"CPT 
CODE",Modifier,Procedure Name,Revenue Code,Fee Schedule, 2021   GROSS FEES 
300,,PC EPIDURAL STEROID INJECTION-CRNA,964,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$514.00 
10021,,PR FINE NEEDLE ASPIRATION BX W/O IMG G,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$249.00 
10060,,PR DRAIN SKIN ABSCESS SIMPLE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$321.00 
10060,,PR DRAIN SKIN ABSCESS SIMPLE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$321.00 
10060,,PR DRAIN SKIN ABSCESS SIMPLE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$266.00 
10061,,PR DRAIN SKIN ABSCESS COMPLIC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$530.00 
10061,,PR DRAIN SKIN ABSCESS COMPLIC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
10061,,PR DRAIN SKIN ABSCESS COMPLIC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$462.00 
10080,,PR DRAIN PILONIDAL CYST SIMPL,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$531.00 
10080,,PR DRAIN PILONIDAL CYST SIMPL,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
10080,,PR DRAIN PILONIDAL CYST SIMPL,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$288.00 
10081,,PR DRAIN PILONIDAL CYST COMPLIC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$769.00 
10081,,PR DRAIN PILONIDAL CYST COMPLIC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
10081,,PR DRAIN PILONIDAL CYST COMPLIC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$477.00 
10120,,PR REMOVE FOREIGN BODY SIMPLE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$425.00 
10120,,PR REMOVE FOREIGN BODY SIMPLE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
10120,,PR REMOVE FOREIGN BODY SIMPLE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$288.00 
10121,,PR REMOVE FOREIGN BODY COMPLIC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$688.00 
10121,,PR REMOVE FOREIGN BODY COMPLIC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
10121,,PR REMOVE FOREIGN BODY COMPLIC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$514.00 
10140,,PR DRAINAGE OF HEMATOMA/FLUID,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$453.00 
10140,,PR DRAINAGE OF HEMATOMA/FLUID,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
10140,,PR DRAINAGE OF HEMATOMA/FLUID,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$327.00 
10160,,PR PUNCTURE DRAINAGE OF LESION,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$363.00 
10160,,PR PUNCTURE DRAINAGE OF LESION,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
10160,,PR PUNCTURE DRAINAGE OF LESION,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$266.00 
10180,,"PR COMPLEX DRAINAGE, WOUND",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$648.00 
10180,,"PR COMPLEX DRAINAGE, WOUND",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
10180,,"PR COMPLEX DRAINAGE, WOUND",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$493.00 
11000,,"PR DEBRIDEMENT, INFECTED SKIN, UP TO 1",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$151.00 
11000,,"PR DEBRIDEMENT, INFECTED SKIN, UP TO 1",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
11000,,"PR DEBRIDEMENT, INFECTED SKIN, UP TO 1",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$78.00 
11005,,"PR DEBRIDE NECROTIC SKIN/ TISSUE, ABD ",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,116.00 "
11005,,"PR DEBRIDE NECROTIC SKIN/ TISSUE, ABD ",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,116.00 "
11005,,"PR DEBRIDE NECROTIC SKIN/ TISSUE, ABD ",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,116.00 "
11006,,"PR DEBRIDE NECROT SKIN/ TISS, GENIT,PE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,906.00 "
11006,,"PR DEBRIDE NECROT SKIN/ TISS, GENIT,PE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,906.00 "
11006,,"PR DEBRIDE NECROT SKIN/ TISS, GENIT,PE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,906.00 "
11008,,REMOVE MESH FROM ABD WALL FOR INFECTIO,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$747.00 
11008,,REMOVE MESH FROM ABD WALL FOR INFECTIO,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$747.00 
11008,,REMOVE MESH FROM ABD WALL FOR INFECTIO,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$747.00 
11012,,PR DEBRIDE ASSOC OPEN FX/DISLO SKIN/MU,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,715.00 "
11012,,PR DEBRIDE ASSOC OPEN FX/DISLO SKIN/MU,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
11012,,PR DEBRIDE ASSOC OPEN FX/DISLO SKIN/MU,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,152.00 "
11042,,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<2",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$327.00 
11042,,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<2",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
11042,,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<2",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$171.00 
11043,,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$589.00 
11043,,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUS",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
11043,,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUS",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$429.00 
11044,,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUS",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$795.00 
11044,,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUS",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11044,,"PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUS",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$638.00 
11055,,"PR TRIM HYPERKERATOTIC SKIN LESION, ON",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$158.00 
11056,,PR TRIM BENIGN HYPERKERATOTIC SKIN LES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$187.00 
11200,,"PR REMOVAL OF SKIN TAGS, UP TO 15",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$244.00 
11200,,"PR REMOVAL OF SKIN TAGS, UP TO 15",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
11200,,"PR REMOVAL OF SKIN TAGS, UP TO 15",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$202.00 
11201,,"PR REMOVAL OF SKIN TAGS, EACH ADD 10",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$52.00 
11201,,"PR REMOVAL OF SKIN TAGS, EACH ADD 10",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$47.00 
11201,,"PR REMOVAL OF SKIN TAGS, EACH ADD 10",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$47.00 
11300,,"PR SHAV SKIN LES <5MM TRUNK,ARM,LEG",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$272.00 
11301,,"PR SHAV SKIN LES 6-10MM TRUNK,ARM,LEG",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$336.00 
11305,,PR SHAV SKIN LES <5MM REMAINDR BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$272.00 
11306,,PR SHAV SKIN LES 6-10MM REMAINDR BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$311.00 
11306,,PR SHAV SKIN LES 6-10MM REMAINDR BODY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
11306,,PR SHAV SKIN LES 6-10MM REMAINDR BODY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$144.00 
11400,,"PR EXC SKIN BENIG <5MM TRUNK,ARM,LEG",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$344.00 
11400,,"PR EXC SKIN BENIG <5MM TRUNK,ARM,LEG",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11400,,"PR EXC SKIN BENIG <5MM TRUNK,ARM,LEG",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$222.00 
11401,,"PR EXC SKIN BENIG 0.6-1CM TRUNK,ARM,LE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$462.00 
11401,,"PR EXC SKIN BENIG 0.6-1CM TRUNK,ARM,LE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
11401,,"PR EXC SKIN BENIG 0.6-1CM TRUNK,ARM,LE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$289.00 
11402,,"PR EXC SKIN BENIG 1.1-2CM TRUNK,ARM,LE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$434.00 
11402,,"PR EXC SKIN BENIG 1.1-2CM TRUNK,ARM,LE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11402,,"PR EXC SKIN BENIG 1.1-2CM TRUNK,ARM,LE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$315.00 
11402,,"HC EXC SKIN BENIG 1.1-2CM TRUNK,ARM,LE",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11403,,"PR EXC SKIN BENIG 2.1-3CM TRUNK,ARM,LE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$530.00 
11403,,"PR EXC SKIN BENIG 2.1-3CM TRUNK,ARM,LE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11403,,"PR EXC SKIN BENIG 2.1-3CM TRUNK,ARM,LE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$406.00 
11404,,"PR EXC SKIN BENIG 3.1-4CM TRUNK,ARM,LE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$602.00 
11404,,"PR EXC SKIN BENIG 3.1-4CM TRUNK,ARM,LE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11404,,"PR EXC SKIN BENIG 3.1-4CM TRUNK,ARM,LE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$446.00 
11406,,"PR EXC SKIN BENIG >4CM TRUNK,ARM,LEG",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$860.00 
11406,,"PR EXC SKIN BENIG >4CM TRUNK,ARM,LEG",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11406,,"PR EXC SKIN BENIG >4CM TRUNK,ARM,LEG",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$675.00 
11420,,PR EXC SKIN BENIG <5MM REMAINDR BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$320.00 
11420,,PR EXC SKIN BENIG <5MM REMAINDR BODY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11420,,PR EXC SKIN BENIG <5MM REMAINDR BODY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$225.00 
11421,,PR EXC SKIN BENIG 0.6-1CM REMAINDR BOD,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$438.00 
11421,,PR EXC SKIN BENIG 0.6-1CM REMAINDR BOD,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11421,,PR EXC SKIN BENIG 0.6-1CM REMAINDR BOD,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$307.00 
11422,,PR EXC SKIN BENIG 1.1-2CM REMAINDR BOD,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$489.00 
11422,,PR EXC SKIN BENIG 1.1-2CM REMAINDR BOD,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11422,,PR EXC SKIN BENIG 1.1-2CM REMAINDR BOD,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$375.00 
11423,,PR EXC SKIN BENIG 2.1-3CM REMAINDR BOD,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$516.00 
11423,,PR EXC SKIN BENIG 2.1-3CM REMAINDR BOD,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11423,,PR EXC SKIN BENIG 2.1-3CM REMAINDR BOD,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$437.00 
11424,,PR EXC SKIN BENIG 3.1-4CM REMAINDR BOD,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$595.00 
11424,,PR EXC SKIN BENIG 3.1-4CM REMAINDR BOD,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11424,,PR EXC SKIN BENIG 3.1-4CM REMAINDR BOD,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$494.00 
11426,,PR EXC SKIN BENIG >4CM REMAINDR BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$854.00 
11426,,PR EXC SKIN BENIG >4CM REMAINDR BODY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
11426,,PR EXC SKIN BENIG >4CM REMAINDR BODY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$751.00 
11440,,"PR EXC SKIN BENIG <5MM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$378.00 
11440,,"PR EXC SKIN BENIG <5MM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11440,,"PR EXC SKIN BENIG <5MM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$290.00 
11441,,"PR EXC SKIN BENIG 0.6-1CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$468.00 
11441,,"PR EXC SKIN BENIG 0.6-1CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11441,,"PR EXC SKIN BENIG 0.6-1CM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$366.00 
11442,,"PR EXC SKIN BENIG 1.1-2CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$522.00 
11442,,"PR EXC SKIN BENIG 1.1-2CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11442,,"PR EXC SKIN BENIG 1.1-2CM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$404.00 
11443,,"PR EXC SKIN BENIG 2.1-3CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$619.00 
11443,,"PR EXC SKIN BENIG 2.1-3CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11443,,"PR EXC SKIN BENIG 2.1-3CM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$492.00 
11444,,"PR EXC SKIN BENIG 3.1-4CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$774.00 
11444,,"PR EXC SKIN BENIG 3.1-4CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11444,,"PR EXC SKIN BENIG 3.1-4CM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$622.00 
11446,,"PR EXC SKIN BENIG >4CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,067.00 "
11450,,"PR EXC SWEAT GLAND LESN AXILL,SIMPL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,035.00 "
11450,,"PR EXC SWEAT GLAND LESN AXILL,SIMPL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
11450,,"PR EXC SWEAT GLAND LESN AXILL,SIMPL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$696.00 
11451,,"PR EXC SWEAT GLAND LESN AXILL,COMPLX",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,289.00 "
11451,,"PR EXC SWEAT GLAND LESN AXILL,COMPLX",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
11451,,"PR EXC SWEAT GLAND LESN AXILL,COMPLX",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$890.00 
11470,,"PR EXC SWEAT GLAND LESN PERINEAL,SIMPL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,152.00 "
11600,,"PR EXC SKIN MALIG <5MM TRUNK,ARM,LEG",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$535.00 
11600,,"PR EXC SKIN MALIG <5MM TRUNK,ARM,LEG",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11600,,"PR EXC SKIN MALIG <5MM TRUNK,ARM,LEG",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$331.00 
11601,,"PR EXC SKIN MALIG 0.6-1CM TRUNK,ARM,LE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$635.00 
11601,,"PR EXC SKIN MALIG 0.6-1CM TRUNK,ARM,LE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11601,,"PR EXC SKIN MALIG 0.6-1CM TRUNK,ARM,LE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$412.00 
11602,,"PR EXC SKIN MALIG 1.1-2CM TRUNK,ARM,LE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$688.00 
11602,,"PR EXC SKIN MALIG 1.1-2CM TRUNK,ARM,LE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
11602,,"PR EXC SKIN MALIG 1.1-2CM TRUNK,ARM,LE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$451.00 
11603,,"PR EXC SKIN MALIG 2.1-3CM TRUNK,ARM,LE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$781.00 
11603,,"PR EXC SKIN MALIG 2.1-3CM TRUNK,ARM,LE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11603,,"PR EXC SKIN MALIG 2.1-3CM TRUNK,ARM,LE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$535.00 
11604,,"PR EXC SKIN MALIG 3.1-4CM TRUNK,ARM,LE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$872.00 
11604,,"PR EXC SKIN MALIG 3.1-4CM TRUNK,ARM,LE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11604,,"PR EXC SKIN MALIG 3.1-4CM TRUNK,ARM,LE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$592.00 
11606,,"PR EXC SKIN MALIG >4CM TRUNK,ARM,LEG",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,242.00 "
11606,,"PR EXC SKIN MALIG >4CM TRUNK,ARM,LEG",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11606,,"PR EXC SKIN MALIG >4CM TRUNK,ARM,LEG",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$874.00 
11621,,PR EXC SKIN MALIG 0.6-1CM REMAINDR BOD,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$581.00 
11621,,PR EXC SKIN MALIG 0.6-1CM REMAINDR BOD,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11621,,PR EXC SKIN MALIG 0.6-1CM REMAINDR BOD,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$414.00 
11622,,PR EXC SKIN MALIG 1.1-2CM REMAINDR BOD,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$711.00 
11622,,PR EXC SKIN MALIG 1.1-2CM REMAINDR BOD,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11622,,PR EXC SKIN MALIG 1.1-2CM REMAINDR BOD,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$473.00 
11623,,PR EXC SKIN MALIG 2.1-3CM REMAINDR BOD,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$756.00 
11623,,PR EXC SKIN MALIG 2.1-3CM REMAINDR BOD,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11623,,PR EXC SKIN MALIG 2.1-3CM REMAINDR BOD,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$582.00 
11624,,PR EXC SKIN MALIG 3.1-4CM REMAINDR BOD,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$856.00 
11624,,PR EXC SKIN MALIG 3.1-4CM REMAINDR BOD,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11624,,PR EXC SKIN MALIG 3.1-4CM REMAINDR BOD,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$659.00 
11626,,PR EXC SKIN MALIG >4CM REMAINDR BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,124.00 "
11626,,PR EXC SKIN MALIG >4CM REMAINDR BODY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
11626,,PR EXC SKIN MALIG >4CM REMAINDR BODY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$806.00 
11640,,"PR EXC SKIN MALIG <5MM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$559.00 
11640,,"PR EXC SKIN MALIG <5MM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11640,,"PR EXC SKIN MALIG <5MM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$346.00 
11641,59,"PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$601.00 
11641,,"PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$660.00 
11641,,"PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11641,59,"PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11641,,"PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$432.00 
11641,,"HC EXC SKIN MALIG 0.6-1CM FACE,FACIAL",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11642,,"PR EXC SKIN MALIG 1.1-2CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$752.00 
11642,,"PR EXC SKIN MALIG 1.1-2CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
11642,,"PR EXC SKIN MALIG 1.1-2CM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$506.00 
11643,,"PR EXC SKIN MALIG 2.1-3CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$884.00 
11643,,"PR EXC SKIN MALIG 2.1-3CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11643,,"PR EXC SKIN MALIG 2.1-3CM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$634.00 
11643,,"HC EXC SKIN MALIG 2.1-3CM FACE,FACIAL",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11644,,"PR EXC SKIN MALIG 3.1-4CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,087.00 "
11644,,"PR EXC SKIN MALIG 3.1-4CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
11644,,"PR EXC SKIN MALIG 3.1-4CM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$782.00 
11646,,"PR EXC SKIN MALIG >4CM FACE,FACIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,413.00 "
11646,,"PR EXC SKIN MALIG >4CM FACE,FACIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
11646,,"PR EXC SKIN MALIG >4CM FACE,FACIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,083.00 "
11719,,PR TRIM NAIL(S),521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$36.00 
11720,,"PR DEBRIDEMENT OF NAIL(S), 1-5",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$98.00 
11720,,"PR DEBRIDEMENT OF NAIL(S), 1-5",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.00 
11720,,"PR DEBRIDEMENT OF NAIL(S), 1-5",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$98.00 
11730,,PR REMOVAL OF NAIL PLATE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$279.00 
11730,,PR REMOVAL OF NAIL PLATE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
11730,,PR REMOVAL OF NAIL PLATE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$140.00 
11732,,PR REMOVE ADDITIONAL NAIL PLATE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$98.00 
11740,,PR DRAIN BLOOD FROM UNDER NAIL,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$138.00 
11740,,PR DRAIN BLOOD FROM UNDER NAIL,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$187.00 
11740,,PR DRAIN BLOOD FROM UNDER NAIL,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$91.00 
11750,,PR REMOVAL OF NAIL BED,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$395.00 
11750,,PR REMOVAL OF NAIL BED,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
11750,,PR REMOVAL OF NAIL BED,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$258.00 
11760,,PR RECONSTRUC OF NAIL BED,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$492.00 
11760,,PR RECONSTRUC OF NAIL BED,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
11760,,PR RECONSTRUC OF NAIL BED,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$370.00 
11765,,"PR EXCISION OF NAIL FOLD, TOE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$462.00 
11765,,"PR EXCISION OF NAIL FOLD, TOE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
11765,,"PR EXCISION OF NAIL FOLD, TOE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$258.00 
11771,,PR REMV PILONIDAL LESION EXTENS,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,533.00 "
11771,,PR REMV PILONIDAL LESION EXTENS,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
11771,,PR REMV PILONIDAL LESION EXTENS,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,171.00 "
11900,,"PR INJECTION INTO SKIN LESIONS, UP TO ",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$154.00 
11976,,PR REMOVAL OF CONTRACEPTIVE CAPSUL,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$368.00 
11976,,HC REMOVE CONTRACEPTIVE CAP,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
1200000,,HC SWING BED,120,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$400.00 
12001,Q6,PR REPR SUPERF WND BODY <2.5CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$229.00 
12001,,PR REPR SUPERF WND BODY <2.5CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$229.00 
12001,,PR REPR SUPERF WND BODY <2.5CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12001,Q6,PR REPR SUPERF WND BODY <2.5CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12001,,PR REPR SUPERF WND BODY <2.5CM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$124.00 
12001,,HC REPR SUPERF WND BODY <2.5CM,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12002,Q6,PR REPR SUP NPTERF WND BODY 2.6-7.5,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$281.00 
12002,,PR REPR SUP NPTERF WND BODY 2.6-7.5,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$281.00 
12002,,PR REPR SUP NPTERF WND BODY 2.6-7.5,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12002,Q6,PR REPR SUP NPTERF WND BODY 2.6-7.5,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12002,,PR REPR SUP NPTERF WND BODY 2.6-7.5,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$164.00 
12002,,HC REPR SUP NPTERF WND BODY 2.6-7.5,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12004,,PR REPR SUPERF WND BODY 7.6-12.5,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$356.00 
12004,,PR REPR SUPERF WND BODY 7.6-12.5,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12004,,PR REPR SUPERF WND BODY 7.6-12.5,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$201.00 
12004,,HC REPR SUPERF WND BODY 7.6-12.5,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12005,,PR REPR SUPERF WND BODY 12.6-20,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$433.00 
12005,,PR REPR SUPERF WND BODY 12.6-20,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12005,,PR REPR SUPERF WND BODY 12.6-20,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$272.00 
12005,,HC REPR SUPERF WND BODY 12.6-20,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12006,,PR REPR SUPERF WND BODY 20.1-30,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$556.00 
12006,,PR REPR SUPERF WND BODY 20.1-30,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12006,,PR REPR SUPERF WND BODY 20.1-30,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$331.00 
12007,,PR REPR SUPERF WND BODY >30CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$634.00 
12007,,PR REPR SUPERF WND BODY >30CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12007,,PR REPR SUPERF WND BODY >30CM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$415.00 
12011,Q6,PR REPR SUPERF WND FACE <2.5CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$280.00 
12011,,PR REPR SUPERF WND FACE <2.5CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$307.00 
12011,,PR REPR SUPERF WND FACE <2.5CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12011,Q6,PR REPR SUPERF WND FACE <2.5CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12011,,PR REPR SUPERF WND FACE <2.5CM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$154.00 
12011,,HC REPR SUPERF WND FACE <2.5CM,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12013,Q6,PR REPR SUPERF WND FACE 2.6-5,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$292.00 
12013,,PR REPR SUPERF WND FACE 2.6-5,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$336.00 
12013,,PR REPR SUPERF WND FACE 2.6-5,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12013,Q6,PR REPR SUPERF WND FACE 2.6-5,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12013,,PR REPR SUPERF WND FACE 2.6-5,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$171.00 
12013,,HC REPR SUPERF WND FACE 2.6-5,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12014,,PR REPR SUPERF WND FACE 5.1-7.5,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$392.00 
12014,,PR REPR SUPERF WND FACE 5.1-7.5,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12014,,PR REPR SUPERF WND FACE 5.1-7.5,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$218.00 
12015,,PR REPR SUPERF WND FACE 7.6-12.5,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$478.00 
12015,,PR REPR SUPERF WND FACE 7.6-12.5,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12015,,PR REPR SUPERF WND FACE 7.6-12.5,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$269.00 
12016,,PR REPR SUPERF WND FACE 12.6-20,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$593.00 
12016,,PR REPR SUPERF WND FACE 12.6-20,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12016,,PR REPR SUPERF WND FACE 12.6-20,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$366.00 
12017,,PR REPR SUPERF WND FACE 20.1-30,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$417.00 
12017,,PR REPR SUPERF WND FACE 20.1-30,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12017,,PR REPR SUPERF WND FACE 20.1-30,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$417.00 
12018,,PR REPR SUPERF WND FACE >30CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$451.00 
12018,,PR REPR SUPERF WND FACE >30CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
12018,,PR REPR SUPERF WND FACE >30CM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$451.00 
12020,,PR CLOSURE SUPERF WND DEHIS SIMPLE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$781.00 
12020,,PR CLOSURE SUPERF WND DEHIS SIMPLE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
12020,,PR CLOSURE SUPERF WND DEHIS SIMPLE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$520.00 
12031,Q6,"PR LAYR CLOS WND TRUNK,ARM,LEG <2.5CM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$636.00 
12031,,"PR LAYR CLOS WND TRUNK,ARM,LEG <2.5CM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$662.00 
12031,,"PR LAYR CLOS WND TRUNK,ARM,LEG <2.5CM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12031,Q6,"PR LAYR CLOS WND TRUNK,ARM,LEG <2.5CM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12031,,"PR LAYR CLOS WND TRUNK,ARM,LEG <2.5CM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$425.00 
12031,,"HC LAYR CLOS WND TRUNK,ARM,LEG <2.5CM",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12032,,"PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$846.00 
12032,,"PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12032,,"PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$541.00 
12032,,"HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12034,,"PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$867.00 
12034,,"PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$570.00 
12034,,"PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$570.00 
12034,,"HC LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12035,,"PR LAYR CLOS WND TRUNK,ARM,LEG 12.6-20",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,079.00 "
12035,,"PR LAYR CLOS WND TRUNK,ARM,LEG 12.6-20",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12035,,"PR LAYR CLOS WND TRUNK,ARM,LEG 12.6-20",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$667.00 
12035,,"HC LAYR CLOS WND TRUNK,ARM,LEG 12.6-20",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12036,,"PR LAYR CLOS WND TRUNK,ARM,LEG 20.1-30",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,094.00 "
12036,,"PR LAYR CLOS WND TRUNK,ARM,LEG 20.1-30",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
12036,,"PR LAYR CLOS WND TRUNK,ARM,LEG 20.1-30",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$771.00 
12041,,PR LAYR CLOS WND REST BODY <2.5CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$671.00 
12041,,PR LAYR CLOS WND REST BODY <2.5CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12041,,PR LAYR CLOS WND REST BODY <2.5CM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$433.00 
12042,,PR LAYR CLOS WND REST BODY 2.6-7.5,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$801.00 
12042,,PR LAYR CLOS WND REST BODY 2.6-7.5,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$553.00 
12042,,PR LAYR CLOS WND REST BODY 2.6-7.5,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$553.00 
12042,,HC LAYR CLOS WND REST BODY 2.6-7.5,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$653.00 
12045,,PR LAYR CLOS WND REST BODY 12.6-20,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,031.00 "
12045,,PR LAYR CLOS WND REST BODY 12.6-20,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
12045,,PR LAYR CLOS WND REST BODY 12.6-20,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$751.00 
12051,,"PR LAYR CLOS WND FACE,FACIAL <2.5CM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$721.00 
12051,,"PR LAYR CLOS WND FACE,FACIAL <2.5CM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12051,,"PR LAYR CLOS WND FACE,FACIAL <2.5CM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$476.00 
12051,,HC LAYR CLOS WND FACIAL<2.5CM,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$653.00 
12052,,"PR LAYR CLOS WND FACE,FACIAL 2.5-5",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$816.00 
12052,,"PR LAYR CLOS WND FACE,FACIAL 2.5-5",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$561.00 
12052,,"PR LAYR CLOS WND FACE,FACIAL 2.5-5",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$561.00 
12052,,"HC LAYR CLOS WND FACE,FACIAL 2.5-5",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12053,,"PR LAYR CLOS WND FACE,FACIAL 5.1-7.5",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$901.00 
12053,,"PR LAYR CLOS WND FACE,FACIAL 5.1-7.5",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$598.00 
12053,,"PR LAYR CLOS WND FACE,FACIAL 5.1-7.5",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$598.00 
12053,,"HC LAYR CLOS WND FACE,FACIAL 5.1-7.5",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
12054,,"PR LAYR CLOS WND FACE,FACIAL 7.6-12.5",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,002.00 "
13100,,PR REPR CMPL WND TRUNK 1.1-2.5CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$862.00 
13100,,PR REPR CMPL WND TRUNK 1.1-2.5CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
13100,,PR REPR CMPL WND TRUNK 1.1-2.5CM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$566.00 
13101,,PR REPR CMPL WND TRUNK 2.6-7.5CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,012.00 "
13101,,PR REPR CMPL WND TRUNK 2.6-7.5CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
13101,,PR REPR CMPL WND TRUNK 2.6-7.5CM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$702.00 
13102,,"PR REP,SKIN,TRUNK,CMPLX,+5CM/<",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$305.00 
13102,,"PR REP,SKIN,TRUNK,CMPLX,+5CM/<",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$305.00 
13102,,"PR REP,SKIN,TRUNK,CMPLX,+5CM/<",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$203.00 
13120,,"PR REPR CMPL WND SCALP,EXTR 1.1-2.5",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$899.00 
13120,,"PR REPR CMPL WND SCALP,EXTR 1.1-2.5",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
13120,,"PR REPR CMPL WND SCALP,EXTR 1.1-2.5",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$655.00 
13121,,"PR REPR CMPL WND SCALP,EXTR 2.6-7.5",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,085.00 "
13121,,"PR REPR CMPL WND SCALP,EXTR 2.6-7.5",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
13121,,"PR REPR CMPL WND SCALP,EXTR 2.6-7.5",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$733.00 
13122,,"PR REP,SKIN,SCALP/EXTREM+5CM/<",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$332.00 
13122,,"PR REP,SKIN,SCALP/EXTREM+5CM/<",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$332.00 
13122,,"PR REP,SKIN,SCALP/EXTREM+5CM/<",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$238.00 
13131,,"PR REPR CMPL WND HEAD,FAC,HAND 1.1-2.5",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$985.00 
13131,,"PR REPR CMPL WND HEAD,FAC,HAND 1.1-2.5",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$687.00 
13131,,"PR REPR CMPL WND HEAD,FAC,HAND 1.1-2.5",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$687.00 
13132,,"PR REPR CMPL WND HEAD,FAC,HAND 2.6-7.5",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,205.00 "
13132,,"PR REPR CMPL WND HEAD,FAC,HAND 2.6-7.5",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$865.00 
13132,,"PR REPR CMPL WND HEAD,FAC,HAND 2.6-7.5",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$865.00 
13133,,"PR REP,FACE,GENITAL,HAND,FT+5CM/<",981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$442.00 
13133,,"PR REP,FACE,GENITAL,HAND,FT+5CM/<",981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$442.00 
13133,,"PR REP,FACE,GENITAL,HAND,FT+5CM/<",981,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$357.00 
13152,,"PR REPR CMPL WND LID,NOS,EAR 2.5-7.5",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,273.00 "
13152,,"PR REPR CMPL WND LID,NOS,EAR 2.5-7.5",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$882.00 
13152,,"PR REPR CMPL WND LID,NOS,EAR 2.5-7.5",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$882.00 
13160,,PR SECD CLOS SURG WND EXTEN/COMPLIC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,217.00 "
13160,,PR SECD CLOS SURG WND EXTEN/COMPLIC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,706.00 "
13160,,PR SECD CLOS SURG WND EXTEN/COMPLIC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,217.00 "
14020,,"PR ADJ TISS XFER SCALP,EXTREM <10SQCM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,756.00 "
14020,,"PR ADJ TISS XFER SCALP,EXTREM <10SQCM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,706.00 "
14020,,"PR ADJ TISS XFER SCALP,EXTREM <10SQCM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,579.00 "
14021,,"PR ADJ TISS XFER SCALP,EXTREM 10.1-30",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,184.00 "
14021,,"PR ADJ TISS XFER SCALP,EXTREM 10.1-30",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,706.00 "
14021,,"PR ADJ TISS XFER SCALP,EXTREM 10.1-30",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,988.00 "
14040,,"PR ADJ TISS XFER HEAD,FAC,HAND <10SQCM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,912.00 "
14040,,"PR ADJ TISS XFER HEAD,FAC,HAND <10SQCM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,706.00 "
14040,,"PR ADJ TISS XFER HEAD,FAC,HAND <10SQCM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,581.00 "
14060,,"PR ADJ TISS XFER LID,NOS,EAR <10SQCM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,942.00 "
14060,,"PR ADJ TISS XFER LID,NOS,EAR <10SQCM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,706.00 "
14060,,"PR ADJ TISS XFER LID,NOS,EAR <10SQCM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,864.00 "
15200,,PR FULL THICK GRFT TRUNK <20 SQCM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,122.00 "
15200,,PR FULL THICK GRFT TRUNK <20 SQCM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,706.00 "
15200,,PR FULL THICK GRFT TRUNK <20 SQCM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,855.00 "
15201,,PR FULL THICK GRFT TRUNK ADD 20 SQCM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$373.00 
15201,,PR FULL THICK GRFT TRUNK ADD 20 SQCM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$373.00 
15201,,PR FULL THICK GRFT TRUNK ADD 20 SQCM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$218.00 
15220,,"PR FULL THICK GRFT SCALP,ARM,LEG <20SQ",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,949.00 "
15220,,"PR FULL THICK GRFT SCALP,ARM,LEG <20SQ",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,706.00 "
15220,,"PR FULL THICK GRFT SCALP,ARM,LEG <20SQ",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,550.00 "
15240,,"PR FULL THICK GRFT HEAD,FAC,HAND <20SQ",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,352.00 "
15240,,"PR FULL THICK GRFT HEAD,FAC,HAND <20SQ",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,706.00 "
15240,,"PR FULL THICK GRFT HEAD,FAC,HAND <20SQ",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,016.00 "
15260,,"PR FULL THICK GRFT NOS,EAR,LID <20SQCM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,527.00 "
15260,,"PR FULL THICK GRFT NOS,EAR,LID <20SQCM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,706.00 "
15260,,"PR FULL THICK GRFT NOS,EAR,LID <20SQCM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,144.00 "
15734,,"PR MUSCLE-SKIN FLAP,TRUNK",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,866.00 "
15734,,"PR MUSCLE-SKIN FLAP,TRUNK",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,866.00 "
15734,,"HC MUSCLE-SKIN GRAFT, TRUNK",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,833.00 "
15830,,"PR EXCISE EXCESS SKIN TISSUE,ABDOMEN",982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,140.00 "
15830,,"PR EXCISE EXCESS SKIN TISSUE,ABDOMEN",982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,587.00 "
15836,,"HC EXCISE EXCESS SKIN TISSUE,ARM",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
15852,,"PR DRESSING CHANGE,NOT FOR BURN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$128.00 
15852,,"PR DRESSING CHANGE,NOT FOR BURN",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$844.00 
15852,,"PR DRESSING CHANGE,NOT FOR BURN",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$128.00 
15940,,PR EXC ISCH PRES ULC W PRIM CLOS,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,799.00 "
15940,,PR EXC ISCH PRES ULC W PRIM CLOS,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,155.00 "
15940,,PR EXC ISCH PRES ULC W PRIM CLOS,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,799.00 "
16000,Q6,PR INITIAL RX BURN(S) 1ST DEGREE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$186.00 
16000,,PR INITIAL RX BURN(S) 1ST DEGREE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$192.00 
16000,,PR INITIAL RX BURN(S) 1ST DEGREE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
16000,Q6,PR INITIAL RX BURN(S) 1ST DEGREE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
16000,,PR INITIAL RX BURN(S) 1ST DEGREE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$126.00 
16000,,HC INITIAL RX BURN(S) 1ST DEGREE,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
16020,,PR DRESS/DEBRID SMALL BURN NO ANES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$226.00 
16020,,PR DRESS/DEBRID SMALL BURN NO ANES,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
16020,,PR DRESS/DEBRID SMALL BURN NO ANES,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$151.00 
16025,,PR DRESS/DEBRID MED BURN NO ANESTH,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$407.00 
16025,,PR DRESS/DEBRID MED BURN NO ANESTH,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
16025,,PR DRESS/DEBRID MED BURN NO ANESTH,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$307.00 
16030,,PR DRESS/DEBRID LARGE BURN NO ANESTH,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$508.00 
16030,,PR DRESS/DEBRID LARGE BURN NO ANESTH,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$549.00 
16030,,PR DRESS/DEBRID LARGE BURN NO ANESTH,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$367.00 
17000,,"PR DESTRUC PREMALIGNANT, FIRST LESION",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$226.00 
17000,,"PR DESTRUC PREMALIGNANT, FIRST LESION",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
17000,,"PR DESTRUC PREMALIGNANT, FIRST LESION",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$156.00 
17003,,"PR DESTRUC PREMALIGNANT,2-14 LESIONS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$19.00 
17110,,PR DESTRUCTION BENIGN LESIONS UP TO 14,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$282.00 
17110,,PR DESTRUCTION BENIGN LESIONS UP TO 14,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
17110,,PR DESTRUCTION BENIGN LESIONS UP TO 14,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$195.00 
17110,,"HC DESTRUCT BENIGN LESION, 1-14",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
17111,,PR DESTRUCTION BENIGN LESIONS 15 OR MO,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$367.00 
17250,,PR CHEMICAL CAUTERIZATION OF GRANULATI,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$224.00 
17270,,"PR DESTR MALIG SCAL,NCK,HAND <0.6 CM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$419.00 
19000,,PR PUNC/ASPIR BREAST CYST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$312.00 
19000,,PR PUNC/ASPIR BREAST CYST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,013.00 "
19000,,PR PUNC/ASPIR BREAST CYST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$112.00 
19001,,"PR PUCT/ASPIR BREAST CYST,EACH ADDN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$70.00 
19001,,"PR PUCT/ASPIR BREAST CYST,EACH ADDN",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$70.00 
19001,,"PR PUCT/ASPIR BREAST CYST,EACH ADDN",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$60.00 
19020,,PR EXPLO/DRAIN BREAST ABSCESS,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,201.00 "
19020,,PR EXPLO/DRAIN BREAST ABSCESS,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
19020,,PR EXPLO/DRAIN BREAST ABSCESS,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$846.00 
19100,,"PR BIOPSY OF BREAST, NEEDLE CORE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$391.00 
19100,,"PR BIOPSY OF BREAST, NEEDLE CORE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
19100,,"PR BIOPSY OF BREAST, NEEDLE CORE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$191.00 
19101,,"PR BIOPSY OF BREAST, INCISIONAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$853.00 
19101,,"PR BIOPSY OF BREAST, INCISIONAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,920.00 "
19101,,"PR BIOPSY OF BREAST, INCISIONAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$607.00 
19120,,PR REMOVAL OF BREAST LESION,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,131.00 "
19120,,PR REMOVAL OF BREAST LESION,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,920.00 "
19120,,PR REMOVAL OF BREAST LESION,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,131.00 "
19125,,PR EXCISE BREAST LES W XRAY MARKER,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,423.00 "
19125,,PR EXCISE BREAST LES W XRAY MARKER,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,920.00 "
19125,,PR EXCISE BREAST LES W XRAY MARKER,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,256.00 "
19300,,PR MASTECTOMY FOR GYNECOMASTIA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,404.00 "
19300,,PR MASTECTOMY FOR GYNECOMASTIA,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,920.00 "
19300,,PR MASTECTOMY FOR GYNECOMASTIA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,131.00 "
19302,,"PR MASTECTOMY,PARTIAL,  WITH AXILLARY ",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,445.00 "
19302,,"PR MASTECTOMY,PARTIAL,  WITH AXILLARY ",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,587.00 "
19302,,"PR MASTECTOMY,PARTIAL,  WITH AXILLARY ",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,445.00 "
19303,,"PR MASTECTOMY, SIMPLE, COMPLETE",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,468.00 "
19303,,"PR MASTECTOMY, SIMPLE, COMPLETE",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,587.00 "
19303,,"PR MASTECTOMY, SIMPLE, COMPLETE",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,468.00 "
19305,,"PR MASTECTOMY, RADICAL",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,078.00 "
19305,,"PR MASTECTOMY, RADICAL",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,078.00 "
19305,,"PR MASTECTOMY, RADICAL",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,078.00 "
19307,,"PR MASTECTOMY, MODIFIED RADICAL",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,260.00 "
19307,,"PR MASTECTOMY, MODIFIED RADICAL",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,587.00 "
19307,,"PR MASTECTOMY, MODIFIED RADICAL",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,260.00 "
20103,,"PR EXPLORE WOUND,EXTREMITY",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,469.00 "
20103,,"PR EXPLORE WOUND,EXTREMITY",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,083.00 "
20103,,"PR EXPLORE WOUND,EXTREMITY",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$955.00 
20206,,"PR NEEDLE BIOPSY,MUSCLE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$600.00 
20206,,"PR NEEDLE BIOPSY,MUSCLE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
20206,,"PR NEEDLE BIOPSY,MUSCLE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$162.00 
20520,,PR REMOVAL OF FOREIGN BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$566.00 
20520,,PR REMOVAL OF FOREIGN BODY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
20520,,PR REMOVAL OF FOREIGN BODY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$404.00 
20525,,PR REMOVAL OF FOREIGN BODY DEEP/COMPLI,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,206.00 "
20525,,PR REMOVAL OF FOREIGN BODY DEEP/COMPLI,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
20525,,PR REMOVAL OF FOREIGN BODY DEEP/COMPLI,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$684.00 
20550,,PR INJECT TENDON SHEATH/LIGAMENT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$139.00 
20550,,PR INJECT TENDON SHEATH/LIGAMENT,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$463.00 
20550,,PR INJECT TENDON SHEATH/LIGAMENT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$113.00 
20551,,PR INJECT TENDON ORIGIN/INSERT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$142.00 
20551,,PR INJECT TENDON ORIGIN/INSERT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$103.00 
20552,,"PR INJECT TRIGGER POINT, 1 OR 2",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$141.00 
20552,,"PR INJECT TRIGGER POINT, 1 OR 2",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$463.00 
20552,,"PR INJECT TRIGGER POINT, 1 OR 2",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$103.00 
20553,,"PR INJECT TRIGGER POINTS, > 3",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$173.00 
20553,,"PR INJECT TRIGGER POINTS, > 3",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$115.00 
20553,,"HC INJ TRIGGER POINT,3 OR MORE",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$466.00 
20600,,PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$66.00 
20605,,PR ARTHROCENTESIS ASPIR&/INJ INTERM JT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$133.00 
20610,,PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$166.00 
20610,,PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$463.00 
20610,,PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$126.00 
20610,,HC RAD INJECT/ASPIR JNTMAJOR,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$463.00 
20612,,PR ASPIRAT/INJECTION GANGLION CYST(S),521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$157.00 
20612,,PR ASPIRAT/INJECTION GANGLION CYST(S),521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$463.00 
20612,,PR ASPIRAT/INJECTION GANGLION CYST(S),521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$114.00 
21011,,EXCISION TUMOR SOFT TISS FACE/SCALP SU,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$918.00 
21011,,EXCISION TUMOR SOFT TISS FACE/SCALP SU,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
21011,,EXCISION TUMOR SOFT TISS FACE/SCALP SU,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$713.00 
21012,,EXCISION TUMOR SOFT TISS FACE/SCALP SU,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$923.00 
21012,,EXCISION TUMOR SOFT TISS FACE/SCALP SU,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
21012,,EXCISION TUMOR SOFT TISS FACE/SCALP SU,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$923.00 
21030,,"PR EXCISION,BENIGN TUMOR,MAXILLA/ZYGOM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,248.00 "
21030,,"PR EXCISION,BENIGN TUMOR,MAXILLA/ZYGOM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,267.00 "
21030,,"PR EXCISION,BENIGN TUMOR,MAXILLA/ZYGOM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,159.00 "
21310,,PR CLOSED RX NOSE FRACTURE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$319.00 
21310,,PR CLOSED RX NOSE FRACTURE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
21310,,PR CLOSED RX NOSE FRACTURE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$76.00 
21501,,PR I&D DEEP ABSC/HEMATOMA NECK/CHEST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,191.00 "
21501,,PR I&D DEEP ABSC/HEMATOMA NECK/CHEST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
21501,,PR I&D DEEP ABSC/HEMATOMA NECK/CHEST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$897.00 
21552,,PR EXC NECK LES SC=3CM,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,222.00 "
21552,,PR EXC NECK LES SC=3CM,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
21552,,PR EXC NECK LES SC=3CM,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,222.00 "
21554,,EXC TUMOR SOFT TISSUE NECK/THORAX SUBF,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,997.00 "
21554,,EXC TUMOR SOFT TISSUE NECK/THORAX SUBF,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
21554,,EXC TUMOR SOFT TISSUE NECK/THORAX SUBF,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,997.00 "
21555,,"PR EXCISE LESN NECK/CHEST,SUBCUTAN",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,168.00 "
21555,,"PR EXCISE LESN NECK/CHEST,SUBCUTAN",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
21555,,"PR EXCISE LESN NECK/CHEST,SUBCUTAN",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$852.00 
21556,,"PR EXCISE LESN NECK/CHEST,DEEP",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,350.00 "
21556,,"PR EXCISE LESN NECK/CHEST,DEEP",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
21556,,"PR EXCISE LESN NECK/CHEST,DEEP",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,350.00 "
21558,,PR RAD RESECT TUMOR SOFT TISS NECK/ANT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,445.00 "
21558,,PR RAD RESECT TUMOR SOFT TISS NECK/ANT,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
21558,,PR RAD RESECT TUMOR SOFT TISS NECK/ANT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,445.00 "
21930,,"PR EXCISE LESION,BACK OR FLANK",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,320.00 "
21930,,"PR EXCISE LESION,BACK OR FLANK",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
21930,,"PR EXCISE LESION,BACK OR FLANK",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,011.00 "
21931,,PR EXC BACK LES SC=3CM,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,289.00 "
21931,,PR EXC BACK LES SC=3CM,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
21931,,PR EXC BACK LES SC=3CM,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,289.00 "
21932,,EXC TUMOR SOFT TISS BACK/FLANK SUBFASC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,701.00 "
21932,,EXC TUMOR SOFT TISS BACK/FLANK SUBFASC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
21932,,EXC TUMOR SOFT TISS BACK/FLANK SUBFASC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,701.00 "
21933,,EXC TUMOR SOFT TISS BACK/FLANK SUBFASC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,016.00 "
21933,,EXC TUMOR SOFT TISS BACK/FLANK SUBFASC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
21933,,EXC TUMOR SOFT TISS BACK/FLANK SUBFASC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,016.00 "
21936,,PR RAD RESECTION TUMOR SOFT TISSUE BAC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,635.00 "
21936,,PR RAD RESECTION TUMOR SOFT TISSUE BAC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
21936,,PR RAD RESECTION TUMOR SOFT TISSUE BAC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,635.00 "
22900,,PR REMOVE ABDOMINAL WALL LESION,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,454.00 "
22902,,EXC TUMOR SOFT TISSUE ABDOMINAL WALL S,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,169.00 "
22902,,EXC TUMOR SOFT TISSUE ABDOMINAL WALL S,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
22902,,EXC TUMOR SOFT TISSUE ABDOMINAL WALL S,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$895.00 
22903,,EXC TUMOR SOFT TISSUE ABDOMINAL WALL S,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,192.00 "
22903,,EXC TUMOR SOFT TISSUE ABDOMINAL WALL S,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
22903,,EXC TUMOR SOFT TISSUE ABDOMINAL WALL S,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,192.00 "
23065,,PR EXPLOR INFECT A-C/S-C JT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$609.00 
23065,,PR EXPLOR INFECT A-C/S-C JT,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
23065,,PR EXPLOR INFECT A-C/S-C JT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$468.00 
23071,,PR EXC SHOULDER LES SC > 3CM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,149.00 "
23071,,PR EXC SHOULDER LES SC > 3CM,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
23071,,PR EXC SHOULDER LES SC > 3CM,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,149.00 "
23076,,PR EXCIS SUBCUT SHLDR TUMOR,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,386.00 "
23076,,PR EXCIS SUBCUT SHLDR TUMOR,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
23076,,PR EXCIS SUBCUT SHLDR TUMOR,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,386.00 "
23500,,PR CLOSED RX CLAVICLE FRACTURE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$609.00 
23500,,PR CLOSED RX CLAVICLE FRACTURE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
23500,,PR CLOSED RX CLAVICLE FRACTURE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$609.00 
23500,,HC CLOSED RX CLAVICLE FRACTURE,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
23505,,"PR CLOSED RX CLAVICLE FX,MANIPULATN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$977.00 
23505,,"PR CLOSED RX CLAVICLE FX,MANIPULATN",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,454.00 "
23505,,"PR CLOSED RX CLAVICLE FX,MANIPULATN",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$852.00 
23540,,PR CLOSED RX A-C JT DISLOC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$623.00 
23570,,PR CLOSED RX SCAPULA FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$643.00 
23570,,PR CLOSED RX SCAPULA FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
23570,,PR CLOSED RX SCAPULA FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$643.00 
23600,,PR CLOSED RX PROX HUMERUS FRACTURE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$838.00 
23600,,PR CLOSED RX PROX HUMERUS FRACTURE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$791.00 
23600,,PR CLOSED RX PROX HUMERUS FRACTURE,521,PC PROF PBB FEE SCHEDULE [8053],$838.00 
23600,,HC CLOSED RX PROX HUMERUS FRACTURE,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
23650,,PR CLOSED RX SHLDR DISLOCATION,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$875.00 
23650,,PR CLOSED RX SHLDR DISLOCATION,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
23650,,PR CLOSED RX SHLDR DISLOCATION,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$802.00 
23650,,HC CLOSED RX SHLDR DISLOCATION,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
23655,,"PR CLOSED RX SHLDR DISLOC,ANESTHESIA",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,103.00 "
23655,,"PR CLOSED RX SHLDR DISLOC,ANESTHESIA",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,454.00 "
23655,,"PR CLOSED RX SHLDR DISLOC,ANESTHESIA",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,103.00 "
23675,,"PR CLOSED RX SHLDR DISLOC,PROX HUM FX",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,410.00 "
23675,,"PR CLOSED RX SHLDR DISLOC,PROX HUM FX",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,454.00 "
23675,,"PR CLOSED RX SHLDR DISLOC,PROX HUM FX",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,373.00 "
23930,,"PR INCIS/DRAIN ARM,DEEP ABSC/HEMATOMA",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$994.00 
23930,,"PR INCIS/DRAIN ARM,DEEP ABSC/HEMATOMA",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
23930,,"PR INCIS/DRAIN ARM,DEEP ABSC/HEMATOMA",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$595.00 
23931,,PR INCIS/DRAIN ARM/ELBOW INFECT BURSA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$735.00 
23931,,PR INCIS/DRAIN ARM/ELBOW INFECT BURSA,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
23931,,PR INCIS/DRAIN ARM/ELBOW INFECT BURSA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$443.00 
24071,,EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,115.00 "
24071,,EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW ,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
24071,,EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW ,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,115.00 "
24075,,"PR EXCIS TUMOR,SOFT TISS UP ARM/ELBOW,",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,319.00 "
24075,,"PR EXCIS TUMOR,SOFT TISS UP ARM/ELBOW,",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
24075,,"PR EXCIS TUMOR,SOFT TISS UP ARM/ELBOW,",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$910.00 
24200,,"PR REMOVAL ARM/ELBOW F.B.,SUPERFICIAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$550.00 
24200,,"PR REMOVAL ARM/ELBOW F.B.,SUPERFICIAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
24200,,"PR REMOVAL ARM/ELBOW F.B.,SUPERFICIAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$360.00 
24500,,PR CLOSED RX MID HUMERUS FRACTURE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$912.00 
24500,,PR CLOSED RX MID HUMERUS FRACTURE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
24500,,PR CLOSED RX MID HUMERUS FRACTURE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$902.00 
24530,,PR CLOSED RX HUMERAL SUPRACONDYLAR FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,055.00 "
24530,,PR CLOSED RX HUMERAL SUPRACONDYLAR FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
24530,,PR CLOSED RX HUMERAL SUPRACONDYLAR FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$953.00 
24560,,PR CLOSED RX HUMER EPICONDYLR FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$836.00 
24560,,PR CLOSED RX HUMER EPICONDYLR FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
24560,,PR CLOSED RX HUMER EPICONDYLR FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$801.00 
24576,,PR CLOSED RX HUMER CONDYLR FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$949.00 
24576,,PR CLOSED RX HUMER CONDYLR FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
24576,,PR CLOSED RX HUMER CONDYLR FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$850.00 
24600,,PR CLOSED RX ELBOW DISLOCATION,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,017.00 "
24600,,PR CLOSED RX ELBOW DISLOCATION,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
24600,,PR CLOSED RX ELBOW DISLOCATION,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$927.00 
24640,,"PR CLOSED RX RADIAL HEAD DISLOC,CHILD",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$266.00 
24640,,"PR CLOSED RX RADIAL HEAD DISLOC,CHILD",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
24640,,"PR CLOSED RX RADIAL HEAD DISLOC,CHILD",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$266.00 
24650,,PR CLOSED RX RADIAL HEAD/NECK FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$666.00 
24650,,HC CLOSED RX RADIAL HEAD/NECK FX,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
25071,,EXC TUMOR SOFT TISS FOREARM AND/WRIST ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,118.00 "
25075,,"PR EXCIS TUMOR,SOFT TISS FOREARM/WRIST",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$875.00 
25075,,"PR EXCIS TUMOR,SOFT TISS FOREARM/WRIST",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
25075,,"PR EXCIS TUMOR,SOFT TISS FOREARM/WRIST",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$875.00 
25111,,PR EXCIS PRIMARY GANGLION WRIST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$882.00 
25111,,PR EXCIS PRIMARY GANGLION WRIST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,454.00 "
25111,,PR EXCIS PRIMARY GANGLION WRIST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$882.00 
25248,,PR REMOVE FOREARM/WRIST FOREIGN BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,132.00 "
25248,,PR REMOVE FOREARM/WRIST FOREIGN BODY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,454.00 "
25248,,PR REMOVE FOREARM/WRIST FOREIGN BODY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,132.00 "
25500,,PR CLOSED RX RADIAL SHAFT FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$755.00 
25500,,PR CLOSED RX RADIAL SHAFT FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
25500,,PR CLOSED RX RADIAL SHAFT FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$693.00 
25530,,PR CLOSED RX ULNA SHAFT FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$730.00 
25530,,PR CLOSED RX ULNA SHAFT FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
25530,,PR CLOSED RX ULNA SHAFT FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$659.00 
25560,,PR CLOSED RX RAD/ULNA SHAFT FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$776.00 
25560,,PR CLOSED RX RAD/ULNA SHAFT FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
25560,,PR CLOSED RX RAD/ULNA SHAFT FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$700.00 
25560,,HC CLOSED RX RAD/ULNA SHAFT FX,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
25600,,PR CLOSED RX DIST RAD/ULNA FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$916.00 
25600,,PR CLOSED RX DIST RAD/ULNA FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
25600,,PR CLOSED RX DIST RAD/ULNA FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$866.00 
25622,,PR CLOSED RX NAVICULAR FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$850.00 
25622,,PR CLOSED RX NAVICULAR FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
25622,,PR CLOSED RX NAVICULAR FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$772.00 
25630,,PR CLOSED RX CARPAL FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$847.00 
25650,,PR CLOSED RX ULNA STYLOID FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$891.00 
25675,,PR CLOSED RX RADIO-ULNA DISLOCATION,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,129.00 "
25675,,PR CLOSED RX RADIO-ULNA DISLOCATION,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,061.00 "
25675,,PR CLOSED RX RADIO-ULNA DISLOCATION,521,PC PROF PBB FEE SCHEDULE [8053],"$1,129.00 "
25680,,PR CLOSED RX NAVIC/LUNATE FX/DISLOC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,340.00 "
25680,,PR CLOSED RX NAVIC/LUNATE FX/DISLOC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
25680,,PR CLOSED RX NAVIC/LUNATE FX/DISLOC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,340.00 "
26010,,"PR DRAIN FINGER ABSCESS,SIMPLE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$765.00 
26010,,"PR DRAIN FINGER ABSCESS,SIMPLE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$330.00 
26010,,"PR DRAIN FINGER ABSCESS,SIMPLE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$387.00 
26011,,"PR DRAIN FINGER ABSCESS,COMPLICATED",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,106.00 "
26011,,"PR DRAIN FINGER ABSCESS,COMPLICATED",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
26011,,"PR DRAIN FINGER ABSCESS,COMPLICATED",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$508.00 
26160,,"PR EXCIS TENDON SHEATH LESION, HAND/FI",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,449.00 "
26160,,"PR EXCIS TENDON SHEATH LESION, HAND/FI",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,454.00 "
26160,,"PR EXCIS TENDON SHEATH LESION, HAND/FI",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$802.00 
26600,,PR CLOSED RX METACARPAL FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$821.00 
26600,,PR CLOSED RX METACARPAL FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
26600,,PR CLOSED RX METACARPAL FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$772.00 
26605,,"PR CLOSED RX METACARPAL FX,MANIP",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$828.00 
26605,,"PR CLOSED RX METACARPAL FX,MANIP",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
26605,,"PR CLOSED RX METACARPAL FX,MANIP",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$813.00 
26607,,"PR CLOSED RX METACARP FX,W/MANIP,W/EXT",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,255.00 "
26607,,"PR CLOSED RX METACARP FX,W/MANIP,W/EXT",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
26607,,"PR CLOSED RX METACARP FX,W/MANIP,W/EXT",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,255.00 "
26641,,"PR TREAT THUMB DISLOC,MANIPULATN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,017.00 "
26641,,"PR TREAT THUMB DISLOC,MANIPULATN",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
26641,,"PR TREAT THUMB DISLOC,MANIPULATN",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$927.00 
26645,,"PR TREAT THUMB FX/DISLOC,MANIP",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,098.00 "
26645,,"PR TREAT THUMB FX/DISLOC,MANIP",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,454.00 "
26645,,"PR TREAT THUMB FX/DISLOC,MANIP",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,076.00 "
26720,,PR CLOSE RX PROX/MID FING SHFT FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$554.00 
26720,,PR CLOSE RX PROX/MID FING SHFT FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
26720,,PR CLOSE RX PROX/MID FING SHFT FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$515.00 
26750,,PR CLOSE RX DIST FINGR FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$472.00 
26750,,PR CLOSE RX DIST FINGR FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
26750,,PR CLOSE RX DIST FINGR FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$472.00 
26755,,"PR CLOSE RX DIST FINGR FX,MANIPULATN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$809.00 
26755,,"PR CLOSE RX DIST FINGR FX,MANIPULATN",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
26755,,"PR CLOSE RX DIST FINGR FX,MANIPULATN",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$758.00 
26765,,OPEN TX DISTAL PHALANGEAL FRACTURE EAC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,377.00 "
26765,,OPEN TX DISTAL PHALANGEAL FRACTURE EAC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
26765,,OPEN TX DISTAL PHALANGEAL FRACTURE EAC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,377.00 "
26770,,PR CLOSED RX IP JT DISLOCATION,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$770.00 
26770,,PR CLOSED RX IP JT DISLOCATION,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
26770,,PR CLOSED RX IP JT DISLOCATION,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$711.00 
26775,,"PR CLOSED RX IP JT DISLOCATION,ANESTH",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,065.00 "
26952,,PR AMPUTATION FINGER/THUMB+FLAPS,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,759.00 "
26952,,PR AMPUTATION FINGER/THUMB+FLAPS,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
26952,,PR AMPUTATION FINGER/THUMB+FLAPS,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,759.00 "
27301,,"PR INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,723.00 "
27301,,"PR INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
27301,,"PR INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,377.00 "
27327,,"PR REMV THIGH/KNEE TUMOR,SUBCUTANEOUS",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,236.00 "
27327,,"PR REMV THIGH/KNEE TUMOR,SUBCUTANEOUS",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
27327,,"PR REMV THIGH/KNEE TUMOR,SUBCUTANEOUS",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$866.00 
27337,,EXCISON TUMOR SOFT TISSUE THIGH/KNEE S,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,152.00 "
27337,,EXCISON TUMOR SOFT TISSUE THIGH/KNEE S,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
27337,,EXCISON TUMOR SOFT TISSUE THIGH/KNEE S,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,152.00 "
27345,,"PR REMOVAL SYNOVIAL CYST,KNEE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,236.00 "
27345,,"PR REMOVAL SYNOVIAL CYST,KNEE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
27345,,"PR REMOVAL SYNOVIAL CYST,KNEE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,236.00 "
27372,,"PR REMV FOREIGN BODY,KNEE/THIGH,DEEP",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,530.00 "
27372,,"PR REMV FOREIGN BODY,KNEE/THIGH,DEEP",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
27372,,"PR REMV FOREIGN BODY,KNEE/THIGH,DEEP",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,028.00 "
27520,,PR CLOSED RX PATELLA FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$822.00 
27520,,PR CLOSED RX PATELLA FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27520,,PR CLOSED RX PATELLA FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$822.00 
27550,,PR CLOSED RX KNEE DISLOCATN,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,335.00 "
27550,,HC TREAT KNEE DISLOCATION,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27560,,PR CLOSED RX KNEECAP DISLOCATN,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$953.00 
27560,,PR CLOSED RX KNEECAP DISLOCATN,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27560,,PR CLOSED RX KNEECAP DISLOCATN,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$935.00 
27562,,PR CLOSED RX KNEECAP DISLOC+ANESTH,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,329.00 "
27562,,PR CLOSED RX KNEECAP DISLOC+ANESTH,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27562,,PR CLOSED RX KNEECAP DISLOC+ANESTH,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,329.00 "
27590,,"PR AMPUTATE THIGH,THRU FEMUR",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,041.00 "
27590,,"PR AMPUTATE THIGH,THRU FEMUR",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,041.00 "
27590,,"PR AMPUTATE THIGH,THRU FEMUR",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,041.00 "
27603,,PR DRAIN LOWER LEG DEEP ABSC/HEMATOMA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,359.00 "
27603,,PR DRAIN LOWER LEG DEEP ABSC/HEMATOMA,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
27603,,PR DRAIN LOWER LEG DEEP ABSC/HEMATOMA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,083.00 "
27618,,"PR RESEC TUMOR LOWER LEG,SUBCUT",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,202.00 "
27618,,"PR RESEC TUMOR LOWER LEG,SUBCUT",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
27618,,"PR RESEC TUMOR LOWER LEG,SUBCUT",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$843.00 
27630,,PR EXCIS LESN TENDON SHEALTH LEG/ANKLE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,402.00 "
27630,,PR EXCIS LESN TENDON SHEALTH LEG/ANKLE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
27630,,PR EXCIS LESN TENDON SHEALTH LEG/ANKLE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,007.00 "
27632,,EXCISION TUMOR SOFT TISSUE LEG/ANKLE S,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,144.00 "
27632,,EXCISION TUMOR SOFT TISSUE LEG/ANKLE S,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,444.00 "
27632,,EXCISION TUMOR SOFT TISSUE LEG/ANKLE S,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,144.00 "
27705,,PR OSTEOTOMY TIBIA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,939.00 "
27705,,PR OSTEOTOMY TIBIA,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$10,650.00 "
27705,,PR OSTEOTOMY TIBIA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,939.00 "
27750,,PR CLOSED RX TIBIA SHAFT FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,928.00 "
27750,,PR CLOSED RX TIBIA SHAFT FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27750,,PR CLOSED RX TIBIA SHAFT FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,928.00 "
27752,,"PR CLOSED RX TIBIA SHAFT FX,MANIPULATN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,367.00 "
27752,,"PR CLOSED RX TIBIA SHAFT FX,MANIPULATN",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,454.00 "
27752,,"PR CLOSED RX TIBIA SHAFT FX,MANIPULATN",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,367.00 "
27760,,PR CLOSED RX MED MALLEOLUS FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$933.00 
27760,,PR CLOSED RX MED MALLEOLUS FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27760,,PR CLOSED RX MED MALLEOLUS FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$850.00 
27780,,PR CLOSED RX PROX/SHAFT FIBULA FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$856.00 
27780,,PR CLOSED RX PROX/SHAFT FIBULA FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27780,,PR CLOSED RX PROX/SHAFT FIBULA FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$777.00 
27786,,PR CLOSED RX DIST FIBULA FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$884.00 
27786,,PR CLOSED RX DIST FIBULA FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27786,,PR CLOSED RX DIST FIBULA FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$797.00 
27808,,PR CLOSED TX BIMALLEOLAR ANKLE FRACTUR,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$849.00 
27808,,PR CLOSED TX BIMALLEOLAR ANKLE FRACTUR,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27808,,PR CLOSED TX BIMALLEOLAR ANKLE FRACTUR,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$838.00 
27824,,PR CLOSED RX WEIGHT BEAR DIST TIBIA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$867.00 
27824,,PR CLOSED RX WEIGHT BEAR DIST TIBIA,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
27824,,PR CLOSED RX WEIGHT BEAR DIST TIBIA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$867.00 
27824,,HC CLOSED RX WEIGHT BEAR DIST TIBIA,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
28008,,PR INCISION OF FOOT/TOE FASCIA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,109.00 "
28008,,PR INCISION OF FOOT/TOE FASCIA,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
28008,,PR INCISION OF FOOT/TOE FASCIA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$803.00 
28020,,PR EXPLOR TARSAL/TARSOMETATAR JT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,374.00 "
28020,,PR EXPLOR TARSAL/TARSOMETATAR JT,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
28020,,PR EXPLOR TARSAL/TARSOMETATAR JT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$996.00 
28060,,"HC PARTIAL REMOVAL,FOOT FASCIA",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
28092,,"PR EXCIS TENDN/CAPSULE LESN,TOES",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,083.00 "
28092,,"PR EXCIS TENDN/CAPSULE LESN,TOES",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,454.00 "
28092,,"PR EXCIS TENDN/CAPSULE LESN,TOES",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$748.00 
28122,,PR PART REMV OTHR TARSAL/METATARSAL,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,522.00 "
28122,,PR PART REMV OTHR TARSAL/METATARSAL,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
28122,,PR PART REMV OTHR TARSAL/METATARSAL,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,212.00 "
28190,,"PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$728.00 
28190,,"PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,083.00 "
28190,,"PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$369.00 
28190,,"HC REMV FOOT FOREIGN BODY,SUBCUTANEOUS",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,083.00 "
28192,,"PR REMV FOOT FOREIGN BODY,DEEP",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,197.00 "
28192,,"PR REMV FOOT FOREIGN BODY,DEEP",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,571.00 "
28192,,"PR REMV FOOT FOREIGN BODY,DEEP",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$869.00 
28430,,PR CLOSED RX TALUS FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$535.00 
28450,,"PR CLOSED RX TARSAL FX,EACH",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$539.00 
28450,,"PR CLOSED RX TARSAL FX,EACH",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
28450,,"PR CLOSED RX TARSAL FX,EACH",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$539.00 
28470,,PR CLOSED RX METATARSAL FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$619.00 
28470,,PR CLOSED RX METATARSAL FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
28470,,PR CLOSED RX METATARSAL FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$577.00 
28490,,PR CLOSED RX BIG TOE FRACTURE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$413.00 
28490,,PR CLOSED RX BIG TOE FRACTURE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
28490,,PR CLOSED RX BIG TOE FRACTURE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$354.00 
28510,,PR CLOSED RX TOE FX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$346.00 
28510,,PR CLOSED RX TOE FX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
28510,,PR CLOSED RX TOE FX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$339.00 
28515,,"PR CLOSED RX TOE FX,MANIPULATN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$414.00 
28515,,"PR CLOSED RX TOE FX,MANIPULATN",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$398.00 
28515,,"PR CLOSED RX TOE FX,MANIPULATN",521,PC PROF PBB FEE SCHEDULE [8053],$414.00 
28660,,"PR CLOSED RX I-P JT,TOE DISLOCATION",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$328.00 
28660,,"PR CLOSED RX I-P JT,TOE DISLOCATION",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$421.00 
28660,,"PR CLOSED RX I-P JT,TOE DISLOCATION",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$247.00 
28810,,"PR AMPUTATION METATARSAL+TOE,SINGLE",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,097.00 "
28810,,"PR AMPUTATION METATARSAL+TOE,SINGLE",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,902.00 "
28810,,"PR AMPUTATION METATARSAL+TOE,SINGLE",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,097.00 "
29065,,PR APPLY LONG ARM CAST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$269.00 
29065,,PR APPLY LONG ARM CAST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$441.00 
29065,,PR APPLY LONG ARM CAST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$192.00 
29075,,PR APPLY FOREARM CAST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$244.00 
29075,,PR APPLY FOREARM CAST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$441.00 
29075,,PR APPLY FOREARM CAST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$157.00 
29075,,HC APPLY FOREARM CAST,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$441.00 
29105,,PR APPLY LONG ARM SPLINT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$205.00 
29105,,PR APPLY LONG ARM SPLINT,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$252.00 
29105,,PR APPLY LONG ARM SPLINT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$108.00 
29105,,HC APPLY LONG ARM SPLINT,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$252.00 
29125,,"PR APPLY FOREARM SPLINT,STATIC",981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$183.00 
29125,,"PR APPLY FOREARM SPLINT,STATIC",981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$199.00 
29125,,"PR APPLY FOREARM SPLINT,STATIC",981,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$112.00 
29125,,"HC APPLY FOREARM SPLINT,STATIC",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$199.00 
29130,,"PR APPLY FINGER SPLINT,STATIC",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$115.00 
29130,,"PR APPLY FINGER SPLINT,STATIC",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
29130,,"PR APPLY FINGER SPLINT,STATIC",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$78.00 
29240,,PR STRAPPING OF SHOULDER,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$79.00 
29240,,PR STRAPPING OF SHOULDER,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$199.00 
29240,,PR STRAPPING OF SHOULDER,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$48.00 
29260,,PR STRAPPING OF ELBOW OR WRIST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$77.00 
29260,,PR STRAPPING OF ELBOW OR WRIST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$61.00 
29260,,PR STRAPPING OF ELBOW OR WRIST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$50.00 
29280,,PR STRAPPING OF HAND OR FINGER,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$79.00 
29280,,PR STRAPPING OF HAND OR FINGER,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$61.00 
29280,,PR STRAPPING OF HAND OR FINGER,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$54.00 
29345,,PR APPLY LONG LEG CAST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$382.00 
29345,,PR APPLY LONG LEG CAST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$441.00 
29345,,PR APPLY LONG LEG CAST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$255.00 
29405,,PR APPLY SHORT LEG CAST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$227.00 
29405,,PR APPLY SHORT LEG CAST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$441.00 
29405,,PR APPLY SHORT LEG CAST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$167.00 
29405,,HC APPLY SHORT LEG CAST,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$441.00 
29425,,"PR APPLY SHORT LEG CAST,WALKER",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$220.00 
29425,,"PR APPLY SHORT LEG CAST,WALKER",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$441.00 
29425,,"PR APPLY SHORT LEG CAST,WALKER",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$157.00 
29515,,PR APPLY LOWER LEG SPLINT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$179.00 
29515,,PR APPLY LOWER LEG SPLINT,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$252.00 
29515,,PR APPLY LOWER LEG SPLINT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$139.00 
29530,,PR STRAPPING OF KNEE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$78.00 
29530,,PR STRAPPING OF KNEE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$199.00 
29530,,PR STRAPPING OF KNEE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$48.00 
29550,,PR STRAPPING OF TOES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$48.00 
29550,,PR STRAPPING OF TOES,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
29550,,PR STRAPPING OF TOES,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$30.00 
30300,,PR REMOVE NASAL FOREIGN BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$479.00 
30300,,PR REMOVE NASAL FOREIGN BODY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$178.00 
30300,,PR REMOVE NASAL FOREIGN BODY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$287.00 
30901,,"PR CTRL NOSEBLEED,ANTER,SIMPLE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$363.00 
30901,,"PR CTRL NOSEBLEED,ANTER,SIMPLE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$178.00 
30901,,"PR CTRL NOSEBLEED,ANTER,SIMPLE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$154.00 
30901,,"HC CONTROL NOSE BLEED,SMPL",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$178.00 
30903,,"PR CTRL NOSEBLEED,ANTER,COMPLEX",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$587.00 
30903,,"PR CTRL NOSEBLEED,ANTER,COMPLEX",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$178.00 
30903,,"PR CTRL NOSEBLEED,ANTER,COMPLEX",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$218.00 
30903,,"HC CONTROL NOSE BLEED,CMPLX",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$201.00 
30905,,"PR CTRL NOSEBLEED,POST,W/PACKS &/OR CA",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$855.00 
30905,,"PR CTRL NOSEBLEED,POST,W/PACKS &/OR CA",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$273.00 
30905,,"PR CTRL NOSEBLEED,POST,W/PACKS &/OR CA",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$273.00 
30905,,"HC CONTROL NOSE BLEED,INITIAL",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$201.00 
30906,,PR REPEAT CONTROL OF NOSEBLEED,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$890.00 
30906,,PR REPEAT CONTROL OF NOSEBLEED,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$356.00 
30906,,PR REPEAT CONTROL OF NOSEBLEED,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$356.00 
30906,,"HC CONTROL NOSE BLEED,SUBSEQUENT",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$345.00 
31500,,PR INSERT EMERGENCY ENDOTRACH AIRWAY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$367.00 
31500,,PR INSERT EMERGENCY ENDOTRACH AIRWAY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$345.00 
31500,,PR INSERT EMERGENCY ENDOTRACH AIRWAY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$367.00 
31505,,"PR LARYNGOSCOPY,INDIRECT,DX",981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$220.00 
31505,,"PR LARYNGOSCOPY,INDIRECT,DX",981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$274.00 
31505,,"PR LARYNGOSCOPY,INDIRECT,DX",981,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$139.00 
31622,,PR BRNCHSC INCL FLUOR GDNCE DX W/CELL ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$611.00 
31622,,PR BRNCHSC INCL FLUOR GDNCE DX W/CELL ,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,289.00 "
31622,,PR BRNCHSC INCL FLUOR GDNCE DX W/CELL ,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$336.00 
32405,,PR BIOPSY LUNG/MEDIASTINUM PERCUTANEOU,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,004.00 "
32405,,PR BIOPSY LUNG/MEDIASTINUM PERCUTANEOU,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,299.00 "
32405,,PR BIOPSY LUNG/MEDIASTINUM PERCUTANEOU,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$230.00 
32551,,PR TUBE THORACOSTOMY INCLUDES WATER SE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$405.00 
32551,,PR TUBE THORACOSTOMY INCLUDES WATER SE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,828.00 "
32551,,PR TUBE THORACOSTOMY INCLUDES WATER SE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$405.00 
32554,,PR THORACENTESIS NEEDLE/CATH PLEURA W/,960,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$562.00 
32554,,PR THORACENTESIS NEEDLE/CATH PLEURA W/,960,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,037.00 "
32554,,PR THORACENTESIS NEEDLE/CATH PLEURA W/,960,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$244.00 
32555,,PR THORACENTESIS NEEDLE/CATH PLEURA W/,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$785.00 
32555,,PR THORACENTESIS NEEDLE/CATH PLEURA W/,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,037.00 "
32555,,PR THORACENTESIS NEEDLE/CATH PLEURA W/,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$307.00 
32960,,PR THERAPEUTIC PNEUMOTHORAX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$320.00 
32960,,PR THERAPEUTIC PNEUMOTHORAX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,037.00 "
32960,,PR THERAPEUTIC PNEUMOTHORAX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$285.00 
35206,,"PR REPR BL VES DIRECT,UP EXTREM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,011.00 "
35206,,"PR REPR BL VES DIRECT,UP EXTREM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,518.00 "
35206,,"PR REPR BL VES DIRECT,UP EXTREM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,011.00 "
36415,,"PR COLLECTION VENOUS BLOOD,VENIPUNCTUR",300,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$17.00 
36415,,PC VENIPUNCTURE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$17.00 
36415,,PC CATH COLLECT SPECI:SINGLE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$17.00 
36416,,PC CAPILLARY,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$17.00 
36430,,HC BLOOD ADMIN 2+ HRS,391,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$800.00 
36430,,HC BLOOD ADMIN 0-2 HRS,391,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$800.00 
36430,,PC TRANSF BLOOD/BLOOD COMPON,390,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$800.00 
36556,,PR INSERT NON-TUNNEL CV CATH,987,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$539.00 
36556,,PR INSERT NON-TUNNEL CV CATH,987,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,285.00 "
36556,,PR INSERT NON-TUNNEL CV CATH,987,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$330.00 
36558,,PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,054.00 "
36558,,PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,518.00 "
36558,,PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$770.00 
36561,,PR INSJ TUNNELED CTR VAD W/SUBQ PORT A,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,714.00 "
36561,,PR INSJ TUNNELED CTR VAD W/SUBQ PORT A,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,518.00 "
36561,,PR INSJ TUNNELED CTR VAD W/SUBQ PORT A,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$984.00 
36569,,PR INSERTION PICC W/O IMG GDN 5 YR/>,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$249.00 
36569,,PR INSERTION PICC W/O IMG GDN 5 YR/>,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,285.00 "
36569,,PR INSERTION PICC W/O IMG GDN 5 YR/>,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$249.00 
36589,,PR REMOVAL TUNNELED CV CATH,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$422.00 
36589,,PR REMOVAL TUNNELED CV CATH,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,296.00 "
36589,,PR REMOVAL TUNNELED CV CATH,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$389.00 
36591,,HC COLLECT BLOOD VENOUS DEVICE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$161.00 
36592,,HC COLLECT BLOOD PICC,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$161.00 
36600,,PR WITHDRAWAL OF ARTERIAL BLOOD,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$89.00 
36600,,PC ARTERIAL COLLECTION,920,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$223.00 
36620,,"PR INSERT CATH,ART,PERCUT,SHORTTERM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$138.00 
36620,,"PR INSERT CATH,ART,PERCUT,SHORTTERM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$138.00 
36620,,"PR INSERT CATH,ART,PERCUT,SHORTTERM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$138.00 
38100,,"PR REMOVAL SPLEEN, TOTAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,135.00 "
38100,,"PR REMOVAL SPLEEN, TOTAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,135.00 "
38100,,"PR REMOVAL SPLEEN, TOTAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,135.00 "
38500,,"PR BIOPSY/EXCISION, LYMPH NODE(S)",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$859.00 
38500,,"PR BIOPSY/EXCISION, LYMPH NODE(S)",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,920.00 "
38500,,"PR BIOPSY/EXCISION, LYMPH NODE(S)",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$699.00 
38505,,"PR NEEDLE BIOPSY, LYMPH NODE(S)",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$315.00 
38505,,"PR NEEDLE BIOPSY, LYMPH NODE(S)",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,403.00 "
38505,,"PR NEEDLE BIOPSY, LYMPH NODE(S)",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$198.00 
38510,,"PR BX/REMV,LYMPH NODE,DEEP CERV",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,339.00 "
38510,,"PR BX/REMV,LYMPH NODE,DEEP CERV",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,920.00 "
38510,,"PR BX/REMV,LYMPH NODE,DEEP CERV",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,153.00 "
38525,,"PR BX/REMV,LYMPH NODE,DEEP AXILL",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,196.00 "
38525,,"PR BX/REMV,LYMPH NODE,DEEP AXILL",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,920.00 "
38525,,"PR BX/REMV,LYMPH NODE,DEEP AXILL",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,196.00 "
38542,,"PR EXPLORE DEEP NODE(S), NECK",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,427.00 "
38542,,"PR EXPLORE DEEP NODE(S), NECK",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,029.00 "
38542,,"PR EXPLORE DEEP NODE(S), NECK",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,427.00 "
40490,,PR BIOPSY OF LIP,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$344.00 
40490,,PR BIOPSY OF LIP,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$398.00 
40490,,PR BIOPSY OF LIP,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$198.00 
40510,,"PR PARTIAL EXCIS LIP,WEDGE PRIM CLOS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,239.00 "
40510,,"PR PARTIAL EXCIS LIP,WEDGE PRIM CLOS",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,305.00 "
40510,,"PR PARTIAL EXCIS LIP,WEDGE PRIM CLOS",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$991.00 
40804,,"PR REMOVAL FOREIGN BODY,MOUTH,SIMPLE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$500.00 
41100,,"PR BIOPSY TONGUE,ANTER 2/3",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$444.00 
41100,,"HC BIOPSY TONGUE,ANTER 2/3",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$940.00 
41110,,PR EXCIS TONGUE LESN,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$558.00 
41110,,PR EXCIS TONGUE LESN,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,305.00 "
41110,,PR EXCIS TONGUE LESN,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$375.00 
41250,,"PR REPAIR TONGUE LACER,<2.6CM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$708.00 
41250,,"PR REPAIR TONGUE LACER,<2.6CM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$206.00 
41250,,"PR REPAIR TONGUE LACER,<2.6CM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$443.00 
41252,,"PR REPAIR TONGUE LACER,2.6CM+/COMPLX",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$814.00 
41252,,"PR REPAIR TONGUE LACER,2.6CM+/COMPLX",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$398.00 
41252,,"PR REPAIR TONGUE LACER,2.6CM+/COMPLX",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$592.00 
41805,,"PR REMOVAL FOREIGN BODY, GUM",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$750.00 
41805,,"PR REMOVAL FOREIGN BODY, GUM",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,468.00 "
41805,,"PR REMOVAL FOREIGN BODY, GUM",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$490.00 
42330,,"PR REMOVAL SALIVARY STONE,UNCOMPLIC",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$588.00 
42330,,"PR REMOVAL SALIVARY STONE,UNCOMPLIC",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,305.00 "
42330,,"PR REMOVAL SALIVARY STONE,UNCOMPLIC",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$464.00 
42405,,"PR BIOPSY SALIVARY GLAND,INCISIONAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$764.00 
42405,,"PR BIOPSY SALIVARY GLAND,INCISIONAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,305.00 "
42405,,"PR BIOPSY SALIVARY GLAND,INCISIONAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$629.00 
42809,,PR REMOVE PHARYNX FOREIGN BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$511.00 
42809,,PR REMOVE PHARYNX FOREIGN BODY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$672.00 
42809,,PR REMOVE PHARYNX FOREIGN BODY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$374.00 
43130,,"PR REMOV ESOPHAG DIVERTIC,CERV APPRCH",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,175.00 "
43130,,"PR REMOV ESOPHAG DIVERTIC,CERV APPRCH",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,536.00 "
43130,,"PR REMOV ESOPHAG DIVERTIC,CERV APPRCH",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,175.00 "
43195,,HC EGD RIGID BALLOON,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,450.00 "
43200,,PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DI,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$611.00 
43200,,PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DI,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,407.00 "
43200,,PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DI,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$291.00 
43202,,PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WI,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$855.00 
43202,,PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WI,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,862.00 "
43202,,PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WI,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$321.00 
43235,,PR ESOPHAGOGASTRODUODENOSCOPY TRANSORA,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$708.00 
43235,,PR ESOPHAGOGASTRODUODENOSCOPY TRANSORA,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,470.00 "
43235,,PR ESOPHAGOGASTRODUODENOSCOPY TRANSORA,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$403.00 
43235,,"HC UPPER GI ENDOSCOPY,DX",750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,470.00 "
43239,,PR EGD TRANSORAL BIOPSY SINGLE/MULTIPL,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$943.00 
43239,,PR EGD TRANSORAL BIOPSY SINGLE/MULTIPL,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,470.00 "
43239,,PR EGD TRANSORAL BIOPSY SINGLE/MULTIPL,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$476.00 
43239,,"HC UPPER GI ENDOSCOPY,BIOPSY",750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,470.00 "
43245,,PR EGD DILATION GASTRIC/DUODENAL STRIC,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,489.00 "
43245,,PR EGD DILATION GASTRIC/DUODENAL STRIC,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,862.00 "
43245,,PR EGD DILATION GASTRIC/DUODENAL STRIC,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$517.00 
43246,,PR EGD PERCUTANEOUS PLACEMENT GASTROST,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$693.00 
43246,,PR EGD PERCUTANEOUS PLACEMENT GASTROST,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,862.00 "
43246,,PR EGD PERCUTANEOUS PLACEMENT GASTROST,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$693.00 
43247,,PR EGD FLEXIBLE FOREIGN BODY REMOVAL,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$937.00 
43247,,PR EGD FLEXIBLE FOREIGN BODY REMOVAL,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,470.00 "
43247,,PR EGD FLEXIBLE FOREIGN BODY REMOVAL,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$553.00 
43249,,PR EGD BALLOON DILATION ESOPHAGUS <30 ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,753.00 "
43249,,PR EGD BALLOON DILATION ESOPHAGUS <30 ,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,862.00 "
43249,,PR EGD BALLOON DILATION ESOPHAGUS <30 ,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$479.00 
43249,,HC UPPER GI BALLOON DILATION,750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,862.00 "
43250,,PR EGD FLEX REMOVAL LESION(S) BY HOT B,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,095.00 "
43250,,PR EGD FLEX REMOVAL LESION(S) BY HOT B,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,862.00 "
43250,,PR EGD FLEX REMOVAL LESION(S) BY HOT B,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$522.00 
43250,,"HC UPPER GI ENDOSCOPY,TUMOR",750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,862.00 "
43251,,PR EGD REMOVAL TUMOR POLYP/OTHER LESIO,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,204.00 "
43251,,PR EGD REMOVAL TUMOR POLYP/OTHER LESIO,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,862.00 "
43251,,PR EGD REMOVAL TUMOR POLYP/OTHER LESIO,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$601.00 
43251,,"HC UP GI ENDOSCOPY,REMV TUMOR,SNARE",750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,862.00 "
43280,,"PR LAP,ESOPHAGOGAST FUNDOPLASTY",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,791.00 "
43280,,"PR LAP,ESOPHAGOGAST FUNDOPLASTY",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$14,936.00 "
43280,,"PR LAP,ESOPHAGOGAST FUNDOPLASTY",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,791.00 "
43280,,"HC LAPAROSCOPY,FUNDOPLASTY",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$14,936.00 "
43281,,LAPS RPR PARAESPHGL HRNA INCL FUNDPLST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,991.00 "
43281,,LAPS RPR PARAESPHGL HRNA INCL FUNDPLST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$14,936.00 "
43281,,LAPS RPR PARAESPHGL HRNA INCL FUNDPLST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,991.00 "
43450,,PR DILATE ESOPHAGUS,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$432.00 
43450,,PR DILATE ESOPHAGUS,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,470.00 "
43450,,PR DILATE ESOPHAGUS,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$248.00 
43753,,"PR GASTRIC INTUBATION/ASPIRATION, THER",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$58.00 
43753,,"PR GASTRIC INTUBATION/ASPIRATION, THER",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$487.00 
43753,,"PR GASTRIC INTUBATION/ASPIRATION, THER",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$58.00 
43754,,"PR GASTRIC INTUBATION/ASPIRATION, DIAG",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$460.00 
43754,,"PR GASTRIC INTUBATION/ASPIRATION, DIAG",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$487.00 
43754,,"PR GASTRIC INTUBATION/ASPIRATION, DIAG",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$95.00 
43755,,"PR GASTRIC INTUBATION/ASPIRATION, DIAG",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$434.00 
43755,,"PR GASTRIC INTUBATION/ASPIRATION, DIAG",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$263.00 
43755,,"PR GASTRIC INTUBATION/ASPIRATION, DIAG",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$162.00 
43756,,"PR DUODENAL INTUBATION/ASPIRATION, DIA",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$631.00 
43756,,"PR DUODENAL INTUBATION/ASPIRATION, DIA",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,470.00 "
43756,,"PR DUODENAL INTUBATION/ASPIRATION, DIA",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$145.00 
43757,,"PR DUODENAL INTUBATION/ASPIRATION, DIA",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$866.00 
43757,,"PR DUODENAL INTUBATION/ASPIRATION, DIA",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,470.00 "
43757,,"PR DUODENAL INTUBATION/ASPIRATION, DIA",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$217.00 
43800,,PR RECONSTRUCTION OF PYLORUS,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,534.00 "
43800,,PR RECONSTRUCTION OF PYLORUS,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,534.00 "
43800,,PR RECONSTRUCTION OF PYLORUS,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,534.00 "
43860,,"PR REVISE,GASTROJEJUN ANAST,W/O VAGOTO",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$4,231.00 "
43860,,"PR REVISE,GASTROJEJUN ANAST,W/O VAGOTO",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,231.00 "
43860,,"PR REVISE,GASTROJEJUN ANAST,W/O VAGOTO",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$4,231.00 "
44005,,"PR FREEING BOWEL ADHESION,ENTEROLYSIS",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,977.00 "
44005,,"PR FREEING BOWEL ADHESION,ENTEROLYSIS",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,977.00 "
44005,,"PR FREEING BOWEL ADHESION,ENTEROLYSIS",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,977.00 "
44015,,"PR INSERT TUBE-BOWEL,ENTERAL ALIMENT",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$388.00 
44015,,"PR INSERT TUBE-BOWEL,ENTERAL ALIMENT",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$388.00 
44015,,"PR INSERT TUBE-BOWEL,ENTERAL ALIMENT",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$388.00 
44021,,PR ENTEROTOMY DECOMPRESS SMALL BOWEL,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,516.00 "
44021,,PR ENTEROTOMY DECOMPRESS SMALL BOWEL,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,516.00 "
44021,,PR ENTEROTOMY DECOMPRESS SMALL BOWEL,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,516.00 "
44050,,"PR REDUCE VOLVULUS,INTUSS,INTERN HERNI",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,551.00 "
44050,,"PR REDUCE VOLVULUS,INTUSS,INTERN HERNI",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,551.00 "
44050,,"PR REDUCE VOLVULUS,INTUSS,INTERN HERNI",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,551.00 "
44055,,PR CORRECT MALROTATION OF BOWEL,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,850.00 "
44055,,PR CORRECT MALROTATION OF BOWEL,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,850.00 "
44055,,PR CORRECT MALROTATION OF BOWEL,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,850.00 "
44055,,HC CORRECT MALROTATION OF BOWEL,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,850.00 "
44120,,"PR RESECT SMALL INTEST,SINGL RESEC/ANA",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,159.00 "
44120,,"PR RESECT SMALL INTEST,SINGL RESEC/ANA",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,159.00 "
44120,,"PR RESECT SMALL INTEST,SINGL RESEC/ANA",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,159.00 "
44121,,"PR RESECT SMALL INTEST,EACH ADDNL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$627.00 
44125,,PR RESECT SMALL INTEST W ENTEROSTOMY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,044.00 "
44125,,PR RESECT SMALL INTEST W ENTEROSTOMY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,044.00 "
44125,,PR RESECT SMALL INTEST W ENTEROSTOMY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,044.00 "
44130,,PR BOWEL TO BOWEL ANASTOMOSIS,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,394.00 "
44130,,PR BOWEL TO BOWEL ANASTOMOSIS,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,394.00 "
44130,,PR BOWEL TO BOWEL ANASTOMOSIS,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,394.00 "
44139,,PR MOBILIZE SPLENIC FLEX,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$330.00 
44139,,PR MOBILIZE SPLENIC FLEX,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$330.00 
44139,,PR MOBILIZE SPLENIC FLEX,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$330.00 
44140,,PR PART REMOVAL COLON W ANASTOMOSIS,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,464.00 "
44140,,PR PART REMOVAL COLON W ANASTOMOSIS,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,464.00 "
44140,,PR PART REMOVAL COLON W ANASTOMOSIS,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,464.00 "
44141,,PR PART REMOVAL COLON W COLOSTOMY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$4,702.00 "
44141,,PR PART REMOVAL COLON W COLOSTOMY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,702.00 "
44141,,PR PART REMOVAL COLON W COLOSTOMY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$4,702.00 "
44143,,PR PART REMOVAL COLON W END COLOSTOMY,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$4,292.00 "
44143,,PR PART REMOVAL COLON W END COLOSTOMY,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,292.00 "
44143,,PR PART REMOVAL COLON W END COLOSTOMY,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$4,292.00 "
44144,,PR PART REMOVAL COLON W OSTOMY/MUCOFIS,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$4,559.00 "
44144,,PR PART REMOVAL COLON W OSTOMY/MUCOFIS,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,559.00 "
44144,,PR PART REMOVAL COLON W OSTOMY/MUCOFIS,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$4,559.00 "
44145,,PR PART REMOVAL COLON W COLOPROCTOSTOM,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$4,261.00 "
44145,,PR PART REMOVAL COLON W COLOPROCTOSTOM,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,261.00 "
44145,,PR PART REMOVAL COLON W COLOPROCTOSTOM,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$4,261.00 "
44160,,PR REMVL COLON & TERM ILEUM W/ILEOCOLO,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,204.00 "
44160,,PR REMVL COLON & TERM ILEUM W/ILEOCOLO,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,204.00 "
44160,,PR REMVL COLON & TERM ILEUM W/ILEOCOLO,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,204.00 "
44180,,"PR LAP, SURG ENTEROLYSIS",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,375.00 "
44180,,"PR LAP, SURG ENTEROLYSIS",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,867.00 "
44180,,"PR LAP, SURG ENTEROLYSIS",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,375.00 "
44204,,"PR LAP,SURG,COLECTOMY, PARTIAL, W/ANAS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,963.00 "
44204,,"PR LAP,SURG,COLECTOMY, PARTIAL, W/ANAS",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,963.00 "
44204,,"PR LAP,SURG,COLECTOMY, PARTIAL, W/ANAS",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,963.00 "
44207,,"PR LAP,SURG,COLECTOMY,W/ANAST",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$4,671.00 "
44207,,"PR LAP,SURG,COLECTOMY,W/ANAST",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,671.00 "
44207,,"PR LAP,SURG,COLECTOMY,W/ANAST",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$4,671.00 "
44213,,"PR LAP, SURG MOBIL SPLENIC FL DUR PTL ",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$514.00 
44213,,"PR LAP, SURG MOBIL SPLENIC FL DUR PTL ",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$514.00 
44213,,"PR LAP, SURG MOBIL SPLENIC FL DUR PTL ",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$514.00 
44310,,"PR ILEOSTOMY/JEJUNOSTOMY,NONTUBE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,683.00 "
44310,,"PR ILEOSTOMY/JEJUNOSTOMY,NONTUBE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,683.00 "
44310,,"PR ILEOSTOMY/JEJUNOSTOMY,NONTUBE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,683.00 "
44320,,PR COLOSTOMY,974,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,095.00 "
44320,,PR COLOSTOMY,974,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,095.00 "
44320,,PR COLOSTOMY,974,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,095.00 "
44340,,"PR REVISION OF COLOSTOMY,SIMPLE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,722.00 "
44340,,"PR REVISION OF COLOSTOMY,SIMPLE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,337.00 "
44340,,"PR REVISION OF COLOSTOMY,SIMPLE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,722.00 "
44388,,PR COLONOSCOPY STOMA DX INCLUDING COLL,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$771.00 
44388,,PR COLONOSCOPY STOMA DX INCLUDING COLL,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
44388,,PR COLONOSCOPY STOMA DX INCLUDING COLL,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$459.00 
44602,,"PR SUTURE SM INTEST,SINGLE PERF",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,643.00 "
44602,,"PR SUTURE SM INTEST,SINGLE PERF",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,643.00 "
44602,,"PR SUTURE SM INTEST,SINGLE PERF",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,643.00 "
44604,,PR SUTURE LRG INTEST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,875.00 "
44604,,PR SUTURE LRG INTEST,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,875.00 "
44604,,PR SUTURE LRG INTEST,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,875.00 "
44625,,"PR CLOSE ENTEROSTOMY,RESEC+ANAST",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,605.00 "
44625,,"PR CLOSE ENTEROSTOMY,RESEC+ANAST",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,605.00 "
44625,,"PR CLOSE ENTEROSTOMY,RESEC+ANAST",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,605.00 "
44626,,"PR CLOSE ENTEROSTOMY,RESEC+COLOREC ANA",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$4,125.00 "
44626,,"PR CLOSE ENTEROSTOMY,RESEC+COLOREC ANA",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,125.00 "
44626,,"PR CLOSE ENTEROSTOMY,RESEC+COLOREC ANA",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$4,125.00 "
44799,59,PR UNLISTED PROCEDURE SMALL INTESTINE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,470.00 "
44799,59,PR UNLISTED PROCEDURE SMALL INTESTINE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,470.00 "
44799,59,PR UNLISTED PROCEDURE SMALL INTESTINE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,470.00 "
44800,,"PR EXCISION MECKEL,OMPHALOMES DUCT",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,091.00 "
44800,,"PR EXCISION MECKEL,OMPHALOMES DUCT",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,091.00 "
44800,,"PR EXCISION MECKEL,OMPHALOMES DUCT",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,091.00 "
44820,,PR EXCISION OF MESENTERY LESION,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,293.00 "
44820,,PR EXCISION OF MESENTERY LESION,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,293.00 "
44820,,PR EXCISION OF MESENTERY LESION,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,293.00 "
44950,,PR APPENDECTOMY,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,750.00 "
44950,,PR APPENDECTOMY,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
44950,,PR APPENDECTOMY,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,750.00 "
44955,,"PR APPENDECTOMY,W OTHR PROC",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$227.00 
44955,,"PR APPENDECTOMY,W OTHR PROC",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$227.00 
44955,,"PR APPENDECTOMY,W OTHR PROC",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$227.00 
44960,,"PR APPENDECTOMY,RUPT APPENDX+ABSCESS",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,380.00 "
44960,,"PR APPENDECTOMY,RUPT APPENDX+ABSCESS",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,380.00 "
44960,,"PR APPENDECTOMY,RUPT APPENDX+ABSCESS",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,380.00 "
44970,,"PR LAP,APPENDECTOMY",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,644.00 "
44970,,"PR LAP,APPENDECTOMY",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,867.00 "
44970,,"PR LAP,APPENDECTOMY",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,644.00 "
44970,,HC LAPAROSCOPY/APPENDECTOMY,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,867.00 "
45171,,PR EXC RECTAL TUMOR TRANSANAL,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,670.00 "
45171,,PR EXC RECTAL TUMOR TRANSANAL,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
45171,,PR EXC RECTAL TUMOR TRANSANAL,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,670.00 "
45172,,EXC RCT TUM INCL MUSCULARIS PROPRIA,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,084.00 "
45172,,EXC RCT TUM INCL MUSCULARIS PROPRIA,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
45172,,EXC RCT TUM INCL MUSCULARIS PROPRIA,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,084.00 "
45300,,"PR PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$313.00 
45300,,"PR PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
45300,,"PR PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$152.00 
45305,,PR PROCTOSGMDSC RIGID W/BX SINGLE/MULT,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$411.00 
45305,,PR PROCTOSGMDSC RIGID W/BX SINGLE/MULT,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45305,,PR PROCTOSGMDSC RIGID W/BX SINGLE/MULT,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$220.00 
45309,,PR PROCTOSGMDSC RIGID RMVL 1 LESION SN,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$482.00 
45309,,PR PROCTOSGMDSC RIGID RMVL 1 LESION SN,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45309,,PR PROCTOSGMDSC RIGID RMVL 1 LESION SN,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$260.00 
45330,,PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC B,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$442.00 
45330,,PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC B,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
45330,,PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC B,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$178.00 
45330,,HC DIAGNOSTIC SIGMOIDOSCOPY,750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
45331,,"PR SIGMOIDOSCOPY,BIOPSY",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$695.00 
45331,,"PR SIGMOIDOSCOPY,BIOPSY",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
45331,,"PR SIGMOIDOSCOPY,BIOPSY",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$215.00 
45338,,PR SGMDSC FLX RMVL TUM POLYP/OTH LES S,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$716.00 
45338,,PR SGMDSC FLX RMVL TUM POLYP/OTH LES S,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45338,,PR SGMDSC FLX RMVL TUM POLYP/OTH LES S,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$391.00 
45340,,PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,146.00 "
45340,,PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$199.00 
45340,,HC SIG W/BALLOON DILATION,750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45378,,PR COLONOSCOPY FLX DX W/COLLJ SPEC WHE,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$836.00 
45378,,PR COLONOSCOPY FLX DX W/COLLJ SPEC WHE,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
45378,,PR COLONOSCOPY FLX DX W/COLLJ SPEC WHE,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$475.00 
45378,,HC COLONOSCOPY,750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
45380,,PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPL,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,076.00 "
45380,,PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPL,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45380,,PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPL,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$514.00 
45380,,HC COLONOSCOPY W/BIOPSY(S),750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45381,,PR COLSC FLX WITH DIRECTED SUBMUCOSAL ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,068.00 "
45381,,PR COLSC FLX WITH DIRECTED SUBMUCOSAL ,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45381,,PR COLSC FLX WITH DIRECTED SUBMUCOSAL ,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$514.00 
45382,,PR COLSC FLEXIBLE W/CONTROL BLEEDING A,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,775.00 "
45382,,PR COLSC FLEXIBLE W/CONTROL BLEEDING A,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45382,,PR COLSC FLEXIBLE W/CONTROL BLEEDING A,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$664.00 
45384,,PR COLSC FLX W/REMOVAL LESION BY HOT B,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,200.00 "
45384,,PR COLSC FLX W/REMOVAL LESION BY HOT B,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45384,,PR COLSC FLX W/REMOVAL LESION BY HOT B,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$586.00 
45384,,HC COLONOSCOPY/POLYPECTOMY,750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45385,,PR COLSC FLX W/RMVL OF TUMOR POLYP LES,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,124.00 "
45385,,PR COLSC FLX W/RMVL OF TUMOR POLYP LES,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45385,,PR COLSC FLX W/RMVL OF TUMOR POLYP LES,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$652.00 
45385,,HC COLONOSCOPY/POLYPECTOMY SNARE,750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45386,,PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,544.00 "
45386,,PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BA,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45386,,PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$542.00 
45386,,HC COLONOSCOPY DILATE STRICTURE,750,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
45990,,"PR SURG DIAGNOSTIC EXAM, ANORECTAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$293.00 
45990,,"PR SURG DIAGNOSTIC EXAM, ANORECTAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
45990,,"PR SURG DIAGNOSTIC EXAM, ANORECTAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$293.00 
45999,59,PR RECTUM SURGERY PROCEDURE UNLISTED,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,438.00 "
45999,59,PR RECTUM SURGERY PROCEDURE UNLISTED,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
45999,59,PR RECTUM SURGERY PROCEDURE UNLISTED,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,438.00 "
46040,,PR I&D PERIRECTAL ABSCESS,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,395.00 "
46040,,PR I&D PERIRECTAL ABSCESS,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
46040,,PR I&D PERIRECTAL ABSCESS,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,146.00 "
46045,,PR I&D RECTAL WALL ABSCESS W ANESTH,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,200.00 "
46045,,PR I&D RECTAL WALL ABSCESS W ANESTH,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46045,,PR I&D RECTAL WALL ABSCESS W ANESTH,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,200.00 "
46050,,"PR I&D PERIANAL ABSCESS,SUPERFICIAL",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$556.00 
46050,,"PR I&D PERIANAL ABSCESS,SUPERFICIAL",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
46050,,"PR I&D PERIANAL ABSCESS,SUPERFICIAL",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$275.00 
46080,,PR ANAL SPHINCTEROTOMY,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$687.00 
46080,,PR ANAL SPHINCTEROTOMY,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46080,,PR ANAL SPHINCTEROTOMY,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$439.00 
46083,,PR INCISE EXTERNAL HEMORRHOID,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$500.00 
46083,,PR INCISE EXTERNAL HEMORRHOID,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$447.00 
46083,,PR INCISE EXTERNAL HEMORRHOID,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$297.00 
46200,,PR REMOVAL OF ANAL FISSURE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,175.00 "
46200,,PR REMOVAL OF ANAL FISSURE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46200,,PR REMOVAL OF ANAL FISSURE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$909.00 
46220,,PR REMOVAL OF ANAL TAB,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$580.00 
46220,,PR REMOVAL OF ANAL TAB,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,891.00 "
46220,,PR REMOVAL OF ANAL TAB,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$331.00 
46221,,PR LIGATION OF HEMORRHOID(S),981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$695.00 
46221,,HC LIGATION OF HEMORRHOID(S),360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$695.00 
46230,,PR REMOVAL OF ANAL TAGS,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$763.00 
46230,,PR REMOVAL OF ANAL TAGS,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46230,,PR REMOVAL OF ANAL TAGS,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$479.00 
46250,,"PR HEMORRHOIDECTOMY,EXTERNAL",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,207.00 "
46250,,"PR HEMORRHOIDECTOMY,EXTERNAL",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46250,,"PR HEMORRHOIDECTOMY,EXTERNAL",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$872.00 
46255,,"PR HEMORRHOIDECTOMY,INT/EXT,SIMPLE",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,319.00 "
46255,,"PR HEMORRHOIDECTOMY,INT/EXT,SIMPLE",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46255,,"PR HEMORRHOIDECTOMY,INT/EXT,SIMPLE",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$977.00 
46260,,"PR HEMORRHOIDECTOMY,INT/EXT,COMPLX",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,311.00 "
46260,,"PR HEMORRHOIDECTOMY,INT/EXT,COMPLX",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46260,,"PR HEMORRHOIDECTOMY,INT/EXT,COMPLX",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,311.00 "
46270,,"PR REMOVAL ANAL FISTULA,SUBCUTANEOUS",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,361.00 "
46275,,"PR REMOVAL ANAL FISTULA,SUBMUSCULAR",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,407.00 "
46275,,"PR REMOVAL ANAL FISTULA,SUBMUSCULAR",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46275,,"PR REMOVAL ANAL FISTULA,SUBMUSCULAR",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,149.00 "
46280,,"PR REMOVAL ANAL FISTULA,COMPLEX/MULTI",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,304.00 "
46280,,"PR REMOVAL ANAL FISTULA,COMPLEX/MULTI",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46280,,"PR REMOVAL ANAL FISTULA,COMPLEX/MULTI",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,304.00 "
46320,,PR REMOVAL OF HEMORRHOID CLOT,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$501.00 
46320,,PR REMOVAL OF HEMORRHOID CLOT,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,890.00 "
46320,,PR REMOVAL OF HEMORRHOID CLOT,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$308.00 
46600,,PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX ,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$261.00 
46600,,PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX ,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$205.00 
46600,,PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX ,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$115.00 
46612,,"PR ANOSCOPY,REMOVE LESIONS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$789.00 
46612,,"PR ANOSCOPY,REMOVE LESIONS",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46612,,"PR ANOSCOPY,REMOVE LESIONS",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$262.00 
46910,,"PR ELECTRODESSICATN,ANAL LESN(S)",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$655.00 
46910,,"PR ELECTRODESSICATN,ANAL LESN(S)",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,988.00 "
46910,,"PR ELECTRODESSICATN,ANAL LESN(S)",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$375.00 
46945,,PR INT HRHC BY LIGATION SINGLE HROID W,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$854.00 
46945,,PR INT HRHC BY LIGATION SINGLE HROID W,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46945,,PR INT HRHC BY LIGATION SINGLE HROID W,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$854.00 
46946,,PR INT HRHC BY LIGATION 2+ HROID W/O I,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$963.00 
46946,,PR INT HRHC BY LIGATION 2+ HROID W/O I,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,504.00 "
46946,,PR INT HRHC BY LIGATION 2+ HROID W/O I,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$963.00 
47001,,"PR NEEDLE BIOPSY LIVER,W OTHR PROC",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$279.00 
47001,,"PR NEEDLE BIOPSY LIVER,W OTHR PROC",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$279.00 
47001,,"PR NEEDLE BIOPSY LIVER,W OTHR PROC",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$279.00 
47100,,PR WEDGE BIOPSY OF LIVER,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,184.00 "
47100,,PR WEDGE BIOPSY OF LIVER,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,184.00 "
47100,,PR WEDGE BIOPSY OF LIVER,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,184.00 "
47562,,"PR LAP,CHOLECYSTECTOMY",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,798.00 "
47562,,"PR LAP,CHOLECYSTECTOMY",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
47562,,"PR LAP,CHOLECYSTECTOMY",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,798.00 "
47562,,HC LAPAROSCOPIC CHOLECYSTECTOMY,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
47563,,"PR LAP,CHOLECYSTECTOMY/GRAPH",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,950.00 "
47563,,"PR LAP,CHOLECYSTECTOMY/GRAPH",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
47563,,"PR LAP,CHOLECYSTECTOMY/GRAPH",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,950.00 "
47600,,PR REMOVAL GALLBLADDER,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,763.00 "
47600,,PR REMOVAL GALLBLADDER,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,178.00 "
47600,,PR REMOVAL GALLBLADDER,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,763.00 "
49000,,PR EXPLORATORY OF ABDOMEN,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,102.00 "
49000,,PR EXPLORATORY OF ABDOMEN,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,102.00 "
49000,,PR EXPLORATORY OF ABDOMEN,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,102.00 "
49002,,PR REOPEN RECENT ABD EXPLORATORY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,698.00 "
49002,,PR REOPEN RECENT ABD EXPLORATORY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,698.00 "
49002,,PR REOPEN RECENT ABD EXPLORATORY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,698.00 "
49010,,PR EXPLORATORY RETROPERITONEAL,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,384.00 "
49010,,PR EXPLORATORY RETROPERITONEAL,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,384.00 "
49010,,PR EXPLORATORY RETROPERITONEAL,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,384.00 "
49020,,PR DRAIN ABD ABSCESS OPEN,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$4,109.00 "
49020,,PR DRAIN ABD ABSCESS OPEN,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,109.00 "
49020,,PR DRAIN ABD ABSCESS OPEN,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$4,109.00 "
49060,,"PR DRAIN RETROPERITONEAL ABSCESS,OPEN",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,838.00 "
49060,,"PR DRAIN RETROPERITONEAL ABSCESS,OPEN",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,838.00 "
49060,,"PR DRAIN RETROPERITONEAL ABSCESS,OPEN",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,838.00 "
49082,,PR ABDOM PARACENTESIS DX/THER W/O IMAG,987,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$516.00 
49082,,PR ABDOM PARACENTESIS DX/THER W/O IMAG,987,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,469.00 "
49082,,PR ABDOM PARACENTESIS DX/THER W/O IMAG,987,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$198.00 
49083,,PR ABDOM PARACENTESIS DX/THER W IMAGIN,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$759.00 
49083,,PR ABDOM PARACENTESIS DX/THER W IMAGIN,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,469.00 "
49083,,PR ABDOM PARACENTESIS DX/THER W IMAGIN,982,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$304.00 
49084,,PR PERITONEAL LAVAGE W/WO IMAGING GUID,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$280.00 
49084,,PR PERITONEAL LAVAGE W/WO IMAGING GUID,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,469.00 "
49084,,PR PERITONEAL LAVAGE W/WO IMAGING GUID,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$280.00 
49203,,PR EXCISION/DESTRUCTION OPEN ABDOMINAL,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$3,074.00 "
49203,,PR EXCISION/DESTRUCTION OPEN ABDOMINAL,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,074.00 "
49203,,PR EXCISION/DESTRUCTION OPEN ABDOMINAL,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$3,074.00 "
49320,,"PR LAP,DIAGNOSTIC ABDOMEN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$898.00 
49320,,"PR LAP,DIAGNOSTIC ABDOMEN",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49320,,"PR LAP,DIAGNOSTIC ABDOMEN",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$898.00 
49321,,"PR LAP,DX SURGICAL ABD W/BIOPSY",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$950.00 
49321,,"PR LAP,DX SURGICAL ABD W/BIOPSY",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49321,,"PR LAP,DX SURGICAL ABD W/BIOPSY",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$950.00 
49322,,"PR LAP,ABDOMEN,ASPIRATE CYST",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,016.00 "
49322,,"PR LAP,ABDOMEN,ASPIRATE CYST",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49322,,"PR LAP,ABDOMEN,ASPIRATE CYST",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,016.00 "
49402,,PR REMOVE PERITONEAL FOREIGN BODY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,333.00 "
49402,,PR REMOVE PERITONEAL FOREIGN BODY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
49402,,PR REMOVE PERITONEAL FOREIGN BODY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,333.00 "
49422,,PR REMOVAL TUNNELED INTRAPERITONEAL CA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$573.00 
49422,,PR REMOVAL TUNNELED INTRAPERITONEAL CA,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,096.00 "
49422,,PR REMOVAL TUNNELED INTRAPERITONEAL CA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$573.00 
49505,,"PR REPAIR ING HERNIA,5+Y/O,REDUCIBL",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,425.00 "
49505,,"PR REPAIR ING HERNIA,5+Y/O,REDUCIBL",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
49505,,"PR REPAIR ING HERNIA,5+Y/O,REDUCIBL",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,425.00 "
49507,,"PR REPAIR ING HERNIA,5+Y/O,STRANG",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,603.00 "
49507,,"PR REPAIR ING HERNIA,5+Y/O,STRANG",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
49507,,"PR REPAIR ING HERNIA,5+Y/O,STRANG",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,603.00 "
49520,,"PR REPAIR RECURR INGUIN HERN,REDUCIBL",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,725.00 "
49520,,"PR REPAIR RECURR INGUIN HERN,REDUCIBL",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
49520,,"PR REPAIR RECURR INGUIN HERN,REDUCIBL",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,725.00 "
49525,,PR REPAIR SLIDING INGUINAL HERNIA,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,565.00 "
49525,,PR REPAIR SLIDING INGUINAL HERNIA,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
49525,,PR REPAIR SLIDING INGUINAL HERNIA,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,565.00 "
49540,,PR REPAIR LUMBAR HERNIA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,846.00 "
49540,,PR REPAIR LUMBAR HERNIA,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49540,,PR REPAIR LUMBAR HERNIA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,846.00 "
49553,,"PR REPAIR FEMORAL HERNIA,STRANG",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,725.00 "
49553,,"PR REPAIR FEMORAL HERNIA,STRANG",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,868.00 "
49553,,"PR REPAIR FEMORAL HERNIA,STRANG",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,725.00 "
49560,,"HC RPR HERNIA,REDUC",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$6,274.00 "
49560,,"PR REPAIR INCISIONAL HERNIA,REDUCIBLE",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,010.00 "
49560,,"PR REPAIR INCISIONAL HERNIA,REDUCIBLE",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$6,274.00 "
49560,,"PR REPAIR INCISIONAL HERNIA,REDUCIBLE",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,010.00 "
49561,,"PR REPAIR INCISIONAL HERNIA,STRANG",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,401.00 "
49561,,"PR REPAIR INCISIONAL HERNIA,STRANG",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
49561,,"PR REPAIR INCISIONAL HERNIA,STRANG",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,401.00 "
49565,,"PR REPAIR RECURR INCIS HERNIA,REDUC",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,093.00 "
49565,,"PR REPAIR RECURR INCIS HERNIA,REDUC",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49565,,"PR REPAIR RECURR INCIS HERNIA,REDUC",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,093.00 "
49566,,"PR REPAIR RECURR INCIS HERNIA,STRANG",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,558.00 "
49566,,"PR REPAIR RECURR INCIS HERNIA,STRANG",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49566,,"PR REPAIR RECURR INCIS HERNIA,STRANG",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,558.00 "
49568,,HC RPR HERNIA W/MESH,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$6,274.00 "
49568,,IMPLANT MESH HERNIA REPAIR/DEBRIDEMENT,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$726.00 
49568,,IMPLANT MESH HERNIA REPAIR/DEBRIDEMENT,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$6,274.00 "
49568,,IMPLANT MESH HERNIA REPAIR/DEBRIDEMENT,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$726.00 
49570,,"PR REPAIR EPIGASTRIC HERNIA,REDUC",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,146.00 "
49570,,"PR REPAIR EPIGASTRIC HERNIA,REDUC",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
49570,,"PR REPAIR EPIGASTRIC HERNIA,REDUC",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,146.00 "
49585,,"REPAIR UMBILICAL HERN,5+Y/O,REDUC",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,217.00 "
49585,,"REPAIR UMBILICAL HERN,5+Y/O,REDUC",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
49585,,"REPAIR UMBILICAL HERN,5+Y/O,REDUC",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,217.00 "
49587,,"REPAIR UMBILICAL HERN,5+Y/O,STRANG",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,307.00 "
49587,,"REPAIR UMBILICAL HERN,5+Y/O,STRANG",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,686.00 "
49587,,"REPAIR UMBILICAL HERN,5+Y/O,STRANG",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,307.00 "
49590,,HC REPAIR SPIGILIAN HERNIA,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,717.00 "
49590,,PR REPAIR SPIEGELIAN HERNIA,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,479.00 "
49650,,HC LAPARO HERNIA REPAIR INITIAL,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49650,,"PR LAP,INGUINAL HERNIA REPR,INITIAL",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,173.00 "
49650,,"PR LAP,INGUINAL HERNIA REPR,INITIAL",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49650,,"PR LAP,INGUINAL HERNIA REPR,INITIAL",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,173.00 "
49651,,"PR LAP,INGUINAL HERNIA REPR,RECUR",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,527.00 "
49651,,"PR LAP,INGUINAL HERNIA REPR,RECUR",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49651,,"PR LAP,INGUINAL HERNIA REPR,RECUR",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,527.00 "
49652,,LAPS REPAIR HERNIA EXCEPT INCAL/INGUN ,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,923.00 "
49652,,LAPS REPAIR HERNIA EXCEPT INCAL/INGUN ,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49652,,LAPS REPAIR HERNIA EXCEPT INCAL/INGUN ,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,923.00 "
49654,,LAPAROSCOPY REPAIR INCISIONAL HERNIA R,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,183.00 "
49654,,LAPAROSCOPY REPAIR INCISIONAL HERNIA R,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$14,935.00 "
49654,,LAPAROSCOPY REPAIR INCISIONAL HERNIA R,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,183.00 "
49656,,LAPS RPR RECURRENT INCISIONAL HERNIA R,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,369.00 "
49656,,LAPS RPR RECURRENT INCISIONAL HERNIA R,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$14,935.00 "
49656,,LAPS RPR RECURRENT INCISIONAL HERNIA R,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,369.00 "
49659,,"PR LAP,HERNIA REPAIR PROC,UNLIST",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$8,866.00 "
49659,,"PR LAP,HERNIA REPAIR PROC,UNLIST",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,866.00 "
49659,,"PR LAP,HERNIA REPAIR PROC,UNLIST",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$8,866.00 "
51020,,PR INCISE/FULGUR LESN BLADDER,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,264.00 "
51020,,PR INCISE/FULGUR LESN BLADDER,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,171.00 "
51020,,PR INCISE/FULGUR LESN BLADDER,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,264.00 "
51040,,PR INCISE/DRAIN BLADDER,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$782.00 
51040,,PR INCISE/DRAIN BLADDER,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,171.00 "
51040,,PR INCISE/DRAIN BLADDER,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$782.00 
51700,,PR IRRIGATION OF BLADDER,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$190.00 
51700,,PR IRRIGATION OF BLADDER,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$422.00 
51700,,PR IRRIGATION OF BLADDER,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$119.00 
51702,,"PR INSERT,TEMP INDWELLING BLAD CATH,SI",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$154.00 
51702,,"PR INSERT,TEMP INDWELLING BLAD CATH,SI",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$194.00 
51702,,"PR INSERT,TEMP INDWELLING BLAD CATH,SI",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$82.00 
51705,,"PR CHANGE OF BLADDER TUBE,SIMPLE",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$240.00 
51705,,"PR CHANGE OF BLADDER TUBE,SIMPLE",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$422.00 
51705,,"PR CHANGE OF BLADDER TUBE,SIMPLE",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$142.00 
51710,,"PR CHANGE OF BLADDER TUBE,COMPLICATED",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$334.00 
51710,,"PR CHANGE OF BLADDER TUBE,COMPLICATED",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,025.00 "
51710,,"PR CHANGE OF BLADDER TUBE,COMPLICATED",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$217.00 
51720,,HC TREATMENT OF BLADDER LESION,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$422.00 
51720,,PR INSTILL ANTICANCER AGENT IN BLADDER,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$216.00 
51720,,PR INSTILL ANTICANCER AGENT IN BLADDER,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$422.00 
51720,,PR INSTILL ANTICANCER AGENT IN BLADDER,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$112.00 
51860,59,"PR REPAIR BLADDER WOUND/INJ,SIMPLE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,026.00 "
51860,59,"PR REPAIR BLADDER WOUND/INJ,SIMPLE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$7,329.00 "
51925,,PR CLOSE BLAD/UTERINE FIST+HYSTERECT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,853.00 "
51925,,PR CLOSE BLAD/UTERINE FIST+HYSTERECT,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,853.00 "
51925,,PR CLOSE BLAD/UTERINE FIST+HYSTERECT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,853.00 "
52000,,PR CYSTOURETHROSCOPY,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$531.00 
52000,,PR CYSTOURETHROSCOPY,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,025.00 "
52000,,PR CYSTOURETHROSCOPY,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$207.00 
52204,,"PR CYSTOURETHROSCOPY,BIOPSIES",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$972.00 
52204,,"PR CYSTOURETHROSCOPY,BIOPSIES",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,171.00 "
52204,,"PR CYSTOURETHROSCOPY,BIOPSIES",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$382.00 
54150,,PR CIRCUMCISION W/REGIONAL BLOCK,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$390.00 
54150,,PR CIRCUMCISION W/REGIONAL BLOCK,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,039.00 "
54150,,PR CIRCUMCISION W/REGIONAL BLOCK,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$266.00 
54161,,"PR CIRCUMCISION,OTHER,28+ D/O",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$531.00 
54161,,"PR CIRCUMCISION,OTHER,28+ D/O",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,039.00 "
54161,,"PR CIRCUMCISION,OTHER,28+ D/O",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$531.00 
54530,,"PR REMOVAL TESTIS,RADICAL",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,363.00 "
54530,,"PR REMOVAL TESTIS,RADICAL",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,149.00 "
54530,,"PR REMOVAL TESTIS,RADICAL",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,363.00 "
54640,,PR ORCHIOPEXY INGUINAL OR SCROTAL APPR,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,112.00 "
54640,,PR ORCHIOPEXY INGUINAL OR SCROTAL APPR,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,112.00 "
54640,,PR ORCHIOPEXY INGUINAL OR SCROTAL APPR,521,PC PROF PBB FEE SCHEDULE [8053],"$1,112.00 "
54700,,"PR INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$579.00 
54700,,"PR INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,039.00 "
54700,,"PR INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$579.00 
54840,,PR EXCIS SPERMATOCELE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$867.00 
54840,,PR EXCIS SPERMATOCELE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,039.00 "
54840,,PR EXCIS SPERMATOCELE,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$867.00 
55040,,"PR REMOVAL OF HYDROCELE,TUNICA,UNILAT",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$862.00 
55040,,"PR REMOVAL OF HYDROCELE,TUNICA,UNILAT",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$862.00 
55040,,"PR REMOVAL OF HYDROCELE,TUNICA,UNILAT",975,PC PROF PBB FEE SCHEDULE [8053],$862.00 
55250,,PR REMOVAL OF SPERM DUCT(S),975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$915.00 
55250,,PR REMOVAL OF SPERM DUCT(S),975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,039.00 "
55250,,PR REMOVAL OF SPERM DUCT(S),975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$617.00 
55500,,"PR REMV HYDROCELE,SPERM CORD,UNILAT",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,083.00 "
55500,,"PR REMV HYDROCELE,SPERM CORD,UNILAT",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,039.00 "
55500,,"PR REMV HYDROCELE,SPERM CORD,UNILAT",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,083.00 "
56405,,PR I&D OF VULVA/PERINEUM ABSCESS,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$327.00 
56405,,PR I&D OF VULVA/PERINEUM ABSCESS,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$477.00 
56405,,PR I&D OF VULVA/PERINEUM ABSCESS,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$304.00 
56420,,PR I&D BARTHOLIN GLAND ABSCESS,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$396.00 
56420,,PR I&D BARTHOLIN GLAND ABSCESS,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$290.00 
56420,,PR I&D BARTHOLIN GLAND ABSCESS,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$288.00 
57454,,"PR COLPOSC,CERVIX W/ADJ VAG,W/BX & CUR",983,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$418.00 
57500,,"PR BIOPSY CERVIX, 1 OR MORE, OR EXCISI",983,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$364.00 
57520,,"PR CONIZATION CERVIX,KNIFE/LASER",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$850.00 
57520,,"PR CONIZATION CERVIX,KNIFE/LASER",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,125.00 "
57520,,"PR CONIZATION CERVIX,KNIFE/LASER",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$846.00 
58150,,PR TOTAL ABDOM HYSTERECTOMY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,593.00 "
58150,,PR TOTAL ABDOM HYSTERECTOMY,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,593.00 "
58150,,PR TOTAL ABDOM HYSTERECTOMY,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,593.00 "
58301,,PR REMOVE INTRAUTERINE DEVICE,983,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$258.00 
58660,,"PR LAP,LYSIS OF ADHESIONS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,855.00 "
58660,,"PR LAP,LYSIS OF ADHESIONS",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,029.00 "
58660,,"PR LAP,LYSIS OF ADHESIONS",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,855.00 "
58661,,"PR LAP,RMV  ADNEXAL STRUCTURE",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,773.00 "
58661,,"PR LAP,RMV  ADNEXAL STRUCTURE",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,029.00 "
58661,,"PR LAP,RMV  ADNEXAL STRUCTURE",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,773.00 "
58662,,"PR LAP,FULGURATE/EXCISE LESIONS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,829.00 "
58662,,"PR LAP,FULGURATE/EXCISE LESIONS",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,029.00 "
58662,,"PR LAP,FULGURATE/EXCISE LESIONS",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,829.00 "
58670,,"PR LAP,TUBAL CAUTERY",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,012.00 "
58670,,"PR LAP,TUBAL CAUTERY",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,029.00 "
58670,,"PR LAP,TUBAL CAUTERY",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,012.00 "
58925,,PR REMOVAL OF OVARIAN CYST(S),975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,044.00 "
58925,,PR REMOVAL OF OVARIAN CYST(S),975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$7,207.00 "
58925,,PR REMOVAL OF OVARIAN CYST(S),975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,044.00 "
59409,,"PR OBSTETRICAL CARE,VAG DELIV ONLY",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$2,086.00 "
59409,,"PR OBSTETRICAL CARE,VAG DELIV ONLY",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$4,304.00 "
59409,,"PR OBSTETRICAL CARE,VAG DELIV ONLY",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$2,086.00 "
60220,,"PR THYROID LOBECTOMY,UNILAT",975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,803.00 "
60220,,"PR THYROID LOBECTOMY,UNILAT",975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$8,971.00 "
60220,,"PR THYROID LOBECTOMY,UNILAT",975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,803.00 "
64420,,PR INJECTION AA&/STRD INTERCOSTAL NRV ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$253.00 
64420,,PR INJECTION AA&/STRD INTERCOSTAL NRV ,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,632.00 "
64420,,PR INJECTION AA&/STRD INTERCOSTAL NRV ,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$192.00 
64455,,HC PLANTAR NERVE BLOCK,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$12,762.00 "
64721,,PR REVISE MEDIAN N/CARPAL TUNNEL SURG,975,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,173.00 "
64721,,PR REVISE MEDIAN N/CARPAL TUNNEL SURG,975,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,482.00 "
64721,,PR REVISE MEDIAN N/CARPAL TUNNEL SURG,975,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,173.00 "
64788,,PR EXCISE CUTANEOUS NEUROFIBROMA,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,028.00 "
64788,,PR EXCISE CUTANEOUS NEUROFIBROMA,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,028.00 "
64788,,PR EXCISE CUTANEOUS NEUROFIBROMA,521,PC PROF PBB FEE SCHEDULE [8053],"$1,028.00 "
65205,,"PR REMV F.B.,EYE,SUPERF CONJUNC",981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$94.00 
65210,,"PR REMV F.B.,EYE,EMBED CONJUNC",981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$115.00 
65210,,"PR REMV F.B.,EYE,EMBED CONJUNC",981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$770.00 
65210,,"PR REMV F.B.,EYE,EMBED CONJUNC",981,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$92.00 
65220,,HC REMOVE FB FROM EYE CORNEA NO SLIT,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$770.00 
65220,,"PR REMV F.B.,EYE,CORNEA,NO SLIT",981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$164.00 
65220,,"PR REMV F.B.,EYE,CORNEA,NO SLIT",981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$770.00 
65220,,"PR REMV F.B.,EYE,CORNEA,NO SLIT",981,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$118.00 
65222,,HC REMOVE FB FROM EYE CORNEA SLIT LAMP,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$235.00 
65222,,"PR REMV F.B.,EYE,CORNEA,SLIT LAMP",981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$193.00 
65222,,"PR REMV F.B.,EYE,CORNEA,SLIT LAMP",981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$235.00 
65222,,"PR REMV F.B.,EYE,CORNEA,SLIT LAMP",981,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$150.00 
6560000,,HC HOSPICE/IP NON-RESPITE,656,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$900.00 
66761,,HC IRIDOTOMY/IRIDECTOMY BY LASER,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,097.00 "
66821,,"HC DISCISSION,2ND CATARACT,LASER",360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,097.00 "
67840,,PR REMOVE EYELID LESN (NOT CHALAZION),521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$701.00 
67840,,PR REMOVE EYELID LESN (NOT CHALAZION),521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,784.00 "
67840,,PR REMOVE EYELID LESN (NOT CHALAZION),521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$449.00 
67938,,"PR REMOVE EYELID FOREIGN BODY,EMBEDDED",981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$687.00 
68400,,PR INCISE/DRAIN TEAR GLAND,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$736.00 
68400,,PR INCISE/DRAIN TEAR GLAND,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,784.00 "
68400,,PR INCISE/DRAIN TEAR GLAND,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$381.00 
68810,,PR PROBE NASOLACRIMAL DUCT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$400.00 
68810,,PR PROBE NASOLACRIMAL DUCT,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$627.00 
68810,,PR PROBE NASOLACRIMAL DUCT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$319.00 
69000,,"PR DRAIN EXT EAR ABSC/BLOOD,SIMPLE",983,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$533.00 
69000,,"PR DRAIN EXT EAR ABSC/BLOOD,SIMPLE",983,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,241.00 "
69000,,"PR DRAIN EXT EAR ABSC/BLOOD,SIMPLE",983,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$338.00 
69200,,PR REMV EXT CANAL FOREIGN BODY,981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$205.00 
69200,,PR REMV EXT CANAL FOREIGN BODY,981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$228.00 
69200,,PR REMV EXT CANAL FOREIGN BODY,981,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$164.00 
69205,,"PR REMV EXT CANAL F.B.,GEN ANESTH",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$285.00 
69205,,"PR REMV EXT CANAL F.B.,GEN ANESTH",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,946.00 "
69205,,"PR REMV EXT CANAL F.B.,GEN ANESTH",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$285.00 
69209,,PR REMOVAL IMPACTED CERUMEN IRRIGATION,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$35.00 
69210,,PR REMOVAL IMPACTED CERUMEN INSTRUMENT,981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$145.00 
69210,,PR REMOVAL IMPACTED CERUMEN INSTRUMENT,981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$120.00 
69210,,PR REMOVAL IMPACTED CERUMEN INSTRUMENT,981,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$90.00 
70030,,HC ORBIT XRAY FOR FOREIGN BODY,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$96.00 
70030,26,PR X-RAY EYE FOR FOREIGN BODY,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
70030,26,PR X-RAY EYE FOR FOREIGN BODY,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
70100,26,PR X-RAY JAW <4 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$26.00 
70100,26,PR X-RAY JAW <4 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
70100,,HC X-RAY JAW <4 VW,972,,$116.00 
70110,,HC MANDIBLE 4 OR MORE VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$125.00 
70110,26,PR X-RAY JAW 4+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
70110,26,PR X-RAY JAW 4+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
70140,,HC X-RAY FACIAL BONES <3 VW,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
70140,26,PR X-RAY FACIAL BONES <3 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
70140,26,PR X-RAY FACIAL BONES <3 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
70150,,HC FACIAL BONES MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$138.00 
70150,26,PR X-RAY FACIAL BONES 3+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$36.00 
70150,26,PR X-RAY FACIAL BONES 3+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$36.00 
70160,,HC NOSE BONES MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$117.00 
70160,26,PR X-RAY NASAL BONES,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
70160,26,PR X-RAY NASAL BONES,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
70200,,HC ORBITS MIN 4 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$137.00 
70200,26,PR X-RAY ORBITS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$38.00 
70200,26,PR X-RAY ORBITS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
70210,26,PR X-RAY SINUSES <3 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
70210,26,PR X-RAY SINUSES <3 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
70210,,HC X-RAY SINUSES <3 VW,972,,$104.00 
70220,,HC SINUSES COMPLETE MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$123.00 
70220,26,PR X-RAY SINUSES 3+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
70220,26,PR X-RAY SINUSES 3+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
70250,,HC SKULL <4 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$116.00 
70250,26,PR X-RAY SKULL <4 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
70250,26,PR X-RAY SKULL <4 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
70260,,HC SKULL COMPLETE MIN 4 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$138.00 
70260,26,PR X-RAY SKULL 4+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$44.00 
70260,26,PR X-RAY SKULL 4+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
70328,26,PR X-RAY TMJ UNILAT,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$26.00 
70328,26,PR X-RAY TMJ UNILAT,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
70328,,HC X-RAY TMJ UNILAT,972,,$138.00 
70330,,HC T-M JOINT BILATERAL,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$169.00 
70330,26,PR X-RAY TMJ BILAT,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
70330,26,PR X-RAY TMJ BILAT,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
70336,,HC MRI-TMJ,611,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,044.00 "
70336,26,"PR MRI, TMJ",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$186.00 
70336,26,"PR MRI, TMJ",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$186.00 
70360,26,PR X-RAY NECK SOFT TISSUE,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
70360,26,PR X-RAY NECK SOFT TISSUE,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
70360,,HC X-RAY NECK SOFT TISSUE,972,,$99.00 
70371,,HC CMPLX DYNAMIC PHARYNGEAL,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$254.00 
70450,,HC CT BRAIN W/O DYE,351,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$746.00 
70450,26,"PR CT SCAN,HEAD/BRAIN,W/O CONTRAST MAT",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$112.00 
70450,26,"PR CT SCAN,HEAD/BRAIN,W/O CONTRAST MAT",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$112.00 
70460,,HC CT BRAIN W/DYE,351,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$968.00 
70460,26,PR CT SCAN HEAD CONTRAST,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$147.00 
70460,26,PR CT SCAN HEAD CONTRAST,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$147.00 
70470,,HC CT BRAIN W/WO DYE,351,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,081.00 "
70470,26,PR CT SCAN HEAD COMBO,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$167.00 
70470,26,PR CT SCAN HEAD COMBO,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$167.00 
70480,,HC CT ORBITS/FOSSA/SELLA/IAC,351,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,428.00 "
70480,26,"PR CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$168.00 
70480,26,"PR CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$168.00 
70481,,HC CT ORBITS/FOSSA/SELLA/IAC W/DYE,351,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,748.00 "
70481,26,PR CT SCAN SKULL CONTRAST,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$142.00 
70481,26,PR CT SCAN SKULL CONTRAST,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$142.00 
70482,,HC CT ORBITS/FOSSA/SELLA/IAC W/WO DYE,351,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,929.00 "
70482,26,PR CT SCAN SKULL COMBO,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$159.00 
70482,26,PR CT SCAN SKULL COMBO,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$159.00 
70486,,HC CT FACIAL BONES W/O DYE,351,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$815.00 
70486,26,"PR CT SCAN,MAXILLOFACIAL AREA,W/O CONT",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$108.00 
70486,26,"PR CT SCAN,MAXILLOFACIAL AREA,W/O CONT",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$108.00 
70487,,HC CT MAXILOFACIAL W/DYE,351,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$939.00 
70487,26,"PR CT SCAN, FACE/JAW CONTRAST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$142.00 
70487,26,"PR CT SCAN, FACE/JAW CONTRAST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$142.00 
70488,26,PR CT SCANS FACE/JAW COMBO,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$188.00 
70488,26,PR CT SCANS FACE/JAW COMBO,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$188.00 
70488,,HC CT SANS FACE/JAW COMBO,972,,"$1,186.00 "
70490,,HC CT SOFT TISSUE NECK W/O DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$848.00 
70490,26,"PR CT SCAN,SOFT TISSUE NECK,W/O CONTRA",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$168.00 
70490,26,"PR CT SCAN,SOFT TISSUE NECK,W/O CONTRA",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$168.00 
70491,,HC CT SOFT TISSUE NECK W/DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,166.00 "
70491,26,PR CT NECK TISSUE CONTRAST,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$179.00 
70491,26,PR CT NECK TISSUE CONTRAST,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$179.00 
70492,,HC CT SOFT TISSUE NECK W/WO DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,467.00 "
70492,26,PR CT NECK TISSUE COMBO,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$205.00 
70492,26,PR CT NECK TISSUE COMBO,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$205.00 
70496,26,"PR CT ANGIO,HEAD COMBO,INCL IMAGE PROC",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$236.00 
70496,26,"PR CT ANGIO,HEAD COMBO,INCL IMAGE PROC",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$236.00 
70496,,"HC CT ANGIO, HEAD COMBO, INCL IMAGE PROC",521,,"$1,757.00 "
70498,,HC CTA NECK,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,205.00 "
70498,26,"PR CT ANGIO,NECK COMBO,INCL IMAGE PROC",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$242.00 
70498,26,"PR CT ANGIO,NECK COMBO,INCL IMAGE PROC",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
70540,,HC MRI-ORBIT/FACE/NECK W/O DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,839.00 "
70540,26,"PR MRI, FACE, NECK",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$180.00 
70543,,HC MRI ORBIT/FACE/NECK W/WO DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,884.00 "
70543,26,"PR MRI, FACE, NECK, COMBO",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$277.00 
70543,26,"PR MRI, FACE, NECK, COMBO",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$277.00 
70544,,HC MRA HEAD W/O DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,128.00 "
70544,26,"PR MR ANGIO, HEAD",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$162.00 
70544,26,"PR MR ANGIO, HEAD",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$162.00 
70548,,HC MRA NECK W/DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,264.00 "
70548,26,PR MRA NECK W/DYE,610,,$189.00 
70549,,HC MRA NECK W/WO DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,285.00 "
70549,26,"PR MR ANGIO, NECK, COMBO",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$242.00 
70549,26,"PR MR ANGIO, NECK, COMBO",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
70551,,HC MRI-BRAIN/BRAIN STEM,611,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,483.00 "
70551,26,PR MRI BRAIN,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$187.00 
70551,26,PR MRI BRAIN,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$187.00 
70552,,HC MRI-BRAIN WITH CONTRAST,611,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,195.00 "
70552,26,PR MRI BRAIN CONTRAST,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$229.00 
70552,26,PR MRI BRAIN CONTRAST,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$229.00 
70553,,HC MRI-BRAIN W/WO DYE,611,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,501.00 "
70553,26,PR MRI BRAIN COMBO,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$306.00 
70553,26,PR MRI BRAIN COMBO,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$306.00 
71045,,HC XRAY CHEST 1 VIEW,324,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$72.00 
71045,26,CHG RADIOLOGIC EXAM CHEST SINGLE VIEW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
71045,26,CHG RADIOLOGIC EXAM CHEST SINGLE VIEW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
71046,,HC XRAY CHEST 2 VIEWS,324,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$94.00 
71046,26,CHG RADIOLOGIC EXAM CHEST 2 VIEWS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
71046,26,CHG RADIOLOGIC EXAM CHEST 2 VIEWS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
71047,,HC XRAY CHEST 3 VIEWS,324,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$117.00 
71047,26,CHG RADIOLOGIC EXAM CHEST 3 VIEWS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$35.00 
71047,26,CHG RADIOLOGIC EXAM CHEST 3 VIEWS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$35.00 
71048,,HC XRAY CHEST 4+ VIEWS,324,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$144.00 
71048,26,CHG RADIOLOGIC EXAM CHEST 4+ VIEWS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$41.00 
71048,26,CHG RADIOLOGIC EXAM CHEST 4+ VIEWS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
71100,,HC RIB 2 VIEWS,324,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$106.00 
71100,26,PR X-RAY RIBS 2 VW UNILAT,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$30.00 
71100,26,PR X-RAY RIBS 2 VW UNILAT,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
71101,,HC RIBS UNILATERAL 2 V PA CHEST,324,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$119.00 
71101,26,"PR X-RAY RIBS, CHEST 3+ VW",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$36.00 
71101,26,"PR X-RAY RIBS, CHEST 3+ VW",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$36.00 
71110,,"HC RIBS ONLY,BILATERAL 3 VIEWS",324,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$124.00 
71110,26,PR X-RAY RIBS 3 VW BILAT,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$37.00 
71110,26,PR X-RAY RIBS 3 VW BILAT,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$37.00 
71111,,HC RIBS BILAT W/PA CHEST 4 VIEWS,324,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$148.00 
71111,26,"PR X-RAY RIBS, CHEST 4+ VW",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$42.00 
71111,26,"PR X-RAY RIBS, CHEST 4+ VW",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$42.00 
71120,,HC STERNUM MIN 2 VIEWS,324,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.00 
71120,26,PR X-RAY STERNUM 2+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
71120,26,PR X-RAY STERNUM 2+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
71130,,HC STERNO-CLAV JTS MIN 3 V,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$120.00 
71130,26,PR X-RAY STERNO-CLAVICLUAR JT,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$30.00 
71130,26,PR X-RAY STERNO-CLAVICLUAR JT,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
71250,,HC CT THORAX WO CONTRAST,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$964.00 
71250,26,"PR CT SCAN,THORAX,W/O CONTRAST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$145.00 
71250,26,"PR CT SCAN,THORAX,W/O CONTRAST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$145.00 
71260,,HC CT THORAX W CONTRAST,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,207.00 "
71260,26,PR CAT SCAN OF CHEST CONTRAST,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$162.00 
71260,26,PR CAT SCAN OF CHEST CONTRAST,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$162.00 
71270,,HC CT THORAX W+WO CONTRAST,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,511.00 "
71270,26,PR CAT SCAN OF CHEST COMBO,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$178.00 
71270,26,PR CAT SCAN OF CHEST COMBO,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$178.00 
71275,,HC CTA CHEST,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,784.00 "
71275,26,"PR CT ANGIO, CHEST (NON-CORON), COMBO,",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$248.00 
71275,26,"PR CT ANGIO, CHEST (NON-CORON), COMBO,",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$248.00 
71550,,HC MRI-CHEST WO DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,820.00 "
71550,26,"PR MRI, CHEST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$196.00 
71550,26,"PR MRI, CHEST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$196.00 
72020,,HC SPINE SINGLE VIEW,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$74.00 
72020,26,PR X-RAY SPINE ONE VIEW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$21.00 
72020,26,PR X-RAY SPINE ONE VIEW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$21.00 
72040,,HC CERVICAL SPINE 2/3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$126.00 
72040,26,CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
72040,26,CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
72050,,HC CERVICAL SPINE 4 OR 5 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$170.00 
72050,26,CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$42.00 
72050,26,CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$42.00 
72052,,HC CERVICAL SPINE 6 OR MORE VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$223.00 
72052,26,CHG RADEX SPINE CERVICAL 6 OR MORE VIE,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$38.00 
72052,26,CHG RADEX SPINE CERVICAL 6 OR MORE VIE,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
72070,,HC SPINE THORACIC 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$104.00 
72070,26,PR X-RAY THORACIC SPINE 2 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$30.00 
72070,26,PR X-RAY THORACIC SPINE 2 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
72072,,HC THORACIC SPINE 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$120.00 
72072,26,PR X-RAY THORACIC SPINE+SWIM 3 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$30.00 
72072,26,PR X-RAY THORACIC SPINE+SWIM 3 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
72074,26,PR X-RAY THORACIC SPINE 4 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$31.00 
72074,26,PR X-RAY THORACIC SPINE 4 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$31.00 
72074,,HC X-RAY THORACIC SPINE 4 VW,972,,$132.00 
72080,,HC THORACOLUMBAR 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$114.00 
72080,26,CHG RADEX SPINE THORACOLUMBAR JUNCTION,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
72080,26,CHG RADEX SPINE THORACOLUMBAR JUNCTION,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
72100,,HC LUMBAR SPINE 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$116.00 
72100,26,PR X-RAY LUMBAR SPINE 2/3 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
72100,26,PR X-RAY LUMBAR SPINE 2/3 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
72110,,HC LUMBAR SPINE COM,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$161.00 
72110,26,PR X-RAY LUMBAR SPINE 4 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$33.00 
72110,26,PR X-RAY LUMBAR SPINE 4 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
72114,,HC LUMBAR COMP W BENDING,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$218.00 
72114,26,PR RADEX SPINE LUMBSCRL COMPL W/BENDIN,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$38.00 
72114,26,PR RADEX SPINE LUMBSCRL COMPL W/BENDIN,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
72120,26,PR RADEX SPINE LUMBOSACRAL ONLY BENDIN,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
72120,26,PR RADEX SPINE LUMBOSACRAL ONLY BENDIN,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
72120,,HC RADEX SPINE LUMOSACRAL ONLY BENDIN,972,,$145.00 
72125,,HC CT SPINE CERVICAL W/O DYE,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,105.00 "
72125,26,"PR CT SCAN,CERVICAL SPINE,W/O CONTRAST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$136.00 
72125,26,"PR CT SCAN,CERVICAL SPINE,W/O CONTRAST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$136.00 
72128,,HC CT SPINE THORACIC W/O DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,268.00 "
72128,26,"PR CT SCAN,THORACIC SPINE,W/O CONTRAST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$136.00 
72128,26,"PR CT SCAN,THORACIC SPINE,W/O CONTRAST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$136.00 
72131,,HC CT SPINE LUMBAR W/O DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,096.00 "
72131,26,"PR CT SCAN,LUMBAR SPINE,W/O CONTRAST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$126.00 
72131,26,"PR CT SCAN,LUMBAR SPINE,W/O CONTRAST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$126.00 
72141,,HC MRI-C-SPINE W/O DYE,612,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,424.00 "
72141,26,"PR MRI, CERV SPINE",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$208.00 
72141,26,"PR MRI, CERV SPINE",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$208.00 
72142,,HC MRI-CERVICAL W/DYE,612,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,366.00 "
72142,26,PR MRI-CERVICAL W/DYE,612,,$225.00 
72146,,HC MRI-T-SPINE W/O DYE,612,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,428.00 "
72146,26,"PR MRI, DORSAL SPINE",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$187.00 
72146,26,"PR MRI, DORSAL SPINE",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$187.00 
72148,,HC MRI-L-SPINE W/O DYE,612,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,428.00 "
72148,26,"PR MRI, LUMBAR SPINE",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$195.00 
72148,26,"PR MRI, LUMBAR SPINE",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$195.00 
72149,,HC MRI-LUMBAR W/DYE,612,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,331.00 "
72149,26,"PR MRI, LUMBAR SPINE CONTRAST",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$240.00 
72149,26,"PR MRI, LUMBAR SPINE CONTRAST",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$240.00 
72156,,HC MRI C-SPINE W/WO DYE,612,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,758.00 "
72156,26,"PR MRI, CERV SPINE COMBO",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$288.00 
72156,26,"PR MRI, CERV SPINE COMBO",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$288.00 
72157,,HC MRI T-SPINE W/WO DYE,612,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,543.00 "
72157,26,"PR MRI, DORSAL SPINE COMBO",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$308.00 
72157,26,"PR MRI, DORSAL SPINE COMBO",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$308.00 
72158,,HC MRI L-SPINE W/WO DYE,612,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,751.00 "
72158,26,"PR MRI, LUMBAR SPINE COMBO",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$308.00 
72158,26,"PR MRI, LUMBAR SPINE COMBO",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$308.00 
72170,,HC PELVIS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$111.00 
72170,26,PR X-RAY PELVIS 1/2 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
72170,26,PR X-RAY PELVIS 1/2 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
72190,,HC PELVIS MINIMUM 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$142.00 
72190,26,PR X-RAY PELVIS 3+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
72190,26,PR X-RAY PELVIS 3+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
72192,,HC CT PELVIS W/O DYE,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$908.00 
72192,26,"PR CT SCAN,PELVIS,W/O CONTRAST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$142.00 
72192,26,"PR CT SCAN,PELVIS,W/O CONTRAST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$142.00 
72193,,HC CT PELVIS W/DYE,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,488.00 "
72193,26,PR CT SCAN OF PELVIS CONTRAST,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$152.00 
72193,26,PR CT SCAN OF PELVIS CONTRAST,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$152.00 
72194,,HC CT PELVIS W/WO DYE,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,736.00 "
72194,26,PR CT SCAN OF PELVIS COMBO,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$160.00 
72194,26,PR CT SCAN OF PELVIS COMBO,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$160.00 
72195,,HC MRI PELVIS WO DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,923.00 "
72195,26,"PR MRI, PELVIS, W/O CONTRAST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$195.00 
72196,,HC MRI-PELVIS,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,336.00 "
72196,26,PR MRI-PELVIS,610,,$218.00 
72197,,HC MRI PELVIS W/WO DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,816.00 "
72197,26,"PR MRI, PELVIS, COMBO",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$275.00 
72197,26,"PR MRI, PELVIS, COMBO",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$275.00 
72200,26,PR X-RAY SACROILIAC JTS <3 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
72200,26,PR X-RAY SACROILIAC JTS <3 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
72200,,HC X-RAY SACROILIAC JTS <3 VW,972,,$101.00 
72202,,HC SACROILIAC JOINTS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$115.00 
72202,26,PR X-RAY SACROILIAC JTS 3+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$29.00 
72202,26,PR X-RAY SACROILIAC JTS 3+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
72220,,HC SACRUN COCCYX MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$99.00 
72220,26,PR X-RAY SACRUM/COCCYX 2+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
72220,26,PR X-RAY SACRUM/COCCYX 2+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
73000,,HC CLAVICLE COMPLETE,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$94.00 
73000,26,PR X-RAY CLAVICLE,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$23.00 
73000,26,PR X-RAY CLAVICLE,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
73010,,HC SCAPULA COMPLETE,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$104.00 
73010,26,PR X-RAY SCAPULA,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$26.00 
73010,26,PR X-RAY SCAPULA,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
73020,,HC SHOULDER 1 VIEW,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$75.00 
73020,50,HC SHOULDER 1 VIEW,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$75.00 
73020,26,PR X-RAY SHOULDER 1 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$21.00 
73020,26,PR X-RAY SHOULDER 1 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$21.00 
73030,,HC SHOULDER MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
73030,50,HC SHOULDER MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
73030,26,PR X-RAY SHOULDER 2+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$29.00 
73030,26,PR X-RAY SHOULDER 2+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
73040,26,PR ARTHROGRAM OF SHOULDER,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$74.00 
73040,26,PR ARTHROGRAM OF SHOULDER,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$74.00 
73040,,HC ARTHROGRAM OF SHOULDER,972,,$381.00 
73050,,HC AC JOINTS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$131.00 
73050,50,HC AC JOINTS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$131.00 
73050,26,PR X-RAY AC JTS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$30.00 
73050,26,PR X-RAY AC JTS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
73060,,HC HUMERUS 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$99.00 
73060,50,HC HUMERUS 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$99.00 
73060,26,PR X-RAY HUMERUS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
73060,26,PR X-RAY HUMERUS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
73070,,HC ELBOW 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
73070,50,HC ELBOW 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
73070,26,PR X-RAY ELBOW 2 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$21.00 
73070,26,PR X-RAY ELBOW 2 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$21.00 
73080,,HC ELBOW MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$115.00 
73080,50,HC ELBOW MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$115.00 
73080,26,PR X-RAY ELBOW 3+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
73080,26,PR X-RAY ELBOW 3+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
73090,,HC FOREARM 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$90.00 
73090,50,HC FOREARM 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$90.00 
73090,26,PR X-RAY FOREARM 2 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$23.00 
73090,26,PR X-RAY FOREARM 2 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
73092,,HC CHILD UPPER EXTREMITY,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$94.00 
73092,50,HC CHILD UPPER EXTREMITY,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$94.00 
73092,26,"PR X-RAY ARM, INFANT",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$23.00 
73092,26,"PR X-RAY ARM, INFANT",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
73100,,HC WRIST 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$107.00 
73100,50,HC WRIST 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$107.00 
73100,26,PR X-RAY WRIST 2 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$26.00 
73100,26,PR X-RAY WRIST 2 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
73110,,HC WRIST COMP MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
73110,50,HC WRIST COMP MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
73110,26,PR X-RAY WRIST 3+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
73110,26,PR X-RAY WRIST 3+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
73120,,HC HAND 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$94.00 
73120,50,HC HAND 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$94.00 
73120,26,PR X-RAY HAND 2 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$23.00 
73120,26,PR X-RAY HAND 2 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
73130,,HC HAND MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$112.00 
73130,50,HC HAND MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$112.00 
73130,26,PR X-RAY HAND 3+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
73130,26,PR X-RAY HAND 3+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
73140,,HC FINGER MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$122.00 
73140,50,HC FINGER MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$122.00 
73140,26,PR X-RAY EXAM OF FINGER(S),972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$18.00 
73140,26,PR X-RAY EXAM OF FINGER(S),972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$18.00 
73200,,HC CT UPPER EXTREM W/O DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,093.00 "
73200,26,"PR CT SCAN,UPPER EXTREMITY,W/O CONTRAS",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$135.00 
73200,26,"PR CT SCAN,UPPER EXTREMITY,W/O CONTRAS",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$135.00 
73201,,HC CT UPPER EXTREM W/DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,395.00 "
73201,26,PR CT UPPER EXTREM W/DYE,350,,$145.00 
73206,,HC CTA UPPER EXTREMITY,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,020.00 "
73206,26,PR CTA UPPER EXTREMITY,350,,$225.00 
73218,,HC MRI UPPER EXT W/O DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,472.00 "
73218,26,"PR MRI, UPPER EXTREM",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$178.00 
73220,,HC MRI-UPPER EXT W/WO DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,230.00 "
73220,26,PR MRI-UPPER EXT W/WO DYE,610,,$269.00 
73221,,HC MRI-UPPER EXT JOINT W/O DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,608.00 "
73221,26,"PR MRI, JOINT UPPER EXTREM",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$181.00 
73221,26,"PR MRI, JOINT UPPER EXTREM",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$181.00 
73223,26,"PR MRI, JOINT UPPER EXTREM COMBO",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$288.00 
73223,26,"PR MRI, JOINT UPPER EXTREM COMBO",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$288.00 
73223,,"HC MRI, JOINT UPPER EXTREM COMBO",521,,"$2,998.00 "
73501,26,CHG RADEX HIP UNILATERAL WITH PELVIS 1,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$26.00 
73501,26,CHG RADEX HIP UNILATERAL WITH PELVIS 1,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
73502,26,CHG RADEX HIP UNILATERAL WITH PELVIS 2,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$31.00 
73502,26,CHG RADEX HIP UNILATERAL WITH PELVIS 2,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$31.00 
73521,26,CHG RADEX HIPS BILATERAL WITH PELVIS 2,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$31.00 
73521,26,CHG RADEX HIPS BILATERAL WITH PELVIS 2,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$31.00 
73551,,HC X-RAY EXAM FEMUR 1 VW,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$91.00 
73551,26,CHG RADIOLOGIC EXAMINATION FEMUR 1 VIE,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$23.00 
73551,26,CHG RADIOLOGIC EXAMINATION FEMUR 1 VIE,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
73552,,HC X-RAY EXAM FEMUR 2/>,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$111.00 
73552,26,CHG RADIOLOGIC EXAMINATION FEMUR MINIM,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
73552,26,CHG RADIOLOGIC EXAMINATION FEMUR MINIM,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
73560,,HC KNEE 1 OR 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$109.00 
73560,50,HC KNEE 1 OR 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$109.00 
73560,26,PR X-RAY KNEE 1 OR 2 VIEW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$26.00 
73560,26,PR X-RAY KNEE 1 OR 2 VIEW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
73562,,HC KNEE MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$127.00 
73562,50,HC KNEE MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$127.00 
73562,,HC KNEE MIN 3 VIEWS BILATERAL,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$127.00 
73562,26,PR X-RAY KNEE 3 VIEW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$29.00 
73562,26,PR X-RAY KNEE 3 VIEW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
73564,,HC KNEE 4 OR MORE VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$142.00 
73564,50,HC KNEE 4 OR MORE VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$142.00 
73564,26,PR X-RAY KNEE 4+ VIEW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
73564,26,PR X-RAY KNEE 4+ VIEW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
73565,,HC STANDING KNEES,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$130.00 
73565,26,PR X-RAY KNEE BILAT STANDING,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
73565,26,PR X-RAY KNEE BILAT STANDING,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
73580,26,PR ARTHROGRAM OF KNEE JOINT,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$76.00 
73580,26,PR ARTHROGRAM OF KNEE JOINT,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$76.00 
73590,,HC TIBIA FIBULA 2 VIEW,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.00 
73590,50,HC TIBIA FIBULA 2 VIEW,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.00 
73590,26,"PR X-RAY TIB + FIB, 2VW",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
73590,26,"PR X-RAY TIB + FIB, 2VW",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
73592,,HC CHILD LOWER EXT MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$111.00 
73592,50,HC CHILD LOWER EXT MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$111.00 
73592,26,"PR X-RAY LEG, INFANT",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$23.00 
73592,26,"PR X-RAY LEG, INFANT",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
73600,,HC ANKLE STANDING 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$103.00 
73600,50,HC ANKLE STANDING 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$103.00 
73600,26,PR X-RAY ANKLE 2 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$23.00 
73600,26,PR X-RAY ANKLE 2 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
73610,,HC ANKLE MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$113.00 
73610,50,HC ANKLE MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$113.00 
73610,26,PR X-RAY ANKLE 3+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
73610,26,PR X-RAY ANKLE 3+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
73620,,HC FOOT 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$90.00 
73620,50,HC FOOT 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$90.00 
73620,26,PR X-RAY FOOT 2 VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$21.00 
73620,26,PR X-RAY FOOT 2 VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$21.00 
73630,,HC FOOT MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
73630,50,HC FOOT MIN 3 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
73630,26,PR X-RAY FOOT 3+ VW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$24.00 
73630,26,PR X-RAY FOOT 3+ VW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
73650,,HC HEEL MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
73650,50,HC HEEL MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
73650,26,PR X-RAY HEEL,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$23.00 
73650,26,PR X-RAY HEEL,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
73660,,HC TOE MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
73660,50,HC TOE MIN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
73660,26,PR X-RAY TOE(S),972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$18.00 
73660,26,PR X-RAY TOE(S),972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$18.00 
73700,,HC CT LOWER EXTREM W/O DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,096.00 "
73700,26,"PR CT SCAN,LOWER EXTREMITY,W/O CONTRAS",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$132.00 
73700,26,"PR CT SCAN,LOWER EXTREMITY,W/O CONTRAS",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$132.00 
73701,,HC CT LOWER EXTREM W/DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,419.00 "
73701,26,PR CT SCAN OF LEG CONTRAST,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$156.00 
73701,26,PR CT SCAN OF LEG CONTRAST,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$156.00 
73702,,HC CT LOWER EXTREM W/WO DYE,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,802.00 "
73702,26,PR CT LOWER EXTREM W/WO DYE,350,,$152.00 
73718,,HC MRI LOWER EXT W/O DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,899.00 "
73718,26,"PR MRI, LOWER EXTREM",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$175.00 
73718,26,"PR MRI, LOWER EXTREM",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$175.00 
73720,26,"PR MRI, LOWER EXTR, W/O CONTRAST F/U B",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$288.00 
73720,26,"PR MRI, LOWER EXTR, W/O CONTRAST F/U B",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$288.00 
73721,,HC MRI-LOWER EXT JOINT W/O DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,608.00 "
73721,26,"PR MRI LOWER EXTREM JT, W/O CONTRAST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$178.00 
73721,26,"PR MRI LOWER EXTREM JT, W/O CONTRAST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$178.00 
73723,26,"PR MRI, JOINT OF LEG. COMBO",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$288.00 
73723,26,"PR MRI, JOINT OF LEG. COMBO",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$288.00 
73725,,HC MRA LOWER EXT W/WO DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,581.00 "
73725,26,PR MRA LOWER EXT W/WO DYE,610,,$226.00 
74018,,HC XRAY ABDOMEN 1 VIEW,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$88.00 
74018,26,CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
74018,26,CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
74019,,HC XRAY ABDOMEN 2 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$123.00 
74019,26,CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$29.00 
74019,26,CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
74021,,HC XRAY ABDOMEN 3+ VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
74021,26,CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$34.00 
74021,26,CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$34.00 
74022,,HC ABDOMEN 4 VIEWS,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$147.00 
74022,26,CHG RADIOLOGIC EXAM COMPLETE ACUTE ABD,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$42.00 
74022,26,CHG RADIOLOGIC EXAM COMPLETE ACUTE ABD,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$42.00 
74150,,HC CT ABD W/O DYE,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$761.00 
74150,26,"PR CT SCAN,ABDOMEN,W/O CONTRAST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$156.00 
74150,26,"PR CT SCAN,ABDOMEN,W/O CONTRAST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$156.00 
74160,,HC CT ABD W/DYE,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,482.00 "
74160,26,PR CT SCAN OF ABDOMEN CONTRAST,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$167.00 
74160,26,PR CT SCAN OF ABDOMEN CONTRAST,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$167.00 
74170,,HC CT ABD W/WO DYE,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,787.00 "
74170,26,PR CT SCAN OF ABDOMEN COMBO,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$183.00 
74170,26,PR CT SCAN OF ABDOMEN COMBO,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$183.00 
74174,,HC CTA ABDOMEN/PELVIS W/CONTRAST,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,433.00 "
74174,26,PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$275.00 
74174,26,PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$275.00 
74175,26,"PR CT ANGIO, ABD, COMBO,INCL IMAGE PRO",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$242.00 
74175,26,"PR CT ANGIO, ABD, COMBO,INCL IMAGE PRO",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
74176,,HC CT ABD/PELVIS W/O CONTRAST,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$957.00 
74176,26,"CHG CT SCAN,ABDOMEN AND PELVIS,W/O CON",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$222.00 
74176,26,"CHG CT SCAN,ABDOMEN AND PELVIS,W/O CON",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$222.00 
74177,,HC CT ABD/PELVIS W/CONTRAST,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,929.00 "
74177,26,"CHG CT SCAN,ABDOMEN AND PELVIS,W CONTR",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$230.00 
74177,26,"CHG CT SCAN,ABDOMEN AND PELVIS,W CONTR",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$230.00 
74178,,HC CT ABD/PELVIS W/O&W CONTRAST,352,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,204.00 "
74178,26,"CHG CT SCAN,ABDOMEN AND PELVIS,COMBO",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$258.00 
74178,26,"CHG CT SCAN,ABDOMEN AND PELVIS,COMBO",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$258.00 
74181,,HC MRI-ABDOMEN W/O DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,667.00 "
74181,26,"PR MRI, ABDOMEN (MRI)",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$196.00 
74182,,HC MRI ABDOMEN W/DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,593.00 "
74182,26,"PR MRI, ABDOMEN W/CONTRAST",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$233.00 
74182,26,"PR MRI, ABDOMEN W/CONTRAST",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$233.00 
74183,,HC MRI ABDOMEN W/WO DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,819.00 "
74183,26,"PR MRI, ABDOMEN, COMBO",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$275.00 
74183,26,"PR MRI, ABDOMEN, COMBO",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$275.00 
74185,,HC MRA ABDOMEN W/WO DYE,610,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,593.00 "
74185,26,PR MRA ABDOMEN W/WO DYE,610,,$224.00 
74220,26,CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE C,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$75.00 
74220,26,CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE C,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$75.00 
74240,26,CHG RADIOLOGIC EXAM UPR GI TRC SINGLE ,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$102.00 
74240,26,CHG RADIOLOGIC EXAM UPR GI TRC SINGLE ,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$102.00 
74246,26,CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE ,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$113.00 
74246,26,CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE ,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$113.00 
74250,,HC SMALL BOWEL EXAM,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$408.00 
74250,26,CHG RADIOLOGIC EXAM SMALL INT SINGLE C,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$103.00 
74250,26,CHG RADIOLOGIC EXAM SMALL INT SINGLE C,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$103.00 
74270,26,CHG RADIOLOGIC EXAM COLON SINGLE CONTR,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$130.00 
74270,26,CHG RADIOLOGIC EXAM COLON SINGLE CONTR,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$130.00 
74280,26,CHG RADIOLOGIC EXAM COLON DOUBLE CONTR,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$158.00 
74280,26,CHG RADIOLOGIC EXAM COLON DOUBLE CONTR,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$158.00 
74290,26,PR X-RAY GALLBLADDER SINGLE DOSE,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$42.00 
74290,26,PR X-RAY GALLBLADDER SINGLE DOSE,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$42.00 
74290,,HC X-RAY GALLBLADDER SINGLE DOSE,972,,$275.00 
74300,26,PR X-RAY OPER CHOLANGIOGRAM,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$49.00 
74300,26,PR X-RAY OPER CHOLANGIOGRAM,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$49.00 
74300,,HC X-RAY OPER CHOLANGIOGRAM,972,,$185.00 
74410,26,PR X-RAY IV PYELOGRAM+DRIP INFUSN,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$66.00 
74410,26,PR X-RAY IV PYELOGRAM+DRIP INFUSN,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$66.00 
74410,,HC X-RAY IV PYELOGRAM+DRIP INFUSN,972,,$443.00 
74420,26,PR X-RAY RETROGRADE PYELOGRAM,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$64.00 
74420,26,PR X-RAY RETROGRADE PYELOGRAM,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$64.00 
74420,,HC X-RAY RETROGRADE PYELOGRAM,972,,$210.00 
74425,26,PR X-RAY ANTEGRADE PYELOGRAM TUBE,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$63.00 
74425,26,PR X-RAY ANTEGRADE PYELOGRAM TUBE,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$63.00 
74425,,HC X-RAY ANTEGRADE PYELOGRAM TUBE,972,,$257.00 
74430,26,"X-RAY CYSTOGRAM, MIN 3 VIEW",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$42.00 
74430,26,"X-RAY CYSTOGRAM, MIN 3 VIEW",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$42.00 
74430,,"HC X-RAY CYSTOGRAM, MIN 3 VIEW",972,,$106.00 
74455,26,PR X-RAY URETHROCYSTOGRAM+VOIDING,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$44.00 
74455,26,PR X-RAY URETHROCYSTOGRAM+VOIDING,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
,,HC X-RAY URETHROCYSTOGRAM+VOIDING,972,,$338.00 
74710,26,PR X-RAY PELVIMETRY,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$44.00 
74710,26,PR X-RAY PELVIMETRY,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
74710,,HC X-RAY PELVIMETRY,972,,$96.00 
74740,26,PR X-RAY HYSTEROSALPINGOGRAM,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$50.00 
74740,26,PR X-RAY HYSTEROSALPINGOGRAM,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$50.00 
74740,,HC X-RAY HYSTEROSALPINGOGRAM,972,,$290.00 
75820,26,PR VENOGRAM EXTREM UNILAT,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$92.00 
75820,26,PR VENOGRAM EXTREM UNILAT,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
75820,,HC VENOGRAM EXTREM UNILAT,972,,$351.00 
75822,26,PR VENOGRAM EXTREM BILAT,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$139.00 
75822,26,PR VENOGRAM EXTREM BILAT,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$139.00 
75822,,HC VENOGRAM EXTREM BILAT,972,,$360.00 
76000,26,CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$39.00 
76000,26,CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
76010,26,PR X-RAY NOSE-RECTUM CHILD F.B.,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$26.00 
76010,26,PR X-RAY NOSE-RECTUM CHILD F.B.,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
76010,,HC X-RAY NOSE-RECTUM CHILD F.B.,972,,$83.00 
76080,26,"PR X-RAY FISTULA,ABSCESS,SINUS TRACT",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$73.00 
76080,26,"PR X-RAY FISTULA,ABSCESS,SINUS TRACT",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$73.00 
76080,,"HC X-RAY FISTULA,ABSCESS,SINUS TRACT",972,,$142.00 
76098,26,"PR X-RAY EXAM, BREAST SPECIMEN",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$40.00 
76098,26,"PR X-RAY EXAM, BREAST SPECIMEN",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$49.00 
76098,,"HC X-RAY EXAM, BREAST SPECIMEN",972,,$39.00 
76100,26,PR X-RAY TOMOGRAM,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$81.00 
76100,26,PR X-RAY TOMOGRAM,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$81.00 
76100,,HC X-RAY TOMOGRAM,972,,$290.00 
7620022,,HC OBSERVATION DISCHARGE,9999,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
76380,,HC CT STEALTH SCAN,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$812.00 
76380,26,"PR CT SCAN,LIMITED/LOCALIZED F/U STUDY",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$128.00 
76380,26,"PR CT SCAN,LIMITED/LOCALIZED F/U STUDY",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$128.00 
76506,,HC ECHO EXAM OF HEAD,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$414.00 
76506,26,PR ECHO EXAM OF HEAD,402,,$81.00 
76536,,HC US EXAM HEAD/NECK,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$416.00 
76536,26,"US,HEAD/NECK TISSUES,B-SCAN/REAL TIME",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$74.00 
76536,26,"US,HEAD/NECK TISSUES,B-SCAN/REAL TIME",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$74.00 
76700,,HC US EXAM ABDOMEN COMPLETE,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$467.00 
76700,26,"US,ABDOM,B-SCAN &/OR REAL TIME,COMPLET",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$105.00 
76700,26,"US,ABDOM,B-SCAN &/OR REAL TIME,COMPLET",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
76705,,HC US ECHO EXAM OF ABDOMEN,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$357.00 
76705,26,"US, ABDOMEN LIMITED",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$78.00 
76705,26,"US, ABDOMEN LIMITED",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$78.00 
76770,,HC US RETROPERIT (RENAL LAAA),402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$455.00 
76770,26,"PR US,RETROPERIT,REAL TIME,COMPLETE",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$98.00 
76770,26,"PR US,RETROPERIT,REAL TIME,COMPLETE",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.00 
76775,,"HC US RETROPERIT LTD (RENAL,LAAA)",402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$355.00 
76775,26,"PR US, RETROPERITNL ABD,  LTD",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$76.00 
76775,26,"PR US, RETROPERITNL ABD,  LTD",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$76.00 
76801,,HC US OB COMPLETE(<14 WKS),402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$406.00 
76801,26,"US, OB < 14 WKS, SINGLE FETUS",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$129.00 
76801,26,"US, OB < 14 WKS, SINGLE FETUS",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
76802,,HC MULTIPLE GESTATION(<14 WKS),402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$99.00 
76802,26,"US, OB < 14 WKS, ADD'L FETUS",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$108.00 
76802,26,"US, OB < 14 WKS, ADD'L FETUS",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$108.00 
76805,,HC US PREGNANCY >=14WKS SNGL FETUS,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$477.00 
76805,26,"US, OB >/= 14 WKS, SNGL FETUS",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$128.00 
76805,26,"US, OB >/= 14 WKS, SNGL FETUS",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$128.00 
76810,,HC US PREGNANCY >= 14WKS ADDL FETUS,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$265.00 
76810,26,"US, OB >/= 14 WKS, ADDL FETUS",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$128.00 
76810,26,"US, OB >/= 14 WKS, ADDL FETUS",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$128.00 
76811,,"HC OB US DETAILED,SNGL",402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$382.00 
76811,26,"PR OB US DETAILED,SNGL",402,,$238.00 
76812,,"HC OB US DETAILED,EA ADDL",402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$567.00 
76815,,HC US PREGNANCY LMTD,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$319.00 
76815,26,"PR US,PREGNANT UTERUS,LIMITED, 1/> FET",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$84.00 
76815,26,"PR US,PREGNANT UTERUS,LIMITED, 1/> FET",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$84.00 
76816,,HC FOLLOW UP/REPEAT OB,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$345.00 
76816,26,"PR US,PREGNANT UTERUS,F/U,TRANSABD APP",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$112.00 
76816,26,"PR US,PREGNANT UTERUS,F/U,TRANSABD APP",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$112.00 
76817,26,"PR US,PREGNANT UTERUS,TRANSVAGINAL",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$98.00 
76817,26,"PR US,PREGNANT UTERUS,TRANSVAGINAL",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.00 
76817,,"HC US,PREGNANT UTERUS,TRANSVAGINAL",972,,$268.00 
76819,,HC BIO PROFILE,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$287.00 
76819,26,"PR FETAL BIOPHYS PROF,W/O NST",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$101.00 
76819,26,"PR FETAL BIOPHYS PROF,W/O NST",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$101.00 
76830,,HC US TRANSVAGINAL,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$416.00 
76830,26,"PR ECHOGRAPHY,TRANSVAGINAL",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$91.00 
76830,26,"PR ECHOGRAPHY,TRANSVAGINAL",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$91.00 
76856,,HC US PELVIC COMPLETE,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$417.00 
76856,26,"PR US,PELVIC (NONOBSTETRIC),REAL TIME,",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$91.00 
76856,26,"PR US,PELVIC (NONOBSTETRIC),REAL TIME,",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$91.00 
76857,,HC US PELVIC LIMITED,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$109.00 
76857,26,"PR US,PELVIC (NONOBSTETRIC),REAL TIME,",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$62.00 
76857,26,"PR US,PELVIC (NONOBSTETRIC),REAL TIME,",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$62.00 
76870,,HC US SCROTUM,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$335.00 
76870,26,"PR ECHO,SCROTUM & CONTENTS",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$87.00 
76870,26,"PR ECHO,SCROTUM & CONTENTS",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$87.00 
76881,,HC ULTRASOUND OF EXTREMITY,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$262.00 
76881,26,CHG US COMPL JOINT R-T W/IMAGE DOCUMEN,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$79.00 
76881,26,CHG US COMPL JOINT R-T W/IMAGE DOCUMEN,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$79.00 
76882,,HC US XTR NON-VASC LMTD,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$150.00 
76882,26,CHG US LMTD JOINT/OTH NONVASC XTR STRU,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$61.00 
76882,26,CHG US LMTD JOINT/OTH NONVASC XTR STRU,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$61.00 
76930,,HC ECHO GUIDE CARDIOCENTESIS,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$251.00 
76937,,HC US GUIDANCE VASCULAR ACCESS,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$103.00 
76942,,HC US GUIDANCE/NDL PLACEMENT,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$114.00 
76946,,HC AMNIOCENTESIS GUIDANCE,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$60.00 
76948,,HC US ASP OF OVA,402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$184.00 
76999,,"HC ULTRASOUND PROCEDURE,UNLISTED",402,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$139.00 
76999,26,PR UNLISTED ULTRASOUND PROCEDURE,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$73.00 
76999,26,PR UNLISTED ULTRASOUND PROCEDURE,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$73.00 
77012,,HC CT BIOPSY/CYST ASPIR,350,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$655.00 
77065,,HC DIAGNOSTIC MAMMO CAD UNILATERAL,401,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$425.00 
77065,26,CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AI,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$103.00 
77065,26,CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AI,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$103.00 
77066,,HC DIAGNOSTIC MAMMO CAD BILATERAL,401,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$543.00 
77066,26,CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AI,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$126.00 
77066,26,CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AI,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$126.00 
77067,,HC SCREENING MAMMO CAD BILATERAL,403,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$449.00 
77067,26,CHG SCREENING MAMMOGRAPHY BI 2-VIEW BR,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$97.00 
77067,26,CHG SCREENING MAMMOGRAPHY BI 2-VIEW BR,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$97.00 
77075,,HC BONE SURVEY COMPLETE,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$344.00 
77080,,HC DEXASCAN,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$138.00 
77080,26,"PR DEXA,BONE DENSITY,AXIAL SKELETON",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$39.00 
77080,26,"PR DEXA,BONE DENSITY,AXIAL SKELETON",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
78013,,HC THYROID IMAGING W/BLOOD FLOW,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$817.00 
78215,,HC NM LIVER SPLEEN SCAN,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$801.00 
78215,26,PR LIVER AND SPLEEN IMAGING,974,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$66.00 
78215,26,PR LIVER AND SPLEEN IMAGING,974,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$66.00 
78226,,HC NM HIDA IMAGE,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,380.00 "
78226,26,PR HEPATOBILIARY SYST IMAGING INCLUDIN,974,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$93.00 
78226,26,PR HEPATOBILIARY SYST IMAGING INCLUDIN,974,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
78227,,HC NM HIDA WITH CCK,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,887.00 "
78227,26,PR HEPATOBIL SYST IMAG INC GB W/PHARMA,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$114.00 
78227,26,PR HEPATOBIL SYST IMAG INC GB W/PHARMA,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$114.00 
78262,,HC GASTRO-REFLUX SCAN,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$980.00 
78262,26,PR GASTROESOPHAGEAL REFLUX EXAM,974,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$88.00 
78262,26,PR GASTROESOPHAGEAL REFLUX EXAM,974,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$88.00 
78290,,HC NM MECKELS,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,396.00 "
78290,26,PR BOWEL IMAGING,974,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$90.00 
78290,26,PR BOWEL IMAGING,974,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$90.00 
78300,,HC NM BONE LIMITED,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$936.00 
78300,26,"PR BONE IMAGING, LIMITED AREA",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$81.00 
78300,26,"PR BONE IMAGING, LIMITED AREA",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$81.00 
78305,,HC NM BONE MULTIPLE AREAS,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,124.00 "
78305,26,"PR BONE IMAGING, MULTIPLE AREAS",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$107.00 
78305,26,"PR BONE IMAGING, MULTIPLE AREAS",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$107.00 
78306,,HC NM BONE WHOLE BODY/JOINT SCAN,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,222.00 "
78306,26,"PR BONE IMAGING, WHOLE BODY",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$113.00 
78306,26,"PR BONE IMAGING, WHOLE BODY",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$113.00 
78315,,HC NM BONE THREE-PHASE,341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,393.00 "
78315,26,"PR BONE IMAGING, 3 PHASE",974,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$132.00 
78315,26,"PR BONE IMAGING, 3 PHASE",974,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$132.00 
78472,,HC NM CARDIAC BLOOD POOL (MUGA),341,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$849.00 
78472,26,"PR GATED HEART, PLANAR SINGLE",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$129.00 
78472,26,"PR GATED HEART, PLANAR SINGLE",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
78580,26,PR PULMONARY PERFUSION IMAGING PARTICU,972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$95.00 
78580,26,PR PULMONARY PERFUSION IMAGING PARTICU,972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
78580,,HC PULMONARY PERFUSION IMAGING PARTICU,972,,$949.00 
78701,,HC NM KIDNEY IMAG VASCULAR FLOW,320,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$906.00 
78701,26,"PR RENAL IMAGING, MORPH W/ FLOW",974,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$66.00 
78701,26,"PR RENAL IMAGING, MORPH W/ FLOW",974,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$66.00 
78740,26,PR URETERAL REFLUX STUDY,974,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$76.00 
78740,26,PR URETERAL REFLUX STUDY,974,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$76.00 
78740,,HC URETERAL REFLUX STUDY,974,,$897.00 
80048,,PC BASIC METABOLIC PANEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$61.00 
80050,,PC GENERAL HEALTH PANEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$251.00 
80051,,PC ELECTROLYTE PANEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$51.00 
80053,,PC COMP METABOLIC PANEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$75.00 
80055,,PC OBSTETRIC PANEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$288.00 
80061,,PC LIPID PANEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$87.00 
80069,,PC RENAL FUNCTION PANEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$56.00 
80074,,PC ACUTE HEPATITIS PANEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$287.00 
80076,,PC HEPATIC FUNCTION PANEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$62.00 
80143,,PC DRUG ASSAY ACETAMINOPHEN,301,,$92.00 
80151,,PC DRUG ASSAY AMIODARONE,301,,$92.00 
80156,,PC CARBAMEZEPINE; TOTAL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
80157,,PC CARBAMAZEPINE; FREE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
80158,,PC CYCLOSPORINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
80162,,PC DIGOXIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
80164,,PC VALPORIC ACID,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$97.00 
80168,,PC ETHOSUXIMIDE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$117.00 
80170,,PC GENTAMYCIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$118.00 
80175,,PC LAMOTRIGINE MAYO,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
80177,,PC LEVITIRACETAM,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
80178,,PC LITHIUM,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$48.00 
80179,,PC DRUG ASSAY SALICYLATE,301,,$92.00 
80183,,PC OXCARBAZEPINE LEVEL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
80184,,PC PHENOBARBITAL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$83.00 
80185,,"PC PHENYTOIN, TOTAL",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
80188,,PC PRIMIDONE (MYSOLINE),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$119.00 
80197,,PC TACROLIMUS,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.00 
80198,,PC THEOPHYLLINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$101.00 
80200,,PC TOBRAMYCIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$114.00 
80201,,PC TOPIRAMATE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$85.00 
80202,,PC VANCOMYCIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$97.00 
80299,,"PC QUANT OF DRUG, NOT ELSEWH",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$130.00 
80305,,PC DRUG SCRN NON TLC DEVICES,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
80307,,PC SALICYLATE/ACETAMINOPHENE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$334.00 
80320,,PC ALCOHOL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$77.00 
80324,,PC DRUG SCRN AMPHETAMINES 1/2 80324,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
80327,,PC DRUG SCREEN QUANT ANA,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$153.00 
80329,,PC DRUG SCREEN ANALGESICS 1 OR 2,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$52.00 
80346,,PC BENZODIAZEPINES;1-12,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$117.00 
80349,,"PC CANNABINOIDS,NATURAL",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$123.00 
80358,,PC METHADONE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$223.00 
80359,,PC METHYLENEDIOXYAMPHETAMINES,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$115.00 
80361,,"PC OPIATES,1 OR MORE",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$115.00 
80365,,PC OXYCODONE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$231.00 
80500,,"PC CLINIC PATH CONSULT, LIMI",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$10.00 
81001,,PC UA AUTO W/MICRO,307,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
81003,,PC UA AUTO W/O MICRO,307,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$17.00 
81025,,PC URINE PREGNANCY TEST,307,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$46.00 
81050,,PC UA VOLUME MEASURE,307,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$22.00 
81206,,PC BCR/ABL P210,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,062.00 "
81207,,PC BCR/ABL P190,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$957.00 
81208,,PC BCR/ABL1 GENE OTHER BP,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,108.00 "
81219,,"PC CALCR,GENE MUTATION",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$830.00 
81220,,PC CYSTIC FIBROSIS MUTATION PANEL,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,873.00 "
81240,90,PC PROTHROMBIN GENE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$323.00 
81241,90,PC FFGENE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$379.00 
81241,,PC FACTOR V LEIDEN,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$379.00 
81256,,"PC HEMOCHROMATOSIS,HFE",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$398.00 
81256,,PC HEMOCHROMATOSIS HPE,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$398.00 
81270,,PC JAK2 GENE ANALYSIS,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$709.00 
81340,,PC T-CELL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,198.00 "
81342,,PC T-CELL ANTIGEN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,156.00 "
81376,,PC HLA II TYPING LOCUS LR,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$701.00 
81403,,PC MPL EXON 10 MUT PATH,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$956.00 
81405,,"PC MOPATH PROCEDURE,LEVEL",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,556.00 "
81406,,PC MOPATH PROC LEVEL,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,460.00 "
81479,,PC CST3R EXON 14/17,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$630.00 
81479,,PC MATERNI T21,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$630.00 
81511,,PC FTL CGEN ABNOR  FOUR ANA,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$380.00 
82024,,PC ACTH,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$250.00 
82040,,PC ALBUMIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$37.00 
82043,,PC MICROALBUMIN (24 HR UR),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
82044,,PC URINE MICROALBUMN SEMIQUA,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$34.00 
82085,,PC ALDOLASE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$195.00 
82088,,PC ALDOSTERONE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$270.00 
82103,,PC ALPHA-1 ANTITRYPSIN TOTAL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$89.00 
82104,,PC ALPHA-1 ANTI PHENO,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$137.00 
82105,,"PC ALPHA FETOPROTEIN, SERUM",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$104.00 
82135,,PC AMINOLEVULINIC ACID (ALA),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$118.00 
82140,,PC AMMONIA,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
82150,,PC AMYLASE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$47.00 
82157,,PC ANDROSTENEDIONE SERUM,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$194.00 
82164,,PC ANGIOTENSIN I/CONVER ENZY,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
82175,,PC ARSENIC,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$143.00 
82232,,PC BETA-2 MICROGLOBULIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$117.00 
82247,,PC BILIRUBIN: TOTAL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$37.00 
82248,,PC DIRECT BILIRUBIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$37.00 
82270,,"PC OCCULT BLOOD, STOOL 1-3",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
82271,,"PC OCCULT BLOOD, OTHER",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
82272,,"PC BLOOD, OCCULT, CARD",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
82274,,"PC OCCULT BLOOD,FECAL,TUBE",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$113.00 
82300,,PC CADMIUM,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$165.00 
82306,,PC MAYO 25-HYDROXYVITAMIN D2/D3,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$221.00 
82310,,"PC CALCIUM, TOTAL",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
82330,90,"ASSAY OF CALCIUM, IONIZED",300,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$97.00 
82330,,PC CALCIUM; IONIZED,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$97.00 
82340,,"PC CALCIUM URINE, QUANTIT",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
82355,,"PC CALCULUS ANALYSIS, QUALIT",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$84.00 
82365,,PC MAYO KIDNEY STONE ANALYSIS,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$164.00 
82365,,"PC CALCULUS ASSAY,INFRARED SPECTR",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$164.00 
82374,,PC CARBON DIOXIDE URINE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$37.00 
82375,,PC CARBON MONOXIDE QUANT,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$71.00 
82378,,PC CEA,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$122.00 
82380,,PC CAROTENE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$65.00 
82384,,"PC CATECHOLIMINES, FRACT",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$167.00 
82390,,PC CERULOPLASMIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$142.00 
82397,,PC CHEMILUMINESCENT ASSAY,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$101.00 
82435,,PC CHLORIDE BLOOD,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$34.00 
82436,,PC CHLORIDE URINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$37.00 
82465,,PC CHOLESTEROL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
82495,,PC CHROMIUM,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$134.00 
82507,,PC CITRATE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$197.00 
82525,,PC COPPER,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$137.00 
82530,,PC CORTISOL FREE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$119.00 
82533,,"PC CORTISOL, TOTAL",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$107.00 
82542,,"PC GC-MS,QUANTITATIVE",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$221.00 
82550,,PC CPK TOTAL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$43.00 
82553,,PC CPK MB FRACTION ONLY,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$83.00 
82565,,PC CREATININE BLOOD,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
82570,90,ASSAY OF URINE CREATININE,300,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$38.00 
82570,,PC CREATININE OTHER SOURCE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
82575,,PC CREATININE CLEARANCE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$68.00 
82585,,PC ASSAY OF CRYOFIBRINOGEN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$73.00 
82595,,PC ASSAY OF CRYOGLOBULIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$37.00 
82607,,PC CYANOCOBALAMIN (VIT B12),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$108.00 
82626,,PC DHEA,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$167.00 
82627,,PC DHEA SULFATE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$238.00 
82652,,"PC VITAMIN D 1,25",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$221.00 
82656,,"PC PANCREATIC ELASTASE,FECAL",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$187.00 
82657,,"PC TPMT ACTIVITY PROFILE,RB",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$311.00 
82668,,PC ERYTHROPOIETIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$125.00 
82670,,PC ESTRADIOL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$198.00 
82671,,PC ESTRADIOL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$198.00 
82677,,PC ESTRIOL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$170.00 
82705,90,"CHG FATS/LIPIDS, FECES, QUALITATIVE",300,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$37.00 
82710,,PC FAT OR LIPIDS;FECES,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$120.00 
82728,,PC FERRITIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$97.00 
82731,,PC FETAL FIBRONECTIN,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$369.00 
82746,,PC FOLIC ACID SERUM,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$106.00 
82747,,PC FOLIC ACID RBC,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$122.00 
82784,,"PC GAMMAGLOBULIN A,D,G,M EAC",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$110.00 
82785,,PC GAMMAGLOBULIN IGE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$109.00 
82787,,PC IMMUNOGLOBULIN SUBCLASS,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$46.00 
82800,,"PC GASES, BLOOD, PH ONLY",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$61.00 
82805,,"PC GASES, BLOOD CALC",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$407.00 
82941,,PC GASTRIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$125.00 
82947,,PC GLUCOSE QUANTITIVE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
82948,,"PC GLUCOSE, REAGENT STRIP",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
82951,,PC GTT 3 SPECIMENS,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
82952,,PC GTT EACH ADD'L SPECIMEN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$28.00 
82955,,"PC G-6-PD,QN,RBC",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$128.00 
82977,,PC GGT,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$53.00 
82985,,PC GLYCATED PROTEIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$87.00 
83001,,PC FSH,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$132.00 
83002,,PC LH,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$132.00 
83003,,PC GROWTH HORMONE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$132.00 
83009,,PC AB HELICOBACTER PYLORI,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$444.00 
83010,,PC HAPTOGLOBIN QUANTITIVE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$90.00 
83013,,"PC H PYLORI,UREASE",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$411.00 
83014,,"PC H PYLORI,UREASE",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
83018,,PC HEAVY METAL SCREEN,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$145.00 
83020,,PC HEMOGLOBIN ELECTRO,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$74.00 
83021,,PC HEMOGLOBIN A2 AND F,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$104.00 
83036,,PC HEMOGLOBIN GLYCATED,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$70.00 
83088,,PC HISTAMINE URINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$195.00 
83090,,PC HOMOCYSTINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$112.00 
83497,,PC HYDROXINDOLACETIC ACID/HI,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
83498,,PC 17-HYDROXYPROGESTERONE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$166.00 
83516,,PC TISSUE TRANSGL IGG,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$88.00 
83516,,PC TISSUE TRANSGL IGA,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$88.00 
83519,,PC IMMUNOASSAY RIA,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$110.00 
83520,,PC IMMUNOASSAY NOS,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$209.00 
83525,,"PC INSULIN, TOTAL",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$83.00 
83540,,PC IRON,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$47.00 
83550,,PC IRON BUILDING CAPACITY,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$63.00 
83582,,PC KETOGENIC STEROIDS FRAC,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$101.00 
83586,,"PC KETOSTEROIDS, 17, TOTAL",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
83605,,PC LACTIC ACID,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$77.00 
83615,,PC LDH,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
83625,,PC LDH ISO ENZYMES,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
83655,,PC LEAD,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$80.00 
83690,,PC LIPASE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$49.00 
83700,,PC LIPOPROTEIN ELECTROPHORES,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$65.00 
83718,,PC LIPOPROTEIN DIR MEAS HDLC,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$51.00 
83735,,PC MAGNESIUM,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$48.00 
83825,,"PC MERCURY, QUANTITIVE",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$142.00 
83835,,PC METANEPHRINES,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$112.00 
83874,,PC MYOGLOBIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
83880,,PC BNP,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$239.00 
83883,,PC NEPHELOMETRY NES,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$190.00 
83921,,PC ORGANIC ACID (MMA),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$110.00 
83930,,PC OSMOLITY BLOOD,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$48.00 
83935,,"PC OSMOLITY, URINE",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$49.00 
83945,,PC OXALATE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
83970,,PC PARATHYROID HORMONE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$293.00 
83986,,PC PH - BODY FLUID,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
83993,,PC CALPROTECTIN,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$130.00 
84030,,PC PKU,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$40.00 
84060,,PC PHOSPHATASE ACID TOTAL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$54.00 
84075,,PC PHOSPHATASE ALKALINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$106.00 
84080,,"PC PHOSPHATASE, ALK ISO",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$117.00 
84100,,PC PHOSPHORUS,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$36.00 
84105,,"PC PHOSPHORUS, URINE",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
84120,,PC PORPHYRINS QUAN/FRAC,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$106.00 
84132,,PC POTASSIUM SERUM,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$34.00 
84133,,PC POTASSIUM URINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
84134,,PC PREALBUMIN,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$84.00 
84143,,"PC 17-HYDROXYPREGNENONONE,S",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$151.00 
84144,,PC PROGESTERONE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$148.00 
84145,,PC PROCALCITONIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$154.00 
84146,,PC PROLACTIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$138.00 
84153,,PC PSA TOTAL DIAGNOSTIC,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$122.00 
84154,,PC PSA; FREE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$122.00 
84155,,PC PROTEIN TOTAL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$43.00 
84156,,PC PROTEIN TOTAL; URINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
84165,,"PC PROTEIN ELECTRO, SERUM",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$72.00 
84166,,"PC PROTEIN ELECTRO, URINE",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$128.00 
84207,,PC B-6,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$186.00 
84244,,PC RENIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$145.00 
84252,,"PC RIBOFLAVIN, B-2",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$144.00 
84260,,PC SEROTONIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$205.00 
84270,,PC SEX HORMONE BINDING GLOB,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$132.00 
84295,,"PC SODIUM, SERUM",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$36.00 
84300,,PC SODIUM URINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$36.00 
84305,,PC IGF (SOMA - C),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$141.00 
84315,,PC SPEC GRAVITY NOT URINE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$18.00 
84392,,"PC SULFATE,URINE",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$153.00 
84402,,PC TESTOSTERONE FREE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$168.00 
84403,,PC TESTOSTERONE TOTAL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$171.00 
84425,,PC THIAMIN VIT B1 (MAYO),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$122.00 
84432,,PC THYROGLOBULIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$145.00 
84436,,"PC T-4/THYROXIN, TOTAL",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$88.00 
84439,,"PC THYROXIN, FREE/ T-4",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$59.00 
84443,,PC TSH,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$120.00 
84446,,PC VITAMIN E - LAB,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$101.00 
84450,,PC SGOT/AST,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
84460,,PC SGPT/ALT,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
84466,,PC TRANSFERRIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
84478,,PC TRIGLYCERIDES,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
84479,,PC THYROID HORMONE/T3,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$47.00 
84480,,PC T-3 TOTAL,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
84481,,PC T-3; FREE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$121.00 
84482,,PC T3;REVERSE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$104.00 
84484,,"PC TROPONIN, QUANTITATIVE",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$64.00 
84520,,PC BUN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
84540,,"PC UREA NITROEN,U",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$153.00 
84550,,"PC URIC ACID, BLOOD",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$34.00 
84560,,PC URIC ACID; OTHER SOURCE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$36.00 
84585,,PC VMA,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$110.00 
84586,,PC VASOACTIVE INTEST POLYPEP,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$203.00 
84588,,PC VASOPRESSIN (ADH),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$225.00 
84590,,PC VITAMIN A,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$78.00 
84630,,PC ZINC,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$124.00 
84681,,PC C-PEPTIDE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$137.00 
84702,,PC HCG-QUANTITIVE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$108.00 
84703,,PC HCG-QUALITIVE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$54.00 
84999,,PC TESTOSTERONE BIOAVAIL (MAYO),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$77.00 
85002,,PC BLEEDING TIME,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$34.00 
85007,,PC MANUAL DIFF,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$25.00 
85014,,PC HEMATOCRIT,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$17.00 
85018,,PC HEMOGLOBIN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$17.00 
85025,,PC CBC AUTO DIFF,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$57.00 
85027,,PC CBC W/O AUTO DIFF,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$47.00 
85041,,PC RBC,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$22.00 
85045,,"PC RETICULOCYTE COUNT,AUTO",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$40.00 
85048,,PC WBC,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$18.00 
85049,,"PC PLATELET COUNT, AUTO",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
85060,,"PC BLOOD SMEAR, PERIPH,BY DR",305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$65.00 
85210,,PC FACTOR II,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
85220,,PC CLOTTING: FACTOR V.,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$125.00 
85220,,PC FACTOR V,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$125.00 
85230,,PC FACTOR VII,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
85240,,PC FACTOR VIII,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$120.00 
85246,,"PC VON WILLEBRAND FAC AG,P",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$337.00 
85247,,PC VON WILLEBRAND FACTOR MULTI,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$264.00 
85250,,PC FACTOR IX,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$137.00 
85260,,PC FACTOR X,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
85270,,PC FACTOR XI,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
85280,,PC FACTOR XII,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$138.00 
85300,,PC ANTITHROMBIN III TEST,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$182.00 
85301,,PC A-III ANTIGEN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$78.00 
85302,,PC PROTEIN C ANTIGEN,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
85303,,"PC PROTEIN C, ACTIVITY",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$163.00 
85305,,"PC PROTEIN S, TOTAL",305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$84.00 
85306,,"PC PROTEIN S, FREE",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$163.00 
85307,,PC ACTIVATED PROTEIN C (APC),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$84.00 
85366,90,PC THROMBOPHILIA,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$139.00 
85378,,PC D-DIMER SEMIQUANT,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$51.00 
85379,,PC D-DIMER QUANT,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$156.00 
85384,,PC FIBRINOGEN ACTIVITY,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$130.00 
85390,90,PC FIBRINOGEN,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$208.00 
85397,,PC VON WILLEBRAND FAC ACT,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$414.00 
85420,,PC FIBRIN PLASMINOLGEN,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$47.00 
85460,,PC FETAL KLEI-BETKE,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$56.00 
85461,,PC HGB ROSETTE,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$48.00 
85520,,PC HEPARIN ASSAY/ANTI XA,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$87.00 
85520,,PC ANTI-XA HEPARIN ASSAY,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$87.00 
85540,,PC LEUKOCYTE ALK PHOS,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$62.00 
85597,,PC PLATELET NEUTRALIZATION,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$109.00 
85598,,PC HEXAGONAL PHASE CONFIRM,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$396.00 
85610,,PC PROTHROMBIN TIME,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
85611,,PC PLASMA FRACTIONS,305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
85613,,"PC RUSSEL VIPER VENOM,DILUTE",305,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$69.00 
85635,,PC REPTILASE TEST,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$71.00 
85651,,"PC SED RATE, NONAUTO",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
85670,,"PC THROMBIN TIME, PLASMA",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
85730,,PC PTT,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$43.00 
85732,,"PC THROMBOPLASTIN TIME,PARTI",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$47.00 
86003,,"PC IGE,SINGLE ALLERGEN,EACH",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
86021,,PC WBC ANTIBODY ID,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$107.00 
86038,,PC ANA SCREEN,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
86039,,PC ANA TITER,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
86060,,PC ASO TITER,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$100.00 
86060,90,PC ANA TITER,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$100.00 
86063,,PC ASO SCREEN,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
86140,,PC C-REACTIVE PROTEIN,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
86141,,PC C-REACT PROTEIN;HIGH SENS,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
86146,,PC BETA 2 GLYCOPROTEIN 1 ANT,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$193.00 
86147,,PC CARDIOLIPIN ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$193.00 
86156,,PC COLD AGGLUTININ,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$193.00 
86157,,"PC COLD AGGLUTININS, TITER",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$193.00 
86160,,"PC COMPLIMENT ANTIGEN, EACH",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$174.00 
86161,,"PC COMPLEMENT, FUNCTIONAL",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$174.00 
86162,,"PC COMPLEMENT,TOTAL,SERUM",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$117.00 
86200,,PC CCP ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$100.00 
86215,,PC D-NASE B ANTIBODY,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$88.00 
86225,,PC ANTIDNA DOUBLE STRAND,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$91.00 
86235,,PC EXTRACT NUC ANTGN EA ADD',300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
86255,,PC FLUORESCENT AB SCREEN,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$250.00 
86256,,PC FLUORESCENT AB TITER,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
86300,,PC IMMUNO TUMOR ANTI;CA 27.29,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$148.00 
86301,,PC CA 19-9,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$148.00 
86304,,PC IMMUNOASSAY TUMOR CA 125,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$148.00 
86308,,PC HETEROPHILE AB SCREEN/MON,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
86316,,PC IMMUNO TUMOR ANTIGEN/CA12,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$148.00 
86317,,PC S.PNEUM IGG AB,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
86320,,"PC IMMUNOELECTRO, SERUM",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$160.00 
86334,,PC IMMUNOFIXATION ELECTRO,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$148.00 
86335,,PC IMMUNO E-PHORESIS/URINE,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$194.00 
86336,,PC INHIBIN A,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
86337,,PC INSULIN ANTIBODIES,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$153.00 
86341,,PC ISLET CELL ANTIBODY (GLAD,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$141.00 
86359,,PC T CELLS; TOTAL COUNT,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$249.00 
86360,,PC T CELLS;ABSOLUTE CD4 & CD,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$310.00 
86376,,PC MICROSOMAL ANTIBODIES EA,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$96.00 
86430,,PC RA FACTOR QUALITIVE,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
86480,,PC QUANTIFERRON (MAYO),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$356.00 
86481,,PC QUANTIFERON TB GOLD PL,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$516.00 
86580,,PC TUBERCULIN SKIN TEST,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
86592,,PC SYPHILIS TEST QUALITIVE,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
86606,,PC ASPERGILLUS FUMIGATUS IGG,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$145.00 
86612,,PC BLASTOMYCES AB,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
86617,,PC BORRELIA (LYME) CONFIRMAT,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$103.00 
86618,,PC ANTIBODY BORELIA LYME,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$103.00 
86631,,PC CHLAMYDIA IGG,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$73.00 
86632,,PC CHLAMYDIA IGM,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$73.00 
86635,,"PC COCCIDIOIDES AB,S",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$74.00 
86644,,PC ANTIBODY CMV,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$102.00 
86645,,PC CYTOMEGALOVIRUS,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$97.00 
86654,,"PC ENCEPHALITIS, WESTERN EQU",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
86663,,PC EPSTEIN BARR VIRUS,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$99.00 
86664,,PC ANTIBODY EBV NUCLEAR,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$102.00 
86665,,"PC EBV,CAPSID",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$102.00 
86666,,PC EHRLICHA CHAFFENIS,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$72.00 
86674,,PC ANTIBODY GIARDIA LAMBIA,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$102.00 
86677,,PC AB HELICOBACT PYLORI,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
86684,,PC ANTIBODY HEMOPHILUS FLU,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
86687,,PC ANTIBODY HTLV-I,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$61.00 
86689,,PC ANTIBDY HTLV/HIV CONFIRM,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$128.00 
86694,,"PC HERPES AB SCREEN IGM,S",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$139.00 
86695,90,CHG HERPES SIMPLEX TEST,300,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$85.00 
86695,,"PC HSV TYPE 1 AB,IGG",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$85.00 
86696,90,"CHG HERPES SIMPLEX TEST, TYPE 2",300,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$122.00 
86696,,"PC HSV TYPE 2 AB,IGG",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$122.00 
86698,,"PC HISTOPLASMA AB,S",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$82.00 
86701,,PC HIV,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$63.00 
86703,,PC ANTIBODY HIV-1 & 2 SINGLE,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$79.00 
86704,,PC HEP B CORE ANTIBODY;TOTAL,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$80.00 
86705,,PC HEP B IGM ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$80.00 
86706,,PC HEPATITIS B SUR ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$100.00 
86707,,PC HEP B ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$100.00 
86708,,"PC HEPATITIS A TOTAL AB,S",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
86709,,PC HEP A IGM ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$83.00 
86710,,PC ANTIBODY INFLUENZA VIRUS,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$90.00 
86713,,PC ANTIBODY LEGIONELLA,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$102.00 
86720,,PC BABESIA MICROTI,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
86720,,PC LEPTOSPIRA ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
86735,,PC MMR TITER,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
86738,,PC ANTIBODY MYCOPLASMA,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
86747,,PC PAROVIRUS ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$108.00 
86753,,"PC ANTIBODY,PROTOZOA",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$71.00 
86756,,PC ANTIBODY RSV,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$92.00 
86759,,PC ANTIBODY ROTAVIRUS,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
86762,,PC ANTIBODY RUBELLA,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$137.00 
86777,,PC ANTIBODY TOXOPLASMA,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$102.00 
86780,,PC SYPHILLUS,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$81.00 
86787,,PC ANTIBODY VARICELLA ZOSTER,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$89.00 
86787,,PC ANTIBODY VARICELLA ZOSTER,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$89.00 
86788,,PC WEST NILE VIRUS IGM,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$123.00 
86789,,PC WEST NILE VIRUS IGG,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$113.00 
86790,,PC HANTAVIRUS ANTIBODY IGG,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$103.00 
86800,,PC THYROGLOBULIN ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$110.00 
86803,,PC HEPATITIS C ANTIBODY,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$122.00 
86812,,PC HLA-B27,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$156.00 
86850,,PC ANTIBODY SCREEN RBC,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$104.00 
86870,,"PC ANTIBODY IDENTIFY, RBC",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$447.00 
86880,,PC COOMS DIRECT,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
86885,,PC COOMBS INDIRECT,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
86886,,"PC COOMBS, INDIRECT, EA TITE",302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
86900,,PC BLOOD TYPING ABO,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$22.00 
86901,,PC BLOOD TYPING RH (D),300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$22.00 
86902,,PC BLOOD TYPE ANTIGEN SCREEN,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
86905,,PC BLOOD TYPING RBC ANTIGEN,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$28.00 
86920,,PC COMPATABILITY TEST IS,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$218.00 
86922,,PC COMPATABILITY ANTIGLOB,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$218.00 
86927,,PC FRESH FROZEN PLASMA THAW,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$236.00 
86945,,PC IRRADIATED PRODUCTS,390,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$68.00 
86965,,PC POOLING OF PLATELETS,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$236.00 
86999,,PC MISC TRANSFUSION MED PROC,390,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$28.00 
87015,90,CHG CONCENTRATION FOR INFECTIOUS AGENT,300,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$46.00 
87015,,PC SPEC INFECT AGENT,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$46.00 
87040,,PC CULTURE BLOOD,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$74.00 
87045,,PC CULTURE STOOL,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$68.00 
87046,,PC CULTURE-STOOL ADDL PATHO,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$68.00 
87070,,PC CULTURE THROAT OR NOSE,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$62.00 
87070,,"PC CULTURE, OTHER SOURCE",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$62.00 
87075,,PC CULTURE ANAEROBIC,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$68.00 
87076,,PC ANAEROBIC ID,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$59.00 
87077,,PC CULTURE ADDITIONAL ID,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$59.00 
87081,,"PC CULTURE, SINGLE ORGANISM",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
87086,,PC CLTR URNE ADD TO QUAN/KIT,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$50.00 
87086,,"PC URINE CULTURE,QUANTITATION",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$50.00 
87088,,"PC URINE CULTURE,PRESUMP ID",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$46.00 
87102,,"PC CULTURE FUNGUS, OTHER",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$61.00 
87103,,PC MICRO MOLD PATH,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$106.00 
87106,,PC CULTURE-YEAST IDENTIFICAT,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$74.00 
87107,,PC CULTURE-FUNGAL ID,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$74.00 
87110,,PC CULTURE CHLAMYDIA,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$112.00 
87116,,PC CULTURE ACID FAST BACILLI,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$62.00 
87147,,"PC CULTURE, IMMUNOLOGIC METH",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
87147,,"PC CULTURE, IMMUNOLOGIC METH",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
87150,,"PC CULTURE,TYPING,ID BY DNA/RNA AMP PR",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
87177,,PC OVA AND PARASITES SMEAR,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$64.00 
87181,,PC SENSITIVITY & DIFFUSION,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$36.00 
87184,,PC SUSCEPTIBILITY DISK PERP,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$43.00 
87185,,PC BETA LACTAMASE,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
87185,,"PC SUSCEPTIBILITY,BETA LACTAMASE",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
87186,,PC SENSITIVITY/MIC,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$60.00 
87205,,PC SMEAR ROUTINE STAIN,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
87206,,PC SMEAR FLOURESC/ACID FAST,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
87207,,PC SMEAR INCLUSION BODIES/PAR,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
87209,,"PC SMEAR,COMPLEX STAIN OVA/PARA",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$110.00 
87210,,PC SMEAR WET MOUNT,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
87220,,"PC TISSUE EXAM, KOH",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
87230,,PC TOXIN/ANTITOXIN ASSAY,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$136.00 
87252,,PC VIRUS ID TISSUE CULTURE,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$180.00 
87272,90,"CHG CRYPTOSPORIDUM AG, DFA",300,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$83.00 
87280,,"PC HC RSV,DFA",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$83.00 
87305,,"PC ASPERGILLUS AG,S",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$83.00 
87324,,PC IAAD IA CLOST DIFF TOXIN,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$83.00 
87328,,PC CULTURE-CRYPTOSPORIDIUM,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
87329,,PC GIARDIA ASSAY,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
87338,,"PC HELICIBACTER PYLORI AG,F",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$99.00 
87340,,PC INF AGNT HEP B SURF ANTGN,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$71.00 
87340,,PC HEP B SURFACE ANTIGEN,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$71.00 
87385,,PC HISTOPLASMA CAPSULATUM,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
87389,,PC VIRAL SEROLOGY,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$166.00 
87425,,PC ROTAVIRUS,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$82.00 
87449,,PC ANTIGEN MULTIPLE STEP NOS,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$82.00 
87476,,"PC LYME DISEASE PCR,B",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
87480,,PC CANDIDA SP DIRECT PROBE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$123.00 
87491,,PC CHLAMYDIA;AMPL PROBE TECH,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
87493,,PC INF AGENT DET ACID,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
87496,,"PC CYTOMEGALOVIRUS,AMPL PROB",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$250.00 
87498,,"PC ENTEROVIRUS PCR,P",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
87506,,PC ENTERIC PANEL,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,358.00 "
87510,,PC G VAGINALIS DIRECT PROBE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$123.00 
87517,,"PC HEPATITIS B VIRUS,QUANT",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$258.00 
87521,,"PC HEP C, AMPLIFIED PROBE",306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$250.00 
87522,,PC HEPATITIS C,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$296.00 
87529,,PC HSV PCR,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
87552,,PC HCV RNA (MAYO),301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$296.00 
87591,,PC N. GONORRHOEAE;AMPLIF PR,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
87624,,PC HPV HIGH-RISK TYPES,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$242.00 
87641,,PC MRSA BY PCR,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$250.00 
87653,,PC GRP B STREP,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$250.00 
87660,,PC T VAGINALIS DIRECT PROBE,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$123.00 
87797,,PC INF AN\GNT DNA/ RNA NES,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$155.00 
87798,,PC MALARIA PCR W/PARASIT,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$216.00 
87799,,"PC JC POLYOMA VIRUS DAN,QN PC",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$296.00 
87801,,PC INFECT AGNT DET;AMPLIFIED,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$484.00 
87804,,PC INFLUENZA,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$85.00 
87804,,PC INFLUENZA,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$85.00 
87807,,"PC DETECT AGENT,RSV",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$83.00 
87899,,PC INFECT AGENT ANTIGEN,306,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$83.00 
87902,,"PC HCV GENOTYPE,S",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,477.00 "
88104,,PC SMEAR W/ INTERP/NOT PAPS,311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$134.00 
88104,,PC SMEAR W/ INTERP/NOT PAP,311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$134.00 
88108,,PC CYTOLOGY NON-GYN,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$124.00 
88112,,PC CYTOPATHOLOGY TL NON-GYN,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
88120,,PC UROVYSION FOR BLADDER,311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,663.00 "
88141,,"PC CYTO, PHYSICIAN INTERP",311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$64.00 
88142,,HC PAP SMEAR (TL),311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$140.00 
88142,,PC CYTO THIN PREP PAP,311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$140.00 
88164,,"PC PAP SMEAR SCREEN, M.D.",311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$77.00 
88175,,PC CYSTOPATHY W SCREENING,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$188.00 
88184,,PC FLOW CYTOMETRY 1ST MARKER,311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$205.00 
88185,,PC FLOW CYTOMETRY ADD'L MARK,311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$75.00 
88187,,"PC FLOW CYTOMETRY INTERP,2-8 MARKER",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$75.00 
88189,,PC FLOW CYTOMETRY INTERP >16,311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$75.00 
88233,,PC TISSUE CULTURE SKIN/BIOPSY,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$807.00 
88262,,"PC CHROMOSOME,BLOOD",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$715.00 
88271,,PC CYTOGENETICS DNA PROBE,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$123.00 
88275,,"PC INTERPHASES,100-300",300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$264.00 
88291,,PC CYTO/MOLECULAR REPORT,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$103.00 
88302,,PC TISSUE EXAM PATHOLOGIST,314,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
88304,,HC SURGICAL PATH-LEVEL III,312,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$124.00 
88304,,PC TISSUE EXAM PATHOLOGIST,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$124.00 
88305,,HC SURGICAL PATH-LEVEL IV,312,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$212.00 
88305,,PC TISSUE EXAM PATHOLOGIST,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$212.00 
88307,,PC TISSUE EXAM PATHOLOGIST,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$575.00 
88309,,PC TISSUE EXAM PATHOLOGIST,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$810.00 
88312,,PC SPECIAL STAIN GROUP 1,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$234.00 
88313,,PC SPECIAL STAIN GROUP II,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$191.00 
88342,,PC IMMUNOHISTOCHEMISTRY,310,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$213.00 
88365,,PC HPV TESTING,311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$406.00 
89051,,PC CELL COUNT FLUID/DIFF,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
89055,,PC WBC SMEAR STOOL,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
89060,,PC CRYSTAL IDENTIFICATION,309,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$51.00 
89321,,PC SEMEN ANALYSIS,309,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$86.00 
90375,,"PR RABIES IG, IM/SUBCUT",636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$328.00 
90375,,"PR RABIES IG, IM/SUBCUT",636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$328.00 
90375,,"PR RABIES IG, IM/SUBCUT",636,PC PROF PBB FEE SCHEDULE [8053], $-   
90375,,"PR RABIES IG, IM/SUBCUT",636,PC TECH PBB FEE SCHEDULE [8043], $-   
90389,,"PR TETANUS IG, IM",636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$235.00 
90389,,"PR TETANUS IG, IM",636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$235.00 
90389,,"PR TETANUS IG, IM",636,PC PROF PBB FEE SCHEDULE [8053], $-   
90389,,"PR TETANUS IG, IM",636,PC TECH PBB FEE SCHEDULE [8043], $-   
90396,,"PR VARICELLA-ZOSTER IG, IM",636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,003.00 "
90396,,"PR VARICELLA-ZOSTER IG, IM",636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$954.00 
90396,,"PR VARICELLA-ZOSTER IG, IM",636,PC PROF PBB FEE SCHEDULE [8053], $-   
90396,,"PR VARICELLA-ZOSTER IG, IM",636,PC TECH PBB FEE SCHEDULE [8043], $-   
90460,SL,PR IM ADM THRU 18YR ANY RTE 1ST/ONLY C,771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90460,,PR IM ADM THRU 18YR ANY RTE 1ST/ONLY C,771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90460,SL,PR IM ADM THRU 18YR ANY RTE 1ST/ONLY C,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90460,,PR IM ADM THRU 18YR ANY RTE 1ST/ONLY C,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90460,,PR IM ADM THRU 18YR ANY RTE 1ST/ONLY C,771,PC PROF PBB FEE SCHEDULE [8053],$20.99 
90460,,PR IM ADM THRU 18YR ANY RTE 1ST/ONLY C,771,PC TECH PBB FEE SCHEDULE [8043],$20.99 
90461,,PR IM ADM THRU 18YR ANY RTE ADDL VAC/T,771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$21.99 
90461,SL,PR IM ADM THRU 18YR ANY RTE ADDL VAC/T,771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$22.99 
90461,,PR IM ADM THRU 18YR ANY RTE ADDL VAC/T,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.99 
90461,SL,PR IM ADM THRU 18YR ANY RTE ADDL VAC/T,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.99 
90461,,PR IM ADM THRU 18YR ANY RTE ADDL VAC/T,771,PC PROF PBB FEE SCHEDULE [8053],$25.99 
90461,,PR IM ADM THRU 18YR ANY RTE ADDL VAC/T,771,PC TECH PBB FEE SCHEDULE [8043],$26.99 
90471,,HC IMMUNIZATION ADMINISTRATION,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90471,,HC IMMUNIZATION ADMINISTRATION,771,PC TECH PBB FEE SCHEDULE [8043],$20.99 
90471,SL,"PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOX",771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90471,,"PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOX",771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90471,SL,"PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOX",771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90471,,"PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOX",771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90471,,"PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOX",771,PC PROF PBB FEE SCHEDULE [8053],$20.99 
90471,,"PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOX",771,PC TECH PBB FEE SCHEDULE [8043],$20.99 
90472,,HC IMMUNIZATION ADMIN EA ADDL,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90472,,HC IMMUNIZATION ADMIN EA ADDL,771,PC TECH PBB FEE SCHEDULE [8043],$20.99 
90472,,"PR IMMUNIZ,ADMIN,EACH ADDL",771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90472,SL,"PR IMMUNIZ,ADMIN,EACH ADDL",771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90472,,"PR IMMUNIZ,ADMIN,EACH ADDL",771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90472,SL,"PR IMMUNIZ,ADMIN,EACH ADDL",771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90472,,"PR IMMUNIZ,ADMIN,EACH ADDL",771,PC PROF PBB FEE SCHEDULE [8053],$20.99 
90472,,"PR IMMUNIZ,ADMIN,EACH ADDL",771,PC TECH PBB FEE SCHEDULE [8043],$20.99 
90473,,"HC IMMUNIZATION ADMIN,ORAL/NASAL",771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90473,,"HC IMMUNIZATION ADMIN,ORAL/NASAL",771,PC TECH PBB FEE SCHEDULE [8043],$20.99 
90473,SL,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90473,,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90473,SL,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90473,,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90473,,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC",521,PC PROF PBB FEE SCHEDULE [8053],$20.99 
90473,,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC",521,PC TECH PBB FEE SCHEDULE [8043],$20.99 
90474,,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90474,SL,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$20.99 
90474,,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90474,SL,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.99 
90474,,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ",521,PC PROF PBB FEE SCHEDULE [8053],$20.99 
90474,,"PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ",521,PC TECH PBB FEE SCHEDULE [8043],$20.99 
90620,,PR MENB-4C RECOMBNT PROT & OUTER MEMB ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$219.75 
90620,,PR MENB-4C RECOMBNT PROT & OUTER MEMB ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$219.75 
90620,,PR MENB-4C RECOMBNT PROT & OUTER MEMB ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90620,,PR MENB-4C RECOMBNT PROT & OUTER MEMB ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90632,,PR HEPA VACCINE ADULT DOSE FOR INTRAMU,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$108.00 
90632,,PR HEPA VACCINE ADULT DOSE FOR INTRAMU,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$108.00 
90632,,PR HEPA VACCINE ADULT DOSE FOR INTRAMU,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90632,,PR HEPA VACCINE ADULT DOSE FOR INTRAMU,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90633,,PR HEPA VACCINE 2 DOSE SCHEDULE PED/AD,250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$43.50 
90633,,PR HEPA VACCINE 2 DOSE SCHEDULE PED/AD,250,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$50.00 
90633,,PR HEPA VACCINE 2 DOSE SCHEDULE PED/AD,250,PC PROF PBB FEE SCHEDULE [8053], $-   
90633,,PR HEPA VACCINE 2 DOSE SCHEDULE PED/AD,250,PC TECH PBB FEE SCHEDULE [8043], $-   
90636,,PR HEPA/HEPB VACCINE ADULT IM,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$152.00 
90636,,PR HEPA/HEPB VACCINE ADULT IM,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$152.00 
90636,,PR HEPA/HEPB VACCINE ADULT IM,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90636,,PR HEPA/HEPB VACCINE ADULT IM,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90647,,PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE,250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$39.00 
90647,,PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE,250,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
90647,,PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE,250,PC PROF PBB FEE SCHEDULE [8053], $-   
90647,,PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE,250,PC TECH PBB FEE SCHEDULE [8043], $-   
90648,,PR HIB PRP-T VACCINE 4 DOSE SCHEDULE I,250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$16.75 
90648,,PR HIB PRP-T VACCINE 4 DOSE SCHEDULE I,250,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$16.75 
90648,,PR HIB PRP-T VACCINE 4 DOSE SCHEDULE I,250,PC PROF PBB FEE SCHEDULE [8053], $-   
90648,,PR HIB PRP-T VACCINE 4 DOSE SCHEDULE I,250,PC TECH PBB FEE SCHEDULE [8043], $-   
90648,,PR HIBEREX VACCINE,250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$19.00 
90648,,PR HIBEREX VACCINE,250,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$19.00 
90648,,PR HIBEREX VACCINE,250,PC PROF PBB FEE SCHEDULE [8053], $-   
90648,,PR HIBEREX VACCINE,250,PC TECH PBB FEE SCHEDULE [8043], $-   
90649,,PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR I,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$249.00 
90649,,PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR I,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$249.00 
90649,,PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR I,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90649,,PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR I,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90651,,PR 9VHPV VACC 2/3 DOSE SCHED IM USE,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$326.00 
90651,,PR 9VHPV VACC 2/3 DOSE SCHED IM USE,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$326.00 
90651,,PR 9VHPV VACC 2/3 DOSE SCHED IM USE,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90651,,PR 9VHPV VACC 2/3 DOSE SCHED IM USE,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90655,,PR IIV3 VACC PRESRV FREE 0.25 ML DOSAG,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$33.00 
90655,,PR IIV3 VACC PRESRV FREE 0.25 ML DOSAG,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
90655,,PR IIV3 VACC PRESRV FREE 0.25 ML DOSAG,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90655,,PR IIV3 VACC PRESRV FREE 0.25 ML DOSAG,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90657,,PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DO,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$33.00 
90657,,PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DO,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
90657,,PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DO,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90657,,PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DO,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90658,,PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOS,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$33.00 
90658,,PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOS,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
90658,,PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOS,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90658,,PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOS,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90660,,PR LAIV3 VACCINE LIVE FOR INTRANASAL U,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$33.00 
90660,,PR LAIV3 VACCINE LIVE FOR INTRANASAL U,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
90660,,PR LAIV3 VACCINE LIVE FOR INTRANASAL U,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90660,,PR LAIV3 VACCINE LIVE FOR INTRANASAL U,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90662,,PR IIV VACCINE PRESERV FREE INCREASED ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$35.00 
90662,,PR IIV VACCINE PRESERV FREE INCREASED ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$35.00 
90662,,PR IIV VACCINE PRESERV FREE INCREASED ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90662,,PR IIV VACCINE PRESERV FREE INCREASED ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90670,,PR PCV13 VACCINE FOR INTRAMUSCULAR USE,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$278.75 
90670,,PR PCV13 VACCINE FOR INTRAMUSCULAR USE,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$278.75 
90670,,PR PCV13 VACCINE FOR INTRAMUSCULAR USE,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90670,,PR PCV13 VACCINE FOR INTRAMUSCULAR USE,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90672,,PR LAIV4 VACCINE FOR INTRANASAL USE,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$33.00 
90672,,PR LAIV4 VACCINE FOR INTRANASAL USE,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
90672,,PR LAIV4 VACCINE FOR INTRANASAL USE,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90672,,PR LAIV4 VACCINE FOR INTRANASAL USE,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90675,,"PR RABIES VACCINE, IM",636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$924.00 
90675,,"PR RABIES VACCINE, IM",636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$924.00 
90675,,"PR RABIES VACCINE, IM",636,PC PROF PBB FEE SCHEDULE [8053], $-   
90675,,"PR RABIES VACCINE, IM",636,PC TECH PBB FEE SCHEDULE [8043], $-   
90680,,PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FO,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$98.75 
90680,,PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FO,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$119.00 
90680,,PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FO,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90680,,PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FO,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90685,,PR IIV4 VACC PRSRV FREE 0.25 ML DOS FO,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$35.00 
90685,,PR IIV4 VACC PRSRV FREE 0.25 ML DOS FO,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$35.00 
90685,,PR IIV4 VACC PRSRV FREE 0.25 ML DOS FO,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90685,,PR IIV4 VACC PRSRV FREE 0.25 ML DOS FO,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90686,,PR IIV4 VACC PRESRV FREE 0.5 ML DOS FO,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$35.00 
90686,,PR IIV4 VACC PRESRV FREE 0.5 ML DOS FO,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$35.00 
90688,,PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FO,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$41.00 
90688,,PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FO,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
90688,,PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FO,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90688,,PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FO,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90691,,"PR TYPHOID VACCINE, IM",636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$141.75 
90691,,"PR TYPHOID VACCINE, IM",636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$141.75 
90691,,"PR TYPHOID VACCINE, IM",636,PC PROF PBB FEE SCHEDULE [8053], $-   
90691,,"PR TYPHOID VACCINE, IM",636,PC TECH PBB FEE SCHEDULE [8043], $-   
90696,,PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$68.00 
90696,,PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$197.00 
90696,,PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90696,,PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90698,,PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCU,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$131.00 
90698,,PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCU,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$131.00 
90698,,PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCU,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90698,,PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCU,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90700,,"PR DTAP IMMUN,IM,<7 YRS",250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$39.00 
90700,,"PR DTAP IMMUN,IM,<7 YRS",250,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
90700,,"PR DTAP IMMUN,IM,<7 YRS",250,PC PROF PBB FEE SCHEDULE [8053], $-   
90700,,"PR DTAP IMMUN,IM,<7 YRS",250,PC TECH PBB FEE SCHEDULE [8043], $-   
90702,,PR DT VACCINE YOUNGER THAN 7 YRS FOR I,250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$54.75 
90707,,"PR MMR VIRUS IMMUNIZATION, SUBCUT",250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$106.25 
90707,,"PR MMR VIRUS IMMUNIZATION, SUBCUT",250,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$65.00 
90707,,"PR MMR VIRUS IMMUNIZATION, SUBCUT",250,PC PROF PBB FEE SCHEDULE [8053], $-   
90707,,"PR MMR VIRUS IMMUNIZATION, SUBCUT",250,PC TECH PBB FEE SCHEDULE [8043], $-   
90710,,"PR COMBINED VACCINE,MMR+VARICELLA,SUB-",636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$322.50 
90710,,"PR COMBINED VACCINE,MMR+VARICELLA,SUB-",636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$322.50 
90710,,"PR COMBINED VACCINE,MMR+VARICELLA,SUB-",636,PC PROF PBB FEE SCHEDULE [8053], $-   
90710,,"PR COMBINED VACCINE,MMR+VARICELLA,SUB-",636,PC TECH PBB FEE SCHEDULE [8043], $-   
90713,,"PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB",636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$54.00 
90713,,"PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB",636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$54.00 
90713,,"PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB",636,PC PROF PBB FEE SCHEDULE [8053], $-   
90713,,"PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB",636,PC TECH PBB FEE SCHEDULE [8043], $-   
90714,,PR TD VACCINE PRSRV FREE 7 YRS OR OLDE,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$46.00 
90714,,PR TD VACCINE PRSRV FREE 7 YRS OR OLDE,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$46.00 
90714,,PR TD VACCINE PRSRV FREE 7 YRS OR OLDE,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90714,,PR TD VACCINE PRSRV FREE 7 YRS OR OLDE,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90715,,"PR TDAP VACCINE >7 YO, IM",636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$52.25 
90715,,"PR TDAP VACCINE >7 YO, IM",636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$52.25 
90715,,"PR TDAP VACCINE >7 YO, IM",636,PC PROF PBB FEE SCHEDULE [8053], $-   
90715,,"PR TDAP VACCINE >7 YO, IM",636,PC TECH PBB FEE SCHEDULE [8043], $-   
90716,,PR VAR VACCINE LIVE FOR SUBCUTANEOUS U,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$186.00 
90716,,PR VAR VACCINE LIVE FOR SUBCUTANEOUS U,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$194.00 
90716,,PR VAR VACCINE LIVE FOR SUBCUTANEOUS U,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90716,,PR VAR VACCINE LIVE FOR SUBCUTANEOUS U,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90723,,PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$98.75 
90723,,PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.75 
90723,,PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90723,,PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90732,,PR PPSV23 VACCINE 2 YRS OR OLDER FOR S,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$151.25 
90732,,PR PPSV23 VACCINE 2 YRS OR OLDER FOR S,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$151.25 
90732,,PR PPSV23 VACCINE 2 YRS OR OLDER FOR S,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90732,,PR PPSV23 VACCINE 2 YRS OR OLDER FOR S,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90733,,PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ ,250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$185.00 
90733,,PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ ,250,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$185.00 
90733,,PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ ,250,PC PROF PBB FEE SCHEDULE [8053], $-   
90733,,PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ ,250,PC TECH PBB FEE SCHEDULE [8043], $-   
90734,,PR MENACWYD/MENACWY-CRM CONJ VACC GRPS,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$170.50 
90734,,PR MENACWYD/MENACWY-CRM CONJ VACC GRPS,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$170.50 
90734,,PR MENACWYD/MENACWY-CRM CONJ VACC GRPS,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90734,,PR MENACWYD/MENACWY-CRM CONJ VACC GRPS,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90736,,PR ZOSTER VACCINE HZV LIVE FOR SUBCUTA,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$347.00 
90736,,PR ZOSTER VACCINE HZV LIVE FOR SUBCUTA,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$347.00 
90736,,PR ZOSTER VACCINE HZV LIVE FOR SUBCUTA,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90736,,PR ZOSTER VACCINE HZV LIVE FOR SUBCUTA,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90744,,PR HEPB VACCINE PED/ADOLESC 3 DOSE SCH,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
90744,,PR HEPB VACCINE PED/ADOLESC 3 DOSE SCH,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
90744,,PR HEPB VACCINE PED/ADOLESC 3 DOSE SCH,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90744,,PR HEPB VACCINE PED/ADOLESC 3 DOSE SCH,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90746,,PR HEPB VACCINE ADULT 3 DOSE SCHEDULE ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$88.00 
90746,,PR HEPB VACCINE ADULT 3 DOSE SCHEDULE ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$88.00 
90746,,PR HEPB VACCINE ADULT 3 DOSE SCHEDULE ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90746,,PR HEPB VACCINE ADULT 3 DOSE SCHEDULE ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90747,,PR HEPB VACCINE DIALYSIS/IMMUNSUP PAT ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$179.00 
90747,,PR HEPB VACCINE DIALYSIS/IMMUNSUP PAT ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$168.00 
90747,,PR HEPB VACCINE DIALYSIS/IMMUNSUP PAT ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90747,,PR HEPB VACCINE DIALYSIS/IMMUNSUP PAT ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90748,,PR HIB-HEPB VACCINE FOR INTRAMUSCULAR ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$74.00 
90748,,PR HIB-HEPB VACCINE FOR INTRAMUSCULAR ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$74.00 
90748,,PR HIB-HEPB VACCINE FOR INTRAMUSCULAR ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
90748,,PR HIB-HEPB VACCINE FOR INTRAMUSCULAR ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
90750,,PR HZV ZOSTER VACC RECOMBINANT ADJUVAN,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$217.75 
92507,,HC SPEECH/HEARING THERAPY INDIV,440,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$296.00 
92526,,HC DYSPHAGIA STUDY,440,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$324.00 
92610,,HC CLINIC EVAL/SWALLOW,440,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$325.00 
92611,,HC SWAL VIDEO,440,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$341.00 
92950,,PR HEART/LUNG RESUSCITATION (CPR),521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$1,128.00 "
92950,,PR HEART/LUNG RESUSCITATION (CPR),521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,128.00 "
92950,,PR HEART/LUNG RESUSCITATION (CPR),521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],"$1,128.00 "
92960,,PR CARDIOVERSION ELECTIVE ARRHYTHMIA E,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$400.00 
92960,,PR CARDIOVERSION ELECTIVE ARRHYTHMIA E,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$599.00 
92960,A6,PR CARDIOVERSION ELECTIVE ARRHYTHMIA E,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$599.00 
92960,,PR CARDIOVERSION ELECTIVE ARRHYTHMIA E,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$325.00 
93005,,HC ROUTINE EKG,730,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$56.00 
93016,,PR CV STRS TST XERS&/OR RX CONT ECG W/,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$60.00 
93016,,PR CV STRS TST XERS&/OR RX CONT ECG W/,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$60.00 
93016,,PR CV STRS TST XERS&/OR RX CONT ECG W/,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$60.00 
93017,,HC STRESS TEST,482,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$153.00 
93018,,"PR CARDIAC STRESS TST,INTERP/REPT ONLY",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$41.00 
93018,,"PR CARDIAC STRESS TST,INTERP/REPT ONLY",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
93018,,"PR CARDIAC STRESS TST,INTERP/REPT ONLY",521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$41.00 
93040,,PR RHYTHM ECG WITH REPORT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$36.00 
93041,,"HC RHYTHM ECG,TRACING",730,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$31.00 
93224,,PR XTRNL ECG & 48 HR RECORD SCAN STOR ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$266.00 
93225,,HC ECG MONITOR/RECORD UP TO 48 HRS,731,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$117.00 
93225,,"PR EXT ECG RECORD CONTIN 48 HR, RECORD",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$64.00 
93279,,"HC PACER EVAL,PROGRAM,SINGLE",921,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$102.00 
93296,,"HC PM/ICD INTERR REMOTE,TECH REVIEW & ",480,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$115.00 
93306,,HC TTE W/DOPPLER COMPLETE,483,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$599.00 
93308,,HC ECHO EXAM OF HEART LMTD,483,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$272.00 
93784,,PR AMBULATORY BP MNTR W/SW 24 HR+ REC ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$140.00 
93784,,PR AMBULATORY BP MNTR W/SW 24 HR+ REC ,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$200.00 
93797,,HC CARDIAC REHAB/PHASE I NON-MONITORED,943,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$90.00 
93798,,HC PHASE II MONITORED,943,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$132.00 
93880,,HC CAROTID DOPPLER,921,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$605.00 
93880,26,"PR DUPLEX SCAN EXTRACRANIAL,BILAT",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$100.00 
93880,26,"PR DUPLEX SCAN EXTRACRANIAL,BILAT",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$100.00 
93926,,HC DUPLEX LOWER EXT FOLLOW UP,921,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$474.00 
93970,,HC VENOUS IMAGING,921,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$603.00 
93970,26,"PR DUPLEX EXTREM VENOUS,BILAT",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$95.00 
93970,26,"PR DUPLEX EXTREM VENOUS,BILAT",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$95.00 
93971,,HC UNILAT/LTD VENOUS,921,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$369.00 
93971,26,"PR DUPLEX EXTREM VENOUS,UNI OR LTD",972,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$62.00 
93971,26,"PR DUPLEX EXTREM VENOUS,UNI OR LTD",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$62.00 
93976,,HC DUPLEX ABD ORGAN FOLLOW UP,921,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$466.00 
93976,26,"PR DUPLEX ABD/PEL VASC STUDY,LIMITD",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$100.00 
93978,,HC ABD VASCULATURE DUPLEX,921,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$560.00 
93978,26,"PR DUPLEX LARGE VESSEL(S),COMPLETE",972,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$99.00 
94010,,PR BREATHING CAPACITY TEST,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$89.00 
94200,,PR LUNG FUNCTION TEST (MBC/MVV),521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$56.00 
94375,,PR RESPIRATORY FLOW VOLUME LOOP,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$98.00 
94640,,PR PRESSURIZED/NONPRESSURIZED INHALATI,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$54.00 
94640,,PR PRESSURIZED/NONPRESSURIZED INHALATI,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$54.00 
94640,,PR PRESSURIZED/NONPRESSURIZED INHALATI,982,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$54.00 
94660,,HC C-PAP,410,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$240.00 
95115,,HC ALLERGEN IMMUN;SINGLE INJECTIO,510,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$36.00 
95115,,"PR IMMUNOTHERAPY, ONE INJECTION",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
95117,,HC ALLERGEN IMMUN;2 OR MORE INJEC,510,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$42.00 
95117,,"PR IMMUNOTHERAPY, 2+ INJECTIONS",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$32.00 
95805,,HC MSLT,920,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,353.00 "
95807,,HC SLEEP OXIMETRY,920,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,379.00 "
95810,,HC POLYSOMNOGRAM;SLEEP STG;4+,920,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,845.00 "
95811,,HC POLYSOMNOGRAM;SLEEP STG;4+CPAP,920,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,940.00 "
95816,,"HC EEG,AWAKE & DROWSY",740,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,144.00 "
95831,,HC MANUAL MUSCLE TEST-EXTREMITY/TRUNK,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$149.00 
95832,,HC MANUAL MUSCLE TEST-HAND,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$131.00 
95833,,HC ROM TEST-TOTAL BODY,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$159.00 
95851,,HC ROM TEST-EXTREMITY/TRUNK,420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
95852,,HC ROM HAND,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$75.00 
96360,,"HC HYDRATION IV INFUSION,INIT",260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$397.00 
96361,,HC HYDRATION IV INFUSION ADD-ON,260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$80.00 
96365,,"HC THER/PROPH/DIAG IV INF,INIT",260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$449.00 
96366,,HC THER/PROPH/DIAG IV INF ADD-ON,260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$84.00 
96367,,HC THER/PROP/DG ADDL SEQ IV INF,260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$127.00 
96368,,HC THER/DIAG CONCURRENT INFUSION,260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$127.00 
96372,,"HC THER/PROPH/DIAG INJ,SC/IM",260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$127.00 
96374,,"HC THER/PROPH/DIAG INJ,IV PUSH",260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$397.00 
96375,,HC TX/PROP/DG INJ NEW DRUG ADDON,260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$80.00 
96376,,HC TX/PROP/DG INJ SAME DRUG ADDON,260,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$80.00 
96401,,"HC CHEMO NONHORM ANTINEOPL,SQ/IM",331,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$127.00 
96409,,"HC CHEMO,IV PUSH,SNGL DRUG",335,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$397.00 
96413,,"HC CHEMO,IV INFUSION,1 HR",335,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$611.00 
96415,,"HC CHEMO,IV INFUSION,ADDL HR",335,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$127.00 
96417,,HC CHEMO IV INFUS EA ADDL SEQ,335,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$127.00 
96422,,HC CHEMO INFUSION UP TO 1 HR,335,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$397.00 
96522,,HC IMPLANTABLE PUMP REFILL/MAINT,335,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$397.00 
96523,,HC PIC/PORT FLUSH,761,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$118.00 
97010,,HC HOT OR COLD PACKS,420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
97012,,HC TRACTION MECHANICAL,420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$56.00 
97014,,HC UNATTEND E-STIM,420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$56.00 
97016,,HC VASOPNEUMATIC DEVICE,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$48.00 
97018,,HC PARAFFIN BATH,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$38.00 
97022,,HC WHIRLPOOL,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$78.00 
97026,,HC INFRARED,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
97032,,HC E-STIM 15 MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$66.00 
97033,,HC IONTOPHORESIS 15 MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$78.00 
97034,,HC CONTRAST BATHS 15 MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$60.00 
97035,,HC ULTRASOUND 15 MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$52.00 
97110,,HC THERAP EX 15MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$115.00 
97112,,HC NEUROMUSC RE-ED 15MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$131.00 
97116,,HC GAIT TRAINING,420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$114.00 
97124,,HC MASSAGE,420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$108.00 
97127,,HC THERAPEUTIC INTERVENTION-COGNITIVE ,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$326.00 
97140,,HC MANUAL THERAPY 15MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
97150,,HC THERAPEUTIC GROUP 15 MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$69.00 
97161,GP,HC PT EVAL LOW COMPLEX 20 MIN,424,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$299.00 
97162,GP,HC PT EVAL MOD COMPLEX 30 MIN,424,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$309.00 
97163,GP,HC PT EVAL HIGH COMPLEX 45 MIN,424,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$319.00 
97164,GP,HC PT RE-EVAL EST PLAN OF CARE,424,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$216.00 
97165,GO,HC OT EVAL LOW COMPLEX 30 MIN,434,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$384.00 
97166,GO,HC OT EVAL MOD COMPLEX 45 MIN,434,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$333.00 
97167,GO,HC OT EVAL HIGH COMPLEX 60 MIN,434,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$343.00 
97168,GO,HC OT RE-EVAL EST PLAN OF CARE,434,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$235.00 
97530,,HC THERAP ACTIVITY 15MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$150.00 
97535,,HC SELF-CARE/HM MGMT TX 15MIN,335,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
97537,,HC COM/WORK RE-INTEGRA 15 MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$123.00 
97542,,HC WHEELCHAIR MGMT/PROP 15 MIN,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$125.00 
97597,,HC SELECT DEBRIDE 20 SQ CENT OR <,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$335.00 
97597,,PR DEBRIDEMENT OPEN WOUND 20 SQ CM<,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$243.00 
97597,,PR DEBRIDEMENT OPEN WOUND 20 SQ CM<,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$93.00 
97597,,PR DEBRIDEMENT OPEN WOUND 20 SQ CM<,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$93.00 
97605,,"HC NEG PRESSURE WOUND TX,< 50 CM",420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$165.00 
97605,,PR NEGATIVE PRESSURE WOUND THERAPY DME,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$111.00 
97605,,PR NEGATIVE PRESSURE WOUND THERAPY DME,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$81.00 
97605,,PR NEGATIVE PRESSURE WOUND THERAPY DME,982,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$81.00 
97606,,"HC NEG PRESSURE WOUND TX, > 50 CM",420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$194.00 
97750,,HC PHYS PER TEST/MEAS 15 MIN,420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$131.00 
97760,,HC ORTHO MGT/TRAINING INITIAL,420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$179.00 
97761,,HC PROSTHETIC TRAINING 15 MIN,420,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$154.00 
97802,,PC MNT-15 MINUTES,942,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$139.00 
97803,,PC MNT-RE-ASSESSMENT/15 MIN,942,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$121.00 
97804,,PC MNT-GROUP (2 OR MORE),942,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$64.00 
99000,,PR HANDLG&/OR CONVEY OF SPEC FOR TR OF,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$25.00 
99000,,PC MISC COLLECTION,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$25.00 
99001,,PR HANDLG&/OR CONVEY OF SPEC FOR TR FR,300,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$25.00 
99001,,PC COMMERCIAL HANDLING FEE,301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$25.00 
99024,,PR POST-OP FOLLOW-UP VISIT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033], $-   
99024,,PR POST-OP FOLLOW-UP VISIT,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
99024,,PR POST-OP FOLLOW-UP VISIT,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023], $-   
99080,,PR SPECIAL REPORTS OR FORMS,983,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$25.00 
99151,,PR MOD SED SAME PHYS/QHP INITIAL 15 MI,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$186.00 
99151,,PR MOD SED SAME PHYS/QHP INITIAL 15 MI,982,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$186.00 
99152,,PR MOD SED SAME PHYS/QHP INITIAL 15 MI,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$127.00 
99152,,PR MOD SED SAME PHYS/QHP INITIAL 15 MI,982,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$127.00 
99153,,PR MOD SED SAME PHYS/QHP EACH ADDL 15 ,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
99153,,PR MOD SED SAME PHYS/QHP EACH ADDL 15 ,982,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$27.00 
99155,,PR MOD SED OTHER PHYS/QHP INITIAL 15 M,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$215.00 
99155,,PR MOD SED OTHER PHYS/QHP INITIAL 15 M,982,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$215.00 
99156,,PR MOD SED OTHER PHYS/QHP INITIAL 15 M,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$197.00 
99156,,PR MOD SED OTHER PHYS/QHP INITIAL 15 M,982,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$197.00 
99157,,PR MOD SED OTHER PHYS/QHP EACH ADDL 15,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$160.00 
99157,,PR MOD SED OTHER PHYS/QHP EACH ADDL 15,982,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$160.00 
99195,,HC PHLEBOTOMY IN INFUSION CTR,940,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$380.00 
99195,,PR PHLEBOTOMY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$380.00 
99199,,PR SPECIAL SERVICE/PROC/REPORT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$25.00 
99201,,PR OFFICE OUTPATIENT NEW 10 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$114.00 
99201,,PR OFFICE OUTPATIENT NEW 10 MINUTES,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$72.00 
99201,,PR OFFICE OUTPATIENT NEW 10 MINUTES,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$72.00 
99202,,PR OFFICE OUTPATIENT NEW 20 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$202.00 
99202,,PR OFFICE OUTPATIENT NEW 20 MINUTES,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$135.00 
99202,,PR OFFICE OUTPATIENT NEW 20 MINUTES,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$135.00 
99203,,PR OFFICE OUTPATIENT NEW 30 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$293.00 
99203,,PR OFFICE OUTPATIENT NEW 30 MINUTES,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$203.00 
99203,,PR OFFICE OUTPATIENT NEW 30 MINUTES,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$203.00 
99204,,PR OFFICE OUTPATIENT NEW 45 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$447.00 
99204,,PR OFFICE OUTPATIENT NEW 45 MINUTES,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$324.00 
99205,,PR OFFICE OUTPATIENT NEW 60 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$554.00 
99205,,PR OFFICE OUTPATIENT NEW 60 MINUTES,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$424.00 
99211,,HC URGENT CARE VISIT-EST PT LEVEL I,456,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$58.00 
99211,,PR OFFICE OUTPATIENT VISIT 5 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$58.00 
99211,,PR OFFICE OUTPATIENT VISIT 5 MINUTES,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$58.00 
99211,,PR OFFICE OUTPATIENT VISIT 5 MINUTES,521,PC MEDICARE/MEDICAID PROF FEE SCHEDULE [8023],$58.00 
99211,,PC MEDICATION DISP-NOT SEEN,450,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
99211,,PC TREATMENT ROOM/NON ER NURSE VISIT,761,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$58.00 
99212,,PR OFFICE OUTPATIENT VISIT 10 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$120.00 
99213,,PR OFFICE OUTPATIENT VISIT 15 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$198.00 
99214,,PR OFFICE OUTPATIENT VISIT 25 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$290.00 
99215,,PR OFFICE OUTPATIENT VISIT 40 MINUTES,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$389.00 
99217,,PR OBSERVATION CARE DISCHARGE MANAGEME,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$194.00 
99217,,PR OBSERVATION CARE DISCHARGE MANAGEME,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$194.00 
99218,,PR INITIAL OBSERVATION CARE/DAY 30 MIN,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$264.00 
99218,,PR INITIAL OBSERVATION CARE/DAY 30 MIN,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$264.00 
99219,,PR INITIAL OBSERVATION CARE/DAY 50 MIN,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$357.00 
99219,,PR INITIAL OBSERVATION CARE/DAY 50 MIN,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$357.00 
99220,,PR INITIAL OBSERVATION CARE/DAY 70 MIN,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$491.00 
99220,,PR INITIAL OBSERVATION CARE/DAY 70 MIN,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$491.00 
99221,,PR INITIAL HOSPITAL CARE/DAY 30 MINUTE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$269.00 
99221,AI,PR INITIAL HOSPITAL CARE/DAY 30 MINUTE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$269.00 
99221,,PR INITIAL HOSPITAL CARE/DAY 30 MINUTE,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$269.00 
99221,AI,PR INITIAL HOSPITAL CARE/DAY 30 MINUTE,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$269.00 
99222,,PR INITIAL HOSPITAL CARE/DAY 50 MINUTE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$366.00 
99223,,PR INITIAL HOSPITAL CARE/DAY 70 MINUTE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$537.00 
99224,,PR SBSQ OBSERVATION CARE/DAY 15 MINUTE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$107.00 
99224,,PR SBSQ OBSERVATION CARE/DAY 15 MINUTE,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$107.00 
99225,,PR SBSQ OBSERVATION CARE/DAY 25 MINUTE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$193.00 
99225,,PR SBSQ OBSERVATION CARE/DAY 25 MINUTE,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$193.00 
99226,,PR SBSQ OBSERVATION CARE/DAY 35 MINUTE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$275.00 
99226,,PR SBSQ OBSERVATION CARE/DAY 35 MINUTE,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$275.00 
99231,,PR SBSQ HOSPITAL CARE/DAY 15 MINUTES,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$105.00 
99232,,PR SBSQ HOSPITAL CARE/DAY 25 MINUTES,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$193.00 
99233,,PR SBSQ HOSPITAL CARE/DAY 35 MINUTES,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$275.00 
99234,,PR OBSERVATION/INPATIENT HOSPITAL CARE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$356.00 
99234,,PR OBSERVATION/INPATIENT HOSPITAL CARE,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$356.00 
99235,,PR OBSERVATION/INPATIENT HOSPITAL CARE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$446.00 
99235,,PR OBSERVATION/INPATIENT HOSPITAL CARE,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$446.00 
99236,,PR OBSERVATION/INPATIENT HOSPITAL CARE,982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$577.00 
99236,,PR OBSERVATION/INPATIENT HOSPITAL CARE,982,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$577.00 
99238,,"PR HOSPITAL DISCHARGE DAY,<30 MIN",982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$194.00 
99239,,"PR HOSPITAL DISCHARGE DAY,>30 MIN",982,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$285.00 
99241,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$90.00 
99241,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$90.00 
99242,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$185.00 
99242,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$185.00 
99243,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$258.00 
99243,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$258.00 
99244,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$405.00 
99244,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$405.00 
99245,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$503.00 
99245,,PR OFFICE CONSULTATION NEW/ESTAB PATIE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$503.00 
99251,,PR INITL INPATIENT CONSULT NEW/ESTAB P,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$129.00 
99251,,PR INITL INPATIENT CONSULT NEW/ESTAB P,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$129.00 
99252,,PR INITL INPATIENT CONSULT NEW/ESTAB P,981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$199.00 
99253,,PR INITL INPATIENT CONSULT NEW/ESTAB P,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$301.00 
99254,,PR INITL INPATIENT CONSULT NEW/ESTAB P,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$434.00 
99255,,PR INITIAL INPATIENT CONSULT NEW/ESTAB,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$542.00 
99281,,HC ED LEVEL I,450,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$198.00 
99281,,PR EMERGENCY DEPARTMENT VISIT LIMITED/,981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$60.00 
99281,,PR EMERGENCY DEPARTMENT VISIT LIMITED/,981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$60.00 
99282,,HC ED LEVEL II,450,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$269.00 
99282,,PR EMERGENCY DEPARTMENT VISIT LOW/MODE,981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$112.00 
99282,,PR EMERGENCY DEPARTMENT VISIT LOW/MODE,981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$112.00 
99283,,HC ED LEVEL III,450,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$445.00 
99283,,PR EMERGENCY DEPARTMENT VISIT MODERATE,981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$164.00 
99283,,PR EMERGENCY DEPARTMENT VISIT MODERATE,981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$164.00 
99284,,HC ED LEVEL IV,450,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$750.00 
99284,,PR EMERGENCY DEPARTMENT VISIT HIGH/URG,981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$312.00 
99284,,PR EMERGENCY DEPARTMENT VISIT HIGH/URG,981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$312.00 
99285,,HC ED LEVEL V,450,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,238.00 "
99285,,PR EMERGENCY DEPT VISIT HIGH SEVERITY&,981,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$456.00 
99285,,PR EMERGENCY DEPT VISIT HIGH SEVERITY&,981,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$456.00 
99291,,HC CRITICAL CARE 1ST HOUR,450,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,922.00 "
99291,,"PR CRITICAL CARE, E/M 30-74 MINUTES",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$592.00 
99291,,"PR CRITICAL CARE, E/M 30-74 MINUTES",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$592.00 
99292,,HC CRITICAL CARE ADDL 30 MIN,450,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$516.00 
99292,,"PR CRITICAL CARE, ADDL 30 MIN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$299.00 
99292,,"PR CRITICAL CARE, ADDL 30 MIN",521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$299.00 
99304,,PR INITIAL NURSING FACILITY CARE/DAY 2,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$236.00 
99304,,PC INITIAL NURSING FACILITY CARE/DAY 2,524,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$236.00 
99305,,PR INITIAL NURSING FACILITY CARE/DAY 3,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$337.00 
99305,,PC INITIAL NURSING FACILITY CARE/DAY 3,524,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$337.00 
99306,,PR INITIAL NURSING FACILITY CARE/DAY 4,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$424.00 
99306,,PC INITIAL NURSING FACILITY CARE/DAY 4,524,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$424.00 
99307,,PR SBSQ NURSING FACILITY CARE/DAY E/M ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$113.00 
99307,,PC SBSQ NURSING FACIL CARE/DAY E/M STA,524,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$113.00 
99308,,PR SBSQ NURSING FACIL CARE/DAY MINOR C,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$176.00 
99308,,PC SBSQ NURSING FACIL CARE/DAY MINOR C,524,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$176.00 
99309,,PR SBSQ NURSING FACIL CARE/DAY NEW PRO,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$230.00 
99309,,PC SBSQ NURSING FACIL CARE/DAY NEW PRO,524,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$230.00 
99310,,PR SBSQ NURSING FACIL CARE/DAY UNSTABL,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$336.00 
99310,,PC SBSQ NURSING FACIL CAR/DAY UNSTABL/,524,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$336.00 
99315,,"PR NURSING FAC DISCHRGE DAY,1-30 MIN",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$185.00 
99316,,"PR NURSING FAC DISCHRGE DAY,MORE 30 MI",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$264.00 
99324,,PR DOMICIL/REST HOME NEW PT VISIT LOW ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$140.00 
99325,,PR DOMICIL/REST HOME NEW PT VISIT MOD ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$204.00 
99326,,PR DOMICIL/REST HOME NEW PT HI-MOD SEV,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$346.00 
99327,,PR DOMICIL/REST HOME NEW PT VISIT HI S,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$466.00 
99328,,PR DOM/R-HOME E/M NEW PT SIGNIF NEW PR,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$545.00 
99334,,PR DOM/R-HOME E/M EST PT SELF-LMTD/MIN,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$152.00 
99335,,PR DOM/R-HOME E/M EST PT LW MOD SEVERI,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$238.00 
99336,,PR DOM/R-HOME E/M EST PT MOD HI SEVERI,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$339.00 
99337,,PR DOM/R-HOME E/M EST PT SIGNIF NEW PR,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$484.00 
99341,,PR HOME VISIT NEW PATIENT LOW SEVERITY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$139.00 
99342,,PR HOME VISIT NEW PATIENT MOD SEVERITY,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$201.00 
99343,,PR HOME VST NEW PATIENT MOD-HI SEVERIT,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$327.00 
99344,,PR HOME VISIT NEW PATIENT HI SEVERITY ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$458.00 
99345,,PR HOME VISIT NEW PT UNSTABL/SIGNIF NE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$554.00 
99347,,PR HOME VISIT EST PT SELF LIMITED/MINO,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$140.00 
99348,,PR HOME VISIT EST PT LOW-MOD SEVERITY ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$211.00 
99349,,PR HOME VISIT EST PT MOD-HI SEVERITY 4,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$321.00 
99350,,PR HOME VST EST PT UNSTABLE/SIGNIF NEW,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$446.00 
99381,,"PR PREVENTIVE VISIT,NEW,INFANT < 1 YR",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$290.00 
99382,,"PR PREVENTIVE VISIT,NEW,AGE 1-4",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$304.00 
99383,,"PR PREVENTIVE VISIT,NEW,AGE5-11",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$220.00 
99384,,"PR PREVENTIVE VISIT,NEW,12-17",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$260.00 
99385,,"PR PREVENTIVE VISIT,NEW,18-39",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$250.00 
99386,,"PR PREVENTIVE VISIT,NEW,40-64",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$303.00 
99387,,"PR PREVENTIVE VISIT,NEW,65 & OVER",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$436.00 
99391,,"PR PREVENTIVE VISIT,EST, INFANT < 1 YR",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$179.00 
99392,,"PR PREVENTIVE VISIT,EST,AGE 1-4",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$195.00 
99393,,"PR PREVENTIVE VISIT,EST,AGE5-11",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$195.00 
99394,,"PR PREVENTIVE VISIT,EST,12-17",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$220.00 
99395,,"PR PREVENTIVE VISIT,EST,18-39",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$227.00 
99396,,"PR PREVENTIVE VISIT,EST,40-64",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$247.00 
99397,,"PR PREVENTIVE VISIT,EST,65 & OVER",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$261.00 
99456,,PR DISABILITY EXAM/OTHER DR,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$208.00 
99460,,PR INITIAL NB EM PER DAY HOSP,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$240.00 
99464,,PR ATTN AT DELIVERY 1ST STABILIZATION ,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$188.00 
99466,,PR CRITICAL CARE INTERFACILITY TRANSPO,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$609.00 
99499,,UNLISTED E/M SERVICE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$35.00 
A4216,,PC IVF DEXTROSE 5% 100ML PF,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
A4216,,PC IVF-DEXTROSE 5% WATER 250,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
A4216,,PC D5W 100 ML MINIBAG,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
A4216,,PC IVF-SODIUM CHLORIDE 0.9%,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
A4216,,PC D5W 250 ML ADVANTAGE,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
A4216,,PC D5W 50 ML MINIBAG,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
A4216,,PC IVF-SODIUM CHLORIDE 0.9%,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
A4216,,PC IVF-SODIUM CHLORIDE 0.9%,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$24.00 
A4565,,PR SLINGS,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$16.00 
A4570,,PC SPLINT METAL,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$199.00 
A4570,,PC SPLINT COLLES,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$49.00 
A4570,,PR DELUXE KNEE DRESSING,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$108.00 
A4570,,PR WRIST SPLINT,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$42.00 
A4570,,PR FINGER SPLINT,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$42.00 
A4570,,PR CERVICAL COLLAR-RIGID,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
A4570,,PR ANKLE BRACE,272,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$42.00 
A4580,,PR CAST SUPPLIES (PLASTER),271,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$156.00 
A6025,,PC GEL SHEET; DERMAL OR EPID,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$219.00 
A6441,,PC OT ROSIDAL SOFT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$17.00 
A6443,,"PC OT STOCINETTE 4"" / YD",270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$6.00 
A6452,,PC OT KT(SUPPLY) 10CM,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$32.00 
A6452,,PC OT KT (SUPPLY) 12 CM,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
A6452,,PC OT KT (SUPPLY) 8 CM,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
A6452,,PC OT COMPRILAN 8 CM,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$23.00 
A6452,,PC OT COMPRILAN 10 CM,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
A6452,,PC OT COMPRILAN 12 CM,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
A6457,,PC OT TUBI GRIP G/3 YD,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$41.00 
A6457,,"PC OT STOCKINETTE 6""",270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$7.00 
A6549,,PC OT ISOTONER GLOVE,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$19.00 
A9300,,PC OT FOAM BLOCKS,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$7.00 
A9300,,PC OT BLUE PUTTY,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$12.00 
A9300,,PC OT HAND GRIPPERS,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$31.00 
A9300,,PC OT THERABAND,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$12.00 
A9500,,HC NM CARDIOLITE PER SYRINGE,343,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$224.00 
A9503,,HC MDP PER DOSE,343,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$110.00 
A9512,,HC TC04 PER DOSE,343,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$21.00 
A9537,,HC CHOLETEC PER DOSE,343,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$164.00 
A9537,,HC NUC MEBROFENIN,343,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$124.00 
A9546,,PC CYANOCOBALAMIN 1000MCG,343,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$5.00 
A9562,,HC MAG-3 PER DOSE,343,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$239.00 
A9579,,"HC GADOLINIUM INJ,PER ML",255,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$14.00 
A9584,,HC I-123 UP TO 5MCI (AKA DATSCAN),343,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$375.00 
A9698,,PC GASTROVIEW,255,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$15.00 
C1781,,PC MESH: IMPLANTABLE,278,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,678.00 "
C1781,,PC SURGI WRAP MESH 120X200MM,278,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,000.00 "
E0673,,PC PNEUMATIC COMPRESSION SCD'S,947,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$604.00 
E0782,,"PC INF PUMP, IMPLANT, NONPRO",271,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,276.00 "
G0008,,PR ADMIN INFLUENZA VIRUS VAC,771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$9.00 
G0008,SL,PR ADMIN INFLUENZA VIRUS VAC,771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$29.00 
G0008,,PR ADMIN INFLUENZA VIRUS VAC,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$9.00 
G0008,SL,PR ADMIN INFLUENZA VIRUS VAC,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
G0008,,PR ADMIN INFLUENZA VIRUS VAC,771,PC PROF PBB FEE SCHEDULE [8053], $-   
G0008,,PR ADMIN INFLUENZA VIRUS VAC,771,PC TECH PBB FEE SCHEDULE [8043], $-   
G0009,,PR ADMIN PNEUMOCOCCAL VACCINE,771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$8.00 
G0009,SL,PR ADMIN PNEUMOCOCCAL VACCINE,771,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
G0009,,PR ADMIN PNEUMOCOCCAL VACCINE,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$8.00 
G0009,SL,PR ADMIN PNEUMOCOCCAL VACCINE,771,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
G0009,,PR ADMIN PNEUMOCOCCAL VACCINE,771,PC PROF PBB FEE SCHEDULE [8053], $-   
G0009,,PR ADMIN PNEUMOCOCCAL VACCINE,771,PC TECH PBB FEE SCHEDULE [8043], $-   
G0010,SL,PR ADMIN HEPATITIS B VACCINE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
G0010,,PR ADMIN HEPATITIS B VACCINE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$44.00 
G0010,SL,PR ADMIN HEPATITIS B VACCINE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
G0010,,PR ADMIN HEPATITIS B VACCINE,521,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
G0010,,PR ADMIN HEPATITIS B VACCINE,521,PC PROF PBB FEE SCHEDULE [8053], $-   
G0010,,PR ADMIN HEPATITIS B VACCINE,521,PC TECH PBB FEE SCHEDULE [8043], $-   
G0101,,PR CA SCREEN;PELVIC/BREAST EXAM,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$116.00 
G0103,,"PC PSA, TOTAL SCREENING",301,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$131.00 
G0105,,HC SCRN COLONOSCOPY HI RISK,490,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,583.00 "
G0105,,PR COLORECTAL SCRN; HI RISK IND,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$598.00 
G0108,,HC DIABETES TRAIN/INDIV 30 MIN,942,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$163.00 
G0109,,HC DIABETES EDUCATION,942,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$45.00 
G0121,,HC SCRN COLONOSCOPY NOT HI RISK,490,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,438.00 "
G0121,,PR COLON CA SCRN NOT HI RSK IND,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$598.00 
G0123,,PC SCREENING CYTOPATHOLOGY,311,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$144.00 
G0271,,PC MNT-GROUP RE-ASSESS/30 MIN,942,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$64.00 
G0283,,HC E-STIM-UNATTENDED,430,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$54.00 
G0378,,HC HOURLY OBSERVATION,762,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
G0378,,HC ICU HOURLY OBS,762,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
G0390,,PC LEVEL IV TRAUMA,684,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$818.00 
G0402,,PR IPPE,521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$445.00 
G0438,,"PR PPPS, INITIAL VISIT",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$413.00 
G0439,,"PR PPPS, SUBSEQ VISIT",521,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$275.00 
J0171,,PR ADRENALIN EPINEPHRINE INJECT,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
J0171,,PR ADRENALIN EPINEPHRINE INJECT,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
J0171,,PR ADRENALIN EPINEPHRINE INJECT,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J0171,,PR ADRENALIN EPINEPHRINE INJECT,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J0558,,PR PENG BENZATHINE/PROCAINE INJ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.21 
J0561,,PR PENICILLIN G BENZATHINE INJ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
J0690,,PR CEFAZOLIN SODIUM INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$14.00 
J0690,,PR CEFAZOLIN SODIUM INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$14.00 
J0690,,PR CEFAZOLIN SODIUM INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J0690,,PR CEFAZOLIN SODIUM INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J0696,,PR CEFTRIAXONE SODIUM INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$7.00 
J0696,,PR CEFTRIAXONE SODIUM INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$7.00 
J0696,,PR CEFTRIAXONE SODIUM INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J0696,,PR CEFTRIAXONE SODIUM INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1040,,PR METHYLPREDNISOLONE 80 MG INJ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$37.00 
J1040,,PR METHYLPREDNISOLONE 80 MG INJ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$37.00 
J1040,,PR METHYLPREDNISOLONE 80 MG INJ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1040,,PR METHYLPREDNISOLONE 80 MG INJ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1050,,PR MEDROXYPROGESTERONE ACETATE,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$1.00 
J1050,,PR MEDROXYPROGESTERONE ACETATE,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$1.00 
J1050,,PR MEDROXYPROGESTERONE ACETATE,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1050,,PR MEDROXYPROGESTERONE ACETATE,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1050,,PR DEPO-PROVERA (CAVALIER),636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$2.00 
J1050,,PR DEPO-PROVERA (CAVALIER),636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$2.00 
J1050,,PR DEPO-PROVERA (CAVALIER),636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1050,,PR DEPO-PROVERA (CAVALIER),636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1100,,PR DEXAMETHASONE 1MG INJ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$3.00 
J1100,,PR DEXAMETHASONE 1MG INJ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$3.00 
J1100,,PR DEXAMETHASONE 1MG INJ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1100,,PR DEXAMETHASONE 1MG INJ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1200,,PR DIPHENHYDRAMINE HCL INJECTIO,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
J1200,,PR DIPHENHYDRAMINE HCL INJECTIO,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
J1200,,PR DIPHENHYDRAMINE HCL INJECTIO,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1200,,PR DIPHENHYDRAMINE HCL INJECTIO,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1610,,PR GLUCAGON HYDROCHLORIDE/1 MG,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$529.00 
J1610,,PR GLUCAGON HYDROCHLORIDE/1 MG,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$529.00 
J1610,,PR GLUCAGON HYDROCHLORIDE/1 MG,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1610,,PR GLUCAGON HYDROCHLORIDE/1 MG,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1630,,PR HALOPERIDOL INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$40.00 
J1630,,PR HALOPERIDOL INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$40.00 
J1630,,PR HALOPERIDOL INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1630,,PR HALOPERIDOL INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1650,,PR INJ ENOXAPARIN SODIUM,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
J1650,,PR INJ ENOXAPARIN SODIUM,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
J1650,,PR INJ ENOXAPARIN SODIUM,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1650,,PR INJ ENOXAPARIN SODIUM,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1670,,PR HUMAN TETANUS IG UP TO 250UNITS,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$652.00 
J1670,,PR HUMAN TETANUS IG UP TO 250UNITS,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$652.00 
J1670,,PR HUMAN TETANUS IG UP TO 250UNITS,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1670,,PR HUMAN TETANUS IG UP TO 250UNITS,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J1885,,PR KETOROLAC TROMETHAMINE INJ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$7.00 
J1885,,PR KETOROLAC TROMETHAMINE INJ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$7.00 
J1885,,PR KETOROLAC TROMETHAMINE INJ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J1885,,PR KETOROLAC TROMETHAMINE INJ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J2060,,PR LORAZEPAM INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
J2060,,PR LORAZEPAM INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
J2060,,PR LORAZEPAM INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J2060,,PR LORAZEPAM INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J2175,,PR MEPERIDINE HYDROCHL /100 MG,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$30.00 
J2175,,PR MEPERIDINE HYDROCHL /100 MG,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$30.00 
J2175,,PR MEPERIDINE HYDROCHL /100 MG,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J2175,,PR MEPERIDINE HYDROCHL /100 MG,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J2270,,PR MORPHINE SULFATE INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
J2270,,PR MORPHINE SULFATE INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
J2270,,PR MORPHINE SULFATE INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J2270,,PR MORPHINE SULFATE INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J2310,,PR INJ NALOXONE HYDROCHLORIDE,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$69.00 
J2310,,PR INJ NALOXONE HYDROCHLORIDE,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$69.00 
J2310,,PR INJ NALOXONE HYDROCHLORIDE,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J2310,,PR INJ NALOXONE HYDROCHLORIDE,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J2405,,PR ONDANSETRON HCL INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$7.00 
J2405,,PR ONDANSETRON HCL INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$7.00 
J2405,,PR ONDANSETRON HCL INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J2405,,PR ONDANSETRON HCL INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J2505,,"PR INJECTION, PEGFILGRASTIM 6MG",636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],"$13,485.00 "
J2505,,"PR INJECTION, PEGFILGRASTIM 6MG",636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$13,485.00 "
J2505,,"PR INJECTION, PEGFILGRASTIM 6MG",636,PC PROF PBB FEE SCHEDULE [8053], $-   
J2505,,"PR INJECTION, PEGFILGRASTIM 6MG",636,PC TECH PBB FEE SCHEDULE [8043], $-   
J2550,,PR PROMETHAZINE HCL INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$27.00 
J2550,,PR PROMETHAZINE HCL INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$27.00 
J2550,,PR PROMETHAZINE HCL INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J2550,,PR PROMETHAZINE HCL INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J2930,,PR METHYLPREDNISOLONE INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$39.00 
J2930,,PR METHYLPREDNISOLONE INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$39.00 
J2930,,PR METHYLPREDNISOLONE INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J2930,,PR METHYLPREDNISOLONE INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J3030,,PR IMITREX INJ 6MG,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$394.00 
J3030,,PR IMITREX INJ 6MG,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$394.00 
J3030,,PR IMITREX INJ 6MG,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J3030,,PR IMITREX INJ 6MG,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J3120,,PR TESTOSTERONE ENANTHATE INJ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$14.00 
J3120,,PR TESTOSTERONE ENANTHATE INJ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$14.00 
J3120,,PR TESTOSTERONE ENANTHATE INJ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J3120,,PR TESTOSTERONE ENANTHATE INJ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J3301,,PR TRIAMCINOLONE ACETONIDE INJ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$7.00 
J3301,,PR TRIAMCINOLONE ACETONIDE INJ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$7.00 
J3301,,PR TRIAMCINOLONE ACETONIDE INJ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J3301,,PR TRIAMCINOLONE ACETONIDE INJ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J3360,,PR DIAZEPAM INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$70.00 
J3360,,PR DIAZEPAM INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$70.00 
J3360,,PR DIAZEPAM INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J3360,,PR DIAZEPAM INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J3410,,PR HYDROXYZINE HCL INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$33.00 
J3410,,PR HYDROXYZINE HCL INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$33.00 
J3410,,PR HYDROXYZINE HCL INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J3410,,PR HYDROXYZINE HCL INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J3420,,PR VITAMIN B12 INJECTION,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$35.00 
J3420,,PR VITAMIN B12 INJECTION,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$35.00 
J3420,,PR VITAMIN B12 INJECTION,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J3420,,PR VITAMIN B12 INJECTION,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J3430,,PR VITAMIN K PHYTONADIONE INJ,636,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$2.00 
J3430,,PR VITAMIN K PHYTONADIONE INJ,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$2.00 
J3430,,PR VITAMIN K PHYTONADIONE INJ,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J3430,,PR VITAMIN K PHYTONADIONE INJ,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J3490,,PR CLINDAMYCIN 600MG/4 ML INJ,250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$26.00 
J3490,,PR CLINDAMYCIN 600MG/4 ML INJ,250,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$26.00 
J3490,,PR CLINDAMYCIN 600MG/4 ML INJ,250,PC PROF PBB FEE SCHEDULE [8053], $-   
J3490,,PR CLINDAMYCIN 600MG/4 ML INJ,250,PC TECH PBB FEE SCHEDULE [8043], $-   
J7325,,PR SYNVISC PER 1MG,636,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$76.00 
J7325,,PR SYNVISC PER 1MG,636,PC PROF PBB FEE SCHEDULE [8053], $-   
J7325,,PR SYNVISC PER 1MG,636,PC TECH PBB FEE SCHEDULE [8043], $-   
J7613,,PR ALBUTEROL INHALATION UD,250,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$5.00 
J7613,,PR ALBUTEROL INHALATION UD,250,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$5.00 
J7613,,PR ALBUTEROL INHALATION UD,250,PC PROF PBB FEE SCHEDULE [8053], $-   
J7613,,PR ALBUTEROL INHALATION UD,250,PC TECH PBB FEE SCHEDULE [8043], $-   
L0120,,PR CERV FLEXIBLE NON-ADJUSTABLE,272,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$44.00 
L0220,,PR THOR RIB BELT CUSTOM FABRICA,272,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$158.00 
L1830,,PR KO IMMOBILIZER CANVAS LONGIT,272,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$119.00 
L1906,,PC OT MULTILIGAMENT ANKLE SP,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$207.00 
L1906,,PC OT MULTILIGAMENT ANKLE SP,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$207.00 
L1930,,PR AFO PLASTIC,272,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$333.00 
L3260,,PR AMBULATORY SURGICAL BOOT EAC,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$50.00 
L3260,,"PC SURGICAL BOOT/SHOE, EA",274,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$50.00 
L3260,,"PC SURGICAL BOOT/SHOE, EA",274,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$50.00 
L3650,,PR SHLDER FIG 8 ABDUCT RESTRAIN,272,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$75.00 
L3660,,PC A/C SPLINT DEPUY UNIVERSA,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$169.00 
L3660,,PC A/C SPLINT DEPUY UNIVERSA,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$169.00 
L3660,,PC CLAV/SHOULDER SPLINT/HVY,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$169.00 
L3660,,PC CLAV/SHOULDER SPLINT/HVY,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$169.00 
L3762,,PC ELBOW SPLINT POSTERIOR,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$84.00 
L3762,,PC ELBOW SPLINT POSTERIOR,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$84.00 
L3807,,"PR WHFO,NO JOINT, PREFABRICATED",272,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$317.00 
L3807,,PC MASON ALLAN SPLINT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$317.00 
L3807,,PC MASON ALLAN SPLINT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$317.00 
L3807,,PC SPEED HAND SPLINT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$317.00 
L3807,,PC SPEED HAND SPLINT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$317.00 
L3923,,PR HFO W/O JOINTS PF,272,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$110.00 
L3923,,PC THUMB SPICA,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$110.00 
L3923,,PC THUMB SPICA,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$110.00 
L3999,,PC METACARPAL SPLINT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$14.00 
L3999,,PC METACARPAL SPLINT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$14.00 
L4386,,PR NON-PNEUM WALK BOOT PREFAB,274,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$221.00 
L4386,,PC WALKER BOOT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$221.00 
L4386,,PC WALKER BOOT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$221.00 
L4386,,PC SHORT CAM BOOT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$221.00 
L4386,,PC SHORT CAM BOOT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$221.00 
L8630,,PC METACARPOPHALANGEAL JT IM,278,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$818.00 
L8630,,PC METACARPOPHALANGEAL JT IM,278,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$818.00 
L8641,,PC METATARSAL JOINT IMPLANT,278,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$865.00 
L8641,,PC METATARSAL JOINT IMPLANT,278,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$865.00 
L8642,,PC HALLUX IMPLANT,278,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$567.00 
L8642,,PC HALLUX IMPLANT,278,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$567.00 
L8658,,PC INTERPHALANGEAL JT SPACER,278,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$895.00 
L8658,,PC INTERPHALANGEAL JT SPACER,278,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$895.00 
P9016,,PC RBCS; LEUK-REDUCED EA UNT,390,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$302.00 
P9017,,PC FR FRZN PLASMA S/P,390,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$117.00 
P9035,,PC PLATELETS;PHERESIS;LEUKOC,390,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$793.00 
P9037,,PC PLATLETS; IRRATIATED,390,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,019.00 "
P9040,,PC RBC S; IRRADIATED,390,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$417.00 
P9603,,PC TRAVEL;PER MILE CHG,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$0.56 
P9615,,PC CATH COLLECT SPEC: MULTIP,300,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$15.00 
Q9965,,"HC LOCM 100-199 MG/ML IODINE,1ML",255,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$5.00 
Q9966,,"HC LOCM 200-299 MG/ML IODINE,1ML",255,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$4.00 
Q9967,,"HC LOCM 300-399 MG/ML IODINE,1ML",255,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$4.00 
V2632,,PC INTRA OCULAR LENS,276,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$387.00 
V2632,,PC INTRA OCULAR LENS,276,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$387.00 
,,HC ROOM & NURSING SP,121,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,512.00 "
,,HC ICU ROOM & NURSING,200,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,618.00 "
,,HC ER OXYGEN,271,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$35.00 
,,HC OXYGEN PER DAY,271,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$338.00 
,,HC OUT OF ROOM PROCEDURE,9999,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
,,HC IN ROOM PROCEDURE,9999,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
,,HC STAT THERAPIST DIRECT TIME,9999,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
,,OFFICE VISIT NO-CHG,9999,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033], $-   
,,OFFICE VISIT NO-CHG,9999,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
,,PC INPT DAILY ISOLATION,110,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,725.00 "
,,PC OBSERVATION ISOLATION,762,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
,,PC LEVEL 1 SURGERY,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,583.00 "
,,PC LEVEL 2 SURGERY,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$2,425.00 "
,,PC LEVEL 3 SURGERY,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$3,879.00 "
,,PC LEVEL 4 SURGERY,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$6,201.00 "
,,PC LEVEL 3.5 SURGERY,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$5,040.00 "
,,PC YAG LASER SURGERY,360,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$943.00 
,,PC RECOVERY CARE (PAR),710,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$16.00 
,,PC EXTENDED RECOVERY 1ST HR,710,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$530.00 
,,PC EXTENDED RECOVERY ADDL HR,710,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$78.00 
,,PC TREATMENT ROOM,761,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$245.00 
,,PC BLOOD ALCOHOL-LAW ENFORCEMENT,450,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$59.00 
,,PC ARM SHOULDER IMMOBILIZER,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$101.00 
,,PC ARM SHOULDER IMMOBILIZER,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$101.00 
,,PC ANKLE BRACE,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$40.00 
,,PC ANKLE BRACE,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$40.00 
,,PC KNEE IMMOBILIZER,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$118.00 
,,PC KNEE IMMOBILIZER,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$118.00 
,,PC FINGER METAL TIPS,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$5.00 
,,PC FINGER METAL TIPS,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$5.00 
,,PC CERVICAL FOAM COLLAR,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$52.00 
,,PC CERVICAL FOAM COLLAR,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$52.00 
,,PC WRIST SPLINT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$60.00 
,,PC WRIST SPLINT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$60.00 
,,"PC FINGER SPLINT, FOAM",270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$139.00 
,,"PC FINGER SPLINT, FOAM",270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$139.00 
,,PC PADDED CLAVICLE BRACE,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$59.00 
,,PC PADDED CLAVICLE BRACE,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$59.00 
,,PC UNIVERSAL ABD BINDER,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$81.00 
,,PC UNIVERSAL ABD BINDER,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$81.00 
,,PC FREDDIE THE FROG SPL,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$9.00 
,,PC FREDDIE THE FROG SPL,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$9.00 
,,PC UNIVERSAL RIB BELT WOMENS,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$44.00 
,,PC UNIVERSAL RIB BELT WOMENS,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
,,PC UNIVERSAL RIB BELT MALE,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$36.00 
,,PC UNIVERSAL RIB BELT MALE,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$36.00 
,,PC ARM SLING STRAP/CUFF LRG,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$63.00 
,,PC ARM SLING STRAP/CUFF LRG,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$63.00 
,,PC OPEN THIMBLE SPLINT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$15.00 
,,PC OPEN THIMBLE SPLINT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$15.00 
,,PC RICHARDS AC SPLINT S,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$293.00 
,,PC RICHARDS AC SPLINT S,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$293.00 
,,PC RICHARDS AC SPLINT L,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$239.00 
,,PC RICHARDS AC SPLINT L,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$239.00 
,,"PC ARM SLING STRAP, MEDIUM",270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$35.00 
,,"PC ARM SLING STRAP, MEDIUM",270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$35.00 
,,PC CLAVICLE BRACE MEEK,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$63.00 
,,PC CLAVICLE BRACE MEEK,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$63.00 
,,PC ELASTIC KNEE SUPPORT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$40.00 
,,PC ELASTIC KNEE SUPPORT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$40.00 
,,PC DEPUY HEEL/ELBOW PROTECTO,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$44.00 
,,PC DEPUY HEEL/ELBOW PROTECTO,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
,,PC HEELBO,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$44.00 
,,PC HEELBO,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$44.00 
,,PC RIGID CERVICAL COLLAR,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$128.00 
,,PC RIGID CERVICAL COLLAR,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$128.00 
,,PC BURNAM THUMB SPLINT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$105.00 
,,PC BURNAM THUMB SPLINT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$105.00 
,,PC METAL STRIPS FINGER,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$14.00 
,,PC METAL STRIPS FINGER,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$14.00 
,,PC METAL STRIPS STYRO,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$14.00 
,,PC METAL STRIPS STYRO,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$14.00 
,,PC VELFOAM SLING & SWAT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$76.00 
,,PC VELFOAM SLING & SWAT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$76.00 
,,"PC ARM SLING, AMER, LARGE",270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$66.00 
,,"PC ARM SLING, AMER, LARGE",270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$66.00 
,,"PC ARM SLING, AMER, SMALL",270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$49.00 
,,"PC ARM SLING, AMER, SMALL",270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$49.00 
,,PC WALKING HEEL FOR PLAST,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$29.00 
,,PC WALKING HEEL FOR PLAST,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
,,"PC ARM SLING, AMER, MED",270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$88.00 
,,"PC ARM SLING, AMER, MED",270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$88.00 
,,PC WALKING HEEL FOR HEX,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$40.00 
,,PC WALKING HEEL FOR HEX,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$40.00 
,,PC UNA BOOT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$46.00 
,,PC UNA BOOT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$46.00 
,,PC SKIN STAPLES 35W,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$84.00 
,,PC SKIN STAPLES 35W,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$84.00 
,,PC SUTURE OR DERMABOND,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$29.00 
,,PC SUTURE OR DERMABOND,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$29.00 
,,PC SACRAL LUMBAR SUPPORT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$98.00 
,,PC SACRAL LUMBAR SUPPORT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.00 
,,PC ELBOW SPLINT RIGID,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$177.00 
,,PC ELBOW SPLINT RIGID,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$177.00 
,,PC CRUTCHES,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$20.00 
,,PC COMPRILON BANDAGE,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$21.00 
,,PC COMPRILON BANDAGE,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$21.00 
,,PC CELLONA PADDING,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$9.00 
,,PC CELLONA PADDING,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$9.00 
,,PC SOFT ROSIDAL,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$17.00 
,,PC SOFT ROSIDAL,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$17.00 
,,PC STOCKINETTE,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$12.00 
,,PC STOCKINETTE,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$12.00 
,,PC COTTON WRAP,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$12.00 
,,PC COTTON WRAP,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$12.00 
,,PC THUMB SPLINT,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$128.00 
,,PC THUMB SPLINT,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$128.00 
,,PC SPOT ENDOSCOPY MARKER,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$145.00 
,,PC SPOT ENDOSCOPY MARKER,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$145.00 
,,PC EYE IRRIGATION SOLUTION,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$50.00 
,,PC EYE IRRIGATION SOLUTION,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$50.00 
,,PC EYE SUTURES,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$98.00 
,,PC EYE SUTURES,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$98.00 
,,PC NH WND SUPPLIES NON STERI,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033], $-   
,,PC NH WND SUPPLIES NON STERI,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
,,PC NH WND SUPPLIES STERILE,272,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033], $-   
,,PC NH WND SUPPLIES STERILE,272,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
,,PC LOCAL ANESTHESIA,370,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$14.00 
,,PC APL STABIL TB.PPD 1ML,302,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$154.00 
,,PC BIER BLOCK,370,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$171.00 
,,PC REGIONAL ANES ADDL 15MIN,370,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$68.00 
,,PC CRNA SERVICES 1ST HR,964,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],"$1,341.00 "
,,PC CRNA SERVICES EA ADDL HR,964,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$136.00 
,,"PC ANESTHESIA,GEN 1ST HR",370,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$264.00 
,,"PC ANESTHESIA,ADDL 15 MIN",370,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$68.00 
,,PC REGIONAL ANES 1ST HR,370,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$31.00 
,,PC PELVIC TX UNIVERSAL,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$57.00 
,,PC PELVIC TX UNIVERSAL,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$57.00 
,,PC SPLINT BUCK UNIVERSAL,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$62.00 
,,PC SPLINT BUCK UNIVERSAL,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$62.00 
,,PC MISC PT SUPPLY,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033], $-   
,,PC MISC PT SUPPLY,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013], $-   
,,PC LUMBOSACRAL SUPPORT UNIVE,270,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$512.00 
,,PC LUMBOSACRAL SUPPORT UNIVE,270,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$512.00 
,,PC NH CABLE TV,279,PC DEFAULT PROFESSIONAL FEE SCHEDULE [8033],$3.00 
,,PC NH CABLE TV,279,PC DEFAULT TECHNICAL FEE SCHEDULE [8013],$3.00 
G2024,,SPEC COLL SNF/LAB COVID-19,301,,$33.00 
G2023,,SPEC COLL COVID-19,301,,$33.00 
C9803,,HOPD COVID-19 SPEC COLL,301,,$36.00 
U0002,,COVID-19 LAB TEST NON-CDC,301,,$161.00 
U0001,,2019-NCOV DIAGNOSTIC,301,,$113.00