NW,,,,,,$851.07,$0.00,1,1,1,1,1,1,20131001,E0600,HCPCS,SUCTION PUMP PORTAB HOM MODL,,,28 ,,NW,,,,,,"$1,146.96",$0.00,1,1,1,1,1,1,20131001,E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,NU,,28 ,,NW,,,,,,"$2,455.41",$0.00,1,1,1,1,1,1,20131001,E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,RR,,28 ,,NW,,,,,,$199.14,$0.00,1,1,1,1,1,1,20131001,E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,UE,,28 ,,NW,,,,,,"$1,832.13",$0.00,1,1,1,1,1,1,20131001,E0601,HCPCS,CONT AIRWAY PRESSURE DEVICE,,,28 ,,NW,,,,,,"$2,455.41",$0.00,1,1,1,1,1,1,20131001,E0602,HCPCS,MANUAL BREAST PUMP,NU,,28 ,,NW,,,,,,$56.15,$0.00,1,1,1,1,1,1,20131001,E0602,HCPCS,MANUAL BREAST PUMP,RR,,28 ,,NW,,,,,,$10.18,$0.00,1,1,1,1,1,1,20131001,E0602,HCPCS,MANUAL BREAST PUMP,UE,,28 ,,NW,,,,,,$44.25,$0.00,1,1,1,1,1,1,20131001,E0602,HCPCS,MANUAL BREAST PUMP,,,28 ,,NW,,,,,,$56.15,$0.00,1,1,1,1,1,1,20131001,E0603,HCPCS,ELECTRIC BREAST PUMP,NU,,28 ,,NW,,,,,,$179.41,$0.00,1,1,1,1,1,1,20131001,E0603,HCPCS,ELECTRIC BREAST PUMP,RR,,28 ,,NW,,,,,,$53.86,$0.00,1,1,1,1,1,1,20131001,E0603,HCPCS,ELECTRIC BREAST PUMP,UE,,28 ,,NW,,,,,,$135.53,$0.00,1,1,1,1,1,1,20131001,E0603,HCPCS,ELECTRIC BREAST PUMP,,,28 ,,NW,,,,,,$179.41,$0.00,1,1,1,1,1,1,20131001,E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,NU,,28 ,,NW,,,,,,$587.81,$0.00,1,1,1,1,1,1,20131001,E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,RR,,28 ,,NW,,,,,,$201.91,$0.00,1,1,1,1,1,1,20131001,E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,UE,,28 ,,NW,,,,,,$431.42,$0.00,1,1,1,1,1,1,20131001,E0604,HCPCS,HOSP GRADE ELEC BREAST PUMP,,,28 ,,NW,,,,,,$587.81,$0.00,1,1,1,1,1,1,20131001,E0605,HCPCS,VAPORIZER ROOM TYPE,NU,,28 ,,NW,,,,,,$50.69,$0.00,1,1,1,1,1,1,20131001,E0605,HCPCS,VAPORIZER ROOM TYPE,RR,,28 ,,NW,,,,,,$11.00,$0.00,1,1,1,1,1,1,20131001,E0605,HCPCS,VAPORIZER ROOM TYPE,UE,,28 ,,NW,,,,,,$42.41,$0.00,1,1,1,1,1,1,20131001,E0605,HCPCS,VAPORIZER ROOM TYPE,,,28 ,,NW,,,,,,$50.69,$0.00,1,1,1,1,1,1,20131001,E0606,HCPCS,DRAINAGE BOARD POSTURAL,NU,,28 ,,NW,,,,,,$555.18,$0.00,1,1,1,1,1,1,20131001,E0606,HCPCS,DRAINAGE BOARD POSTURAL,RR,,28 ,,NW,,,,,,$43.25,$0.00,1,1,1,1,1,1,20131001,E0606,HCPCS,DRAINAGE BOARD POSTURAL,UE,,28 ,,NW,,,,,,$406.67,$0.00,1,1,1,1,1,1,20131001,E0606,HCPCS,DRAINAGE BOARD POSTURAL,,,28 ,,NW,,,,,,$555.18,$0.00,1,1,1,1,1,1,20131001,E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,NU,,28 ,,NW,,,,,,$135.19,$0.00,1,1,1,1,1,1,20131001,E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,RR,,28 ,,NW,,,,,,$19.28,$0.00,1,1,1,1,1,1,20131001,E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,UE,,28 ,,NW,,,,,,$91.66,$0.00,1,1,1,1,1,1,20131001,E0607,HCPCS,BLOOD GLUCOSE MONITOR HOME,,,28 ,,NW,,,,,,$135.19,$0.00,1,1,1,1,1,1,20131001,E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,NU,,28 ,,NW,,,,,,$563.82,$0.00,1,1,1,1,1,1,20131001,E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,RR,,28 ,,NW,,,,,,$47.80,$0.00,1,1,1,1,1,1,20131001,E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,UE,,28 ,,NW,,,,,,$413.03,$0.00,1,1,1,1,1,1,20131001,E0610,HCPCS,PACEMAKER MONITR AUDIBLE/VIS,,,28 ,,NW,,,,,,$563.82,$0.00,1,1,1,1,1,1,20131001,E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,NU,,28 ,,NW,,,,,,"$1,148.06",$0.00,1,1,1,1,1,1,20131001,E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,RR,,28 ,,NW,,,,,,$104.29,$0.00,1,1,1,1,1,1,20131001,E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,UE,,28 ,,NW,,,,,,$849.62,$0.00,1,1,1,1,1,1,20131001,E0615,HCPCS,PACEMAKER MONITR DIGITAL/VIS,,,28 ,,NW,,,,,,"$1,148.06",$0.00,1,1,1,1,1,1,20131001,E0616,HCPCS,CARDIAC EVENT RECORDER,,,28 ,,NW,,,,,,"$10,518.99",$0.00,1,1,1,1,1,1,20131001,E0617,HCPCS,AUTOMATIC EXT DEFIBRILLATOR,RR,,28 ,,NW,,,,,,"$1,630.89",$0.00,1,1,1,1,1,1,20131001,E0617,HCPCS,AUTOMATIC EXT DEFIBRILLATOR,,,28 ,,NW,,,,,,"$15,723.48",$0.00,1,1,1,1,1,1,20131001,E0618,HCPCS,APNEA MONITOR,RR,,28 ,,NW,,,,,,$647.10,$0.00,1,1,1,1,1,1,20131001,E0618,HCPCS,APNEA MONITOR,,,28 ,,NW,,,,,,"$6,238.69",$0.00,1,1,1,1,1,1,20131001,E0619,HCPCS,APNEA MONITOR W RECORDER,RR,,28 ,,NW,,,,,,$647.10,$0.00,1,1,1,1,1,1,20131001,E0619,HCPCS,APNEA MONITOR W RECORDER,,,28 ,,NW,,,,,,"$6,238.69",$0.00,1,1,1,1,1,1,20131001,E0620,HCPCS,CAP BLD SKIN PIERCING LASER,NU,,28 ,,NW,,,,,,"$2,236.64",$0.00,1,1,1,1,1,1,20131001,E0620,HCPCS,CAP BLD SKIN PIERCING LASER,RR,,28 ,,NW,,,,,,$188.67,$0.00,1,1,1,1,1,1,20131001,E0620,HCPCS,CAP BLD SKIN PIERCING LASER,UE,,28 ,,NW,,,,,,"$1,667.76",$0.00,1,1,1,1,1,1,20131001,E0620,HCPCS,CAP BLD SKIN PIERCING LASER,,,28 ,,NW,,,,,,"$2,236.64",$0.00,1,1,1,1,1,1,20131001,E0621,HCPCS,PATIENT LIFT SLING OR SEAT,NU,,28 ,,NW,,,,,,$193.36,$0.00,1,1,1,1,1,1,20131001,E0621,HCPCS,PATIENT LIFT SLING OR SEAT,RR,,28 ,,NW,,,,,,$22.61,$0.00,1,1,1,1,1,1,20131001,E0621,HCPCS,PATIENT LIFT SLING OR SEAT,UE,,28 ,,NW,,,,,,$136.14,$0.00,1,1,1,1,1,1,20131001,E0621,HCPCS,PATIENT LIFT SLING OR SEAT,,,28 ,,NW,,,,,,$193.36,$0.00,1,1,1,1,1,1,20131001,E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,NU,,28 ,,NW,,,,,,"$2,007.14",$0.00,1,1,1,1,1,1,20131001,E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,RR,,28 ,,NW,,,,,,$208.19,$0.00,1,1,1,1,1,1,20131001,E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,UE,,28 ,,NW,,,,,,"$1,506.89",$0.00,1,1,1,1,1,1,20131001,E0625,HCPCS,PATIENT LIFT BATHROOM OR TOI,,,28 ,,NW,,,,,,"$2,007.14",$0.00,1,1,1,1,1,1,20131001,E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,NU,,28 ,,NW,,,,,,$827.81,$0.00,1,1,1,1,1,1,20131001,E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,RR,,28 ,,NW,,,,,,$62.26,$0.00,1,1,1,1,1,1,20131001,E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,UE,,28 ,,NW,,,,,,$611.10,$0.00,1,1,1,1,1,1,20131001,E0627,HCPCS,SEAT LIFT INCORP LIFT-CHAIR,,,28 ,,NW,,,,,,$827.81,$0.00,1,1,1,1,1,1,20131001,E0628,HCPCS,SEAT LIFT FOR PT FURN-ELECTR,NU,,28 ,,NW,,,,,,$827.81,$0.00,1,1,1,1,1,1,20131001,E0628,HCPCS,SEAT LIFT FOR PT FURN-ELECTR,RR,,28 ,,NW,,,,,,$62.26,$0.00,1,1,1,1,1,1,20131001,E0628,HCPCS,SEAT LIFT FOR PT FURN-ELECTR,UE,,28 ,,NW,,,,,,$611.10,$0.00,1,1,1,1,1,1,20131001,E0628,HCPCS,SEAT LIFT FOR PT FURN-ELECTR,,,28 ,,NW,,,,,,$827.81,$0.00,1,1,1,1,1,1,20131001,E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,NU,,28 ,,NW,,,,,,$813.14,$0.00,1,1,1,1,1,1,20131001,E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,RR,,28 ,,NW,,,,,,$61.35,$0.00,1,1,1,1,1,1,20131001,E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,UE,,28 ,,NW,,,,,,$600.06,$0.00,1,1,1,1,1,1,20131001,E0629,HCPCS,SEAT LIFT FOR PT FURN-NON-EL,,,28 ,,NW,,,,,,$813.14,$0.00,1,1,1,1,1,1,20131001,E0630,HCPCS,PATIENT LIFT HYDRAULIC,NU,,28 ,,NW,,,,,,"$2,600.54",$0.00,1,1,1,1,1,1,20131001,E0630,HCPCS,PATIENT LIFT HYDRAULIC,RR,,28 ,,NW,,,,,,$213.87,$0.00,1,1,1,1,1,1,20131001,E0630,HCPCS,PATIENT LIFT HYDRAULIC,UE,,28 ,,NW,,,,,,"$1,941.26",$0.00,1,1,1,1,1,1,20131001,E0630,HCPCS,PATIENT LIFT HYDRAULIC,,,28 ,,NW,,,,,,"$2,600.54",$0.00,1,1,1,1,1,1,20131001,E0635,HCPCS,PATIENT LIFT ELECTRIC,NU,,28 ,,NW,,,,,,"$3,131.57",$0.00,1,1,1,1,1,1,20131001,E0635,HCPCS,PATIENT LIFT ELECTRIC,RR,,28 ,,NW,,,,,,$260.54,$0.00,1,1,1,1,1,1,20131001,E0635,HCPCS,PATIENT LIFT ELECTRIC,UE,,28 ,,NW,,,,,,"$2,338.40",$0.00,1,1,1,1,1,1,20131001,E0635,HCPCS,PATIENT LIFT ELECTRIC,,,28 ,,NW,,,,,,"$3,131.57",$0.00,1,1,1,1,1,1,20131001,E0636,HCPCS,PT SUPPORT & POSITIONING SYS,RR,,28 ,,NW,,,,,,"$2,705.52",$0.00,1,1,1,1,1,1,20131001,E0636,HCPCS,PT SUPPORT & POSITIONING SYS,,,28 ,,NW,,,,,,"$26,084.08",$0.00,1,1,1,1,1,1,20131001,E0637,HCPCS,COMBINATION SIT TO STAND SYS,,,28 ,,NW,,,,,,"$1,496.69",$0.00,1,1,1,1,1,1,20131001,E0638,HCPCS,STANDING FRAME SYS,,,28 ,,NW,,,,,,"$1,892.99",$0.00,1,1,1,1,1,1,20131001,E0640,HCPCS,FIXED PATIENT LIFT SYSTEM,,,28 ,,NW,,,,,,"$2,073.58",$0.00,1,1,1,1,1,1,20131001,E0641,HCPCS,MULTI-POSITION STND FRAM SYS,,,28 ,,NW,,,,,,"$2,161.70",$0.00,1,1,1,1,1,1,20131001,E0642,HCPCS,DYNAMIC STANDING FRAME,,,28 ,,NW,,,,,,"$2,668.75",$0.00,1,1,1,1,1,1,20131001,E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,NU,,28 ,,NW,,,,,,"$1,746.65",$0.00,1,1,1,1,1,1,20131001,E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,RR,,28 ,,NW,,,,,,$181.76,$0.00,1,1,1,1,1,1,20131001,E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,UE,,28 ,,NW,,,,,,"$1,293.40",$0.00,1,1,1,1,1,1,20131001,E0650,HCPCS,PNEUMA COMPRESOR NON-SEGMENT,,,28 ,,NW,,,,,,"$1,746.65",$0.00,1,1,1,1,1,1,20131001,E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,NU,,28 ,,NW,,,,,,"$2,216.63",$0.00,1,1,1,1,1,1,20131001,E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,RR,,28 ,,NW,,,,,,$193.83,$0.00,1,1,1,1,1,1,20131001,E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,UE,,28 ,,NW,,,,,,"$1,652.77",$0.00,1,1,1,1,1,1,20131001,E0651,HCPCS,PNEUM COMPRESSOR SEGMENTAL,,,28 ,,NW,,,,,,"$2,216.63",$0.00,1,1,1,1,1,1,20131001,E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,NU,,28 ,,NW,,,,,,"$13,373.27",$0.00,1,1,1,1,1,1,20131001,E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,RR,,28 ,,NW,,,,,,"$1,270.59",$0.00,1,1,1,1,1,1,20131001,E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,UE,,28 ,,NW,,,,,,"$9,913.18",$0.00,1,1,1,1,1,1,20131001,E0652,HCPCS,PNEUM COMPRES W/CAL PRESSURE,,,28 ,,NW,,,,,,"$13,373.27",$0.00,1,1,1,1,1,1,20131001,E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,NU,,28 ,,NW,,,,,,$229.85,$0.00,1,1,1,1,1,1,20131001,E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,RR,,28 ,,NW,,,,,,$27.25,$0.00,1,1,1,1,1,1,20131001,E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,UE,,28 ,,NW,,,,,,$163.88,$0.00,1,1,1,1,1,1,20131001,E0655,HCPCS,PNEUMATIC APPLIANCE HALF ARM,,,28 ,,NW,,,,,,$229.85,$0.00,1,1,1,1,1,1,20131001,E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,NU,,28 ,,NW,,,,,,"$1,464.56",$0.00,1,1,1,1,1,1,20131001,E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,RR,,28 ,,NW,,,,,,$111.31,$0.00,1,1,1,1,1,1,20131001,E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,UE,,28 ,,NW,,,,,,"$1,088.86",$0.00,1,1,1,1,1,1,20131001,E0656,HCPCS,SEGMENTAL PNEUMATIC TRUNK,,,28 ,,NW,,,,,,"$1,464.56",$0.00,1,1,1,1,1,1,20131001,E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,NU,,28 ,,NW,,,,,,"$1,373.56",$0.00,1,1,1,1,1,1,20131001,E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,RR,,28 ,,NW,,,,,,$102.12,$0.00,1,1,1,1,1,1,20131001,E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,UE,,28 ,,NW,,,,,,"$1,020.54",$0.00,1,1,1,1,1,1,20131001,E0657,HCPCS,SEGMENTAL PNEUMATIC CHEST,,,28 ,,NW,,,,,,"$1,373.56",$0.00,1,1,1,1,1,1,20131001,E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,NU,,28 ,,NW,,,,,,$354.19,$0.00,1,1,1,1,1,1,20131001,E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,RR,,28 ,,NW,,,,,,$33.68,$0.00,1,1,1,1,1,1,20131001,E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,UE,,28 ,,NW,,,,,,$255.29,$0.00,1,1,1,1,1,1,20131001,E0660,HCPCS,PNEUMATIC APPLIANCE FULL LEG,,,28 ,,NW,,,,,,$354.19,$0.00,1,1,1,1,1,1,20131001,E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,NU,,28 ,,NW,,,,,,$297.23,$0.00,1,1,1,1,1,1,20131001,E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,RR,,28 ,,NW,,,,,,$30.00,$0.00,1,1,1,1,1,1,20131001,E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,UE,,28 ,,NW,,,,,,$211.48,$0.00,1,1,1,1,1,1,20131001,E0665,HCPCS,PNEUMATIC APPLIANCE FULL ARM,,,28 ,,NW,,,,,,$297.23,$0.00,1,1,1,1,1,1,20131001,E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,NU,,28 ,,NW,,,,,,$301.51,$0.00,1,1,1,1,1,1,20131001,E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,RR,,28 ,,NW,,,,,,$30.29,$0.00,1,1,1,1,1,1,20131001,E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,UE,,28 ,,NW,,,,,,$217.02,$0.00,1,1,1,1,1,1,20131001,E0666,HCPCS,PNEUMATIC APPLIANCE HALF LEG,,,28 ,,NW,,,,,,$301.51,$0.00,1,1,1,1,1,1,20131001,E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,NU,,28 ,,NW,,,,,,$787.69,$0.00,1,1,1,1,1,1,20131001,E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,RR,,28 ,,NW,,,,,,$65.50,$0.00,1,1,1,1,1,1,20131001,E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,UE,,28 ,,NW,,,,,,$581.06,$0.00,1,1,1,1,1,1,20131001,E0667,HCPCS,SEG PNEUMATIC APPL FULL LEG,,,28 ,,NW,,,,,,$787.69,$0.00,1,1,1,1,1,1,20131001,E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,NU,,28 ,,NW,,,,,,"$1,048.91",$0.00,1,1,1,1,1,1,20131001,E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,RR,,28 ,,NW,,,,,,$75.10,$0.00,1,1,1,1,1,1,20131001,E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,UE,,28 ,,NW,,,,,,$776.98,$0.00,1,1,1,1,1,1,20131001,E0668,HCPCS,SEG PNEUMATIC APPL FULL ARM,,,28 ,,NW,,,,,,"$1,048.91",$0.00,1,1,1,1,1,1,20131001,E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,NU,,28 ,,NW,,,,,,$428.35,$0.00,1,1,1,1,1,1,20131001,E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,RR,,28 ,,NW,,,,,,$37.48,$0.00,1,1,1,1,1,1,20131001,E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,UE,,28 ,,NW,,,,,,$311.59,$0.00,1,1,1,1,1,1,20131001,E0669,HCPCS,SEG PNEUMATIC APPLI HALF LEG,,,28 ,,NW,,,,,,$428.35,$0.00,1,1,1,1,1,1,20131001,E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,NU,,28 ,,NW,,,,,,"$1,042.44",$0.00,1,1,1,1,1,1,20131001,E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,RR,,28 ,,NW,,,,,,$75.59,$0.00,1,1,1,1,1,1,20131001,E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,UE,,28 ,,NW,,,,,,$772.08,$0.00,1,1,1,1,1,1,20131001,E0671,HCPCS,PRESSURE PNEUM APPL FULL LEG,,,28 ,,NW,,,,,,"$1,042.44",$0.00,1,1,1,1,1,1,20131001,E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,NU,,28 ,,NW,,,,,,$801.31,$0.00,1,1,1,1,1,1,20131001,E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,RR,,28 ,,NW,,,,,,$60.62,$0.00,1,1,1,1,1,1,20131001,E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,UE,,28 ,,NW,,,,,,$591.30,$0.00,1,1,1,1,1,1,20131001,E0672,HCPCS,PRESSURE PNEUM APPL FULL ARM,,,28 ,,NW,,,,,,$801.31,$0.00,1,1,1,1,1,1,20131001,E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,NU,,28 ,,NW,,,,,,$659.28,$0.00,1,1,1,1,1,1,20131001,E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,RR,,28 ,,NW,,,,,,$51.81,$0.00,1,1,1,1,1,1,20131001,E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,UE,,28 ,,NW,,,,,,$484.80,$0.00,1,1,1,1,1,1,20131001,E0673,HCPCS,PRESSURE PNEUM APPL HALF LEG,,,28 ,,NW,,,,,,$659.28,$0.00,1,1,1,1,1,1,20131001,E0675,HCPCS,PNEUMATIC COMPRESSION DEVICE,RR,,28 ,,NW,,,,,,$961.91,$0.00,1,1,1,1,1,1,20131001,E0675,HCPCS,PNEUMATIC COMPRESSION DEVICE,,,28 ,,NW,,,,,,"$9,273.77",$0.00,1,1,1,1,1,1,20131001,E0676,HCPCS,INTER LIMB COMPRESS DEV NOS,,,28 ,,NW,,,,,,$500.93,$0.00,1,1,1,1,1,1,20131001,E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,NU,,28 ,,NW,,,,,,"$2,299.63",$0.00,1,1,1,1,1,1,20131001,E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,RR,,28 ,,NW,,,,,,$194.99,$0.00,1,1,1,1,1,1,20131001,E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,UE,,28 ,,NW,,,,,,"$1,715.01",$0.00,1,1,1,1,1,1,20131001,E0691,HCPCS,UVL PNL 2 SQ FT OR LESS,,,28 ,,NW,,,,,,"$2,299.63",$0.00,1,1,1,1,1,1,20131001,E0692,HCPCS,UVL SYS PANEL 4 FT,NU,,28 ,,NW,,,,,,"$2,897.63",$0.00,1,1,1,1,1,1,20131001,E0692,HCPCS,UVL SYS PANEL 4 FT,RR,,28 ,,NW,,,,,,$254.70,$0.00,1,1,1,1,1,1,20131001,E0692,HCPCS,UVL SYS PANEL 4 FT,UE,,28 ,,NW,,,,,,"$2,163.52",$0.00,1,1,1,1,1,1,20131001,E0692,HCPCS,UVL SYS PANEL 4 FT,,,28 ,,NW,,,,,,"$2,897.63",$0.00,1,1,1,1,1,1,20131001,E0693,HCPCS,UVL SYS PANEL 6 FT,NU,,28 ,,NW,,,,,,"$3,581.03",$0.00,1,1,1,1,1,1,20131001,E0693,HCPCS,UVL SYS PANEL 6 FT,RR,,28 ,,NW,,,,,,$323.13,$0.00,1,1,1,1,1,1,20131001,E0693,HCPCS,UVL SYS PANEL 6 FT,UE,,28 ,,NW,,,,,,"$2,676.04",$0.00,1,1,1,1,1,1,20131001,E0693,HCPCS,UVL SYS PANEL 6 FT,,,28 ,,NW,,,,,,"$3,581.03",$0.00,1,1,1,1,1,1,20131001,E0694,HCPCS,UVL MD CABINET SYS 6 FT,NU,,28 ,,NW,,,,,,"$11,482.83",$0.00,1,1,1,1,1,1,20131001,E0694,HCPCS,UVL MD CABINET SYS 6 FT,RR,,28 ,,NW,,,,,,"$1,113.33",$0.00,1,1,1,1,1,1,20131001,E0694,HCPCS,UVL MD CABINET SYS 6 FT,UE,,28 ,,NW,,,,,,"$8,602.46",$0.00,1,1,1,1,1,1,20131001,E0694,HCPCS,UVL MD CABINET SYS 6 FT,,,28 ,,NW,,,,,,"$11,482.83",$0.00,1,1,1,1,1,1,20131001,E0700,HCPCS,SAFETY EQUIPMENT,,,28 ,,NW,,,,,,$74.00,$0.00,1,1,1,1,1,1,20131001,E0705,HCPCS,TRANSFER DEVICE,NU,,28 ,,NW,,,,,,$94.78,$0.00,1,1,1,1,1,1,20131001,E0705,HCPCS,TRANSFER DEVICE,RR,,28 ,,NW,,,,,,$16.92,$0.00,1,1,1,1,1,1,20131001,E0705,HCPCS,TRANSFER DEVICE,UE,,28 ,,NW,,,,,,$69.53,$0.00,1,1,1,1,1,1,20131001,E0705,HCPCS,TRANSFER DEVICE,,,28 ,,NW,,,,,,$94.78,$0.00,1,1,1,1,1,1,20131001,E0710,HCPCS,RESTRAINTS ANY TYPE,,,28 ,,NW,,,,,,$33.27,$0.00,1,1,1,1,1,1,20131001,E0720,HCPCS,TENS TWO LEAD,NU,,28 ,,NW,,,,,,$863.99,$0.00,1,1,1,1,1,1,20131001,E0720,HCPCS,TENS TWO LEAD,RR,,28 ,,NW,,,,,,$67.82,$0.00,1,1,1,1,1,1,20131001,E0720,HCPCS,TENS TWO LEAD,UE,,28 ,,NW,,,,,,$675.56,$0.00,1,1,1,1,1,1,20131001,E0720,HCPCS,TENS TWO LEAD,,,28 ,,NW,,,,,,$863.99,$0.00,1,1,1,1,1,1,20131001,E0730,HCPCS,TENS FOUR LEAD,NU,,28 ,,NW,,,,,,$880.27,$0.00,1,1,1,1,1,1,20131001,E0730,HCPCS,TENS FOUR LEAD,RR,,28 ,,NW,,,,,,$67.82,$0.00,1,1,1,1,1,1,20131001,E0730,HCPCS,TENS FOUR LEAD,UE,,28 ,,NW,,,,,,$681.19,$0.00,1,1,1,1,1,1,20131001,E0730,HCPCS,TENS FOUR LEAD,,,28 ,,NW,,,,,,$880.27,$0.00,1,1,1,1,1,1,20131001,E0731,HCPCS,CONDUCTIVE GARMENT FOR TENS/,NU,,28 ,,NW,,,,,,$833.72,$0.00,1,1,1,1,1,1,20131001,E0731,HCPCS,CONDUCTIVE GARMENT FOR TENS/,RR,,28 ,,NW,,,,,,$86.48,$0.00,1,1,1,1,1,1,20131001,E0731,HCPCS,CONDUCTIVE GARMENT FOR TENS/,,,28 ,,NW,,,,,,$833.72,$0.00,1,1,1,1,1,1,20131001,E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,NU,,28 ,,NW,,,,,,"$1,321.84",$0.00,1,1,1,1,1,1,20131001,E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,RR,,28 ,,NW,,,,,,$97.23,$0.00,1,1,1,1,1,1,20131001,E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,UE,,28 ,,NW,,,,,,$981.75,$0.00,1,1,1,1,1,1,20131001,E0740,HCPCS,INCONTINENCE TREATMENT SYSTM,,,28 ,,NW,,,,,,"$1,321.84",$0.00,1,1,1,1,1,1,20131001,E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,NU,,28 ,,NW,,,,,,"$2,333.90",$0.00,1,1,1,1,1,1,20131001,E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,RR,,28 ,,NW,,,,,,$185.25,$0.00,1,1,1,1,1,1,20131001,E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,UE,,28 ,,NW,,,,,,"$1,739.87",$0.00,1,1,1,1,1,1,20131001,E0744,HCPCS,NEUROMUSCULAR STIM FOR SCOLI,,,28 ,,NW,,,,,,"$2,333.90",$0.00,1,1,1,1,1,1,20131001,E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,NU,,28 ,,NW,,,,,,"$2,279.90",$0.00,1,1,1,1,1,1,20131001,E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,RR,,28 ,,NW,,,,,,$182.17,$0.00,1,1,1,1,1,1,20131001,E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,UE,,28 ,,NW,,,,,,"$1,700.49",$0.00,1,1,1,1,1,1,20131001,E0745,HCPCS,NEUROMUSCULAR STIM FOR SHOCK,,,28 ,,NW,,,,,,"$2,279.90",$0.00,1,1,1,1,1,1,20131001,E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,NU,,28 ,,NW,,,,,,$211.17,$0.00,1,1,1,1,1,1,20131001,E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,RR,,28 ,,NW,,,,,,$23.11,$0.00,1,1,1,1,1,1,20131001,E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,UE,,28 ,,NW,,,,,,$159.02,$0.00,1,1,1,1,1,1,20131001,E0746,HCPCS,ELECTROMYOGRAPH BIOFEEDBACK,,,28 ,,NW,,,,,,$211.17,$0.00,1,1,1,1,1,1,20131001,E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,NU,,28 ,,NW,,,,,,"$9,660.20",$0.00,1,1,1,1,1,1,20131001,E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,RR,,28 ,,NW,,,,,,$928.32,$0.00,1,1,1,1,1,1,20131001,E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,UE,,28 ,,NW,,,,,,"$7,181.98",$0.00,1,1,1,1,1,1,20131001,E0747,HCPCS,ELEC OSTEOGEN STIM NOT SPINE,,,28 ,,NW,,,,,,"$9,660.20",$0.00,1,1,1,1,1,1,20131001,E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,NU,,28 ,,NW,,,,,,"$10,089.95",$0.00,1,1,1,1,1,1,20131001,E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,RR,,28 ,,NW,,,,,,$974.00,$0.00,1,1,1,1,1,1,20131001,E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,UE,,28 ,,NW,,,,,,"$7,557.79",$0.00,1,1,1,1,1,1,20131001,E0748,HCPCS,ELEC OSTEOGEN STIM SPINAL,,,28 ,,NW,,,,,,"$10,089.95",$0.00,1,1,1,1,1,1,20131001,E0749,HCPCS,ELEC OSTEOGEN STIM IMPLANTED,RR,,28 ,,NW,,,,,,$658.66,$0.00,1,1,1,1,1,1,20131001,E0749,HCPCS,ELEC OSTEOGEN STIM IMPLANTED,,,28 ,,NW,,,,,,"$6,350.13",$0.00,1,1,1,1,1,1,20131001,E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,NU,,28 ,,NW,,,,,,"$8,374.96",$0.00,1,1,1,1,1,1,20131001,E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,RR,,28 ,,NW,,,,,,$802.56,$0.00,1,1,1,1,1,1,20131001,E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,UE,,28 ,,NW,,,,,,"$6,271.48",$0.00,1,1,1,1,1,1,20131001,E0760,HCPCS,OSTEOGEN ULTRASOUND STIMLTOR,,,28 ,,NW,,,,,,"$8,374.96",$0.00,1,1,1,1,1,1,20131001,E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,NU,,28 ,,NW,,,,,,"$2,641.69",$0.00,1,1,1,1,1,1,20131001,E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,RR,,28 ,,NW,,,,,,$229.20,$0.00,1,1,1,1,1,1,20131001,E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,UE,,28 ,,NW,,,,,,"$1,971.48",$0.00,1,1,1,1,1,1,20131001,E0762,HCPCS,TRANS ELEC JT STIM DEV SYS,,,28 ,,NW,,,,,,"$2,641.69",$0.00,1,1,1,1,1,1,20131001,E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,NU,,28 ,,NW,,,,,,"$28,761.35",$0.00,1,1,1,1,1,1,20131001,E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,RR,,28 ,,NW,,,,,,"$2,841.13",$0.00,1,1,1,1,1,1,20131001,E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,UE,,28 ,,NW,,,,,,"$21,561.31",$0.00,1,1,1,1,1,1,20131001,E0764,HCPCS,FUNCTIONAL NEUROMUSCULARSTIM,,,28 ,,NW,,,,,,"$28,761.35",$0.00,1,1,1,1,1,1,20131001,E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,NU,,28 ,,NW,,,,,,$180.09,$0.00,1,1,1,1,1,1,20131001,E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,RR,,28 ,,NW,,,,,,$22.10,$0.00,1,1,1,1,1,1,20131001,E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,UE,,28 ,,NW,,,,,,$125.41,$0.00,1,1,1,1,1,1,20131001,E0765,HCPCS,NERVE STIMULATOR FOR TX N&V,,,28 ,,NW,,,,,,$180.09,$0.00,1,1,1,1,1,1,20131001,E0769,HCPCS,ELECTRIC WOUND TREATMENT DEV,,,28 ,,NW,,,,,,$319.89,$0.00,1,1,1,1,1,1,20131001,E0770,HCPCS,FUNCTIONAL ELECTRIC STIM NOS,,,28 ,,NW,,,,,,$319.89,$0.00,1,1,1,1,1,1,20131001,E0776,HCPCS,IV POLE,NU,,28 ,,NW,,,,,,$308.87,$0.00,1,1,1,1,1,1,20131001,E0776,HCPCS,IV POLE,RR,,28 ,,NW,,,,,,$36.72,$0.00,1,1,1,1,1,1,20131001,E0776,HCPCS,IV POLE,UE,,28 ,,NW,,,,,,$217.57,$0.00,1,1,1,1,1,1,20131001,E0776,HCPCS,IV POLE,,,28 ,,NW,,,,,,$308.87,$0.00,1,1,1,1,1,1,20131001,E0779,HCPCS,AMB INFUSION PUMP MECHANICAL,RR,,28 ,,NW,,,,,,$34.89,$0.00,1,1,1,1,1,1,20131001,E0779,HCPCS,AMB INFUSION PUMP MECHANICAL,,,28 ,,NW,,,,,,$336.39,$0.00,1,1,1,1,1,1,20131001,E0780,HCPCS,MECH AMB INFUSION PUMP <8HRS,NU,,28 ,,NW,,,,,,$25.25,$0.00,1,1,1,1,1,1,20131001,E0780,HCPCS,MECH AMB INFUSION PUMP <8HRS,,,28 ,,NW,,,,,,$25.25,$0.00,1,1,1,1,1,1,20131001,E0781,HCPCS,EXTERNAL AMBULATORY INFUS PU,RR,,28 ,,NW,,,,,,$623.23,$0.00,1,1,1,1,1,1,20131001,E0781,HCPCS,EXTERNAL AMBULATORY INFUS PU,,,28 ,,NW,,,,,,"$6,008.61",$0.00,1,1,1,1,1,1,20131001,E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,NU,,28 ,,NW,,,,,,"$10,511.12",$0.00,1,1,1,1,1,1,20131001,E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,RR,,28 ,,NW,,,,,,"$1,016.18",$0.00,1,1,1,1,1,1,20131001,E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,UE,,28 ,,NW,,,,,,"$7,873.63",$0.00,1,1,1,1,1,1,20131001,E0782,HCPCS,NON-PROGRAMBLE INFUSION PUMP,,,28 ,,NW,,,,,,"$10,511.12",$0.00,1,1,1,1,1,1,20131001,E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,NU,,28 ,,NW,,,,,,"$20,751.82",$0.00,1,1,1,1,1,1,20131001,E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,RR,,28 ,,NW,,,,,,"$2,040.25",$0.00,1,1,1,1,1,1,20131001,E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,UE,,28 ,,NW,,,,,,"$15,554.18",$0.00,1,1,1,1,1,1,20131001,E0783,HCPCS,PROGRAMMABLE INFUSION PUMP,,,28 ,,NW,,,,,,"$20,751.82",$0.00,1,1,1,1,1,1,20131001,E0784,HCPCS,EXT AMB INFUSN PUMP INSULIN,RR,,28 ,,NW,,,,,,"$1,047.71",$0.00,1,1,1,1,1,1,20131001,E0784,HCPCS,EXT AMB INFUSN PUMP INSULIN,,,28 ,,NW,,,,,,"$10,100.99",$0.00,1,1,1,1,1,1,20131001,E0785,HCPCS,REPLACEMENT IMPL PUMP CATHET,KF,,28 ,,NW,,,,,,"$1,136.55",$0.00,1,1,1,1,1,1,20131001,E0785,HCPCS,REPLACEMENT IMPL PUMP CATHET,,,28 ,,NW,,,,,,"$1,136.55",$0.00,1,1,1,1,1,1,20131001,E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,NU,,28 ,,NW,,,,,,"$20,212.94",$0.00,1,1,1,1,1,1,20131001,E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,RR,,28 ,,NW,,,,,,"$1,986.30",$0.00,1,1,1,1,1,1,20131001,E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,UE,,28 ,,NW,,,,,,"$15,150.00",$0.00,1,1,1,1,1,1,20131001,E0786,HCPCS,IMPLANTABLE PUMP REPLACEMENT,,,28 ,,NW,,,,,,"$20,212.94",$0.00,1,1,1,1,1,1,20131001,E0791,HCPCS,PARENTERAL INFUSION PUMP STA,RR,,28 ,,NW,,,,,,$718.52,$0.00,1,1,1,1,1,1,20131001,E0791,HCPCS,PARENTERAL INFUSION PUMP STA,UE,,28 ,,NW,,,,,,"$5,396.75",$0.00,1,1,1,1,1,1,20131001,E0791,HCPCS,PARENTERAL INFUSION PUMP STA,,,28 ,,NW,,,,,,"$6,927.28",$0.00,1,1,1,1,1,1,20131001,E0830,HCPCS,AMBULATORY TRACTION DEVICE,,,28 ,,NW,,,,,,"$3,273.06",$0.00,1,1,1,1,1,1,20131001,E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,NU,,28 ,,NW,,,,,,$141.06,$0.00,1,1,1,1,1,1,20131001,E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,RR,,28 ,,NW,,,,,,$33.23,$0.00,1,1,1,1,1,1,20131001,E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,UE,,28 ,,NW,,,,,,$105.76,$0.00,1,1,1,1,1,1,20131001,E0840,HCPCS,TRACT FRAME ATTACH HEADBOARD,,,28 ,,NW,,,,,,$141.06,$0.00,1,1,1,1,1,1,20131001,E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,NU,,28 ,,NW,,,,,,"$1,302.19",$0.00,1,1,1,1,1,1,20131001,E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,RR,,28 ,,NW,,,,,,$95.26,$0.00,1,1,1,1,1,1,20131001,E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,UE,,28 ,,NW,,,,,,$966.85,$0.00,1,1,1,1,1,1,20131001,E0849,HCPCS,CERVICAL PNEUM TRAC EQUIP,,,28 ,,NW,,,,,,"$1,302.19",$0.00,1,1,1,1,1,1,20131001,E0850,HCPCS,TRACTION STAND FREE STANDING,NU,,28 ,,NW,,,,,,$201.25,$0.00,1,1,1,1,1,1,20131001,E0850,HCPCS,TRACTION STAND FREE STANDING,RR,,28 ,,NW,,,,,,$29.10,$0.00,1,1,1,1,1,1,20131001,E0850,HCPCS,TRACTION STAND FREE STANDING,UE,,28 ,,NW,,,,,,$152.05,$0.00,1,1,1,1,1,1,20131001,E0850,HCPCS,TRACTION STAND FREE STANDING,,,28 ,,NW,,,,,,$201.25,$0.00,1,1,1,1,1,1,20131001,E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,NU,,28 ,,NW,,,,,,"$1,259.04",$0.00,1,1,1,1,1,1,20131001,E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,RR,,28 ,,NW,,,,,,$90.95,$0.00,1,1,1,1,1,1,20131001,E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,UE,,28 ,,NW,,,,,,$934.53,$0.00,1,1,1,1,1,1,20131001,E0855,HCPCS,CERVICAL TRACTION EQUIPMENT,,,28 ,,NW,,,,,,"$1,259.04",$0.00,1,1,1,1,1,1,20131001,E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,NU,,28 ,,NW,,,,,,$361.99,$0.00,1,1,1,1,1,1,20131001,E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,RR,,28 ,,NW,,,,,,$33.37,$0.00,1,1,1,1,1,1,20131001,E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,UE,,28 ,,NW,,,,,,$261.81,$0.00,1,1,1,1,1,1,20131001,E0856,HCPCS,CERVIC COLLAR W AIR BLADDER,,,28 ,,NW,,,,,,$361.99,$0.00,1,1,1,1,1,1,20131001,E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,NU,,28 ,,NW,,,,,,$74.10,$0.00,1,1,1,1,1,1,20131001,E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,RR,,28 ,,NW,,,,,,$13.83,$0.00,1,1,1,1,1,1,20131001,E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,UE,,28 ,,NW,,,,,,$57.42,$0.00,1,1,1,1,1,1,20131001,E0860,HCPCS,TRACT EQUIP CERVICAL TRACT,,,28 ,,NW,,,,,,$74.10,$0.00,1,1,1,1,1,1,20131001,E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,NU,,28 ,,NW,,,,,,$219.42,$0.00,1,1,1,1,1,1,20131001,E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,RR,,28 ,,NW,,,,,,$27.89,$0.00,1,1,1,1,1,1,20131001,E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,UE,,28 ,,NW,,,,,,$165.63,$0.00,1,1,1,1,1,1,20131001,E0870,HCPCS,TRACT FRAME ATTACH FOOTBOARD,,,28 ,,NW,,,,,,$219.42,$0.00,1,1,1,1,1,1,20131001,E0880,HCPCS,TRAC STAND FREE STAND EXTREM,NU,,28 ,,NW,,,,,,$231.59,$0.00,1,1,1,1,1,1,20131001,E0880,HCPCS,TRAC STAND FREE STAND EXTREM,RR,,28 ,,NW,,,,,,$38.89,$0.00,1,1,1,1,1,1,20131001,E0880,HCPCS,TRAC STAND FREE STAND EXTREM,UE,,28 ,,NW,,,,,,$177.49,$0.00,1,1,1,1,1,1,20131001,E0880,HCPCS,TRAC STAND FREE STAND EXTREM,,,28 ,,NW,,,,,,$231.59,$0.00,1,1,1,1,1,1,20131001,E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,NU,,28 ,,NW,,,,,,$225.09,$0.00,1,1,1,1,1,1,20131001,E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,RR,,28 ,,NW,,,,,,$64.68,$0.00,1,1,1,1,1,1,20131001,E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,UE,,28 ,,NW,,,,,,$180.99,$0.00,1,1,1,1,1,1,20131001,E0890,HCPCS,TRACTION FRAME ATTACH PELVIC,,,28 ,,NW,,,,,,$225.09,$0.00,1,1,1,1,1,1,20131001,E0900,HCPCS,TRAC STAND FREE STAND PELVIC,NU,,28 ,,NW,,,,,,$239.16,$0.00,1,1,1,1,1,1,20131001,E0900,HCPCS,TRAC STAND FREE STAND PELVIC,RR,,28 ,,NW,,,,,,$53.64,$0.00,1,1,1,1,1,1,20131001,E0900,HCPCS,TRAC STAND FREE STAND PELVIC,UE,,28 ,,NW,,,,,,$183.47,$0.00,1,1,1,1,1,1,20131001,E0900,HCPCS,TRAC STAND FREE STAND PELVIC,,,28 ,,NW,,,,,,$239.16,$0.00,1,1,1,1,1,1,20131001,E0910,HCPCS,TRAPEZE BAR ATTACHED TO BED,RR,,28 ,,NW,,,,,,$34.65,$0.00,1,1,1,1,1,1,20131001,E0910,HCPCS,TRAPEZE BAR ATTACHED TO BED,UE,,28 ,,NW,,,,,,$244.63,$0.00,1,1,1,1,1,1,20131001,E0910,HCPCS,TRAPEZE BAR ATTACHED TO BED,,,28 ,,NW,,,,,,$334.02,$0.00,1,1,1,1,1,1,20131001,E0911,HCPCS,HD TRAPEZE BAR ATTACH TO BED,RR,,28 ,,NW,,,,,,$88.01,$0.00,1,1,1,1,1,1,20131001,E0911,HCPCS,HD TRAPEZE BAR ATTACH TO BED,,,28 ,,NW,,,,,,$848.50,$0.00,1,1,1,1,1,1,20131001,E0912,HCPCS,HD TRAPEZE BAR FREE STANDING,RR,,28 ,,NW,,,,,,$200.41,$0.00,1,1,1,1,1,1,20131001,E0912,HCPCS,HD TRAPEZE BAR FREE STANDING,,,28 ,,NW,,,,,,"$1,932.12",$0.00,1,1,1,1,1,1,20131001,E0920,HCPCS,FRACTURE FRAME ATTACHED TO B,RR,,28 ,,NW,,,,,,$88.91,$0.00,1,1,1,1,1,1,20131001,E0920,HCPCS,FRACTURE FRAME ATTACHED TO B,UE,,28 ,,NW,,,,,,$591.66,$0.00,1,1,1,1,1,1,20131001,E0920,HCPCS,FRACTURE FRAME ATTACHED TO B,,,28 ,,NW,,,,,,$857.22,$0.00,1,1,1,1,1,1,20131001,E0930,HCPCS,FRACTURE FRAME FREE STANDING,RR,,28 ,,NW,,,,,,$88.36,$0.00,1,1,1,1,1,1,20131001,E0930,HCPCS,FRACTURE FRAME FREE STANDING,UE,,28 ,,NW,,,,,,$639.55,$0.00,1,1,1,1,1,1,20131001,E0930,HCPCS,FRACTURE FRAME FREE STANDING,,,28 ,,NW,,,,,,$851.87,$0.00,1,1,1,1,1,1,20131001,E0935,HCPCS,CONT PAS MOTION EXERCISE DEV,RR,,28 ,,NW,,,,,,$42.94,$0.00,1,1,1,1,1,1,20131001,E0935,HCPCS,CONT PAS MOTION EXERCISE DEV,,,28 ,,NW,,,,,,$413.97,$0.00,1,1,1,1,1,1,20131001,E0936,HCPCS,"CPM DEVICE, OTHER THAN KNEE",RR,,28 ,,NW,,,,,,$12.11,$0.00,1,1,1,1,1,1,20131001,E0936,HCPCS,"CPM DEVICE, OTHER THAN KNEE",,,28 ,,NW,,,,,,$147.24,$0.00,1,1,1,1,1,1,20131001,E0940,HCPCS,TRAPEZE BAR FREE STANDING,RR,,28 ,,NW,,,,,,$58.77,$0.00,1,1,1,1,1,1,20131001,E0940,HCPCS,TRAPEZE BAR FREE STANDING,UE,,28 ,,NW,,,,,,$397.63,$0.00,1,1,1,1,1,1,20131001,E0940,HCPCS,TRAPEZE BAR FREE STANDING,,,28 ,,NW,,,,,,$566.58,$0.00,1,1,1,1,1,1,20131001,E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,NU,,28 ,,NW,,,,,,$830.45,$0.00,1,1,1,1,1,1,20131001,E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,RR,,28 ,,NW,,,,,,$86.14,$0.00,1,1,1,1,1,1,20131001,E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,UE,,28 ,,NW,,,,,,$623.47,$0.00,1,1,1,1,1,1,20131001,E0941,HCPCS,GRAVITY ASSISTED TRACTION DE,,,28 ,,NW,,,,,,$830.45,$0.00,1,1,1,1,1,1,20131001,E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,NU,,28 ,,NW,,,,,,$39.62,$0.00,1,1,1,1,1,1,20131001,E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,RR,,28 ,,NW,,,,,,$5.83,$0.00,1,1,1,1,1,1,20131001,E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,UE,,28 ,,NW,,,,,,$30.02,$0.00,1,1,1,1,1,1,20131001,E0942,HCPCS,CERVICAL HEAD HARNESS/HALTER,,,28 ,,NW,,,,,,$39.62,$0.00,1,1,1,1,1,1,20131001,E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,NU,,28 ,,NW,,,,,,$91.53,$0.00,1,1,1,1,1,1,20131001,E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,RR,,28 ,,NW,,,,,,$10.54,$0.00,1,1,1,1,1,1,20131001,E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,UE,,28 ,,NW,,,,,,$69.16,$0.00,1,1,1,1,1,1,20131001,E0944,HCPCS,PELVIC BELT/HARNESS/BOOT,,,28 ,,NW,,,,,,$91.53,$0.00,1,1,1,1,1,1,20131001,E0945,HCPCS,BELT/HARNESS EXTREMITY,NU,,28 ,,NW,,,,,,$90.58,$0.00,1,1,1,1,1,1,20131001,E0945,HCPCS,BELT/HARNESS EXTREMITY,RR,,28 ,,NW,,,,,,$10.39,$0.00,1,1,1,1,1,1,20131001,E0945,HCPCS,BELT/HARNESS EXTREMITY,UE,,28 ,,NW,,,,,,$70.09,$0.00,1,1,1,1,1,1,20131001,E0945,HCPCS,BELT/HARNESS EXTREMITY,,,28 ,,NW,,,,,,$90.58,$0.00,1,1,1,1,1,1,20131001,E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,NU,,28 ,,NW,,,,,,"$1,075.40",$0.00,1,1,1,1,1,1,20131001,E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,RR,,28 ,,NW,,,,,,$111.54,$0.00,1,1,1,1,1,1,20131001,E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,UE,,28 ,,NW,,,,,,$807.37,$0.00,1,1,1,1,1,1,20131001,E0946,HCPCS,FRACTURE FRAME DUAL W CROSS,,,28 ,,NW,,,,,,"$1,075.40",$0.00,1,1,1,1,1,1,20131001,E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,NU,,28 ,,NW,,,,,,$976.68,$0.00,1,1,1,1,1,1,20131001,E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,RR,,28 ,,NW,,,,,,$118.97,$0.00,1,1,1,1,1,1,20131001,E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,UE,,28 ,,NW,,,,,,$741.85,$0.00,1,1,1,1,1,1,20131001,E0947,HCPCS,FRACTURE FRAME ATTACHMNTS PE,,,28 ,,NW,,,,,,$976.68,$0.00,1,1,1,1,1,1,20131001,E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,NU,,28 ,,NW,,,,,,$957.50,$0.00,1,1,1,1,1,1,20131001,E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,RR,,28 ,,NW,,,,,,$111.35,$0.00,1,1,1,1,1,1,20131001,E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,UE,,28 ,,NW,,,,,,$692.31,$0.00,1,1,1,1,1,1,20131001,E0948,HCPCS,FRACTURE FRAME ATTACHMNTS CE,,,28 ,,NW,,,,,,$957.50,$0.00,1,1,1,1,1,1,20131001,E0950,HCPCS,TRAY,NU,,28 ,,NW,,,,,,$365.34,$0.00,1,1,1,1,1,1,20131001,E0950,HCPCS,TRAY,RR,,28 ,,NW,,,,,,$40.59,$0.00,1,1,1,1,1,1,20131001,E0950,HCPCS,TRAY,UE,,28 ,,NW,,,,,,$283.88,$0.00,1,1,1,1,1,1,20131001,E0950,HCPCS,TRAY,,,28 ,,NW,,,,,,$365.34,$0.00,1,1,1,1,1,1,20131001,E0951,HCPCS,LOOP HEEL,NU,,28 ,,NW,,,,,,$74.72,$0.00,1,1,1,1,1,1,20131001,E0951,HCPCS,LOOP HEEL,RR,,28 ,,NW,,,,,,$8.97,$0.00,1,1,1,1,1,1,20131001,E0951,HCPCS,LOOP HEEL,UE,,28 ,,NW,,,,,,$56.37,$0.00,1,1,1,1,1,1,20131001,E0951,HCPCS,LOOP HEEL,,,28 ,,NW,,,,,,$74.72,$0.00,1,1,1,1,1,1,20131001,E0952,HCPCS,"TOE LOOP/HOLDER, EACH",NU,,28 ,,NW,,,,,,$72.24,$0.00,1,1,1,1,1,1,20131001,E0952,HCPCS,"TOE LOOP/HOLDER, EACH",RR,,28 ,,NW,,,,,,$8.77,$0.00,1,1,1,1,1,1,20131001,E0952,HCPCS,"TOE LOOP/HOLDER, EACH",UE,,28 ,,NW,,,,,,$54.68,$0.00,1,1,1,1,1,1,20131001,E0952,HCPCS,"TOE LOOP/HOLDER, EACH",,,28 ,,NW,,,,,,$72.24,$0.00,1,1,1,1,1,1,20131001,E0955,HCPCS,CUSHIONED HEADREST,NU,,28 ,,NW,,,,,,$717.65,$0.00,1,1,1,1,1,1,20131001,E0955,HCPCS,CUSHIONED HEADREST,RR,,28 ,,NW,,,,,,$82.61,$0.00,1,1,1,1,1,1,20131001,E0955,HCPCS,CUSHIONED HEADREST,UE,,28 ,,NW,,,,,,$548.20,$0.00,1,1,1,1,1,1,20131001,E0955,HCPCS,CUSHIONED HEADREST,,,28 ,,NW,,,,,,$717.65,$0.00,1,1,1,1,1,1,20131001,E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,NU,,28 ,,NW,,,,,,$370.37,$0.00,1,1,1,1,1,1,20131001,E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,RR,,28 ,,NW,,,,,,$41.02,$0.00,1,1,1,1,1,1,20131001,E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,UE,,28 ,,NW,,,,,,$287.75,$0.00,1,1,1,1,1,1,20131001,E0956,HCPCS,W/C LATERAL TRUNK/HIP SUPPOR,,,28 ,,NW,,,,,,$370.37,$0.00,1,1,1,1,1,1,20131001,E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,NU,,28 ,,NW,,,,,,$502.30,$0.00,1,1,1,1,1,1,20131001,E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,RR,,28 ,,NW,,,,,,$56.79,$0.00,1,1,1,1,1,1,20131001,E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,UE,,28 ,,NW,,,,,,$386.68,$0.00,1,1,1,1,1,1,20131001,E0957,HCPCS,W/C MEDIAL THIGH SUPPORT,,,28 ,,NW,,,,,,$502.30,$0.00,1,1,1,1,1,1,20131001,E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,NU,,28 ,,NW,,,,,,$786.52,$0.00,1,1,1,1,1,1,20131001,E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,RR,,28 ,,NW,,,,,,$90.89,$0.00,1,1,1,1,1,1,20131001,E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,UE,,28 ,,NW,,,,,,$599.32,$0.00,1,1,1,1,1,1,20131001,E0958,HCPCS,WHLCHR ATT- CONV 1 ARM DRIVE,,,28 ,,NW,,,,,,$786.52,$0.00,1,1,1,1,1,1,20131001,E0959,HCPCS,AMPUTEE ADAPTER,NU,,28 ,,NW,,,,,,$91.82,$0.00,1,1,1,1,1,1,20131001,E0959,HCPCS,AMPUTEE ADAPTER,RR,,28 ,,NW,,,,,,$10.54,$0.00,1,1,1,1,1,1,20131001,E0959,HCPCS,AMPUTEE ADAPTER,UE,,28 ,,NW,,,,,,$69.81,$0.00,1,1,1,1,1,1,20131001,E0959,HCPCS,AMPUTEE ADAPTER,,,28 ,,NW,,,,,,$91.82,$0.00,1,1,1,1,1,1,20131001,E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,NU,,28 ,,NW,,,,,,$344.90,$0.00,1,1,1,1,1,1,20131001,E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,RR,,28 ,,NW,,,,,,$37.97,$0.00,1,1,1,1,1,1,20131001,E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,UE,,28 ,,NW,,,,,,$268.69,$0.00,1,1,1,1,1,1,20131001,E0960,HCPCS,W/C SHOULDER HARNESS/STRAPS,,,28 ,,NW,,,,,,$344.90,$0.00,1,1,1,1,1,1,20131001,E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,NU,,28 ,,NW,,,,,,$60.38,$0.00,1,1,1,1,1,1,20131001,E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,RR,,28 ,,NW,,,,,,$7.67,$0.00,1,1,1,1,1,1,20131001,E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,UE,,28 ,,NW,,,,,,$31.20,$0.00,1,1,1,1,1,1,20131001,E0961,HCPCS,WHEELCHAIR BRAKE EXTENSION,,,28 ,,NW,,,,,,$60.38,$0.00,1,1,1,1,1,1,20131001,E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,NU,,28 ,,NW,,,,,,$150.16,$0.00,1,1,1,1,1,1,20131001,E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,RR,,28 ,,NW,,,,,,$16.19,$0.00,1,1,1,1,1,1,20131001,E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,UE,,28 ,,NW,,,,,,$112.97,$0.00,1,1,1,1,1,1,20131001,E0966,HCPCS,WHEELCHAIR HEAD REST EXTENSI,,,28 ,,NW,,,,,,$150.16,$0.00,1,1,1,1,1,1,20131001,E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,NU,,28 ,,NW,,,,,,$142.47,$0.00,1,1,1,1,1,1,20131001,E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,RR,,28 ,,NW,,,,,,$15.54,$0.00,1,1,1,1,1,1,20131001,E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,UE,,28 ,,NW,,,,,,$107.20,$0.00,1,1,1,1,1,1,20131001,E0967,HCPCS,MANUAL WC HAND RIM W PROJECT,,,28 ,,NW,,,,,,$142.47,$0.00,1,1,1,1,1,1,20131001,E0968,HCPCS,WHEELCHAIR COMMODE SEAT,NU,,28 ,,NW,,,,,,$346.74,$0.00,1,1,1,1,1,1,20131001,E0968,HCPCS,WHEELCHAIR COMMODE SEAT,RR,,28 ,,NW,,,,,,$38.84,$0.00,1,1,1,1,1,1,20131001,E0968,HCPCS,WHEELCHAIR COMMODE SEAT,UE,,28 ,,NW,,,,,,$270.23,$0.00,1,1,1,1,1,1,20131001,E0968,HCPCS,WHEELCHAIR COMMODE SEAT,,,28 ,,NW,,,,,,$346.74,$0.00,1,1,1,1,1,1,20131001,E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,NU,,28 ,,NW,,,,,,$311.22,$0.00,1,1,1,1,1,1,20131001,E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,RR,,28 ,,NW,,,,,,$33.65,$0.00,1,1,1,1,1,1,20131001,E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,UE,,28 ,,NW,,,,,,$244.58,$0.00,1,1,1,1,1,1,20131001,E0969,HCPCS,WHEELCHAIR NARROWING DEVICE,,,28 ,,NW,,,,,,$311.22,$0.00,1,1,1,1,1,1,20131001,E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,NU,,28 ,,NW,,,,,,$117.04,$0.00,1,1,1,1,1,1,20131001,E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,RR,,28 ,,NW,,,,,,$12.11,$0.00,1,1,1,1,1,1,20131001,E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,UE,,28 ,,NW,,,,,,$88.58,$0.00,1,1,1,1,1,1,20131001,E0970,HCPCS,WHEELCHAIR NO. 2 FOOTPLATES,,,28 ,,NW,,,,,,$117.04,$0.00,1,1,1,1,1,1,20131001,E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,NU,,28 ,,NW,,,,,,$94.93,$0.00,1,1,1,1,1,1,20131001,E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,RR,,28 ,,NW,,,,,,$10.81,$0.00,1,1,1,1,1,1,20131001,E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,UE,,28 ,,NW,,,,,,$71.62,$0.00,1,1,1,1,1,1,20131001,E0971,HCPCS,WHEELCHAIR ANTI-TIPPING DEVI,,,28 ,,NW,,,,,,$94.93,$0.00,1,1,1,1,1,1,20131001,E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,NU,,28 ,,NW,,,,,,$391.95,$0.00,1,1,1,1,1,1,20131001,E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,RR,,28 ,,NW,,,,,,$41.93,$0.00,1,1,1,1,1,1,20131001,E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,UE,,28 ,,NW,,,,,,$305.64,$0.00,1,1,1,1,1,1,20131001,E0973,HCPCS,W/CH ACCESS DET ADJ ARMREST,,,28 ,,NW,,,,,,$391.95,$0.00,1,1,1,1,1,1,20131001,E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,NU,,28 ,,NW,,,,,,$161.70,$0.00,1,1,1,1,1,1,20131001,E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,RR,,28 ,,NW,,,,,,$18.44,$0.00,1,1,1,1,1,1,20131001,E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,UE,,28 ,,NW,,,,,,$123.46,$0.00,1,1,1,1,1,1,20131001,E0974,HCPCS,W/CH ACCESS ANTI-ROLLBACK,,,28 ,,NW,,,,,,$161.70,$0.00,1,1,1,1,1,1,20131001,E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",NU,,28 ,,NW,,,,,,$163.24,$0.00,1,1,1,1,1,1,20131001,E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",RR,,28 ,,NW,,,,,,$17.55,$0.00,1,1,1,1,1,1,20131001,E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",UE,,28 ,,NW,,,,,,$121.93,$0.00,1,1,1,1,1,1,20131001,E0978,HCPCS,"W/C ACC,SAF BELT PELV STRAP",,,28 ,,NW,,,,,,$163.24,$0.00,1,1,1,1,1,1,20131001,E0980,HCPCS,WHEELCHAIR SAFETY VEST,NU,,28 ,,NW,,,,,,$67.30,$0.00,1,1,1,1,1,1,20131001,E0980,HCPCS,WHEELCHAIR SAFETY VEST,RR,,28 ,,NW,,,,,,$8.01,$0.00,1,1,1,1,1,1,20131001,E0980,HCPCS,WHEELCHAIR SAFETY VEST,UE,,28 ,,NW,,,,,,$50.65,$0.00,1,1,1,1,1,1,20131001,E0980,HCPCS,WHEELCHAIR SAFETY VEST,,,28 ,,NW,,,,,,$67.30,$0.00,1,1,1,1,1,1,20131001,E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",NU,,28 ,,NW,,,,,,$182.86,$0.00,1,1,1,1,1,1,20131001,E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",RR,,28 ,,NW,,,,,,$19.73,$0.00,1,1,1,1,1,1,20131001,E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",UE,,28 ,,NW,,,,,,$138.47,$0.00,1,1,1,1,1,1,20131001,E0981,HCPCS,"SEAT UPHOLSTERY, REPLACEMENT",,,28 ,,NW,,,,,,$182.86,$0.00,1,1,1,1,1,1,20131001,E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",NU,,28 ,,NW,,,,,,$193.48,$0.00,1,1,1,1,1,1,20131001,E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",RR,,28 ,,NW,,,,,,$20.66,$0.00,1,1,1,1,1,1,20131001,E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",UE,,28 ,,NW,,,,,,$145.70,$0.00,1,1,1,1,1,1,20131001,E0982,HCPCS,"BACK UPHOLSTERY, REPLACEMENT",,,28 ,,NW,,,,,,$193.48,$0.00,1,1,1,1,1,1,20131001,E0983,HCPCS,ADD PWR JOYSTICK,RR,,28 ,,NW,,,,,,$478.30,$0.00,1,1,1,1,1,1,20131001,E0983,HCPCS,ADD PWR JOYSTICK,,,28 ,,NW,,,,,,"$4,611.31",$0.00,1,1,1,1,1,1,20131001,E0984,HCPCS,ADD PWR TILLER,NU,,28 ,,NW,,,,,,"$3,229.75",$0.00,1,1,1,1,1,1,20131001,E0984,HCPCS,ADD PWR TILLER,RR,,28 ,,NW,,,,,,$334.70,$0.00,1,1,1,1,1,1,20131001,E0984,HCPCS,ADD PWR TILLER,UE,,28 ,,NW,,,,,,"$2,494.54",$0.00,1,1,1,1,1,1,20131001,E0984,HCPCS,ADD PWR TILLER,,,28 ,,NW,,,,,,"$3,229.75",$0.00,1,1,1,1,1,1,20131001,E0985,HCPCS,W/C SEAT LIFT MECHANISM,NU,,28 ,,NW,,,,,,$405.14,$0.00,1,1,1,1,1,1,20131001,E0985,HCPCS,W/C SEAT LIFT MECHANISM,RR,,28 ,,NW,,,,,,$45.20,$0.00,1,1,1,1,1,1,20131001,E0985,HCPCS,W/C SEAT LIFT MECHANISM,UE,,28 ,,NW,,,,,,$313.81,$0.00,1,1,1,1,1,1,20131001,E0985,HCPCS,W/C SEAT LIFT MECHANISM,,,28 ,,NW,,,,,,$405.14,$0.00,1,1,1,1,1,1,20131001,E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,NU,,28 ,,NW,,,,,,"$8,796.94",$0.00,1,1,1,1,1,1,20131001,E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,RR,,28 ,,NW,,,,,,$915.66,$0.00,1,1,1,1,1,1,20131001,E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,UE,,28 ,,NW,,,,,,"$6,607.72",$0.00,1,1,1,1,1,1,20131001,E0986,HCPCS,MAN W/C PUSH-RIM POW ASSIST,,,28 ,,NW,,,,,,"$8,796.94",$0.00,1,1,1,1,1,1,20131001,E0988,HCPCS,LEVER-ACTIVATED WHEEL DRIVE,RR,,28 ,,NW,,,,,,$569.73,$0.00,1,1,1,1,1,1,20131001,E0988,HCPCS,LEVER-ACTIVATED WHEEL DRIVE,,,28 ,,NW,,,,,,"$5,492.78",$0.00,1,1,1,1,1,1,20131001,E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,NU,,28 ,,NW,,,,,,$411.87,$0.00,1,1,1,1,1,1,20131001,E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,RR,,28 ,,NW,,,,,,$51.61,$0.00,1,1,1,1,1,1,20131001,E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,UE,,28 ,,NW,,,,,,$325.04,$0.00,1,1,1,1,1,1,20131001,E0990,HCPCS,WHEELCHAIR ELEVATING LEG RES,,,28 ,,NW,,,,,,$411.87,$0.00,1,1,1,1,1,1,20131001,E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,NU,,28 ,,NW,,,,,,$193.95,$0.00,1,1,1,1,1,1,20131001,E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,RR,,28 ,,NW,,,,,,$20.17,$0.00,1,1,1,1,1,1,20131001,E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,UE,,28 ,,NW,,,,,,$145.84,$0.00,1,1,1,1,1,1,20131001,E0992,HCPCS,WHEELCHAIR SOLID SEAT INSERT,,,28 ,,NW,,,,,,$193.95,$0.00,1,1,1,1,1,1,20131001,E0994,HCPCS,WHEELCHAIR ARM REST,NU,,28 ,,NW,,,,,,$37.52,$0.00,1,1,1,1,1,1,20131001,E0994,HCPCS,WHEELCHAIR ARM REST,RR,,28 ,,NW,,,,,,$5.07,$0.00,1,1,1,1,1,1,20131001,E0994,HCPCS,WHEELCHAIR ARM REST,UE,,28 ,,NW,,,,,,$28.56,$0.00,1,1,1,1,1,1,20131001,E0994,HCPCS,WHEELCHAIR ARM REST,,,28 ,,NW,,,,,,$37.52,$0.00,1,1,1,1,1,1,20131001,E0995,HCPCS,WHEELCHAIR CALF REST,NU,,28 ,,NW,,,,,,$115.61,$0.00,1,1,1,1,1,1,20131001,E0995,HCPCS,WHEELCHAIR CALF REST,RR,,28 ,,NW,,,,,,$12.92,$0.00,1,1,1,1,1,1,20131001,E0995,HCPCS,WHEELCHAIR CALF REST,UE,,28 ,,NW,,,,,,$87.02,$0.00,1,1,1,1,1,1,20131001,E0995,HCPCS,WHEELCHAIR CALF REST,,,28 ,,NW,,,,,,$115.61,$0.00,1,1,1,1,1,1,20131001,E1002,HCPCS,PWR SEAT TILT,NU,,28 ,,NW,,,,,,"$13,626.10",$0.00,1,1,1,1,1,1,20131001,E1002,HCPCS,PWR SEAT TILT,RR,,28 ,,NW,,,,,,"$1,398.53",$0.00,1,1,1,1,1,1,20131001,E1002,HCPCS,PWR SEAT TILT,UE,,28 ,,NW,,,,,,"$10,229.55",$0.00,1,1,1,1,1,1,20131001,E1002,HCPCS,PWR SEAT TILT,,,28 ,,NW,,,,,,"$13,626.10",$0.00,1,1,1,1,1,1,20131001,E1003,HCPCS,PWR SEAT RECLINE,NU,,28 ,,NW,,,,,,"$14,759.38",$0.00,1,1,1,1,1,1,20131001,E1003,HCPCS,PWR SEAT RECLINE,RR,,28 ,,NW,,,,,,"$1,511.93",$0.00,1,1,1,1,1,1,20131001,E1003,HCPCS,PWR SEAT RECLINE,UE,,28 ,,NW,,,,,,"$11,079.51",$0.00,1,1,1,1,1,1,20131001,E1003,HCPCS,PWR SEAT RECLINE,,,28 ,,NW,,,,,,"$14,759.38",$0.00,1,1,1,1,1,1,20131001,E1004,HCPCS,PWR SEAT RECLINE MECH,NU,,28 ,,NW,,,,,,"$16,360.75",$0.00,1,1,1,1,1,1,20131001,E1004,HCPCS,PWR SEAT RECLINE MECH,RR,,28 ,,NW,,,,,,"$1,672.01",$0.00,1,1,1,1,1,1,20131001,E1004,HCPCS,PWR SEAT RECLINE MECH,UE,,28 ,,NW,,,,,,"$12,280.51",$0.00,1,1,1,1,1,1,20131001,E1004,HCPCS,PWR SEAT RECLINE MECH,,,28 ,,NW,,,,,,"$16,360.75",$0.00,1,1,1,1,1,1,20131001,E1005,HCPCS,PWR SEAT RECLINE PWR,NU,,28 ,,NW,,,,,,"$17,705.95",$0.00,1,1,1,1,1,1,20131001,E1005,HCPCS,PWR SEAT RECLINE PWR,RR,,28 ,,NW,,,,,,"$1,806.53",$0.00,1,1,1,1,1,1,20131001,E1005,HCPCS,PWR SEAT RECLINE PWR,UE,,28 ,,NW,,,,,,"$13,289.47",$0.00,1,1,1,1,1,1,20131001,E1005,HCPCS,PWR SEAT RECLINE PWR,,,28 ,,NW,,,,,,"$17,705.95",$0.00,1,1,1,1,1,1,20131001,E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,NU,,28 ,,NW,,,,,,"$21,679.14",$0.00,1,1,1,1,1,1,20131001,E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,RR,,28 ,,NW,,,,,,"$2,203.80",$0.00,1,1,1,1,1,1,20131001,E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,UE,,28 ,,NW,,,,,,"$16,269.36",$0.00,1,1,1,1,1,1,20131001,E1006,HCPCS,PWR SEAT COMBO W/O SHEAR,,,28 ,,NW,,,,,,"$21,679.14",$0.00,1,1,1,1,1,1,20131001,E1007,HCPCS,PWR SEAT COMBO W/SHEAR,NU,,28 ,,NW,,,,,,"$29,340.24",$0.00,1,1,1,1,1,1,20131001,E1007,HCPCS,PWR SEAT COMBO W/SHEAR,RR,,28 ,,NW,,,,,,"$2,970.00",$0.00,1,1,1,1,1,1,20131001,E1007,HCPCS,PWR SEAT COMBO W/SHEAR,UE,,28 ,,NW,,,,,,"$22,015.14",$0.00,1,1,1,1,1,1,20131001,E1007,HCPCS,PWR SEAT COMBO W/SHEAR,,,28 ,,NW,,,,,,"$29,340.24",$0.00,1,1,1,1,1,1,20131001,E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,NU,,28 ,,NW,,,,,,"$29,342.87",$0.00,1,1,1,1,1,1,20131001,E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,RR,,28 ,,NW,,,,,,"$2,970.22",$0.00,1,1,1,1,1,1,20131001,E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,UE,,28 ,,NW,,,,,,"$22,017.20",$0.00,1,1,1,1,1,1,20131001,E1008,HCPCS,PWR SEAT COMBO PWR SHEAR,,,28 ,,NW,,,,,,"$29,342.87",$0.00,1,1,1,1,1,1,20131001,E1009,HCPCS,ADD MECH LEG ELEVATION,NU,,28 ,,NW,,,,,,"$2,633.27",$0.00,1,1,1,1,1,1,20131001,E1009,HCPCS,ADD MECH LEG ELEVATION,RR,,28 ,,NW,,,,,,$286.23,$0.00,1,1,1,1,1,1,20131001,E1009,HCPCS,ADD MECH LEG ELEVATION,UE,,28 ,,NW,,,,,,"$1,982.34",$0.00,1,1,1,1,1,1,20131001,E1009,HCPCS,ADD MECH LEG ELEVATION,,,28 ,,NW,,,,,,"$2,633.27",$0.00,1,1,1,1,1,1,20131001,E1010,HCPCS,ADD PWR LEG ELEVATION,NU,,28 ,,NW,,,,,,"$3,873.86",$0.00,1,1,1,1,1,1,20131001,E1010,HCPCS,ADD PWR LEG ELEVATION,RR,,28 ,,NW,,,,,,$423.34,$0.00,1,1,1,1,1,1,20131001,E1010,HCPCS,ADD PWR LEG ELEVATION,UE,,28 ,,NW,,,,,,"$2,915.43",$0.00,1,1,1,1,1,1,20131001,E1010,HCPCS,ADD PWR LEG ELEVATION,,,28 ,,NW,,,,,,"$3,873.86",$0.00,1,1,1,1,1,1,20131001,E1014,HCPCS,RECLINING BACK ADD PED W/C,NU,,28 ,,NW,,,,,,$697.30,$0.00,1,1,1,1,1,1,20131001,E1014,HCPCS,RECLINING BACK ADD PED W/C,RR,,28 ,,NW,,,,,,$80.15,$0.00,1,1,1,1,1,1,20131001,E1014,HCPCS,RECLINING BACK ADD PED W/C,UE,,28 ,,NW,,,,,,$532.93,$0.00,1,1,1,1,1,1,20131001,E1014,HCPCS,RECLINING BACK ADD PED W/C,,,28 ,,NW,,,,,,$697.30,$0.00,1,1,1,1,1,1,20131001,E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,NU,,28 ,,NW,,,,,,$246.45,$0.00,1,1,1,1,1,1,20131001,E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,RR,,28 ,,NW,,,,,,$26.13,$0.00,1,1,1,1,1,1,20131001,E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,UE,,28 ,,NW,,,,,,$186.83,$0.00,1,1,1,1,1,1,20131001,E1015,HCPCS,SHOCK ABSORBER FOR MAN W/C,,,28 ,,NW,,,,,,$246.45,$0.00,1,1,1,1,1,1,20131001,E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,NU,,28 ,,NW,,,,,,$480.11,$0.00,1,1,1,1,1,1,20131001,E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,RR,,28 ,,NW,,,,,,$54.18,$0.00,1,1,1,1,1,1,20131001,E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,UE,,28 ,,NW,,,,,,$370.04,$0.00,1,1,1,1,1,1,20131001,E1016,HCPCS,SHOCK ABSORBER FOR POWER W/C,,,28 ,,NW,,,,,,$480.11,$0.00,1,1,1,1,1,1,20131001,E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,NU,,28 ,,NW,,,,,,$653.32,$0.00,1,1,1,1,1,1,20131001,E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,RR,,28 ,,NW,,,,,,$69.46,$0.00,1,1,1,1,1,1,20131001,E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,UE,,28 ,,NW,,,,,,$491.19,$0.00,1,1,1,1,1,1,20131001,E1017,HCPCS,HD SHCK ABSRBR FOR HD MAN WC,,,28 ,,NW,,,,,,$653.32,$0.00,1,1,1,1,1,1,20131001,E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,NU,,28 ,,NW,,,,,,$316.51,$0.00,1,1,1,1,1,1,20131001,E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,RR,,28 ,,NW,,,,,,$32.99,$0.00,1,1,1,1,1,1,20131001,E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,UE,,28 ,,NW,,,,,,$237.72,$0.00,1,1,1,1,1,1,20131001,E1018,HCPCS,HD SHCK ABSRBER FOR HD POWWC,,,28 ,,NW,,,,,,$316.51,$0.00,1,1,1,1,1,1,20131001,E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,NU,,28 ,,NW,,,,,,$855.84,$0.00,1,1,1,1,1,1,20131001,E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,RR,,28 ,,NW,,,,,,$99.03,$0.00,1,1,1,1,1,1,20131001,E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,UE,,28 ,,NW,,,,,,$651.85,$0.00,1,1,1,1,1,1,20131001,E1020,HCPCS,RESIDUAL LIMB SUPPORT SYSTEM,,,28 ,,NW,,,,,,$855.84,$0.00,1,1,1,1,1,1,20131001,E1028,HCPCS,W/C MANUAL SWINGAWAY,NU,,28 ,,NW,,,,,,$732.25,$0.00,1,1,1,1,1,1,20131001,E1028,HCPCS,W/C MANUAL SWINGAWAY,RR,,28 ,,NW,,,,,,$84.30,$0.00,1,1,1,1,1,1,20131001,E1028,HCPCS,W/C MANUAL SWINGAWAY,UE,,28 ,,NW,,,,,,$559.13,$0.00,1,1,1,1,1,1,20131001,E1028,HCPCS,W/C MANUAL SWINGAWAY,,,28 ,,NW,,,,,,$732.25,$0.00,1,1,1,1,1,1,20131001,E1029,HCPCS,W/C VENT TRAY FIXED,NU,,28 ,,NW,,,,,,"$1,278.62",$0.00,1,1,1,1,1,1,20131001,E1029,HCPCS,W/C VENT TRAY FIXED,RR,,28 ,,NW,,,,,,$149.71,$0.00,1,1,1,1,1,1,20131001,E1029,HCPCS,W/C VENT TRAY FIXED,UE,,28 ,,NW,,,,,,$968.94,$0.00,1,1,1,1,1,1,20131001,E1029,HCPCS,W/C VENT TRAY FIXED,,,28 ,,NW,,,,,,"$1,278.62",$0.00,1,1,1,1,1,1,20131001,E1030,HCPCS,W/C VENT TRAY GIMBALED,NU,,28 ,,NW,,,,,,"$3,945.88",$0.00,1,1,1,1,1,1,20131001,E1030,HCPCS,W/C VENT TRAY GIMBALED,RR,,28 ,,NW,,,,,,$430.54,$0.00,1,1,1,1,1,1,20131001,E1030,HCPCS,W/C VENT TRAY GIMBALED,UE,,28 ,,NW,,,,,,"$2,969.40",$0.00,1,1,1,1,1,1,20131001,E1030,HCPCS,W/C VENT TRAY GIMBALED,,,28 ,,NW,,,,,,"$3,945.88",$0.00,1,1,1,1,1,1,20131001,E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,NU,,28 ,,NW,,,,,,$903.89,$0.00,1,1,1,1,1,1,20131001,E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,RR,,28 ,,NW,,,,,,$104.71,$0.00,1,1,1,1,1,1,20131001,E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,UE,,28 ,,NW,,,,,,$687.72,$0.00,1,1,1,1,1,1,20131001,E1031,HCPCS,ROLLABOUT CHAIR WITH CASTERS,,,28 ,,NW,,,,,,$903.89,$0.00,1,1,1,1,1,1,20131001,E1035,HCPCS,PATIENT TRANSFER SYSTEM <300,RR,,28 ,,NW,,,,,,"$1,143.89",$0.00,1,1,1,1,1,1,20131001,E1035,HCPCS,PATIENT TRANSFER SYSTEM <300,,,28 ,,NW,,,,,,"$11,028.25",$0.00,1,1,1,1,1,1,20131001,E1036,HCPCS,PATIENT TRANSFER SYSTEM >300,RR,,28 ,,NW,,,,,,"$1,587.55",$0.00,1,1,1,1,1,1,20131001,E1036,HCPCS,PATIENT TRANSFER SYSTEM >300,,,28 ,,NW,,,,,,"$15,305.65",$0.00,1,1,1,1,1,1,20131001,E1037,HCPCS,"TRANSPORT CHAIR, PED SIZE",RR,,28 ,,NW,,,,,,$235.24,$0.00,1,1,1,1,1,1,20131001,E1037,HCPCS,"TRANSPORT CHAIR, PED SIZE",,,28 ,,NW,,,,,,"$2,267.95",$0.00,1,1,1,1,1,1,20131001,E1038,HCPCS,TRANSPORT CHAIR PT WT<=300LB,RR,,28 ,,NW,,,,,,$40.28,$0.00,1,1,1,1,1,1,20131001,E1038,HCPCS,TRANSPORT CHAIR PT WT<=300LB,,,28 ,,NW,,,,,,$388.34,$0.00,1,1,1,1,1,1,20131001,E1039,HCPCS,TRANSPORT CHAIR PT WT >300LB,RR,,28 ,,NW,,,,,,$75.13,$0.00,1,1,1,1,1,1,20131001,E1039,HCPCS,TRANSPORT CHAIR PT WT >300LB,,,28 ,,NW,,,,,,$724.34,$0.00,1,1,1,1,1,1,20131001,E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,NU,,28 ,,NW,,,,,,"$1,781.95",$0.00,1,1,1,1,1,1,20131001,E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,RR,,28 ,,NW,,,,,,$212.12,$0.00,1,1,1,1,1,1,20131001,E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,UE,,28 ,,NW,,,,,,"$1,346.63",$0.00,1,1,1,1,1,1,20131001,E1050,HCPCS,WHELCHR FXD FULL LENGTH ARMS,,,28 ,,NW,,,,,,"$1,781.95",$0.00,1,1,1,1,1,1,20131001,E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,NU,,28 ,,NW,,,,,,"$2,196.46",$0.00,1,1,1,1,1,1,20131001,E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,RR,,28 ,,NW,,,,,,$252.09,$0.00,1,1,1,1,1,1,20131001,E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,UE,,28 ,,NW,,,,,,"$1,657.15",$0.00,1,1,1,1,1,1,20131001,E1060,HCPCS,WHEELCHAIR DETACHABLE ARMS,,,28 ,,NW,,,,,,"$2,196.46",$0.00,1,1,1,1,1,1,20131001,E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,NU,,28 ,,NW,,,,,,"$1,913.44",$0.00,1,1,1,1,1,1,20131001,E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,RR,,28 ,,NW,,,,,,$226.56,$0.00,1,1,1,1,1,1,20131001,E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,UE,,28 ,,NW,,,,,,"$1,445.43",$0.00,1,1,1,1,1,1,20131001,E1070,HCPCS,WHEELCHAIR DETACHABLE FOOT R,,,28 ,,NW,,,,,,"$1,913.44",$0.00,1,1,1,1,1,1,20131001,E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,NU,,28 ,,NW,,,,,,"$1,386.75",$0.00,1,1,1,1,1,1,20131001,E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,RR,,28 ,,NW,,,,,,$158.63,$0.00,1,1,1,1,1,1,20131001,E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,UE,,28 ,,NW,,,,,,"$1,050.23",$0.00,1,1,1,1,1,1,20131001,E1083,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,,,28 ,,NW,,,,,,"$1,386.75",$0.00,1,1,1,1,1,1,20131001,E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,NU,,28 ,,NW,,,,,,"$1,718.06",$0.00,1,1,1,1,1,1,20131001,E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,RR,,28 ,,NW,,,,,,$204.53,$0.00,1,1,1,1,1,1,20131001,E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,UE,,28 ,,NW,,,,,,"$1,298.35",$0.00,1,1,1,1,1,1,20131001,E1084,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,,,28 ,,NW,,,,,,"$1,718.06",$0.00,1,1,1,1,1,1,20131001,E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,NU,,28 ,,NW,,,,,,"$1,534.58",$0.00,1,1,1,1,1,1,20131001,E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,RR,,28 ,,NW,,,,,,$180.18,$0.00,1,1,1,1,1,1,20131001,E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,UE,,28 ,,NW,,,,,,"$1,113.38",$0.00,1,1,1,1,1,1,20131001,E1085,HCPCS,HEMI-WHEELCHAIR FIXED ARMS,,,28 ,,NW,,,,,,"$1,534.58",$0.00,1,1,1,1,1,1,20131001,E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,NU,,28 ,,NW,,,,,,"$1,860.69",$0.00,1,1,1,1,1,1,20131001,E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,RR,,28 ,,NW,,,,,,$199.74,$0.00,1,1,1,1,1,1,20131001,E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,UE,,28 ,,NW,,,,,,"$1,362.23",$0.00,1,1,1,1,1,1,20131001,E1086,HCPCS,HEMI-WHEELCHAIR DETACHABLE A,,,28 ,,NW,,,,,,"$1,860.69",$0.00,1,1,1,1,1,1,20131001,E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,NU,,28 ,,NW,,,,,,"$2,203.89",$0.00,1,1,1,1,1,1,20131001,E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,RR,,28 ,,NW,,,,,,$257.18,$0.00,1,1,1,1,1,1,20131001,E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,UE,,28 ,,NW,,,,,,"$1,663.09",$0.00,1,1,1,1,1,1,20131001,E1087,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,,,28 ,,NW,,,,,,"$2,203.89",$0.00,1,1,1,1,1,1,20131001,E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,NU,,28 ,,NW,,,,,,"$2,619.15",$0.00,1,1,1,1,1,1,20131001,E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,RR,,28 ,,NW,,,,,,$293.01,$0.00,1,1,1,1,1,1,20131001,E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,UE,,28 ,,NW,,,,,,"$1,974.35",$0.00,1,1,1,1,1,1,20131001,E1088,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,,,28 ,,NW,,,,,,"$2,619.15",$0.00,1,1,1,1,1,1,20131001,E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,NU,,28 ,,NW,,,,,,"$2,456.47",$0.00,1,1,1,1,1,1,20131001,E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,RR,,28 ,,NW,,,,,,$281.37,$0.00,1,1,1,1,1,1,20131001,E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,UE,,28 ,,NW,,,,,,"$1,852.52",$0.00,1,1,1,1,1,1,20131001,E1089,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,,,28 ,,NW,,,,,,"$2,456.47",$0.00,1,1,1,1,1,1,20131001,E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,NU,,28 ,,NW,,,,,,"$2,531.49",$0.00,1,1,1,1,1,1,20131001,E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,RR,,28 ,,NW,,,,,,$281.37,$0.00,1,1,1,1,1,1,20131001,E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,UE,,28 ,,NW,,,,,,"$1,860.69",$0.00,1,1,1,1,1,1,20131001,E1090,HCPCS,WHEELCHAIR LIGHTWEIGHT DET A,,,28 ,,NW,,,,,,"$2,531.49",$0.00,1,1,1,1,1,1,20131001,E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,NU,,28 ,,NW,,,,,,"$2,238.06",$0.00,1,1,1,1,1,1,20131001,E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,RR,,28 ,,NW,,,,,,$257.52,$0.00,1,1,1,1,1,1,20131001,E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,UE,,28 ,,NW,,,,,,"$1,688.35",$0.00,1,1,1,1,1,1,20131001,E1092,HCPCS,WHEELCHAIR WIDE W/ LEG RESTS,,,28 ,,NW,,,,,,"$2,238.06",$0.00,1,1,1,1,1,1,20131001,E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,NU,,28 ,,NW,,,,,,"$1,930.52",$0.00,1,1,1,1,1,1,20131001,E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,RR,,28 ,,NW,,,,,,$227.01,$0.00,1,1,1,1,1,1,20131001,E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,UE,,28 ,,NW,,,,,,"$1,458.06",$0.00,1,1,1,1,1,1,20131001,E1093,HCPCS,WHEELCHAIR WIDE W/ FOOT REST,,,28 ,,NW,,,,,,"$1,930.52",$0.00,1,1,1,1,1,1,20131001,E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,NU,,28 ,,NW,,,,,,"$1,815.38",$0.00,1,1,1,1,1,1,20131001,E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,RR,,28 ,,NW,,,,,,$213.00,$0.00,1,1,1,1,1,1,20131001,E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,UE,,28 ,,NW,,,,,,"$1,371.89",$0.00,1,1,1,1,1,1,20131001,E1100,HCPCS,WHCHR S-RECL FXD ARM LEG RES,,,28 ,,NW,,,,,,"$1,815.38",$0.00,1,1,1,1,1,1,20131001,E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,NU,,28 ,,NW,,,,,,"$1,778.98",$0.00,1,1,1,1,1,1,20131001,E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,RR,,28 ,,NW,,,,,,$206.96,$0.00,1,1,1,1,1,1,20131001,E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,UE,,28 ,,NW,,,,,,"$1,344.40",$0.00,1,1,1,1,1,1,20131001,E1110,HCPCS,WHEELCHAIR SEMI-RECL DETACH,,,28 ,,NW,,,,,,"$1,778.98",$0.00,1,1,1,1,1,1,20131001,E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,NU,,28 ,,NW,,,,,,$998.23,$0.00,1,1,1,1,1,1,20131001,E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,RR,,28 ,,NW,,,,,,$116.15,$0.00,1,1,1,1,1,1,20131001,E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,UE,,28 ,,NW,,,,,,$767.95,$0.00,1,1,1,1,1,1,20131001,E1130,HCPCS,WHLCHR STAND FXD ARM FT REST,,,28 ,,NW,,,,,,$998.23,$0.00,1,1,1,1,1,1,20131001,E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,NU,,28 ,,NW,,,,,,"$1,420.18",$0.00,1,1,1,1,1,1,20131001,E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,RR,,28 ,,NW,,,,,,$166.84,$0.00,1,1,1,1,1,1,20131001,E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,UE,,28 ,,NW,,,,,,"$1,017.55",$0.00,1,1,1,1,1,1,20131001,E1140,HCPCS,WHEELCHAIR STANDARD DETACH A,,,28 ,,NW,,,,,,"$1,420.18",$0.00,1,1,1,1,1,1,20131001,E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,NU,,28 ,,NW,,,,,,"$1,435.03",$0.00,1,1,1,1,1,1,20131001,E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,RR,,28 ,,NW,,,,,,$168.34,$0.00,1,1,1,1,1,1,20131001,E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,UE,,28 ,,NW,,,,,,"$1,086.63",$0.00,1,1,1,1,1,1,20131001,E1150,HCPCS,WHEELCHAIR STANDARD W/ LEG R,,,28 ,,NW,,,,,,"$1,435.03",$0.00,1,1,1,1,1,1,20131001,E1160,HCPCS,WHEELCHAIR FIXED ARMS,NU,,28 ,,NW,,,,,,"$1,108.92",$0.00,1,1,1,1,1,1,20131001,E1160,HCPCS,WHEELCHAIR FIXED ARMS,RR,,28 ,,NW,,,,,,$130.93,$0.00,1,1,1,1,1,1,20131001,E1160,HCPCS,WHEELCHAIR FIXED ARMS,UE,,28 ,,NW,,,,,,$842.23,$0.00,1,1,1,1,1,1,20131001,E1160,HCPCS,WHEELCHAIR FIXED ARMS,,,28 ,,NW,,,,,,"$1,108.92",$0.00,1,1,1,1,1,1,20131001,E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,NU,,28 ,,NW,,,,,,"$4,299.57",$0.00,1,1,1,1,1,1,20131001,E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,RR,,28 ,,NW,,,,,,$465.91,$0.00,1,1,1,1,1,1,20131001,E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,UE,,28 ,,NW,,,,,,"$3,234.70",$0.00,1,1,1,1,1,1,20131001,E1161,HCPCS,MANUAL ADULT WC W TILTINSPAC,,,28 ,,NW,,,,,,"$4,299.57",$0.00,1,1,1,1,1,1,20131001,E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,NU,,28 ,,NW,,,,,,"$1,568.01",$0.00,1,1,1,1,1,1,20131001,E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,RR,,28 ,,NW,,,,,,$178.11,$0.00,1,1,1,1,1,1,20131001,E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,UE,,28 ,,NW,,,,,,"$1,185.43",$0.00,1,1,1,1,1,1,20131001,E1170,HCPCS,WHLCHR AMPU FXD ARM LEG REST,,,28 ,,NW,,,,,,"$1,568.01",$0.00,1,1,1,1,1,1,20131001,E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,NU,,28 ,,NW,,,,,,"$1,411.26",$0.00,1,1,1,1,1,1,20131001,E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,RR,,28 ,,NW,,,,,,$164.31,$0.00,1,1,1,1,1,1,20131001,E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,UE,,28 ,,NW,,,,,,"$1,068.06",$0.00,1,1,1,1,1,1,20131001,E1171,HCPCS,WHEELCHAIR AMPUTEE W/O LEG R,,,28 ,,NW,,,,,,"$1,411.26",$0.00,1,1,1,1,1,1,20131001,E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,NU,,28 ,,NW,,,,,,"$1,715.09",$0.00,1,1,1,1,1,1,20131001,E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,RR,,28 ,,NW,,,,,,$202.80,$0.00,1,1,1,1,1,1,20131001,E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,UE,,28 ,,NW,,,,,,"$1,296.86",$0.00,1,1,1,1,1,1,20131001,E1172,HCPCS,WHEELCHAIR AMPUTEE DETACH AR,,,28 ,,NW,,,,,,"$1,715.09",$0.00,1,1,1,1,1,1,20131001,E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,NU,,28 ,,NW,,,,,,"$1,773.78",$0.00,1,1,1,1,1,1,20131001,E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,RR,,28 ,,NW,,,,,,$208.06,$0.00,1,1,1,1,1,1,20131001,E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,UE,,28 ,,NW,,,,,,"$1,339.95",$0.00,1,1,1,1,1,1,20131001,E1180,HCPCS,WHEELCHAIR AMPUTEE W/ FOOT R,,,28 ,,NW,,,,,,"$1,773.78",$0.00,1,1,1,1,1,1,20131001,E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,NU,,28 ,,NW,,,,,,"$2,042.69",$0.00,1,1,1,1,1,1,20131001,E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,RR,,28 ,,NW,,,,,,$236.55,$0.00,1,1,1,1,1,1,20131001,E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,UE,,28 ,,NW,,,,,,"$1,542.01",$0.00,1,1,1,1,1,1,20131001,E1190,HCPCS,WHEELCHAIR AMPUTEE W/ LEG RE,,,28 ,,NW,,,,,,"$2,042.69",$0.00,1,1,1,1,1,1,20131001,E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,NU,,28 ,,NW,,,,,,"$2,189.04",$0.00,1,1,1,1,1,1,20131001,E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,RR,,28 ,,NW,,,,,,$251.02,$0.00,1,1,1,1,1,1,20131001,E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,UE,,28 ,,NW,,,,,,"$1,651.95",$0.00,1,1,1,1,1,1,20131001,E1195,HCPCS,WHEELCHAIR AMPUTEE HEAVY DUT,,,28 ,,NW,,,,,,"$2,189.04",$0.00,1,1,1,1,1,1,20131001,E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,NU,,28 ,,NW,,,,,,"$1,528.63",$0.00,1,1,1,1,1,1,20131001,E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,RR,,28 ,,NW,,,,,,$180.06,$0.00,1,1,1,1,1,1,20131001,E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,UE,,28 ,,NW,,,,,,"$1,156.46",$0.00,1,1,1,1,1,1,20131001,E1200,HCPCS,WHEELCHAIR AMPUTEE FIXED ARM,,,28 ,,NW,,,,,,"$1,528.63",$0.00,1,1,1,1,1,1,20131001,E1220,HCPCS,WHLCHR SPECIAL SIZE/CONSTRC,,,28 ,,NW,,,,,,"$4,816.62",$0.00,1,1,1,1,1,1,20131001,E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,NU,,28 ,,NW,,,,,,$852.63,$0.00,1,1,1,1,1,1,20131001,E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,RR,,28 ,,NW,,,,,,$98.40,$0.00,1,1,1,1,1,1,20131001,E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,UE,,28 ,,NW,,,,,,$649.83,$0.00,1,1,1,1,1,1,20131001,E1221,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,,,28 ,,NW,,,,,,$852.63,$0.00,1,1,1,1,1,1,20131001,E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,NU,,28 ,,NW,,,,,,"$1,199.55",$0.00,1,1,1,1,1,1,20131001,E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,RR,,28 ,,NW,,,,,,$142.51,$0.00,1,1,1,1,1,1,20131001,E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,UE,,28 ,,NW,,,,,,$909.83,$0.00,1,1,1,1,1,1,20131001,E1222,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,,,28 ,,NW,,,,,,"$1,199.55",$0.00,1,1,1,1,1,1,20131001,E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,NU,,28 ,,NW,,,,,,"$1,305.78",$0.00,1,1,1,1,1,1,20131001,E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,RR,,28 ,,NW,,,,,,$151.39,$0.00,1,1,1,1,1,1,20131001,E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,UE,,28 ,,NW,,,,,,$989.32,$0.00,1,1,1,1,1,1,20131001,E1223,HCPCS,WHEELCHAIR SPEC SIZE W FOOT,,,28 ,,NW,,,,,,"$1,305.78",$0.00,1,1,1,1,1,1,20131001,E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,NU,,28 ,,NW,,,,,,"$1,428.35",$0.00,1,1,1,1,1,1,20131001,E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,RR,,28 ,,NW,,,,,,$165.43,$0.00,1,1,1,1,1,1,20131001,E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,UE,,28 ,,NW,,,,,,"$1,081.43",$0.00,1,1,1,1,1,1,20131001,E1224,HCPCS,WHEELCHAIR SPEC SIZE W/ LEG,,,28 ,,NW,,,,,,"$1,428.35",$0.00,1,1,1,1,1,1,20131001,E1225,HCPCS,MANUAL SEMI-RECLINING BACK,NU,,28 ,,NW,,,,,,$813.26,$0.00,1,1,1,1,1,1,20131001,E1225,HCPCS,MANUAL SEMI-RECLINING BACK,RR,,28 ,,NW,,,,,,$91.92,$0.00,1,1,1,1,1,1,20131001,E1225,HCPCS,MANUAL SEMI-RECLINING BACK,UE,,28 ,,NW,,,,,,$620.12,$0.00,1,1,1,1,1,1,20131001,E1225,HCPCS,MANUAL SEMI-RECLINING BACK,,,28 ,,NW,,,,,,$813.26,$0.00,1,1,1,1,1,1,20131001,E1226,HCPCS,MANUAL FULLY RECLINING BACK,NU,,28 ,,NW,,,,,,$948.44,$0.00,1,1,1,1,1,1,20131001,E1226,HCPCS,MANUAL FULLY RECLINING BACK,RR,,28 ,,NW,,,,,,$113.60,$0.00,1,1,1,1,1,1,20131001,E1226,HCPCS,MANUAL FULLY RECLINING BACK,UE,,28 ,,NW,,,,,,$721.53,$0.00,1,1,1,1,1,1,20131001,E1226,HCPCS,MANUAL FULLY RECLINING BACK,,,28 ,,NW,,,,,,$948.44,$0.00,1,1,1,1,1,1,20131001,E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,NU,,28 ,,NW,,,,,,$508.38,$0.00,1,1,1,1,1,1,20131001,E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,RR,,28 ,,NW,,,,,,$57.52,$0.00,1,1,1,1,1,1,20131001,E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,UE,,28 ,,NW,,,,,,$391.41,$0.00,1,1,1,1,1,1,20131001,E1227,HCPCS,WHEELCHAIR SPEC SZ SPEC HT A,,,28 ,,NW,,,,,,$508.38,$0.00,1,1,1,1,1,1,20131001,E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,NU,,28 ,,NW,,,,,,$519.09,$0.00,1,1,1,1,1,1,20131001,E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,RR,,28 ,,NW,,,,,,$56.68,$0.00,1,1,1,1,1,1,20131001,E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,UE,,28 ,,NW,,,,,,$399.49,$0.00,1,1,1,1,1,1,20131001,E1228,HCPCS,WHEELCHAIR SPEC SZ SPEC HT B,,,28 ,,NW,,,,,,$519.09,$0.00,1,1,1,1,1,1,20131001,E1229,HCPCS,PEDIATRIC WHEELCHAIR NOS,,,28 ,,NW,,,,,,"$1,554.00",$0.00,1,1,1,1,1,1,20131001,E1230,HCPCS,POWER OPERATED VEHICLE,NU,,28 ,,NW,,,,,,"$3,803.84",$0.00,1,1,1,1,1,1,20131001,E1230,HCPCS,POWER OPERATED VEHICLE,RR,,28 ,,NW,,,,,,$413.24,$0.00,1,1,1,1,1,1,20131001,E1230,HCPCS,POWER OPERATED VEHICLE,UE,,28 ,,NW,,,,,,"$2,970.01",$0.00,1,1,1,1,1,1,20131001,E1230,HCPCS,POWER OPERATED VEHICLE,,,28 ,,NW,,,,,,"$3,803.84",$0.00,1,1,1,1,1,1,20131001,E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,NU,,28 ,,NW,,,,,,"$2,977.82",$0.00,1,1,1,1,1,1,20131001,E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,RR,,28 ,,NW,,,,,,$325.90,$0.00,1,1,1,1,1,1,20131001,E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,UE,,28 ,,NW,,,,,,"$2,242.48",$0.00,1,1,1,1,1,1,20131001,E1231,HCPCS,RIGID PED W/C TILT-IN-SPACE,,,28 ,,NW,,,,,,"$2,977.82",$0.00,1,1,1,1,1,1,20131001,E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,NU,,28 ,,NW,,,,,,"$3,889.66",$0.00,1,1,1,1,1,1,20131001,E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,RR,,28 ,,NW,,,,,,$424.93,$0.00,1,1,1,1,1,1,20131001,E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,UE,,28 ,,NW,,,,,,"$2,927.28",$0.00,1,1,1,1,1,1,20131001,E1232,HCPCS,FOLDING PED WC TILT-IN-SPACE,,,28 ,,NW,,,,,,"$3,889.66",$0.00,1,1,1,1,1,1,20131001,E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,NU,,28 ,,NW,,,,,,"$4,028.88",$0.00,1,1,1,1,1,1,20131001,E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,RR,,28 ,,NW,,,,,,$438.84,$0.00,1,1,1,1,1,1,20131001,E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,UE,,28 ,,NW,,,,,,"$3,031.65",$0.00,1,1,1,1,1,1,20131001,E1233,HCPCS,RIG PED WC TLTNSPC W/O SEAT,,,28 ,,NW,,,,,,"$4,028.88",$0.00,1,1,1,1,1,1,20131001,E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,NU,,28 ,,NW,,,,,,"$3,512.59",$0.00,1,1,1,1,1,1,20131001,E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,RR,,28 ,,NW,,,,,,$387.25,$0.00,1,1,1,1,1,1,20131001,E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,UE,,28 ,,NW,,,,,,"$2,644.41",$0.00,1,1,1,1,1,1,20131001,E1234,HCPCS,FLD PED WC TLTNSPC W/O SEAT,,,28 ,,NW,,,,,,"$3,512.59",$0.00,1,1,1,1,1,1,20131001,E1235,HCPCS,RIGID PED WC ADJUSTABLE,NU,,28 ,,NW,,,,,,"$3,383.83",$0.00,1,1,1,1,1,1,20131001,E1235,HCPCS,RIGID PED WC ADJUSTABLE,RR,,28 ,,NW,,,,,,$374.35,$0.00,1,1,1,1,1,1,20131001,E1235,HCPCS,RIGID PED WC ADJUSTABLE,UE,,28 ,,NW,,,,,,"$2,547.86",$0.00,1,1,1,1,1,1,20131001,E1235,HCPCS,RIGID PED WC ADJUSTABLE,,,28 ,,NW,,,,,,"$3,383.83",$0.00,1,1,1,1,1,1,20131001,E1236,HCPCS,FOLDING PED WC ADJUSTABLE,NU,,28 ,,NW,,,,,,"$2,990.11",$0.00,1,1,1,1,1,1,20131001,E1236,HCPCS,FOLDING PED WC ADJUSTABLE,RR,,28 ,,NW,,,,,,$334.96,$0.00,1,1,1,1,1,1,20131001,E1236,HCPCS,FOLDING PED WC ADJUSTABLE,UE,,28 ,,NW,,,,,,"$2,252.57",$0.00,1,1,1,1,1,1,20131001,E1236,HCPCS,FOLDING PED WC ADJUSTABLE,,,28 ,,NW,,,,,,"$2,990.11",$0.00,1,1,1,1,1,1,20131001,E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,NU,,28 ,,NW,,,,,,"$3,015.89",$0.00,1,1,1,1,1,1,20131001,E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,RR,,28 ,,NW,,,,,,$337.54,$0.00,1,1,1,1,1,1,20131001,E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,UE,,28 ,,NW,,,,,,"$2,271.93",$0.00,1,1,1,1,1,1,20131001,E1237,HCPCS,RGD PED WC ADJSTABL W/O SEAT,,,28 ,,NW,,,,,,"$3,015.89",$0.00,1,1,1,1,1,1,20131001,E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,NU,,28 ,,NW,,,,,,"$2,990.11",$0.00,1,1,1,1,1,1,20131001,E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,RR,,28 ,,NW,,,,,,$334.96,$0.00,1,1,1,1,1,1,20131001,E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,UE,,28 ,,NW,,,,,,"$2,252.57",$0.00,1,1,1,1,1,1,20131001,E1238,HCPCS,FLD PED WC ADJSTABL W/O SEAT,,,28 ,,NW,,,,,,"$2,990.11",$0.00,1,1,1,1,1,1,20131001,E1239,HCPCS,PED POWER WHEELCHAIR NOS,,,28 ,,NW,,,,,,"$1,554.00",$0.00,1,1,1,1,1,1,20131001,E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,NU,,28 ,,NW,,,,,,"$1,802.01",$0.00,1,1,1,1,1,1,20131001,E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,RR,,28 ,,NW,,,,,,$209.23,$0.00,1,1,1,1,1,1,20131001,E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,UE,,28 ,,NW,,,,,,"$1,361.49",$0.00,1,1,1,1,1,1,20131001,E1240,HCPCS,WHCHR LITWT DET ARM LEG REST,,,28 ,,NW,,,,,,"$1,802.01",$0.00,1,1,1,1,1,1,20131001,E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,NU,,28 ,,NW,,,,,,"$1,516.01",$0.00,1,1,1,1,1,1,20131001,E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,RR,,28 ,,NW,,,,,,$162.39,$0.00,1,1,1,1,1,1,20131001,E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,UE,,28 ,,NW,,,,,,"$1,209.20",$0.00,1,1,1,1,1,1,20131001,E1250,HCPCS,WHEELCHAIR LIGHTWT FIXED ARM,,,28 ,,NW,,,,,,"$1,516.01",$0.00,1,1,1,1,1,1,20131001,E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,NU,,28 ,,NW,,,,,,"$1,764.86",$0.00,1,1,1,1,1,1,20131001,E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,RR,,28 ,,NW,,,,,,$207.75,$0.00,1,1,1,1,1,1,20131001,E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,UE,,28 ,,NW,,,,,,"$1,400.86",$0.00,1,1,1,1,1,1,20131001,E1260,HCPCS,WHEELCHAIR LIGHTWT FOOT REST,,,28 ,,NW,,,,,,"$1,764.86",$0.00,1,1,1,1,1,1,20131001,E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,NU,,28 ,,NW,,,,,,"$1,390.46",$0.00,1,1,1,1,1,1,20131001,E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,RR,,28 ,,NW,,,,,,$160.59,$0.00,1,1,1,1,1,1,20131001,E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,UE,,28 ,,NW,,,,,,"$1,052.46",$0.00,1,1,1,1,1,1,20131001,E1270,HCPCS,WHEELCHAIR LIGHTWEIGHT LEG R,,,28 ,,NW,,,,,,"$1,390.46",$0.00,1,1,1,1,1,1,20131001,E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,NU,,28 ,,NW,,,,,,"$2,284.87",$0.00,1,1,1,1,1,1,20131001,E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,RR,,28 ,,NW,,,,,,$260.96,$0.00,1,1,1,1,1,1,20131001,E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,UE,,28 ,,NW,,,,,,"$1,724.01",$0.00,1,1,1,1,1,1,20131001,E1280,HCPCS,WHCHR H-DUTY DET ARM LEG RES,,,28 ,,NW,,,,,,"$2,284.87",$0.00,1,1,1,1,1,1,20131001,E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,NU,,28 ,,NW,,,,,,"$2,263.32",$0.00,1,1,1,1,1,1,20131001,E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,RR,,28 ,,NW,,,,,,$262.06,$0.00,1,1,1,1,1,1,20131001,E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,UE,,28 ,,NW,,,,,,"$1,669.03",$0.00,1,1,1,1,1,1,20131001,E1285,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,,,28 ,,NW,,,,,,"$2,263.32",$0.00,1,1,1,1,1,1,20131001,E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,NU,,28 ,,NW,,,,,,"$2,339.84",$0.00,1,1,1,1,1,1,20131001,E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,RR,,28 ,,NW,,,,,,$270.23,$0.00,1,1,1,1,1,1,20131001,E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,UE,,28 ,,NW,,,,,,"$1,717.32",$0.00,1,1,1,1,1,1,20131001,E1290,HCPCS,WHEELCHAIR HVY DUTY DETACH A,,,28 ,,NW,,,,,,"$2,339.84",$0.00,1,1,1,1,1,1,20131001,E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,NU,,28 ,,NW,,,,,,"$2,117.72",$0.00,1,1,1,1,1,1,20131001,E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,RR,,28 ,,NW,,,,,,$249.19,$0.00,1,1,1,1,1,1,20131001,E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,UE,,28 ,,NW,,,,,,"$1,598.46",$0.00,1,1,1,1,1,1,20131001,E1295,HCPCS,WHEELCHAIR HEAVY DUTY FIXED,,,28 ,,NW,,,,,,"$2,117.72",$0.00,1,1,1,1,1,1,20131001,E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,NU,,28 ,,NW,,,,,,$851.79,$0.00,1,1,1,1,1,1,20131001,E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,RR,,28 ,,NW,,,,,,$100.46,$0.00,1,1,1,1,1,1,20131001,E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,UE,,28 ,,NW,,,,,,$648.80,$0.00,1,1,1,1,1,1,20131001,E1296,HCPCS,WHEELCHAIR SPECIAL SEAT HEIG,,,28 ,,NW,,,,,,$851.79,$0.00,1,1,1,1,1,1,20131001,E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,NU,,28 ,,NW,,,,,,$208.21,$0.00,1,1,1,1,1,1,20131001,E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,RR,,28 ,,NW,,,,,,$25.09,$0.00,1,1,1,1,1,1,20131001,E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,UE,,28 ,,NW,,,,,,$156.50,$0.00,1,1,1,1,1,1,20131001,E1297,HCPCS,WHEELCHAIR SPECIAL SEAT DEPT,,,28 ,,NW,,,,,,$208.21,$0.00,1,1,1,1,1,1,20131001,E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,NU,,28 ,,NW,,,,,,$751.81,$0.00,1,1,1,1,1,1,20131001,E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,RR,,28 ,,NW,,,,,,$88.02,$0.00,1,1,1,1,1,1,20131001,E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,UE,,28 ,,NW,,,,,,$573.84,$0.00,1,1,1,1,1,1,20131001,E1298,HCPCS,WHEELCHAIR SPEC SEAT DEPTH/W,,,28 ,,NW,,,,,,$751.81,$0.00,1,1,1,1,1,1,20131001,E1300,HCPCS,WHIRLPOOL PORTABLE,NU,,28 ,,NW,,,,,,$183.51,$0.00,1,1,1,1,1,1,20131001,E1300,HCPCS,WHIRLPOOL PORTABLE,RR,,28 ,,NW,,,,,,$19.10,$0.00,1,1,1,1,1,1,20131001,E1300,HCPCS,WHIRLPOOL PORTABLE,UE,,28 ,,NW,,,,,,$137.81,$0.00,1,1,1,1,1,1,20131001,E1300,HCPCS,WHIRLPOOL PORTABLE,,,28 ,,NW,,,,,,$183.51,$0.00,1,1,1,1,1,1,20131001,E1310,HCPCS,WHIRLPOOL NON-PORTABLE,NU,,28 ,,NW,,,,,,"$5,191.83",$0.00,1,1,1,1,1,1,20131001,E1310,HCPCS,WHIRLPOOL NON-PORTABLE,RR,,28 ,,NW,,,,,,$411.71,$0.00,1,1,1,1,1,1,20131001,E1310,HCPCS,WHIRLPOOL NON-PORTABLE,UE,,28 ,,NW,,,,,,"$3,884.17",$0.00,1,1,1,1,1,1,20131001,E1310,HCPCS,WHIRLPOOL NON-PORTABLE,,,28 ,,NW,,,,,,"$5,191.83",$0.00,1,1,1,1,1,1,20131001,E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,NU,,28 ,,NW,,,,,,$63.09,$0.00,1,1,1,1,1,1,20131001,E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,RR,,28 ,,NW,,,,,,$6.54,$0.00,1,1,1,1,1,1,20131001,E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,UE,,28 ,,NW,,,,,,$43.51,$0.00,1,1,1,1,1,1,20131001,E1353,HCPCS,OXYGEN SUPPLIES REGULATOR,,,28 ,,NW,,,,,,$63.09,$0.00,1,1,1,1,1,1,20131001,E1354,HCPCS,"WHEELED CART, PORT CYL/CONC",,,28 ,,NW,,,,,,$68.46,$0.00,1,1,1,1,1,1,20131001,E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,NU,,28 ,,NW,,,,,,$36.55,$0.00,1,1,1,1,1,1,20131001,E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,RR,,28 ,,NW,,,,,,$5.38,$0.00,1,1,1,1,1,1,20131001,E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,UE,,28 ,,NW,,,,,,$27.44,$0.00,1,1,1,1,1,1,20131001,E1355,HCPCS,OXYGEN SUPPLIES STAND/RACK,,,28 ,,NW,,,,,,$36.55,$0.00,1,1,1,1,1,1,20131001,E1356,HCPCS,"BATT PACK/CART, PORT CONC",,,28 ,,NW,,,,,,$173.48,$0.00,1,1,1,1,1,1,20131001,E1357,HCPCS,"BATTERY CHARGER, PORT CONC",,,28 ,,NW,,,,,,$272.78,$0.00,1,1,1,1,1,1,20131001,E1358,HCPCS,"DC POWER ADAPTER, PORT CONC",,,28 ,,NW,,,,,,$146.23,$0.00,1,1,1,1,1,1,20131001,E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,NU,,28 ,,NW,,,,,,$358.00,$0.00,1,1,1,1,1,1,20131001,E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,RR,,28 ,,NW,,,,,,$44.50,$0.00,1,1,1,1,1,1,20131001,E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,UE,,28 ,,NW,,,,,,$254.22,$0.00,1,1,1,1,1,1,20131001,E1372,HCPCS,OXY SUPPL HEATER FOR NEBULIZ,,,28 ,,NW,,,,,,$358.00,$0.00,1,1,1,1,1,1,20131001,E1390,HCPCS,OXYGEN CONCENTRATOR,NU,,28 ,,NW,,,,,,"$5,569.00",$0.00,1,1,1,1,1,1,20131001,E1390,HCPCS,OXYGEN CONCENTRATOR,RR,,28 ,,NW,,,,,,$577.63,$0.00,1,1,1,1,1,1,20131001,E1390,HCPCS,OXYGEN CONCENTRATOR,,,28 ,,NW,,,,,,"$5,569.00",$0.00,1,1,1,1,1,1,20131001,E1391,HCPCS,"OXYGEN CONCENTRATOR, DUAL",RR,,28 ,,NW,,,,,,$577.63,$0.00,1,1,1,1,1,1,20131001,E1391,HCPCS,"OXYGEN CONCENTRATOR, DUAL",,,28 ,,NW,,,,,,"$5,569.00",$0.00,1,1,1,1,1,1,20131001,E1392,HCPCS,PORTABLE OXYGEN CONCENTRATOR,RR,,28 ,,NW,,,,,,$137.99,$0.00,1,1,1,1,1,1,20131001,E1392,HCPCS,PORTABLE OXYGEN CONCENTRATOR,,,28 ,,NW,,,,,,"$1,330.37",$0.00,1,1,1,1,1,1,20131001,E1399,HCPCS,DURABLE MEDICAL EQUIPMENT MI,,,28 ,,NW,,,,,,$162.90,$0.00,1,1,1,1,1,1,20131001,E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,NU,,28 ,,NW,,,,,,"$6,793.36",$0.00,1,1,1,1,1,1,20131001,E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,RR,,28 ,,NW,,,,,,$704.63,$0.00,1,1,1,1,1,1,20131001,E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,UE,,28 ,,NW,,,,,,"$5,100.21",$0.00,1,1,1,1,1,1,20131001,E1405,HCPCS,O2/WATER VAPOR ENRICH W/HEAT,,,28 ,,NW,,,,,,"$6,793.36",$0.00,1,1,1,1,1,1,20131001,E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,NU,,28 ,,NW,,,,,,"$6,158.39",$0.00,1,1,1,1,1,1,20131001,E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,RR,,28 ,,NW,,,,,,$638.77,$0.00,1,1,1,1,1,1,20131001,E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,UE,,28 ,,NW,,,,,,"$4,623.50",$0.00,1,1,1,1,1,1,20131001,E1406,HCPCS,O2/WATER VAPOR ENRICH W/O HE,,,28 ,,NW,,,,,,"$6,158.39",$0.00,1,1,1,1,1,1,20131001,E1500,HCPCS,CENTRIFUGE,,,28 ,,NW,,,,,,$278.29,$0.00,1,1,1,1,1,1,20131001,E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,NU,,28 ,,NW,,,,,,"$2,480.80",$0.00,1,1,1,1,1,1,20131001,E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,RR,,28 ,,NW,,,,,,$261.33,$0.00,1,1,1,1,1,1,20131001,E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,UE,,28 ,,NW,,,,,,"$1,868.20",$0.00,1,1,1,1,1,1,20131001,E1510,HCPCS,KIDNEY DIALYSATE DELIVRY SYS,,,28 ,,NW,,,,,,"$2,480.80",$0.00,1,1,1,1,1,1,20131001,E1520,HCPCS,HEPARIN INFUSION PUMP,NU,,28 ,,NW,,,,,,$975.42,$0.00,1,1,1,1,1,1,20131001,E1520,HCPCS,HEPARIN INFUSION PUMP,RR,,28 ,,NW,,,,,,$100.78,$0.00,1,1,1,1,1,1,20131001,E1520,HCPCS,HEPARIN INFUSION PUMP,UE,,28 ,,NW,,,,,,$725.42,$0.00,1,1,1,1,1,1,20131001,E1520,HCPCS,HEPARIN INFUSION PUMP,,,28 ,,NW,,,,,,$975.42,$0.00,1,1,1,1,1,1,20131001,E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,NU,,28 ,,NW,,,,,,"$1,817.96",$0.00,1,1,1,1,1,1,20131001,E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,RR,,28 ,,NW,,,,,,$187.47,$0.00,1,1,1,1,1,1,20131001,E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,UE,,28 ,,NW,,,,,,"$1,363.85",$0.00,1,1,1,1,1,1,20131001,E1530,HCPCS,REPLACEMENT AIR BUBBLE DETEC,,,28 ,,NW,,,,,,"$1,817.96",$0.00,1,1,1,1,1,1,20131001,E1540,HCPCS,REPLACEMENT PRESSURE ALARM,NU,,28 ,,NW,,,,,,$317.74,$0.00,1,1,1,1,1,1,20131001,E1540,HCPCS,REPLACEMENT PRESSURE ALARM,RR,,28 ,,NW,,,,,,$33.65,$0.00,1,1,1,1,1,1,20131001,E1540,HCPCS,REPLACEMENT PRESSURE ALARM,UE,,28 ,,NW,,,,,,$238.84,$0.00,1,1,1,1,1,1,20131001,E1540,HCPCS,REPLACEMENT PRESSURE ALARM,,,28 ,,NW,,,,,,$317.74,$0.00,1,1,1,1,1,1,20131001,E1550,HCPCS,BATH CONDUCTIVITY METER,NU,,28 ,,NW,,,,,,$274.72,$0.00,1,1,1,1,1,1,20131001,E1550,HCPCS,BATH CONDUCTIVITY METER,RR,,28 ,,NW,,,,,,$28.65,$0.00,1,1,1,1,1,1,20131001,E1550,HCPCS,BATH CONDUCTIVITY METER,UE,,28 ,,NW,,,,,,$206.34,$0.00,1,1,1,1,1,1,20131001,E1550,HCPCS,BATH CONDUCTIVITY METER,,,28 ,,NW,,,,,,$274.72,$0.00,1,1,1,1,1,1,20131001,E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,NU,,28 ,,NW,,,,,,"$2,103.65",$0.00,1,1,1,1,1,1,20131001,E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,RR,,28 ,,NW,,,,,,$216.91,$0.00,1,1,1,1,1,1,20131001,E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,UE,,28 ,,NW,,,,,,"$1,556.70",$0.00,1,1,1,1,1,1,20131001,E1560,HCPCS,REPLACE BLOOD LEAK DETECTOR,,,28 ,,NW,,,,,,"$2,103.65",$0.00,1,1,1,1,1,1,20131001,E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,NU,,28 ,,NW,,,,,,"$1,707.32",$0.00,1,1,1,1,1,1,20131001,E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,RR,,28 ,,NW,,,,,,$177.66,$0.00,1,1,1,1,1,1,20131001,E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,UE,,28 ,,NW,,,,,,"$1,282.14",$0.00,1,1,1,1,1,1,20131001,E1570,HCPCS,ADJUSTABLE CHAIR FOR ESRD PT,,,28 ,,NW,,,,,,"$1,707.32",$0.00,1,1,1,1,1,1,20131001,E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,NU,,28 ,,NW,,,,,,$110.35,$0.00,1,1,1,1,1,1,20131001,E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,RR,,28 ,,NW,,,,,,$11.38,$0.00,1,1,1,1,1,1,20131001,E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,UE,,28 ,,NW,,,,,,$81.66,$0.00,1,1,1,1,1,1,20131001,E1575,HCPCS,TRANSDUCER PROTECT/FLD BAR,,,28 ,,NW,,,,,,$110.35,$0.00,1,1,1,1,1,1,20131001,E1590,HCPCS,HEMODIALYSIS MACHINE,NU,,28 ,,NW,,,,,,"$2,806.35",$0.00,1,1,1,1,1,1,20131001,E1590,HCPCS,HEMODIALYSIS MACHINE,RR,,28 ,,NW,,,,,,$307.12,$0.00,1,1,1,1,1,1,20131001,E1590,HCPCS,HEMODIALYSIS MACHINE,UE,,28 ,,NW,,,,,,"$2,113.35",$0.00,1,1,1,1,1,1,20131001,E1590,HCPCS,HEMODIALYSIS MACHINE,,,28 ,,NW,,,,,,"$2,806.35",$0.00,1,1,1,1,1,1,20131001,E1592,HCPCS,AUTO INTERM PERITONEAL DIALY,,,28 ,,NW,,,,,,$7.21,$0.00,1,1,1,1,1,1,20131001,E1594,HCPCS,CYCLER DIALYSIS MACHINE,NU,,28 ,,NW,,,,,,"$7,407.90",$0.00,1,1,1,1,1,1,20131001,E1594,HCPCS,CYCLER DIALYSIS MACHINE,RR,,28 ,,NW,,,,,,$810.72,$0.00,1,1,1,1,1,1,20131001,E1594,HCPCS,CYCLER DIALYSIS MACHINE,UE,,28 ,,NW,,,,,,"$5,578.62",$0.00,1,1,1,1,1,1,20131001,E1594,HCPCS,CYCLER DIALYSIS MACHINE,,,28 ,,NW,,,,,,"$7,407.90",$0.00,1,1,1,1,1,1,20131001,E1600,HCPCS,DELI/INSTALL CHRG HEMO EQUIP,,,28 ,,NW,,,,,,$247.60,$0.00,1,1,1,1,1,1,20131001,E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,NU,,28 ,,NW,,,,,,"$4,923.67",$0.00,1,1,1,1,1,1,20131001,E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,RR,,28 ,,NW,,,,,,$514.54,$0.00,1,1,1,1,1,1,20131001,E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,UE,,28 ,,NW,,,,,,"$3,698.80",$0.00,1,1,1,1,1,1,20131001,E1610,HCPCS,REVERSE OSMOSIS H2O PURI SYS,,,28 ,,NW,,,,,,"$4,923.67",$0.00,1,1,1,1,1,1,20131001,E1615,HCPCS,DEIONIZER H2O PURI SYSTEM,,,28 ,,NW,,,,,,$579.16,$0.00,1,1,1,1,1,1,20131001,E1620,HCPCS,REPLACEMENT BLOOD PUMP,,,28 ,,NW,,,,,,$618.19,$0.00,1,1,1,1,1,1,20131001,E1625,HCPCS,WATER SOFTENING SYSTEM,,,28 ,,NW,,,,,,"$2,222.26",$0.00,1,1,1,1,1,1,20131001,E1630,HCPCS,RECIPROCATING PERITONEAL DIA,,,28 ,,NW,,,,,,$180.08,$0.00,1,1,1,1,1,1,20131001,E1634,HCPCS,PERITONEAL DIALYSIS CLAMP,,,28 ,,NW,,,,,,$12.52,$0.00,1,1,1,1,1,1,20131001,E1635,HCPCS,COMPACT TRAVEL HEMODIALYZER,,,28 ,,NW,,,,,,$465.44,$0.00,1,1,1,1,1,1,20131001,E1636,HCPCS,SORBENT CARTRIDGES PER 10,,,28 ,,NW,,,,,,$53.84,$0.00,1,1,1,1,1,1,20131001,E1637,HCPCS,"HEMOSTATS FOR DIALYSIS, EACH",,,28 ,,NW,,,,,,$45.92,$0.00,1,1,1,1,1,1,20131001,E1639,HCPCS,DIALYSIS SCALE,,,28 ,,NW,,,,,,$211.49,$0.00,1,1,1,1,1,1,20131001,E1699,HCPCS,DIALYSIS EQUIPMENT NOC,,,28 ,,NW,,,,,,$218.43,$0.00,1,1,1,1,1,1,20131001,E1700,HCPCS,JAW MOTION REHAB SYSTEM,NU,,28 ,,NW,,,,,,$807.21,$0.00,1,1,1,1,1,1,20131001,E1700,HCPCS,JAW MOTION REHAB SYSTEM,RR,,28 ,,NW,,,,,,$59.91,$0.00,1,1,1,1,1,1,20131001,E1700,HCPCS,JAW MOTION REHAB SYSTEM,UE,,28 ,,NW,,,,,,$594.58,$0.00,1,1,1,1,1,1,20131001,E1700,HCPCS,JAW MOTION REHAB SYSTEM,,,28 ,,NW,,,,,,$807.21,$0.00,1,1,1,1,1,1,20131001,E1701,HCPCS,REPL CUSHIONS FOR JAW MOTION,,,28 ,,NW,,,,,,$25.12,$0.00,1,1,1,1,1,1,20131001,E1702,HCPCS,REPL MEASR SCALES JAW MOTION,,,28 ,,NW,,,,,,$42.83,$0.00,1,1,1,1,1,1,20131001,E1800,HCPCS,ADJUST ELBOW EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$256.18,$0.00,1,1,1,1,1,1,20131001,E1800,HCPCS,ADJUST ELBOW EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,469.84",$0.00,1,1,1,1,1,1,20131001,E1801,HCPCS,SPS ELBOW DEVICE,RR,,28 ,,NW,,,,,,$287.29,$0.00,1,1,1,1,1,1,20131001,E1801,HCPCS,SPS ELBOW DEVICE,,,28 ,,NW,,,,,,"$2,769.74",$0.00,1,1,1,1,1,1,20131001,E1802,HCPCS,ADJST FOREARM PRO/SUP DEVICE,RR,,28 ,,NW,,,,,,$811.62,$0.00,1,1,1,1,1,1,20131001,E1802,HCPCS,ADJST FOREARM PRO/SUP DEVICE,,,28 ,,NW,,,,,,"$7,824.85",$0.00,1,1,1,1,1,1,20131001,E1805,HCPCS,ADJUST WRIST EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$269.64,$0.00,1,1,1,1,1,1,20131001,E1805,HCPCS,ADJUST WRIST EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,599.63",$0.00,1,1,1,1,1,1,20131001,E1806,HCPCS,SPS WRIST DEVICE,RR,,28 ,,NW,,,,,,$228.89,$0.00,1,1,1,1,1,1,20131001,E1806,HCPCS,SPS WRIST DEVICE,,,28 ,,NW,,,,,,"$2,206.71",$0.00,1,1,1,1,1,1,20131001,E1810,HCPCS,ADJUST KNEE EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$264.58,$0.00,1,1,1,1,1,1,20131001,E1810,HCPCS,ADJUST KNEE EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,550.83",$0.00,1,1,1,1,1,1,20131001,E1811,HCPCS,SPS KNEE DEVICE,RR,,28 ,,NW,,,,,,$300.25,$0.00,1,1,1,1,1,1,20131001,E1811,HCPCS,SPS KNEE DEVICE,,,28 ,,NW,,,,,,"$2,894.70",$0.00,1,1,1,1,1,1,20131001,E1812,HCPCS,KNEE EXT/FLEX W ACT RES CTRL,RR,,28 ,,NW,,,,,,$184.91,$0.00,1,1,1,1,1,1,20131001,E1812,HCPCS,KNEE EXT/FLEX W ACT RES CTRL,,,28 ,,NW,,,,,,"$1,782.74",$0.00,1,1,1,1,1,1,20131001,E1815,HCPCS,ADJUST ANKLE EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$269.71,$0.00,1,1,1,1,1,1,20131001,E1815,HCPCS,ADJUST ANKLE EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,600.27",$0.00,1,1,1,1,1,1,20131001,E1816,HCPCS,SPS ANKLE DEVICE,RR,,28 ,,NW,,,,,,$305.57,$0.00,1,1,1,1,1,1,20131001,E1816,HCPCS,SPS ANKLE DEVICE,,,28 ,,NW,,,,,,"$2,945.99",$0.00,1,1,1,1,1,1,20131001,E1818,HCPCS,SPS FOREARM DEVICE,RR,,28 ,,NW,,,,,,$312.76,$0.00,1,1,1,1,1,1,20131001,E1818,HCPCS,SPS FOREARM DEVICE,,,28 ,,NW,,,,,,"$3,015.30",$0.00,1,1,1,1,1,1,20131001,E1820,HCPCS,SOFT INTERFACE MATERIAL,NU,,28 ,,NW,,,,,,$169.20,$0.00,1,1,1,1,1,1,20131001,E1820,HCPCS,SOFT INTERFACE MATERIAL,RR,,28 ,,NW,,,,,,$21.41,$0.00,1,1,1,1,1,1,20131001,E1820,HCPCS,SOFT INTERFACE MATERIAL,UE,,28 ,,NW,,,,,,$117.20,$0.00,1,1,1,1,1,1,20131001,E1820,HCPCS,SOFT INTERFACE MATERIAL,,,28 ,,NW,,,,,,$169.20,$0.00,1,1,1,1,1,1,20131001,E1821,HCPCS,REPLACEMENT INTERFACE SPSD,NU,,28 ,,NW,,,,,,$235.04,$0.00,1,1,1,1,1,1,20131001,E1821,HCPCS,REPLACEMENT INTERFACE SPSD,RR,,28 ,,NW,,,,,,$25.46,$0.00,1,1,1,1,1,1,20131001,E1821,HCPCS,REPLACEMENT INTERFACE SPSD,UE,,28 ,,NW,,,,,,$166.62,$0.00,1,1,1,1,1,1,20131001,E1821,HCPCS,REPLACEMENT INTERFACE SPSD,,,28 ,,NW,,,,,,$235.04,$0.00,1,1,1,1,1,1,20131001,E1825,HCPCS,ADJUST FINGER EXT/FLEX DEVC,RR,,28 ,,NW,,,,,,$269.64,$0.00,1,1,1,1,1,1,20131001,E1825,HCPCS,ADJUST FINGER EXT/FLEX DEVC,,,28 ,,NW,,,,,,"$2,599.63",$0.00,1,1,1,1,1,1,20131001,E1830,HCPCS,ADJUST TOE EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$269.64,$0.00,1,1,1,1,1,1,20131001,E1830,HCPCS,ADJUST TOE EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$2,599.63",$0.00,1,1,1,1,1,1,20131001,E1831,HCPCS,STATIC STR TOE DEV EXT/FLEX,RR,,28 ,,NW,,,,,,$130.19,$0.00,1,1,1,1,1,1,20131001,E1831,HCPCS,STATIC STR TOE DEV EXT/FLEX,,,28 ,,NW,,,,,,"$1,255.13",$0.00,1,1,1,1,1,1,20131001,E1840,HCPCS,ADJ SHOULDER EXT/FLEX DEVICE,RR,,28 ,,NW,,,,,,$938.27,$0.00,1,1,1,1,1,1,20131001,E1840,HCPCS,ADJ SHOULDER EXT/FLEX DEVICE,,,28 ,,NW,,,,,,"$9,045.88",$0.00,1,1,1,1,1,1,20131001,E1841,HCPCS,STATIC STR SHLDR DEV ROM ADJ,RR,,28 ,,NW,,,,,,"$1,140.01",$0.00,1,1,1,1,1,1,20131001,E1841,HCPCS,STATIC STR SHLDR DEV ROM ADJ,,,28 ,,NW,,,,,,"$10,990.84",$0.00,1,1,1,1,1,1,20131001,E1902,HCPCS,AAC NON-ELECTRONIC BOARD,,,28 ,,NW,,,,,,"$2,916.78",$0.00,1,1,1,1,1,1,20131001,E2000,HCPCS,GASTRIC SUCTION PUMP HME MDL,RR,,28 ,,NW,,,,,,$92.15,$0.00,1,1,1,1,1,1,20131001,E2000,HCPCS,GASTRIC SUCTION PUMP HME MDL,,,28 ,,NW,,,,,,$888.43,$0.00,1,1,1,1,1,1,20131001,E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,NU,,28 ,,NW,,,,,,"$1,492.57",$0.00,1,1,1,1,1,1,20131001,E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,RR,,28 ,,NW,,,,,,$115.72,$0.00,1,1,1,1,1,1,20131001,E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,UE,,28 ,,NW,,,,,,"$1,113.55",$0.00,1,1,1,1,1,1,20131001,E2100,HCPCS,BLD GLUCOSE MONITOR W VOICE,,,28 ,,NW,,,,,,"$1,492.57",$0.00,1,1,1,1,1,1,20131001,E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,NU,,28 ,,NW,,,,,,$451.86,$0.00,1,1,1,1,1,1,20131001,E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,RR,,28 ,,NW,,,,,,$38.93,$0.00,1,1,1,1,1,1,20131001,E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,UE,,28 ,,NW,,,,,,$329.17,$0.00,1,1,1,1,1,1,20131001,E2101,HCPCS,BLD GLUCOSE MONITOR W LANCE,,,28 ,,NW,,,,,,$451.86,$0.00,1,1,1,1,1,1,20131001,E2120,HCPCS,PULSE GEN SYS TX ENDOLYMP FL,RR,,28 ,,NW,,,,,,$698.98,$0.00,1,1,1,1,1,1,20131001,E2120,HCPCS,PULSE GEN SYS TX ENDOLYMP FL,,,28 ,,NW,,,,,,"$6,738.92",$0.00,1,1,1,1,1,1,20131001,E2201,HCPCS,MAN W/CH ACC SEAT W>=20ö<24ö,NU,,28 ,,NW,,,,,,$711.63,$0.00,1,1,1,1,1,1,20131001,E2201,HCPCS,MAN W/CH ACC SEAT W>=20ö<24ö,RR,,28 ,,NW,,,,,,$81.85,$0.00,1,1,1,1,1,1,20131001,E2201,HCPCS,MAN W/CH ACC SEAT W>=20ö<24ö,UE,,28 ,,NW,,,,,,$543.71,$0.00,1,1,1,1,1,1,20131001,E2201,HCPCS,MAN W/CH ACC SEAT W>=20ö<24ö,,,28 ,,NW,,,,,,$711.63,$0.00,1,1,1,1,1,1,20131001,E2202,HCPCS,SEAT WIDTH 24-27 IN,NU,,28 ,,NW,,,,,,$893.23,$0.00,1,1,1,1,1,1,20131001,E2202,HCPCS,SEAT WIDTH 24-27 IN,RR,,28 ,,NW,,,,,,$103.58,$0.00,1,1,1,1,1,1,20131001,E2202,HCPCS,SEAT WIDTH 24-27 IN,UE,,28 ,,NW,,,,,,$679.96,$0.00,1,1,1,1,1,1,20131001,E2202,HCPCS,SEAT WIDTH 24-27 IN,,,28 ,,NW,,,,,,$893.23,$0.00,1,1,1,1,1,1,20131001,E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,NU,,28 ,,NW,,,,,,$902.37,$0.00,1,1,1,1,1,1,20131001,E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,RR,,28 ,,NW,,,,,,$104.64,$0.00,1,1,1,1,1,1,20131001,E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,UE,,28 ,,NW,,,,,,$686.73,$0.00,1,1,1,1,1,1,20131001,E2203,HCPCS,FRAME DEPTH LESS THAN 22 IN,,,28 ,,NW,,,,,,$902.37,$0.00,1,1,1,1,1,1,20131001,E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,NU,,28 ,,NW,,,,,,"$1,504.30",$0.00,1,1,1,1,1,1,20131001,E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,RR,,28 ,,NW,,,,,,$176.75,$0.00,1,1,1,1,1,1,20131001,E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,UE,,28 ,,NW,,,,,,"$1,138.20",$0.00,1,1,1,1,1,1,20131001,E2204,HCPCS,FRAME DEPTH 22 TO 25 IN,,,28 ,,NW,,,,,,"$1,504.30",$0.00,1,1,1,1,1,1,20131001,E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",NU,,28 ,,NW,,,,,,$71.58,$0.00,1,1,1,1,1,1,20131001,E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",RR,,28 ,,NW,,,,,,$8.41,$0.00,1,1,1,1,1,1,20131001,E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",UE,,28 ,,NW,,,,,,$54.09,$0.00,1,1,1,1,1,1,20131001,E2205,HCPCS,"MANUAL WC ACCESSORY, HANDRIM",,,28 ,,NW,,,,,,$71.58,$0.00,1,1,1,1,1,1,20131001,E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,NU,,28 ,,NW,,,,,,$88.79,$0.00,1,1,1,1,1,1,20131001,E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,RR,,28 ,,NW,,,,,,$10.15,$0.00,1,1,1,1,1,1,20131001,E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,UE,,28 ,,NW,,,,,,$66.96,$0.00,1,1,1,1,1,1,20131001,E2206,HCPCS,COMPLETE WHEEL LOCK ASSEMBLY,,,28 ,,NW,,,,,,$88.79,$0.00,1,1,1,1,1,1,20131001,E2207,HCPCS,CRUTCH AND CANE HOLDER,NU,,28 ,,NW,,,,,,$94.52,$0.00,1,1,1,1,1,1,20131001,E2207,HCPCS,CRUTCH AND CANE HOLDER,RR,,28 ,,NW,,,,,,$10.77,$0.00,1,1,1,1,1,1,20131001,E2207,HCPCS,CRUTCH AND CANE HOLDER,UE,,28 ,,NW,,,,,,$71.27,$0.00,1,1,1,1,1,1,20131001,E2207,HCPCS,CRUTCH AND CANE HOLDER,,,28 ,,NW,,,,,,$94.52,$0.00,1,1,1,1,1,1,20131001,E2208,HCPCS,CYLINDER TANK CARRIER,NU,,28 ,,NW,,,,,,$436.67,$0.00,1,1,1,1,1,1,20131001,E2208,HCPCS,CYLINDER TANK CARRIER,RR,,28 ,,NW,,,,,,$48.90,$0.00,1,1,1,1,1,1,20131001,E2208,HCPCS,CYLINDER TANK CARRIER,UE,,28 ,,NW,,,,,,$337.50,$0.00,1,1,1,1,1,1,20131001,E2208,HCPCS,CYLINDER TANK CARRIER,,,28 ,,NW,,,,,,$436.67,$0.00,1,1,1,1,1,1,20131001,E2209,HCPCS,ARM TROUGH EACH,NU,,28 ,,NW,,,,,,$397.89,$0.00,1,1,1,1,1,1,20131001,E2209,HCPCS,ARM TROUGH EACH,RR,,28 ,,NW,,,,,,$44.35,$0.00,1,1,1,1,1,1,20131001,E2209,HCPCS,ARM TROUGH EACH,UE,,28 ,,NW,,,,,,$308.42,$0.00,1,1,1,1,1,1,20131001,E2209,HCPCS,ARM TROUGH EACH,,,28 ,,NW,,,,,,$397.89,$0.00,1,1,1,1,1,1,20131001,E2210,HCPCS,WHEELCHAIR BEARINGS,NU,,28 ,,NW,,,,,,$27.71,$0.00,1,1,1,1,1,1,20131001,E2210,HCPCS,WHEELCHAIR BEARINGS,RR,,28 ,,NW,,,,,,$4.01,$0.00,1,1,1,1,1,1,20131001,E2210,HCPCS,WHEELCHAIR BEARINGS,UE,,28 ,,NW,,,,,,$21.19,$0.00,1,1,1,1,1,1,20131001,E2210,HCPCS,WHEELCHAIR BEARINGS,,,28 ,,NW,,,,,,$27.71,$0.00,1,1,1,1,1,1,20131001,E2211,HCPCS,PNEUMATIC PROPULSION TIRE,NU,,28 ,,NW,,,,,,$84.82,$0.00,1,1,1,1,1,1,20131001,E2211,HCPCS,PNEUMATIC PROPULSION TIRE,RR,,28 ,,NW,,,,,,$9.70,$0.00,1,1,1,1,1,1,20131001,E2211,HCPCS,PNEUMATIC PROPULSION TIRE,UE,,28 ,,NW,,,,,,$61.48,$0.00,1,1,1,1,1,1,20131001,E2211,HCPCS,PNEUMATIC PROPULSION TIRE,,,28 ,,NW,,,,,,$84.82,$0.00,1,1,1,1,1,1,20131001,E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,NU,,28 ,,NW,,,,,,$14.05,$0.00,1,1,1,1,1,1,20131001,E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,RR,,28 ,,NW,,,,,,$2.76,$0.00,1,1,1,1,1,1,20131001,E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,UE,,28 ,,NW,,,,,,$10.93,$0.00,1,1,1,1,1,1,20131001,E2212,HCPCS,PNEUMATIC PROP TIRE TUBE,,,28 ,,NW,,,,,,$14.05,$0.00,1,1,1,1,1,1,20131001,E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,NU,,28 ,,NW,,,,,,$66.75,$0.00,1,1,1,1,1,1,20131001,E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,RR,,28 ,,NW,,,,,,$8.00,$0.00,1,1,1,1,1,1,20131001,E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,UE,,28 ,,NW,,,,,,$50.37,$0.00,1,1,1,1,1,1,20131001,E2213,HCPCS,PNEUMATIC PROP TIRE INSERT,,,28 ,,NW,,,,,,$66.75,$0.00,1,1,1,1,1,1,20131001,E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,NU,,28 ,,NW,,,,,,$72.90,$0.00,1,1,1,1,1,1,20131001,E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,RR,,28 ,,NW,,,,,,$9.30,$0.00,1,1,1,1,1,1,20131001,E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,UE,,28 ,,NW,,,,,,$55.06,$0.00,1,1,1,1,1,1,20131001,E2214,HCPCS,PNEUMATIC CASTER TIRE EACH,,,28 ,,NW,,,,,,$72.90,$0.00,1,1,1,1,1,1,20131001,E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,NU,,28 ,,NW,,,,,,$22.05,$0.00,1,1,1,1,1,1,20131001,E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,RR,,28 ,,NW,,,,,,$3.48,$0.00,1,1,1,1,1,1,20131001,E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,UE,,28 ,,NW,,,,,,$16.85,$0.00,1,1,1,1,1,1,20131001,E2215,HCPCS,PNEUMATIC CASTER TIRE TUBE,,,28 ,,NW,,,,,,$22.05,$0.00,1,1,1,1,1,1,20131001,E2216,HCPCS,FOAM FILLED PROPULSION TIRE,NU,,28 ,,NW,,,,,,$119.69,$0.00,1,1,1,1,1,1,20131001,E2216,HCPCS,FOAM FILLED PROPULSION TIRE,RR,,28 ,,NW,,,,,,$12.49,$0.00,1,1,1,1,1,1,20131001,E2216,HCPCS,FOAM FILLED PROPULSION TIRE,UE,,28 ,,NW,,,,,,$89.90,$0.00,1,1,1,1,1,1,20131001,E2216,HCPCS,FOAM FILLED PROPULSION TIRE,,,28 ,,NW,,,,,,$119.69,$0.00,1,1,1,1,1,1,20131001,E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,NU,,28 ,,NW,,,,,,$93.71,$0.00,1,1,1,1,1,1,20131001,E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,RR,,28 ,,NW,,,,,,$9.72,$0.00,1,1,1,1,1,1,20131001,E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,UE,,28 ,,NW,,,,,,$70.36,$0.00,1,1,1,1,1,1,20131001,E2217,HCPCS,FOAM FILLED CASTER TIRE EACH,,,28 ,,NW,,,,,,$93.71,$0.00,1,1,1,1,1,1,20131001,E2218,HCPCS,FOAM PROPULSION TIRE EACH,NU,,28 ,,NW,,,,,,$127.88,$0.00,1,1,1,1,1,1,20131001,E2218,HCPCS,FOAM PROPULSION TIRE EACH,RR,,28 ,,NW,,,,,,$13.62,$0.00,1,1,1,1,1,1,20131001,E2218,HCPCS,FOAM PROPULSION TIRE EACH,UE,,28 ,,NW,,,,,,$96.16,$0.00,1,1,1,1,1,1,20131001,E2218,HCPCS,FOAM PROPULSION TIRE EACH,,,28 ,,NW,,,,,,$127.88,$0.00,1,1,1,1,1,1,20131001,E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,NU,,28 ,,NW,,,,,,$87.29,$0.00,1,1,1,1,1,1,20131001,E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,RR,,28 ,,NW,,,,,,$11.06,$0.00,1,1,1,1,1,1,20131001,E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,UE,,28 ,,NW,,,,,,$65.84,$0.00,1,1,1,1,1,1,20131001,E2219,HCPCS,FOAM CASTER TIRE ANY SIZE EA,,,28 ,,NW,,,,,,$87.29,$0.00,1,1,1,1,1,1,20131001,E2220,HCPCS,SOLID PROPULSION TIRE EACH,NU,,28 ,,NW,,,,,,$59.46,$0.00,1,1,1,1,1,1,20131001,E2220,HCPCS,SOLID PROPULSION TIRE EACH,RR,,28 ,,NW,,,,,,$7.08,$0.00,1,1,1,1,1,1,20131001,E2220,HCPCS,SOLID PROPULSION TIRE EACH,UE,,28 ,,NW,,,,,,$45.87,$0.00,1,1,1,1,1,1,20131001,E2220,HCPCS,SOLID PROPULSION TIRE EACH,,,28 ,,NW,,,,,,$59.46,$0.00,1,1,1,1,1,1,20131001,E2221,HCPCS,SOLID CASTER TIRE EACH,NU,,28 ,,NW,,,,,,$56.29,$0.00,1,1,1,1,1,1,20131001,E2221,HCPCS,SOLID CASTER TIRE EACH,RR,,28 ,,NW,,,,,,$6.97,$0.00,1,1,1,1,1,1,20131001,E2221,HCPCS,SOLID CASTER TIRE EACH,UE,,28 ,,NW,,,,,,$42.60,$0.00,1,1,1,1,1,1,20131001,E2221,HCPCS,SOLID CASTER TIRE EACH,,,28 ,,NW,,,,,,$56.29,$0.00,1,1,1,1,1,1,20131001,E2222,HCPCS,SOLID CASTER INTEGRATED WHL,NU,,28 ,,NW,,,,,,$46.82,$0.00,1,1,1,1,1,1,20131001,E2222,HCPCS,SOLID CASTER INTEGRATED WHL,RR,,28 ,,NW,,,,,,$5.93,$0.00,1,1,1,1,1,1,20131001,E2222,HCPCS,SOLID CASTER INTEGRATED WHL,UE,,28 ,,NW,,,,,,$35.50,$0.00,1,1,1,1,1,1,20131001,E2222,HCPCS,SOLID CASTER INTEGRATED WHL,,,28 ,,NW,,,,,,$46.82,$0.00,1,1,1,1,1,1,20131001,E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,NU,,28 ,,NW,,,,,,$192.96,$0.00,1,1,1,1,1,1,20131001,E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,RR,,28 ,,NW,,,,,,$21.53,$0.00,1,1,1,1,1,1,20131001,E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,UE,,28 ,,NW,,,,,,$144.85,$0.00,1,1,1,1,1,1,20131001,E2224,HCPCS,PROPULSION WHL EXCLUDES TIRE,,,28 ,,NW,,,,,,$192.96,$0.00,1,1,1,1,1,1,20131001,E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,NU,,28 ,,NW,,,,,,$38.94,$0.00,1,1,1,1,1,1,20131001,E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,RR,,28 ,,NW,,,,,,$5.19,$0.00,1,1,1,1,1,1,20131001,E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,UE,,28 ,,NW,,,,,,$29.55,$0.00,1,1,1,1,1,1,20131001,E2225,HCPCS,CASTER WHEEL EXCLUDES TIRE,,,28 ,,NW,,,,,,$38.94,$0.00,1,1,1,1,1,1,20131001,E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,NU,,28 ,,NW,,,,,,$83.22,$0.00,1,1,1,1,1,1,20131001,E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,RR,,28 ,,NW,,,,,,$9.62,$0.00,1,1,1,1,1,1,20131001,E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,UE,,28 ,,NW,,,,,,$62.77,$0.00,1,1,1,1,1,1,20131001,E2226,HCPCS,CASTER FORK REPLACEMENT ONLY,,,28 ,,NW,,,,,,$83.22,$0.00,1,1,1,1,1,1,20131001,E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,NU,,28 ,,NW,,,,,,"$3,350.62",$0.00,1,1,1,1,1,1,20131001,E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,RR,,28 ,,NW,,,,,,$371.01,$0.00,1,1,1,1,1,1,20131001,E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,UE,,28 ,,NW,,,,,,"$2,522.96",$0.00,1,1,1,1,1,1,20131001,E2227,HCPCS,GEAR REDUCTION DRIVE WHEEL,,,28 ,,NW,,,,,,"$3,350.62",$0.00,1,1,1,1,1,1,20131001,E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",NU,,28 ,,NW,,,,,,"$1,725.47",$0.00,1,1,1,1,1,1,20131001,E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",RR,,28 ,,NW,,,,,,$203.20,$0.00,1,1,1,1,1,1,20131001,E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",UE,,28 ,,NW,,,,,,"$1,304.13",$0.00,1,1,1,1,1,1,20131001,E2228,HCPCS,"MWC ACC, WHEELCHAIR BRAKE",,,28 ,,NW,,,,,,"$1,725.47",$0.00,1,1,1,1,1,1,20131001,E2230,HCPCS,MANUAL STANDING SYSTEM,,,28 ,,NW,,,,,,"$1,529.73",$0.00,1,1,1,1,1,1,20131001,E2231,HCPCS,SOLID SEAT SUPPORT BASE,NU,,28 ,,NW,,,,,,$316.61,$0.00,1,1,1,1,1,1,20131001,E2231,HCPCS,SOLID SEAT SUPPORT BASE,RR,,28 ,,NW,,,,,,$34.56,$0.00,1,1,1,1,1,1,20131001,E2231,HCPCS,SOLID SEAT SUPPORT BASE,UE,,28 ,,NW,,,,,,$247.42,$0.00,1,1,1,1,1,1,20131001,E2231,HCPCS,SOLID SEAT SUPPORT BASE,,,28 ,,NW,,,,,,$316.61,$0.00,1,1,1,1,1,1,20131001,E2295,HCPCS,PED DYNAMIC SEATING FRAME,,,28 ,,NW,,,,,,$118.84,$0.00,1,1,1,1,1,1,20131001,E2300,HCPCS,PWR SEAT ELEVATION SYS,,,28 ,,NW,,,,,,"$1,364.00",$0.00,1,1,1,1,1,1,20131001,E2301,HCPCS,PWR STANDING,,,28 ,,NW,,,,,,"$2,753.59",$0.00,1,1,1,1,1,1,20131001,E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,NU,,28 ,,NW,,,,,,"$3,962.52",$0.00,1,1,1,1,1,1,20131001,E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,RR,,28 ,,NW,,,,,,$432.19,$0.00,1,1,1,1,1,1,20131001,E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,UE,,28 ,,NW,,,,,,"$2,981.89",$0.00,1,1,1,1,1,1,20131001,E2310,HCPCS,ELECTRO CONNECT BTW CONTROL,,,28 ,,NW,,,,,,"$3,962.52",$0.00,1,1,1,1,1,1,20131001,E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,NU,,28 ,,NW,,,,,,"$7,981.39",$0.00,1,1,1,1,1,1,20131001,E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,RR,,28 ,,NW,,,,,,$834.12,$0.00,1,1,1,1,1,1,20131001,E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,UE,,28 ,,NW,,,,,,"$5,996.02",$0.00,1,1,1,1,1,1,20131001,E2311,HCPCS,ELECTRO CONNECT BTW 2 SYS,,,28 ,,NW,,,,,,"$7,981.39",$0.00,1,1,1,1,1,1,20131001,E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,NU,,28 ,,NW,,,,,,"$8,161.23",$0.00,1,1,1,1,1,1,20131001,E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,RR,,28 ,,NW,,,,,,$852.07,$0.00,1,1,1,1,1,1,20131001,E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,UE,,28 ,,NW,,,,,,"$6,130.89",$0.00,1,1,1,1,1,1,20131001,E2312,HCPCS,MINI-PROP REMOTE JOYSTICK,,,28 ,,NW,,,,,,"$8,161.23",$0.00,1,1,1,1,1,1,20131001,E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",NU,,28 ,,NW,,,,,,$606.72,$0.00,1,1,1,1,1,1,20131001,E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",RR,,28 ,,NW,,,,,,$69.32,$0.00,1,1,1,1,1,1,20131001,E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",UE,,28 ,,NW,,,,,,$465.03,$0.00,1,1,1,1,1,1,20131001,E2313,HCPCS,"PWC HARNESS, EXPAND CONTROL",,,28 ,,NW,,,,,,$606.72,$0.00,1,1,1,1,1,1,20131001,E2321,HCPCS,HAND INTERFACE JOYSTICK,NU,,28 ,,NW,,,,,,"$9,382.98",$0.00,1,1,1,1,1,1,20131001,E2321,HCPCS,HAND INTERFACE JOYSTICK,RR,,28 ,,NW,,,,,,$974.30,$0.00,1,1,1,1,1,1,20131001,E2321,HCPCS,HAND INTERFACE JOYSTICK,UE,,28 ,,NW,,,,,,"$7,047.23",$0.00,1,1,1,1,1,1,20131001,E2321,HCPCS,HAND INTERFACE JOYSTICK,,,28 ,,NW,,,,,,"$9,382.98",$0.00,1,1,1,1,1,1,20131001,E2322,HCPCS,MULT MECH SWITCHES,NU,,28 ,,NW,,,,,,"$9,020.74",$0.00,1,1,1,1,1,1,20131001,E2322,HCPCS,MULT MECH SWITCHES,RR,,28 ,,NW,,,,,,$937.98,$0.00,1,1,1,1,1,1,20131001,E2322,HCPCS,MULT MECH SWITCHES,UE,,28 ,,NW,,,,,,"$6,775.56",$0.00,1,1,1,1,1,1,20131001,E2322,HCPCS,MULT MECH SWITCHES,,,28 ,,NW,,,,,,"$9,020.74",$0.00,1,1,1,1,1,1,20131001,E2323,HCPCS,SPECIAL JOYSTICK HANDLE,NU,,28 ,,NW,,,,,,$271.77,$0.00,1,1,1,1,1,1,20131001,E2323,HCPCS,SPECIAL JOYSTICK HANDLE,RR,,28 ,,NW,,,,,,$29.18,$0.00,1,1,1,1,1,1,20131001,E2323,HCPCS,SPECIAL JOYSTICK HANDLE,UE,,28 ,,NW,,,,,,$209.58,$0.00,1,1,1,1,1,1,20131001,E2323,HCPCS,SPECIAL JOYSTICK HANDLE,,,28 ,,NW,,,,,,$271.77,$0.00,1,1,1,1,1,1,20131001,E2324,HCPCS,CHIN CUP INTERFACE,NU,,28 ,,NW,,,,,,$177.25,$0.00,1,1,1,1,1,1,20131001,E2324,HCPCS,CHIN CUP INTERFACE,RR,,28 ,,NW,,,,,,$18.97,$0.00,1,1,1,1,1,1,20131001,E2324,HCPCS,CHIN CUP INTERFACE,UE,,28 ,,NW,,,,,,$133.34,$0.00,1,1,1,1,1,1,20131001,E2324,HCPCS,CHIN CUP INTERFACE,,,28 ,,NW,,,,,,$177.25,$0.00,1,1,1,1,1,1,20131001,E2325,HCPCS,SIP AND PUFF INTERFACE,NU,,28 ,,NW,,,,,,"$4,554.45",$0.00,1,1,1,1,1,1,20131001,E2325,HCPCS,SIP AND PUFF INTERFACE,RR,,28 ,,NW,,,,,,$491.45,$0.00,1,1,1,1,1,1,20131001,E2325,HCPCS,SIP AND PUFF INTERFACE,UE,,28 ,,NW,,,,,,"$3,425.87",$0.00,1,1,1,1,1,1,20131001,E2325,HCPCS,SIP AND PUFF INTERFACE,,,28 ,,NW,,,,,,"$4,554.45",$0.00,1,1,1,1,1,1,20131001,E2326,HCPCS,BREATH TUBE KIT,NU,,28 ,,NW,,,,,,"$1,203.55",$0.00,1,1,1,1,1,1,20131001,E2326,HCPCS,BREATH TUBE KIT,RR,,28 ,,NW,,,,,,$140.78,$0.00,1,1,1,1,1,1,20131001,E2326,HCPCS,BREATH TUBE KIT,UE,,28 ,,NW,,,,,,$912.59,$0.00,1,1,1,1,1,1,20131001,E2326,HCPCS,BREATH TUBE KIT,,,28 ,,NW,,,,,,"$1,203.55",$0.00,1,1,1,1,1,1,20131001,E2327,HCPCS,HEAD CONTROL INTERFACE MECH,NU,,28 ,,NW,,,,,,"$14,954.87",$0.00,1,1,1,1,1,1,20131001,E2327,HCPCS,HEAD CONTROL INTERFACE MECH,RR,,28 ,,NW,,,,,,"$1,531.44",$0.00,1,1,1,1,1,1,20131001,E2327,HCPCS,HEAD CONTROL INTERFACE MECH,UE,,28 ,,NW,,,,,,"$11,226.09",$0.00,1,1,1,1,1,1,20131001,E2327,HCPCS,HEAD CONTROL INTERFACE MECH,,,28 ,,NW,,,,,,"$14,954.87",$0.00,1,1,1,1,1,1,20131001,E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,NU,,28 ,,NW,,,,,,"$16,649.94",$0.00,1,1,1,1,1,1,20131001,E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,RR,,28 ,,NW,,,,,,"$1,700.90",$0.00,1,1,1,1,1,1,20131001,E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,UE,,28 ,,NW,,,,,,"$12,497.47",$0.00,1,1,1,1,1,1,20131001,E2328,HCPCS,HEAD/EXTREMITY CONTROL INTER,,,28 ,,NW,,,,,,"$16,649.94",$0.00,1,1,1,1,1,1,20131001,E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,NU,,28 ,,NW,,,,,,"$5,959.93",$0.00,1,1,1,1,1,1,20131001,E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,RR,,28 ,,NW,,,,,,$631.92,$0.00,1,1,1,1,1,1,20131001,E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,UE,,28 ,,NW,,,,,,"$4,479.93",$0.00,1,1,1,1,1,1,20131001,E2329,HCPCS,HEAD CONTROL NONPROPORTIONAL,,,28 ,,NW,,,,,,"$5,959.93",$0.00,1,1,1,1,1,1,20131001,E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,NU,,28 ,,NW,,,,,,"$11,510.60",$0.00,1,1,1,1,1,1,20131001,E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,RR,,28 ,,NW,,,,,,"$1,186.98",$0.00,1,1,1,1,1,1,20131001,E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,UE,,28 ,,NW,,,,,,"$8,642.99",$0.00,1,1,1,1,1,1,20131001,E2330,HCPCS,HEAD CONTROL PROXIMITY SWITC,,,28 ,,NW,,,,,,"$11,510.60",$0.00,1,1,1,1,1,1,20131001,E2331,HCPCS,ATTENDANT CONTROL,,,28 ,,NW,,,,,,$680.40,$0.00,1,1,1,1,1,1,20131001,E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,NU,,28 ,,NW,,,,,,$685.09,$0.00,1,1,1,1,1,1,20131001,E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,RR,,28 ,,NW,,,,,,$78.68,$0.00,1,1,1,1,1,1,20131001,E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,UE,,28 ,,NW,,,,,,$523.85,$0.00,1,1,1,1,1,1,20131001,E2340,HCPCS,W/C WDTH 20-23 IN SEAT FRAME,,,28 ,,NW,,,,,,$685.09,$0.00,1,1,1,1,1,1,20131001,E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,NU,,28 ,,NW,,,,,,"$1,007.74",$0.00,1,1,1,1,1,1,20131001,E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,RR,,28 ,,NW,,,,,,$117.28,$0.00,1,1,1,1,1,1,20131001,E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,UE,,28 ,,NW,,,,,,$765.80,$0.00,1,1,1,1,1,1,20131001,E2341,HCPCS,W/C WDTH 24-27 IN SEAT FRAME,,,28 ,,NW,,,,,,"$1,007.74",$0.00,1,1,1,1,1,1,20131001,E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,NU,,28 ,,NW,,,,,,$846.44,$0.00,1,1,1,1,1,1,20131001,E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,RR,,28 ,,NW,,,,,,$97.98,$0.00,1,1,1,1,1,1,20131001,E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,UE,,28 ,,NW,,,,,,$644.83,$0.00,1,1,1,1,1,1,20131001,E2342,HCPCS,W/C DPTH 20-21 IN SEAT FRAME,,,28 ,,NW,,,,,,$846.44,$0.00,1,1,1,1,1,1,20131001,E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,NU,,28 ,,NW,,,,,,"$1,330.35",$0.00,1,1,1,1,1,1,20131001,E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,RR,,28 ,,NW,,,,,,$155.87,$0.00,1,1,1,1,1,1,20131001,E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,UE,,28 ,,NW,,,,,,"$1,007.74",$0.00,1,1,1,1,1,1,20131001,E2343,HCPCS,W/C DPTH 22-25 IN SEAT FRAME,,,28 ,,NW,,,,,,"$1,330.35",$0.00,1,1,1,1,1,1,20131001,E2351,HCPCS,ELECTRONIC SGD INTERFACE,NU,,28 ,,NW,,,,,,"$2,381.73",$0.00,1,1,1,1,1,1,20131001,E2351,HCPCS,ELECTRONIC SGD INTERFACE,RR,,28 ,,NW,,,,,,$274.19,$0.00,1,1,1,1,1,1,20131001,E2351,HCPCS,ELECTRONIC SGD INTERFACE,UE,,28 ,,NW,,,,,,"$1,796.24",$0.00,1,1,1,1,1,1,20131001,E2351,HCPCS,ELECTRONIC SGD INTERFACE,,,28 ,,NW,,,,,,"$2,381.73",$0.00,1,1,1,1,1,1,20131001,E2358,HCPCS,GR 34 NONSEALED LEADACID,,,28 ,,NW,,,,,,$157.56,$0.00,1,1,1,1,1,1,20131001,E2359,HCPCS,GR34 SEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$348.11,$0.00,1,1,1,1,1,1,20131001,E2359,HCPCS,GR34 SEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$38.34,$0.00,1,1,1,1,1,1,20131001,E2359,HCPCS,GR34 SEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$271.07,$0.00,1,1,1,1,1,1,20131001,E2359,HCPCS,GR34 SEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$348.11,$0.00,1,1,1,1,1,1,20131001,E2360,HCPCS,22NF NONSEALED LEADACID,NU,,28 ,,NW,,,,,,$228.89,$0.00,1,1,1,1,1,1,20131001,E2360,HCPCS,22NF NONSEALED LEADACID,RR,,28 ,,NW,,,,,,$24.28,$0.00,1,1,1,1,1,1,20131001,E2360,HCPCS,22NF NONSEALED LEADACID,UE,,28 ,,NW,,,,,,$172.07,$0.00,1,1,1,1,1,1,20131001,E2360,HCPCS,22NF NONSEALED LEADACID,,,28 ,,NW,,,,,,$228.89,$0.00,1,1,1,1,1,1,20131001,E2361,HCPCS,22NF SEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$505.71,$0.00,1,1,1,1,1,1,20131001,E2361,HCPCS,22NF SEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$57.22,$0.00,1,1,1,1,1,1,20131001,E2361,HCPCS,22NF SEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$389.32,$0.00,1,1,1,1,1,1,20131001,E2361,HCPCS,22NF SEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$505.71,$0.00,1,1,1,1,1,1,20131001,E2362,HCPCS,GR24 NONSEALED LEADACID,NU,,28 ,,NW,,,,,,$198.96,$0.00,1,1,1,1,1,1,20131001,E2362,HCPCS,GR24 NONSEALED LEADACID,RR,,28 ,,NW,,,,,,$21.19,$0.00,1,1,1,1,1,1,20131001,E2362,HCPCS,GR24 NONSEALED LEADACID,UE,,28 ,,NW,,,,,,$149.58,$0.00,1,1,1,1,1,1,20131001,E2362,HCPCS,GR24 NONSEALED LEADACID,,,28 ,,NW,,,,,,$198.96,$0.00,1,1,1,1,1,1,20131001,E2363,HCPCS,GR24 SEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$661.18,$0.00,1,1,1,1,1,1,20131001,E2363,HCPCS,GR24 SEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$75.83,$0.00,1,1,1,1,1,1,20131001,E2363,HCPCS,GR24 SEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$505.89,$0.00,1,1,1,1,1,1,20131001,E2363,HCPCS,GR24 SEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$661.18,$0.00,1,1,1,1,1,1,20131001,E2364,HCPCS,U1NONSEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$228.89,$0.00,1,1,1,1,1,1,20131001,E2364,HCPCS,U1NONSEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$24.28,$0.00,1,1,1,1,1,1,20131001,E2364,HCPCS,U1NONSEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$172.06,$0.00,1,1,1,1,1,1,20131001,E2364,HCPCS,U1NONSEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$228.89,$0.00,1,1,1,1,1,1,20131001,E2365,HCPCS,U1 SEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$414.59,$0.00,1,1,1,1,1,1,20131001,E2365,HCPCS,U1 SEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$46.28,$0.00,1,1,1,1,1,1,20131001,E2365,HCPCS,U1 SEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$321.11,$0.00,1,1,1,1,1,1,20131001,E2365,HCPCS,U1 SEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$414.59,$0.00,1,1,1,1,1,1,20131001,E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",NU,,28 ,,NW,,,,,,$869.87,$0.00,1,1,1,1,1,1,20131001,E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",RR,,28 ,,NW,,,,,,$101.07,$0.00,1,1,1,1,1,1,20131001,E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",UE,,28 ,,NW,,,,,,$662.87,$0.00,1,1,1,1,1,1,20131001,E2366,HCPCS,"BATTERY CHARGER, SINGLE MODE",,,28 ,,NW,,,,,,$869.87,$0.00,1,1,1,1,1,1,20131001,E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",NU,,28 ,,NW,,,,,,"$1,444.67",$0.00,1,1,1,1,1,1,20131001,E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",RR,,28 ,,NW,,,,,,$169.63,$0.00,1,1,1,1,1,1,20131001,E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",UE,,28 ,,NW,,,,,,"$1,093.50",$0.00,1,1,1,1,1,1,20131001,E2367,HCPCS,"BATTERY CHARGER, DUAL MODE",,,28 ,,NW,,,,,,"$1,444.67",$0.00,1,1,1,1,1,1,20131001,E2368,HCPCS,POWER WC MOTOR REPLACEMENT,NU,,28 ,,NW,,,,,,"$1,771.46",$0.00,1,1,1,1,1,1,20131001,E2368,HCPCS,POWER WC MOTOR REPLACEMENT,RR,,28 ,,NW,,,,,,$208.75,$0.00,1,1,1,1,1,1,20131001,E2368,HCPCS,POWER WC MOTOR REPLACEMENT,UE,,28 ,,NW,,,,,,"$1,338.61",$0.00,1,1,1,1,1,1,20131001,E2368,HCPCS,POWER WC MOTOR REPLACEMENT,,,28 ,,NW,,,,,,"$1,771.46",$0.00,1,1,1,1,1,1,20131001,E2369,HCPCS,PWR WC GEAR BOX REPLACEMENT,NU,,28 ,,NW,,,,,,"$1,548.13",$0.00,1,1,1,1,1,1,20131001,E2369,HCPCS,PWR WC GEAR BOX REPLACEMENT,RR,,28 ,,NW,,,,,,$182.01,$0.00,1,1,1,1,1,1,20131001,E2369,HCPCS,PWR WC GEAR BOX REPLACEMENT,UE,,28 ,,NW,,,,,,"$1,171.05",$0.00,1,1,1,1,1,1,20131001,E2369,HCPCS,PWR WC GEAR BOX REPLACEMENT,,,28 ,,NW,,,,,,"$1,548.13",$0.00,1,1,1,1,1,1,20131001,E2370,HCPCS,PWR WC MOTOR/GEAR BOX COMBO,NU,,28 ,,NW,,,,,,"$2,731.02",$0.00,1,1,1,1,1,1,20131001,E2370,HCPCS,PWR WC MOTOR/GEAR BOX COMBO,RR,,28 ,,NW,,,,,,$309.07,$0.00,1,1,1,1,1,1,20131001,E2370,HCPCS,PWR WC MOTOR/GEAR BOX COMBO,UE,,28 ,,NW,,,,,,"$2,058.25",$0.00,1,1,1,1,1,1,20131001,E2370,HCPCS,PWR WC MOTOR/GEAR BOX COMBO,,,28 ,,NW,,,,,,"$2,731.02",$0.00,1,1,1,1,1,1,20131001,E2371,HCPCS,GR27 SEALED LEADACID BATTERY,NU,,28 ,,NW,,,,,,$545.20,$0.00,1,1,1,1,1,1,20131001,E2371,HCPCS,GR27 SEALED LEADACID BATTERY,RR,,28 ,,NW,,,,,,$61.95,$0.00,1,1,1,1,1,1,20131001,E2371,HCPCS,GR27 SEALED LEADACID BATTERY,UE,,28 ,,NW,,,,,,$418.91,$0.00,1,1,1,1,1,1,20131001,E2371,HCPCS,GR27 SEALED LEADACID BATTERY,,,28 ,,NW,,,,,,$545.20,$0.00,1,1,1,1,1,1,20131001,E2372,HCPCS,GR27 NON-SEALED LEADACID,NU,,28 ,,NW,,,,,,$487.86,$0.00,1,1,1,1,1,1,20131001,E2372,HCPCS,GR27 NON-SEALED LEADACID,RR,,28 ,,NW,,,,,,$51.96,$0.00,1,1,1,1,1,1,20131001,E2372,HCPCS,GR27 NON-SEALED LEADACID,UE,,28 ,,NW,,,,,,$366.85,$0.00,1,1,1,1,1,1,20131001,E2372,HCPCS,GR27 NON-SEALED LEADACID,,,28 ,,NW,,,,,,$487.86,$0.00,1,1,1,1,1,1,20131001,E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,NU,,28 ,,NW,,,,,,"$4,447.65",$0.00,1,1,1,1,1,1,20131001,E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,RR,,28 ,,NW,,,,,,$480.74,$0.00,1,1,1,1,1,1,20131001,E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,UE,,28 ,,NW,,,,,,"$3,345.79",$0.00,1,1,1,1,1,1,20131001,E2373,HCPCS,HAND/CHIN CTRL SPEC JOYSTICK,,,28 ,,NW,,,,,,"$4,447.65",$0.00,1,1,1,1,1,1,20131001,E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,NU,,28 ,,NW,,,,,,"$1,829.96",$0.00,1,1,1,1,1,1,20131001,E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,RR,,28 ,,NW,,,,,,$215.70,$0.00,1,1,1,1,1,1,20131001,E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,UE,,28 ,,NW,,,,,,"$1,382.50",$0.00,1,1,1,1,1,1,20131001,E2374,HCPCS,HAND/CHIN CTRL STD JOYSTICK,,,28 ,,NW,,,,,,"$1,829.96",$0.00,1,1,1,1,1,1,20131001,E2375,HCPCS,NON-EXPANDABLE CONTROLLER,NU,,28 ,,NW,,,,,,"$2,911.09",$0.00,1,1,1,1,1,1,20131001,E2375,HCPCS,NON-EXPANDABLE CONTROLLER,RR,,28 ,,NW,,,,,,$327.03,$0.00,1,1,1,1,1,1,20131001,E2375,HCPCS,NON-EXPANDABLE CONTROLLER,UE,,28 ,,NW,,,,,,"$2,193.24",$0.00,1,1,1,1,1,1,20131001,E2375,HCPCS,NON-EXPANDABLE CONTROLLER,,,28 ,,NW,,,,,,"$2,911.09",$0.00,1,1,1,1,1,1,20131001,E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",NU,,28 ,,NW,,,,,,"$4,539.15",$0.00,1,1,1,1,1,1,20131001,E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",RR,,28 ,,NW,,,,,,$489.88,$0.00,1,1,1,1,1,1,20131001,E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",UE,,28 ,,NW,,,,,,"$3,414.41",$0.00,1,1,1,1,1,1,20131001,E2376,HCPCS,"EXPANDABLE CONTROLLER, REPL",,,28 ,,NW,,,,,,"$4,539.15",$0.00,1,1,1,1,1,1,20131001,E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",NU,,28 ,,NW,,,,,,"$1,668.03",$0.00,1,1,1,1,1,1,20131001,E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",RR,,28 ,,NW,,,,,,$196.30,$0.00,1,1,1,1,1,1,20131001,E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",UE,,28 ,,NW,,,,,,"$1,261.06",$0.00,1,1,1,1,1,1,20131001,E2377,HCPCS,"EXPANDABLE CONTROLLER, INITL",,,28 ,,NW,,,,,,"$1,668.03",$0.00,1,1,1,1,1,1,20131001,E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,NU,,28 ,,NW,,,,,,$294.29,$0.00,1,1,1,1,1,1,20131001,E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,RR,,28 ,,NW,,,,,,$31.90,$0.00,1,1,1,1,1,1,20131001,E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,UE,,28 ,,NW,,,,,,$229.82,$0.00,1,1,1,1,1,1,20131001,E2381,HCPCS,PNEUM DRIVE WHEEL TIRE,,,28 ,,NW,,,,,,$294.29,$0.00,1,1,1,1,1,1,20131001,E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",NU,,28 ,,NW,,,,,,$84.47,$0.00,1,1,1,1,1,1,20131001,E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",RR,,28 ,,NW,,,,,,$9.68,$0.00,1,1,1,1,1,1,20131001,E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",UE,,28 ,,NW,,,,,,$63.70,$0.00,1,1,1,1,1,1,20131001,E2382,HCPCS,"TUBE, PNEUM WHEEL DRIVE TIRE",,,28 ,,NW,,,,,,$84.47,$0.00,1,1,1,1,1,1,20131001,E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",NU,,28 ,,NW,,,,,,$547.21,$0.00,1,1,1,1,1,1,20131001,E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",RR,,28 ,,NW,,,,,,$62.17,$0.00,1,1,1,1,1,1,20131001,E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",UE,,28 ,,NW,,,,,,$420.43,$0.00,1,1,1,1,1,1,20131001,E2383,HCPCS,"INSERT, PNEUM WHEEL DRIVE",,,28 ,,NW,,,,,,$547.21,$0.00,1,1,1,1,1,1,20131001,E2384,HCPCS,PNEUMATIC CASTER TIRE,NU,,28 ,,NW,,,,,,$310.22,$0.00,1,1,1,1,1,1,20131001,E2384,HCPCS,PNEUMATIC CASTER TIRE,RR,,28 ,,NW,,,,,,$33.83,$0.00,1,1,1,1,1,1,20131001,E2384,HCPCS,PNEUMATIC CASTER TIRE,UE,,28 ,,NW,,,,,,$242.64,$0.00,1,1,1,1,1,1,20131001,E2384,HCPCS,PNEUMATIC CASTER TIRE,,,28 ,,NW,,,,,,$310.22,$0.00,1,1,1,1,1,1,20131001,E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",NU,,28 ,,NW,,,,,,$199.72,$0.00,1,1,1,1,1,1,20131001,E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",RR,,28 ,,NW,,,,,,$21.25,$0.00,1,1,1,1,1,1,20131001,E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",UE,,28 ,,NW,,,,,,$149.83,$0.00,1,1,1,1,1,1,20131001,E2385,HCPCS,"TUBE, PNEUMATIC CASTER TIRE",,,28 ,,NW,,,,,,$199.72,$0.00,1,1,1,1,1,1,20131001,E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,NU,,28 ,,NW,,,,,,$542.65,$0.00,1,1,1,1,1,1,20131001,E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,RR,,28 ,,NW,,,,,,$61.61,$0.00,1,1,1,1,1,1,20131001,E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,UE,,28 ,,NW,,,,,,$416.95,$0.00,1,1,1,1,1,1,20131001,E2386,HCPCS,FOAM FILLED DRIVE WHEEL TIRE,,,28 ,,NW,,,,,,$542.65,$0.00,1,1,1,1,1,1,20131001,E2387,HCPCS,FOAM FILLED CASTER TIRE,NU,,28 ,,NW,,,,,,$261.11,$0.00,1,1,1,1,1,1,20131001,E2387,HCPCS,FOAM FILLED CASTER TIRE,RR,,28 ,,NW,,,,,,$27.91,$0.00,1,1,1,1,1,1,20131001,E2387,HCPCS,FOAM FILLED CASTER TIRE,UE,,28 ,,NW,,,,,,$200.09,$0.00,1,1,1,1,1,1,20131001,E2387,HCPCS,FOAM FILLED CASTER TIRE,,,28 ,,NW,,,,,,$261.11,$0.00,1,1,1,1,1,1,20131001,E2388,HCPCS,FOAM DRIVE WHEEL TIRE,NU,,28 ,,NW,,,,,,$203.62,$0.00,1,1,1,1,1,1,20131001,E2388,HCPCS,FOAM DRIVE WHEEL TIRE,RR,,28 ,,NW,,,,,,$21.66,$0.00,1,1,1,1,1,1,20131001,E2388,HCPCS,FOAM DRIVE WHEEL TIRE,UE,,28 ,,NW,,,,,,$153.12,$0.00,1,1,1,1,1,1,20131001,E2388,HCPCS,FOAM DRIVE WHEEL TIRE,,,28 ,,NW,,,,,,$203.62,$0.00,1,1,1,1,1,1,20131001,E2389,HCPCS,FOAM CASTER TIRE,NU,,28 ,,NW,,,,,,$111.22,$0.00,1,1,1,1,1,1,20131001,E2389,HCPCS,FOAM CASTER TIRE,RR,,28 ,,NW,,,,,,$12.45,$0.00,1,1,1,1,1,1,20131001,E2389,HCPCS,FOAM CASTER TIRE,UE,,28 ,,NW,,,,,,$83.74,$0.00,1,1,1,1,1,1,20131001,E2389,HCPCS,FOAM CASTER TIRE,,,28 ,,NW,,,,,,$111.22,$0.00,1,1,1,1,1,1,20131001,E2390,HCPCS,SOLID DRIVE WHEEL TIRE,NU,,28 ,,NW,,,,,,$173.14,$0.00,1,1,1,1,1,1,20131001,E2390,HCPCS,SOLID DRIVE WHEEL TIRE,RR,,28 ,,NW,,,,,,$18.61,$0.00,1,1,1,1,1,1,20131001,E2390,HCPCS,SOLID DRIVE WHEEL TIRE,UE,,28 ,,NW,,,,,,$130.13,$0.00,1,1,1,1,1,1,20131001,E2390,HCPCS,SOLID DRIVE WHEEL TIRE,,,28 ,,NW,,,,,,$173.14,$0.00,1,1,1,1,1,1,20131001,E2391,HCPCS,SOLID CASTER TIRE,NU,,28 ,,NW,,,,,,$83.70,$0.00,1,1,1,1,1,1,20131001,E2391,HCPCS,SOLID CASTER TIRE,RR,,28 ,,NW,,,,,,$9.66,$0.00,1,1,1,1,1,1,20131001,E2391,HCPCS,SOLID CASTER TIRE,UE,,28 ,,NW,,,,,,$63.15,$0.00,1,1,1,1,1,1,20131001,E2391,HCPCS,SOLID CASTER TIRE,,,28 ,,NW,,,,,,$83.70,$0.00,1,1,1,1,1,1,20131001,E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",NU,,28 ,,NW,,,,,,$217.62,$0.00,1,1,1,1,1,1,20131001,E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",RR,,28 ,,NW,,,,,,$23.13,$0.00,1,1,1,1,1,1,20131001,E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",UE,,28 ,,NW,,,,,,$163.59,$0.00,1,1,1,1,1,1,20131001,E2392,HCPCS,"SOLID CASTER TIRE, INTEGRATE",,,28 ,,NW,,,,,,$217.62,$0.00,1,1,1,1,1,1,20131001,E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,NU,,28 ,,NW,,,,,,$297.22,$0.00,1,1,1,1,1,1,20131001,E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,RR,,28 ,,NW,,,,,,$32.27,$0.00,1,1,1,1,1,1,20131001,E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,UE,,28 ,,NW,,,,,,$232.45,$0.00,1,1,1,1,1,1,20131001,E2394,HCPCS,DRIVE WHEEL EXCLUDES TIRE,,,28 ,,NW,,,,,,$297.22,$0.00,1,1,1,1,1,1,20131001,E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,NU,,28 ,,NW,,,,,,$220.31,$0.00,1,1,1,1,1,1,20131001,E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,RR,,28 ,,NW,,,,,,$23.35,$0.00,1,1,1,1,1,1,20131001,E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,UE,,28 ,,NW,,,,,,$165.68,$0.00,1,1,1,1,1,1,20131001,E2395,HCPCS,CASTER WHEEL EXCLUDES TIRE,,,28 ,,NW,,,,,,$220.31,$0.00,1,1,1,1,1,1,20131001,E2396,HCPCS,CASTER FORK,NU,,28 ,,NW,,,,,,$251.02,$0.00,1,1,1,1,1,1,20131001,E2396,HCPCS,CASTER FORK,RR,,28 ,,NW,,,,,,$28.36,$0.00,1,1,1,1,1,1,20131001,E2396,HCPCS,CASTER FORK,UE,,28 ,,NW,,,,,,$190.96,$0.00,1,1,1,1,1,1,20131001,E2396,HCPCS,CASTER FORK,,,28 ,,NW,,,,,,$251.02,$0.00,1,1,1,1,1,1,20131001,E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",NU,,28 ,,NW,,,,,,$785.51,$0.00,1,1,1,1,1,1,20131001,E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",RR,,28 ,,NW,,,,,,$90.68,$0.00,1,1,1,1,1,1,20131001,E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",UE,,28 ,,NW,,,,,,$599.08,$0.00,1,1,1,1,1,1,20131001,E2397,HCPCS,"PWC ACC, LITH-BASED BATTERY",,,28 ,,NW,,,,,,$785.51,$0.00,1,1,1,1,1,1,20131001,E2402,HCPCS,NEG PRESS WOUND THERAPY PUMP,RR,,28 ,,NW,,,,,,"$3,811.19",$0.00,1,1,1,1,1,1,20131001,E2402,HCPCS,NEG PRESS WOUND THERAPY PUMP,,,28 ,,NW,,,,,,"$36,743.90",$0.00,1,1,1,1,1,1,20131001,E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,NU,,28 ,,NW,,,,,,$978.82,$0.00,1,1,1,1,1,1,20131001,E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,RR,,28 ,,NW,,,,,,$71.63,$0.00,1,1,1,1,1,1,20131001,E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,UE,,28 ,,NW,,,,,,$724.37,$0.00,1,1,1,1,1,1,20131001,E2500,HCPCS,SGD DIGITIZED PRE-REC <=8MIN,,,28 ,,NW,,,,,,$978.82,$0.00,1,1,1,1,1,1,20131001,E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,NU,,28 ,,NW,,,,,,"$3,073.06",$0.00,1,1,1,1,1,1,20131001,E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,RR,,28 ,,NW,,,,,,$272.35,$0.00,1,1,1,1,1,1,20131001,E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,UE,,28 ,,NW,,,,,,"$2,295.13",$0.00,1,1,1,1,1,1,20131001,E2502,HCPCS,SGD PREREC MSG >8MIN <=20MIN,,,28 ,,NW,,,,,,"$3,073.06",$0.00,1,1,1,1,1,1,20131001,E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,NU,,28 ,,NW,,,,,,"$4,066.19",$0.00,1,1,1,1,1,1,20131001,E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,RR,,28 ,,NW,,,,,,$371.69,$0.00,1,1,1,1,1,1,20131001,E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,UE,,28 ,,NW,,,,,,"$3,039.90",$0.00,1,1,1,1,1,1,20131001,E2504,HCPCS,SGD PREREC MSG>20MIN <=40MIN,,,28 ,,NW,,,,,,"$4,066.19",$0.00,1,1,1,1,1,1,20131001,E2506,HCPCS,SGD PREREC MSG > 40 MIN,NU,,28 ,,NW,,,,,,"$5,980.38",$0.00,1,1,1,1,1,1,20131001,E2506,HCPCS,SGD PREREC MSG > 40 MIN,RR,,28 ,,NW,,,,,,$563.04,$0.00,1,1,1,1,1,1,20131001,E2506,HCPCS,SGD PREREC MSG > 40 MIN,UE,,28 ,,NW,,,,,,"$4,475.48",$0.00,1,1,1,1,1,1,20131001,E2506,HCPCS,SGD PREREC MSG > 40 MIN,,,28 ,,NW,,,,,,"$5,980.38",$0.00,1,1,1,1,1,1,20131001,E2508,HCPCS,SGD SPELLING PHYS CONTACT,NU,,28 ,,NW,,,,,,"$9,268.87",$0.00,1,1,1,1,1,1,20131001,E2508,HCPCS,SGD SPELLING PHYS CONTACT,RR,,28 ,,NW,,,,,,$891.91,$0.00,1,1,1,1,1,1,20131001,E2508,HCPCS,SGD SPELLING PHYS CONTACT,UE,,28 ,,NW,,,,,,"$6,941.97",$0.00,1,1,1,1,1,1,20131001,E2508,HCPCS,SGD SPELLING PHYS CONTACT,,,28 ,,NW,,,,,,"$9,268.87",$0.00,1,1,1,1,1,1,20131001,E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,NU,,28 ,,NW,,,,,,"$17,574.78",$0.00,1,1,1,1,1,1,20131001,E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,RR,,28 ,,NW,,,,,,"$1,722.50",$0.00,1,1,1,1,1,1,20131001,E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,UE,,28 ,,NW,,,,,,"$13,171.36",$0.00,1,1,1,1,1,1,20131001,E2510,HCPCS,SGD W MULTI METHODS MSG/ACCS,,,28 ,,NW,,,,,,"$17,574.78",$0.00,1,1,1,1,1,1,20131001,E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,NU,,28 ,,NW,,,,,,$963.96,$0.00,1,1,1,1,1,1,20131001,E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,RR,,28 ,,NW,,,,,,$99.99,$0.00,1,1,1,1,1,1,20131001,E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,UE,,28 ,,NW,,,,,,$723.71,$0.00,1,1,1,1,1,1,20131001,E2511,HCPCS,SGD SFTWRE PRGRM FOR PC/PDA,,,28 ,,NW,,,,,,$963.96,$0.00,1,1,1,1,1,1,20131001,E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",NU,,28 ,,NW,,,,,,"$1,992.55",$0.00,1,1,1,1,1,1,20131001,E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",RR,,28 ,,NW,,,,,,$206.67,$0.00,1,1,1,1,1,1,20131001,E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",UE,,28 ,,NW,,,,,,"$1,495.93",$0.00,1,1,1,1,1,1,20131001,E2512,HCPCS,"SGD ACCESSORY, MOUNTING SYS",,,28 ,,NW,,,,,,"$1,992.55",$0.00,1,1,1,1,1,1,20131001,E2599,HCPCS,SGD ACCESSORY NOC,,,28 ,,NW,,,,,,$414.59,$0.00,1,1,1,1,1,1,20131001,E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,NU,,28 ,,NW,,,,,,$244.96,$0.00,1,1,1,1,1,1,20131001,E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,RR,,28 ,,NW,,,,,,$26.01,$0.00,1,1,1,1,1,1,20131001,E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,UE,,28 ,,NW,,,,,,$185.48,$0.00,1,1,1,1,1,1,20131001,E2601,HCPCS,GEN W/C CUSHION WDTH < 22 IN,,,28 ,,NW,,,,,,$244.96,$0.00,1,1,1,1,1,1,20131001,E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,NU,,28 ,,NW,,,,,,$440.17,$0.00,1,1,1,1,1,1,20131001,E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,RR,,28 ,,NW,,,,,,$49.37,$0.00,1,1,1,1,1,1,20131001,E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,UE,,28 ,,NW,,,,,,$340.11,$0.00,1,1,1,1,1,1,20131001,E2602,HCPCS,GEN W/C CUSHION WDTH >=22 IN,,,28 ,,NW,,,,,,$440.17,$0.00,1,1,1,1,1,1,20131001,E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,NU,,28 ,,NW,,,,,,$548.07,$0.00,1,1,1,1,1,1,20131001,E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,RR,,28 ,,NW,,,,,,$62.31,$0.00,1,1,1,1,1,1,20131001,E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,UE,,28 ,,NW,,,,,,$421.02,$0.00,1,1,1,1,1,1,20131001,E2603,HCPCS,SKIN PROTECT WC CUS WD <22IN,,,28 ,,NW,,,,,,$548.07,$0.00,1,1,1,1,1,1,20131001,E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,NU,,28 ,,NW,,,,,,$671.48,$0.00,1,1,1,1,1,1,20131001,E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,RR,,28 ,,NW,,,,,,$76.98,$0.00,1,1,1,1,1,1,20131001,E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,UE,,28 ,,NW,,,,,,$513.68,$0.00,1,1,1,1,1,1,20131001,E2604,HCPCS,SKIN PROTECT WC CUS WD>=22IN,,,28 ,,NW,,,,,,$671.48,$0.00,1,1,1,1,1,1,20131001,E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,NU,,28 ,,NW,,,,,,$942.21,$0.00,1,1,1,1,1,1,20131001,E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,RR,,28 ,,NW,,,,,,$109.50,$0.00,1,1,1,1,1,1,20131001,E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,UE,,28 ,,NW,,,,,,$716.75,$0.00,1,1,1,1,1,1,20131001,E2605,HCPCS,POSITION WC CUSH WDTH <22 IN,,,28 ,,NW,,,,,,$942.21,$0.00,1,1,1,1,1,1,20131001,E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,NU,,28 ,,NW,,,,,,"$1,447.53",$0.00,1,1,1,1,1,1,20131001,E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,RR,,28 ,,NW,,,,,,$170.01,$0.00,1,1,1,1,1,1,20131001,E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,UE,,28 ,,NW,,,,,,"$1,095.60",$0.00,1,1,1,1,1,1,20131001,E2606,HCPCS,POSITION WC CUSH WDTH>=22 IN,,,28 ,,NW,,,,,,"$1,447.53",$0.00,1,1,1,1,1,1,20131001,E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,NU,,28 ,,NW,,,,,,"$1,011.51",$0.00,1,1,1,1,1,1,20131001,E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,RR,,28 ,,NW,,,,,,$117.77,$0.00,1,1,1,1,1,1,20131001,E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,UE,,28 ,,NW,,,,,,$768.62,$0.00,1,1,1,1,1,1,20131001,E2607,HCPCS,SKIN PRO/POS WC CUS WD <22IN,,,28 ,,NW,,,,,,"$1,011.51",$0.00,1,1,1,1,1,1,20131001,E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,NU,,28 ,,NW,,,,,,"$1,206.69",$0.00,1,1,1,1,1,1,20131001,E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,RR,,28 ,,NW,,,,,,$141.08,$0.00,1,1,1,1,1,1,20131001,E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,UE,,28 ,,NW,,,,,,$915.02,$0.00,1,1,1,1,1,1,20131001,E2608,HCPCS,SKIN PRO/POS WC CUS WD>=22IN,,,28 ,,NW,,,,,,"$1,206.69",$0.00,1,1,1,1,1,1,20131001,E2609,HCPCS,CUSTOM FABRICATE W/C CUSHION,,,28 ,,NW,,,,,,$409.43,$0.00,1,1,1,1,1,1,20131001,E2610,HCPCS,POWERED W/C CUSHION,,,28 ,,NW,,,,,,$448.83,$0.00,1,1,1,1,1,1,20131001,E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,NU,,28 ,,NW,,,,,,"$1,086.93",$0.00,1,1,1,1,1,1,20131001,E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,RR,,28 ,,NW,,,,,,$126.75,$0.00,1,1,1,1,1,1,20131001,E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,UE,,28 ,,NW,,,,,,$825.25,$0.00,1,1,1,1,1,1,20131001,E2611,HCPCS,GEN USE BACK CUSH WDTH <22IN,,,28 ,,NW,,,,,,"$1,086.93",$0.00,1,1,1,1,1,1,20131001,E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,NU,,28 ,,NW,,,,,,"$1,456.30",$0.00,1,1,1,1,1,1,20131001,E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,RR,,28 ,,NW,,,,,,$170.97,$0.00,1,1,1,1,1,1,20131001,E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,UE,,28 ,,NW,,,,,,"$1,102.15",$0.00,1,1,1,1,1,1,20131001,E2612,HCPCS,GEN USE BACK CUSH WDTH>=22IN,,,28 ,,NW,,,,,,"$1,456.30",$0.00,1,1,1,1,1,1,20131001,E2613,HCPCS,POSITION BACK CUSH WD <22IN,NU,,28 ,,NW,,,,,,"$1,357.38",$0.00,1,1,1,1,1,1,20131001,E2613,HCPCS,POSITION BACK CUSH WD <22IN,RR,,28 ,,NW,,,,,,$159.18,$0.00,1,1,1,1,1,1,20131001,E2613,HCPCS,POSITION BACK CUSH WD <22IN,UE,,28 ,,NW,,,,,,"$1,028.04",$0.00,1,1,1,1,1,1,20131001,E2613,HCPCS,POSITION BACK CUSH WD <22IN,,,28 ,,NW,,,,,,"$1,357.38",$0.00,1,1,1,1,1,1,20131001,E2614,HCPCS,POSITION BACK CUSH WD>=22IN,NU,,28 ,,NW,,,,,,"$1,863.18",$0.00,1,1,1,1,1,1,20131001,E2614,HCPCS,POSITION BACK CUSH WD>=22IN,RR,,28 ,,NW,,,,,,$219.71,$0.00,1,1,1,1,1,1,20131001,E2614,HCPCS,POSITION BACK CUSH WD>=22IN,UE,,28 ,,NW,,,,,,"$1,407.43",$0.00,1,1,1,1,1,1,20131001,E2614,HCPCS,POSITION BACK CUSH WD>=22IN,,,28 ,,NW,,,,,,"$1,863.18",$0.00,1,1,1,1,1,1,20131001,E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,NU,,28 ,,NW,,,,,,"$1,556.11",$0.00,1,1,1,1,1,1,20131001,E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,RR,,28 ,,NW,,,,,,$182.95,$0.00,1,1,1,1,1,1,20131001,E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,UE,,28 ,,NW,,,,,,"$1,177.00",$0.00,1,1,1,1,1,1,20131001,E2615,HCPCS,POS BACK POST/LAT WDTH <22IN,,,28 ,,NW,,,,,,"$1,556.11",$0.00,1,1,1,1,1,1,20131001,E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,NU,,28 ,,NW,,,,,,"$2,079.87",$0.00,1,1,1,1,1,1,20131001,E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,RR,,28 ,,NW,,,,,,$243.93,$0.00,1,1,1,1,1,1,20131001,E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,UE,,28 ,,NW,,,,,,"$1,569.94",$0.00,1,1,1,1,1,1,20131001,E2616,HCPCS,POS BACK POST/LAT WDTH>=22IN,,,28 ,,NW,,,,,,"$2,079.87",$0.00,1,1,1,1,1,1,20131001,E2617,HCPCS,CUSTOM FAB W/C BACK CUSHION,,,28 ,,NW,,,,,,$701.21,$0.00,1,1,1,1,1,1,20131001,E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,NU,,28 ,,NW,,,,,,$207.35,$0.00,1,1,1,1,1,1,20131001,E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,RR,,28 ,,NW,,,,,,$22.02,$0.00,1,1,1,1,1,1,20131001,E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,UE,,28 ,,NW,,,,,,$155.99,$0.00,1,1,1,1,1,1,20131001,E2619,HCPCS,REPLACE COVER W/C SEAT CUSH,,,28 ,,NW,,,,,,$207.35,$0.00,1,1,1,1,1,1,20131001,E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,NU,,28 ,,NW,,,,,,"$1,875.80",$0.00,1,1,1,1,1,1,20131001,E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,RR,,28 ,,NW,,,,,,$221.21,$0.00,1,1,1,1,1,1,20131001,E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,UE,,28 ,,NW,,,,,,"$1,416.88",$0.00,1,1,1,1,1,1,20131001,E2620,HCPCS,WC PLANAR BACK CUSH WD <22IN,,,28 ,,NW,,,,,,"$1,875.80",$0.00,1,1,1,1,1,1,20131001,E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,NU,,28 ,,NW,,,,,,"$1,966.52",$0.00,1,1,1,1,1,1,20131001,E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,RR,,28 ,,NW,,,,,,$232.05,$0.00,1,1,1,1,1,1,20131001,E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,UE,,28 ,,NW,,,,,,"$1,484.89",$0.00,1,1,1,1,1,1,20131001,E2621,HCPCS,WC PLANAR BACK CUSH WD>=22IN,,,28 ,,NW,,,,,,"$1,966.52",$0.00,1,1,1,1,1,1,20131001,E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,NU,,28 ,,NW,,,,,,"$1,150.99",$0.00,1,1,1,1,1,1,20131001,E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,RR,,28 ,,NW,,,,,,$134.46,$0.00,1,1,1,1,1,1,20131001,E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,UE,,28 ,,NW,,,,,,$873.24,$0.00,1,1,1,1,1,1,20131001,E2622,HCPCS,ADJ SKIN PRO W/C CUS WD<22IN,,,28 ,,NW,,,,,,"$1,150.99",$0.00,1,1,1,1,1,1,20131001,E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,NU,,28 ,,NW,,,,,,"$1,453.74",$0.00,1,1,1,1,1,1,20131001,E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,RR,,28 ,,NW,,,,,,$170.73,$0.00,1,1,1,1,1,1,20131001,E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,UE,,28 ,,NW,,,,,,"$1,100.26",$0.00,1,1,1,1,1,1,20131001,E2623,HCPCS,ADJ SKIN PRO WC CUS WD>=22IN,,,28 ,,NW,,,,,,"$1,453.74",$0.00,1,1,1,1,1,1,20131001,E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,NU,,28 ,,NW,,,,,,"$1,160.13",$0.00,1,1,1,1,1,1,20131001,E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,RR,,28 ,,NW,,,,,,$135.54,$0.00,1,1,1,1,1,1,20131001,E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,UE,,28 ,,NW,,,,,,$880.14,$0.00,1,1,1,1,1,1,20131001,E2624,HCPCS,ADJ SKIN PRO/POS CUS<22IN,,,28 ,,NW,,,,,,"$1,160.13",$0.00,1,1,1,1,1,1,20131001,E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,NU,,28 ,,NW,,,,,,"$1,458.03",$0.00,1,1,1,1,1,1,20131001,E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,RR,,28 ,,NW,,,,,,$171.20,$0.00,1,1,1,1,1,1,20131001,E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,UE,,28 ,,NW,,,,,,"$1,103.48",$0.00,1,1,1,1,1,1,20131001,E2625,HCPCS,ADJ SKIN PRO/POS WC CUS>=22,,,28 ,,NW,,,,,,"$1,458.03",$0.00,1,1,1,1,1,1,20131001,E2626,HCPCS,SEO MOBILE ARM SUP ATT TO WC,NU,,28 ,,NW,,,,,,"$1,135.39",$0.00,1,1,1,1,1,1,20131001,E2626,HCPCS,SEO MOBILE ARM SUP ATT TO WC,RR,,28 ,,NW,,,,,,$132.55,$0.00,1,1,1,1,1,1,20131001,E2626,HCPCS,SEO MOBILE ARM SUP ATT TO WC,UE,,28 ,,NW,,,,,,$861.48,$0.00,1,1,1,1,1,1,20131001,E2626,HCPCS,SEO MOBILE ARM SUP ATT TO WC,,,28 ,,NW,,,,,,"$1,135.39",$0.00,1,1,1,1,1,1,20131001,E2627,HCPCS,ARM SUPP ATT TO WC RANCHO TY,NU,,28 ,,NW,,,,,,"$1,738.06",$0.00,1,1,1,1,1,1,20131001,E2627,HCPCS,ARM SUPP ATT TO WC RANCHO TY,RR,,28 ,,NW,,,,,,$204.78,$0.00,1,1,1,1,1,1,20131001,E2627,HCPCS,ARM SUPP ATT TO WC RANCHO TY,UE,,28 ,,NW,,,,,,"$1,313.53",$0.00,1,1,1,1,1,1,20131001,E2627,HCPCS,ARM SUPP ATT TO WC RANCHO TY,,,28 ,,NW,,,,,,"$1,738.06",$0.00,1,1,1,1,1,1,20131001,E2628,HCPCS,MOBILE ARM SUPPORTS RECLININ,NU,,28 ,,NW,,,,,,"$1,334.38",$0.00,1,1,1,1,1,1,20131001,E2628,HCPCS,MOBILE ARM SUPPORTS RECLININ,RR,,28 ,,NW,,,,,,$156.39,$0.00,1,1,1,1,1,1,20131001,E2628,HCPCS,MOBILE ARM SUPPORTS RECLININ,UE,,28 ,,NW,,,,,,"$1,010.77",$0.00,1,1,1,1,1,1,20131001,E2628,HCPCS,MOBILE ARM SUPPORTS RECLININ,,,28 ,,NW,,,,,,"$1,334.38",$0.00,1,1,1,1,1,1,20131001,E2629,HCPCS,FRICTION DAMPENING ARM SUPP,NU,,28 ,,NW,,,,,,"$1,688.86",$0.00,1,1,1,1,1,1,20131001,E2629,HCPCS,FRICTION DAMPENING ARM SUPP,RR,,28 ,,NW,,,,,,$198.81,$0.00,1,1,1,1,1,1,20131001,E2629,HCPCS,FRICTION DAMPENING ARM SUPP,UE,,28 ,,NW,,,,,,"$1,276.64",$0.00,1,1,1,1,1,1,20131001,E2629,HCPCS,FRICTION DAMPENING ARM SUPP,,,28 ,,NW,,,,,,"$1,688.86",$0.00,1,1,1,1,1,1,20131001,E2630,HCPCS,MONOSUSPENSION ARM/HAND SUPP,NU,,28 ,,NW,,,,,,"$1,189.95",$0.00,1,1,1,1,1,1,20131001,E2630,HCPCS,MONOSUSPENSION ARM/HAND SUPP,RR,,28 ,,NW,,,,,,$139.10,$0.00,1,1,1,1,1,1,20131001,E2630,HCPCS,MONOSUSPENSION ARM/HAND SUPP,UE,,28 ,,NW,,,,,,$902.44,$0.00,1,1,1,1,1,1,20131001,E2630,HCPCS,MONOSUSPENSION ARM/HAND SUPP,,,28 ,,NW,,,,,,"$1,189.95",$0.00,1,1,1,1,1,1,20131001,E2631,HCPCS,ELEVAT PROXIMAL ARM SUPPORT,NU,,28 ,,NW,,,,,,$501.53,$0.00,1,1,1,1,1,1,20131001,E2631,HCPCS,ELEVAT PROXIMAL ARM SUPPORT,RR,,28 ,,NW,,,,,,$56.69,$0.00,1,1,1,1,1,1,20131001,E2631,HCPCS,ELEVAT PROXIMAL ARM SUPPORT,UE,,28 ,,NW,,,,,,$386.12,$0.00,1,1,1,1,1,1,20131001,E2631,HCPCS,ELEVAT PROXIMAL ARM SUPPORT,,,28 ,,NW,,,,,,$501.53,$0.00,1,1,1,1,1,1,20131001,E2632,HCPCS,OFFSET/LAT ROCKER ARM W/ELA,NU,,28 ,,NW,,,,,,$333.50,$0.00,1,1,1,1,1,1,20131001,E2632,HCPCS,OFFSET/LAT ROCKER ARM W/ELA,RR,,28 ,,NW,,,,,,$36.57,$0.00,1,1,1,1,1,1,20131001,E2632,HCPCS,OFFSET/LAT ROCKER ARM W/ELA,UE,,28 ,,NW,,,,,,$260.11,$0.00,1,1,1,1,1,1,20131001,E2632,HCPCS,OFFSET/LAT ROCKER ARM W/ELA,,,28 ,,NW,,,,,,$333.50,$0.00,1,1,1,1,1,1,20131001,E2633,HCPCS,MOBILE ARM SUPPORT SUPINATOR,NU,,28 ,,NW,,,,,,$288.25,$0.00,1,1,1,1,1,1,20131001,E2633,HCPCS,MOBILE ARM SUPPORT SUPINATOR,RR,,28 ,,NW,,,,,,$31.18,$0.00,1,1,1,1,1,1,20131001,E2633,HCPCS,MOBILE ARM SUPPORT SUPINATOR,UE,,28 ,,NW,,,,,,$224.37,$0.00,1,1,1,1,1,1,20131001,E2633,HCPCS,MOBILE ARM SUPPORT SUPINATOR,,,28 ,,NW,,,,,,$288.25,$0.00,1,1,1,1,1,1,20131001,G0008,HCPCS,ADMIN INFLUENZA VIRUS VAC,,,9 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0009,HCPCS,ADMIN PNEUMOCOCCAL VACCINE,,,9 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0010,HCPCS,ADMIN HEPATITIS B VACCINE,,,9 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0027,HCPCS,SEMEN ANALYSIS,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0101,HCPCS,CA SCREEN;PELVIC/BREAST EXAM,,,18 ,,RBRVS,0.45 ,0.32 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0102,HCPCS,PROSTATE CA SCREENING; DRE,,,18 ,,RBRVS,0.17 ,0.08 ,0.39 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0103,HCPCS,PSA SCREENING,,,17 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0104,HCPCS,CA SCREEN;FLEXI SIGMOIDSCOPE,,,21 ,,RBRVS,0.96 ,0.79 ,3.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0105,HCPCS,COLORECTAL SCRN; HI RISK IND,,,21 ,,RBRVS,3.69 ,2.20 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,,,20 ,,RBRVS,0.99 ,5.43 ,5.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,26,,20 ,,RBRVS,0.99 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,TC,,20 ,,RBRVS,,5.06 ,5.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0108,HCPCS,DIAB MANAGE TRN PER INDIV,,,14 ,,RBRVS,0.90 ,0.62 ,0.62 ,,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0109,HCPCS,DIAB MANAGE TRN IND/GROUP,,,14 ,,RBRVS,0.25 ,0.22 ,0.22 ,,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0117,HCPCS,GLAUCOMA SCRN HGH RISK DIREC,,,14 ,,RBRVS,0.45 ,1.04 ,1.04 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0118,HCPCS,GLAUCOMA SCRN HGH RISK DIREC,,,14 ,,RBRVS,0.17 ,0.89 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,,,20 ,,RBRVS,0.99 ,5.43 ,5.43 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,26,,20 ,,RBRVS,0.99 ,0.37 ,0.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,TC,,20 ,,RBRVS,,5.06 ,5.06 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0121,HCPCS,COLON CA SCRN NOT HI RSK IND,,,21 ,,RBRVS,3.69 ,2.20 ,7.55 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0122,HCPCS,COLON CA SCRN; BARIUM ENEMA,,,20 ,,RBRVS,0.99 ,7.36 ,7.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0122,HCPCS,COLON CA SCRN; BARIUM ENEMA,26,,20 ,,RBRVS,0.99 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0122,HCPCS,COLON CA SCRN; BARIUM ENEMA,TC,,20 ,,RBRVS,,6.95 ,6.95 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0123,HCPCS,SCREEN CERV/VAG THIN LAYER,,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0124,HCPCS,SCREEN C/V THIN LAYER BY MD,,,17 ,,RBRVS,0.42 ,0.41 ,0.41 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0127,HCPCS,TRIM NAIL(S),,,21 ,,RBRVS,0.17 ,0.05 ,0.47 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0128,HCPCS,CORF SKILLED NURSING SERVICE,,,14 ,,RBRVS,0.08 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,,,20 ,,RBRVS,0.22 ,0.76 ,0.76 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,26,,20 ,,RBRVS,0.22 ,0.09 ,0.09 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,TC,,20 ,,RBRVS,,0.67 ,0.67 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0141,HCPCS,"SCR C/V CYTO, AUTOSYS AND MD",,,17 ,,RBRVS,0.42 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0143,HCPCS,"SCR C/V CYTO, THINLAYER, RESCR",,,17 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0144,HCPCS,"SCR C/V CYTO, THINLAYER, RESCR",,,17 ,,TotalUnits,,,,0.89 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0145,HCPCS,"SCR C/V CYTO, THINLAYER, RESCR",,,17 ,,TotalUnits,,,,1.10 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0147,HCPCS,"SCR C/V CYTO, AUTOMATED SYS",,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0148,HCPCS,"SCR C/V CYTO, AUTOSYS, RESCR",,,17 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0151,HCPCS,"HHCP-SERV OF PT, EA 15 MIN",,,14 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0152,HCPCS,"HHCP-SERV OF OT, EA 15 MIN",,,14 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0153,HCPCS,"HHCP-SVS OF S/L PATH, EA 15MN",,,14 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0154,HCPCS,"HHCP-SVS OF RN, EA 15 MIN",,,14 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0155,HCPCS,"HHCP-SVS OF CSW, EA 15 MIN",,,14 ,,TotalUnits,,,,0.77 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0156,HCPCS,"HHCP-SVS OF AIDE, EA 15 MIN",,,14 ,,TotalUnits,,,,0.16 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0157,HCPCS,HHC PT ASSISTANT EA 15,,,14 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0158,HCPCS,HHC OT ASSISTANT EA 15,,,14 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0159,HCPCS,HHC PT MAINT EA 15 MIN,,,14 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0160,HCPCS,HHC OCCUP THERAPY EA 15,,,14 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0161,HCPCS,HHC SLP EA 15 MIN,,,14 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0162,HCPCS,"HHC RN E&M PLAN SVS, 15 MIN",,,14 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0163,HCPCS,HHC LPN/RN OBS/ASSES EA 15,,,14 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0164,HCPCS,HHC LIS NURSE TRAIN EA 15,,,14 ,,TotalUnits,,,,0.33 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,G0166,HCPCS,"EXTRNL COUNTERPULSE, PER TX",,,14 ,,RBRVS,0.07 ,4.33 ,4.33 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0168,HCPCS,WOUND CLOSURE BY ADHESIVE,,,21 ,,RBRVS,0.45 ,0.30 ,2.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0175,HCPCS,"OPPS SERVICE, SCHED TEAM CONF",,,14 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0176,HCPCS,OPPS/PHP;ACTIVITY THERAPY,,,16 ,,TotalUnits,,,,1.46 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0177,HCPCS,OPPS/PHP; TRAIN & EDUC SERV,,,16 ,,TotalUnits,,,,2.04 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0179,HCPCS,MD RECERTIFICATION HHA PT,,,15 ,,RBRVS,0.45 ,0.72 ,0.72 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0180,HCPCS,MD CERTIFICATION HHA PATIENT,,,15 ,,RBRVS,0.67 ,0.84 ,0.84 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0181,HCPCS,HOME HEALTH CARE SUPERVISION,,,15 ,,RBRVS,1.73 ,1.25 ,1.25 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0182,HCPCS,HOSPICE CARE SUPERVISION,,,15 ,,RBRVS,1.73 ,1.29 ,1.29 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0186,HCPCS,"DSTRY EYE LESN, FDR VSSL TECH",,,14 ,,TotalUnits,,,,9.21 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0202,HCPCS,SCREENINGMAMMOGRAPHYDIGITAL,,,20 ,,RBRVS,0.70 ,3.36 ,3.36 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0202,HCPCS,SCREENINGMAMMOGRAPHYDIGITAL,26,,20 ,,RBRVS,0.70 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0202,HCPCS,SCREENINGMAMMOGRAPHYDIGITAL,TC,,20 ,,RBRVS,,3.08 ,3.08 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,,,20 ,,RBRVS,0.87 ,4.03 ,4.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,26,,20 ,,RBRVS,0.87 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,TC,,20 ,,RBRVS,,3.68 ,3.68 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,,,20 ,,RBRVS,0.70 ,3.17 ,3.17 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,26,,20 ,,RBRVS,0.70 ,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,TC,,20 ,,RBRVS,,2.89 ,2.89 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,,,20 ,,TotalUnits,,,,28.08 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,26,,20 ,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,TC,,20 ,,TotalUnits,,,,26.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,,,20 ,,TotalUnits,,,,26.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,26,,20 ,,TotalUnits,,,,1.87 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,TC,,20 ,,TotalUnits,,,,24.85 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0237,HCPCS,THERAPEUTIC PROCD STRG ENDUR,,,14 ,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0238,HCPCS,"OTH RESP PROC, INDIV",,,14 ,,RBRVS,,0.31 ,0.31 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0239,HCPCS,"OTH RESP PROC, GROUP",,,14 ,,RBRVS,,0.36 ,0.36 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0245,HCPCS,INITIAL FOOT EXAM PT LOPS,,,15 ,,RBRVS,0.88 ,0.31 ,0.95 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0246,HCPCS,FOLLOWUP EVAL OF FOOT PT LOP,,,15 ,,RBRVS,0.45 ,0.14 ,0.62 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0247,HCPCS,ROUTINE FOOTCARE PT W LOPS,,,15 ,,RBRVS,0.50 ,0.16 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0248,HCPCS,DEMONSTRATE USE HOME INR MON,,TC,14 ,,RBRVS,,3.65 ,3.65 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0249,HCPCS,PROVIDE INR TEST MATER/EQUIP,,TC,14 ,,RBRVS,,3.36 ,3.36 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0250,HCPCS,MD INR TEST REVIE INTER MGMT,,PC,4 ,,RBRVS,0.18 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0252,HCPCS,PET IMAGING INITIAL DX,,,20 ,,RBRVS,1.50 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0252,HCPCS,PET IMAGING INITIAL DX,26,,20 ,,RBRVS,1.50 ,0.64 ,0.64 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0255,HCPCS,CURRENT PERCEP THRESHOLD TST,,,14 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0255,HCPCS,CURRENT PERCEP THRESHOLD TST,26,,14 ,,TotalUnits,,,,0.34 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0255,HCPCS,CURRENT PERCEP THRESHOLD TST,TC,,14 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0257,HCPCS,UNSCHED DIALYSIS ESRD PT HOS,,,14 ,,TotalUnits,,,,7.20 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0259,HCPCS,INJECT FOR SACROILIAC JOINT,,,21 ,,TotalUnits,,,,4.77 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0260,HCPCS,INJ FOR SACROILIAC JT ANESTH,,,21 ,,TotalUnits,,,,15.41 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0268,HCPCS,REMOVAL OF IMPACTED WAX MD,,,14 ,,RBRVS,0.61 ,0.31 ,0.89 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0269,HCPCS,OCCLUSIVE DEVICE IN VEIN ART,,,21 ,,TotalUnits,,,,3.58 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0270,HCPCS,MNT SUBS TX FOR CHANGE DX,,,14 ,,RBRVS,0.45 ,0.32 ,0.39 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0271,HCPCS,GROUP MNT 2 OR MORE 30 MINS,,,14 ,,RBRVS,0.25 ,0.17 ,0.18 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0275,HCPCS,"RENAL ANGIO, CARDIAC CATH",,,20 ,,RBRVS,0.25 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0278,HCPCS,"ILIAC ART ANGIO, CARDIAC CATH",,,20 ,,RBRVS,0.25 ,0.11 ,0.11 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0281,HCPCS,ELEC STIM UNATTEND FOR PRESS,,,19 ,,RBRVS,0.18 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0282,HCPCS,ELECT STIM WOUND CARE NOT PD,,,19 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0283,HCPCS,ELEC STIM OTHER THAN WOUND,,,19 ,,RBRVS,0.18 ,0.20 ,0.20 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0288,HCPCS,"RECON, CTA FOR SURG PLAN",,TC,20 ,,RBRVS,,1.83 ,1.83 ,,,$0.00,$0.00,1,0,1,0,1,1,20131001,G0289,HCPCS,"ARTHRO, LOOSE BODY + CHONDRO",,,21 ,,RBRVS,1.48 ,0.81 ,0.81 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0290,HCPCS,"DRUG-ELUTING STENTS, SINGLE",,,21 ,,TotalUnits,,,,90.75 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0293,HCPCS,"NON-COV SURG PROC, CLIN TRIAL",,,14 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0295,HCPCS,ELECTROMAGNETIC THERAPY ONC,,,19 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0306,HCPCS,CBC/DIFFWBC W/O PLATELET,,,17 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0307,HCPCS,CBC WITHOUT PLATELET,,,17 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0328,HCPCS,FECAL BLOOD SCRN IMMUNOASSAY,,,17 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0329,HCPCS,ELECTROMAGNTIC TX FOR ULCERS,,,19 ,,RBRVS,0.06 ,0.22 ,0.22 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0333,HCPCS,DISPENSE FEE INITIAL 30 DAY,,,28 ,,NW,,,,,,$73.99,$0.00,1,1,1,0,0,1,20131001,G0337,HCPCS,HOSPICE EVALUATION PREELECTI,,,15 ,,RBRVS,1.42 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0339,HCPCS,"ROBOT LIN-RADSURG COM, FIRST",,,21 ,,TotalUnits,,,,175.42 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0340,HCPCS,ROBT LIN-RADSURG FRACTX 2-5,,,21 ,,TotalUnits,,,,179.16 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0341,HCPCS,PERCUTANEOUS ISLET CELLTRANS,,,21 ,,RBRVS,6.98 ,2.03 ,22.49 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,G0342,HCPCS,LAPAROSCOPY ISLET CELL TRANS,,,21 ,,RBRVS,11.92 ,6.43 ,6.43 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,G0343,HCPCS,LAPAROTOMY ISLET CELL TRANSP,,,21 ,,RBRVS,19.85 ,12.01 ,12.01 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,G0364,HCPCS,BONE MARROW ASPIRATE &BIOPSY,,,21 ,,RBRVS,0.16 ,0.09 ,0.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,,,14 ,,RBRVS,0.25 ,6.22 ,6.22 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,26,,14 ,,RBRVS,0.25 ,0.08 ,0.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,TC,,14 ,,RBRVS,,6.14 ,6.14 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0372,HCPCS,MD SERVICE REQUIRED FOR PMD,,,14 ,,RBRVS,0.17 ,0.07 ,0.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0378,HCPCS,HOSPITAL OBSERVATION PER HR,,,10 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0382,HCPCS,LEV 3 HOSP TYPE B ED VISIT,,,7 ,,TotalUnits,,,,0.70 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0389,HCPCS,ULTRASOUND EXAM AAA SCREEN,,,20 ,,RBRVS,0.58 ,2.68 ,2.68 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0389,HCPCS,ULTRASOUND EXAM AAA SCREEN,26,,20 ,,RBRVS,0.58 ,0.22 ,0.22 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0389,HCPCS,ULTRASOUND EXAM AAA SCREEN,TC,,20 ,,RBRVS,,2.46 ,2.46 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0396,HCPCS,ALCOHOL/SUBS INTERV 15-30MN,,,16 ,,RBRVS,0.65 ,0.27 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0397,HCPCS,ALCOHOL/SUBS INTERV >30 MIN,,,16 ,,RBRVS,1.30 ,0.56 ,0.61 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0398,HCPCS,HOME SLEEP TEST/TYPE 2 PORTA,,,14 ,,TotalUnits,,,,4.26 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0398,HCPCS,HOME SLEEP TEST/TYPE 2 PORTA,26,,14 ,,TotalUnits,,,,1.28 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0398,HCPCS,HOME SLEEP TEST/TYPE 2 PORTA,TC,,14 ,,TotalUnits,,,,2.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,,14 ,,TotalUnits,,,,4.09 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,PC,14 ,,TotalUnits,,,,1.23 ,,$0.00,$0.00,1,0,1,1,1,0,20131001,G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,TC,14 ,,TotalUnits,,,,2.86 ,,$0.00,$0.00,1,1,1,0,1,0,20131001,G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,,,14 ,,TotalUnits,,,,3.92 ,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,26,,14 ,,TotalUnits,,,,1.18 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,TC,,14 ,,TotalUnits,,,,2.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0402,HCPCS,INITIAL PREVENTIVE EXAM,,,18 ,,RBRVS,2.43 ,1.09 ,2.03 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0403,HCPCS,EKG FOR INITIAL PREVENT EXAM,,,18 ,,RBRVS,0.17 ,0.36 ,0.37 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0404,HCPCS,EKG TRACING FOR INITIAL PREV,,TC,18 ,,RBRVS,,0.30 ,0.30 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0405,HCPCS,EKG INTERPRET & REPORT PREVE,,PC,18 ,,RBRVS,0.17 ,0.06 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0406,HCPCS,INPT/TELE FOLLOW UP 15,,,6 ,,RBRVS,0.76 ,0.31 ,0.31 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0407,HCPCS,INPT/TELE FOLLOW UP 25,,,6 ,,RBRVS,1.39 ,0.58 ,0.58 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0408,HCPCS,INPT/TELE FOLLOW UP 35,,,6 ,,RBRVS,2.00 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0409,HCPCS,CORF RELATED SERV 15 MINS EA,,,16 ,,RBRVS,,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0410,HCPCS,GRP PSYCH PARTIAL HOSP 45-50,,,16 ,,TotalUnits,,,,2.73 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0412,HCPCS,OPEN TX ILIAC SPINE UNI/BIL,,,21 ,,RBRVS,10.45 ,8.80 ,8.80 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,G0413,HCPCS,PELVIC RING FRACTURE UNI/BIL,,,21 ,,RBRVS,15.73 ,12.37 ,12.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0414,HCPCS,PELVIC RING FX TREAT INT FIX,,,21 ,,RBRVS,14.65 ,12.07 ,12.07 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,G0415,HCPCS,OPEN TX POST PELVIC FXCTURE,,,21 ,,RBRVS,20.93 ,15.31 ,15.31 ,,,$0.00,$0.00,1,0,0,1,1,1,20131001,G0416,HCPCS,SAT BIOPSY 10-20,,,17 ,,RBRVS,3.09 ,16.50 ,16.50 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0416,HCPCS,SAT BIOPSY 10-20,,PC,17 ,,RBRVS,3.09 ,2.15 ,2.15 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,G0416,HCPCS,SAT BIOPSY 10-20,,TC,17 ,,RBRVS,,14.35 ,14.35 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,G0417,HCPCS,SAT BIOPSY PROSTATE 21-40,,,17 ,,RBRVS,5.86 ,32.23 ,32.23 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0417,HCPCS,SAT BIOPSY PROSTATE 21-40,,PC,17 ,,RBRVS,5.86 ,4.20 ,4.20 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,G0417,HCPCS,SAT BIOPSY PROSTATE 21-40,,TC,17 ,,RBRVS,,28.03 ,28.03 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,G0418,HCPCS,SAT BIOPSY PROSTATE 41-60,,,17 ,,RBRVS,10.30 ,55.03 ,55.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0418,HCPCS,SAT BIOPSY PROSTATE 41-60,,PC,17 ,,RBRVS,10.30 ,7.16 ,7.16 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,G0418,HCPCS,SAT BIOPSY PROSTATE 41-60,,TC,17 ,,RBRVS,,47.87 ,47.87 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,G0419,HCPCS,SAT BIOPSY PROSTATE: >60,,,17 ,,RBRVS,11.61 ,66.03 ,66.03 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,G0419,HCPCS,SAT BIOPSY PROSTATE: >60,,PC,17 ,,RBRVS,11.61 ,8.58 ,8.58 ,,,$0.00,$0.00,1,0,1,1,1,0,20131001,G0419,HCPCS,SAT BIOPSY PROSTATE: >60,,TC,17 ,,RBRVS,,57.45 ,57.45 ,,,$0.00,$0.00,1,1,1,0,1,0,20131001,G0420,HCPCS,ED SVC CKD IND PER SESSION,,,14 ,,RBRVS,2.12 ,0.88 ,0.88 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0421,HCPCS,ED SVC CKD GRP PER SESSION,,,14 ,,RBRVS,0.50 ,0.19 ,0.19 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0422,HCPCS,INTENS CARDIAC REHAB W/EXERC,,,4 ,,RBRVS,1.06 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0423,HCPCS,INTENS CARDIAC REHAB NO EXER,,,4 ,,RBRVS,1.06 ,0.93 ,0.93 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0424,HCPCS,PULMONARY REHAB W EXER,,,14 ,,RBRVS,0.28 ,0.11 ,0.60 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0425,HCPCS,INPT/ED TELECONSULT30,,,6 ,,RBRVS,1.92 ,0.82 ,0.82 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0426,HCPCS,INPT/ED TELECONSULT50,,,6 ,,RBRVS,2.61 ,1.13 ,1.13 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0427,HCPCS,INPT/ED TELECONSULT70,,,6 ,,RBRVS,3.86 ,1.67 ,1.67 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0429,HCPCS,DERMAL FILLER INJECTION(S),,,14 ,,RBRVS,1.19 ,0.77 ,1.57 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0431,HCPCS,DRUG SCREEN MULTIPLE CLASS,,,17 ,,TotalUnits,,,,3.03 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0432,HCPCS,EIA HIV-1/HIV-2 SCREEN,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0433,HCPCS,ELISA HIV-1/HIV-2 SCREEN,,,17 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0434,HCPCS,DRUG SCREEN MULTI DRUG CLASS,,,17 ,,TotalUnits,,,,0.61 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0435,HCPCS,ORAL HIV-1/HIV-2 SCREEN,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0436,HCPCS,TOBACCO-USE COUNSEL 3-10 MIN,,,14 ,,RBRVS,0.24 ,0.10 ,0.15 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0437,HCPCS,TOBACCO-USE COUNSEL>10MIN,,,14 ,,RBRVS,0.50 ,0.23 ,0.30 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,G0438,HCPCS,"PPPS, INITIAL VISIT",,,15 ,,RBRVS,2.43 ,2.34 ,2.34 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0439,HCPCS,"PPPS, SUBSEQ VISIT",,,15 ,,RBRVS,1.50 ,1.73 ,1.73 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0442,HCPCS,ANNUAL ALCOHOL SCREEN 15 MIN,,,16 ,,RBRVS,0.18 ,0.08 ,0.32 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0443,HCPCS,BRIEF ALCOHOL MISUSE COUNSEL,,,16 ,,RBRVS,0.45 ,0.20 ,0.26 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0444,HCPCS,DEPRESSION SCREEN ANNUAL,,,16 ,,RBRVS,0.18 ,0.08 ,0.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0445,HCPCS,HIGH INTEN BEH COUNS STD 30M,,,16 ,,RBRVS,0.45 ,0.20 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0446,HCPCS,INTENS BEHAVE THER CARDIO DX,,,16 ,,RBRVS,0.45 ,0.20 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0447,HCPCS,BEHAVIOR COUNSEL OBESITY 15M,,,16 ,,RBRVS,0.45 ,0.20 ,0.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0451,HCPCS,DEVLOPMENT TEST INTERPT&REP,,,17 ,,RBRVS,,0.28 ,0.28 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0452,HCPCS,MOLECULAR PATHOLOGY INTERPR,26,,17 ,,RBRVS,0.37 ,0.15 ,0.15 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0453,HCPCS,CONT INTRAOP NEURO MONITOR,,,14 ,,RBRVS,0.50 ,0.24 ,0.24 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,G0454,HCPCS,MD DOCUMENT VISIT BY NPP,,,14 ,,RBRVS,0.18 ,0.07 ,0.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G0455,HCPCS,FECAL MICROBIOTA PREP INSTIL,,,21 ,,RBRVS,0.97 ,2.48 ,2.48 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,G9017,HCPCS,AMANTADINE HCL 100MG ORAL,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,G9018,HCPCS,"ZANAMIVIR,INHALATION PWD 10M",,,29 ,,NW,,,,,,$18.86,$0.00,1,1,1,0,0,1,20131001,G9019,HCPCS,OSELTAMIVIR PHOSPHATE 75MG,,,29 ,,NW,,,,,,$19.95,$0.00,1,1,1,0,0,1,20131001,G9020,HCPCS,RIMANTADINE HCL 100MG ORAL,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,G9033,HCPCS,AMANTADINE HCL ORAL BRAND,,,29 ,,NW,,,,,,$64.57,$0.00,1,1,1,0,0,1,20131001,G9034,HCPCS,"ZANAMIVIR, INH PWDR, BRAND",,,29 ,,NW,,,,,,$51.54,$0.00,1,1,1,0,0,1,20131001,G9036,HCPCS,"RIMANTADINE HCL, BRAND",,,29 ,,NW,,,,,,$199.88,$0.00,1,1,1,0,0,1,20131001,G9141,HCPCS,"INFLUENZA A H1N1,ADMIN W COU",,,9 ,,TotalUnits,,,,0.59 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G9142,HCPCS,"INFLUENZA A H1N1, VACCINE",,,9 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,G9143,HCPCS,WARFARIN RESPON GENETIC TEST,,,17 ,,TotalUnits,,,,5.02 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0001,HCPCS,ALCOHOL AND/OR DRUG ASSESS,,,16 ,,TotalUnits,,,,1.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0002,HCPCS,ALCOHOL AND/OR DRUG SCREENIN,,,16 ,,TotalUnits,,,,3.01 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0003,HCPCS,ALCOHOL AND/OR DRUG SCREENIN,,,16 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0004,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0005,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,0.84 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0006,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0010,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,2.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0011,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,7.96 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0014,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,5.32 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0015,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,2.26 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0016,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,1.88 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0017,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,3.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0018,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,4.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0019,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,2.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0020,HCPCS,ALCOHOL AND/OR DRUG SERVICES,,,16 ,,TotalUnits,,,,0.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0022,HCPCS,ALCOHOL AND/OR DRUG INTERVEN,,,16 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0024,HCPCS,ALCOHOL AND/OR DRUG PREVENTI,,,16 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0025,HCPCS,ALCOHOL AND/OR DRUG PREVENTI,,,16 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0031,HCPCS,MH HEALTH ASSESS BY NON-MD,,,16 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0032,HCPCS,MH SVC PLAN DEV BY NON-MD,,,16 ,,TotalUnits,,,,0.74 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0033,HCPCS,ORAL MED ADM DIRECT OBSERVE,,,16 ,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0034,HCPCS,MED TRNG & SUPPORT PER 15MIN,,,16 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0035,HCPCS,MH PARTIAL HOSP TX UNDER 24H,,,16 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0036,HCPCS,COMM PSY FACE-FACE PER 15MIN,,,16 ,,TotalUnits,,,,0.38 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0037,HCPCS,COMM PSY SUP TX PGM PER DIEM,,,16 ,,TotalUnits,,,,2.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0038,HCPCS,SELF-HELP/PEER SVC PER 15MIN,,,16 ,,TotalUnits,,,,0.22 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0039,HCPCS,ASSER COM TX FACE-FACE/15MIN,,,16 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0040,HCPCS,ASSERT COMM TX PGM PER DIEM,,,16 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0041,HCPCS,FOS C CHLD NON-THER PER DIEM,,,16 ,,TotalUnits,,,,1.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0043,HCPCS,"SUPPORTED HOUSING, PER DIEM",,,16 ,,TotalUnits,,,,0.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0044,HCPCS,"SUPPORTED HOUSING, PER MONTH",,,16 ,,TotalUnits,,,,9.57 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0045,HCPCS,RESPITE NOT-IN-HOME PER DIEM,,,16 ,,TotalUnits,,,,2.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0048,HCPCS,SPEC COLL NON-BLOOD:A/D TEST,,,16 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H0050,HCPCS,ALCOHOL/DRUG SERVICE 15 MIN,,,16 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H1000,HCPCS,PRENATAL CARE ATRISK ASSESSM,,,16 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H1001,HCPCS,ANTEPARTUM MANAGEMENT,,,16 ,,TotalUnits,,,,2.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H1002,HCPCS,CARECOORDINATION PRENATAL,,,16 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H1003,HCPCS,PRENATAL AT RISK EDUCATION,,,16 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H1004,HCPCS,FOLLOW UP HOME VISIT/PRENTAL,,,16 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H1005,HCPCS,PRENATALCARE ENHANCED SRV PK,,,16 ,,TotalUnits,,,,1.96 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2000,HCPCS,COMP MULTIDISIPLN EVALUATION,,,16 ,,TotalUnits,,,,1.94 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2010,HCPCS,COMPREHENSIVE MED SVC 15 MIN,,,16 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2011,HCPCS,"CRISIS INTERVEN SVC, 15 MIN",,,16 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2012,HCPCS,"BEHAV HLTH DAY TREAT, PER HR",,,16 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2013,HCPCS,"PSYCH HLTH FAC SVC, PER DIEM",,,16 ,,TotalUnits,,,,2.33 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2014,HCPCS,"SKILLS TRAIN AND DEV, 15 MIN",,,16 ,,TotalUnits,,,,1.54 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2017,HCPCS,"PSYSOC REHAB SVC, PER 15 MIN",,,16 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2018,HCPCS,"PSYSOC REHAB SVC, PER DIEM",,,16 ,,TotalUnits,,,,1.76 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2019,HCPCS,"THER BEHAV SVC, PER 15 MIN",,,16 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2020,HCPCS,"THER BEHAV SVC, PER DIEM",,,16 ,,TotalUnits,,,,1.56 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2021,HCPCS,"COM WRAP-AROUND SV, 15 MIN",,,16 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2022,HCPCS,"COM WRAP-AROUND SV, PER DIEM",,,16 ,,TotalUnits,,,,3.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2023,HCPCS,"SUPPORTED EMPLOY, PER 15 MIN",,,16 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2024,HCPCS,"SUPPORTED EMPLOY, PER DIEM",,,16 ,,TotalUnits,,,,0.72 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2026,HCPCS,"SUPP MAINT EMPLOY, PER DIEM",,,16 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2029,HCPCS,"SEX OFFEND TX SVC, PER DIEM",,,16 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2032,HCPCS,"ACTIVITY THERAPY, PER 15 MIN",,,16 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2033,HCPCS,MULTISYS THER/JUVENILE 15MIN,,,16 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2035,HCPCS,"A/D TX PROGRAM, PER HOUR",,,16 ,,TotalUnits,,,,1.73 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,H2036,HCPCS,"A/D TX PROGRAM, PER DIEM",,,16 ,,TotalUnits,,,,1.01 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,J0120,HCPCS,TETRACYCLIN INJECTION,,,29 ,,NW,,,,,,$64.94,$0.00,1,1,1,0,0,1,20131001,J0129,HCPCS,ABATACEPT INJECTION,,,29 ,,NW,,,,,,$60.37,$0.00,1,1,1,0,0,1,20131001,J0130,HCPCS,ABCIXIMAB INJECTION,,,29 ,,NW,,,,,,"$1,464.79",$0.00,1,1,1,0,0,1,20131001,J0132,HCPCS,ACETYLCYSTEINE INJECTION,,,29 ,,NW,,,,,,$11.05,$0.00,1,1,1,0,0,1,20131001,J0133,HCPCS,ACYCLOVIR INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J0135,HCPCS,ADALIMUMAB INJECTION,,,29 ,,NW,,,,,,"$1,166.37",$0.00,1,1,1,0,0,1,20131001,J0150,HCPCS,INJECTION ADENOSINE 6 MG,,,29 ,,NW,,,,,,$19.95,$0.00,1,1,1,0,0,1,20131001,J0152,HCPCS,ADENOSINE INJECTION,,,29 ,,NW,,,,,,$280.54,$0.00,1,1,1,0,0,1,20131001,J0171,HCPCS,ADRENALIN EPINEPHRINE INJECT,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J0180,HCPCS,AGALSIDASE BETA INJECTION,,,29 ,,NW,,,,,,$359.66,$0.00,1,1,1,0,0,1,20131001,J0190,HCPCS,INJ BIPERIDEN LACTATE/5 MG,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20131001,J0200,HCPCS,ALATROFLOXACIN MESYLATE,,,29 ,,NW,,,,,,$34.00,$0.00,1,1,1,0,0,1,20131001,J0205,HCPCS,ALGLUCERASE INJECTION,,,29 ,,NW,,,,,,$111.12,$0.00,1,1,1,0,0,1,20131001,J0207,HCPCS,AMIFOSTINE,,,29 ,,NW,,,,,,$950.56,$0.00,1,1,1,0,0,1,20131001,J0210,HCPCS,METHYLDOPATE HCL INJECTION,,,29 ,,NW,,,,,,$112.84,$0.00,1,1,1,0,0,1,20131001,J0215,HCPCS,ALEFACEPT,,,29 ,,NW,,,,,,$110.26,$0.00,1,1,1,0,0,1,20131001,J0220,HCPCS,ALGLUCOSIDASE ALFA INJECTION,,,29 ,,NW,,,,,,$523.93,$0.00,1,1,1,0,0,1,20131001,J0221,HCPCS,LUMIZYME INJECTION,,,29 ,,NW,,,,,,$393.20,$0.00,1,1,1,0,0,1,20131001,J0256,HCPCS,ALPHA 1 PROTEINASE INHIBITOR,,,29 ,,NW,,,,,,$13.38,$0.00,1,1,1,0,0,1,20131001,J0257,HCPCS,GLASSIA INJECTION,,,29 ,,NW,,,,,,$14.47,$0.00,1,1,1,0,0,1,20131001,J0270,HCPCS,ALPROSTADIL FOR INJECTION,,,29 ,,NW,,,,,,$8.60,$0.00,1,1,1,0,0,1,20131001,J0275,HCPCS,ALPROSTADIL URETHRAL SUPPOS,,,29 ,,NW,,,,,,$58.35,$0.00,1,1,1,0,0,1,20131001,J0278,HCPCS,AMIKACIN SULFATE INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0280,HCPCS,AMINOPHYLLIN 250 MG INJ,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J0282,HCPCS,AMIODARONE HCL,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0285,HCPCS,AMPHOTERICIN B,,,29 ,,NW,,,,,,$33.71,$0.00,1,1,1,0,0,1,20131001,J0287,HCPCS,AMPHOTERICIN B LIPID COMPLEX,,,29 ,,NW,,,,,,$33.71,$0.00,1,1,1,0,0,1,20131001,J0288,HCPCS,AMPHO B CHOLESTERYL SULFATE,,,29 ,,NW,,,,,,$40.59,$0.00,1,1,1,0,0,1,20131001,J0289,HCPCS,AMPHOTERICIN B LIPOSOME INJ,,,29 ,,NW,,,,,,$42.31,$0.00,1,1,1,0,0,1,20131001,J0290,HCPCS,AMPICILLIN 500 MG INJ,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J0295,HCPCS,AMPICILLIN SODIUM PER 1.5 GM,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J0300,HCPCS,AMOBARBITAL 125 MG INJ,,,29 ,,NW,,,,,,$35.43,$0.00,1,1,1,0,0,1,20131001,J0330,HCPCS,SUCCINYCHOLINE CHLORIDE INJ,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0348,HCPCS,ANIDULAFUNGIN INJECTION,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J0350,HCPCS,INJECTION ANISTREPLASE 30 U,,,29 ,,NW,,,,,,$251.69,$0.00,1,1,1,0,0,1,20131001,J0360,HCPCS,HYDRALAZINE HCL INJECTION,,,29 ,,NW,,,,,,$13.38,$0.00,1,1,1,0,0,1,20131001,J0364,HCPCS,APOMORPHINE HYDROCHLORIDE,,,29 ,,NW,,,,,,$83.59,$0.00,1,1,1,0,0,1,20131001,J0365,HCPCS,"APROTONIN, 10,000 KIU",,,29 ,,NW,,,,,,$9.82,$0.00,1,0,0,0,0,1,20131001,J0380,HCPCS,INJ METARAMINOL BITARTRATE,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J0390,HCPCS,CHLOROQUINE INJECTION,,,29 ,,NW,,,,,,$213.29,$0.00,1,1,1,0,0,1,20131001,J0395,HCPCS,ARBUTAMINE HCL INJECTION,,,29 ,,NW,,,,,,$28.44,$0.00,1,1,1,0,0,1,20131001,J0400,HCPCS,ARIPIPRAZOLE INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J0456,HCPCS,AZITHROMYCIN,,,29 ,,NW,,,,,,$15.57,$0.00,1,1,1,0,0,1,20131001,J0461,HCPCS,ATROPINE SULFATE INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J0470,HCPCS,DIMECAPROL INJECTION,,,29 ,,NW,,,,,,$74.13,$0.00,1,1,1,0,0,1,20131001,J0475,HCPCS,BACLOFEN 10 MG INJECTION,,,29 ,,NW,,,,,,$462.87,$0.00,1,1,1,0,0,1,20131001,J0476,HCPCS,BACLOFEN INTRATHECAL TRIAL,,,29 ,,NW,,,,,,$197.12,$0.00,1,1,1,0,0,1,20131001,J0480,HCPCS,BASILIXIMAB,,,29 ,,NW,,,,,,"$5,877.58",$0.00,1,1,1,0,0,1,20131001,J0490,HCPCS,BELIMUMAB INJECTION,,,29 ,,NW,,,,,,$102.52,$0.00,1,1,1,0,0,1,20131001,J0500,HCPCS,DICYCLOMINE INJECTION,,,29 ,,NW,,,,,,$82.73,$0.00,1,1,1,0,0,1,20131001,J0515,HCPCS,INJ BENZTROPINE MESYLATE,,,29 ,,NW,,,,,,$69.83,$0.00,1,1,1,0,0,1,20131001,J0520,HCPCS,BETHANECHOL CHLORIDE INJECT,,,29 ,,NW,,,,,,$7.95,$0.00,1,1,1,0,0,1,20131001,J0558,HCPCS,PENG BENZATHINE/PROCAINE INJ,,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J0561,HCPCS,PENICILLIN G BENZATHINE INJ,,,29 ,,NW,,,,,,$15.57,$0.00,1,1,1,0,0,1,20131001,J0583,HCPCS,BIVALIRUDIN,,,29 ,,NW,,,,,,$11.05,$0.00,1,1,1,0,0,1,20131001,J0585,HCPCS,"INJECTION,ONABOTULINUMTOXINA",,,29 ,,NW,,,,,,$18.86,$0.00,1,1,1,0,0,1,20131001,J0586,HCPCS,ABOBOTULINUMTOXINA,,,29 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20131001,J0587,HCPCS,"INJ, RIMABOTULINUMTOXINB",,,29 ,,NW,,,,,,$32.85,$0.00,1,1,1,0,0,1,20131001,J0588,HCPCS,INCOBOTULINUMTOXIN A,,,29 ,,NW,,,,,,$15.57,$0.00,1,1,1,0,0,1,20131001,J0592,HCPCS,BUPRENORPHINE HYDROCHLORIDE,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0594,HCPCS,BUSULFAN INJECTION,,,29 ,,NW,,,,,,$60.37,$0.00,1,1,1,0,0,1,20131001,J0595,HCPCS,BUTORPHANOL TARTRATE 1 MG,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J0597,HCPCS,"C-1 ESTERASE, BERINERT",,,29 ,,NW,,,,,,$81.87,$0.00,1,1,1,0,0,1,20131001,J0598,HCPCS,"C-1 ESTERASE, CINRYZE",,,29 ,,NW,,,,,,$120.58,$0.00,1,1,1,0,0,1,20131001,J0600,HCPCS,EDETATE CALCIUM DISODIUM INJ,,,29 ,,NW,,,,,,$514.47,$0.00,1,1,1,0,0,1,20131001,J0610,HCPCS,CALCIUM GLUCONATE INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0620,HCPCS,CALCIUM GLYCER & LACT/10 ML,,,29 ,,NW,,,,,,$34.57,$0.00,1,1,1,0,0,1,20131001,J0630,HCPCS,CALCITONIN SALMON INJECTION,,,29 ,,NW,,,,,,$162.72,$0.00,1,1,1,0,0,1,20131001,J0636,HCPCS,INJ CALCITRIOL PER 0.1 MCG,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J0637,HCPCS,CASPOFUNGIN ACETATE,,,29 ,,NW,,,,,,$38.01,$0.00,1,1,1,0,0,1,20131001,J0638,HCPCS,CANAKINUMAB INJECTION,,,29 ,,NW,,,,,,$230.66,$0.00,1,1,1,0,0,1,20131001,J0640,HCPCS,LEUCOVORIN CALCIUM INJECTION,,,29 ,,NW,,,,,,$11.05,$0.00,1,1,1,0,0,1,20131001,J0641,HCPCS,LEVOLEUCOVORIN INJECTION,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J0670,HCPCS,INJ MEPIVACAINE HCL/10 ML,,,29 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20131001,J0690,HCPCS,CEFAZOLIN SODIUM INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0692,HCPCS,CEFEPIME HCL FOR INJECTION,,,29 ,,NW,,,,,,$9.82,$0.00,1,1,1,0,0,1,20131001,J0694,HCPCS,CEFOXITIN SODIUM INJECTION,,,29 ,,NW,,,,,,$20.81,$0.00,1,1,1,0,0,1,20131001,J0696,HCPCS,CEFTRIAXONE SODIUM INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0697,HCPCS,STERILE CEFUROXIME INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0698,HCPCS,CEFOTAXIME SODIUM INJECTION,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J0702,HCPCS,BETAMETHASONE ACET&SOD PHOSP,,,29 ,,NW,,,,,,$18.86,$0.00,1,1,1,0,0,1,20131001,J0706,HCPCS,CAFFEINE CITRATE INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0710,HCPCS,CEPHAPIRIN SODIUM INJECTION,,,29 ,,NW,,,,,,$15.05,$0.00,1,1,1,0,0,1,20131001,J0712,HCPCS,CEFTAROLINE FOSAMIL INJ,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0713,HCPCS,INJ CEFTAZIDIME PER 500 MG,,,29 ,,NW,,,,,,$9.82,$0.00,1,1,1,0,0,1,20131001,J0715,HCPCS,CEFTIZOXIME SODIUM / 500 MG,,,29 ,,NW,,,,,,$26.04,$0.00,1,1,1,0,0,1,20131001,J0718,HCPCS,CERTOLIZUMAB PEGOL INJ,,,29 ,,NW,,,,,,$16.66,$0.00,1,1,1,0,0,1,20131001,J0720,HCPCS,CHLORAMPHENICOL SODIUM INJEC,,,29 ,,NW,,,,,,$54.35,$0.00,1,1,1,0,0,1,20131001,J0725,HCPCS,CHORIONIC GONADOTROPIN/1000U,,,29 ,,NW,,,,,,$34.57,$0.00,1,1,1,0,0,1,20131001,J0735,HCPCS,CLONIDINE HYDROCHLORIDE,,,29 ,,NW,,,,,,$64.67,$0.00,1,1,1,0,0,1,20131001,J0740,HCPCS,CIDOFOVIR INJECTION,,,29 ,,NW,,,,,,"$1,918.89",$0.00,1,1,1,0,0,1,20131001,J0743,HCPCS,CILASTATIN SODIUM INJECTION,,,29 ,,NW,,,,,,$29.41,$0.00,1,1,1,0,0,1,20131001,J0744,HCPCS,CIPROFLOXACIN IV,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J0745,HCPCS,INJ CODEINE PHOSPHATE /30 MG,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J0760,HCPCS,COLCHICINE INJECTION,,,29 ,,NW,,,,,,$21.67,$0.00,1,1,1,0,0,1,20131001,J0770,HCPCS,COLISTIMETHATE SODIUM INJ,,,29 ,,NW,,,,,,$36.29,$0.00,1,1,1,0,0,1,20131001,J0775,HCPCS,"COLLAGENASE, CLOST HIST INJ",,,29 ,,NW,,,,,,$99.94,$0.00,1,1,1,0,0,1,20131001,J0780,HCPCS,PROCHLORPERAZINE INJECTION,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J0795,HCPCS,CORTICORELIN OVINE TRIFLUTAL,,,29 ,,NW,,,,,,$16.66,$0.00,1,1,1,0,0,1,20131001,J0800,HCPCS,CORTICOTROPIN INJECTION,,,29 ,,NW,,,,,,"$7,277.70",$0.00,1,1,1,0,0,1,20131001,J0833,HCPCS,COSYNTROPIN INJECTION NOS,,,29 ,,NW,,,,,,$247.86,$0.00,1,1,1,0,0,1,20131001,J0834,HCPCS,COSYNTROPIN CORTROSYN INJ,,,29 ,,NW,,,,,,$177.34,$0.00,1,1,1,0,0,1,20131001,J0840,HCPCS,CROTALIDAE POLY IMMUNE FAB,,,29 ,,NW,,,,,,"$5,607.53",$0.00,1,1,1,0,0,1,20131001,J0850,HCPCS,CYTOMEGALOVIRUS IMM IV /VIAL,,,29 ,,NW,,,,,,"$2,558.75",$0.00,1,1,1,0,0,1,20131001,J0878,HCPCS,DAPTOMYCIN INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J0881,HCPCS,"DARBEPOETIN ALFA, NON-ESRD",,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J0882,HCPCS,"DARBEPOETIN ALFA, ESRD USE",,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J0885,HCPCS,"EPOETIN ALFA, NON-ESRD",,,29 ,,NW,,,,,,$30.27,$0.00,1,1,1,0,0,1,20131001,J0886,HCPCS,EPOETIN ALFA 1000 UNITS ESRD,,,29 ,,NW,,,,,,$30.27,$0.00,1,1,1,0,0,1,20131001,J0894,HCPCS,DECITABINE INJECTION,,,29 ,,NW,,,,,,$90.47,$0.00,1,1,1,0,0,1,20131001,J0895,HCPCS,DEFEROXAMINE MESYLATE INJ,,,29 ,,NW,,,,,,$27.69,$0.00,1,1,1,0,0,1,20131001,J0897,HCPCS,DENOSUMAB INJECTION,,,29 ,,NW,,,,,,$41.45,$0.00,1,1,1,0,0,1,20131001,J0900,HCPCS,TESTOSTERONE ENANTHATE INJ,,,29 ,,NW,,,,,,$21.37,$0.00,1,1,1,0,0,1,20131001,J0945,HCPCS,BROMPHENIRAMINE MALEATE INJ,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1000,HCPCS,DEPO-ESTRADIOL CYPIONATE INJ,,,29 ,,NW,,,,,,$22.53,$0.00,1,1,1,0,0,1,20131001,J1020,HCPCS,METHYLPREDNISOLONE 20 MG INJ,,,29 ,,NW,,,,,,$11.05,$0.00,1,1,1,0,0,1,20131001,J1030,HCPCS,METHYLPREDNISOLONE 40 MG INJ,,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J1040,HCPCS,METHYLPREDNISOLONE 80 MG INJ,,,29 ,,NW,,,,,,$21.67,$0.00,1,1,1,0,0,1,20131001,J1051,HCPCS,MEDROXYPROGESTERONE INJ,,,29 ,,NW,,,,,,$28.55,$0.00,1,0,0,0,0,1,20131001,J1055,HCPCS,MEDRXYPROGESTER ACETATE INJ,,,29 ,,NW,,,,,,$140.36,$0.00,1,1,1,0,0,1,20131001,J1056,HCPCS,MA/EC CONTRACEPTIVEINJECTION,,,29 ,,NW,,,,,,$69.83,$0.00,1,1,1,0,0,1,20131001,J1060,HCPCS,TESTOSTERONE CYPIONATE 1 ML,,,29 ,,NW,,,,,,$22.08,$0.00,1,1,1,0,0,1,20131001,J1070,HCPCS,TESTOSTERONE CYPIONAT 100 MG,,,29 ,,NW,,,,,,$14.47,$0.00,1,1,1,0,0,1,20131001,J1080,HCPCS,TESTOSTERONE CYPIONAT 200 MG,,,29 ,,NW,,,,,,$24.25,$0.00,1,1,1,0,0,1,20131001,J1094,HCPCS,INJ DEXAMETHASONE ACETATE,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1100,HCPCS,DEXAMETHASONE SODIUM PHOS,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1110,HCPCS,INJ DIHYDROERGOTAMINE MESYLT,,,29 ,,NW,,,,,,$77.57,$0.00,1,1,1,0,0,1,20131001,J1120,HCPCS,ACETAZOLAMID SODIUM INJECTIO,,,29 ,,NW,,,,,,$81.87,$0.00,1,1,1,0,0,1,20131001,J1160,HCPCS,DIGOXIN INJECTION,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J1162,HCPCS,DIGOXIN IMMUNE FAB (OVINE),,,29 ,,NW,,,,,,"$1,987.69",$0.00,1,1,1,0,0,1,20131001,J1165,HCPCS,PHENYTOIN SODIUM INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1170,HCPCS,HYDROMORPHONE INJECTION,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J1180,HCPCS,DYPHYLLINE INJECTION,,,29 ,,NW,,,,,,$18.06,$0.00,1,1,1,0,0,1,20131001,J1190,HCPCS,DEXRAZOXANE HCL INJECTION,,,29 ,,NW,,,,,,$448.25,$0.00,1,1,1,0,0,1,20131001,J1200,HCPCS,DIPHENHYDRAMINE HCL INJECTIO,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J1205,HCPCS,CHLOROTHIAZIDE SODIUM INJ,,,29 ,,NW,,,,,,$689.91,$0.00,1,1,1,0,0,1,20131001,J1212,HCPCS,DIMETHYL SULFOXIDE 50% 50 ML,,,29 ,,NW,,,,,,$224.64,$0.00,1,1,1,0,0,1,20131001,J1230,HCPCS,METHADONE INJECTION,,,29 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20131001,J1240,HCPCS,DIMENHYDRINATE INJECTION,,,29 ,,NW,,,,,,$14.47,$0.00,1,1,1,0,0,1,20131001,J1245,HCPCS,DIPYRIDAMOLE INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J1250,HCPCS,INJ DOBUTAMINE HCL/250 MG,,,29 ,,NW,,,,,,$19.95,$0.00,1,1,1,0,0,1,20131001,J1260,HCPCS,DOLASETRON MESYLATE,,,29 ,,NW,,,,,,$21.18,$0.00,1,1,1,0,0,1,20131001,J1265,HCPCS,DOPAMINE INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1267,HCPCS,DORIPENEM INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1270,HCPCS,"INJECTION, DOXERCALCIFEROL",,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J1290,HCPCS,ECALLANTIDE INJECTION,,,29 ,,NW,,,,,,$725.17,$0.00,1,1,1,0,0,1,20131001,J1300,HCPCS,ECULIZUMAB INJECTION,,,29 ,,NW,,,,,,$498.99,$0.00,1,1,1,0,0,1,20131001,J1320,HCPCS,AMITRIPTYLINE INJECTION,,,29 ,,NW,,,,,,$82.26,$0.00,1,1,1,0,0,1,20131001,J1324,HCPCS,ENFUVIRTIDE INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1325,HCPCS,EPOPROSTENOL INJECTION,,,29 ,,NW,,,,,,$41.45,$0.00,1,1,1,0,0,1,20131001,J1327,HCPCS,EPTIFIBATIDE INJECTION,,,29 ,,NW,,,,,,$65.53,$0.00,1,1,1,0,0,1,20131001,J1330,HCPCS,ERGONOVINE MALEATE INJECTION,,,29 ,,NW,,,,,,$7.42,$0.00,1,1,1,0,0,1,20131001,J1335,HCPCS,ERTAPENEM INJECTION,,,29 ,,NW,,,,,,$81.01,$0.00,1,1,1,0,0,1,20131001,J1364,HCPCS,ERYTHRO LACTOBIONATE /500 MG,,,29 ,,NW,,,,,,$31.99,$0.00,1,1,1,0,0,1,20131001,J1380,HCPCS,ESTRADIOL VALERATE 10 MG INJ,,,29 ,,NW,,,,,,$29.41,$0.00,1,1,1,0,0,1,20131001,J1410,HCPCS,INJ ESTROGEN CONJUGATE 25 MG,,,29 ,,NW,,,,,,$321.82,$0.00,1,1,1,0,0,1,20131001,J1430,HCPCS,ETHANOLAMINE OLEATE 100 MG,,,29 ,,NW,,,,,,$763.01,$0.00,1,1,1,0,0,1,20131001,J1435,HCPCS,INJECTION ESTRONE PER 1 MG,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1436,HCPCS,ETIDRONATE DISODIUM INJ,,,29 ,,NW,,,,,,$203.15,$0.00,1,1,1,0,0,1,20131001,J1438,HCPCS,ETANERCEPT INJECTION,,,29 ,,NW,,,,,,$583.27,$0.00,1,1,1,0,0,1,20131001,J1440,HCPCS,FILGRASTIM 300 MCG INJECTION,,,29 ,,NW,,,,,,$679.59,$0.00,1,1,1,0,0,1,20131001,J1441,HCPCS,FILGRASTIM 480 MCG INJECTION,,,29 ,,NW,,,,,,"$1,075.20",$0.00,1,1,1,0,0,1,20131001,J1450,HCPCS,FLUCONAZOLE,,,29 ,,NW,,,,,,$16.66,$0.00,1,1,1,0,0,1,20131001,J1451,HCPCS,"FOMEPIZOLE, 15 MG",,,29 ,,NW,,,,,,$21.67,$0.00,1,1,1,0,0,1,20131001,J1452,HCPCS,INTRAOCULAR FOMIVIRSEN NA,,,29 ,,NW,,,,,,"$2,268.34",$0.00,1,1,1,0,0,1,20131001,J1453,HCPCS,FOSAPREPITANT INJECTION,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J1455,HCPCS,FOSCARNET SODIUM INJECTION,,,29 ,,NW,,,,,,$38.87,$0.00,1,1,1,0,0,1,20131001,J1457,HCPCS,GALLIUM NITRATE INJECTION,,,29 ,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20131001,J1458,HCPCS,GALSULFASE INJECTION,,,29 ,,NW,,,,,,$889.44,$0.00,1,1,1,0,0,1,20131001,J1459,HCPCS,INJ IVIG PRIVIGEN 500 MG,,,29 ,,NW,,,,,,$93.91,$0.00,1,1,1,0,0,1,20131001,J1460,HCPCS,GAMMA GLOBULIN 1 CC INJ,,,29 ,,NW,,,,,,$62.95,$0.00,1,0,0,0,0,1,20131001,J1557,HCPCS,GAMMAPLEX INJECTION,,,29 ,,NW,,,,,,$99.94,$0.00,1,1,1,0,0,1,20131001,J1559,HCPCS,HIZENTRA INJECTION,,,29 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20131001,J1560,HCPCS,GAMMA GLOBULIN > 10 CC INJ,,,29 ,,NW,,,,,,$584.13,$0.00,1,0,0,0,0,1,20131001,J1561,HCPCS,GAMUNEX/GAMUNEX C,,,29 ,,NW,,,,,,$102.52,$0.00,1,1,1,0,0,1,20131001,J1562,HCPCS,"VIVAGLOBIN, INJ",,,29 ,,NW,,,,,,$29.41,$0.00,1,1,1,0,0,1,20131001,J1566,HCPCS,"IMMUNE GLOBULIN, POWDER",,,29 ,,NW,,,,,,$83.59,$0.00,1,1,1,0,0,1,20131001,J1568,HCPCS,OCTAGAM INJECTION,,,29 ,,NW,,,,,,$92.19,$0.00,1,1,1,0,0,1,20131001,J1569,HCPCS,GAMMAGARD LIQUID INJECTION,,,29 ,,NW,,,,,,$104.24,$0.00,1,1,1,0,0,1,20131001,J1570,HCPCS,GANCICLOVIR SODIUM INJECTION,,,29 ,,NW,,,,,,$214.32,$0.00,1,1,1,0,0,1,20131001,J1571,HCPCS,HEPAGAM B IM INJECTION,,,29 ,,NW,,,,,,$134.34,$0.00,1,1,1,0,0,1,20131001,J1572,HCPCS,FLEBOGAMMA INJECTION,,,29 ,,NW,,,,,,$92.19,$0.00,1,1,1,0,0,1,20131001,J1573,HCPCS,"HEPAGAM B INTRAVENOUS, INJ",,,29 ,,NW,,,,,,$134.34,$0.00,1,1,1,0,0,1,20131001,J1580,HCPCS,GARAMYCIN GENTAMICIN INJ,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J1590,HCPCS,GATIFLOXACIN INJECTION,,,29 ,,NW,,,,,,$2.74,$0.00,1,1,1,0,0,1,20131001,J1595,HCPCS,INJECTION GLATIRAMER ACETATE,,,29 ,,NW,,,,,,"$4,133.45",$0.00,1,1,1,0,0,1,20131001,J1599,HCPCS,"IVIG NON-LYOPHILIZED, NOS",,,29 ,,NW,,,,,,$204.54,$0.00,1,1,1,0,0,1,20131001,J1600,HCPCS,GOLD SODIUM THIOMALEATE INJ,,,29 ,,NW,,,,,,$68.97,$0.00,1,1,1,0,0,1,20131001,J1610,HCPCS,GLUCAGON HYDROCHLORIDE/1 MG,,,29 ,,NW,,,,,,$292.58,$0.00,1,1,1,0,0,1,20131001,J1620,HCPCS,GONADORELIN HYDROCH/ 100 MCG,,,29 ,,NW,,,,,,$641.31,$0.00,1,1,1,0,0,1,20131001,J1626,HCPCS,GRANISETRON HCL INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1630,HCPCS,HALOPERIDOL INJECTION,,,29 ,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20131001,J1631,HCPCS,HALOPERIDOL DECANOATE INJ,,,29 ,,NW,,,,,,$53.49,$0.00,1,1,1,0,0,1,20131001,J1640,HCPCS,"HEMIN, 1 MG",,,29 ,,NW,,,,,,$38.87,$0.00,1,1,1,0,0,1,20131001,J1642,HCPCS,INJ HEPARIN SODIUM PER 10 U,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1644,HCPCS,INJ HEPARIN SODIUM PER 1000U,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1645,HCPCS,DALTEPARIN SODIUM,,,29 ,,NW,,,,,,$33.71,$0.00,1,1,1,0,0,1,20131001,J1650,HCPCS,INJ ENOXAPARIN SODIUM,,,29 ,,NW,,,,,,$15.57,$0.00,1,1,1,0,0,1,20131001,J1652,HCPCS,FONDAPARINUX SODIUM,,,29 ,,NW,,,,,,$17.76,$0.00,1,1,1,0,0,1,20131001,J1655,HCPCS,TINZAPARIN SODIUM INJECTION,,,29 ,,NW,,,,,,$13.38,$0.00,1,1,1,0,0,1,20131001,J1670,HCPCS,TETANUS IMMUNE GLOBULIN INJ,,,29 ,,NW,,,,,,$698.51,$0.00,1,1,1,0,0,1,20131001,J1675,HCPCS,HISTRELIN ACETATE,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J1680,HCPCS,HUMAN FIBRINOGEN CONC INJ,,,29 ,,NW,,,,,,$1.71,$0.00,1,1,1,0,0,1,20131001,J1700,HCPCS,HYDROCORTISONE ACETATE INJ,,,29 ,,NW,,,,,,$1.17,$0.00,1,1,1,0,0,1,20131001,J1710,HCPCS,HYDROCORTISONE SODIUM PH INJ,,,29 ,,NW,,,,,,$14.87,$0.00,1,1,1,0,0,1,20131001,J1720,HCPCS,HYDROCORTISONE SODIUM SUCC I,,,29 ,,NW,,,,,,$15.57,$0.00,1,1,1,0,0,1,20131001,J1725,HCPCS,HYDROXYPROGESTERONE CAPROATE,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1730,HCPCS,DIAZOXIDE INJECTION,,,29 ,,NW,,,,,,$266.78,$0.00,1,1,1,0,0,1,20131001,J1740,HCPCS,IBANDRONATE SODIUM INJECTION,,,29 ,,NW,,,,,,$388.90,$0.00,1,1,1,0,0,1,20131001,J1742,HCPCS,IBUTILIDE FUMARATE INJECTION,,,29 ,,NW,,,,,,$457.71,$0.00,1,1,1,0,0,1,20131001,J1743,HCPCS,IDURSULFASE INJECTION,,,29 ,,NW,,,,,,"$1,155.19",$0.00,1,1,1,0,0,1,20131001,J1745,HCPCS,INFLIXIMAB INJECTION,,,29 ,,NW,,,,,,$167.88,$0.00,1,1,1,0,0,1,20131001,J1750,HCPCS,INJ IRON DEXTRAN,,,29 ,,NW,,,,,,$35.43,$0.00,1,1,1,0,0,1,20131001,J1756,HCPCS,IRON SUCROSE INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1786,HCPCS,IMUGLUCERASE INJECTION,,,29 ,,NW,,,,,,$111.12,$0.00,1,1,1,0,0,1,20131001,J1790,HCPCS,DROPERIDOL INJECTION,,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J1800,HCPCS,PROPRANOLOL INJECTION,,,29 ,,NW,,,,,,$9.82,$0.00,1,1,1,0,0,1,20131001,J1810,HCPCS,DROPERIDOL/FENTANYL INJ,,,29 ,,NW,,,,,,$23.10,$0.00,1,1,1,0,0,1,20131001,J1815,HCPCS,INSULIN INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1817,HCPCS,INSULIN FOR INSULIN PUMP USE,,,29 ,,NW,,,,,,$11.05,$0.00,1,1,1,0,0,1,20131001,J1826,HCPCS,INTERFERON BETA-1A INJ,,,29 ,,NW,,,,,,"$1,502.64",$0.00,1,1,1,0,0,1,20131001,J1830,HCPCS,INTERFERON BETA-1B / .25 MG,,,29 ,,NW,,,,,,$390.36,$0.00,1,1,1,0,0,1,20131001,J1835,HCPCS,ITRACONAZOLE INJECTION,,,29 ,,NW,,,,,,"$2,423.72",$0.00,1,1,1,0,0,1,20131001,J1840,HCPCS,KANAMYCIN SULFATE 500 MG INJ,,,29 ,,NW,,,,,,$25.11,$0.00,1,1,1,0,0,1,20131001,J1850,HCPCS,KANAMYCIN SULFATE 75 MG INJ,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J1885,HCPCS,KETOROLAC TROMETHAMINE INJ,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1890,HCPCS,CEPHALOTHIN SODIUM INJECTION,,,29 ,,NW,,,,,,$26.63,$0.00,1,1,1,0,0,1,20131001,J1930,HCPCS,LANREOTIDE INJECTION,,,29 ,,NW,,,,,,$90.47,$0.00,1,1,1,0,0,1,20131001,J1931,HCPCS,LARONIDASE INJECTION,,,29 ,,NW,,,,,,$72.41,$0.00,1,1,1,0,0,1,20131001,J1940,HCPCS,FUROSEMIDE INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J1945,HCPCS,LEPIRUDIN,,,29 ,,NW,,,,,,"$1,008.12",$0.00,1,1,1,0,0,1,20131001,J1950,HCPCS,LEUPROLIDE ACETATE /3.75 MG,,,29 ,,NW,,,,,,"$1,655.72",$0.00,1,1,1,0,0,1,20131001,J1953,HCPCS,LEVETIRACETAM INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J1955,HCPCS,INJ LEVOCARNITINE PER 1 GM,,,29 ,,NW,,,,,,$24.25,$0.00,1,1,1,0,0,1,20131001,J1956,HCPCS,LEVOFLOXACIN INJECTION,,,29 ,,NW,,,,,,$15.57,$0.00,1,1,1,0,0,1,20131001,J1960,HCPCS,LEVORPHANOL TARTRATE INJ,,,29 ,,NW,,,,,,$11.05,$0.00,1,1,1,0,0,1,20131001,J1980,HCPCS,HYOSCYAMINE SULFATE INJ,,,29 ,,NW,,,,,,$42.31,$0.00,1,1,1,0,0,1,20131001,J1990,HCPCS,CHLORDIAZEPOXIDE INJECTION,,,29 ,,NW,,,,,,$58.65,$0.00,1,1,1,0,0,1,20131001,J2001,HCPCS,LIDOCAINE INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J2010,HCPCS,LINCOMYCIN INJECTION,,,29 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20131001,J2020,HCPCS,LINEZOLID INJECTION,,,29 ,,NW,,,,,,$102.52,$0.00,1,1,1,0,0,1,20131001,J2060,HCPCS,LORAZEPAM INJECTION,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J2150,HCPCS,MANNITOL INJECTION,,,29 ,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20131001,J2170,HCPCS,MECASERMIN INJECTION,,,29 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20131001,J2175,HCPCS,MEPERIDINE HYDROCHL /100 MG,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J2180,HCPCS,MEPERIDINE/PROMETHAZINE INJ,,,29 ,,NW,,,,,,$25.11,$0.00,1,1,1,0,0,1,20131001,J2185,HCPCS,MEROPENEM,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J2210,HCPCS,METHYLERGONOVIN MALEATE INJ,,,29 ,,NW,,,,,,$14.47,$0.00,1,1,1,0,0,1,20131001,J2248,HCPCS,MICAFUNGIN SODIUM INJECTION,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J2250,HCPCS,INJ MIDAZOLAM HYDROCHLORIDE,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J2260,HCPCS,INJ MILRINONE LACTATE / 5 MG,,,29 ,,NW,,,,,,$18.86,$0.00,1,1,1,0,0,1,20131001,J2265,HCPCS,MINOCYCLINE HYDROCHLORIDE,,,29 ,,NW,,,,,,$3.83,$0.00,1,1,1,0,0,1,20131001,J2270,HCPCS,MORPHINE SULFATE INJECTION,,,29 ,,NW,,,,,,$11.05,$0.00,1,1,1,0,0,1,20131001,J2271,HCPCS,MORPHINE SO4 INJECTION 100MG,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J2275,HCPCS,MORPHINE SULFATE INJECTION,,,29 ,,NW,,,,,,$17.76,$0.00,1,1,1,0,0,1,20131001,J2278,HCPCS,ZICONOTIDE INJECTION,,,29 ,,NW,,,,,,$21.67,$0.00,1,1,1,0,0,1,20131001,J2280,HCPCS,"INJ, MOXIFLOXACIN 100 MG",,,29 ,,NW,,,,,,$13.38,$0.00,1,1,1,0,0,1,20131001,J2300,HCPCS,INJ NALBUPHINE HYDROCHLORIDE,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J2310,HCPCS,INJ NALOXONE HYDROCHLORIDE,,,29 ,,NW,,,,,,$25.97,$0.00,1,1,1,0,0,1,20131001,J2315,HCPCS,"NALTREXONE, DEPOT FORM",,,29 ,,NW,,,,,,$9.82,$0.00,1,1,1,0,0,1,20131001,J2320,HCPCS,NANDROLONE DECANOATE 50 MG,,,29 ,,NW,,,,,,$14.47,$0.00,1,1,1,0,0,1,20131001,J2323,HCPCS,NATALIZUMAB INJECTION,,,29 ,,NW,,,,,,$34.57,$0.00,1,1,1,0,0,1,20131001,J2325,HCPCS,NESIRITIDE INJECTION,,,29 ,,NW,,,,,,$136.06,$0.00,1,1,1,0,0,1,20131001,J2353,HCPCS,"OCTREOTIDE INJECTION, DEPOT",,,29 ,,NW,,,,,,$323.54,$0.00,1,1,1,0,0,1,20131001,J2354,HCPCS,"OCTREOTIDE INJ, NON-DEPOT",,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J2355,HCPCS,OPRELVEKIN INJECTION,,,29 ,,NW,,,,,,$622.83,$0.00,1,1,1,0,0,1,20131001,J2357,HCPCS,OMALIZUMAB INJECTION,,,29 ,,NW,,,,,,$62.95,$0.00,1,1,1,0,0,1,20131001,J2358,HCPCS,OLANZAPINE LONG-ACTING INJ,,,29 ,,NW,,,,,,$9.82,$0.00,1,1,1,0,0,1,20131001,J2360,HCPCS,ORPHENADRINE INJECTION,,,29 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20131001,J2370,HCPCS,PHENYLEPHRINE HCL INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J2400,HCPCS,CHLOROPROCAINE HCL INJECTION,,,29 ,,NW,,,,,,$81.01,$0.00,1,1,1,0,0,1,20131001,J2405,HCPCS,ONDANSETRON HCL INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J2410,HCPCS,OXYMORPHONE HCL INJECTION,,,29 ,,NW,,,,,,$8.60,$0.00,1,1,1,0,0,1,20131001,J2425,HCPCS,PALIFERMIN INJECTION,,,29 ,,NW,,,,,,$35.43,$0.00,1,1,1,0,0,1,20131001,J2426,HCPCS,PALIPERIDONE PALMITATE INJ,,,29 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20131001,J2430,HCPCS,PAMIDRONATE DISODIUM /30 MG,,,29 ,,NW,,,,,,$33.71,$0.00,1,1,1,0,0,1,20131001,J2440,HCPCS,PAPAVERIN HCL INJECTION,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J2460,HCPCS,OXYTETRACYCLINE INJECTION,,,29 ,,NW,,,,,,$2.12,$0.00,1,1,1,0,0,1,20131001,J2469,HCPCS,PALONOSETRON HCL,,,29 ,,NW,,,,,,$52.63,$0.00,1,1,1,0,0,1,20131001,J2501,HCPCS,PARICALCITOL,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J2503,HCPCS,PEGAPTANIB SODIUM INJECTION,,,29 ,,NW,,,,,,"$2,622.39",$0.00,1,1,1,0,0,1,20131001,J2504,HCPCS,"PEGADEMASE BOVINE, 25 IU",,,29 ,,NW,,,,,,$661.53,$0.00,1,1,1,0,0,1,20131001,J2505,HCPCS,"INJECTION, PEGFILGRASTIM 6MG",,,29 ,,NW,,,,,,"$7,214.92",$0.00,1,1,1,0,0,1,20131001,J2507,HCPCS,PEGLOTICASE INJECTION,,,29 ,,NW,,,,,,$768.17,$0.00,1,1,1,0,0,1,20131001,J2510,HCPCS,PENICILLIN G PROCAINE INJ,,,29 ,,NW,,,,,,$37.15,$0.00,1,1,1,0,0,1,20131001,J2513,HCPCS,PENTASTARCH 10% SOLUTION,,,29 ,,NW,,,,,,$9.18,$0.00,1,1,1,0,0,1,20131001,J2515,HCPCS,PENTOBARBITAL SODIUM INJ,,,29 ,,NW,,,,,,$59.51,$0.00,1,1,1,0,0,1,20131001,J2540,HCPCS,PENICILLIN G POTASSIUM INJ,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J2543,HCPCS,PIPERACILLIN/TAZOBACTAM,,,29 ,,NW,,,,,,$9.82,$0.00,1,1,1,0,0,1,20131001,J2545,HCPCS,PENTAMIDINE NON-COMP UNIT,,,29 ,,NW,,,,,,$156.70,$0.00,1,1,1,0,0,1,20131001,J2550,HCPCS,PROMETHAZINE HCL INJECTION,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J2560,HCPCS,PHENOBARBITAL SODIUM INJ,,,29 ,,NW,,,,,,$42.31,$0.00,1,1,1,0,0,1,20131001,J2562,HCPCS,PLERIXAFOR INJECTION,,,29 ,,NW,,,,,,$733.77,$0.00,1,1,1,0,0,1,20131001,J2590,HCPCS,OXYTOCIN INJECTION,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J2597,HCPCS,INJ DESMOPRESSIN ACETATE,,,29 ,,NW,,,,,,$18.86,$0.00,1,1,1,0,0,1,20131001,J2650,HCPCS,PREDNISOLONE ACETATE INJ,,,29 ,,NW,,,,,,$5.86,$0.00,1,1,1,0,0,1,20131001,J2670,HCPCS,TOTAZOLINE HCL INJECTION,,,29 ,,NW,,,,,,$11.70,$0.00,1,1,1,0,0,1,20131001,J2675,HCPCS,INJ PROGESTERONE PER 50 MG,,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J2680,HCPCS,FLUPHENAZINE DECANOATE 25 MG,,,29 ,,NW,,,,,,$17.76,$0.00,1,1,1,0,0,1,20131001,J2690,HCPCS,PROCAINAMIDE HCL INJECTION,,,29 ,,NW,,,,,,$35.43,$0.00,1,1,1,0,0,1,20131001,J2700,HCPCS,OXACILLIN SODIUM INJECITON,,,29 ,,NW,,,,,,$8.60,$0.00,1,1,1,0,0,1,20131001,J2710,HCPCS,NEOSTIGMINE METHYLSLFTE INJ,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J2720,HCPCS,INJ PROTAMINE SULFATE/10 MG,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J2724,HCPCS,PROTEIN C CONCENTRATE,,,29 ,,NW,,,,,,$39.73,$0.00,1,1,1,0,0,1,20131001,J2725,HCPCS,INJ PROTIRELIN PER 250 MCG,,,29 ,,NW,,,,,,$83.44,$0.00,1,1,1,0,0,1,20131001,J2730,HCPCS,PRALIDOXIME CHLORIDE INJ,,,29 ,,NW,,,,,,$228.94,$0.00,1,1,1,0,0,1,20131001,J2760,HCPCS,PHENTOLAINE MESYLATE INJ,,,29 ,,NW,,,,,,$142.94,$0.00,1,1,1,0,0,1,20131001,J2765,HCPCS,METOCLOPRAMIDE HCL INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J2770,HCPCS,QUINUPRISTIN/DALFOPRISTIN,,,29 ,,NW,,,,,,$447.39,$0.00,1,1,1,0,0,1,20131001,J2778,HCPCS,RANIBIZUMAB INJECTION,,,29 ,,NW,,,,,,"$1,013.28",$0.00,1,1,1,0,0,1,20131001,J2780,HCPCS,RANITIDINE HYDROCHLORIDE INJ,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J2783,HCPCS,RASBURICASE,,,29 ,,NW,,,,,,$523.07,$0.00,1,1,1,0,0,1,20131001,J2785,HCPCS,REGADENOSON INJECTION,,,29 ,,NW,,,,,,$138.64,$0.00,1,1,1,0,0,1,20131001,J2788,HCPCS,RHO D IMMUNE GLOBULIN 50 MCG,,,29 ,,NW,,,,,,$70.69,$0.00,1,1,1,0,0,1,20131001,J2790,HCPCS,RHO D IMMUNE GLOBULIN INJ,,,29 ,,NW,,,,,,$216.90,$0.00,1,1,1,0,0,1,20131001,J2791,HCPCS,RHOPHYLAC INJECTION,,,29 ,,NW,,,,,,$17.76,$0.00,1,1,1,0,0,1,20131001,J2792,HCPCS,"RHO(D) IMMUNE GLOBULIN H, SD",,,29 ,,NW,,,,,,$50.91,$0.00,1,1,1,0,0,1,20131001,J2793,HCPCS,RILONACEPT INJECTION,,,29 ,,NW,,,,,,$60.37,$0.00,1,1,1,0,0,1,20131001,J2794,HCPCS,"RISPERIDONE, LONG ACTING",,,29 ,,NW,,,,,,$18.86,$0.00,1,1,1,0,0,1,20131001,J2795,HCPCS,ROPIVACAINE HCL INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J2796,HCPCS,ROMIPLOSTIM INJECTION,,,29 ,,NW,,,,,,$126.60,$0.00,1,1,1,0,0,1,20131001,J2800,HCPCS,METHOCARBAMOL INJECTION,,,29 ,,NW,,,,,,$76.71,$0.00,1,1,1,0,0,1,20131001,J2805,HCPCS,SINCALIDE INJECTION,,,29 ,,NW,,,,,,$205.72,$0.00,1,1,1,0,0,1,20131001,J2810,HCPCS,INJ THEOPHYLLINE PER 40 MG,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J2820,HCPCS,SARGRAMOSTIM INJECTION,,,29 ,,NW,,,,,,$68.97,$0.00,1,1,1,0,0,1,20131001,J2850,HCPCS,INJ SECRETIN SYNTHETIC HUMAN,,,29 ,,NW,,,,,,$74.99,$0.00,1,1,1,0,0,1,20131001,J2910,HCPCS,AUROTHIOGLUCOSE INJECITON,,,29 ,,NW,,,,,,$78.26,$0.00,1,1,1,0,0,1,20131001,J2916,HCPCS,NA FERRIC GLUCONATE COMPLEX,,,29 ,,NW,,,,,,$13.38,$0.00,1,1,1,0,0,1,20131001,J2920,HCPCS,METHYLPREDNISOLONE INJECTION,,,29 ,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20131001,J2930,HCPCS,METHYLPREDNISOLONE INJECTION,,,29 ,,NW,,,,,,$11.05,$0.00,1,1,1,0,0,1,20131001,J2940,HCPCS,SOMATREM INJECTION,,,29 ,,NW,,,,,,$127.42,$0.00,1,1,1,0,0,1,20131001,J2941,HCPCS,SOMATROPIN INJECTION,,,29 ,,NW,,,,,,$120.58,$0.00,1,1,1,0,0,1,20131001,J2950,HCPCS,PROMAZINE HCL INJECTION,,,29 ,,NW,,,,,,$33.47,$0.00,1,1,1,0,0,1,20131001,J2993,HCPCS,RETEPLASE INJECTION,,,29 ,,NW,,,,,,"$5,821.68",$0.00,1,1,1,0,0,1,20131001,J2995,HCPCS,INJ STREPTOKINASE /250000 IU,,,29 ,,NW,,,,,,$194.54,$0.00,1,1,1,0,0,1,20131001,J2997,HCPCS,ALTEPLASE RECOMBINANT,,,29 ,,NW,,,,,,$129.18,$0.00,1,1,1,0,0,1,20131001,J3000,HCPCS,STREPTOMYCIN INJECTION,,,29 ,,NW,,,,,,$32.85,$0.00,1,1,1,0,0,1,20131001,J3010,HCPCS,FENTANYL CITRATE INJECITON,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J3030,HCPCS,SUMATRIPTAN SUCCINATE / 6 MG,,,29 ,,NW,,,,,,$155.84,$0.00,1,1,1,0,0,1,20131001,J3070,HCPCS,PENTAZOCINE INJECTION,,,29 ,,NW,,,,,,$39.73,$0.00,1,1,1,0,0,1,20131001,J3095,HCPCS,TELAVANCIN INJECTION,,,29 ,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20131001,J3101,HCPCS,TENECTEPLASE INJECTION,,,29 ,,NW,,,,,,$173.04,$0.00,1,1,1,0,0,1,20131001,J3105,HCPCS,TERBUTALINE SULFATE INJ,,,29 ,,NW,,,,,,$20.81,$0.00,1,1,1,0,0,1,20131001,J3110,HCPCS,TERIPARATIDE INJECTION,,,29 ,,NW,,,,,,$25.97,$0.00,1,1,1,0,0,1,20131001,J3120,HCPCS,TESTOSTERONE ENANTHATE INJ,,,29 ,,NW,,,,,,$16.66,$0.00,1,1,1,0,0,1,20131001,J3130,HCPCS,TESTOSTERONE ENANTHATE INJ,,,29 ,,NW,,,,,,$28.55,$0.00,1,1,1,0,0,1,20131001,J3140,HCPCS,TESTOSTERONE SUSPENSION INJ,,,29 ,,NW,,,,,,$31.18,$0.00,1,1,1,0,0,1,20131001,J3150,HCPCS,TESTOSTERON PROPIONATE INJ,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J3230,HCPCS,CHLORPROMAZINE HCL INJECTION,,,29 ,,NW,,,,,,$28.55,$0.00,1,1,1,0,0,1,20131001,J3240,HCPCS,THYROTROPIN INJECTION,,,29 ,,NW,,,,,,"$2,668.83",$0.00,1,1,1,0,0,1,20131001,J3243,HCPCS,TIGECYCLINE INJECTION,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J3246,HCPCS,TIROFIBAN HCL,,,29 ,,NW,,,,,,$31.13,$0.00,1,1,1,0,0,1,20131001,J3250,HCPCS,TRIMETHOBENZAMIDE HCL INJ,,,29 ,,NW,,,,,,$31.99,$0.00,1,1,1,0,0,1,20131001,J3260,HCPCS,TOBRAMYCIN SULFATE INJECTION,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J3262,HCPCS,TOCILIZUMAB INJECTION,,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J3265,HCPCS,INJECTION TORSEMIDE 10 MG/ML,,,29 ,,NW,,,,,,$10.66,$0.00,1,1,1,0,0,1,20131001,J3280,HCPCS,THIETHYLPERAZINE MALEATE INJ,,,29 ,,NW,,,,,,$16.66,$0.00,1,1,1,0,0,1,20131001,J3285,HCPCS,TREPROSTINIL INJECTION,,,29 ,,NW,,,,,,$160.14,$0.00,1,1,1,0,0,1,20131001,J3300,HCPCS,TRIAMCINOLONE A INJ PRS-FREE,,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J3301,HCPCS,TRIAMCINOLONE ACET INJ NOS,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J3302,HCPCS,TRIAMCINOLONE DIACETATE INJ,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J3303,HCPCS,TRIAMCINOLONE HEXACETONL INJ,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J3305,HCPCS,INJ TRIMETREXATE GLUCORONATE,,,29 ,,NW,,,,,,$106.64,$0.00,1,1,1,0,0,1,20131001,J3310,HCPCS,PERPHENAZINE INJECITON,,,29 ,,NW,,,,,,$47.12,$0.00,1,1,1,0,0,1,20131001,J3315,HCPCS,TRIPTORELIN PAMOATE,,,29 ,,NW,,,,,,$437.92,$0.00,1,1,1,0,0,1,20131001,J3320,HCPCS,SPECTINOMYCN DI-HCL INJ,,,29 ,,NW,,,,,,$86.00,$0.00,1,1,1,0,0,1,20131001,J3350,HCPCS,UREA INJECTION,,,29 ,,NW,,,,,,$29.86,$0.00,1,1,1,0,0,1,20131001,J3355,HCPCS,"UROFOLLITROPIN, 75 IU",,,29 ,,NW,,,,,,$160.14,$0.00,1,1,1,0,0,1,20131001,J3357,HCPCS,USTEKINUMAB INJECTION,,,29 ,,NW,,,,,,$331.28,$0.00,1,1,1,0,0,1,20131001,J3360,HCPCS,DIAZEPAM INJECTION,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J3364,HCPCS,UROKINASE 5000 IU INJECTION,,,29 ,,NW,,,,,,$23.60,$0.00,1,1,1,0,0,1,20131001,J3365,HCPCS,"UROKINASE 250,000 IU INJ",,,29 ,,NW,,,,,,"$1,162.07",$0.00,1,1,1,0,0,1,20131001,J3370,HCPCS,VANCOMYCIN HCL INJECTION,,,29 ,,NW,,,,,,$9.82,$0.00,1,1,1,0,0,1,20131001,J3385,HCPCS,VELAGLUCERASE ALFA,,,29 ,,NW,,,,,,$887.72,$0.00,1,1,1,0,0,1,20131001,J3396,HCPCS,VERTEPORFIN INJECTION,,,29 ,,NW,,,,,,$31.13,$0.00,1,1,1,0,0,1,20131001,J3400,HCPCS,TRIFLUPROMAZINE HCL INJ,,,29 ,,NW,,,,,,$38.61,$0.00,1,1,1,0,0,1,20131001,J3410,HCPCS,HYDROXYZINE HCL INJECTION,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J3411,HCPCS,THIAMINE HCL 100 MG,,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J3415,HCPCS,PYRIDOXINE HCL 100 MG,,,29 ,,NW,,,,,,$22.53,$0.00,1,1,1,0,0,1,20131001,J3420,HCPCS,VITAMIN B12 INJECTION,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J3430,HCPCS,VITAMIN K PHYTONADIONE INJ,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J3465,HCPCS,"INJECTION, VORICONAZOLE",,,29 ,,NW,,,,,,$22.53,$0.00,1,1,1,0,0,1,20131001,J3470,HCPCS,HYALURONIDASE INJECTION,,,29 ,,NW,,,,,,$58.65,$0.00,1,1,1,0,0,1,20131001,J3471,HCPCS,"OVINE, UP TO 999 USP UNITS",,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J3472,HCPCS,"OVINE, 1000 USP UNITS",,,29 ,,NW,,,,,,$288.28,$0.00,1,1,1,0,0,1,20131001,J3473,HCPCS,HYALURONIDASE RECOMBINANT,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J3475,HCPCS,INJ MAGNESIUM SULFATE,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J3480,HCPCS,INJ POTASSIUM CHLORIDE,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J3485,HCPCS,ZIDOVUDINE,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J3486,HCPCS,ZIPRASIDONE MESYLATE,,,29 ,,NW,,,,,,$26.83,$0.00,1,1,1,0,0,1,20131001,J3487,HCPCS,ZOLEDRONIC ACID,,,29 ,,NW,,,,,,$574.67,$0.00,1,1,1,0,0,1,20131001,J3488,HCPCS,RECLAST INJECTION,,,29 ,,NW,,,,,,$572.95,$0.00,1,1,1,0,0,1,20131001,J3490,HCPCS,DRUGS UNCLASSIFIED INJECTION,,,29 ,,NW,,,,,,$5.38,$0.00,1,1,1,0,0,1,20131001,J3520,HCPCS,EDETATE DISODIUM PER 150 MG,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J3530,HCPCS,NASAL VACCINE INHALATION,,,29 ,,NW,,,,,,$51.76,$0.00,1,1,1,0,1,1,20131001,J3535,HCPCS,METERED DOSE INHALER DRUG,,,29 ,,NW,,,,,,$17.63,$0.00,1,1,1,0,0,1,20131001,J3570,HCPCS,LAETRILE AMYGDALIN VIT B17,,,29 ,,NW,,,,,,$54.97,$0.00,1,1,1,0,0,1,20131001,J3590,HCPCS,UNCLASSIFIED BIOLOGICS,,,29 ,,NW,,,,,,$58.42,$0.00,1,1,1,0,0,1,20131001,J7030,HCPCS,NORMAL SALINE SOLUTION INFUS,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7040,HCPCS,NORMAL SALINE SOLUTION INFUS,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J7042,HCPCS,5% DEXTROSE/NORMAL SALINE,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7050,HCPCS,NORMAL SALINE SOLUTION INFUS,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7060,HCPCS,5% DEXTROSE/WATER,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7070,HCPCS,D5W INFUSION,,,29 ,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20131001,J7100,HCPCS,DEXTRAN 40 INFUSION,,,29 ,,NW,,,,,,$60.37,$0.00,1,1,1,0,0,1,20131001,J7110,HCPCS,DEXTRAN 75 INFUSION,,,29 ,,NW,,,,,,$42.31,$0.00,1,1,1,0,0,1,20131001,J7120,HCPCS,RINGERS LACTATE INFUSION,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7131,HCPCS,HYPERTONIC SALINE SOL,,,29 ,,NW,,,,,,$8.48,$0.00,1,1,1,0,0,1,20131001,J7180,HCPCS,FACTOR XIII ANTI-HEM FACTOR,,,29 ,,NW,,,,,,$24.25,$0.00,1,1,1,0,0,1,20131001,J7183,HCPCS,WILATE INJECTION,,,29 ,,NW,,,,,,$3.68,$0.00,1,0,0,0,0,1,20131001,J7185,HCPCS,XYNTHA INJ,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7186,HCPCS,ANTIHEMOPHILIC VIII/VWF COMP,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7187,HCPCS,"HUMATE-P, INJ",,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7189,HCPCS,FACTOR VIIA,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J7190,HCPCS,FACTOR VIII,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7191,HCPCS,FACTOR VIII (PORCINE),,,29 ,,NW,,,,,,$6.23,$0.00,1,1,1,0,0,1,20131001,J7192,HCPCS,FACTOR VIII RECOMBINANT NOS,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7193,HCPCS,FACTOR IX NON-RECOMBINANT,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7194,HCPCS,FACTOR IX COMPLEX,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7195,HCPCS,FACTOR IX RECOMBINANT,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J7196,HCPCS,ANTITHROMBIN RECOMBINANT,,,29 ,,NW,,,,,,$8.23,$0.00,1,1,1,0,0,1,20131001,J7197,HCPCS,ANTITHROMBIN III INJECTION,,,29 ,,NW,,,,,,$9.82,$0.00,1,1,1,0,0,1,20131001,J7198,HCPCS,ANTI-INHIBITOR,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J7199,HCPCS,HEMOPHILIA CLOT FACTOR NOC,,,29 ,,NW,,,,,,$1.36,$0.00,1,1,1,0,0,1,20131001,J7300,HCPCS,INTRAUT COPPER CONTRACEPTIVE,,,29 ,,NW,,,,,,$965.12,$0.00,1,1,1,1,1,1,20131001,J7302,HCPCS,LEVONORGESTREL IU CONTRACEPT,,,29 ,,NW,,,,,,"$1,004.68",$0.00,1,1,1,1,1,1,20131001,J7303,HCPCS,CONTRACEPTIVE VAGINAL RING,,,29 ,,NW,,,,,,$98.21,$0.00,1,1,1,1,1,1,20131001,J7304,HCPCS,CONTRACEPTIVE HORMONE PATCH,,,29 ,,NW,,,,,,$49.83,$0.00,1,1,1,1,1,1,20131001,J7306,HCPCS,LEVONORGESTREL IMPLANT SYS,,,29 ,,NW,,,,,,"$1,004.68",$0.00,1,1,1,1,1,1,20131001,J7307,HCPCS,ETONOGESTREL IMPLANT SYSTEM,,,29 ,,NW,,,,,,$912.95,$0.00,1,1,1,1,1,1,20131001,J7308,HCPCS,AMINOLEVULINIC ACID HCL TOP,,,29 ,,NW,,,,,,$413.84,$0.00,1,1,1,0,0,1,20131001,J7309,HCPCS,"METHYL AMINOLEVULINATE, TOP",,,29 ,,NW,,,,,,$197.12,$0.00,1,1,1,0,0,1,20131001,J7310,HCPCS,GANCICLOVIR LONG ACT IMPLANT,,,29 ,,NW,,,,,,"$42,857.79",$0.00,1,1,1,0,0,1,20131001,J7311,HCPCS,FLUOCINOLONE ACETONIDE IMPLT,,,29 ,,NW,,,,,,"$48,883.98",$0.00,1,1,1,0,0,1,20131001,J7312,HCPCS,DEXAMETHASONE INTRA IMPLANT,,,29 ,,NW,,,,,,$499.85,$0.00,1,1,1,0,0,1,20131001,J7321,HCPCS,HYALGAN/SUPARTZ INJ PER DOSE,,,29 ,,NW,,,,,,$230.66,$0.00,1,1,1,0,0,1,20131001,J7323,HCPCS,EUFLEXXA INJ PER DOSE,,,29 ,,NW,,,,,,$399.22,$0.00,1,1,1,0,0,1,20131001,J7324,HCPCS,ORTHOVISC INJ PER DOSE,,,29 ,,NW,,,,,,$431.90,$0.00,1,1,1,0,0,1,20131001,J7325,HCPCS,SYNVISC OR SYNVISC-ONE,,,29 ,,NW,,,,,,$36.29,$0.00,1,1,1,0,0,1,20131001,J7330,HCPCS,CULTURED CHONDROCYTES IMPLNT,,,29 ,,NW,,,,,,"$74,569.48",$0.00,1,1,1,0,0,1,20131001,J7335,HCPCS,CAPSAICIN 8% PATCH,,,29 ,,NW,,,,,,$69.83,$0.00,1,1,1,0,0,1,20131001,J7500,HCPCS,AZATHIOPRINE ORAL 50MG,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7501,HCPCS,AZATHIOPRINE PARENTERAL,,,29 ,,NW,,,,,,$339.02,$0.00,1,1,1,0,0,1,20131001,J7502,HCPCS,CYCLOSPORINE ORAL 100 MG,,,29 ,,NW,,,,,,$12.28,$0.00,1,1,1,0,0,1,20131001,J7504,HCPCS,LYMPHOCYTE IMMUNE GLOBULIN,,,29 ,,NW,,,,,,"$1,637.66",$0.00,1,1,1,0,0,1,20131001,J7505,HCPCS,MONOCLONAL ANTIBODIES,,,29 ,,NW,,,,,,"$2,925.98",$0.00,1,1,1,0,0,1,20131001,J7506,HCPCS,PREDNISONE ORAL,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7507,HCPCS,TACROLIMUS ORAL PER 1 MG,,,29 ,,NW,,,,,,$8.60,$0.00,1,1,1,0,0,1,20131001,J7509,HCPCS,METHYLPREDNISOLONE ORAL,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J7510,HCPCS,PREDNISOLONE ORAL PER 5 MG,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7511,HCPCS,ANTITHYMOCYTE GLOBULN RABBIT,,,29 ,,NW,,,,,,"$1,191.31",$0.00,1,1,1,0,0,1,20131001,J7513,HCPCS,"DACLIZUMAB, PARENTERAL",,,29 ,,NW,,,,,,"$1,334.93",$0.00,1,1,1,0,0,1,20131001,J7515,HCPCS,CYCLOSPORINE ORAL 25 MG,,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,J7516,HCPCS,CYCLOSPORIN PARENTERAL 250MG,,,29 ,,NW,,,,,,$93.91,$0.00,1,1,1,0,0,1,20131001,J7517,HCPCS,MYCOPHENOLATE MOFETIL ORAL,,,29 ,,NW,,,,,,$4.91,$0.00,1,1,1,0,0,1,20131001,J7518,HCPCS,MYCOPHENOLIC ACID,,,29 ,,NW,,,,,,$13.38,$0.00,1,1,1,0,0,1,20131001,J7520,HCPCS,"SIROLIMUS, ORAL",,,29 ,,NW,,,,,,$34.57,$0.00,1,1,1,0,0,1,20131001,J7525,HCPCS,TACROLIMUS INJECTION,,,29 ,,NW,,,,,,$357.94,$0.00,1,1,1,0,0,1,20131001,J7599,HCPCS,IMMUNOSUPPRESSIVE DRUG NOC,,,29 ,,NW,,,,,,$6.17,$0.00,1,1,1,0,0,1,20131001,J7604,HCPCS,ACETYLCYSTEINE COMP UNIT,,,29 ,,NW,,,,,,$15.70,$0.00,1,1,1,0,0,1,20131001,J7605,HCPCS,ARFORMOTEROL NON-COMP UNIT,,,29 ,,NW,,,,,,$18.86,$0.00,1,1,1,0,0,1,20131001,J7606,HCPCS,"FORMOTEROL FUMARATE, INH",,,29 ,,NW,,,,,,$17.76,$0.00,1,1,1,0,0,1,20131001,J7607,HCPCS,LEVALBUTEROL COMP CON,,,29 ,,NW,,,,,,$13.02,$0.00,1,1,1,0,0,1,20131001,J7608,HCPCS,ACETYLCYSTEINE NON-COMP UNIT,,,29 ,,NW,,,,,,$8.60,$0.00,1,1,1,0,0,1,20131001,J7609,HCPCS,ALBUTEROL COMP UNIT,,,29 ,,NW,,,,,,$12.56,$0.00,1,1,1,0,0,1,20131001,J7610,HCPCS,ALBUTEROL COMP CON,,,29 ,,NW,,,,,,$16.13,$0.00,1,1,1,0,0,1,20131001,J7611,HCPCS,ALBUTEROL NON-COMP CON,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7612,HCPCS,LEVALBUTEROL NON-COMP CON,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7613,HCPCS,ALBUTEROL NON-COMP UNIT,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7614,HCPCS,LEVALBUTEROL NON-COMP UNIT,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7615,HCPCS,LEVALBUTEROL COMP UNIT,,,29 ,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20131001,J7620,HCPCS,ALBUTEROL IPRATROP NON-COMP,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7622,HCPCS,BECLOMETHASONE COMP UNIT,,,29 ,,NW,,,,,,$14.21,$0.00,1,1,1,0,0,1,20131001,J7624,HCPCS,BETAMETHASONE COMP UNIT,,,29 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20131001,J7626,HCPCS,BUDESONIDE NON-COMP UNIT,,,29 ,,NW,,,,,,$17.76,$0.00,1,1,1,0,0,1,20131001,J7627,HCPCS,BUDESONIDE COMP UNIT,,,29 ,,NW,,,,,,$16.66,$0.00,1,1,1,0,0,1,20131001,J7628,HCPCS,BITOLTEROL MESYLATE COMP CON,,,29 ,,NW,,,,,,$5.78,$0.00,1,1,1,0,0,1,20131001,J7629,HCPCS,BITOLTEROL MESYLATE COMP UNT,,,29 ,,NW,,,,,,$5.78,$0.00,1,1,1,0,0,1,20131001,J7631,HCPCS,CROMOLYN SODIUM NONCOMP UNIT,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J7632,HCPCS,CROMOLYN SODIUM COMP UNIT,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7633,HCPCS,BUDESONIDE NON-COMP CON,,,29 ,,NW,,,,,,$26.60,$0.00,1,1,1,0,0,1,20131001,J7634,HCPCS,BUDESONIDE COMP CON,,,29 ,,NW,,,,,,$47.99,$0.00,1,1,1,0,0,1,20131001,J7635,HCPCS,ATROPINE COMP CON,,,29 ,,NW,,,,,,$35.94,$0.00,1,1,1,0,0,1,20131001,J7636,HCPCS,ATROPINE COMP UNIT,,,29 ,,NW,,,,,,$14.25,$0.00,1,1,1,0,0,1,20131001,J7637,HCPCS,DEXAMETHASONE COMP CON,,,29 ,,NW,,,,,,$1.01,$0.00,1,1,1,0,0,1,20131001,J7638,HCPCS,DEXAMETHASONE COMP UNIT,,,29 ,,NW,,,,,,$1.01,$0.00,1,1,1,0,0,1,20131001,J7639,HCPCS,DORNASE ALFA NON-COMP UNIT,,,29 ,,NW,,,,,,$82.73,$0.00,1,1,1,0,0,1,20131001,J7640,HCPCS,FORMOTEROL COMP UNIT,,,29 ,,NW,,,,,,$19.81,$0.00,1,1,1,0,0,1,20131001,J7641,HCPCS,FLUNISOLIDE COMP UNIT,,,29 ,,NW,,,,,,$31.99,$0.00,1,1,1,0,0,1,20131001,J7642,HCPCS,GLYCOPYRROLATE COMP CON,,,29 ,,NW,,,,,,$0.74,$0.00,1,1,1,0,0,1,20131001,J7643,HCPCS,GLYCOPYRROLATE COMP UNIT,,,29 ,,NW,,,,,,$0.74,$0.00,1,1,1,0,0,1,20131001,J7644,HCPCS,IPRATROPIUM BROMIDE NON-COMP,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7645,HCPCS,IPRATROPIUM BROMIDE COMP,,,29 ,,NW,,,,,,$0.62,$0.00,1,1,1,0,0,1,20131001,J7647,HCPCS,ISOETHARINE COMP CON,,,29 ,,NW,,,,,,$6.27,$0.00,1,1,1,0,0,1,20131001,J7648,HCPCS,ISOETHARINE NON-COMP CON,,,29 ,,NW,,,,,,$2.12,$0.00,1,1,1,0,0,1,20131001,J7649,HCPCS,ISOETHARINE NON-COMP UNIT,,,29 ,,NW,,,,,,$2.12,$0.00,1,1,1,0,0,1,20131001,J7650,HCPCS,ISOETHARINE COMP UNIT,,,29 ,,NW,,,,,,$6.27,$0.00,1,1,1,0,0,1,20131001,J7657,HCPCS,ISOPROTERENOL COMP CON,,,29 ,,NW,,,,,,$8.53,$0.00,1,1,1,0,0,1,20131001,J7658,HCPCS,ISOPROTERENOL NON-COMP CON,,,29 ,,NW,,,,,,$11.70,$0.00,1,1,1,0,0,1,20131001,J7659,HCPCS,ISOPROTERENOL NON-COMP UNIT,,,29 ,,NW,,,,,,$11.70,$0.00,1,1,1,0,0,1,20131001,J7660,HCPCS,ISOPROTERENOL COMP UNIT,,,29 ,,NW,,,,,,$1.42,$0.00,1,1,1,0,0,1,20131001,J7665,HCPCS,MANNITOL FOR INHALER,,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,J7667,HCPCS,METAPROTERENOL COMP CON,,,29 ,,NW,,,,,,$11.37,$0.00,1,1,1,0,0,1,20131001,J7668,HCPCS,METAPROTERENOL NON-COMP CON,,,29 ,,NW,,,,,,$0.24,$0.00,1,1,1,0,0,1,20131001,J7669,HCPCS,METAPROTERENOL NON-COMP UNIT,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7670,HCPCS,METAPROTERENOL COMP UNIT,,,29 ,,NW,,,,,,$7.37,$0.00,1,1,1,0,0,1,20131001,J7674,HCPCS,"METHACHOLINE CHLORIDE, NEB",,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J7676,HCPCS,PENTAMIDINE COMP UNIT DOSE,,,29 ,,NW,,,,,,$515.52,$0.00,1,1,1,0,0,1,20131001,J7680,HCPCS,TERBUTALINE SULF COMP CON,,,29 ,,NW,,,,,,$38.87,$0.00,1,1,1,0,0,1,20131001,J7681,HCPCS,TERBUTALINE SULF COMP UNIT,,,29 ,,NW,,,,,,$38.87,$0.00,1,1,1,0,0,1,20131001,J7682,HCPCS,TOBRAMYCIN NON-COMP UNIT,,,29 ,,NW,,,,,,$236.68,$0.00,1,1,1,0,0,1,20131001,J7683,HCPCS,TRIAMCINOLONE COMP CON,,,29 ,,NW,,,,,,$16.66,$0.00,1,1,1,0,0,1,20131001,J7684,HCPCS,TRIAMCINOLONE COMP UNIT,,,29 ,,NW,,,,,,$10.71,$0.00,1,1,1,0,0,1,20131001,J7685,HCPCS,TOBRAMYCIN COMP UNIT,,,29 ,,NW,,,,,,$159.28,$0.00,1,1,1,0,0,1,20131001,J7686,HCPCS,"TREPROSTINIL, NON-COMP UNIT",,,29 ,,NW,,,,,,"$1,062.30",$0.00,1,1,1,0,0,1,20131001,J7699,HCPCS,INHALATION SOLUTION FOR DME,,,29 ,,NW,,,,,,$6.68,$0.00,1,1,1,0,0,1,20131001,J7799,HCPCS,NON-INHALATION DRUG FOR DME,,,29 ,,NW,,,,,,$15.50,$0.00,1,1,1,0,0,1,20131001,J8498,HCPCS,ANTIEMETIC RECTAL/SUPP NOS,,,29 ,,NW,,,,,,$1.36,$0.00,1,1,1,0,0,1,20131001,J8499,HCPCS,ORAL PRESCRIP DRUG NON CHEMO,,,29 ,,NW,,,,,,$1.19,$0.00,1,1,1,0,0,1,20131001,J8501,HCPCS,ORAL APREPITANT,,,29 ,,NW,,,,,,$20.81,$0.00,1,1,1,0,0,1,20131001,J8510,HCPCS,ORAL BUSULFAN,,,29 ,,NW,,,,,,$19.77,$0.00,1,1,1,0,0,1,20131001,J8515,HCPCS,"CABERGOLINE, ORAL 0.25MG",,,29 ,,NW,,,,,,$41.45,$0.00,1,1,1,0,0,1,20131001,J8520,HCPCS,"CAPECITABINE, ORAL, 150 MG",,,29 ,,NW,,,,,,$33.89,$0.00,1,1,1,0,0,1,20131001,J8521,HCPCS,"CAPECITABINE, ORAL, 500 MG",,,29 ,,NW,,,,,,$100.81,$0.00,1,1,1,0,0,1,20131001,J8530,HCPCS,CYCLOPHOSPHAMIDE ORAL 25 MG,,,29 ,,NW,,,,,,$4.24,$0.00,1,1,1,0,0,1,20131001,J8540,HCPCS,ORAL DEXAMETHASONE,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,J8560,HCPCS,ETOPOSIDE ORAL 50 MG,,,29 ,,NW,,,,,,$171.29,$0.00,1,1,1,0,0,1,20131001,J8561,HCPCS,ORAL EVEROLIMUS,,,29 ,,NW,,,,,,$25.42,$0.00,1,1,1,0,0,1,20131001,J8562,HCPCS,ORAL FLUDARABINE PHOSPHATE,,,29 ,,NW,,,,,,$261.90,$0.00,1,1,1,0,0,1,20131001,J8565,HCPCS,GEFITINIB ORAL,,,29 ,,NW,,,,,,$142.94,$0.00,1,1,1,0,0,1,20131001,J8597,HCPCS,ANTIEMETIC DRUG ORAL NOS,,,29 ,,NW,,,,,,$857.45,$0.00,1,1,1,0,0,1,20131001,J8600,HCPCS,MELPHALAN ORAL 2 MG,,,29 ,,NW,,,,,,$33.89,$0.00,1,1,1,0,0,1,20131001,J8610,HCPCS,METHOTREXATE ORAL 2.5 MG,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,J8650,HCPCS,NABILONE ORAL,,,29 ,,NW,,,,,,$45.75,$0.00,1,1,1,0,0,1,20131001,J8700,HCPCS,TEMOZOLOMIDE,,,29 ,,NW,,,,,,$42.36,$0.00,1,1,1,0,0,1,20131001,J8705,HCPCS,TOPOTECAN ORAL,,,29 ,,NW,,,,,,$261.90,$0.00,1,1,1,0,0,1,20131001,J8999,HCPCS,ORAL PRESCRIPTION DRUG CHEMO,,,29 ,,NW,,,,,,$13.63,$0.00,1,1,1,0,0,1,20131001,J9000,HCPCS,DOXORUBICIN HCL INJECTION,,,29 ,,NW,,,,,,$14.12,$0.00,1,1,1,0,0,1,20131001,J9001,HCPCS,DOXORUBICIN HCL LIPOSOME INJ,,,29 ,,NW,,,,,,"$1,035.64",$0.00,1,1,1,0,0,1,20131001,J9010,HCPCS,ALEMTUZUMAB INJECTION,,,29 ,,NW,,,,,,"$1,523.28",$0.00,1,1,1,0,0,1,20131001,J9015,HCPCS,ALDESLEUKIN INJECTION,,,29 ,,NW,,,,,,"$2,131.39",$0.00,1,1,1,0,0,1,20131001,J9017,HCPCS,ARSENIC TRIOXIDE INJECTION,,,29 ,,NW,,,,,,$146.12,$0.00,1,1,1,0,0,1,20131001,J9020,HCPCS,ASPARAGINASE INJECTION,,,29 ,,NW,,,,,,$207.53,$0.00,1,1,1,0,0,1,20131001,J9025,HCPCS,AZACITIDINE INJECTION,,,29 ,,NW,,,,,,$22.59,$0.00,1,1,1,0,0,1,20131001,J9027,HCPCS,CLOFARABINE INJECTION,,,29 ,,NW,,,,,,$323.54,$0.00,1,1,1,0,0,1,20131001,J9031,HCPCS,BCG LIVE INTRAVESICAL VAC,,,29 ,,NW,,,,,,$372.65,$0.00,1,1,1,0,0,1,20131001,J9033,HCPCS,BENDAMUSTINE INJECTION,,,29 ,,NW,,,,,,$76.64,$0.00,1,1,1,0,0,1,20131001,J9035,HCPCS,BEVACIZUMAB INJECTION,,,29 ,,NW,,,,,,$162.72,$0.00,1,1,1,0,0,1,20131001,J9040,HCPCS,BLEOMYCIN SULFATE INJECTION,,,29 ,,NW,,,,,,$95.77,$0.00,1,1,1,0,0,1,20131001,J9041,HCPCS,BORTEZOMIB INJECTION,,,29 ,,NW,,,,,,$115.42,$0.00,1,1,1,0,0,1,20131001,J9043,HCPCS,CABAZITAXEL INJECTION,,,29 ,,NW,,,,,,$419.97,$0.00,1,1,1,0,0,1,20131001,J9045,HCPCS,CARBOPLATIN INJECTION,,,29 ,,NW,,,,,,$15.53,$0.00,1,1,1,0,0,1,20131001,J9050,HCPCS,CARMUSTINE INJECTION,,,29 ,,NW,,,,,,$538.78,$0.00,1,1,1,0,0,1,20131001,J9055,HCPCS,CETUXIMAB INJECTION,,,29 ,,NW,,,,,,$134.34,$0.00,1,1,1,0,0,1,20131001,J9060,HCPCS,CISPLATIN 10 MG INJECTION,,,29 ,,NW,,,,,,$8.47,$0.00,1,1,1,0,0,1,20131001,J9065,HCPCS,INJ CLADRIBINE PER 1 MG,,,29 ,,NW,,,,,,$105.84,$0.00,1,1,1,0,0,1,20131001,J9070,HCPCS,CYCLOPHOSPHAMIDE 100 MG INJ,,,29 ,,NW,,,,,,$88.73,$0.00,1,1,1,0,0,1,20131001,J9098,HCPCS,CYTARABINE LIPOSOME INJ,,,29 ,,NW,,,,,,"$1,302.25",$0.00,1,1,1,0,0,1,20131001,J9100,HCPCS,CYTARABINE HCL 100 MG INJ,,,29 ,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20131001,J9120,HCPCS,DACTINOMYCIN INJECTION,,,29 ,,NW,,,,,,"$1,313.11",$0.00,1,1,1,0,0,1,20131001,J9130,HCPCS,DACARBAZINE 100 MG INJ,,,29 ,,NW,,,,,,$14.12,$0.00,1,1,1,0,0,1,20131001,J9150,HCPCS,DAUNORUBICIN INJECTION,,,29 ,,NW,,,,,,$76.64,$0.00,1,1,1,0,0,1,20131001,J9151,HCPCS,DAUNORUBICIN CITRATE INJ,,,29 ,,NW,,,,,,$190.42,$0.00,1,1,1,0,0,1,20131001,J9155,HCPCS,DEGARELIX INJECTION,,,29 ,,NW,,,,,,$11.05,$0.00,1,1,1,0,0,1,20131001,J9160,HCPCS,DENILEUKIN DIFTITOX INJ,,,29 ,,NW,,,,,,"$4,164.41",$0.00,1,1,1,0,0,1,20131001,J9165,HCPCS,DIETHYLSTILBESTROL INJECTION,,,29 ,,NW,,,,,,$58.31,$0.00,1,1,1,0,0,1,20131001,J9171,HCPCS,DOCETAXEL INJECTION,,,29 ,,NW,,,,,,$26.83,$0.00,1,1,1,0,0,1,20131001,J9175,HCPCS,ELLIOTTS B SOLUTION PER ML,,,29 ,,NW,,,,,,$14.47,$0.00,1,1,1,0,0,1,20131001,J9178,HCPCS,"INJ, EPIRUBICIN HCL, 2 MG",,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,J9179,HCPCS,ERIBULIN MESYLATE INJECTION,,,29 ,,NW,,,,,,$295.12,$0.00,1,1,1,0,0,1,20131001,J9181,HCPCS,ETOPOSIDE INJECTION,,,29 ,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20131001,J9185,HCPCS,FLUDARABINE PHOSPHATE INJ,,,29 ,,NW,,,,,,$265.93,$0.00,1,1,1,0,0,1,20131001,J9190,HCPCS,FLUOROURACIL INJECTION,,,29 ,,NW,,,,,,$7.06,$0.00,1,1,1,0,0,1,20131001,J9200,HCPCS,FLOXURIDINE INJECTION,,,29 ,,NW,,,,,,$178.33,$0.00,1,1,1,0,0,1,20131001,J9201,HCPCS,GEMCITABINE HCL INJECTION,,,29 ,,NW,,,,,,$97.79,$0.00,1,1,1,0,0,1,20131001,J9202,HCPCS,GOSERELIN ACETATE IMPLANT,,,29 ,,NW,,,,,,$465.28,$0.00,1,1,1,0,0,1,20131001,J9206,HCPCS,IRINOTECAN INJECTION,,,29 ,,NW,,,,,,$15.53,$0.00,1,1,1,0,0,1,20131001,J9207,HCPCS,IXABEPILONE INJECTION,,,29 ,,NW,,,,,,$214.58,$0.00,1,1,1,0,0,1,20131001,J9208,HCPCS,IFOSFAMIDE INJECTION,,,29 ,,NW,,,,,,$109.87,$0.00,1,1,1,0,0,1,20131001,J9209,HCPCS,MESNA INJECTION,,,29 ,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20131001,J9211,HCPCS,IDARUBICIN HCL INJECTION,,,29 ,,NW,,,,,,$278.01,$0.00,1,1,1,0,0,1,20131001,J9212,HCPCS,INTERFERON ALFACON-1 INJ,,,29 ,,NW,,,,,,$21.67,$0.00,1,1,1,0,0,1,20131001,J9213,HCPCS,INTERFERON ALFA-2A INJ,,,29 ,,NW,,,,,,$125.98,$0.00,1,1,1,0,0,1,20131001,J9214,HCPCS,INTERFERON ALFA-2B INJ,,,29 ,,NW,,,,,,$74.63,$0.00,1,1,1,0,0,1,20131001,J9215,HCPCS,INTERFERON ALFA-N3 INJ,,,29 ,,NW,,,,,,$71.61,$0.00,1,1,1,0,0,1,20131001,J9216,HCPCS,INTERFERON GAMMA 1-B INJ,,,29 ,,NW,,,,,,$921.37,$0.00,1,1,1,0,0,1,20131001,J9217,HCPCS,LEUPROLIDE ACETATE SUSPNSION,,,29 ,,NW,,,,,,$661.61,$0.00,1,1,1,0,0,1,20131001,J9218,HCPCS,LEUPROLIDE ACETATE INJECITON,,,29 ,,NW,,,,,,$24.01,$0.00,1,1,1,0,0,1,20131001,J9219,HCPCS,LEUPROLIDE ACETATE IMPLANT,,,29 ,,NW,,,,,,"$6,482.30",$0.00,1,1,1,0,0,1,20131001,J9225,HCPCS,VANTAS IMPLANT,,,29 ,,NW,,,,,,"$4,294.00",$0.00,1,1,1,0,0,1,20131001,J9226,HCPCS,SUPPRELIN LA IMPLANT,,,29 ,,NW,,,,,,"$20,017.54",$0.00,1,1,1,0,0,1,20131001,J9228,HCPCS,IPILIMUMAB INJECTION,,,29 ,,NW,,,,,,$390.77,$0.00,1,1,1,0,0,1,20131001,J9230,HCPCS,MECHLORETHAMINE HCL INJ,,,29 ,,NW,,,,,,$487.43,$0.00,1,1,1,0,0,1,20131001,J9245,HCPCS,INJ MELPHALAN HYDROCHL 50 MG,,,29 ,,NW,,,,,,"$2,213.47",$0.00,1,1,1,0,0,1,20131001,J9250,HCPCS,METHOTREXATE SODIUM INJ,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,J9260,HCPCS,METHOTREXATE SODIUM INJ,,,29 ,,NW,,,,,,$8.47,$0.00,1,1,1,0,0,1,20131001,J9261,HCPCS,NELARABINE INJECTION,,,29 ,,NW,,,,,,$307.20,$0.00,1,1,1,0,0,1,20131001,J9263,HCPCS,OXALIPLATIN,,,29 ,,NW,,,,,,$39.54,$0.00,1,1,1,0,0,1,20131001,J9264,HCPCS,PACLITAXEL PROTEIN BOUND,,,29 ,,NW,,,,,,$29.41,$0.00,1,1,1,0,0,1,20131001,J9265,HCPCS,PACLITAXEL INJECTION,,,29 ,,NW,,,,,,$31.07,$0.00,1,1,1,0,0,1,20131001,J9266,HCPCS,PEGASPARGASE INJECTION,,,29 ,,NW,,,,,,"$7,785.58",$0.00,1,1,1,0,0,1,20131001,J9268,HCPCS,PENTOSTATIN INJECTION,,,29 ,,NW,,,,,,"$1,735.93",$0.00,1,1,1,0,0,1,20131001,J9270,HCPCS,PLICAMYCIN (MITHRAMYCIN) INJ,,,29 ,,NW,,,,,,$313.02,$0.00,1,1,1,0,0,1,20131001,J9280,HCPCS,MITOMYCIN 5 MG INJ,,,29 ,,NW,,,,,,$73.62,$0.00,1,1,1,0,0,1,20131001,J9293,HCPCS,MITOXANTRONE HYDROCHL / 5 MG,,,29 ,,NW,,,,,,$105.84,$0.00,1,1,1,0,0,1,20131001,J9300,HCPCS,GEMTUZUMAB OZOGAMICIN INJ,,,29 ,,NW,,,,,,"$3,952.84",$0.00,1,1,1,0,0,1,20131001,J9302,HCPCS,OFATUMUMAB INJECTION,,,29 ,,NW,,,,,,$154.17,$0.00,1,1,1,0,0,1,20131001,J9303,HCPCS,PANITUMUMAB INJECTION,,,29 ,,NW,,,,,,$283.04,$0.00,1,1,1,0,0,1,20131001,J9305,HCPCS,PEMETREXED INJECTION,,,29 ,,NW,,,,,,$148.10,$0.00,1,1,1,0,0,1,20131001,J9307,HCPCS,PRALATREXATE INJECTION,,,29 ,,NW,,,,,,$534.75,$0.00,1,1,1,0,0,1,20131001,J9310,HCPCS,RITUXIMAB INJECTION,,,29 ,,NW,,,,,,"$1,395.60",$0.00,1,1,1,0,0,1,20131001,J9315,HCPCS,ROMIDEPSIN INJECTION,,,29 ,,NW,,,,,,$704.90,$0.00,1,1,1,0,0,1,20131001,J9320,HCPCS,STREPTOZOCIN INJECTION,,,29 ,,NW,,,,,,$837.80,$0.00,1,1,1,0,0,1,20131001,J9328,HCPCS,TEMOZOLOMIDE INJECTION,,,29 ,,NW,,,,,,$19.77,$0.00,1,1,1,0,0,1,20131001,J9330,HCPCS,TEMSIROLIMUS INJECTION,,,29 ,,NW,,,,,,$178.33,$0.00,1,1,1,0,0,1,20131001,J9340,HCPCS,THIOTEPA INJECTION,,,29 ,,NW,,,,,,$443.13,$0.00,1,1,1,0,0,1,20131001,J9351,HCPCS,TOPOTECAN INJECTION,,,29 ,,NW,,,,,,$16.94,$0.00,1,1,1,0,0,1,20131001,J9355,HCPCS,TRASTUZUMAB INJECTION,,,29 ,,NW,,,,,,$193.68,$0.00,1,1,1,0,0,1,20131001,J9357,HCPCS,VALRUBICIN INJECTION,,,29 ,,NW,,,,,,"$2,549.29",$0.00,1,1,1,0,0,1,20131001,J9360,HCPCS,VINBLASTINE SULFATE INJ,,,29 ,,NW,,,,,,$5.65,$0.00,1,1,1,0,0,1,20131001,J9370,HCPCS,VINCRISTINE SULFATE 1 MG INJ,,,29 ,,NW,,,,,,$15.53,$0.00,1,1,1,0,0,1,20131001,J9390,HCPCS,VINORELBINE TARTRATE INJ,,,29 ,,NW,,,,,,$40.95,$0.00,1,1,1,0,0,1,20131001,J9395,HCPCS,"INJECTION, FULVESTRANT",,,29 ,,NW,,,,,,$225.50,$0.00,1,1,1,0,0,1,20131001,J9600,HCPCS,PORFIMER SODIUM INJECTION,,,29 ,,NW,,,,,,"$3,431.77",$0.00,1,1,1,0,0,1,20131001,J9999,HCPCS,CHEMOTHERAPY DRUG,,,29 ,,NW,,,,,,$42.13,$0.00,1,1,1,0,0,1,20131001,K0001,HCPCS,STANDARD WHEELCHAIR,NU,,28 ,,NW,,,,,,"$1,088.39",$0.00,1,1,1,1,1,1,20131001,K0001,HCPCS,STANDARD WHEELCHAIR,RR,,28 ,,NW,,,,,,$112.89,$0.00,1,1,1,1,1,1,20131001,K0001,HCPCS,STANDARD WHEELCHAIR,UE,,28 ,,NW,,,,,,$817.12,$0.00,1,1,1,1,1,1,20131001,K0001,HCPCS,STANDARD WHEELCHAIR,,,28 ,,NW,,,,,,"$1,088.39",$0.00,1,1,1,1,1,1,20131001,K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,NU,,28 ,,NW,,,,,,"$1,038.35",$0.00,1,1,1,1,1,1,20131001,K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,RR,,28 ,,NW,,,,,,$168.72,$0.00,1,1,1,1,1,1,20131001,K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,UE,,28 ,,NW,,,,,,$788.75,$0.00,1,1,1,1,1,1,20131001,K0002,HCPCS,STND HEMI (LOW SEAT) WHLCHR,,,28 ,,NW,,,,,,"$1,038.35",$0.00,1,1,1,1,1,1,20131001,K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,NU,,28 ,,NW,,,,,,"$1,132.69",$0.00,1,1,1,1,1,1,20131001,K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,RR,,28 ,,NW,,,,,,$184.04,$0.00,1,1,1,1,1,1,20131001,K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,UE,,28 ,,NW,,,,,,$859.32,$0.00,1,1,1,1,1,1,20131001,K0003,HCPCS,LIGHTWEIGHT WHEELCHAIR,,,28 ,,NW,,,,,,"$1,132.69",$0.00,1,1,1,1,1,1,20131001,K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,NU,,28 ,,NW,,,,,,"$1,670.52",$0.00,1,1,1,1,1,1,20131001,K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,RR,,28 ,,NW,,,,,,$263.71,$0.00,1,1,1,1,1,1,20131001,K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,UE,,28 ,,NW,,,,,,"$1,262.69",$0.00,1,1,1,1,1,1,20131001,K0004,HCPCS,HIGH STRENGTH LTWT WHLCHR,,,28 ,,NW,,,,,,"$1,670.52",$0.00,1,1,1,1,1,1,20131001,K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,NU,,28 ,,NW,,,,,,"$3,357.58",$0.00,1,1,1,1,1,1,20131001,K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,RR,,28 ,,NW,,,,,,$371.56,$0.00,1,1,1,1,1,1,20131001,K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,UE,,28 ,,NW,,,,,,"$2,528.15",$0.00,1,1,1,1,1,1,20131001,K0005,HCPCS,ULTRALIGHTWEIGHT WHEELCHAIR,,,28 ,,NW,,,,,,"$3,357.58",$0.00,1,1,1,1,1,1,20131001,K0006,HCPCS,HEAVY DUTY WHEELCHAIR,NU,,28 ,,NW,,,,,,"$1,570.23",$0.00,1,1,1,1,1,1,20131001,K0006,HCPCS,HEAVY DUTY WHEELCHAIR,RR,,28 ,,NW,,,,,,$250.61,$0.00,1,1,1,1,1,1,20131001,K0006,HCPCS,HEAVY DUTY WHEELCHAIR,UE,,28 ,,NW,,,,,,"$1,187.66",$0.00,1,1,1,1,1,1,20131001,K0006,HCPCS,HEAVY DUTY WHEELCHAIR,,,28 ,,NW,,,,,,"$1,570.23",$0.00,1,1,1,1,1,1,20131001,K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,NU,,28 ,,NW,,,,,,"$2,217.26",$0.00,1,1,1,1,1,1,20131001,K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,RR,,28 ,,NW,,,,,,$353.89,$0.00,1,1,1,1,1,1,20131001,K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,UE,,28 ,,NW,,,,,,"$1,673.49",$0.00,1,1,1,1,1,1,20131001,K0007,HCPCS,EXTRA HEAVY DUTY WHEELCHAIR,,,28 ,,NW,,,,,,"$2,217.26",$0.00,1,1,1,1,1,1,20131001,K0009,HCPCS,OTHER MANUAL WHEELCHAIR/BASE,,,28 ,,NW,,,,,,"$1,048.51",$0.00,1,1,1,1,1,1,20131001,K0010,HCPCS,STND WT FRAME POWER WHLCHR,NU,,28 ,,NW,,,,,,"$5,236.99",$0.00,1,1,1,1,1,1,20131001,K0010,HCPCS,STND WT FRAME POWER WHLCHR,RR,,28 ,,NW,,,,,,$749.62,$0.00,1,1,1,1,1,1,20131001,K0010,HCPCS,STND WT FRAME POWER WHLCHR,UE,,28 ,,NW,,,,,,"$3,937.73",$0.00,1,1,1,1,1,1,20131001,K0010,HCPCS,STND WT FRAME POWER WHLCHR,,,28 ,,NW,,,,,,"$5,236.99",$0.00,1,1,1,1,1,1,20131001,K0011,HCPCS,STND WT PWR WHLCHR W CONTROL,NU,,28 ,,NW,,,,,,"$18,934.18",$0.00,1,1,1,1,1,1,20131001,K0011,HCPCS,STND WT PWR WHLCHR W CONTROL,RR,,28 ,,NW,,,,,,"$1,963.91",$0.00,1,1,1,1,1,1,20131001,K0011,HCPCS,STND WT PWR WHLCHR W CONTROL,,,28 ,,NW,,,,,,"$18,934.18",$0.00,1,1,1,1,1,1,20131001,K0012,HCPCS,LTWT PORTBL POWER WHLCHR,RR,,28 ,,NW,,,,,,$608.39,$0.00,1,1,1,1,1,1,20131001,K0012,HCPCS,LTWT PORTBL POWER WHLCHR,,,28 ,,NW,,,,,,"$5,865.47",$0.00,1,1,1,1,1,1,20131001,K0014,HCPCS,OTHER POWER WHLCHR BASE,,,28 ,,NW,,,,,,"$2,123.92",$0.00,1,1,1,1,1,1,20131001,K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,NU,,28 ,,NW,,,,,,$646.62,$0.00,1,1,1,1,1,1,20131001,K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,RR,,28 ,,NW,,,,,,$74.03,$0.00,1,1,1,1,1,1,20131001,K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,UE,,28 ,,NW,,,,,,$494.94,$0.00,1,1,1,1,1,1,20131001,K0015,HCPCS,DETACH NON-ADJUS HGHT ARMRST,,,28 ,,NW,,,,,,$646.62,$0.00,1,1,1,1,1,1,20131001,K0017,HCPCS,DETACH ADJUST ARMREST BASE,NU,,28 ,,NW,,,,,,$205.79,$0.00,1,1,1,1,1,1,20131001,K0017,HCPCS,DETACH ADJUST ARMREST BASE,RR,,28 ,,NW,,,,,,$21.87,$0.00,1,1,1,1,1,1,20131001,K0017,HCPCS,DETACH ADJUST ARMREST BASE,UE,,28 ,,NW,,,,,,$154.71,$0.00,1,1,1,1,1,1,20131001,K0017,HCPCS,DETACH ADJUST ARMREST BASE,,,28 ,,NW,,,,,,$205.79,$0.00,1,1,1,1,1,1,20131001,K0018,HCPCS,DETACH ADJUST ARMRST UPPER,NU,,28 ,,NW,,,,,,$115.60,$0.00,1,1,1,1,1,1,20131001,K0018,HCPCS,DETACH ADJUST ARMRST UPPER,RR,,28 ,,NW,,,,,,$12.80,$0.00,1,1,1,1,1,1,20131001,K0018,HCPCS,DETACH ADJUST ARMRST UPPER,UE,,28 ,,NW,,,,,,$87.10,$0.00,1,1,1,1,1,1,20131001,K0018,HCPCS,DETACH ADJUST ARMRST UPPER,,,28 ,,NW,,,,,,$115.60,$0.00,1,1,1,1,1,1,20131001,K0019,HCPCS,ARM PAD EACH,NU,,28 ,,NW,,,,,,$69.20,$0.00,1,1,1,1,1,1,20131001,K0019,HCPCS,ARM PAD EACH,RR,,28 ,,NW,,,,,,$8.23,$0.00,1,1,1,1,1,1,20131001,K0019,HCPCS,ARM PAD EACH,UE,,28 ,,NW,,,,,,$52.27,$0.00,1,1,1,1,1,1,20131001,K0019,HCPCS,ARM PAD EACH,,,28 ,,NW,,,,,,$69.20,$0.00,1,1,1,1,1,1,20131001,K0020,HCPCS,FIXED ADJUST ARMREST PAIR,NU,,28 ,,NW,,,,,,$187.19,$0.00,1,1,1,1,1,1,20131001,K0020,HCPCS,FIXED ADJUST ARMREST PAIR,RR,,28 ,,NW,,,,,,$20.04,$0.00,1,1,1,1,1,1,20131001,K0020,HCPCS,FIXED ADJUST ARMREST PAIR,UE,,28 ,,NW,,,,,,$140.71,$0.00,1,1,1,1,1,1,20131001,K0020,HCPCS,FIXED ADJUST ARMREST PAIR,,,28 ,,NW,,,,,,$187.19,$0.00,1,1,1,1,1,1,20131001,K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,NU,,28 ,,NW,,,,,,$187.90,$0.00,1,1,1,1,1,1,20131001,K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,RR,,28 ,,NW,,,,,,$18.20,$0.00,1,1,1,1,1,1,20131001,K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,UE,,28 ,,NW,,,,,,$141.33,$0.00,1,1,1,1,1,1,20131001,K0037,HCPCS,HIGH MOUNT FLIP-UP FOOTREST,,,28 ,,NW,,,,,,$187.90,$0.00,1,1,1,1,1,1,20131001,K0038,HCPCS,LEG STRAP EACH,NU,,28 ,,NW,,,,,,$98.43,$0.00,1,1,1,1,1,1,20131001,K0038,HCPCS,LEG STRAP EACH,RR,,28 ,,NW,,,,,,$11.14,$0.00,1,1,1,1,1,1,20131001,K0038,HCPCS,LEG STRAP EACH,UE,,28 ,,NW,,,,,,$74.18,$0.00,1,1,1,1,1,1,20131001,K0038,HCPCS,LEG STRAP EACH,,,28 ,,NW,,,,,,$98.43,$0.00,1,1,1,1,1,1,20131001,K0039,HCPCS,LEG STRAP H STYLE EACH,NU,,28 ,,NW,,,,,,$216.86,$0.00,1,1,1,1,1,1,20131001,K0039,HCPCS,LEG STRAP H STYLE EACH,RR,,28 ,,NW,,,,,,$23.05,$0.00,1,1,1,1,1,1,20131001,K0039,HCPCS,LEG STRAP H STYLE EACH,UE,,28 ,,NW,,,,,,$163.01,$0.00,1,1,1,1,1,1,20131001,K0039,HCPCS,LEG STRAP H STYLE EACH,,,28 ,,NW,,,,,,$216.86,$0.00,1,1,1,1,1,1,20131001,K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,NU,,28 ,,NW,,,,,,$289.33,$0.00,1,1,1,1,1,1,20131001,K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,RR,,28 ,,NW,,,,,,$31.23,$0.00,1,1,1,1,1,1,20131001,K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,UE,,28 ,,NW,,,,,,$225.31,$0.00,1,1,1,1,1,1,20131001,K0040,HCPCS,ADJUSTABLE ANGLE FOOTPLATE,,,28 ,,NW,,,,,,$289.33,$0.00,1,1,1,1,1,1,20131001,K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,NU,,28 ,,NW,,,,,,$213.03,$0.00,1,1,1,1,1,1,20131001,K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,RR,,28 ,,NW,,,,,,$22.66,$0.00,1,1,1,1,1,1,20131001,K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,UE,,28 ,,NW,,,,,,$160.11,$0.00,1,1,1,1,1,1,20131001,K0041,HCPCS,LARGE SIZE FOOTPLATE EACH,,,28 ,,NW,,,,,,$213.03,$0.00,1,1,1,1,1,1,20131001,K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,NU,,28 ,,NW,,,,,,$139.40,$0.00,1,1,1,1,1,1,20131001,K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,RR,,28 ,,NW,,,,,,$15.21,$0.00,1,1,1,1,1,1,20131001,K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,UE,,28 ,,NW,,,,,,$104.91,$0.00,1,1,1,1,1,1,20131001,K0042,HCPCS,STANDARD SIZE FOOTPLATE EACH,,,28 ,,NW,,,,,,$139.40,$0.00,1,1,1,1,1,1,20131001,K0043,HCPCS,FTRST LOWER EXTENSION TUBE,NU,,28 ,,NW,,,,,,$79.51,$0.00,1,1,1,1,1,1,20131001,K0043,HCPCS,FTRST LOWER EXTENSION TUBE,RR,,28 ,,NW,,,,,,$9.24,$0.00,1,1,1,1,1,1,20131001,K0043,HCPCS,FTRST LOWER EXTENSION TUBE,UE,,28 ,,NW,,,,,,$60.03,$0.00,1,1,1,1,1,1,20131001,K0043,HCPCS,FTRST LOWER EXTENSION TUBE,,,28 ,,NW,,,,,,$79.51,$0.00,1,1,1,1,1,1,20131001,K0044,HCPCS,FTRST UPPER HANGER BRACKET,NU,,28 ,,NW,,,,,,$67.96,$0.00,1,1,1,1,1,1,20131001,K0044,HCPCS,FTRST UPPER HANGER BRACKET,RR,,28 ,,NW,,,,,,$8.11,$0.00,1,1,1,1,1,1,20131001,K0044,HCPCS,FTRST UPPER HANGER BRACKET,UE,,28 ,,NW,,,,,,$51.31,$0.00,1,1,1,1,1,1,20131001,K0044,HCPCS,FTRST UPPER HANGER BRACKET,,,28 ,,NW,,,,,,$67.96,$0.00,1,1,1,1,1,1,20131001,K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,NU,,28 ,,NW,,,,,,$228.64,$0.00,1,1,1,1,1,1,20131001,K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,RR,,28 ,,NW,,,,,,$24.61,$0.00,1,1,1,1,1,1,20131001,K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,UE,,28 ,,NW,,,,,,$171.86,$0.00,1,1,1,1,1,1,20131001,K0045,HCPCS,FOOTREST COMPLETE ASSEMBLY,,,28 ,,NW,,,,,,$228.64,$0.00,1,1,1,1,1,1,20131001,K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,NU,,28 ,,NW,,,,,,$79.51,$0.00,1,1,1,1,1,1,20131001,K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,RR,,28 ,,NW,,,,,,$9.24,$0.00,1,1,1,1,1,1,20131001,K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,UE,,28 ,,NW,,,,,,$60.05,$0.00,1,1,1,1,1,1,20131001,K0046,HCPCS,ELEVAT LEGRST LOW EXTENSION,,,28 ,,NW,,,,,,$79.51,$0.00,1,1,1,1,1,1,20131001,K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,NU,,28 ,,NW,,,,,,$295.37,$0.00,1,1,1,1,1,1,20131001,K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,RR,,28 ,,NW,,,,,,$32.07,$0.00,1,1,1,1,1,1,20131001,K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,UE,,28 ,,NW,,,,,,$230.71,$0.00,1,1,1,1,1,1,20131001,K0047,HCPCS,ELEVAT LEGRST UP HANGR BRACK,,,28 ,,NW,,,,,,$295.37,$0.00,1,1,1,1,1,1,20131001,K0050,HCPCS,RATCHET ASSEMBLY,NU,,28 ,,NW,,,,,,$131.40,$0.00,1,1,1,1,1,1,20131001,K0050,HCPCS,RATCHET ASSEMBLY,RR,,28 ,,NW,,,,,,$14.39,$0.00,1,1,1,1,1,1,20131001,K0050,HCPCS,RATCHET ASSEMBLY,UE,,28 ,,NW,,,,,,$98.94,$0.00,1,1,1,1,1,1,20131001,K0050,HCPCS,RATCHET ASSEMBLY,,,28 ,,NW,,,,,,$131.40,$0.00,1,1,1,1,1,1,20131001,K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,NU,,28 ,,NW,,,,,,$211.76,$0.00,1,1,1,1,1,1,20131001,K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,RR,,28 ,,NW,,,,,,$22.54,$0.00,1,1,1,1,1,1,20131001,K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,UE,,28 ,,NW,,,,,,$159.12,$0.00,1,1,1,1,1,1,20131001,K0051,HCPCS,CAM RELESE ASSEM FTRST/LGRST,,,28 ,,NW,,,,,,$211.76,$0.00,1,1,1,1,1,1,20131001,K0052,HCPCS,SWINGAWAY DETACH FOOTREST,NU,,28 ,,NW,,,,,,$348.71,$0.00,1,1,1,1,1,1,20131001,K0052,HCPCS,SWINGAWAY DETACH FOOTREST,RR,,28 ,,NW,,,,,,$38.38,$0.00,1,1,1,1,1,1,20131001,K0052,HCPCS,SWINGAWAY DETACH FOOTREST,UE,,28 ,,NW,,,,,,$271.48,$0.00,1,1,1,1,1,1,20131001,K0052,HCPCS,SWINGAWAY DETACH FOOTREST,,,28 ,,NW,,,,,,$348.71,$0.00,1,1,1,1,1,1,20131001,K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,NU,,28 ,,NW,,,,,,$380.66,$0.00,1,1,1,1,1,1,20131001,K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,RR,,28 ,,NW,,,,,,$42.20,$0.00,1,1,1,1,1,1,20131001,K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,UE,,28 ,,NW,,,,,,$295.48,$0.00,1,1,1,1,1,1,20131001,K0053,HCPCS,ELEVATE FOOTREST ARTICULATE,,,28 ,,NW,,,,,,$380.66,$0.00,1,1,1,1,1,1,20131001,K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,NU,,28 ,,NW,,,,,,$205.58,$0.00,1,1,1,1,1,1,20131001,K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,RR,,28 ,,NW,,,,,,$21.87,$0.00,1,1,1,1,1,1,20131001,K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,UE,,28 ,,NW,,,,,,$154.60,$0.00,1,1,1,1,1,1,20131001,K0056,HCPCS,SEAT HT <17 OR >=21 LTWT WC,,,28 ,,NW,,,,,,$205.58,$0.00,1,1,1,1,1,1,20131001,K0065,HCPCS,SPOKE PROTECTORS,NU,,28 ,,NW,,,,,,$96.90,$0.00,1,1,1,1,1,1,20131001,K0065,HCPCS,SPOKE PROTECTORS,RR,,28 ,,NW,,,,,,$10.99,$0.00,1,1,1,1,1,1,20131001,K0065,HCPCS,SPOKE PROTECTORS,UE,,28 ,,NW,,,,,,$73.04,$0.00,1,1,1,1,1,1,20131001,K0065,HCPCS,SPOKE PROTECTORS,,,28 ,,NW,,,,,,$96.90,$0.00,1,1,1,1,1,1,20131001,K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,NU,,28 ,,NW,,,,,,$215.94,$0.00,1,1,1,1,1,1,20131001,K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,RR,,28 ,,NW,,,,,,$23.31,$0.00,1,1,1,1,1,1,20131001,K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,UE,,28 ,,NW,,,,,,$162.31,$0.00,1,1,1,1,1,1,20131001,K0069,HCPCS,REAR WHL COMPLETE SOLID TIRE,,,28 ,,NW,,,,,,$215.94,$0.00,1,1,1,1,1,1,20131001,K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,NU,,28 ,,NW,,,,,,$368.40,$0.00,1,1,1,1,1,1,20131001,K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,RR,,28 ,,NW,,,,,,$40.77,$0.00,1,1,1,1,1,1,20131001,K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,UE,,28 ,,NW,,,,,,$286.21,$0.00,1,1,1,1,1,1,20131001,K0070,HCPCS,REAR WHL COMPL PNEUM TIRE,,,28 ,,NW,,,,,,$368.40,$0.00,1,1,1,1,1,1,20131001,K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,NU,,28 ,,NW,,,,,,$235.92,$0.00,1,1,1,1,1,1,20131001,K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,RR,,28 ,,NW,,,,,,$24.93,$0.00,1,1,1,1,1,1,20131001,K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,UE,,28 ,,NW,,,,,,$177.36,$0.00,1,1,1,1,1,1,20131001,K0071,HCPCS,FRONT CASTR COMPL PNEUM TIRE,,,28 ,,NW,,,,,,$235.92,$0.00,1,1,1,1,1,1,20131001,K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,NU,,28 ,,NW,,,,,,$141.94,$0.00,1,1,1,1,1,1,20131001,K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,RR,,28 ,,NW,,,,,,$15.48,$0.00,1,1,1,1,1,1,20131001,K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,UE,,28 ,,NW,,,,,,$106.81,$0.00,1,1,1,1,1,1,20131001,K0072,HCPCS,FRNT CSTR CMPL SEM-PNEUM TIR,,,28 ,,NW,,,,,,$141.94,$0.00,1,1,1,1,1,1,20131001,K0073,HCPCS,CASTER PIN LOCK EACH,NU,,28 ,,NW,,,,,,$74.74,$0.00,1,1,1,1,1,1,20131001,K0073,HCPCS,CASTER PIN LOCK EACH,RR,,28 ,,NW,,,,,,$8.78,$0.00,1,1,1,1,1,1,20131001,K0073,HCPCS,CASTER PIN LOCK EACH,UE,,28 ,,NW,,,,,,$56.41,$0.00,1,1,1,1,1,1,20131001,K0073,HCPCS,CASTER PIN LOCK EACH,,,28 ,,NW,,,,,,$74.74,$0.00,1,1,1,1,1,1,20131001,K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,NU,,28 ,,NW,,,,,,$127.80,$0.00,1,1,1,1,1,1,20131001,K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,RR,,28 ,,NW,,,,,,$14.05,$0.00,1,1,1,1,1,1,20131001,K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,UE,,28 ,,NW,,,,,,$96.19,$0.00,1,1,1,1,1,1,20131001,K0077,HCPCS,FRONT CASTER ASSEM COMPLETE,,,28 ,,NW,,,,,,$127.80,$0.00,1,1,1,1,1,1,20131001,K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,NU,,28 ,,NW,,,,,,$108.61,$0.00,1,1,1,1,1,1,20131001,K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,RR,,28 ,,NW,,,,,,$12.20,$0.00,1,1,1,1,1,1,20131001,K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,UE,,28 ,,NW,,,,,,$81.80,$0.00,1,1,1,1,1,1,20131001,K0098,HCPCS,DRIVE BELT POWER WHEELCHAIR,,,28 ,,NW,,,,,,$108.61,$0.00,1,1,1,1,1,1,20131001,K0105,HCPCS,IV HANGER,NU,,28 ,,NW,,,,,,$214.95,$0.00,1,1,1,1,1,1,20131001,K0105,HCPCS,IV HANGER,RR,,28 ,,NW,,,,,,$22.77,$0.00,1,1,1,1,1,1,20131001,K0105,HCPCS,IV HANGER,UE,,28 ,,NW,,,,,,$161.58,$0.00,1,1,1,1,1,1,20131001,K0105,HCPCS,IV HANGER,,,28 ,,NW,,,,,,$214.95,$0.00,1,1,1,1,1,1,20131001,K0108,HCPCS,W/C COMPONENT-ACCESSORY NOS,,,28 ,,NW,,,,,,$161.34,$0.00,1,1,1,1,1,1,20131001,K0195,HCPCS,ELEVATING WHLCHAIR LEG RESTS,RR,,28 ,,NW,,,,,,$82.86,$0.00,1,1,1,1,1,1,20131001,K0195,HCPCS,ELEVATING WHLCHAIR LEG RESTS,,,28 ,,NW,,,,,,$798.90,$0.00,1,1,1,1,1,1,20131001,K0455,HCPCS,PUMP UNINTERRUPTED INFUSION,RR,,28 ,,NW,,,,,,$623.23,$0.00,1,1,1,1,1,1,20131001,K0455,HCPCS,PUMP UNINTERRUPTED INFUSION,,,28 ,,NW,,,,,,"$6,008.61",$0.00,1,1,1,1,1,1,20131001,K0462,HCPCS,TEMPORARY REPLACEMENT EQPMNT,,,28 ,,NW,,,,,,$522.31,$0.00,1,1,1,1,1,1,20131001,K0552,HCPCS,SUPPLY/EXT INF PUMP SYR TYPE,,,28 ,,NW,,,,,,$9.06,$0.00,1,1,1,1,1,1,20131001,K0601,HCPCS,REPL BATT SILVER OXIDE 1.5 V,NU,,28 ,,NW,,,,,,$3.81,$0.00,1,1,1,1,1,1,20131001,K0601,HCPCS,REPL BATT SILVER OXIDE 1.5 V,,,28 ,,NW,,,,,,$3.81,$0.00,1,1,1,1,1,1,20131001,K0602,HCPCS,REPL BATT SILVER OXIDE 3 V,NU,,28 ,,NW,,,,,,$18.76,$0.00,1,1,1,1,1,1,20131001,K0602,HCPCS,REPL BATT SILVER OXIDE 3 V,,,28 ,,NW,,,,,,$18.76,$0.00,1,1,1,1,1,1,20131001,K0603,HCPCS,REPL BATT ALKALINE 1.5 V,NU,,28 ,,NW,,,,,,$1.95,$0.00,1,1,1,1,1,1,20131001,K0603,HCPCS,REPL BATT ALKALINE 1.5 V,,,28 ,,NW,,,,,,$1.95,$0.00,1,1,1,1,1,1,20131001,K0604,HCPCS,REPL BATT LITHIUM 3.6 V,NU,,28 ,,NW,,,,,,$18.31,$0.00,1,1,1,1,1,1,20131001,K0604,HCPCS,REPL BATT LITHIUM 3.6 V,,,28 ,,NW,,,,,,$18.31,$0.00,1,1,1,1,1,1,20131001,K0605,HCPCS,REPL BATT LITHIUM 4.5 V,NU,,28 ,,NW,,,,,,$32.06,$0.00,1,1,1,1,1,1,20131001,K0605,HCPCS,REPL BATT LITHIUM 4.5 V,,,28 ,,NW,,,,,,$32.06,$0.00,1,1,1,1,1,1,20131001,K0606,HCPCS,AED GARMENT W ELEC ANALYSIS,KF,,28 ,,NW,,,,,,"$62,808.33",$0.00,1,1,1,1,1,1,20131001,K0606,HCPCS,AED GARMENT W ELEC ANALYSIS,RR,,28 ,,NW,,,,,,"$6,514.68",$0.00,1,1,1,1,1,1,20131001,K0606,HCPCS,AED GARMENT W ELEC ANALYSIS,,,28 ,,NW,,,,,,"$62,808.33",$0.00,1,1,1,1,1,1,20131001,K0607,HCPCS,REPL BATT FOR AED,NU,,28 ,,NW,,,,,,"$1,027.78",$0.00,1,1,1,1,1,1,20131001,K0607,HCPCS,REPL BATT FOR AED,RR,,28 ,,NW,,,,,,$74.68,$0.00,1,1,1,1,1,1,20131001,K0607,HCPCS,REPL BATT FOR AED,UE,,28 ,,NW,,,,,,$761.13,$0.00,1,1,1,1,1,1,20131001,K0607,HCPCS,REPL BATT FOR AED,,,28 ,,NW,,,,,,"$1,027.78",$0.00,1,1,1,1,1,1,20131001,K0608,HCPCS,REPL GARMENT FOR AED,NU,,28 ,,NW,,,,,,$626.81,$0.00,1,1,1,1,1,1,20131001,K0608,HCPCS,REPL GARMENT FOR AED,RR,,28 ,,NW,,,,,,$49.86,$0.00,1,1,1,1,1,1,20131001,K0608,HCPCS,REPL GARMENT FOR AED,UE,,28 ,,NW,,,,,,$460.38,$0.00,1,1,1,1,1,1,20131001,K0608,HCPCS,REPL GARMENT FOR AED,,,28 ,,NW,,,,,,$626.81,$0.00,1,1,1,1,1,1,20131001,K0609,HCPCS,REPL ELECTRODE FOR AED,KF,,28 ,,NW,,,,,,"$2,290.18",$0.00,1,1,1,1,1,1,20131001,K0609,HCPCS,REPL ELECTRODE FOR AED,,,28 ,,NW,,,,,,"$2,290.18",$0.00,1,1,1,1,1,1,20131001,K0669,HCPCS,SEAT/BACK CUS NO DMEPDAC VER,NU,,28 ,,NW,,,,,,$666.18,$0.00,1,1,1,1,1,1,20131001,K0669,HCPCS,SEAT/BACK CUS NO DMEPDAC VER,,,28 ,,NW,,,,,,$666.18,$0.00,1,1,1,1,1,1,20131001,K0672,HCPCS,REMOVABLE SOFT INTERFACE LE,,,28 ,,NW,,,,,,$156.11,$0.00,1,1,1,1,1,1,20131001,K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,NU,,28 ,,NW,,,,,,"$4,447.71",$0.00,1,1,1,1,1,1,20131001,K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,RR,,28 ,,NW,,,,,,$409.80,$0.00,1,1,1,1,1,1,20131001,K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,UE,,28 ,,NW,,,,,,"$3,326.05",$0.00,1,1,1,1,1,1,20131001,K0730,HCPCS,CTRL DOSE INH DRUG DELIV SYS,,,28 ,,NW,,,,,,"$4,447.71",$0.00,1,1,1,1,1,1,20131001,K0733,HCPCS,12-24HR SEALED LEAD ACID,NU,,28 ,,NW,,,,,,$122.66,$0.00,1,1,1,1,1,1,20131001,K0733,HCPCS,12-24HR SEALED LEAD ACID,RR,,28 ,,NW,,,,,,$13.66,$0.00,1,1,1,1,1,1,20131001,K0733,HCPCS,12-24HR SEALED LEAD ACID,UE,,28 ,,NW,,,,,,$92.41,$0.00,1,1,1,1,1,1,20131001,K0733,HCPCS,12-24HR SEALED LEAD ACID,,,28 ,,NW,,,,,,$122.66,$0.00,1,1,1,1,1,1,20131001,K0738,HCPCS,PORTABLE GAS OXYGEN SYSTEM,RR,,28 ,,NW,,,,,,$137.99,$0.00,1,1,1,1,1,1,20131001,K0738,HCPCS,PORTABLE GAS OXYGEN SYSTEM,,,28 ,,NW,,,,,,"$1,330.37",$0.00,1,1,1,1,1,1,20131001,K0739,HCPCS,REPAIR/SVC DME NON-OXYGEN EQ,,,28 ,,NW,,,,,,$32.00,$0.00,1,1,1,1,1,1,20131001,K0740,HCPCS,REPAIR/SVC OXYGEN EQUIPMENT,,,28 ,,NW,,,,,,$85.34,$0.00,1,1,1,1,1,1,20131001,K0741,HCPCS,PORTABLE GASEOUS OXYGEN SYS,,,28 ,,NW,,,,,,$738.34,$0.00,1,1,1,1,1,1,20131001,K0742,HCPCS,PORTABLE GASEOUS OXYGEN,,,28 ,,NW,,,,,,$237.17,$0.00,1,1,1,1,1,1,20131001,K0743,HCPCS,PORTABLE HOME SUCTION PUMP,,,28 ,,NW,,,,,,$162.90,$0.00,1,1,1,1,1,1,20131001,K0744,HCPCS,ABSORP DRG <= 16 SUC PUMP,,,28 ,,NW,,,,,,$3.53,$0.00,1,1,1,1,1,1,20131001,K0745,HCPCS,ABSORP DRG >16<=48 SUC PUMP,,,28 ,,NW,,,,,,$5.76,$0.00,1,1,1,1,1,1,20131001,K0746,HCPCS,ABSORP DRG >48 SUC PUMP,,,28 ,,NW,,,,,,$11.22,$0.00,1,1,1,1,1,1,20131001,K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,NU,,28 ,,NW,,,,,,"$2,045.90",$0.00,1,1,1,1,1,1,20131001,K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,RR,,28 ,,NW,,,,,,$240.55,$0.00,1,1,1,1,1,1,20131001,K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,UE,,28 ,,NW,,,,,,"$1,544.41",$0.00,1,1,1,1,1,1,20131001,K0800,HCPCS,POV GROUP 1 STD UP TO 300LBS,,,28 ,,NW,,,,,,"$2,045.90",$0.00,1,1,1,1,1,1,20131001,K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,NU,,28 ,,NW,,,,,,"$3,273.95",$0.00,1,1,1,1,1,1,20131001,K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,RR,,28 ,,NW,,,,,,$363.30,$0.00,1,1,1,1,1,1,20131001,K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,UE,,28 ,,NW,,,,,,"$2,465.45",$0.00,1,1,1,1,1,1,20131001,K0801,HCPCS,POV GROUP 1 HD 301-450 LBS,,,28 ,,NW,,,,,,"$3,273.95",$0.00,1,1,1,1,1,1,20131001,K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,NU,,28 ,,NW,,,,,,"$3,699.82",$0.00,1,1,1,1,1,1,20131001,K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,RR,,28 ,,NW,,,,,,$405.92,$0.00,1,1,1,1,1,1,20131001,K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,UE,,28 ,,NW,,,,,,"$2,784.85",$0.00,1,1,1,1,1,1,20131001,K0802,HCPCS,POV GROUP 1 VHD 451-600 LBS,,,28 ,,NW,,,,,,"$3,699.82",$0.00,1,1,1,1,1,1,20131001,K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,NU,,28 ,,NW,,,,,,"$2,466.60",$0.00,1,1,1,1,1,1,20131001,K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,RR,,28 ,,NW,,,,,,$282.60,$0.00,1,1,1,1,1,1,20131001,K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,UE,,28 ,,NW,,,,,,"$1,859.94",$0.00,1,1,1,1,1,1,20131001,K0806,HCPCS,POV GROUP 2 STD UP TO 300LBS,,,28 ,,NW,,,,,,"$2,466.60",$0.00,1,1,1,1,1,1,20131001,K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,NU,,28 ,,NW,,,,,,"$3,722.13",$0.00,1,1,1,1,1,1,20131001,K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,RR,,28 ,,NW,,,,,,$408.17,$0.00,1,1,1,1,1,1,20131001,K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,UE,,28 ,,NW,,,,,,"$2,801.61",$0.00,1,1,1,1,1,1,20131001,K0807,HCPCS,POV GROUP 2 HD 301-450 LBS,,,28 ,,NW,,,,,,"$3,722.13",$0.00,1,1,1,1,1,1,20131001,K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,NU,,28 ,,NW,,,,,,"$5,737.07",$0.00,1,1,1,1,1,1,20131001,K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,RR,,28 ,,NW,,,,,,$609.65,$0.00,1,1,1,1,1,1,20131001,K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,UE,,28 ,,NW,,,,,,"$4,312.76",$0.00,1,1,1,1,1,1,20131001,K0808,HCPCS,POV GROUP 2 VHD 451-600 LBS,,,28 ,,NW,,,,,,"$5,737.07",$0.00,1,1,1,1,1,1,20131001,K0812,HCPCS,POWER OPERATED VEHICLE NOC,,,28 ,,NW,,,,,,"$1,479.46",$0.00,1,1,1,1,1,1,20131001,K0813,HCPCS,PWC GP 1 STD PORT SEAT/BACK,RR,,28 ,,NW,,,,,,$529.20,$0.00,1,1,1,1,1,1,20131001,K0813,HCPCS,PWC GP 1 STD PORT SEAT/BACK,,,28 ,,NW,,,,,,"$5,067.65",$0.00,1,1,1,1,1,1,20131001,K0814,HCPCS,PWC GP 1 STD PORT CAP CHAIR,RR,,28 ,,NW,,,,,,$664.51,$0.00,1,1,1,1,1,1,20131001,K0814,HCPCS,PWC GP 1 STD PORT CAP CHAIR,,,28 ,,NW,,,,,,"$6,364.32",$0.00,1,1,1,1,1,1,20131001,K0815,HCPCS,PWC GP 1 STD SEAT/BACK,RR,,28 ,,NW,,,,,,$750.24,$0.00,1,1,1,1,1,1,20131001,K0815,HCPCS,PWC GP 1 STD SEAT/BACK,,,28 ,,NW,,,,,,"$7,185.84",$0.00,1,1,1,1,1,1,20131001,K0816,HCPCS,PWC GP 1 STD CAP CHAIR,RR,,28 ,,NW,,,,,,$720.47,$0.00,1,1,1,1,1,1,20131001,K0816,HCPCS,PWC GP 1 STD CAP CHAIR,,,28 ,,NW,,,,,,"$6,900.53",$0.00,1,1,1,1,1,1,20131001,K0820,HCPCS,PWC GP 2 STD PORT SEAT/BACK,RR,,28 ,,NW,,,,,,$562.12,$0.00,1,1,1,1,1,1,20131001,K0820,HCPCS,PWC GP 2 STD PORT SEAT/BACK,,,28 ,,NW,,,,,,"$5,383.05",$0.00,1,1,1,1,1,1,20131001,K0821,HCPCS,PWC GP 2 STD PORT CAP CHAIR,RR,,28 ,,NW,,,,,,$708.50,$0.00,1,1,1,1,1,1,20131001,K0821,HCPCS,PWC GP 2 STD PORT CAP CHAIR,,,28 ,,NW,,,,,,"$6,785.84",$0.00,1,1,1,1,1,1,20131001,K0822,HCPCS,PWC GP 2 STD SEAT/BACK,RR,,28 ,,NW,,,,,,$846.63,$0.00,1,1,1,1,1,1,20131001,K0822,HCPCS,PWC GP 2 STD SEAT/BACK,,,28 ,,NW,,,,,,"$8,109.53",$0.00,1,1,1,1,1,1,20131001,K0823,HCPCS,PWC GP 2 STD CAP CHAIR,RR,,28 ,,NW,,,,,,$851.91,$0.00,1,1,1,1,1,1,20131001,K0823,HCPCS,PWC GP 2 STD CAP CHAIR,,,28 ,,NW,,,,,,"$8,160.05",$0.00,1,1,1,1,1,1,20131001,K0824,HCPCS,PWC GP 2 HD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,015.88",$0.00,1,1,1,1,1,1,20131001,K0824,HCPCS,PWC GP 2 HD SEAT/BACK,,,28 ,,NW,,,,,,"$9,731.32",$0.00,1,1,1,1,1,1,20131001,K0825,HCPCS,PWC GP 2 HD CAP CHAIR,RR,,28 ,,NW,,,,,,$933.92,$0.00,1,1,1,1,1,1,20131001,K0825,HCPCS,PWC GP 2 HD CAP CHAIR,,,28 ,,NW,,,,,,"$8,945.93",$0.00,1,1,1,1,1,1,20131001,K0826,HCPCS,PWC GP 2 VHD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,301.60",$0.00,1,1,1,1,1,1,20131001,K0826,HCPCS,PWC GP 2 VHD SEAT/BACK,,,28 ,,NW,,,,,,"$12,469.29",$0.00,1,1,1,1,1,1,20131001,K0827,HCPCS,PWC GP VHD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,113.65",$0.00,1,1,1,1,1,1,20131001,K0827,HCPCS,PWC GP VHD CAP CHAIR,,,28 ,,NW,,,,,,"$10,668.24",$0.00,1,1,1,1,1,1,20131001,K0828,HCPCS,PWC GP 2 XTRA HD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,429.53",$0.00,1,1,1,1,1,1,20131001,K0828,HCPCS,PWC GP 2 XTRA HD SEAT/BACK,,,28 ,,NW,,,,,,"$13,695.21",$0.00,1,1,1,1,1,1,20131001,K0829,HCPCS,PWC GP 2 XTRA HD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,316.49",$0.00,1,1,1,1,1,1,20131001,K0829,HCPCS,PWC GP 2 XTRA HD CAP CHAIR,,,28 ,,NW,,,,,,"$12,612.04",$0.00,1,1,1,1,1,1,20131001,K0830,HCPCS,PWC GP2 STD SEAT ELEVATE S/B,,,28 ,,NW,,,,,,"$1,166.52",$0.00,1,1,1,1,1,1,20131001,K0831,HCPCS,PWC GP2 STD SEAT ELEVATE CAP,,,28 ,,NW,,,,,,"$1,937.22",$0.00,1,1,1,1,1,1,20131001,K0835,HCPCS,PWC GP2 STD SING POW OPT S/B,RR,,28 ,,NW,,,,,,$858.63,$0.00,1,1,1,1,1,1,20131001,K0835,HCPCS,PWC GP2 STD SING POW OPT S/B,,,28 ,,NW,,,,,,"$8,224.48",$0.00,1,1,1,1,1,1,20131001,K0836,HCPCS,PWC GP2 STD SING POW OPT CAP,RR,,28 ,,NW,,,,,,$888.74,$0.00,1,1,1,1,1,1,20131001,K0836,HCPCS,PWC GP2 STD SING POW OPT CAP,,,28 ,,NW,,,,,,"$8,512.96",$0.00,1,1,1,1,1,1,20131001,K0837,HCPCS,PWC GP 2 HD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,015.88",$0.00,1,1,1,1,1,1,20131001,K0837,HCPCS,PWC GP 2 HD SING POW OPT S/B,,,28 ,,NW,,,,,,"$9,731.32",$0.00,1,1,1,1,1,1,20131001,K0838,HCPCS,PWC GP 2 HD SING POW OPT CAP,RR,,28 ,,NW,,,,,,$913.66,$0.00,1,1,1,1,1,1,20131001,K0838,HCPCS,PWC GP 2 HD SING POW OPT CAP,,,28 ,,NW,,,,,,"$8,751.85",$0.00,1,1,1,1,1,1,20131001,K0839,HCPCS,PWC GP2 VHD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,301.60",$0.00,1,1,1,1,1,1,20131001,K0839,HCPCS,PWC GP2 VHD SING POW OPT S/B,,,28 ,,NW,,,,,,"$12,469.29",$0.00,1,1,1,1,1,1,20131001,K0840,HCPCS,PWC GP2 XHD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,948.17",$0.00,1,1,1,1,1,1,20131001,K0840,HCPCS,PWC GP2 XHD SING POW OPT S/B,,,28 ,,NW,,,,,,"$18,665.19",$0.00,1,1,1,1,1,1,20131001,K0841,HCPCS,PWC GP2 STD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,$910.95,$0.00,1,1,1,1,1,1,20131001,K0841,HCPCS,PWC GP2 STD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$8,725.82",$0.00,1,1,1,1,1,1,20131001,K0842,HCPCS,PWC GP2 STD MULT POW OPT CAP,RR,,28 ,,NW,,,,,,$910.95,$0.00,1,1,1,1,1,1,20131001,K0842,HCPCS,PWC GP2 STD MULT POW OPT CAP,,,28 ,,NW,,,,,,"$8,725.82",$0.00,1,1,1,1,1,1,20131001,K0843,HCPCS,PWC GP2 HD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,087.36",$0.00,1,1,1,1,1,1,20131001,K0843,HCPCS,PWC GP2 HD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$10,416.31",$0.00,1,1,1,1,1,1,20131001,K0848,HCPCS,PWC GP 3 STD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,104.33",$0.00,1,1,1,1,1,1,20131001,K0848,HCPCS,PWC GP 3 STD SEAT/BACK,,,28 ,,NW,,,,,,"$10,578.97",$0.00,1,1,1,1,1,1,20131001,K0849,HCPCS,PWC GP 3 STD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,063.56",$0.00,1,1,1,1,1,1,20131001,K0849,HCPCS,PWC GP 3 STD CAP CHAIR,,,28 ,,NW,,,,,,"$10,188.25",$0.00,1,1,1,1,1,1,20131001,K0850,HCPCS,PWC GP 3 HD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,273.63",$0.00,1,1,1,1,1,1,20131001,K0850,HCPCS,PWC GP 3 HD SEAT/BACK,,,28 ,,NW,,,,,,"$12,201.30",$0.00,1,1,1,1,1,1,20131001,K0851,HCPCS,PWC GP 3 HD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,226.36",$0.00,1,1,1,1,1,1,20131001,K0851,HCPCS,PWC GP 3 HD CAP CHAIR,,,28 ,,NW,,,,,,"$11,748.30",$0.00,1,1,1,1,1,1,20131001,K0852,HCPCS,PWC GP 3 VHD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,464.43",$0.00,1,1,1,1,1,1,20131001,K0852,HCPCS,PWC GP 3 VHD SEAT/BACK,,,28 ,,NW,,,,,,"$14,029.67",$0.00,1,1,1,1,1,1,20131001,K0853,HCPCS,PWC GP 3 VHD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,503.09",$0.00,1,1,1,1,1,1,20131001,K0853,HCPCS,PWC GP 3 VHD CAP CHAIR,,,28 ,,NW,,,,,,"$14,400.11",$0.00,1,1,1,1,1,1,20131001,K0854,HCPCS,PWC GP 3 XHD SEAT/BACK,RR,,28 ,,NW,,,,,,"$1,976.27",$0.00,1,1,1,1,1,1,20131001,K0854,HCPCS,PWC GP 3 XHD SEAT/BACK,,,28 ,,NW,,,,,,"$18,934.47",$0.00,1,1,1,1,1,1,20131001,K0855,HCPCS,PWC GP 3 XHD CAP CHAIR,RR,,28 ,,NW,,,,,,"$1,869.43",$0.00,1,1,1,1,1,1,20131001,K0855,HCPCS,PWC GP 3 XHD CAP CHAIR,,,28 ,,NW,,,,,,"$17,910.67",$0.00,1,1,1,1,1,1,20131001,K0856,HCPCS,PWC GP3 STD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,182.02",$0.00,1,1,1,1,1,1,20131001,K0856,HCPCS,PWC GP3 STD SING POW OPT S/B,,,28 ,,NW,,,,,,"$11,323.37",$0.00,1,1,1,1,1,1,20131001,K0857,HCPCS,PWC GP3 STD SING POW OPT CAP,RR,,28 ,,NW,,,,,,"$1,204.77",$0.00,1,1,1,1,1,1,20131001,K0857,HCPCS,PWC GP3 STD SING POW OPT CAP,,,28 ,,NW,,,,,,"$11,541.45",$0.00,1,1,1,1,1,1,20131001,K0858,HCPCS,PWC GP3 HD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,455.44",$0.00,1,1,1,1,1,1,20131001,K0858,HCPCS,PWC GP3 HD SING POW OPT S/B,,,28 ,,NW,,,,,,"$13,943.49",$0.00,1,1,1,1,1,1,20131001,K0859,HCPCS,PWC GP3 HD SING POW OPT CAP,RR,,28 ,,NW,,,,,,"$1,390.16",$0.00,1,1,1,1,1,1,20131001,K0859,HCPCS,PWC GP3 HD SING POW OPT CAP,,,28 ,,NW,,,,,,"$13,317.99",$0.00,1,1,1,1,1,1,20131001,K0860,HCPCS,PWC GP3 VHD SING POW OPT S/B,RR,,28 ,,NW,,,,,,"$2,059.50",$0.00,1,1,1,1,1,1,20131001,K0860,HCPCS,PWC GP3 VHD SING POW OPT S/B,,,28 ,,NW,,,,,,"$19,732.08",$0.00,1,1,1,1,1,1,20131001,K0861,HCPCS,PWC GP3 STD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,"$2,649.37",$0.00,1,1,1,1,1,1,20131001,K0861,HCPCS,PWC GP3 STD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$25,384.62",$0.00,1,1,1,1,1,1,20131001,K0862,HCPCS,PWC GP3 HD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,"$1,455.44",$0.00,1,1,1,1,1,1,20131001,K0862,HCPCS,PWC GP3 HD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$13,943.49",$0.00,1,1,1,1,1,1,20131001,K0863,HCPCS,PWC GP3 VHD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,"$2,059.50",$0.00,1,1,1,1,1,1,20131001,K0863,HCPCS,PWC GP3 VHD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$19,732.08",$0.00,1,1,1,1,1,1,20131001,K0864,HCPCS,PWC GP3 XHD MULT POW OPT S/B,RR,,28 ,,NW,,,,,,"$2,442.07",$0.00,1,1,1,1,1,1,20131001,K0864,HCPCS,PWC GP3 XHD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$23,398.04",$0.00,1,1,1,1,1,1,20131001,K0868,HCPCS,PWC GP 4 STD SEAT/BACK,,,28 ,,NW,,,,,,"$3,931.74",$0.00,1,1,1,1,1,1,20131001,K0869,HCPCS,PWC GP 4 STD CAP CHAIR,,,28 ,,NW,,,,,,"$3,564.17",$0.00,1,1,1,1,1,1,20131001,K0870,HCPCS,PWC GP 4 HD SEAT/BACK,,,28 ,,NW,,,,,,"$5,390.93",$0.00,1,1,1,1,1,1,20131001,K0871,HCPCS,PWC GP 4 VHD SEAT/BACK,,,28 ,,NW,,,,,,"$9,579.29",$0.00,1,1,1,1,1,1,20131001,K0877,HCPCS,PWC GP4 STD SING POW OPT S/B,,,28 ,,NW,,,,,,"$4,350.55",$0.00,1,1,1,1,1,1,20131001,K0878,HCPCS,PWC GP4 STD SING POW OPT CAP,,,28 ,,NW,,,,,,"$3,692.41",$0.00,1,1,1,1,1,1,20131001,K0879,HCPCS,PWC GP4 HD SING POW OPT S/B,,,28 ,,NW,,,,,,"$4,466.20",$0.00,1,1,1,1,1,1,20131001,K0880,HCPCS,PWC GP4 VHD SING POW OPT S/B,,,28 ,,NW,,,,,,"$4,780.00",$0.00,1,1,1,1,1,1,20131001,K0884,HCPCS,PWC GP4 STD MULT POW OPT S/B,,,28 ,,NW,,,,,,"$4,355.09",$0.00,1,1,1,1,1,1,20131001,K0885,HCPCS,PWC GP4 STD MULT POW OPT CAP,,,28 ,,NW,,,,,,"$4,038.78",$0.00,1,1,1,1,1,1,20131001,K0886,HCPCS,PWC GP4 HD MULT POW S/B,,,28 ,,NW,,,,,,"$5,712.12",$0.00,1,1,1,1,1,1,20131001,K0890,HCPCS,PWC GP5 PED SING POW OPT S/B,,,28 ,,NW,,,,,,"$1,676.90",$0.00,1,1,1,1,1,1,20131001,K0891,HCPCS,PWC GP5 PED MULT POW OPT S/B,,,28 ,,NW,,,,,,"$2,764.84",$0.00,1,1,1,1,1,1,20131001,K0898,HCPCS,POWER WHEELCHAIR NOC,,,28 ,,NW,,,,,,"$2,536.52",$0.00,1,1,1,1,1,1,20131001,K0899,HCPCS,POW MOBIL DEV NO DMEPDAC,,,28 ,,NW,,,,,,"$1,866.46",$0.00,1,1,1,1,1,1,20131001,L0112,HCPCS,CRANIAL CERVICAL ORTHOSIS,,,28 ,,NW,,,,,,"$2,066.27",$0.00,1,1,1,1,1,1,20131001,L0113,HCPCS,CRANIAL CERVICAL TORTICOLLIS,,,28 ,,NW,,,,,,$386.13,$0.00,1,1,1,1,1,1,20131001,L0120,HCPCS,CERV FLEXIBLE NON-ADJUSTABLE,,,28 ,,NW,,,,,,$38.34,$0.00,1,1,1,1,1,1,20131001,L0130,HCPCS,FLEX THERMOPLASTIC COLLAR MO,,,28 ,,NW,,,,,,$224.63,$0.00,1,1,1,1,1,1,20131001,L0140,HCPCS,CERVICAL SEMI-RIGID ADJUSTAB,,,28 ,,NW,,,,,,$85.42,$0.00,1,1,1,1,1,1,20131001,L0150,HCPCS,CERV SEMI-RIG ADJ MOLDED CHN,,,28 ,,NW,,,,,,$149.95,$0.00,1,1,1,1,1,1,20131001,L0160,HCPCS,CERV SEMI-RIG WIRE OCC/MAND,,,28 ,,NW,,,,,,$213.46,$0.00,1,1,1,1,1,1,20131001,L0170,HCPCS,CERVICAL COLLAR MOLDED TO PT,,,28 ,,NW,,,,,,"$1,028.79",$0.00,1,1,1,1,1,1,20131001,L0172,HCPCS,CERV COL THERMPLAS FOAM 2 PI,,,28 ,,NW,,,,,,$177.95,$0.00,1,1,1,1,1,1,20131001,L0174,HCPCS,CERV COL FOAM 2 PIECE W THOR,,,28 ,,NW,,,,,,$383.80,$0.00,1,1,1,1,1,1,20131001,L0180,HCPCS,CER POST COL OCC/MAN SUP ADJ,,,28 ,,NW,,,,,,$559.09,$0.00,1,1,1,1,1,1,20131001,L0190,HCPCS,CERV COLLAR SUPP ADJ CERV BA,,,28 ,,NW,,,,,,$762.90,$0.00,1,1,1,1,1,1,20131001,L0200,HCPCS,CERV COL SUPP ADJ BAR & THOR,,,28 ,,NW,,,,,,$800.93,$0.00,1,1,1,1,1,1,20131001,L0220,HCPCS,THOR RIB BELT CUSTOM FABRICA,,,28 ,,NW,,,,,,$165.19,$0.00,1,1,1,1,1,1,20131001,L0430,HCPCS,DEWALL POSTURE PROTECTOR,,,28 ,,NW,,,,,,"$2,138.33",$0.00,1,1,1,1,1,1,20131001,L0450,HCPCS,TLSO FLEX PREFAB THORACIC,,,28 ,,NW,,,,,,$238.75,$0.00,1,1,1,1,1,1,20131001,L0452,HCPCS,TLSO FLEX CUSTOM FAB THORACI,,,28 ,,NW,,,,,,$506.99,$0.00,1,1,1,1,1,1,20131001,L0454,HCPCS,TLSO FLEX PREFAB SACROCOC-T9,,,28 ,,NW,,,,,,$478.46,$0.00,1,1,1,1,1,1,20131001,L0456,HCPCS,TLSO FLEX PREFAB,,,28 ,,NW,,,,,,"$1,455.40",$0.00,1,1,1,1,1,1,20131001,L0458,HCPCS,TLSO 2MOD SYMPHIS-XIPHO PRE,,,28 ,,NW,,,,,,"$1,300.44",$0.00,1,1,1,1,1,1,20131001,L0460,HCPCS,TLSO2MOD SYMPHYSIS-STERN PRE,,,28 ,,NW,,,,,,"$1,469.34",$0.00,1,1,1,1,1,1,20131001,L0462,HCPCS,TLSO 3MOD SACRO-SCAP PRE,,,28 ,,NW,,,,,,"$1,838.50",$0.00,1,1,1,1,1,1,20131001,L0464,HCPCS,TLSO 4MOD SACRO-SCAP PRE,,,28 ,,NW,,,,,,"$2,197.20",$0.00,1,1,1,1,1,1,20131001,L0466,HCPCS,TLSO RIGID FRAME PRE SOFT AP,,,28 ,,NW,,,,,,$554.83,$0.00,1,1,1,1,1,1,20131001,L0468,HCPCS,TLSO RIGID FRAME PREFAB PELV,,,28 ,,NW,,,,,,$695.52,$0.00,1,1,1,1,1,1,20131001,L0470,HCPCS,TLSO RIGID FRAME PRE SUBCLAV,,,28 ,,NW,,,,,,$985.62,$0.00,1,1,1,1,1,1,20131001,L0472,HCPCS,TLSO RIGID FRAME HYPEREX PRE,,,28 ,,NW,,,,,,$613.23,$0.00,1,1,1,1,1,1,20131001,L0480,HCPCS,TLSO RIGID PLASTIC CUSTOM FA,,,28 ,,NW,,,,,,"$2,203.38",$0.00,1,1,1,1,1,1,20131001,L0482,HCPCS,TLSO RIGID LINED CUSTOM FAB,,,28 ,,NW,,,,,,"$2,427.95",$0.00,1,1,1,1,1,1,20131001,L0484,HCPCS,TLSO RIGID PLASTIC CUST FAB,,,28 ,,NW,,,,,,"$2,704.12",$0.00,1,1,1,1,1,1,20131001,L0486,HCPCS,TLSO RIGIDLINED CUST FAB TWO,,,28 ,,NW,,,,,,"$2,875.64",$0.00,1,1,1,1,1,1,20131001,L0488,HCPCS,TLSO RIGID LINED PRE ONE PIE,,,28 ,,NW,,,,,,"$1,469.34",$0.00,1,1,1,1,1,1,20131001,L0490,HCPCS,TLSO RIGID PLASTIC PRE ONE,,,28 ,,NW,,,,,,$382.02,$0.00,1,1,1,1,1,1,20131001,L0491,HCPCS,TLSO 2 PIECE RIGID SHELL,,,28 ,,NW,,,,,,"$1,113.67",$0.00,1,1,1,1,1,1,20131001,L0492,HCPCS,TLSO 3 PIECE RIGID SHELL,,,28 ,,NW,,,,,,$714.85,$0.00,1,1,1,1,1,1,20131001,L0621,HCPCS,SIO FLEX PELVISACRAL PREFAB,,,28 ,,NW,,,,,,$125.75,$0.00,1,1,1,1,1,1,20131001,L0622,HCPCS,SIO FLEX PELVISACRAL CUSTOM,,,28 ,,NW,,,,,,$368.73,$0.00,1,1,1,1,1,1,20131001,L0623,HCPCS,SIO PANEL PREFAB,,,28 ,,NW,,,,,,$50.06,$0.00,1,1,1,1,1,1,20131001,L0624,HCPCS,SIO PANEL CUSTOM,,,28 ,,NW,,,,,,$86.94,$0.00,1,1,1,1,1,1,20131001,L0625,HCPCS,LO FLEXIBL L1-BELOW L5 PRE,,,28 ,,NW,,,,,,$72.38,$0.00,1,1,1,1,1,1,20131001,L0626,HCPCS,LO SAG STAYS/PANELS PRE-FAB,,,28 ,,NW,,,,,,$101.33,$0.00,1,1,1,1,1,1,20131001,L0627,HCPCS,LO SAGITT RIGID PANEL PREFAB,,,28 ,,NW,,,,,,$575.37,$0.00,1,1,1,1,1,1,20131001,L0628,HCPCS,LO FLEX W/O RIGID STAYS PRE,,,28 ,,NW,,,,,,$108.86,$0.00,1,1,1,1,1,1,20131001,L0629,HCPCS,LSO FLEX W/RIGID STAYS CUST,,,28 ,,NW,,,,,,$137.64,$0.00,1,1,1,1,1,1,20131001,L0630,HCPCS,LSO POST RIGID PANEL PRE,,,28 ,,NW,,,,,,$207.73,$0.00,1,1,1,1,1,1,20131001,L0631,HCPCS,LSO SAG-CORO RIGID FRAME PRE,,,28 ,,NW,,,,,,"$1,503.76",$0.00,1,1,1,1,1,1,20131001,L0632,HCPCS,LSO SAG RIGID FRAME CUST,,,28 ,,NW,,,,,,"$2,167.89",$0.00,1,1,1,1,1,1,20131001,L0633,HCPCS,LSO FLEXION CONTROL PREFAB,,,28 ,,NW,,,,,,$387.91,$0.00,1,1,1,1,1,1,20131001,L0634,HCPCS,LSO FLEXION CONTROL CUSTOM,,,28 ,,NW,,,,,,$568.69,$0.00,1,1,1,1,1,1,20131001,L0635,HCPCS,LSO SAGIT RIGID PANEL PREFAB,,,28 ,,NW,,,,,,"$1,516.50",$0.00,1,1,1,1,1,1,20131001,L0636,HCPCS,LSO SAGITTAL RIGID PANEL CUS,,,28 ,,NW,,,,,,"$2,227.37",$0.00,1,1,1,1,1,1,20131001,L0637,HCPCS,LSO SAG-CORONAL PANEL PREFAB,,,28 ,,NW,,,,,,"$1,792.83",$0.00,1,1,1,1,1,1,20131001,L0638,HCPCS,LSO SAG-CORONAL PANEL CUSTOM,,,28 ,,NW,,,,,,"$1,944.55",$0.00,1,1,1,1,1,1,20131001,L0639,HCPCS,LSO S/C SHELL/PANEL PREFAB,,,28 ,,NW,,,,,,"$1,792.83",$0.00,1,1,1,1,1,1,20131001,L0640,HCPCS,LSO S/C SHELL/PANEL CUSTOM,,,28 ,,NW,,,,,,"$1,533.55",$0.00,1,1,1,1,1,1,20131001,L0700,HCPCS,CTLSO A-P-L CONTROL MOLDED,,,28 ,,NW,,,,,,"$3,160.90",$0.00,1,1,1,1,1,1,20131001,L0710,HCPCS,CTLSO A-P-L CONTROL W/ INTER,,,28 ,,NW,,,,,,"$3,348.74",$0.00,1,1,1,1,1,1,20131001,L0810,HCPCS,HALO CERVICAL INTO JCKT VEST,,,28 ,,NW,,,,,,"$4,040.57",$0.00,1,1,1,1,1,1,20131001,L0820,HCPCS,HALO CERVICAL INTO BODY JACK,,,28 ,,NW,,,,,,"$3,319.56",$0.00,1,1,1,1,1,1,20131001,L0830,HCPCS,HALO CERV INTO MILWAUKEE TYP,,,28 ,,NW,,,,,,"$4,950.60",$0.00,1,1,1,1,1,1,20131001,L0859,HCPCS,MRI COMPATIBLE SYSTEM,,,28 ,,NW,,,,,,"$1,804.68",$0.00,1,1,1,1,1,1,20131001,L0861,HCPCS,HALO REPL LINER/INTERFACE,,,28 ,,NW,,,,,,$280.46,$0.00,1,1,1,1,1,1,20131001,L0970,HCPCS,TLSO CORSET FRONT,,,28 ,,NW,,,,,,$155.61,$0.00,1,1,1,1,1,1,20131001,L0972,HCPCS,LSO CORSET FRONT,,,28 ,,NW,,,,,,$143.89,$0.00,1,1,1,1,1,1,20131001,L0974,HCPCS,TLSO FULL CORSET,,,28 ,,NW,,,,,,$248.62,$0.00,1,1,1,1,1,1,20131001,L0976,HCPCS,LSO FULL CORSET,,,28 ,,NW,,,,,,$215.61,$0.00,1,1,1,1,1,1,20131001,L0978,HCPCS,AXILLARY CRUTCH EXTENSION,,,28 ,,NW,,,,,,$258.10,$0.00,1,1,1,1,1,1,20131001,L0980,HCPCS,PERONEAL STRAPS PAIR,,,28 ,,NW,,,,,,$25.48,$0.00,1,1,1,1,1,1,20131001,L0982,HCPCS,STOCKING SUPP GRIPS SET OF F,,,28 ,,NW,,,,,,$24.25,$0.00,1,1,1,1,1,1,20131001,L0984,HCPCS,PROTECTIVE BODY SOCK EACH,,,28 ,,NW,,,,,,$81.89,$0.00,1,1,1,1,1,1,20131001,L0999,HCPCS,ADD TO SPINAL ORTHOSIS NOS,,,28 ,,NW,,,,,,$125.75,$0.00,1,1,1,1,1,1,20131001,L1000,HCPCS,CTLSO MILWAUKE INITIAL MODEL,,,28 ,,NW,,,,,,"$3,152.68",$0.00,1,1,1,1,1,1,20131001,L1001,HCPCS,CTLSO INFANT IMMOBILIZER,,,28 ,,NW,,,,,,$61.24,$0.00,1,1,1,1,1,1,20131001,L1005,HCPCS,TENSION BASED SCOLIOSIS ORTH,,,28 ,,NW,,,,,,"$4,782.53",$0.00,1,1,1,1,1,1,20131001,L1010,HCPCS,CTLSO AXILLA SLING,,,28 ,,NW,,,,,,$95.10,$0.00,1,1,1,1,1,1,20131001,L1020,HCPCS,KYPHOSIS PAD,,,28 ,,NW,,,,,,$127.55,$0.00,1,1,1,1,1,1,20131001,L1025,HCPCS,KYPHOSIS PAD FLOATING,,,28 ,,NW,,,,,,$176.23,$0.00,1,1,1,1,1,1,20131001,L1030,HCPCS,LUMBAR BOLSTER PAD,,,28 ,,NW,,,,,,$91.38,$0.00,1,1,1,1,1,1,20131001,L1040,HCPCS,LUMBAR OR LUMBAR RIB PAD,,,28 ,,NW,,,,,,$113.13,$0.00,1,1,1,1,1,1,20131001,L1050,HCPCS,STERNAL PAD,,,28 ,,NW,,,,,,$119.94,$0.00,1,1,1,1,1,1,20131001,L1060,HCPCS,THORACIC PAD,,,28 ,,NW,,,,,,$133.41,$0.00,1,1,1,1,1,1,20131001,L1070,HCPCS,TRAPEZIUS SLING,,,28 ,,NW,,,,,,$130.21,$0.00,1,1,1,1,1,1,20131001,L1080,HCPCS,OUTRIGGER,,,28 ,,NW,,,,,,$76.77,$0.00,1,1,1,1,1,1,20131001,L1085,HCPCS,OUTRIGGER BIL W/ VERT EXTENS,,,28 ,,NW,,,,,,$219.46,$0.00,1,1,1,1,1,1,20131001,L1090,HCPCS,LUMBAR SLING,,,28 ,,NW,,,,,,$127.74,$0.00,1,1,1,1,1,1,20131001,L1100,HCPCS,RING FLANGE PLASTIC/LEATHER,,,28 ,,NW,,,,,,$222.78,$0.00,1,1,1,1,1,1,20131001,L1110,HCPCS,RING FLANGE PLAS/LEATHER MOL,,,28 ,,NW,,,,,,$375.05,$0.00,1,1,1,1,1,1,20131001,L1120,HCPCS,COVERS FOR UPRIGHT EACH,,,28 ,,NW,,,,,,$56.04,$0.00,1,1,1,1,1,1,20131001,L1200,HCPCS,FURNSH INITIAL ORTHOSIS ONLY,,,28 ,,NW,,,,,,"$2,563.04",$0.00,1,1,1,1,1,1,20131001,L1210,HCPCS,LATERAL THORACIC EXTENSION,,,28 ,,NW,,,,,,$363.92,$0.00,1,1,1,1,1,1,20131001,L1220,HCPCS,ANTERIOR THORACIC EXTENSION,,,28 ,,NW,,,,,,$318.88,$0.00,1,1,1,1,1,1,20131001,L1230,HCPCS,MILWAUKEE TYPE SUPERSTRUCTUR,,,28 ,,NW,,,,,,$853.83,$0.00,1,1,1,1,1,1,20131001,L1240,HCPCS,LUMBAR DEROTATION PAD,,,28 ,,NW,,,,,,$111.81,$0.00,1,1,1,1,1,1,20131001,L1250,HCPCS,ANTERIOR ASIS PAD,,,28 ,,NW,,,,,,$102.79,$0.00,1,1,1,1,1,1,20131001,L1260,HCPCS,ANTERIOR THORACIC DEROTATION,,,28 ,,NW,,,,,,$109.41,$0.00,1,1,1,1,1,1,20131001,L1270,HCPCS,ABDOMINAL PAD,,,28 ,,NW,,,,,,$109.62,$0.00,1,1,1,1,1,1,20131001,L1280,HCPCS,RIB GUSSET (ELASTIC) EACH,,,28 ,,NW,,,,,,$117.73,$0.00,1,1,1,1,1,1,20131001,L1290,HCPCS,LATERAL TROCHANTERIC PAD,,,28 ,,NW,,,,,,$108.89,$0.00,1,1,1,1,1,1,20131001,L1300,HCPCS,BODY JACKET MOLD TO PATIENT,,,28 ,,NW,,,,,,"$2,681.70",$0.00,1,1,1,1,1,1,20131001,L1310,HCPCS,POST-OPERATIVE BODY JACKET,,,28 ,,NW,,,,,,"$2,708.06",$0.00,1,1,1,1,1,1,20131001,L1499,HCPCS,SPINAL ORTHOSIS NOS,,,28 ,,NW,,,,,,"$2,767.48",$0.00,1,1,1,1,1,1,20131001,L1600,HCPCS,ABDUCT HIP FLEX FREJKA W CVR,,,28 ,,NW,,,,,,$173.00,$0.00,1,1,1,1,1,1,20131001,L1610,HCPCS,ABDUCT HIP FLEX FREJKA COVR,,,28 ,,NW,,,,,,$63.68,$0.00,1,1,1,1,1,1,20131001,L1620,HCPCS,ABDUCT HIP FLEX PAVLIK HARNE,,,28 ,,NW,,,,,,$184.87,$0.00,1,1,1,1,1,1,20131001,L1630,HCPCS,ABDUCT CONTROL HIP SEMI-FLEX,,,28 ,,NW,,,,,,$224.85,$0.00,1,1,1,1,1,1,20131001,L1640,HCPCS,PELV BAND/SPREAD BAR THIGH C,,,28 ,,NW,,,,,,$672.34,$0.00,1,1,1,1,1,1,20131001,L1650,HCPCS,HO ABDUCTION HIP ADJUSTABLE,,,28 ,,NW,,,,,,$318.44,$0.00,1,1,1,1,1,1,20131001,L1652,HCPCS,HO BI THIGHCUFFS W SPRDR BAR,,,28 ,,NW,,,,,,$493.01,$0.00,1,1,1,1,1,1,20131001,L1660,HCPCS,HO ABDUCTION STATIC PLASTIC,,,28 ,,NW,,,,,,$222.70,$0.00,1,1,1,1,1,1,20131001,L1680,HCPCS,PELVIC & HIP CONTROL THIGH C,,,28 ,,NW,,,,,,"$1,921.34",$0.00,1,1,1,1,1,1,20131001,L1685,HCPCS,POST-OP HIP ABDUCT CUSTOM FA,,,28 ,,NW,,,,,,"$1,860.01",$0.00,1,1,1,1,1,1,20131001,L1686,HCPCS,HO POST-OP HIP ABDUCTION,,,28 ,,NW,,,,,,"$1,454.84",$0.00,1,1,1,1,1,1,20131001,L1690,HCPCS,COMBINATION BILATERAL HO,,,28 ,,NW,,,,,,"$2,871.83",$0.00,1,1,1,1,1,1,20131001,L1700,HCPCS,LEG PERTHES ORTH TORONTO TYP,,,28 ,,NW,,,,,,"$2,416.61",$0.00,1,1,1,1,1,1,20131001,L1710,HCPCS,LEGG PERTHES ORTH NEWINGTON,,,28 ,,NW,,,,,,"$2,913.62",$0.00,1,1,1,1,1,1,20131001,L1720,HCPCS,LEGG PERTHES ORTHOSIS TRILAT,,,28 ,,NW,,,,,,"$2,129.53",$0.00,1,1,1,1,1,1,20131001,L1730,HCPCS,LEGG PERTHES ORTH SCOTTISH R,,,28 ,,NW,,,,,,"$1,767.43",$0.00,1,1,1,1,1,1,20131001,L1755,HCPCS,LEGG PERTHES PATTEN BOTTOM T,,,28 ,,NW,,,,,,"$2,498.75",$0.00,1,1,1,1,1,1,20131001,L1810,HCPCS,KO ELASTIC WITH JOINTS,,,28 ,,NW,,,,,,$139.48,$0.00,1,1,1,1,1,1,20131001,L1820,HCPCS,KO ELAS W/ CONDYLE PADS & JO,,,28 ,,NW,,,,,,$176.85,$0.00,1,1,1,1,1,1,20131001,L1830,HCPCS,KO IMMOBILIZER CANVAS LONGIT,,,28 ,,NW,,,,,,$122.35,$0.00,1,1,1,1,1,1,20131001,L1831,HCPCS,KNEE ORTH POS LOCKING JOINT,,,28 ,,NW,,,,,,$399.27,$0.00,1,1,1,1,1,1,20131001,L1832,HCPCS,KO ADJ JNT POS RIGID SUPPORT,,,28 ,,NW,,,,,,$986.97,$0.00,1,1,1,1,1,1,20131001,L1834,HCPCS,KO W/0 JOINT RIGID MOLDED TO,,,28 ,,NW,,,,,,"$1,192.03",$0.00,1,1,1,1,1,1,20131001,L1836,HCPCS,RIGID KO WO JOINTS,,,28 ,,NW,,,,,,$171.59,$0.00,1,1,1,1,1,1,20131001,L1840,HCPCS,KO DEROT ANT CRUCIATE CUSTOM,,,28 ,,NW,,,,,,"$1,459.14",$0.00,1,1,1,1,1,1,20131001,L1843,HCPCS,KO SINGLE UPRIGHT CUSTOM FIT,,,28 ,,NW,,,,,,"$1,308.62",$0.00,1,1,1,1,1,1,20131001,L1844,HCPCS,KO W/ADJ JT ROT CNTRL MOLDED,,,28 ,,NW,,,,,,"$2,465.02",$0.00,1,1,1,1,1,1,20131001,L1845,HCPCS,KO W/ ADJ FLEX/EXT ROTAT CUS,,,28 ,,NW,,,,,,"$1,265.80",$0.00,1,1,1,1,1,1,20131001,L1846,HCPCS,KO W ADJ FLEX/EXT ROTAT MOLD,,,28 ,,NW,,,,,,"$1,779.84",$0.00,1,1,1,1,1,1,20131001,L1847,HCPCS,KO ADJUSTABLE W AIR CHAMBERS,,,28 ,,NW,,,,,,$822.85,$0.00,1,1,1,1,1,1,20131001,L1850,HCPCS,KO SWEDISH TYPE,,,28 ,,NW,,,,,,$414.48,$0.00,1,1,1,1,1,1,20131001,L1860,HCPCS,KO SUPRACONDYLAR SOCKET MOLD,,,28 ,,NW,,,,,,"$1,711.42",$0.00,1,1,1,1,1,1,20131001,L1900,HCPCS,AFO SPRNG WIR DRSFLX CALF BD,,,28 ,,NW,,,,,,$384.85,$0.00,1,1,1,1,1,1,20131001,L1902,HCPCS,AFO ANKLE GAUNTLET,,,28 ,,NW,,,,,,$110.69,$0.00,1,1,1,1,1,1,20131001,L1904,HCPCS,AFO MOLDED ANKLE GAUNTLET,,,28 ,,NW,,,,,,$690.34,$0.00,1,1,1,1,1,1,20131001,L1906,HCPCS,AFO MULTILIGAMENTUS ANKLE SU,,,28 ,,NW,,,,,,$161.39,$0.00,1,1,1,1,1,1,20131001,L1907,HCPCS,AFO SUPRAMALLEOLAR CUSTOM,,,28 ,,NW,,,,,,$804.03,$0.00,1,1,1,1,1,1,20131001,L1910,HCPCS,AFO SING BAR CLASP ATTACH SH,,,28 ,,NW,,,,,,$387.62,$0.00,1,1,1,1,1,1,20131001,L1920,HCPCS,AFO SING UPRIGHT W/ ADJUST S,,,28 ,,NW,,,,,,$500.60,$0.00,1,1,1,1,1,1,20131001,L1930,HCPCS,AFO PLASTIC,,,28 ,,NW,,,,,,$340.58,$0.00,1,1,1,1,1,1,20131001,L1932,HCPCS,AFO RIG ANT TIB PREFAB TCF/=,,,28 ,,NW,,,,,,"$1,301.23",$0.00,1,1,1,1,1,1,20131001,L1940,HCPCS,AFO MOLDED TO PATIENT PLASTI,,,28 ,,NW,,,,,,$750.25,$0.00,1,1,1,1,1,1,20131001,L1945,HCPCS,AFO MOLDED PLAS RIG ANT TIB,,,28 ,,NW,,,,,,"$1,489.65",$0.00,1,1,1,1,1,1,20131001,L1950,HCPCS,AFO SPIRAL MOLDED TO PT PLAS,,,28 ,,NW,,,,,,"$1,163.26",$0.00,1,1,1,1,1,1,20131001,L1951,HCPCS,AFO SPIRAL PREFABRICATED,,,28 ,,NW,,,,,,"$1,222.01",$0.00,1,1,1,1,1,1,20131001,L1960,HCPCS,AFO POS SOLID ANK PLASTIC MO,,,28 ,,NW,,,,,,$855.28,$0.00,1,1,1,1,1,1,20131001,L1970,HCPCS,AFO PLASTIC MOLDED W/ANKLE J,,,28 ,,NW,,,,,,"$1,076.82",$0.00,1,1,1,1,1,1,20131001,L1971,HCPCS,"AFO W/ANKLE JOINT, PREFAB",,,28 ,,NW,,,,,,$662.32,$0.00,1,1,1,1,1,1,20131001,L1980,HCPCS,AFO SING SOLID STIRRUP CALF,,,28 ,,NW,,,,,,$548.60,$0.00,1,1,1,1,1,1,20131001,L1990,HCPCS,AFO DOUB SOLID STIRRUP CALF,,,28 ,,NW,,,,,,$675.90,$0.00,1,1,1,1,1,1,20131001,L2000,HCPCS,KAFO SING FRE STIRR THI/CALF,,,28 ,,NW,,,,,,"$1,580.22",$0.00,1,1,1,1,1,1,20131001,L2005,HCPCS,KAFO SNG/DBL MECHANICAL ACT,,,28 ,,NW,,,,,,"$6,135.93",$0.00,1,1,1,1,1,1,20131001,L2010,HCPCS,KAFO SNG SOLID STIRRUP W/O J,,,28 ,,NW,,,,,,"$1,442.60",$0.00,1,1,1,1,1,1,20131001,L2020,HCPCS,KAFO DBL SOLID STIRRUP BAND/,,,28 ,,NW,,,,,,"$1,785.09",$0.00,1,1,1,1,1,1,20131001,L2030,HCPCS,KAFO DBL SOLID STIRRUP W/O J,,,28 ,,NW,,,,,,"$1,602.31",$0.00,1,1,1,1,1,1,20131001,L2034,HCPCS,KAFO PLA SIN UP W/WO K/A CUS,,,28 ,,NW,,,,,,"$3,044.09",$0.00,1,1,1,1,1,1,20131001,L2035,HCPCS,KAFO PLASTIC PEDIATRIC SIZE,,,28 ,,NW,,,,,,$223.13,$0.00,1,1,1,1,1,1,20131001,L2036,HCPCS,KAFO PLAS DOUB FREE KNEE MOL,,,28 ,,NW,,,,,,"$2,897.00",$0.00,1,1,1,1,1,1,20131001,L2037,HCPCS,KAFO PLAS SING FREE KNEE MOL,,,28 ,,NW,,,,,,"$2,632.58",$0.00,1,1,1,1,1,1,20131001,L2038,HCPCS,KAFO W/O JOINT MULTI-AXIS AN,,,28 ,,NW,,,,,,"$2,192.87",$0.00,1,1,1,1,1,1,20131001,L2040,HCPCS,HKAFO TORSION BIL ROT STRAPS,,,28 ,,NW,,,,,,$236.01,$0.00,1,1,1,1,1,1,20131001,L2050,HCPCS,HKAFO TORSION CABLE HIP PELV,,,28 ,,NW,,,,,,$715.76,$0.00,1,1,1,1,1,1,20131001,L2060,HCPCS,HKAFO TORSION BALL BEARING J,,,28 ,,NW,,,,,,$886.88,$0.00,1,1,1,1,1,1,20131001,L2070,HCPCS,HKAFO TORSION UNILAT ROT STR,,,28 ,,NW,,,,,,$186.12,$0.00,1,1,1,1,1,1,20131001,L2080,HCPCS,HKAFO UNILAT TORSION CABLE,,,28 ,,NW,,,,,,$531.29,$0.00,1,1,1,1,1,1,20131001,L2090,HCPCS,HKAFO UNILAT TORSION BALL BR,,,28 ,,NW,,,,,,$665.61,$0.00,1,1,1,1,1,1,20131001,L2106,HCPCS,AFO TIB FX CAST PLASTER MOLD,,,28 ,,NW,,,,,,"$1,086.42",$0.00,1,1,1,1,1,1,20131001,L2108,HCPCS,AFO TIB FX CAST MOLDED TO PT,,,28 ,,NW,,,,,,"$1,669.65",$0.00,1,1,1,1,1,1,20131001,L2112,HCPCS,AFO TIBIAL FRACTURE SOFT,,,28 ,,NW,,,,,,$725.04,$0.00,1,1,1,1,1,1,20131001,L2114,HCPCS,AFO TIB FX SEMI-RIGID,,,28 ,,NW,,,,,,$912.70,$0.00,1,1,1,1,1,1,20131001,L2116,HCPCS,AFO TIBIAL FRACTURE RIGID,,,28 ,,NW,,,,,,"$1,121.42",$0.00,1,1,1,1,1,1,20131001,L2126,HCPCS,KAFO FEM FX CAST THERMOPLAS,,,28 ,,NW,,,,,,"$1,877.40",$0.00,1,1,1,1,1,1,20131001,L2128,HCPCS,KAFO FEM FX CAST MOLDED TO P,,,28 ,,NW,,,,,,"$2,632.70",$0.00,1,1,1,1,1,1,20131001,L2132,HCPCS,KAFO FEMORAL FX CAST SOFT,,,28 ,,NW,,,,,,"$1,261.33",$0.00,1,1,1,1,1,1,20131001,L2134,HCPCS,KAFO FEM FX CAST SEMI-RIGID,,,28 ,,NW,,,,,,"$1,575.39",$0.00,1,1,1,1,1,1,20131001,L2136,HCPCS,KAFO FEMORAL FX CAST RIGID,,,28 ,,NW,,,,,,"$1,873.81",$0.00,1,1,1,1,1,1,20131001,L2180,HCPCS,PLAS SHOE INSERT W ANK JOINT,,,28 ,,NW,,,,,,$164.02,$0.00,1,1,1,1,1,1,20131001,L2182,HCPCS,DROP LOCK KNEE,,,28 ,,NW,,,,,,$129.22,$0.00,1,1,1,1,1,1,20131001,L2184,HCPCS,LIMITED MOTION KNEE JOINT,,,28 ,,NW,,,,,,$165.67,$0.00,1,1,1,1,1,1,20131001,L2186,HCPCS,ADJ MOTION KNEE JNT LERMAN T,,,28 ,,NW,,,,,,$201.64,$0.00,1,1,1,1,1,1,20131001,L2188,HCPCS,QUADRILATERAL BRIM,,,28 ,,NW,,,,,,$443.71,$0.00,1,1,1,1,1,1,20131001,L2190,HCPCS,WAIST BELT,,,28 ,,NW,,,,,,$116.66,$0.00,1,1,1,1,1,1,20131001,L2192,HCPCS,PELVIC BAND & BELT THIGH FLA,,,28 ,,NW,,,,,,$528.93,$0.00,1,1,1,1,1,1,20131001,L2200,HCPCS,LIMITED ANKLE MOTION EA JNT,,,28 ,,NW,,,,,,$68.00,$0.00,1,1,1,1,1,1,20131001,L2210,HCPCS,DORSIFLEXION ASSIST EACH JOI,,,28 ,,NW,,,,,,$91.85,$0.00,1,1,1,1,1,1,20131001,L2220,HCPCS,DORSI & PLANTAR FLEX ASS/RES,,,28 ,,NW,,,,,,$112.45,$0.00,1,1,1,1,1,1,20131001,L2230,HCPCS,SPLIT FLAT CALIPER STIRR & P,,,28 ,,NW,,,,,,$106.90,$0.00,1,1,1,1,1,1,20131001,L2232,HCPCS,"ROCKER BOTTOM, CONTACT AFO",,,28 ,,NW,,,,,,$126.69,$0.00,1,1,1,1,1,1,20131001,L2240,HCPCS,ROUND CALIPER AND PLATE ATTA,,,28 ,,NW,,,,,,$114.83,$0.00,1,1,1,1,1,1,20131001,L2250,HCPCS,FOOT PLATE MOLDED STIRRUP AT,,,28 ,,NW,,,,,,$509.49,$0.00,1,1,1,1,1,1,20131001,L2260,HCPCS,REINFORCED SOLID STIRRUP,,,28 ,,NW,,,,,,$271.41,$0.00,1,1,1,1,1,1,20131001,L2265,HCPCS,LONG TONGUE STIRRUP,,,28 ,,NW,,,,,,$165.34,$0.00,1,1,1,1,1,1,20131001,L2270,HCPCS,VARUS/VALGUS STRAP PADDED/LI,,,28 ,,NW,,,,,,$74.88,$0.00,1,1,1,1,1,1,20131001,L2275,HCPCS,PLASTIC MOD LOW EXT PAD/LINE,,,28 ,,NW,,,,,,$168.60,$0.00,1,1,1,1,1,1,20131001,L2280,HCPCS,MOLDED INNER BOOT,,,28 ,,NW,,,,,,$693.70,$0.00,1,1,1,1,1,1,20131001,L2300,HCPCS,ABDUCTION BAR JOINTED ADJUST,,,28 ,,NW,,,,,,$396.00,$0.00,1,1,1,1,1,1,20131001,L2310,HCPCS,ABDUCTION BAR-STRAIGHT,,,28 ,,NW,,,,,,$169.04,$0.00,1,1,1,1,1,1,20131001,L2320,HCPCS,NON-MOLDED LACER,,,28 ,,NW,,,,,,$282.47,$0.00,1,1,1,1,1,1,20131001,L2330,HCPCS,LACER MOLDED TO PATIENT MODE,,,28 ,,NW,,,,,,$583.32,$0.00,1,1,1,1,1,1,20131001,L2335,HCPCS,ANTERIOR SWING BAND,,,28 ,,NW,,,,,,$332.30,$0.00,1,1,1,1,1,1,20131001,L2340,HCPCS,PRE-TIBIAL SHELL MOLDED TO P,,,28 ,,NW,,,,,,$699.98,$0.00,1,1,1,1,1,1,20131001,L2350,HCPCS,PROSTHETIC TYPE SOCKET MOLDE,,,28 ,,NW,,,,,,"$1,381.83",$0.00,1,1,1,1,1,1,20131001,L2360,HCPCS,EXTENDED STEEL SHANK,,,28 ,,NW,,,,,,$73.97,$0.00,1,1,1,1,1,1,20131001,L2370,HCPCS,PATTEN BOTTOM,,,28 ,,NW,,,,,,$398.24,$0.00,1,1,1,1,1,1,20131001,L2375,HCPCS,TORSION ANK & HALF SOLID STI,,,28 ,,NW,,,,,,$158.52,$0.00,1,1,1,1,1,1,20131001,L2380,HCPCS,TORSION STRAIGHT KNEE JOINT,,,28 ,,NW,,,,,,$170.08,$0.00,1,1,1,1,1,1,20131001,L2385,HCPCS,STRAIGHT KNEE JOINT HEAVY DU,,,28 ,,NW,,,,,,$185.77,$0.00,1,1,1,1,1,1,20131001,L2387,HCPCS,ADD LE POLY KNEE CUSTOM KAFO,,,28 ,,NW,,,,,,$230.77,$0.00,1,1,1,1,1,1,20131001,L2390,HCPCS,OFFSET KNEE JOINT EACH,,,28 ,,NW,,,,,,$145.43,$0.00,1,1,1,1,1,1,20131001,L2395,HCPCS,OFFSET KNEE JOINT HEAVY DUTY,,,28 ,,NW,,,,,,$211.01,$0.00,1,1,1,1,1,1,20131001,L2397,HCPCS,SUSPENSION SLEEVE LOWER EXT,,,28 ,,NW,,,,,,$151.23,$0.00,1,1,1,1,1,1,20131001,L2405,HCPCS,KNEE JOINT DROP LOCK EA JNT,,,28 ,,NW,,,,,,$113.03,$0.00,1,1,1,1,1,1,20131001,L2415,HCPCS,KNEE JOINT CAM LOCK EACH JOI,,,28 ,,NW,,,,,,$156.45,$0.00,1,1,1,1,1,1,20131001,L2425,HCPCS,KNEE DISC/DIAL LOCK/ADJ FLEX,,,28 ,,NW,,,,,,$184.15,$0.00,1,1,1,1,1,1,20131001,L2430,HCPCS,KNEE JNT RATCHET LOCK EA JNT,,,28 ,,NW,,,,,,$184.15,$0.00,1,1,1,1,1,1,20131001,L2492,HCPCS,KNEE LIFT LOOP DROP LOCK RIN,,,28 ,,NW,,,,,,$141.76,$0.00,1,1,1,1,1,1,20131001,L2500,HCPCS,THI/GLUT/ISCHIA WGT BEARING,,,28 ,,NW,,,,,,$452.23,$0.00,1,1,1,1,1,1,20131001,L2510,HCPCS,TH/WGHT BEAR QUAD-LAT BRIM M,,,28 ,,NW,,,,,,"$1,159.92",$0.00,1,1,1,1,1,1,20131001,L2520,HCPCS,TH/WGHT BEAR QUAD-LAT BRIM C,,,28 ,,NW,,,,,,$714.45,$0.00,1,1,1,1,1,1,20131001,L2525,HCPCS,TH/WGHT BEAR NAR M-L BRIM MO,,,28 ,,NW,,,,,,"$1,938.85",$0.00,1,1,1,1,1,1,20131001,L2526,HCPCS,TH/WGHT BEAR NAR M-L BRIM CU,,,28 ,,NW,,,,,,"$1,056.17",$0.00,1,1,1,1,1,1,20131001,L2530,HCPCS,THIGH/WGHT BEAR LACER NON-MO,,,28 ,,NW,,,,,,$331.99,$0.00,1,1,1,1,1,1,20131001,L2540,HCPCS,THIGH/WGHT BEAR LACER MOLDED,,,28 ,,NW,,,,,,$630.41,$0.00,1,1,1,1,1,1,20131001,L2550,HCPCS,THIGH/WGHT BEAR HIGH ROLL CU,,,28 ,,NW,,,,,,$420.11,$0.00,1,1,1,1,1,1,20131001,L2570,HCPCS,HIP CLEVIS TYPE 2 POSIT JNT,,,28 ,,NW,,,,,,$749.43,$0.00,1,1,1,1,1,1,20131001,L2580,HCPCS,PELVIC CONTROL PELVIC SLING,,,28 ,,NW,,,,,,$714.55,$0.00,1,1,1,1,1,1,20131001,L2600,HCPCS,HIP CLEVIS/THRUST BEARING FR,,,28 ,,NW,,,,,,$291.61,$0.00,1,1,1,1,1,1,20131001,L2610,HCPCS,HIP CLEVIS/THRUST BEARING LO,,,28 ,,NW,,,,,,$349.28,$0.00,1,1,1,1,1,1,20131001,L2620,HCPCS,PELVIC CONTROL HIP HEAVY DUT,,,28 ,,NW,,,,,,$394.68,$0.00,1,1,1,1,1,1,20131001,L2622,HCPCS,HIP JOINT ADJUSTABLE FLEXION,,,28 ,,NW,,,,,,$455.53,$0.00,1,1,1,1,1,1,20131001,L2624,HCPCS,HIP ADJ FLEX EXT ABDUCT CONT,,,28 ,,NW,,,,,,$510.15,$0.00,1,1,1,1,1,1,20131001,L2627,HCPCS,PLASTIC MOLD RECIPRO HIP & C,,,28 ,,NW,,,,,,"$2,658.31",$0.00,1,1,1,1,1,1,20131001,L2628,HCPCS,METAL FRAME RECIPRO HIP & CA,,,28 ,,NW,,,,,,"$2,587.25",$0.00,1,1,1,1,1,1,20131001,L2630,HCPCS,PELVIC CONTROL BAND & BELT U,,,28 ,,NW,,,,,,$350.89,$0.00,1,1,1,1,1,1,20131001,L2640,HCPCS,PELVIC CONTROL BAND & BELT B,,,28 ,,NW,,,,,,$496.73,$0.00,1,1,1,1,1,1,20131001,L2650,HCPCS,PELV & THOR CONTROL GLUTEAL,,,28 ,,NW,,,,,,$164.35,$0.00,1,1,1,1,1,1,20131001,L2660,HCPCS,THORACIC CONTROL THORACIC BA,,,28 ,,NW,,,,,,$250.06,$0.00,1,1,1,1,1,1,20131001,L2670,HCPCS,THORAC CONT PARASPINAL UPRIG,,,28 ,,NW,,,,,,$229.61,$0.00,1,1,1,1,1,1,20131001,L2680,HCPCS,THORAC CONT LAT SUPPORT UPRI,,,28 ,,NW,,,,,,$212.28,$0.00,1,1,1,1,1,1,20131001,L2750,HCPCS,PLATING CHROME/NICKEL PR BAR,,,28 ,,NW,,,,,,$110.59,$0.00,1,1,1,1,1,1,20131001,L2755,HCPCS,CARBON GRAPHITE LAMINATION,,,28 ,,NW,,,,,,$168.16,$0.00,1,1,1,1,1,1,20131001,L2760,HCPCS,EXTENSION PER EXTENSION PER,,,28 ,,NW,,,,,,$84.91,$0.00,1,1,1,1,1,1,20131001,L2768,HCPCS,ORTHO SIDEBAR DISCONNECT,,,28 ,,NW,,,,,,$167.62,$0.00,1,1,1,1,1,1,20131001,L2780,HCPCS,NON-CORROSIVE FINISH,,,28 ,,NW,,,,,,$92.72,$0.00,1,1,1,1,1,1,20131001,L2785,HCPCS,DROP LOCK RETAINER EACH,,,28 ,,NW,,,,,,$46.14,$0.00,1,1,1,1,1,1,20131001,L2795,HCPCS,KNEE CONTROL FULL KNEECAP,,,28 ,,NW,,,,,,$116.14,$0.00,1,1,1,1,1,1,20131001,L2800,HCPCS,KNEE CAP MEDIAL OR LATERAL P,,,28 ,,NW,,,,,,$143.51,$0.00,1,1,1,1,1,1,20131001,L2810,HCPCS,KNEE CONTROL CONDYLAR PAD,,,28 ,,NW,,,,,,$108.88,$0.00,1,1,1,1,1,1,20131001,L2820,HCPCS,SOFT INTERFACE BELOW KNEE SE,,,28 ,,NW,,,,,,$116.96,$0.00,1,1,1,1,1,1,20131001,L2830,HCPCS,SOFT INTERFACE ABOVE KNEE SE,,,28 ,,NW,,,,,,$127.65,$0.00,1,1,1,1,1,1,20131001,L2840,HCPCS,TIBIAL LENGTH SOCK FX OR EQU,,,28 ,,NW,,,,,,$62.26,$0.00,1,1,1,1,1,1,20131001,L2850,HCPCS,FEMORAL LGTH SOCK FX OR EQUA,,,28 ,,NW,,,,,,$83.62,$0.00,1,1,1,1,1,1,20131001,L2861,HCPCS,TORSION MECHANISM KNEE/ANKLE,,,28 ,,NW,,,,,,"$1,005.51",$0.00,1,1,1,1,1,1,20131001,L2999,HCPCS,LOWER EXTREMITY ORTHOSIS NOS,,,28 ,,NW,,,,,,$151.23,$0.00,1,1,1,1,1,1,20131001,L3000,HCPCS,FT INSERT UCB BERKELEY SHELL,,,28 ,,NW,,,,,,$429.16,$0.00,1,1,1,1,1,1,20131001,L3001,HCPCS,FOOT INSERT REMOV MOLDED SPE,,,28 ,,NW,,,,,,$170.12,$0.00,1,1,1,1,1,1,20131001,L3002,HCPCS,FOOT INSERT PLASTAZOTE OR EQ,,,28 ,,NW,,,,,,$207.15,$0.00,1,1,1,1,1,1,20131001,L3003,HCPCS,FOOT INSERT SILICONE GEL EAC,,,28 ,,NW,,,,,,$223.29,$0.00,1,1,1,1,1,1,20131001,L3010,HCPCS,FOOT LONGITUDINAL ARCH SUPPO,,,28 ,,NW,,,,,,$223.29,$0.00,1,1,1,1,1,1,20131001,L3020,HCPCS,FOOT LONGITUD/METATARSAL SUP,,,28 ,,NW,,,,,,$254.62,$0.00,1,1,1,1,1,1,20131001,L3030,HCPCS,FOOT ARCH SUPPORT REMOV PREM,,,28 ,,NW,,,,,,$99.26,$0.00,1,1,1,1,1,1,20131001,L3031,HCPCS,FOOT LAMIN/PREPREG COMPOSITE,,,28 ,,NW,,,,,,$123.21,$0.00,1,1,1,1,1,1,20131001,L3040,HCPCS,FT ARCH SUPRT PREMOLD LONGIT,,,28 ,,NW,,,,,,$62.21,$0.00,1,1,1,1,1,1,20131001,L3050,HCPCS,FOOT ARCH SUPP PREMOLD METAT,,,28 ,,NW,,,,,,$62.21,$0.00,1,1,1,1,1,1,20131001,L3060,HCPCS,FOOT ARCH SUPP LONGITUD/META,,,28 ,,NW,,,,,,$96.02,$0.00,1,1,1,1,1,1,20131001,L3070,HCPCS,ARCH SUPRT ATT TO SHO LONGIT,,,28 ,,NW,,,,,,$42.85,$0.00,1,1,1,1,1,1,20131001,L3080,HCPCS,ARCH SUPP ATT TO SHOE METATA,,,28 ,,NW,,,,,,$42.85,$0.00,1,1,1,1,1,1,20131001,L3090,HCPCS,ARCH SUPP ATT TO SHOE LONG/M,,,28 ,,NW,,,,,,$54.17,$0.00,1,1,1,1,1,1,20131001,L3100,HCPCS,HALLUS-VALGUS NGHT DYNAMIC S,,,28 ,,NW,,,,,,$57.37,$0.00,1,1,1,1,1,1,20131001,L3140,HCPCS,ABDUCTION ROTATION BAR SHOE,,,28 ,,NW,,,,,,$115.37,$0.00,1,1,1,1,1,1,20131001,L3150,HCPCS,ABDUCT ROTATION BAR W/O SHOE,,,28 ,,NW,,,,,,$105.70,$0.00,1,1,1,1,1,1,20131001,L3160,HCPCS,SHOE STYLED POSITIONING DEV,,,28 ,,NW,,,,,,$26.22,$0.00,1,1,1,1,1,1,20131001,L3170,HCPCS,FOOT PLASTIC HEEL STABILIZER,,,28 ,,NW,,,,,,$67.06,$0.00,1,1,1,1,1,1,20131001,L3201,HCPCS,OXFORD W SUPINAT/PRONAT INF,,,28 ,,NW,,,,,,$91.98,$0.00,1,1,1,1,1,1,20131001,L3202,HCPCS,OXFORD W/ SUPINAT/PRONATOR C,,,28 ,,NW,,,,,,$90.30,$0.00,1,1,1,1,1,1,20131001,L3203,HCPCS,OXFORD W/ SUPINATOR/PRONATOR,,,28 ,,NW,,,,,,$87.77,$0.00,1,1,1,1,1,1,20131001,L3204,HCPCS,HIGHTOP W/ SUPP/PRONATOR INF,,,28 ,,NW,,,,,,$87.77,$0.00,1,1,1,1,1,1,20131001,L3206,HCPCS,HIGHTOP W/ SUPP/PRONATOR CHI,,,28 ,,NW,,,,,,$91.14,$0.00,1,1,1,1,1,1,20131001,L3207,HCPCS,HIGHTOP W/ SUPP/PRONATOR JUN,,,28 ,,NW,,,,,,$92.83,$0.00,1,1,1,1,1,1,20131001,L3208,HCPCS,SURGICAL BOOT EACH INFANT,,,28 ,,NW,,,,,,$49.83,$0.00,1,1,1,1,1,1,20131001,L3209,HCPCS,SURGICAL BOOT EACH CHILD,,,28 ,,NW,,,,,,$70.06,$0.00,1,1,1,1,1,1,20131001,L3211,HCPCS,SURGICAL BOOT EACH JUNIOR,,,28 ,,NW,,,,,,$74.28,$0.00,1,1,1,1,1,1,20131001,L3212,HCPCS,BENESCH BOOT PAIR INFANT,,,28 ,,NW,,,,,,$102.10,$0.00,1,1,1,1,1,1,20131001,L3213,HCPCS,BENESCH BOOT PAIR CHILD,,,28 ,,NW,,,,,,$123.18,$0.00,1,1,1,1,1,1,20131001,L3214,HCPCS,BENESCH BOOT PAIR JUNIOR,,,28 ,,NW,,,,,,$130.77,$0.00,1,1,1,1,1,1,20131001,L3215,HCPCS,ORTHOPEDIC FTWEAR LADIES OXF,,,28 ,,NW,,,,,,$165.34,$0.00,1,1,1,1,1,1,20131001,L3216,HCPCS,ORTHOPED LADIES SHOES DPTH I,,,28 ,,NW,,,,,,$199.91,$0.00,1,1,1,1,1,1,20131001,L3217,HCPCS,LADIES SHOES HIGHTOP DEPTH I,,,28 ,,NW,,,,,,$215.93,$0.00,1,1,1,1,1,1,20131001,L3219,HCPCS,ORTHOPEDIC MENS SHOES OXFORD,,,28 ,,NW,,,,,,$185.58,$0.00,1,1,1,1,1,1,20131001,L3221,HCPCS,ORTHOPEDIC MENS SHOES DPTH I,,,28 ,,NW,,,,,,$221.83,$0.00,1,1,1,1,1,1,20131001,L3222,HCPCS,MENS SHOES HIGHTOP DEPTH INL,,,28 ,,NW,,,,,,$245.44,$0.00,1,1,1,1,1,1,20131001,L3224,HCPCS,WOMAN'S SHOE OXFORD BRACE,,,28 ,,NW,,,,,,$82.79,$0.00,1,1,1,1,1,1,20131001,L3225,HCPCS,MAN'S SHOE OXFORD BRACE,,,28 ,,NW,,,,,,$93.80,$0.00,1,1,1,1,1,1,20131001,L3230,HCPCS,CUSTOM SHOES DEPTH INLAY,,,28 ,,NW,,,,,,$295.77,$0.00,1,1,1,1,1,1,20131001,L3250,HCPCS,CUSTOM MOLD SHOE REMOV PROST,,,28 ,,NW,,,,,,$617.06,$0.00,1,1,1,1,1,1,20131001,L3251,HCPCS,SHOE MOLDED TO PT SILICONE S,,,28 ,,NW,,,,,,$79.34,$0.00,1,1,1,1,1,1,20131001,L3252,HCPCS,SHOE MOLDED PLASTAZOTE CUST,,,28 ,,NW,,,,,,$317.86,$0.00,1,1,1,1,1,1,20131001,L3253,HCPCS,SHOE MOLDED PLASTAZOTE CUST,,,28 ,,NW,,,,,,$78.49,$0.00,1,1,1,1,1,1,20131001,L3254,HCPCS,ORTH FOOT NON-STNDARD SIZE/W,,,28 ,,NW,,,,,,$104.67,$0.00,1,1,1,1,1,1,20131001,L3255,HCPCS,ORTH FOOT NON-STANDARD SIZE/,,,28 ,,NW,,,,,,$248.16,$0.00,1,1,1,1,1,1,20131001,L3257,HCPCS,ORTH FOOT ADD CHARGE SPLIT S,,,28 ,,NW,,,,,,$57.41,$0.00,1,1,1,1,1,1,20131001,L3260,HCPCS,AMBULATORY SURGICAL BOOT EAC,,,28 ,,NW,,,,,,$33.81,$0.00,1,1,1,1,1,1,20131001,L3265,HCPCS,PLASTAZOTE SANDAL EACH,,,28 ,,NW,,,,,,$36.33,$0.00,1,1,1,1,1,1,20131001,L3300,HCPCS,SHO LIFT TAPER TO METATARSAL,,,28 ,,NW,,,,,,$68.63,$0.00,1,1,1,1,1,1,20131001,L3310,HCPCS,SHOE LIFT ELEV HEEL/SOLE NEO,,,28 ,,NW,,,,,,$105.70,$0.00,1,1,1,1,1,1,20131001,L3320,HCPCS,SHOE LIFT ELEV HEEL/SOLE COR,,,28 ,,NW,,,,,,$208.34,$0.00,1,1,1,1,1,1,20131001,L3330,HCPCS,LIFTS ELEVATION METAL EXTENS,,,28 ,,NW,,,,,,$808.93,$0.00,1,1,1,1,1,1,20131001,L3332,HCPCS,SHOE LIFTS TAPERED TO ONE-HA,,,28 ,,NW,,,,,,$96.02,$0.00,1,1,1,1,1,1,20131001,L3334,HCPCS,SHOE LIFTS ELEVATION HEEL /I,,,28 ,,NW,,,,,,$50.93,$0.00,1,1,1,1,1,1,20131001,L3340,HCPCS,SHOE WEDGE SACH,,,28 ,,NW,,,,,,$110.55,$0.00,1,1,1,1,1,1,20131001,L3350,HCPCS,SHOE HEEL WEDGE,,,28 ,,NW,,,,,,$31.60,$0.00,1,1,1,1,1,1,20131001,L3360,HCPCS,SHOE SOLE WEDGE OUTSIDE SOLE,,,28 ,,NW,,,,,,$47.71,$0.00,1,1,1,1,1,1,20131001,L3370,HCPCS,SHOE SOLE WEDGE BETWEEN SOLE,,,28 ,,NW,,,,,,$65.41,$0.00,1,1,1,1,1,1,20131001,L3380,HCPCS,SHOE CLUBFOOT WEDGE,,,28 ,,NW,,,,,,$65.41,$0.00,1,1,1,1,1,1,20131001,L3390,HCPCS,SHOE OUTFLARE WEDGE,,,28 ,,NW,,,,,,$65.41,$0.00,1,1,1,1,1,1,20131001,L3400,HCPCS,SHOE METATARSAL BAR WEDGE RO,,,28 ,,NW,,,,,,$54.17,$0.00,1,1,1,1,1,1,20131001,L3410,HCPCS,SHOE METATARSAL BAR BETWEEN,,,28 ,,NW,,,,,,$120.20,$0.00,1,1,1,1,1,1,20131001,L3420,HCPCS,FULL SOLE/HEEL WEDGE BTWEEN,,,28 ,,NW,,,,,,$71.86,$0.00,1,1,1,1,1,1,20131001,L3430,HCPCS,SHO HEEL COUNT PLAST REINFOR,,,28 ,,NW,,,,,,$205.57,$0.00,1,1,1,1,1,1,20131001,L3440,HCPCS,HEEL LEATHER REINFORCED,,,28 ,,NW,,,,,,$99.26,$0.00,1,1,1,1,1,1,20131001,L3450,HCPCS,SHOE HEEL SACH CUSHION TYPE,,,28 ,,NW,,,,,,$136.29,$0.00,1,1,1,1,1,1,20131001,L3455,HCPCS,SHOE HEEL NEW LEATHER STANDA,,,28 ,,NW,,,,,,$54.17,$0.00,1,1,1,1,1,1,20131001,L3460,HCPCS,SHOE HEEL NEW RUBBER STANDAR,,,28 ,,NW,,,,,,$46.09,$0.00,1,1,1,1,1,1,20131001,L3465,HCPCS,SHOE HEEL THOMAS WITH WEDGE,,,28 ,,NW,,,,,,$76.72,$0.00,1,1,1,1,1,1,20131001,L3470,HCPCS,SHOE HEEL THOMAS EXTEND TO B,,,28 ,,NW,,,,,,$81.52,$0.00,1,1,1,1,1,1,20131001,L3480,HCPCS,SHOE HEEL PAD & DEPRESS FOR,,,28 ,,NW,,,,,,$81.52,$0.00,1,1,1,1,1,1,20131001,L3485,HCPCS,SHOE HEEL PAD REMOVABLE FOR,,,28 ,,NW,,,,,,$33.81,$0.00,1,1,1,1,1,1,20131001,L3500,HCPCS,ORTHO SHOE ADD LEATHER INSOL,,,28 ,,NW,,,,,,$39.66,$0.00,1,1,1,1,1,1,20131001,L3510,HCPCS,ORTHOPEDIC SHOE ADD RUB INSL,,,28 ,,NW,,,,,,$39.66,$0.00,1,1,1,1,1,1,20131001,L3520,HCPCS,O SHOE ADD FELT W LEATH INSL,,,28 ,,NW,,,,,,$42.85,$0.00,1,1,1,1,1,1,20131001,L3530,HCPCS,ORTHO SHOE ADD HALF SOLE,,,28 ,,NW,,,,,,$42.85,$0.00,1,1,1,1,1,1,20131001,L3540,HCPCS,ORTHO SHOE ADD FULL SOLE,,,28 ,,NW,,,,,,$67.06,$0.00,1,1,1,1,1,1,20131001,L3550,HCPCS,O SHOE ADD STANDARD TOE TAP,,,28 ,,NW,,,,,,$13.88,$0.00,1,1,1,1,1,1,20131001,L3560,HCPCS,O SHOE ADD HORSESHOE TOE TAP,,,28 ,,NW,,,,,,$31.60,$0.00,1,1,1,1,1,1,20131001,L3570,HCPCS,O SHOE ADD INSTEP EXTENSION,,,28 ,,NW,,,,,,$110.55,$0.00,1,1,1,1,1,1,20131001,L3580,HCPCS,O SHOE ADD INSTEP VELCRO CLO,,,28 ,,NW,,,,,,$84.75,$0.00,1,1,1,1,1,1,20131001,L3590,HCPCS,O SHOE CONVERT TO SOF COUNTE,,,28 ,,NW,,,,,,$70.26,$0.00,1,1,1,1,1,1,20131001,L3595,HCPCS,ORTHO SHOE ADD MARCH BAR,,,28 ,,NW,,,,,,$55.75,$0.00,1,1,1,1,1,1,20131001,L3600,HCPCS,TRANS SHOE CALIP PLATE EXIST,,,28 ,,NW,,,,,,$99.26,$0.00,1,1,1,1,1,1,20131001,L3610,HCPCS,TRANS SHOE CALIPER PLATE NEW,,,28 ,,NW,,,,,,$129.85,$0.00,1,1,1,1,1,1,20131001,L3620,HCPCS,TRANS SHOE SOLID STIRRUP EXI,,,28 ,,NW,,,,,,$99.26,$0.00,1,1,1,1,1,1,20131001,L3630,HCPCS,TRANS SHOE SOLID STIRRUP NEW,,,28 ,,NW,,,,,,$129.85,$0.00,1,1,1,1,1,1,20131001,L3640,HCPCS,SHOE DENNIS BROWNE SPLINT BO,,,28 ,,NW,,,,,,$57.37,$0.00,1,1,1,1,1,1,20131001,L3649,HCPCS,ORTHOPEDIC SHOE MODIFICA NOS,,,28 ,,NW,,,,,,$62.14,$0.00,1,1,1,1,1,1,20131001,L3650,HCPCS,SHLDER FIG 8 ABDUCT RESTRAIN,,,28 ,,NW,,,,,,$82.61,$0.00,1,1,1,1,1,1,20131001,L3670,HCPCS,ACROMIO/CLAVICULAR CANVAS&WE,,,28 ,,NW,,,,,,$156.55,$0.00,1,1,1,1,1,1,20131001,L3671,HCPCS,SO CAP DESIGN W/O JNTS CF,,,28 ,,NW,,,,,,"$1,192.18",$0.00,1,1,1,1,1,1,20131001,L3674,HCPCS,SO AIRPLANE W/WO JOINT CF,,,28 ,,NW,,,,,,"$1,577.84",$0.00,1,1,1,1,1,1,20131001,L3677,HCPCS,SO HARD PLASTIC STABILIZER,,,28 ,,NW,,,,,,$227.74,$0.00,1,1,1,1,1,1,20131001,L3702,HCPCS,EO W/O JOINTS CF,,,28 ,,NW,,,,,,$351.73,$0.00,1,1,1,1,1,1,20131001,L3710,HCPCS,ELBOW ELASTIC WITH METAL JOI,,,28 ,,NW,,,,,,$168.00,$0.00,1,1,1,1,1,1,20131001,L3720,HCPCS,FOREARM/ARM CUFFS FREE MOTIO,,,28 ,,NW,,,,,,"$1,004.07",$0.00,1,1,1,1,1,1,20131001,L3730,HCPCS,FOREARM/ARM CUFFS EXT/FLEX A,,,28 ,,NW,,,,,,"$1,402.40",$0.00,1,1,1,1,1,1,20131001,L3740,HCPCS,CUFFS ADJ LOCK W/ ACTIVE CON,,,28 ,,NW,,,,,,"$1,650.50",$0.00,1,1,1,1,1,1,20131001,L3760,HCPCS,"EO WITHJOINT, PREFABRICATED",,,28 ,,NW,,,,,,$641.81,$0.00,1,1,1,1,1,1,20131001,L3762,HCPCS,RIGID EO WO JOINTS,,,28 ,,NW,,,,,,$126.55,$0.00,1,1,1,1,1,1,20131001,L3763,HCPCS,EWHO RIGID W/O JNTS CF,,,28 ,,NW,,,,,,$996.53,$0.00,1,1,1,1,1,1,20131001,L3764,HCPCS,EWHO W/JOINT(S) CF,,,28 ,,NW,,,,,,"$1,120.54",$0.00,1,1,1,1,1,1,20131001,L3765,HCPCS,EWHFO RIGID W/O JNTS CF,,,28 ,,NW,,,,,,"$1,715.38",$0.00,1,1,1,1,1,1,20131001,L3766,HCPCS,EWHFO W/JOINT(S) CF,,,28 ,,NW,,,,,,"$1,819.08",$0.00,1,1,1,1,1,1,20131001,L3806,HCPCS,WHFO W/JOINT(S) CUSTOM FAB,,,28 ,,NW,,,,,,$578.87,$0.00,1,1,1,1,1,1,20131001,L3807,HCPCS,"WHFO,NO JOINT, PREFABRICATED",,,28 ,,NW,,,,,,$298.60,$0.00,1,1,1,1,1,1,20131001,L3808,HCPCS,"WHFO, RIGID W/O JOINTS",,,28 ,,NW,,,,,,$469.58,$0.00,1,1,1,1,1,1,20131001,L3891,HCPCS,TORSION MECHANISM WRIST/ELBO,,,28 ,,NW,,,,,,$296.50,$0.00,1,1,1,1,1,1,20131001,L3900,HCPCS,HINGE EXTENSION/FLEX WRIST/F,,,28 ,,NW,,,,,,"$2,017.64",$0.00,1,1,1,1,1,1,20131001,L3901,HCPCS,HINGE EXT/FLEX WRIST FINGER,,,28 ,,NW,,,,,,"$2,500.16",$0.00,1,1,1,1,1,1,20131001,L3904,HCPCS,WHFO ELECTRIC CUSTOM FITTED,,,28 ,,NW,,,,,,"$4,595.84",$0.00,1,1,1,1,1,1,20131001,L3905,HCPCS,WHO W/NONTORSION JNT(S) CF,,,28 ,,NW,,,,,,"$1,316.58",$0.00,1,1,1,1,1,1,20131001,L3906,HCPCS,WHO W/O JOINTS CF,,,28 ,,NW,,,,,,$581.26,$0.00,1,1,1,1,1,1,20131001,L3908,HCPCS,WRIST COCK-UP NON-MOLDED,,,28 ,,NW,,,,,,$84.28,$0.00,1,1,1,1,1,1,20131001,L3912,HCPCS,FLEX GLOVE W/ELASTIC FINGER,,,28 ,,NW,,,,,,$131.15,$0.00,1,1,1,1,1,1,20131001,L3913,HCPCS,HFO W/O JOINTS CF,,,28 ,,NW,,,,,,$327.14,$0.00,1,1,1,1,1,1,20131001,L3915,HCPCS,WHO W NONTOR JNT(S) PREFAB,,,28 ,,NW,,,,,,$685.01,$0.00,1,1,1,1,1,1,20131001,L3917,HCPCS,PREFAB METACARPL FX ORTHOSIS,,,28 ,,NW,,,,,,$124.36,$0.00,1,1,1,1,1,1,20131001,L3919,HCPCS,HO W/O JOINTS CF,,,28 ,,NW,,,,,,$327.14,$0.00,1,1,1,1,1,1,20131001,L3921,HCPCS,HFO W/JOINT(S) CF,,,28 ,,NW,,,,,,$396.27,$0.00,1,1,1,1,1,1,20131001,L3923,HCPCS,HFO W/O JOINTS PF,,,28 ,,NW,,,,,,$108.88,$0.00,1,1,1,1,1,1,20131001,L3925,HCPCS,FO PIP/DIP WITH JOINT/SPRING,,,28 ,,NW,,,,,,$69.20,$0.00,1,1,1,1,1,1,20131001,L3927,HCPCS,FO PIP/DIP W/O JOINT/SPRING,,,28 ,,NW,,,,,,$42.92,$0.00,1,1,1,1,1,1,20131001,L3929,HCPCS,"HFO NONTORSION JOINT, PREFAB",,,28 ,,NW,,,,,,$107.94,$0.00,1,1,1,1,1,1,20131001,L3931,HCPCS,WHFO NONTORSION JOINT PREFAB,,,28 ,,NW,,,,,,$243.48,$0.00,1,1,1,1,1,1,20131001,L3933,HCPCS,FO W/O JOINTS CF,,,28 ,,NW,,,,,,$248.55,$0.00,1,1,1,1,1,1,20131001,L3935,HCPCS,FO NONTORSION JOINT CF,,,28 ,,NW,,,,,,$258.63,$0.00,1,1,1,1,1,1,20131001,L3956,HCPCS,ADD JOINT UPPER EXT ORTHOSIS,,,28 ,,NW,,,,,,$106.85,$0.00,1,1,1,1,1,1,20131001,L3960,HCPCS,SEWHO AIRPLAN DESIG ABDU POS,,,28 ,,NW,,,,,,"$1,120.69",$0.00,1,1,1,1,1,1,20131001,L3961,HCPCS,SEWHO CAP DESIGN W/O JNTS CF,,,28 ,,NW,,,,,,"$2,261.49",$0.00,1,1,1,1,1,1,20131001,L3962,HCPCS,SEWHO ERBS PALSEY DESIGN ABD,,,28 ,,NW,,,,,,"$1,078.47",$0.00,1,1,1,1,1,1,20131001,L3967,HCPCS,SEWHO AIRPLANE W/O JNTS CF,,,28 ,,NW,,,,,,"$2,678.11",$0.00,1,1,1,1,1,1,20131001,L3971,HCPCS,SEWHO CAP DESIGN W/JNT(S) CF,,,28 ,,NW,,,,,,"$2,539.87",$0.00,1,1,1,1,1,1,20131001,L3973,HCPCS,SEWHO AIRPLANE W/JNT(S) CF,,,28 ,,NW,,,,,,"$2,678.11",$0.00,1,1,1,1,1,1,20131001,L3975,HCPCS,SEWHFO CAP DESIGN W/O JNT CF,,,28 ,,NW,,,,,,"$2,261.49",$0.00,1,1,1,1,1,1,20131001,L3976,HCPCS,SEWHFO AIRPLANE W/O JNTS CF,,,28 ,,NW,,,,,,"$2,261.49",$0.00,1,1,1,1,1,1,20131001,L3977,HCPCS,SEWHFO CAP DESGN W/JNT(S) CF,,,28 ,,NW,,,,,,"$2,539.87",$0.00,1,1,1,1,1,1,20131001,L3978,HCPCS,SEWHFO AIRPLANE W/JNT(S) CF,,,28 ,,NW,,,,,,"$2,678.11",$0.00,1,1,1,1,1,1,20131001,L3980,HCPCS,UPP EXT FX ORTHOSIS HUMERAL,,,28 ,,NW,,,,,,$455.37,$0.00,1,1,1,1,1,1,20131001,L3982,HCPCS,UPPER EXT FX ORTHOSIS RAD/UL,,,28 ,,NW,,,,,,$540.76,$0.00,1,1,1,1,1,1,20131001,L3984,HCPCS,UPPER EXT FX ORTHOSIS WRIST,,,28 ,,NW,,,,,,$497.07,$0.00,1,1,1,1,1,1,20131001,L3995,HCPCS,SOCK FRACTURE OR EQUAL EACH,,,28 ,,NW,,,,,,$47.54,$0.00,1,1,1,1,1,1,20131001,L3999,HCPCS,UPPER LIMB ORTHOSIS NOS,,,28 ,,NW,,,,,,$42.59,$0.00,1,1,1,1,1,1,20131001,L4000,HCPCS,REPL GIRDLE MILWAUKEE ORTH,,,28 ,,NW,,,,,,"$1,980.10",$0.00,1,1,1,1,1,1,20131001,L4002,HCPCS,"REPLACE STRAP, ANY ORTHOSIS",,,28 ,,NW,,,,,,$45.70,$0.00,1,1,1,1,1,1,20131001,L4010,HCPCS,REPLACE TRILATERAL SOCKET BR,,,28 ,,NW,,,,,,"$1,060.10",$0.00,1,1,1,1,1,1,20131001,L4020,HCPCS,REPLACE QUADLAT SOCKET BRIM,,,28 ,,NW,,,,,,"$1,383.65",$0.00,1,1,1,1,1,1,20131001,L4030,HCPCS,REPLACE SOCKET BRIM CUST FIT,,,28 ,,NW,,,,,,$808.47,$0.00,1,1,1,1,1,1,20131001,L4040,HCPCS,REPLACE MOLDED THIGH LACER,,,28 ,,NW,,,,,,$603.87,$0.00,1,1,1,1,1,1,20131001,L4045,HCPCS,REPLACE NON-MOLDED THIGH LAC,,,28 ,,NW,,,,,,$461.16,$0.00,1,1,1,1,1,1,20131001,L4050,HCPCS,REPLACE MOLDED CALF LACER,,,28 ,,NW,,,,,,$616.38,$0.00,1,1,1,1,1,1,20131001,L4055,HCPCS,REPLACE NON-MOLDED CALF LACE,,,28 ,,NW,,,,,,$366.41,$0.00,1,1,1,1,1,1,20131001,L4060,HCPCS,REPLACE HIGH ROLL CUFF,,,28 ,,NW,,,,,,$452.03,$0.00,1,1,1,1,1,1,20131001,L4070,HCPCS,REPLACE PROX & DIST UPRIGHT,,,28 ,,NW,,,,,,$407.42,$0.00,1,1,1,1,1,1,20131001,L4080,HCPCS,REPL MET BAND KAFO-AFO PROX,,,28 ,,NW,,,,,,$134.33,$0.00,1,1,1,1,1,1,20131001,L4090,HCPCS,REPL MET BAND KAFO-AFO CALF/,,,28 ,,NW,,,,,,$124.34,$0.00,1,1,1,1,1,1,20131001,L4100,HCPCS,REPL LEATH CUFF KAFO PROX TH,,,28 ,,NW,,,,,,$144.50,$0.00,1,1,1,1,1,1,20131001,L4110,HCPCS,REPL LEATH CUFF KAFO-AFO CAL,,,28 ,,NW,,,,,,$117.07,$0.00,1,1,1,1,1,1,20131001,L4130,HCPCS,REPLACE PRETIBIAL SHELL,,,28 ,,NW,,,,,,$758.78,$0.00,1,1,1,1,1,1,20131001,L4205,HCPCS,ORTHO DVC REPAIR PER 15 MIN,,,28 ,,NW,,,,,,$35.03,$0.00,1,1,1,1,1,1,20131001,L4210,HCPCS,ORTH DEV REPAIR/REPL MINOR P,,,28 ,,NW,,,,,,$43.21,$0.00,1,1,1,1,1,1,20131001,L4350,HCPCS,ANKLE CONTROL ORTHOSI PREFAB,,,28 ,,NW,,,,,,$124.91,$0.00,1,1,1,1,1,1,20131001,L4360,HCPCS,PNEUMATI WALKING BOOT PREFAB,,,28 ,,NW,,,,,,$382.61,$0.00,1,1,1,1,1,1,20131001,L4370,HCPCS,PNEUMATIC FULL LEG SPLINT,,,28 ,,NW,,,,,,$249.82,$0.00,1,1,1,1,1,1,20131001,L4386,HCPCS,NON-PNEUM WALK BOOT PREFAB,,,28 ,,NW,,,,,,$203.42,$0.00,1,1,1,1,1,1,20131001,L4392,HCPCS,REPLACE AFO SOFT INTERFACE,,,28 ,,NW,,,,,,$32.32,$0.00,1,1,1,1,1,1,20131001,L4394,HCPCS,REPLACE FOOT DROP SPINT,,,28 ,,NW,,,,,,$24.29,$0.00,1,1,1,1,1,1,20131001,L4396,HCPCS,STATIC AFO,,,28 ,,NW,,,,,,$214.43,$0.00,1,1,1,1,1,1,20131001,L4398,HCPCS,FOOT DROP SPLINT RECUMBENT,,,28 ,,NW,,,,,,$100.12,$0.00,1,1,1,1,1,1,20131001,L4631,HCPCS,"AFO, WALK BOOT TYPE, CUS FAB",,,28 ,,NW,,,,,,"$2,354.09",$0.00,1,1,1,1,1,1,20131001,L5000,HCPCS,SHO INSERT W ARCH TOE FILLER,,,28 ,,NW,,,,,,$810.31,$0.00,1,1,1,1,1,1,20131001,L5010,HCPCS,MOLD SOCKET ANK HGT W/ TOE F,,,28 ,,NW,,,,,,"$2,076.09",$0.00,1,1,1,1,1,1,20131001,L5020,HCPCS,TIBIAL TUBERCLE HGT W/ TOE F,,,28 ,,NW,,,,,,"$3,419.17",$0.00,1,1,1,1,1,1,20131001,L5050,HCPCS,ANK SYMES MOLD SCKT SACH FT,,,28 ,,NW,,,,,,"$3,872.21",$0.00,1,1,1,1,1,1,20131001,L5060,HCPCS,SYMES MET FR LEATH SOCKET AR,,,28 ,,NW,,,,,,"$4,854.14",$0.00,1,1,1,1,1,1,20131001,L5100,HCPCS,MOLDED SOCKET SHIN SACH FOOT,,,28 ,,NW,,,,,,"$3,916.56",$0.00,1,1,1,1,1,1,20131001,L5105,HCPCS,PLAST SOCKET JTS/THGH LACER,,,28 ,,NW,,,,,,"$5,884.30",$0.00,1,1,1,1,1,1,20131001,L5150,HCPCS,MOLD SCKT EXT KNEE SHIN SACH,,,28 ,,NW,,,,,,"$6,043.97",$0.00,1,1,1,1,1,1,20131001,L5160,HCPCS,MOLD SOCKET BENT KNEE SHIN S,,,28 ,,NW,,,,,,"$6,554.14",$0.00,1,1,1,1,1,1,20131001,L5200,HCPCS,KNE SING AXIS FRIC SHIN SACH,,,28 ,,NW,,,,,,"$5,546.93",$0.00,1,1,1,1,1,1,20131001,L5210,HCPCS,NO KNEE/ANKLE JOINTS W/ FT B,,,28 ,,NW,,,,,,"$4,156.70",$0.00,1,1,1,1,1,1,20131001,L5220,HCPCS,NO KNEE JOINT WITH ARTIC ALI,,,28 ,,NW,,,,,,"$4,741.54",$0.00,1,1,1,1,1,1,20131001,L5230,HCPCS,FEM FOCAL DEFIC CONSTANT FRI,,,28 ,,NW,,,,,,"$6,522.55",$0.00,1,1,1,1,1,1,20131001,L5250,HCPCS,HIP CANAD SING AXI CONS FRIC,,,28 ,,NW,,,,,,"$8,719.32",$0.00,1,1,1,1,1,1,20131001,L5270,HCPCS,TILT TABLE LOCKING HIP SING,,,28 ,,NW,,,,,,"$8,796.67",$0.00,1,1,1,1,1,1,20131001,L5280,HCPCS,HEMIPELVECT CANAD SING AXIS,,,28 ,,NW,,,,,,"$8,839.05",$0.00,1,1,1,1,1,1,20131001,L5301,HCPCS,BK MOLD SOCKET SACH FT ENDO,,,28 ,,NW,,,,,,"$4,006.46",$0.00,1,1,1,1,1,1,20131001,L5312,HCPCS,"KNEE DISART, SACH FT, ENDO",,,28 ,,NW,,,,,,"$5,748.12",$0.00,1,1,1,1,1,1,20131001,L5321,HCPCS,AK OPEN END SACH,,,28 ,,NW,,,,,,"$5,674.87",$0.00,1,1,1,1,1,1,20131001,L5331,HCPCS,HIP DISART CANADIAN SACH FT,,,28 ,,NW,,,,,,"$8,019.11",$0.00,1,1,1,1,1,1,20131001,L5341,HCPCS,HEMIPELVECTOMY CANADIAN SACH,,,28 ,,NW,,,,,,"$8,633.21",$0.00,1,1,1,1,1,1,20131001,L5400,HCPCS,POSTOP DRESS & 1 CAST CHG BK,,,28 ,,NW,,,,,,"$2,084.84",$0.00,1,1,1,1,1,1,20131001,L5410,HCPCS,POSTOP DSG BK EA ADD CAST CH,,,28 ,,NW,,,,,,$650.36,$0.00,1,1,1,1,1,1,20131001,L5420,HCPCS,POSTOP DSG & 1 CAST CHG AK/D,,,28 ,,NW,,,,,,"$2,651.29",$0.00,1,1,1,1,1,1,20131001,L5430,HCPCS,POSTOP DSG AK EA ADD CAST CH,,,28 ,,NW,,,,,,$832.60,$0.00,1,1,1,1,1,1,20131001,L5450,HCPCS,POSTOP APP NON-WGT BEAR DSG,,,28 ,,NW,,,,,,$637.07,$0.00,1,1,1,1,1,1,20131001,L5460,HCPCS,POSTOP APP NON-WGT BEAR DSG,,,28 ,,NW,,,,,,$861.16,$0.00,1,1,1,1,1,1,20131001,L5500,HCPCS,INIT BK PTB PLASTER DIRECT,,,28 ,,NW,,,,,,"$2,145.49",$0.00,1,1,1,1,1,1,20131001,L5505,HCPCS,INIT AK ISCHAL PLSTR DIRECT,,,28 ,,NW,,,,,,"$2,991.27",$0.00,1,1,1,1,1,1,20131001,L5510,HCPCS,PREP BK PTB PLASTER MOLDED,,,28 ,,NW,,,,,,"$2,428.17",$0.00,1,1,1,1,1,1,20131001,L5520,HCPCS,PERP BK PTB THERMOPLS DIRECT,,,28 ,,NW,,,,,,"$2,478.98",$0.00,1,1,1,1,1,1,20131001,L5530,HCPCS,PREP BK PTB THERMOPLS MOLDED,,,28 ,,NW,,,,,,"$2,928.12",$0.00,1,1,1,1,1,1,20131001,L5535,HCPCS,PREP BK PTB OPEN END SOCKET,,,28 ,,NW,,,,,,"$2,908.68",$0.00,1,1,1,1,1,1,20131001,L5540,HCPCS,PREP BK PTB LAMINATED SOCKET,,,28 ,,NW,,,,,,"$3,065.55",$0.00,1,1,1,1,1,1,20131001,L5560,HCPCS,PREP AK ISCHIAL PLAST MOLDED,,,28 ,,NW,,,,,,"$3,318.72",$0.00,1,1,1,1,1,1,20131001,L5570,HCPCS,PREP AK ISCHIAL DIRECT FORM,,,28 ,,NW,,,,,,"$3,447.49",$0.00,1,1,1,1,1,1,20131001,L5580,HCPCS,PREP AK ISCHIAL THERMO MOLD,,,28 ,,NW,,,,,,"$4,026.19",$0.00,1,1,1,1,1,1,20131001,L5585,HCPCS,PREP AK ISCHIAL OPEN END,,,28 ,,NW,,,,,,"$4,298.27",$0.00,1,1,1,1,1,1,20131001,L5590,HCPCS,PREP AK ISCHIAL LAMINATED,,,28 ,,NW,,,,,,"$4,138.85",$0.00,1,1,1,1,1,1,20131001,L5595,HCPCS,HIP DISARTIC SACH THERMOPLS,,,28 ,,NW,,,,,,"$6,817.96",$0.00,1,1,1,1,1,1,20131001,L5600,HCPCS,HIP DISART SACH LAMINAT MOLD,,,28 ,,NW,,,,,,"$7,583.90",$0.00,1,1,1,1,1,1,20131001,L5610,HCPCS,ABOVE KNEE HYDRACADENCE,,,28 ,,NW,,,,,,"$3,508.29",$0.00,1,1,1,1,1,1,20131001,L5611,HCPCS,AK 4 BAR LINK W/FRIC SWING,,,28 ,,NW,,,,,,"$2,580.57",$0.00,1,1,1,1,1,1,20131001,L5613,HCPCS,AK 4 BAR LING W/HYDRAUL SWIG,,,28 ,,NW,,,,,,"$4,024.35",$0.00,1,1,1,1,1,1,20131001,L5614,HCPCS,4-BAR LINK ABOVE KNEE W/SWNG,,,28 ,,NW,,,,,,"$2,506.26",$0.00,1,1,1,1,1,1,20131001,L5616,HCPCS,AK UNIV MULTIPLEX SYS FRICT,,,28 ,,NW,,,,,,"$2,193.12",$0.00,1,1,1,1,1,1,20131001,L5617,HCPCS,AK/BK SELF-ALIGNING UNIT EA,,,28 ,,NW,,,,,,$804.57,$0.00,1,1,1,1,1,1,20131001,L5618,HCPCS,TEST SOCKET SYMES,,,28 ,,NW,,,,,,$423.66,$0.00,1,1,1,1,1,1,20131001,L5620,HCPCS,TEST SOCKET BELOW KNEE,,,28 ,,NW,,,,,,$417.95,$0.00,1,1,1,1,1,1,20131001,L5622,HCPCS,TEST SOCKET KNEE DISARTICULA,,,28 ,,NW,,,,,,$577.32,$0.00,1,1,1,1,1,1,20131001,L5624,HCPCS,TEST SOCKET ABOVE KNEE,,,28 ,,NW,,,,,,$575.13,$0.00,1,1,1,1,1,1,20131001,L5626,HCPCS,TEST SOCKET HIP DISARTICULAT,,,28 ,,NW,,,,,,$772.05,$0.00,1,1,1,1,1,1,20131001,L5628,HCPCS,TEST SOCKET HEMIPELVECTOMY,,,28 ,,NW,,,,,,$777.46,$0.00,1,1,1,1,1,1,20131001,L5629,HCPCS,BELOW KNEE ACRYLIC SOCKET,,,28 ,,NW,,,,,,$492.03,$0.00,1,1,1,1,1,1,20131001,L5630,HCPCS,SYME TYP EXPANDABL WALL SCKT,,,28 ,,NW,,,,,,$719.46,$0.00,1,1,1,1,1,1,20131001,L5631,HCPCS,AK/KNEE DISARTIC ACRYLIC SOC,,,28 ,,NW,,,,,,$693.64,$0.00,1,1,1,1,1,1,20131001,L5632,HCPCS,SYMES TYPE PTB BRIM DESIGN S,,,28 ,,NW,,,,,,$328.95,$0.00,1,1,1,1,1,1,20131001,L5634,HCPCS,SYMES TYPE POSTER OPENING SO,,,28 ,,NW,,,,,,$474.93,$0.00,1,1,1,1,1,1,20131001,L5636,HCPCS,SYMES TYPE MEDIAL OPENING SO,,,28 ,,NW,,,,,,$368.80,$0.00,1,1,1,1,1,1,20131001,L5637,HCPCS,BELOW KNEE TOTAL CONTACT,,,28 ,,NW,,,,,,$481.54,$0.00,1,1,1,1,1,1,20131001,L5638,HCPCS,BELOW KNEE LEATHER SOCKET,,,28 ,,NW,,,,,,$810.02,$0.00,1,1,1,1,1,1,20131001,L5639,HCPCS,BELOW KNEE WOOD SOCKET,,,28 ,,NW,,,,,,"$1,851.49",$0.00,1,1,1,1,1,1,20131001,L5640,HCPCS,KNEE DISARTICULAT LEATHER SO,,,28 ,,NW,,,,,,"$1,046.33",$0.00,1,1,1,1,1,1,20131001,L5642,HCPCS,ABOVE KNEE LEATHER SOCKET,,,28 ,,NW,,,,,,$954.53,$0.00,1,1,1,1,1,1,20131001,L5643,HCPCS,HIP FLEX INNER SOCKET EXT FR,,,28 ,,NW,,,,,,"$2,532.81",$0.00,1,1,1,1,1,1,20131001,L5644,HCPCS,ABOVE KNEE WOOD SOCKET,,,28 ,,NW,,,,,,$902.39,$0.00,1,1,1,1,1,1,20131001,L5645,HCPCS,BK FLEX INNER SOCKET EXT FRA,,,28 ,,NW,,,,,,"$1,259.09",$0.00,1,1,1,1,1,1,20131001,L5646,HCPCS,BELOW KNEE CUSHION SOCKET,,,28 ,,NW,,,,,,$862.27,$0.00,1,1,1,1,1,1,20131001,L5647,HCPCS,BELOW KNEE SUCTION SOCKET,,,28 ,,NW,,,,,,"$1,278.65",$0.00,1,1,1,1,1,1,20131001,L5648,HCPCS,ABOVE KNEE CUSHION SOCKET,,,28 ,,NW,,,,,,"$1,018.07",$0.00,1,1,1,1,1,1,20131001,L5649,HCPCS,ISCH CONTAINMT/NARROW M-L SO,,,28 ,,NW,,,,,,"$3,259.88",$0.00,1,1,1,1,1,1,20131001,L5650,HCPCS,TOT CONTACT AK/KNEE DISART S,,,28 ,,NW,,,,,,$787.59,$0.00,1,1,1,1,1,1,20131001,L5651,HCPCS,AK FLEX INNER SOCKET EXT FRA,,,28 ,,NW,,,,,,"$1,957.34",$0.00,1,1,1,1,1,1,20131001,L5652,HCPCS,SUCTION SUSP AK/KNEE DISART,,,28 ,,NW,,,,,,$642.30,$0.00,1,1,1,1,1,1,20131001,L5653,HCPCS,KNEE DISART EXPAND WALL SOCK,,,28 ,,NW,,,,,,$908.56,$0.00,1,1,1,1,1,1,20131001,L5654,HCPCS,SOCKET INSERT SYMES,,,28 ,,NW,,,,,,$519.98,$0.00,1,1,1,1,1,1,20131001,L5655,HCPCS,SOCKET INSERT BELOW KNEE,,,28 ,,NW,,,,,,$417.78,$0.00,1,1,1,1,1,1,20131001,L5656,HCPCS,SOCKET INSERT KNEE ARTICULAT,,,28 ,,NW,,,,,,$598.58,$0.00,1,1,1,1,1,1,20131001,L5658,HCPCS,SOCKET INSERT ABOVE KNEE,,,28 ,,NW,,,,,,$559.73,$0.00,1,1,1,1,1,1,20131001,L5661,HCPCS,MULTI-DUROMETER SYMES,,,28 ,,NW,,,,,,$953.75,$0.00,1,1,1,1,1,1,20131001,L5665,HCPCS,MULTI-DUROMETER BELOW KNEE,,,28 ,,NW,,,,,,$822.32,$0.00,1,1,1,1,1,1,20131001,L5666,HCPCS,BELOW KNEE CUFF SUSPENSION,,,28 ,,NW,,,,,,$104.76,$0.00,1,1,1,1,1,1,20131001,L5668,HCPCS,SOCKET INSERT W/O LOCK LOWER,,,28 ,,NW,,,,,,$151.90,$0.00,1,1,1,1,1,1,20131001,L5670,HCPCS,BK MOLDED SUPRACONDYLAR SUSP,,,28 ,,NW,,,,,,$420.01,$0.00,1,1,1,1,1,1,20131001,L5671,HCPCS,BK/AK LOCKING MECHANISM,,,28 ,,NW,,,,,,$817.78,$0.00,1,1,1,1,1,1,20131001,L5672,HCPCS,BK REMOVABLE MEDIAL BRIM SUS,,,28 ,,NW,,,,,,$449.81,$0.00,1,1,1,1,1,1,20131001,L5673,HCPCS,SOCKET INSERT W LOCK MECH,,,28 ,,NW,,,,,,"$1,080.26",$0.00,1,1,1,1,1,1,20131001,L5676,HCPCS,BK KNEE JOINTS SINGLE AXIS P,,,28 ,,NW,,,,,,$570.77,$0.00,1,1,1,1,1,1,20131001,L5677,HCPCS,BK KNEE JOINTS POLYCENTRIC P,,,28 ,,NW,,,,,,$808.13,$0.00,1,1,1,1,1,1,20131001,L5678,HCPCS,BK JOINT COVERS PAIR,,,28 ,,NW,,,,,,$59.37,$0.00,1,1,1,1,1,1,20131001,L5679,HCPCS,SOCKET INSERT W/O LOCK MECH,,,28 ,,NW,,,,,,$892.76,$0.00,1,1,1,1,1,1,20131001,L5680,HCPCS,BK THIGH LACER NON-MOLDED,,,28 ,,NW,,,,,,$461.58,$0.00,1,1,1,1,1,1,20131001,L5681,HCPCS,INTL CUSTM CONG/LATYP INSERT,,,28 ,,NW,,,,,,"$1,943.25",$0.00,1,1,1,1,1,1,20131001,L5682,HCPCS,BK THIGH LACER GLUT/ISCHIA M,,,28 ,,NW,,,,,,$980.14,$0.00,1,1,1,1,1,1,20131001,L5683,HCPCS,INITIAL CUSTOM SOCKET INSERT,,,28 ,,NW,,,,,,"$1,943.25",$0.00,1,1,1,1,1,1,20131001,L5684,HCPCS,BK FORK STRAP,,,28 ,,NW,,,,,,$70.43,$0.00,1,1,1,1,1,1,20131001,L5685,HCPCS,BELOW KNEE SUS/SEAL SLEEVE,,,28 ,,NW,,,,,,$165.14,$0.00,1,1,1,1,1,1,20131001,L5686,HCPCS,BK BACK CHECK,,,28 ,,NW,,,,,,$77.33,$0.00,1,1,1,1,1,1,20131001,L5688,HCPCS,BK WAIST BELT WEBBING,,,28 ,,NW,,,,,,$91.30,$0.00,1,1,1,1,1,1,20131001,L5690,HCPCS,BK WAIST BELT PADDED AND LIN,,,28 ,,NW,,,,,,$147.10,$0.00,1,1,1,1,1,1,20131001,L5692,HCPCS,AK PELVIC CONTROL BELT LIGHT,,,28 ,,NW,,,,,,$192.98,$0.00,1,1,1,1,1,1,20131001,L5694,HCPCS,AK PELVIC CONTROL BELT PAD/L,,,28 ,,NW,,,,,,$265.75,$0.00,1,1,1,1,1,1,20131001,L5695,HCPCS,AK SLEEVE SUSP NEOPRENE/EQUA,,,28 ,,NW,,,,,,$240.10,$0.00,1,1,1,1,1,1,20131001,L5696,HCPCS,AK/KNEE DISARTIC PELVIC JOIN,,,28 ,,NW,,,,,,$274.97,$0.00,1,1,1,1,1,1,20131001,L5697,HCPCS,AK/KNEE DISARTIC PELVIC BAND,,,28 ,,NW,,,,,,$117.06,$0.00,1,1,1,1,1,1,20131001,L5698,HCPCS,AK/KNEE DISARTIC SILESIAN BA,,,28 ,,NW,,,,,,$160.44,$0.00,1,1,1,1,1,1,20131001,L5699,HCPCS,SHOULDER HARNESS,,,28 ,,NW,,,,,,$281.39,$0.00,1,1,1,1,1,1,20131001,L5700,HCPCS,REPLACE SOCKET BELOW KNEE,,,28 ,,NW,,,,,,"$4,614.83",$0.00,1,1,1,1,1,1,20131001,L5701,HCPCS,REPLACE SOCKET ABOVE KNEE,,,28 ,,NW,,,,,,"$5,680.17",$0.00,1,1,1,1,1,1,20131001,L5702,HCPCS,REPLACE SOCKET HIP,,,28 ,,NW,,,,,,"$7,267.14",$0.00,1,1,1,1,1,1,20131001,L5703,HCPCS,SYMES ANKLE W/O (SACH) FOOT,,,28 ,,NW,,,,,,"$3,555.22",$0.00,1,1,1,1,1,1,20131001,L5704,HCPCS,CUSTOM SHAPE COVER BK,,,28 ,,NW,,,,,,$839.35,$0.00,1,1,1,1,1,1,20131001,L5705,HCPCS,CUSTOM SHAPE COVER AK,,,28 ,,NW,,,,,,"$1,516.21",$0.00,1,1,1,1,1,1,20131001,L5706,HCPCS,CUSTOM SHAPE CVR KNEE DISART,,,28 ,,NW,,,,,,"$1,486.44",$0.00,1,1,1,1,1,1,20131001,L5707,HCPCS,CUSTOM SHAPE CVR HIP DISART,,,28 ,,NW,,,,,,"$2,030.82",$0.00,1,1,1,1,1,1,20131001,L5710,HCPCS,KNE-SHIN EXO SNG AXI MNL LOC,,,28 ,,NW,,,,,,$566.59,$0.00,1,1,1,1,1,1,20131001,L5711,HCPCS,KNEE-SHIN EXO MNL LOCK ULTRA,,,28 ,,NW,,,,,,$845.15,$0.00,1,1,1,1,1,1,20131001,L5712,HCPCS,KNEE-SHIN EXO FRICT SWG & ST,,,28 ,,NW,,,,,,$696.91,$0.00,1,1,1,1,1,1,20131001,L5714,HCPCS,KNEE-SHIN EXO VARIABLE FRICT,,,28 ,,NW,,,,,,$654.39,$0.00,1,1,1,1,1,1,20131001,L5716,HCPCS,KNEE-SHIN EXO MECH STANCE PH,,,28 ,,NW,,,,,,"$1,208.81",$0.00,1,1,1,1,1,1,20131001,L5718,HCPCS,KNEE-SHIN EXO FRCT SWG & STA,,,28 ,,NW,,,,,,"$1,466.02",$0.00,1,1,1,1,1,1,20131001,L5722,HCPCS,KNEE-SHIN PNEUM SWG FRCT EXO,,,28 ,,NW,,,,,,"$1,484.79",$0.00,1,1,1,1,1,1,20131001,L5724,HCPCS,KNEE-SHIN EXO FLUID SWING PH,,,28 ,,NW,,,,,,"$2,603.06",$0.00,1,1,1,1,1,1,20131001,L5726,HCPCS,KNEE-SHIN EXT JNTS FLD SWG E,,,28 ,,NW,,,,,,"$2,944.99",$0.00,1,1,1,1,1,1,20131001,L5728,HCPCS,KNEE-SHIN FLUID SWG & STANCE,,,28 ,,NW,,,,,,"$3,945.62",$0.00,1,1,1,1,1,1,20131001,L5780,HCPCS,KNEE-SHIN PNEUM/HYDRA PNEUM,,,28 ,,NW,,,,,,"$1,906.28",$0.00,1,1,1,1,1,1,20131001,L5781,HCPCS,LOWER LIMB PROS VACUUM PUMP,,,28 ,,NW,,,,,,"$6,001.66",$0.00,1,1,1,1,1,1,20131001,L5782,HCPCS,HD LOW LIMB PROS VACUUM PUMP,,,28 ,,NW,,,,,,"$6,329.52",$0.00,1,1,1,1,1,1,20131001,L5785,HCPCS,EXOSKELETAL BK ULTRALT MATER,,,28 ,,NW,,,,,,$815.81,$0.00,1,1,1,1,1,1,20131001,L5790,HCPCS,EXOSKELETAL AK ULTRA-LIGHT M,,,28 ,,NW,,,,,,"$1,158.31",$0.00,1,1,1,1,1,1,20131001,L5795,HCPCS,EXOSKEL HIP ULTRA-LIGHT MATE,,,28 ,,NW,,,,,,"$1,789.94",$0.00,1,1,1,1,1,1,20131001,L5810,HCPCS,ENDOSKEL KNEE-SHIN MNL LOCK,,,28 ,,NW,,,,,,$789.38,$0.00,1,1,1,1,1,1,20131001,L5811,HCPCS,ENDO KNEE-SHIN MNL LCK ULTRA,,,28 ,,NW,,,,,,"$1,182.52",$0.00,1,1,1,1,1,1,20131001,L5812,HCPCS,ENDO KNEE-SHIN FRCT SWG & ST,,,28 ,,NW,,,,,,$900.54,$0.00,1,1,1,1,1,1,20131001,L5814,HCPCS,ENDO KNEE-SHIN HYDRAL SWG PH,,,28 ,,NW,,,,,,"$5,569.52",$0.00,1,1,1,1,1,1,20131001,L5816,HCPCS,ENDO KNEE-SHIN POLYC MCH STA,,,28 ,,NW,,,,,,"$1,361.32",$0.00,1,1,1,1,1,1,20131001,L5818,HCPCS,ENDO KNEE-SHIN FRCT SWG & ST,,,28 ,,NW,,,,,,"$1,555.21",$0.00,1,1,1,1,1,1,20131001,L5822,HCPCS,ENDO KNEE-SHIN PNEUM SWG FRC,,,28 ,,NW,,,,,,"$2,680.70",$0.00,1,1,1,1,1,1,20131001,L5824,HCPCS,ENDO KNEE-SHIN FLUID SWING P,,,28 ,,NW,,,,,,"$2,600.08",$0.00,1,1,1,1,1,1,20131001,L5826,HCPCS,MINIATURE KNEE JOINT,,,28 ,,NW,,,,,,"$4,698.63",$0.00,1,1,1,1,1,1,20131001,L5828,HCPCS,ENDO KNEE-SHIN FLUID SWG/STA,,,28 ,,NW,,,,,,"$4,686.67",$0.00,1,1,1,1,1,1,20131001,L5830,HCPCS,ENDO KNEE-SHIN PNEUM/SWG PHA,,,28 ,,NW,,,,,,"$3,189.82",$0.00,1,1,1,1,1,1,20131001,L5840,HCPCS,MULTI-AXIAL KNEE/SHIN SYSTEM,,,28 ,,NW,,,,,,"$5,641.00",$0.00,1,1,1,1,1,1,20131001,L5845,HCPCS,KNEE-SHIN SYS STANCE FLEXION,,,28 ,,NW,,,,,,"$2,663.89",$0.00,1,1,1,1,1,1,20131001,L5848,HCPCS,KNEE-SHIN SYS HYDRAUL STANCE,,,28 ,,NW,,,,,,"$1,580.34",$0.00,1,1,1,1,1,1,20131001,L5850,HCPCS,ENDO AK/HIP KNEE EXTENS ASSI,,,28 ,,NW,,,,,,$175.20,$0.00,1,1,1,1,1,1,20131001,L5855,HCPCS,MECH HIP EXTENSION ASSIST,,,28 ,,NW,,,,,,$483.03,$0.00,1,1,1,1,1,1,20131001,L5856,HCPCS,ELEC KNEE-SHIN SWING/STANCE,,,28 ,,NW,,,,,,"$36,267.00",$0.00,1,1,1,1,1,1,20131001,L5857,HCPCS,ELEC KNEE-SHIN SWING ONLY,,,28 ,,NW,,,,,,"$12,863.20",$0.00,1,1,1,1,1,1,20131001,L5858,HCPCS,STANCE PHASE ONLY,,,28 ,,NW,,,,,,"$28,039.93",$0.00,1,1,1,1,1,1,20131001,L5910,HCPCS,ENDO BELOW KNEE ALIGNABLE SY,,,28 ,,NW,,,,,,$546.27,$0.00,1,1,1,1,1,1,20131001,L5920,HCPCS,ENDO AK/HIP ALIGNABLE SYSTEM,,,28 ,,NW,,,,,,$813.69,$0.00,1,1,1,1,1,1,20131001,L5925,HCPCS,ABOVE KNEE MANUAL LOCK,,,28 ,,NW,,,,,,$561.71,$0.00,1,1,1,1,1,1,20131001,L5930,HCPCS,HIGH ACTIVITY KNEE FRAME,,,28 ,,NW,,,,,,"$5,063.92",$0.00,1,1,1,1,1,1,20131001,L5940,HCPCS,ENDO BK ULTRA-LIGHT MATERIAL,,,28 ,,NW,,,,,,$787.34,$0.00,1,1,1,1,1,1,20131001,L5950,HCPCS,ENDO AK ULTRA-LIGHT MATERIAL,,,28 ,,NW,,,,,,"$1,235.91",$0.00,1,1,1,1,1,1,20131001,L5960,HCPCS,ENDO HIP ULTRA-LIGHT MATERIA,,,28 ,,NW,,,,,,"$1,597.79",$0.00,1,1,1,1,1,1,20131001,L5961,HCPCS,"ENDO POLY HIP, PNEU/HYD/ROT",,,28 ,,NW,,,,,,"$7,153.09",$0.00,1,1,1,1,1,1,20131001,L5962,HCPCS,BELOW KNEE FLEX COVER SYSTEM,,,28 ,,NW,,,,,,$948.66,$0.00,1,1,1,1,1,1,20131001,L5964,HCPCS,ABOVE KNEE FLEX COVER SYSTEM,,,28 ,,NW,,,,,,"$1,540.65",$0.00,1,1,1,1,1,1,20131001,L5966,HCPCS,HIP FLEXIBLE COVER SYSTEM,,,28 ,,NW,,,,,,"$1,993.68",$0.00,1,1,1,1,1,1,20131001,L5968,HCPCS,MULTIAXIAL ANKLE W DORSIFLEX,,,28 ,,NW,,,,,,"$5,446.69",$0.00,1,1,1,1,1,1,20131001,L5970,HCPCS,FOOT EXTERNAL KEEL SACH FOOT,,,28 ,,NW,,,,,,$296.09,$0.00,1,1,1,1,1,1,20131001,L5971,HCPCS,"SACH FOOT, REPLACEMENT",,,28 ,,NW,,,,,,$296.09,$0.00,1,1,1,1,1,1,20131001,L5972,HCPCS,FLEXIBLE KEEL FOOT,,,28 ,,NW,,,,,,$566.68,$0.00,1,1,1,1,1,1,20131001,L5973,HCPCS,ANK-FOOT SYS DORS-PLANT FLEX,,,28 ,,NW,,,,,,"$26,314.41",$0.00,1,1,1,1,1,1,20131001,L5974,HCPCS,FOOT SINGLE AXIS ANKLE/FOOT,,,28 ,,NW,,,,,,$355.03,$0.00,1,1,1,1,1,1,20131001,L5975,HCPCS,COMBO ANKLE/FOOT PROSTHESIS,,,28 ,,NW,,,,,,$655.95,$0.00,1,1,1,1,1,1,20131001,L5976,HCPCS,ENERGY STORING FOOT,,,28 ,,NW,,,,,,$909.17,$0.00,1,1,1,1,1,1,20131001,L5978,HCPCS,FT PROSTH MULTIAXIAL ANKL/FT,,,28 ,,NW,,,,,,$453.04,$0.00,1,1,1,1,1,1,20131001,L5979,HCPCS,MULTI-AXIAL ANKLE/FT PROSTH,,,28 ,,NW,,,,,,"$3,781.78",$0.00,1,1,1,1,1,1,20131001,L5980,HCPCS,FLEX FOOT SYSTEM,,,28 ,,NW,,,,,,"$6,094.45",$0.00,1,1,1,1,1,1,20131001,L5981,HCPCS,FLEX-WALK SYS LOW EXT PROSTH,,,28 ,,NW,,,,,,"$4,790.75",$0.00,1,1,1,1,1,1,20131001,L5982,HCPCS,EXOSKELETAL AXIAL ROTATION U,,,28 ,,NW,,,,,,$946.37,$0.00,1,1,1,1,1,1,20131001,L5984,HCPCS,ENDOSKELETAL AXIAL ROTATION,,,28 ,,NW,,,,,,$932.30,$0.00,1,1,1,1,1,1,20131001,L5985,HCPCS,LWR EXT DYNAMIC PROSTH PYLON,,,28 ,,NW,,,,,,$383.97,$0.00,1,1,1,1,1,1,20131001,L5986,HCPCS,MULTI-AXIAL ROTATION UNIT,,,28 ,,NW,,,,,,"$1,040.00",$0.00,1,1,1,1,1,1,20131001,L5987,HCPCS,SHANK FT W VERT LOAD PYLON,,,28 ,,NW,,,,,,"$10,829.91",$0.00,1,1,1,1,1,1,20131001,L5988,HCPCS,VERTICAL SHOCK REDUCING PYLO,,,28 ,,NW,,,,,,"$2,974.16",$0.00,1,1,1,1,1,1,20131001,L5990,HCPCS,USER ADJUSTABLE HEEL HEIGHT,,,28 ,,NW,,,,,,"$2,696.88",$0.00,1,1,1,1,1,1,20131001,L5999,HCPCS,LOWR EXTREMITY PROSTHES NOS,,,28 ,,NW,,,,,,"$1,751.66",$0.00,1,1,1,1,1,1,20131001,L6000,HCPCS,PART HAND THUMB REM,,,28 ,,NW,,,,,,"$2,285.39",$0.00,1,1,1,1,1,1,20131001,L6010,HCPCS,PART HAND LITTLE/RING,,,28 ,,NW,,,,,,"$2,530.25",$0.00,1,1,1,1,1,1,20131001,L6020,HCPCS,PART HAND NO FINGERS,,,28 ,,NW,,,,,,"$2,362.82",$0.00,1,1,1,1,1,1,20131001,L6025,HCPCS,PART HAND DISART MYOELECTRIC,,,28 ,,NW,,,,,,"$12,047.97",$0.00,1,1,1,1,1,1,20131001,L6050,HCPCS,WRST MLD SCK FLX HNG TRI PAD,,,28 ,,NW,,,,,,"$3,326.89",$0.00,1,1,1,1,1,1,20131001,L6055,HCPCS,WRST MOLD SOCK W/EXP INTERFA,,,28 ,,NW,,,,,,"$4,479.61",$0.00,1,1,1,1,1,1,20131001,L6100,HCPCS,ELB MOLD SOCK FLEX HINGE PAD,,,28 ,,NW,,,,,,"$3,316.15",$0.00,1,1,1,1,1,1,20131001,L6110,HCPCS,ELBOW MOLD SOCK SUSPENSION T,,,28 ,,NW,,,,,,"$3,625.86",$0.00,1,1,1,1,1,1,20131001,L6120,HCPCS,ELBOW MOLD DOUB SPLT SOC STE,,,28 ,,NW,,,,,,"$4,169.35",$0.00,1,1,1,1,1,1,20131001,L6130,HCPCS,ELBOW STUMP ACTIVATED LOCK H,,,28 ,,NW,,,,,,"$4,458.43",$0.00,1,1,1,1,1,1,20131001,L6200,HCPCS,ELBOW MOLD OUTSID LOCK HINGE,,,28 ,,NW,,,,,,"$4,688.34",$0.00,1,1,1,1,1,1,20131001,L6205,HCPCS,ELBOW MOLDED W/ EXPAND INTER,,,28 ,,NW,,,,,,"$6,227.25",$0.00,1,1,1,1,1,1,20131001,L6250,HCPCS,ELBOW INTER LOC ELBOW FORARM,,,28 ,,NW,,,,,,"$4,653.11",$0.00,1,1,1,1,1,1,20131001,L6300,HCPCS,SHLDER DISART INT LOCK ELBOW,,,28 ,,NW,,,,,,"$6,447.41",$0.00,1,1,1,1,1,1,20131001,L6310,HCPCS,SHOULDER PASSIVE RESTOR COMP,,,28 ,,NW,,,,,,"$5,274.64",$0.00,1,1,1,1,1,1,20131001,L6320,HCPCS,SHOULDER PASSIVE RESTOR CAP,,,28 ,,NW,,,,,,"$2,891.75",$0.00,1,1,1,1,1,1,20131001,L6350,HCPCS,THORACIC INTERN LOCK ELBOW,,,28 ,,NW,,,,,,"$6,804.86",$0.00,1,1,1,1,1,1,20131001,L6360,HCPCS,THORACIC PASSIVE RESTOR COMP,,,28 ,,NW,,,,,,"$5,501.35",$0.00,1,1,1,1,1,1,20131001,L6370,HCPCS,THORACIC PASSIVE RESTOR CAP,,,28 ,,NW,,,,,,"$3,543.68",$0.00,1,1,1,1,1,1,20131001,L6380,HCPCS,POSTOP DSG CAST CHG WRST/ELB,,,28 ,,NW,,,,,,"$1,936.33",$0.00,1,1,1,1,1,1,20131001,L6382,HCPCS,POSTOP DSG CAST CHG ELB DIS/,,,28 ,,NW,,,,,,"$2,510.33",$0.00,1,1,1,1,1,1,20131001,L6384,HCPCS,POSTOP DSG CAST CHG SHLDER/T,,,28 ,,NW,,,,,,"$3,261.06",$0.00,1,1,1,1,1,1,20131001,L6386,HCPCS,POSTOP EA CAST CHG & REALIGN,,,28 ,,NW,,,,,,$660.97,$0.00,1,1,1,1,1,1,20131001,L6388,HCPCS,POSTOP APPLICAT RIGID DSG ON,,,28 ,,NW,,,,,,$699.42,$0.00,1,1,1,1,1,1,20131001,L6400,HCPCS,BELOW ELBOW PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$3,929.92",$0.00,1,1,1,1,1,1,20131001,L6450,HCPCS,ELB DISART PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$5,106.98",$0.00,1,1,1,1,1,1,20131001,L6500,HCPCS,ABOVE ELBOW PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$5,044.53",$0.00,1,1,1,1,1,1,20131001,L6550,HCPCS,SHLDR DISAR PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$6,428.38",$0.00,1,1,1,1,1,1,20131001,L6570,HCPCS,SCAP THORAC PROSTH TISS SHAP,,,28 ,,NW,,,,,,"$7,403.86",$0.00,1,1,1,1,1,1,20131001,L6580,HCPCS,WRIST/ELBOW BOWDEN CABLE MOL,,,28 ,,NW,,,,,,"$2,598.73",$0.00,1,1,1,1,1,1,20131001,L6582,HCPCS,WRIST/ELBOW BOWDEN CBL DIR F,,,28 ,,NW,,,,,,"$2,230.93",$0.00,1,1,1,1,1,1,20131001,L6584,HCPCS,ELBOW FAIR LEAD CABLE MOLDED,,,28 ,,NW,,,,,,"$3,439.08",$0.00,1,1,1,1,1,1,20131001,L6586,HCPCS,ELBOW FAIR LEAD CABLE DIR FO,,,28 ,,NW,,,,,,"$3,115.57",$0.00,1,1,1,1,1,1,20131001,L6588,HCPCS,SHDR FAIR LEAD CABLE MOLDED,,,28 ,,NW,,,,,,"$4,765.72",$0.00,1,1,1,1,1,1,20131001,L6590,HCPCS,SHDR FAIR LEAD CABLE DIRECT,,,28 ,,NW,,,,,,"$4,360.33",$0.00,1,1,1,1,1,1,20131001,L6600,HCPCS,POLYCENTRIC HINGE PAIR,,,28 ,,NW,,,,,,$289.21,$0.00,1,1,1,1,1,1,20131001,L6605,HCPCS,SINGLE PIVOT HINGE PAIR,,,28 ,,NW,,,,,,$285.51,$0.00,1,1,1,1,1,1,20131001,L6610,HCPCS,FLEXIBLE METAL HINGE PAIR,,,28 ,,NW,,,,,,$248.42,$0.00,1,1,1,1,1,1,20131001,L6611,HCPCS,"ADDITIONAL SWITCH, EXT POWER",,,28 ,,NW,,,,,,$577.55,$0.00,1,1,1,1,1,1,20131001,L6615,HCPCS,DISCONNECT LOCKING WRIST UNI,,,28 ,,NW,,,,,,$251.45,$0.00,1,1,1,1,1,1,20131001,L6616,HCPCS,DISCONNECT INSERT LOCKING WR,,,28 ,,NW,,,,,,$94.37,$0.00,1,1,1,1,1,1,20131001,L6620,HCPCS,FLEXION/EXTENSION WRIST UNIT,,,28 ,,NW,,,,,,$473.46,$0.00,1,1,1,1,1,1,20131001,L6621,HCPCS,FLEX/EXT WRIST W/WO FRICTION,,,28 ,,NW,,,,,,"$3,411.79",$0.00,1,1,1,1,1,1,20131001,L6623,HCPCS,SPRING-ASS ROT WRST W/ LATCH,,,28 ,,NW,,,,,,"$1,043.73",$0.00,1,1,1,1,1,1,20131001,L6624,HCPCS,FLEX/EXT/ROTATION WRIST UNIT,,,28 ,,NW,,,,,,"$5,646.43",$0.00,1,1,1,1,1,1,20131001,L6625,HCPCS,ROTATION WRST W/ CABLE LOCK,,,28 ,,NW,,,,,,$880.32,$0.00,1,1,1,1,1,1,20131001,L6628,HCPCS,QUICK DISCONN HOOK ADAPTER O,,,28 ,,NW,,,,,,$749.54,$0.00,1,1,1,1,1,1,20131001,L6629,HCPCS,LAMINATION COLLAR W/ COUPLIN,,,28 ,,NW,,,,,,$215.87,$0.00,1,1,1,1,1,1,20131001,L6630,HCPCS,STAINLESS STEEL ANY WRIST,,,28 ,,NW,,,,,,$318.94,$0.00,1,1,1,1,1,1,20131001,L6632,HCPCS,LATEX SUSPENSION SLEEVE EACH,,,28 ,,NW,,,,,,$90.11,$0.00,1,1,1,1,1,1,20131001,L6635,HCPCS,LIFT ASSIST FOR ELBOW,,,28 ,,NW,,,,,,$264.63,$0.00,1,1,1,1,1,1,20131001,L6637,HCPCS,NUDGE CONTROL ELBOW LOCK,,,28 ,,NW,,,,,,$572.65,$0.00,1,1,1,1,1,1,20131001,L6638,HCPCS,ELEC LOCK ON MANUAL PW ELBOW,,,28 ,,NW,,,,,,"$3,734.32",$0.00,1,1,1,1,1,1,20131001,L6640,HCPCS,SHOULDER ABDUCTION JOINT PAI,,,28 ,,NW,,,,,,$444.22,$0.00,1,1,1,1,1,1,20131001,L6641,HCPCS,EXCURSION AMPLIFIER PULLEY T,,,28 ,,NW,,,,,,$242.55,$0.00,1,1,1,1,1,1,20131001,L6642,HCPCS,EXCURSION AMPLIFIER LEVER TY,,,28 ,,NW,,,,,,$342.23,$0.00,1,1,1,1,1,1,20131001,L6645,HCPCS,SHOULDER FLEXION-ABDUCTION J,,,28 ,,NW,,,,,,$524.45,$0.00,1,1,1,1,1,1,20131001,L6646,HCPCS,MULTIPO LOCKING SHOULDER JNT,,,28 ,,NW,,,,,,"$4,721.46",$0.00,1,1,1,1,1,1,20131001,L6647,HCPCS,SHOULDER LOCK ACTUATOR,,,28 ,,NW,,,,,,$740.03,$0.00,1,1,1,1,1,1,20131001,L6648,HCPCS,EXT PWRD SHLDER LOCK/UNLOCK,,,28 ,,NW,,,,,,"$4,870.92",$0.00,1,1,1,1,1,1,20131001,L6650,HCPCS,SHOULDER UNIVERSAL JOINT,,,28 ,,NW,,,,,,$559.40,$0.00,1,1,1,1,1,1,20131001,L6655,HCPCS,STANDARD CONTROL CABLE EXTRA,,,28 ,,NW,,,,,,$111.41,$0.00,1,1,1,1,1,1,20131001,L6660,HCPCS,HEAVY DUTY CONTROL CABLE,,,28 ,,NW,,,,,,$133.84,$0.00,1,1,1,1,1,1,20131001,L6665,HCPCS,TEFLON OR EQUAL CABLE LINING,,,28 ,,NW,,,,,,$66.74,$0.00,1,1,1,1,1,1,20131001,L6670,HCPCS,HOOK TO HAND CABLE ADAPTER,,,28 ,,NW,,,,,,$72.83,$0.00,1,1,1,1,1,1,20131001,L6672,HCPCS,HARNESS CHEST/SHLDER SADDLE,,,28 ,,NW,,,,,,$258.23,$0.00,1,1,1,1,1,1,20131001,L6675,HCPCS,HARNESS FIGURE OF 8 SING CON,,,28 ,,NW,,,,,,$167.19,$0.00,1,1,1,1,1,1,20131001,L6676,HCPCS,HARNESS FIGURE OF 8 DUAL CON,,,28 ,,NW,,,,,,$178.26,$0.00,1,1,1,1,1,1,20131001,L6677,HCPCS,UE TRIPLE CONTROL HARNESS,,,28 ,,NW,,,,,,$403.67,$0.00,1,1,1,1,1,1,20131001,L6680,HCPCS,TEST SOCK WRIST DISART/BEL E,,,28 ,,NW,,,,,,$371.24,$0.00,1,1,1,1,1,1,20131001,L6682,HCPCS,TEST SOCK ELBW DISART/ABOVE,,,28 ,,NW,,,,,,$401.95,$0.00,1,1,1,1,1,1,20131001,L6684,HCPCS,TEST SOCKET SHLDR DISART/THO,,,28 ,,NW,,,,,,$571.42,$0.00,1,1,1,1,1,1,20131001,L6686,HCPCS,SUCTION SOCKET,,,28 ,,NW,,,,,,"$1,020.71",$0.00,1,1,1,1,1,1,20131001,L6687,HCPCS,FRAME TYP SOCKET BEL ELBOW/W,,,28 ,,NW,,,,,,$842.96,$0.00,1,1,1,1,1,1,20131001,L6688,HCPCS,FRAME TYP SOCK ABOVE ELB/DIS,,,28 ,,NW,,,,,,$873.32,$0.00,1,1,1,1,1,1,20131001,L6689,HCPCS,FRAME TYP SOCKET SHOULDER DI,,,28 ,,NW,,,,,,"$1,079.09",$0.00,1,1,1,1,1,1,20131001,L6690,HCPCS,FRAME TYP SOCK INTERSCAP-THO,,,28 ,,NW,,,,,,"$1,158.49",$0.00,1,1,1,1,1,1,20131001,L6691,HCPCS,REMOVABLE INSERT EACH,,,28 ,,NW,,,,,,$541.33,$0.00,1,1,1,1,1,1,20131001,L6692,HCPCS,SILICONE GEL INSERT OR EQUAL,,,28 ,,NW,,,,,,$912.92,$0.00,1,1,1,1,1,1,20131001,L6693,HCPCS,LOCKINGELBOW FOREARM CNTRBAL,,,28 ,,NW,,,,,,"$4,245.47",$0.00,1,1,1,1,1,1,20131001,L6694,HCPCS,ELBOW SOCKET INS USE W/LOCK,,,28 ,,NW,,,,,,"$1,080.26",$0.00,1,1,1,1,1,1,20131001,L6695,HCPCS,ELBOW SOCKET INS USE W/O LCK,,,28 ,,NW,,,,,,$892.76,$0.00,1,1,1,1,1,1,20131001,L6696,HCPCS,CUS ELBO SKT IN FOR CON/ATYP,,,28 ,,NW,,,,,,"$1,943.25",$0.00,1,1,1,1,1,1,20131001,L6697,HCPCS,CUS ELBO SKT IN NOT CON/ATYP,,,28 ,,NW,,,,,,"$1,943.25",$0.00,1,1,1,1,1,1,20131001,L6698,HCPCS,BELOW/ABOVE ELBOW LOCK MECH,,,28 ,,NW,,,,,,$817.78,$0.00,1,1,1,1,1,1,20131001,L6703,HCPCS,"TERM DEV, PASSIVE HAND MITT",,,28 ,,NW,,,,,,$503.21,$0.00,1,1,1,1,1,1,20131001,L6704,HCPCS,"TERM DEV, SPORT/REC/WORK ATT",,,28 ,,NW,,,,,,$966.11,$0.00,1,1,1,1,1,1,20131001,L6706,HCPCS,TERM DEV MECH HOOK VOL OPEN,,,28 ,,NW,,,,,,$549.73,$0.00,1,1,1,1,1,1,20131001,L6707,HCPCS,TERM DEV MECH HOOK VOL CLOSE,,,28 ,,NW,,,,,,"$2,150.52",$0.00,1,1,1,1,1,1,20131001,L6708,HCPCS,TERM DEV MECH HAND VOL OPEN,,,28 ,,NW,,,,,,"$1,396.05",$0.00,1,1,1,1,1,1,20131001,L6709,HCPCS,TERM DEV MECH HAND VOL CLOSE,,,28 ,,NW,,,,,,"$2,041.93",$0.00,1,1,1,1,1,1,20131001,L6711,HCPCS,"PED TERM DEV, HOOK, VOL OPEN",,,28 ,,NW,,,,,,$971.33,$0.00,1,1,1,1,1,1,20131001,L6712,HCPCS,"PED TERM DEV, HOOK, VOL CLOS",,,28 ,,NW,,,,,,"$1,825.96",$0.00,1,1,1,1,1,1,20131001,L6713,HCPCS,"PED TERM DEV, HAND, VOL OPEN",,,28 ,,NW,,,,,,"$2,316.23",$0.00,1,1,1,1,1,1,20131001,L6714,HCPCS,"PED TERM DEV, HAND, VOL CLOS",,,28 ,,NW,,,,,,"$1,955.01",$0.00,1,1,1,1,1,1,20131001,L6715,HCPCS,"TERM DEVICE, MULTI ART DIGIT",,,28 ,,NW,,,,,,"$4,726.56",$0.00,1,1,1,1,1,1,20131001,L6721,HCPCS,"HOOK/HAND, HVY DTY, VOL OPEN",,,28 ,,NW,,,,,,"$3,509.51",$0.00,1,1,1,1,1,1,20131001,L6722,HCPCS,"HOOK/HAND, HVY DTY, VOL CLOS",,,28 ,,NW,,,,,,"$3,019.30",$0.00,1,1,1,1,1,1,20131001,L6805,HCPCS,TERM DEV MODIFIER WRIST UNIT,,,28 ,,NW,,,,,,$543.83,$0.00,1,1,1,1,1,1,20131001,L6810,HCPCS,TERM DEV PRECISION PINCH DEV,,,28 ,,NW,,,,,,$269.04,$0.00,1,1,1,1,1,1,20131001,L6880,HCPCS,ELEC HAND IND ART DIGITS,,,28 ,,NW,,,,,,"$36,062.45",$0.00,1,1,1,1,1,1,20131001,L6881,HCPCS,TERM DEV AUTO GRASP FEATURE,,,28 ,,NW,,,,,,"$6,133.23",$0.00,1,1,1,1,1,1,20131001,L6882,HCPCS,MICROPROCESSOR CONTROL UPLMB,,,28 ,,NW,,,,,,"$4,641.58",$0.00,1,1,1,1,1,1,20131001,L6883,HCPCS,REPLC SOCKT BELOW E/W DISA,,,28 ,,NW,,,,,,"$2,691.68",$0.00,1,1,1,1,1,1,20131001,L6884,HCPCS,REPLC SOCKT ABOVE ELBOW DISA,,,28 ,,NW,,,,,,"$3,875.42",$0.00,1,1,1,1,1,1,20131001,L6885,HCPCS,REPLC SOCKT SHLDR DIS/INTERC,,,28 ,,NW,,,,,,"$5,501.35",$0.00,1,1,1,1,1,1,20131001,L6890,HCPCS,PREFAB GLOVE FOR TERM DEVICE,,,28 ,,NW,,,,,,$252.28,$0.00,1,1,1,1,1,1,20131001,L6895,HCPCS,CUSTOM GLOVE FOR TERM DEVICE,,,28 ,,NW,,,,,,$882.28,$0.00,1,1,1,1,1,1,20131001,L6900,HCPCS,HAND RESTORAT THUMB/1 FINGER,,,28 ,,NW,,,,,,"$2,675.41",$0.00,1,1,1,1,1,1,20131001,L6905,HCPCS,HAND RESTORATION MULTIPLE FI,,,28 ,,NW,,,,,,"$2,604.43",$0.00,1,1,1,1,1,1,20131001,L6910,HCPCS,HAND RESTORATION NO FINGERS,,,28 ,,NW,,,,,,"$2,515.70",$0.00,1,1,1,1,1,1,20131001,L6915,HCPCS,HAND RESTORATION REPLACMNT G,,,28 ,,NW,,,,,,"$1,061.51",$0.00,1,1,1,1,1,1,20131001,L6920,HCPCS,WRIST DISARTICUL SWITCH CTRL,,,28 ,,NW,,,,,,"$11,253.11",$0.00,1,1,1,1,1,1,20131001,L6925,HCPCS,WRIST DISART MYOELECTRONIC C,,,28 ,,NW,,,,,,"$12,878.02",$0.00,1,1,1,1,1,1,20131001,L6930,HCPCS,BELOW ELBOW SWITCH CONTROL,,,28 ,,NW,,,,,,"$11,145.84",$0.00,1,1,1,1,1,1,20131001,L6935,HCPCS,BELOW ELBOW MYOELECTRONIC CT,,,28 ,,NW,,,,,,"$13,054.04",$0.00,1,1,1,1,1,1,20131001,L6940,HCPCS,ELBOW DISARTICULATION SWITCH,,,28 ,,NW,,,,,,"$14,360.57",$0.00,1,1,1,1,1,1,20131001,L6945,HCPCS,ELBOW DISART MYOELECTRONIC C,,,28 ,,NW,,,,,,"$16,503.41",$0.00,1,1,1,1,1,1,20131001,L6950,HCPCS,ABOVE ELBOW SWITCH CONTROL,,,28 ,,NW,,,,,,"$15,510.08",$0.00,1,1,1,1,1,1,20131001,L6955,HCPCS,ABOVE ELBOW MYOELECTRONIC CT,,,28 ,,NW,,,,,,"$18,587.14",$0.00,1,1,1,1,1,1,20131001,L6960,HCPCS,SHLDR DISARTIC SWITCH CONTRO,,,28 ,,NW,,,,,,"$19,698.40",$0.00,1,1,1,1,1,1,20131001,L6965,HCPCS,SHLDR DISARTIC MYOELECTRONIC,,,28 ,,NW,,,,,,"$23,218.56",$0.00,1,1,1,1,1,1,20131001,L6970,HCPCS,INTERSCAPULAR-THOR SWITCH CT,,,28 ,,NW,,,,,,"$24,295.85",$0.00,1,1,1,1,1,1,20131001,L6975,HCPCS,INTERSCAP-THOR MYOELECTRONIC,,,28 ,,NW,,,,,,"$26,721.20",$0.00,1,1,1,1,1,1,20131001,L7007,HCPCS,ADULT ELECTRIC HAND,,,28 ,,NW,,,,,,"$5,552.93",$0.00,1,1,1,1,1,1,20131001,L7008,HCPCS,PEDIATRIC ELECTRIC HAND,,,28 ,,NW,,,,,,"$8,983.66",$0.00,1,1,1,1,1,1,20131001,L7009,HCPCS,ADULT ELECTRIC HOOK,,,28 ,,NW,,,,,,"$5,655.26",$0.00,1,1,1,1,1,1,20131001,L7040,HCPCS,PREHENSILE ACTUATOR,,,28 ,,NW,,,,,,"$4,533.86",$0.00,1,1,1,1,1,1,20131001,L7045,HCPCS,PEDIATRIC ELECTRIC HOOK,,,28 ,,NW,,,,,,"$2,502.68",$0.00,1,1,1,1,1,1,20131001,L7170,HCPCS,ELECTRONIC ELBOW HOSMER SWIT,,,28 ,,NW,,,,,,"$9,747.61",$0.00,1,1,1,1,1,1,20131001,L7180,HCPCS,ELECTRONIC ELBOW SEQUENTIAL,,,28 ,,NW,,,,,,"$55,309.49",$0.00,1,1,1,1,1,1,20131001,L7181,HCPCS,ELECTRONIC ELBO SIMULTANEOUS,,,28 ,,NW,,,,,,"$60,503.22",$0.00,1,1,1,1,1,1,20131001,L7185,HCPCS,ELECTRON ELBOW ADOLESCENT SW,,,28 ,,NW,,,,,,"$10,107.80",$0.00,1,1,1,1,1,1,20131001,L7186,HCPCS,ELECTRON ELBOW CHILD SWITCH,,,28 ,,NW,,,,,,"$14,998.60",$0.00,1,1,1,1,1,1,20131001,L7190,HCPCS,ELBOW ADOLESCENT MYOELECTRON,,,28 ,,NW,,,,,,"$12,721.39",$0.00,1,1,1,1,1,1,20131001,L7191,HCPCS,ELBOW CHILD MYOELECTRONIC CT,,,28 ,,NW,,,,,,"$15,693.58",$0.00,1,1,1,1,1,1,20131001,L7260,HCPCS,ELECTRON WRIST ROTATOR OTTO,,,28 ,,NW,,,,,,"$3,430.13",$0.00,1,1,1,1,1,1,20131001,L7261,HCPCS,ELECTRON WRIST ROTATOR UTAH,,,28 ,,NW,,,,,,"$6,408.91",$0.00,1,1,1,1,1,1,20131001,L7360,HCPCS,SIX VOLT BAT OTTO BOCK/EQ EA,,,28 ,,NW,,,,,,$346.03,$0.00,1,1,1,1,1,1,20131001,L7362,HCPCS,BATTERY CHRGR SIX VOLT OTTO,,,28 ,,NW,,,,,,$369.27,$0.00,1,1,1,1,1,1,20131001,L7364,HCPCS,TWELVE VOLT BATTERY UTAH/EQU,,,28 ,,NW,,,,,,$684.72,$0.00,1,1,1,1,1,1,20131001,L7366,HCPCS,BATTERY CHRGR 12 VOLT UTAH/E,,,28 ,,NW,,,,,,$932.10,$0.00,1,1,1,1,1,1,20131001,L7367,HCPCS,REPLACEMNT LITHIUM IONBATTER,,,28 ,,NW,,,,,,$543.71,$0.00,1,1,1,1,1,1,20131001,L7368,HCPCS,LITHIUM ION BATTERY CHARGER,,,28 ,,NW,,,,,,$718.05,$0.00,1,1,1,1,1,1,20131001,L7400,HCPCS,"ADD UE PROST BE/WD, ULTLITE",,,28 ,,NW,,,,,,$418.54,$0.00,1,1,1,1,1,1,20131001,L7401,HCPCS,ADD UE PROST A/E ULTLITE MAT,,,28 ,,NW,,,,,,$473.87,$0.00,1,1,1,1,1,1,20131001,L7402,HCPCS,ADD UE PROST S/D ULTLITE MAT,,,28 ,,NW,,,,,,$515.31,$0.00,1,1,1,1,1,1,20131001,L7403,HCPCS,ADD UE PROST B/E ACRYLIC,,,28 ,,NW,,,,,,$511.89,$0.00,1,1,1,1,1,1,20131001,L7404,HCPCS,ADD UE PROST A/E ACRYLIC,,,28 ,,NW,,,,,,$795.29,$0.00,1,1,1,1,1,1,20131001,L7405,HCPCS,ADD UE PROST S/D ACRYLIC,,,28 ,,NW,,,,,,"$1,053.85",$0.00,1,1,1,1,1,1,20131001,L7499,HCPCS,UPPER EXTREMITY PROSTHES NOS,,,28 ,,NW,,,,,,$882.28,$0.00,1,1,1,1,1,1,20131001,L7510,HCPCS,PROSTHETIC DEVICE REPAIR REP,,,28 ,,NW,,,,,,$51.90,$0.00,1,1,1,1,1,1,20131001,L7520,HCPCS,REPAIR PROSTHESIS PER 15 MIN,,,28 ,,NW,,,,,,$43.49,$0.00,1,1,1,1,1,1,20131001,L7600,HCPCS,PROSTHETIC DONNING SLEEVE,,,28 ,,NW,,,,,,$87.53,$0.00,1,1,1,1,1,1,20131001,L7900,HCPCS,MALE VACUUM ERECTION SYSTEM,,,28 ,,NW,,,,,,$764.38,$0.00,1,1,1,1,1,1,20131001,L8000,HCPCS,MASTECTOMY BRA,,,28 ,,NW,,,,,,$55.58,$0.00,1,1,1,1,1,1,20131001,L8001,HCPCS,BREAST PROSTHESIS BRA & FORM,,,28 ,,NW,,,,,,$161.77,$0.00,1,1,1,1,1,1,20131001,L8002,HCPCS,BRST PRSTH BRA & BILAT FORM,,,28 ,,NW,,,,,,$211.97,$0.00,1,1,1,1,1,1,20131001,L8010,HCPCS,MASTECTOMY SLEEVE,,,28 ,,NW,,,,,,$72.59,$0.00,1,1,1,1,1,1,20131001,L8015,HCPCS,EXT BREASTPROSTHESIS GARMENT,,,28 ,,NW,,,,,,$78.79,$0.00,1,1,1,1,1,1,20131001,L8020,HCPCS,MASTECTOMY FORM,,,28 ,,NW,,,,,,$298.95,$0.00,1,1,1,1,1,1,20131001,L8030,HCPCS,BREAST PROSTHES W/O ADHESIVE,,,28 ,,NW,,,,,,$481.48,$0.00,1,1,1,1,1,1,20131001,L8031,HCPCS,BREAST PROSTHESIS W ADHESIVE,,,28 ,,NW,,,,,,$481.48,$0.00,1,1,1,1,1,1,20131001,L8032,HCPCS,REUSABLE NIPPLE PROSTHESIS,,,28 ,,NW,,,,,,$52.39,$0.00,1,1,1,1,1,1,20131001,L8035,HCPCS,CUSTOM BREAST PROSTHESIS,,,28 ,,NW,,,,,,"$5,491.59",$0.00,1,1,1,1,1,1,20131001,L8039,HCPCS,BREAST PROSTHESIS NOS,,,28 ,,NW,,,,,,$43.49,$0.00,1,1,1,1,1,1,20131001,L8040,HCPCS,NASAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$3,555.90",$0.00,1,1,1,1,1,1,20131001,L8040,HCPCS,NASAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$1,471.39",$0.00,1,1,1,1,1,1,20131001,L8040,HCPCS,NASAL PROSTHESIS,,,28 ,,NW,,,,,,"$3,745.41",$0.00,1,1,1,1,1,1,20131001,L8041,HCPCS,MIDFACIAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$4,295.16",$0.00,1,1,1,1,1,1,20131001,L8041,HCPCS,MIDFACIAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$1,782.69",$0.00,1,1,1,1,1,1,20131001,L8041,HCPCS,MIDFACIAL PROSTHESIS,,,28 ,,NW,,,,,,"$4,523.59",$0.00,1,1,1,1,1,1,20131001,L8042,HCPCS,ORBITAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$4,831.55",$0.00,1,1,1,1,1,1,20131001,L8042,HCPCS,ORBITAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$2,008.52",$0.00,1,1,1,1,1,1,20131001,L8042,HCPCS,ORBITAL PROSTHESIS,,,28 ,,NW,,,,,,"$5,088.19",$0.00,1,1,1,1,1,1,20131001,L8043,HCPCS,UPPER FACIAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$5,416.69",$0.00,1,1,1,1,1,1,20131001,L8043,HCPCS,UPPER FACIAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$2,254.89",$0.00,1,1,1,1,1,1,20131001,L8043,HCPCS,UPPER FACIAL PROSTHESIS,,,28 ,,NW,,,,,,"$5,704.15",$0.00,1,1,1,1,1,1,20131001,L8044,HCPCS,HEMI-FACIAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$6,001.83",$0.00,1,1,1,1,1,1,20131001,L8044,HCPCS,HEMI-FACIAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$2,501.27",$0.00,1,1,1,1,1,1,20131001,L8044,HCPCS,HEMI-FACIAL PROSTHESIS,,,28 ,,NW,,,,,,"$6,320.06",$0.00,1,1,1,1,1,1,20131001,L8045,HCPCS,AURICULAR PROSTHESIS,KM,,28 ,,NW,,,,,,"$3,952.80",$0.00,1,1,1,1,1,1,20131001,L8045,HCPCS,AURICULAR PROSTHESIS,KN,,28 ,,NW,,,,,,"$1,638.51",$0.00,1,1,1,1,1,1,20131001,L8045,HCPCS,AURICULAR PROSTHESIS,,,28 ,,NW,,,,,,"$4,163.18",$0.00,1,1,1,1,1,1,20131001,L8046,HCPCS,PARTIAL FACIAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$3,856.33",$0.00,1,1,1,1,1,1,20131001,L8046,HCPCS,PARTIAL FACIAL PROSTHESIS,KN,,28 ,,NW,,,,,,"$1,597.88",$0.00,1,1,1,1,1,1,20131001,L8046,HCPCS,PARTIAL FACIAL PROSTHESIS,,,28 ,,NW,,,,,,"$4,061.63",$0.00,1,1,1,1,1,1,20131001,L8047,HCPCS,NASAL SEPTAL PROSTHESIS,KM,,28 ,,NW,,,,,,"$1,954.62",$0.00,1,1,1,1,1,1,20131001,L8047,HCPCS,NASAL SEPTAL PROSTHESIS,KN,,28 ,,NW,,,,,,$797.18,$0.00,1,1,1,1,1,1,20131001,L8047,HCPCS,NASAL SEPTAL PROSTHESIS,,,28 ,,NW,,,,,,"$2,059.83",$0.00,1,1,1,1,1,1,20131001,L8048,HCPCS,UNSPEC MAXILLOFACIAL PROSTH,,,28 ,,NW,,,,,,$869.81,$0.00,1,1,1,1,1,1,20131001,L8049,HCPCS,REPAIR MAXILLOFACIAL PROSTH,,,28 ,,NW,,,,,,$59.52,$0.00,1,1,1,1,1,1,20131001,L8300,HCPCS,TRUSS SINGLE W/ STANDARD PAD,,,28 ,,NW,,,,,,$122.83,$0.00,1,1,1,1,1,1,20131001,L8310,HCPCS,TRUSS DOUBLE W/ STANDARD PAD,,,28 ,,NW,,,,,,$198.05,$0.00,1,1,1,1,1,1,20131001,L8320,HCPCS,TRUSS ADDITION TO STD PAD WA,,,28 ,,NW,,,,,,$82.36,$0.00,1,1,1,1,1,1,20131001,L8330,HCPCS,TRUSS ADD TO STD PAD SCROTAL,,,28 ,,NW,,,,,,$76.27,$0.00,1,1,1,1,1,1,20131001,L8400,HCPCS,SHEATH BELOW KNEE,,,28 ,,NW,,,,,,$25.76,$0.00,1,1,1,1,1,1,20131001,L8410,HCPCS,SHEATH ABOVE KNEE,,,28 ,,NW,,,,,,$32.49,$0.00,1,1,1,1,1,1,20131001,L8415,HCPCS,SHEATH UPPER LIMB,,,28 ,,NW,,,,,,$32.16,$0.00,1,1,1,1,1,1,20131001,L8417,HCPCS,PROS SHEATH/SOCK W GEL CUSHN,,,28 ,,NW,,,,,,$98.04,$0.00,1,1,1,1,1,1,20131001,L8420,HCPCS,PROSTHETIC SOCK MULTI PLY BK,,,28 ,,NW,,,,,,$31.35,$0.00,1,1,1,1,1,1,20131001,L8430,HCPCS,PROSTHETIC SOCK MULTI PLY AK,,,28 ,,NW,,,,,,$34.62,$0.00,1,1,1,1,1,1,20131001,L8435,HCPCS,PROS SOCK MULTI PLY UPPER LM,,,28 ,,NW,,,,,,$33.05,$0.00,1,1,1,1,1,1,20131001,L8440,HCPCS,SHRINKER BELOW KNEE,,,28 ,,NW,,,,,,$64.73,$0.00,1,1,1,1,1,1,20131001,L8460,HCPCS,SHRINKER ABOVE KNEE,,,28 ,,NW,,,,,,$97.23,$0.00,1,1,1,1,1,1,20131001,L8465,HCPCS,SHRINKER UPPER LIMB,,,28 ,,NW,,,,,,$73.75,$0.00,1,1,1,1,1,1,20131001,L8470,HCPCS,PROS SOCK SINGLE PLY BK,,,28 ,,NW,,,,,,$11.45,$0.00,1,1,1,1,1,1,20131001,L8480,HCPCS,PROS SOCK SINGLE PLY AK,,,28 ,,NW,,,,,,$15.25,$0.00,1,1,1,1,1,1,20131001,L8485,HCPCS,PROS SOCK SINGLE PLY UPPER L,,,28 ,,NW,,,,,,$18.25,$0.00,1,1,1,1,1,1,20131001,L8499,HCPCS,UNLISTED MISC PROSTHETIC SER,,,28 ,,NW,,,,,,$21.66,$0.00,1,1,1,1,1,1,20131001,L8500,HCPCS,ARTIFICIAL LARYNX,,,28 ,,NW,,,,,,"$1,042.12",$0.00,1,1,1,1,1,1,20131001,L8501,HCPCS,TRACHEOSTOMY SPEAKING VALVE,,,28 ,,NW,,,,,,$164.81,$0.00,1,1,1,1,1,1,20131001,L8505,HCPCS,"ARTIFICIAL LARYNX, ACCESSORY",,,28 ,,NW,,,,,,$30.20,$0.00,1,1,1,1,1,1,20131001,L8507,HCPCS,TRACH-ESOPH VOICE PROS PT IN,,,28 ,,NW,,,,,,$55.77,$0.00,1,1,1,1,1,1,20131001,L8509,HCPCS,TRACH-ESOPH VOICE PROS MD IN,,,28 ,,NW,,,,,,$141.20,$0.00,1,1,1,1,1,1,20131001,L8510,HCPCS,VOICE AMPLIFIER,,,28 ,,NW,,,,,,$337.24,$0.00,1,1,1,1,1,1,20131001,L8511,HCPCS,INDWELLING TRACH INSERT,,,28 ,,NW,,,,,,$94.90,$0.00,1,1,1,1,1,1,20131001,L8512,HCPCS,GEL CAP FOR TRACH VOICE PROS,,,28 ,,NW,,,,,,$3.42,$0.00,1,1,1,1,1,1,20131001,L8513,HCPCS,TRACH PROS CLEANING DEVICE,,,28 ,,NW,,,,,,$8.16,$0.00,1,1,1,1,1,1,20131001,L8514,HCPCS,REPL TRACH PUNCTURE DILATOR,,,28 ,,NW,,,,,,$122.28,$0.00,1,1,1,1,1,1,20131001,L8515,HCPCS,GEL CAP APP DEVICE FOR TRACH,,,28 ,,NW,,,,,,$82.70,$0.00,1,1,1,1,1,1,20131001,L8600,HCPCS,IMPLANT BREAST SILICONE/EQ,,,28 ,,NW,,,,,,$980.20,$0.00,1,1,1,1,1,1,20131001,L8603,HCPCS,COLLAGEN IMP URINARY 2.5 ML,,,28 ,,NW,,,,,,$614.90,$0.00,1,1,1,1,1,1,20131001,L8606,HCPCS,SYNTHETIC IMPLNT URINARY 1ML,,,28 ,,NW,,,,,,$286.76,$0.00,1,1,1,1,1,1,20131001,L8609,HCPCS,ARTIFICIAL CORNEA,,,28 ,,NW,,,,,,"$9,737.67",$0.00,1,1,1,1,1,1,20131001,L8610,HCPCS,OCULAR IMPLANT,,,28 ,,NW,,,,,,$923.02,$0.00,1,1,1,1,1,1,20131001,L8612,HCPCS,AQUEOUS SHUNT PROSTHESIS,,,28 ,,NW,,,,,,"$1,016.30",$0.00,1,1,1,1,1,1,20131001,L8613,HCPCS,OSSICULAR IMPLANT,,,28 ,,NW,,,,,,$420.31,$0.00,1,1,1,1,1,1,20131001,L8614,HCPCS,COCHLEAR DEVICE,,,28 ,,NW,,,,,,"$29,128.90",$0.00,1,1,1,1,1,1,20131001,L8615,HCPCS,COCH IMPLANT HEADSET REPLACE,,,28 ,,NW,,,,,,$632.54,$0.00,1,1,1,1,1,1,20131001,L8616,HCPCS,COCH IMPLANT MICROPHONE REPL,,,28 ,,NW,,,,,,$135.05,$0.00,1,1,1,1,1,1,20131001,L8617,HCPCS,COCH IMPLANT TRANS COIL REPL,,,28 ,,NW,,,,,,$118.30,$0.00,1,1,1,1,1,1,20131001,L8618,HCPCS,COCH IMPLANT TRAN CABLE REPL,,,28 ,,NW,,,,,,$35.67,$0.00,1,1,1,1,1,1,20131001,L8619,HCPCS,COCH IMP EXT PROC/CONTR RPLC,,,28 ,,NW,,,,,,"$12,477.51",$0.00,1,1,1,1,1,1,20131001,L8621,HCPCS,REPL ZINC AIR BATTERY,,,28 ,,NW,,,,,,$0.96,$0.00,1,1,1,1,1,1,20131001,L8622,HCPCS,REPL ALKALINE BATTERY,,,28 ,,NW,,,,,,$0.52,$0.00,1,1,1,1,1,1,20131001,L8623,HCPCS,"LITH ION BATT CID,NON-EARLVL",,,28 ,,NW,,,,,,$84.16,$0.00,1,1,1,1,1,1,20131001,L8624,HCPCS,"LITH ION BATT CID, EAR LEVEL",,,28 ,,NW,,,,,,$205.92,$0.00,1,1,1,1,1,1,20131001,L8627,HCPCS,CID EXT SPEECH PROCESS REPL,,,28 ,,NW,,,,,,"$10,660.31",$0.00,1,1,1,1,1,1,20131001,L8628,HCPCS,CID EXT CONTROLLER REPL,,,28 ,,NW,,,,,,"$1,853.35",$0.00,1,1,1,1,1,1,20131001,L8629,HCPCS,CID TRANSMIT COIL AND CABLE,,,28 ,,NW,,,,,,$229.85,$0.00,1,1,1,1,1,1,20131001,L8630,HCPCS,METACARPOPHALANGEAL IMPLANT,,,28 ,,NW,,,,,,$505.21,$0.00,1,1,1,1,1,1,20131001,L8631,HCPCS,MCP JOINT REPL 2 PC OR MORE,,,28 ,,NW,,,,,,"$3,276.02",$0.00,1,1,1,1,1,1,20131001,L8641,HCPCS,METATARSAL JOINT IMPLANT,,,28 ,,NW,,,,,,$509.07,$0.00,1,1,1,1,1,1,20131001,L8642,HCPCS,HALLUX IMPLANT,,,28 ,,NW,,,,,,$429.30,$0.00,1,1,1,1,1,1,20131001,L8658,HCPCS,INTERPHALANGEAL JOINT SPACER,,,28 ,,NW,,,,,,$439.32,$0.00,1,1,1,1,1,1,20131001,L8659,HCPCS,INTERPHALANGEAL JOINT REPL,,,28 ,,NW,,,,,,"$2,852.63",$0.00,1,1,1,1,1,1,20131001,L8670,HCPCS,"VASCULAR GRAFT, SYNTHETIC",,,28 ,,NW,,,,,,$793.37,$0.00,1,1,1,1,1,1,20131001,L8680,HCPCS,IMPLT NEUROSTIM ELCTR EACH,,,28 ,,NW,,,,,,$655.43,$0.00,1,1,0,1,1,1,20131001,L8681,HCPCS,PT PRGRM FOR IMPLT NEUROSTIM,,,28 ,,NW,,,,,,"$1,690.19",$0.00,1,1,1,1,1,1,20131001,L8682,HCPCS,IMPLT NEUROSTIM RADIOFQ REC,,,28 ,,NW,,,,,,"$9,040.90",$0.00,1,1,0,1,1,1,20131001,L8683,HCPCS,RADIOFQ TRSMTR FOR IMPLT NEU,,,28 ,,NW,,,,,,"$7,952.71",$0.00,1,1,1,1,1,1,20131001,L8684,HCPCS,RADIOF TRSMTR IMPLT SCRL NEU,,,28 ,,NW,,,,,,"$1,112.95",$0.00,1,1,1,1,1,1,20131001,L8685,HCPCS,IMPLT NROSTM PLS GEN SNG REC,,,28 ,,NW,,,,,,"$19,884.28",$0.00,1,1,0,1,1,1,20131001,L8686,HCPCS,IMPLT NROSTM PLS GEN SNG NON,,,28 ,,NW,,,,,,"$12,671.63",$0.00,1,1,0,1,1,1,20131001,L8687,HCPCS,IMPLT NROSTM PLS GEN DUA REC,,,28 ,,NW,,,,,,"$25,890.84",$0.00,1,1,0,1,1,1,20131001,L8688,HCPCS,IMPLT NROSTM PLS GEN DUA NON,,,28 ,,NW,,,,,,"$16,504.30",$0.00,1,1,0,1,1,1,20131001,L8689,HCPCS,EXTERNAL RECHARG SYS INTERN,,,28 ,,NW,,,,,,"$2,562.18",$0.00,1,1,1,1,1,1,20131001,L8690,HCPCS,"AUD OSSEO DEV, INT/EXT COMP",,,28 ,,NW,,,,,,"$7,144.57",$0.00,1,1,1,1,1,1,20131001,L8691,HCPCS,OSSEOINTEGRATED SND PROC RPL,,,28 ,,NW,,,,,,"$3,985.16",$0.00,1,1,1,1,1,1,20131001,L8692,HCPCS,NON-OSSEOINTEGRATED SND PROC,,,28 ,,NW,,,,,,$418.45,$0.00,1,1,1,1,1,1,20131001,L8693,HCPCS,"AUD OSSEO DEV, ABUTMENT",,,28 ,,NW,,,,,,"$2,232.00",$0.00,1,1,1,1,1,1,20131001,L8695,HCPCS,EXTERNAL RECHARG SYS EXTERN,,,28 ,,NW,,,,,,$23.61,$0.00,1,1,1,1,1,1,20131001,L8699,HCPCS,PROSTHETIC IMPLANT NOS,,,28 ,,NW,,,,,,$344.31,$0.00,1,1,1,1,1,1,20131001,L9900,HCPCS,O&P SUPPLY/ACCESSORY/SERVICE,,,28 ,,NW,,,,,,$165.75,$0.00,1,1,1,1,1,1,20131001,M0064,HCPCS,VISIT FOR DRUG MONITORING,,,16 ,,RBRVS,0.37 ,0.07 ,1.07 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,M0076,HCPCS,PROLOTHERAPY,,,14 ,,TotalUnits,,,,2.20 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,M0300,HCPCS,IV CHELATIONTHERAPY,,,4 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P2031,HCPCS,HAIR ANALYSIS,,,17 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P2038,HCPCS,BLOOD MUCOPROTEIN,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P3000,HCPCS,SCREEN PAP BY TECH W MD SUPV,,,17 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P3001,HCPCS,SCREENING PAP SMEAR BY PHYS,,,17 ,,RBRVS,0.42 ,0.41 ,0.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,P7001,HCPCS,CULTURE BACTERIAL URINE,,,17 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9010,HCPCS,WHOLE BLOOD FOR TRANSFUSION,,,14 ,,TotalUnits,,,,1.29 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9011,HCPCS,BLOOD SPLIT UNIT,,,14 ,,TotalUnits,,,,1.85 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9012,HCPCS,CRYOPRECIPITATE EACH UNIT,,,14 ,,TotalUnits,,,,0.55 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9016,HCPCS,RBC LEUKOCYTES REDUCED,,,14 ,,TotalUnits,,,,3.98 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9017,HCPCS,PLASMA 1 DONOR FRZ W/IN 8 HR,,,14 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9019,HCPCS,"PLATELETS, EACH UNIT",,,14 ,,TotalUnits,,,,0.87 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9020,HCPCS,PLAELET RICH PLASMA UNIT,,,14 ,,TotalUnits,,,,4.15 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9021,HCPCS,RED BLOOD CELLS UNIT,,,14 ,,TotalUnits,,,,2.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9022,HCPCS,WASHED RED BLOOD CELLS UNIT,,,14 ,,TotalUnits,,,,1.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9031,HCPCS,PLATELETS LEUKOCYTES REDUCED,,,14 ,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9032,HCPCS,"PLATELETS, IRRADIATED",,,14 ,,TotalUnits,,,,1.38 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9034,HCPCS,"PLATELETS, PHERESIS",,,14 ,,TotalUnits,,,,6.94 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9035,HCPCS,PLATELET PHERES LEUKOREDUCED,,,14 ,,TotalUnits,,,,7.76 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9037,HCPCS,PLATE PHERES LEUKOREDU IRRAD,,,14 ,,TotalUnits,,,,13.34 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9040,HCPCS,RBC LEUKOREDUCED IRRADIATED,,,14 ,,TotalUnits,,,,5.97 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9041,HCPCS,"ALBUMIN (HUMAN), 5%, 50ML",,,14 ,,TotalUnits,,,,0.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9043,HCPCS,"PLASMA PROTEIN FRACT, 5%, 50ML",,,14 ,,TotalUnits,,,,0.43 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9045,HCPCS,"ALBUMIN (HUMAN), 5%, 250 ML",,,14 ,,TotalUnits,,,,2.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9046,HCPCS,"ALBUMIN (HUMAN), 25%, 20 ML",,,14 ,,TotalUnits,,,,0.71 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9047,HCPCS,"ALBUMIN (HUMAN), 25%, 50ML",,,14 ,,TotalUnits,,,,1.78 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9048,HCPCS,"PLASMAPROTEIN FRACT, 5%, 250ML",,,14 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9053,HCPCS,"PLT, PHER, L/R CMV-NEG, IRR",,,14 ,,TotalUnits,,,,15.12 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9058,HCPCS,"RBC, L/R, CMV-NEG, IRRAD",,,14 ,,TotalUnits,,,,7.51 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9059,HCPCS,"PLASMA, FRZ BETWEEN 8-24HOUR",,,14 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9603,HCPCS,ONE-WAY ALLOW PRORATED MILES,,,17 ,,TotalUnits,,,,0.01 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9604,HCPCS,ONE-WAY ALLOW PRORATED TRIP,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9612,HCPCS,CATHETERIZE FOR URINE SPEC,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,P9615,HCPCS,URINE SPECIMEN COLLECT MULT,,,17 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0035,HCPCS,CARDIOKYMOGRAPHY,,,4 ,,RBRVS,0.17 ,0.35 ,0.35 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,Q0035,HCPCS,CARDIOKYMOGRAPHY,26,,4 ,,RBRVS,0.17 ,0.06 ,0.06 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,Q0035,HCPCS,CARDIOKYMOGRAPHY,TC,,4 ,,RBRVS,,0.29 ,0.29 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0081,HCPCS,INFUSION THER OTHER THAN CHE,,,22 ,,TotalUnits,,,,1.93 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,Q0083,HCPCS,CHEMO BY OTHER THAN INFUSION,,,14 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0084,HCPCS,CHEMOTHERAPY BY INFUSION,,,14 ,,TotalUnits,,,,1.75 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0085,HCPCS,CHEMO BY BOTH INFUSION AND O,,,14 ,,TotalUnits,,,,6.14 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0091,HCPCS,OBTAINING SCREEN PAP SMEAR,,,17 ,,RBRVS,0.37 ,0.16 ,0.91 ,,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0092,HCPCS,SET UP PORT XRAY EQUIPMENT,,TC,20 ,,RBRVS,,0.65 ,0.65 ,,,$0.00,$0.00,1,0,1,0,1,1,20131001,Q0111,HCPCS,WET MOUNTS/ W PREPARATIONS,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0112,HCPCS,POTASSIUM HYDROXIDE PREPS,,,17 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0113,HCPCS,PINWORM EXAMINATIONS,,,17 ,,TotalUnits,,,,0.23 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0114,HCPCS,FERN TEST,,,17 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0115,HCPCS,POST-COITAL MUCOUS EXAM,,,17 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q0138,HCPCS,"FERUMOXYTOL, NON-ESRD",,,29 ,,NW,,,,,,$2.46,$0.00,1,1,1,0,0,1,20131001,Q0139,HCPCS,"FERUMOXYTOL, ESRD USE",,,28 ,,NW,,,,,,$54.43,$0.00,1,1,1,0,0,1,20131001,Q0144,HCPCS,"AZITHROMYCIN DIHYDRATE, ORAL",,,29 ,,NW,,,,,,$38.87,$0.00,1,1,1,0,0,1,20131001,Q0162,HCPCS,ONDANSETRON ORAL,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,Q0163,HCPCS,DIPHENHYDRAMINE HCL 50MG,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,Q0164,HCPCS,PROCHLORPERAZINE MALEATE 5MG,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,Q0165,HCPCS,PROCHLORPERAZINE MALEATE10MG,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,Q0166,HCPCS,GRANISETRON HCL 1 MG ORAL,,,29 ,,NW,,,,,,$12.71,$0.00,1,1,1,0,0,1,20131001,Q0167,HCPCS,DRONABINOL 2.5MG ORAL,,,29 ,,NW,,,,,,$15.53,$0.00,1,1,1,0,0,1,20131001,Q0168,HCPCS,DRONABINOL 5MG ORAL,,,29 ,,NW,,,,,,$36.71,$0.00,1,1,1,0,0,1,20131001,Q0169,HCPCS,PROMETHAZINE HCL 12.5MG ORAL,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,Q0170,HCPCS,PROMETHAZINE HCL 25 MG ORAL,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,Q0171,HCPCS,CHLORPROMAZINE HCL 10MG ORAL,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,Q0172,HCPCS,CHLORPROMAZINE HCL 25MG ORAL,,,29 ,,NW,,,,,,$1.41,$0.00,1,1,1,0,0,1,20131001,Q0173,HCPCS,TRIMETHOBENZAMIDE HCL 250MG,,,29 ,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20131001,Q0174,HCPCS,THIETHYLPERAZINE MALEATE10MG,,,29 ,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20131001,Q0175,HCPCS,PERPHENAZINE 4MG ORAL,,,29 ,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20131001,Q0176,HCPCS,PERPHENAZINE 8MG ORAL,,,29 ,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20131001,Q0177,HCPCS,HYDROXYZINE PAMOATE 25MG,,,29 ,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20131001,Q0178,HCPCS,HYDROXYZINE PAMOATE 50MG,,,29 ,,NW,,,,,,$2.82,$0.00,1,1,1,0,0,1,20131001,Q0180,HCPCS,DOLASETRON MESYLATE ORAL,,,29 ,,NW,,,,,,$218.61,$0.00,1,1,1,0,0,1,20131001,Q0181,HCPCS,UNSPECIFIED ORAL ANTI-EMETIC,,,29 ,,NW,,,,,,$47.32,$0.00,1,1,1,0,0,1,20131001,Q0478,HCPCS,"POWER ADAPTER, COMBO VAD",,,28 ,,NW,,,,,,$234.30,$0.00,1,1,1,1,1,1,20131001,Q0479,HCPCS,"POWER MODULE COMBO VAD, REP",,,28 ,,NW,,,,,,"$18,088.84",$0.00,1,1,1,1,1,1,20131001,Q0480,HCPCS,"DRIVER PNEUMATIC VAD, REP",,,28 ,,NW,,,,,,"$136,063.66",$0.00,1,1,1,1,1,1,20131001,Q0481,HCPCS,"MICROPRCSR CU ELEC VAD, REP",,,28 ,,NW,,,,,,"$21,914.88",$0.00,1,1,1,1,1,1,20131001,Q0482,HCPCS,"MICROPRCSR CU COMBO VAD, REP",,,28 ,,NW,,,,,,"$6,833.52",$0.00,1,1,1,1,1,1,20131001,Q0483,HCPCS,"MONITOR ELEC VAD, REP",,,28 ,,NW,,,,,,"$28,290.17",$0.00,1,1,1,1,1,1,20131001,Q0484,HCPCS,MONITOR ELEC OR COMB VAD REP,,,28 ,,NW,,,,,,"$5,457.92",$0.00,1,1,1,1,1,1,20131001,Q0485,HCPCS,"MONITOR CABLE ELEC VAD, REP",,,28 ,,NW,,,,,,$486.66,$0.00,1,1,1,1,1,1,20131001,Q0486,HCPCS,MON CABLE ELEC/PNEUM VAD REP,,,28 ,,NW,,,,,,$397.56,$0.00,1,1,1,1,1,1,20131001,Q0487,HCPCS,"LEADS ANY TYPE VAD, REP ONLY",,,28 ,,NW,,,,,,$471.26,$0.00,1,1,1,1,1,1,20131001,Q0488,HCPCS,"PWR PACK BASE ELEC VAD, REP",,,28 ,,NW,,,,,,"$21,887.82",$0.00,1,1,1,1,1,1,20131001,Q0489,HCPCS,"PWR PCK BASE COMBO VAD, REP",,,28 ,,NW,,,,,,"$24,520.11",$0.00,1,1,1,1,1,1,20131001,Q0490,HCPCS,"EMR PWR SOURCE ELEC VAD, REP",,,28 ,,NW,,,,,,"$1,017.95",$0.00,1,1,1,1,1,1,20131001,Q0491,HCPCS,EMR PWR SOURCE COMBO VAD REP,,,28 ,,NW,,,,,,"$1,625.83",$0.00,1,1,1,1,1,1,20131001,Q0492,HCPCS,"EMR PWR CBL ELEC VAD, REP",,,28 ,,NW,,,,,,$115.63,$0.00,1,1,1,1,1,1,20131001,Q0493,HCPCS,"EMR PWR CBL COMBO VAD, REP",,,28 ,,NW,,,,,,$338.58,$0.00,1,1,1,1,1,1,20131001,Q0494,HCPCS,"EMR HD PMP ELEC/COMBO, REP",,,28 ,,NW,,,,,,$279.65,$0.00,1,1,1,1,1,1,20131001,Q0495,HCPCS,"CHARGER ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,"$6,267.90",$0.00,1,1,1,1,1,1,20131001,Q0496,HCPCS,"BATTERY ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,"$2,221.06",$0.00,1,1,1,1,1,1,20131001,Q0497,HCPCS,"BAT CLPS ELEC/COMB VAD, REP",,,28 ,,NW,,,,,,$662.86,$0.00,1,1,1,1,1,1,20131001,Q0498,HCPCS,"HOLSTER ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,$731.64,$0.00,1,1,1,1,1,1,20131001,Q0499,HCPCS,BELT/VEST ELEC/COMBO VAD REP,,,28 ,,NW,,,,,,$214.40,$0.00,1,1,1,1,1,1,20131001,Q0500,HCPCS,"FILTERS ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,$41.36,$0.00,1,1,1,1,1,1,20131001,Q0501,HCPCS,"SHWR COV ELEC/COMBO VAD, REP",,,28 ,,NW,,,,,,$727.17,$0.00,1,1,1,1,1,1,20131001,Q0502,HCPCS,"MOBILITY CART PNEUM VAD, REP",,,28 ,,NW,,,,,,$937.96,$0.00,1,1,1,1,1,1,20131001,Q0503,HCPCS,BATTERY PNEUM VAD REPLACEMNT,,,28 ,,NW,,,,,,"$1,920.57",$0.00,1,1,1,1,1,1,20131001,Q0504,HCPCS,"PWR ADPT PNEUM VAD, REP VEH",,,28 ,,NW,,,,,,$992.36,$0.00,1,1,1,1,1,1,20131001,Q0506,HCPCS,LITH-ION BATT ELEC/PNEUM VAD,,,28 ,,NW,,,,,,"$1,246.17",$0.00,1,1,1,1,1,1,20131001,Q0510,HCPCS,DISPENS FEE IMMUNOSUPRESSIVE,,,29 ,,NW,,,,,,$71.24,$0.00,1,1,1,0,0,1,20131001,Q0511,HCPCS,"SUP FEE ANTIEM,ANTICA,IMMUNO",,,29 ,,NW,,,,,,$34.19,$0.00,1,1,1,0,0,1,20131001,Q0512,HCPCS,PX SUP FEE ANTI-CAN SUB PRES,,,29 ,,NW,,,,,,$22.80,$0.00,1,1,1,0,0,1,20131001,Q0513,HCPCS,DISP FEE INHAL DRUGS/30 DAYS,,,29 ,,NW,,,,,,$67.46,$0.00,1,1,1,0,0,1,20131001,Q0514,HCPCS,DISP FEE INHAL DRUGS/90 DAYS,,,29 ,,NW,,,,,,$94.03,$0.00,1,1,1,0,0,1,20131001,Q0515,HCPCS,SERMORELIN ACETATE INJECTION,,,29 ,,NW,,,,,,$6.14,$0.00,1,1,1,0,0,1,20131001,Q2004,HCPCS,BLADDER CALCULI IRRIG SOL,,,29 ,,NW,,,,,,$42.31,$0.00,1,1,1,0,0,1,20131001,Q2009,HCPCS,FOSPHENYTOIN INJ PE,,,29 ,,NW,,,,,,$1.23,$0.00,1,1,1,0,0,1,20131001,Q2017,HCPCS,"TENIPOSIDE, 50 MG",,,29 ,,NW,,,,,,$969.69,$0.00,1,1,1,0,0,1,20131001,Q2026,HCPCS,RADIESSE INJECTION,,,14 ,,TotalUnits,,,,8.54 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,Q2027,HCPCS,SCULPTRA INJECTION,,,14 ,,TotalUnits,,,,4.74 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,Q2034,HCPCS,AGRIFLU VACCINE,,,29 ,,NW,,,,,,$31.60,$0.00,1,1,1,0,1,1,20131001,Q2035,HCPCS,"AFLURIA VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q2036,HCPCS,"FLULAVAL VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q2037,HCPCS,"FLUVIRIN VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.53 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q2038,HCPCS,"FLUZONE VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.46 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q2039,HCPCS,"NOS FLU VACC, 3 YRS & >, IM",,,9 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,Q2043,HCPCS,SIPULEUCEL-T AUTO CD54+,,,29 ,,NW,,,,,,"$82,910.86",$0.00,1,1,1,0,0,1,20131001,Q2045,HCPCS,HUMAN FIBRINOGEN CONC INJ,,,29 ,,NW,,,,,,$4.83,$0.00,1,1,1,0,0,1,20131001,Q2046,HCPCS,AFLIBERCEPT INJECTION,,,29 ,,NW,,,,,,"$2,483.06",$0.00,1,1,1,0,0,1,20131001,Q2047,HCPCS,PEGINESATIDE INJECTION,,,29 ,,NW,,,,,,$34.57,$0.00,1,1,1,0,0,1,20131001,Q2048,HCPCS,DOXIL INJECTION,,,29 ,,NW,,,,,,"$1,362.45",$0.00,1,1,1,0,0,1,20131001,Q2049,HCPCS,IMPORTED LIPODOX INJ,,,29 ,,NW,,,,,,"$1,264.41",$0.00,1,1,1,0,0,1,20131001,Q3001,HCPCS,BRACHYTHERAPY RADIOELEMENTS,,,28 ,,NW,,,,,,$95.84,$0.00,1,1,1,0,0,1,20131001,Q3014,HCPCS,TELEHEALTH FACILITY FEE,,,14 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,1,1,0,0,0,20131001,Q3025,HCPCS,IM INJ INTERFERON BETA 1-A,,,29 ,,NW,,,,,,$689.05,$0.00,1,1,1,0,0,1,20131001,Q3026,HCPCS,SUBC INJ INTERFERON BETA-1A,,,29 ,,NW,,,,,,$170.99,$0.00,1,1,1,0,0,1,20131001,Q4001,HCPCS,CAST SUP BODY CAST PLASTER,,,28 ,,NW,,,,,,$174.45,$0.00,1,1,1,0,0,1,20131001,Q4002,HCPCS,CAST SUP BODY CAST FIBERGLAS,,,28 ,,NW,,,,,,$364.29,$0.00,1,1,1,0,0,1,20131001,Q4003,HCPCS,CAST SUP SHOULDER CAST PLSTR,,,28 ,,NW,,,,,,$97.79,$0.00,1,1,1,0,0,1,20131001,Q4004,HCPCS,CAST SUP SHOULDER CAST FBRGL,,,28 ,,NW,,,,,,$200.62,$0.00,1,1,1,0,0,1,20131001,Q4005,HCPCS,CAST SUP LONG ARM ADULT PLST,,,28 ,,NW,,,,,,$56.42,$0.00,1,1,1,0,0,1,20131001,Q4006,HCPCS,CAST SUP LONG ARM ADULT FBRG,,,28 ,,NW,,,,,,$113.00,$0.00,1,1,1,0,0,1,20131001,Q4007,HCPCS,CAST SUP LONG ARM PED PLSTER,,,28 ,,NW,,,,,,$31.47,$0.00,1,1,1,0,0,1,20131001,Q4008,HCPCS,CAST SUP LONG ARM PED FBRGLS,,,28 ,,NW,,,,,,$59.46,$0.00,1,1,1,0,0,1,20131001,Q4009,HCPCS,CAST SUP SHT ARM ADULT PLSTR,,,28 ,,NW,,,,,,$44.86,$0.00,1,1,1,0,0,1,20131001,Q4010,HCPCS,CAST SUP SHT ARM ADULT FBRGL,,,28 ,,NW,,,,,,$89.27,$0.00,1,1,1,0,0,1,20131001,Q4011,HCPCS,CAST SUP SHT ARM PED PLASTER,,,28 ,,NW,,,,,,$25.99,$0.00,1,1,1,0,0,1,20131001,Q4012,HCPCS,CAST SUP SHT ARM PED FBRGLAS,,,28 ,,NW,,,,,,$47.90,$0.00,1,1,1,0,0,1,20131001,Q4013,HCPCS,CAST SUP GAUNTLET PLASTER,,,28 ,,NW,,,,,,$43.03,$0.00,1,1,1,0,0,1,20131001,Q4014,HCPCS,CAST SUP GAUNTLET FIBERGLASS,,,28 ,,NW,,,,,,$84.40,$0.00,1,1,1,0,0,1,20131001,Q4015,HCPCS,CAST SUP GAUNTLET PED PLSTER,,,28 ,,NW,,,,,,$24.78,$0.00,1,1,1,0,0,1,20131001,Q4016,HCPCS,CAST SUP GAUNTLET PED FBRGLS,,,28 ,,NW,,,,,,$45.46,$0.00,1,1,1,0,0,1,20131001,Q4017,HCPCS,CAST SUP LNG ARM SPLINT PLST,,,28 ,,NW,,,,,,$38.16,$0.00,1,1,1,0,0,1,20131001,Q4018,HCPCS,CAST SUP LNG ARM SPLINT FBRG,,,28 ,,NW,,,,,,$74.67,$0.00,1,1,1,0,0,1,20131001,Q4019,HCPCS,CAST SUP LNG ARM SPLNT PED P,,,28 ,,NW,,,,,,$22.34,$0.00,1,1,1,0,0,1,20131001,Q4020,HCPCS,CAST SUP LNG ARM SPLNT PED F,,,28 ,,NW,,,,,,$40.60,$0.00,1,1,1,0,0,1,20131001,Q4021,HCPCS,CAST SUP SHT ARM SPLINT PLST,,,28 ,,NW,,,,,,$38.16,$0.00,1,1,1,0,0,1,20131001,Q4022,HCPCS,CAST SUP SHT ARM SPLINT FBRG,,,28 ,,NW,,,,,,$74.67,$0.00,1,1,1,0,0,1,20131001,Q4023,HCPCS,CAST SUP SHT ARM SPLNT PED P,,,28 ,,NW,,,,,,$22.34,$0.00,1,1,1,0,0,1,20131001,Q4024,HCPCS,CAST SUP SHT ARM SPLNT PED F,,,28 ,,NW,,,,,,$40.60,$0.00,1,1,1,0,0,1,20131001,Q4025,HCPCS,CAST SUP HIP SPICA PLASTER,,,28 ,,NW,,,,,,$147.68,$0.00,1,1,1,0,0,1,20131001,Q4026,HCPCS,CAST SUP HIP SPICA FIBERGLAS,,,28 ,,NW,,,,,,$307.09,$0.00,1,1,1,0,0,1,20131001,Q4027,HCPCS,CAST SUP HIP SPICA PED PLSTR,,,28 ,,NW,,,,,,$77.10,$0.00,1,1,1,0,0,1,20131001,Q4028,HCPCS,CAST SUP HIP SPICA PED FBRGL,,,28 ,,NW,,,,,,$156.81,$0.00,1,1,1,0,0,1,20131001,Q4029,HCPCS,CAST SUP LONG LEG PLASTER,,,28 ,,NW,,,,,,$76.49,$0.00,1,1,1,0,0,1,20131001,Q4030,HCPCS,CAST SUP LONG LEG FIBERGLASS,,,28 ,,NW,,,,,,$154.38,$0.00,1,1,1,0,0,1,20131001,Q4031,HCPCS,CAST SUP LNG LEG PED PLASTER,,,28 ,,NW,,,,,,$41.21,$0.00,1,1,1,0,0,1,20131001,Q4032,HCPCS,CAST SUP LNG LEG PED FBRGLS,,,28 ,,NW,,,,,,$80.75,$0.00,1,1,1,0,0,1,20131001,Q4033,HCPCS,CAST SUP LNG LEG CYLINDER PL,,,28 ,,NW,,,,,,$65.54,$0.00,1,1,1,0,0,1,20131001,Q4034,HCPCS,CAST SUP LNG LEG CYLINDER FB,,,28 ,,NW,,,,,,$132.47,$0.00,1,1,1,0,0,1,20131001,Q4035,HCPCS,CAST SUP LNGLEG CYLNDR PED P,,,28 ,,NW,,,,,,$36.34,$0.00,1,1,1,0,0,1,20131001,Q4036,HCPCS,CAST SUP LNGLEG CYLNDR PED F,,,28 ,,NW,,,,,,$69.80,$0.00,1,1,1,0,0,1,20131001,Q4037,HCPCS,CAST SUP SHRT LEG PLASTER,,,28 ,,NW,,,,,,$86.23,$0.00,1,1,1,0,0,1,20131001,Q4038,HCPCS,CAST SUP SHRT LEG FIBERGLASS,,,28 ,,NW,,,,,,$176.28,$0.00,1,1,1,0,0,1,20131001,Q4039,HCPCS,CAST SUP SHRT LEG PED PLSTER,,,28 ,,NW,,,,,,$46.07,$0.00,1,1,1,0,0,1,20131001,Q4040,HCPCS,CAST SUP SHRT LEG PED FBRGLS,,,28 ,,NW,,,,,,$91.71,$0.00,1,1,1,0,0,1,20131001,Q4041,HCPCS,CAST SUP LNG LEG SPLNT PLSTR,,,28 ,,NW,,,,,,$52.16,$0.00,1,1,1,0,0,1,20131001,Q4042,HCPCS,CAST SUP LNG LEG SPLNT FBRGL,,,28 ,,NW,,,,,,$103.27,$0.00,1,1,1,0,0,1,20131001,Q4043,HCPCS,CAST SUP LNG LEG SPLNT PED P,,,28 ,,NW,,,,,,$29.64,$0.00,1,1,1,0,0,1,20131001,Q4044,HCPCS,CAST SUP LNG LEG SPLNT PED F,,,28 ,,NW,,,,,,$55.20,$0.00,1,1,1,0,0,1,20131001,Q4045,HCPCS,CAST SUP SHT LEG SPLNT PLSTR,,,28 ,,NW,,,,,,$36.34,$0.00,1,1,1,0,0,1,20131001,Q4046,HCPCS,CAST SUP SHT LEG SPLNT FBRGL,,,28 ,,NW,,,,,,$69.80,$0.00,1,1,1,0,0,1,20131001,Q4047,HCPCS,CAST SUP SHT LEG SPLNT PED P,,,28 ,,NW,,,,,,$21.13,$0.00,1,1,1,0,0,1,20131001,Q4048,HCPCS,CAST SUP SHT LEG SPLNT PED F,,,28 ,,NW,,,,,,$38.16,$0.00,1,1,1,0,0,1,20131001,Q4049,HCPCS,"FINGER SPLINT, STATIC",,,28 ,,NW,,,,,,$15.05,$0.00,1,1,1,0,0,1,20131001,Q4050,HCPCS,CAST SUPPLIES UNLISTED,,,28 ,,NW,,,,,,$52.06,$0.00,1,1,1,0,0,1,20131001,Q4051,HCPCS,SPLINT SUPPLIES MISC,,,28 ,,NW,,,,,,$33.37,$0.00,1,1,1,0,0,1,20131001,Q4074,HCPCS,ILOPROST NON-COMP UNIT DOSE,,,29 ,,NW,,,,,,$185.08,$0.00,1,1,1,0,0,1,20131001,Q4081,HCPCS,"EPOETIN ALFA, 100 UNITS ESRD",,,29 ,,NW,,,,,,$3.68,$0.00,1,1,1,0,0,1,20131001,Q4082,HCPCS,DRUG/BIO NOC PART B DRUG CAP,,,29 ,,NW,,,,,,"$2,805.59",$0.00,1,1,1,0,0,1,20131001,Q4100,HCPCS,"SKIN SUBSTITUTE, NOS",,,29 ,,NW,,,,,,$15.89,$0.00,1,1,1,0,0,1,20131001,Q4101,HCPCS,APLIGRAF,,,29 ,,NW,,,,,,$101.66,$0.00,1,1,1,0,0,1,20131001,Q4102,HCPCS,OASIS WOUND MATRIX,,,29 ,,NW,,,,,,$24.25,$0.00,1,1,1,0,0,1,20131001,Q4103,HCPCS,OASIS BURN MATRIX,,,29 ,,NW,,,,,,$24.25,$0.00,1,1,1,0,0,1,20131001,Q4104,HCPCS,INTEGRA BMWD,,,29 ,,NW,,,,,,$46.61,$0.00,1,1,1,0,0,1,20131001,Q4105,HCPCS,INTEGRA DRT,,,29 ,,NW,,,,,,$41.45,$0.00,1,0,0,0,0,1,20131001,Q4106,HCPCS,DERMAGRAFT,,,29 ,,NW,,,,,,$112.84,$0.00,1,1,1,0,0,1,20131001,Q4107,HCPCS,GRAFTJACKET,,,29 ,,NW,,,,,,$242.70,$0.00,1,1,1,0,0,1,20131001,Q4108,HCPCS,INTEGRA MATRIX,,,29 ,,NW,,,,,,$71.55,$0.00,1,1,1,0,0,1,20131001,Q4110,HCPCS,PRIMATRIX,,,29 ,,NW,,,,,,$94.77,$0.00,1,1,1,0,0,1,20131001,Q4111,HCPCS,GAMMAGRAFT,,,29 ,,NW,,,,,,$23.39,$0.00,1,1,1,0,0,1,20131001,Q4112,HCPCS,CYMETRA INJECTABLE,,,29 ,,NW,,,,,,$426.74,$0.00,1,1,1,0,0,1,20131001,Q4113,HCPCS,GRAFTJACKET XPRESS,,,29 ,,NW,,,,,,$838.70,$0.00,1,1,1,0,0,1,20131001,Q4114,HCPCS,INTEGRA FLOWABLE WOUND MATRI,,,29 ,,NW,,,,,,"$2,801.27",$0.00,1,1,1,0,0,1,20131001,Q4115,HCPCS,ALLOSKIN,,,29 ,,NW,,,,,,$26.83,$0.00,1,1,1,0,0,1,20131001,Q4116,HCPCS,ALLODERM,,,29 ,,NW,,,,,,$87.03,$0.00,1,1,1,0,0,1,20131001,Q4119,HCPCS,MATRISTEM WOUND MATRIX,,,29 ,,NW,,,,,,$38.84,$0.00,1,1,1,0,0,1,20131001,Q4120,HCPCS,MATRISTEM BURN MATRIX,,,29 ,,NW,,,,,,"$3,827.29",$0.00,1,1,1,0,0,1,20131001,Q4121,HCPCS,THERASKIN,,,29 ,,NW,,,,,,$62.95,$0.00,1,1,1,0,0,1,20131001,Q4123,HCPCS,ALLOSKIN,,,29 ,,NW,,,,,,$39.73,$0.00,1,1,1,0,0,1,20131001,Q4125,HCPCS,ARTHROFLEX,,,29 ,,NW,,,,,,$797.82,$0.00,1,1,1,0,0,1,20131001,Q4128,HCPCS,FLEXHD OR ALLOPATCH HD,,,29 ,,NW,,,,,,$288.05,$0.00,1,1,1,0,0,1,20131001,Q4129,HCPCS,UNITE BIOMATRIX,,,29 ,,NW,,,,,,$232.48,$0.00,1,1,1,0,0,1,20131001,Q5001,HCPCS,HOSPICE IN PATIENT HOME,,,14 ,,TotalUnits,,,,1.35 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,Q5002,HCPCS,HOSPICE IN ASSISTED LIVING,,,14 ,,TotalUnits,,,,1.61 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,Q5003,HCPCS,HOSPICE IN LT/NON-SKILLED NF,,,14 ,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,Q5004,HCPCS,HOSPICE IN SNF,,,14 ,,TotalUnits,,,,1.52 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,Q5005,HCPCS,"HOSPICE, INPATIENT HOSPITAL",,,14 ,,TotalUnits,,,,5.03 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,Q5006,HCPCS,HOSPICE IN HOSPICE FACILITY,,,14 ,,TotalUnits,,,,6.27 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,Q5010,HCPCS,HOSPICE HOME CARE IN HOSPICE,,,14 ,,TotalUnits,,,,6.27 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,Q9951,HCPCS,"LOCM >= 400 MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$1.65,$0.00,1,1,1,0,0,1,20131001,Q9953,HCPCS,"INJ FE-BASED MR CONTRAST,1ML",,,28 ,,NW,,,,,,$11.01,$0.00,1,1,1,0,0,1,20131001,Q9954,HCPCS,"ORAL MR CONTRAST, 100 ML",,,28 ,,NW,,,,,,$60.52,$0.00,1,1,1,0,0,1,20131001,Q9955,HCPCS,"INJ PERFLEXANE LIP MICROS,ML",,,28 ,,NW,,,,,,$4.11,$0.00,1,1,1,0,0,1,20131001,Q9956,HCPCS,"INJ OCTAFLUOROPROPANE MIC,ML",,,28 ,,NW,,,,,,$57.64,$0.00,1,1,1,0,0,1,20131001,Q9957,HCPCS,"INJ PERFLUTREN LIP MICROS,ML",,,28 ,,NW,,,,,,$194.55,$0.00,1,1,1,0,0,1,20131001,Q9958,HCPCS,"HOCM <=149 MG/ML IODINE, 1ML",,,28 ,,NW,,,,,,$0.08,$0.00,1,1,1,0,0,1,20131001,Q9959,HCPCS,"HOCM 150-199MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$0.54,$0.00,1,1,1,0,0,1,20131001,Q9960,HCPCS,"HOCM 200-249MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$1.08,$0.00,1,1,1,0,0,1,20131001,Q9961,HCPCS,"HOCM 250-299MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$1.62,$0.00,1,1,1,0,0,1,20131001,Q9962,HCPCS,"HOCM 300-349MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$1.67,$0.00,1,1,1,0,0,1,20131001,Q9963,HCPCS,"HOCM 350-399MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$2.12,$0.00,1,1,1,0,0,1,20131001,Q9964,HCPCS,"HOCM>= 400MG/ML IODINE, 1ML",,,28 ,,NW,,,,,,$2.55,$0.00,1,1,1,0,0,1,20131001,Q9965,HCPCS,"LOCM 100-199MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$3.24,$0.00,1,1,1,0,0,1,20131001,Q9966,HCPCS,"LOCM 200-299MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$3.67,$0.00,1,1,1,0,0,1,20131001,Q9967,HCPCS,"LOCM 300-399MG/ML IODINE,1ML",,,28 ,,NW,,,,,,$3.92,$0.00,1,1,1,0,0,1,20131001,R0070,HCPCS,TRANSPORT PORTABLE X-RAY,,TC,20 ,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,R0075,HCPCS,TRANSPORT PORT X-RAY MULTIPL,,TC,20 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,R0076,HCPCS,TRANSPORT PORTABLE EKG,,,20 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,S0012,HCPCS,"BUTORPHANOL TARTRATE, NASAL",,,28 ,,NW,,,,,,$177.26,$0.00,1,1,1,0,0,1,20131001,S0014,HCPCS,"TACRINE HYDROCHLORIDE, 10 MG",,,28 ,,NW,,,,,,$6.07,$0.00,1,1,1,0,0,1,20131001,S0017,HCPCS,"INJECTION, AMINOCAPROIC ACID",,,28 ,,NW,,,,,,$14.86,$0.00,1,1,1,0,0,1,20131001,S0020,HCPCS,"INJECTION, BUPIVICAINE HYDRO",,,28 ,,NW,,,,,,$11.20,$0.00,1,1,1,0,0,1,20131001,S0021,HCPCS,"INJECTION, CEFOPERAZONE SOD",,,28 ,,NW,,,,,,$6.90,$0.00,1,1,1,0,0,1,20131001,S0023,HCPCS,"INJECTION, CIMETIDINE HYDROC",,,28 ,,NW,,,,,,$6.64,$0.00,1,1,1,0,0,1,20131001,S0028,HCPCS,"INJECTION, FAMOTIDINE, 20 MG",,,28 ,,NW,,,,,,$8.04,$0.00,1,1,1,0,0,1,20131001,S0030,HCPCS,"INJECTION, METRONIDAZOLE",,,28 ,,NW,,,,,,$23.35,$0.00,1,1,1,0,0,1,20131001,S0032,HCPCS,"INJECTION, NAFCILLIN SODIUM",,,28 ,,NW,,,,,,$52.85,$0.00,1,1,1,0,0,1,20131001,S0034,HCPCS,"INJECTION, OFLOXACIN, 400 MG",,,28 ,,NW,,,,,,$30.97,$0.00,1,1,1,0,0,1,20131001,S0039,HCPCS,"INJECTION, SULFAMETHOXAZOLE",,,28 ,,NW,,,,,,$22.49,$0.00,1,1,1,0,0,1,20131001,S0040,HCPCS,"INJECTION, TICARCILLIN DISOD",,,28 ,,NW,,,,,,$33.57,$0.00,1,1,1,0,0,1,20131001,S0073,HCPCS,"INJECTION, AZTREONAM, 500 MG",,,28 ,,NW,,,,,,$41.47,$0.00,1,1,1,0,0,1,20131001,S0074,HCPCS,"INJECTION, CEFOTETAN DISODIU",,,28 ,,NW,,,,,,$53.76,$0.00,1,1,1,0,0,1,20131001,S0077,HCPCS,"INJECTION, CLINDAMYCIN PHOSP",,,28 ,,NW,,,,,,$9.49,$0.00,1,1,1,0,0,1,20131001,S0078,HCPCS,"INJECTION, FOSPHENYTOIN SODI",,,28 ,,NW,,,,,,$406.70,$0.00,1,1,1,0,0,1,20131001,S0080,HCPCS,"INJECTION, PENTAMIDINE ISETH",,,28 ,,NW,,,,,,$158.10,$0.00,1,1,1,0,0,1,20131001,S0081,HCPCS,"INJECTION, PIPERACILLIN SODI",,,28 ,,NW,,,,,,$4.34,$0.00,1,1,1,0,0,1,20131001,S0088,HCPCS,IMATINIB 100 MG,,,28 ,,NW,,,,,,$102.05,$0.00,1,1,1,0,0,1,20131001,S0090,HCPCS,"SILDENAFIL CITRATE, 25 MG",,,28 ,,NW,,,,,,$39.24,$0.00,1,1,1,0,0,1,20131001,S0091,HCPCS,GRANISETRON 1MG,,,28 ,,NW,,,,,,$193.21,$0.00,1,1,1,0,0,1,20131001,S0092,HCPCS,HYDROMORPHONE 250 MG,,,28 ,,NW,,,,,,$238.50,$0.00,1,1,1,0,0,1,20131001,S0093,HCPCS,MORPHINE 500 MG,,,28 ,,NW,,,,,,$32.35,$0.00,1,1,1,0,0,1,20131001,S0104,HCPCS,"ZIDOVUDINE, ORAL, 100 MG",,,28 ,,NW,,,,,,$4.20,$0.00,1,1,1,0,0,1,20131001,S0106,HCPCS,BUPROPION HCL SR 60 TABLETS,,,28 ,,NW,,,,,,$252.30,$0.00,1,1,1,0,0,1,20131001,S0108,HCPCS,MERCAPTOPURINE 50 MG,,,28 ,,NW,,,,,,$8.70,$0.00,1,1,1,0,0,1,20131001,S0109,HCPCS,METHADONE ORAL 5MG,,,28 ,,NW,,,,,,$0.65,$0.00,1,1,1,0,0,1,20131001,S0119,HCPCS,ONDANSETRON 4 MG,,,28 ,,NW,,,,,,$43.55,$0.00,1,1,1,0,0,1,20131001,S0122,HCPCS,INJ MENOTROPINS 75 IU,,,28 ,,NW,,,,,,$162.05,$0.00,1,1,1,0,0,1,20131001,S0126,HCPCS,INJ FOLLITROPIN ALFA 75 IU,,,28 ,,NW,,,,,,$184.99,$0.00,1,1,1,0,0,1,20131001,S0128,HCPCS,INJ FOLLITROPIN BETA 75 IU,,,28 ,,NW,,,,,,$176.01,$0.00,1,1,1,0,0,1,20131001,S0132,HCPCS,INJ GANIRELIX ACETAT 250 MCG,,,28 ,,NW,,,,,,$243.72,$0.00,1,1,1,0,0,1,20131001,S0136,HCPCS,"CLOZAPINE, 25 MG",,,28 ,,NW,,,,,,$2.99,$0.00,1,1,1,0,0,1,20131001,S0137,HCPCS,"DIDANOSINE, 25 MG",,,28 ,,NW,,,,,,$15.50,$0.00,1,1,1,0,0,1,20131001,S0138,HCPCS,"FINASTERIDE, 5 MG",,,28 ,,NW,,,,,,$6.50,$0.00,1,1,1,0,0,1,20131001,S0139,HCPCS,"MINOXIDIL, 10 MG",,,28 ,,NW,,,,,,$2.57,$0.00,1,1,1,0,0,1,20131001,S0140,HCPCS,"SAQUINAVIR, 200 MG",,,28 ,,NW,,,,,,$4.34,$0.00,1,1,1,0,0,1,20131001,S0142,HCPCS,COLISTIMETHATE INH SOL MG,,,28 ,,NW,,,,,,$20.67,$0.00,1,1,1,0,0,1,20131001,S0145,HCPCS,PEG INTERFERON ALFA-2A/180,,,28 ,,NW,,,,,,$51.89,$0.00,1,1,1,0,0,1,20131001,S0155,HCPCS,EPOPROSTENOL DILUTANT,,,28 ,,NW,,,,,,$30.25,$0.00,1,1,1,0,0,1,20131001,S0156,HCPCS,"EXEMESTANE, 25 MG",,,28 ,,NW,,,,,,$19.40,$0.00,1,1,1,0,0,1,20131001,S0157,HCPCS,"BECAPLERMIN GEL 1%, 0.5 GM",,,28 ,,NW,,,,,,$40.57,$0.00,1,1,1,0,0,1,20131001,S0160,HCPCS,DEXTROAMPHETAMINE,,,28 ,,NW,,,,,,$0.92,$0.00,1,1,1,0,0,1,20131001,S0164,HCPCS,INJECTION PANTROPRAZOLE,,,28 ,,NW,,,,,,$29.92,$0.00,1,1,1,0,0,1,20131001,S0166,HCPCS,INJ OLANZAPINE 2.5MG,,,28 ,,NW,,,,,,$13.59,$0.00,1,1,1,0,0,1,20131001,S0170,HCPCS,ANASTROZOLE 1 MG,,,28 ,,NW,,,,,,$18.65,$0.00,1,1,1,0,0,1,20131001,S0171,HCPCS,BUMETANIDE 0.5 MG,,,28 ,,NW,,,,,,$2.74,$0.00,1,1,1,0,0,1,20131001,S0172,HCPCS,CHLORAMBUCIL 2 MG,,,28 ,,NW,,,,,,$5.11,$0.00,1,1,1,0,0,1,20131001,S0174,HCPCS,DOLASETRON 50 MG,,,28 ,,NW,,,,,,$119.50,$0.00,1,1,1,0,0,1,20131001,S0175,HCPCS,FLUTAMIDE 125 MG,,,28 ,,NW,,,,,,$4.94,$0.00,1,1,1,0,0,1,20131001,S0176,HCPCS,HYDROXYUREA 500 MG,,,28 ,,NW,,,,,,$2.64,$0.00,1,1,1,0,0,1,20131001,S0177,HCPCS,LEVAMISOLE 50 MG,,,28 ,,NW,,,,,,$11.49,$0.00,1,1,1,0,0,1,20131001,S0178,HCPCS,LOMUSTINE 10 MG,,,28 ,,NW,,,,,,$60.93,$0.00,1,1,1,0,0,1,20131001,S0179,HCPCS,MEGESTROL 20 MG,,,28 ,,NW,,,,,,$1.37,$0.00,1,1,1,0,0,1,20131001,S0182,HCPCS,PROCARBAZINE 5 MG,,,28 ,,NW,,,,,,$119.15,$0.00,1,1,1,0,0,1,20131001,S0183,HCPCS,PROCHLORPERAZINE 5 MG,,,28 ,,NW,,,,,,$1.52,$0.00,1,1,1,0,0,1,20131001,S0187,HCPCS,TAMOXIFEN 10 MG,,,28 ,,NW,,,,,,$5.09,$0.00,1,1,1,0,0,1,20131001,S0189,HCPCS,TESTOSTERONE PELLET 75 MG,,,28 ,,NW,,,,,,$122.49,$0.00,1,1,1,0,0,1,20131001,S0190,HCPCS,"MIFEPRISTONE, ORAL, 200 MG",,,28 ,,NW,,,,,,$192.48,$0.00,1,1,1,0,0,1,20131001,S0191,HCPCS,"MISOPROSTOL, ORAL, 200 MCG",,,28 ,,NW,,,,,,$6.02,$0.00,1,1,1,0,0,1,20131001,S0195,HCPCS,PNEUMO VACCINE 5-9 YRS,,,28 ,,NW,,,,,,$67.99,$0.00,1,1,1,0,1,1,20131001,S0199,HCPCS,MED ABORTION INC ALL EX DRUG,,,12 ,,TotalUnits,,,,4.65 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0201,HCPCS,PARTIAL HOSPITALIZATION SERV,,,14 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S0207,HCPCS,PARAMEDICINTERCEP NONHOSPALS,,,14 ,,TotalUnits,,,,7.09 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S0208,HCPCS,PARAMED INTRCEPT NONVOL,,,14 ,,TotalUnits,,,,4.56 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S0220,HCPCS,MEDICAL CONFERENCE BY PHYSIC,,,15 ,,TotalUnits,,,,2.81 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0221,HCPCS,"MEDICAL CONFERENCE, 60 MIN",,,15 ,,RBRVS,1.42 ,0.44 ,1.10 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0255,HCPCS,HOSPICE REFER VISIT NONMD,,,15 ,,RBRVS,0.48 ,0.11 ,0.36 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0257,HCPCS,END OF LIFE COUNSELING,,,15 ,,TotalUnits,,,,0.41 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0260,HCPCS,H&P FOR SURGERY,,,15 ,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0265,HCPCS,GENETIC COUNSEL 15 MINS,,,14 ,,TotalUnits,,,,0.54 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0302,HCPCS,COMPLETED EPSDT,,,18 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0315,HCPCS,DISEASE MANAGEMENT PROGRAM,,,14 ,,TotalUnits,,,,1.12 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0316,HCPCS,FOLLOW-UP/REASSESSMENT,,,14 ,,TotalUnits,,,,0.83 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0317,HCPCS,DISEASE MGMT PER DIEM,,,14 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0390,HCPCS,ROUT FOOT CARE PER VISIT,,,14 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0395,HCPCS,IMPRESSION CASTING FT,,,28 ,,NW,,,,,,$99.60,$0.00,1,1,1,0,1,1,20131001,S0400,HCPCS,GLOBAL ESWL KIDNEY,,,21 ,,RBRVS,9.64 ,6.13 ,17.10 ,,,$0.00,$0.00,1,0,0,0,0,1,20131001,S0500,HCPCS,DISPOS CONT LENS,,,28 ,,NW,,,,,,$71.98,$0.00,1,1,1,1,1,1,20131001,S0504,HCPCS,SINGL PRSCRP LENS,,,28 ,,NW,,,,,,$112.23,$0.00,1,1,1,1,1,1,20131001,S0506,HCPCS,BIFOC PRSCP LENS,,,28 ,,NW,,,,,,$143.10,$0.00,1,1,1,1,1,1,20131001,S0508,HCPCS,TRIFOC PRSCRP LENS,,,28 ,,NW,,,,,,$80.58,$0.00,1,1,1,1,1,1,20131001,S0510,HCPCS,NON-PRSCRP LENS,,,28 ,,NW,,,,,,$38.10,$0.00,1,1,1,1,1,1,20131001,S0512,HCPCS,DAILY CONT LENS,,,28 ,,NW,,,,,,$79.58,$0.00,1,1,1,1,1,1,20131001,S0514,HCPCS,COLOR CONT LENS,,,28 ,,NW,,,,,,$189.76,$0.00,1,1,1,1,1,1,20131001,S0515,HCPCS,SCLERAL LENS LIQUID BANDAGE,,,28 ,,NW,,,,,,$377.81,$0.00,1,1,1,1,1,1,20131001,S0516,HCPCS,SAFETY FRAMES,,,28 ,,NW,,,,,,$77.57,$0.00,1,1,1,1,1,1,20131001,S0518,HCPCS,SUNGLASS FRAMES,,,28 ,,NW,,,,,,$50.22,$0.00,1,1,1,1,1,1,20131001,S0580,HCPCS,POLYCARB LENS,,,28 ,,NW,,,,,,$80.25,$0.00,1,1,1,1,1,1,20131001,S0581,HCPCS,NONSTND LENS,,,28 ,,NW,,,,,,$239.87,$0.00,1,1,1,1,1,1,20131001,S0592,HCPCS,COMP CONT LENS EVAL,,,23 ,,TotalUnits,,,,1.13 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0595,HCPCS,NEW LENSES IN PTS OLD FRAME,,,28 ,,NW,,,,,,$7.29,$0.00,1,1,1,1,1,1,20131001,S0601,HCPCS,SCREENING PROCTOSCOPY,,,21 ,,RBRVS,0.55 ,0.38 ,1.37 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0610,HCPCS,ANNUAL GYNECOLOGICAL EXAMINA,,,18 ,,TotalUnits,,,,2.79 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0612,HCPCS,ANNUAL GYNECOLOGICAL EXAMINA,,,18 ,,TotalUnits,,,,1.95 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0613,HCPCS,ANN BREAST EXAM,,,18 ,,TotalUnits,,,,0.93 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0618,HCPCS,AUDIOMETRY FOR HEARING AID,,,8 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S0620,HCPCS,ROUTINE OPHTHALMOLOGICAL EXA,,,23 ,,TotalUnits,,,,1.25 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0621,HCPCS,ROUTINE OPHTHALMOLOGICAL EXA,,,23 ,,TotalUnits,,,,1.40 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0622,HCPCS,PHYS EXAM FOR COLLEGE,,,14 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0630,HCPCS,REMOVAL OF SUTURES,,,14 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0800,HCPCS,LASER IN SITU KERATOMILEUSIS,,,14 ,,TotalUnits,,,,15.46 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0810,HCPCS,PHOTOREFRACTIVE KERATECTOMY,,,14 ,,TotalUnits,,,,16.09 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S0812,HCPCS,PHOTOTHERAP KERATECT,,,14 ,,RBRVS,0.92 ,0.64 ,0.86 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S1001,HCPCS,DELUXE ITEM,,,28 ,,NW,,,,,,$22.92,$0.00,1,1,1,1,1,1,20131001,S1002,HCPCS,CUSTOM ITEM,,,28 ,,NW,,,,,,$23.25,$0.00,1,1,1,1,1,1,20131001,S1015,HCPCS,IV TUBING EXTENSION SET,,,28 ,,NW,,,,,,$37.12,$0.00,1,1,1,0,0,1,20131001,S1016,HCPCS,NON-PVC INTRAVENOUS ADMINIST,,,28 ,,NW,,,,,,$52.11,$0.00,1,1,1,0,0,1,20131001,S1040,HCPCS,CRANIAL REMOLDING ORTHOSIS,,,28 ,,NW,,,,,,$585.74,$0.00,1,1,1,1,1,1,20131001,S2053,HCPCS,TRANSPLANTATION OF SMALL INT,,,21 ,,RBRVS,83.29 ,27.76 ,27.76 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2054,HCPCS,TRANSPLANTATION OF MULTIVISC,,,21 ,,RBRVS,61.68 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2055,HCPCS,HARVESTING OF DONOR MULTIVIS,,,21 ,,RBRVS,61.68 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2060,HCPCS,LOBAR LUNG TRANSPLANTATION,,,21 ,,RBRVS,40.94 ,20.19 ,20.19 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2065,HCPCS,SIMULT PANC KIDN TRANS,,,21 ,,RBRVS,61.68 ,22.96 ,22.96 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2068,HCPCS,BREAST DIEP OR SIEA FLAP,,,21 ,,TotalUnits,,,,211.74 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2070,HCPCS,CYSTO LASER TX URETERAL CALC,,,21 ,,RBRVS,6.87 ,3.46 ,3.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2080,HCPCS,LAUP,,,21 ,,RBRVS,9.63 ,7.49 ,7.49 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2083,HCPCS,ADJUSTMENT GASTRIC BAND,,,21 ,,TotalUnits,,,,2.59 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2095,HCPCS,TRANSCATH EMBOLIZ MICROSPHER,,,21 ,,RBRVS,18.11 ,6.24 ,6.24 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2102,HCPCS,ISLET CELL TISSUE TRANSPLANT,,,21 ,,TotalUnits,,,,48.84 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2115,HCPCS,PERIACETABULAR OSTEOTOMY,,,21 ,,RBRVS,21.87 ,12.02 ,12.02 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2120,HCPCS,LOW DENSITY LIPOPROTEIN(LDL),,,17 ,,TotalUnits,,,,41.06 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2140,HCPCS,CORD BLOOD HARVESTING,,,21 ,,TotalUnits,,,,1.86 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2142,HCPCS,CORD BLOOD-DERIVED STEM-CELL,,,21 ,,TotalUnits,,,,1.62 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2150,HCPCS,BMT HARV/TRANSPL 28D PKG,,,21 ,,RBRVS,2.24 ,0.94 ,0.94 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2202,HCPCS,ECHOSCLEROTHERAPY,,,14 ,,RBRVS,1.09 ,0.64 ,2.41 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2205,HCPCS,MINIMALLY INVASIVE DIRECT CO,,,21 ,,RBRVS,33.64 ,12.57 ,12.57 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2206,HCPCS,MINIMALLY INVASIVE DIRECT CO,,,21 ,,RBRVS,39.77 ,14.75 ,14.75 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2207,HCPCS,MINIMALLY INVASIVE DIRECT CO,,,21 ,,RBRVS,34.87 ,12.92 ,12.92 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2225,HCPCS,MYRINGOTOMY LASER-ASSIST,,,21 ,,RBRVS,1.35 ,1.56 ,3.32 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2230,HCPCS,IMPLANT SEMI-IMP HEAR,,,21 ,,TotalUnits,,,,15.48 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2235,HCPCS,IMPLANT AUDITORY BRAIN IMP,,,21 ,,RBRVS,0.73 ,8.52 ,8.52 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2260,HCPCS,INDUCED ABORTION 17-24 WEEKS,,,12 ,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2265,HCPCS,INDUCED ABORTION 25-28 WKS,,,12 ,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2266,HCPCS,INDUCED ABORTION 29-31 WKS,,,12 ,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2267,HCPCS,INDUCED ABORTION 32 OR MORE,,,12 ,,RBRVS,5.90 ,2.46 ,2.46 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2300,HCPCS,"ARTHROSCOPY, SHOULDER, SURGI",,,21 ,,TotalUnits,,,,12.49 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2340,HCPCS,CHEMODENERVATION OF ABDUCTOR,,,21 ,,RBRVS,3.86 ,1.65 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2341,HCPCS,CHEMODENERV ADDUCT VOCAL,,,21 ,,RBRVS,3.86 ,1.65 ,4.26 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2342,HCPCS,NASAL ENDOSCOP PO DEBRID,,,21 ,,RBRVS,2.98 ,1.39 ,4.90 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2348,HCPCS,DECOMPRESS DISC RF LUMBAR,,,21 ,,RBRVS,8.88 ,4.30 ,4.30 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2350,HCPCS,"DISKECTOMY, ANTERIOR, WITH D",,,21 ,,RBRVS,22.75 ,11.08 ,11.08 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2351,HCPCS,"DISKECTOMY, ANTERIOR, WITH D",,,21 ,,RBRVS,3.28 ,1.21 ,1.21 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2361,HCPCS,VERTEBROPLAST CERV ADDL,,,21 ,,RBRVS,4.30 ,1.51 ,1.51 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S2900,HCPCS,ROBOTIC SURGICAL SYSTEM,,,21 ,,TotalUnits,,,,13.28 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3005,HCPCS,EVAL SELF-ASSESS DEPRESSION,,,16 ,,TotalUnits,,,,1.02 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3600,HCPCS,STAT LAB,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3601,HCPCS,STAT LAB HOME/NF,,,17 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3620,HCPCS,NEWBORN METABOLIC SCREENING,,,17 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,S3625,HCPCS,MATERNAL TRIPLE SCREEN TEST,,,17 ,,TotalUnits,,,,0.80 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3630,HCPCS,EOSINOPHIL BLOOD COUNT,,,17 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3645,HCPCS,HIV-1 ANTIBODY TESTING OF OR,,,17 ,,TotalUnits,,,,0.15 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3650,HCPCS,"SALIVA TEST, HORMONE LEVEL;",,,17 ,,TotalUnits,,,,3.09 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3652,HCPCS,"SALIVA TEST, HORMONE LEVEL;",,,17 ,,TotalUnits,,,,2.51 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3655,HCPCS,ANTISPERM ANTIBODIES TEST,,,17 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3833,HCPCS,COMP APC SEQUENCE,,,17 ,,TotalUnits,,,,13.04 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3854,HCPCS,GENE PROFILE PANEL BREAST,,,17 ,,TotalUnits,,,,26.43 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S3900,HCPCS,SURFACE EMG,,,17 ,,TotalUnits,,,,1.27 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4005,HCPCS,INTERIM LABOR FACILITY GLOBA,,,12 ,,TotalUnits,,,,13.24 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4011,HCPCS,IVF PACKAGE,,,14 ,,TotalUnits,,,,66.38 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4015,HCPCS,COMPLETE IVF NOS CASE RATE,,,14 ,,TotalUnits,,,,71.73 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4016,HCPCS,FROZEN IVF CASE RATE,,,14 ,,TotalUnits,,,,20.87 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4022,HCPCS,ASST OOCYTE FERT CASE RATE,,,14 ,,TotalUnits,,,,14.68 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4035,HCPCS,STIMULATED IUI CASE RATE,,,14 ,,TotalUnits,,,,17.70 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4040,HCPCS,MONIT STORE CRYO EMBRYO 30 D,,,14 ,,TotalUnits,,,,0.78 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4042,HCPCS,OVULATION MGMT PER CYCLE,,,14 ,,TotalUnits,,,,3.70 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4981,HCPCS,INSERT LEVONORGESTREL IUS,,,14 ,,TotalUnits,,,,1.74 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S4989,HCPCS,CONTRACEPT IUD,,,28 ,,NW,,,,,,$466.91,$0.00,1,1,1,1,1,1,20131001,S4990,HCPCS,NICOTINE PATCH LEGEND,,,28 ,,NW,,,,,,$29.71,$0.00,1,1,1,0,0,1,20131001,S4993,HCPCS,CONTRACEPTIVE PILLS FOR BC,,,28 ,,NW,,,,,,$32.23,$0.00,1,1,1,1,1,1,20131001,S4995,HCPCS,SMOKING CESSATION GUM,,,28 ,,NW,,,,,,$63.29,$0.00,1,1,1,0,0,1,20131001,S5000,HCPCS,"PRESCRIPTION DRUG, GENERIC",,,28 ,,NW,,,,,,$22.13,$0.00,1,1,1,0,0,1,20131001,S5001,HCPCS,"PRESCRIPTION DRUG,BRAND NAME",,,28 ,,NW,,,,,,$94.55,$0.00,1,1,1,0,0,1,20131001,S5010,HCPCS,5% DEXTROSE AND 0.45% SALINE,,,28 ,,NW,,,,,,$22.66,$0.00,1,1,1,0,0,1,20131001,S5011,HCPCS,5% DEXTROSE IN LACTATED RING,,,28 ,,NW,,,,,,$24.38,$0.00,1,1,1,0,0,1,20131001,S5012,HCPCS,5% DEXTROSE WITH POTASSIUM,,,28 ,,NW,,,,,,$78.77,$0.00,1,1,1,0,0,1,20131001,S5013,HCPCS,5%DEXTROSE/0.45%SALINE1000ML,,,28 ,,NW,,,,,,$21.96,$0.00,1,1,1,0,0,1,20131001,S5014,HCPCS,D5W/0.45NS W KCL AND MGS04,,,28 ,,NW,,,,,,$13.25,$0.00,1,1,1,0,0,1,20131001,S5035,HCPCS,HIT ROUTINE DEVICE MAINT,,,14 ,,RBRVS,0.18 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5102,HCPCS,ADULT DAY CARE PER DIEM,,,14 ,,TotalUnits,,,,0.65 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5105,HCPCS,CENTERBASED DAY CARE PERDIEM,,,14 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5108,HCPCS,HOMECARE TRAIN PT 15 MIN,,,14 ,,RBRVS,0.45 ,0.37 ,0.37 ,,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5109,HCPCS,HOMECARE TRAIN PT SESSION,,,14 ,,TotalUnits,,,,1.08 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5110,HCPCS,FAMILY HOMECARE TRAINING 15M,,,14 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5111,HCPCS,FAMILY HOMECARE TRAIN/SESSIO,,,14 ,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5115,HCPCS,NONFAMILY HOMECARE TRAIN/15M,,,14 ,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5116,HCPCS,NONFAMILY HC TRAIN/SESSION,,,14 ,,TotalUnits,,,,1.68 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5126,HCPCS,ATTENDANT CARE SERVICE /DIEM,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5136,HCPCS,ADULT COMPANIONCARE PER DIEM,,,14 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5140,HCPCS,ADULT FOSTER CARE PER DIEM,,,14 ,,TotalUnits,,,,0.51 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5145,HCPCS,CHILD FOSTERCARE TH PER DIEM,,,14 ,,TotalUnits,,,,1.07 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5151,HCPCS,UNSKILLED RESPITECARE /DIEM,,,14 ,,TotalUnits,,,,1.59 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5161,HCPCS,EMER RSPNS SYS SERV PERMONTH,,,14 ,,TotalUnits,,,,0.27 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5180,HCPCS,HH RESPIRATORY THRPY IN EVAL,,,14 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5181,HCPCS,HH RESPIRATORY THRPY NOS/DAY,,,14 ,,TotalUnits,,,,1.47 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5190,HCPCS,WELLNESS ASSESSMENT BY NONPH,,,14 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S5199,HCPCS,PERSONAL CARE ITEM NOS EACH,,,28 ,,NW,,,,,,$76.31,$0.00,1,1,1,0,0,1,20131001,S5497,HCPCS,HIT CATH CARE NOC,,,28 ,,NW,,,,,,$76.31,$0.00,1,1,1,1,1,1,20131001,S5498,HCPCS,HIT SIMPLE CATH CARE,,,28 ,,NW,,,,,,$38.36,$0.00,1,1,1,1,1,1,20131001,S5501,HCPCS,HIT COMPLEX CATH CARE,,,28 ,,NW,,,,,,$41.36,$0.00,1,1,1,1,1,1,20131001,S5502,HCPCS,HIT INTERIM CATH CARE,,,28 ,,NW,,,,,,$72.85,$0.00,1,1,1,1,1,1,20131001,S5517,HCPCS,HIT DECLOTTING KIT,,,28 ,,NW,,,,,,$84.23,$0.00,1,1,1,1,1,1,20131001,S5520,HCPCS,HIT PICC INSERT KIT,,,28 ,,NW,,,,,,$101.96,$0.00,1,1,1,1,1,1,20131001,S5521,HCPCS,HIT MIDLINE CATH INSERT KIT,,,28 ,,NW,,,,,,$150.80,$0.00,1,1,1,1,1,1,20131001,S5522,HCPCS,HIT PICC INSERT NO SUPP,,,14 ,,TotalUnits,,,,1.45 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5523,HCPCS,HIP MIDLINE CATH INSERT KIT,,,14 ,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S5550,HCPCS,INSULIN RAPID 5 U,,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20131001,S5551,HCPCS,INSULIN MOST RAPID 5 U,,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20131001,S5552,HCPCS,INSULIN INTERMED 5 U,,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20131001,S5553,HCPCS,INSULIN LONG ACTING 5 U,,,28 ,,NW,,,,,,$0.14,$0.00,1,1,1,0,0,1,20131001,S5560,HCPCS,INSULIN REUSE PEN 1.5 ML,,,28 ,,NW,,,,,,$3.66,$0.00,1,1,1,1,1,1,20131001,S8030,HCPCS,TANTALUM RING APPLICATION,,,20 ,,RBRVS,9.46 ,7.66 ,7.66 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S8037,HCPCS,MRCP,,,20 ,,TotalUnits,,,,7.77 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S8040,HCPCS,TOPOGRAPHIC BRAIN MAPPING,,,14 ,,RBRVS,2.97 ,3.05 ,3.05 ,,,$0.00,$0.00,1,0,1,1,1,1,20131001,S8080,HCPCS,SCINTIMAMMOGRAPHY,,,20 ,,TotalUnits,,,,3.57 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S8085,HCPCS,FLUORINE-18 FLUORODEOXYGLUCO,,,20 ,,TotalUnits,,,,2.91 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,S8092,HCPCS,ELECTRON BEAM COMPUTED TOMOG,,,20 ,,TotalUnits,,,,2.28 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,S8096,HCPCS,PORTABLE PEAK FLOW METER,,,28 ,,NW,,,,,,$50.45,$0.00,1,1,1,1,1,1,20131001,S8097,HCPCS,ASTHMA KIT,,,28 ,,NW,,,,,,$57.21,$0.00,1,1,1,1,1,1,20131001,S8100,HCPCS,SPACER WITHOUT MASK,,,28 ,,NW,,,,,,$25.42,$0.00,1,1,1,1,1,1,20131001,S8101,HCPCS,SPACER WITH MASK,,,28 ,,NW,,,,,,$41.88,$0.00,1,1,1,1,1,1,20131001,S8110,HCPCS,PEAK EXPIRATORY FLOW RATE (P,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S8185,HCPCS,FLUTTER DEVICE,,,28 ,,NW,,,,,,$89.25,$0.00,1,1,1,1,1,1,20131001,S8186,HCPCS,SWIVEL ADAPTOR,,,28 ,,NW,,,,,,$14.43,$0.00,1,1,1,1,1,1,20131001,S8189,HCPCS,TRACH SUPPLY NOC,,,28 ,,NW,,,,,,$76.31,$0.00,1,1,1,1,1,1,20131001,S8210,HCPCS,MUCUS TRAP,,,28 ,,NW,,,,,,$1.29,$0.00,1,1,1,1,1,1,20131001,S8262,HCPCS,MANDIB ORTHO REPOS DEVICE,,,28 ,,NW,,,,,,"$2,234.97",$0.00,1,1,1,1,1,1,20131001,S8265,HCPCS,HABERMAN FEEDER,,,28 ,,NW,,,,,,$67.38,$0.00,1,1,1,1,1,1,20131001,S8301,HCPCS,INFECT CONTROL SUPPLIES NOS,,,28 ,,NW,,,,,,$76.31,$0.00,1,1,1,1,1,1,20131001,S8415,HCPCS,SUPPLIES FOR HOME DELIVERY,,,28 ,,NW,,,,,,$158.79,$0.00,1,1,1,1,1,1,20131001,S8420,HCPCS,CUSTOM GRADIENT SLEEV/GLOV,,,28 ,,NW,,,,,,$157.23,$0.00,1,1,1,1,1,1,20131001,S8421,HCPCS,READY GRADIENT SLEEV/GLOV,,,28 ,,NW,,,,,,$103.33,$0.00,1,1,1,1,1,1,20131001,S8422,HCPCS,CUSTOM GRAD SLEEVE MED,,,28 ,,NW,,,,,,$267.97,$0.00,1,1,1,1,1,1,20131001,S8423,HCPCS,CUSTOM GRAD SLEEVE HEAVY,,,28 ,,NW,,,,,,$213.19,$0.00,1,1,1,1,1,1,20131001,S8424,HCPCS,READY GRADIENT SLEEVE,,,28 ,,NW,,,,,,$124.66,$0.00,1,1,1,1,1,1,20131001,S8425,HCPCS,CUSTOM GRAD GLOVE MED,,,28 ,,NW,,,,,,$203.49,$0.00,1,1,1,1,1,1,20131001,S8426,HCPCS,CUSTOM GRAD GLOVE HEAVY,,,28 ,,NW,,,,,,$221.35,$0.00,1,1,1,1,1,1,20131001,S8427,HCPCS,READY GRADIENT GLOVE,,,28 ,,NW,,,,,,$94.41,$0.00,1,1,1,1,1,1,20131001,S8428,HCPCS,READY GRADIENT GAUNTLET,,,28 ,,NW,,,,,,$67.35,$0.00,1,1,1,1,1,1,20131001,S8429,HCPCS,GRADIENT PRESSURE WRAP,,,28 ,,NW,,,,,,$159.46,$0.00,1,1,1,1,1,1,20131001,S8430,HCPCS,PADDING FOR COMPRSSN BDG,,,28 ,,NW,,,,,,$23.07,$0.00,1,1,1,1,1,1,20131001,S8431,HCPCS,COMPRESSION BANDAGE,,,28 ,,NW,,,,,,$16.35,$0.00,1,1,1,1,1,1,20131001,S8450,HCPCS,SPLINT DIGIT,,,28 ,,NW,,,,,,$33.37,$0.00,1,1,1,1,1,1,20131001,S8451,HCPCS,SPLINT WRIST OR ANKLE,,,28 ,,NW,,,,,,$51.00,$0.00,1,1,1,1,1,1,20131001,S8452,HCPCS,SPLINT ELBOW,,,28 ,,NW,,,,,,$34.25,$0.00,1,1,1,1,1,1,20131001,S8460,HCPCS,CAMISOLE POST-MAST,,,28 ,,NW,,,,,,$105.65,$0.00,1,1,1,1,1,1,20131001,S8490,HCPCS,100 INSULIN SYRINGES,,,28 ,,NW,,,,,,$1.29,$0.00,1,1,1,1,1,1,20131001,S8930,HCPCS,AURICULAR ELECTROSTIMULATION,,,14 ,,TotalUnits,,,,1.03 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S8940,HCPCS,HIPPOTHERAPY PER SESSION,,,19 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S8948,HCPCS,LOW-LEVEL LASER TRMT 15 MIN,,,14 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S8950,HCPCS,"COMPLEX LYMPHEDEMA THERAPY,",,,14 ,,TotalUnits,,,,0.60 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S8990,HCPCS,PT OR MANIP FOR MAINT,,,19 ,,TotalUnits,,,,0.58 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S8999,HCPCS,RESUSCITATION BAG,,,28 ,,NW,,,,,,$233.19,$0.00,1,1,1,1,1,1,20131001,S9001,HCPCS,HOME UTERINE MONITOR WITH OR,,,28 ,,NW,,,,,,$118.66,$0.00,1,1,1,1,1,1,20131001,S9024,HCPCS,PARANASAL SINUS ULTRASOUND,,,20 ,,TotalUnits,,,,2.17 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9034,HCPCS,ESWL FOR GALLSTONES,,,21 ,,RBRVS,9.64 ,6.13 ,17.10 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9061,HCPCS,MEDICAL SUPPLIES AND EQUIPME,,,28 ,,NW,,,,,,$68.99,$0.00,1,1,1,1,1,1,20131001,S9083,HCPCS,URGENT CARE CENTER GLOBAL,,,15 ,,TotalUnits,,,,1.90 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9088,HCPCS,SERVICES PROVIDED IN URGENT,,,15 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9090,HCPCS,VERTEBRAL AXIAL DECOMPRESSIO,,,14 ,,TotalUnits,,,,1.63 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9097,HCPCS,HOME VISIT WOUND CARE,,,14 ,,TotalUnits,,,,1.15 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9098,HCPCS,HOME PHOTOTHERAPY VISIT,,,14 ,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9109,HCPCS,CHF TELEMONITORING MONTH,,,4 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S9117,HCPCS,BACK SCHOOL VISIT,,,14 ,,RBRVS,0.17 ,0.06 ,0.32 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9122,HCPCS,HOME HEALTH AIDE OR CERTIFIE,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9123,HCPCS,NURSING CARE IN HOME RN,,,14 ,,TotalUnits,,,,0.76 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9124,HCPCS,"NURSING CARE, IN THE HOME; B",,,14 ,,TotalUnits,,,,0.49 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9125,HCPCS,"RESPITE CARE, IN THE HOME, P",,,14 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9126,HCPCS,"HOSPICE CARE, IN THE HOME, P",,,14 ,,TotalUnits,,,,1.38 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9127,HCPCS,"SOCIAL WORK VISIT, IN THE HO",,,14 ,,TotalUnits,,,,1.64 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9128,HCPCS,"SPEECH THERAPY, IN THE HOME,",,,14 ,,TotalUnits,,,,1.21 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9129,HCPCS,"OCCUPATIONAL THERAPY, IN THE",,,14 ,,TotalUnits,,,,1.19 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9131,HCPCS,PT IN THE HOME PER DIEM,,,14 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9140,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,TotalUnits,,,,1.36 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9141,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,RBRVS,,0.59 ,0.59 ,,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9145,HCPCS,INSULIN PUMP INITIATION,,,14 ,,TotalUnits,,,,3.81 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9152,HCPCS,"SPEECH THERAPY, RE-EVAL",,,8 ,,TotalUnits,,,,2.94 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9208,HCPCS,HOME MGMT PRETERM LABOR,,,28 ,,NW,,,,,,$257.88,$0.00,1,1,1,1,1,1,20131001,S9211,HCPCS,HOME MGMT GEST HYPERTENSION,,,28 ,,NW,,,,,,$109.29,$0.00,1,1,1,1,1,1,20131001,S9212,HCPCS,HM POSTPAR HYPER PER DIEM,,,28 ,,NW,,,,,,$129.18,$0.00,1,1,1,1,1,1,20131001,S9213,HCPCS,HM PREECLAMP PER DIEM,,,28 ,,NW,,,,,,$254.99,$0.00,1,1,1,1,1,1,20131001,S9214,HCPCS,HM GEST DM PER DIEM,,,28 ,,NW,,,,,,$236.12,$0.00,1,1,1,1,1,1,20131001,S9325,HCPCS,HIT PAIN MGMT PER DIEM,,,28 ,,NW,,,,,,$131.71,$0.00,1,1,1,1,1,1,20131001,S9326,HCPCS,HIT CONT PAIN PER DIEM,,,28 ,,NW,,,,,,$187.01,$0.00,1,1,1,1,1,1,20131001,S9327,HCPCS,HIT INT PAIN PER DIEM,,,28 ,,NW,,,,,,$185.56,$0.00,1,1,1,1,1,1,20131001,S9328,HCPCS,HIT PAIN IMP PUMP DIEM,,,28 ,,NW,,,,,,$134.75,$0.00,1,1,1,1,1,1,20131001,S9329,HCPCS,HIT CHEMO PER DIEM,,,28 ,,NW,,,,,,$201.10,$0.00,1,1,1,1,1,1,20131001,S9330,HCPCS,HIT CONT CHEM DIEM,,,28 ,,NW,,,,,,$197.78,$0.00,1,1,1,1,1,1,20131001,S9331,HCPCS,HIT INTERMIT CHEMO DIEM,,,28 ,,NW,,,,,,$220.24,$0.00,1,1,1,1,1,1,20131001,S9335,HCPCS,HT HEMODIALYSIS DIEM,,,28 ,,NW,,,,,,$603.89,$0.00,1,1,1,1,1,1,20131001,S9336,HCPCS,HIT CONT ANTICOAG DIEM,,,28 ,,NW,,,,,,$189.15,$0.00,1,1,1,1,1,1,20131001,S9338,HCPCS,HIT IMMUNOTHERAPY DIEM,,,28 ,,NW,,,,,,$234.35,$0.00,1,1,1,1,1,1,20131001,S9339,HCPCS,HIT PERITON DIALYSIS DIEM,,,28 ,,NW,,,,,,$486.72,$0.00,1,1,1,1,1,1,20131001,S9340,HCPCS,HIT ENTERAL PER DIEM,,,28 ,,NW,,,,,,$78.17,$0.00,1,1,1,1,1,1,20131001,S9341,HCPCS,HIT ENTERAL GRAV DIEM,,,28 ,,NW,,,,,,$53.66,$0.00,1,1,1,1,1,1,20131001,S9342,HCPCS,HIT ENTERAL PUMP DIEM,,,28 ,,NW,,,,,,$57.63,$0.00,1,1,1,1,1,1,20131001,S9343,HCPCS,HIT ENTERAL BOLUS NURS,,,28 ,,NW,,,,,,$35.75,$0.00,1,1,1,1,1,1,20131001,S9345,HCPCS,HIT ANTI-HEMOPHIL DIEM,,,28 ,,NW,,,,,,$119.29,$0.00,1,1,1,1,1,1,20131001,S9346,HCPCS,HIT ALPHA-1-PROTEINAS DIEM,,,28 ,,NW,,,,,,$83.48,$0.00,1,1,1,1,1,1,20131001,S9347,HCPCS,HIT LONGTERM INFUSION DIEM,,,28 ,,NW,,,,,,$93.08,$0.00,1,1,1,1,1,1,20131001,S9348,HCPCS,HIT SYMPATHOMIM DIEM,,,28 ,,NW,,,,,,$206.47,$0.00,1,1,1,1,1,1,20131001,S9349,HCPCS,HIT TOCOLYSIS DIEM,,,28 ,,NW,,,,,,$297.82,$0.00,1,1,1,1,1,1,20131001,S9351,HCPCS,HIT CONT ANTIEMETIC DIEM,,,28 ,,NW,,,,,,$378.87,$0.00,1,1,1,1,1,1,20131001,S9353,HCPCS,HIT CONT INSULIN DIEM,,,28 ,,NW,,,,,,$518.05,$0.00,1,1,1,1,1,1,20131001,S9355,HCPCS,HIT CHELATION DIEM,,,28 ,,NW,,,,,,$154.70,$0.00,1,1,1,1,1,1,20131001,S9357,HCPCS,HIT ENZYME REPLACE DIEM,,,28 ,,NW,,,,,,$168.10,$0.00,1,1,1,1,1,1,20131001,S9359,HCPCS,HIT ANTI-TNF PER DIEM,,,28 ,,NW,,,,,,$307.65,$0.00,1,1,1,1,1,1,20131001,S9361,HCPCS,HIT DIURETIC INFUS DIEM,,,28 ,,NW,,,,,,$112.00,$0.00,1,1,1,1,1,1,20131001,S9363,HCPCS,HIT ANTI-SPASMOTIC DIEM,,,28 ,,NW,,,,,,$225.86,$0.00,1,1,1,1,1,1,20131001,S9364,HCPCS,HIT TPN TOTAL DIEM,,,28 ,,NW,,,,,,$352.15,$0.00,1,1,1,1,1,1,20131001,S9365,HCPCS,HIT TPN 1 LITER DIEM,,,28 ,,NW,,,,,,$405.85,$0.00,1,1,1,1,1,1,20131001,S9366,HCPCS,HIT TPN 2 LITER DIEM,,,28 ,,NW,,,,,,$495.26,$0.00,1,1,1,1,1,1,20131001,S9367,HCPCS,HIT TPN 3 LITER DIEM,,,28 ,,NW,,,,,,$551.46,$0.00,1,1,1,1,1,1,20131001,S9368,HCPCS,HIT TPN OVER 3L DIEM,,,28 ,,NW,,,,,,$706.48,$0.00,1,1,1,1,1,1,20131001,S9370,HCPCS,HT INJ ANTIEMETIC DIEM,,,28 ,,NW,,,,,,$143.11,$0.00,1,1,1,1,1,1,20131001,S9372,HCPCS,HT INJ ANTICOAG DIEM,,,28 ,,NW,,,,,,$97.04,$0.00,1,1,1,1,1,1,20131001,S9373,HCPCS,HIT HYDRA TOTAL DIEM,,,28 ,,NW,,,,,,$108.66,$0.00,1,1,1,1,1,1,20131001,S9374,HCPCS,HIT HYDRA 1 LITER DIEM,,,28 ,,NW,,,,,,$157.04,$0.00,1,1,1,1,1,1,20131001,S9375,HCPCS,HIT HYDRA 2 LITER DIEM,,,28 ,,NW,,,,,,$201.19,$0.00,1,1,1,1,1,1,20131001,S9376,HCPCS,HIT HYDRA 3 LITER DIEM,,,28 ,,NW,,,,,,$219.29,$0.00,1,1,1,1,1,1,20131001,S9377,HCPCS,HIT HYDRA OVER 3L DIEM,,,28 ,,NW,,,,,,$237.38,$0.00,1,1,1,1,1,1,20131001,S9379,HCPCS,HIT NOC PER DIEM,,,28 ,,NW,,,,,,$76.31,$0.00,1,1,1,1,1,1,20131001,S9401,HCPCS,ANTICOAG CLINIC PER SESSION,,,14 ,,TotalUnits,,,,0.30 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9430,HCPCS,PHARMACY COMP/DISP SERV,,,14 ,,TotalUnits,,,,0.66 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9433,HCPCS,MEDICAL FOOD ORAL 100% NUTR,,,28 ,,NW,,,,,,$33.58,$0.00,1,1,1,0,1,1,20131001,S9434,HCPCS,MOD SOLID FOOD SUPPL,,,28 ,,NW,,,,,,$51.39,$0.00,1,1,1,0,1,1,20131001,S9435,HCPCS,MEDICAL FOODS FOR INBORN ERR,,,28 ,,NW,,,,,,$32.36,$0.00,1,1,1,0,1,1,20131001,S9436,HCPCS,LAMAZE CLASS,,,14 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9441,HCPCS,ASTHMA EDUCATION,,,14 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9442,HCPCS,BIRTHING CLASS,,,14 ,,TotalUnits,,,,0.42 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9443,HCPCS,LACTATION CLASS,,,14 ,,TotalUnits,,,,0.48 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9449,HCPCS,WEIGHT MGMT CLASS,,,14 ,,TotalUnits,,,,0.39 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9451,HCPCS,EXERCISE CLASS,,,14 ,,TotalUnits,,,,0.24 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9452,HCPCS,NUTRITION CLASS,,,14 ,,TotalUnits,,,,0.12 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9453,HCPCS,SMOKING CESSATION CLASS,,,14 ,,TotalUnits,,,,1.53 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9455,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,TotalUnits,,,,0.40 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9460,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,TotalUnits,,,,0.69 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9465,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,,14 ,,TotalUnits,,,,1.26 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,S9470,HCPCS,"NUTRITIONAL COUNSELING, DIET",,,14 ,,TotalUnits,,,,0.96 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,S9474,HCPCS,ENTEROSTOMAL THERAPY BY A RE,,,14 ,,TotalUnits,,,,0.67 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,S9475,HCPCS,AMBULATORY SETTING SUBSTANCE,,,16 ,,TotalUnits,,,,1.79 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,S9480,HCPCS,INTENSIVE OUTPATIENT PSYCHIA,,,16 ,,TotalUnits,,,,3.91 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S9484,HCPCS,CRISIS INTERVENTION PER HOUR,,,16 ,,TotalUnits,,,,0.91 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S9485,HCPCS,CRISIS INTERVENTION MENTAL H,,,16 ,,TotalUnits,,,,4.63 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,S9490,HCPCS,HIT CORTICOSTEROID/DIEM,,,28 ,,NW,,,,,,$243.46,$0.00,1,1,1,1,1,1,20131001,S9494,HCPCS,HIT ANTIBIOTIC TOTAL DIEM,,,28 ,,NW,,,,,,$194.29,$0.00,1,1,1,1,1,1,20131001,S9497,HCPCS,HIT ANTIBIOTIC Q3H DIEM,,,28 ,,NW,,,,,,$242.27,$0.00,1,1,1,1,1,1,20131001,S9500,HCPCS,HIT ANTIBIOTIC Q24H DIEM,,,28 ,,NW,,,,,,$278.09,$0.00,1,1,1,1,1,1,20131001,S9501,HCPCS,HIT ANTIBIOTIC Q12H DIEM,,,28 ,,NW,,,,,,$271.79,$0.00,1,1,1,1,1,1,20131001,S9502,HCPCS,HIT ANTIBIOTIC Q8H DIEM,,,28 ,,NW,,,,,,$339.20,$0.00,1,1,1,1,1,1,20131001,S9503,HCPCS,HIT ANTIBIOTIC Q6H DIEM,,,28 ,,NW,,,,,,$312.75,$0.00,1,1,1,1,1,1,20131001,S9504,HCPCS,HIT ANTIBIOTIC Q4H DIEM,,,28 ,,NW,,,,,,$288.37,$0.00,1,1,1,1,1,1,20131001,S9529,HCPCS,VENIPUNCTURE HOME/SNF,,,28 ,,NW,,,,,,$96.89,$0.00,1,1,1,0,1,1,20131001,S9537,HCPCS,HT HEM HORM INJ DIEM,,,28 ,,NW,,,,,,$80.66,$0.00,1,1,1,1,1,1,20131001,S9538,HCPCS,HIT BLOOD PRODUCTS DIEM,,,28 ,,NW,,,,,,$261.61,$0.00,1,1,1,1,1,1,20131001,S9542,HCPCS,HT INJ NOC PER DIEM,,,28 ,,NW,,,,,,$76.31,$0.00,1,1,1,1,1,1,20131001,S9558,HCPCS,HT INJ GROWTH HORM DIEM,,,28 ,,NW,,,,,,$35.05,$0.00,1,1,1,1,1,1,20131001,S9559,HCPCS,HIT INJ INTERFERON DIEM,,,28 ,,NW,,,,,,$329.42,$0.00,1,1,1,1,1,1,20131001,S9560,HCPCS,HT INJ HORMONE DIEM,,,28 ,,NW,,,,,,$89.71,$0.00,1,1,1,1,1,1,20131001,S9562,HCPCS,HT INJ PALIVIZUMAB DIEM,,,28 ,,NW,,,,,,$89.71,$0.00,1,1,1,1,1,1,20131001,S9590,HCPCS,HT IRRIGATION DIEM,,,28 ,,NW,,,,,,$128.75,$0.00,1,1,1,1,1,1,20131001,S9810,HCPCS,HT PHARM PER HOUR,,,28 ,,NW,,,,,,$76.31,$0.00,1,1,1,0,0,1,20131001,S9900,HCPCS,CHRISTIAN SCI PRACT VISIT,,,14 ,,TotalUnits,,,,0.08 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9970,HCPCS,HEALTH CLUB MEMBERSHIP YR,,,14 ,,TotalUnits,,,,0.86 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9981,HCPCS,MED RECORD COPY ADMIN,,,14 ,,TotalUnits,,,,0.35 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9986,HCPCS,NOT MEDICALLY NECESSARY SVC,,,14 ,,TotalUnits,,,,2.58 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9988,HCPCS,SERV PART OF PHASE I TRIAL,,,14 ,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,S9990,HCPCS,SERVICES PROVIDED AS PART OF,,,14 ,,TotalUnits,,,,1.04 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T1000,HCPCS,PRIVATE DUTY/INDEPENDENT NSG,,,15 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1001,HCPCS,NURSING ASSESSMENT/EVALUATN,,,15 ,,TotalUnits,,,,1.06 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1002,HCPCS,RN SERVICES UP TO 15 MINUTES,,,15 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1003,HCPCS,LPN/LVN SERVICES UP TO 15MIN,,,15 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1004,HCPCS,NSG AIDE SERVICE UP TO 15MIN,,,15 ,,TotalUnits,,,,0.21 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1005,HCPCS,RESPITE CARE SERVICE 15 MIN,,,15 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1006,HCPCS,FAMILY/COUPLE COUNSELING,,,16 ,,TotalUnits,,,,0.47 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T1007,HCPCS,TREATMENT PLAN DEVELOPMENT,,,16 ,,TotalUnits,,,,3.02 ,,$0.00,$0.00,1,1,1,0,1,1,20131001,T1009,HCPCS,CHILD SITTING SERVICES,,,14 ,,TotalUnits,,,,0.06 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T1012,HCPCS,ALCOHOL/SUBSTANCE ABUSE SKIL,,,16 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T1013,HCPCS,SIGN LANG/ORAL INTERPRETER,,,14 ,,TotalUnits,,,,0.17 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T1015,HCPCS,CLINIC SERVICE,,,15 ,,TotalUnits,,,,1.00 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T1016,HCPCS,CASE MANAGEMENT,,,15 ,,TotalUnits,,,,0.37 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T1019,HCPCS,PERSONAL CARE SER PER 15 MIN,,,15 ,,TotalUnits,,,,0.09 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1020,HCPCS,PERSONAL CARE SER PER DIEM,,,15 ,,TotalUnits,,,,1.88 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1021,HCPCS,HH AIDE OR CN AIDE PER VISIT,,,15 ,,TotalUnits,,,,0.79 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1023,HCPCS,PROGRAM INTAKE ASSESSMENT,,,15 ,,TotalUnits,,,,0.82 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T1024,HCPCS,TEAM EVALUATION & MANAGEMENT,,,15 ,,TotalUnits,,,,0.32 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T1026,HCPCS,"PED COMPR CARE PKG, PER HOUR",,,15 ,,TotalUnits,,,,0.81 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T1027,HCPCS,FAMILY TRAINING & COUNSELING,,,16 ,,TotalUnits,,,,0.14 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T1028,HCPCS,HOME ENVIRONMENT ASSESSMENT,,,16 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T1030,HCPCS,RN HOME CARE PER DIEM,,,15 ,,TotalUnits,,,,1.99 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T1031,HCPCS,LPN HOME CARE PER DIEM,,,15 ,,TotalUnits,,,,0.64 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T1502,HCPCS,MEDICATION ADMIN VISIT,,,15 ,,TotalUnits,,,,0.25 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T2001,HCPCS,N-ET; PATIENT ATTEND/ESCORT,,,14 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2003,HCPCS,N-ET; ENCOUNTER/TRIP,,,14 ,,TotalUnits,,,,0.50 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2004,HCPCS,N-ET; COMMERC CARRIER PASS,,,14 ,,TotalUnits,,,,0.07 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2005,HCPCS,N-ET; STRETCHER VAN,,,14 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2007,HCPCS,NON-EMER TRANSPORT WAIT TIME,,,14 ,,TotalUnits,,,,0.26 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2013,HCPCS,HABIL ED WAIVER PER HOUR,,,14 ,,TotalUnits,,,,0.52 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T2014,HCPCS,"HABIL PREVOC WAIVER, PER D",,,14 ,,TotalUnits,,,,0.57 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T2016,HCPCS,HABIL RES WAIVER PER DIEM,,,14 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T2017,HCPCS,HABIL RES WAIVER 15 MIN,,,14 ,,TotalUnits,,,,0.11 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T2018,HCPCS,HABIL SUP EMPL WAIVER/DIEM,,,14 ,,TotalUnits,,,,1.82 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T2020,HCPCS,DAY HABIL WAIVER PER DIEM,,,14 ,,TotalUnits,,,,1.05 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T2022,HCPCS,"CASE MANAGEMENT, PER MONTH",,,14 ,,TotalUnits,,,,0.63 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T2023,HCPCS,TARGETED CASE MGMT PER MONTH,,,14 ,,TotalUnits,,,,1.51 ,,$0.00,$0.00,1,0,1,1,1,1,20131001,T2025,HCPCS,"WAIVER SERVICE, NOS",,,14 ,,TotalUnits,,,,0.18 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,T2031,HCPCS,ASSIST LIVING WAIVER/DIEM,,,14 ,,TotalUnits,,,,2.47 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2032,HCPCS,"RES CARE, NOS WAIVER/MONTH",,,14 ,,TotalUnits,,,,2.48 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2033,HCPCS,"RES, NOS WAIVER PER DIEM",,,14 ,,TotalUnits,,,,1.65 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2040,HCPCS,FINANCIAL MGT WAIVER/15MIN,,,14 ,,TotalUnits,,,,0.13 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2042,HCPCS,HOSPICE ROUTINE HOME CARE,,,14 ,,TotalUnits,,,,1.20 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2043,HCPCS,HOSPICE CONTINUOUS HOME CARE,,,14 ,,TotalUnits,,,,0.28 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2045,HCPCS,HOSPICE GENERAL CARE,,,14 ,,TotalUnits,,,,5.70 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2046,HCPCS,"HOSPICE LONG TERM CARE, R&B",,,14 ,,TotalUnits,,,,1.37 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2048,HCPCS,"BH LTC RES R&B, PER DIEM",,,14 ,,TotalUnits,,,,1.67 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T2049,HCPCS,"N-ET; STRETCHER VAN, MILEAGE",,,14 ,,TotalUnits,,,,0.10 ,,$0.00,$0.00,1,1,1,1,1,1,20131001,T4521,HCPCS,ADULT SIZE BRIEF/DIAPER SM,,,28 ,,NW,,,,,,$1.36,$0.00,1,1,1,1,1,1,20131001,T4522,HCPCS,ADULT SIZE BRIEF/DIAPER MED,,,28 ,,NW,,,,,,$1.39,$0.00,1,1,1,1,1,1,20131001,T4523,HCPCS,ADULT SIZE BRIEF/DIAPER LG,,,28 ,,NW,,,,,,$1.49,$0.00,1,1,1,1,1,1,20131001,T4524,HCPCS,ADULT SIZE BRIEF/DIAPER XL,,,28 ,,NW,,,,,,$1.83,$0.00,1,1,1,1,1,1,20131001,T4525,HCPCS,ADULT SIZE PULL-ON SM,,,28 ,,NW,,,,,,$1.66,$0.00,1,1,1,1,1,1,20131001,T4526,HCPCS,ADULT SIZE PULL-ON MED,,,28 ,,NW,,,,,,$1.67,$0.00,1,1,1,1,1,1,20131001,T4527,HCPCS,ADULT SIZE PULL-ON LG,,,28 ,,NW,,,,,,$1.69,$0.00,1,1,1,1,1,1,20131001,T4528,HCPCS,ADULT SIZE PULL-ON XL,,,28 ,,NW,,,,,,$1.82,$0.00,1,1,1,1,1,1,20131001,T4529,HCPCS,PED SIZE BRIEF/DIAPER SM/MED,,,28 ,,NW,,,,,,$1.35,$0.00,1,1,1,1,1,1,20131001,T4530,HCPCS,PED SIZE BRIEF/DIAPER LG,,,28 ,,NW,,,,,,$1.54,$0.00,1,1,1,1,1,1,20131001,T4531,HCPCS,PED SIZE PULL-ON SM/MED,,,28 ,,NW,,,,,,$1.77,$0.00,1,1,1,1,1,1,20131001,T4532,HCPCS,PED SIZE PULL-ON LG,,,28 ,,NW,,,,,,$2.01,$0.00,1,1,1,1,1,1,20131001,T4533,HCPCS,YOUTH SIZE BRIEF/DIAPER,,,28 ,,NW,,,,,,$1.44,$0.00,1,1,1,1,1,1,20131001,T4534,HCPCS,YOUTH SIZE PULL-ON,,,28 ,,NW,,,,,,$1.79,$0.00,1,1,1,1,1,1,20131001,T4535,HCPCS,DISPOSABLE LINER/SHIELD/PAD,,,28 ,,NW,,,,,,$1.24,$0.00,1,1,1,1,1,1,20131001,T4536,HCPCS,REUSABLE PULL-ON ANY SIZE,,,28 ,,NW,,,,,,$1.42,$0.00,1,1,1,1,1,1,20131001,T4537,HCPCS,REUSABLE UNDERPAD BED SIZE,,,28 ,,NW,,,,,,$23.51,$0.00,1,1,1,1,1,1,20131001,T4539,HCPCS,REUSE DIAPER/BRIEF ANY SIZE,,,28 ,,NW,,,,,,$9.95,$0.00,1,1,1,1,1,1,20131001,T4540,HCPCS,REUSABLE UNDERPAD CHAIR SIZE,,,28 ,,NW,,,,,,$9.07,$0.00,1,1,1,1,1,1,20131001,T4541,HCPCS,LARGE DISPOSABLE UNDERPAD,,,28 ,,NW,,,,,,$1.18,$0.00,1,1,1,1,1,1,20131001,T4542,HCPCS,SMALL DISPOSABLE UNDERPAD,,,28 ,,NW,,,,,,$1.35,$0.00,1,1,1,1,1,1,20131001,T4543,HCPCS,DISP BARIATRIC BRIEF/DIAPER,,,28 ,,NW,,,,,,$2.10,$0.00,1,1,1,1,1,1,20131001,T5001,HCPCS,POSITION SEAT SPEC ORTH NEED,,,28 ,,NW,,,,,,$694.12,$0.00,1,1,1,1,1,1,20131001,T5999,HCPCS,"SUPPLY, NOS",,,28 ,,NW,,,,,,$22.96,$0.00,1,1,1,1,1,1,20131001,V2020,HCPCS,VISION SVCS FRAMES PURCHASES,,,28 ,,NW,,,,,,$95.62,$0.00,1,1,1,1,1,1,20131001,V2025,HCPCS,EYEGLASSES DELUX FRAMES,,,28 ,,NW,,,,,,$118.23,$0.00,1,1,1,1,1,1,20131001,V2100,HCPCS,LENS SPHER SINGLE PLANO 4.00,,,28 ,,NW,,,,,,$76.36,$0.00,1,1,1,1,1,1,20131001,V2101,HCPCS,SINGLE VISN SPHERE 4.12-7.00,,,28 ,,NW,,,,,,$79.39,$0.00,1,1,1,1,1,1,20131001,V2102,HCPCS,SINGL VISN SPHERE 7.12-20.00,,,28 ,,NW,,,,,,$92.67,$0.00,1,1,1,1,1,1,20131001,V2103,HCPCS,SPHEROCYLINDR 4.00D/12-2.00D,,,28 ,,NW,,,,,,$71.95,$0.00,1,1,1,1,1,1,20131001,V2104,HCPCS,SPHEROCYLINDR 4.00D/2.12-4D,,,28 ,,NW,,,,,,$74.61,$0.00,1,1,1,1,1,1,20131001,V2105,HCPCS,SPHEROCYLINDER 4.00D/4.25-6D,,,28 ,,NW,,,,,,$78.19,$0.00,1,1,1,1,1,1,20131001,V2106,HCPCS,SPHEROCYLINDER 4.00D/>6.00D,,,28 ,,NW,,,,,,$82.31,$0.00,1,1,1,1,1,1,20131001,V2107,HCPCS,SPHEROCYLINDER 4.25D/12-2D,,,28 ,,NW,,,,,,$81.79,$0.00,1,1,1,1,1,1,20131001,V2108,HCPCS,SPHEROCYLINDER 4.25D/2.12-4D,,,28 ,,NW,,,,,,$81.73,$0.00,1,1,1,1,1,1,20131001,V2109,HCPCS,SPHEROCYLINDER 4.25D/4.25-6D,,,28 ,,NW,,,,,,$87.21,$0.00,1,1,1,1,1,1,20131001,V2110,HCPCS,SPHEROCYLINDER 4.25D/OVER 6D,,,28 ,,NW,,,,,,$85.46,$0.00,1,1,1,1,1,1,20131001,V2111,HCPCS,SPHEROCYLINDR 7.25D/.25-2.25,,,28 ,,NW,,,,,,$88.30,$0.00,1,1,1,1,1,1,20131001,V2112,HCPCS,SPHEROCYLINDR 7.25D/2.25-4D,,,28 ,,NW,,,,,,$92.82,$0.00,1,1,1,1,1,1,20131001,V2113,HCPCS,SPHEROCYLINDR 7.25D/4.25-6D,,,28 ,,NW,,,,,,$98.27,$0.00,1,1,1,1,1,1,20131001,V2114,HCPCS,SPHEROCYLINDER OVER 12.00D,,,28 ,,NW,,,,,,$103.05,$0.00,1,1,1,1,1,1,20131001,V2115,HCPCS,LENS LENTICULAR BIFOCAL,,,28 ,,NW,,,,,,$107.37,$0.00,1,1,1,1,1,1,20131001,V2118,HCPCS,LENS ANISEIKONIC SINGLE,,,28 ,,NW,,,,,,$108.03,$0.00,1,1,1,1,1,1,20131001,V2121,HCPCS,"LENTICULAR LENS, SINGLE",,,28 ,,NW,,,,,,$109.37,$0.00,1,1,1,1,1,1,20131001,V2199,HCPCS,LENS SINGLE VISION NOT OTH C,,,28 ,,NW,,,,,,$91.95,$0.00,1,1,1,1,1,1,20131001,V2200,HCPCS,LENS SPHER BIFOC PLANO 4.00D,,,28 ,,NW,,,,,,$86.53,$0.00,1,1,1,1,1,1,20131001,V2201,HCPCS,LENS SPHERE BIFOCAL 4.12-7.0,,,28 ,,NW,,,,,,$91.02,$0.00,1,1,1,1,1,1,20131001,V2202,HCPCS,LENS SPHERE BIFOCAL 7.12-20.,,,28 ,,NW,,,,,,$97.42,$0.00,1,1,1,1,1,1,20131001,V2203,HCPCS,LENS SPHCYL BIFOCAL 4.00D/.1,,,28 ,,NW,,,,,,$87.47,$0.00,1,1,1,1,1,1,20131001,V2204,HCPCS,LENS SPHCY BIFOCAL 4.00D/2.1,,,28 ,,NW,,,,,,$89.19,$0.00,1,1,1,1,1,1,20131001,V2205,HCPCS,LENS SPHCY BIFOCAL 4.00D/4.2,,,28 ,,NW,,,,,,$92.38,$0.00,1,1,1,1,1,1,20131001,V2206,HCPCS,LENS SPHCY BIFOCAL 4.00D/OVE,,,28 ,,NW,,,,,,$97.48,$0.00,1,1,1,1,1,1,20131001,V2207,HCPCS,LENS SPHCY BIFOCAL 4.25-7D/.,,,28 ,,NW,,,,,,$92.04,$0.00,1,1,1,1,1,1,20131001,V2208,HCPCS,LENS SPHCY BIFOCAL 4.25-7/2.,,,28 ,,NW,,,,,,$94.37,$0.00,1,1,1,1,1,1,20131001,V2209,HCPCS,LENS SPHCY BIFOCAL 4.25-7/4.,,,28 ,,NW,,,,,,$97.45,$0.00,1,1,1,1,1,1,20131001,V2210,HCPCS,LENS SPHCY BIFOCAL 4.25-7/OV,,,28 ,,NW,,,,,,$104.03,$0.00,1,1,1,1,1,1,20131001,V2211,HCPCS,LENS SPHCY BIFO 7.25-12/.25-,,,28 ,,NW,,,,,,$104.84,$0.00,1,1,1,1,1,1,20131001,V2212,HCPCS,LENS SPHCYL BIFO 7.25-12/2.2,,,28 ,,NW,,,,,,$106.61,$0.00,1,1,1,1,1,1,20131001,V2213,HCPCS,LENS SPHCYL BIFO 7.25-12/4.2,,,28 ,,NW,,,,,,$106.88,$0.00,1,1,1,1,1,1,20131001,V2214,HCPCS,LENS SPHCYL BIFOCAL OVER 12.,,,28 ,,NW,,,,,,$113.29,$0.00,1,1,1,1,1,1,20131001,V2215,HCPCS,LENS LENTICULAR BIFOCAL,,,28 ,,NW,,,,,,$119.54,$0.00,1,1,1,1,1,1,20131001,V2218,HCPCS,LENS ANISEIKONIC BIFOCAL,,,28 ,,NW,,,,,,$127.91,$0.00,1,1,1,1,1,1,20131001,V2219,HCPCS,LENS BIFOCAL SEG WIDTH OVER,,,28 ,,NW,,,,,,$80.34,$0.00,1,1,1,1,1,1,20131001,V2220,HCPCS,LENS BIFOCAL ADD OVER 3.25D,,,28 ,,NW,,,,,,$75.15,$0.00,1,1,1,1,1,1,20131001,V2221,HCPCS,"LENTICULAR LENS, BIFOCAL",,,28 ,,NW,,,,,,$118.48,$0.00,1,1,1,1,1,1,20131001,V2299,HCPCS,LENS BIFOCAL SPECIALITY,,,28 ,,NW,,,,,,$65.82,$0.00,1,1,1,1,1,1,20131001,V2300,HCPCS,LENS SPHERE TRIFOCAL 4.00D,,,28 ,,NW,,,,,,$98.65,$0.00,1,1,1,1,1,1,20131001,V2301,HCPCS,LENS SPHERE TRIFOCAL 4.12-7.,,,28 ,,NW,,,,,,$109.03,$0.00,1,1,1,1,1,1,20131001,V2302,HCPCS,LENS SPHERE TRIFOCAL 7.12-20,,,28 ,,NW,,,,,,$110.49,$0.00,1,1,1,1,1,1,20131001,V2303,HCPCS,LENS SPHCY TRIFOCAL 4.0/.12-,,,28 ,,NW,,,,,,$98.29,$0.00,1,1,1,1,1,1,20131001,V2304,HCPCS,LENS SPHCY TRIFOCAL 4.0/2.25,,,28 ,,NW,,,,,,$100.56,$0.00,1,1,1,1,1,1,20131001,V2305,HCPCS,LENS SPHCY TRIFOCAL 4.0/4.25,,,28 ,,NW,,,,,,$108.42,$0.00,1,1,1,1,1,1,20131001,V2306,HCPCS,LENS SPHCYL TRIFOCAL 4.00/>6,,,28 ,,NW,,,,,,$110.48,$0.00,1,1,1,1,1,1,20131001,V2307,HCPCS,LENS SPHCY TRIFOCAL 4.25-7/.,,,28 ,,NW,,,,,,$107.10,$0.00,1,1,1,1,1,1,20131001,V2308,HCPCS,LENS SPHC TRIFOCAL 4.25-7/2.,,,28 ,,NW,,,,,,$109.74,$0.00,1,1,1,1,1,1,20131001,V2309,HCPCS,LENS SPHC TRIFOCAL 4.25-7/4.,,,28 ,,NW,,,,,,$117.13,$0.00,1,1,1,1,1,1,20131001,V2310,HCPCS,LENS SPHC TRIFOCAL 4.25-7/>6,,,28 ,,NW,,,,,,$116.17,$0.00,1,1,1,1,1,1,20131001,V2311,HCPCS,LENS SPHC TRIFO 7.25-12/.25-,,,28 ,,NW,,,,,,$121.39,$0.00,1,1,1,1,1,1,20131001,V2312,HCPCS,LENS SPHC TRIFO 7.25-12/2.25,,,28 ,,NW,,,,,,$119.87,$0.00,1,1,1,1,1,1,20131001,V2313,HCPCS,LENS SPHC TRIFO 7.25-12/4.25,,,28 ,,NW,,,,,,$130.74,$0.00,1,1,1,1,1,1,20131001,V2314,HCPCS,LENS SPHCYL TRIFOCAL OVER 12,,,28 ,,NW,,,,,,$134.75,$0.00,1,1,1,1,1,1,20131001,V2315,HCPCS,LENS LENTICULAR TRIFOCAL,,,28 ,,NW,,,,,,$147.38,$0.00,1,1,1,1,1,1,20131001,V2318,HCPCS,LENS ANISEIKONIC TRIFOCAL,,,28 ,,NW,,,,,,$170.26,$0.00,1,1,1,1,1,1,20131001,V2319,HCPCS,LENS TRIFOCAL SEG WIDTH > 28,,,28 ,,NW,,,,,,$85.01,$0.00,1,1,1,1,1,1,20131001,V2320,HCPCS,LENS TRIFOCAL ADD OVER 3.25D,,,28 ,,NW,,,,,,$89.67,$0.00,1,1,1,1,1,1,20131001,V2321,HCPCS,"LENTICULAR LENS, TRIFOCAL",,,28 ,,NW,,,,,,$145.25,$0.00,1,1,1,1,1,1,20131001,V2399,HCPCS,LENS TRIFOCAL SPECIALITY,,,28 ,,NW,,,,,,$160.35,$0.00,1,1,1,1,1,1,20131001,V2410,HCPCS,LENS VARIAB ASPHERICITY SING,,,28 ,,NW,,,,,,$122.01,$0.00,1,1,1,1,1,1,20131001,V2430,HCPCS,LENS VARIABLE ASPHERICITY BI,,,28 ,,NW,,,,,,$136.46,$0.00,1,1,1,1,1,1,20131001,V2499,HCPCS,VARIABLE ASPHERICITY LENS,,,28 ,,NW,,,,,,$118.35,$0.00,1,1,1,1,1,1,20131001,V2500,HCPCS,CONTACT LENS PMMA SPHERICAL,,,28 ,,NW,,,,,,$113.97,$0.00,1,1,1,1,1,1,20131001,V2501,HCPCS,CNTCT LENS PMMA-TORIC/PRISM,,,28 ,,NW,,,,,,$148.41,$0.00,1,1,1,1,1,1,20131001,V2502,HCPCS,CONTACT LENS PMMA BIFOCAL,,,28 ,,NW,,,,,,$178.60,$0.00,1,1,1,1,1,1,20131001,V2503,HCPCS,CNTCT LENS PMMA COLOR VISION,,,28 ,,NW,,,,,,$163.61,$0.00,1,1,1,1,1,1,20131001,V2510,HCPCS,CNTCT GAS PERMEABLE SPHERICL,,,28 ,,NW,,,,,,$139.09,$0.00,1,1,1,1,1,1,20131001,V2511,HCPCS,CNTCT TORIC PRISM BALLAST,,,28 ,,NW,,,,,,$183.58,$0.00,1,1,1,1,1,1,20131001,V2512,HCPCS,CNTCT LENS GAS PERMBL BIFOCL,,,28 ,,NW,,,,,,$210.14,$0.00,1,1,1,1,1,1,20131001,V2513,HCPCS,CONTACT LENS EXTENDED WEAR,,,28 ,,NW,,,,,,$188.55,$0.00,1,1,1,1,1,1,20131001,V2520,HCPCS,CONTACT LENS HYDROPHILIC,,,28 ,,NW,,,,,,$133.20,$0.00,1,1,1,1,1,1,20131001,V2521,HCPCS,CNTCT LENS HYDROPHILIC TORIC,,,28 ,,NW,,,,,,$199.23,$0.00,1,1,1,1,1,1,20131001,V2522,HCPCS,CNTCT LENS HYDROPHIL BIFOCL,,,28 ,,NW,,,,,,$200.33,$0.00,1,1,1,1,1,1,20131001,V2523,HCPCS,CNTCT LENS HYDROPHIL EXTEND,,,28 ,,NW,,,,,,$172.82,$0.00,1,1,1,1,1,1,20131001,V2530,HCPCS,CONTACT LENS GAS IMPERMEABLE,,,28 ,,NW,,,,,,$233.91,$0.00,1,1,1,1,1,1,20131001,V2531,HCPCS,CONTACT LENS GAS PERMEABLE,,,28 ,,NW,,,,,,$457.97,$0.00,1,1,1,1,1,1,20131001,V2599,HCPCS,CONTACT LENS/ES OTHER TYPE,,,28 ,,NW,,,,,,$132.67,$0.00,1,1,1,1,1,1,20131001,V2600,HCPCS,HAND HELD LOW VISION AIDS,,,28 ,,NW,,,,,,$135.07,$0.00,1,1,1,1,1,1,20131001,V2610,HCPCS,SINGLE LENS SPECTACLE MOUNT,,,28 ,,NW,,,,,,$125.91,$0.00,1,1,1,1,1,1,20131001,V2615,HCPCS,TELESCOP/OTHR COMPOUND LENS,,,28 ,,NW,,,,,,$446.89,$0.00,1,1,1,1,1,1,20131001,V2623,HCPCS,PLASTIC EYE PROSTH CUSTOM,,,28 ,,NW,,,,,,"$2,757.98",$0.00,1,1,1,1,1,1,20131001,V2624,HCPCS,POLISHING ARTIFICAL EYE,,,28 ,,NW,,,,,,$81.68,$0.00,1,1,1,1,1,1,20131001,V2625,HCPCS,ENLARGEMNT OF EYE PROSTHESIS,,,28 ,,NW,,,,,,$870.42,$0.00,1,1,1,1,1,1,20131001,V2626,HCPCS,REDUCTION OF EYE PROSTHESIS,,,28 ,,NW,,,,,,$406.12,$0.00,1,1,1,1,1,1,20131001,V2627,HCPCS,SCLERAL COVER SHELL,,,28 ,,NW,,,,,,"$3,951.41",$0.00,1,1,1,1,1,1,20131001,V2628,HCPCS,FABRICATION & FITTING,,,28 ,,NW,,,,,,$592.41,$0.00,1,1,1,1,1,1,20131001,V2629,HCPCS,PROSTHETIC EYE OTHER TYPE,,,28 ,,NW,,,,,,$143.89,$0.00,1,1,1,1,1,1,20131001,V2630,HCPCS,ANTER CHAMBER INTRAOCUL LENS,,,28 ,,NW,,,,,,$348.12,$0.00,1,1,1,0,1,1,20131001,V2631,HCPCS,IRIS SUPPORT INTRAOCLR LENS,,,28 ,,NW,,,,,,$402.63,$0.00,1,1,1,0,1,1,20131001,V2632,HCPCS,POST CHMBR INTRAOCULAR LENS,,,28 ,,NW,,,,,,$454.64,$0.00,1,1,1,0,1,1,20131001,V2700,HCPCS,BALANCE LENS,,,28 ,,NW,,,,,,$80.52,$0.00,1,1,1,1,1,1,20131001,V2702,HCPCS,DELUXE LENS FEATURE,,,28 ,,NW,,,,,,$19.04,$0.00,1,1,1,1,1,1,20131001,V2710,HCPCS,GLASS/PLASTIC SLAB OFF PRISM,,,28 ,,NW,,,,,,$99.48,$0.00,1,1,1,1,1,1,20131001,V2715,HCPCS,PRISM LENS/ES,,,28 ,,NW,,,,,,$15.28,$0.00,1,1,1,1,1,1,20131001,V2718,HCPCS,FRESNELL PRISM PRESS-ON LENS,,,28 ,,NW,,,,,,$67.29,$0.00,1,1,1,1,1,1,20131001,V2730,HCPCS,SPECIAL BASE CURVE,,,28 ,,NW,,,,,,$60.74,$0.00,1,1,1,1,1,1,20131001,V2744,HCPCS,TINT PHOTOCHROMATIC LENS/ES,,,28 ,,NW,,,,,,$40.93,$0.00,1,1,1,1,1,1,20131001,V2745,HCPCS,"TINT, ANY COLOR/SOLID/GRAD",,,28 ,,NW,,,,,,$5.17,$0.00,1,1,1,1,1,1,20131001,V2750,HCPCS,ANTI-REFLECTIVE COATING,,,28 ,,NW,,,,,,$59.70,$0.00,1,1,1,1,1,1,20131001,V2755,HCPCS,UV LENS/ES,,,28 ,,NW,,,,,,$39.02,$0.00,1,1,1,1,1,1,20131001,V2756,HCPCS,EYE GLASS CASE,,,28 ,,NW,,,,,,$4.84,$0.00,1,1,1,1,1,1,20131001,V2760,HCPCS,SCRATCH RESISTANT COATING,,,28 ,,NW,,,,,,$39.05,$0.00,1,1,1,1,1,1,20131001,V2761,HCPCS,MIRROR COATING,,,28 ,,NW,,,,,,$30.91,$0.00,1,1,1,1,1,1,20131001,V2762,HCPCS,"POLARIZATION, ANY LENS",,,28 ,,NW,,,,,,$88.01,$0.00,1,1,1,1,1,1,20131001,V2770,HCPCS,OCCLUDER LENS/ES,,,28 ,,NW,,,,,,$59.41,$0.00,1,1,1,1,1,1,20131001,V2780,HCPCS,OVERSIZE LENS/ES,,,28 ,,NW,,,,,,$18.07,$0.00,1,1,1,1,1,1,20131001,V2781,HCPCS,PROGRESSIVE LENS PER LENS,,,28 ,,NW,,,,,,$87.65,$0.00,1,1,1,1,1,1,20131001,V2782,HCPCS,"LENS, 1.54-1.65 P/1.60-1.79G",,,28 ,,NW,,,,,,$91.64,$0.00,1,1,1,1,1,1,20131001,V2783,HCPCS,"LENS, >= 1.66 P/>=1.80 G",,,28 ,,NW,,,,,,$97.92,$0.00,1,1,1,1,1,1,20131001,V2784,HCPCS,LENS POLYCARB OR EQUAL,,,28 ,,NW,,,,,,$78.53,$0.00,1,1,1,1,1,1,20131001,V2785,HCPCS,CORNEAL TISSUE PROCESSING,,,28 ,,NW,,,,,,"$4,416.48",$0.00,1,1,1,1,1,1,20131001,V2786,HCPCS,OCCUPATIONAL MULTIFOCAL LENS,,,28 ,,NW,,,,,,$120.52,$0.00,1,1,1,1,1,1,20131001,V2787,HCPCS,ASTIGMATISM-CORRECT FUNCTION,,,28 ,,NW,,,,,,$724.98,$0.00,1,1,1,1,1,1,20131001,V2788,HCPCS,PRESBYOPIA-CORRECT FUNCTION,,,28 ,,NW,,,,,,"$1,384.05",$0.00,1,1,1,1,1,1,20131001,V2790,HCPCS,AMNIOTIC MEMBRANE,,,28 ,,NW,,,,,,"$1,165.82",$0.00,1,1,1,0,1,1,20131001,V2797,HCPCS,VIS ITEM/SVC IN OTHER CODE,,,28 ,,NW,,,,,,$443.03,$0.00,1,1,1,1,1,1,20131001,V2799,HCPCS,MISCELLANEOUS VISION SERVICE,,,28 ,,NW,,,,,,$132.67,$0.00,1,1,1,0,1,1,20131001,V5008,HCPCS,HEARING SCREENING,,,8 ,,TotalUnits,,,,1.44 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,V5010,HCPCS,ASSESSMENT FOR HEARING AID,,,8 ,,TotalUnits,,,,1.89 ,,$0.00,$0.00,1,1,1,0,0,1,20131001,V5011,HCPCS,HEARING AID FITTING/CHECKING,,,28 ,,NW,,,,,,$176.55,$0.00,1,1,1,1,1,1,20131001,V5014,HCPCS,HEARING AID REPAIR/MODIFYING,,,28 ,,NW,,,,,,$109.39,$0.00,1,1,1,1,1,1,20131001,V5020,HCPCS,CONFORMITY EVALUATION,,,28 ,,NW,,,,,,$99.36,$0.00,1,1,1,1,1,1,20131001,V5030,HCPCS,BODY-WORN HEARING AID AIR,,,28 ,,NW,,,,,,"$2,654.33",$0.00,1,1,1,1,1,1,20131001,V5040,HCPCS,BODY-WORN HEARING AID BONE,,,28 ,,NW,,,,,,"$1,859.36",$0.00,1,1,1,1,1,1,20131001,V5050,HCPCS,HEARING AID MONAURAL IN EAR,,,28 ,,NW,,,,,,"$2,252.00",$0.00,1,1,1,1,1,1,20131001,V5060,HCPCS,BEHIND EAR HEARING AID,,,28 ,,NW,,,,,,"$1,773.72",$0.00,1,1,1,1,1,1,20131001,V5070,HCPCS,GLASSES AIR CONDUCTION,,,28 ,,NW,,,,,,$692.76,$0.00,1,1,1,1,1,1,20131001,V5080,HCPCS,GLASSES BONE CONDUCTION,,,28 ,,NW,,,,,,"$2,738.35",$0.00,1,1,1,1,1,1,20131001,V5090,HCPCS,HEARING AID DISPENSING FEE,,,28 ,,NW,,,,,,$554.93,$0.00,1,1,1,1,1,1,20131001,V5100,HCPCS,BODY-WORN BILAT HEARING AID,,,28 ,,NW,,,,,,"$4,792.03",$0.00,1,1,1,1,1,1,20131001,V5110,HCPCS,HEARING AID DISPENSING FEE,,,28 ,,NW,,,,,,$569.96,$0.00,1,1,1,1,1,1,20131001,V5120,HCPCS,BODY-WORN BINAUR HEARING AID,,,28 ,,NW,,,,,,"$4,105.32",$0.00,1,1,1,1,1,1,20131001,V5130,HCPCS,IN EAR BINAURAL HEARING AID,,,28 ,,NW,,,,,,"$2,790.39",$0.00,1,1,1,1,1,1,20131001,V5140,HCPCS,BEHIND EAR BINAUR HEARING AI,,,28 ,,NW,,,,,,"$4,612.67",$0.00,1,1,1,1,1,1,20131001,V5150,HCPCS,GLASSES BINAURAL HEARING AID,,,28 ,,NW,,,,,,"$4,969.77",$0.00,1,1,1,1,1,1,20131001,V5160,HCPCS,DISPENSING FEE BINAURAL,,,28 ,,NW,,,,,,$812.33,$0.00,1,1,1,1,1,1,20131001,V5170,HCPCS,WITHIN EAR CROS HEARING AID,,,28 ,,NW,,,,,,"$3,255.41",$0.00,1,1,1,1,1,1,20131001,V5180,HCPCS,BEHIND EAR CROS HEARING AID,,,28 ,,NW,,,,,,"$2,654.33",$0.00,1,1,1,1,1,1,20131001,V5190,HCPCS,GLASSES CROS HEARING AID,,,28 ,,NW,,,,,,"$3,213.40",$0.00,1,1,1,1,1,1,20131001,V5200,HCPCS,CROS HEARING AID DISPENS FEE,,,28 ,,NW,,,,,,$559.11,$0.00,1,1,1,1,1,1,20131001,V5210,HCPCS,IN EAR BICROS HEARING AID,,,28 ,,NW,,,,,,"$3,594.72",$0.00,1,1,1,1,1,1,20131001,V5220,HCPCS,BEHIND EAR BICROS HEARING AI,,,28 ,,NW,,,,,,"$3,428.30",$0.00,1,1,1,1,1,1,20131001,V5230,HCPCS,GLASSES BICROS HEARING AID,,,28 ,,NW,,,,,,"$3,565.64",$0.00,1,1,1,1,1,1,20131001,V5240,HCPCS,DISPENSING FEE BICROS,,,28 ,,NW,,,,,,$602.27,$0.00,1,1,1,1,1,1,20131001,V5241,HCPCS,"DISPENSING FEE, MONAURAL",,,28 ,,NW,,,,,,$162.47,$0.00,1,1,1,1,1,1,20131001,V5242,HCPCS,"HEARING AID, MONAURAL, CIC",,,28 ,,NW,,,,,,"$1,841.27",$0.00,1,1,1,1,1,1,20131001,V5243,HCPCS,"HEARING AID, MONAURAL, ITC",,,28 ,,NW,,,,,,"$1,939.40",$0.00,1,1,1,1,1,1,20131001,V5244,HCPCS,"HEARING AID, PROG, MON, CIC",,,28 ,,NW,,,,,,"$2,550.62",$0.00,1,1,1,1,1,1,20131001,V5245,HCPCS,"HEARING AID, PROG, MON, ITC",,,28 ,,NW,,,,,,"$2,334.90",$0.00,1,1,1,1,1,1,20131001,V5246,HCPCS,"HEARING AID, PROG, MON, ITE",,,28 ,,NW,,,,,,"$2,154.02",$0.00,1,1,1,1,1,1,20131001,V5247,HCPCS,"HEARING AID, PROG, MON, BTE",,,28 ,,NW,,,,,,"$2,565.94",$0.00,1,1,1,1,1,1,20131001,V5248,HCPCS,"HEARING AID, BINAURAL, CIC",,,28 ,,NW,,,,,,"$2,370.61",$0.00,1,1,1,1,1,1,20131001,V5249,HCPCS,"HEARING AID, BINAURAL, ITC",,,28 ,,NW,,,,,,"$1,900.73",$0.00,1,1,1,1,1,1,20131001,V5250,HCPCS,"HEARING AID, PROG, BIN, CIC",,,28 ,,NW,,,,,,"$6,160.68",$0.00,1,1,1,1,1,1,20131001,V5251,HCPCS,"HEARING AID, PROG, BIN, ITC",,,28 ,,NW,,,,,,"$5,509.73",$0.00,1,1,1,1,1,1,20131001,V5252,HCPCS,"HEARING AID, PROG, BIN, ITE",,,28 ,,NW,,,,,,"$7,871.25",$0.00,1,1,1,1,1,1,20131001,V5253,HCPCS,"HEARING AID, PROG, BIN, BTE",,,28 ,,NW,,,,,,"$3,657.39",$0.00,1,1,1,1,1,1,20131001,V5254,HCPCS,"HEARING ID, DIGIT, MON, CIC",,,28 ,,NW,,,,,,"$4,015.94",$0.00,1,1,1,1,1,1,20131001,V5255,HCPCS,"HEARING AID, DIGIT, MON, ITC",,,28 ,,NW,,,,,,"$2,927.71",$0.00,1,1,1,1,1,1,20131001,V5256,HCPCS,"HEARING AID, DIGIT, MON, ITE",,,28 ,,NW,,,,,,"$2,157.26",$0.00,1,1,1,1,1,1,20131001,V5257,HCPCS,"HEARING AID, DIGIT, MON, BTE",,,28 ,,NW,,,,,,"$2,773.62",$0.00,1,1,1,1,1,1,20131001,V5258,HCPCS,"HEARING AID, DIGIT, BIN, CIC",,,28 ,,NW,,,,,,"$4,930.89",$0.00,1,1,1,1,1,1,20131001,V5259,HCPCS,"HEARING AID, DIGIT, BIN, ITC",,,28 ,,NW,,,,,,"$4,511.09",$0.00,1,1,1,1,1,1,20131001,V5260,HCPCS,"HEARING AID, DIGIT, BIN, ITE",,,28 ,,NW,,,,,,"$3,937.20",$0.00,1,1,1,1,1,1,20131001,V5261,HCPCS,"HEARING AID, DIGIT, BIN, BTE",,,28 ,,NW,,,,,,"$4,457.06",$0.00,1,1,1,1,1,1,20131001,V5262,HCPCS,"HEARING AID, DISP, MONAURAL",,,28 ,,NW,,,,,,$127.53,$0.00,1,1,1,1,1,1,20131001,V5263,HCPCS,"HEARING AID, DISP, BINAURAL",,,28 ,,NW,,,,,,$175.03,$0.00,1,1,1,1,1,1,20131001,V5264,HCPCS,EAR MOLD/INSERT,,,28 ,,NW,,,,,,$107.86,$0.00,1,1,1,1,1,1,20131001,V5265,HCPCS,"EAR MOLD/INSERT, DISP",,,28 ,,NW,,,,,,$66.08,$0.00,1,1,1,1,1,1,20131001,V5266,HCPCS,BATTERY FOR HEARING DEVICE,,,28 ,,NW,,,,,,$1.93,$0.00,1,1,1,1,1,1,20131001,V5267,HCPCS,HEARING AID SUPPLY/ACCESSORY,,,28 ,,NW,,,,,,$26.15,$0.00,1,1,1,1,1,1,20131001,V5268,HCPCS,ALD TELEPHONE AMPLIFIER,,,28 ,,NW,,,,,,$141.56,$0.00,1,1,1,1,1,1,20131001,V5269,HCPCS,"ALERTING DEVICE, ANY TYPE",,,28 ,,NW,,,,,,$165.67,$0.00,1,1,1,1,1,1,20131001,V5270,HCPCS,"ALD, TV AMPLIFIER, ANY TYPE",,,28 ,,NW,,,,,,$237.21,$0.00,1,1,1,1,1,1,20131001,V5271,HCPCS,"ALD, TV CAPTION DECODER",,,28 ,,NW,,,,,,$395.88,$0.00,1,1,1,1,1,1,20131001,V5272,HCPCS,TDD,,,28 ,,NW,,,,,,$316.84,$0.00,1,1,1,1,1,1,20131001,V5273,HCPCS,ALD FOR COCHLEAR IMPLANT,,,28 ,,NW,,,,,,$583.50,$0.00,1,1,1,1,1,1,20131001,V5274,HCPCS,ALD UNSPECIFIED,,,28 ,,NW,,,,,,$142.38,$0.00,1,1,1,1,1,1,20131001,V5275,HCPCS,EAR IMPRESSION,,,28 ,,NW,,,,,,$71.65,$0.00,1,1,1,1,1,1,20131001,V5298,HCPCS,HEARING AID NOC,,,28 ,,NW,,,,,,"$3,528.17",$0.00,1,1,1,1,1,1,20131001,V5299,HCPCS,HEARING SERVICE,,,28 ,,NW,,,,,,$73.54,$0.00,1,1,1,0,0,1,20131001,V5362,HCPCS,SPEECH SCREENING,,,8 ,,RBRVS,0.86 ,0.28 ,3.50 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,V5363,HCPCS,LANGUAGE SCREENING,,,8 ,,RBRVS,0.86 ,0.28 ,3.50 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,V5364,HCPCS,DYSPHAGIA SCREENING,,,8 ,,RBRVS,,1.70 ,1.70 ,,,$0.00,$0.00,1,1,1,0,0,1,20131001,