AB 1045 - List of 25 Common Outpatient Procedures for 2017 Office of Statewide Health Planning and Development AB 1045 (May 2008) Hospital Name: Mercy Medical Center Redding OSHPD Facility No: 106450949 Effective Date of Charges: June 1, 2017 Evaluation & Management Services (CPT Codes 99201-99499) 2017 CPT Code Average Charge Emergency Room Visit, Level 2 (low to moderate severity) 99282 $1,297.00 Emergency Room Visit, Level 3 (moderate severity) 99283 $2,093.00 Emergency Room Visit, Level 4 (high severity) 99284 $3,248.00 Outpatient Visit, established patient, 15 minutes 99213 $473.00 Laboratory & Pathology Services (CPT Codes 80047-89398) 2017 CPT Code Average Charge Basic Metabolic Panel 80048 $61.00 82805 $887.00 Complete Blood Count, automated 85027 $41.00 Complete Blood Count, with differential WBC, automated 85025 $41.00 Comprehensive Metabolic Panel 80053 $76.00 Creatine Kinase (CK), (CPK), Total 82550 Lipid Panel 80061 $79.00 Partial Thromboplastin Time 85730 $43.00 Prothrombin Time 85610 $28.00 Thyroid Stimulating Hormone 84443 $108.00 Troponin, Quantitative 84484 $120.00 Urinalysis, without microscopy 81002 $17.00 Urinalysis, with microscopy 81001 $30.00 Radiology Services (CPT Codes 70010-79999) 2017 CPT Code Average Charge CT Scan, Abdomen, with contrast 74160 $4,724.00 CT Scan, Head or Brain, without contrast 70450 $3,651.00 CT Scan, Pelvis, with contrast 72193 $7,884.00 Mammography, Screening, Bilateral 77057 MRI, Head or Brain, without contrast, followed by contras 70553 $7,230.00 Ultrasound, Abdomen, Complete 76700 $2,433.00 Ultrasound, OB, 14 weeks or more, transabdominal 76805 $755.00 X-Ray, Lower Back, four views 72110 $1,443.00 X-Ray, Chest, two views 71020 $1,087.00 Medicine Services (CPT Codes 90281-99607) 2017 CPT Code Average Charge Cardiac Catheterization, Left Heart, percutaneous 93452 $18,861.00 Echocardiography, complete 93307 $1,642.00 Electrocardiogram, routine, with interpretation and repor 93000 Inhalation Treatment, pressurized or nonpressurized 94640 $93.00 Physical Therapy, Evaluation 97001 Physical Therapy, Gait Training 97116 $115.00 Physical Therapy, Therapeutic Exercise 97110 $129.00 assist hospitals in collecting and submitting the average charge for 25 common outpatient procedures performed by hospitals, as required by AB 1045 (Chapter 532, Statutes of 2005). Use of the OSHPD form is voluntary, but highly encouraged, as it allows hospitals to report and the public to compare uniform information regarding common outpatient procedures. Blood Gas Analysis, including 02 saturation
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AB 1045 - List of 25 CommonOutpatient Procedures for 2017
Office of Statewide Health Planning and Development AB 1045 (May 2008)
Hospital Name: Mercy Medical Center ReddingOSHPD Facility No: 106450949Effective Date of Charges: June 1, 2017
82805 $887.00Complete Blood Count, automated 85027 $41.00Complete Blood Count, with differential WBC, automated 85025 $41.00Comprehensive Metabolic Panel 80053 $76.00Creatine Kinase (CK), (CPK), Total 82550Lipid Panel 80061 $79.00Partial Thromboplastin Time 85730 $43.00Prothrombin Time 85610 $28.00Thyroid Stimulating Hormone 84443 $108.00Troponin, Quantitative 84484 $120.00Urinalysis, without microscopy 81002 $17.00Urinalysis, with microscopy 81001 $30.00
Radiology Services (CPT Codes 70010-79999) 2017 CPT Code Average ChargeCT Scan, Abdomen, with contrast 74160 $4,724.00CT Scan, Head or Brain, without contrast 70450 $3,651.00CT Scan, Pelvis, with contrast 72193 $7,884.00Mammography, Screening, Bilateral 77057MRI, Head or Brain, without contrast, followed by contrast 70553 $7,230.00Ultrasound, Abdomen, Complete 76700 $2,433.00Ultrasound, OB, 14 weeks or more, transabdominal 76805 $755.00X-Ray, Lower Back, four views 72110 $1,443.00X-Ray, Chest, two views 71020 $1,087.00
Medicine Services (CPT Codes 90281-99607) 2017 CPT Code Average ChargeCardiac Catheterization, Left Heart, percutaneous 93452 $18,861.00Echocardiography, complete 93307 $1,642.00Electrocardiogram, routine, with interpretation and report 93000Inhalation Treatment, pressurized or nonpressurized 94640 $93.00Physical Therapy, Evaluation 97001Physical Therapy, Gait Training 97116 $115.00Physical Therapy, Therapeutic Exercise 97110 $129.00
In response to requests from hospitals and the public, OSHPD has developed this form to assist hospitals in collecting and submitting the average charge for 25 common outpatient procedures performed by hospitals, as required by AB 1045 (Chapter 532, Statutes of 2005). Use of the OSHPD form is voluntary, but highly encouraged, as it allows hospitals to report and the public to compare uniform information regarding common outpatient procedures.
Blood Gas Analysis, including 02 saturation
AB 1045 - List of 25 CommonOutpatient Procedures for 2017
Office of Statewide Health Planning and Development AB 1045 (May 2008)
Hospital Name: Mercy Medical Center ReddingOSHPD Facility No: 106450949Effective Date of Charges: June 1, 2017
Surgery Services (CPT Codes 10021-69990) 2017 CPT Code Average ChargeArthroscopy, Knee, with meniscectomy (medial or lateral) 29881Arthroscopy, Shoulder, with partial acromioplasty 29826Carpal Tunnel Surgery 64721Cataract Removal with Insertion of Intraocular Lens, 1 Stage 66984Colonoscopy, diagnostic 45378Colonoscopy, with biopsy 45380Colonoscopy, with lesion removal, by snare technique 45385Discission, secondary membranous cataract, laser surgery 66821Endoscopy, Upper GI, with biopsy 43239Endoscopy, Upper GI, diagnostic 43235Excision, Breast Lesion 19120Hernia Repair, Inguinal, 5 years and older 49505
62311Injection, Anesthetic or Steroid, transforaminal epidural, lumbar 64483Laparoscopic Cholecystectomy 47562Tympanostomy (insert ventilating tube, general anesthesia) 69436Tonsillectomy with Adenoidectomy, less than 12 years old 42820
Other Common Outpatient Procedures (list as needed) 2017 CPT Code Average Charge
Count of Reported Procedures (minimum 25 required) 29Instructions for Completing AB 1045 Common Outpatient Procedure Form1. Enter Hospital Name and OSHPD Facility Number. Revise Effective Date of Charges, if necessary.2. Enter Average Charge for at least 25 commonly performed outpatient procedures. For Evaluation & Management Services, do not include related ancillary charges. For all other procedures, include related ancillary charges.
(e.g., supplies, drugs, lab, use of operating room, etc.) should be included in the average charge for that procedure.3. Do not change procedure descriptions or CPT code references. Use "Other Common Outpatient Procedures" (rows 62-71) if you are unable to select procedures from list.4. Submit completed form as Excel (.xls) file, along with chargemaster and percent change in gross revenue calculation, by e-mail to [email protected] or by standard mail on CD.
Injection, Diagnostic or Therapeutic substance, epidural, lumbar
NOTE: The CPT codes are included on this form to help identify the listed procedures based on the frequencies across hospital-based ambulatory surgery data. The average charge for all related services and procedures
Hospital Name: Mercy Medical Center ReddingOSHPD Facility No: 106450949Effective Date of Charges: June 1, 2017
600561 ADMIN OTHER IMMUN VAC ADD 364600562 ADMIN OTHER IMMUN VAC ONE 364600563 OB VST/FTL MON EST W/PROC 90600564 OB VST/FTL MON NEW W/PROC 250600565 OB OBSERV PER HR NO HCPCS 166600566 D5% W ELECTROL 148 1000ML 78600567 MOD SEDAT =>5YRS 1ST 15M 554600568 MODERATE SEDAT ADD 15MIN 465600569 PUMP PORTABL REFILL/MAINT 544600570 PUMP IMPLANTD REFIL/MAINT 544600571 INF IV TX/DX PUMP PROLONG 401600572 BLOOD COLLECTION PICC 376600573 AMNIOTIC FLUID REDUC W/US 875600574 CERCLAGE REMOVAL 6618600575 INF TX/PROPH SUBQ 1ST HR 570600576 INF TX/PROPH SUBQ ADD HR 110
2000020 PT MANUAL THERAPY EA 15 1282000070 PT THR ACTIVITY EA 15 1152000080 PT THERAPY GROUP 15 3132000090 PT WHIRLPOOL ONE EXTRMITY 2302000100 PT ULTRASOUND EA 15 752000150 PT THERAPY GROUP 30 3222000160 PT THERAPY GROUP 45 3742000170 PT THERAPY GROUP 60 4202000180 PT THERAPY GROUP 75 4672000190 PT THERAPY GROUP 90 5182000230 PT E-STIM ATTEND EA 15 592000240 PT EXERCISE THR EA 15 1292000250 PT GAIT TRAINING EA 15 1152000270 PT NEUROMSCL RE-ED EA 15 1072000290 PT SELF CARE/HOME EA 15 1122000300 PT WHEELCHAIR TRN EA 15 1272000320 PT NON-CPT CLNT SRV 15 NC 0 12000330 PT STUDENT PRODUCT/DAY NC 0 12000340 PT DEBR SL SESSION 1ST 20 5652000350 PT DEBR SL SESSION ADD 20 2712000360 PT DEBR SL SESS EA 15 NC 0 12000560 PT PHYS PRF TEST EA 15 622000570 PT MC THERAPY COMBO ADD15 702000580 PT ORTHOTIC FIT/TRN EA 15 742000590 PT E-STIM UNATTENDED OTHR 502000600 PT PARAFFIN BATH THERAPY 502000610 PT TRACTION MECHANICAL 702000630 PT IONTOPHORESIS EA 15 622000640 PT MC EVALUATION INI 30 2842000660 PT PROSTHETIC TRN EA 15 742000690 PT NON-CPT CLNT SRV 15 NC 0 1
2000710 PT MC THERAPY COMBO INI30 1382000720 PT STRAPPING UNNA BOOT 3452001260 PT E-STIM UNATTENDED ULCR 952001270 PT MC EXERCISE THR INI 30 902001290 PT MC MANUAL THR INI 30 1282001300 PT MC MANUAL THR ADD 15 1282001640 PT NON-CPT INSTRUCT 15 NC 0 12001650 PT NON-CPT INSTRUCT 15 NC 0 12001670 PT DEBR SL SESS EA 15 NC 0 12001750 PT MC EVALUATION ADD 15 1422001760 PT MASSAGE EA 15 452001770 PT MOBILITY CURRENT CH 0.012001780 PT MOBILITY CURRENT CI 0.012001790 PT MOBILITY CURRENT CJ 0.012001800 PT MOBILITY CURRENT CK 0.012001810 PT MOBILITY CURRENT CL 0.012001820 PT MOBILITY CURRENT CM 0.012001830 PT MOBILITY CURRENT CN 0.012001840 PT MOBILITY GOAL CH 0.012001850 PT MOBILITY GOAL CI 0.012001860 PT MOBILITY GOAL CJ 0.012001870 PT MOBILITY GOAL CK 0.012001880 PT MOBILITY GOAL CL 0.012001890 PT MOBILITY GOAL CM 0.012001900 PT MOBILITY GOAL CN 0.012001910 PT MOBILITY D/C STATUS CH 0.012001920 PT MOBILITY D/C STATUS CI 0.012001930 PT MOBILITY D/C STATUS CJ 0.012001940 PT MOBILITY D/C STATUS CK 0.012001950 PT MOBILITY D/C STATUS CL 0.012001960 PT MOBILITY D/C STATUS CM 0.012001970 PT MOBILITY D/C STATUS CN 0.012001980 PT BODY POS CURRENT CH 0.012001990 PT BODY POS CURRENT CI 0.012002000 PT BODY POS CURRENT CJ 0.012002010 PT BODY POS CURRENT CK 0.012002020 PT BODY POS CURRENT CL 0.012002030 PT BODY POS CURRENT CM 0.012002040 PT BODY POS CURRENT CN 0.012002050 PT BODY POS GOAL CH 0.012002060 PT BODY POS GOAL CI 0.012002070 PT BODY POS GOAL CJ 0.012002080 PT BODY POS GOAL CK 0.012002090 PT BODY POS GOAL CL 0.012002100 PT BODY POS GOAL CM 0.012002110 PT BODY POS GOAL CN 0.012002120 PT BODY POS D/C STATUS CH 0.01
2002130 PT BODY POS D/C STATUS CI 0.012002140 PT BODY POS D/C STATUS CJ 0.012002150 PT BODY POS D/C STATUS CK 0.012002160 PT BODY POS D/C STATUS CL 0.012002170 PT BODY POS D/C STATUS CM 0.012002180 PT BODY POS D/C STATUS CN 0.012002190 PT CARRY CURRENT CH 0.012002200 PT CARRY CURRENT CI 0.012002210 PT CARRY CURRENT CJ 0.012002220 PT CARRY CURRENT CK 0.012002230 PT CARRY CURRENT CL 0.012002240 PT CARRY CURRENT CM 0.012002250 PT CARRY CURRENT CN 0.012002260 PT CARRY GOAL STATUS CH 0.012002270 PT CARRY GOAL STATUS CI 0.012002280 PT CARRY GOAL STATUS CJ 0.012002290 PT CARRY GOAL STATUS CK 0.012002300 PT CARRY GOAL STATUS CL 0.012002310 PT CARRY GOAL STATUS CM 0.012002320 PT CARRY GOAL STATUS CN 0.012002330 PT CARRY D/C STATUS CH 0.012002340 PT CARRY D/C STATUS CI 0.012002350 PT CARRY D/C STATUS CJ 0.012002360 PT CARRY D/C STATUS CK 0.012002370 PT CARRY D/C STATUS CL 0.012002380 PT CARRY D/C STATUS CM 0.012002390 PT CARRY D/C STATUS CN 0.012002400 PT SELF CARE CURRENT CH 0.012002410 PT SELF CARE CURRENT CI 0.012002420 PT SELF CARE CURRENT CJ 0.012002430 PT SELF CARE CURRENT CK 0.012002440 PT SELF CARE CURRENT CL 0.012002450 PT SELF CARE CURRENT CM 0.012002460 PT SELF CARE CURRENT CN 0.012002470 PT SELF CARE GOAL CH 0.012002480 PT SELF CARE GOAL CI 0.012002490 PT SELF CARE GOAL CJ 0.012002500 PT SELF CARE GOAL CK 0.012002510 PT SELF CARE GOAL CL 0.012002520 PT SELF CARE GOAL CM 0.012002530 PT SELF CARE GOAL CN 0.012002540 PT SELF CARE D/C CH 0.012002550 PT SELF CARE D/C CI 0.012002560 PT SELF CARE D/C CJ 0.012002570 PT SELF CARE D/C CK 0.012002580 PT SELF CARE D/C CL 0.012002590 PT SELF CARE D/C CM 0.01
2002600 PT SELF CARE D/C CN 0.012002610 PT OTHER PT/OT CURRENT CH 0.012002620 PT OTHER PT/OT CURRENT CI 0.012002630 PT OTHER PT/OT CURRENT CJ 0.012002640 PT OTHER PT/OT CURRENT CK 0.012002650 PT OTHER PT/OT CURRENT CL 0.012002660 PT OTHER PT/OT CURRENT CM 0.012002670 PT OTHER PT/OT CURRENT CN 0.012002680 PT OTHER PT/OT GOAL CH 0.012002690 PT OTHER PT/OT GOAL CI 0.012002700 PT OTHER PT/OT GOAL CJ 0.012002710 PT OTHER PT/OT GOAL CK 0.012002720 PT OTHER PT/OT GOAL CL 0.012002730 PT OTHER PT/OT GOAL CM 0.012002740 PT OTHER PT/OT GOAL CN 0.012002750 PT OTHER PT/OT D/C CH 0.012002760 PT OTHER PT/OT D/C CI 0.012002770 PT OTHER PT/OT D/C CJ 0.012002780 PT OTHER PT/OT D/C CK 0.012002790 PT OTHER PT/OT D/C CL 0.012002800 PT OTHER PT/OT D/C CM 0.012002810 PT OTHER PT/OT D/C CN 0.012002820 PT SUB PT/OT CURRENT CH 0.012002830 PT SUB PT/OT CURRENT CI 0.012002840 PT SUB PT/OT CURRENT CJ 0.012002850 PT SUB PT/OT CURRENT CK 0.012002860 PT SUB PT/OT CURRENT CL 0.012002870 PT SUB PT/OT CURRENT CM 0.012002880 PT SUB PT/OT CURRENT CN 0.012002890 PT SUB PT/OT GOAL CH 0.012002900 PT SUB PT/OT GOAL CI 0.012002910 PT SUB PT/OT GOAL CJ 0.012002920 PT SUB PT/OT GOAL CK 0.012002930 PT SUB PT/OT GOAL CL 0.012002940 PT SUB PT/OT GOAL CM 0.012002950 PT SUB PT/OT GOAL CN 0.012002960 PT SUB PT/OT D/C CH 0.012002970 PT SUB PT/OT D/C CI 0.012002980 PT SUB PT/OT D/C CJ 0.012002990 PT SUB PT/OT D/C CK 0.012003000 PT SUB PT/OT D/C CL 0.012003010 PT SUB PT/OT D/C CM 0.012003020 PT SUB PT/OT D/C CN 0.012003030 PT ATTEN CURRENT CH 0.012003040 PT ATTEN CURRENT CI 0.012003050 PT ATTEN CURRENT CJ 0.012003060 PT ATTEN CURRENT CK 0.01
2003070 PT ATTEN CURRENT CL 0.012003080 PT ATTEN CURRENT CM 0.012003090 PT ATTEN CURRENT CN 0.012003100 PT ATTEN GOAL STATUS CH 0.012003110 PT ATTEN GOAL STATUS CI 0.012003120 PT ATTEN GOAL STATUS CJ 0.012003130 PT ATTEN GOAL STATUS CK 0.012003140 PT ATTEN GOAL STATUS CL 0.012003150 PT ATTEN GOAL STATUS CM 0.012003160 PT ATTEN GOAL STATUS CN 0.012003170 PT ATTEN D/C STATUS CH 0.012003180 PT ATTEN D/C STATUS CI 0.012003190 PT ATTEN D/C STATUS CJ 0.012003200 PT ATTEN D/C STATUS CK 0.012003210 PT ATTEN D/C STATUS CL 0.012003220 PT ATTEN D/C STATUS CM 0.012003230 PT ATTEN D/C STATUS CN 0.012003240 PT MEMORY CURRENT CH 0.012003250 PT MEMORY CURRENT CI 0.012003260 PT MEMORY CURRENT CJ 0.012003270 PT MEMORY CURRENT CK 0.012003280 PT MEMORY CURRENT CL 0.012003290 PT MEMORY CURRENT CM 0.012003300 PT MEMORY CURRENT CN 0.012003310 PT MEMORY GOAL STATUS CH 0.012003320 PT MEMORY GOAL STATUS CI 0.012003330 PT MEMORY GOAL STATUS CJ 0.012003340 PT MEMORY GOAL STATUS CK 0.012003350 PT MEMORY GOAL STATUS CL 0.012003360 PT MEMORY GOAL STATUS CM 0.012003370 PT MEMORY GOAL STATUS CN 0.012003380 PT MEMORY D/C STATUS CH 0.012003390 PT MEMORY D/C STATUS CI 0.012003400 PT MEMORY D/C STATUS CJ 0.012003410 PT MEMORY D/C STATUS CK 0.012003420 PT MEMORY D/C STATUS CL 0.012003430 PT MEMORY D/C STATUS CM 0.012003440 PT MEMORY D/C STATUS CN 0.012003450 PT MOBILITY CURRENT CH 0.012003460 PT MOBILITY CURRENT CI 0.012003470 PT MOBILITY CURRENT CJ 0.012003480 PT MOBILITY CURRENT CK 0.012003490 PT MOBILITY CURRENT CL 0.012003500 PT MOBILITY CURRENT CM 0.012003510 PT MOBILITY CURRENT CN 0.012003520 PT MOBILITY GOAL CH 0.012003530 PT MOBILITY GOAL CI 0.01
2003540 PT MOBILITY GOAL CJ 0.012003550 PT MOBILITY GOAL CK 0.012003560 PT MOBILITY GOAL CL 0.012003570 PT MOBILITY GOAL CM 0.012003580 PT MOBILITY GOAL CN 0.012003590 PT MOBILITY D/C STATUS CH 0.012003600 PT MOBILITY D/C STATUS CI 0.012003610 PT MOBILITY D/C STATUS CJ 0.012003620 PT MOBILITY D/C STATUS CK 0.012003630 PT MOBILITY D/C STATUS CL 0.012003640 PT MOBILITY D/C STATUS CM 0.012003650 PT MOBILITY D/C STATUS CN 0.012003660 PT BODY POS CURRENT CH 0.012003670 PT BODY POS CURRENT CI 0.012003680 PT BODY POS CURRENT CJ 0.012003690 PT BODY POS CURRENT CK 0.012003700 PT BODY POS CURRENT CL 0.012003710 PT BODY POS CURRENT CM 0.012003720 PT BODY POS CURRENT CN 0.012003730 PT BODY POS GOAL CH 0.012003740 PT BODY POS GOAL CI 0.012003750 PT BODY POS GOAL CJ 0.012003760 PT BODY POS GOAL CK 0.012003770 PT BODY POS GOAL CL 0.012003780 PT BODY POS GOAL CM 0.012003790 PT BODY POS GOAL CN 0.012003800 PT BODY POS D/C STATUS CH 0.012003810 PT BODY POS D/C STATUS CI 0.012003820 PT BODY POS D/C STATUS CJ 0.012003830 PT BODY POS D/C STATUS CK 0.012003840 PT BODY POS D/C STATUS CL 0.012003850 PT BODY POS D/C STATUS CM 0.012003860 PT BODY POS D/C STATUS CN 0.012003870 PT CARRY CURRENT CH 0.012003880 PT CARRY CURRENT CI 0.012003890 PT CARRY CURRENT CJ 0.012003900 PT CARRY CURRENT CK 0.012003910 PT CARRY CURRENT CL 0.012003920 PT CARRY CURRENT CM 0.012003930 PT CARRY CURRENT CN 0.012003940 PT CARRY GOAL STATUS CH 0.012003950 PT CARRY GOAL STATUS CI 0.012003960 PT CARRY GOAL STATUS CJ 0.012003970 PT CARRY GOAL STATUS CK 0.012003980 PT CARRY GOAL STATUS CL 0.012003990 PT CARRY GOAL STATUS CM 0.012004000 PT CARRY GOAL STATUS CN 0.01
2004010 PT CARRY D/C STATUS CH 0.012004020 PT CARRY D/C STATUS CI 0.012004030 PT CARRY D/C STATUS CJ 0.012004040 PT CARRY D/C STATUS CK 0.012004050 PT CARRY D/C STATUS CL 0.012004060 PT CARRY D/C STATUS CM 0.012004070 PT CARRY D/C STATUS CN 0.012004080 PT SELF CARE CURRENT CH 0.012004090 PT SELF CARE CURRENT CI 0.012004100 PT SELF CARE CURRENT CJ 0.012004110 PT SELF CARE CURRENT CK 0.012004120 PT SELF CARE CURRENT CL 0.012004130 PT SELF CARE CURRENT CM 0.012004140 PT SELF CARE CURRENT CN 0.012004150 PT SELF CARE GOAL CH 0.012004160 PT SELF CARE GOAL CI 0.012004170 PT SELF CARE GOAL CJ 0.012004180 PT SELF CARE GOAL CK 0.012004190 PT SELF CARE GOAL CL 0.012004200 PT SELF CARE GOAL CM 0.012004210 PT SELF CARE GOAL CN 0.012004220 PT SELF CARE D/C CH 0.012004230 PT SELF CARE D/C CI 0.012004240 PT SELF CARE D/C CJ 0.012004250 PT SELF CARE D/C CK 0.012004260 PT SELF CARE D/C CL 0.012004270 PT SELF CARE D/C CM 0.012004280 PT SELF CARE D/C CN 0.012004290 PT OTHER PT/OT CURRENT CH 0.012004300 PT OTHER PT/OT CURRENT CI 0.012004310 PT OTHER PT/OT CURRENT CJ 0.012004320 PT OTHER PT/OT CURRENT CK 0.012004330 PT OTHER PT/OT CURRENT CL 0.012004340 PT OTHER PT/OT CURRENT CM 0.012004350 PT OTHER PT/OT CURRENT CN 0.012004360 PT OTHER PT/OT GOAL CH 0.012004370 PT OTHER PT/OT GOAL CI 0.012004380 PT OTHER PT/OT GOAL CJ 0.012004390 PT OTHER PT/OT GOAL CK 0.012004400 PT OTHER PT/OT GOAL CL 0.012004410 PT OTHER PT/OT GOAL CM 0.012004420 PT OTHER PT/OT GOAL CN 0.012004430 PT OTHER PT/OT D/C CH 0.012004440 PT OTHER PT/OT D/C CI 0.012004450 PT OTHER PT/OT D/C CJ 0.012004460 PT OTHER PT/OT D/C CK 0.012004470 PT OTHER PT/OT D/C CL 0.01
2004480 PT OTHER PT/OT D/C CM 0.012004490 PT OTHER PT/OT D/C CN 0.012004500 PT SUB PT/OT CURRENT CH 0.012004510 PT SUB PT/OT CURRENT CI 0.012004520 PT SUB PT/OT CURRENT CJ 0.012004530 PT SUB PT/OT CURRENT CK 0.012004540 PT SUB PT/OT CURRENT CL 0.012004550 PT SUB PT/OT CURRENT CM 0.012004560 PT SUB PT/OT CURRENT CN 0.012004570 PT SUB PT/OT GOAL CH 0.012004580 PT SUB PT/OT GOAL CI 0.012004590 PT SUB PT/OT GOAL CJ 0.012004600 PT SUB PT/OT GOAL CK 0.012004610 PT SUB PT/OT GOAL CL 0.012004620 PT SUB PT/OT GOAL CM 0.012004630 PT SUB PT/OT GOAL CN 0.012004640 PT SUB PT/OT D/C CH 0.012004650 PT SUB PT/OT D/C CI 0.012004660 PT SUB PT/OT D/C CJ 0.012004670 PT SUB PT/OT D/C CK 0.012004680 PT SUB PT/OT D/C CL 0.012004690 PT SUB PT/OT D/C CM 0.012004700 PT SUB PT/OT D/C CN 0.012004710 PT ATTEN CURRENT CH 0.012004720 PT ATTEN CURRENT CI 0.012004730 PT ATTEN CURRENT CJ 0.012004740 PT ATTEN CURRENT CK 0.012004750 PT ATTEN CURRENT CL 0.012004760 PT ATTEN CURRENT CM 0.012004770 PT ATTEN CURRENT CN 0.012004780 PT ATTEN GOAL STATUS CH 0.012004790 PT ATTEN GOAL STATUS CI 0.012004800 PT ATTEN GOAL STATUS CJ 0.012004810 PT ATTEN GOAL STATUS CK 0.012004820 PT ATTEN GOAL STATUS CL 0.012004830 PT ATTEN GOAL STATUS CM 0.012004840 PT ATTEN GOAL STATUS CN 0.012004850 PT ATTEN D/C STATUS CH 0.012004860 PT ATTEN D/C STATUS CI 0.012004870 PT ATTEN D/C STATUS CJ 0.012004880 PT ATTEN D/C STATUS CK 0.012004890 PT ATTEN D/C STATUS CL 0.012004900 PT ATTEN D/C STATUS CM 0.012004910 PT ATTEN D/C STATUS CN 0.012004920 PT MEMORY CURRENT CH 0.012004930 PT MEMORY CURRENT CI 0.012004940 PT MEMORY CURRENT CJ 0.01
2004950 PT MEMORY CURRENT CK 0.012004960 PT MEMORY CURRENT CL 0.012004970 PT MEMORY CURRENT CM 0.012004980 PT MEMORY CURRENT CN 0.012004990 PT MEMORY GOAL STATUS CH 0.012005000 PT MEMORY GOAL STATUS CI 0.012005010 PT MEMORY GOAL STATUS CJ 0.012005020 PT MEMORY GOAL STATUS CK 0.012005030 PT MEMORY GOAL STATUS CL 0.012005040 PT MEMORY GOAL STATUS CM 0.012005050 PT MEMORY GOAL STATUS CN 0.012005060 PT MEMORY D/C STATUS CH 0.012005070 PT MEMORY D/C STATUS CI 0.012005080 PT MEMORY D/C STATUS CJ 0.012005090 PT MEMORY D/C STATUS CK 0.012005100 PT MEMORY D/C STATUS CL 0.012005110 PT MEMORY D/C STATUS CM 0.012005120 PT MEMORY D/C STATUS CN 0.012005130 PT DEBRIDE NONSEL W/POC 2542005164 PT MC RE-EVAL INI 30 2902005165 PT MC RE-EVAL ADD 15 2632005166 PT MC CASE CONSULT W RPT 2712005167 PT MC COM/WK REINT ADD 15 1172005168 PT MC COM/WK REINT INI 30 2712005169 PT MC CONFERENCE ADD 15 1172005170 PT MC CONFERENCE INI 30 2712005171 PT MC CONTRST BATH ADD 15 1172005172 PT MC CONTRST BATH INI 30 2712005173 PT MC DEBR WO ANES ADD 15 1172005174 PT MC DEBR WO ANES INI 30 2712005175 PT MC DIATH/MICRO ADD 15 1172005176 PT MC DIATH/MICRO INI 30 2712005177 PT MC DVL COGNT ADD 15 1172005178 PT MC DVL COGNT INI 30 2712005179 PT MC E-STIM ATTND ADD 15 1172005180 PT MC E-STIM ATTND INI 30 2712005181 PT MC E-STIM UNATT ADD 15 1172005182 PT MC E-STIM UNATT INI 30 2712005183 PT MC EVAL ATH TRN ADD 15 1172005184 PT MC EVAL ATH TRN INI 30 2712005185 PT MC EXERCISE THR ADD 15 1172005186 PT MC GAIT TRAIN ADD 15 1172005187 PT MC GAIT TRAIN INI 30 2712005188 PT MC HOT/COLD PCK ADD 15 1172005189 PT MC HOT/COLD PCK INI 30 2712005190 PT MC HUBBARD TANK ADD 15 1172005191 PT MC HUBBARD TANK INI 30 271
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2102060 ST OTHER SP LANG D/C CI 0.012102070 ST OTHER SP LANG D/C CJ 0.012102080 ST OTHER SP LANG D/C CK 0.012102090 ST OTHER SP LANG D/C CL 0.012102100 ST OTHER SP LANG D/C CM 0.012102110 ST OTHER SP LANG D/C CN 0.012102120 ST MOTOR SPEECH GOAL CH 0.012102130 ST MOTOR SPEECH GOAL CI 0.012102140 ST MOTOR SPEECH GOAL CJ 0.012102150 ST MOTOR SPEECH GOAL CK 0.012102160 ST MOTOR SPEECH GOAL CL 0.012102170 ST MOTOR SPEECH GOAL CM 0.012102180 ST MOTOR SPEECH GOAL CN 0.012102181 ST EVAL SPEECH FLUENCY 15 1372102182 ST EVAL SPEECH FLUENCY 30 2402102183 ST EVAL SPEECH FLUENCY 45 3552102184 ST EVAL SPEECH FLUENCY 60 5722102185 ST EVAL SPEECH FLUENCY 75 6352102186 ST EVAL SPEECH FLUENCY 90 7722102187 ST EVAL SPEECH FLUENC 105 9552102188 ST EVAL SPEECH FLUENC 120 11442102189 ST EVAL SPEECH PRODUCT 15 1662102190 ST EVAL SPEECH PRODUCT 30 2912102191 ST EVAL SPEECH PRODUCT 45 4302102192 ST EVAL SPEECH PRODUCT 60 6932102193 ST EVAL SPEECH PRODUCT 75 7692102194 ST EVAL SPEECH PRODUCT 90 9362102195 ST EVAL SPEECH PRODUC 105 11572102196 ST EVAL SPEECH PRODUC 120 13862102197 ST EVAL SP SOUND COMP 15 1852102198 ST EVAL SP SOUND COMP 30 3182102199 ST EVAL SP SOUND COMP 45 4722102200 ST EVAL SP SOUND COMP 60 7602102201 ST EVAL SP SOUND COMP 75 8422102202 ST EVAL SP SOUND COMP 90 10272102203 ST EVAL SP SOUND COMP 105 12732102204 ST EVAL SP SOUND COMP 120 15202102205 ST VOICE BEHAV ANALY 15 1392102206 ST VOICE BEHAV ANALY 30 2402102207 ST VOICE BEHAV ANALY 45 3552102208 ST VOICE BEHAV ANALY 60 5722102209 ST VOICE BEHAV ANALY 75 6332102210 ST VOICE BEHAV ANALY 90 7712102211 ST VOICE BEHAV ANALY 105 9572102212 ST VOICE BEHAV ANALY 120 11432102213 ST TREATMENT SPEECH 75 5022102214 ST TREATMENT SPEECH 90 588
2102215 ST TREATMENT SWALLOW 75 5142102216 ST TREATMENT SWALLOW 90 5652102217 ST THPY CAP KX REVIEW NC 0 22102218 ST EVAL VOICE PROS 30 2402102219 ST EVAL VOICE PROS 45 3552102220 ST EVAL VOICE PROS 60 5722102221 ST EVAL VOICE PROS 75 6332200050 OT THR ACTIVITY EA 15 1152200100 OT EXERCISE THR EA 15 1292200120 OT SELF CARE/HOME EA 15 1122200210 OT NON-CPT CLNT SRV 15 NC 0 12200220 OT STUDENT PRODUCT/DAY NC 0 12200240 OT SENSORY TECH EA 15 772200250 OT MC EVALUATION INI 30 1942200260 OT MC EVALUATION ADD 15 1562200270 OT COM/WORK REINT EA 15 522200280 OT MC THR ACTIVITY INI 30 1802200290 OT MC THR ACTIVITY ADD 15 902200300 OT NEUROMSCL RE-ED EA 15 772200340 OT MC NEUROMSCL ED INI 30 1562200350 OT MC NEUROMSCL ED ADD 15 772200360 OT MC SLF CARE/HME INI 30 2252200370 OT MC SLF CARE/HME ADD 15 1122200380 OT MOBILITY CURRENT CH 0.012200390 OT MOBILITY CURRENT CI 0.012200400 OT MOBILITY CURRENT CJ 0.012200410 OT MOBILITY CURRENT CK 0.012200420 OT MOBILITY CURRENT CL 0.012200430 OT MOBILITY CURRENT CM 0.012200440 OT MOBILITY CURRENT CN 0.012200450 OT MOBILITY GOAL CH 0.012200460 OT MOBILITY GOAL CI 0.012200470 OT MOBILITY GOAL CJ 0.012200480 OT MOBILITY GOAL CK 0.012200490 OT MOBILITY GOAL CL 0.012200500 OT MOBILITY GOAL CM 0.012200510 OT MOBILITY GOAL CN 0.012200520 OT MOBILITY D/C STATUS CH 0.012200530 OT MOBILITY D/C STATUS CI 0.012200540 OT MOBILITY D/C STATUS CJ 0.012200550 OT MOBILITY D/C STATUS CK 0.012200560 OT MOBILITY D/C STATUS CL 0.012200570 OT MOBILITY D/C STATUS CM 0.012200580 OT MOBILITY D/C STATUS CN 0.012200590 OT BODY POS CURRENT CH 0.012200600 OT BODY POS CURRENT CI 0.012200610 OT BODY POS CURRENT CJ 0.01
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2201090 OT SELF CARE GOAL CI 0.012201100 OT SELF CARE GOAL CJ 0.012201110 OT SELF CARE GOAL CK 0.012201120 OT SELF CARE GOAL CL 0.012201130 OT SELF CARE GOAL CM 0.012201140 OT SELF CARE GOAL CN 0.012201150 OT SELF CARE D/C CH 0.012201160 OT SELF CARE D/C CI 0.012201170 OT SELF CARE D/C CJ 0.012201180 OT SELF CARE D/C CK 0.012201190 OT SELF CARE D/C CL 0.012201200 OT SELF CARE D/C CM 0.012201210 OT SELF CARE D/C CN 0.012201220 OT OTHER PT/OT CURRENT CH 0.012201230 OT OTHER PT/OT CURRENT CI 0.012201240 OT OTHER PT/OT CURRENT CJ 0.012201250 OT OTHER PT/OT CURRENT CK 0.012201260 OT OTHER PT/OT CURRENT CL 0.012201270 OT OTHER PT/OT CURRENT CM 0.012201280 OT OTHER PT/OT CURRENT CN 0.012201290 OT OTHER PT/OT GOAL CH 0.012201300 OT OTHER PT/OT GOAL CI 0.012201310 OT OTHER PT/OT GOAL CJ 0.012201320 OT OTHER PT/OT GOAL CK 0.012201330 OT OTHER PT/OT GOAL CL 0.012201340 OT OTHER PT/OT GOAL CM 0.012201350 OT OTHER PT/OT GOAL CN 0.012201360 OT OTHER PT/OT D/C CH 0.012201370 OT OTHER PT/OT D/C CI 0.012201380 OT OTHER PT/OT D/C CJ 0.012201390 OT OTHER PT/OT D/C CK 0.012201400 OT OTHER PT/OT D/C CL 0.012201410 OT OTHER PT/OT D/C CM 0.012201420 OT OTHER PT/OT D/C CN 0.012201430 OT SUB PT/OT CURRENT CH 0.012201440 OT SUB PT/OT CURRENT CI 0.012201450 OT SUB PT/OT CURRENT CJ 0.012201460 OT SUB PT/OT CURRENT CK 0.012201470 OT SUB PT/OT CURRENT CL 0.012201480 OT SUB PT/OT CURRENT CM 0.012201490 OT SUB PT/OT CURRENT CN 0.012201500 OT SUB PT/OT GOAL CH 0.012201510 OT SUB PT/OT GOAL CI 0.012201520 OT SUB PT/OT GOAL CJ 0.012201530 OT SUB PT/OT GOAL CK 0.012201540 OT SUB PT/OT GOAL CL 0.012201550 OT SUB PT/OT GOAL CM 0.01
2201560 OT SUB PT/OT GOAL CN 0.012201570 OT SUB PT/OT D/C CH 0.012201580 OT SUB PT/OT D/C CI 0.012201590 OT SUB PT/OT D/C CJ 0.012201600 OT SUB PT/OT D/C CK 0.012201610 OT SUB PT/OT D/C CL 0.012201620 OT SUB PT/OT D/C CM 0.012201630 OT SUB PT/OT D/C CN 0.012201640 OT SWALLOW CURRENT CH 0.012201650 OT SWALLOW CURRENT CI 0.012201660 OT SWALLOW CURRENT CJ 0.012201670 OT SWALLOW CURRENT CK 0.012201680 OT SWALLOW CURRENT CL 0.012201690 OT SWALLOW CURRENT CM 0.012201700 OT SWALLOW CURRENT CN 0.012201710 OT SWALLOW GOAL STATUS CH 0.012201720 OT SWALLOW GOAL STATUS CI 0.012201730 OT SWALLOW GOAL STATUS CJ 0.012201740 OT SWALLOW GOAL STATUS CK 0.012201750 OT SWALLOW GOAL STATUS CL 0.012201760 OT SWALLOW GOAL STATUS CM 0.012201770 OT SWALLOW GOAL STATUS CN 0.012201780 OT SWALLOW D/C STATUS CH 0.012201790 OT SWALLOW D/C STATUS CI 0.012201800 OT SWALLOW D/C STATUS CJ 0.012201810 OT SWALLOW D/C STATUS CK 0.012201820 OT SWALLOW D/C STATUS CL 0.012201830 OT SWALLOW D/C STATUS CM 0.012201840 OT SWALLOW D/C STATUS CN 0.012201850 OT ATTEN CURRENT CH 0.012201860 OT ATTEN CURRENT CI 0.012201870 OT ATTEN CURRENT CJ 0.012201880 OT ATTEN CURRENT CK 0.012201890 OT ATTEN CURRENT CL 0.012201900 OT ATTEN CURRENT CM 0.012201910 OT ATTEN CURRENT CN 0.012201920 OT ATTEN GOAL STATUS CH 0.012201930 OT ATTEN GOAL STATUS CI 0.012201940 OT ATTEN GOAL STATUS CJ 0.012201950 OT ATTEN GOAL STATUS CK 0.012201960 OT ATTEN GOAL STATUS CL 0.012201970 OT ATTEN GOAL STATUS CM 0.012201980 OT ATTEN GOAL STATUS CN 0.012201990 OT ATTEN D/C STATUS CH 0.012202000 OT ATTEN D/C STATUS CI 0.012202010 OT ATTEN D/C STATUS CJ 0.012202020 OT ATTEN D/C STATUS CK 0.01
2202030 OT ATTEN D/C STATUS CL 0.012202040 OT ATTEN D/C STATUS CM 0.012202050 OT ATTEN D/C STATUS CN 0.012202060 OT MEMORY CURRENT CH 0.012202070 OT MEMORY CURRENT CI 0.012202080 OT MEMORY CURRENT CJ 0.012202090 OT MEMORY CURRENT CK 0.012202100 OT MEMORY CURRENT CL 0.012202110 OT MEMORY CURRENT CM 0.012202120 OT MEMORY CURRENT CN 0.012202130 OT MEMORY GOAL STATUS CH 0.012202140 OT MEMORY GOAL STATUS CI 0.012202150 OT MEMORY GOAL STATUS CJ 0.012202160 OT MEMORY GOAL STATUS CK 0.012202170 OT MEMORY GOAL STATUS CL 0.012202180 OT MEMORY GOAL STATUS CM 0.012202190 OT MEMORY GOAL STATUS CN 0.012202200 OT MEMORY D/C STATUS CH 0.012202210 OT MEMORY D/C STATUS CI 0.012202220 OT MEMORY D/C STATUS CJ 0.012202230 OT MEMORY D/C STATUS CK 0.012202240 OT MEMORY D/C STATUS CL 0.012202250 OT MEMORY D/C STATUS CM 0.012202260 OT MEMORY D/C STATUS CN 0.012202261 OT MC COM/WK REINT ADD 15 902202262 OT MC COM/WK REINT INI 30 1802202263 OT MC CONFERENCE ADD 15 902202264 OT MC CONFERENCE INI 30 1802202265 OT MC DIATH/MICRO ADD 15 902202266 OT MC DIATH/MICRO INI 30 1802202267 OT MC DVL COGNT ADD 15 902202268 OT MC DVL COGNT INI 30 1802202269 OT MC E-STIM ATTND ADD 15 902202270 OT MC E-STIM ATTND INI 30 1802202271 OT MC E-STIM UNATT ADD 15 902202272 OT MC E-STIM UNATT INI 30 1802202273 OT MC EXERCISE THR ADD 15 902202274 OT MC EXERCISE THR INI 30 1802202275 OT MC FAB SPLINT ADD 15 902202276 OT MC FAB SPLINT INI 30 1802202277 OT MC GAIT TRAIN ADD 15 902202278 OT MC GAIT TRAIN INI 30 1802202279 OT MC INFRARED THR ADD 15 902202280 OT MC INFRARED THR INI 30 1802202281 OT MC IONTOPHORES ADD 15 902202282 OT MC IONTOPHORES INI 30 1802202283 OT MC MANUAL THR ADD 15 90
2202284 OT MC MANUAL THR INI 30 1802202285 OT MC MASSAGE ADD 15 902202286 OT MC MASSAGE INI 30 1802202287 OT MC ORTH FIT/TRN ADD 15 902202288 OT MC ORTH FIT/TRN INI 30 1802202289 OT MC ORTH/PROS CK ADD 15 902202290 OT MC ORTH/PROS CK INI 30 1802202291 OT MC PROSTHTC TRN ADD 15 902202292 OT MC PROSTHTC TRN INI 30 1802202293 OT MC RE-EVAL ADD 15 1562202294 OT MC RE-EVAL INI 30 1942202295 OT MC SENSORY TECH ADD 15 902202296 OT MC SENSORY TECH INI 30 1802202297 OT MC TRACTION MEC ADD 15 902202298 OT MC TRACTION MEC INI 30 1802202299 OT MC TST DVLPMNTL ADD 15 902202300 OT MC TST DVLPMNTL INI 30 1802202301 OT MC TST NEUROBVL ADD 15 902202302 OT MC TST NEUROBVL INI 30 1802202303 OT MC ULTRASOUND ADD 15 902202304 OT MC ULTRASOUND INI 30 1802202305 OT MC UV THERAPY ADD 15 902202306 OT MC UV THERAPY INI 30 1802202307 OT MC VASOPN TX ADD 15 902202308 OT MC VASOPN TX INI 30 1802202309 OT MC WHEELCHR TRN ADD 15 902202310 OT MC WHEELCHR TRN INI 30 1802202311 OT THPY CAP KX REVIEW NC 0 22202312 OT MC TREATMENT ADD 15 902202313 OT MC TREATMENT INI 30 1802202320 OT EVAL LOW COMPLEX 30 MN 2242202321 OT EVAL MOD COMPLEX 45 MN 3382202322 OT EVAL HIGH COMPLEX 60MN 5112202323 OT RE-EVAL EST CARE PL 30 2582202324 OT EVAL LOW COMPLEX 15 MN 1792202325 OT EVAL LOW COMPLEX 45 MN 3382202326 OT EVAL MOD COMPLEX 30 MN 2242202327 OT EVAL MOD COMPLEX 60 MN 5112202328 OT EVAL HIGH COMPLEX 45MN 3382202329 OT EVAL HIGH COMPLEX 75MN 6842202330 OT EVAL HIGH COMPLEX 90MN 8572202331 OT RE-EVAL EST CARE PL 15 2442202332 OT RE-EVAL EST CARE PL 45 3022202333 OT RE-EVAL EST CARE PL 60 3472700250 LACTATED RINGERS 1L INJ 42700260 NACL 0.9% 500ML INJ 22701220 ORTHO L0150 115X-150 464
3032295 RL-A-FATTY ACID VERY LONG 19.973032296 RL-A-PREALBUMIN 16.133032297 RL-A-DRONEDARONE 1273032298 MRSA AMP PROBE 763032300 RL-A-SUSCEPT ENZYME DET 2.493032301 RL-A-MOLEC PATH PROC LVL1 503032302 RL-A-MOLEC GENE SEQ MISC 503032303 RL-A-ANTIEPILEPTICS 1-3 15.143032304 RL-A-STRONGYLOIDES IGG 14.383032305 RL-A-GBA COMMON VAR 223.853032307 RL-US-C-KIT MUTATION LIQ 8403032308 RL-US-CEBPA MUT ANALYSIS 3903032309 RL-US-FLT3 TAND DUPL VAR 1503032310 RL-US-FTL3 GENE ANALY VAR 1503032311 RL-BW-REDCELL GENOTYP CMN 2453032312 RL-A-ENZYME CELL ACTIVITY 153032313 RL-A-CELL FUNC ASSY W/STM 1503032314 RL-A-IMMUNOFLUOR PER INIT 1003032315 RL-A-IMMUNOFLU EA SPE ADD 1003032316 INFLUENZA AB MOLECULR EXP 0 33032317 RL-A-18-HYDROXYCORTICOST 150.63032318 FFP THAWING EA UNIT 2463032319 H-PH BODY FLUID 163032321 CRYO THAWING 2213032322 RL-A-DRGSCRURQL EXP 90500 0 33032323 RL-A-DRG ANYL UR AD 90500 23.43032324 RL-A-AMPHETAMINE QNT EXP 0 33032325 RL-A-AMPHETAMINE QT ADDL 8.593032326 RL-A-OPIATE QNT EXP 0 33032327 RL-A-OPIATE QT ADDL 10.753032329 H-MAGNESIUM URINE 403032330 H-FLUID LDH 393032331 H-FLUID PROTEIN 363032332 RL-A-OSTEOCALCIN EIA 17.813032333 RL-QD-LYME IGG/IGM WB 19.063032334 RL-DV-RAST IGE QN EA 573032335 RL-A-DHEA 27.943032336 RL-A-17-HYDROXYPREGN 25.233032337 RL-A-SUSCEPT PER ENZYME 2.493032338 RL-A-DEOXYCORTISOL 32.373032339 BONE MARROW ASSIST NC 0 13032340 ASP FINE NDL ASSIST NC 0 13032341 PTH INTRAOP ASSIST NC 0 13032342 RL-BR-IMMUNOHIST SNGL STN 3933032343 RESP VIRUS 3-5 TARGETS 3683032344 H-ALBUMIN FLUID 483032345 RSV A/B MOLECULAR EXP 0 3
3032346 H-LITHIUM 563032347 RL-A-AFB ID BY MALDI 5.783032348 RL-A-N MENINGIT 2001603 13.473032349 RL-A-N MENING AD 2001603 13.453032350 H-MAGNESIUM 403032352 RL-A-FIBROMETER 2012521 1453032353 RL-A-ANTIPLASMIN ACTIVITY 8.533032354 RL-A-FIBRINOLYTIC PLASMIN 19.013032355 RL-A-ALLOPUR/METAB 91204 1363032356 RL-A-FIBRINOGEN 9.393032357 RL-QD-GLUCOSE FLUID 3.13032358 RL-A-DCP 81312 72.983032359 RL-QD-HEP INDUC PLT AB 100.543032360 RL-QD-LYME AB WEST BLOT 19.063032361 RL-QD-PARVO B19 QL PCR 101.13032362 RL-A-DRUG PNL ADDL 90499 34.33032363 RL-A-STRPTZYM TTR 2013574 11.763032364 RL-A-MUSK AB RIA 2012420 9543032365 RL-A-PROTHROMBIN 1/2 178.853032366 RL-A-A1 ANTITRYP 51256 39.263032367 RL-A-A1ANTITRP PTYP 51256 39.253032368 RL-BS-HBG S SCRN UNIT 863032369 RL-A-PURKINJE CELL AB 13.333032373 H-RETICULOCYTE AUTO 433032376 RL-SR-OCCULT BLD OTHER QL 4.433032377 H-STREP B AMP PROBE 603032378 RL-A-VIRUS ANTIBODY NOS 14.253032379 RL-A-14-3-3 CSF 2008095A 503032380 RL-A-14-3-3 CSF 2008095B 50.883032381 RL-A-VPA-F 99310A 16.713032382 RL-A-VPA-F 99310B 16.713032383 PLATELET AGG ASPIRIN 853032384 PLATELET AGG PLAVIX 853032385 RL-A-LEISH IGG 51726 13.543032387 RL-A-TROPHERYMA PCR 38.593032388 RL-US-TISS CULT OTHER 586.753032389 RL-A-HYPOGLYPAN 2010292 19.973032390 RL-QD-FREE KAPPA UR 72.963032391 RL-QD-FREE LAMBDA UR 72.973032394 RL-A-CDT 70412 9.323032395 RL-A-B CELL TLT CNT 95862 68.083032396 RL-A-IONCA S 20135 15.13032397 RL-A-ITRACONAZ 98519 15.143032398 H-CULT AER ID LIM BROTH 333032400 H-NA PROBE MTB AMP 6650 963032401 H-NA PRB AMP RIF RES 6650 963032402 RL-QD-VAGINALIS RNA PCR 90.8
3032403 RL-US-CHROMO MICROARY 21003032406 RL-A-GLUCA 99165 15.83032407 RL-A-ENT AB PAN 2014108 14.413032408 RL-NE-B CELL GENE REARNGE 1323032409 RL-NE-IGK GENE ANALYSIS 1283032410 RL-NE-BRAF GENE 753032411 RL-NE-KRAS GENE 2563032412 RL-A-LEAD WB 20098 13.383032413 RL-A-K RBC 2014041 813032414 RL-DV-HC MENINGITIS/ENCH 46143100006 RL-PL-PATH LEVEL 4 34.783100007 RL-PL-SPECIAL STAIN EA 58.083100008 RL-PL-WRIGHT-GIEMSA STN 59.633100009 RL-PL-IMMUNOFL STAIN EA 68.563100010 RL-PL-ELECTRON MCR DIAG 6003100030 SP-GROSS & MICRO LVL 6 6553100040 SP-GROSS & MICRO LVL 5 4593100060 SP-GROSS ONLY LEVEL 1 553100070 SP-GROSS & MICRO LVL 2 1503100090 SP-FROZEN SEC 1ST BLK 1293100100 SP-FROZN SEC EA ADD 793100110 SP-DECALCIFICATION 443100120 SP-SPECIAL STAIN 1 2543100130 SP-SPECIAL STAIN 2 2033100140 SP-GROSS & MICRO LVL 3 1903100150 SP-GROSS & MICRO LVL 4 2463100170 SP-FNA INTERPRET 2833100180 SP-CYTOPATH CON SMR/IN 1593100190 SP-FNA DIAG 1ST EVAL 1293100300 FFP 8-24 HR EA UNIT PEDI 1993100330 RED CELLS DEGLY EA 7853100390 SP-IMMUNOHISTCHM EA AB 2183100410 PLATELETS PHER L/R EA 13073100450 RED CELLS AUTO PREPAID 3153100460 SP-CYTOPATH FLD SMEAR 1293100540 FFP > 8 HR JUMBO 7653100560 BLOOD SPLT UNIT 80 ML 3163100650 SP-IMUNCYT HER2 NEU QN 2643100750 CRYOPRECIP POOLED EA UNIT 16393100760 SP-INTRAOP CYTPTH CNS1 1543100770 SP-INTRAOP CYTPTH CNS2 973100780 PLASMA CRYO REDUCE EA 5683100820 RED CELLS L/R EA 5963100840 FFP 8-24 HR EA UNIT 3123100850 PLASMA PLT- RICH EA 9083100860 RED CELLS WASHED EA 9323100940 FFP 8-24 HR EA UNIT 498
3100970 RED CELLS L/R IRR EA 6493100980 PLT PHERESIS L/R IRRAD 13593100990 RBC FRZ/DEG/WSH L/R IRR 11133101150 RED CELLS WASHED EA 9853101160 SP-SMEAR CYTO OTHER 1133101280 FFP 8-24 HR EA UNIT IRR 4983101390 RL-A-PROCALCITONIN 20763 37.693101590 WHOLE BLOOD EA IRR 7893101600 RL-US-UROVYSN (FISH) 7353101610 RL-US-MOLEC EGFR MICRD 496.123101620 RL-US-CHROM ANLYS KRTYPE 51.843101630 RL-US-CHROM TISS CULT SLD 206.123101640 RL-US-CHROM TISSUE CULT 1003101650 RL-US-CHROM ANLY15-20CELL 1803101660 RL-US-CHROMO ANALY ADD 1003101670 RL-US-CHRM TISCLT NONNEO 1503101680 RL-US-CHROM ANLY5CEL CNT 2753101690 RL-US-CHROM MOSAIC CT 1903101700 RL-US-CHROMO CNT ADD 403101710 RL-US-FISH CULTURE 176.473101720 RL-US-FISH DNA PRB 403101730 RL-US-FISH DNAPRB25-99CEL 53.493101740 RL-US-FISH DNA PROB ADD 61.723101750 RL-US-FLOW DNA PLOIDY 80.753101760 RL-US-FLOW CYTO 1ST MARK 403101770 RL-US-FLOW CYTO ADDL MARK 123101780 RL-US-HER-2 FISH CMP AST 753101790 RL-US-HER-2 FISH PATHVYSN 753102090 RL-A-PEMPHIGUS PNL AB 215.963102100 RL-A-PEMPHIGUS PNL ADD 215.953102110 RL-A-PHENYLALANINE 80315 18.653102231 SP-IMMUNOPEROX QT COMP 3573102232 SP-INSITU HYBRID MANL 2643102258 GRANULOCYTES PHER EA 48883102259 RL-SF-PATH EXAM LEVEL 4 247.23102260 RL-SF-SPECIAL STAIN GP 2 171.23102266 RED CELLS DEGLY EA 10413102274 PLATELETS L/R 10873102276 RL-US-JAK2EXON 12 MUT PCR 4503102277 RL-US-IGVH SOMAT MUT ANAL 4073102278 RL-US-CEBPA MUT ANALYSIS 3903102279 RL-SF-HISTOCHEM STN FRZ 274.43102280 RL-SF-ENZYME STAIN 465.63102281 RL-SF-ELECT MICROSC DIAG 1486.83102287 RL-US-IMMUNOHIST STN 1ST 383102288 RL-US-SPEC STAIN GR II 653102289 RL-US-IMMUNOHIST STN ADDL 38
3102290 RL-US-CONSULT/REPORT TECH 503102313 RL-NE-NOTCH1 MUT ANALY 7753102314 RL-NE-SF3B1 MUT ANALYSIS 2753102315 RL-NE-FISH PROBE EACH 1303102316 RL-NE-IHC MORPHO ANALYSIS 753102317 RL-NE-FISH MULTIPLEX PRB 2603102320 RL-NE-IHC QUAL INIT STN 423102322 RL-NE-IHC QUAL MLTPX STN 673102323 RL-NE-IHC QUAL ADDL STN 423102324 RL-NE-PROFESSIONAL CNSLT 503102326 RL-NE-SPECIAL STAIN 443102329 RL-NE-IHC QUANTITATIVE 453200000 ARTHROCEN ASP MAJOR JT WO 4593200001 GASTRO TUBE CHANGE W IMAG 10653200002 DUOD/JEJ TUBE REPLC PERC 14553200003 JEJUNOSTMY TUBE REPL PERC 22363200004 DUOD/JEJ TUBE PERC PLACE 40813200010 IOHEXOL 240MG/ML 50ML INJ 101.483200020 IOPAMID 300MG/ML 30ML INJ 100.793200030 IOHEXOL 300MG/ML 50ML INJ 119.293200040 IOHEXOL 300MG/ML 100ML IN 231.533200050 IOHEXOL 300MG/ML 150ML IN 296.753200060 IOHEXOL 350MG/ML 50ML INJ 128.873200070 IOHEXOL 350MG/ML 100ML IN 248.773200080 IOHEXOL 350MG/ML 150ML IN 363.043200090 XR SWALLOW FUNCT CINE/VID 17983200150 XR AC JTS W/WO WTS BIL 7963200250 XR PELVIS 1 OR 2 VIEWS 6743200260 XR PELVIS CMPL 3+ VIEWS 10043200400 XR BONE SURVEY COMPLETE 18393200410 XR CHEST 1 VIEW 8363200420 XR CHEST 2 VIEWS 10873200430 XR CHEST 4+ VIEWS 11983200440 XR CHEST 4+ VWS W FLUORO 14313200450 XR STERNUM 2+ VIEWS 12193200460 XR STERNOCLAVIC JT(S) 3+ 9163200480 XR RIBS 3 VIEWS BIL 12743200490 XR ABDOMEN 1 VIEW (AP) 7563200500 XR ABD AP + OBLIQ+ CONE 12023200510 XR ABD AP DECUB UPR+CHEST 15123200530 XR SKULL <4 VIEWS 9863200540 XR TMJ OPEN/CLOSED BIL 12213200550 XR SINUSES <3 VIEWS 8613200560 XR SINUSES 3+ VIEWS 13053200570 XR FACIAL BONES <3 VIEWS 8603200580 XR FACIAL BONES 3+ VIEWS 12213200590 XR NASAL BONES 3+ VIEWS 875
3200600 XR MANDIBLE <4 VIEWS 8653200610 XR MANDIBLE 4+ VIEWS 9953200630 XR NECK SOFT TISSUE 7223200650 XR CERVICAL SPINE 2-3 VW 11583200660 XR CERVICAL SPINE 4-5 VW 15633200670 XR CERVICAL SPINE >=6 VW 20033200680 XR THORACIC SPINE 2 VIEWS 11813200690 XR THORACOLUM JUNCT>=2 VW 10543200700 XR LUMBAR SPINE 2 OR 3 VW 10543200710 XR LUMBAR SPINE 4+ VIEWS 14433200720 XR L SPINE CMP W BND 6+VW 18863200730 XR L SPINE BEND ONLY 2-3V 11903200740 XR SACROILIAC JTS <3 VWS 9183200750 XR SACROILIAC JT 3+ VWS 10783200760 XR SACRUM & COCCYX 2+ VWS 8993200770 XR MYELOGRAM THORACIC 34183200780 IR DISKOGRAM C/T SPINE 48263200800 IR RENAL CYST STDY TRANSL 14313200810 XR CERVICAL SPINE 1 VIEW 6113200820 XR CHOLANGIO/PANC INTRAOP 8353200840 XR ESOPHAGUS 14283200850 XR UGI W KUB 20093200860 XR UGI W SMALL INTESTINE 30143200870 XR SMALL BOWEL 15703200880 XR COLON BE W OR WO KUB 17213200890 XR COLON BE W AIR CON 24103200900 XR FLUORO < 1 HR 26373200910 XR UROGRM (IVP) WWO TOMO 28203200920 XR UROGRM INFUS DRP/BOLUS 29333200930 XR UROGRAM RETROGRADE 14103200940 XR CYSTOGRAM 3+ VIEWS 13433200960 IR SINUS TRACT/FIST/ABSC 12783200970 XR PORTABLE PER TRIP NC 0 13200980 IR AORTOGRM ABD W ILIOFEM 97813200990 IR VENOUS SAMPLE WWO ANG 75993201010 IR VENOGRAM EXTREMITY BIL 33173201020 IR VENACAVAGRAM INFERIOR 81513201040 US GUIDED NEEDL PLACEMENT 18023201050 IR TRNSCTH ANG EXIST CATH 19813201060 IR FLUORO GUIDE NDL PLCMT 19123201070 IR DISKOGRM LUMBAR SPINE 55053201120 XR CYSTOURETHROGR RETRO 16883201130 XR MYELOGRAM CERVICAL 37883201140 XR MYELOGRAM LUMBAR 37943201190 GASTRO TUBE PERC PLACE 35493201200 IR REMOVE FB ESOPHAGUS 24343201210 XR ENTEROCLYSIS TUBE PERC 2258
3201220 IR INTRALUMINL STRICT DIL 23523201230 IR TUBE/CATH CHANGE W CON 19173201250 IR BILE DUCT DIL WWO STNT 58283201270 XR NEPHRO/URET/URTHRA DIL 47803201300 IR VENACAVAGRAM SUPERIOR 26083201320 IR VENOGRAM RENAL BIL 101883201340 IR VENOGRAM ADRENAL BIL 78723201350 IR TRANSCATH THRPY EMBOLZ 92043201400 MC IR PTA RENAL/VISCERAL 180443201410 MC IR PTA REN/VISC EA ADD 29413201420 IR BIOPSY TRANSCATH 44113201430 MC IR PTA VENOUS 117993201440 MC IR ANGIO AV DIAL SHUNT 26583201450 IR ANGIO EA ADD VESSEL 33393201470 IR AORTOGRAM THORAC W SER 66713201480 IR AORTOGRAM ABD W SERIAL 81513201500 IR ANGIO BRACHIAL RETRO 66713201580 IR ANGIO SPINAL 62983201600 IR ANGIO EXTREMITY BIL 97813201630 IR ANGIO ADRENAL BIL 66713201640 IR ANGIO PELVIC 81513201670 IR ANGIO PULM NON SELECT 48033201680 DIATRIZO MEG 60% 50MLINJ 5.443201690 DIATRIZOATE MEG 60% 150ML 22.433201700 IR VENOGRM HEPAT W HEMODY 66713201710 XR GI TUBE LONG INTRO 10043201720 IODIXANOL 320MG/ML 50ML 68.583201730 IODIXANOL 320MG/ML 150ML 189.113201750 IOTHALAM MEG17.2%250MLINJ 43.613201820 XR BONE SURVEY INFANT 18573201910 THROMBOLY CEREBR IV INFUS 12003201920 CATH PLACE PUL ART SEGMNT 9693201930 CATH/NDL PLC CARO/VER ART 9693201940 CATH/NDL PLACE EXTREM ART 9993201950 CTH PLC ABD/PEL/EX 1ST EA 14663201960 CTH PLC ABD/PEL/ 2ND INIT 10823201970 CTH PLC ABD/PEL/ 3RD INIT 12883201980 CTH PLC ABD/PEL/EX EA ADD 7573201990 ARTHROGRAM SHOULDER INJ 7623202000 ARTHROGRAM KNEE CON INJ 7623202010 DACRYOCYSTOGRAPHY INJ 7623202020 SIALOGRAM INJ 8763202030 ARTHROGRAM ELBOW INJ 6523202040 ARTHROGRAM WRIST INJ 7623202050 ARTHROGRM HIP WO ANES INJ 8323202060 ARTHROGRAM ANKLE INJ 7623202270 ABS/CYST DRN CATH EXCHNGE 7986
3202280 BONE MARROW ASP ONLY 9233202290 BX BONE SUPERFIC TROC/NDL 15243202300 BIOPSY PROSTATE NDL/PUNCH 25483202310 CTH PLC THOR/BRAC 1ST SEL 10703202320 CTH PLC THOR/BRAC 2ND SEL 13103202330 CTH PLC THOR/BRAC 3RD SEL 15723202340 CTH PLC THOR/BRAC ADD 2-3 2493202360 CATH PLACE RT HRT/PUL ART 9693202370 CATH PLC PULM L/R ART SEL 11133202380 CATH PLACE VEN 1ST SELECT 10573202390 CATH PLACE VEN 2ND ORD 11733202400 CATH PLACE AORTA 13753202410 CATH/NDL PLC RETROG BRACH 11993202420 CATH/NDL PLC AORTA TRANSL 11993202430 VENA CAVA INTRO CATH 9613202440 VENOGRAM EXTREMTY INJ 9613202450 PORTAL VEIN CATH PERC 14943202500 OCCLUSON/EMBOLIZ CNS PERM 17093202510 OCCLUS/EMBOL NON CNS PERM 193683202530 TRANSCATHETER BIOPSY 55883202540 MC PTA RENAL/VISCERAL 129383202550 MC PTA AORTIC 86643202560 MC PTA BRACHIOCEP EA VES 115523202570 MC PTA VENOUS 113453202600 MC THROMBECT AV FISTL GRF 77093202610 IR ANGIO INTERNAL MAMMARY 31463202620 IR VENOGRAM SINUS/JUGULAR 31463202630 IR VENOGRAM SUP SAGITTAL 23663202660 IR VENOGRM HEPAT WO HEMOD 66713202670 IR PORTOGRAM W HEMODYNAMC 66713202680 IR PORTOGRAM WO HEMODYNAM 42393202700 REPOSITION CV CATH W FLUR 20423202710 INS TUNNEL CVAD W PUMP 59793202720 REPL TUN CVAD W PORT CV 74573202730 REM TUN CVA DEV W PORT/P 21073202740 VASC ACCES THROMBL DECLOT 4203202760 GASTRO TUBE CHANG WO IMAG 8343202770 GASTROSTOMY TUBE REPOSIT 15563202780 PLACE NG/OG TUBE PHY SKIL 7833202810 DILATE BILE DUCT WO STENT 53713202820 DILATE BILE DUCT W STENT 107653202860 XR CYSTOURETHROGRAM VOID 11823202870 RENAL CYST ASP/INJ PERC 28223202910 NEPHRO TRACT DILAT W GUID 48393202920 LUMBAR PUNCTURE DIAGNOSTC 16773202930 MYELOGRAM/CT LUMBAR INJ 10453203040 XR FLUORO NDL LOCAL SPINE 2398
3203190 BX BONE TROCAR/NDL DEEP 33543203200 THORACOSTOMY TUBE 13233203210 US GUIDED VASCULAR ACCESS 17583203220 INSERT NONTUN CV CATH >5 26703203230 INS TUN CV CATH WO PORT>5 78673203240 INS TUNNEL CVAD W PORT>5 55883203260 INS PICC WO PORT/PUMP>5YR 28113203270 INS CVAD PERIPH WPOR=>5YR 98103203280 REPAIR CV CATH WO PUM/POR 11443203290 REPAIR CVAD W PORT OR PMP 20423203300 REPLACE CATH ONLY CVAD W 46543203310 REPL NOTUN CV CATH WO PRT 21623203320 REPL TUN CV CATH WO PORT 48113203340 REPL PICC WO PORT 21623203350 REM TUN CV CATH WO PORT/P 12223203380 REM PERICATH MATER CV DEV 46543203390 IR REMOV PERICATH MATERL 6663203400 REM INTRALUM MATERL CVDEV 20423203410 INSERT TIPS 461613203420 REVISE TIPS 407053203460 XR TIBIA & FIBULA 1VW BIL 8363203490 XR SURGICAL SPECIMEN EA 16603203550 EVAL CV DVCE W FLUORO INJ 4593203560 IR FLUORO CVAD PL/RPL/REM 14823203580 ART MECH THROMBECTMY PRIM 80493203590 ART MECH THROMB PRIM ADD 28983203600 VENOUS MECH THROMBECTOMY 97813203630 NEPHRO TB REMOVE W FLUORO 12473203640 CAROTID STNT TRANSCATH W 233133203670 BX SALIVARY GLAND NDL 17633203680 INTRACRN VASO BLN DIL INI 49163203690 DUOD/JEJ TUBE PERC PLACE 40813203700 DUOD/JEJ TUBE REPLC PERC 14553203710 GASTRO TUBE CHANGE W IMAG 10653203720 JEJUNOSTMY TUBE REPL PERC 22363203730 REM TUBE OBSTR W FLUORO 7453203740 EVAL GI TBE PRC W FLU INJ 4973203750 VENOUS BLOOD SAMPL SPECIF 13793203760 IR FLUORO NDL LOCAL SPINE 23983203770 CHEMO ADMIN INTRATHECAL 8193203780 PLEURODESIS INSTIL AGENT 12853203790 INS TUN CTH PLEURAL W CUF 71863203800 URETER STNT REM&REP TRANS 48393203810 URETEROSTOMY TUBE CHANGE 37523203820 URETERAL STENT REM&REPL 61563203830 IOHEXOL 300MG/ML 100ML IN 152.773203840 CYSTO/VOID URETHR INJ 991
3203850 OCCLUSIVE DEVICE ART/VEIN 52063203860 IR PERITONEOGRAM 8343203870 PERITONEL CAV AIR/CON INJ 11903203890 SACRL AUGMENT INJ IMAG BI 92273203900 REM TUNNEL PLEURAL CATH 3713203910 LYSE CHEST FIBRIN SUB DAY 12843203920 MC CATH PLC AV SH DI INI 20673203930 MC CATH PLC AV SH DI ADD 803203950 LYSE CHEST FIBRIN INI DAY 12843203960 URETERAL STNT REM TRANSUR 29293203970 REM&REP NEPHROURE CTH EXT 29933203980 LUMBAR PUNCTURE THERA 9313203990 XR FLUORO 1-2 HOURS NC 0 13204000 XR FLUORO 2-3 HOURS NC 0 13204010 XR FLUORO 4-5 HOURS NC 0 13204020 XR FLUORO 3-4 HOURS NC 0 13204030 XR FLUORO 5-6 HOURS NC 0 13204050 IR ANGIO VISC WO OR W FLS 102673204070 XR FLUORO <1 HOUR NC 0 13204080 IR FLUORO 1-2 HOURS NC 0 13204090 IR FLUORO 2-3 HOURS NC 0 13204100 IR FLUORO 3-4 HOURS NC 0 13204110 IR FLUORO 4-5 HOURS NC 0 13204120 IR FLUORO <1 HOUR NC 0 13204390 BX BONE MARROW 13013204400 BONE MARRW ASP BX SME INC 13013204410 IOPAMID 300MG/ML 500MLINJ 151.83204420 IOPAMID 300MG/ML 150MLINJ 47.643204430 IOPAMID 300MG/ML 100MLINJ 32.73204440 IOPAMID 300MG/ML 50ML INJ 16.743204450 IOPAMID 300MG/ML 15MLINTH 46.53204460 IOPAMID 200MG/ML 20MLINTH 47.953204470 IOPAMID 370MG/ML 100MLINJ 37.393204480 IOPAMID 370MG/ML 500MLINJ 18.733204490 IOPAMID 250MG/ML 100MLINJ 35.023204500 IOPAMID 250MG/ML 50ML INJ 19.763204510 IOPAMID 300MG/ML 50ML INJ 16.743204520 IOPAMID 250MG/ML 50ML INJ 16.483204550 TRANSLUM ATHEREC ILIAC EA 220793204560 REVAS ILIAC TRNS ANG INI 394023204570 REVAS ILIAC STENT INI VES 486453204580 REVAS IPSIL ILI ANGIO ADD 179993204590 REVAS IPSIL ILI STENT ADD 204313204600 REVAS FEM POP TRANS ANGIO 283803204610 REVAS FEM POP ATHERECTOMY 383513204620 REVAS FEMORAL POPLT STENT 333653204630 REVAS FEM POP STENT ATHER 46405
3204640 REVAS TIBIAL PERN ANG INI 281163204650 REVAS TIB PERON ATHER INI 362703204660 REVAS TIB PERON STENT INI 359883204670 REVAS TIB PR STNT ATH INI 390813204680 REVAS TIB PERON ANGIO ADD 101223204690 REVAS TIB PERON ATHER ADD 165883204700 REVAS TIB PERON STENT ADD 143393204710 REVAS TIB PR STNT ATH ADD 196813204720 BILIARY ENDO DX PERC 74493204730 PERITN-VEN SHUNT EVAL INJ 6393204740 IR SHUNTOGRAM NONVASCULAR 5923204790 MSI ABDOMEN/PELVIS NC 0 13204800 MSI CHEST AP/OBLIQUE NC 0 13204810 MSI CRANIUM AP/LATERAL NC 0 13204820 MSI EXT LOW AP/LAT LT NC 0 13204830 MSI EXT LOW AP/LAT RT NC 0 13204840 MSI EXT UPPR AP/LAT LT NC 0 13204850 MSI EXT UPPR AP/LAT RT NC 0 13204860 MSI SPINE AP/PA/LATERL NC 0 13204870 MSI VAGINA AND INLET NC 0 13204880 INTERVRT DISC DX ASP PERC 13483204970 NACL 0.9% 250ML INJ 1003204980 NACL 0.9% 1000ML INJ 1003205040 INS IVC FILTER ENDOVAS 110743205050 CTH PLC RENAL SUPRSEL BIL 102113205070 CTH PLC RENAL ART SEL BIL 88033205090 REPOS IVC FILTER ENDOVAS 173863205100 RETR IVC FILTER ENDOVAS 169433205110 LYMPHOCELE ABLAT INGUINAL 11283205120 XR MYELOGRAM 2 OR>REGIONS 19313205130 LYMPHATIC IMMUNOTHRPY INJ 11283205140 SINUS TRACT INJ DIAG 7193205150 PERITL CTH DRN/DIALY PERM 70803205160 REM PERM PERITONEAL CATH 41963205180 CTH PLC RENAL ART SEL LT 66023205190 CTH PLC RENAL ART SEL RT 66023205200 CTH PLC RENAL SUPRSEL LT 89793205210 CTH PLC RENAL SUPRSEL RT 89793205220 IR ANGIO ADRENAL LT 78973205230 IR ANGIO ADRENAL RT 78973205300 IR ANGIO EXTREMITY LT 81513205310 IR ANGIO EXTREMITY LT XU 81513205320 IR ANGIO EXTREMITY RT 81513205330 IR ANGIO EXTREMITY RT XU 81513205340 IR ANGIO PULMONARY LT 66713205350 IR ANGIO PULMONARY RT 66713205420 IR UROGRAM ANTEGRADE LT 1410
3207990 XR UGI WO KUB 19283208000 XR UGI W AIR CON WO KUB 3733208040 XR UROGRM (IVP) LTD 28203208060 XR UROGRAM ANTEGRADE 14103208070 XR SINUS TRACT/FIST/ABSC 12783208120 XR HYSTEROSALPINGOGRAM 7773208130 XR THORACIC SPINE 3 VIEWS 13223208140 HYSTERO NS/CON INTRO 6523208150 URETHROCYSTOGRM RETRO INJ 2473208570 XR TELERADIOGRPHY/EXAM NC 0 13208590 XR KNEE AP STANDING BIL 7463208610 XR HAND 2 VIEWS BIL 8363208630 ARTHROGRAM HIP W ANES INJ 9823208640 LUMBAR PUNCTURE THERA 9313208760 BIOPSY LUNG/MEDIASTIN NDL 31043208810 EGD G TUBE PLACE PERC 23303208820 GASTRO TUBE CHANG WO IMAG 8343208860 BX PANCREAS NEEDLE PERC 31043208890 BX ABD/RETROPERITONL MASS 32063208950 XR CHEST 2 VWS W APIC LOR 13383208960 XR CHEST SPECIAL VIEWS 1403208970 XR UGI W AIR CON+SM BOWEL 3733208990 XR CHOLAN INTRAOP ADD SET 5053209030 XR FLUOR GUIDE CATH DRAIN 43333209040 XR UROGRM DRP/BOLUS W/TOM 34413209130 XR FLUORO GUIDE NDL PLCMT 19123209160 XR READ OUTSIDE IMAGES NC 0 13209200 XR TUBE/CATH CHANGE W CON 19173209220 XR UGI W AIR CON W KUB 3733209230 INS PICC WO PORT/PUMP>5YR 28113209240 REPOSITION CV CATH W FLUR 20423209280 XR FLUORO CVAD PL/RPL/REM 14823209540 XR IMAGE COPY NC 0 13209550 XR READ OUTSIDE IMAGES NC 0 13210250 GASTRO TUBE PERC PLACE 35493210270 ARTHROCEN ASP INTER JT WO 3723210290 PARACENTSIS ABD W IMAGING 22203210560 CTH PL CAR/INM ART SEL BI 198963210570 CTH PL CAR/INM SEL ICA BI 218643210580 CTH PL SUB/INM ART SEL BI 218643210590 CTH PLC CAR/INOM ART SEL 132643210600 CTH PLC CAR/INOM SEL ICA 145763210610 CTH PLC ECA SEL ADDON 52473210620 CTH PLC ICA SEL 164713210630 CTH PLC ICA SEL BILAT 247063210640 CTH PLC ICA/VER SEL ADDON 59383210650 CTH PLC SUBC/INOM ART SEL 14576
3210660 CTH PLC THOR AOR NSEL 97663210670 CTH PLC VERT SEL 163253210680 CTH PLC VERT SEL BILAT 244873210690 INS CATH PLEURAL W IMAG 14753210700 IOPAMID 370MG/ML 100MLINJ 373210760 THORACENTESIS W IMAGING 20193210770 THROMBOLYS ART INIT DAY 173763210780 THROMBOLYS FINAL DAY 59713210790 THROMBOLYS SUBSEQUENT DAY 107483210800 THROMBOLYS VEN INIT DAY 151663210810 TRANSCTH RET IVAS FB PERC 97643210840 PORT INDWELL 254X-331 10243210850 PORT INDWELL 195X-254 7863210860 PORT INDWELL 331X-431 13343210870 FILTER VENA CAV 730X-949 29383210880 FILTER VENA CAV 949X-1234 38203210890 FILTER VENA CAV1234X-1605 49683210900 STENT NCOV W 730X-949 29383210910 STENT NCOV W 949X-1234 38203210920 INTRO SHTH OTH 39X-51 1583210930 INTRO SHTH OTH 67X-88 2713210940 INTRO SHTH OTH 88X-115 3553210960 CATH PTA NLASR 115X-150 4643210970 CATH PTA NLASR 195X-254 7863210980 CATH PTA NLASR 254X-331 10243210990 CATH PTA NLASR 331X-431 13343211000 CATH GUIDING 561X-730 22593211010 CATH GUIDING 254X-331 10243211020 XR FB LOCAL NOSE TO RECTM 2033211040 XR EYE FOREIGN BODY BIL 7733211050 XR BONE LENGTH STUDIES 2153211070 XR JNT SURVEY 1 VW 2+ JTS 1513211080 HOCM 350-399MG/ML IODINE 533211090 XR MYELOGRAM 2 OR>REGIONS 19313211100 BX LIVER NEEDLE PERC 31043211120 XR CHOLECYSTOGRM ORAL CON 2513211200 CATH GUIDING 88X-115 3553211700 PORT INDWELL 150X-195 6043211740 STENT NCOV W 1234X-1605 49683211760 STENT NCOV W 561X-730 22593211840 MA MAMMO DIAG W CAD BIL 3033211850 MA MAMMO DIAG W CAD LT 1643211860 MA MAMMO SCREEN W CAD BIL 2483211960 XR BONE SURVEY LIMITED 12333212010 XR HUMERUS 1 VIEW LT 8863212020 XR HUMERUS 1 VIEW RT 8863212030 CATH PTA NLASR 88X-115 355
3212040 CATH PTA NLASR 150X-195 6043212050 CATH GUIDING 331X-431 13343212060 GASTRO IMP 30X-39 1213212070 VASC CLOSE DVC 150X-195 6043212110 MODERATE SEDAT ADD 15MIN 4883212120 MA MAMMO DIAG W CAD RT 1643212130 IR FLUOR GUIDE CATH DRAIN 43333212156 IOPAMID 300MG/ML 100MLINJ 403212164 IOPAMID 300MG/ML 200MLINJ 743212172 XR PORTABLE PER TRIP NC 0 13212198 IOPAMID 300MG/ML 200MLINJ 743212263 GUIDEWIRE 88X-115 3553212289 XR FLUORO 1-2 HOURS NC 0 13212313 INS CATH PLEURAL W IMAG 14753212339 PARACENTSIS ABD W IMAGING 22203212362 THORACENTESIS W IMAGING 20193212370 US V DPLX AO/IVC/GRFT CMP 17873212388 MR CHOLANGIO MRCP WO CON 16743212396 XR PHARYX &/OR CERV ESOPH 2943212453 INST/SUPP STERL 23X-30 933212461 INST/SUPP STERL 30X-39 1213212479 INST/SUPP STERL 39X-51 1583212487 INST/SUPP STERL 67X-88 2713212511 KIT/PACK DISP 431X-561 17363212529 KIT/PACK DISP 50X-67 2073212537 CATH DRAINAGE 67X-88 2713212554 CATH DIALYS LT 331X-431 13343212555 CATH DIALYSIS ST 67X-88 2713212556 CATH DRAINAGE 949X-1234 38203212557 CATH INFUSION 331X-431 13343212558 CATH THROM EMB 2087X-2714 84023212559 CATH THROM EMB 331X-431 13343212560 XR FLUORO 2-3 HOURS NC 0 13212561 CATH THROM EMB 431X-561 17363212562 CATH THROM EMB 730X-949 29383212563 CATH THROM EMB 949X-1234 38203212564 INST/SUPP STERL 88X-115 3553212565 STENT NONCOR W 115X-150 4643212566 STENT NONCOR W 88X-115 3553212579 PLC BRST LOC DEV MAMM 1ST 29783212581 PLC BRST LOC DEV MAMM ADD 29783212585 PLC BRST LOC DEV US 1ST 32053212587 PLC BRST LOC DEV US ADD 32053212588 PLC BRST LOC DEV MRI 1ST 30953212590 PLC BRST LOC DEV MRI ADD 30953212591 IMAGE CATH FLUID PERITO 52833212613 STNT PLC TRANSCTH ART INI 26324
3212614 STNT PLC TRANSCTH ART ADD 212913212615 STNT PLC TRANSC VEIN INI 263243212616 STNT PLC TRANSC VEIN ADD 212913212617 OCC/EMB NON HEMORR VENOUS 273193212618 OCC/EMB NON HEMORR ART 273193212619 OCC/EMB TUMOR/ORGAN INFAR 292423212620 OCC/EMB HEMORRHAG/LYMPH 273193212621 IMAGE CATH FLUID VISCERAL 52833212622 MR CHOLANGIO MRCP W CON 59803212623 MR CHOLANGIO MRCP WO CON 41243212624 MR CHOLANGI MRCP WO&WCON 68883212633 IMAGE CATH FLUID SOFT TIS 4193212634 CATH DIALYS LT 254X-331 10243212635 ANCHOR/SCREW 331X-431 13343212636 CATH PTA NLASR 431X-561 17363212637 CATH INFUSION 195X-254 7863212638 CATH INFUSION 254X-331 10243212639 CATH THROM EMB 150X-195 6043212640 VASC CLOSE DVC 195X-254 7863212641 GUIDEWIRE 51X-67 2073212642 GUIDEWIRE 115X-150 4643212643 GUIDEWIRE 254X-331 10243212644 GUIDEWIRE 431X-561 17363212645 STENT COV W 3529X-4588 142053212646 INTRO SHTH OTH 51X-67 2073212647 STENT NCOV W 2087X-2714 84023212648 STENT NCOV W 1605X-2087 64613212649 EMB PROTCT SYS 1605X-2087 64613212650 EMB PROTCT SYS 254X-331 10243212651 CATH OCCLUSION 331X-431 13343212652 CATH OTHER 150X-195 6043212653 CATH OTHER 13X-17 533212654 CATH OTHER 115X-150 4643212655 GASTRO IMP 23X-30 933212656 GASTRO IMP 195X-254 7863212657 GASTRO IMP 88X-115 3553212658 INST/SUPP STERL 17X-23 703212659 INST/SUPP STERL 331X-431 13343212660 INST/SUPP STERL 150X-195 6043212662 VASCULAR IMP 730X-949 29383212663 VASCULAR IMP 67X-88 2713212664 VASCULAR IMP 254X-331 10243212665 XR UGI W SMALL INTESTINE 30143212666 XR PORTABLE PER TRIP NC 0 13212667 MR ABDOMEN WO CON 41243212668 MR ANGIO HEAD WO CON 35033212669 MR BRAIN FUNCT WO PHY/PSY 3688
3212721 INTRO SHTH OTH 23X-30 933212722 INTRO SHTH OTH 254X-331 10243212723 INTRO SHTH OTH 30X-39 1213212724 INTRO SHTH OTH 331X-431 13343212725 INTRO SHTH OTH 561X-730 22593212726 KIT/PACK DISP 115X-150 4643212727 KIT/PACK DISP 150X-195 6043212728 KIT/PACK DISP 2087X-2714 84023212729 KIT/PACK DISP 2714X-3529 109253212731 KIT/PACK DISP 331X-431 13343212732 KIT/PACK DISP 3529X-4588 142053212733 NACL 0.9% 1000ML INJ 783212734 NACL 0.9% 250ML INJ 783212735 PORT INDWELL 431X-561 17363212736 RETRV FRAC DVC 254X-331 10243212737 RETRV FRAC DVC 561X-730 22593212738 STENT COV W 2714X-3529 109253212739 VASCULAR IMP 331X-431 13343212740 VASCULAR IMP 431X-561 17363212741 VASCULAR IMP 51X-67 2073212742 VASCULAR IMP 88X-115 3553212743 INS CATH PLEURAL WO IMAG 11803212744 LIVER TUM ABLAT CRYO PERC 10283212745 BX ADRENAL GLAND NDL PERC 99323212747 VERTEBROPL INJ C/T W IMAG 80523212748 VERTEBROPL INJ L/S W IMAG 80523212749 VERTEBROPL INJ ADD W IMAG 80523212750 VERTEB AUGM THORAC W IMAG 179623212751 VERTEB AUGM LUMBAR W IMAG 179623212752 VERTEB AUGM EA ADD W IMAG 95033212753 BONE TUM ABLAT CRYO IMAGE 98133212758 CATH THROM EMB 2714X-3529 109253212760 PULM TUM ABLAT CRYO IMAGE 134683212761 MYELOGRA CERVIC W INJ LUM 20203212762 MYELOGRA THORAC W INJ LUM 20203212763 MYELOGRA LUMBOS W INJ LUM 20203212764 MYELOGR>= 2 REG W INJ LUM 20203212765 MA BREAST TOMO DIG DX LT 1643212766 MA BREAST TOMO DIG DX RT 1643212767 MA BREAST TOMO DIG DX BIL 3033212768 MA BRST TOMO DIG SCRN BIL 2483212769 XR DXA VERTEBRA FX ASSESS 2263212770 MA BRST TOMO DIG SCRN BIL 3033212771 MYELOGRA CERVIC W INJ LUM 20203212772 MYELOGRA THORAC W INJ LUM 20203212773 MYELOGRA LUMBOS W INJ LUM 20203212774 MYELOGR>= 2 REG W INJ LUM 2020
3212775 CAROTID STNT TRANSC ANTEG 233133212778 XR TOMOGRAM SINGLE PLANE 3443212779 XR TOMOGRAM SINGLE PLANE 3443212782 INST/SUPP STERL 88X-115 3553212783 ARTHROGRAM SACROIL JT INJ 7623212784 SACROIL JT TX W/WO ARTHRO 7623212785 CHOLANG EX ACCES INJ IMAG 18923212786 CHOLANG EX ACCES INJ IMAG 18923212789 CHOLANG NW ACCES INJ IMAG 23743212792 CONV BILI DRN CTH INT-EXT 54343212793 EXCH BILI DRN CATH W IMAG 47843212794 REM BILI DRN CTH W FLUORO 47843212795 PLC STENT BILE DUCT EXIST 47843212796 PLC STENT BILE DUCT NEW 47843212797 PLC STNT BILE DUCT CTH NW 47843212800 PLC BILI DRN CTH EXT IMAG 90463212803 PLC BILI DRN CTH INT-EXT 104243212806 REM CALCULI BILI DUCT/GB 101643212810 PLC NEPHROSTOM CTH W IMAG 79343212812 EXCHNG NEPHROS CTH W IMAG 52173212814 XR SPINE ENTIRE 2-3 VIEWS 21093212816 XR HIP W PELVIS 1 VIEW RT 5033212818 XR HIP W PELVIS 1 VIEW LT 5033212828 XR FEMUR 1 VIEW LT 6963212830 XR FEMUR 1 VIEW RT 6963212832 INJ ANTEGR NEPH&/URETE NW 33033212833 INJ ANTEG NEPH&/URETER EX 33033212835 INJ ANTEGR NEPH&/URETE NW 22913212836 INJ ANTEG NEPH&/URETER EX 22913212840 PLC NEPHROUR CTH IMAG NEW 89573212841 CONV NEPHRS TO NEPHRU CTH 89573212842 ENDOLUM BX UETER/RNL PELV 89573212843 PLC URETER STNT PRE EXIST 89573212844 PLC URETER STNT NW ACCESS 89573212845 PLC URETER STNT NEW W CTH 89573212847 ENDO INTR PRLNG AD RX INI 146913212848 ENDO INTR PRLNG AD RX ADD 146913212856 XR SPINE ENTIRE 1 VIEW 10543212857 XR SPINE ENTIRE 4-5 VIEWS 26373212858 XR SPINE ENTIRE 6+ VIEWS 32943212869 XR HIP W PEL 2-3 VIEWS LT 7283212870 XR HIP W PEL 2-3 VIEWS RT 7283212871 XR HIP W PELV 4+ VIEWS LT 9093212872 XR HIP W PELV 4+ VIEWS RT 9093212873 XR HIP W PELV 2 VIEWS BIL 7723212874 XR HIP W PEL 3-4 VIEWS BI 9653212875 XR HIP W PEL 5+ VIEWS BIL 1205
3212899 XR FEMUR 2+ VIEWS LT 6963212900 XR FEMUR 2+ VIEWS RT 6963212913 PLC ACCESS BILI TREE SB 89573212914 PLC NEPHROU CTH IMA NW BI 134353212915 CON NPHRS TO NPHRU CTH BI 134353212916 EXCHNG NEPHRO CTH IMAG BI 78253212917 IVUS NON CORON W IMAG INI 34033212918 IVUS NON CORO W IM EA ADD 42543212919 PLC URETER STNT PRE EX BI 134353212920 PLC URETER STNT NW ACC BI 134353212921 PLC URET STNT NW W CTH BI 134353212922 INJ ANTE NEPH&/URET NW BI 49543212923 INJ ANTE NEPH&/URET EX BI 49543212925 XR ENDO ERCP LTD 18433212926 INS INTRAPERIT CATH PERM 71863212928 INTRCRN VASO DIL SAME ADD 24583212929 INTRCRN VASO DIL DIF ADD 24583212930 THROMBECT ART MECHAN PERC 24583212931 IOPAMID 200MG/ML 20MLINTH 483212932 INST/SUPP STERL5965X-7755 240103212933 CATH GUIDING 1234X-1605 49683212934 CATH THROM EMB 5965X-7755 240103212935 CATH GUIDING 1605X-2087 64613212936 VASCULAR IMP 2714X-3529 109253212937 GUIDEWIRE 561X-730 22593212938 CATH GUIDING 949X-1234 38203212939 INST/SUPP STERL2714X-3529 109253212940 VASCULAR IMP 2087X-2714 84023212941 CATH OCCLUSION 2087X-2714 84023212942 CATH OCCLUSION 1605X-2087 64613212943 VASCULAR IMP 13419X-14761 493153212944 CATH GUIDING 730X-949 29383212945 CATH OCCLUSION 1234X-1605 49683212946 CATH GUIDING 2087X-2714 84023212947 STENT NCOV W 5965X-7755 240103212948 INST/SUPP STER7755X-10082 312153212949 CATH PTA NLASR 949X-1234 38203212950 VASCULAR IMP 5965X-7755 240103212952 CATH INFUSION 88X-115 3553212954 MOD SEDAT <5YRS 1ST 15M 4653212955 MOD SEDAT =>5YRS 1ST 15M 5543212956 MA MAMMO SCREEN W CAD RT 2363212957 MA MAMMO SCREEN W CAD LT 2363212962 INTRO CATH DIALY CIRCUIT 26113212963 INTRO CTH DIALY CIRCU BLN 199013212964 INT CTH DIALY CIR IVAS ST 228893212965 THROMBECT DIALY CIRCUIT 19901
3212966 THROMB DIALY CIRCUIT BLN 228893212967 THROMB DIALY CIRC IVAS ST 228893212968 ANGIO BLN CENT DIALY SEG 228893212969 ANGIO BLN TRANS ART INI 199013212970 ANGIO BLN TRANS ART EAADD 199013212971 ANGIO BLN TRANSL VEIN INI 199013212972 ANGIO BLN TRAN VEIN EAADD 199013212973 STNT PLC TRANSC DIALY SEG 212913212974 EMBOLIZ DIALY CIRCU PERM 17093212975 INJ EPI/SUBAR L/S W IMAG 16773212976 DIL URETER STRICT W IMAG 48393212977 FACET JT NRV C/T DEST SGL 45963212978 FACET JT NRV C/T DEST BIL 57453212979 FACET JT NRV C-T ADD JNT 34473212980 FACET JT NRV L/S DEST SGL 45963212981 FACET JT NRV L-S ADD JNT 34473212982 DESTR NEUR PER NRV/BRANCH 49603212983 PTA INTRACRANIAL PERC 186553212984 INTRACRAN STNT TRANSCATH 239023212985 FACET JT/NRV L/S SNG INJ 20253212986 FACET JT/NRV L/S 2ND LVL 20253300010 VISIT LEVEL 1 NEW PT 2653300020 THERAPEUT RAD PORT IMAGES 3603300030 SPECIAL TX PROCEDURE 45243300060 SPECIAL TELETX PORT PLAN 25313300080 SPEC MED RAD PHYS CONSULT 12503300090 BASIC RAD DOSIM CALC PLAN 7183300100 TX DEVICE DESIGN SIMPLE 17263300110 SIMUL AIDED FIELD SIMPLE 34413300120 SIMUL AIDED FIELD COMPLEX 64523300150 TELETX ISODOSE PLAN SIMP 25043300160 TELETX ISODOSE PLAN CPLX 41183300170 SPECIAL RAD DOSIMETRY TLD 8733300180 TX DEVICE DESIGN COMPLEX 32583300190 CONTINUING PHYSICS CONSLT 8163300200 CT GUIDED THERAPY PLACEMT 22353300210 RADIOTHERAPY PLAN 3D 61453300220 VISIT LEVEL 1 EST PT 973300240 IMRT TREATMENT PLAN 144213300260 INJ TX/DX/PROPH SUBQ/IM 3823300280 VASC ACCES THROMBL DECLOT 4473300290 BLOOD COLLECTION VAD 3393300350 INF IV HYDRA INIT 31-60MN 21703300360 INF TX/DX/PRO SEQ 1HR 11123300370 INF TX/DX/PRO INIT 1ST HR 25773300380 INF TX/DX CONCURRENT 15473300390 INF IV HYDRAT EA ADD HR 570
3300400 INF TX/DX/PRO EA ADD HR 7053300410 INJ TX/DX/PRO IVPUSH INIT 3823300420 INJ TX/DX/PRO IV PUSH SEQ 3823300430 CHEMO SQ/IM NONHORMONAL 9503300440 CHEMO SQ/IM HORMONAL 4103300450 CHEMO IV PUSH INITIAL 11713300460 CHEMO IV PUSH EA ADD 6543300470 CHEMO INF INIT 1ST HR 20913300480 CHEMO INF EA ADD HR 4393300490 CHEMO INF EA SEQ 1ST HR 20913300510 VENIPUNCTURE NON LAB 223300520 VISIT LEVEL 2 EST PT 2603300530 VISIT LEVEL 3 EST PT 5093300560 IRRIG IMPLANTED VEN ACCES 3233300570 ADMIN INFLUENZA VACCINE 3643300580 ADMIN PNEUMO VACCINE 3643300660 VISIT LEVEL 1 NEW W PROC 2653300670 VISIT LEVEL 2 NEW PT 5093300680 VISIT LEVEL 2 NEW W PROC 5093300690 VISIT LEVEL 3 NEW PT 7693300700 VISIT LEVEL 3 NEW W PROC 7693300710 VISIT LEVEL 4 NEW PT 9213300720 VISIT LEVEL 4 NEW W PROC 9213300730 VISIT LEVEL 5 NEW PT 12323300740 VISIT LEVEL 5 NEW W PROC 12323300750 VISIT LEVEL 1 EST W PROC 973300760 VISIT LEVEL 2 EST W PROC 2603300770 VISIT LEVEL 3 EST W PROC 5093300780 VISIT LEVEL 4 EST PT 7893300790 VISIT LEVEL 4 EST W PROC 7893300800 VISIT LEVEL 5 EST PT 11103300810 VISIT LEVEL 5 EST W PROC 11103300870 PICC INSERT/REPLACE RN 15823300970 INJ TX/PRO/DX IVP SME DRG 3823300980 ADMIN OTHER IMMUN VAC ADD 1823300990 ADMIN OTHER IMMUN VAC ONE 3643301000 BLOOD COLLECTION PICC 3763301020 DESIGN MLC DEVIC FOR IMRT 31073301040 SIMUL AIDED FIELD INTER 54083301061 PUMP PORTABL REFILL/MAINT 5443301062 PUMP IMPLANTD REFIL/MAINT 5443301063 TRANSFUS BLOOD/COMP 1HR 10033301064 TRANSFUS BLOOD/COMP 2HR 12543301065 TRANSFUS BLOOD/COMP 3HR 15053301066 TRANSFUS BLOOD/COMP 4HR 17553301067 TRANSFUS BLOOD/COMP 5HR 20063301068 TRANSFUS BLOOD/COMP 6HR 2257
3301069 TRANSFUS BLOOD/COMP 7HR 25083301070 TRANSFUS BLOOD/COMP 8HR 27583301071 TRANSFUS BLOOD/COMP >8HR 30093301072 D5% 250ML INJ 783301073 D5% 500ML INJ 783301074 LACTATED RINGERS 1L INJ 783301075 LACTATED RINGERS 500MLINJ 783301076 NACL 0.45% 1000ML INJ 783301077 NACL 0.9% 1000ML INJ 783301078 NACL 0.9% 250ML INJ 783301079 NACL 0.9% 500ML INJ 783301080 IMRT SIMPLE 29513301081 IMRT COMPLEX 35423301082 RAD TX SIMPLE >1 MEV 13893301083 RAD TX COMPLEX >1 MEV 15893301084 GUIDANCE RAD TX DELIVERY 37183301085 ADMIN HEP B VACCINE 3643400010 NM RADIOPHARM THRPY ORAL 9003400011 PET BRAIN METABOLIC EVAL 32103400012 PET MYOCARD METABOL EVAL 32103400013 PET MYOCARD PERFUS MULTI 32103400014 PET MYOCARD PERFUS SINGLE 32103400020 NM COMPUTER <30 MIN NC 0 13400030 NM PARATHYROID PLANAR 21203400040 NM COMPUTER >30 MIN NC 0 13400050 F-18 FDG DX UP TO 45MCI 8313400080 NM INFLAM PROCESS LOC WB 45473400090 NM INFLAM PROCESS LOC LTD 25003400100 CARDIOVAS STR TEST WO RX 12913400110 NM BONE LTD 20373400120 NM URETERAL REFLUX (VCUG) 36553400130 NM BRAIN FLOW ONLY 17543400150 NM CSF FLOW CISTERNOGRAM 37523400170 NM BONE MARROW WHOLE BODY 22233400180 NM BONE WHOLE BODY 28303400190 NM CARD BLOOD POOL SNGL 27573400200 NM LIVER & SPLEEN 29793400210 NM PUL PERF PARTICULATE 21143400220 NM GASTROINTEST BL LOSS 21173400230 NM GASTRIC EMPTYING 32613400250 NM THYROID CA METS WB 11643400260 NM TUMOR LOCAL WB SNG DAY 41543400360 NM KIDNEY W FLW&FUN SNG W 26023400370 NM KIDNEY W FLOW & FUNC 35183400380 PET W CT LTD AREA 97693400390 PET SKULL MIDTHIGH 97693400400 PET LIMITED AREA 9769
3400410 PET WHOLE BODY 97693400420 SESTAMBI DX PER DOSE 6403400430 MEDRONATE DX UP TO 30MCI 3033400440 THALLIUM TL201 DX PER MCI 6883400480 MACROAG ALBUM DX TO 10MCI 2683400490 MEBROFENIN DX TO 15MCI 3463400500 PENTETATE DX AERO TO 75MC 3993400520 SULF COLL TC99<=20MCI FLT 1953400530 NM I-131 NA IODID SOL/MCI 5003400540 GALLIUM GA-67 DX PER MCI 2963400550 MERTIATIDE DX TO 15MCI 4213400560 LABELED RBC DX TO 30MCI 1433400590 NM MYOCAR PLNR WALL SNGL 49543400600 NM MYOCAR PLNR WALL MULT 59683400670 CARDIOVAS STR TEST W RX 12913400680 NM MYOCAR PERF 1 DAY NC 0 13400690 NM GASTROESOPHAG REFLUX 23223400700 DELAYED SCAN 1 UNIT NC 0 23400710 NM MYOCAR SPECT WALL SNGL 49543400720 NM MYOCAR SPECT WALL MULT 59683400730 NM PERTECHNETATE PER MCI 593400750 NM HEPATOBILIARY SYSTEM 10883400760 NM HEPATOBILIARY SYS W/RX 14913400770 NM PUL PERF VNT QUAN DIFF 12363400780 NM PUL PERFUSN QUANT DIFF 7923400850 DIPYRIDAMOLE 50MG/10MLINJ 1013400860 NM BONE 3 PHASE 39343400880 NM KIDNEY SCAN 26393400890 NM KID W FLO/FN MULT WO&W 55573400910 NM TESTES W FLOW 10123400920 NM TUMOR LOCALIZE MULTI 15273400940 NM BONE MULTIPLE 26033400950 NM TUMOR LOCALIZE LTD 9113400960 NM LYMPH SYSTEM 8523400970 SENTINL NDE RAD TR ID INJ 8763401000 EXAMETAZIME DX TO 25MCI 52203401010 NM BRAIN <4 VIEWS 8023401020 NM BRAIN <4 VWS W FLOW 13923401040 IN-111 PENTETR DX TO 6MCI 116053401050 NM TELERADIOGRPY/EXAM NC 0 13401060 NM CSF LEAK DETECTION 15183401070 NM CSF SHUNT EVALUATION 8023401080 NM PERIT-VEN SHUNT PATEN 7803401090 NM UREA TEST C-14 ACQ 323401100 NM UREA TEST C-14 ANALYS 2823401110 NM BONE MARROW LTD 8523401120 NM BONE MARROW MULTI AREA 852
3401130 NM SALIVARY GLAND 7803401140 SUCCIMER DX TO 10MCI 16853401150 I-131 NA IODID CAP DX/MCI 503401160 I-123 IOBENGUANE TO 15MCI 141753401170 NM ADRENAL CORTEX/MEDULLA 29033401180 NM RADIOPHARM INPT ADMIT 13401190 I-123 NA IO DX 100UCI/CAP 1253401200 DISOFENIN DX UP TO 15MCI 3153401210 OXIDRONATE DX TO 30MCI 653401220 NM CARDIOVAS STRES TEST 12913401230 NM PUL VENT PERFUSN IMAG 29813401240 NM PUL VENTILATION IMAG 16493401250 PERSANTINE IV 1963401260 NM SPLEEN W OR WO VAS FLW 8523401280 XENON XE-133 DX PER 10MCI 1823401290 NM LIVER W FLOW 15183401300 NM INTESTINE MECK/VOLVUL 7803401310 NM INFLAM PROCES LOC SPEC 46383401320 NM TUMOR LOCALIZE SPECT 19263401330 NM KIDNEY SPECT 30253401340 NM CSF FLOW SPECT 23993401350 NM BRAIN TOMO SPECT 23993401360 NM CARD BLD POOL SPECT 11633401370 NM BONE SPECT 25763401380 NM LIVER SPECT W VAS FLOW 11483401390 NM LIVER SPECT 11483401400 NM MYOCARD INFARCT SPECT 11633401420 NM PARATHYRO PLANAR SPECT 12033401430 NM THYROID IMAG W MEASURE 12223401440 NM THYROID IMAGING 5613401450 NM THYROID UPTAKE MEASURE 4263401460 NM TUMOR LOC WB MULTI DAY 35703401480 NM PORTABLE PER TRIP NC 0 13401510 PENTETATE DX UP TO 25MCI 853401520 NM RED CELL VOLUME SINGLE 13243401530 NM CARD BLOOD POOL MULTI 30113401531 IN-111 WBC DX PER DOSE 80003401532 IMT STDY FOR CHD RSK FCTR 1733401533 NM GASTRIC EMPTY SB TRANS 31063401534 NM GASTRIC EMPTY SB&COLON 31063500010 CT GUIDED NEEDLE PLACEMNT 45393500030 CT GUIDE CATH DRAIN 43333500050 CT CHEST WO CON 24873500060 CT CERVICAL SPINE W CON 104543500070 CT CERVICAL SPINE WO CON 53073500080 CT THORACIC SPINE WO CON 53073500090 CT CHEST W CON 4877
3500100 CT LUMBAR SPINE WO CON 53073500110 CT CHEST WO&W CON 55113500160 CT THORACIC SPINE W CON 104543500170 CT LUMBAR SPINE W CON 104543500190 CT PELVIS W CON 78843500200 CT MAXILLOFACIAL WO&W CON 58403500210 CT MAXILLOFACIAL WO CON 40283500220 CT MAXILLOFACIAL W CON 48743500250 CT SOFT TISSUE NECK W CON 41623500260 CT SOFT TISSUE NECK WO 34553500270 CT SOFT TISSUE NECK WO&W 49533500300 CT ANGIO PELVIS W CON 44383500310 CT ANGIO NECK W CON 51783500330 CT ANGIO HEAD W CON 38383500340 CT ANGIO CHEST W CON 48433500350 CT ANGIO AORTA W RUNOFF 48433500360 CT ANGIO ABDOMEN W CON 48433500400 BX ABD/RETROPERITONL MASS 32063500410 BX BONE TROCAR/NDL DEEP 33543500420 BX BONE SUPERFIC TROC/NDL 15243500480 BIOPSY LUNG/MEDIASTIN NDL 31043500490 BX MUSCLE NEEDLE PERC 17553500500 BX PANCREAS NEEDLE PERC 31043500510 BIOPSY PLEURA PERC NEEDLE 21553500520 ASP FINE NDL W IMAGING 12173500540 CT GUIDE TISSUE ABLATION 12743500610 MODERATE SEDAT ADD 15MIN 4883500620 CT 3D W SEPARATE WKSTATN 7253500630 CT 3D WO SEPARATE WKSTATN 2503500640 CT PELVIS WO&W CON 88853500650 CT ORBIT/SEL/FOS/EAR WO 13323500660 CT HRT STRC/MORP/3D W CON 16113500670 CT ANGIO HRT/COR ART 3D W 16113500710 CT HRT STRC/MORP CONGENTL 16113500730 PULM TUMOR ABLAT RADIO 107653500740 CT HRT EVAL COR CA WO CON 3903500750 BX LIVER NEEDLE PERC 31043500760 BX/EXC LYMPH NODE SUPERFI 19533500770 BX RENAL NDL/TROCAR PERC 26323500780 ASP ABSC/HEMA/CYST/BULLA 4043500790 THORACOSTOMY TUBE 13233500800 I&D ABSCESS SIMPLE 5993500810 CT HEAD W CON 50013500820 CT HEAD WO CON 36513500830 CT HEAD WO&W CON 59873500850 CT ABDOMEN W CON 47243500860 CT ABDOMEN WO CON 4302
3500870 CT ABDOMEN WO&W CON 43023500880 CT PELVIS WO CON 40033500900 LIVER TUMOR ABLAT RF PERC 107653500910 BLADDER ASP W INS SUPRAP 37653500920 IOPAMID 300MG/ML 100MLINJ 32.73500930 IOPAMID 300MG/ML 50ML INJ 16.743500940 IOPAMID 370MG/ML 100MLINJ 37.393500950 IOPAMID 250MG/ML 50ML INJ 19.763500960 BONE TUMOR ABLAT RADIO W 98133500970 CT ABDOMEN PELVIS WO CON 83313500980 CT ABDOMEN PELVIS W CON 89863500990 CT ABDOMEN PELVIS WWO CON 99963501010 RENAL TISSUE ABLAT PERC 22563501020 CCTA POST PROCESSING NC 0 13501030 CT ANGIO LOW EXTREM W LT 50423501050 CT ANGIO LOW EXTREM W RT 50423501070 CT ANGIO UPP EXTREM W LT 38793501090 CT ANGIO UPP EXTREM W RT 38793501110 CT LOW EXTREMITY W LT 51613501130 CT LOW EXTREMITY W RT 51613501150 CT LOW EXTREMITY WO LT 41623501170 CT LOW EXTREMITY WO RT 41623501190 CT LOW EXTREMITY WO&W LT 64513501210 CT LOW EXTREMITY WO&W RT 64513501230 CT UPP EXTREM W CON LT 48263501250 CT UPP EXTREM W CON RT 48263501270 CT UPP EXTREM WO CON LT 39553501290 CT UPP EXTREM WO CON RT 39553501310 CT UPP EXTREM WO&W LT 61723501330 CT UPP EXTREM WO&W RT 61723501350 CT ORBIT/SEL/FOS/EAR WO&W 17193501390 CT IMAGE COPY NC 0 13501400 CT BONE MIN DENSITY AXIAL 2253501420 BX NECK/THORAX SOFT TISS 29733501440 BX SALIVARY GLAND NDL 17633501450 BX THYROID NDL CORE PERC 10283501460 CT GUIDED THERAPY PLACEMT 22353501480 CT TELERADIOGRPY/EXAM NC 0 13501490 CT ANGIO UPP EXTREM W BIL 58163501500 CT ANGIO LOW EXTREM W BIL 50423501510 IOPAMID 200MG/ML 20MLINTH 483501540 CT L SPINE WO NC 0 23501550 CT T SPINE WO NC 0 23502890 INS CATH PLEURAL W IMAG 14753502900 IOPAMID 370MG/ML 500MLINJ 2983502950 IR MYELOGRAM LUMBAR 37943502960 GADOLINIUM-BAS MR CON/ML 85
3502970 CT ORBIT/SEL/FOS/EAR W 15593502980 CT CERVICAL SPINE WO&W 117803502990 CT THORACIC SPINE WO&W 117803503000 XR BONE DENSITY(DXA)AXAL 2253503020 KIT/PACK DISP 115X-150 4643503030 CT ANGIO ABD/PELVIS W CON 68283503059 CT BONE LENGTH STUDIES 2153503067 IOPAMID 300MG/ML 200MLINJ 743503083 IOPAMID 350MG/ML 100MLINJ 333503091 IODIXANOL 370MG/ML 100ML 373503125 INST/SUPP STERL 23X-30 933503133 INST/SUPP STERL 30X-39 1213503141 INST/SUPP STERL 39X-51 1583503158 INST/SUPP STERL 67X-88 2713503174 KIT/PACK DISP 431X-561 17363503182 KIT/PACK DISP 50X-67 2073503183 IMAGE CATH FLUID VISCERAL 72633503184 IMAGE CATH FLUID PERITO 72633503185 IMAGE CATH FLUID SOFT TIS 4193503186 CT LUNG SCREEN LOW DOSE 2773503187 BONE TUM ABLAT CRYO IMAGE 98133503188 PULM TUM ABLAT CRYO IMAGE 134683503189 CT VIRTUAL COLON DIAG WO 3313503190 CT LOW EXTREMITY W BIL 77423503191 CT LOW EXTREMITY WO BIL 62433503192 CT LOW EXTREMITY WO&W BIL 96773503196 CT ABDOMEN PELV W CON CT 89863503197 CT ABDOMEN PELV WO CON CT 83313503198 CT ABDOMEN PEL WWO CON CT 99963503199 CT ABDOMEN W CON CT 47243503200 CT ABDOMEN WO CON CT 43023503201 CT ABDOMEN WO&W CON CT 43023503202 CT ANGIO ABD/PEL W CON CT 68283503203 CT ANGIO ABDOMEN W CON CT 48433503204 CT ANGIO CHEST W CON CT 48433503205 CT ANGIO HEAD W CON CT 38383503206 CT ANG HRT/COR AR 3D W CT 16113503207 CT ANG LOW EXTREM W BI CT 50423503208 CT ANG LOW EXTREM W LT CT 50423503209 CT ANG LOW EXTREM W RT CT 50423503210 CT ANGIO NECK W CON CT 51783503211 CT ANGIO PELVIS W CON CT 44383503212 CT ANGIO UP EXTR W BIL CT 58163503213 CT ANG UPP EXTREM W LT CT 38793503214 CT ANG UP EXTREM W RT CT 38793503215 CT CERVIC SPINE W CON CT 104543503216 CT CERVIC SPINE WO CON CT 5307
3503217 CT CERVICAL SPINE WO&W CT 117803503218 CT CHEST W CON CT 48773503219 CT CHEST WO CON CT 24873503220 CT CHEST WO&W CON CT 55113503221 CT HEAD W CON CT 50013503222 CT HEAD WO CON CT 36513503223 CT HEAD WO&W CON CT 59873503224 CT HRT EVAL COR CA WO CT 3903503225 CT HRT STR/MORP CONGEN CT 16113503226 CT HRT STRC/MORP/3D W CT 16113503227 CT LOW EXTREMITY W BIL CT 77423503228 CT LOW EXTREMITY W LT CT 51613503229 CT LOW EXTREMITY W RT CT 51613503230 CT LOW EXTREM WO BIL CT 62433503231 CT LOW EXTREMITY WO LT CT 41623503232 CT LOW EXTREMITY WO RT CT 41623503233 CT LOW EXTREM WO&W BIL CT 96773503234 CT LOW EXTREM WO&W LT CT 64513503235 CT LOW EXTREM WO&W RT CT 64513503236 CT LUMBAR SPINE W CON CT 104543503237 CT LUMBAR SPINE WO CON CT 53073503238 CT MAXILLOFACIAL W CON CT 48743503239 CT MAXILLOFACIA WO CON CT 40283503240 CT MAXILLOFAC WO&W CON CT 58403503241 CT ORBIT/SEL/FOS/EAR W CT 15593503242 CT ORBIT/SEL/FO/EAR WO CT 13323503243 CT ORBIT/SEL/FO/E WO&W CT 17193503244 CT PELVIS W CON CT 78843503245 CT PELVIS WO CON CT 40033503246 CT PELVIS WO&W CON CT 88853503247 CT SOFT TIS NECK W CON CT 41623503248 CT SOFT TISSUE NECK WO CT 34553503249 CT SOFT TISS NECK WO&W CT 49533503250 CT THORAC SPINE W CON CT 104543503251 CT THORAC SPINE WO CON CT 53073503252 CT THORACIC SPINE WO&W CT 117803503253 CT UPP EXTREM W CON LT CT 48263503254 CT UPP EXTREM W CON RT CT 48263503255 CT UP EXTREM WO CON LT CT 39553503256 CT UPP EXTR WO CON RT CT 39553503257 CT UPP EXTREM WO&W LT CT 61723503258 CT UPP EXTREM WO&W RT CT 61723503259 CT VIRTU COLON DIAG WO CT 3313503260 CT MYELOGRAM LUMBAR CT 37943503321 BIOPSY SKIN SINGLE LESION 5573503322 CT UPP EXTREM WO CON BIL 56513503324 CT UPP EXTR WO CON BIL CT 5651
3503326 CT CEREBRL PERFUSION WCON 36553503327 MOD SEDAT <5YRS 1ST 15M 4603503328 MOD SEDAT =>5YRS 1ST 15M 5543503329 RENAL TUMOR(S ABLAT RADIO 107653503330 SACROIL JT TX W/WO ARTHRO 7623503331 CT THERAPY TX PLANNING 2143503333 INJ EPI/SUBAR L/S W IMAG 16773600300 LACTATED RINGERS 1L INJ 43600319 PROG PT REPLC 1234X-1605 49683600327 NEURSTM RECH 16237X-17861 596723600335 NEURSTM RECH 17861X-19647 656393600343 INST/SUPP NONST2714X-3529 109253600350 NEURSTM RECH 21611X-23772 794203600368 LEAD NEUROSTIM 4588X-5965 184683600376 LEAD NEUROSTIM 3529X-4588 142053600384 NEUROSTIM PROG 1234X-1605 49683600392 LEAD NEUROSTIM 5965X-7755 240103600400 MICROMATR 500MG1234X-1605 49683600418 CATH INTRASPINE 949X-1234 38203600426 CATH INTRASPINE 561X-730 22593600434 INF PUMP PRG 11090X-12199 407563602167 CATH PTA NLASR 88X-115 2073602168 CATH DIALYS LT 254X-331 10243602169 KIT/PACK DISP 2714X-3529 109253602820 APLIGRF/SQCM 2464.283603030 ALLODERM 8X16 3529X-4588 142053604520 ALLODERM 6X16 811.133605440 SURGERY LEVEL 1 1ST 30MIN 39753605450 SURGERY LEVEL 1 ADD 15MIN 13853605460 SURGERY LEVEL 2 1ST 30MIN 48183605470 SURGERY LEVEL 2 ADD 15MIN 16793605480 SURGERY LEVEL 3 1ST 30MIN 58393605490 SURGERY LEVEL 3 ADD 15MIN 20343605500 SURGERY LEVEL 4 1ST 30MIN 71513605510 SURGERY LEVEL 4 ADD 15MIN 24833605520 SURGERY LEVEL 5 1ST 30MIN 85783605530 SURGERY LEVEL 5 ADD 15MIN 29893605540 SURGERY LEVEL 6 1ST 30MIN 103963605550 SURGERY LEVEL 6 ADD 15MIN 36223605560 ANESTH GENERAL 1ST 30MIN 11013605570 ANESTH GENERAL ADDL 15MIN 3863605580 ANESTH MAC/REG 1ST 30MIN 8473605590 ANESTH MAC/REG ADDL 15MIN 3863605600 LOCAL ANESTHESIA 4043605620 SURGERY PER MINUTE NC 0 13615920 NEEDLE EMG 3 EXTREMITIES 8223615930 NEEDLE EMG 4 EXTREMITIES 935
3615940 NEEDLE EMG 1 EXTREMITY 4713615950 NEEDLE EMG 2 EXTREMITIES 6633615960 SOMATOSEN TSTNG UPP EXT 10993615970 SOMATOSEN TSTNG LOW EXT 8183615980 AD EVOKED POTENTIALS COMP 4983615990 SOMATOSEN TSTNG HEAD/TRUN 6503616290 C MOTOR EVOKED UPP EXTREM 8583616300 C MOTOR EVOKED LOW EXTREM 8583618050 PACU STANDARD 1ST 30MIN 7913618060 PACU STANDARD ADDL 15MIN 2773618070 PACU COMPLEX 1ST 30MIN 10283618080 PACU COMPLEX ADDL 15MIN 3593618170 ANLY NEUROSTM SMPL REPROG 2953618180 TRANSFUS BLD/BLD COMP 8613618190 GLUCOSE BLD BY DEVICE POC 173618220 ANCHOR/SCREW <10 183618230 ANCHOR/SCREW 115X-150 4643618240 ANCHOR/SCREW 1234X-1605 49683618250 ANCHOR/SCREW 13X-17 533618260 ANCHOR/SCREW 150X-195 6043618270 ANCHOR/SCREW 1605X-2087 64613618280 ANCHOR/SCREW 17X-23 703618290 ANCHOR/SCREW 195X-254 7863618300 ANCHOR/SCREW 2087X-2714 84023618310 ANCHOR/SCREW 23X-30 933618320 ANCHOR/SCREW 254X-331 10243618330 ANCHOR/SCREW 2714X-3529 109253618340 ANCHOR/SCREW 30X-39 1213618350 ANCHOR/SCREW 331X-431 13343618360 ANCHOR/SCREW 3529X-4588 142053618370 ANCHOR/SCREW 39X-51 1583618380 ANCHOR/SCREW 431X-561 17363618390 ANCHOR/SCREW 4588X-5965 184683618400 ANCHOR/SCREW 51X-67 2073618410 ANCHOR/SCREW 561X-730 22593618420 ANCHOR/SCREW 67X-88 2713618430 ANCHOR/SCREW 730X-949 29383618440 ANCHOR/SCREW 88X-115 3553618450 ANCHOR/SCREW 949X-1234 38203618460 BONE SUBSTITUTE 115X-150 4643618470 BONE SUBSTITUTE 150X-195 6043618480 BONE SUBSTITUTE 195X-254 7863618490 BONE SUBSTITUTE 431X-561 17363618500 BONE SUBSTITUTE 51X-67 2073618510 BONE SUBSTITUTE 561X-730 22593618520 BONE SUBSTITUTE 730X-949 29383618530 BONE SUBSTITUTE 88X-115 355
4502106 ORTHO L3961 88X-115 3554502107 DEBR SL SESSION 1ST 20CM 6324502108 CLOSURE EXTERN 17X-23 704502109 PLACE NG/OG TUBE PHY SKIL 17974502111 OP/ED PSYCH SITTER/HR NC 0 14502112 OB/GYN PROCEDURE LEVEL 1 13814502116 NACL 0.9% 250ML INJ 784502117 MOD SEDAT <5YRS 1ST 15M 4654502118 MOD SEDAT =>5YRS 1ST 15M 4654502119 BRONCHOSCPY PROC INTERMED 25004800000 CAROTID STNT TRANSCATH W 230364800010 CAROTID STNT TRANSCATH WO 230364800020 PACEMKER INS TEMP SNGL 103234800030 PERICARDIOCENTES INITIAL 38224800040 CARDIOVERSION ELCTIVE EXT 24914800060 THROMBOLYSIS CORONARY IC 26584800170 INSERT IAB DEVICE PERC 65604800310 CARDIAC CATH CPR 22984800400 ECHO TEE WO CON 31374800420 OCCLUSIVE DEVICE ART/VEIN 52064800430 ENDOLUM COR VESS IVUS INI 42544800440 ENDOLUM COR VESS IVUS ADD 34034800450 COR DOPL VEL/PRESS INITAL 18464800460 COR DOPL VEL/PRESS ADDL 14774800530 CL AORTOGRAM ABD W SERIAL 81514800550 NON IONIC CONTRAST 50ML 344.024800610 ANGIO IN L VNT/AT CRD CTH 67124800620 INTERATRIAL CLOSURE PERC 410024800640 CL AORTOGRM ABD W ILIOFEM 97814800650 ANGIO IN SUPR AORT CD CTH 75424800680 INTRACARDIAC ECHO 37734800690 ANGIO IN PULM AORT CD CTH 67884800700 PACEMAKER UPGR SNGL-DUAL 272254800710 PACEMK GENERATOR REM ONLY 92664800720 PACEMK INS EXIS DUAL LEAD 213724800730 PACEMAKER LEAD REM SINGLE 111194800750 PACEMKR SKIN POCK RELOCAT 64374800760 L VENT LEAD INS W DEF/GEN 275384800870 MC PTA BRACHIOCEP EA VES 115524800880 MC PTA RENAL/VISCERAL 129384800920 MC CL PTA VENOUS 117994800930 CTH PLC THOR/BRAC 1ST SEL 10704800940 CTH PLC THOR/BRAC 2ND SEL 13104800960 CTH PLC THOR/BRAC ADD 2-3 2494801020 CTH PLC ABD/PEL/EX 1ST EA 14664801030 CTH PLC ABD/PEL/ 3RD INIT 12884801040 CTH PLC ABD/PEL/ 2ND INIT 1082
4801050 CATH PLACE AORTA 13754801100 LOOP RECORDER REMOVAL 55984801110 LOOP RECORDER IMPLANT 163584801150 DEFIB IMP INS EX SNG LEAD 851184801180 PACEMAKER LEAD REM DUAL 138994801280 DEFIB IMP SYS INS/REPL TV 977094801300 LEAD INS PACE/DEF IMP 1TV 139314801310 LEAD INS PACE/DEF IMP 2TV 174764801360 DEFIB IMP SKIN POCK RELOC 79804801370 PACEMAKER INS/REPL ATRIAL 230304801380 PACEMAKER INS/REPL VENT 243534801390 PACEMAKER INS/REPL A/V 264714801410 LEAD PACE/DEFIB IMP REPOS 62064801420 LEAD REPOS W GEN REM/RPL 58964801430 DEFIB IMP LEAD REM TRANSV 141874801450 EP EVAL LEADS & GEN INIT 24234801460 DEFIB IMP REM GEN ONLY 64374801470 L VENT LEAD IMP INS&CONNE 305144801500 LEAD REP PACE/DEF IMP 2TV 146494801540 ART MECH THROMBECTMY PRIM 80494801690 MC PTA VENOUS 113454801710 CATH/NDL PLACE EXTREM ART 9994801720 CATH/NDL PLC RETROG BRACH 11994801730 ART MECH THROM 2NDARY ADD 109764801820 TRANSFUS BLD/BLD COMP 9834801880 CL PER MINUTE NC 0 14801950 IOPAMIDOL 300MG/ML 150ML 47.644801970 RIGHT HEART CATH 166914801980 RT LT HRT CTH LT VNTRICUL 242024801990 COR ANGIO CATH PLACE 233504802000 COR ANG CTH PLC BYPS GRFT 270864802010 RT HRT CATH COR ANGIO 512734802020 RT HRT CTH COR ANG BYP GR 581754802030 LT HRT CTH COR ANG VNTRCU 493014802040 LT HRT CTH ANG VNT BYP GR 542314802050 RT LT HRT CTH COR ANG VNT 581754802060 RT LT HRT CTH ANG VNT BYP 665564802080 DRUG ADMIN HEMODYN MEAS 8874802090 ANGIO INJ CONG CR CRD CTH 84474802130 RT HRT CTH COGEN ANOMAL 175704802150 RT< HC SEPTAL OPEN ANOM 738874802230 REVAS ILIAC TRNS ANG INI 394024802240 REVAS ILIAC STENT INI VES 486454802250 REVAS IPSIL ILI ANGIO ADD 179994802260 REVAS IPSIL ILI STENT ADD 204314802270 REVAS FEM POP TRANS ANGIO 283804802280 REVAS FEM POP ATHERECTOMY 38351
4802290 REVAS FEMORAL POPLT STENT 333654802300 REVAS FEM POP STENT ATHER 464054802310 REVAS TIBIAL PERN ANG INI 281164802340 REVAS TIB PERON ANGIO ADD 101224802390 CL ANGIO EXTREMITY BIL 97814802510 CL AORTOGRAM THOR WO SER 81514802640 IOPAMIDOL 250MG/ML 150ML 44.14802660 CTH PLC RENAL ART SEL BIL 88034802710 PACEMK GEN REPL SNGL LEAD 264124802720 PACEMK GEN REPL DUAL LEAD 275124802730 PACEMK GEN REPL MULT LEAD 291634802750 DEFIB IMP GEN REPLACE SNG 859014802760 DEFIB IMP GEN REPLC MULT 923674802770 DEFIB IMP GEN REPLC DUAL 886724802800 CL FLUORO < 1 HR 26374802880 VENOUS MECH THROMBECTOMY 97814803030 CL ANGIO EXTREMITY LT 81514803040 CL ANGIO EXTREMITY RT 81514803070 CL VENOGRAM EXTREMITY LT 26544803080 CL VENOGRAM EXTREMITY RT 26544803090 CTH PLC RENAL ART SEL LT 66024803100 CTH PLC RENAL ART SEL RT 66024803140 CATH ATHR DIR 2714X-3529 109254803150 CATH EP NCOOL 561X-730 22594803160 CATH GUIDING 115X-150 4644803170 CATH GUIDING 150X-195 6044803180 CATH GUIDING 195X-254 7864803190 CATH GUIDING 39X-51 1584803200 CATH GUIDING 51X-67 2074803210 CATH GUIDING 67X-88 2714803220 CATH GUIDING 88X-115 3554803230 CATH INTVAS US 730X-949 29384803240 CATH OTHER 1605X-2087 64614803250 CATH OTHER 17X-23 704803260 CATH OTHER 331X-431 13344803270 CATH OTHER 561X-730 22594803280 CATH OTHER 730X-949 29384803290 CATH OTHER 88X-115 3554803300 CATH PTA NLASR 115X-150 4644803310 CATH PTA NLASR 150X-195 6044803320 CATH PTA NLASR 254X-331 10244803330 CATH PTA NLASR 561X-730 22594803340 CATH PTA NLASR 730X-949 29384803350 CATH PTA NLASR 949X-1234 38204803360 CATH THROM EMB 1234X-1605 49684803370 CATH THROM EMB 431X-561 17364803380 CLOSURE EXTERN 17X-23 70
4803940 COR ATHERECT DES SNGL RI 309444803950 COR ATHERECT EA ADD 352764803960 COR ATHERECT NDES ADD 253744803970 COR ATHERECT NDES SNGL LC 253744803980 COR ATHERECT NDES SNGL LD 253744803990 COR ATHERECT NDES SNGL LM 253744804000 COR ATHERECT NDES SNGL RC 253744804010 COR ATHERECT NDES SNGL RI 253744804020 COR ATHERECT SNGL LC 352764804030 COR ATHERECT SNGL LD 352764804040 COR ATHERECT SNGL LM 352764804050 COR ATHERECT SNGL RC 352764804060 COR ATHERECT SNGL RI 352764804070 CTH PL CAR/INM ART SEL BI 198964804080 CTH PL CAR/INM SEL ICA BI 218644804090 CTH PL SUB/INM ART SEL BI 218644804100 CTH PLC CAR/INOM ART SEL 132644804110 CTH PLC CAR/INOM SEL ICA 145764804120 CTH PLC ECA SEL ADDON 52474804130 CTH PLC ICA SEL 164714804140 CTH PLC ICA SEL BILAT 247064804150 CTH PLC ICA/VER SEL ADDON 59384804160 CTH PLC SUBC/INOM ART SEL 145764804170 CTH PLC THOR AOR NSEL 97664804180 CTH PLC VERT SEL 163254804190 CTH PLC VERT SEL BILAT 244874804200 IC DES PLC EA ADD 309444804210 IC DES PLC SNGL LC 309444804220 IC DES PLC SNGL LD 309444804230 IC DES PLC SNGL LM 309444804240 IC DES PLC SNGL RC 309444804250 IC DES PLC SNGL RI 309444804260 IC NDES PLC EA ADD 253744804270 IC NDES PLC SNGL LC 253744804280 IC NDES PLC SNGL LD 253744804290 IC NDES PLC SNGL LM 253744804300 IC NDES PLC SNGL RC 253744804310 IC NDES PLC SNGL RI 253744804320 PTCA EA ADDITIONAL 176384804330 PTCA SINGLE LC 176384804340 PTCA SINGLE LD 176384804350 PTCA SINGLE LM 176384804360 PTCA SINGLE RC 176384804370 PTCA SINGLE RI 176384804380 REVASC ACUT MI DES SNG LC 309444804390 REVASC ACUT MI DES SNG LD 309444804400 REVASC ACUT MI DES SNG LM 30944
4804410 REVASC ACUT MI DES SNG RC 309444804420 REVASC ACUT MI DES SNG RI 309444804430 REVASC ACUT MI NDES SG LC 253744804440 REVASC ACUT MI NDES SG LD 253744804450 REVASC ACUT MI NDES SG LM 253744804460 REVASC ACUT MI NDES SG RC 253744804470 REVASC ACUT MI NDES SG RI 253744804480 REVASC CABG DES ADD 309444804490 REVASC CABG DES SNGL LC 309444804500 REVASC CABG DES SNGL LD 309444804510 REVASC CABG DES SNGL LM 309444804520 REVASC CABG DES SNGL RC 309444804530 REVASC CABG DES SNGL RI 309444804540 REVASC CABG NDES SNGL LC 253744804550 REVASC CABG NDES SNGL LD 253744804560 REVASC CABG NDES SNGL LM 253744804570 REVASC CABG NDES SNGL RC 253744804580 REVASC CABG NDES SNGL RI 253744804590 REVASC CABG NDES ADD 253744804600 REVASC CHRONC NDES SNG LC 253744804610 REVASC CHRONC NDES SNG LD 253744804620 REVASC CHRONC NDES SNG LM 253744804630 REVASC CHRONC NDES SNG RC 253744804640 REVASC CHRONC NDES SNG RI 253744804650 REVASC CHRONIC DES ADD 309444804660 REVASC CHRONIC DES SNG LC 309444804670 REVASC CHRONIC DES SNG LD 309444804680 REVASC CHRONIC DES SNG LM 309444804690 REVASC CHRONIC DES SNG RC 309444804700 REVASC CHRONIC DES SNG RI 309444804710 REVASC CHRONC NDES ADD 253744804720 THORACENTESIS W IMAGING 20194804730 TRANSCTH RET IVAS FB PERC 72594804770 CATH PTA NLASR 195X-254 7864804790 CATH PTA NLASR 331X-431 13344804820 CATH THROM EMB 115X-150 4644804840 CATH THROM EMB 150X-195 6044804850 CATH THROM EMB 1605X-2087 64614804860 CATH THROM EMB 331X-431 13344804900 EVENT REC CARD 3529X-4588 142054804940 GUIDEWIRE 150X-195 6044804950 GUIDEWIRE 2087X-2714 84024804960 GUIDEWIRE 23X-30 934804990 GUIDEWIRE 561X-730 22594805040 INST/SUPP STERL 561X-730 22594805070 INTRO SHTH OTH 115X-150 4644805100 INTRO SHTH OTH 39X-51 158
4805636 SEPTAL DEFECT 4588X-5965 184684805640 INST/SUPP STERL 51X-67 2074805650 INST/SUPP STERL 88X-115 3554805660 INTRO EP FC NPL 561X-730 22594805690 LEAD PMKR NO VDD949X-1234 38204805701 GUIDEWIRE 13X-17 534805719 GUIDEWIRE 30X-39 1214805727 GUIDEWIRE 195X-254 7864805735 CATH GUIDING 254X-331 10244805743 CATH GUIDING 331X-431 13344805750 CATH GUIDING 431X-561 17364805768 CATH GUIDING 561X-730 22594805776 CATH GUIDING 730X-949 29384805784 CATH OTHER 10-13 404805792 CATH OTHER 150X-195 6044805800 CATH OTHER 2087X-2714 84024805818 INTRO EP FC PEEL 51X-67 2074805826 INTRO SHTH OTH 254X-331 10244805834 LEAD ICD DUAL 4588X-5965 184684805842 LEAD ICD SNGL 3529X-4588 142054805859 INST/SUPP STERL 23X-30 934805867 KIT/PACK DISP 331X-431 13344805875 KIT/PACK DISP 730X-949 29384805883 ADPT/EXT LEAD 561X-730 22594805891 INST/SUPP STERL 17X-23 704805900 CATH OTHER 23X-30 934805910 CATH ATHR ROT 2714X-3529 109254805920 ICD SINGLE 11090X-12199 407564805933 THROMBECTOMY CORON MECHAN 109764805941 LT HRT CTH VENTRICULGRPHY 188614805942 STNT PLC TRANSCTH ART INI 273194805943 STNT PLC TRANSCTH ART ADD 224394805944 STNT PLC TRANSC VEIN INI 273194805945 STNT PLC TRANSC VEIN ADD 224394805946 PACEMKR LEAD TEMP150X-195 6044805947 REVAS TIB PERON ATHER INI 362704805948 REVAS TIB PERON ATHER ADD 165884805949 REVAS TIB PERON STENT ADD 143394805950 REVAS TIB PERON STENT INI 359884805951 REVAS TIB PR STNT ATH INI 390814805952 REVAS TIB PR STNT ATH ADD 196814818198 I&D HEMATOMA/SEROMA/FLUID 43424818199 CATH OTHER 1234X-1605 49684818200 CATH GUIDING 2087X-2714 84024818202 NON JOINT IMP 3529X-4588 142054818203 PACU STANDARD 1ST 30MIN 7914818204 PACU STANDARD ADDL 15MIN 277
4818205 PACU COMPLEX 1ST 30MIN 10284818206 PACU COMPLEX ADDL 15MIN 3594818207 REVISION PACEMAKER POCKET 79804818208 EP EVAL DEFIB TRANSV PROG 32954818209 HEPARIN FL PF 1KU/500MLIV 784818210 LEAD LT VENTRC 3529X-4588 142054818211 EVENT REC CARD 4588X-5965 184684818212 DEFIB SUBQ INS/REP W LEAD 1028524818213 LEAD SUBQ DEFIB INSERT 215154818214 DEFIB SUBQ LEAD REMOVAL 77154818215 DEFIB&/OR LEAD SUBQ REPOS 77154818216 TRANSCTH RPR MITRAL INIT 65604818217 TRANSCTH RPR MITRAL ADDL 65604818218 THORACOSTOMY TUBE 13234818219 ICD NOT S/D 7755X-10082 312154818220 PACEMKER INS TEMP DUAL 215224818221 STENT NCOV W 1605X-2087 64614818223 LEAD PMKR NO VDD254X-331 10244818224 PACEMKR SNG RR 1234X-1605 49684818225 PACEMKR SNG RR 1605X-2087 64614818226 CATH ATHR ROT 3529X-4588 142054818227 ADPT/EXT LEAD 115X-150 4644818228 ADPT/EXT LEAD 195X-254 7864818229 ADPT/EXT LEAD 67X-88 2714818230 CLOSURE IMPLNT 23X-30 934818231 INST/SUPP NONST 431X-561 17364818232 INST/SUPP STERL 115X-150 4644818233 INST/SUPP STERL 331X-431 13344818234 INST/SUPP STERL 949X-1234 38204818235 INTRO EP FC PEEL 195X-254 7864818236 INTRO SHTH OTH 331X-431 13344818237 INTRO SHTH OTH 51X-67 2074818238 NON JOINT IMP 10-13 404818239 NON JOINT IMP 17X-23 704818240 NON JOINT IMP 30X-39 1214818241 NON JOINT IMP 39X-51 1584818242 NON JOINT IMP 67X-88 2714818243 NON JOINT IMP 730X-949 29384818244 ADPT/EXT LEAD 431X-561 17364818245 CATH OCCLUSION 88X-115 3554818246 CLOSURE IMPLNT 30X-39 1214818247 EVENT REC CARD 1605X-2087 64614818248 EVENT REC CARD 2714X-3529 109254818249 ICD DUAL 11090X-12199 407564818250 ICD DUAL 5965X-7755 240104818251 ICD DUAL 7755X-10082 312154818252 ICD NOT S/D 10082X-11090 37051
4818253 ICD NOT S/D 11090X-12199 407564818254 ICD NOT S/D 12199X-13419 448324818255 ICD NOT S/D 14761X-16237 542474818256 ICD NOT S/D 16237X-17861 596724818257 ICD SINGLE 10082X-11090 370514818258 ICD SINGLE 17861X-19647 656394818259 ICD SINGLE 21611X-23772 794204818260 ICD SINGLE 5965X-7755 240104818261 ICD SINGLE 7755X-10082 312154818262 INST/SUPP NONST 150X-195 6044818263 INST/SUPP STERL 195X-254 7864818264 INTRO EP FC NPL 431X-561 17364818265 INTRO EP FC PEEL 254X-331 10244818266 INTRO EP FC PEEL 39X-51 1584818267 INTRO EP FC PEEL 431X-561 17364818268 KIT/PACK DISP 67X-88 2714818269 LEAD ICD DUAL 2087X-2714 84024818270 LEAD ICD DUAL 2714X-3529 109254818271 LEAD ICD OTHER 3529X-4588 142054818272 LEAD ICD SNGL 2087X-2714 84024818273 LEAD ICD SNGL 2714X-3529 109254818274 LEAD LT VENTRC 1234X-1605 49684818275 LEAD LT VENTRC 730X-949 29384818276 LEAD PMKR NO VDD 331X-431 13344818277 LEAD PMKR TRN VDD431X-561 17364818278 NON JOINT IMP 561X-730 22594818279 PACEMKR DUAL RR1605X-2087 64614818280 PACEMKR DUAL RR2087X-2714 84024818281 PACEMKR OTHR 3529X-4588 142054818282 PACEMKR OTHR 4588X-5965 184684818283 PACEMKR SNG RR 2087X-2714 84024818284 INST/SUPP STERL 150X-195 6044818285 NON JOINT IMP 88X-115 3554818286 ICD NOT S/D 13419X-14761 493154818287 CATH PTA DC 1234X-1605 49684818289 THROMBOLYS ART INIT DAY 20424818290 THROMBOLYS VEN INIT DAY 20424818291 THROMBOLYS SUBSEQUENT DAY 72594818292 THROMBOLYS FINAL DAY 72594818293 ENDO INTR PRLNG AD RX INI 146914818294 ENDO INTR PRLNG AD RX ADD 146914818295 KIT/PACK DISP 254X-331 10244818296 DEBR SUBQ TISS 1ST 20SQCM 9594818297 DEBR SUBQ TISS ADD 20SQCM 4134818298 DEBR SUBQ/MSCL 1ST 20SQCM 24354818299 DEBR SUBQ/MSCL ADD 20SQCM 8544818300 INTRO SHTH OTH 17X-23 70
4818301 STENT COV W 730X-949 29384818302 INTRO SHTH OTH 13X-17 534818303 INTRO SHTH OTH 431X-561 17364818304 STENT NCOV W 331X-431 13344818305 ICD DUAL 19647X-21611 722024818306 INST/SUPP NONST1234X-1605 49684818307 INST/SUPP NONST 730X-949 29384818308 PACEMKR SNG RR 4588X-5965 184684818309 INTRO CTH DIALY CIRCU BLN 227894818310 THROMB DIALY CIRCUIT BLN 241754818311 ANGIO BLN CENT DIALY SEG 227894818312 ANGIO BLN TRANS ART INI 227894818313 ANGIO BLN TRANS ART EAADD 227894818314 ANGIO BLN TRANSL VEIN INI 227894818315 ANGIO BLN TRAN VEIN EAADD 227894818316 VNT ASST DVC 23772X-26149 873624818317 MOD SEDAT <5YRS 1ST 15M 4654818318 MOD SEDAT =>5YRS 1ST 15M 5544818319 MODERATE SEDAT ADD 15MIN 4654818320 RETRV FRAC DVC 1605X-2087 64614818321 CATH INTVAS US 949X-1234 38204818322 INS VAD ART ACCESS S&I 65604818323 REM VAD SEPARATE SESSION 55984818324 REPOS VAD W IMAG SEP SESS 55985100080 I&D ABSCESS SIMPLE 5995100090 I&D ABSCESS COMPLEX 11135100100 DEBR SUBQ TISS 1ST 20SQCM 9595100110 DEBR SUBQ/MSCL 1ST 20SQCM 24355100120 DEBR SUBQ/MUS/BONE 1ST 20 36425100130 TRIM SKIN LESION 1ST 2565100140 BIOPSY SKIN SINGLE LESION 3665100150 BIOPSY SKIN LESION EA ADD 2455100160 EXC BEN LES S/N/HF .6-1CM 26915100170 TRIM NONDYSTROPHIC NAILS 2705100180 DEBRIDE NAIL UP TO 5 2705100190 DEBRIDE NAIL 6 OR > 3455100200 AVULSION NAIL PLAT SINGLE 3525100210 EXC NAIL & MATRIX 14605100220 DRESS/DEBR BURN SMALL 4955100230 CHEMICAL CAUTERIZ TISSUE 4955100240 TRANS O2 MEAS >=3 LVL BI 8135100250 DEBR NON-SELECTIV SESSION 2545100260 NEG PRESS WD DME<=50CM 45 3415100270 NEG PRESS WD DME<=50CM 60 3415100280 NEG PRESS WD DME>50CM 45 6005100290 NEG PRESS WD DME>50CM 60 6005100300 VISIT LEVEL 1 NEW PT 265
5100310 VISIT LEVEL 2 NEW PT 5095100320 VISIT LEVEL 2 NEW W PROC 5095100330 VISIT LEVEL 3 NEW PT 7695100340 VISIT LEVEL 3 NEW W PROC 7695100350 VISIT LEVEL 4 NEW PT 9215100360 VISIT LEVEL 4 NEW W PROC 9215100370 VISIT LEVEL 5 NEW PT 12325100380 VISIT LEVEL 5 NEW W PROC 12325100390 VISIT LEVEL 1 EST PT 975100400 VISIT LEVEL 1 EST W PROC 975100410 VISIT LEVEL 2 EST PT 2605100420 VISIT LEVEL 2 EST W PROC 2605100430 VISIT LEVEL 3 EST PT 5095100440 VISIT LEVEL 3 EST W PROC 5095100450 VISIT LEVEL 4 EST PT 7895100460 VISIT LEVEL 4 EST W PROC 7895100470 VISIT LEVEL 5 EST PT 11105100480 VISIT LEVEL 5 EST W PROC 11105100490 STRAPPING UNNA BOOT 3625100500 BX BONE SUPERFIC TROC/NDL 26915100510 BX BONE TROCAR/NDL DEEP 32895100520 BX BONE OPEN SUPERFICIAL 71195100530 APLIGRF/SQCM 98.115100540 DERMAGRFT SQCM 116.685100550 HYPERBARIC O2 EACH 30 MN 6535100560 MC HBO THERAPY 1ST 15 MN 2705100570 MC HBO THPY EA ADD 15 MN 2705100630 STRAPPING UNNA BOOT BIL 3625100650 I&D HEMATOMA/SEROMA/FLUID 41045100660 I&R FB SUBQ SIMPLE 8895100670 PREP SITE FN/HF/G 1ST 100 12605100680 ASP ABSC/HEMA/CYST/BULLA 4375100690 TRIM SKIN LESION 2-4 3615100700 APPL LAYRD COMPRES BK BIL 3145100710 APPL LAYRED COMPRES BK LT 3145100720 APPL LAYRED COMPRES BK RT 3145100730 OASIS WND MATRIX/SQCM 15.685100740 PART EXC BONE PHALANX TOE 66605100750 DEBR SELCT SESSION ADD 20 2715100760 DEBR SL SESSION 1ST 20CM 5655100780 DEBR SUBQ TISS ADD 20SQCM 4135100790 DEBR SUBQ/MSCL ADD 20SQCM 8545100800 DEBR SUBQ/MUS/BONE ADD 20 15055100820 DRESS/DEBR BURN MEDIUM 10195100830 DRESS/DEBR BURN LARGE 12325100840 AP SK HI GR T/A/L<100 1ST 7565100850 AP SK HI GR T/A/L<100 ADD 151
5100860 AP SK HI GR T/A>=100 1ST 17695100870 AP SK HI GR T/A>=100 ADD 3855100880 AP SK HI GR F/N/G<100 1ST 8775100890 AP SK HI GR F/N/G<100 ADD 2195100900 AP SK HI GR F/N>=100 1ST 19355100910 AP SK HI GR F/N>=100 ADD 4845100920 APP LAYR CMPRS ARM/HND BI 3935100930 APP LAYR CMPRS ARM/HND LT 3935100940 APP LAYR CMPRS ARM/HND RT 3935100950 APPL LAYRD COMPRES ARM LT 2795100960 APPL LAYRD COMPRES ARM RT 2795100970 APPL LAYRD COMPRES LEG LT 3935100980 APPL LAYRD COMPRES LEG RT 3935100990 APPL LAYRD COMPRS ARM BIL 2795101000 APPL LAYRD COMPRS LEG BIL 3935101010 EXC S/P ULCER W/PRIM SUT 54355101020 TX DSLC HIP TRAUMA CLSD 4525101030 APPL CST LEG RIGD CONTACT 5695101040 INST/SUPP STERL 10-13 405101050 INST/SUPP STERL 13X-17 535101060 VISIT LEVEL 1 NEW W PROC 2655101070 NEG PRESS WD DME<=50CM 15 3415101080 NEG PRESS WD DME>50CM 15 6005101090 GLUCOSE BLD BY DEVICE POC 175101100 NEG PRESS WD DME<=50CM 30 3415101110 NEG PRESS WD DME>50CM 30 6005101120 STRAPPING UNNA BOOT RT 3625101130 STRAPPING UNNA BOOT LT 3625101140 TX BURN 1ST DEG INITIAL 24205101160 INSERT CATH BLADDER SMPL 3355101170 SOMATOSEN TSTNG UPP EXT 8875101180 TRANS O2 MEAS 1-2 LVL BI 5185101190 OASIS ULT TRILY MTRX/SQCM 475101191 AP SK LO GR T/A/L<100 1ST 7945101192 AP SK LO GR T/A/L<100 ADD 3765101193 AP SK LO GR T/A>=100 1ST 15555101194 AP SK LO GR T/A>=100 ADD 10215101195 AP SK LO GR F/N/G<100 1ST 10215101196 AP SK LO GR F/N/G<100 ADD 3765101197 AP SK LO GR F/N>=100 1ST 15555101198 AP SK LO GR F/N>=100 ADD 10215101199 REARRANGE TIS TRUNK <=10 7565101200 ARTHROCEN ASP MAJOR JT WO 5305101201 LR SMPL TRNK/NECK 2.6-7.5 2195101202 EXPLORE WOUND EXTREMITY 22175101203 LR CPLX TRUNK 2.6-7.5 10745101204 LR CPLX TRUNK ADD <=5 399
5101205 REMOVE SKIN TAGS <=15 2845101206 NEG PRES WD NONDME<=50 15 4555101207 NEG PRES WD NONDME<=50 30 4555101208 NEG PRES WD NONDME<=50 45 4555101209 NEG PRES WD NONDME<=50 60 4555101210 NEG PRES WD NONDME<=50 75 4555101211 NEG PRES WD NONDME<=50 90 4555101212 NEG PRES WD NON DME>50 15 4555101213 NEG PRES WD NON DME>50 30 4555101214 NEG PRES WD NON DME>50 45 4555101215 NEG PRES WD NON DME>50 60 4555101216 NEG PRES WD NON DME>50 75 4555101217 NEG PRES WD NON DME>50 90 4555101218 EPIFIX 18MM 561X-730 22595101219 EPIFIX 2X2CM 949X-1234 38205101220 EPIFIX MSH 2X3 949X-1234 38205101221 EPIFIX 4X4CM 2714X-3529 109255101222 EPIFIX 5X6CM 4588X-5965 184685101223 EPIFIX 7X7CM 7755X-10082 312155101224 EPIFIX 14MM 254X-331 10245101225 PURAPLY AM 5X5 2714X-3529 109255101226 PURAPLY AM 2X2 561X-730 22595101227 PURAPLY AM 2X4 730X-949 29385101228 PURAPLY AM 6X9 5965X-7755 240105101229 IRRIG/LAVG CERUMEN IMPACT 2335101230 EPIFIX MSH 4.5 1234X-1605 49685101231 REARRAN TIS S/A/L 10.1-30 13535101232 REMOVAL IMPLNT SUPRFICIAL 44625101233 EXC MAL LES T/A/L 2.1-3CM 12615101234 INST/SUPP STERL 195X-254 7865101235 EXC BEN LES T/A/L 2.1-3CM 12615101236 GRAFIX P 1.5X2CM 730X-949 29385101237 GRAFIX P 2X3CM 949X-1234 38205101238 GRAFIX P 3X4CM1234X-1605 49685101239 GRAFIX P 14MM 431X-561 17365101240 GRAFIX C 14MM 431X-561 17365101241 GRAFIX C 1.5X2CM 730X-949 29385101242 GRAFIX C 2X3CM 949X-1234 38205101243 GRAFIX C 3X4 1605X-2087 49685101244 GRAFIX C 16MM 431X-561 17365101245 LR SMPL FACE/EAR <=2.5 2195101246 CNTRL NOSEBLEED ANTR SMPL 3175101247 I&D ABSC PERIANAL SUPERFC 2125101248 AMPUTATE METATARSO JOINT 77355101249 I&R FB SUBQ COMPLEX 41045101250 EPIFIX 2X4CM 1234X-1605 49685101251 GRAFIX P 16MM 431X-561 1736
5101252 EPIFIX MSH 3.5 949X-1234 38205200610 ADMIN INFLUENZA VACCINE 3645200620 ADMIN OTHER IMMUN VAC ADD 1825200630 ADMIN OTHER IMMUN VAC ONE 3645200640 ADMIN PNEUMO VACCINE 3645200650 BLOOD COLLECTION PICC 3765200660 BLOOD COLLECTION VAD 3395200670 CHEMO INF EA ADD HR 4395200680 CHEMO INF EA SEQ 1ST HR 20915200690 CHEMO INF INIT 1ST HR 20915200700 CHEMO IV PUSH EA ADD 6545200710 CHEMO IV PUSH INITIAL 11715200720 CHEMO SQ/IM HORMONAL 4105200730 CHEMO SQ/IM NONHORMONAL 9505200740 INF IV HYDRA INIT 31-60MN 21705200750 INF IV HYDRAT EA ADD HR 5705200770 INF TX/DX CONCURRENT 15475200780 INF TX/DX/PRO EA ADD HR 7055200790 INF TX/DX/PRO INIT 1ST HR 25775200800 INF TX/DX/PRO SEQ 1HR 11125200810 INJ TX/DX/PRO IV PUSH SEQ 3825200820 INJ TX/DX/PRO IVPUSH INIT 3825200830 INJ TX/DX/PROPH SUBQ/IM 3825200840 INJ TX/PRO/DX IVP SME DRG 3825200850 IRRIG IMPLANTED VEN ACCES 3235200870 PICC INSERT/REPLACE RN 16775200900 VENIPUNCTURE NON LAB 225200910 VISIT LEVEL 1 EST PT 975200920 VISIT LEVEL 1 EST W PROC 975200930 VISIT LEVEL 1 NEW PT 2655200940 VISIT LEVEL 1 NEW W PROC 2655200950 VISIT LEVEL 2 EST PT 2605200960 VISIT LEVEL 2 EST W PROC 2605200970 VISIT LEVEL 2 NEW PT 5095200980 VISIT LEVEL 2 NEW W PROC 5095200990 VISIT LEVEL 3 EST PT 5095201000 VISIT LEVEL 3 EST W PROC 5095201010 VISIT LEVEL 3 NEW PT 7695201020 VISIT LEVEL 3 NEW W PROC 7695201030 VISIT LEVEL 4 EST PT 7895201040 VISIT LEVEL 4 EST W PROC 7895201050 VISIT LEVEL 4 NEW PT 9215201060 VISIT LEVEL 4 NEW W PROC 9215201070 VISIT LEVEL 5 EST PT 11105201080 VISIT LEVEL 5 EST W PROC 11105201090 VISIT LEVEL 5 NEW PT 12325201100 VISIT LEVEL 5 NEW W PROC 1232
5201110 CATH INFUSION 195X-254 7865201537 PUMP PORTABL REFILL/MAINT 5445201538 PUMP IMPLANTD REFIL/MAINT 5445201539 INF IV TX/DX PUMP PROLONG 4015201540 INJ TX/DX/PRO INTRA-ARTER 3825201541 CATH FOR SPECIMEN COLLECT 1255201542 GLUCOSE BLD BY DEVICE POC 175201543 CHEMO INJ SUBARAC/VENTRIC 18995201544 CHEMO INTRA-ART PUSH 6605201545 CHEM ART INF PUMP PROLONG 18995201546 CHEMO ADMIN THORACENTESIS 12505201547 CHEMO ADMIN INTRATHECAL 8195201548 CHEMO IV INF PUMP PROLONG 46405201549 CHEMO ART INF INIT 1ST HR 8195201550 CHEMO ART INF EA ADD HR 6605201551 VASC ACCES THROMBL DECLOT 4475201552 APHERESIS PLASM THERAPEUT 30335201553 INSERT CATH BLADDER 3195201554 PHLEBOTOMY THERAPEUT 3415201555 CATH FOR SPECIMEN COLLECT 1255201565 TRANSFUS BLOOD/COMP 1HR 10035201566 TRANSFUS BLOOD/COMP 2HR 12545201567 TRANSFUS BLOOD/COMP 3HR 15055201568 TRANSFUS BLOOD/COMP 4HR 17555201569 TRANSFUS BLOOD/COMP 5HR 20065201570 TRANSFUS BLOOD/COMP 6HR 22575201571 TRANSFUS BLOOD/COMP 7HR 25085201572 TRANSFUS BLOOD/COMP 8HR 27585201573 TRANSFUS BLOOD/COMP >8HR 30095201574 D5% 250ML INJ 785201575 D5% 500ML INJ 785201576 LACTATED RINGERS 1L INJ 785201577 LACTATED RINGERS 500MLINJ 785201578 NACL 0.45% 1000ML INJ 785201579 NACL 0.9% 1000ML INJ 785201580 NACL 0.9% 250ML INJ 785201581 NACL 0.9% 500ML INJ 785201582 ADMIN HEP B VACCINE 3646100010 MR PELVIS WO&W CON 84996100060 MR ABDOMEN W CON 59806100070 MR ABDOMEN WO&W CON 68886100080 MR ORB/FAC/NECK WO CON 35186100090 MR ORB/FAC/NECK WO&W CON 58616100100 MR ANGIO HEAD WO CON 35036100110 MR ANGIO HEAD W CON 50796100120 MR ANGIO NECK WO CON 36206100130 MR ANGIO NECK W CON 5250
6100140 MR ANGIO NECK WO&W CON 60356100150 MR BRAIN WO CON 43296100160 MR BRAIN W CON 62786100170 MR BRAIN WO&W CON 72306100171 MR BRAIN FUNCT WO PHY/PSY 36886100180 MR CHEST WO CON 64876100190 MR CHEST WO&W CON 64876100200 MR C SPINE WO CON 50706100210 MR C SPINE W CON 73526100220 MR T SPINE WO CON 50566100230 MR T SPINE W CON 73336100240 MR L SPINE WO CON 52746100250 MR L SPINE W CON 76476100260 MR C SPINE WO&W CON 84686100270 MR T SPINE WO&W CON 84456100280 MR L SPINE WO&W CON 88076100290 MR PELVIS WO CON 50996100300 MR ANGIO PELVIS W CON 30726100400 MR ABDOMEN WO CON 41246100410 MR ANGIO ABDOMEN W CON 36886100420 MR ANGIO ABDOMEN WO CON 36886100430 MR ANGIO ABDOMEN WO&W CON 36886100440 GADOLINIUM-BAS MR CON/ML 84.866100460 GADOBEN DIMEG /1ML-20MLVL 104.036100470 GADOBEN DIMEG /1ML 15MLVL 78.076100480 GADOBEN DIMEG /1ML-10MLVL 52.046100490 MR ANGIO LOW EXTR WO&W LT 16706100500 MR ANGIO LOW EXTR WO&W RT 16706100510 MR ANGIO LOW EXTREM W LT 13826100520 MR ANGIO LOW EXTREM W RT 13826100530 MR ANGIO LOW EXTREM WO LT 10296100540 MR ANGIO LOW EXTREM WO RT 10296100550 MR ANGIO UPP EXTR WO&W LT 16706100560 MR ANGIO UPP EXTR WO&W RT 16706100570 MR BREAST W CON LT 13826100580 MR BREAST W CON RT 13826100590 MR BREAST WO CON LT 10296100600 MR BREAST WO CON RT 10296100610 MR BREAST WO&W CON LT 16706100620 MR BREAST WO&W CON RT 16706100630 MR LOW EXTREM JNT W LT 52596100640 MR LOW EXTREM JNT W RT 52596100650 MR LOW EXTREM JNT WO LT 36286100660 MR LOW EXTREM JNT WO RT 36286100670 MR LOW EXTREM JNT WO&W LT 60576100680 MR LOW EXTREM JNT WO&W RT 60576100690 MR LOW EXTREM W CON LT 4565
6100700 MR LOW EXTREM W CON RT 45656100710 MR LOW EXTREM WO CON LT 31496100720 MR LOW EXTREM WO CON RT 31496100730 MR LOW EXTREM WO&W CON LT 52576100740 MR LOW EXTREM WO&W CON RT 52576100750 MR UPP EXTREM JNT W LT 52596100760 MR UPP EXTREM JNT W RT 52596100770 MR UPP EXTREM JNT WO LT 36286100780 MR UPP EXTREM JNT WO RT 36286100790 MR UPP EXTREM JNT WO&W LT 60576100800 MR UPP EXTREM JNT WO&W RT 60576100810 MR UPP EXTREM W CON LT 19586100820 MR UPP EXTREM W CON RT 19586100830 MR UPP EXTREM WO CON LT 25846100840 MR UPP EXTREM WO CON RT 25846100850 MR UPP EXTREM WO&W CON LT 45406100860 MR UPP EXTREM WO&W CON RT 45406100870 MR ANGIO LOW EXTREM WO BI 15446100880 MR ANGIO PELVIS WO&W CON 16706100910 MR BREAST W CON BIL 13826100930 MR TELERADIOGRPY/EXAM NC 0 16100940 MR LOW EXTREM JNT WO LTD 36286100950 MR TMJ(S) UNI OR BIL 10296100970 MR ANGIO HEAD WO&W CON 58506100980 MR ANGIO CHEST W CON 13826100990 MR ANGIO SPINE WO&W CON 16706101000 MR ORB/FAC/NECK W CON 50996101010 MR CHEST W CON 13826101030 MR ANGIO CHEST WO CON 10296101050 MR BREAST WO&W CON BIL 16706101110 MR 3D WO SEPARATE WKSTATN 2506101130 MR BREAST WO CON BIL 10296101160 MR ANGIO CHEST WO&W CON 16706101170 MR PELVIS W CON 73946101180 MR GUIDED NDL BX/ASP/INJ 16746101190 MR CHOLANGIO MRCP WO CON 16746101191 MR CHOLANGIO MRCP W CON 59806101192 MR CHOLANGIO MRCP WO CON 41246101193 MR CHOLANGI MRCP WO&WCON 68886101194 BX BREAST MRI PERC 1ST 44106101196 BX BREAST MRI PERC EA ADD 44106101197 PLC BRST LOC DEV MRI 1ST 30956101199 PLC BRST LOC DEV MRI ADD 30956101200 MR CAD BREAST DATA ANALY 466101201 MR ANGIO LOW EXTREM W BIL 20736300018 aprepitant 80 mg Cap 5896300020 Fluzone Quadrival. influenza virus vac 195
8100480 BLS-NE HD/HOSP-DIAG TX 21078100490 BLS-NE ES/ECF-SCENE 21078100500 BLS-NE ER/ECF-RESIDENCE 21078100510 BLS-NE EP/ECF-MD OFFICE 21078100520 BLS-NE EH/ECF-HOSP 21078100530 BLS-NE DN/DIAG-SNF 21078100540 BLS-NE DH/DIAG TX-HOSP 21078100550 CB EMERGNT ORGAN TRANSPRT 9338100570 BLS-E SI/SCENE-SITE 25038100580 BLS-E SH/SCENE-HOSP 25038100590 BLS-E RH/RESIDENCE-HOSP 25038100600 BLS-E PH/MD OFFICE-HOSP 25038100610 BLS-E NH/SNF-HOSP 25038100620 BLS-E HP/HOSP-MD OFFICE 25038100630 BLS-E HH/HOSP-HOSP 25038100640 BLS-E EH/ECF-HOSP 25038100910 CB QUOTED PER MILE RATE 128100920 CB QUOTED BASE RATE 9838100930 CB IFT CONTRACT TRANSPORT 19148100940 CB IFT MILEAGE 178100950 SNF TRANSPORT NE/SNF-ECF 18968100960 SNF TRANSPORT ND/SNF-DIAG 18968100970 SNF TRANSPORT NH/SNF-HOSP 18968100980 SNF TRANSPORT NI/SNF-SITE 18968100990 SNF TRANSPORT NJ/SNF-DIAL 18968101000 SNF TRANSPORT NN/SNF-SNF 18968101010 SNF TRANSPORT NP/SNF-OFFC 18968101020 SNF TRANSPORT NR/SNF-RES 18968101030 SNF TRANSPORT NS/SNF-SCEN 18968101040 SNF TRANSPORT EN/ECF-SNF 18968101050 SNF TRANSPORT DN/DIAG-SNF 18968101060 SNF TRANSPORT HN/HOSP-SNF 18968101070 SNF TRANSPORT IN/SITE-SNF 18968101080 SNF TRANSPORT JN/DIAL-SNF 18968101090 SNF TRANSPORT PN/OFFC-SNF 18968101100 SNF TRANSPORT RN/RES-SNF 18968101110 SNF TRANSPORT SN/SCEN-SNF 18968101300 IP TRANSPRT DX OUTSIDE NC 0 18101310 BLS-E HR/HOSP-RES QL MOD 25038101320 BLS-EHS/HOSP-SCEN QL MOD 25038101330 IP TRNSPRT DX MILE OUT NC 0 28101340 ALS2-JH/DIALYSIS-HOSP 59718101350 ALS2-HJ/HOSP-DIALYSIS 59718101360 BLS-E JH/DIALYSIS-HOSP 25038101370 BLS-E HJ/HOSP-DIALYSIS 25038101380 BLS-E HI/HOSP-SITE 25038101400 BLS-NE IH/SITE-HOSP 2107
8101411 BLS-E IH/SITE-HOSP 25038101412 BLS-NE SH/SCENE-HOSP 21078101413 BLS-NE HR/HOSP-RES QL MOD 21078101414 BLS-NE HS/HOS-SCEN QL MOD 21078101415 CB IFT MILEAGE H-H 178101416 CB IFT MILEAGE N-H 178101417 CB IFT MILEAGE H-N 178101418 CB IFT CONTRACT TRANS H-H 19148101419 CB IFT CONTRACT TRANS H-N 19148101420 CB IFT CONTRACT TRANS N-H 19148101421 BLS-NE PT DECEASED QL/QN 21078101422 ALS1-NE HN/HOSP-SNF 48568101423 BLS-E DS/DIAG TX-SCENE 25038101424 BLS-NE DS/DIAG TX-SCENE 21078101426 MILEAGE ALS EH/ECF-HOSP 178101427 MILE ALS ER/ECF-RESIDENCE 178101428 MILEAGE ALS ES/ECF-SCENE 178101429 MILEAGE ALS HE/HOSP-ECF 178101430 MILEAGE ALS HH/HOSP-HOSP 178101431 MILEAGE ALS HI/HOSP-SITE 178101432 MILE ALS HJ/HOSP-DIALYSIS 178101433 MILEAGE ALS HN/HOSP-SNF 178101434 MILEAGE ALS HR/HOSP-RES 178101435 MILEAGE ALS IH/SITE-HOSP 178101436 MILE ALS JH/DIALYSIS-HOSP 178101437 MILE ALS JN/DIALYSIS-SNF 178101438 MILEAGE ALS NE/SNF-ECF 178101439 MILEAGE ALS NH/SNF-HOSP 178101440 MILE ALS NJ/SNF-DIALYSIS 178101441 MILEAGE ALS NN/SNF-SNF 178101442 MILEAGE ALS NR/SNF-RES 178101443 MILE ALSPH/MD OFFICE-HOSP 178101444 MILE ALS PR/MD OFFICE-RES 178101445 MILEAGE ALS RE/RES-ECF 178101446 MILEAGE ALS RH/RES-HOSP 178101447 MILEAGE ALS RI/RES-SITE 178101448 MILEAGE ALS RN/RES-SNF 178101449 MILE ALS RP/RES-MD OFFICE 178101450 MILEAGE ALS RR/RES-RES 178101451 MILEAGE ALS SH/SCENE-HOSP 178101452 MILEAGE ALS SI/SCENE-SITE 178101453 MILEAGE BLS EH/ECF-HOSP 178101454 MILE BLS ER/ECF-RESIDENCE 178101455 MILEAGE BLS ES/ECF-SCENE 178101456 MILEAGE BLS HE/HOSP-ECF 178101457 MILEAGE BLS HH/HOSP-HOSP 178101458 MILEAGE BLS HI/HOSP-SITE 17
8101459 MILE BLS HJ/HOSP-DIALYSIS 178101460 MILEAGE BLS HN/HOSP-SNF 178101461 MILEAGE BLS HR/HOSP-RES 178101462 MILEAGE BLS IH/SITE-HOSP 178101463 MILE BLS JH/DIALYSIS-HOSP 178101464 MILE BLS JN/DIALYSIS-SNF 178101465 MILEAGE BLS NE/SNF-ECF 178101466 MILEAGE BLS NH/SNF-HOSP 178101467 MILE BLS NJ/SNF-DIALYSIS 178101468 MILEAGE BLS NN/SNF-SNF 178101469 MILEAGE BLS NR/SNF-RES 178101470 MILE BLS PH/MD OFFIC-HOSP 178101471 MILE BLS PR/MD OFFICE-RES 178101472 MILEAGE BLS RE/RES-ECF 178101473 MILEAGE BLS RH/RES-HOSP 178101474 MILEAGE BLS RI/RES-SITE 178101475 MILEAGE BLS RN/RES-SNF 178101476 MILE BLS RP/RES-MD OFFICE 178101477 MILEAGE BLS RR/RES-RES 178101478 MILEAGE BLS SH/SCENE-HOSP 178101479 MILEAGE BLS SI/SCENE-SITE 178101480 MILEAGE LITT EH/ECF-HOSP 178101481 MILE LITT ER/ECF-RES 178101482 MILEAGE LITT ES/ECF-SCENE 178101483 MILEAGE LITT HE/HOSP-ECF 178101484 MILEAGE LITT HH/HOSP-HOSP 178101485 MILEAGE LITT HI/HOSP-SITE 178101486 MILE LITT HJ/HOSP-DIALY 178101487 MILEAGE LITT HN/HOSP-SNF 178101488 MILEAGE LITT HR/HOSP-RES 178101489 MILEAGE LITT IH/SITE-HOSP 178101490 MILE LITT JH/DIALY-HOSP 178101491 MILE LITT JN/DIALYSIS-SNF 178101492 MILEAGE LITT NE/SNF-ECF 178101493 MILEAGE LITT NH/SNF-HOSP 178101494 MILE LITT NJ/SNF-DIALYSIS 178101495 MILEAGE LITT NN/SNF-SNF 178101496 MILEAGE LITT NR/SNF-RES 178101497 MILE LITT PH/MD OFFI-HOSP 178101498 MILE LITT PR/MD OFFIC-RES 178101499 MILEAGE LITT RE/RES-ECF 178101500 MILEAGE LITT RH/RES-HOSP 178101501 MILEAGE LITT RI/RES-SITE 178101502 MILEAGE LITT RN/RES-SNF 178101503 MILE LITT RP/RES-MD OFFIC 178101504 MILEAGE LITT RR/RES-RES 178101505 MILE LITT SH/SCENE-HOSP 17
8101506 MILE LITT SI/SCENE-SITE 178101507 SNFMILE1W ALS DN/DIAG-SNF 178101508 SNF MILE1W ALS EN/ECF-SNF 178101509 SNFMILE1W ALS HN/HOSP-SNF 178101510 SNFMILE1W ALS IN/SITE-SNF 178101511 SNFMILE1W ALS JN/DIAL-SNF 178101512 SNFMILE1W ALS ND/SNF-DIAG 178101513 SNF MILE1W ALS NE/SNF-ECF 178101514 SNFMILE1W ALS NH/SNF-HOSP 178101515 SNFMILE1W ALS NI/SNF-SITE 178101516 SNFMILE1W ALS NJ/SNF-DIAL 178101517 SNF MILE1W ALS NN/SNF-SNF 178101518 SNFMILE1W ALS NP/SNF-OFFC 178101519 SNF MILE1W ALS NR/SNF-RES 178101520 SNFMILE1W ALS NS/SNF-SCEN 178101521 SNFMILE1W ALS PN/OFFC-SNF 178101522 SNF MILE1W ALS RN/RES-SNF 178101523 SNFMILE1W ALS SN/SCEN-SNF 178101524 SNFMILE1W BLS DN/DIAG-SNF 178101525 SNF MILE1W BLS EN/ECF-SNF 178101526 SNFMILE1W BLS HN/HOSP-SNF 178101527 SNFMILE1W BLS IN/SITE-SNF 178101528 SNFMILE1W BLS JN/DIAL-SNF 178101529 SNF MILE1W BLS NE/SNF-ECF 178101530 SNFMILE1W BLS NH/SNF-HOSP 178101531 SNFMILE1W BLS NI/SNF-SITE 178101532 SNFMILE1W BLS NJ/SNF-DIAL 178101533 SNF MILE1W BLS NN/SNF-SNF 178101534 SNFMILE1W BLS NP/SNF-OFFC 178101535 SNF MILE1W BLS NR/SNF-RES 178101536 SNFMILE1W BLS NS/SNF-SCEN 178101537 SNFMILE1W BLS PN/OFFC-SNF 178101538 SNF MILE1W BLS RN/RES-SNF 178101539 SNFMILE1W BLS SN/SCEN-SNF 178101540 SNFMILE1WLITT DN/DIAG-SNF 178101541 SNFMILE1W LITT EN/ECF-SNF 178101542 SNFMILE1WLITT HN/HOSP-SNF 178101543 SNFMILE1WLITT IN/SITE-SNF 178101544 SNFMILE1WLITT JN/DIAL-SNF 178101545 SNFMILE1WLITT ND/SNF-DIAG 178101546 SNFMILE1W LITT NE/SNF-ECF 178101547 SNFMILE1WLITT NH/SNF-HOSP 178101548 SNFMILE1WLITT NI/SNF-SITE 178101549 SNFMILE1WLITT NJ/SNF-DIAL 178101550 SNFMILE1W LITT NN/SNF-SNF 178101551 SNFMILE1WLITT NP/SNF-OFFC 178101552 SNFMILE1W LITT NR/SNF-RES 17
8101553 SNFMILE1WLITT NS/SNF-SCEN 178101554 SNFMILE1WLITT PN/OFFC-SNF 178101555 SNFMILE1W LITT RN/RES-SNF 178101556 SNFMILE1WLITT SN/SCEN-SNF 178200010 ECHO TEE WO CON 31378200020 ECG 12 LEAD TRACING ONLY 3608200030 ECHO 2D COM WO CON WO DOP 16428200040 CARDIAC REHAB II W ECG OP 3518200060 DOP ECHO COLOR FLOW ADDON 9778200070 DOP ECHO COMP STUDY ADDON 20368200080 ECHO STR TEST COMP WO CON 21108200090 CARD REHAB I INIT IP NC 0 18200100 CARD REHAB III OP NC 0 18200110 CARDIOVAS STR TEST WO RX 12918200130 INJ FOR MICROBUBBLE STUDY 3828200140 CARDIOVAS STR TEST W RX 12918200150 ECHO 2D LTD WO CON 14408200170 ECHO 2D COMP W CON 16428200180 ECHO 2D LMTD W CON 14408200190 ECHO TEE W CON 31378200210 ECHO STR TEST COMP W CON 19208200220 CARD REHAB III SP 398200230 CARD REHAB INI ASMT OP NC 0 18200240 TTE W/DOPPLER COMPLETE 29268200250 TTE COMP W SPEC/CF W CON 29268200260 ECHO PORTABLE PER TRIP NC 0 18200270 ECG PORTABLE PER TRIP NC 0 18200280 DOP ECHO LMTD STUDY ADDON 10188200290 ECH CNG TRNSTHR LTD WOCON 22628200300 ECH CNG TRNSTHR COM WOCON 31868200310 ECG 1-3 LEAD TRACING ONLY 718200320 HOLTER RECRD ONLY <= 48HR 1768200330 HOLTER SCN & RPRT <= 48HR 1768200341 PULM REHAB COPD W EX 1HR 1318200342 PULM REHAB PHASE III NC 0 18200343 PULM STRESS TEST SIMPLE 1678200344 THERAP STRG ENDR EA 15MIN 1318200345 THRP RSP STG END GR<=105M 8538200346 THRP RSP STG END GR<=120M 9738200347 THRP RSP STRG END GR<=30M 2468200348 THRP RSP STRG END GR<=45M 3698200349 THRP RSP STRG END GR<=60M 4898200351 THRP RSP STRG END GR<=90M 7318200352 THRP RSP-OTH INDV EA15MIN 1318200354 TOBACCO COUNSELING 3-10MN 1058200356 TOBACCO COUNSELING >10MIN 2188200370 ECHO CNG TRNSTHR COM WCON 3696
8200371 PULM REHAB III SP 398200372 CARD REHAB II WO ECG OP 3518200373 ECHO STR TEST COMP W ECG 21109200010 US FETAL BIOP PROF WO NST 8749200030 US SOFT TISS HEAD & NECK 18729200060 US PREG TRANSVAGINAL 22099200070 US SCROTUM 25379200080 US ABD COMPLETE WO CON 24339200090 US ABDOMEN WO CON LTD 18729200100 US RETROPERITONEAL COMPL 24379200110 US PREG=>14WK SNG 1ST GES 7559200120 US PELVIS NON OB COMP 22099200130 CT GUIDE CATH DRAIN 43339200150 US PREG+DETL SNGL1ST GEST 16579200170 US FETAL BIOPH PROF W NST 11969200200 US CHEST 17739200210 US HIPS INFANT DYNAMIC 19099200240 BX LIVER NEEDLE PERC 31049200250 BX THYROID NDL CORE PERC 10289200260 CHOLECYSTOSTOMY PERC 53719200270 LIVER TUMOR ABLAT RF PERC 107659200310 AMNIOCENTESIS 15249200320 US GUIDED NEEDL PLACEMENT 18029200330 US SPINAL CANAL & CONTENT 5519200340 US PORTABLE PER TRIP NC 0 19200350 US TRANSVAGINAL 18439200360 US PREG<14WK SNGL1ST GEST 6499200370 US PREG<14WKS EA ADD GEST 3489200380 US PREG=>14WKS EA ADD GES 4999200390 US PREG 1 OR >FETUSES LTD 19679200400 US V DPLX AB/PEL/RET LTD 15279200430 US ENCEPHALOGRAM 17029200440 US FETAL ECHO UMBIL ART 4349200450 US FETAL ECHO MID CEREBRL 3939200480 PSEUDOANEURY TX EXTRM INJ 5229200490 ASP ABSC/HEMA/CYST/BULLA 4049200500 PARACENTSIS ABD W IMAGING 22209200510 PERITONEAL LAVAGE 13139200520 PARACENTESIS ABD WO IMAG 15109200530 US BREAST COMPLETE LT 3069200540 US BREAST COMPLETE RT 3069200550 US BREAST COMPLETE LT 3069200560 US BREAST COMPLETE RT 3069200570 US EXTREM NONVAS COMP LT 20019200580 US EXTREM NONVAS COMP RT 20019200590 US EXTREM NONVAS LTD LT 6019200600 US EXTREM NONVAS LTD RT 601
9200610 US V DPLX ART LOW EXT LT 15789200620 US V DPLX ART LOW EXT RT 15789200630 US V DPLX ART UP EXT LT 10569200640 US V DPLX ART UP EXT RT 10569200650 US V DPLX VENOUS EXT LT 13979200660 US V DPLX VENOUS EXT RT 13979200670 US TRANSRECTAL 3029200680 US RETROPERITONEAL LTD 11959200700 US PREG FOLLOWUP/EA GEST 25419200710 DOP ECHO COMP STUDY ADDON 20369200730 ECHO 2D COM WO CON WO DOP 16429200740 US V DPLX ART LOW EXT BIL 26749200750 US V DPLX ART UP EXT BIL 17049200760 US SONOHYSTEROGRAM 4699200770 US DOP ART EXT >=3 LVL BI 9929200780 US V DOP ART LOWEXT W/S B 12429200790 US PELVIS NON OB LTD F/U 14819200800 US GUIDED COMPRESS REPAR 3309200810 US GUIDE INTRAOP 1-2 HOUR 5109200820 US V DPLX AB/PEL/RET CMP 26269200830 US GUIDE INTRAOP 0-1 HOUR 3349200840 HYSTERO NS/CON INTRO 6529200850 US PREG+DETL EA ADDL GEST 8309200860 US DOP ART EXT 1-2 LVL BI 6409200870 US TELERADIOGRAPY/EXAM NC 0 19200880 ECHO 2D LTD WO CON 14409200890 BIOPSY PROSTATE NDL/PUNCH 14259200900 PLACE RT DEVICE PROSTATE 26099200930 US AAA SCREENING 3179200940 US BREAST COMPLETE BIL 4599200960 BREAST CYST PUNC ASPIRATE 9169200970 ECHO TEE WO CON 31379200980 DOP ECHO LMTD STUDY ADDON 10189201000 ASP FINE NDL W IMAGING 12179201030 US GUIDED VASCULAR ACCESS 17589201040 BREAST CYST ASP EA ADDL 3259201060 US V DPLX AO/IVC/GRFT LTD 11309201070 US V DPLX AO/IVC/GRFT CMP 17879201090 US PREG NUCAL TRANSLU 1ST 4869201100 US PREG NUCAL TRANSL ADD 2449201120 INS CATH PLEURAL W IMAG 14759201130 THORACENTESIS W IMAGING 20199201140 US GUIDED AMNIOCENTESIS 16839201150 DOP ECHO COLOR FLOW ADDON 9779201160 US DPLX EXTRACRAN CMP BIL 22529201170 US V DOP TRANSCRAN CMP 20029201180 US V DOP TRANSCRAN LTD 1335
9201200 US V DPLX VENOUS EXT BIL 22909201210 INST/SUPP STERL 30X-39 1219201220 INST/SUPP STERL 51X-67 2079201290 MODERATE SEDAT ADD 15MIN 4889201328 TTE W/DOPPLER COMPLETE 29269201336 BX/EXC LYMPH NODE SUPERFI 19539201344 INST/SUPP STERL 23X-30 939201351 INST/SUPP STERL 39X-51 1589201369 INST/SUPP STERL 67X-88 2719201385 KIT/PACK DISP 431X-561 17369201393 KIT/PACK DISP 50X-67 2079201394 IMAGE CATH FLUID VISCERAL 71879201395 IMAGE CATH FLUID PERITO 71879201399 BX BREAST US PERC 1ST 45209201401 BX BRST US PERC EA ADD 45209201402 BX BREAST MRI PERC 1ST 44109201404 BX BREAST MRI PERC EA ADD 44109201405 PLC BRST LOC DEV MAMM 1ST 29789201407 PLC BRST LOC DEV MAMM ADD 29789201411 PLC BRST LOC DEV US 1ST 32059201413 PLC BRST LOC DEV US ADD 32059201414 PLC BRST LOC DEV MRI 1ST 30959201416 PLC BRST LOC DEV MRI ADD 30959201417 IMAGE CATH FLUID SOFT TIS 4199201419 US UPPER BACK SOFT TISSUE 17739201420 US LO BACK SFT TIS WO CON 18729201421 IMT STDY FOR CHD RSK FCTR 1739201422 US BREAST LIMITED LT 2299201423 US BREAST LIMITED RT 2299201424 US BREAST LIMITED BIL 3449201425 BX NECK/THORAX SOFT TISS 44109201426 ARTHROGRAM SACROIL JT INJ 7629201427 SACROIL JT TX W/WO ARTHRO 7629201428 PLC SOFT TISS LOC DEV 1ST 29789201429 BIOPSY SKIN SINGLE LESION 5579201430 US DPLX EXTRACRAN LTD LT 17799201431 US DPLX EXTRACRAN LTD RT 17799201433 MOD SEDAT <5YRS 1ST 15M 4609201434 MOD SEDAT =>5YRS 1ST 15M 5549400009 VIT B12 1000MCG/ML 1ML PC 59400011 INTRALESIONAL INJ >7 PO 939400012 INTRALESIONAL INJ >7 PO 939400013 INTRALESIONAL INJ >7 PO 939400014 INTRALESIONAL INJ >7 PO 2059400560 ARTHROC ASP MAJR JT WO PO 929400610 CIRCUMCISION PO 849400690 COMP PREV EVL12-17 INI NW 416
9400700 COMP PREV EVL 5-11 INI NW 4169400710 COMP PREV EVAL 1-4 INI NW 4169400720 COMP PREV EVAL <1 INI NEW 4169400730 COMP PREV REEVL 12-17 EST 4739400740 COMP PREV REEVAL 5-11 EST 4739400750 COMP PREV REEVAL 1-4 EST 4739400760 COMP PREV REEVAL <1YR EST 4739400770 UA NONAUTO W MICRO POC PO 399400780 UA NONAUT WO MICRO POC PO 219400790 OCC BLD FEC QL3 SP POC PO 229400800 GLUCOSE BLD BY DEV POC PO 259400810 PREG URINE VISUAL POC PO 199400820 STREP A IMMUNO OPT POC PO 319400830 SKIN TST TB INTRDRM POCPO 369400840 SMEAR WET MT W STN POC PO 929400850 TISSUE EXAM FUNGUS POC PO 169400860 ECG 12 LEAD TRAC ONLY PO 1449400870 SPIROMETRY PO 1649400880 BRNCHSPASM EVL PRE/PST PO 2599400890 INH TX INITIAL EA DAY PO 939400900 PULSE OX SNGL DETERM PO 309401260 FETAL NON STRESS TEST PO 49401270 SMEAR WET MT W STN POC PO 929401280 MC POSTPARTUM FU VISIT 4439401290 RHO(D) IMM GLOB 300MCG PC 389401300 VENIPUNCTURE OP PO 339401320 GLUCOSE BLD BY DEV POC PO 259401330 PREG URINE VISUAL POC PO 199401340 MNT NUTRIT SUBSEQ EA15 PO 229401360 MC PERINATAL ED IND EA15 489401370 MC PERINATAL ED GRP EA15 179401400 MC INIT ANTEPARTUM>16 WKS 8259401410 MC ANTEPARTUM FU VISIT 4439401560 MC INIT ANTEPARTUM<=16WKS 8259401561 MC INIT ANTEPARTUM<=16WKS 8259401580 MC NUTR ASSMT INIT ADD 15 229401590 MC POSTPART NUTRIT INDIV 439401600 MC PSYCH INIT EA ADD 15MN 299401610 MC PSYCH F/U ASSESS EA15 489401620 MC PSYCH POSTPT EA 15 MIN 489401630 MC HLTH ED INIT EA ADD15M 299401640 MC HLTH ED F/U INDIV EA15 489401650 MC POSTPART HEALTHED EA15 489401660 MC COMPHREHENS CARE PLAN 8069401690 COLPOSCPY CERVX BX CUR PO 12159401700 MC HLTH ED ORIENT EA 15 1169401710 MC INIT NUTR ASSESS 1ST30 91
9401720 MC ANTEPA F/U NUTR GRP 15 179401730 MC INI PSY ASSESS 1ST 30 889401740 COLPOSCOPY CERVIX PO 6799401810 MC INIT ANTEPARTUM>16 WKS 8259401820 MC ANTEPARTUM FU VISIT 4439401830 MC POSTPARTUM FU VISIT 4439401850 HEMATOCRIT SPUN POC PO 219401860 PRENATAL VITAMINS 30 DAY 519401870 MC COMPHREHENS CARE PLAN 8069401880 MC HLTH ED ORIENT EA 15 1169401890 MC INIT NUTR ASSESS 1ST30 919401910 MNT NUTRIT SUBSEQ EA15 PO 229401920 MC ANTEPA F/U NUTR GRP 15 179401930 MC NUTR ASSMT INIT ADD 15 229401940 MC INI PSY ASSESS 1ST 30 489401950 MC PSYCH INIT EA ADD 15MN 299401960 MC PSYCH F/U ASSESS EA15 489401970 MC PSYCH F/U GRP EA 15MN 59401980 MC PSYCH POSTPT EA 15 MIN 489401990 MC HLTH ED INIT 1ST 30MIN 489402000 MC HLTH ED INIT EA ADD15M 299402010 MC HLTH ED F/U INDIV EA15 489402020 MC HLTH ED F/U GRP EA 15 59402030 MC PERINATAL ED IND EA15 489402040 MC PERINATAL ED GRP EA15 179402050 MC POSTPART HEALTHED EA15 489402260 CATH SPECIMEN COLLECT PO 229402270 VIT B12100MCG/0.1ML IN PC 59402280 IG RHO-D RHOPH/100IUIV PC 1939402290 BETAMETH NA PH/AC 3MG PC 389402310 US PREG F/U EA GST 59 PO 23059402320 US PREG 1OR>FETUSES LTDPO 16039402330 VISIT LEVEL 2 EST PT PO 3789402340 VISIT LEVEL 3 EST PT PO 4739402350 VISIT LEVEL 4 EST PT PO 5679402360 CAST REINFORCE PO 2919402780 VISIT LEVEL 1 EST PT PO 959402790 VISIT LEVEL 5 EST PT PO 6809402800 INJ TX/DX/PROP SUBQ/IM PO 1019402810 VISIT LEVEL 1 NEW PT PO 3339402820 VISIT LEVEL 3 NEW PT PO 5209402830 INJ TX/DX/IV PUSH INIT PO 2139402840 ADMN OTHR IMMUN VAC ADDPO 889402850 ADMIN OTHR IMMUN VAC 1 PO 1279402860 INJ TX/DX/PROP SUBQ/IM PO 1019402870 INF IV HYDR INT 31-60MNPO 4899402880 INF IV HYDRAT EA AD HR PO 407
9402930 ADMIN INFLUENZ VACCINE PO 889402940 ADMIN PNEUMO VACCINE PO 889402970 CIRCUMCISION >28 DAYS PO 339402980 DIABETE SELF-MGNT 30MN PO 509402990 DIABET SELFMGT GRP 30M PO 329403010 FERN TEST POC PO 169403130 PH BODY FLUID NOS POC PO 179403320 VISIT LEVEL 1 EST PT PO 959403330 VISIT LEV 1 EST W PROC PO 3029403340 VISIT LEVEL 2 EST PT PO 3789403350 VISIT LEV 2 EST W PROC PO 3789403360 VISIT LEVEL 2 NEW PT PO 4169403370 VISIT LEV 2 NEW W PROC PO 4169403380 VISIT LEVEL 3 EST PT PO 4739403390 VISIT LEV 3 EST W PROC PO 4739403400 VISIT LEVEL 3 NEW PT PO 5209403410 VISIT LEV 3 NEW W PROC PO 5209403420 VISIT LEVEL 4 EST PT PO 5679403430 VISIT LEV 4 EST W PROC PO 5679403440 VISIT LEVEL 4 NEW PT PO 6249403450 VISIT LEV 4 NEW W PROC PO 6249403460 VISIT LEVEL 5 EST PT PO 6809403470 VISIT LEV 5 EST W PROC PO 6809403480 VISIT LEVEL 5 NEW PT PO 7499403490 VISIT LEV 5 NEW W PROC PO 7499403500 ACNE SURGERY PO 339403510 I&D ABSCESS SIMPLE PO 759403520 I&D ABSCESS COMP/MULTI PO 379403530 I&D CYST PILONIDAL SMP PO 99403540 I&D HEMATO/SEROM/FLUID PO 549403550 BX SKIN SINGLE LESION PO 689403560 BX SKIN LESION EA ADD PO 509403570 REMOVE SKIN TAGS <=15 PO 289403580 SHAVE LES T/A/L<=0.5CM PO 739403590 SHAVE LES T/A/L 0.6-1C PO 819403600 SHAVE LES T/A/L 1.1-2C PO 1519403610 SHAVE LES T/A/L >2.0CM PO 1209403620 SHAVE LES S/N/HF<=0.5C PO 699403630 SHAVE LES S/N/HF 0.6-1 PO 1229403640 SHAVE LES S/N/HF1.1-2C PO 1069403650 SHAVE LES F/E/NL<=0.5C PO 1639403660 SHAVE LES F/E/NL 0.6-1 PO 1569403670 SHAVE LES F/E/NL 1.1-2 PO 1609403680 SHAVE LES F/E/NL >2.0C PO 1869403690 EXC BEN LES T/A/L<0.5CMPO 929403700 EXC BEN LES T/A/L0.6-1 PO 1519403710 EXC BEN LES T/A/L1.1-2 PO 178
9403720 EXC BEN LES T/A/L2.1-3 PO 1609403730 EXC BEN LES T/A/L3.1-4 PO 3059403740 EXC BEN LES S/N/HF<=0.5PO 1079403750 EXC BEN LES S/N/HF.6-1 PO 1589403760 EXC BEN LES S/N/HF1.1-2PO 1669403770 EXC BEN LES F/E/NL<=0.5PO 999403780 EXC BEN LES F/E/NL.6-1 PO 1619403790 EXC BEN LES F/E/NL1.1-2PO 1959403800 EXC BEN LES F/E/NL2.1-3PO 1839403810 EXC MAL LES T/A/L<=0.5 PO 1679403820 EXC MAL LES T/A/L 0.6-1PO 1929403830 EXC MAL LES T/A/L1.1-2 PO 1779403840 EXC MAL LES T/A/L2.1-3 PO 2629403850 EXC MAL LES T/A/L 3.1-4PO 2619403860 EXC MAL LES S/N/HF<=0.5PO 1439403870 EXC MAL LES S/N/HF.6-1 PO 6759403880 EXC MAL LES S/N/HF1.1-2PO 2409403890 EXC MAL LES F/E/NL<=0.5PO 2559403900 EXC MAL LES F/E/NL0.6-1PO 3649403910 EXC MAL LES F/E/NL1.1-2PO 4549403920 EXC MAL LES F/E/NL2.1-3PO 4719403930 AVULSION NAIL PLAT SNG PO 869403940 EVAC HEMATOMA SUBUNGAL PO 279403950 EXC NAIL & MATRIX PO 1369403960 INTRALESIONAL INJ 1-7 PO 279403970 LR INT NK/HND/FT <=2.5 PO 519403980 LESION PREMAL DEST 1ST PO 369403990 LES PREMAL DES 2-14 EA PO 559404000 LES BENIGN DESTR 1-14 PO 129404020 LESION BENIGN DESTR=>15PO 1719404050 FERN TEST POC PO 169404060 FETAL FIBRONECTIN POC PO 4529404090 TOBACCO COUNSEL 3-10MN PO 599404100 TOBACCO COUNSELING >10 PO 69404230 US PREG+DETL SNGL GST PO 12289404240 US GUIDE AMNIOCENTESIS PO 9099404260 AMNIOCENTESIS PO 15399404280 US PREG+DETL EA AD GST PO 4849404290 US FETAL BIO PRO W NST PO 8969404300 US FET BIOP PRO WO NST PO 6549404310 US FET BIOP PRO WO NST PO 7929404420 INITIAL PREV PHYS EXAM PO 3329404460 STRAPPING UNNA BOOT PO 169404470 ROTAVIR VAC PENTA SUS PC 1429404480 MEASLES/MUMPS/RUBE VAC PC 1059404490 DTAP HIB IP VACCINE IM PC 1709404500 VARICELLA VACPF1350U/0.5 177
9404510 HEPATITI A VACC 0.5 ML PC 1019404520 HEP B VACC 10MCG PEDIM PC 529404570 DTAP IPV 0.5ML 4-6PDIM PC 899404580 ANNUAL DEPRESS SCRN 15 PO 1359404590 INTEN BEH THRY CARD 15 PO 669404600 HI INTEN BH CNSL STI 30PO 909404610 PNEUMOCOC VACC 13 VAL PC 3209404630 FLU VAC TRIVAL PF6-35M PC 629404640 HIB VA PRP-OMP CONJ IM PC 879404650 FLU TRI LIVE INTRANA PC 419404660 HPV VACC 4-VAL 0.5ML INJ 2619404670 DIP-TET-ACPRT0.5ML<7IM PC 509404680 BEH COUNSEL OBESITY 15 PO 909404690 US PREG F/U EA GST 59 PO 23059404700 TDAP 0.5ML >=7YR IM PC 689410130 ADMIN INFLUENZ VACCINE PO 1279410210 US FETL ECHO MID CEREB PO 2349410220 US FETAL ECHO UMBI ART PO 3219410230 US PREG NUCH TRANS ADD PO 1199410240 US PREG NUCH TRANS 1ST PO 2849410270 PSYCH DX EVAL 15 MIN PO 4329410290 PSYCH DX EVAL 30 MIN PO 3829410310 PSYCH DX EVAL 45 MIN PO 4799410330 PSYCH DX EVAL 60 MIN PO 5979410350 PSYCH DX EVAL 90 MIN PO 7479410370 PSYCHO PT W EVAL >53M PO 1319410390 PSYCH PT W EVAL 16-37 PO 729410410 PSYCH PT W EVAL 38-52 PO 859410430 PSYCHOTH PAT >53 MIN PO 2279410450 PSYCHOTH PAT 16-37 MIN PO 1519410470 PSYCHOTH PAT 38-52 MIN PO 2019410480 VISIT LEV 1 EST W PROC PO 1859410540 HEP B VAC/DTAP/IPV0.5MLIM 1299411050 ARTHROC ASP SMAL JT WO PO 939411060 ARTHROC ASP INTM JT WO PO 979411070 ASP FINE NDL WO IMAG PO 1659411080 DES MAL LS F/E/N/L<=0.5PO 1029411090 EXC BEN LES F/E/NL3.1-4PO 2279411100 I&R FB SUBQ SIMPLE PO 439411110 INJ TRIGER PT 1-2MUSCL PO 779411120 INSERT CATH BLADDER PO 1199411130 DES MAL LES T/A/L 1.1-2PO 1039411140 DES MAL LES T/A/L 2.1-3PO 1489411190 REMOVE CERUMEN IMPACT PO 519411200 TX DSLC SHLDR MAN CLS PO 279411210 TX ELBW CHLD W/MAN CLS PO 599411220 BLOOD COLLECTION PICC PO 273
9411230 BLOOD COLLECTION VAD PO 2449411240 CHEMO INF EA ADD HR PO 4909411250 CHEMO INF EA SEQ1ST HR PO 15709411260 CHEMO INF INIT 1ST HR PO 14889411270 CHEMO IV PUSH EA ADD PO 4439411530 INS/REPL/DECL NONTUN/PIC 15829411540 VASC ACC THROMB DECLOT PO 3229411550 ADMIN INFLUENZ VACCINE PO 3719411560 ADMN OTHR IMMUN VAC ADDPO 259411570 ADMIN OTHR IMMUN VAC 1 PO 3649411580 ADMIN PNEUMO VACCINE PO 889411590 BLOOD COLLECTION PICC PO 2739411600 BLOOD COLLECTION VAD PO 2449411610 CHEMO INF EA ADD HR PO 4909411620 CHEMO INF EA SEQ1ST HR PO 15709411630 CHEMO INF INIT 1ST HR PO 14889411640 CHEMO IV PUSH EA ADD PO 4439411650 CHEMO IV PUSH INITIAL PO 3889411660 CHEMO IV PUSH INITIAL PO 3889411670 CHEMO SQ/IM HORMONAL PO 7099411680 CHEMO SQ/IM HORMONAL PO 7099411690 CHEMO SQ/IM NONHORMONA PO 6619411700 CHEMO SQ/IM NONHORMONA PO 6619411710 INF IV HYDR INT 31-60MNPO 4899411720 INF IV HYDR INT 31-60MNPO 4899411730 INF IV HYDRAT EA AD HR PO 4079411740 INF IV HYDRAT EA AD HR PO 4079411750 INF TX/DX CONCURRENT PO 10019411760 INF TX/DX CONCURRENT PO 10019411770 INF TX/DX/PRO EA AD HR PO 5189411780 INF TX/DX/PRO EA AD HR PO 5189411790 INF TX/DX/PRO INI1ST HRPO 10009411800 INF TX/DX/PRO INI1ST HRPO 10009411810 INF TX/DX/PRO SEQ 1HR PO 5069411820 INF TX/DX/PRO SEQ 1HR PO 5069411830 INJ TX/DX/IV PUSH SEQ PO 2369411840 INJ TX/DX/IV PUSH SEQ PO 2369411850 INJ TX/DX/IV PUSH INIT PO 2139411860 INJ TX/DX/IV PUSH INIT PO 2139411870 INJ TX/DX/PROP SUBQ/IM PO 1019411880 INJ TX/DX/PROP SUBQ/IM PO 1019411890 INJ TX/DX IVP SME DRG PO 3829411900 INJ TX/DX IVP SME DRG PO 3829411910 IRRI IMPLANT VEN ACCES PO 2849411920 IRRI IMPLANT VEN ACCES PO 2849412150 PICC INSERT/REPLACE RN 16299412160 VENIPUNCTURE OP PO 33
9412170 VISIT LEVEL 1 EST PT PO 979412180 VISIT LEV 1 EST W PROC PO 3009412190 VISIT LEVEL 1 NEW PT PO 3319412200 VISIT LEV 1 NEW W PROC PO 3319412210 VISIT LEVEL 2 EST PT PO 3779412220 VISIT LEV 2 EST W PROC PO 3779412230 VISIT LEVEL 2 NEW PT PO 4179412240 VISIT LEVEL 2 NEW PT PO 4169412250 VISIT LEV 2 NEW W PROC PO 4179412260 VISIT LEVEL 3 EST PT PO 4739412270 VISIT LEV 3 EST W PROC PO 4739412280 VISIT LEVEL 3 NEW PT PO 5199412290 VISIT LEV 3 NEW W PROC PO 5199412300 VISIT LEVEL 4 EST PT PO 5659412310 VISIT LEV 4 EST W PROC PO 5659412320 VISIT LEVEL 4 NEW PT PO 6269412330 VISIT LEVEL 4 NEW PT PO 6249412340 VISIT LEV 4 NEW W PROC PO 6269412350 VISIT LEVEL 5 EST PT PO 6829412360 VISIT LEV 5 EST W PROC PO 6829412370 VISIT LEVEL 5 NEW PT PO 7489412380 VISIT LEVEL 5 NEW PT PO 7499412390 VISIT LEV 5 NEW W PROC PO 7489412420 CLINIC PATIENT COUNT NC 0 19412460 PRENATAL VITAMINS 30 DAY 2679412545 VISIT LEVEL 1 NEW PT PO 3339412552 CLINIC PATIENT COUNT NC 0 19412560 VISIT LEV 1 NEW W PROC PO 3339412610 DESTR VULVA LES SIMPLE PO 45759412628 DEST VULV LES EXTENSIV PO 45759412636 DESTR VAG LES SIMPLE PO 46949412644 DESTR VAG LES COMPLEX PO 46949412651 DESTR LSN PENS SMP CRY PO 899413181 SUTURE REMOVAL NC 0 29413182 GLOBAL OB PT COUNT 0 29413582 I&D ABSCESS SIMPLE PO 759413770 LR SMPL TRK/NECK <=2.5 PO 1269413771 LR SMPL TRK/NCK 2.6-7.5PO 2869413772 LR INT SCLP/TRNK <=2.5 PO 559413773 LR INT SCLP/TRNK2.6-7.5PO 2349413774 LR CPLX TRUNK 1.1-2.5 PO 579413775 LR CPLX TRUNK 2.6-7.5 PO 2909413782 LES PREMALG DESTR >=15 PO 599413788 HEP A 720U/0.5MLPDIM PC 679413798 EXC SNGL EXT TAG ANUS PO 329413799 EXC MULT EXT TAGS ANUS PO 569413800 ANOSCOPY DIAG PO 21
9413801 I&D ABSC VULV/PERINEAL PO 3249413802 I&D ABSC GLAND BARTHOL PO 3249413803 COLPOSCOPY CERVIX PO 6799413804 COLPOSCPY CERVX BX CUR PO 12159413805 CAUTERY CERVIX CRYO PO 3239413806 BX ENDOMETRIAL WO DIL PO 1559413807 LUMBAR PUNCT DIAGNOSTC PO 879413854 ZOSTER VAC LIVE SC 2459413855 TYPHYOI LIVE ATTEN VAC PC 829413856 TYPHOID POLY25MCG/0.5 PC 829413857 HEP A VAC 1440U 1ML IN PC 789413858 POLIO VACC(INACT) 0.5M PC 569413859 YELLOW FEV VAC 0.5MLSQ PC 829413860 HEP B VAC 10MCG 1ML IN PO 829413861 ADMIN HEP B VACCINE PO 3829413874 DES MAL LES T/A/L 0.6-1PO 2899413876 VISIT LEV 1 NEW W PROC PO 3339413877 VISIT LEV 2 NEW W PROC PO 4169413878 VISIT LEV 3 NEW W PROC PO 5209413879 VISIT LEV 4 NEW W PROC PO 6249413880 VISIT LEV 5 NEW W PROC PO 7499413881 VISIT LEV 1 EST W PROC PO 3029413882 VISIT LEV 2 EST W PROC PO 3789413883 VISIT LEV 3 EST W PROC PO 4739413884 VISIT LEV 4 EST W PROC PO 5679413885 VISIT LEV 5 EST W PROC PO 6809413896 APPLY CAST LONG ARM PO 2869413897 APPLY CAST SHORT ARM PO 2119413898 APP CAST HAND/FOREARM PO 1639413899 APPLY SPLINT LONG ARM PO 1639413900 APP SPLNT SHRT ARM STC PO 1639413901 APP SPLINT FINGER STC PO 989413902 APPLY CAST LONG LEG PO 3249413903 APPLY CAST SHORT LEG PO 3249413904 APP CAST SHORT LEG BIL PO 2329413905 APPL CAST PATELLR TEND PO 3249413906 APP SPLINT LONG LEG BI PO 2329413907 APPLY SPLINT SHORT LEG PO 1729413908 STRAPPING KNEE PO 829413909 STRAPP ANKLE &/OR FOOT PO 829413910 REM BIVL GNT BT BDY CSTPO 3249413911 REM/BIVAL CAST ARM/LEG PO 3249413975 CARE MISCARRIAGE TRI 2 PO 25969413976 MC HLTH ED INIT 1ST 30MIN 489413980 YELLOW FEVER VACC 0.5MLSQ 1259413981 TYPHYOID LIVE ATTEN VAC 549413982 TYPHOID VAC POLY25MCG/0.5 72
9413984 HEPAT A VACC 1440U 1ML IN 509413985 JAPAN ENCEPH VACC 0.5MLIM 2839413987 POLIO VACC(INACTIVE) 0.5M 289413988 TRAV CNSLT INDIV SELF PAY 609413989 TRAV CNSLT GRP 4 SELF PAY 37.59413990 TRAV CNSLT GRP 5 SELF PAY 359413991 TRAV CNSLT GRP 2 SELF PAY 459413992 TRAV CNSLT GRP 3 SELF PAY 409413993 TRAV CNSLT GR10-24SELFPAY 259413994 TRAV CNSLT GRP>25SELF PAY 209413995 TRVL CLINIC VAC ADMIN SP 119413996 VISIT LEVEL 1 EST PT PO 929413997 VISIT LEV 1 EST W PROC PO 2909413998 VISIT LEVEL 1 NEW PT PO 3169413999 VISIT LEV 1 NEW W PROC PO 3169414000 VISIT LEVEL 2 EST PT PO 3619414001 VISIT LEV 2 EST W PROC PO 3619414002 VISIT LEVEL 2 NEW PT PO 3979414003 VISIT LEV 2 NEW W PROC PO 3979414004 VISIT LEVEL 3 EST PT PO 4489414005 VISIT LEV 3 EST W PROC PO 4489414006 VISIT LEVEL 3 NEW PT PO 4949414007 VISIT LEV 3 NEW W PROC PO 4949414008 VISIT LEVEL 4 EST PT PO 5409414009 VISIT LEV 4 EST W PROC PO 5409414010 VISIT LEVEL 4 NEW PT PO 5969414011 VISIT LEV 4 NEW W PROC PO 5969414012 VISIT LEVEL 5 EST PT PO 6469414013 VISIT LEV 5 EST W PROC PO 6469414014 VISIT LEVEL 5 NEW PT PO 7139414015 VISIT LEV 5 NEW W PROC PO 7139414016 TRIM DYSTROPHIC NAILS PO 1709414017 TET/DIP PFVAC 0.5ML>=7 PC 75.19414018 GE VISIT LEVEL1 NEW PT PO 879414019 GE VISIT LEVEL1 NEW PT PO 879414020 GE VISIT LEVEL1 NEW PT PO 879414021 GE VISIT LEVEL1 NEW PT PO 879414022 ADMIN HEP B VACCINE PO 1279414023 ADMN OTHR IMMUN VAC ADDPO 259414024 ADMIN OTHR IMMUN VAC 1 PO 1279414025 ADMIN PNEUMO VACCINE PO 1279414026 ADMIN HEP B VACCINE PO 3719414027 OBTAIN SCRN PAP SM POC PO 39414028 BETAMETH NA PH/AC 3MG INJ 389414029 TOBACCO COUNSEL 3-10MN PO 349414030 UA NONAUT WO MICRO POC PO 219414031 EXC BEN LES SNHF>4.0CM PO 1642
9414032 LAPAR SURG WSALPINGOST PO 34029414033 HEMOGLOBIN A1C POC PO 169414035 ECH2D COM WO CON WO DP PO 3819414036 REM FB EXT AUD CANAL PO 1199414037 EXC BEN LES T/A/L >4.0 PO 12089414038 FLU VACC 4V PF 3YR+ IM PC 419414039 FLU VACC 4V PF 6-35MOS PC 529414040 PNEUMOCOC VACC 23 VAL PC 1579414041 FLU VAC FLUMIST 4V NAS PC 479414042 HEMOGLOBIN A1C POC PO 49414043 IRR/LAV CERUMEN IMPACT PO 429414044 COLLECT CAPILLAR BLOOD PO 169414045 MEDROXYPROG150MG/ML1ML PC 849414046 KETOROLAC 15MG/ML 1ML PC 179414047 TESTOST ENA200MG/ML5ML PC 359414048 TRIAMCIN ACE10MG/ML1ML PC 259414049 CEFTRIAXON500MG PWD IN PC 2179414050 CEFTRIAXONE 1GM PWD IN PC 309414051 HYALUR ART SYNVISC 1MG PC 11459414052 METHYLPRED NA 125MG IN PC 269414053 DENOSUMAB 60MG/ML 1ML PC 11399414054 ONDANSETRO/1MG20ML MDV PC 169414055 PROCHLORPER 5MG/ML 2ML PC 169414056 HIB VACC PRP-T CONJ IM PC 559414057 OCCULT BLD FECES QL POCPO 49414073 HPV VACC 9-VAL 0.5ML IM 3789414077 MENINGOC B OMV 0.5MLVACC 1439414081 SHAVE LES S/N/HF >2.0 PO 1129414082 EXC BEN LES S/N/HF2.1-3PO 8919414083 EXC BEN LES SNHF 3.1-4 PO 13379414084 EXC MAL LES T/A/L >4.0 PO 13379414085 EXC MAL LES S/N/HF>4.0 PO 13379414086 SMEAR WET MT INFEC POC PO 119414087 OSTEOPATHIC MAN1-2 REG PO 229414088 OSTEOPATHIC MAN3-4 REG PO 229414089 OSTEOPATHIC MAN5-6 REG PO 229414090 OSTEOPATHIC MAN7-8 REG PO 229414091 OSTEOPATHIC MAN9-10REG PO 229414092 TYMPANOMETRY PO 299414093 VISION ACUITY PO 69414094 HEAR TST PURE TONE AIR PO 239414095 INJ TENDON SHTH/LIG PO 2129414096 EPINEPH PF 1MG/1ML INJPC 269414097 TISS EX FUNG/ECTOP POC PO 119414098 HGB QN TRANSCUT POC PO 379414100 APPL ONBODY TIME INJ SUBQ 3599414101 APPL ONBODY TIME INJ SUBQ 359
9414102 DEBOSUMAB 1MG INJ 0 29414103 DEBOSUMAB 1MG INJ JW 0 29414104 VISIT LEVEL 4 EST PT 7889414105 VISIT LEVEL 3 EST PT 5099414106 VISIT LEVEL 1 EST PT 959414107 PROTHROMBIN TIME POC 119414108 LDCT SCREEN COUNSEL VISIT 1019414109 OCCULT BLD CA SCREEN IA 419414110 PROSTATE CA SCREENING 409414111 PELVIC/BREAST SCR EXAM PO 779414112 DENOSUMAB60MG/ML 1ML PCJW 199500200 MNT NUTRITION INITL EA15 509500250 DIABETES SELF-MGNT 30MIN 1799500260 MNT NUTRITION GRP EA 30MN 449500270 MNT NUTRITION SUBSEQ EA15 689500280 P-CARE CONSULT NC 0 29500281 IP/OBSV PSYCH SITTR/HR NC 0 19700006 ADJ BERGER REHAB 0 29700014 ADJ COMBINE ACCTS 0 29700030 ADJ MEDICARE UNBILLABLE 0 29700048 ADJ NO NDC 0 29700055 ADJ RETURNED CHK 0 29700063 ADJ SLF PAY PKG DISCOUNT 0 29700071 ADJ TRFR PT CREDIT 0 29700089 ADJ UNBILLABLE 0 29700097 ADJ UNCLAIMED PROPERTY 0 29700113 ADJ WCMG BLUD SHIELD 0 29700121 ADJ WCMG BLUE SHIELD NET 0 29700139 ADJ WCMG CAL CARE 0 29700147 ADJ WCMG CIGNA 0 29700154 ADJ WCMG HEALTHNET 0 29700162 ADJ WCMG HEALTHNET SR 0 29700170 ADJ WCMG PACIFICARE 0 29700188 ADJ WCMG PARTNERSHIP 0 29700196 ADJ WCMG SECURE HORIZONS 0 29700204 ADJ WCMG WHA 0 29700212 ADJ WCMG WHA SR 0 29700220 ADJ CONTRACT SUB CAP 0 29700238 ADJ CONTRACTUAL ADJUSTMEN 0 29700246 DEN ABN 0 29700253 DEN ALL OTH ADMIN 0 29700261 DEN CONTRACT INTERP 0 29700279 DEN DAYS MCL 0 29700287 DEN LEVEL OF CARE 0 29700295 DEN MCR RAC 0 29700303 DEN MED NEC 0 29700311 DEN NO AUTH FULL PMT 0 2
9700329 DEN NO AUTH PART PMT 0 29700337 DEN NON COVERED 0 29700345 DEN NOT AUTHORIZED 0 29700352 DEN OTHER 0 29700360 DEN UNTIMELY PFS 0 29700378 LATE CHG ADJUSTMENT 0 29700386 DEN ADMINISTRATIVE DAYS 0 29700394 DEN MAC 0 29700402 ADJ MENTAL HLTH TFR 0 29700410 ADJ OUTREACH LAB 0 29700428 ADJ ESCHEAT TO THE STATE 0 29700436 ADJ NON 340B 0 29700592 INS ZERO PAY 0 29700600 DEN MCD RAC 0 29700618 ADJ RE-ADMISSION DAYS 0 29700626 DEN UNTIMELY FACILITY 0 29700634 DEN UNTIMELY VENDOR 0 29700642 INTEREST PMT PATIENT 0 29700667 DEN MEDNEC MCAL IP NOTMET 0 29704008 CHARITY ADJUSTMENT 0 29704016 CHARITY PARO 0 29704024 CHARITY W/O PMT ASST AR 0 29708009 ADJ EMP FIST AID 0 29708017 ADJ EMP PHYSICAL 0 29708025 HOSPTIAL EVENT 0 29708033 SMALL BAL ADJUSTMENT 0 29708041 ADJ UNINSURED DISC 0 29708074 ADJ PROF COURTESY DISC 0 29708090 ADJ PROMPT PAY DISCOUNT 0 29709007 ADMIN ADJUSTMENT 0 29709106 HARDSHIP ADJUSTMENT 0 29709114 ADMIN ALLOWANCE FAP 0 29709502 REFUND INSURANCE 0 29709510 REFUND OTHER 0 29709528 REFUND PATIENT 0 29799917 TRANSFER FROM BD TO AR 0 29799990 TRANSFER FROM AR TO BD 0 29800004 BD ADJ BANKRUPTCY 0 29800012 BD ADJ CHARITY 0 29800020 BD ADJ INSURANCE 0 29800038 BD ADJ PARO CHARITY 0 29800046 BD ADJ TRAUMA FUNDING 0 29800053 BD ADJ ADMIN ADJ 0 29800061 BD SETTLEMENT IN FULL 0 29800079 BD SMALL BALANCE ADJ 0 29800087 BD CHARITY W/O PMT ASST 0 29800095 BD ADJ UNINSURED DISCOUNT 0 2
9800103 BAD DEBT INS ZERO PAY 0 29800129 BD HARDSHIP ADJUSTMENT 0 29800137 BD ADMIN ALLOWANCE FAP 0 29800152 BD ADJ RE-ADMISSION DAYS 0 29801002 BD DEN ABN 0 29801010 BD DEN ALL OTH ADMIN 0 29801028 BD DEN CONTRACT INTERP 0 29801036 BD DEN DAYS MCL 0 29801044 BD DEN LEVEL OF CARE 0 29801051 BD DEN MCR RAC 0 29801069 BD DEN MCD RAC 0 29801077 BD DEN MED NEC 0 29801085 BD DEN NO AUTH FULL PMT 0 29801093 BD DEN NO AUTH PART PMT 0 29801101 BD DEN NON COVERED 0 29801119 BD DEN NOT AUTHORIZED 0 29801127 BD DEN OTHER 0 29801135 BD DEN TAR 0 29801143 BD DEN UNTIMELY PFS 0 29801150 BD DEN UNTIMELY FACILITY 0 29801168 BD DEN UNTIMELY VENDOR 0 29801176 BD DEN ADMINISTRATIVE DAY 0 29801184 BD DEN MAC 0 29809500 BD REFUND 0 29810011 BD PMT RECOVERY 0 29810029 BD PMT RECOVERY MCR* 0 29810037 BD PMT RECOVERY MCL* 0 29810045 BD PMT RECOVERY COMM* 0 29810052 BD PMT RECOVERY AGENCY 0 29820010 AMBULANCE OTHER REVENUE 0 29820028 AR CASH TRANSFER-MMCMS 0 29820036 AR CASH TRANSFER-MMCR 0 29820044 AR CASH TRANSFER-REGION 0 29820051 AR CASH TRANSFER-SECH 0 29820069 AR CLEARING OTHER 0 29820077 AR-LEGACY SYSTEM 0 29820085 CAFETERIA REBATE/REFUND 0 29820093 CAFETERIA REVENUE 0 29820101 CARDIAC REHAB 0 29820119 CELL TOWER REVENUE 0 29820127 DUE TO CMSP 2004 0 29820135 DUE TO OTHER GOVERNMENT 0 29820143 EDUCATION DEPT REVENUE 0 29820150 ELECTRONEURO REVENUE 0 29820168 ENG-SALE OF SCRAP & WASTE 0 29820176 ER SEMINARS 0 29820184 FAMILY PRAC CLINIC REV 0 2
9820192 GUILD/AUX GIFT SHOP SALES 0 29820200 HEALTHNET RECOVERY-OLD AR 0 29820218 HOME HEALTH A/R 0 29820226 HOSPICE A/R 0 29820234 HOUSE OF MERCY(GUEST HOUS 0 29820242 INTEREST 0 29820259 INTEREST EXPENSE 0 39820267 MCAL PROVIDER FEE PAYMENT 0 29820275 MED STAFF STIPENDS 0 29820283 MEDICAID EHR INCENTIVE 0 29820291 MEDI-CAL OP CO-PAY 0 29820309 MEDICAL RECORDS AUDIT FEE 0 29820317 MEDICAL RECORDS/ABSTRACT 0 29820325 MEDICARE B/D ADJUSTMENT 0 29820333 MEDICARE D/M 0 29820341 MEDICARE GME 0 29820358 MEDICARE PART B PASS THRU 0 29820366 NSF CHECKS 0 29820374 NUTRITION SERV CONSULTING 0 29820390 OB/GYN CLINIC REVENUE 0 29820408 PHARM SALES TO EMP/VOLUN 0 29820416 PHARMACY REBATES 0 29820424 PHARMACY RETURN OLD LOTS 0 29820432 PUBLIC RELATION(COMM EDUC 0 29820440 RADIOLOGY FILM COPIES 0 29820457 SURGERY-HEART SEMINARS 0 29820465 TRAUMA SEMINARS 0 29820473 TRICARE REVENUE-CASH 0 29820481 VENDING MACHINE COMM 0 29820523 COLLECTION AGY FEE 0 29820531 LATE CHARGE PENALTIES 0 29820622 AFFILIATE PROVIDER WITHLD 0 29820804 CLINIC PYMT FOR PT AR 0 29821018 DUE TO MEDICARE 2000 0 29821026 DUE TO MEDICARE 2001 0 29821034 DUE TO MEDICARE 2002 0 29821042 DUE TO MEDICARE 2004 0 29821059 DUE TO MEDICARE 2004 0 29821067 DUE TO MEDICARE 2005 0 29821075 DUE TO MEDICARE 2006 0 29821083 DUE TO MEDICARE 2007 0 29821091 DUE TO MEDICARE 2008 0 29821109 DUE TO MEDICARE 2009 0 29821117 DUE TO MEDICARE 2010 0 29821125 DUE TO MEDICARE 2011 0 29821133 DUE TO MEDICARE 2012 0 29821141 DUE TO MEDICARE 2013 0 2
9821158 DUE TO MEDICARE 2014 0 29821166 DUE TO MEDICARE HOLDING A 0 29821174 DUE TO MEDICARE 2015 0 29821182 DUE TO MEDI-CAL 2016 0 29821984 MEDICARE EHR INCENTIVE 15 0 29821992 MEDICARE OP CONTRACTUAL 0 29822016 DUE TO MEDI-CAL 2000 0 29822024 DUE TO MEDI-CAL 2003 0 29822032 DUE TO MEDI-CAL 2004 0 29822040 DUE TO MEDI-CAL 2005 0 29822057 DUE TO MEDI-CAL 2006 0 29822065 DUE TO MEDI-CAL 2007 0 29822073 DUE TO MEDI-CAL 2008 0 29822081 DUE TO MEDI-CAL 2009 0 29822099 DUE TO MEDI-CAL 2010 0 29822107 DUE TO MEDI-CAL 2011 0 29822115 DUE TO MEDI-CAL 2012 0 29822123 DUE TO MEDI-CAL 2013 0 29822131 DUE TO MEDI-CAL 2014 0 29822149 DUE TO MEDI-CAL HOLDING A 0 29822164 DUE TO MEDICARE 2016 0 29822172 DUE TO MEDICARE 2017 0 29822198 DUE TO MEDI-CAL 2017 0 29822206 SB855 MEDI-CAL IP DISP SH 0 29900002 PMT BALANCE AFTER INSU 0 29900010 PMT SELF PAY UNINSURED 0 29900028 PMT HOMELESS 0 29900036 PMT SELF PAY NO DISCOUNT 0 29900044 PMT CARE PGM RYAN WHITE 0 29900051 PMT PEND TRAUMA FUND ELIG 0 29900069 PMT PENDING CHARITY 0 29900077 PMT DH MENTAL HLTH TRNSF 0 29900085 PMT PEND WORKERS COMP 0 29900093 PMT SELF PAY CARDIAC REH 0 29900101 PMT SELF PAY PACKAGE 0 29900119 PMT HOSPITAL EVENT 0 29900127 PMT CLIENT BILLING 0 29900135 PMT NORTH HIGHLANDS CLINI 0 29900143 PMT WHITE ROCK CLINIC 0 29900150 PMT FOLSOM FAMILY CLINIC 0 29900168 PMT INTERFACLIITY TANSFER 0 29900176 PMT PAYMENT ARRANGEMENT 0 29900184 PMT INTERNATIONAL ACCOUNT 0 29900192 PMT RESTRICT FOR PHI 0 29900994 PMT CONVERSION BAL AFTER 0 29909011 PMT PEND GOVT ELIGILBILIT 0 29910001 PMT MEDICARE INPT PARTB O 0 2
9910019 PMT MEDICARE 0 29910027 PMT MEDICARE ENCOUNTER 0 29910068 PMT RAC MAC 0 29910993 PMT UNID MCARE 0 29911009 PMT MD CARE HEALTHPLAN SR 0 29911017 PMT AETNA SR SEL CHOICE P 0 29911025 PMT AIDS HLTH FNDTN SR 0 29911033 PMT BLUE SHIELD CA SR 0 29911041 PMT MOLINA ADVANTAGE SR 0 29911058 PMT AARP SECURE HORIZONS 0 29911066 PMT HEALTH NET CA SR 0 29911074 PMT SECURE HORIZON SR 0 29911082 PMT BLUE CROSS CA SR 0 29911090 PMT SCAN SR 0 29911108 PMT AETNA SR 0 29911116 PMT HUMANA GOLD CHOICE SR 0 29911124 PMT CAREMORE HP SR 0 29911132 PMT BLUE CROSS FREEDOM BL 0 29911140 PMT CITIZEN CHOICE HLTH P 0 29911157 PMT PARTNERSHIP ADV SR 0 29911165 PMT CARE 1ST CA SR 0 29911173 PMT EASY CHOICE HLTH PLAN 0 29911181 PMT KAISER ST 0 29911199 PMT KAISER SR CARDIAC 0 29911207 PMT MEDICARE SR OTH 0 29911249 PMT BCBS ADV SR 0 29911371 PMT UHC SR 0 29915000 PMT HEALTH NET SR PLUS CA 0 29915018 PMT SECURE HORIZONS CAP 0 29915026 PMT AARP SECURE HORIZONS 0 29920000 PMT MEDICAID 0 29920018 PMT MEDI-CAL OP PRESUMPT 0 29920026 PMT MEDICARE IP B E MCAID 0 29920034 PMT MEDICAID OUT OF STATE 0 29920042 PMT MEDI-CAL FAM PAC 0 29920059 PMT MEDI-CAL SOC 0 29920075 PMT MEDI-CAL RESTICRED EL 0 29920083 PMT NEWBORN HEARING STUDY 0 29920091 PMT CANCER DETECTION PROG 0 29920109 PMT CCS CA CHILD SVCS 0 29920125 PMT MEDI-CAL CHDP 0 29920166 PMT MEDI-CAL HOSP PRESUM 0 29920992 PMT UNID MCAID 0 29921008 PMT PARTNERSHIP HLTHPLAN 0 29921016 PMT AIDS HLTH FNDTN MCAL 0 29921024 PMT KAISER MCAL 0 29921032 PMT CALOPTIMA 0 2
9921040 PMT CARE 1ST MCAL 0 29921057 PMT COMMUNITY HP MCAL 0 29921065 PMT LA CARE MCAL 0 29921073 PMT BLUE CROSS MCAL 0 29921081 PMT MOLINA MCAL 0 29921099 PMT HEALTH NET MCAL 0 29921107 PMT CCS PARTNERHSIP HP 0 29921115 PMT PARTNERSHIP HLTHPLAN 0 29921123 PMT MEDI CAL MGD OTH 0 29921305 PMT CA HEALTH WELLNESS 0 29921339 PMT PARTNERSHIP HLTH CHDP 0 29925017 PMT PARTNERSHIP HLTHPLAN 0 29925025 PMT COMMUNITY HP MCAL CAP 0 29925033 PMT HEALTH NET MCAL CAP 0 29930009 PMT CMSP 0 29930017 PMT Y CHIP YOLO COUNTY 0 29930025 PMT QUEENS CARE 0 29931007 PMT CMSP BLUE CROSS 0 29931015 PMT YOLO COUNTY CONTRACT 0 29931023 PMT CMSP BLUE CROSS SOC 0 29931031 PMT YOLO COUNTY MENTAL HL 0 29932005 PMT ZURICH WC 0 29932013 PMT BROADSPIRE WC 0 29932021 PMT CHARTIS WC 0 29932039 PMT CITY OF SACRAMENTO WC 0 29932047 PMT COUNTY OF SACRAMENTO 0 29932054 PMT ESIS WC 0 29932062 PMT FIRST AID ONLY DH EM 0 29932070 PMT GALLAGHER AND BASSETT 0 29932088 PMT LIBERTY MUTUAL WC 0 29932096 PMT PG E WC 0 29932104 PMT SCHOOL INS AUTH WC 0 29932112 PMT SEDGWICK CMS WC 0 29932120 PMT SPECIALITY RISK SVCS 0 29932138 PMT STATE COMP INS FUNDWC 0 29932146 PMT TRAVELERS WC 0 29932153 PMT TRISTAR WC 0 29932161 PMT US DEPT OF LABOR WC 0 29932179 PMT YORK INSURANCE WC 0 29932187 PMT WORK COMP OTH 0 29932310 PMT HARTFORD WORK COMP 0 29932328 PMT SIERRA PACIFIC WC 0 29937004 PMT BLUE CROSS MCS WORK 0 29937012 PMT NETWORKS BY DESIGN WC 0 29937020 PMT RISK MANAGEMENT 0 29940008 PMT AARP 0 29940016 PMT AMERICAN POSTAL WRKRS 0 2
9940024 PMT BANKERS LIFE AND CASU 0 29940032 PMT FED CORR INST TERM IS 0 29940040 PMT UNITED AMERICAN INS 0 29940057 PMT MUTUAL OF OMAHA 0 29940065 PMT GEHA 0 29940073 PMT STATE FARM 0 29940081 PMT MISC COMM INS 0 29940099 PMT SECONDARY COMM INS OT 0 29940107 PMT PHYSICIANS MUTUAL 0 29940115 PMT STANDARD LIFE & ACCI 0 29940123 PMT MERCY HOSPICE 0 29940131 PMT INTERNATIONAL 0 29940222 PMT KAISER NON CONTR INDV 0 29940313 PMT IAC SUPPLEMENTAL 0 29940990 PMT UNID COMM 0 29950015 PMT AFFLIATED HLTH FUNDS 0 29950023 PMT AETNA PPO 0 29950031 PMT BCE EMERGIS 0 29950049 PMT BLUE CROSS BLUE SHLD 0 29950056 PMT BLUE CROSS CA HMO 0 29950064 PMT BLUE CROSS CAL PERS P 0 29950072 PMT BEECH STREET 0 29950080 PMT BLUE CROSS DELTA HLTH 0 29950098 PMT BLUE CROSS FEC EMP PR 0 29950106 PMT BLUE CROSS MCS 0 29950114 PMT BLUE CROSS OUT OF STA 0 29950122 PMT BLUE CROSS PRUD BUYER 0 29950130 PMT BLUE SHIELD CAL PERS 0 29950148 PMT BLUE SHIELD HMO POS 0 29950155 PMT CHOICECARE NETWORK 0 29950163 PMT CIGNA PPO 0 29950171 PMT BLUE SHIELD NET VALUE 0 29950189 PMT BLUE SHIELD PPO 0 29950197 PMT BUTTE CO MENTAL HLTH 0 29950205 PMT CA FORENCIS MED GRP 0 29950213 PMT CIGNA HMO 0 29950221 PMT HEALTH NET HMO POS 0 29950239 PMT SECONDARY HOM PPO INS 0 29950247 PMT COUNTY OF SAC PRISON 0 29950254 PMT DEPT OF SOCIAL SVCS 0 29950262 PMT FIRST HEALTH AFFORDAB 0 29950270 PMT FOLSOM PRISON 0 29950288 PMT HEALTH NET PPO 0 29950296 PMT ORGAN DONOR 0 29950304 PMT GREAT WEST 0 29950312 PMT HEALTHCARE PARTNERS 0 29950320 PMT HILL REHAB 0 2
9950338 PMT HILL REHAB SENIOR 0 29950346 PMT HUMANA PPO 0 29950353 PMT KAISER CARDIAC 0 29950361 PMT KAISER 0 29950379 PMT INTERPLAN MISC 0 29950387 PMT MISC HMO PPO INS 0 29950395 PMT PACIFICARE PPO 0 29950403 PMT PCIP PRE EXISTING INS 0 29950411 PMT MULTIPLAN 0 29950429 PMT UNITED HEALTHCARE HMO 0 29950437 PMT VALUEOPTIONS 0 29950445 PMT AETNA HMO 0 29950452 PMT WESTERN HLTH ADV NTH 0 29950460 PMT PHCS PRIVATE HC PPO 0 29950478 PMT UNITED HEALTHCARE OPT 0 29950486 PMT UNITED HEALTHCARE CHO 0 29950494 PMT UMR 0 29950502 PMT WESTERN HLTH ADV 0 29950510 PMT COMMUNITH HLTH PLAN S 0 29950528 PMT BLUE CROSS AIM 0 29950536 PMT SUPERIOR CA PPO 0 29950544 PMT CA TRANSPLANT DONOR 0 29950551 PMT UC DAVIS AFP PROGRAM 0 29950593 PMT KEENAN HEALTH DIGNITY 0 29950619 PMT WESTERN GROWERS 0 29950627 PMT PINNACLE CLAIMS MGMT 0 29950643 PMT NETWORKS BY DESIGN PP 0 29950932 PMT UHC NAVIGATE 0 29950981 PMT BLUE CROSS PPO IND EX 0 29950999 PMT BC CAL PERS HMO 0 29951005 PMT BLUE SHIELD EPO IND E 0 29951013 PMT OTHER NON CONTRACTED 0 29951039 PMT HEALTH NET PURECARE 0 29951047 PMT HEALTH NET WHOLECARE 0 29951054 PMT HEALTH NET SMARTCARE 0 29951088 PMT HNET BLUE AND GOLD 0 29951278 PMT HEALTH NET INDV EX 0 29980004 PMT WEST HLTH ADV CAP 0 29980012 PMT HEALTH NET HMO CAP 0 29980020 PMT UNITED HEALTHCARE HMO 0 29980038 PMT BLUE SHIELD CAL PERS 0 29980046 PMT BLUE SHIELD NET VALUE 0 29984014 PMT ACTIVE DUTY MILITARY 0 29984022 PMT AIDS HLTH FNDTN POSS 0 29984030 PMT CORRECTCARE INTEG HLT 0 29984048 PMT EISNER PED AND FAMILY 0 29984055 PMT IN CUSTODY 0 2
9984063 PMT MLK IMPACTED HOSP PRG 0 29984071 PMT TRAUMA FUNDING 0 29984089 PMT TRICARE UMVS 0 29984097 PMT VETERANS ADMINISTATIO 0 29984105 PMT VICTIM OF CRIME 0 29984113 PMT CHAMPVA 0 29984121 PMT SECTION 1011 0 29984139 PMT INDIAN HLTH SERVICES 0 29984147 PMT TRICARE FOR LIFE 0 29984212 PMT MADDY FUND 0 29987009 PMT PARTNERSHIP HELTHY KI 0 29987017 PMT BLUE CROSS HLTHY FAM 0 29987025 PMT BLUE SHIELD HEALTHY F 0 29987033 PMT CARE 1ST HEALTHY FAM 0 29987041 PMT COMMUNITY HP HLTHY FA 0 29987058 PMT HEALTH NET HLTHY FAM 0 29987066 PMT LA CARE HEALTHY FAM 0 29987074 PMT MOLINA HEALTHY FAM 0 29987082 PMT PARTNERSHIP HEALTHY F 0 29987090 PMT LA CARE HELATHY KIDS 0 29989005 PMT GRANTS & RESEARCHES 0 29989013 PMT DIGNITY HLTH FOUNDATI 0 29989088 PMT INTERFACILITY TRNSF 0 2
Hospital Name: Mercy Medical Center ReddingOSHPD Facility No: 106450949Effective Date of Charges: June 1, 2017
Gross RevenueFacility Initial Increase
151 MERCY MEDICAL CENTER REDDING $ 1,663,351,388 $ 41,992,165