Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST	PRXOVR	DEF					NA	NA	NA	N
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0001F	HEART FAILURE COMPOSITE	PRXOVR	DEF					NA	NA	NA	N
0001F	HEART FAILURE COMPOSITE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND	PRXOVR	DEF					NA	NA	NA	N
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0002F	TOBACCO USE; SMOKING; ASSESS	PRXOVR	DEF					NA	NA	NA	N
0002F	TOBACCO USE; SMOKING; ASSESS	MAXFEE	DEF					NA			N
0003A	ADM SARSCOV2 30MCG/0.3ML 3RD	PRXOVR	DEF					NA	NA	NA	N
0003A	ADM SARSCOV2 30MCG/0.3ML 3RD	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0003F	TOBACCO USE; NON-SMOKING	PRXOVR	DEF					NA	NA	NA	N
0003F	TOBACCO USE; NON-SMOKING	MAXFEE	DEF					NA			N
0004A	ADM SARSCOV2 30MCG/0.3ML BST	PRXOVR	DEF					NA	NA	NA	N
0004A	ADM SARSCOV2 30MCG/0.3ML BST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0004F	TOBACCO USE TXMNT COUNSELING	PRXOVR	DEF					NA	NA	NA	N
0004F	TOBACCO USE TXMNT COUNSELING	MAXFEE	DEF					NA			N
0005F	OSTEOARTHRITIS COMPOSITE	PRXOVR	DEF					NA	NA	NA	N
0005F	OSTEOARTHRITIS COMPOSITE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0006F	STATIN THERAPY; PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
0006F	STATIN THERAPY; PRESCRIBED	MAXFEE	DEF					NA			N
0007F	BETA-BLOCKER THX PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
0007F	BETA-BLOCKER THX PRESCRIBED	MAXFEE	DEF					NA			N
0008F	ACE INHIBITOR THX PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
0008F	ACE INHIBITOR THX PRESCRIBED	MAXFEE	DEF					NA			N
0009F	ASSESS ANGINAL SYMPTOM/LEVEL	PRXOVR	DEF					NA	NA	NA	N
0009F	ASSESS ANGINAL SYMPTOM/LEVEL	MAXFEE	DEF					NA			N
0010F	ASSESS ANGINAL SYMPTOM/LEVEL	PRXOVR	DEF					NA	NA	NA	N
0010F	ASSESS ANGINAL SYMPTOM/LEVEL	MAXFEE	DEF					NA			N
0011A	ADM SARSCOV2 100MCG/0.5ML1ST	PRXOVR	DEF					NA	NA	NA	N
0011A	ADM SARSCOV2 100MCG/0.5ML1ST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0011F	ORAL ANTIPLAT THX PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
0011F	ORAL ANTIPLAT THX PRESCRIBED	MAXFEE	DEF					NA			N
0012A	ADM SARSCOV2 100MCG/0.5ML2ND	PRXOVR	DEF					NA	NA	NA	N
0012A	ADM SARSCOV2 100MCG/0.5ML2ND	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0012F	CAP BACTERIAL ASSESS	PRXOVR	DEF					NA	NA	NA	N
0012F	CAP BACTERIAL ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0013A	ADM SARSCOV2 100MCG/0.5ML3RD	PRXOVR	DEF					NA	NA	NA	N
0013A	ADM SARSCOV2 100MCG/0.5ML3RD	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0014F	COMP PREOP ASSESS CAT SURG	PRXOVR	DEF					NA	NA	NA	N
0014F	COMP PREOP ASSESS CAT SURG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0015F	MELAN FOLLOW-UP COMPLETE	PRXOVR	DEF					NA	NA	NA	N
0015F	MELAN FOLLOW-UP COMPLETE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0041A	ADM SARSCOV2 5MCG/0.5ML 1ST	PRXOVR	DEF					NA	NA	NA	N
0041A	ADM SARSCOV2 5MCG/0.5ML 1ST	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0042A	ADM SARSCOV2 5MCG/0.5ML 2ND	PRXOVR	DEF					NA	NA	NA	N
0042A	ADM SARSCOV2 5MCG/0.5ML 2ND	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0044A	ADM SARSCOV2 5MCG/0.5ML BST	PRXOVR	DEF					NA	NA	NA	N
0044A	ADM SARSCOV2 5MCG/0.5ML BST	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0051A	ADM SARSCV2 30MCG TRS-SUCR 1	PRXOVR	DEF					NA	NA	NA	N
0051A	ADM SARSCV2 30MCG TRS-SUCR 1	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0052A	ADM SARSCV2 30MCG TRS-SUCR 2	PRXOVR	DEF					NA	NA	NA	N
0052A	ADM SARSCV2 30MCG TRS-SUCR 2	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0053A	ADM SARSCV2 30MCG TRS-SUCR 3	PRXOVR	DEF					NA	NA	NA	N
0053A	ADM SARSCV2 30MCG TRS-SUCR 3	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0054A	ADM SARSCV2 30MCG TRS-SUCR B	PRXOVR	DEF					NA	NA	NA	N
0054A	ADM SARSCV2 30MCG TRS-SUCR B	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0064A	ADM SARSCOV2 50MCG/0.25MLBST	PRXOVR	DEF					NA	NA	NA	N
0064A	ADM SARSCOV2 50MCG/0.25MLBST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0071A	ADM SARSCV2 10MCG TRS-SUCR 1	PRXOVR	DEF					NA	NA	NA	N
0071A	ADM SARSCV2 10MCG TRS-SUCR 1	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0072A	ADM SARSCV2 10MCG TRS-SUCR 2	PRXOVR	DEF					NA	NA	NA	N
0072A	ADM SARSCV2 10MCG TRS-SUCR 2	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0073A	ADM SARSCV2 10MCG TRS-SUCR 3	PRXOVR	DEF					NA	NA	NA	N
0073A	ADM SARSCV2 10MCG TRS-SUCR 3	MAXFEE	DEF					37.66	1/3/2022	12/31/2299	N
0074A	ADM SARSCV2 10MCG TRS-SUCR B	PRXOVR	DEF					NA	NA	NA	N
0074A	ADM SARSCV2 10MCG TRS-SUCR B	MAXFEE	DEF					37.66	5/17/2022	12/31/2299	N
0081A	ADM SARSCV2 3MCG TRS-SUCR 1	PRXOVR	DEF					NA	NA	NA	N
0081A	ADM SARSCV2 3MCG TRS-SUCR 1	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0082A	ADM SARSCV2 3MCG TRS-SUCR 2	PRXOVR	DEF					NA	NA	NA	N
0082A	ADM SARSCV2 3MCG TRS-SUCR 2	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0083A	ADM SARSCV2 3MCG TRS-SUCR 3	PRXOVR	DEF					NA	NA	NA	N
0083A	ADM SARSCV2 3MCG TRS-SUCR 3	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0091A	ADM SARSCOV2 50 MCG/.5 ML1ST	PRXOVR	DEF					NA	NA	NA	N
0091A	ADM SARSCOV2 50 MCG/.5 ML1ST	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0092A	ADM SARSCOV2 50 MCG/.5 ML2ND	PRXOVR	DEF					NA	NA	NA	N
0092A	ADM SARSCOV2 50 MCG/.5 ML2ND	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0093A	ADM SARSCOV2 50 MCG/.5 ML3RD	PRXOVR	DEF					NA	NA	NA	N
0093A	ADM SARSCOV2 50 MCG/.5 ML3RD	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0094A	ADM SARSCOV2 50 MCG/.5 MLBST	PRXOVR	DEF					NA	NA	NA	N
0094A	ADM SARSCOV2 50 MCG/.5 MLBST	MAXFEE	DEF					37.66	3/29/2022	12/31/2299	N
0111A	ADM SARSCOV2 25MCG/0.25ML1ST	PRXOVR	DEF					NA	NA	NA	N
0111A	ADM SARSCOV2 25MCG/0.25ML1ST	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0112A	ADM SARSCOV2 25MCG/0.25ML2ND	PRXOVR	DEF					NA	NA	NA	N
0112A	ADM SARSCOV2 25MCG/0.25ML2ND	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0113A	ADM SARSCOV2 25MCG/0.25ML3RD	PRXOVR	DEF					NA	NA	NA	N
0113A	ADM SARSCOV2 25MCG/0.25ML3RD	MAXFEE	DEF					37.66	8/31/2022	12/31/2299	N
0121A	ADM SARSCV2 BVL 30MCG/.3ML 1	PRXOVR	DEF					NA	NA	NA	N
0121A	ADM SARSCV2 BVL 30MCG/.3ML 1	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0124A	ADM SARSCV2 BVL 30MCG/.3ML A	PRXOVR	DEF					NA	NA	NA	N
0124A	ADM SARSCV2 BVL 30MCG/.3ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0134A	ADM SARSCV2 BVL 50MCG/.5ML A	PRXOVR	DEF					NA	NA	NA	N
0134A	ADM SARSCV2 BVL 50MCG/.5ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0141A	ADM SRSCV2 BVL 25MCG/.25ML 1	PRXOVR	DEF					NA	NA	NA	N
0141A	ADM SRSCV2 BVL 25MCG/.25ML 1	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0142A	ADM SRSCV2 BVL 25MCG/.25ML 2	PRXOVR	DEF					NA	NA	NA	N
0142A	ADM SRSCV2 BVL 25MCG/.25ML 2	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0144A	ADM SRSCV2 BVL 25MCG/.25ML A	PRXOVR	DEF					NA	NA	NA	N
0144A	ADM SRSCV2 BVL 25MCG/.25ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0151A	ADM SARSCV2 BVL 10MCG/.2ML 1	PRXOVR	DEF					NA	NA	NA	N
0151A	ADM SARSCV2 BVL 10MCG/.2ML 1	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0154A	ADM SARSCV2 BVL 10MCG/.2ML A	PRXOVR	DEF					NA	NA	NA	N
0154A	ADM SARSCV2 BVL 10MCG/.2ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0164A	ADM SRSCV2 BVL 10MCG/0.2ML A	PRXOVR	DEF					NA	NA	NA	N
0164A	ADM SRSCV2 BVL 10MCG/0.2ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0171A	ADM SARSCV2 BVL 3MCG/0.2ML 1	PRXOVR	DEF					NA	NA	NA	N
0171A	ADM SARSCV2 BVL 3MCG/0.2ML 1	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0172A	ADM SARSCV2 BVL 3MCG/0.2ML 2	PRXOVR	DEF					NA	NA	NA	N
0172A	ADM SARSCV2 BVL 3MCG/0.2ML 2	MAXFEE	DEF					39.94	4/18/2023	12/31/2299	N
0173A	ADM SARSCV2 BVL 3MCG/0.2ML 3	PRXOVR	DEF					NA	NA	NA	N
0173A	ADM SARSCV2 BVL 3MCG/0.2ML 3	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0174A	ADM SARSCV2 BVL 3MCG/0.2ML A	PRXOVR	DEF					NA	NA	NA	N
0174A	ADM SARSCV2 BVL 3MCG/0.2ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0275T	PERQ LAMOT/LAM LUMBAR	PRXOVR	DEF					NA	NA	NA	E
0275T	PERQ LAMOT/LAM LUMBAR	MAXFEE	DEF					550	7/1/2021	12/31/2299	E
0403T	DIABETES PREV STANDARD CURR	PRXOVR	DEF					NA	NA	NA	N
0403T	DIABETES PREV STANDARD CURR	MAXFEE	DEF					23	1/1/2022	12/31/2299	N
0488T	DIABETES PREV ONLINE/ELEC	PRXOVR	DEF					NA	NA	NA	N
0488T	DIABETES PREV ONLINE/ELEC	MAXFEE	DEF					49	1/1/2022	12/31/2299	N
0500F	INITIAL PRENATAL CARE VISIT	PRXOVR	DEF					NA	NA	NA	N
0500F	INITIAL PRENATAL CARE VISIT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0501F	PRENATAL FLOW SHEET	PRXOVR	DEF					NA	NA	NA	N
0501F	PRENATAL FLOW SHEET	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0502F	SUBSEQUENT PRENATAL CARE	PRXOVR	DEF					NA	NA	NA	N
0502F	SUBSEQUENT PRENATAL CARE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0503F	POSTPARTUM CARE VISIT	PRXOVR	DEF					NA	NA	NA	N
0503F	POSTPARTUM CARE VISIT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0505F	HEMODIALYSIS PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0505F	HEMODIALYSIS PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0507F	PERITON DIALYSIS PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0507F	PERITON DIALYSIS PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0509F	URINE INCON PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0509F	URINE INCON PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0513F	ELEV BP PLAN OF CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0513F	ELEV BP PLAN OF CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0514F	CARE PLAN HGB DOCD ESA PT	PRXOVR	DEF					NA	NA	NA	N
0514F	CARE PLAN HGB DOCD ESA PT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0516F	ANEMIA PLAN OF CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0516F	ANEMIA PLAN OF CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0517F	GLAUCOMA PLAN OF CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0517F	GLAUCOMA PLAN OF CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0518F	FALL PLAN OF CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0518F	FALL PLAN OF CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0519F	PLAND CHEMO DOCD B/4 TXMNT	PRXOVR	DEF					NA	NA	NA	N
0519F	PLAND CHEMO DOCD B/4 TXMNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0520F	RAD DOS LIMTS B/4 3D RAD	PRXOVR	DEF					NA	NA	NA	N
0520F	RAD DOS LIMTS B/4 3D RAD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0521F	PLAN OF CARE 4 PAIN DOCD	PRXOVR	DEF					NA	NA	NA	N
0521F	PLAN OF CARE 4 PAIN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0525F	INITIAL VISIT FOR EPISODE	PRXOVR	DEF					NA	NA	NA	N
0525F	INITIAL VISIT FOR EPISODE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0526F	SUBS VISIT FOR EPISODE	PRXOVR	DEF					NA	NA	NA	N
0526F	SUBS VISIT FOR EPISODE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0528F	RCMND FLW-UP 10 YRS DOCD	PRXOVR	DEF					NA	NA	NA	N
0528F	RCMND FLW-UP 10 YRS DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0529F	INTRVL 3/>YR PTS CLNSCP DOCD	PRXOVR	DEF					NA	NA	NA	N
0529F	INTRVL 3/>YR PTS CLNSCP DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0535F	DYSPNEA MNGMNT PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0535F	DYSPNEA MNGMNT PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0540F	GLUCO MNGMNT PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0540F	GLUCO MNGMNT PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0545F	FOLLOW UP CARE PLAN MDD DOCD	PRXOVR	DEF					NA	NA	NA	N
0545F	FOLLOW UP CARE PLAN MDD DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0550F	CYTOPATH REPORT NONGYN SPCMN	PRXOVR	DEF					NA	NA	NA	N
0550F	CYTOPATH REPORT NONGYN SPCMN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0551F	CYTOPATH REPORT NON ROUTINE	PRXOVR	DEF					NA	NA	NA	N
0551F	CYTOPATH REPORT NON ROUTINE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0555F	SYMPTOM MGMNT PLAN CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0555F	SYMPTOM MGMNT PLAN CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0556F	PLAN CARE LIPID CONTROL DOCD	PRXOVR	DEF					NA	NA	NA	N
0556F	PLAN CARE LIPID CONTROL DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0557F	PLAN CAREMNG ANGNL SYMPTDOCD	PRXOVR	DEF					NA	NA	NA	N
0557F	PLAN CAREMNG ANGNL SYMPTDOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0575F	HIV RNA PLAN CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0575F	HIV RNA PLAN CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0580F	MULTIDISCIPLINARY CARE PLAN	PRXOVR	DEF					NA	NA	NA	N
0580F	MULTIDISCIPLINARY CARE PLAN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0581F	PT TRNSFRD FROM ANESTH TO CC	PRXOVR	DEF					NA	NA	NA	N
0581F	PT TRNSFRD FROM ANESTH TO CC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0582F	NO TRNSFR FROM ANESTH TO CC	PRXOVR	DEF					NA	NA	NA	N
0582F	NO TRNSFR FROM ANESTH TO CC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0583F	TRANSFER CARE CHECKLIST USED	PRXOVR	DEF					NA	NA	NA	N
0583F	TRANSFER CARE CHECKLIST USED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0584F	NO TRANSFERCARE CHKLIST USED	PRXOVR	DEF					NA	NA	NA	N
0584F	NO TRANSFERCARE CHKLIST USED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10004	FNA BX W/O IMG GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10004	FNA BX W/O IMG GDN EA ADDL	MAXFEE	FAC					35.24	1/1/2019	12/31/2299	N
10004	FNA BX W/O IMG GDN EA ADDL	MAXFEE	NFF					41.59	1/1/2019	12/31/2299	N
10005	FNA BX W/US GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10005	FNA BX W/US GDN 1ST LES	MAXFEE	FAC					21.95	1/1/2019	12/31/2299	N
10005	FNA BX W/US GDN 1ST LES	MAXFEE	NFF					57.36	1/1/2019	12/31/2299	N
10006	FNA BX W/US GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10006	FNA BX W/US GDN EA ADDL	MAXFEE	FAC					15.37	1/1/2019	12/31/2299	N
10006	FNA BX W/US GDN EA ADDL	MAXFEE	NFF					28.68	1/1/2019	12/31/2299	N
10007	FNA BX W/FLUOR GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10007	FNA BX W/FLUOR GDN 1ST LES	MAXFEE	FAC					28.10	1/1/2019	12/31/2299	N
10007	FNA BX W/FLUOR GDN 1ST LES	MAXFEE	NFF					126.77	1/1/2019	12/31/2299	N
10008	FNA BX W/FLUOR GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10008	FNA BX W/FLUOR GDN EA ADDL	MAXFEE	FAC					18.44	1/1/2019	12/31/2299	N
10008	FNA BX W/FLUOR GDN EA ADDL	MAXFEE	NFF					71.70	1/1/2019	12/31/2299	N
10009	FNA BX W/CT GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10009	FNA BX W/CT GDN 1ST LES	MAXFEE	FAC					34.24	1/1/2019	12/31/2299	N
10009	FNA BX W/CT GDN 1ST LES	MAXFEE	NFF					206.50	1/1/2019	12/31/2299	N
1000F	TOBACCO USE ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1000F	TOBACCO USE ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10010	FNA BX W/CT GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10010	FNA BX W/CT GDN EA ADDL	MAXFEE	FAC					25.68	1/1/2019	12/31/2299	N
10010	FNA BX W/CT GDN EA ADDL	MAXFEE	NFF					123.90	1/1/2019	12/31/2299	N
10011	FNA BX W/MR GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10011	FNA BX W/MR GDN 1ST LES	MANUAL	DEF					NA	NA	NA	N
10012	FNA BX W/MR GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10012	FNA BX W/MR GDN EA ADDL	MANUAL	DEF					NA	NA	NA	N
1001F	TOBACCO USE; NON-SMOKING	PRXOVR	DEF					NA	NA	NA	N
1001F	TOBACCO USE; NON-SMOKING	MAXFEE	DEF					NA			N
10021	FNA BX W/O IMG GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10021	FNA BX W/O IMG GDN 1ST LES	MAXFEE	FAC					49.77	1/1/2014	12/31/2299	N
10021	FNA BX W/O IMG GDN 1ST LES	MAXFEE	NFF					73.55	1/1/2014	12/31/2299	N
10022	FNA W/IMAGE	PRXOVR	DEF					NA	NA	NA	N
10022	FNA W/IMAGE	MAXFEE	DEF					NA			N
1002F	ASSESS ANGINAL SYMPTOM/LEVEL	PRXOVR	DEF					NA	NA	NA	N
1002F	ASSESS ANGINAL SYMPTOM/LEVEL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10030	GUIDE CATHET FLUID DRAINAGE	PRXOVR	DEF					NA	NA	NA	N
10030	GUIDE CATHET FLUID DRAINAGE	MAXFEE	FAC					119.43	1/1/2014	12/31/2299	N
10030	GUIDE CATHET FLUID DRAINAGE	MAXFEE	NFF					561.80	1/1/2014	12/31/2299	N
10035	PERQ DEV SOFT TISS 1ST IMAG	PRXOVR	DEF					NA	NA	NA	N
10035	PERQ DEV SOFT TISS 1ST IMAG	MAXFEE	FAC					70.14	1/1/2016	12/31/2299	N
10035	PERQ DEV SOFT TISS 1ST IMAG	MAXFEE	NFF					403.78	1/1/2016	12/31/2299	N
10036	PERQ DEV SOFT TISS ADD IMAG	PRXOVR	DEF					NA	NA	NA	N
10036	PERQ DEV SOFT TISS ADD IMAG	MAXFEE	FAC					35.34	1/1/2016	12/31/2299	N
10036	PERQ DEV SOFT TISS ADD IMAG	MAXFEE	NFF					349.25	1/1/2016	12/31/2299	N
1003F	LEVEL OF ACTIVITY ASSESS	PRXOVR	DEF					NA	NA	NA	N
1003F	LEVEL OF ACTIVITY ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10040	ACNE SURGERY	PRXOVR	DEF					NA	NA	NA	N
10040	ACNE SURGERY	MAXFEE	FAC					48.33	1/1/2014	12/31/2299	N
10040	ACNE SURGERY	MAXFEE	NFF					62.13	1/1/2014	12/31/2299	N
1004F	CLIN SYMP VOL OVRLD ASSESS	PRXOVR	DEF					NA	NA	NA	N
1004F	CLIN SYMP VOL OVRLD ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1005F	ASTHMA SYMPTOMS EVALUATE	PRXOVR	DEF					NA	NA	NA	N
1005F	ASTHMA SYMPTOMS EVALUATE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10060	DRAINAGE OF SKIN ABSCESS	PRXOVR	DEF					NA	NA	NA	N
10060	DRAINAGE OF SKIN ABSCESS	MAXFEE	FAC					56.90	1/1/2014	12/31/2299	N
10060	DRAINAGE OF SKIN ABSCESS	MAXFEE	NFF					72.81	1/1/2014	12/31/2299	N
10061	DRAINAGE OF SKIN ABSCESS	PRXOVR	DEF					NA	NA	NA	N
10061	DRAINAGE OF SKIN ABSCESS	MAXFEE	FAC					62.08	1/1/2014	12/31/2299	N
10061	DRAINAGE OF SKIN ABSCESS	MAXFEE	NFF					87.31	1/1/2014	12/31/2299	N
1006F	OSTEOARTHRITIS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1006F	OSTEOARTHRITIS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1007F	ANTI-INFLM/ANLGSC OTC ASSESS	PRXOVR	DEF					NA	NA	NA	N
1007F	ANTI-INFLM/ANLGSC OTC ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10080	DRAINAGE OF PILONIDAL CYST	PRXOVR	DEF					NA	NA	NA	N
10080	DRAINAGE OF PILONIDAL CYST	MAXFEE	FAC					47.35	1/1/2014	12/31/2299	N
10080	DRAINAGE OF PILONIDAL CYST	MAXFEE	NFF					76.13	1/1/2014	12/31/2299	N
10081	DRAINAGE OF PILONIDAL CYST	PRXOVR	DEF					NA	NA	NA	N
10081	DRAINAGE OF PILONIDAL CYST	MAXFEE	FAC					58.97	1/1/2014	12/31/2299	N
10081	DRAINAGE OF PILONIDAL CYST	MAXFEE	NFF					103.02	1/1/2014	12/31/2299	N
1008F	GI/RENAL RISK ASSESS	PRXOVR	DEF					NA	NA	NA	N
1008F	GI/RENAL RISK ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1010F	SEVERITY ANGINA BY ACTVTY	PRXOVR	DEF					NA	NA	NA	N
1010F	SEVERITY ANGINA BY ACTVTY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1011F	ANGINA PRESENT	PRXOVR	DEF					NA	NA	NA	N
1011F	ANGINA PRESENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10120	REMOVE FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
10120	REMOVE FOREIGN BODY	MAXFEE	FAC					41	1/1/2014	12/31/2299	N
10120	REMOVE FOREIGN BODY	MAXFEE	NFF					65.78	1/1/2014	12/31/2299	N
10121	REMOVE FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
10121	REMOVE FOREIGN BODY	MAXFEE	FAC					63.31	1/1/2014	12/31/2299	N
10121	REMOVE FOREIGN BODY	MAXFEE	NFF					106.80	1/1/2014	12/31/2299	N
1012F	ANGINA ABSENT	PRXOVR	DEF					NA	NA	NA	N
1012F	ANGINA ABSENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10140	DRAINAGE OF HEMATOMA/FLUID	PRXOVR	DEF					NA	NA	NA	N
10140	DRAINAGE OF HEMATOMA/FLUID	MAXFEE	FAC					55.17	1/1/2014	12/31/2299	N
10140	DRAINAGE OF HEMATOMA/FLUID	MAXFEE	NFF					84.47	1/1/2014	12/31/2299	N
1015F	COPD SYMPTOMS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1015F	COPD SYMPTOMS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10160	PUNCTURE DRAINAGE OF LESION	PRXOVR	DEF					NA	NA	NA	N
10160	PUNCTURE DRAINAGE OF LESION	MAXFEE	FAC					38	1/1/2014	12/31/2299	N
10160	PUNCTURE DRAINAGE OF LESION	MAXFEE	NFF					55.67	1/1/2014	12/31/2299	N
10180	COMPLEX DRAINAGE WOUND	PRXOVR	DEF					NA	NA	NA	N
10180	COMPLEX DRAINAGE WOUND	MAXFEE	FAC					59.25	1/1/2014	12/31/2299	N
10180	COMPLEX DRAINAGE WOUND	MAXFEE	NFF					95.23	1/1/2014	12/31/2299	N
1018F	ASSESS DYSPNEA NOT PRESENT	PRXOVR	DEF					NA	NA	NA	N
1018F	ASSESS DYSPNEA NOT PRESENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1019F	ASSESS DYSPNEA PRESENT	PRXOVR	DEF					NA	NA	NA	N
1019F	ASSESS DYSPNEA PRESENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1022F	PNEUMO IMM STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1022F	PNEUMO IMM STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1026F	CO-MORBID CONDITION ASSESS	PRXOVR	DEF					NA	NA	NA	N
1026F	CO-MORBID CONDITION ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1030F	INFLUENZA IMM STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1030F	INFLUENZA IMM STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1031F	SMOKING & 2ND HAND ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1031F	SMOKING & 2ND HAND ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1032F	SMOKER/EXPOSED 2ND HND SMOKE	PRXOVR	DEF					NA	NA	NA	N
1032F	SMOKER/EXPOSED 2ND HND SMOKE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1033F	TOBACCO NONSMOKER NOR 2NDHND	PRXOVR	DEF					NA	NA	NA	N
1033F	TOBACCO NONSMOKER NOR 2NDHND	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1034F	CURRENT TOBACCO SMOKER	PRXOVR	DEF					NA	NA	NA	N
1034F	CURRENT TOBACCO SMOKER	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
1035F	SMOKELESS TOBACCO USER	PRXOVR	DEF					NA	NA	NA	N
1035F	SMOKELESS TOBACCO USER	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
1036F	TOBACCO NON-USER	PRXOVR	DEF					NA	NA	NA	N
1036F	TOBACCO NON-USER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1038F	PERSISTENT ASTHMA	PRXOVR	DEF					NA	NA	NA	N
1038F	PERSISTENT ASTHMA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1039F	INTERMITTENT ASTHMA	PRXOVR	DEF					NA	NA	NA	N
1039F	INTERMITTENT ASTHMA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1040F	DSM-5 INFO MDD DOCD	PRXOVR	DEF					NA	NA	NA	N
1040F	DSM-5 INFO MDD DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1050F	HISTORY OF MOLE CHANGES	PRXOVR	DEF					NA	NA	NA	N
1050F	HISTORY OF MOLE CHANGES	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1052F	TYPE LOCATION ACTIVITYASSESS	PRXOVR	DEF					NA	NA	NA	N
1052F	TYPE LOCATION ACTIVITYASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1055F	VISUAL FUNCT STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1055F	VISUAL FUNCT STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1060F	DOC PERM/CONT/PAROX ATR FIB	PRXOVR	DEF					NA	NA	NA	N
1060F	DOC PERM/CONT/PAROX ATR FIB	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1061F	DOC LACK PERM&CONT&PAROX FIB	PRXOVR	DEF					NA	NA	NA	N
1061F	DOC LACK PERM&CONT&PAROX FIB	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1065F	ISCHM STROKE SYMP LT3 HRSB/4	PRXOVR	DEF					NA	NA	NA	N
1065F	ISCHM STROKE SYMP LT3 HRSB/4	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1066F	ISCHM STROKE SYMP GE3 HRSB/4	PRXOVR	DEF					NA	NA	NA	N
1066F	ISCHM STROKE SYMP GE3 HRSB/4	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1070F	ALARM SYMP ASSESSED-ABSENT	PRXOVR	DEF					NA	NA	NA	N
1070F	ALARM SYMP ASSESSED-ABSENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1071F	ALARM SYMP ASSESSED-1+ PRSNT	PRXOVR	DEF					NA	NA	NA	N
1071F	ALARM SYMP ASSESSED-1+ PRSNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1080F	DECIS MKR/ADVNCD PLAN DOC'D	PRXOVR	DEF					NA	NA	NA	N
1080F	DECIS MKR/ADVNCD PLAN DOC'D	MAXFEE	DEF					NA			N
1090F	PRES/ABSN URINE INCON ASSESS	PRXOVR	DEF					NA	NA	NA	N
1090F	PRES/ABSN URINE INCON ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1091F	URINE INCON CHARACTERIZED	PRXOVR	DEF					NA	NA	NA	N
1091F	URINE INCON CHARACTERIZED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11000	DEBRIDE INFECTED SKIN	PRXOVR	DEF					NA	NA	NA	N
11000	DEBRIDE INFECTED SKIN	MAXFEE	FAC					19.74	1/1/2014	12/31/2299	N
11000	DEBRIDE INFECTED SKIN	MAXFEE	NFF					34.34	1/1/2014	12/31/2299	N
11001	DEBRIDE INFECTED SKIN ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11001	DEBRIDE INFECTED SKIN ADD-ON	MAXFEE	FAC					10.02	1/1/2014	12/31/2299	N
11001	DEBRIDE INFECTED SKIN ADD-ON	MAXFEE	NFF					15.02	1/1/2014	12/31/2299	N
11004	DEBRIDE GENITALIA & PERINEUM	PRXOVR	DEF					NA	NA	NA	N
11004	DEBRIDE GENITALIA & PERINEUM	MAXFEE	DEF					415.55	1/1/2005	12/31/2299	N
11005	DEBRIDE ABDOM WALL	PRXOVR	DEF					NA	NA	NA	N
11005	DEBRIDE ABDOM WALL	MAXFEE	DEF					565.62	1/1/2005	12/31/2299	N
11006	DEBRIDE GENIT/PER/ABDOM WALL	PRXOVR	DEF					NA	NA	NA	N
11006	DEBRIDE GENIT/PER/ABDOM WALL	MAXFEE	DEF					523.27	1/1/2005	12/31/2299	N
11008	REMOVE MESH FROM ABD WALL	PRXOVR	DEF					NA	NA	NA	N
11008	REMOVE MESH FROM ABD WALL	MAXFEE	DEF					212.89	1/1/2005	12/31/2299	N
1100F	PTFALLS ASSESS-DOCD GE2>/YR	PRXOVR	DEF					NA	NA	NA	N
1100F	PTFALLS ASSESS-DOCD GE2>/YR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11010	DEBRIDE SKIN AT FX SITE	PRXOVR	DEF					NA	NA	NA	N
11010	DEBRIDE SKIN AT FX SITE	MAXFEE	FAC					126.27	1/1/2014	12/31/2299	N
11010	DEBRIDE SKIN AT FX SITE	MAXFEE	NFF					214.12	1/1/2014	12/31/2299	N
11011	DEBRIDE SKIN MUSC AT FX SITE	PRXOVR	DEF					NA	NA	NA	N
11011	DEBRIDE SKIN MUSC AT FX SITE	MAXFEE	FAC					126.63	1/1/2014	12/31/2299	N
11011	DEBRIDE SKIN MUSC AT FX SITE	MAXFEE	NFF					256.44	1/1/2014	12/31/2299	N
11012	DEB SKIN BONE AT FX SITE	PRXOVR	DEF					NA	NA	NA	N
11012	DEB SKIN BONE AT FX SITE	MAXFEE	FAC					199.72	1/1/2014	12/31/2299	N
11012	DEB SKIN BONE AT FX SITE	MAXFEE	NFF					360.03	1/1/2014	12/31/2299	N
1101F	PT FALLS ASSESS-DOCD LE1/YR	PRXOVR	DEF					NA	NA	NA	N
1101F	PT FALLS ASSESS-DOCD LE1/YR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11040	DEBRIDE SKIN; PARTIAL	PRXOVR	DEF					NA	NA	NA	N
11040	DEBRIDE SKIN; PARTIAL	MAXFEE	DEF					NA			N
11041	DEBRIDE SKIN; FULL	PRXOVR	DEF					NA	NA	NA	N
11041	DEBRIDE SKIN; FULL	MAXFEE	DEF					NA			N
11042	DEB SUBQ TISSUE 20 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
11042	DEB SUBQ TISSUE 20 SQ CM/<	MAXFEE	FAC					20.33	1/1/2014	12/31/2299	N
11042	DEB SUBQ TISSUE 20 SQ CM/<	MAXFEE	NFF					40.19	1/1/2014	12/31/2299	N
11043	DEB MUSC/FASCIA 20 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
11043	DEB MUSC/FASCIA 20 SQ CM/<	MAXFEE	FAC					74.18	1/1/2014	12/31/2299	N
11043	DEB MUSC/FASCIA 20 SQ CM/<	MAXFEE	NFF					124.70	1/1/2014	12/31/2299	N
11044	DEB BONE 20 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
11044	DEB BONE 20 SQ CM/<	MAXFEE	FAC					110.67	1/1/2014	12/31/2299	N
11044	DEB BONE 20 SQ CM/<	MAXFEE	NFF					172.73	1/1/2014	12/31/2299	N
11045	DEB SUBQ TISSUE ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11045	DEB SUBQ TISSUE ADD-ON	MAXFEE	FAC					9.23	1/1/2014	12/31/2299	N
11045	DEB SUBQ TISSUE ADD-ON	MAXFEE	NFF					15.55	1/1/2014	12/31/2299	N
11046	DEB MUSC/FASCIA ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11046	DEB MUSC/FASCIA ADD-ON	MAXFEE	FAC					18.65	1/1/2014	12/31/2299	N
11046	DEB MUSC/FASCIA ADD-ON	MAXFEE	NFF					27.23	1/1/2014	12/31/2299	N
11047	DEB BONE ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11047	DEB BONE ADD-ON	MAXFEE	FAC					35.03	1/1/2014	12/31/2299	N
11047	DEB BONE ADD-ON	MAXFEE	NFF					44.83	1/1/2014	12/31/2299	N
11055	TRIM SKIN LESION	PRXOVR	DEF					NA	NA	NA	N
11055	TRIM SKIN LESION	MAXFEE	FAC					9.35	1/1/2014	12/31/2299	N
11055	TRIM SKIN LESION	MAXFEE	NFF					23.34	1/1/2014	12/31/2299	N
11056	TRIM SKIN LESIONS 2 TO 4	PRXOVR	DEF					NA	NA	NA	N
11056	TRIM SKIN LESIONS 2 TO 4	MAXFEE	FAC					15.67	1/1/2014	12/31/2299	N
11056	TRIM SKIN LESIONS 2 TO 4	MAXFEE	NFF					28.90	1/1/2014	12/31/2299	N
11057	TRIM SKIN LESIONS OVER 4	PRXOVR	DEF					NA	NA	NA	N
11057	TRIM SKIN LESIONS OVER 4	MAXFEE	FAC					20.41	1/1/2014	12/31/2299	N
11057	TRIM SKIN LESIONS OVER 4	MAXFEE	NFF					35.53	1/1/2014	12/31/2299	N
11100	BIOPSY SKIN LESION	PRXOVR	DEF					NA	NA	NA	N
11100	BIOPSY SKIN LESION	MAXFEE	DEF					NA			N
11101	BIOPSY SKIN ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11101	BIOPSY SKIN ADD-ON	MAXFEE	DEF					NA			N
11102	TANGNTL BX SKIN SINGLE LES	PRXOVR	DEF					NA	NA	NA	N
11102	TANGNTL BX SKIN SINGLE LES	MAXFEE	FAC					24.30	1/1/2019	12/31/2299	N
11102	TANGNTL BX SKIN SINGLE LES	MAXFEE	NFF					47.20	1/1/2019	12/31/2299	N
11103	TANGNTL BX SKIN EA SEP/ADDL	PRXOVR	DEF					NA	NA	NA	N
11103	TANGNTL BX SKIN EA SEP/ADDL	MAXFEE	FAC					14.58	1/1/2019	12/31/2299	N
11103	TANGNTL BX SKIN EA SEP/ADDL	MAXFEE	NFF					28.32	1/1/2019	12/31/2299	N
11104	PUNCH BX SKIN SINGLE LESION	PRXOVR	DEF					NA	NA	NA	N
11104	PUNCH BX SKIN SINGLE LESION	MAXFEE	FAC					30.38	1/1/2019	12/31/2299	N
11104	PUNCH BX SKIN SINGLE LESION	MAXFEE	NFF					59	1/1/2019	12/31/2299	N
11105	PUNCH BX SKIN EA SEP/ADDL	PRXOVR	DEF					NA	NA	NA	N
11105	PUNCH BX SKIN EA SEP/ADDL	MAXFEE	FAC					8.02	1/1/2019	12/31/2299	N
11105	PUNCH BX SKIN EA SEP/ADDL	MAXFEE	NFF					32.45	1/1/2019	12/31/2299	N
11106	INCAL BX SKN SINGLE LES	PRXOVR	DEF					NA	NA	NA	N
11106	INCAL BX SKN SINGLE LES	MAXFEE	FAC					36.94	1/1/2019	12/31/2299	N
11106	INCAL BX SKN SINGLE LES	MAXFEE	NFF					71.74	1/1/2019	12/31/2299	N
11107	INCAL BX SKN EA SEP/ADDL	PRXOVR	DEF					NA	NA	NA	N
11107	INCAL BX SKN EA SEP/ADDL	MAXFEE	FAC					20.31	1/1/2019	12/31/2299	N
11107	INCAL BX SKN EA SEP/ADDL	MAXFEE	NFF					39.46	1/1/2019	12/31/2299	N
1110F	PT LFT INPT FAC W/IN 60 DAYS	PRXOVR	DEF					NA	NA	NA	N
1110F	PT LFT INPT FAC W/IN 60 DAYS	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
1111F	DSCHRG MED/CURRENT MED MERGE	PRXOVR	DEF					NA	NA	NA	N
1111F	DSCHRG MED/CURRENT MED MERGE	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
1116F	AURIC/PERI PAIN ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1116F	AURIC/PERI PAIN ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1118F	GERD SYMPS ASSESSED 12 MONTH	PRXOVR	DEF					NA	NA	NA	N
1118F	GERD SYMPS ASSESSED 12 MONTH	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1119F	INIT EVAL FOR CONDITION	PRXOVR	DEF					NA	NA	NA	N
1119F	INIT EVAL FOR CONDITION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11200	REMOVAL OF SKIN TAGS <W/15	PRXOVR	DEF					NA	NA	NA	N
11200	REMOVAL OF SKIN TAGS <W/15	MAXFEE	FAC					41.92	1/1/2014	12/31/2299	N
11200	REMOVAL OF SKIN TAGS <W/15	MAXFEE	NFF					54.08	1/1/2014	12/31/2299	N
11201	REMOVE SKIN TAGS ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11201	REMOVE SKIN TAGS ADD-ON	MAXFEE	FAC					9.96	1/1/2014	12/31/2299	N
11201	REMOVE SKIN TAGS ADD-ON	MAXFEE	NFF					13.28	1/1/2014	12/31/2299	N
1121F	SUBS EVAL FOR CONDITION	PRXOVR	DEF					NA	NA	NA	N
1121F	SUBS EVAL FOR CONDITION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1123F	ACP DISCUSS/DSCN MKR DOCD	PRXOVR	DEF					NA	NA	NA	N
1123F	ACP DISCUSS/DSCN MKR DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1124F	ACP DISCUSS-NO DSCNMKR DOCD	PRXOVR	DEF					NA	NA	NA	N
1124F	ACP DISCUSS-NO DSCNMKR DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1125F	AMNT PAIN NOTED PAIN PRSNT	PRXOVR	DEF					NA	NA	NA	N
1125F	AMNT PAIN NOTED PAIN PRSNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1126F	AMNT PAIN NOTED NONE PRSNT	PRXOVR	DEF					NA	NA	NA	N
1126F	AMNT PAIN NOTED NONE PRSNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1127F	NEW EPISODE FOR CONDITION	PRXOVR	DEF					NA	NA	NA	N
1127F	NEW EPISODE FOR CONDITION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1128F	SUBS EPISODE FOR CONDITION	PRXOVR	DEF					NA	NA	NA	N
1128F	SUBS EPISODE FOR CONDITION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11300	SHAVE SKIN LESION 0.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
11300	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	FAC					27.86	1/1/2014	12/31/2299	N
11300	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	NFF					40.48	1/1/2014	12/31/2299	N
11301	SHAVE SKIN LESION 0.6-1.0 CM	PRXOVR	DEF					NA	NA	NA	N
11301	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	FAC					33.08	1/1/2014	12/31/2299	N
11301	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	NFF					43.85	1/1/2014	12/31/2299	N
11302	SHAVE SKIN LESION 1.1-2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11302	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	FAC					40.59	1/1/2014	12/31/2299	N
11302	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	NFF					53.13	1/1/2014	12/31/2299	N
11303	SHAVE SKIN LESION >2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11303	SHAVE SKIN LESION >2.0 CM	MAXFEE	FAC					55.06	1/1/2014	12/31/2299	N
11303	SHAVE SKIN LESION >2.0 CM	MAXFEE	NFF					69.80	1/1/2014	12/31/2299	N
11305	SHAVE SKIN LESION 0.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
11305	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	FAC					30.62	1/1/2014	12/31/2299	N
11305	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	NFF					41.20	1/1/2014	12/31/2299	N
11306	SHAVE SKIN LESION 0.6-1.0 CM	PRXOVR	DEF					NA	NA	NA	N
11306	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	FAC					36.85	1/1/2014	12/31/2299	N
11306	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	NFF					46.86	1/1/2014	12/31/2299	N
11307	SHAVE SKIN LESION 1.1-2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11307	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	FAC					43.15	1/1/2014	12/31/2299	N
11307	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	NFF					56.65	1/1/2014	12/31/2299	N
11308	SHAVE SKIN LESION >2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11308	SHAVE SKIN LESION >2.0 CM	MAXFEE	FAC					59.10	1/1/2014	12/31/2299	N
11308	SHAVE SKIN LESION >2.0 CM	MAXFEE	NFF					74.85	1/1/2014	12/31/2299	N
1130F	BK PAIN & FXN ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1130F	BK PAIN & FXN ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11310	SHAVE SKIN LESION 0.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
11310	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	FAC					37.60	1/1/2014	12/31/2299	N
11310	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	NFF					49.86	1/1/2014	12/31/2299	N
11311	SHAVE SKIN LESION 0.6-1.0 CM	PRXOVR	DEF					NA	NA	NA	N
11311	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	FAC					38.66	1/1/2014	12/31/2299	N
11311	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	NFF					51.99	1/1/2014	12/31/2299	N
11312	SHAVE SKIN LESION 1.1-2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11312	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	FAC					47.12	1/1/2014	12/31/2299	N
11312	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	NFF					62.63	1/1/2014	12/31/2299	N
11313	SHAVE SKIN LESION >2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11313	SHAVE SKIN LESION >2.0 CM	MAXFEE	FAC					63.32	1/1/2014	12/31/2299	N
11313	SHAVE SKIN LESION >2.0 CM	MAXFEE	NFF					83.17	1/1/2014	12/31/2299	N
1134F	EPSD BK PAIN FOR 6 WKS/<	PRXOVR	DEF					NA	NA	NA	N
1134F	EPSD BK PAIN FOR 6 WKS/<	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1135F	EPSD BK PAIN FOR >6 WKS	PRXOVR	DEF					NA	NA	NA	N
1135F	EPSD BK PAIN FOR >6 WKS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1136F	EPSD BK PAIN FOR 12 WKS/<	PRXOVR	DEF					NA	NA	NA	N
1136F	EPSD BK PAIN FOR 12 WKS/<	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1137F	EPSD BK PAIN FOR >12 WKS	PRXOVR	DEF					NA	NA	NA	N
1137F	EPSD BK PAIN FOR >12 WKS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11400	EXC TR-EXT B9+MARG 0.5 CM<	PRXOVR	DEF					NA	NA	NA	N
11400	EXC TR-EXT B9+MARG 0.5 CM<	MAXFEE	FAC					44.97	1/1/2014	12/31/2299	N
11400	EXC TR-EXT B9+MARG 0.5 CM<	MAXFEE	NFF					60.67	1/1/2014	12/31/2299	N
11401	EXC TR-EXT B9+MARG 0.6-1 CM	PRXOVR	DEF					NA	NA	NA	N
11401	EXC TR-EXT B9+MARG 0.6-1 CM	MAXFEE	FAC					55.84	1/1/2014	12/31/2299	N
11401	EXC TR-EXT B9+MARG 0.6-1 CM	MAXFEE	NFF					71.83	1/1/2014	12/31/2299	N
11402	EXC TR-EXT B9+MARG 1.1-2 CM	PRXOVR	DEF					NA	NA	NA	N
11402	EXC TR-EXT B9+MARG 1.1-2 CM	MAXFEE	FAC					56.86	1/1/2014	12/31/2299	N
11402	EXC TR-EXT B9+MARG 1.1-2 CM	MAXFEE	NFF					79.94	1/1/2014	12/31/2299	N
11403	EXC TR-EXT B9+MARG 2.1-3CM	PRXOVR	DEF					NA	NA	NA	N
11403	EXC TR-EXT B9+MARG 2.1-3CM	MAXFEE	FAC					65.99	1/1/2014	12/31/2299	N
11403	EXC TR-EXT B9+MARG 2.1-3CM	MAXFEE	NFF					87.35	1/1/2014	12/31/2299	N
11404	EXC TR-EXT B9+MARG 3.1-4 CM	PRXOVR	DEF					NA	NA	NA	N
11404	EXC TR-EXT B9+MARG 3.1-4 CM	MAXFEE	FAC					76.06	1/1/2014	12/31/2299	N
11404	EXC TR-EXT B9+MARG 3.1-4 CM	MAXFEE	NFF					100.48	1/1/2014	12/31/2299	N
11406	EXC TR-EXT B9+MARG >4.0 CM	PRXOVR	DEF					NA	NA	NA	N
11406	EXC TR-EXT B9+MARG >4.0 CM	MAXFEE	FAC					95.98	1/1/2014	12/31/2299	N
11406	EXC TR-EXT B9+MARG >4.0 CM	MAXFEE	NFF					132.81	1/1/2014	12/31/2299	N
11420	EXC H-F-NK-SP B9+MARG 0.5/<	PRXOVR	DEF					NA	NA	NA	N
11420	EXC H-F-NK-SP B9+MARG 0.5/<	MAXFEE	FAC					44.43	1/1/2014	12/31/2299	N
11420	EXC H-F-NK-SP B9+MARG 0.5/<	MAXFEE	NFF					60.23	1/1/2014	12/31/2299	N
11421	EXC H-F-NK-SP B9+MARG 0.6-1	PRXOVR	DEF					NA	NA	NA	N
11421	EXC H-F-NK-SP B9+MARG 0.6-1	MAXFEE	FAC					55.20	1/1/2014	12/31/2299	N
11421	EXC H-F-NK-SP B9+MARG 0.6-1	MAXFEE	NFF					77	1/1/2014	12/31/2299	N
11422	EXC H-F-NK-SP B9+MARG 1.1-2	PRXOVR	DEF					NA	NA	NA	N
11422	EXC H-F-NK-SP B9+MARG 1.1-2	MAXFEE	FAC					59.54	1/1/2014	12/31/2299	N
11422	EXC H-F-NK-SP B9+MARG 1.1-2	MAXFEE	NFF					79.42	1/1/2014	12/31/2299	N
11423	EXC H-F-NK-SP B9+MARG 2.1-3	PRXOVR	DEF					NA	NA	NA	N
11423	EXC H-F-NK-SP B9+MARG 2.1-3	MAXFEE	FAC					73.87	1/1/2014	12/31/2299	N
11423	EXC H-F-NK-SP B9+MARG 2.1-3	MAXFEE	NFF					97.96	1/1/2014	12/31/2299	N
11424	EXC H-F-NK-SP B9+MARG 3.1-4	PRXOVR	DEF					NA	NA	NA	N
11424	EXC H-F-NK-SP B9+MARG 3.1-4	MAXFEE	FAC					86.04	1/1/2014	12/31/2299	N
11424	EXC H-F-NK-SP B9+MARG 3.1-4	MAXFEE	NFF					112.42	1/1/2014	12/31/2299	N
11426	EXC H-F-NK-SP B9+MARG >4 CM	PRXOVR	DEF					NA	NA	NA	N
11426	EXC H-F-NK-SP B9+MARG >4 CM	MAXFEE	FAC					117.74	1/1/2014	12/31/2299	N
11426	EXC H-F-NK-SP B9+MARG >4 CM	MAXFEE	NFF					160.11	1/1/2014	12/31/2299	N
11440	EXC FACE-MM B9+MARG 0.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
11440	EXC FACE-MM B9+MARG 0.5 CM/<	MAXFEE	FAC					52.55	1/1/2014	12/31/2299	N
11440	EXC FACE-MM B9+MARG 0.5 CM/<	MAXFEE	NFF					68.33	1/1/2014	12/31/2299	N
11441	EXC FACE-MM B9+MARG 0.6-1 CM	PRXOVR	DEF					NA	NA	NA	N
11441	EXC FACE-MM B9+MARG 0.6-1 CM	MAXFEE	FAC					64.16	1/1/2014	12/31/2299	N
11441	EXC FACE-MM B9+MARG 0.6-1 CM	MAXFEE	NFF					83.44	1/1/2014	12/31/2299	N
11442	EXC FACE-MM B9+MARG 1.1-2 CM	PRXOVR	DEF					NA	NA	NA	N
11442	EXC FACE-MM B9+MARG 1.1-2 CM	MAXFEE	FAC					65.39	1/1/2014	12/31/2299	N
11442	EXC FACE-MM B9+MARG 1.1-2 CM	MAXFEE	NFF					87.37	1/1/2014	12/31/2299	N
11443	EXC FACE-MM B9+MARG 2.1-3 CM	PRXOVR	DEF					NA	NA	NA	N
11443	EXC FACE-MM B9+MARG 2.1-3 CM	MAXFEE	FAC					87.20	1/1/2014	12/31/2299	N
11443	EXC FACE-MM B9+MARG 2.1-3 CM	MAXFEE	NFF					113.37	1/1/2014	12/31/2299	N
11444	EXC FACE-MM B9+MARG 3.1-4 CM	PRXOVR	DEF					NA	NA	NA	N
11444	EXC FACE-MM B9+MARG 3.1-4 CM	MAXFEE	FAC					104.12	1/1/2014	12/31/2299	N
11444	EXC FACE-MM B9+MARG 3.1-4 CM	MAXFEE	NFF					137.81	1/1/2014	12/31/2299	N
11446	EXC FACE-MM B9+MARG >4 CM	PRXOVR	DEF					NA	NA	NA	N
11446	EXC FACE-MM B9+MARG >4 CM	MAXFEE	FAC					129.54	1/1/2014	12/31/2299	N
11446	EXC FACE-MM B9+MARG >4 CM	MAXFEE	NFF					177.67	1/1/2014	12/31/2299	N
11450	REMOVAL SWEAT GLAND LESION	PRXOVR	DEF					NA	NA	NA	N
11450	REMOVAL SWEAT GLAND LESION	MAXFEE	FAC					115.97	1/1/2014	12/31/2299	N
11450	REMOVAL SWEAT GLAND LESION	MAXFEE	NFF					154.33	1/1/2014	12/31/2299	N
11451	REMOVAL SWEAT GLAND LESION	PRXOVR	DEF					NA	NA	NA	N
11451	REMOVAL SWEAT GLAND LESION	MAXFEE	FAC					146.08	1/1/2014	12/31/2299	N
11451	REMOVAL SWEAT GLAND LESION	MAXFEE	NFF					194.12	1/1/2014	12/31/2299	N
11462	REMOVAL SWEAT GLAND LESION	PRXOVR	DEF					NA	NA	NA	N
11462	REMOVAL SWEAT GLAND LESION	MAXFEE	FAC					124.90	1/1/2014	12/31/2299	N
11462	REMOVAL SWEAT GLAND LESION	MAXFEE	NFF					162.21	1/1/2014	12/31/2299	N
11463	REMOVAL SWEAT GLAND LESION	PRXOVR	DEF					NA	NA	NA	N
11463	REMOVAL SWEAT GLAND LESION	MAXFEE	FAC					155.57	1/1/2014	12/31/2299	N
11463	REMOVAL SWEAT GLAND LESION	MAXFEE	NFF					205.97	1/1/2014	12/31/2299	N
11470	REMOVAL SWEAT GLAND LESION	PRXOVR	DEF					NA	NA	NA	N
11470	REMOVAL SWEAT GLAND LESION	MAXFEE	FAC					104.38	1/1/2014	12/31/2299	N
11470	REMOVAL SWEAT GLAND LESION	MAXFEE	NFF					174.01	1/1/2014	12/31/2299	N
11471	REMOVAL SWEAT GLAND LESION	PRXOVR	DEF					NA	NA	NA	N
11471	REMOVAL SWEAT GLAND LESION	MAXFEE	FAC					150.71	1/1/2014	12/31/2299	N
11471	REMOVAL SWEAT GLAND LESION	MAXFEE	NFF					202.63	1/1/2014	12/31/2299	N
1150F	DOC PT RSK DEATH W/IN 1YR	PRXOVR	DEF					NA	NA	NA	N
1150F	DOC PT RSK DEATH W/IN 1YR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1151F	DOC NO PT RSK DEATH W/IN 1YR	PRXOVR	DEF					NA	NA	NA	N
1151F	DOC NO PT RSK DEATH W/IN 1YR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1152F	DOC ADVNCD DIS COMFORT 1ST	PRXOVR	DEF					NA	NA	NA	N
1152F	DOC ADVNCD DIS COMFORT 1ST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1153F	DOC ADVNCD DIS CMFRT NOT 1ST	PRXOVR	DEF					NA	NA	NA	N
1153F	DOC ADVNCD DIS CMFRT NOT 1ST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1157F	ADVNC CARE PLAN IN RCRD	PRXOVR	DEF					NA	NA	NA	N
1157F	ADVNC CARE PLAN IN RCRD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1158F	ADVNC CARE PLAN TLK DOCD	PRXOVR	DEF					NA	NA	NA	N
1158F	ADVNC CARE PLAN TLK DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1159F	MED LIST DOCD IN RCRD	PRXOVR	DEF					NA	NA	NA	N
1159F	MED LIST DOCD IN RCRD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11600	EXC TR-EXT MAL+MARG 0.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
11600	EXC TR-EXT MAL+MARG 0.5 CM/<	MAXFEE	FAC					64.48	1/1/2014	12/31/2299	N
11600	EXC TR-EXT MAL+MARG 0.5 CM/<	MAXFEE	NFF					88.69	1/1/2014	12/31/2299	N
11601	EXC TR-EXT MAL+MARG 0.6-1 CM	PRXOVR	DEF					NA	NA	NA	N
11601	EXC TR-EXT MAL+MARG 0.6-1 CM	MAXFEE	FAC					75.72	1/1/2014	12/31/2299	N
11601	EXC TR-EXT MAL+MARG 0.6-1 CM	MAXFEE	NFF					105.38	1/1/2014	12/31/2299	N
11602	EXC TR-EXT MAL+MARG 1.1-2 CM	PRXOVR	DEF					NA	NA	NA	N
11602	EXC TR-EXT MAL+MARG 1.1-2 CM	MAXFEE	FAC					81.59	1/1/2014	12/31/2299	N
11602	EXC TR-EXT MAL+MARG 1.1-2 CM	MAXFEE	NFF					113.51	1/1/2014	12/31/2299	N
11603	EXC TR-EXT MAL+MARG 2.1-3 CM	PRXOVR	DEF					NA	NA	NA	N
11603	EXC TR-EXT MAL+MARG 2.1-3 CM	MAXFEE	FAC					101.09	1/1/2014	12/31/2299	N
11603	EXC TR-EXT MAL+MARG 2.1-3 CM	MAXFEE	NFF					130.62	1/1/2014	12/31/2299	N
11604	EXC TR-EXT MAL+MARG 3.1-4 CM	PRXOVR	DEF					NA	NA	NA	N
11604	EXC TR-EXT MAL+MARG 3.1-4 CM	MAXFEE	FAC					105.48	1/1/2014	12/31/2299	N
11604	EXC TR-EXT MAL+MARG 3.1-4 CM	MAXFEE	NFF					137.37	1/1/2014	12/31/2299	N
11606	EXC TR-EXT MAL+MARG >4 CM	PRXOVR	DEF					NA	NA	NA	N
11606	EXC TR-EXT MAL+MARG >4 CM	MAXFEE	FAC					131.41	1/1/2014	12/31/2299	N
11606	EXC TR-EXT MAL+MARG >4 CM	MAXFEE	NFF					179.86	1/1/2014	12/31/2299	N
1160F	RVW MEDS BY RX/DR IN RCRD	PRXOVR	DEF					NA	NA	NA	N
1160F	RVW MEDS BY RX/DR IN RCRD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11620	EXC H-F-NK-SP MAL+MARG 0.5/<	PRXOVR	DEF					NA	NA	NA	N
11620	EXC H-F-NK-SP MAL+MARG 0.5/<	MAXFEE	FAC					65.52	1/1/2014	12/31/2299	N
11620	EXC H-F-NK-SP MAL+MARG 0.5/<	MAXFEE	NFF					89.81	1/1/2014	12/31/2299	N
11621	EXC S/N/H/F/G MAL+MRG 0.6-1	PRXOVR	DEF					NA	NA	NA	N
11621	EXC S/N/H/F/G MAL+MRG 0.6-1	MAXFEE	FAC					76.22	1/1/2014	12/31/2299	N
11621	EXC S/N/H/F/G MAL+MRG 0.6-1	MAXFEE	NFF					105.82	1/1/2014	12/31/2299	N
11622	EXC S/N/H/F/G MAL+MRG 1.1-2	PRXOVR	DEF					NA	NA	NA	N
11622	EXC S/N/H/F/G MAL+MRG 1.1-2	MAXFEE	FAC					89.13	1/1/2014	12/31/2299	N
11622	EXC S/N/H/F/G MAL+MRG 1.1-2	MAXFEE	NFF					123.12	1/1/2014	12/31/2299	N
11623	EXC S/N/H/F/G MAL+MRG 2.1-3	PRXOVR	DEF					NA	NA	NA	N
11623	EXC S/N/H/F/G MAL+MRG 2.1-3	MAXFEE	FAC					114.63	1/1/2014	12/31/2299	N
11623	EXC S/N/H/F/G MAL+MRG 2.1-3	MAXFEE	NFF					147.13	1/1/2014	12/31/2299	N
11624	EXC S/N/H/F/G MAL+MRG 3.1-4	PRXOVR	DEF					NA	NA	NA	N
11624	EXC S/N/H/F/G MAL+MRG 3.1-4	MAXFEE	FAC					127.50	1/1/2014	12/31/2299	N
11624	EXC S/N/H/F/G MAL+MRG 3.1-4	MAXFEE	NFF					175.74	1/1/2014	12/31/2299	N
11626	EXC S/N/H/F/G MAL+MRG >4 CM	PRXOVR	DEF					NA	NA	NA	N
11626	EXC S/N/H/F/G MAL+MRG >4 CM	MAXFEE	FAC					153.72	1/1/2014	12/31/2299	N
11626	EXC S/N/H/F/G MAL+MRG >4 CM	MAXFEE	NFF					211.54	1/1/2014	12/31/2299	N
11640	EXC F/E/E/N/L MAL+MRG 0.5CM<	PRXOVR	DEF					NA	NA	NA	N
11640	EXC F/E/E/N/L MAL+MRG 0.5CM<	MAXFEE	FAC					68.85	1/1/2014	12/31/2299	N
11640	EXC F/E/E/N/L MAL+MRG 0.5CM<	MAXFEE	NFF					94	1/1/2014	12/31/2299	N
11641	EXC F/E/E/N/L MAL+MRG 0.6-1	PRXOVR	DEF					NA	NA	NA	N
11641	EXC F/E/E/N/L MAL+MRG 0.6-1	MAXFEE	FAC					107.77	1/1/2014	12/31/2299	N
11641	EXC F/E/E/N/L MAL+MRG 0.6-1	MAXFEE	NFF					123.83	1/1/2014	12/31/2299	N
11642	EXC F/E/E/N/L MAL+MRG 1.1-2	PRXOVR	DEF					NA	NA	NA	N
11642	EXC F/E/E/N/L MAL+MRG 1.1-2	MAXFEE	FAC					110.10	1/1/2014	12/31/2299	N
11642	EXC F/E/E/N/L MAL+MRG 1.1-2	MAXFEE	NFF					146.94	1/1/2014	12/31/2299	N
11643	EXC F/E/E/N/L MAL+MRG 2.1-3	PRXOVR	DEF					NA	NA	NA	N
11643	EXC F/E/E/N/L MAL+MRG 2.1-3	MAXFEE	FAC					127.01	1/1/2014	12/31/2299	N
11643	EXC F/E/E/N/L MAL+MRG 2.1-3	MAXFEE	NFF					173.46	1/1/2014	12/31/2299	N
11644	EXC F/E/E/N/L MAL+MRG 3.1-4	PRXOVR	DEF					NA	NA	NA	N
11644	EXC F/E/E/N/L MAL+MRG 3.1-4	MAXFEE	FAC					157.36	1/1/2014	12/31/2299	N
11644	EXC F/E/E/N/L MAL+MRG 3.1-4	MAXFEE	NFF					215.29	1/1/2014	12/31/2299	N
11646	EXC F/E/E/N/L MAL+MRG >4 CM	PRXOVR	DEF					NA	NA	NA	N
11646	EXC F/E/E/N/L MAL+MRG >4 CM	MAXFEE	FAC					202.47	1/1/2014	12/31/2299	N
11646	EXC F/E/E/N/L MAL+MRG >4 CM	MAXFEE	NFF					280.33	1/1/2014	12/31/2299	N
1170F	FXNL STATUS ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1170F	FXNL STATUS ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11720	DEBRIDE NAIL 1-5	PRXOVR	DEF					NA	NA	NA	N
11720	DEBRIDE NAIL 1-5	MAXFEE	FAC					5.87	1/1/2014	12/31/2299	N
11720	DEBRIDE NAIL 1-5	MAXFEE	NFF					14.69	1/1/2014	12/31/2299	N
11721	DEBRIDE NAIL 6 OR MORE	PRXOVR	DEF					NA	NA	NA	N
11721	DEBRIDE NAIL 6 OR MORE	MAXFEE	FAC					14.20	1/1/2014	12/31/2299	N
11721	DEBRIDE NAIL 6 OR MORE	MAXFEE	NFF					28.86	1/1/2014	12/31/2299	N
11730	REMOVAL OF NAIL PLATE	PRXOVR	DEF					NA	NA	NA	N
11730	REMOVAL OF NAIL PLATE	MAXFEE	FAC					21.48	1/1/2014	12/31/2299	N
11730	REMOVAL OF NAIL PLATE	MAXFEE	NFF					49.14	1/1/2014	12/31/2299	N
11732	REMOVE NAIL PLATE ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11732	REMOVE NAIL PLATE ADD-ON	MAXFEE	FAC					16.02	1/1/2014	12/31/2299	N
11732	REMOVE NAIL PLATE ADD-ON	MAXFEE	NFF					23.11	1/1/2014	12/31/2299	N
11740	DRAIN BLOOD FROM UNDER NAIL	PRXOVR	DEF					NA	NA	NA	N
11740	DRAIN BLOOD FROM UNDER NAIL	MAXFEE	FAC					14.32	1/1/2014	12/31/2299	N
11740	DRAIN BLOOD FROM UNDER NAIL	MAXFEE	NFF					21.69	1/1/2014	12/31/2299	N
11750	REMOVAL OF NAIL BED	PRXOVR	DEF					NA	NA	NA	N
11750	REMOVAL OF NAIL BED	MAXFEE	FAC					68.39	1/1/2014	12/31/2299	N
11750	REMOVAL OF NAIL BED	MAXFEE	NFF					104.25	1/1/2014	12/31/2299	N
11752	REMOVE NAIL BED/TIP	PRXOVR	DEF					NA	NA	NA	N
11752	REMOVE NAIL BED/TIP	MAXFEE	DEF					NA			N
11755	BIOPSY NAIL UNIT	PRXOVR	DEF					NA	NA	NA	N
11755	BIOPSY NAIL UNIT	MAXFEE	FAC					50.44	1/1/2014	12/31/2299	N
11755	BIOPSY NAIL UNIT	MAXFEE	NFF					65.78	1/1/2014	12/31/2299	N
1175F	FUNCTION STAT ASSESSED RVWD	PRXOVR	DEF					NA	NA	NA	N
1175F	FUNCTION STAT ASSESSED RVWD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11760	REPAIR OF NAIL BED	PRXOVR	DEF					NA	NA	NA	N
11760	REPAIR OF NAIL BED	MAXFEE	FAC					53.32	1/1/2014	12/31/2299	N
11760	REPAIR OF NAIL BED	MAXFEE	NFF					91.92	1/1/2014	12/31/2299	N
11762	RECONSTRUCTION OF NAIL BED	PRXOVR	DEF					NA	NA	NA	N
11762	RECONSTRUCTION OF NAIL BED	MAXFEE	FAC					105.46	1/1/2014	12/31/2299	N
11762	RECONSTRUCTION OF NAIL BED	MAXFEE	NFF					142.15	1/1/2014	12/31/2299	N
11765	EXCISION OF NAIL FOLD TOE	PRXOVR	DEF					NA	NA	NA	N
11765	EXCISION OF NAIL FOLD TOE	MAXFEE	FAC					34.26	1/1/2014	12/31/2299	N
11765	EXCISION OF NAIL FOLD TOE	MAXFEE	NFF					71.10	1/1/2014	12/31/2299	N
11770	REMOVE PILONIDAL CYST SIMPLE	PRXOVR	DEF					NA	NA	NA	N
11770	REMOVE PILONIDAL CYST SIMPLE	MAXFEE	FAC					107.47	1/1/2014	12/31/2299	N
11770	REMOVE PILONIDAL CYST SIMPLE	MAXFEE	NFF					144.57	1/1/2014	12/31/2299	N
11771	REMOVE PILONIDAL CYST EXTEN	PRXOVR	DEF					NA	NA	NA	N
11771	REMOVE PILONIDAL CYST EXTEN	MAXFEE	FAC					221.46	1/1/2014	12/31/2299	N
11771	REMOVE PILONIDAL CYST EXTEN	MAXFEE	NFF					286.73	1/1/2014	12/31/2299	N
11772	REMOVE PILONIDAL CYST COMPL	PRXOVR	DEF					NA	NA	NA	N
11772	REMOVE PILONIDAL CYST COMPL	MAXFEE	FAC					242.21	1/1/2014	12/31/2299	N
11772	REMOVE PILONIDAL CYST COMPL	MAXFEE	NFF					331.49	1/1/2014	12/31/2299	N
1180F	THROMBOEMB RISK ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1180F	THROMBOEMB RISK ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1181F	NEUROPSYCHIA SYMPTS ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1181F	NEUROPSYCHIA SYMPTS ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1182F	NEUROPSYCHI SYMPT 1+PRESENT	PRXOVR	DEF					NA	NA	NA	N
1182F	NEUROPSYCHI SYMPT 1+PRESENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1183F	NEUROPSYCHIATRIC SYMP ABSENT	PRXOVR	DEF					NA	NA	NA	N
1183F	NEUROPSYCHIATRIC SYMP ABSENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11900	INJECT SKIN LESIONS </W 7	PRXOVR	DEF					NA	NA	NA	N
11900	INJECT SKIN LESIONS </W 7	MAXFEE	FAC					18.82	1/1/2014	12/31/2299	N
11900	INJECT SKIN LESIONS </W 7	MAXFEE	NFF					34.24	1/1/2014	12/31/2299	N
11901	INJECT SKIN LESIONS >7	PRXOVR	DEF					NA	NA	NA	N
11901	INJECT SKIN LESIONS >7	MAXFEE	FAC					31.57	1/1/2014	12/31/2299	N
11901	INJECT SKIN LESIONS >7	MAXFEE	NFF					41.35	1/1/2014	12/31/2299	N
11920	CORRECT SKIN COLOR 6.0 CM/<	PRXOVR	DEF					NA	NA	NA	N
11920	CORRECT SKIN COLOR 6.0 CM/<	MAXFEE	DEF					119.14	1/1/2000	12/31/2299	N
11921	CORRECT SKN COLOR 6.1-20.0CM	PRXOVR	DEF					NA	NA	NA	N
11921	CORRECT SKN COLOR 6.1-20.0CM	MAXFEE	DEF					137.03	1/1/2000	12/31/2299	N
11922	CORRECT SKIN COLOR EA 20.0CM	PRXOVR	DEF					NA	NA	NA	N
11922	CORRECT SKIN COLOR EA 20.0CM	MAXFEE	DEF					41.36	1/1/2000	12/31/2299	N
11950	TX CONTOUR DEFECTS 1 CC/<	PRXOVR	DEF					NA	NA	NA	N
11950	TX CONTOUR DEFECTS 1 CC/<	MAXFEE	FAC					34.44	1/1/2014	12/31/2299	N
11950	TX CONTOUR DEFECTS 1 CC/<	MAXFEE	NFF					44.44	1/1/2014	12/31/2299	N
11951	TX CONTOUR DEFECTS 1.1-5.0CC	PRXOVR	DEF					NA	NA	NA	N
11951	TX CONTOUR DEFECTS 1.1-5.0CC	MAXFEE	FAC					45.70	1/1/2014	12/31/2299	N
11951	TX CONTOUR DEFECTS 1.1-5.0CC	MAXFEE	NFF					62.96	1/1/2014	12/31/2299	N
11952	TX CONTOUR DEFECTS 5.1-10CC	PRXOVR	DEF					NA	NA	NA	N
11952	TX CONTOUR DEFECTS 5.1-10CC	MAXFEE	FAC					67.94	1/1/2014	12/31/2299	N
11952	TX CONTOUR DEFECTS 5.1-10CC	MAXFEE	NFF					88.91	1/1/2014	12/31/2299	N
11954	TX CONTOUR DEFECTS >10.0 CC	PRXOVR	DEF					NA	NA	NA	N
11954	TX CONTOUR DEFECTS >10.0 CC	MAXFEE	FAC					91.79	1/1/2014	12/31/2299	N
11954	TX CONTOUR DEFECTS >10.0 CC	MAXFEE	NFF					115.45	1/1/2014	12/31/2299	N
11960	INSERT TISSUE EXPANDER(S)	PRXOVR	DEF					NA	NA	NA	N
11960	INSERT TISSUE EXPANDER(S)	MAXFEE	DEF					522.51	7/1/2003	12/31/2299	N
11970	RPLCMT TISS XPNDR PERM IMPLT	PRXOVR	DEF					NA	NA	NA	E
11970	RPLCMT TISS XPNDR PERM IMPLT	MAXFEE	DEF					343.21	1/1/2000	12/31/2299	E
11971	RMVL TIS XPNDR WO INSJ IMPLT	PRXOVR	DEF					NA	NA	NA	N
11971	RMVL TIS XPNDR WO INSJ IMPLT	MAXFEE	FAC					112.21	1/1/2014	12/31/2299	N
11971	RMVL TIS XPNDR WO INSJ IMPLT	MAXFEE	NFF					205.86	1/1/2014	12/31/2299	N
11975	INSERT CONTRACEPTIVE CAP	PRXOVR	DEF					NA	NA	NA	N
11975	INSERT CONTRACEPTIVE CAP	MAXFEE	DEF					NA			N
11976	REMOVE CONTRACEPTIVE CAPSULE	PRXOVR	DEF					NA	NA	NA	N
11976	REMOVE CONTRACEPTIVE CAPSULE	MAXFEE	FAC					49.57	1/1/2014	12/31/2299	N
11976	REMOVE CONTRACEPTIVE CAPSULE	MAXFEE	NFF					86.83	1/1/2014	12/31/2299	N
11977	REMOVAL/REINSERT CONTRA CAP	PRXOVR	DEF					NA	NA	NA	N
11977	REMOVAL/REINSERT CONTRA CAP	MAXFEE	DEF					NA			N
11980	IMPLANT HORMONE PELLET(S)	PRXOVR	DEF					NA	NA	NA	N
11980	IMPLANT HORMONE PELLET(S)	MAXFEE	FAC					56.17	1/1/2014	12/31/2299	N
11980	IMPLANT HORMONE PELLET(S)	MAXFEE	NFF					81.56	1/1/2014	12/31/2299	N
11981	INSERTION DRUG DLVR IMPLANT	PRXOVR	DEF					NA	NA	NA	N
11981	INSERTION DRUG DLVR IMPLANT	MAXFEE	FAC					35.63	1/1/2014	12/31/2299	N
11981	INSERTION DRUG DLVR IMPLANT	MAXFEE	NFF					71.80	1/1/2014	12/31/2299	N
11982	REMOVE DRUG IMPLANT DEVICE	PRXOVR	DEF					NA	NA	NA	N
11982	REMOVE DRUG IMPLANT DEVICE	MAXFEE	FAC					47.15	1/1/2014	12/31/2299	N
11982	REMOVE DRUG IMPLANT DEVICE	MAXFEE	NFF					88.05	1/1/2014	12/31/2299	N
11983	REMOVE/INSERT DRUG IMPLANT	PRXOVR	DEF					NA	NA	NA	N
11983	REMOVE/INSERT DRUG IMPLANT	MAXFEE	FAC					104.67	1/1/2014	12/31/2299	N
11983	REMOVE/INSERT DRUG IMPLANT	MAXFEE	NFF					155.84	1/1/2014	12/31/2299	N
12001	RPR S/N/AX/GEN/TRNK 2.5CM/<	PRXOVR	DEF					NA	NA	NA	N
12001	RPR S/N/AX/GEN/TRNK 2.5CM/<	MAXFEE	FAC					29.39	1/1/2014	12/31/2299	N
12001	RPR S/N/AX/GEN/TRNK 2.5CM/<	MAXFEE	NFF					67.35	1/1/2014	12/31/2299	N
12002	RPR S/N/AX/GEN/TRNK2.6-7.5CM	PRXOVR	DEF					NA	NA	NA	N
12002	RPR S/N/AX/GEN/TRNK2.6-7.5CM	MAXFEE	FAC					37.23	1/1/2014	12/31/2299	N
12002	RPR S/N/AX/GEN/TRNK2.6-7.5CM	MAXFEE	NFF					77.98	1/1/2014	12/31/2299	N
12004	RPR S/N/AX/GEN/TRK7.6-12.5CM	PRXOVR	DEF					NA	NA	NA	N
12004	RPR S/N/AX/GEN/TRK7.6-12.5CM	MAXFEE	FAC					37.45	1/1/2014	12/31/2299	N
12004	RPR S/N/AX/GEN/TRK7.6-12.5CM	MAXFEE	NFF					96.45	1/1/2014	12/31/2299	N
12005	RPR S/N/A/GEN/TRK12.6-20.0CM	PRXOVR	DEF					NA	NA	NA	N
12005	RPR S/N/A/GEN/TRK12.6-20.0CM	MAXFEE	FAC					64.72	1/1/2014	12/31/2299	N
12005	RPR S/N/A/GEN/TRK12.6-20.0CM	MAXFEE	NFF					122.20	1/1/2014	12/31/2299	N
12006	RPR S/N/A/GEN/TRK20.1-30.0CM	PRXOVR	DEF					NA	NA	NA	N
12006	RPR S/N/A/GEN/TRK20.1-30.0CM	MAXFEE	FAC					83.78	1/1/2014	12/31/2299	N
12006	RPR S/N/A/GEN/TRK20.1-30.0CM	MAXFEE	NFF					156.01	1/1/2014	12/31/2299	N
12007	RPR S/N/AX/GEN/TRNK >30.0 CM	PRXOVR	DEF					NA	NA	NA	N
12007	RPR S/N/AX/GEN/TRNK >30.0 CM	MAXFEE	FAC					97.11	1/1/2014	12/31/2299	N
12007	RPR S/N/AX/GEN/TRNK >30.0 CM	MAXFEE	NFF					170.61	1/1/2014	12/31/2299	N
1200F	SEIZURE TYPE& FREQU DOCD	PRXOVR	DEF					NA	NA	NA	N
1200F	SEIZURE TYPE& FREQU DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
12011	RPR F/E/E/N/L/M 2.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
12011	RPR F/E/E/N/L/M 2.5 CM/<	MAXFEE	FAC					33.08	1/1/2014	12/31/2299	N
12011	RPR F/E/E/N/L/M 2.5 CM/<	MAXFEE	NFF					74.24	1/1/2014	12/31/2299	N
12013	RPR F/E/E/N/L/M 2.6-5.0 CM	PRXOVR	DEF					NA	NA	NA	N
12013	RPR F/E/E/N/L/M 2.6-5.0 CM	MAXFEE	FAC					39.81	1/1/2014	12/31/2299	N
12013	RPR F/E/E/N/L/M 2.6-5.0 CM	MAXFEE	NFF					87.06	1/1/2014	12/31/2299	N
12014	RPR F/E/E/N/L/M 5.1-7.5 CM	PRXOVR	DEF					NA	NA	NA	N
12014	RPR F/E/E/N/L/M 5.1-7.5 CM	MAXFEE	FAC					51.50	1/1/2014	12/31/2299	N
12014	RPR F/E/E/N/L/M 5.1-7.5 CM	MAXFEE	NFF					104.63	1/1/2014	12/31/2299	N
12015	RPR F/E/E/N/L/M 7.6-12.5 CM	PRXOVR	DEF					NA	NA	NA	N
12015	RPR F/E/E/N/L/M 7.6-12.5 CM	MAXFEE	FAC					68.36	1/1/2014	12/31/2299	N
12015	RPR F/E/E/N/L/M 7.6-12.5 CM	MAXFEE	NFF					135.24	1/1/2014	12/31/2299	N
12016	RPR FE/E/EN/L/M 12.6-20.0 CM	PRXOVR	DEF					NA	NA	NA	N
12016	RPR FE/E/EN/L/M 12.6-20.0 CM	MAXFEE	FAC					93.72	1/1/2014	12/31/2299	N
12016	RPR FE/E/EN/L/M 12.6-20.0 CM	MAXFEE	NFF					169.44	1/1/2014	12/31/2299	N
12017	RPR FE/E/EN/L/M 20.1-30.0 CM	PRXOVR	DEF					NA	NA	NA	N
12017	RPR FE/E/EN/L/M 20.1-30.0 CM	MAXFEE	DEF					148.51	9/1/2013	12/31/2299	N
12018	RPR F/E/E/N/L/M >30.0 CM	PRXOVR	DEF					NA	NA	NA	N
12018	RPR F/E/E/N/L/M >30.0 CM	MAXFEE	DEF					172.10	9/1/2013	12/31/2299	N
12020	CLOSURE OF SPLIT WOUND	PRXOVR	DEF					NA	NA	NA	N
12020	CLOSURE OF SPLIT WOUND	MAXFEE	FAC					66.03	1/1/2014	12/31/2299	N
12020	CLOSURE OF SPLIT WOUND	MAXFEE	NFF					109.03	1/1/2014	12/31/2299	N
12021	CLOSURE OF SPLIT WOUND	PRXOVR	DEF					NA	NA	NA	N
12021	CLOSURE OF SPLIT WOUND	MAXFEE	FAC					59.01	1/1/2014	12/31/2299	N
12021	CLOSURE OF SPLIT WOUND	MAXFEE	NFF					82.08	1/1/2014	12/31/2299	N
12031	INTMD RPR S/A/T/EXT 2.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
12031	INTMD RPR S/A/T/EXT 2.5 CM/<	MAXFEE	FAC					85.58	1/1/2014	12/31/2299	N
12031	INTMD RPR S/A/T/EXT 2.5 CM/<	MAXFEE	NFF					103.33	1/1/2014	12/31/2299	N
12032	INTMD RPR S/A/T/EXT 2.6-7.5	PRXOVR	DEF					NA	NA	NA	N
12032	INTMD RPR S/A/T/EXT 2.6-7.5	MAXFEE	FAC					77.92	1/1/2014	12/31/2299	N
12032	INTMD RPR S/A/T/EXT 2.6-7.5	MAXFEE	NFF					143.77	1/1/2014	12/31/2299	N
12034	INTMD RPR S/TR/EXT 7.6-12.5	PRXOVR	DEF					NA	NA	NA	N
12034	INTMD RPR S/TR/EXT 7.6-12.5	MAXFEE	FAC					72.56	1/1/2014	12/31/2299	N
12034	INTMD RPR S/TR/EXT 7.6-12.5	MAXFEE	NFF					123.85	1/1/2014	12/31/2299	N
12035	INTMD RPR S/A/T/EXT 12.6-20	PRXOVR	DEF					NA	NA	NA	N
12035	INTMD RPR S/A/T/EXT 12.6-20	MAXFEE	FAC					85.39	1/1/2014	12/31/2299	N
12035	INTMD RPR S/A/T/EXT 12.6-20	MAXFEE	NFF					147.97	1/1/2014	12/31/2299	N
12036	INTMD RPR S/A/T/EXT 20.1-30	PRXOVR	DEF					NA	NA	NA	N
12036	INTMD RPR S/A/T/EXT 20.1-30	MAXFEE	FAC					98.87	1/1/2014	12/31/2299	N
12036	INTMD RPR S/A/T/EXT 20.1-30	MAXFEE	NFF					185.44	1/1/2014	12/31/2299	N
12037	INTMD RPR S/TR/EXT >30.0 CM	PRXOVR	DEF					NA	NA	NA	N
12037	INTMD RPR S/TR/EXT >30.0 CM	MAXFEE	FAC					124.14	1/1/2014	12/31/2299	N
12037	INTMD RPR S/TR/EXT >30.0 CM	MAXFEE	NFF					221.75	1/1/2014	12/31/2299	N
12041	INTMD RPR N-HF/GENIT 2.5CM/<	PRXOVR	DEF					NA	NA	NA	N
12041	INTMD RPR N-HF/GENIT 2.5CM/<	MAXFEE	FAC					54.68	1/1/2014	12/31/2299	N
12041	INTMD RPR N-HF/GENIT 2.5CM/<	MAXFEE	NFF					95.57	1/1/2014	12/31/2299	N
12042	INTMD RPR N-HF/GENIT2.6-7.5	PRXOVR	DEF					NA	NA	NA	N
12042	INTMD RPR N-HF/GENIT2.6-7.5	MAXFEE	FAC					69.97	1/1/2014	12/31/2299	N
12042	INTMD RPR N-HF/GENIT2.6-7.5	MAXFEE	NFF					112.31	1/1/2014	12/31/2299	N
12044	INTMD RPR N-HF/GENIT7.6-12.5	PRXOVR	DEF					NA	NA	NA	N
12044	INTMD RPR N-HF/GENIT7.6-12.5	MAXFEE	FAC					71.05	1/1/2014	12/31/2299	N
12044	INTMD RPR N-HF/GENIT7.6-12.5	MAXFEE	NFF					133.41	1/1/2014	12/31/2299	N
12045	INTMD RPR N-HF/GENIT12.6-20	PRXOVR	DEF					NA	NA	NA	N
12045	INTMD RPR N-HF/GENIT12.6-20	MAXFEE	FAC					92.56	1/1/2014	12/31/2299	N
12045	INTMD RPR N-HF/GENIT12.6-20	MAXFEE	NFF					160.11	1/1/2014	12/31/2299	N
12046	INTMD RPR N-HF/GENIT20.1-30	PRXOVR	DEF					NA	NA	NA	N
12046	INTMD RPR N-HF/GENIT20.1-30	MAXFEE	FAC					135.77	1/1/2014	12/31/2299	N
12046	INTMD RPR N-HF/GENIT20.1-30	MAXFEE	NFF					202.40	1/1/2014	12/31/2299	N
12047	INTMD RPR N-HF/GENIT >30.0CM	PRXOVR	DEF					NA	NA	NA	N
12047	INTMD RPR N-HF/GENIT >30.0CM	MAXFEE	FAC					158.61	1/1/2014	12/31/2299	N
12047	INTMD RPR N-HF/GENIT >30.0CM	MAXFEE	NFF					243.52	1/1/2014	12/31/2299	N
12051	INTMD RPR FACE/MM 2.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
12051	INTMD RPR FACE/MM 2.5 CM/<	MAXFEE	FAC					58.39	1/1/2014	12/31/2299	N
12051	INTMD RPR FACE/MM 2.5 CM/<	MAXFEE	NFF					101.83	1/1/2014	12/31/2299	N
12052	INTMD RPR FACE/MM 2.6-5.0 CM	PRXOVR	DEF					NA	NA	NA	N
12052	INTMD RPR FACE/MM 2.6-5.0 CM	MAXFEE	FAC					71.18	1/1/2014	12/31/2299	N
12052	INTMD RPR FACE/MM 2.6-5.0 CM	MAXFEE	NFF					119.27	1/1/2014	12/31/2299	N
12053	INTMD RPR FACE/MM 5.1-7.5 CM	PRXOVR	DEF					NA	NA	NA	N
12053	INTMD RPR FACE/MM 5.1-7.5 CM	MAXFEE	FAC					73.97	1/1/2014	12/31/2299	N
12053	INTMD RPR FACE/MM 5.1-7.5 CM	MAXFEE	NFF					135.28	1/1/2014	12/31/2299	N
12054	INTMD RPR FACE/MM 7.6-12.5CM	PRXOVR	DEF					NA	NA	NA	N
12054	INTMD RPR FACE/MM 7.6-12.5CM	MAXFEE	FAC					85.24	1/1/2014	12/31/2299	N
12054	INTMD RPR FACE/MM 7.6-12.5CM	MAXFEE	NFF					164.53	1/1/2014	12/31/2299	N
12055	INTMD RPR FACE/MM 12.6-20 CM	PRXOVR	DEF					NA	NA	NA	N
12055	INTMD RPR FACE/MM 12.6-20 CM	MAXFEE	FAC					120.62	1/1/2014	12/31/2299	N
12055	INTMD RPR FACE/MM 12.6-20 CM	MAXFEE	NFF					209.37	1/1/2014	12/31/2299	N
12056	INTMD RPR FACE/MM 20.1-30.0	PRXOVR	DEF					NA	NA	NA	N
12056	INTMD RPR FACE/MM 20.1-30.0	MAXFEE	FAC					168.38	1/1/2014	12/31/2299	N
12056	INTMD RPR FACE/MM 20.1-30.0	MAXFEE	NFF					272.32	1/1/2014	12/31/2299	N
12057	INTMD RPR FACE/MM >30.0 CM	PRXOVR	DEF					NA	NA	NA	N
12057	INTMD RPR FACE/MM >30.0 CM	MAXFEE	FAC					153.87	1/1/2014	12/31/2299	N
12057	INTMD RPR FACE/MM >30.0 CM	MAXFEE	NFF					303.87	1/1/2014	12/31/2299	N
1205F	EPI ETIOL SYND RVWD AND DOCD	PRXOVR	DEF					NA	NA	NA	N
1205F	EPI ETIOL SYND RVWD AND DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1220F	PT SCREENED FOR DEPRESSION	PRXOVR	DEF					NA	NA	NA	N
1220F	PT SCREENED FOR DEPRESSION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
13100	CMPLX RPR TRUNK 1.1-2.5 CM	PRXOVR	DEF					NA	NA	NA	N
13100	CMPLX RPR TRUNK 1.1-2.5 CM	MAXFEE	FAC					69.97	1/1/2014	12/31/2299	N
13100	CMPLX RPR TRUNK 1.1-2.5 CM	MAXFEE	NFF					123.92	1/1/2014	12/31/2299	N
13101	CMPLX RPR TRUNK 2.6-7.5 CM	PRXOVR	DEF					NA	NA	NA	N
13101	CMPLX RPR TRUNK 2.6-7.5 CM	MAXFEE	FAC					88.95	1/1/2014	12/31/2299	N
13101	CMPLX RPR TRUNK 2.6-7.5 CM	MAXFEE	NFF					166.23	1/1/2014	12/31/2299	N
13102	CMPLX RPR TRUNK ADDL 5CM/<	PRXOVR	DEF					NA	NA	NA	N
13102	CMPLX RPR TRUNK ADDL 5CM/<	MAXFEE	FAC					32.22	1/1/2014	12/31/2299	N
13102	CMPLX RPR TRUNK ADDL 5CM/<	MAXFEE	NFF					56.24	1/1/2014	12/31/2299	N
13120	CMPLX RPR S/A/L 1.1-2.5 CM	PRXOVR	DEF					NA	NA	NA	N
13120	CMPLX RPR S/A/L 1.1-2.5 CM	MAXFEE	FAC					82.72	1/1/2014	12/31/2299	N
13120	CMPLX RPR S/A/L 1.1-2.5 CM	MAXFEE	NFF					134.11	1/1/2014	12/31/2299	N
13121	CMPLX RPR S/A/L 2.6-7.5 CM	PRXOVR	DEF					NA	NA	NA	N
13121	CMPLX RPR S/A/L 2.6-7.5 CM	MAXFEE	FAC					93.73	1/1/2014	12/31/2299	N
13121	CMPLX RPR S/A/L 2.6-7.5 CM	MAXFEE	NFF					192.19	1/1/2014	12/31/2299	N
13122	CMPLX RPR S/A/L ADDL 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
13122	CMPLX RPR S/A/L ADDL 5 CM/>	MAXFEE	FAC					39.77	1/1/2014	12/31/2299	N
13122	CMPLX RPR S/A/L ADDL 5 CM/>	MAXFEE	NFF					65.60	1/1/2014	12/31/2299	N
13131	CMPLX RPR F/C/C/M/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
13131	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	FAC					92.73	1/1/2014	12/31/2299	N
13131	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	NFF					162.27	1/1/2014	12/31/2299	N
13132	CMPLX RPR F/C/C/M/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
13132	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	FAC					119.68	1/1/2014	12/31/2299	N
13132	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	NFF					270.46	1/1/2014	12/31/2299	N
13133	CMPLX RPR F/C/C/M/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
13133	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	FAC					63.09	1/1/2014	12/31/2299	N
13133	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	NFF					95.96	1/1/2014	12/31/2299	N
13150	CMPLX RPR E/N/E/L 1.0 CM/<	PRXOVR	DEF					NA	NA	NA	N
13150	CMPLX RPR E/N/E/L 1.0 CM/<	MAXFEE	FAC					82.91	1/1/2014	12/31/2299	N
13150	CMPLX RPR E/N/E/L 1.0 CM/<	MAXFEE	NFF					165.11	1/1/2014	12/31/2299	N
13151	CMPLX RPR E/N/E/L 1.1-2.5 CM	PRXOVR	DEF					NA	NA	NA	N
13151	CMPLX RPR E/N/E/L 1.1-2.5 CM	MAXFEE	FAC					115.20	1/1/2014	12/31/2299	N
13151	CMPLX RPR E/N/E/L 1.1-2.5 CM	MAXFEE	NFF					197.77	1/1/2014	12/31/2299	N
13152	CMPLX RPR E/N/E/L 2.6-7.5 CM	PRXOVR	DEF					NA	NA	NA	N
13152	CMPLX RPR E/N/E/L 2.6-7.5 CM	MAXFEE	FAC					151.09	1/1/2014	12/31/2299	N
13152	CMPLX RPR E/N/E/L 2.6-7.5 CM	MAXFEE	NFF					311.49	1/1/2014	12/31/2299	N
13153	CMPLX RPR E/N/E/L ADDL 5CM/<	PRXOVR	DEF					NA	NA	NA	N
13153	CMPLX RPR E/N/E/L ADDL 5CM/<	MAXFEE	FAC					68.06	1/1/2014	12/31/2299	N
13153	CMPLX RPR E/N/E/L ADDL 5CM/<	MAXFEE	NFF					105.31	1/1/2014	12/31/2299	N
13160	LATE CLOSURE OF WOUND	PRXOVR	DEF					NA	NA	NA	N
13160	LATE CLOSURE OF WOUND	MAXFEE	DEF					427.63	7/1/2008	12/31/2299	N
14000	TIS TRNFR TRUNK 10 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
14000	TIS TRNFR TRUNK 10 SQ CM/<	MAXFEE	FAC					176.99	1/1/2014	12/31/2299	N
14000	TIS TRNFR TRUNK 10 SQ CM/<	MAXFEE	NFF					272.06	1/1/2014	12/31/2299	N
14001	TIS TRNFR TRUNK 10.1-30SQCM	PRXOVR	DEF					NA	NA	NA	N
14001	TIS TRNFR TRUNK 10.1-30SQCM	MAXFEE	FAC					249.78	1/1/2014	12/31/2299	N
14001	TIS TRNFR TRUNK 10.1-30SQCM	MAXFEE	NFF					374.23	1/1/2014	12/31/2299	N
1400F	PRKNS DIAG RVIEWED	PRXOVR	DEF					NA	NA	NA	N
1400F	PRKNS DIAG RVIEWED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
14020	TIS TRNFR S/A/L 10 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
14020	TIS TRNFR S/A/L 10 SQ CM/<	MAXFEE	FAC					211.18	1/1/2014	12/31/2299	N
14020	TIS TRNFR S/A/L 10 SQ CM/<	MAXFEE	NFF					317.79	1/1/2014	12/31/2299	N
14021	TIS TRNFR S/A/L 10.1-30 SQCM	PRXOVR	DEF					NA	NA	NA	N
14021	TIS TRNFR S/A/L 10.1-30 SQCM	MAXFEE	FAC					310.15	1/1/2014	12/31/2299	N
14021	TIS TRNFR S/A/L 10.1-30 SQCM	MAXFEE	NFF					452.14	1/1/2014	12/31/2299	N
14040	TIS TRNFR F/C/C/M/N/A/G/H/F	PRXOVR	DEF					NA	NA	NA	N
14040	TIS TRNFR F/C/C/M/N/A/G/H/F	MAXFEE	FAC					273.31	1/1/2014	12/31/2299	N
14040	TIS TRNFR F/C/C/M/N/A/G/H/F	MAXFEE	NFF					394.31	1/1/2014	12/31/2299	N
14041	TIS TRNFR F/C/C/M/N/A/G/H/F	PRXOVR	DEF					NA	NA	NA	N
14041	TIS TRNFR F/C/C/M/N/A/G/H/F	MAXFEE	FAC					366.14	1/1/2014	12/31/2299	N
14041	TIS TRNFR F/C/C/M/N/A/G/H/F	MAXFEE	NFF					527.88	1/1/2014	12/31/2299	N
14060	TIS TRNFR E/N/E/L 10 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
14060	TIS TRNFR E/N/E/L 10 SQ CM/<	MAXFEE	FAC					324.52	1/1/2014	12/31/2299	N
14060	TIS TRNFR E/N/E/L 10 SQ CM/<	MAXFEE	NFF					441.45	1/1/2014	12/31/2299	N
14061	TIS TRNFR E/N/E/L10.1-30SQCM	PRXOVR	DEF					NA	NA	NA	N
14061	TIS TRNFR E/N/E/L10.1-30SQCM	MAXFEE	FAC					424.35	1/1/2014	12/31/2299	N
14061	TIS TRNFR E/N/E/L10.1-30SQCM	MAXFEE	NFF					611.24	1/1/2014	12/31/2299	N
14300	SKIN TISSUE REARRANGEMENT	PRXOVR	DEF					NA	NA	NA	N
14300	SKIN TISSUE REARRANGEMENT	MAXFEE	DEF					NA			N
14301	TIS TRNFR ANY 30.1-60 SQ CM	PRXOVR	DEF					NA	NA	NA	N
14301	TIS TRNFR ANY 30.1-60 SQ CM	MAXFEE	FAC					319.72	1/1/2014	12/31/2299	N
14301	TIS TRNFR ANY 30.1-60 SQ CM	MAXFEE	NFF					488.86	1/1/2014	12/31/2299	N
14302	TIS TRNFR ADDL 30 SQ CM	PRXOVR	DEF					NA	NA	NA	N
14302	TIS TRNFR ADDL 30 SQ CM	MAXFEE	DEF					127.72	1/1/2010	12/31/2299	N
14350	FILLETED FINGER/TOE FLAP	PRXOVR	DEF					NA	NA	NA	N
14350	FILLETED FINGER/TOE FLAP	MAXFEE	DEF					427.18	1/1/2000	12/31/2299	N
1450F	SYMPTOMS IMPROVED/CONSIST	PRXOVR	DEF					NA	NA	NA	N
1450F	SYMPTOMS IMPROVED/CONSIST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1451F	SYMPT SHOW CLIN IMPORT DROP	PRXOVR	DEF					NA	NA	NA	N
1451F	SYMPT SHOW CLIN IMPORT DROP	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1460F	QUAL CARD DIAG PRIOR 12 MONS	PRXOVR	DEF					NA	NA	NA	N
1460F	QUAL CARD DIAG PRIOR 12 MONS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1461F	NO QUAL CARD DIAG PRIOR12MON	PRXOVR	DEF					NA	NA	NA	N
1461F	NO QUAL CARD DIAG PRIOR12MON	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1490F	DEM SEVERITY CLASSIFIED MILD	PRXOVR	DEF					NA	NA	NA	N
1490F	DEM SEVERITY CLASSIFIED MILD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1491F	DEM SEVERITY CLASSIFIED MOD	PRXOVR	DEF					NA	NA	NA	N
1491F	DEM SEVERITY CLASSIFIED MOD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1493F	DEM SEVERITY CLASS SEVERE	PRXOVR	DEF					NA	NA	NA	N
1493F	DEM SEVERITY CLASS SEVERE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1494F	COGNIT ASSESSED AND REVIEWED	PRXOVR	DEF					NA	NA	NA	N
1494F	COGNIT ASSESSED AND REVIEWED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
15000	WOUND PREP; 1ST 100 SQ CM	PRXOVR	DEF					NA	NA	NA	N
15000	WOUND PREP; 1ST 100 SQ CM	MAXFEE	DEF					NA			N
15001	WOUND PREP; ADDL 100 SQ CM	PRXOVR	DEF					NA	NA	NA	N
15001	WOUND PREP; ADDL 100 SQ CM	MAXFEE	DEF					NA			N
15002	WOUND PREP TRK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15002	WOUND PREP TRK/ARM/LEG	MAXFEE	FAC					101.12	1/1/2014	12/31/2299	N
15002	WOUND PREP TRK/ARM/LEG	MAXFEE	NFF					180	1/1/2014	12/31/2299	N
15003	WOUND PREP ADDL 100 CM	PRXOVR	DEF					NA	NA	NA	N
15003	WOUND PREP ADDL 100 CM	MAXFEE	FAC					19.90	1/1/2014	12/31/2299	N
15003	WOUND PREP ADDL 100 CM	MAXFEE	NFF					38.79	1/1/2014	12/31/2299	N
15004	WOUND PREP F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15004	WOUND PREP F/N/HF/G	MAXFEE	FAC					125.45	1/1/2014	12/31/2299	N
15004	WOUND PREP F/N/HF/G	MAXFEE	NFF					217.41	1/1/2014	12/31/2299	N
15005	WND PREP F/N/HF/G ADDL CM	PRXOVR	DEF					NA	NA	NA	N
15005	WND PREP F/N/HF/G ADDL CM	MAXFEE	FAC					41.59	1/1/2014	12/31/2299	N
15005	WND PREP F/N/HF/G ADDL CM	MAXFEE	NFF					67.78	1/1/2014	12/31/2299	N
1500F	SYMPTOM&SIGN SYMM POLYNEURO	PRXOVR	DEF					NA	NA	NA	N
1500F	SYMPTOM&SIGN SYMM POLYNEURO	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1501F	NOT INITIAL EVAL FOR COND	PRXOVR	DEF					NA	NA	NA	N
1501F	NOT INITIAL EVAL FOR COND	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1502F	PT QUERIED PAIN FXN W/ INSTR	PRXOVR	DEF					NA	NA	NA	N
1502F	PT QUERIED PAIN FXN W/ INSTR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1503F	PT QUERIED SYMP RESP INSUFF	PRXOVR	DEF					NA	NA	NA	N
1503F	PT QUERIED SYMP RESP INSUFF	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
15040	HARVEST CULTURED SKIN GRAFT	PRXOVR	DEF					NA	NA	NA	N
15040	HARVEST CULTURED SKIN GRAFT	MAXFEE	FAC					43.78	1/1/2014	12/31/2299	N
15040	HARVEST CULTURED SKIN GRAFT	MAXFEE	NFF					106.11	1/1/2014	12/31/2299	N
1504F	PT HAS RESP INSUFFICIENCY	PRXOVR	DEF					NA	NA	NA	N
1504F	PT HAS RESP INSUFFICIENCY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
15050	SKIN PINCH GRAFT	PRXOVR	DEF					NA	NA	NA	N
15050	SKIN PINCH GRAFT	MAXFEE	FAC					151.98	1/1/2014	12/31/2299	N
15050	SKIN PINCH GRAFT	MAXFEE	NFF					230.80	1/1/2014	12/31/2299	N
1505F	PT HAS NO RESP INSUFFICIENCY	PRXOVR	DEF					NA	NA	NA	N
1505F	PT HAS NO RESP INSUFFICIENCY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
15100	SKIN SPLT GRFT TRNK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15100	SKIN SPLT GRFT TRNK/ARM/LEG	MAXFEE	FAC					260.10	1/1/2014	12/31/2299	N
15100	SKIN SPLT GRFT TRNK/ARM/LEG	MAXFEE	NFF					387.90	1/1/2014	12/31/2299	N
15101	SKIN SPLT GRFT T/A/L ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15101	SKIN SPLT GRFT T/A/L ADD-ON	MAXFEE	FAC					44.66	1/1/2014	12/31/2299	N
15101	SKIN SPLT GRFT T/A/L ADD-ON	MAXFEE	NFF					90.21	1/1/2014	12/31/2299	N
15110	EPIDRM AUTOGRFT TRNK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15110	EPIDRM AUTOGRFT TRNK/ARM/LEG	MAXFEE	FAC					427.42	1/1/2014	12/31/2299	N
15110	EPIDRM AUTOGRFT TRNK/ARM/LEG	MAXFEE	NFF					563.28	1/1/2014	12/31/2299	N
15111	EPIDRM AUTOGRFT T/A/L ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15111	EPIDRM AUTOGRFT T/A/L ADD-ON	MAXFEE	FAC					70.86	1/1/2014	12/31/2299	N
15111	EPIDRM AUTOGRFT T/A/L ADD-ON	MAXFEE	NFF					89.81	1/1/2014	12/31/2299	N
15115	EPIDRM A-GRFT FACE/NCK/HF/G	PRXOVR	DEF					NA	NA	NA	N
15115	EPIDRM A-GRFT FACE/NCK/HF/G	MAXFEE	FAC					394.64	1/1/2014	12/31/2299	N
15115	EPIDRM A-GRFT FACE/NCK/HF/G	MAXFEE	NFF					530.72	1/1/2014	12/31/2299	N
15116	EPIDRM A-GRFT F/N/HF/G ADDL	PRXOVR	DEF					NA	NA	NA	N
15116	EPIDRM A-GRFT F/N/HF/G ADDL	MAXFEE	FAC					80.80	1/1/2014	12/31/2299	N
15116	EPIDRM A-GRFT F/N/HF/G ADDL	MAXFEE	NFF					116.67	1/1/2014	12/31/2299	N
15120	SKN SPLT A-GRFT FAC/NCK/HF/G	PRXOVR	DEF					NA	NA	NA	N
15120	SKN SPLT A-GRFT FAC/NCK/HF/G	MAXFEE	FAC					294.52	1/1/2014	12/31/2299	N
15120	SKN SPLT A-GRFT FAC/NCK/HF/G	MAXFEE	NFF					438.51	1/1/2014	12/31/2299	N
15121	SKN SPLT A-GRFT F/N/HF/G ADD	PRXOVR	DEF					NA	NA	NA	N
15121	SKN SPLT A-GRFT F/N/HF/G ADD	MAXFEE	FAC					78.39	1/1/2014	12/31/2299	N
15121	SKN SPLT A-GRFT F/N/HF/G ADD	MAXFEE	NFF					143.79	1/1/2014	12/31/2299	N
15130	DERM AUTOGRAFT TRNK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15130	DERM AUTOGRAFT TRNK/ARM/LEG	MAXFEE	FAC					329.32	1/1/2014	12/31/2299	N
15130	DERM AUTOGRAFT TRNK/ARM/LEG	MAXFEE	NFF					452.64	1/1/2014	12/31/2299	N
15131	DERM AUTOGRAFT T/A/L ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15131	DERM AUTOGRAFT T/A/L ADD-ON	MAXFEE	FAC					51.29	1/1/2014	12/31/2299	N
15131	DERM AUTOGRAFT T/A/L ADD-ON	MAXFEE	NFF					73.28	1/1/2014	12/31/2299	N
15135	DERM AUTOGRAFT FACE/NCK/HF/G	PRXOVR	DEF					NA	NA	NA	N
15135	DERM AUTOGRAFT FACE/NCK/HF/G	MAXFEE	FAC					431.19	1/1/2014	12/31/2299	N
15135	DERM AUTOGRAFT FACE/NCK/HF/G	MAXFEE	NFF					568.16	1/1/2014	12/31/2299	N
15136	DERM AUTOGRAFT F/N/HF/G ADD	PRXOVR	DEF					NA	NA	NA	N
15136	DERM AUTOGRAFT F/N/HF/G ADD	MAXFEE	FAC					67.75	1/1/2014	12/31/2299	N
15136	DERM AUTOGRAFT F/N/HF/G ADD	MAXFEE	NFF					68.65	1/1/2014	12/31/2299	N
15150	CULT SKIN GRFT T/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15150	CULT SKIN GRFT T/ARM/LEG	MAXFEE	FAC					426.46	1/1/2014	12/31/2299	N
15150	CULT SKIN GRFT T/ARM/LEG	MAXFEE	NFF					468.58	1/1/2014	12/31/2299	N
15151	CULT SKIN GRFT T/A/L ADDL	PRXOVR	DEF					NA	NA	NA	N
15151	CULT SKIN GRFT T/A/L ADDL	MAXFEE	FAC					83.01	1/1/2014	12/31/2299	N
15151	CULT SKIN GRFT T/A/L ADDL	MAXFEE	NFF					94.96	1/1/2014	12/31/2299	N
15152	CULT SKIN GRAFT T/A/L +%	PRXOVR	DEF					NA	NA	NA	N
15152	CULT SKIN GRAFT T/A/L +%	MAXFEE	FAC					88.04	1/1/2014	12/31/2299	N
15152	CULT SKIN GRAFT T/A/L +%	MAXFEE	NFF					116.67	1/1/2014	12/31/2299	N
15155	CULT SKIN GRAFT F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15155	CULT SKIN GRAFT F/N/HF/G	MAXFEE	FAC					449.68	1/1/2014	12/31/2299	N
15155	CULT SKIN GRAFT F/N/HF/G	MAXFEE	NFF					470.48	1/1/2014	12/31/2299	N
15156	CULT SKIN GRFT F/N/HFG ADD	PRXOVR	DEF					NA	NA	NA	N
15156	CULT SKIN GRFT F/N/HFG ADD	MAXFEE	FAC					93.23	1/1/2014	12/31/2299	N
15156	CULT SKIN GRFT F/N/HFG ADD	MAXFEE	NFF					123.73	1/1/2014	12/31/2299	N
15157	CULT EPIDERM GRFT F/N/HFG +%	PRXOVR	DEF					NA	NA	NA	N
15157	CULT EPIDERM GRFT F/N/HFG +%	MAXFEE	FAC					126.33	1/1/2014	12/31/2299	N
15157	CULT EPIDERM GRFT F/N/HFG +%	MAXFEE	NFF					136.75	1/1/2014	12/31/2299	N
15170	ACELL GRAFT TRUNK/ARMS/LEGS	PRXOVR	DEF					NA	NA	NA	N
15170	ACELL GRAFT TRUNK/ARMS/LEGS	MAXFEE	DEF					NA			N
15171	ACELL GRAFT T/ARM/LEG ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15171	ACELL GRAFT T/ARM/LEG ADD-ON	MAXFEE	DEF					NA			N
15175	ACELLULAR GRAFT F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15175	ACELLULAR GRAFT F/N/HF/G	MAXFEE	DEF					NA			N
15176	ACELL GRAFT F/N/HF/G ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15176	ACELL GRAFT F/N/HF/G ADD-ON	MAXFEE	DEF					NA			N
15200	SKIN FULL GRAFT TRUNK	PRXOVR	DEF					NA	NA	NA	N
15200	SKIN FULL GRAFT TRUNK	MAXFEE	FAC					243.18	1/1/2014	12/31/2299	N
15200	SKIN FULL GRAFT TRUNK	MAXFEE	NFF					351.64	1/1/2014	12/31/2299	N
15201	SKIN FULL GRAFT TRUNK ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15201	SKIN FULL GRAFT TRUNK ADD-ON	MAXFEE	FAC					51.30	1/1/2014	12/31/2299	N
15201	SKIN FULL GRAFT TRUNK ADD-ON	MAXFEE	NFF					67.60	1/1/2014	12/31/2299	N
15220	SKIN FULL GRAFT SCLP/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15220	SKIN FULL GRAFT SCLP/ARM/LEG	MAXFEE	FAC					253.53	1/1/2014	12/31/2299	N
15220	SKIN FULL GRAFT SCLP/ARM/LEG	MAXFEE	NFF					365.48	1/1/2014	12/31/2299	N
15221	SKIN FULL GRAFT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15221	SKIN FULL GRAFT ADD-ON	MAXFEE	FAC					46.98	1/1/2014	12/31/2299	N
15221	SKIN FULL GRAFT ADD-ON	MAXFEE	NFF					61.58	1/1/2014	12/31/2299	N
15240	SKIN FULL GRFT FACE/GENIT/HF	PRXOVR	DEF					NA	NA	NA	N
15240	SKIN FULL GRFT FACE/GENIT/HF	MAXFEE	FAC					305.78	1/1/2014	12/31/2299	N
15240	SKIN FULL GRFT FACE/GENIT/HF	MAXFEE	NFF					423.82	1/1/2014	12/31/2299	N
15241	SKIN FULL GRAFT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15241	SKIN FULL GRAFT ADD-ON	MAXFEE	FAC					73.14	1/1/2014	12/31/2299	N
15241	SKIN FULL GRAFT ADD-ON	MAXFEE	NFF					95.75	1/1/2014	12/31/2299	N
15260	SKIN FULL GRAFT EEN & LIPS	PRXOVR	DEF					NA	NA	NA	N
15260	SKIN FULL GRAFT EEN & LIPS	MAXFEE	FAC					345.22	1/1/2014	12/31/2299	N
15260	SKIN FULL GRAFT EEN & LIPS	MAXFEE	NFF					477.26	1/1/2014	12/31/2299	N
15261	SKIN FULL GRAFT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15261	SKIN FULL GRAFT ADD-ON	MAXFEE	FAC					102.20	1/1/2014	12/31/2299	N
15261	SKIN FULL GRAFT ADD-ON	MAXFEE	NFF					131.25	1/1/2014	12/31/2299	N
15271	SKIN SUB GRAFT TRNK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15271	SKIN SUB GRAFT TRNK/ARM/LEG	MAXFEE	FAC					41.67	1/1/2014	12/31/2299	N
15271	SKIN SUB GRAFT TRNK/ARM/LEG	MAXFEE	NFF					54.82	1/1/2014	12/31/2299	N
15272	SKIN SUB GRAFT T/A/L ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15272	SKIN SUB GRAFT T/A/L ADD-ON	MAXFEE	FAC					7.83	1/1/2014	12/31/2299	N
15272	SKIN SUB GRAFT T/A/L ADD-ON	MAXFEE	NFF					10.36	1/1/2014	12/31/2299	N
15273	SKIN SUB GRFT T/ARM/LG CHILD	PRXOVR	DEF					NA	NA	NA	N
15273	SKIN SUB GRFT T/ARM/LG CHILD	MAXFEE	FAC					84.29	1/1/2014	12/31/2299	N
15273	SKIN SUB GRFT T/ARM/LG CHILD	MAXFEE	NFF					113.46	1/1/2014	12/31/2299	N
15274	SKN SUB GRFT T/A/L CHILD ADD	PRXOVR	DEF					NA	NA	NA	N
15274	SKN SUB GRFT T/A/L CHILD ADD	MAXFEE	FAC					20.35	1/1/2014	12/31/2299	N
15274	SKN SUB GRFT T/A/L CHILD ADD	MAXFEE	NFF					26.49	1/1/2014	12/31/2299	N
15275	SKIN SUB GRAFT FACE/NK/HF/G	PRXOVR	DEF					NA	NA	NA	N
15275	SKIN SUB GRAFT FACE/NK/HF/G	MAXFEE	FAC					43.05	1/1/2014	12/31/2299	N
15275	SKIN SUB GRAFT FACE/NK/HF/G	MAXFEE	NFF					59.22	1/1/2014	12/31/2299	N
15276	SKIN SUB GRAFT F/N/HF/G ADDL	PRXOVR	DEF					NA	NA	NA	N
15276	SKIN SUB GRAFT F/N/HF/G ADDL	MAXFEE	FAC					9.05	1/1/2014	12/31/2299	N
15276	SKIN SUB GRAFT F/N/HF/G ADDL	MAXFEE	NFF					12.95	1/1/2014	12/31/2299	N
15277	SKN SUB GRFT F/N/HF/G CHILD	PRXOVR	DEF					NA	NA	NA	N
15277	SKN SUB GRFT F/N/HF/G CHILD	MAXFEE	FAC					76.32	1/1/2014	12/31/2299	N
15277	SKN SUB GRFT F/N/HF/G CHILD	MAXFEE	NFF					114.43	1/1/2014	12/31/2299	N
15278	SKN SUB GRFT F/N/HF/G CH ADD	PRXOVR	DEF					NA	NA	NA	N
15278	SKN SUB GRFT F/N/HF/G CH ADD	MAXFEE	FAC					23.60	1/1/2014	12/31/2299	N
15278	SKN SUB GRFT F/N/HF/G CH ADD	MAXFEE	NFF					31.37	1/1/2014	12/31/2299	N
15300	APPLY SKINALLOGRFT T/ARM/LG	PRXOVR	DEF					NA	NA	NA	N
15300	APPLY SKINALLOGRFT T/ARM/LG	MAXFEE	DEF					NA			N
15301	APPLY SKNALLOGRFT T/A/L ADDL	PRXOVR	DEF					NA	NA	NA	N
15301	APPLY SKNALLOGRFT T/A/L ADDL	MAXFEE	DEF					NA			N
15320	APPLY SKIN ALLOGRFT F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15320	APPLY SKIN ALLOGRFT F/N/HF/G	MAXFEE	DEF					NA			N
15321	APLY SKNALLOGRFT F/N/HFG ADD	PRXOVR	DEF					NA	NA	NA	N
15321	APLY SKNALLOGRFT F/N/HFG ADD	MAXFEE	DEF					NA			N
15330	APLY ACELL ALOGRFT T/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15330	APLY ACELL ALOGRFT T/ARM/LEG	MAXFEE	DEF					NA			N
15331	APLY ACELL GRFT T/A/L ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15331	APLY ACELL GRFT T/A/L ADD-ON	MAXFEE	DEF					NA			N
15335	APPLY ACELL GRAFT F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15335	APPLY ACELL GRAFT F/N/HF/G	MAXFEE	DEF					NA			N
15336	APLY ACELL GRFT F/N/HF/G ADD	PRXOVR	DEF					NA	NA	NA	N
15336	APLY ACELL GRFT F/N/HF/G ADD	MAXFEE	DEF					NA			N
15340	APPLY CULT SKIN SUBSTITUTE	PRXOVR	DEF					NA	NA	NA	N
15340	APPLY CULT SKIN SUBSTITUTE	MAXFEE	DEF					NA			N
15341	APPLY CULT SKIN SUB ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15341	APPLY CULT SKIN SUB ADD-ON	MAXFEE	DEF					NA			N
15342	CULTURED SKIN GRAFT; 25 CM	PRXOVR	DEF					NA	NA	NA	N
15342	CULTURED SKIN GRAFT; 25 CM	MAXFEE	DEF					NA			N
15343	CULTURE SKN GRAFT ADDL 25 CM	PRXOVR	DEF					NA	NA	NA	N
15343	CULTURE SKN GRAFT ADDL 25 CM	MAXFEE	DEF					NA			N
15350	SKIN HOMOGRAFT	PRXOVR	DEF					NA	NA	NA	N
15350	SKIN HOMOGRAFT	MAXFEE	DEF					NA			N
15351	SKIN HOMOGRAFT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15351	SKIN HOMOGRAFT ADD-ON	MAXFEE	DEF					NA			N
15360	APPLY CULT DERM SUB T/A/L	PRXOVR	DEF					NA	NA	NA	N
15360	APPLY CULT DERM SUB T/A/L	MAXFEE	DEF					NA			N
15361	APLY CULT DERM SUB T/A/L ADD	PRXOVR	DEF					NA	NA	NA	N
15361	APLY CULT DERM SUB T/A/L ADD	MAXFEE	DEF					NA			N
15365	APPLY CULT DERM SUB F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15365	APPLY CULT DERM SUB F/N/HF/G	MAXFEE	DEF					NA			N
15366	APPLY CULT DERM F/HF/G ADD	PRXOVR	DEF					NA	NA	NA	N
15366	APPLY CULT DERM F/HF/G ADD	MAXFEE	DEF					NA			N
15400	APPLY SKIN XENOGRAFT T/A/L	PRXOVR	DEF					NA	NA	NA	N
15400	APPLY SKIN XENOGRAFT T/A/L	MAXFEE	DEF					NA			N
15401	APPLY SKN XENOGRFT T/A/L ADD	PRXOVR	DEF					NA	NA	NA	N
15401	APPLY SKN XENOGRFT T/A/L ADD	MAXFEE	DEF					NA			N
15420	APPLY SKIN XGRAFT F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15420	APPLY SKIN XGRAFT F/N/HF/G	MAXFEE	DEF					NA			N
15421	APPLY SKN XGRFT F/N/HF/G ADD	PRXOVR	DEF					NA	NA	NA	N
15421	APPLY SKN XGRFT F/N/HF/G ADD	MAXFEE	DEF					NA			N
15430	APPLY ACELLULAR XENOGRAFT	PRXOVR	DEF					NA	NA	NA	N
15430	APPLY ACELLULAR XENOGRAFT	MAXFEE	DEF					NA			N
15431	APPLY ACELLULAR XGRAFT ADD	PRXOVR	DEF					NA	NA	NA	N
15431	APPLY ACELLULAR XGRAFT ADD	MANUAL	DEF					NA	NA	NA	N
15570	SKIN PEDICLE FLAP TRUNK	PRXOVR	DEF					NA	NA	NA	N
15570	SKIN PEDICLE FLAP TRUNK	MAXFEE	FAC					260.88	1/1/2014	12/31/2299	N
15570	SKIN PEDICLE FLAP TRUNK	MAXFEE	NFF					376.18	1/1/2014	12/31/2299	N
15572	SKIN PEDICLE FLAP ARMS/LEGS	PRXOVR	DEF					NA	NA	NA	N
15572	SKIN PEDICLE FLAP ARMS/LEGS	MAXFEE	FAC					267.18	1/1/2014	12/31/2299	N
15572	SKIN PEDICLE FLAP ARMS/LEGS	MAXFEE	NFF					368.16	1/1/2014	12/31/2299	N
15574	PEDCLE FH/CH/CH/M/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
15574	PEDCLE FH/CH/CH/M/N/AX/G/H/F	MAXFEE	FAC					269.42	1/1/2014	12/31/2299	N
15574	PEDCLE FH/CH/CH/M/N/AX/G/H/F	MAXFEE	NFF					402.71	1/1/2014	12/31/2299	N
15576	PEDICLE E/N/E/L/NTRORAL	PRXOVR	DEF					NA	NA	NA	N
15576	PEDICLE E/N/E/L/NTRORAL	MAXFEE	FAC					237.42	1/1/2014	12/31/2299	N
15576	PEDICLE E/N/E/L/NTRORAL	MAXFEE	NFF					352.58	1/1/2014	12/31/2299	N
15580	ATTACH SKIN PEDICLE GRAFT	PRXOVR	DEF					NA	NA	NA	N
15580	ATTACH SKIN PEDICLE GRAFT	MAXFEE	DEF					NA			N
15600	DELAY FLAP TRUNK	PRXOVR	DEF					NA	NA	NA	N
15600	DELAY FLAP TRUNK	MAXFEE	FAC					103.71	1/1/2014	12/31/2299	N
15600	DELAY FLAP TRUNK	MAXFEE	NFF					146.03	1/1/2014	12/31/2299	N
15610	DELAY FLAP ARMS/LEGS	PRXOVR	DEF					NA	NA	NA	N
15610	DELAY FLAP ARMS/LEGS	MAXFEE	FAC					125.30	1/1/2014	12/31/2299	N
15610	DELAY FLAP ARMS/LEGS	MAXFEE	NFF					160.75	1/1/2014	12/31/2299	N
15620	DELAY FLAP F/C/C/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
15620	DELAY FLAP F/C/C/N/AX/G/H/F	MAXFEE	FAC					143.51	1/1/2014	12/31/2299	N
15620	DELAY FLAP F/C/C/N/AX/G/H/F	MAXFEE	NFF					193.62	1/1/2014	12/31/2299	N
15625	SKIN GRAFT	PRXOVR	DEF					NA	NA	NA	N
15625	SKIN GRAFT	MAXFEE	DEF					NA			N
15630	DELAY FLAP EYE/NOS/EAR/LIP	PRXOVR	DEF					NA	NA	NA	N
15630	DELAY FLAP EYE/NOS/EAR/LIP	MAXFEE	FAC					153.08	1/1/2014	12/31/2299	N
15630	DELAY FLAP EYE/NOS/EAR/LIP	MAXFEE	NFF					205.36	1/1/2014	12/31/2299	N
15650	TRANSFER SKIN PEDICLE FLAP	PRXOVR	DEF					NA	NA	NA	N
15650	TRANSFER SKIN PEDICLE FLAP	MAXFEE	FAC					180.54	1/1/2014	12/31/2299	N
15650	TRANSFER SKIN PEDICLE FLAP	MAXFEE	NFF					238.74	1/1/2014	12/31/2299	N
15730	MDFC FLAP W/PRSRV VASC PEDCL	PRXOVR	DEF					NA	NA	NA	N
15730	MDFC FLAP W/PRSRV VASC PEDCL	MAXFEE	FAC					730.73	1/1/2018	12/31/2299	N
15730	MDFC FLAP W/PRSRV VASC PEDCL	MAXFEE	NFF					1201.34	1/1/2018	12/31/2299	N
15731	FOREHEAD FLAP W/VASC PEDICLE	PRXOVR	DEF					NA	NA	NA	N
15731	FOREHEAD FLAP W/VASC PEDICLE	MAXFEE	FAC					498.96	1/1/2014	12/31/2299	N
15731	FOREHEAD FLAP W/VASC PEDICLE	MAXFEE	NFF					602.35	1/1/2014	12/31/2299	N
15732	MUSCLE-SKIN GRAFT HEAD/NECK	PRXOVR	DEF					NA	NA	NA	N
15732	MUSCLE-SKIN GRAFT HEAD/NECK	MAXFEE	DEF					NA			N
15733	MUSC MYOQ/FSCQ FLP H&N PEDCL	PRXOVR	DEF					NA	NA	NA	N
15733	MUSC MYOQ/FSCQ FLP H&N PEDCL	MAXFEE	DEF					835.16	1/1/2018	12/31/2299	N
15734	MUSCLE-SKIN GRAFT TRUNK	PRXOVR	DEF					NA	NA	NA	N
15734	MUSCLE-SKIN GRAFT TRUNK	MAXFEE	FAC					721.29	1/1/2014	12/31/2299	N
15734	MUSCLE-SKIN GRAFT TRUNK	MAXFEE	NFF					971.60	1/1/2014	12/31/2299	N
15736	MUSCLE-SKIN GRAFT ARM	PRXOVR	DEF					NA	NA	NA	N
15736	MUSCLE-SKIN GRAFT ARM	MAXFEE	FAC					638.12	1/1/2014	12/31/2299	N
15736	MUSCLE-SKIN GRAFT ARM	MAXFEE	NFF					868.45	1/1/2014	12/31/2299	N
15738	MUSCLE-SKIN GRAFT LEG	PRXOVR	DEF					NA	NA	NA	N
15738	MUSCLE-SKIN GRAFT LEG	MAXFEE	FAC					565.52	1/1/2014	12/31/2299	N
15738	MUSCLE-SKIN GRAFT LEG	MAXFEE	NFF					773.80	1/1/2014	12/31/2299	N
15740	ISLAND PEDICLE FLAP GRAFT	PRXOVR	DEF					NA	NA	NA	N
15740	ISLAND PEDICLE FLAP GRAFT	MAXFEE	FAC					409.46	1/1/2014	12/31/2299	N
15740	ISLAND PEDICLE FLAP GRAFT	MAXFEE	NFF					552.47	1/1/2014	12/31/2299	N
15750	NEUROVASCULAR PEDICLE FLAP	PRXOVR	DEF					NA	NA	NA	N
15750	NEUROVASCULAR PEDICLE FLAP	MAXFEE	DEF					622.70	1/1/2000	12/31/2299	N
15756	FREE MYO/SKIN FLAP MICROVASC	PRXOVR	DEF					NA	NA	NA	N
15756	FREE MYO/SKIN FLAP MICROVASC	MAXFEE	DEF					1749.79	1/1/2000	12/31/2299	N
15757	FREE SKIN FLAP MICROVASC	PRXOVR	DEF					NA	NA	NA	N
15757	FREE SKIN FLAP MICROVASC	MAXFEE	DEF					1753.10	1/1/2004	12/31/2299	N
15758	FREE FASCIAL FLAP MICROVASC	PRXOVR	DEF					NA	NA	NA	N
15758	FREE FASCIAL FLAP MICROVASC	MAXFEE	DEF					1749.93	1/1/2004	12/31/2299	N
15760	COMPOSITE SKIN GRAFT	PRXOVR	DEF					NA	NA	NA	N
15760	COMPOSITE SKIN GRAFT	MAXFEE	FAC					329.04	1/1/2014	12/31/2299	N
15760	COMPOSITE SKIN GRAFT	MAXFEE	NFF					441.25	1/1/2014	12/31/2299	N
15769	GRFG AUTOL SOFT TISS DIR EXC	PRXOVR	DEF					NA	NA	NA	N
15769	GRFG AUTOL SOFT TISS DIR EXC	MAXFEE	DEF					385.35	1/1/2020	12/31/2299	N
15770	DERMA-FAT-FASCIA GRAFT	PRXOVR	DEF					NA	NA	NA	N
15770	DERMA-FAT-FASCIA GRAFT	MAXFEE	DEF					397.28	1/1/2000	12/31/2299	N
15771	GRFG AUTOL FAT LIPO 50 CC/<	PRXOVR	DEF					NA	NA	NA	N
15771	GRFG AUTOL FAT LIPO 50 CC/<	MAXFEE	FAC					382.86	1/1/2020	12/31/2299	N
15771	GRFG AUTOL FAT LIPO 50 CC/<	MAXFEE	NFF					456.56	1/1/2020	12/31/2299	N
15772	GRFG AUTOL FAT LIPO EA ADDL	PRXOVR	DEF					NA	NA	NA	N
15772	GRFG AUTOL FAT LIPO EA ADDL	MAXFEE	FAC					114.72	1/1/2020	12/31/2299	N
15772	GRFG AUTOL FAT LIPO EA ADDL	MAXFEE	NFF					145.10	1/1/2020	12/31/2299	N
15773	GRFG AUTOL FAT LIPO 25 CC/<	PRXOVR	DEF					NA	NA	NA	N
15773	GRFG AUTOL FAT LIPO 25 CC/<	MAXFEE	FAC					387.04	1/1/2020	12/31/2299	N
15773	GRFG AUTOL FAT LIPO 25 CC/<	MAXFEE	NFF					460.74	1/1/2020	12/31/2299	N
15774	GFRG AUTOL FAT LIPO EA ADDL	PRXOVR	DEF					NA	NA	NA	N
15774	GFRG AUTOL FAT LIPO EA ADDL	MAXFEE	FAC					110.18	1/1/2020	12/31/2299	N
15774	GFRG AUTOL FAT LIPO EA ADDL	MAXFEE	NFF					140.56	1/1/2020	12/31/2299	N
15777	ACELLULAR DERM MATRIX IMPLT	PRXOVR	DEF					NA	NA	NA	N
15777	ACELLULAR DERM MATRIX IMPLT	MAXFEE	DEF					84.34	1/1/2012	12/31/2299	N
15778	IMPL ABSRB MSH/PRSTH DLY CLS	PRXOVR	DEF					NA	NA	NA	N
15778	IMPL ABSRB MSH/PRSTH DLY CLS	MAXFEE	DEF					298.58	1/1/2023	12/31/2299	N
15786	ABRASION LESION SINGLE	PRXOVR	DEF					NA	NA	NA	N
15786	ABRASION LESION SINGLE	MAXFEE	FAC					89.90	1/1/2014	12/31/2299	N
15786	ABRASION LESION SINGLE	MAXFEE	NFF					117.94	1/1/2014	12/31/2299	N
15787	ABRASION LESIONS ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15787	ABRASION LESIONS ADD-ON	MAXFEE	FAC					10.59	1/1/2014	12/31/2299	N
15787	ABRASION LESIONS ADD-ON	MAXFEE	NFF					23.46	1/1/2014	12/31/2299	N
15823	REVISION OF UPPER EYELID	PRXOVR	DEF					NA	NA	NA	E
15823	REVISION OF UPPER EYELID	MAXFEE	DEF					339.58	1/1/2000	12/31/2299	E
15830	EXC SKIN ABD	PRXOVR	DEF					NA	NA	NA	E
15830	EXC SKIN ABD	MAXFEE	DEF					659.80	1/1/2007	12/31/2299	E
15839	EXCISE EXCESS SKIN & TISSUE	PRXOVR	DEF					NA	NA	NA	E
15839	EXCISE EXCESS SKIN & TISSUE	MAXFEE	DEF					506.83	9/1/2013	12/31/2299	E
15840	NERVE PALSY FASCIAL GRAFT	PRXOVR	DEF					NA	NA	NA	N
15840	NERVE PALSY FASCIAL GRAFT	MAXFEE	DEF					737.91	1/1/2000	12/31/2299	N
15841	NERVE PALSY MUSCLE GRAFT	PRXOVR	DEF					NA	NA	NA	N
15841	NERVE PALSY MUSCLE GRAFT	MAXFEE	DEF					1081.95	1/1/2000	12/31/2299	N
15842	NERVE PALSY MICROSURG GRAFT	PRXOVR	DEF					NA	NA	NA	N
15842	NERVE PALSY MICROSURG GRAFT	MAXFEE	DEF					1737.64	4/1/2008	12/31/2299	N
15845	SKIN AND MUSCLE REPAIR FACE	PRXOVR	DEF					NA	NA	NA	N
15845	SKIN AND MUSCLE REPAIR FACE	MAXFEE	DEF					705.27	1/1/2000	12/31/2299	N
15847	EXC SKIN ABD ADD-ON	PRXOVR	DEF					NA	NA	NA	E
15847	EXC SKIN ABD ADD-ON	MAXFEE	DEF					385.72	9/1/2013	12/31/2299	E
15851	REMOVAL SUTR/STAPLE REQ ANES	PRXOVR	DEF					NA	NA	NA	N
15851	REMOVAL SUTR/STAPLE REQ ANES	MAXFEE	FAC					32.43	1/1/2014	12/31/2299	N
15851	REMOVAL SUTR/STAPLE REQ ANES	MAXFEE	NFF					52.58	1/1/2014	12/31/2299	N
15852	DRESSING CHANGE NOT FOR BURN	PRXOVR	DEF					NA	NA	NA	N
15852	DRESSING CHANGE NOT FOR BURN	MAXFEE	DEF					40.24	1/1/2010	12/31/2299	N
15853	REMOVAL SUTR/STAPL XREQ ANES	PRXOVR	DEF					NA	NA	NA	N
15853	REMOVAL SUTR/STAPL XREQ ANES	MAXFEE	DEF					8.24	1/1/2023	12/31/2299	N
15854	REMOVAL SUTR&STAPL XREQ ANES	PRXOVR	DEF					NA	NA	NA	N
15854	REMOVAL SUTR&STAPL XREQ ANES	MAXFEE	DEF					11.66	1/1/2023	12/31/2299	N
15860	TEST FOR BLOOD FLOW IN GRAFT	PRXOVR	DEF					NA	NA	NA	N
15860	TEST FOR BLOOD FLOW IN GRAFT	MAXFEE	DEF					88.96	1/1/2000	12/31/2299	N
15876	SUCTION LIPECTOMY HEAD&NECK	PRXOVR	DEF					NA	NA	NA	E
15876	SUCTION LIPECTOMY HEAD&NECK	MAXFEE	DEF					499.59	1/1/2000	12/31/2299	E
15877	SUCTION LIPECTOMY TRUNK	PRXOVR	DEF					NA	NA	NA	E
15877	SUCTION LIPECTOMY TRUNK	MAXFEE	DEF					499.59	1/1/2000	12/31/2299	E
15878	SUCTION LIPECTOMY UPR EXTREM	PRXOVR	DEF					NA	NA	NA	E
15878	SUCTION LIPECTOMY UPR EXTREM	MAXFEE	DEF					499.59	1/1/2000	12/31/2299	E
15879	SUCTION LIPECTOMY LWR EXTREM	PRXOVR	DEF					NA	NA	NA	E
15879	SUCTION LIPECTOMY LWR EXTREM	MAXFEE	DEF					499.59	1/1/2000	12/31/2299	E
15920	REMOVAL OF TAIL BONE ULCER	PRXOVR	DEF					NA	NA	NA	N
15920	REMOVAL OF TAIL BONE ULCER	MAXFEE	DEF					308.95	7/1/2008	12/31/2299	N
15922	REMOVAL OF TAIL BONE ULCER	PRXOVR	DEF					NA	NA	NA	N
15922	REMOVAL OF TAIL BONE ULCER	MAXFEE	DEF					440	1/1/2000	12/31/2299	N
15931	REMOVE SACRUM PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15931	REMOVE SACRUM PRESSURE SORE	MAXFEE	DEF					351.02	7/1/2008	12/31/2299	N
15933	REMOVE SACRUM PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15933	REMOVE SACRUM PRESSURE SORE	MAXFEE	DEF					492.50	1/1/2000	12/31/2299	N
15934	REMOVE SACRUM PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15934	REMOVE SACRUM PRESSURE SORE	MAXFEE	DEF					554.80	1/1/2000	12/31/2299	N
15935	REMOVE SACRUM PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15935	REMOVE SACRUM PRESSURE SORE	MAXFEE	DEF					703.70	1/1/2000	12/31/2299	N
15936	REMOVE SACRUM PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15936	REMOVE SACRUM PRESSURE SORE	MAXFEE	DEF					617.24	1/1/2000	12/31/2299	N
15937	REMOVE SACRUM PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15937	REMOVE SACRUM PRESSURE SORE	MAXFEE	DEF					748.89	1/1/2000	12/31/2299	N
15940	REMOVE HIP PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15940	REMOVE HIP PRESSURE SORE	MAXFEE	DEF					365.05	7/1/2008	12/31/2299	N
15941	REMOVE HIP PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15941	REMOVE HIP PRESSURE SORE	MAXFEE	DEF					517.32	1/1/2000	12/31/2299	N
15944	REMOVE HIP PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15944	REMOVE HIP PRESSURE SORE	MAXFEE	DEF					566.10	1/1/2000	12/31/2299	N
15945	REMOVE HIP PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15945	REMOVE HIP PRESSURE SORE	MAXFEE	DEF					645.43	1/1/2000	12/31/2299	N
15946	REMOVE HIP PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15946	REMOVE HIP PRESSURE SORE	MAXFEE	DEF					1030.86	1/1/2000	12/31/2299	N
15950	REMOVE THIGH PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15950	REMOVE THIGH PRESSURE SORE	MAXFEE	DEF					299.48	7/1/2008	12/31/2299	N
15951	REMOVE THIGH PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15951	REMOVE THIGH PRESSURE SORE	MAXFEE	DEF					507.55	1/1/2000	12/31/2299	N
15952	REMOVE THIGH PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15952	REMOVE THIGH PRESSURE SORE	MAXFEE	DEF					506.74	1/1/2000	12/31/2299	N
15953	REMOVE THIGH PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15953	REMOVE THIGH PRESSURE SORE	MAXFEE	DEF					593.90	1/1/2000	12/31/2299	N
15956	REMOVE THIGH PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15956	REMOVE THIGH PRESSURE SORE	MAXFEE	DEF					872.08	1/1/2000	12/31/2299	N
15958	REMOVE THIGH PRESSURE SORE	PRXOVR	DEF					NA	NA	NA	N
15958	REMOVE THIGH PRESSURE SORE	MAXFEE	DEF					878.74	1/1/2000	12/31/2299	N
15999	UNLISTED PX EXC PRESSURE ULC	PRXOVR	DEF					NA	NA	NA	N
15999	UNLISTED PX EXC PRESSURE ULC	MANUAL	DEF					NA	NA	NA	N
16000	INITIAL TREATMENT OF BURN(S)	PRXOVR	DEF					NA	NA	NA	N
16000	INITIAL TREATMENT OF BURN(S)	MAXFEE	FAC					23.19	1/1/2014	12/31/2299	N
16000	INITIAL TREATMENT OF BURN(S)	MAXFEE	NFF					35.86	1/1/2014	12/31/2299	N
16010	TREATMENT OF BURN(S)	PRXOVR	DEF					NA	NA	NA	N
16010	TREATMENT OF BURN(S)	MAXFEE	DEF					NA			N
16015	TREATMENT OF BURN(S)	PRXOVR	DEF					NA	NA	NA	N
16015	TREATMENT OF BURN(S)	MAXFEE	DEF					NA			N
16020	DRESS/DEBRID P-THICK BURN S	PRXOVR	DEF					NA	NA	NA	N
16020	DRESS/DEBRID P-THICK BURN S	MAXFEE	FAC					31.27	1/1/2014	12/31/2299	N
16020	DRESS/DEBRID P-THICK BURN S	MAXFEE	NFF					52.82	1/1/2014	12/31/2299	N
16025	DRESS/DEBRID P-THICK BURN M	PRXOVR	DEF					NA	NA	NA	N
16025	DRESS/DEBRID P-THICK BURN M	MAXFEE	FAC					62.79	1/1/2014	12/31/2299	N
16025	DRESS/DEBRID P-THICK BURN M	MAXFEE	NFF					95.03	1/1/2014	12/31/2299	N
16030	DRESS/DEBRID P-THICK BURN L	PRXOVR	DEF					NA	NA	NA	N
16030	DRESS/DEBRID P-THICK BURN L	MAXFEE	FAC					46.90	1/1/2014	12/31/2299	N
16030	DRESS/DEBRID P-THICK BURN L	MAXFEE	NFF					79.78	1/1/2014	12/31/2299	N
16035	INCISION OF BURN SCAB INITI	PRXOVR	DEF					NA	NA	NA	N
16035	INCISION OF BURN SCAB INITI	MAXFEE	DEF					180.72	1/1/2010	12/31/2299	N
16036	ESCHAROTOMY ADDL INCISION	PRXOVR	DEF					NA	NA	NA	N
16036	ESCHAROTOMY ADDL INCISION	MAXFEE	DEF					65.13	1/1/2001	12/31/2299	N
17000	DESTRUCT PREMALG LESION	PRXOVR	DEF					NA	NA	NA	N
17000	DESTRUCT PREMALG LESION	MAXFEE	FAC					26.06	1/1/2014	12/31/2299	N
17000	DESTRUCT PREMALG LESION	MAXFEE	NFF					44.24	1/1/2014	12/31/2299	N
17003	DESTRUCT PREMALG LES 2-14	PRXOVR	DEF					NA	NA	NA	N
17003	DESTRUCT PREMALG LES 2-14	MAXFEE	FAC					2.24	12/31/2014	12/31/2299	N
17003	DESTRUCT PREMALG LES 2-14	MAXFEE	NFF					5.41	1/1/2017	12/31/2299	N
17004	DESTROY PREMAL LESIONS 15/>	PRXOVR	DEF					NA	NA	NA	N
17004	DESTROY PREMAL LESIONS 15/>	MAXFEE	FAC					88.51	12/31/2014	12/31/2299	N
17004	DESTROY PREMAL LESIONS 15/>	MAXFEE	NFF					132.38	1/1/2014	12/31/2299	N
17106	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17106	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					143.75	1/1/2014	12/31/2299	N
17106	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					200.56	1/1/2014	12/31/2299	N
17107	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17107	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					280.66	1/1/2014	12/31/2299	N
17107	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					355.56	1/1/2014	12/31/2299	N
17108	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17108	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					347.88	1/1/2014	12/31/2299	N
17108	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					457.35	1/1/2014	12/31/2299	N
17110	DESTRUCT B9 LESION 1-14	PRXOVR	DEF					NA	NA	NA	N
17110	DESTRUCT B9 LESION 1-14	MAXFEE	FAC					34.41	1/1/2014	12/31/2299	N
17110	DESTRUCT B9 LESION 1-14	MAXFEE	NFF					63.31	1/1/2014	12/31/2299	N
17111	DESTRUCT LESION 15 OR MORE	PRXOVR	DEF					NA	NA	NA	N
17111	DESTRUCT LESION 15 OR MORE	MAXFEE	FAC					42.37	1/1/2014	12/31/2299	N
17111	DESTRUCT LESION 15 OR MORE	MAXFEE	NFF					75.29	1/1/2014	12/31/2299	N
17250	CHEM CAUT OF GRANLTJ TISSUE	PRXOVR	DEF					NA	NA	NA	N
17250	CHEM CAUT OF GRANLTJ TISSUE	MAXFEE	FAC					19.44	1/1/2014	12/31/2299	N
17250	CHEM CAUT OF GRANLTJ TISSUE	MAXFEE	NFF					46.72	1/1/2014	12/31/2299	N
17260	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17260	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					47.79	1/1/2014	12/31/2299	N
17260	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					61.55	1/1/2014	12/31/2299	N
17261	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17261	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					41.11	1/1/2014	12/31/2299	N
17261	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					67.42	1/1/2014	12/31/2299	N
17262	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17262	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					66.09	1/1/2014	12/31/2299	N
17262	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					88.90	1/1/2014	12/31/2299	N
17263	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17263	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					78.35	1/1/2014	12/31/2299	N
17263	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					104.26	1/1/2014	12/31/2299	N
17264	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17264	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					89.48	1/1/2014	12/31/2299	N
17264	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					116.47	1/1/2014	12/31/2299	N
17266	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17266	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					94.77	1/1/2014	12/31/2299	N
17266	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					126.54	1/1/2014	12/31/2299	N
17270	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17270	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					50.92	1/1/2014	12/31/2299	N
17270	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					70.68	1/1/2014	12/31/2299	N
17271	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17271	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					62.15	1/1/2014	12/31/2299	N
17271	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					84.87	1/1/2014	12/31/2299	N
17272	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17272	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					76.47	1/1/2014	12/31/2299	N
17272	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					102.49	1/1/2014	12/31/2299	N
17273	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17273	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					90.93	1/1/2014	12/31/2299	N
17273	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					119.43	1/1/2014	12/31/2299	N
17274	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17274	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					110.93	1/1/2014	12/31/2299	N
17274	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					146.85	1/1/2014	12/31/2299	N
17276	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17276	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					131.76	1/1/2014	12/31/2299	N
17276	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					174.73	1/1/2014	12/31/2299	N
17280	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17280	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					55.35	1/1/2014	12/31/2299	N
17280	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					73.46	1/1/2014	12/31/2299	N
17281	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17281	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					73.64	1/1/2014	12/31/2299	N
17281	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					98.60	1/1/2014	12/31/2299	N
17282	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17282	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					89.09	1/1/2014	12/31/2299	N
17282	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					118.43	1/1/2014	12/31/2299	N
17283	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17283	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					109.47	1/1/2014	12/31/2299	N
17283	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					145.60	1/1/2014	12/31/2299	N
17284	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17284	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					131.35	1/1/2014	12/31/2299	N
17284	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					173.03	1/1/2014	12/31/2299	N
17286	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17286	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					174.29	1/1/2014	12/31/2299	N
17286	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					230.68	1/1/2014	12/31/2299	N
17304	1 STAGE MOHS; UP TO 5 SPEC	PRXOVR	DEF					NA	NA	NA	N
17304	1 STAGE MOHS; UP TO 5 SPEC	MAXFEE	DEF					NA			N
17305	2 STAGE MOHS; UP TO 5 SPEC	PRXOVR	DEF					NA	NA	NA	N
17305	2 STAGE MOHS; UP TO 5 SPEC	MAXFEE	DEF					NA			N
17306	3 STAGE MOHS; UP TO 5 SPEC	PRXOVR	DEF					NA	NA	NA	N
17306	3 STAGE MOHS; UP TO 5 SPEC	MAXFEE	DEF					NA			N
17307	MOHS ADDL STAGE UP TO 5 SPEC	PRXOVR	DEF					NA	NA	NA	N
17307	MOHS ADDL STAGE UP TO 5 SPEC	MAXFEE	DEF					NA			N
17310	MOHS ANY STAGE > 5 SPEC EACH	PRXOVR	DEF					NA	NA	NA	N
17310	MOHS ANY STAGE > 5 SPEC EACH	MAXFEE	DEF					NA			N
17311	MOHS 1 STAGE H/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
17311	MOHS 1 STAGE H/N/HF/G	MAXFEE	FAC					192.09	1/1/2014	12/31/2299	N
17311	MOHS 1 STAGE H/N/HF/G	MAXFEE	NFF					373.16	1/1/2014	12/31/2299	N
17312	MOHS ADDL STAGE	PRXOVR	DEF					NA	NA	NA	N
17312	MOHS ADDL STAGE	MAXFEE	FAC					103.84	1/1/2014	12/31/2299	N
17312	MOHS ADDL STAGE	MAXFEE	NFF					223.53	1/1/2014	12/31/2299	N
17313	MOHS 1 STAGE T/A/L	PRXOVR	DEF					NA	NA	NA	N
17313	MOHS 1 STAGE T/A/L	MAXFEE	FAC					172.29	1/1/2014	12/31/2299	N
17313	MOHS 1 STAGE T/A/L	MAXFEE	NFF					340.51	1/1/2014	12/31/2299	N
17314	MOHS ADDL STAGE T/A/L	PRXOVR	DEF					NA	NA	NA	N
17314	MOHS ADDL STAGE T/A/L	MAXFEE	FAC					96.48	1/1/2014	12/31/2299	N
17314	MOHS ADDL STAGE T/A/L	MAXFEE	NFF					207.21	1/1/2014	12/31/2299	N
17315	MOHS SURG ADDL BLOCK	PRXOVR	DEF					NA	NA	NA	N
17315	MOHS SURG ADDL BLOCK	MAXFEE	FAC					34.47	1/1/2014	12/31/2299	N
17315	MOHS SURG ADDL BLOCK	MAXFEE	NFF					44.66	1/1/2014	12/31/2299	N
17340	CRYOTHERAPY OF SKIN	PRXOVR	DEF					NA	NA	NA	N
17340	CRYOTHERAPY OF SKIN	MAXFEE	FAC					30.97	1/1/2014	12/31/2299	N
17340	CRYOTHERAPY OF SKIN	MAXFEE	NFF					31.67	1/1/2014	12/31/2299	N
17360	SKIN PEEL THERAPY	PRXOVR	DEF					NA	NA	NA	N
17360	SKIN PEEL THERAPY	MAXFEE	FAC					62.17	1/1/2014	12/31/2299	N
17360	SKIN PEEL THERAPY	MAXFEE	NFF					81.98	1/1/2014	12/31/2299	N
17999	UNLISTD PX SKN MUC MEMB SUBQ	PRXOVR	DEF					NA	NA	NA	N
17999	UNLISTD PX SKN MUC MEMB SUBQ	MANUAL	DEF					NA	NA	NA	N
19000	DRAINAGE OF BREAST LESION	PRXOVR	DEF					NA	NA	NA	N
19000	DRAINAGE OF BREAST LESION	MAXFEE	FAC					27.95	1/1/2014	12/31/2299	N
19000	DRAINAGE OF BREAST LESION	MAXFEE	NFF					60.23	1/1/2014	12/31/2299	N
19001	DRAIN BREAST LESION ADD-ON	PRXOVR	DEF					NA	NA	NA	N
19001	DRAIN BREAST LESION ADD-ON	MAXFEE	FAC					15.44	1/1/2014	12/31/2299	N
19001	DRAIN BREAST LESION ADD-ON	MAXFEE	NFF					19.75	1/1/2014	12/31/2299	N
19020	INCISION OF BREAST LESION	PRXOVR	DEF					NA	NA	NA	N
19020	INCISION OF BREAST LESION	MAXFEE	FAC					107.24	1/1/2014	12/31/2299	N
19020	INCISION OF BREAST LESION	MAXFEE	NFF					212.11	1/1/2014	12/31/2299	N
19030	INJECTION FOR BREAST X-RAY	PRXOVR	DEF					NA	NA	NA	N
19030	INJECTION FOR BREAST X-RAY	MAXFEE	FAC					34.03	1/1/2014	12/31/2299	N
19030	INJECTION FOR BREAST X-RAY	MAXFEE	NFF					61.15	1/1/2014	12/31/2299	N
19081	BX BREAST 1ST LESION STRTCTC	PRXOVR	DEF					NA	NA	NA	N
19081	BX BREAST 1ST LESION STRTCTC	MAXFEE	FAC					142.05	1/1/2014	12/31/2299	N
19081	BX BREAST 1ST LESION STRTCTC	MAXFEE	NFF					488.76	1/1/2014	12/31/2299	N
19082	BX BREAST ADD LESION STRTCTC	PRXOVR	DEF					NA	NA	NA	N
19082	BX BREAST ADD LESION STRTCTC	MAXFEE	FAC					67.24	1/1/2014	12/31/2299	N
19082	BX BREAST ADD LESION STRTCTC	MAXFEE	NFF					390.85	1/1/2014	12/31/2299	N
19083	BX BREAST 1ST LESION US IMAG	PRXOVR	DEF					NA	NA	NA	N
19083	BX BREAST 1ST LESION US IMAG	MAXFEE	FAC					133	1/1/2014	12/31/2299	N
19083	BX BREAST 1ST LESION US IMAG	MAXFEE	NFF					484.73	1/1/2014	12/31/2299	N
19084	BX BREAST ADD LESION US IMAG	PRXOVR	DEF					NA	NA	NA	N
19084	BX BREAST ADD LESION US IMAG	MAXFEE	FAC					63.16	1/1/2014	12/31/2299	N
19084	BX BREAST ADD LESION US IMAG	MAXFEE	NFF					385.27	1/1/2014	12/31/2299	N
19085	BX BREAST 1ST LESION MR IMAG	PRXOVR	DEF					NA	NA	NA	N
19085	BX BREAST 1ST LESION MR IMAG	MAXFEE	FAC					155.19	1/1/2014	12/31/2299	N
19085	BX BREAST 1ST LESION MR IMAG	MAXFEE	NFF					730.12	1/1/2014	12/31/2299	N
19086	BX BREAST ADD LESION MR IMAG	PRXOVR	DEF					NA	NA	NA	N
19086	BX BREAST ADD LESION MR IMAG	MAXFEE	FAC					68.15	1/1/2014	12/31/2299	N
19086	BX BREAST ADD LESION MR IMAG	MAXFEE	NFF					576.80	1/1/2014	12/31/2299	N
19100	BX BREAST PERCUT W/O IMAGE	PRXOVR	DEF					NA	NA	NA	N
19100	BX BREAST PERCUT W/O IMAGE	MAXFEE	FAC					38.47	1/1/2014	12/31/2299	N
19100	BX BREAST PERCUT W/O IMAGE	MAXFEE	NFF					73.37	1/1/2014	12/31/2299	N
19101	BIOPSY OF BREAST OPEN	PRXOVR	DEF					NA	NA	NA	N
19101	BIOPSY OF BREAST OPEN	MAXFEE	FAC					102.15	1/1/2014	12/31/2299	N
19101	BIOPSY OF BREAST OPEN	MAXFEE	NFF					174.83	1/1/2014	12/31/2299	N
19102	BX BREAST PERCUT W/IMAGE	PRXOVR	DEF					NA	NA	NA	N
19102	BX BREAST PERCUT W/IMAGE	MAXFEE	FAC					40.14	1/1/2014	12/31/2299	N
19102	BX BREAST PERCUT W/IMAGE	MAXFEE	NFF					92.48	1/1/2014	12/31/2299	N
19103	BX BREAST PERCUT W/DEVICE	PRXOVR	DEF					NA	NA	NA	N
19103	BX BREAST PERCUT W/DEVICE	MAXFEE	FAC					132.08	1/1/2014	12/31/2299	N
19103	BX BREAST PERCUT W/DEVICE	MAXFEE	NFF					269.23	1/1/2014	12/31/2299	N
19105	CRYOSURG ABLATE FA EACH	PRXOVR	DEF					NA	NA	NA	N
19105	CRYOSURG ABLATE FA EACH	MAXFEE	FAC					133.50	1/1/2014	12/31/2299	N
19105	CRYOSURG ABLATE FA EACH	MAXFEE	NFF					945.27	1/1/2014	12/31/2299	N
19110	NIPPLE EXPLORATION	PRXOVR	DEF					NA	NA	NA	N
19110	NIPPLE EXPLORATION	MAXFEE	FAC					158.19	1/1/2014	12/31/2299	N
19110	NIPPLE EXPLORATION	MAXFEE	NFF					210.81	1/1/2014	12/31/2299	N
19112	EXCISE BREAST DUCT FISTULA	PRXOVR	DEF					NA	NA	NA	N
19112	EXCISE BREAST DUCT FISTULA	MAXFEE	FAC					138.22	1/1/2014	12/31/2299	N
19112	EXCISE BREAST DUCT FISTULA	MAXFEE	NFF					216.20	1/1/2014	12/31/2299	N
19120	REMOVAL OF BREAST LESION	PRXOVR	DEF					NA	NA	NA	N
19120	REMOVAL OF BREAST LESION	MAXFEE	FAC					161.60	1/1/2014	12/31/2299	N
19120	REMOVAL OF BREAST LESION	MAXFEE	NFF					235.54	1/1/2014	12/31/2299	N
19125	EXCISION BREAST LESION	PRXOVR	DEF					NA	NA	NA	N
19125	EXCISION BREAST LESION	MAXFEE	FAC					170.45	1/1/2014	12/31/2299	N
19125	EXCISION BREAST LESION	MAXFEE	NFF					250.45	1/1/2014	12/31/2299	N
19126	EXCISION ADDL BREAST LESION	PRXOVR	DEF					NA	NA	NA	N
19126	EXCISION ADDL BREAST LESION	MAXFEE	DEF					118.78	1/1/2000	12/31/2299	N
19140	REMOVAL OF BREAST TISSUE	PRXOVR	DEF					NA	NA	NA	N
19140	REMOVAL OF BREAST TISSUE	MAXFEE	DEF					NA			N
19160	PARTIAL MASTECTOMY	PRXOVR	DEF					NA	NA	NA	N
19160	PARTIAL MASTECTOMY	MAXFEE	DEF					NA			N
19162	P-MASTECTOMY W/LN REMOVAL	PRXOVR	DEF					NA	NA	NA	N
19162	P-MASTECTOMY W/LN REMOVAL	MAXFEE	DEF					NA			N
19180	REMOVAL OF BREAST	PRXOVR	DEF					NA	NA	NA	N
19180	REMOVAL OF BREAST	MAXFEE	DEF					NA			N
19182	REMOVAL OF BREAST	PRXOVR	DEF					NA	NA	NA	N
19182	REMOVAL OF BREAST	MAXFEE	DEF					NA			N
19200	REMOVAL OF BREAST	PRXOVR	DEF					NA	NA	NA	N
19200	REMOVAL OF BREAST	MAXFEE	DEF					NA			N
19220	REMOVAL OF BREAST	PRXOVR	DEF					NA	NA	NA	N
19220	REMOVAL OF BREAST	MAXFEE	DEF					NA			N
19240	REMOVAL OF BREAST	PRXOVR	DEF					NA	NA	NA	N
19240	REMOVAL OF BREAST	MAXFEE	DEF					NA			N
19260	REMOVAL OF CHEST WALL LESION	PRXOVR	DEF					NA	NA	NA	N
19260	REMOVAL OF CHEST WALL LESION	MAXFEE	DEF					NA			N
19271	REVISION OF CHEST WALL	PRXOVR	DEF					NA	NA	NA	N
19271	REVISION OF CHEST WALL	MAXFEE	DEF					NA			N
19272	EXTENSIVE CHEST WALL SURGERY	PRXOVR	DEF					NA	NA	NA	N
19272	EXTENSIVE CHEST WALL SURGERY	MAXFEE	DEF					NA			N
19281	PERQ DEVICE BREAST 1ST IMAG	PRXOVR	DEF					NA	NA	NA	N
19281	PERQ DEVICE BREAST 1ST IMAG	MAXFEE	FAC					78.75	1/1/2014	12/31/2299	N
19281	PERQ DEVICE BREAST 1ST IMAG	MAXFEE	NFF					177.42	1/1/2014	12/31/2299	N
19282	PERQ DEVICE BREAST EA IMAG	PRXOVR	DEF					NA	NA	NA	N
19282	PERQ DEVICE BREAST EA IMAG	MAXFEE	FAC					37.40	1/1/2014	12/31/2299	N
19282	PERQ DEVICE BREAST EA IMAG	MAXFEE	NFF					121.76	1/1/2014	12/31/2299	N
19283	PERQ DEV BREAST 1ST STRTCTC	PRXOVR	DEF					NA	NA	NA	N
19283	PERQ DEV BREAST 1ST STRTCTC	MAXFEE	FAC					79.51	1/1/2014	12/31/2299	N
19283	PERQ DEV BREAST 1ST STRTCTC	MAXFEE	NFF					200.77	1/1/2014	12/31/2299	N
19284	PERQ DEV BREAST ADD STRTCTC	PRXOVR	DEF					NA	NA	NA	N
19284	PERQ DEV BREAST ADD STRTCTC	MAXFEE	FAC					37.65	1/1/2014	12/31/2299	N
19284	PERQ DEV BREAST ADD STRTCTC	MAXFEE	NFF					145.61	1/1/2014	12/31/2299	N
19285	PERQ DEV BREAST 1ST US IMAG	PRXOVR	DEF					NA	NA	NA	N
19285	PERQ DEV BREAST 1ST US IMAG	MAXFEE	FAC					67.42	1/1/2014	12/31/2299	N
19285	PERQ DEV BREAST 1ST US IMAG	MAXFEE	NFF					335.30	1/1/2014	12/31/2299	N
19286	PERQ DEV BREAST ADD US IMAG	PRXOVR	DEF					NA	NA	NA	N
19286	PERQ DEV BREAST ADD US IMAG	MAXFEE	FAC					32.32	1/1/2014	12/31/2299	N
19286	PERQ DEV BREAST ADD US IMAG	MAXFEE	NFF					279.36	1/1/2014	12/31/2299	N
19287	PERQ DEV BREAST 1ST MR GUIDE	PRXOVR	DEF					NA	NA	NA	N
19287	PERQ DEV BREAST 1ST MR GUIDE	MAXFEE	FAC					110.68	1/1/2014	12/31/2299	N
19287	PERQ DEV BREAST 1ST MR GUIDE	MAXFEE	NFF					621.34	1/1/2014	12/31/2299	N
19288	PERQ DEV BREAST ADD MR GUIDE	PRXOVR	DEF					NA	NA	NA	N
19288	PERQ DEV BREAST ADD MR GUIDE	MAXFEE	FAC					48.33	1/1/2014	12/31/2299	N
19288	PERQ DEV BREAST ADD MR GUIDE	MAXFEE	NFF					490.96	1/1/2014	12/31/2299	N
19290	PLACE NEEDLE WIRE BREAST	PRXOVR	DEF					NA	NA	NA	N
19290	PLACE NEEDLE WIRE BREAST	MAXFEE	FAC					40.18	1/1/2014	12/31/2299	N
19290	PLACE NEEDLE WIRE BREAST	MAXFEE	NFF					68.70	1/1/2014	12/31/2299	N
19291	PLACE NEEDLE WIRE BREAST	PRXOVR	DEF					NA	NA	NA	N
19291	PLACE NEEDLE WIRE BREAST	MAXFEE	FAC					21.25	1/1/2014	12/31/2299	N
19291	PLACE NEEDLE WIRE BREAST	MAXFEE	NFF					27.30	1/1/2014	12/31/2299	N
19294	PREPJ TUM CAV IORT PRTL MAST	PRXOVR	DEF					NA	NA	NA	N
19294	PREPJ TUM CAV IORT PRTL MAST	MAXFEE	DEF					132.38	1/1/2018	12/31/2299	N
19295	PLACE BREAST CLIP PERCUT	PRXOVR	DEF					NA	NA	NA	N
19295	PLACE BREAST CLIP PERCUT	MAXFEE	DEF					NA			N
19296	PLACE PO BREAST CATH FOR RAD	PRXOVR	DEF					NA	NA	NA	N
19296	PLACE PO BREAST CATH FOR RAD	MAXFEE	FAC					158.07	1/1/2014	12/31/2299	N
19296	PLACE PO BREAST CATH FOR RAD	MAXFEE	NFF					2975.46	1/1/2014	12/31/2299	N
19297	PLACE BREAST CATH FOR RAD	PRXOVR	DEF					NA	NA	NA	N
19297	PLACE BREAST CATH FOR RAD	MAXFEE	DEF					70.77	1/1/2007	12/31/2299	N
19298	PLACE BREAST RAD TUBE/CATHS	PRXOVR	DEF					NA	NA	NA	N
19298	PLACE BREAST RAD TUBE/CATHS	MAXFEE	FAC					240.31	1/1/2014	12/31/2299	N
19298	PLACE BREAST RAD TUBE/CATHS	MAXFEE	NFF					531.36	1/1/2014	12/31/2299	N
19300	REMOVAL OF BREAST TISSUE	PRXOVR	DEF					NA	NA	NA	N
19300	REMOVAL OF BREAST TISSUE	MAXFEE	FAC					218.30	1/1/2014	12/31/2299	N
19300	REMOVAL OF BREAST TISSUE	MAXFEE	NFF					300.38	1/1/2014	12/31/2299	N
19301	PARTIAL MASTECTOMY	PRXOVR	DEF					NA	NA	NA	N
19301	PARTIAL MASTECTOMY	MAXFEE	DEF					293.68	12/31/2014	12/31/2299	N
19302	P-MASTECTOMY W/LN REMOVAL	PRXOVR	DEF					NA	NA	NA	N
19302	P-MASTECTOMY W/LN REMOVAL	MAXFEE	DEF					481.52	1/1/2007	12/31/2299	N
19303	MAST SIMPLE COMPLETE	PRXOVR	DEF					NA	NA	NA	N
19303	MAST SIMPLE COMPLETE	MAXFEE	DEF					526.41	1/1/2007	12/31/2299	N
19304	MAST SUBQ	PRXOVR	DEF					NA	NA	NA	N
19304	MAST SUBQ	MAXFEE	DEF					NA			N
19305	MAST RADICAL	PRXOVR	DEF					NA	NA	NA	N
19305	MAST RADICAL	MAXFEE	DEF					602.35	1/1/2007	12/31/2299	N
19306	MAST RAD URBAN TYPE	PRXOVR	DEF					NA	NA	NA	N
19306	MAST RAD URBAN TYPE	MAXFEE	DEF					629.33	1/1/2007	12/31/2299	N
19307	MAST MOD RAD	PRXOVR	DEF					NA	NA	NA	N
19307	MAST MOD RAD	MAXFEE	DEF					635.68	1/1/2007	12/31/2299	N
19316	SUSPENSION OF BREAST	PRXOVR	DEF					NA	NA	NA	E
19316	SUSPENSION OF BREAST	MAXFEE	DEF					437.73	1/1/2000	12/31/2299	E
19318	BREAST REDUCTION	PRXOVR	DEF					NA	NA	NA	E
19318	BREAST REDUCTION	MAXFEE	DEF					729.29	7/1/2003	12/31/2299	E
19324	ENLARGE BREAST	PRXOVR	DEF					NA	NA	NA	E
19324	ENLARGE BREAST	MAXFEE	DEF					NA			E
19325	BREAST AUGMENTATION W/IMPLT	PRXOVR	DEF					NA	NA	NA	E
19325	BREAST AUGMENTATION W/IMPLT	MAXFEE	DEF					353.90	1/1/2000	12/31/2299	E
19328	RMVL INTACT BREAST IMPLANT	PRXOVR	DEF					NA	NA	NA	N
19328	RMVL INTACT BREAST IMPLANT	MAXFEE	DEF					261.67	1/1/2000	12/31/2299	N
19330	RMVL RUPTURED BREAST IMPLANT	PRXOVR	DEF					NA	NA	NA	N
19330	RMVL RUPTURED BREAST IMPLANT	MAXFEE	DEF					328.94	7/1/2008	12/31/2299	N
19340	INSJ BREAST IMPLT SM D MAST	PRXOVR	DEF					NA	NA	NA	N
19340	INSJ BREAST IMPLT SM D MAST	MAXFEE	DEF					456.34	12/31/2014	12/31/2299	N
19342	INSJ/RPLCMT BRST IMPLT SEP D	PRXOVR	DEF					NA	NA	NA	N
19342	INSJ/RPLCMT BRST IMPLT SEP D	MAXFEE	DEF					591.85	1/1/2000	12/31/2299	N
19350	BREAST RECONSTRUCTION	PRXOVR	DEF					NA	NA	NA	N
19350	BREAST RECONSTRUCTION	MAXFEE	FAC					435.36	1/1/2014	12/31/2299	N
19350	BREAST RECONSTRUCTION	MAXFEE	NFF					581.66	1/1/2014	12/31/2299	N
19355	CORRECT INVERTED NIPPLE(S)	PRXOVR	DEF					NA	NA	NA	E
19355	CORRECT INVERTED NIPPLE(S)	MAXFEE	DEF					377.90	1/1/2000	12/31/2299	E
19357	TISS XPNDR PLMT BRST RCNSTJ	PRXOVR	DEF					NA	NA	NA	N
19357	TISS XPNDR PLMT BRST RCNSTJ	MAXFEE	DEF					835.41	1/1/2000	12/31/2299	N
19361	BRST RCNSTJ LATSMS DRSI FLAP	PRXOVR	DEF					NA	NA	NA	N
19361	BRST RCNSTJ LATSMS DRSI FLAP	MAXFEE	DEF					1050.74	1/1/2000	12/31/2299	N
19364	BRST RCNSTJ FREE FLAP	PRXOVR	DEF					NA	NA	NA	N
19364	BRST RCNSTJ FREE FLAP	MAXFEE	DEF					1503.38	7/1/2008	12/31/2299	N
19366	BREAST RECONSTRUCTION	PRXOVR	DEF					NA	NA	NA	N
19366	BREAST RECONSTRUCTION	MAXFEE	DEF					NA			N
19367	BRST RCNSTJ 1 PDCL TRAM FLAP	PRXOVR	DEF					NA	NA	NA	N
19367	BRST RCNSTJ 1 PDCL TRAM FLAP	MAXFEE	DEF					1237.04	1/1/2000	12/31/2299	N
19368	BRST RCNSTJ 1PDCL TRAM ANAST	PRXOVR	DEF					NA	NA	NA	N
19368	BRST RCNSTJ 1PDCL TRAM ANAST	MAXFEE	DEF					1433.47	1/1/2000	12/31/2299	N
19369	BRST RCNSTJ 2 PDCL TRAM FLAP	PRXOVR	DEF					NA	NA	NA	N
19369	BRST RCNSTJ 2 PDCL TRAM FLAP	MAXFEE	DEF					1360.18	1/1/2000	12/31/2299	N
19370	REVJ PERI-IMPLT CAPSULE BRST	PRXOVR	DEF					NA	NA	NA	N
19370	REVJ PERI-IMPLT CAPSULE BRST	MAXFEE	DEF					389.54	1/1/2000	12/31/2299	N
19371	PERI-IMPLT CAPSLC BRST COMPL	PRXOVR	DEF					NA	NA	NA	N
19371	PERI-IMPLT CAPSLC BRST COMPL	MAXFEE	DEF					470.92	1/1/2000	12/31/2299	N
19380	REVJ RECONSTRUCTED BREAST	PRXOVR	DEF					NA	NA	NA	E
19380	REVJ RECONSTRUCTED BREAST	MAXFEE	DEF					424.03	1/1/2000	12/31/2299	E
19396	DESIGN CUSTOM BREAST IMPLANT	PRXOVR	DEF					NA	NA	NA	E
19396	DESIGN CUSTOM BREAST IMPLANT	MAXFEE	DEF					133.63	1/1/2000	12/31/2299	E
19499	UNLISTED PROCEDURE BREAST	PRXOVR	DEF					NA	NA	NA	N
19499	UNLISTED PROCEDURE BREAST	MANUAL	DEF					NA	NA	NA	N
20000	INCISION OF ABSCESS	PRXOVR	DEF					NA	NA	NA	N
20000	INCISION OF ABSCESS	MAXFEE	DEF					NA			N
20005	I&D ABSCESS SUBFASCIAL	PRXOVR	DEF					NA	NA	NA	N
20005	I&D ABSCESS SUBFASCIAL	MAXFEE	DEF					NA			N
2000F	BLOOD PRESSURE MEASURE	PRXOVR	DEF					NA	NA	NA	N
2000F	BLOOD PRESSURE MEASURE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2001F	WEIGHT RECORD	PRXOVR	DEF					NA	NA	NA	N
2001F	WEIGHT RECORD	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
2002F	CLIN SIGN VOL OVRLD ASSESS	PRXOVR	DEF					NA	NA	NA	N
2002F	CLIN SIGN VOL OVRLD ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2003F	AUSCULTATION HEART PERFORM	PRXOVR	DEF					NA	NA	NA	N
2003F	AUSCULTATION HEART PERFORM	MAXFEE	DEF					NA			N
2004F	INITIAL EXAM INVOLVED JOINTS	PRXOVR	DEF					NA	NA	NA	N
2004F	INITIAL EXAM INVOLVED JOINTS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20100	EXPLORE WOUND NECK	PRXOVR	DEF					NA	NA	NA	N
20100	EXPLORE WOUND NECK	MAXFEE	DEF					415.65	1/1/2000	12/31/2299	N
20101	EXPLORE WOUND CHEST	PRXOVR	DEF					NA	NA	NA	N
20101	EXPLORE WOUND CHEST	MAXFEE	FAC					103.04	1/1/2014	12/31/2299	N
20101	EXPLORE WOUND CHEST	MAXFEE	NFF					217.96	1/1/2014	12/31/2299	N
20102	EXPLORE WOUND ABDOMEN	PRXOVR	DEF					NA	NA	NA	N
20102	EXPLORE WOUND ABDOMEN	MAXFEE	FAC					127.95	1/1/2014	12/31/2299	N
20102	EXPLORE WOUND ABDOMEN	MAXFEE	NFF					235.01	1/1/2014	12/31/2299	N
20103	EXPLORE WOUND EXTREMITY	PRXOVR	DEF					NA	NA	NA	N
20103	EXPLORE WOUND EXTREMITY	MAXFEE	FAC					140.10	1/1/2014	12/31/2299	N
20103	EXPLORE WOUND EXTREMITY	MAXFEE	NFF					223.69	1/1/2014	12/31/2299	N
2010F	VITAL SIGNS RECORDED	PRXOVR	DEF					NA	NA	NA	N
2010F	VITAL SIGNS RECORDED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2014F	MENTAL STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
2014F	MENTAL STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20150	EXCISE EPIPHYSEAL BAR	PRXOVR	DEF					NA	NA	NA	N
20150	EXCISE EPIPHYSEAL BAR	MAXFEE	DEF					689.26	4/1/2008	12/31/2299	N
2015F	ASTHMA IMPAIRMENT ASSESSED	PRXOVR	DEF					NA	NA	NA	N
2015F	ASTHMA IMPAIRMENT ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2016F	ASTHMA RISK ASSESSED	PRXOVR	DEF					NA	NA	NA	N
2016F	ASTHMA RISK ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2018F	HYDRATION STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
2018F	HYDRATION STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2019F	DILATED MACUL EXAM DONE	PRXOVR	DEF					NA	NA	NA	N
2019F	DILATED MACUL EXAM DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20200	MUSCLE BIOPSY	PRXOVR	DEF					NA	NA	NA	N
20200	MUSCLE BIOPSY	MAXFEE	FAC					58.42	1/1/2014	12/31/2299	N
20200	MUSCLE BIOPSY	MAXFEE	NFF					98.65	1/1/2014	12/31/2299	N
20205	DEEP MUSCLE BIOPSY	PRXOVR	DEF					NA	NA	NA	N
20205	DEEP MUSCLE BIOPSY	MAXFEE	FAC					78.13	1/1/2014	12/31/2299	N
20205	DEEP MUSCLE BIOPSY	MAXFEE	NFF					124.38	1/1/2014	12/31/2299	N
20206	NEEDLE BIOPSY MUSCLE	PRXOVR	DEF					NA	NA	NA	N
20206	NEEDLE BIOPSY MUSCLE	MAXFEE	FAC					41.82	1/1/2014	12/31/2299	N
20206	NEEDLE BIOPSY MUSCLE	MAXFEE	NFF					99.66	1/1/2014	12/31/2299	N
2020F	DILATED FUNDUS EVAL DONE	PRXOVR	DEF					NA	NA	NA	N
2020F	DILATED FUNDUS EVAL DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2021F	DILAT MACULAR EXAM DONE	PRXOVR	DEF					NA	NA	NA	N
2021F	DILAT MACULAR EXAM DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20220	BONE BIOPSY TROCAR/NEEDLE	PRXOVR	DEF					NA	NA	NA	N
20220	BONE BIOPSY TROCAR/NEEDLE	MAXFEE	FAC					35.60	1/1/2014	12/31/2299	N
20220	BONE BIOPSY TROCAR/NEEDLE	MAXFEE	NFF					66.39	1/1/2014	12/31/2299	N
20225	BONE BIOPSY TROCAR/NEEDLE	PRXOVR	DEF					NA	NA	NA	N
20225	BONE BIOPSY TROCAR/NEEDLE	MAXFEE	FAC					80.50	1/1/2014	12/31/2299	N
20225	BONE BIOPSY TROCAR/NEEDLE	MAXFEE	NFF					226.13	1/1/2014	12/31/2299	N
2022F	DILAT RTA XM EVC RTNOPTHY	PRXOVR	DEF					NA	NA	NA	N
2022F	DILAT RTA XM EVC RTNOPTHY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20240	BONE BIOPSY OPEN SUPERFICIAL	PRXOVR	DEF					NA	NA	NA	N
20240	BONE BIOPSY OPEN SUPERFICIAL	MAXFEE	DEF					143.71	1/1/2000	12/31/2299	N
20245	BONE BIOPSY OPEN DEEP	PRXOVR	DEF					NA	NA	NA	N
20245	BONE BIOPSY OPEN DEEP	MAXFEE	DEF					343.50	7/1/2008	12/31/2299	N
2024F	7 FLD RTA PHOTO EVC RTNOPTHY	PRXOVR	DEF					NA	NA	NA	N
2024F	7 FLD RTA PHOTO EVC RTNOPTHY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20250	OPEN BONE BIOPSY	PRXOVR	DEF					NA	NA	NA	N
20250	OPEN BONE BIOPSY	MAXFEE	DEF					270.54	1/1/2000	12/31/2299	N
20251	OPEN BONE BIOPSY	PRXOVR	DEF					NA	NA	NA	N
20251	OPEN BONE BIOPSY	MAXFEE	DEF					307.90	1/1/2000	12/31/2299	N
2026F	EYE IMG VALID EVC RTNOPTHY	PRXOVR	DEF					NA	NA	NA	N
2026F	EYE IMG VALID EVC RTNOPTHY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2027F	OPTIC NERVE HEAD EVAL DONE	PRXOVR	DEF					NA	NA	NA	N
2027F	OPTIC NERVE HEAD EVAL DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2028F	FOOT EXAM PERFORMED	PRXOVR	DEF					NA	NA	NA	N
2028F	FOOT EXAM PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2029F	COMPLETE PHYS SKIN EXAM DONE	PRXOVR	DEF					NA	NA	NA	N
2029F	COMPLETE PHYS SKIN EXAM DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2030F	H2O STAT DOCD NORMAL	PRXOVR	DEF					NA	NA	NA	N
2030F	H2O STAT DOCD NORMAL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2031F	H2O STAT DOCD DEHYDRATED	PRXOVR	DEF					NA	NA	NA	N
2031F	H2O STAT DOCD DEHYDRATED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2035F	TYMP MEMB MOTION EXAMD	PRXOVR	DEF					NA	NA	NA	N
2035F	TYMP MEMB MOTION EXAMD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2040F	BK PN XM ON INIT VISIT DATE	PRXOVR	DEF					NA	NA	NA	N
2040F	BK PN XM ON INIT VISIT DATE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2044F	DOC MNTL TST B/4 BK TRXMNT	PRXOVR	DEF					NA	NA	NA	N
2044F	DOC MNTL TST B/4 BK TRXMNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20500	INJECTION OF SINUS TRACT	PRXOVR	DEF					NA	NA	NA	N
20500	INJECTION OF SINUS TRACT	MAXFEE	FAC					67.40	1/1/2014	12/31/2299	N
20500	INJECTION OF SINUS TRACT	MAXFEE	NFF					92.92	1/1/2014	12/31/2299	N
20501	INJECT SINUS TRACT FOR X-RAY	PRXOVR	DEF					NA	NA	NA	N
20501	INJECT SINUS TRACT FOR X-RAY	MAXFEE	FAC					28	1/1/2014	12/31/2299	N
20501	INJECT SINUS TRACT FOR X-RAY	MAXFEE	NFF					49.45	1/1/2014	12/31/2299	N
2050F	WOUND CHAR SIZE ETC DOCD	PRXOVR	DEF					NA	NA	NA	N
2050F	WOUND CHAR SIZE ETC DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20520	REMOVAL OF FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
20520	REMOVAL OF FOREIGN BODY	MAXFEE	FAC					85.99	1/1/2014	12/31/2299	N
20520	REMOVAL OF FOREIGN BODY	MAXFEE	NFF					115.14	1/1/2014	12/31/2299	N
20525	REMOVAL OF FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
20525	REMOVAL OF FOREIGN BODY	MAXFEE	FAC					119.82	1/1/2014	12/31/2299	N
20525	REMOVAL OF FOREIGN BODY	MAXFEE	NFF					169.81	1/1/2014	12/31/2299	N
20526	THER INJECTION CARP TUNNEL	PRXOVR	DEF					NA	NA	NA	N
20526	THER INJECTION CARP TUNNEL	MAXFEE	FAC					33.34	1/1/2014	12/31/2299	N
20526	THER INJECTION CARP TUNNEL	MAXFEE	NFF					44.53	1/1/2014	12/31/2299	N
20527	INJ DUPUYTREN CORD W/ENZYME	PRXOVR	DEF					NA	NA	NA	N
20527	INJ DUPUYTREN CORD W/ENZYME	MAXFEE	FAC					21.08	1/1/2014	12/31/2299	N
20527	INJ DUPUYTREN CORD W/ENZYME	MAXFEE	NFF					27.63	1/1/2014	12/31/2299	N
20550	INJ TENDON SHEATH/LIGAMENT	PRXOVR	DEF					NA	NA	NA	N
20550	INJ TENDON SHEATH/LIGAMENT	MAXFEE	FAC					32.70	1/1/2014	12/31/2299	N
20550	INJ TENDON SHEATH/LIGAMENT	MAXFEE	NFF					41.82	1/1/2014	12/31/2299	N
20551	INJ TENDON ORIGIN/INSERTION	PRXOVR	DEF					NA	NA	NA	N
20551	INJ TENDON ORIGIN/INSERTION	MAXFEE	FAC					33.71	1/1/2014	12/31/2299	N
20551	INJ TENDON ORIGIN/INSERTION	MAXFEE	NFF					44.53	1/1/2014	12/31/2299	N
20552	INJ TRIGGER POINT 1/2 MUSCL	PRXOVR	DEF					NA	NA	NA	N
20552	INJ TRIGGER POINT 1/2 MUSCL	MAXFEE	FAC					26.77	1/1/2014	12/31/2299	N
20552	INJ TRIGGER POINT 1/2 MUSCL	MAXFEE	NFF					42.08	1/1/2014	12/31/2299	N
20553	INJECT TRIGGER POINTS 3/>	PRXOVR	DEF					NA	NA	NA	N
20553	INJECT TRIGGER POINTS 3/>	MAXFEE	FAC					33.88	1/1/2014	12/31/2299	N
20553	INJECT TRIGGER POINTS 3/>	MAXFEE	NFF					44.53	1/1/2014	12/31/2299	N
20555	PLACE NDL MUSC/TIS FOR RT	PRXOVR	DEF					NA	NA	NA	N
20555	PLACE NDL MUSC/TIS FOR RT	MAXFEE	DEF					197.78	1/1/2008	12/31/2299	N
20560	NDL INSJ W/O NJX 1 OR 2 MUSC	PRXOVR	DEF					NA	NA	NA	N
20560	NDL INSJ W/O NJX 1 OR 2 MUSC	MAXFEE	FAC					11.85	7/1/2021	12/31/2299	N
20560	NDL INSJ W/O NJX 1 OR 2 MUSC	MAXFEE	NFF					18.95	7/1/2021	12/31/2299	N
20561	NDL INSJ W/O NJX 3+ MUSC	PRXOVR	DEF					NA	NA	NA	N
20561	NDL INSJ W/O NJX 3+ MUSC	MAXFEE	FAC					17.87	7/1/2021	12/31/2299	N
20561	NDL INSJ W/O NJX 3+ MUSC	MAXFEE	NFF					27.81	7/1/2021	12/31/2299	N
20600	DRAIN/INJ JOINT/BURSA W/O US	PRXOVR	DEF					NA	NA	NA	N
20600	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	FAC					24.41	1/1/2014	12/31/2299	N
20600	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	NFF					36.77	1/1/2014	12/31/2299	N
20604	DRAIN/INJ JOINT/BURSA W/US	PRXOVR	DEF					NA	NA	NA	N
20604	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	FAC					36.16	1/1/2015	12/31/2299	N
20604	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	NFF					55.35	1/1/2015	12/31/2299	N
20605	DRAIN/INJ JOINT/BURSA W/O US	PRXOVR	DEF					NA	NA	NA	N
20605	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	FAC					36.82	1/1/2014	12/31/2299	N
20605	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	NFF					40.43	1/1/2014	12/31/2299	N
20606	DRAIN/INJ JOINT/BURSA W/US	PRXOVR	DEF					NA	NA	NA	N
20606	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	FAC					40.89	1/1/2015	12/31/2299	N
20606	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	NFF					60.87	1/1/2015	12/31/2299	N
2060F	PT TALK EVAL HLTHWKR RE MDD	PRXOVR	DEF					NA	NA	NA	N
2060F	PT TALK EVAL HLTHWKR RE MDD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20610	DRAIN/INJ JOINT/BURSA W/O US	PRXOVR	DEF					NA	NA	NA	N
20610	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	FAC					28.41	1/1/2014	12/31/2299	N
20610	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	NFF					48.91	1/1/2014	12/31/2299	N
20611	DRAIN/INJ JOINT/BURSA W/US	PRXOVR	DEF					NA	NA	NA	N
20611	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	FAC					48.04	1/1/2015	12/31/2299	N
20611	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	NFF					69.87	1/1/2015	12/31/2299	N
20612	ASPIRATE/INJ GANGLION CYST	PRXOVR	DEF					NA	NA	NA	N
20612	ASPIRATE/INJ GANGLION CYST	MAXFEE	FAC					29.98	1/1/2014	12/31/2299	N
20612	ASPIRATE/INJ GANGLION CYST	MAXFEE	NFF					38.40	1/1/2014	12/31/2299	N
20615	TREATMENT OF BONE CYST	PRXOVR	DEF					NA	NA	NA	N
20615	TREATMENT OF BONE CYST	MAXFEE	FAC					64.23	1/1/2014	12/31/2299	N
20615	TREATMENT OF BONE CYST	MAXFEE	NFF					88.18	1/1/2014	12/31/2299	N
20650	INSERT AND REMOVE BONE PIN	PRXOVR	DEF					NA	NA	NA	N
20650	INSERT AND REMOVE BONE PIN	MAXFEE	FAC					66.28	1/1/2014	12/31/2299	N
20650	INSERT AND REMOVE BONE PIN	MAXFEE	NFF					97.34	1/1/2014	12/31/2299	N
20660	APPLY REM FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20660	APPLY REM FIXATION DEVICE	MAXFEE	DEF					108.71	1/1/2004	12/31/2299	N
20661	APPLICATION OF HEAD BRACE	PRXOVR	DEF					NA	NA	NA	N
20661	APPLICATION OF HEAD BRACE	MAXFEE	DEF					249.65	1/1/2004	12/31/2299	N
20662	APPLICATION OF PELVIS BRACE	PRXOVR	DEF					NA	NA	NA	N
20662	APPLICATION OF PELVIS BRACE	MAXFEE	DEF					338.43	1/1/2004	12/31/2299	N
20663	APPLICATION OF THIGH BRACE	PRXOVR	DEF					NA	NA	NA	N
20663	APPLICATION OF THIGH BRACE	MAXFEE	DEF					272.05	1/1/2004	12/31/2299	N
20664	APPLICATION OF HALO	PRXOVR	DEF					NA	NA	NA	N
20664	APPLICATION OF HALO	MAXFEE	DEF					395.56	7/1/2008	12/31/2299	N
20665	REMOVAL OF FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20665	REMOVAL OF FIXATION DEVICE	MAXFEE	FAC					69.74	1/1/2014	12/31/2299	N
20665	REMOVAL OF FIXATION DEVICE	MAXFEE	NFF					95.93	1/1/2014	12/31/2299	N
20670	REMOVAL OF SUPPORT IMPLANT	PRXOVR	DEF					NA	NA	NA	N
20670	REMOVAL OF SUPPORT IMPLANT	MAXFEE	FAC					73.84	1/1/2014	12/31/2299	N
20670	REMOVAL OF SUPPORT IMPLANT	MAXFEE	NFF					166	1/1/2014	12/31/2299	N
20680	REMOVAL OF SUPPORT IMPLANT	PRXOVR	DEF					NA	NA	NA	N
20680	REMOVAL OF SUPPORT IMPLANT	MAXFEE	FAC					149.32	1/1/2014	12/31/2299	N
20680	REMOVAL OF SUPPORT IMPLANT	MAXFEE	NFF					272.23	1/1/2014	12/31/2299	N
20690	APPLY BONE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20690	APPLY BONE FIXATION DEVICE	MAXFEE	DEF					267.50	12/31/2014	12/31/2299	N
20692	APPLY BONE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20692	APPLY BONE FIXATION DEVICE	MAXFEE	DEF					504.11	12/31/2014	12/31/2299	N
20693	ADJUST BONE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20693	ADJUST BONE FIXATION DEVICE	MAXFEE	DEF					254.36	7/1/2008	12/31/2299	N
20694	REMOVE BONE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20694	REMOVE BONE FIXATION DEVICE	MAXFEE	FAC					131.29	1/1/2014	12/31/2299	N
20694	REMOVE BONE FIXATION DEVICE	MAXFEE	NFF					201.41	1/1/2014	12/31/2299	N
20696	COMP MULTIPLANE EXT FIXATION	PRXOVR	DEF					NA	NA	NA	N
20696	COMP MULTIPLANE EXT FIXATION	MAXFEE	DEF					793.95	1/1/2009	12/31/2299	N
20697	COMP EXT FIXATE STRUT CHANGE	PRXOVR	DEF					NA	NA	NA	N
20697	COMP EXT FIXATE STRUT CHANGE	MAXFEE	DEF					863.02	1/1/2009	12/31/2299	N
20700	MNL PREP&INSJ DP RX DLVR DEV	PRXOVR	DEF					NA	NA	NA	N
20700	MNL PREP&INSJ DP RX DLVR DEV	MAXFEE	DEF					68.83	1/1/2020	12/31/2299	N
20701	RMVL DEEP RX DELIVERY DEVICE	PRXOVR	DEF					NA	NA	NA	N
20701	RMVL DEEP RX DELIVERY DEVICE	MAXFEE	DEF					51.32	1/1/2020	12/31/2299	N
20702	MNL PREP&INSJ IMED RX DEV	PRXOVR	DEF					NA	NA	NA	N
20702	MNL PREP&INSJ IMED RX DEV	MAXFEE	DEF					114.57	1/1/2020	12/31/2299	N
20703	RMVL IMED RX DELIVERY DEVICE	PRXOVR	DEF					NA	NA	NA	N
20703	RMVL IMED RX DELIVERY DEVICE	MAXFEE	DEF					82.06	1/1/2020	12/31/2299	N
20704	MNL PREP&INSJ I-ARTIC RX DEV	PRXOVR	DEF					NA	NA	NA	N
20704	MNL PREP&INSJ I-ARTIC RX DEV	MAXFEE	DEF					119.36	1/1/2020	12/31/2299	N
20705	RMVL I-ARTIC RX DELIVERY DEV	PRXOVR	DEF					NA	NA	NA	N
20705	RMVL I-ARTIC RX DELIVERY DEV	MAXFEE	DEF					98.17	1/1/2020	12/31/2299	N
20802	REPLANTATION ARM COMPLETE	PRXOVR	DEF					NA	NA	NA	N
20802	REPLANTATION ARM COMPLETE	MAXFEE	DEF					2094.16	1/1/2000	12/31/2299	N
20805	REPLANT FOREARM COMPLETE	PRXOVR	DEF					NA	NA	NA	N
20805	REPLANT FOREARM COMPLETE	MAXFEE	DEF					2616.58	1/1/2000	12/31/2299	N
20808	REPLANTATION HAND COMPLETE	PRXOVR	DEF					NA	NA	NA	N
20808	REPLANTATION HAND COMPLETE	MAXFEE	DEF					3169.36	1/1/2000	12/31/2299	N
20816	REPLANTATION DIGIT COMPLETE	PRXOVR	DEF					NA	NA	NA	N
20816	REPLANTATION DIGIT COMPLETE	MAXFEE	DEF					1704.98	1/1/2000	12/31/2299	N
20822	REPLANTATION DIGIT COMPLETE	PRXOVR	DEF					NA	NA	NA	N
20822	REPLANTATION DIGIT COMPLETE	MAXFEE	DEF					1433.36	1/1/2000	12/31/2299	N
20824	REPLANTATION THUMB COMPLETE	PRXOVR	DEF					NA	NA	NA	N
20824	REPLANTATION THUMB COMPLETE	MAXFEE	DEF					1677.77	1/1/2000	12/31/2299	N
20827	REPLANTATION THUMB COMPLETE	PRXOVR	DEF					NA	NA	NA	N
20827	REPLANTATION THUMB COMPLETE	MAXFEE	DEF					1470.02	1/1/2000	12/31/2299	N
20838	REPLANTATION FOOT COMPLETE	PRXOVR	DEF					NA	NA	NA	N
20838	REPLANTATION FOOT COMPLETE	MAXFEE	DEF					2142.08	1/1/2000	12/31/2299	N
20900	REMOVAL OF BONE FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20900	REMOVAL OF BONE FOR GRAFT	MAXFEE	FAC					126.70	1/1/2014	12/31/2299	N
20900	REMOVAL OF BONE FOR GRAFT	MAXFEE	NFF					226.45	1/1/2014	12/31/2299	N
20902	REMOVAL OF BONE FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20902	REMOVAL OF BONE FOR GRAFT	MAXFEE	DEF					276.60	9/1/2013	12/31/2299	N
20910	REMOVE CARTILAGE FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20910	REMOVE CARTILAGE FOR GRAFT	MAXFEE	DEF					233.70	7/1/2008	12/31/2299	N
20912	REMOVE CARTILAGE FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20912	REMOVE CARTILAGE FOR GRAFT	MAXFEE	DEF					306.28	1/1/2000	12/31/2299	N
20920	REMOVAL OF FASCIA FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20920	REMOVAL OF FASCIA FOR GRAFT	MAXFEE	DEF					254	1/1/2000	12/31/2299	N
20922	REMOVAL OF FASCIA FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20922	REMOVAL OF FASCIA FOR GRAFT	MAXFEE	FAC					230.07	1/1/2014	12/31/2299	N
20922	REMOVAL OF FASCIA FOR GRAFT	MAXFEE	NFF					315.03	1/1/2014	12/31/2299	N
20924	REMOVAL OF TENDON FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20924	REMOVAL OF TENDON FOR GRAFT	MAXFEE	DEF					329.88	1/1/2000	12/31/2299	N
20926	REMOVAL OF TISSUE FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20926	REMOVAL OF TISSUE FOR GRAFT	MAXFEE	DEF					NA			N
20931	SP BONE ALGRFT STRUCT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
20931	SP BONE ALGRFT STRUCT ADD-ON	MAXFEE	DEF					95.02	1/1/2000	12/31/2299	N
20932	OSTEOART ALGRFT W/SURF & B1	PRXOVR	DEF					NA	NA	NA	N
20932	OSTEOART ALGRFT W/SURF & B1	MAXFEE	DEF					579.38	1/1/2019	12/31/2299	N
20933	HEMICRT INTRCLRY ALGRFT PRTL	PRXOVR	DEF					NA	NA	NA	N
20933	HEMICRT INTRCLRY ALGRFT PRTL	MAXFEE	DEF					531.41	1/1/2019	12/31/2299	N
20934	INTERCALARY ALGRFT COMPL	PRXOVR	DEF					NA	NA	NA	N
20934	INTERCALARY ALGRFT COMPL	MAXFEE	DEF					579.09	1/1/2019	12/31/2299	N
20937	SP BONE AGRFT MORSEL ADD-ON	PRXOVR	DEF					NA	NA	NA	N
20937	SP BONE AGRFT MORSEL ADD-ON	MAXFEE	DEF					145.48	1/1/2000	12/31/2299	N
20938	SP BONE AGRFT STRUCT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
20938	SP BONE AGRFT STRUCT ADD-ON	MAXFEE	DEF					157.27	1/1/2000	12/31/2299	N
20939	BONE MARROW ASPIR BONE GRFG	PRXOVR	DEF					NA	NA	NA	N
20939	BONE MARROW ASPIR BONE GRFG	MAXFEE	DEF					54.15	1/1/2018	12/31/2299	N
20950	FLUID PRESSURE MUSCLE	PRXOVR	DEF					NA	NA	NA	N
20950	FLUID PRESSURE MUSCLE	MAXFEE	FAC					45.08	1/1/2014	12/31/2299	N
20950	FLUID PRESSURE MUSCLE	MAXFEE	NFF					110.84	1/1/2014	12/31/2299	N
20955	FIBULA BONE GRAFT MICROVASC	PRXOVR	DEF					NA	NA	NA	N
20955	FIBULA BONE GRAFT MICROVASC	MAXFEE	DEF					2021.90	1/1/2000	12/31/2299	N
20956	ILIAC BONE GRAFT MICROVASC	PRXOVR	DEF					NA	NA	NA	N
20956	ILIAC BONE GRAFT MICROVASC	MAXFEE	DEF					1822.62	4/1/2008	12/31/2299	N
20957	MT BONE GRAFT MICROVASC	PRXOVR	DEF					NA	NA	NA	N
20957	MT BONE GRAFT MICROVASC	MAXFEE	DEF					1844.51	4/1/2008	12/31/2299	N
20962	OTHER BONE GRAFT MICROVASC	PRXOVR	DEF					NA	NA	NA	N
20962	OTHER BONE GRAFT MICROVASC	MAXFEE	DEF					1900.53	1/1/2004	12/31/2299	N
20969	BONE/SKIN GRAFT MICROVASC	PRXOVR	DEF					NA	NA	NA	N
20969	BONE/SKIN GRAFT MICROVASC	MAXFEE	DEF					2249.66	1/1/2004	12/31/2299	N
20970	BONE/SKIN GRAFT ILIAC CREST	PRXOVR	DEF					NA	NA	NA	N
20970	BONE/SKIN GRAFT ILIAC CREST	MAXFEE	DEF					2196.74	1/1/2004	12/31/2299	N
20972	BONE/SKIN GRAFT METATARSAL	PRXOVR	DEF					NA	NA	NA	N
20972	BONE/SKIN GRAFT METATARSAL	MAXFEE	DEF					2160.77	4/1/2008	12/31/2299	N
20973	BONE/SKIN GRAFT GREAT TOE	PRXOVR	DEF					NA	NA	NA	N
20973	BONE/SKIN GRAFT GREAT TOE	MAXFEE	DEF					2333.22	1/1/2004	12/31/2299	N
20974	ELECTRICAL BONE STIMULATION	PRXOVR	DEF					NA	NA	NA	N
20974	ELECTRICAL BONE STIMULATION	MAXFEE	FAC					33.87	1/1/2014	12/31/2299	N
20974	ELECTRICAL BONE STIMULATION	MAXFEE	NFF					38.79	1/1/2014	12/31/2299	N
20975	ELECTRICAL BONE STIMULATION	PRXOVR	DEF					NA	NA	NA	N
20975	ELECTRICAL BONE STIMULATION	MAXFEE	DEF					144.52	12/15/2005	12/31/2299	N
20979	US BONE STIMULATION	PRXOVR	DEF					NA	NA	NA	N
20979	US BONE STIMULATION	MAXFEE	FAC					25.88	1/1/2014	12/31/2299	N
20979	US BONE STIMULATION	MAXFEE	NFF					36.97	1/1/2014	12/31/2299	N
20982	ABLATE BONE TUMOR(S) PERQ	PRXOVR	DEF					NA	NA	NA	N
20982	ABLATE BONE TUMOR(S) PERQ	MAXFEE	FAC					298.81	1/1/2014	12/31/2299	N
20982	ABLATE BONE TUMOR(S) PERQ	MAXFEE	NFF					2850.06	1/1/2014	12/31/2299	N
20983	ABLATE BONE TUMOR(S) PERQ	PRXOVR	DEF					NA	NA	NA	N
20983	ABLATE BONE TUMOR(S) PERQ	MAXFEE	FAC					318.22	1/1/2015	12/31/2299	N
20983	ABLATE BONE TUMOR(S) PERQ	MAXFEE	NFF					5181.80	1/1/2015	12/31/2299	N
20985	CPTR-ASST DIR MS PX	PRXOVR	DEF					NA	NA	NA	N
20985	CPTR-ASST DIR MS PX	MAXFEE	DEF					92.78	1/1/2008	12/31/2299	N
20986	CPTR-ASST DIR MS PX IO IMG	PRXOVR	DEF					NA	NA	NA	N
20986	CPTR-ASST DIR MS PX IO IMG	MANUAL	DEF					NA	NA	NA	N
20987	CPTR-ASST DIR MS PX PRE IMG	PRXOVR	DEF					NA	NA	NA	N
20987	CPTR-ASST DIR MS PX PRE IMG	MANUAL	DEF					NA	NA	NA	N
20999	UNLISTED PX MUSCSKEL GENERAL	PRXOVR	DEF					NA	NA	NA	N
20999	UNLISTED PX MUSCSKEL GENERAL	MANUAL	DEF					NA	NA	NA	N
21010	INCISION OF JAW JOINT	PRXOVR	DEF					NA	NA	NA	N
21010	INCISION OF JAW JOINT	MAXFEE	DEF					532.99	1/1/2000	12/31/2299	N
21011	EXC FACE LES SC <2 CM	PRXOVR	DEF					NA	NA	NA	N
21011	EXC FACE LES SC <2 CM	MAXFEE	FAC					89.83	1/1/2014	12/31/2299	N
21011	EXC FACE LES SC <2 CM	MAXFEE	NFF					133.17	1/1/2014	12/31/2299	N
21012	EXC FACE LES SBQ 2 CM/>	PRXOVR	DEF					NA	NA	NA	N
21012	EXC FACE LES SBQ 2 CM/>	MAXFEE	DEF					183.31	1/1/2010	12/31/2299	N
21013	EXC FACE TUM DEEP < 2 CM	PRXOVR	DEF					NA	NA	NA	N
21013	EXC FACE TUM DEEP < 2 CM	MAXFEE	FAC					155.15	1/1/2014	12/31/2299	N
21013	EXC FACE TUM DEEP < 2 CM	MAXFEE	NFF					215.88	1/1/2014	12/31/2299	N
21014	EXC FACE TUM DEEP 2 CM/>	PRXOVR	DEF					NA	NA	NA	N
21014	EXC FACE TUM DEEP 2 CM/>	MAXFEE	DEF					283.58	1/1/2010	12/31/2299	N
21015	RESECT FACE/SCALP TUM < 2 CM	PRXOVR	DEF					NA	NA	NA	N
21015	RESECT FACE/SCALP TUM < 2 CM	MAXFEE	DEF					319.48	1/1/2004	12/31/2299	N
21016	RESECT FACE/SCALP TUM 2 CM/>	PRXOVR	DEF					NA	NA	NA	N
21016	RESECT FACE/SCALP TUM 2 CM/>	MAXFEE	DEF					574.10	1/1/2010	12/31/2299	N
21025	EXCISION OF BONE LOWER JAW	PRXOVR	DEF					NA	NA	NA	N
21025	EXCISION OF BONE LOWER JAW	MAXFEE	FAC					395.77	1/1/2014	12/31/2299	N
21025	EXCISION OF BONE LOWER JAW	MAXFEE	NFF					516.94	1/1/2014	12/31/2299	N
21026	EXCISION OF FACIAL BONE(S)	PRXOVR	DEF					NA	NA	NA	N
21026	EXCISION OF FACIAL BONE(S)	MAXFEE	FAC					174.07	1/1/2014	12/31/2299	N
21026	EXCISION OF FACIAL BONE(S)	MAXFEE	NFF					258.22	1/1/2014	12/31/2299	N
21029	CONTOUR OF FACE BONE LESION	PRXOVR	DEF					NA	NA	NA	N
21029	CONTOUR OF FACE BONE LESION	MAXFEE	FAC					319.87	1/1/2014	12/31/2299	N
21029	CONTOUR OF FACE BONE LESION	MAXFEE	NFF					427.22	1/1/2014	12/31/2299	N
21030	EXCISE MAX/ZYGOMA B9 TUMOR	PRXOVR	DEF					NA	NA	NA	N
21030	EXCISE MAX/ZYGOMA B9 TUMOR	MAXFEE	FAC					199.88	1/1/2014	12/31/2299	N
21030	EXCISE MAX/ZYGOMA B9 TUMOR	MAXFEE	NFF					272.33	1/1/2014	12/31/2299	N
21031	REMOVE EXOSTOSIS MANDIBLE	PRXOVR	DEF					NA	NA	NA	N
21031	REMOVE EXOSTOSIS MANDIBLE	MAXFEE	FAC					133.30	1/1/2014	12/31/2299	N
21031	REMOVE EXOSTOSIS MANDIBLE	MAXFEE	NFF					191.15	1/1/2014	12/31/2299	N
21032	REMOVE EXOSTOSIS MAXILLA	PRXOVR	DEF					NA	NA	NA	N
21032	REMOVE EXOSTOSIS MAXILLA	MAXFEE	FAC					135.12	1/1/2014	12/31/2299	N
21032	REMOVE EXOSTOSIS MAXILLA	MAXFEE	NFF					194.57	1/1/2014	12/31/2299	N
21034	EXCISE MAX/ZYGOMA MAL TUMOR	PRXOVR	DEF					NA	NA	NA	N
21034	EXCISE MAX/ZYGOMA MAL TUMOR	MAXFEE	FAC					466.06	1/1/2014	12/31/2299	N
21034	EXCISE MAX/ZYGOMA MAL TUMOR	MAXFEE	NFF					641.57	1/1/2014	12/31/2299	N
21040	EXCISE MANDIBLE LESION	PRXOVR	DEF					NA	NA	NA	N
21040	EXCISE MANDIBLE LESION	MAXFEE	FAC					145.82	1/1/2014	12/31/2299	N
21040	EXCISE MANDIBLE LESION	MAXFEE	NFF					210.26	1/1/2014	12/31/2299	N
21044	REMOVAL OF JAW BONE LESION	PRXOVR	DEF					NA	NA	NA	N
21044	REMOVAL OF JAW BONE LESION	MAXFEE	DEF					569.59	1/1/2000	12/31/2299	N
21045	EXTENSIVE JAW SURGERY	PRXOVR	DEF					NA	NA	NA	N
21045	EXTENSIVE JAW SURGERY	MAXFEE	DEF					791.67	1/1/2000	12/31/2299	N
21046	REMOVE MANDIBLE CYST COMPLEX	PRXOVR	DEF					NA	NA	NA	N
21046	REMOVE MANDIBLE CYST COMPLEX	MAXFEE	DEF					613.58	1/1/2004	12/31/2299	N
21047	EXCISE LWR JAW CYST W/REPAIR	PRXOVR	DEF					NA	NA	NA	N
21047	EXCISE LWR JAW CYST W/REPAIR	MAXFEE	DEF					760.42	1/1/2004	12/31/2299	N
21048	REMOVE MAXILLA CYST COMPLEX	PRXOVR	DEF					NA	NA	NA	N
21048	REMOVE MAXILLA CYST COMPLEX	MAXFEE	DEF					631.48	7/1/2003	12/31/2299	N
21049	EXCIS UPPR JAW CYST W/REPAIR	PRXOVR	DEF					NA	NA	NA	N
21049	EXCIS UPPR JAW CYST W/REPAIR	MAXFEE	DEF					720.46	7/1/2003	12/31/2299	N
21050	REMOVAL OF JAW JOINT	PRXOVR	DEF					NA	NA	NA	N
21050	REMOVAL OF JAW JOINT	MAXFEE	DEF					608.02	1/1/2000	12/31/2299	N
21060	REMOVE JAW JOINT CARTILAGE	PRXOVR	DEF					NA	NA	NA	N
21060	REMOVE JAW JOINT CARTILAGE	MAXFEE	DEF					568.62	1/1/2000	12/31/2299	N
21070	REMOVE CORONOID PROCESS	PRXOVR	DEF					NA	NA	NA	N
21070	REMOVE CORONOID PROCESS	MAXFEE	DEF					403.09	1/1/2000	12/31/2299	N
21073	MNPJ OF TMJ W/ANESTH	PRXOVR	DEF					NA	NA	NA	N
21073	MNPJ OF TMJ W/ANESTH	MAXFEE	FAC					131.27	1/1/2014	12/31/2299	N
21073	MNPJ OF TMJ W/ANESTH	MAXFEE	NFF					217.07	1/1/2014	12/31/2299	N
21076	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21076	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					558.46	1/1/2014	12/31/2299	N
21076	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					726.79	1/1/2014	12/31/2299	N
21077	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21077	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					1411.97	1/1/2014	12/31/2299	N
21077	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					1827.48	1/1/2014	12/31/2299	N
21079	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21079	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					744.54	1/1/2014	12/31/2299	N
21079	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					1025.57	1/1/2014	12/31/2299	N
21080	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21080	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					858.80	1/1/2014	12/31/2299	N
21080	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					1171.37	1/1/2014	12/31/2299	N
21081	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21081	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					774.10	1/1/2014	12/31/2299	N
21081	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					1056.18	1/1/2014	12/31/2299	N
21082	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21082	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					662.53	1/1/2014	12/31/2299	N
21082	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					932.95	1/1/2014	12/31/2299	N
21083	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21083	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					639.52	1/1/2014	12/31/2299	N
21083	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					900.52	1/1/2014	12/31/2299	N
21084	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21084	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					740.64	1/1/2014	12/31/2299	N
21084	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					1032.57	1/1/2014	12/31/2299	N
21085	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21085	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					307.13	1/1/2014	12/31/2299	N
21085	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					402.91	1/1/2014	12/31/2299	N
21086	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21086	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					842.35	1/1/2014	12/31/2299	N
21086	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					1146.21	1/1/2014	12/31/2299	N
21087	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21087	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	FAC					826.56	1/1/2014	12/31/2299	N
21087	PREPARE FACE/ORAL PROSTHESIS	MAXFEE	NFF					1125.71	1/1/2014	12/31/2299	N
21088	PREPARE FACE/ORAL PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
21088	PREPARE FACE/ORAL PROSTHESIS	MANUAL	DEF					NA	NA	NA	N
21100	MAXILLOFACIAL FIXATION	PRXOVR	DEF					NA	NA	NA	N
21100	MAXILLOFACIAL FIXATION	MAXFEE	FAC					203.23	1/1/2014	12/31/2299	N
21100	MAXILLOFACIAL FIXATION	MAXFEE	NFF					262.54	1/1/2014	12/31/2299	N
21110	INTERDENTAL FIXATION	PRXOVR	DEF					NA	NA	NA	N
21110	INTERDENTAL FIXATION	MAXFEE	FAC					530.70	10/1/2014	12/31/2299	N
21110	INTERDENTAL FIXATION	MAXFEE	NFF					630.08	10/1/2014	12/31/2299	N
21116	INJECTION JAW JOINT X-RAY	PRXOVR	DEF					NA	NA	NA	N
21116	INJECTION JAW JOINT X-RAY	MAXFEE	FAC					29.60	1/1/2014	12/31/2299	N
21116	INJECTION JAW JOINT X-RAY	MAXFEE	NFF					64.96	1/1/2014	12/31/2299	N
21120	RECONSTRUCTION OF CHIN	PRXOVR	DEF					NA	NA	NA	N
21120	RECONSTRUCTION OF CHIN	MAXFEE	FAC					194.75	1/1/2014	12/31/2299	N
21120	RECONSTRUCTION OF CHIN	MAXFEE	NFF					271.51	1/1/2014	12/31/2299	N
21121	RECONSTRUCTION OF CHIN	PRXOVR	DEF					NA	NA	NA	N
21121	RECONSTRUCTION OF CHIN	MAXFEE	FAC					269.71	1/1/2014	12/31/2299	N
21121	RECONSTRUCTION OF CHIN	MAXFEE	NFF					367.13	1/1/2014	12/31/2299	N
21122	RECONSTRUCTION OF CHIN	PRXOVR	DEF					NA	NA	NA	N
21122	RECONSTRUCTION OF CHIN	MAXFEE	DEF					410.55	1/1/2004	12/31/2299	N
21123	RECONSTRUCTION OF CHIN	PRXOVR	DEF					NA	NA	NA	N
21123	RECONSTRUCTION OF CHIN	MAXFEE	DEF					520.14	1/1/2004	12/31/2299	N
21125	AUGMENTATION LOWER JAW BONE	PRXOVR	DEF					NA	NA	NA	N
21125	AUGMENTATION LOWER JAW BONE	MAXFEE	FAC					406.30	1/1/2014	12/31/2299	N
21125	AUGMENTATION LOWER JAW BONE	MAXFEE	NFF					1016.42	1/1/2014	12/31/2299	N
21127	AUGMENTATION LOWER JAW BONE	PRXOVR	DEF					NA	NA	NA	N
21127	AUGMENTATION LOWER JAW BONE	MAXFEE	FAC					517.63	1/1/2014	12/31/2299	N
21127	AUGMENTATION LOWER JAW BONE	MAXFEE	NFF					1147.21	1/1/2014	12/31/2299	N
21137	REDUCTION OF FOREHEAD	PRXOVR	DEF					NA	NA	NA	N
21137	REDUCTION OF FOREHEAD	MAXFEE	DEF					458.48	4/1/2008	12/31/2299	N
21138	REDUCTION OF FOREHEAD	PRXOVR	DEF					NA	NA	NA	N
21138	REDUCTION OF FOREHEAD	MAXFEE	DEF					566.39	4/1/2008	12/31/2299	N
21139	REDUCTION OF FOREHEAD	PRXOVR	DEF					NA	NA	NA	N
21139	REDUCTION OF FOREHEAD	MAXFEE	DEF					665.17	4/1/2008	12/31/2299	N
21141	LEFORT I-1 PIECE W/O GRAFT	PRXOVR	DEF					NA	NA	NA	N
21141	LEFORT I-1 PIECE W/O GRAFT	MAXFEE	DEF					855.57	1/1/2000	12/31/2299	N
21142	LEFORT I-2 PIECE W/O GRAFT	PRXOVR	DEF					NA	NA	NA	N
21142	LEFORT I-2 PIECE W/O GRAFT	MAXFEE	DEF					889.53	1/1/2000	12/31/2299	N
21143	LEFORT I-3/> PIECE W/O GRAFT	PRXOVR	DEF					NA	NA	NA	N
21143	LEFORT I-3/> PIECE W/O GRAFT	MAXFEE	DEF					924.15	1/1/2000	12/31/2299	N
21145	LEFORT I-1 PIECE W/ GRAFT	PRXOVR	DEF					NA	NA	NA	N
21145	LEFORT I-1 PIECE W/ GRAFT	MAXFEE	DEF					912.07	1/1/2000	12/31/2299	N
21146	LEFORT I-2 PIECE W/ GRAFT	PRXOVR	DEF					NA	NA	NA	N
21146	LEFORT I-2 PIECE W/ GRAFT	MAXFEE	DEF					946.35	1/1/2000	12/31/2299	N
21147	LEFORT I-3/> PIECE W/ GRAFT	PRXOVR	DEF					NA	NA	NA	N
21147	LEFORT I-3/> PIECE W/ GRAFT	MAXFEE	DEF					990.35	1/1/2000	12/31/2299	N
21150	LEFORT II ANTERIOR INTRUSION	PRXOVR	DEF					NA	NA	NA	N
21150	LEFORT II ANTERIOR INTRUSION	MAXFEE	DEF					1177.19	4/1/2008	12/31/2299	N
21151	LEFORT II W/BONE GRAFTS	PRXOVR	DEF					NA	NA	NA	N
21151	LEFORT II W/BONE GRAFTS	MAXFEE	DEF					1300.61	1/1/2000	12/31/2299	N
21154	LEFORT III W/O LEFORT I	PRXOVR	DEF					NA	NA	NA	N
21154	LEFORT III W/O LEFORT I	MAXFEE	DEF					1415.22	1/1/2000	12/31/2299	N
21155	LEFORT III W/ LEFORT I	PRXOVR	DEF					NA	NA	NA	N
21155	LEFORT III W/ LEFORT I	MAXFEE	DEF					1578.36	1/1/2000	12/31/2299	N
21159	LEFORT III W/FHDW/O LEFORT I	PRXOVR	DEF					NA	NA	NA	N
21159	LEFORT III W/FHDW/O LEFORT I	MAXFEE	DEF					1956.16	1/1/2000	12/31/2299	N
21160	LEFORT III W/FHD W/ LEFORT I	PRXOVR	DEF					NA	NA	NA	N
21160	LEFORT III W/FHD W/ LEFORT I	MAXFEE	DEF					2109.20	1/1/2000	12/31/2299	N
21172	RECONSTRUCT ORBIT/FOREHEAD	PRXOVR	DEF					NA	NA	NA	N
21172	RECONSTRUCT ORBIT/FOREHEAD	MAXFEE	DEF					1282.50	1/1/2000	12/31/2299	N
21175	RECONSTRUCT ORBIT/FOREHEAD	PRXOVR	DEF					NA	NA	NA	N
21175	RECONSTRUCT ORBIT/FOREHEAD	MAXFEE	DEF					1548.84	1/1/2000	12/31/2299	N
21179	RECONSTRUCT ENTIRE FOREHEAD	PRXOVR	DEF					NA	NA	NA	N
21179	RECONSTRUCT ENTIRE FOREHEAD	MAXFEE	DEF					1051.34	1/1/2000	12/31/2299	N
21180	RECONSTRUCT ENTIRE FOREHEAD	PRXOVR	DEF					NA	NA	NA	N
21180	RECONSTRUCT ENTIRE FOREHEAD	MAXFEE	DEF					1176.45	1/1/2000	12/31/2299	N
21181	CONTOUR CRANIAL BONE LESION	PRXOVR	DEF					NA	NA	NA	N
21181	CONTOUR CRANIAL BONE LESION	MAXFEE	DEF					462.32	1/1/2004	12/31/2299	N
21182	RECONSTRUCT CRANIAL BONE	PRXOVR	DEF					NA	NA	NA	N
21182	RECONSTRUCT CRANIAL BONE	MAXFEE	DEF					1523.60	1/1/2000	12/31/2299	N
21183	RECONSTRUCT CRANIAL BONE	PRXOVR	DEF					NA	NA	NA	N
21183	RECONSTRUCT CRANIAL BONE	MAXFEE	DEF					1653.31	1/1/2000	12/31/2299	N
21184	RECONSTRUCT CRANIAL BONE	PRXOVR	DEF					NA	NA	NA	N
21184	RECONSTRUCT CRANIAL BONE	MAXFEE	DEF					1781.43	1/1/2000	12/31/2299	N
21188	RECONSTRUCTION OF MIDFACE	PRXOVR	DEF					NA	NA	NA	N
21188	RECONSTRUCTION OF MIDFACE	MAXFEE	DEF					1049.24	1/1/2000	12/31/2299	N
21193	RECONST LWR JAW W/O GRAFT	PRXOVR	DEF					NA	NA	NA	N
21193	RECONST LWR JAW W/O GRAFT	MAXFEE	DEF					788	1/1/2000	12/31/2299	N
21194	RECONST LWR JAW W/GRAFT	PRXOVR	DEF					NA	NA	NA	N
21194	RECONST LWR JAW W/GRAFT	MAXFEE	DEF					921.91	1/1/2000	12/31/2299	N
21195	RECONST LWR JAW W/O FIXATION	PRXOVR	DEF					NA	NA	NA	N
21195	RECONST LWR JAW W/O FIXATION	MAXFEE	DEF					800.29	1/1/2000	12/31/2299	N
21196	RECONST LWR JAW W/FIXATION	PRXOVR	DEF					NA	NA	NA	N
21196	RECONST LWR JAW W/FIXATION	MAXFEE	DEF					878.78	1/1/2000	12/31/2299	N
21198	RECONSTR LWR JAW SEGMENT	PRXOVR	DEF					NA	NA	NA	N
21198	RECONSTR LWR JAW SEGMENT	MAXFEE	DEF					768.88	4/1/2008	12/31/2299	N
21199	RECONSTR LWR JAW W/ADVANCE	PRXOVR	DEF					NA	NA	NA	N
21199	RECONSTR LWR JAW W/ADVANCE	MAXFEE	DEF					767.55	4/1/2008	12/31/2299	N
21206	RECONSTRUCT UPPER JAW BONE	PRXOVR	DEF					NA	NA	NA	N
21206	RECONSTRUCT UPPER JAW BONE	MAXFEE	DEF					657.52	1/1/2000	12/31/2299	N
21208	AUGMENTATION OF FACIAL BONES	PRXOVR	DEF					NA	NA	NA	N
21208	AUGMENTATION OF FACIAL BONES	MAXFEE	FAC					561.14	1/1/2014	12/31/2299	N
21208	AUGMENTATION OF FACIAL BONES	MAXFEE	NFF					764.88	1/1/2014	12/31/2299	N
21209	REDUCTION OF FACIAL BONES	PRXOVR	DEF					NA	NA	NA	N
21209	REDUCTION OF FACIAL BONES	MAXFEE	FAC					244.56	1/1/2014	12/31/2299	N
21209	REDUCTION OF FACIAL BONES	MAXFEE	NFF					343.14	1/1/2014	12/31/2299	N
21210	FACE BONE GRAFT	PRXOVR	DEF					NA	NA	NA	N
21210	FACE BONE GRAFT	MAXFEE	FAC					565.83	1/1/2014	12/31/2299	N
21210	FACE BONE GRAFT	MAXFEE	NFF					791.82	1/1/2014	12/31/2299	N
21215	LOWER JAW BONE GRAFT	PRXOVR	DEF					NA	NA	NA	N
21215	LOWER JAW BONE GRAFT	MAXFEE	FAC					594.54	1/1/2014	12/31/2299	N
21215	LOWER JAW BONE GRAFT	MAXFEE	NFF					1209.25	1/1/2014	12/31/2299	N
21230	RIB CARTILAGE GRAFT	PRXOVR	DEF					NA	NA	NA	N
21230	RIB CARTILAGE GRAFT	MAXFEE	DEF					583.54	1/1/2000	12/31/2299	N
21235	EAR CARTILAGE GRAFT	PRXOVR	DEF					NA	NA	NA	N
21235	EAR CARTILAGE GRAFT	MAXFEE	FAC					285.78	1/1/2014	12/31/2299	N
21235	EAR CARTILAGE GRAFT	MAXFEE	NFF					407.18	1/1/2014	12/31/2299	N
21240	RECONSTRUCTION OF JAW JOINT	PRXOVR	DEF					NA	NA	NA	N
21240	RECONSTRUCTION OF JAW JOINT	MAXFEE	DEF					782.74	1/1/2000	12/31/2299	N
21242	RECONSTRUCTION OF JAW JOINT	PRXOVR	DEF					NA	NA	NA	N
21242	RECONSTRUCTION OF JAW JOINT	MAXFEE	DEF					730.34	1/1/2000	12/31/2299	N
21243	RECONSTRUCTION OF JAW JOINT	PRXOVR	DEF					NA	NA	NA	N
21243	RECONSTRUCTION OF JAW JOINT	MAXFEE	DEF					940.96	1/1/2000	12/31/2299	N
21244	RECONSTRUCTION OF LOWER JAW	PRXOVR	DEF					NA	NA	NA	N
21244	RECONSTRUCTION OF LOWER JAW	MAXFEE	DEF					670.65	1/1/2000	12/31/2299	N
21245	RECONSTRUCTION OF JAW	PRXOVR	DEF					NA	NA	NA	N
21245	RECONSTRUCTION OF JAW	MAXFEE	FAC					444.35	1/1/2014	12/31/2299	N
21245	RECONSTRUCTION OF JAW	MAXFEE	NFF					628.88	1/1/2014	12/31/2299	N
21246	RECONSTRUCTION OF JAW	PRXOVR	DEF					NA	NA	NA	N
21246	RECONSTRUCTION OF JAW	MAXFEE	DEF					576.06	1/1/2000	12/31/2299	N
21247	RECONSTRUCT LOWER JAW BONE	PRXOVR	DEF					NA	NA	NA	N
21247	RECONSTRUCT LOWER JAW BONE	MAXFEE	DEF					1219.56	1/1/2000	12/31/2299	N
21248	RECONSTRUCTION OF JAW	PRXOVR	DEF					NA	NA	NA	N
21248	RECONSTRUCTION OF JAW	MAXFEE	FAC					455.91	1/1/2014	12/31/2299	N
21248	RECONSTRUCTION OF JAW	MAXFEE	NFF					637	1/1/2014	12/31/2299	N
21249	RECONSTRUCTION OF JAW	PRXOVR	DEF					NA	NA	NA	N
21249	RECONSTRUCTION OF JAW	MAXFEE	FAC					724.02	1/1/2014	12/31/2299	N
21249	RECONSTRUCTION OF JAW	MAXFEE	NFF					973.15	1/1/2014	12/31/2299	N
21255	RECONSTRUCT LOWER JAW BONE	PRXOVR	DEF					NA	NA	NA	N
21255	RECONSTRUCT LOWER JAW BONE	MAXFEE	DEF					919.29	1/1/2000	12/31/2299	N
21256	RECONSTRUCTION OF ORBIT	PRXOVR	DEF					NA	NA	NA	N
21256	RECONSTRUCTION OF ORBIT	MAXFEE	DEF					911.51	1/1/2000	12/31/2299	N
21260	REVISE EYE SOCKETS	PRXOVR	DEF					NA	NA	NA	N
21260	REVISE EYE SOCKETS	MAXFEE	DEF					911.10	4/1/2008	12/31/2299	N
21261	REVISE EYE SOCKETS	PRXOVR	DEF					NA	NA	NA	N
21261	REVISE EYE SOCKETS	MAXFEE	DEF					1318.39	1/1/2000	12/31/2299	N
21263	REVISE EYE SOCKETS	PRXOVR	DEF					NA	NA	NA	N
21263	REVISE EYE SOCKETS	MAXFEE	DEF					1517.61	1/1/2000	12/31/2299	N
21267	REVISE EYE SOCKETS	PRXOVR	DEF					NA	NA	NA	N
21267	REVISE EYE SOCKETS	MAXFEE	DEF					959.04	1/1/2000	12/31/2299	N
21268	REVISE EYE SOCKETS	PRXOVR	DEF					NA	NA	NA	N
21268	REVISE EYE SOCKETS	MAXFEE	DEF					1131.98	1/1/2000	12/31/2299	N
21270	AUGMENTATION CHEEK BONE	PRXOVR	DEF					NA	NA	NA	N
21270	AUGMENTATION CHEEK BONE	MAXFEE	FAC					391.94	1/1/2014	12/31/2299	N
21270	AUGMENTATION CHEEK BONE	MAXFEE	NFF					539.79	1/1/2014	12/31/2299	N
21275	REVISION ORBITOFACIAL BONES	PRXOVR	DEF					NA	NA	NA	N
21275	REVISION ORBITOFACIAL BONES	MAXFEE	DEF					582.09	1/1/2000	12/31/2299	N
21280	REVISION OF EYELID	PRXOVR	DEF					NA	NA	NA	N
21280	REVISION OF EYELID	MAXFEE	DEF					354.46	1/1/2000	12/31/2299	N
21282	REVISION OF EYELID	PRXOVR	DEF					NA	NA	NA	N
21282	REVISION OF EYELID	MAXFEE	DEF					228.05	1/1/2000	12/31/2299	N
21295	REVISION OF JAW MUSCLE/BONE	PRXOVR	DEF					NA	NA	NA	N
21295	REVISION OF JAW MUSCLE/BONE	MAXFEE	DEF					94.94	7/1/2008	12/31/2299	N
21296	REVISION OF JAW MUSCLE/BONE	PRXOVR	DEF					NA	NA	NA	N
21296	REVISION OF JAW MUSCLE/BONE	MAXFEE	DEF					217.39	1/1/2004	12/31/2299	N
21299	UNLISTED CRANFCL&MAXLFCL PX	PRXOVR	DEF					NA	NA	NA	N
21299	UNLISTED CRANFCL&MAXLFCL PX	MANUAL	DEF					NA	NA	NA	N
21300	TREATMENT OF SKULL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21300	TREATMENT OF SKULL FRACTURE	MAXFEE	DEF					NA			N
21310	CLOSED TX NOSE FX W/O MANJ	PRXOVR	DEF					NA	NA	NA	N
21310	CLOSED TX NOSE FX W/O MANJ	MAXFEE	DEF					NA			N
21315	CLSD TX NSL FX MNPJ WO STBLJ	PRXOVR	DEF					NA	NA	NA	N
21315	CLSD TX NSL FX MNPJ WO STBLJ	MAXFEE	FAC					100.53	1/1/2014	12/31/2299	N
21315	CLSD TX NSL FX MNPJ WO STBLJ	MAXFEE	NFF					123.68	1/1/2014	12/31/2299	N
21320	CLSD TX NSL FX W/MNPJ&STABLJ	PRXOVR	DEF					NA	NA	NA	N
21320	CLSD TX NSL FX W/MNPJ&STABLJ	MAXFEE	FAC					52.88	1/1/2014	12/31/2299	N
21320	CLSD TX NSL FX W/MNPJ&STABLJ	MAXFEE	NFF					110.90	1/1/2014	12/31/2299	N
21325	OPEN TX NOSE FX UNCOMPLICATD	PRXOVR	DEF					NA	NA	NA	N
21325	OPEN TX NOSE FX UNCOMPLICATD	MAXFEE	DEF					263.29	7/1/2008	12/31/2299	N
21330	OPEN TX NOSE FX W/SKELE FIXJ	PRXOVR	DEF					NA	NA	NA	N
21330	OPEN TX NOSE FX W/SKELE FIXJ	MAXFEE	DEF					322.96	7/1/2008	12/31/2299	N
21335	OPEN TX NOSE & SEPTAL FX	PRXOVR	DEF					NA	NA	NA	N
21335	OPEN TX NOSE & SEPTAL FX	MAXFEE	DEF					500.89	1/1/2000	12/31/2299	N
21336	OPEN TX SEPTAL FX W/WO STABJ	PRXOVR	DEF					NA	NA	NA	N
21336	OPEN TX SEPTAL FX W/WO STABJ	MAXFEE	DEF					343.04	7/1/2008	12/31/2299	N
21337	CLOSED TX SEPTAL&NOSE FX	PRXOVR	DEF					NA	NA	NA	N
21337	CLOSED TX SEPTAL&NOSE FX	MAXFEE	FAC					121.84	1/1/2014	12/31/2299	N
21337	CLOSED TX SEPTAL&NOSE FX	MAXFEE	NFF					165.46	1/1/2014	12/31/2299	N
21338	OPEN NASOETHMOID FX W/O FIXJ	PRXOVR	DEF					NA	NA	NA	N
21338	OPEN NASOETHMOID FX W/O FIXJ	MAXFEE	DEF					431.18	7/1/2008	12/31/2299	N
21339	OPEN NASOETHMOID FX W/ FIXJ	PRXOVR	DEF					NA	NA	NA	N
21339	OPEN NASOETHMOID FX W/ FIXJ	MAXFEE	DEF					471.49	7/1/2008	12/31/2299	N
21340	PERQ TX NASOETHMOID FX	PRXOVR	DEF					NA	NA	NA	N
21340	PERQ TX NASOETHMOID FX	MAXFEE	DEF					541.69	1/1/2000	12/31/2299	N
21343	OPEN TX DPRSD FRONT SINUS FX	PRXOVR	DEF					NA	NA	NA	N
21343	OPEN TX DPRSD FRONT SINUS FX	MAXFEE	DEF					634.32	7/1/2008	12/31/2299	N
21344	OPEN TX COMPL FRONT SINUS FX	PRXOVR	DEF					NA	NA	NA	N
21344	OPEN TX COMPL FRONT SINUS FX	MAXFEE	DEF					823.93	7/1/2008	12/31/2299	N
21345	CLOSED TX NOSE/JAW FX	PRXOVR	DEF					NA	NA	NA	N
21345	CLOSED TX NOSE/JAW FX	MAXFEE	FAC					333.35	1/1/2014	12/31/2299	N
21345	CLOSED TX NOSE/JAW FX	MAXFEE	NFF					447.76	1/1/2014	12/31/2299	N
21346	OPN TX NASOMAX FX W/FIXJ	PRXOVR	DEF					NA	NA	NA	N
21346	OPN TX NASOMAX FX W/FIXJ	MAXFEE	DEF					547.78	1/1/2000	12/31/2299	N
21347	OPN TX NASOMAX FX MULTPLE	PRXOVR	DEF					NA	NA	NA	N
21347	OPN TX NASOMAX FX MULTPLE	MAXFEE	DEF					629.02	1/1/2000	12/31/2299	N
21348	OPN TX NASOMAX FX W/GRAFT	PRXOVR	DEF					NA	NA	NA	N
21348	OPN TX NASOMAX FX W/GRAFT	MAXFEE	DEF					780.24	1/1/2000	12/31/2299	N
21355	PERQ TX MALAR FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21355	PERQ TX MALAR FRACTURE	MAXFEE	FAC					112.59	1/1/2014	12/31/2299	N
21355	PERQ TX MALAR FRACTURE	MAXFEE	NFF					167.45	1/1/2014	12/31/2299	N
21356	OPN TX DPRSD ZYGOMATIC ARCH	PRXOVR	DEF					NA	NA	NA	N
21356	OPN TX DPRSD ZYGOMATIC ARCH	MAXFEE	FAC					177.74	1/1/2014	12/31/2299	N
21356	OPN TX DPRSD ZYGOMATIC ARCH	MAXFEE	NFF					253.06	1/1/2014	12/31/2299	N
21360	OPN TX DPRSD MALAR FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21360	OPN TX DPRSD MALAR FRACTURE	MAXFEE	DEF					375.55	4/1/2008	12/31/2299	N
21365	OPN TX COMPLX MALAR FX	PRXOVR	DEF					NA	NA	NA	N
21365	OPN TX COMPLX MALAR FX	MAXFEE	DEF					743.60	1/1/2004	12/31/2299	N
21366	OPN TX COMPLX MALAR W/GRFT	PRXOVR	DEF					NA	NA	NA	N
21366	OPN TX COMPLX MALAR W/GRFT	MAXFEE	DEF					819.55	1/1/2000	12/31/2299	N
21385	OPN TX ORBIT FX TRANSANTRAL	PRXOVR	DEF					NA	NA	NA	N
21385	OPN TX ORBIT FX TRANSANTRAL	MAXFEE	DEF					502.99	1/1/2004	12/31/2299	N
21386	OPN TX ORBIT FX PERIORBITAL	PRXOVR	DEF					NA	NA	NA	N
21386	OPN TX ORBIT FX PERIORBITAL	MAXFEE	DEF					503.10	1/1/2004	12/31/2299	N
21387	OPN TX ORBIT FX COMBINED	PRXOVR	DEF					NA	NA	NA	N
21387	OPN TX ORBIT FX COMBINED	MAXFEE	DEF					481.11	1/1/2004	12/31/2299	N
21390	OPN TX ORBIT PERIORBTL IMPLT	PRXOVR	DEF					NA	NA	NA	N
21390	OPN TX ORBIT PERIORBTL IMPLT	MAXFEE	DEF					582.12	4/1/2008	12/31/2299	N
21395	OPN TX ORBIT PERIORBT W/GRFT	PRXOVR	DEF					NA	NA	NA	N
21395	OPN TX ORBIT PERIORBT W/GRFT	MAXFEE	DEF					622.68	1/1/2004	12/31/2299	N
21400	CLOSED TX ORBIT W/O MANIPULJ	PRXOVR	DEF					NA	NA	NA	N
21400	CLOSED TX ORBIT W/O MANIPULJ	MAXFEE	FAC					67.94	1/1/2014	12/31/2299	N
21400	CLOSED TX ORBIT W/O MANIPULJ	MAXFEE	NFF					92.28	1/1/2014	12/31/2299	N
21401	CLOSED TX ORBIT W/MANIPULJ	PRXOVR	DEF					NA	NA	NA	N
21401	CLOSED TX ORBIT W/MANIPULJ	MAXFEE	FAC					122.11	1/1/2014	12/31/2299	N
21401	CLOSED TX ORBIT W/MANIPULJ	MAXFEE	NFF					168.17	1/1/2014	12/31/2299	N
21406	OPN TX ORBIT FX W/O IMPLANT	PRXOVR	DEF					NA	NA	NA	N
21406	OPN TX ORBIT FX W/O IMPLANT	MAXFEE	DEF					348.90	4/1/2008	12/31/2299	N
21407	OPN TX ORBIT FX W/IMPLANT	PRXOVR	DEF					NA	NA	NA	N
21407	OPN TX ORBIT FX W/IMPLANT	MAXFEE	DEF					437.29	4/1/2008	12/31/2299	N
21408	OPN TX ORBIT FX W/BONE GRFT	PRXOVR	DEF					NA	NA	NA	N
21408	OPN TX ORBIT FX W/BONE GRFT	MAXFEE	DEF					575.12	1/1/2000	12/31/2299	N
21421	TREAT MOUTH ROOF FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21421	TREAT MOUTH ROOF FRACTURE	MAXFEE	FAC					233.94	1/1/2014	12/31/2299	N
21421	TREAT MOUTH ROOF FRACTURE	MAXFEE	NFF					314.94	1/1/2014	12/31/2299	N
21422	TREAT MOUTH ROOF FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21422	TREAT MOUTH ROOF FRACTURE	MAXFEE	DEF					472.94	1/1/2004	12/31/2299	N
21423	TREAT MOUTH ROOF FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21423	TREAT MOUTH ROOF FRACTURE	MAXFEE	DEF					542.72	1/1/2000	12/31/2299	N
21431	TREAT CRANIOFACIAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21431	TREAT CRANIOFACIAL FRACTURE	MAXFEE	DEF					375.08	7/1/2008	12/31/2299	N
21432	TREAT CRANIOFACIAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21432	TREAT CRANIOFACIAL FRACTURE	MAXFEE	DEF					414.65	1/1/2000	12/31/2299	N
21433	TREAT CRANIOFACIAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21433	TREAT CRANIOFACIAL FRACTURE	MAXFEE	DEF					1174.07	1/1/2000	12/31/2299	N
21435	TREAT CRANIOFACIAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21435	TREAT CRANIOFACIAL FRACTURE	MAXFEE	DEF					833.30	1/1/2000	12/31/2299	N
21436	TREAT CRANIOFACIAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21436	TREAT CRANIOFACIAL FRACTURE	MAXFEE	DEF					1169.23	1/1/2000	12/31/2299	N
21440	TREAT DENTAL RIDGE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21440	TREAT DENTAL RIDGE FRACTURE	MAXFEE	FAC					165.22	1/1/2014	12/31/2299	N
21440	TREAT DENTAL RIDGE FRACTURE	MAXFEE	NFF					243.15	1/1/2014	12/31/2299	N
21445	TREAT DENTAL RIDGE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21445	TREAT DENTAL RIDGE FRACTURE	MAXFEE	FAC					216.39	1/1/2014	12/31/2299	N
21445	TREAT DENTAL RIDGE FRACTURE	MAXFEE	NFF					319.75	1/1/2014	12/31/2299	N
21450	TREAT LOWER JAW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21450	TREAT LOWER JAW FRACTURE	MAXFEE	FAC					172.45	1/1/2014	12/31/2299	N
21450	TREAT LOWER JAW FRACTURE	MAXFEE	NFF					229.89	1/1/2014	12/31/2299	N
21451	TREAT LOWER JAW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21451	TREAT LOWER JAW FRACTURE	MAXFEE	FAC					221.42	1/1/2014	12/31/2299	N
21451	TREAT LOWER JAW FRACTURE	MAXFEE	NFF					310.38	1/1/2014	12/31/2299	N
21452	TREAT LOWER JAW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21452	TREAT LOWER JAW FRACTURE	MAXFEE	FAC					157.44	1/1/2014	12/31/2299	N
21452	TREAT LOWER JAW FRACTURE	MAXFEE	NFF					245.78	1/1/2014	12/31/2299	N
21453	TREAT LOWER JAW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21453	TREAT LOWER JAW FRACTURE	MAXFEE	FAC					273.73	1/1/2014	12/31/2299	N
21453	TREAT LOWER JAW FRACTURE	MAXFEE	NFF					379.90	1/1/2014	12/31/2299	N
21454	TREAT LOWER JAW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21454	TREAT LOWER JAW FRACTURE	MAXFEE	DEF					378.10	1/1/2000	12/31/2299	N
21461	TREAT LOWER JAW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21461	TREAT LOWER JAW FRACTURE	MAXFEE	FAC					475.81	1/1/2014	12/31/2299	N
21461	TREAT LOWER JAW FRACTURE	MAXFEE	NFF					937.22	1/1/2014	12/31/2299	N
21462	TREAT LOWER JAW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21462	TREAT LOWER JAW FRACTURE	MAXFEE	FAC					551.94	1/1/2014	12/31/2299	N
21462	TREAT LOWER JAW FRACTURE	MAXFEE	NFF					986.07	1/1/2014	12/31/2299	N
21465	TREAT LOWER JAW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21465	TREAT LOWER JAW FRACTURE	MAXFEE	DEF					549.24	1/1/2000	12/31/2299	N
21470	TREAT LOWER JAW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21470	TREAT LOWER JAW FRACTURE	MAXFEE	DEF					835.20	1/1/2004	12/31/2299	N
21480	RESET DISLOCATED JAW	PRXOVR	DEF					NA	NA	NA	N
21480	RESET DISLOCATED JAW	MAXFEE	FAC					19.52	1/1/2014	12/31/2299	N
21480	RESET DISLOCATED JAW	MAXFEE	NFF					42.90	1/1/2014	12/31/2299	N
21485	RESET DISLOCATED JAW	PRXOVR	DEF					NA	NA	NA	N
21485	RESET DISLOCATED JAW	MAXFEE	FAC					203.02	1/1/2014	12/31/2299	N
21485	RESET DISLOCATED JAW	MAXFEE	NFF					275.57	1/1/2014	12/31/2299	N
21490	REPAIR DISLOCATED JAW	PRXOVR	DEF					NA	NA	NA	N
21490	REPAIR DISLOCATED JAW	MAXFEE	DEF					499.57	7/1/2008	12/31/2299	N
21493	TREAT HYOID BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21493	TREAT HYOID BONE FRACTURE	MAXFEE	DEF					NA			N
21494	TREAT HYOID BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21494	TREAT HYOID BONE FRACTURE	MAXFEE	DEF					NA			N
21495	TREAT HYOID BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21495	TREAT HYOID BONE FRACTURE	MAXFEE	DEF					NA			N
21497	INTERDENTAL WIRING	PRXOVR	DEF					NA	NA	NA	E
21497	INTERDENTAL WIRING	MAXFEE	FAC					477.12	10/1/2014	12/31/2299	E
21497	INTERDENTAL WIRING	MAXFEE	NFF					572.03	10/1/2014	12/31/2299	E
21499	UNLISTED MUSCSKEL PX HEAD	PRXOVR	DEF					NA	NA	NA	N
21499	UNLISTED MUSCSKEL PX HEAD	MANUAL	DEF					NA	NA	NA	N
21501	DRAIN NECK/CHEST LESION	PRXOVR	DEF					NA	NA	NA	N
21501	DRAIN NECK/CHEST LESION	MAXFEE	FAC					113.55	1/1/2014	12/31/2299	N
21501	DRAIN NECK/CHEST LESION	MAXFEE	NFF					167.74	1/1/2014	12/31/2299	N
21502	DRAIN CHEST LESION	PRXOVR	DEF					NA	NA	NA	N
21502	DRAIN CHEST LESION	MAXFEE	DEF					337.29	1/1/2000	12/31/2299	N
21510	DRAINAGE OF BONE LESION	PRXOVR	DEF					NA	NA	NA	N
21510	DRAINAGE OF BONE LESION	MAXFEE	DEF					275.63	1/1/2004	12/31/2299	N
21550	BIOPSY OF NECK/CHEST	PRXOVR	DEF					NA	NA	NA	N
21550	BIOPSY OF NECK/CHEST	MAXFEE	FAC					62.80	1/1/2014	12/31/2299	N
21550	BIOPSY OF NECK/CHEST	MAXFEE	NFF					114.03	1/1/2014	12/31/2299	N
21552	EXC NECK LES SC 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
21552	EXC NECK LES SC 3 CM/>	MAXFEE	DEF					246.92	1/1/2010	12/31/2299	N
21554	EXC NECK TUM DEEP 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
21554	EXC NECK TUM DEEP 5 CM/>	MAXFEE	DEF					406.23	1/1/2010	12/31/2299	N
21555	EXC NECK LES SC < 3 CM	PRXOVR	DEF					NA	NA	NA	N
21555	EXC NECK LES SC < 3 CM	MAXFEE	FAC					114.30	1/1/2014	12/31/2299	N
21555	EXC NECK LES SC < 3 CM	MAXFEE	NFF					172.38	1/1/2014	12/31/2299	N
21556	EXC NECK TUM DEEP < 5 CM	PRXOVR	DEF					NA	NA	NA	N
21556	EXC NECK TUM DEEP < 5 CM	MAXFEE	DEF					252.29	1/1/2000	12/31/2299	N
21557	RESECT NECK THORAX TUMOR<5CM	PRXOVR	DEF					NA	NA	NA	N
21557	RESECT NECK THORAX TUMOR<5CM	MAXFEE	DEF					478.35	1/1/2010	12/31/2299	N
21558	RESECT NECK TUMOR 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
21558	RESECT NECK TUMOR 5 CM/>	MAXFEE	DEF					764.21	1/1/2010	12/31/2299	N
21600	PARTIAL REMOVAL OF RIB	PRXOVR	DEF					NA	NA	NA	N
21600	PARTIAL REMOVAL OF RIB	MAXFEE	DEF					344.29	1/1/2000	12/31/2299	N
21601	EXC CHEST WALL TUMOR W/RIBS	PRXOVR	DEF					NA	NA	NA	N
21601	EXC CHEST WALL TUMOR W/RIBS	MAXFEE	DEF					958.13	1/1/2020	12/31/2299	N
21602	EXC CH WAL TUM W/O LYMPHADEC	PRXOVR	DEF					NA	NA	NA	N
21602	EXC CH WAL TUM W/O LYMPHADEC	MAXFEE	DEF					1279.36	1/1/2020	12/31/2299	N
21603	EXC CH WAL TUM W/LYMPHADEC	PRXOVR	DEF					NA	NA	NA	N
21603	EXC CH WAL TUM W/LYMPHADEC	MAXFEE	DEF					1418.24	1/1/2020	12/31/2299	N
21610	PARTIAL REMOVAL OF RIB	PRXOVR	DEF					NA	NA	NA	N
21610	PARTIAL REMOVAL OF RIB	MAXFEE	DEF					574.21	7/1/2008	12/31/2299	N
21615	REMOVAL OF RIB	PRXOVR	DEF					NA	NA	NA	N
21615	REMOVAL OF RIB	MAXFEE	DEF					554.53	1/1/2000	12/31/2299	N
21616	REMOVAL OF RIB AND NERVES	PRXOVR	DEF					NA	NA	NA	N
21616	REMOVAL OF RIB AND NERVES	MAXFEE	DEF					558.96	1/1/2000	12/31/2299	N
21620	PARTIAL REMOVAL OF STERNUM	PRXOVR	DEF					NA	NA	NA	N
21620	PARTIAL REMOVAL OF STERNUM	MAXFEE	DEF					392.56	1/1/2004	12/31/2299	N
21627	STERNAL DEBRIDEMENT	PRXOVR	DEF					NA	NA	NA	N
21627	STERNAL DEBRIDEMENT	MAXFEE	DEF					353.71	1/1/2000	12/31/2299	N
21630	EXTENSIVE STERNUM SURGERY	PRXOVR	DEF					NA	NA	NA	N
21630	EXTENSIVE STERNUM SURGERY	MAXFEE	DEF					860.84	1/1/2000	12/31/2299	N
21632	EXTENSIVE STERNUM SURGERY	PRXOVR	DEF					NA	NA	NA	N
21632	EXTENSIVE STERNUM SURGERY	MAXFEE	DEF					829.50	1/1/2000	12/31/2299	N
21685	HYOID MYOTOMY & SUSPENSION	PRXOVR	DEF					NA	NA	NA	N
21685	HYOID MYOTOMY & SUSPENSION	MAXFEE	DEF					628.98	1/1/2004	12/31/2299	N
21700	REVISION OF NECK MUSCLE	PRXOVR	DEF					NA	NA	NA	N
21700	REVISION OF NECK MUSCLE	MAXFEE	DEF					290.15	1/1/2000	12/31/2299	N
21705	REVISION OF NECK MUSCLE/RIB	PRXOVR	DEF					NA	NA	NA	N
21705	REVISION OF NECK MUSCLE/RIB	MAXFEE	DEF					439.64	1/1/2000	12/31/2299	N
21720	REVISION OF NECK MUSCLE	PRXOVR	DEF					NA	NA	NA	N
21720	REVISION OF NECK MUSCLE	MAXFEE	DEF					277.86	1/1/2000	12/31/2299	N
21725	REVISION OF NECK MUSCLE	PRXOVR	DEF					NA	NA	NA	N
21725	REVISION OF NECK MUSCLE	MAXFEE	DEF					328.93	1/1/2000	12/31/2299	N
21740	RECONSTRUCTION OF STERNUM	PRXOVR	DEF					NA	NA	NA	N
21740	RECONSTRUCTION OF STERNUM	MAXFEE	DEF					732.82	1/1/2000	12/31/2299	N
21742	REPAIR STERN/NUSS W/O SCOPE	PRXOVR	DEF					NA	NA	NA	N
21742	REPAIR STERN/NUSS W/O SCOPE	MAXFEE	DEF					584.26	7/1/2003	12/31/2299	N
21743	REPAIR STERNUM/NUSS W/SCOPE	PRXOVR	DEF					NA	NA	NA	N
21743	REPAIR STERNUM/NUSS W/SCOPE	MAXFEE	DEF					629.92	7/1/2003	12/31/2299	N
21750	REPAIR OF STERNUM SEPARATION	PRXOVR	DEF					NA	NA	NA	N
21750	REPAIR OF STERNUM SEPARATION	MAXFEE	DEF					520.40	1/1/2000	12/31/2299	N
21800	TREATMENT OF RIB FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21800	TREATMENT OF RIB FRACTURE	MAXFEE	DEF					NA			N
21805	TREATMENT OF RIB FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21805	TREATMENT OF RIB FRACTURE	MAXFEE	DEF					NA			N
21810	TREATMENT OF RIB FRACTURE(S)	PRXOVR	DEF					NA	NA	NA	N
21810	TREATMENT OF RIB FRACTURE(S)	MAXFEE	DEF					NA			N
21811	OPTX OF RIB FX W/FIXJ SCOPE	PRXOVR	DEF					NA	NA	NA	N
21811	OPTX OF RIB FX W/FIXJ SCOPE	MAXFEE	FAC					427.31	1/1/2015	12/31/2299	N
21811	OPTX OF RIB FX W/FIXJ SCOPE	MAXFEE	NFF					441.50	1/1/2015	12/31/2299	N
21812	TREATMENT OF RIB FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21812	TREATMENT OF RIB FRACTURE	MAXFEE	FAC					511.37	1/1/2015	12/31/2299	N
21812	TREATMENT OF RIB FRACTURE	MAXFEE	NFF					525.57	1/1/2015	12/31/2299	N
21813	TREATMENT OF RIB FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21813	TREATMENT OF RIB FRACTURE	MAXFEE	FAC					698.10	1/1/2015	12/31/2299	N
21813	TREATMENT OF RIB FRACTURE	MAXFEE	NFF					709.14	1/1/2015	12/31/2299	N
21820	TREAT STERNUM FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21820	TREAT STERNUM FRACTURE	MAXFEE	FAC					71.04	1/1/2014	12/31/2299	N
21820	TREAT STERNUM FRACTURE	MAXFEE	NFF					75.35	1/1/2014	12/31/2299	N
21825	TREAT STERNUM FRACTURE	PRXOVR	DEF					NA	NA	NA	N
21825	TREAT STERNUM FRACTURE	MAXFEE	DEF					403.74	1/1/2000	12/31/2299	N
21899	UNLISTED PX NECK/THORAX	PRXOVR	DEF					NA	NA	NA	N
21899	UNLISTED PX NECK/THORAX	MANUAL	DEF					NA	NA	NA	N
21920	BIOPSY SOFT TISSUE OF BACK	PRXOVR	DEF					NA	NA	NA	N
21920	BIOPSY SOFT TISSUE OF BACK	MAXFEE	FAC					83.28	1/1/2014	12/31/2299	N
21920	BIOPSY SOFT TISSUE OF BACK	MAXFEE	NFF					113.81	1/1/2014	12/31/2299	N
21925	BIOPSY SOFT TISSUE OF BACK	PRXOVR	DEF					NA	NA	NA	N
21925	BIOPSY SOFT TISSUE OF BACK	MAXFEE	FAC					135.65	1/1/2014	12/31/2299	N
21925	BIOPSY SOFT TISSUE OF BACK	MAXFEE	NFF					192.66	1/1/2014	12/31/2299	N
21930	EXC BACK LES SC < 3 CM	PRXOVR	DEF					NA	NA	NA	N
21930	EXC BACK LES SC < 3 CM	MAXFEE	FAC					161.99	1/1/2014	12/31/2299	N
21930	EXC BACK LES SC < 3 CM	MAXFEE	NFF					217.96	1/1/2014	12/31/2299	N
21931	EXC BACK LES SC 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
21931	EXC BACK LES SC 3 CM/>	MAXFEE	DEF					258.99	1/1/2010	12/31/2299	N
21932	EXC BACK TUM DEEP < 5 CM	PRXOVR	DEF					NA	NA	NA	N
21932	EXC BACK TUM DEEP < 5 CM	MAXFEE	DEF					372.48	1/1/2010	12/31/2299	N
21933	EXC BACK TUM DEEP 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
21933	EXC BACK TUM DEEP 5 CM/>	MAXFEE	DEF					411.57	1/1/2010	12/31/2299	N
21935	RESECT BACK TUM < 5 CM	PRXOVR	DEF					NA	NA	NA	N
21935	RESECT BACK TUM < 5 CM	MAXFEE	DEF					692.44	1/1/2000	12/31/2299	N
21936	RESECT BACK TUM 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
21936	RESECT BACK TUM 5 CM/>	MAXFEE	DEF					797.71	1/1/2010	12/31/2299	N
22010	I&D P-SPINE C/T/CERV-THOR	PRXOVR	DEF					NA	NA	NA	N
22010	I&D P-SPINE C/T/CERV-THOR	MAXFEE	DEF					571.14	1/1/2006	12/31/2299	N
22015	I&D ABSCESS P-SPINE L/S/LS	PRXOVR	DEF					NA	NA	NA	N
22015	I&D ABSCESS P-SPINE L/S/LS	MAXFEE	DEF					566.26	1/1/2006	12/31/2299	N
22100	REMOVE PART OF NECK VERTEBRA	PRXOVR	DEF					NA	NA	NA	N
22100	REMOVE PART OF NECK VERTEBRA	MAXFEE	DEF					474.72	1/1/2004	12/31/2299	N
22101	REMOVE PART THORAX VERTEBRA	PRXOVR	DEF					NA	NA	NA	N
22101	REMOVE PART THORAX VERTEBRA	MAXFEE	DEF					491.53	1/1/2004	12/31/2299	N
22102	REMOVE PART LUMBAR VERTEBRA	PRXOVR	DEF					NA	NA	NA	N
22102	REMOVE PART LUMBAR VERTEBRA	MAXFEE	DEF					431.42	7/1/2008	12/31/2299	N
22103	REMOVE EXTRA SPINE SEGMENT	PRXOVR	DEF					NA	NA	NA	N
22103	REMOVE EXTRA SPINE SEGMENT	MAXFEE	DEF					121.60	4/1/2008	12/31/2299	N
22110	REMOVE PART OF NECK VERTEBRA	PRXOVR	DEF					NA	NA	NA	N
22110	REMOVE PART OF NECK VERTEBRA	MAXFEE	DEF					619.53	1/1/2000	12/31/2299	N
22112	REMOVE PART THORAX VERTEBRA	PRXOVR	DEF					NA	NA	NA	N
22112	REMOVE PART THORAX VERTEBRA	MAXFEE	DEF					625.79	1/1/2000	12/31/2299	N
22114	REMOVE PART LUMBAR VERTEBRA	PRXOVR	DEF					NA	NA	NA	N
22114	REMOVE PART LUMBAR VERTEBRA	MAXFEE	DEF					569.43	1/1/2000	12/31/2299	N
22116	REMOVE EXTRA SPINE SEGMENT	PRXOVR	DEF					NA	NA	NA	N
22116	REMOVE EXTRA SPINE SEGMENT	MAXFEE	DEF					120.25	1/1/2000	12/31/2299	N
22206	INCIS SPINE 3 COLUMN THORAC	PRXOVR	DEF					NA	NA	NA	N
22206	INCIS SPINE 3 COLUMN THORAC	MAXFEE	DEF					1421.31	1/1/2008	12/31/2299	N
22207	INCIS SPINE 3 COLUMN LUMBAR	PRXOVR	DEF					NA	NA	NA	N
22207	INCIS SPINE 3 COLUMN LUMBAR	MAXFEE	DEF					1402.82	1/1/2008	12/31/2299	N
22208	INCIS SPINE 3 COLUMN ADL SEG	PRXOVR	DEF					NA	NA	NA	N
22208	INCIS SPINE 3 COLUMN ADL SEG	MAXFEE	DEF					362.03	1/1/2008	12/31/2299	N
22210	INCIS 1 VERTEBRAL SEG CERV	PRXOVR	DEF					NA	NA	NA	N
22210	INCIS 1 VERTEBRAL SEG CERV	MAXFEE	DEF					1041.72	1/1/2000	12/31/2299	N
22212	INCIS 1 VERTEBRAL SEG THORAC	PRXOVR	DEF					NA	NA	NA	N
22212	INCIS 1 VERTEBRAL SEG THORAC	MAXFEE	DEF					993.80	1/1/2000	12/31/2299	N
22214	INCIS 1 VERTEBRAL SEG LUMBAR	PRXOVR	DEF					NA	NA	NA	N
22214	INCIS 1 VERTEBRAL SEG LUMBAR	MAXFEE	DEF					949.67	1/1/2000	12/31/2299	N
22216	INCIS ADDL SPINE SEGMENT	PRXOVR	DEF					NA	NA	NA	N
22216	INCIS ADDL SPINE SEGMENT	MAXFEE	DEF					296.66	1/1/2000	12/31/2299	N
22220	OSTEOT DSC ANT 1 VRT SGM CRV	PRXOVR	DEF					NA	NA	NA	N
22220	OSTEOT DSC ANT 1 VRT SGM CRV	MAXFEE	DEF					1029.74	1/1/2000	12/31/2299	N
22222	OSTEOT DSC ANT 1VRT SGM THRC	PRXOVR	DEF					NA	NA	NA	N
22222	OSTEOT DSC ANT 1VRT SGM THRC	MAXFEE	DEF					924.01	1/1/2000	12/31/2299	N
22224	OSTEOT DSC ANT 1VRT SGM LMBR	PRXOVR	DEF					NA	NA	NA	N
22224	OSTEOT DSC ANT 1VRT SGM LMBR	MAXFEE	DEF					997.90	1/1/2000	12/31/2299	N
22226	OSTEOT DSC ANT 1VRT SGM EA	PRXOVR	DEF					NA	NA	NA	N
22226	OSTEOT DSC ANT 1VRT SGM EA	MAXFEE	DEF					296.91	1/1/2000	12/31/2299	N
22305	CLOSED TX SPINE PROCESS FX	PRXOVR	DEF					NA	NA	NA	N
22305	CLOSED TX SPINE PROCESS FX	MAXFEE	DEF					NA			N
22310	CLOSED TX VERT FX W/O MANJ	PRXOVR	DEF					NA	NA	NA	N
22310	CLOSED TX VERT FX W/O MANJ	MAXFEE	FAC					135.64	1/1/2014	12/31/2299	N
22310	CLOSED TX VERT FX W/O MANJ	MAXFEE	NFF					149.50	1/1/2014	12/31/2299	N
22315	CLOSED TX VERT FX W/MANJ	PRXOVR	DEF					NA	NA	NA	N
22315	CLOSED TX VERT FX W/MANJ	MAXFEE	FAC					287.74	1/1/2014	12/31/2299	N
22315	CLOSED TX VERT FX W/MANJ	MAXFEE	NFF					406.37	1/1/2014	12/31/2299	N
22318	TREAT ODONTOID FX W/O GRAFT	PRXOVR	DEF					NA	NA	NA	N
22318	TREAT ODONTOID FX W/O GRAFT	MAXFEE	DEF					1073.15	1/1/2000	12/31/2299	N
22319	TREAT ODONTOID FX W/GRAFT	PRXOVR	DEF					NA	NA	NA	N
22319	TREAT ODONTOID FX W/GRAFT	MAXFEE	DEF					1211.55	1/1/2000	12/31/2299	N
22325	TREAT SPINE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
22325	TREAT SPINE FRACTURE	MAXFEE	DEF					749.56	1/1/2004	12/31/2299	N
22326	TREAT NECK SPINE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
22326	TREAT NECK SPINE FRACTURE	MAXFEE	DEF					971.03	1/1/2004	12/31/2299	N
22327	TREAT THORAX SPINE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
22327	TREAT THORAX SPINE FRACTURE	MAXFEE	DEF					949.70	1/1/2004	12/31/2299	N
22328	TREAT EACH ADD SPINE FX	PRXOVR	DEF					NA	NA	NA	N
22328	TREAT EACH ADD SPINE FX	MAXFEE	DEF					237.83	1/1/2000	12/31/2299	N
22505	MANIPULATION OF SPINE	PRXOVR	DEF					NA	NA	NA	N
22505	MANIPULATION OF SPINE	MAXFEE	DEF					94.67	1/1/2000	12/31/2299	N
22510	PERQ CERVICOTHORACIC INJECT	PRXOVR	DEF					NA	NA	NA	N
22510	PERQ CERVICOTHORACIC INJECT	MAXFEE	FAC					354.63	1/1/2015	12/31/2299	N
22510	PERQ CERVICOTHORACIC INJECT	MAXFEE	NFF					1307.73	1/1/2015	12/31/2299	N
22511	PERQ LUMBOSACRAL INJECTION	PRXOVR	DEF					NA	NA	NA	N
22511	PERQ LUMBOSACRAL INJECTION	MAXFEE	FAC					332.17	1/1/2015	12/31/2299	N
22511	PERQ LUMBOSACRAL INJECTION	MAXFEE	NFF					1294.21	1/1/2015	12/31/2299	N
22512	VERTEBROPLASTY ADDL INJECT	PRXOVR	DEF					NA	NA	NA	N
22512	VERTEBROPLASTY ADDL INJECT	MAXFEE	FAC					162.25	1/1/2015	12/31/2299	N
22512	VERTEBROPLASTY ADDL INJECT	MAXFEE	NFF					722.81	1/1/2015	12/31/2299	N
22513	PERQ VERTEBRAL AUGMENTATION	PRXOVR	DEF					NA	NA	NA	N
22513	PERQ VERTEBRAL AUGMENTATION	MAXFEE	FAC					403.43	1/1/2015	12/31/2299	N
22513	PERQ VERTEBRAL AUGMENTATION	MAXFEE	NFF					5452.90	1/1/2015	12/31/2299	N
22514	PERQ VERTEBRAL AUGMENTATION	PRXOVR	DEF					NA	NA	NA	N
22514	PERQ VERTEBRAL AUGMENTATION	MAXFEE	FAC					376.84	1/1/2015	12/31/2299	N
22514	PERQ VERTEBRAL AUGMENTATION	MAXFEE	NFF					5431.04	1/1/2015	12/31/2299	N
22515	PERQ VERTEBRAL AUGMENTATION	PRXOVR	DEF					NA	NA	NA	N
22515	PERQ VERTEBRAL AUGMENTATION	MAXFEE	FAC					169.11	1/1/2015	12/31/2299	N
22515	PERQ VERTEBRAL AUGMENTATION	MAXFEE	NFF					3293.18	1/1/2015	12/31/2299	N
22520	PERCUT VERTEBROPLASTY THOR	PRXOVR	DEF					NA	NA	NA	N
22520	PERCUT VERTEBROPLASTY THOR	MAXFEE	DEF					NA			N
22521	PERCUT VERTEBROPLASTY LUMB	PRXOVR	DEF					NA	NA	NA	N
22521	PERCUT VERTEBROPLASTY LUMB	MAXFEE	DEF					NA			N
22522	PERCUT VERTEBROPLASTY ADDL	PRXOVR	DEF					NA	NA	NA	N
22522	PERCUT VERTEBROPLASTY ADDL	MAXFEE	DEF					NA			N
22523	PERCUT KYPHOPLASTY THOR	PRXOVR	DEF					NA	NA	NA	N
22523	PERCUT KYPHOPLASTY THOR	MAXFEE	DEF					NA			N
22524	PERCUT KYPHOPLASTY LUMBAR	PRXOVR	DEF					NA	NA	NA	N
22524	PERCUT KYPHOPLASTY LUMBAR	MAXFEE	DEF					NA			N
22525	PERCUT KYPHOPLASTY ADD-ON	PRXOVR	DEF					NA	NA	NA	N
22525	PERCUT KYPHOPLASTY ADD-ON	MAXFEE	DEF					NA			N
22526	IDET SINGLE LEVEL	PRXOVR	DEF					NA	NA	NA	N
22526	IDET SINGLE LEVEL	MAXFEE	FAC					262.59	1/1/2014	12/31/2299	N
22526	IDET SINGLE LEVEL	MAXFEE	NFF					635.09	1/1/2014	12/31/2299	N
22527	IDET 1 OR MORE LEVELS	PRXOVR	DEF					NA	NA	NA	N
22527	IDET 1 OR MORE LEVELS	MAXFEE	FAC					118.38	1/1/2014	12/31/2299	N
22527	IDET 1 OR MORE LEVELS	MAXFEE	NFF					516.55	1/1/2014	12/31/2299	N
22532	ARTHRD LAT XTRCVTRY TQ THRC	PRXOVR	DEF					NA	NA	NA	N
22532	ARTHRD LAT XTRCVTRY TQ THRC	MAXFEE	DEF					1107.77	1/1/2004	12/31/2299	N
22533	ARTHRD LAT XTRCVTRY TQ LMBR	PRXOVR	DEF					NA	NA	NA	N
22533	ARTHRD LAT XTRCVTRY TQ LMBR	MAXFEE	DEF					1033.99	1/1/2004	12/31/2299	N
22534	ARTHRD LAT XTRCVTRY TQ EA AD	PRXOVR	DEF					NA	NA	NA	N
22534	ARTHRD LAT XTRCVTRY TQ EA AD	MAXFEE	DEF					261.92	1/1/2004	12/31/2299	N
22548	ARTHRD ANT TORAL/XORAL C1-C2	PRXOVR	DEF					NA	NA	NA	N
22548	ARTHRD ANT TORAL/XORAL C1-C2	MAXFEE	DEF					1308.83	1/1/2000	12/31/2299	N
22551	ARTHRD ANT NTRBDY CERVICAL	PRXOVR	DEF					NA	NA	NA	N
22551	ARTHRD ANT NTRBDY CERVICAL	MAXFEE	DEF					1136.58	1/1/2011	12/31/2299	N
22552	ARTHRD ANT NTRBD CERVICAL EA	PRXOVR	DEF					NA	NA	NA	N
22552	ARTHRD ANT NTRBD CERVICAL EA	MAXFEE	DEF					265.47	1/1/2011	12/31/2299	N
22554	ARTHRD ANT NTRBD MIN DSC CRV	PRXOVR	DEF					NA	NA	NA	N
22554	ARTHRD ANT NTRBD MIN DSC CRV	MAXFEE	DEF					1031.75	1/1/2000	12/31/2299	N
22556	ARTHRD ANT NTRBD MIN DSC THC	PRXOVR	DEF					NA	NA	NA	N
22556	ARTHRD ANT NTRBD MIN DSC THC	MAXFEE	DEF					1213.18	1/1/2000	12/31/2299	N
22558	ARTHRD ANT NTRBD MIN DSC LUM	PRXOVR	DEF					NA	NA	NA	N
22558	ARTHRD ANT NTRBD MIN DSC LUM	MAXFEE	DEF					1141.40	1/1/2000	12/31/2299	N
22585	ARTHRD ANT NTRBD MIN DSC EA	PRXOVR	DEF					NA	NA	NA	N
22585	ARTHRD ANT NTRBD MIN DSC EA	MAXFEE	DEF					289.24	1/1/2000	12/31/2299	N
22586	ARTHRD PRE-SAC NTRBDY L5-S1	PRXOVR	DEF					NA	NA	NA	N
22586	ARTHRD PRE-SAC NTRBDY L5-S1	MAXFEE	DEF					1093.50	1/1/2013	12/31/2299	N
22590	ARTHRD PST TQ CRANIOCERVICAL	PRXOVR	DEF					NA	NA	NA	N
22590	ARTHRD PST TQ CRANIOCERVICAL	MAXFEE	DEF					1123.08	1/1/2000	12/31/2299	N
22595	ARTHRD PST TQ ATLAS-AXIS	PRXOVR	DEF					NA	NA	NA	N
22595	ARTHRD PST TQ ATLAS-AXIS	MAXFEE	DEF					1093.87	1/1/2000	12/31/2299	N
22600	ARTHRD PST TQ 1NTRSPC CRV	PRXOVR	DEF					NA	NA	NA	N
22600	ARTHRD PST TQ 1NTRSPC CRV	MAXFEE	DEF					916.15	1/1/2000	12/31/2299	N
22610	ARTHRD PST TQ 1NTRSPC THRC	PRXOVR	DEF					NA	NA	NA	N
22610	ARTHRD PST TQ 1NTRSPC THRC	MAXFEE	DEF					899.67	1/1/2000	12/31/2299	N
22612	ARTHRD PST TQ 1NTRSPC LUMBAR	PRXOVR	DEF					NA	NA	NA	N
22612	ARTHRD PST TQ 1NTRSPC LUMBAR	MAXFEE	DEF					1116.73	1/1/2000	12/31/2299	N
22614	ARTHRD PST TQ 1NTRSPC EA ADD	PRXOVR	DEF					NA	NA	NA	N
22614	ARTHRD PST TQ 1NTRSPC EA ADD	MAXFEE	DEF					320.44	1/1/2000	12/31/2299	N
22630	ARTHRD PST TQ 1NTRSPC LUM	PRXOVR	DEF					NA	NA	NA	N
22630	ARTHRD PST TQ 1NTRSPC LUM	MAXFEE	DEF					1067.37	1/1/2000	12/31/2299	N
22632	ARTHRD PST TQ 1NTRSPC LM EA	PRXOVR	DEF					NA	NA	NA	N
22632	ARTHRD PST TQ 1NTRSPC LM EA	MAXFEE	DEF					270	1/1/2000	12/31/2299	N
22633	ARTHRD CMBN 1NTRSPC LUMBAR	PRXOVR	DEF					NA	NA	NA	N
22633	ARTHRD CMBN 1NTRSPC LUMBAR	MAXFEE	DEF					695.98	1/1/2012	12/31/2299	N
22634	ARTHRD CMBN 1NTRSPC EA ADDL	PRXOVR	DEF					NA	NA	NA	N
22634	ARTHRD CMBN 1NTRSPC EA ADDL	MAXFEE	DEF					189.39	1/1/2012	12/31/2299	N
22800	ARTHRD PST DFRM<6 VRT SGM	PRXOVR	DEF					NA	NA	NA	N
22800	ARTHRD PST DFRM<6 VRT SGM	MAXFEE	DEF					1031.86	1/1/2000	12/31/2299	N
22802	ARTHRD PST DFRM 7-12 VRT SGM	PRXOVR	DEF					NA	NA	NA	N
22802	ARTHRD PST DFRM 7-12 VRT SGM	MAXFEE	DEF					1588.56	1/1/2000	12/31/2299	N
22804	ARTHRD PST DFRM 13+ VRT SGM	PRXOVR	DEF					NA	NA	NA	N
22804	ARTHRD PST DFRM 13+ VRT SGM	MAXFEE	DEF					1744.38	1/1/2000	12/31/2299	N
22808	ARTHRD ANT DFRM 2-3 VRT SGM	PRXOVR	DEF					NA	NA	NA	N
22808	ARTHRD ANT DFRM 2-3 VRT SGM	MAXFEE	DEF					1222.44	1/1/2000	12/31/2299	N
22810	ARTHRD ANT DFRM 4-7 VRT SGM	PRXOVR	DEF					NA	NA	NA	N
22810	ARTHRD ANT DFRM 4-7 VRT SGM	MAXFEE	DEF					1335.69	1/1/2000	12/31/2299	N
22812	ARTHRD ANT DFRM 8+ VRT SGM	PRXOVR	DEF					NA	NA	NA	N
22812	ARTHRD ANT DFRM 8+ VRT SGM	MAXFEE	DEF					1578.59	1/1/2000	12/31/2299	N
22818	KYPHECTOMY 1-2 SEGMENTS	PRXOVR	DEF					NA	NA	NA	N
22818	KYPHECTOMY 1-2 SEGMENTS	MAXFEE	DEF					1602.69	1/1/2000	12/31/2299	N
22819	KYPHECTOMY 3 OR MORE	PRXOVR	DEF					NA	NA	NA	N
22819	KYPHECTOMY 3 OR MORE	MAXFEE	DEF					1734.53	1/1/2000	12/31/2299	N
22830	EXPLORATION OF SPINAL FUSION	PRXOVR	DEF					NA	NA	NA	N
22830	EXPLORATION OF SPINAL FUSION	MAXFEE	DEF					622.38	1/1/2000	12/31/2299	N
22840	INSERT SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22840	INSERT SPINE FIXATION DEVICE	MAXFEE	DEF					446.49	7/1/2008	12/31/2299	N
22841	INSERT SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22841	INSERT SPINE FIXATION DEVICE	MANUAL	DEF					NA	NA	NA	N
22842	INSERT SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22842	INSERT SPINE FIXATION DEVICE	MAXFEE	DEF					446.74	7/1/2008	12/31/2299	N
22843	INSERT SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22843	INSERT SPINE FIXATION DEVICE	MAXFEE	DEF					557.16	1/1/2000	12/31/2299	N
22844	INSERT SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22844	INSERT SPINE FIXATION DEVICE	MAXFEE	DEF					680.84	1/1/2000	12/31/2299	N
22845	INSERT SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22845	INSERT SPINE FIXATION DEVICE	MAXFEE	DEF					427.91	7/1/2008	12/31/2299	N
22846	INSERT SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22846	INSERT SPINE FIXATION DEVICE	MAXFEE	DEF					514.45	1/1/2000	12/31/2299	N
22847	INSERT SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22847	INSERT SPINE FIXATION DEVICE	MAXFEE	DEF					571.60	1/1/2000	12/31/2299	N
22848	INSERT PELV FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22848	INSERT PELV FIXATION DEVICE	MAXFEE	DEF					317.36	1/1/2000	12/31/2299	N
22849	REINSERT SPINAL FIXATION	PRXOVR	DEF					NA	NA	NA	N
22849	REINSERT SPINAL FIXATION	MAXFEE	DEF					783.43	1/1/2000	12/31/2299	N
22850	REMOVE SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22850	REMOVE SPINE FIXATION DEVICE	MAXFEE	DEF					510.17	1/1/2000	12/31/2299	N
22851	APPLY SPINE PROSTH DEVICE	PRXOVR	DEF					NA	NA	NA	N
22851	APPLY SPINE PROSTH DEVICE	MAXFEE	DEF					NA			N
22852	REMOVE SPINE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
22852	REMOVE SPINE FIXATION DEVICE	MAXFEE	DEF					510.32	1/1/2000	12/31/2299	N
22853	INSJ BIOMECHANICAL DEVICE	PRXOVR	DEF					NA	NA	NA	N
22853	INSJ BIOMECHANICAL DEVICE	MAXFEE	DEF					214.53	1/1/2017	12/31/2299	N
22854	INSJ BIOMECHANICAL DEVICE	PRXOVR	DEF					NA	NA	NA	N
22854	INSJ BIOMECHANICAL DEVICE	MAXFEE	DEF					277.71	1/1/2017	12/31/2299	N
22855	REMOVAL ANTERIOR INSTRMJ	PRXOVR	DEF					NA	NA	NA	N
22855	REMOVAL ANTERIOR INSTRMJ	MAXFEE	DEF					602.94	7/1/2008	12/31/2299	N
22856	TOT DISC ARTHRP 1NTRSPC CRV	PRXOVR	DEF					NA	NA	NA	N
22856	TOT DISC ARTHRP 1NTRSPC CRV	MAXFEE	DEF					1222.58	1/1/2009	12/31/2299	N
22857	TOT DISC ARTHRP 1NTRSPC LMBR	PRXOVR	DEF					NA	NA	NA	E
22857	TOT DISC ARTHRP 1NTRSPC LMBR	MAXFEE	DEF					1370.80	7/1/2018	12/31/2299	E
22858	TOT DISC ARTHRP 2ND LVL CRV	PRXOVR	DEF					NA	NA	NA	N
22858	TOT DISC ARTHRP 2ND LVL CRV	MAXFEE	DEF					527.99	1/1/2015	12/31/2299	N
22859	INSJ BIOMECHANICAL DEVICE	PRXOVR	DEF					NA	NA	NA	N
22859	INSJ BIOMECHANICAL DEVICE	MAXFEE	DEF					277.71	1/1/2017	12/31/2299	N
22860	TOT DISC ARTHRP 2NTRSPC LMBR	PRXOVR	DEF					NA	NA	NA	N
22860	TOT DISC ARTHRP 2NTRSPC LMBR	MANUAL	DEF					NA	NA	NA	N
22861	REV RPLCM ARTHRP 1NTRSPC CRV	PRXOVR	DEF					NA	NA	NA	N
22861	REV RPLCM ARTHRP 1NTRSPC CRV	MAXFEE	DEF					1477.64	1/1/2009	12/31/2299	N
22864	RMVL TOT ARTHRP 1NTRSPC CRV	PRXOVR	DEF					NA	NA	NA	N
22864	RMVL TOT ARTHRP 1NTRSPC CRV	MAXFEE	DEF					1385.53	1/1/2009	12/31/2299	N
22867	INSJ STABLJ DEV W/DCMPRN	PRXOVR	DEF					NA	NA	NA	N
22867	INSJ STABLJ DEV W/DCMPRN	MAXFEE	DEF					794.20	1/1/2017	12/31/2299	N
22868	INSJ STABLJ DEV W/DCMPRN	PRXOVR	DEF					NA	NA	NA	N
22868	INSJ STABLJ DEV W/DCMPRN	MAXFEE	DEF					200.44	1/1/2017	12/31/2299	N
22869	INSJ STABLJ DEV W/O DCMPRN	PRXOVR	DEF					NA	NA	NA	N
22869	INSJ STABLJ DEV W/O DCMPRN	MAXFEE	DEF					434.91	1/1/2017	12/31/2299	N
22870	INSJ STABLJ DEV W/O DCMPRN	PRXOVR	DEF					NA	NA	NA	N
22870	INSJ STABLJ DEV W/O DCMPRN	MAXFEE	DEF					116.76	1/1/2017	12/31/2299	N
22899	UNLISTED PROCEDURE SPINE	PRXOVR	DEF					NA	NA	NA	N
22899	UNLISTED PROCEDURE SPINE	MANUAL	DEF					NA	NA	NA	N
22900	EXC ABDL TUM DEEP < 5 CM	PRXOVR	DEF					NA	NA	NA	N
22900	EXC ABDL TUM DEEP < 5 CM	MAXFEE	DEF					248.39	1/1/2000	12/31/2299	N
22901	EXC ABDL TUM DEEP 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
22901	EXC ABDL TUM DEEP 5 CM/>	MAXFEE	DEF					367.39	1/1/2010	12/31/2299	N
22902	EXC ABD LES SC < 3 CM	PRXOVR	DEF					NA	NA	NA	N
22902	EXC ABD LES SC < 3 CM	MAXFEE	FAC					123.18	1/1/2014	12/31/2299	N
22902	EXC ABD LES SC < 3 CM	MAXFEE	NFF					182.82	1/1/2014	12/31/2299	N
22903	EXC ABD LES SC 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
22903	EXC ABD LES SC 3 CM/>	MAXFEE	DEF					241.48	1/1/2010	12/31/2299	N
22904	RADICAL RESECT ABD TUMOR<5CM	PRXOVR	DEF					NA	NA	NA	N
22904	RADICAL RESECT ABD TUMOR<5CM	MAXFEE	DEF					577.80	1/1/2010	12/31/2299	N
22905	RAD RESECT ABD TUMOR 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
22905	RAD RESECT ABD TUMOR 5 CM/>	MAXFEE	DEF					748.74	1/1/2010	12/31/2299	N
22999	UNLISTED PX ABDOMEN MUSCSKEL	PRXOVR	DEF					NA	NA	NA	N
22999	UNLISTED PX ABDOMEN MUSCSKEL	MANUAL	DEF					NA	NA	NA	N
23000	REMOVAL OF CALCIUM DEPOSITS	PRXOVR	DEF					NA	NA	NA	N
23000	REMOVAL OF CALCIUM DEPOSITS	MAXFEE	FAC					170.37	1/1/2014	12/31/2299	N
23000	REMOVAL OF CALCIUM DEPOSITS	MAXFEE	NFF					224.36	1/1/2014	12/31/2299	N
23020	RELEASE SHOULDER JOINT	PRXOVR	DEF					NA	NA	NA	N
23020	RELEASE SHOULDER JOINT	MAXFEE	DEF					452.56	1/1/2000	12/31/2299	N
23030	DRAIN SHOULDER LESION	PRXOVR	DEF					NA	NA	NA	N
23030	DRAIN SHOULDER LESION	MAXFEE	FAC					89.67	1/1/2014	12/31/2299	N
23030	DRAIN SHOULDER LESION	MAXFEE	NFF					163.76	1/1/2014	12/31/2299	N
23031	DRAIN SHOULDER BURSA	PRXOVR	DEF					NA	NA	NA	N
23031	DRAIN SHOULDER BURSA	MAXFEE	FAC					89.47	1/1/2014	12/31/2299	N
23031	DRAIN SHOULDER BURSA	MAXFEE	NFF					184.55	1/1/2014	12/31/2299	N
23035	DRAIN SHOULDER BONE LESION	PRXOVR	DEF					NA	NA	NA	N
23035	DRAIN SHOULDER BONE LESION	MAXFEE	DEF					444.26	1/1/2000	12/31/2299	N
23040	EXPLORATORY SHOULDER SURGERY	PRXOVR	DEF					NA	NA	NA	N
23040	EXPLORATORY SHOULDER SURGERY	MAXFEE	DEF					515.43	1/1/2000	12/31/2299	N
23044	EXPLORATORY SHOULDER SURGERY	PRXOVR	DEF					NA	NA	NA	N
23044	EXPLORATORY SHOULDER SURGERY	MAXFEE	DEF					399.28	1/1/2000	12/31/2299	N
23065	BIOPSY SHOULDER TISSUES	PRXOVR	DEF					NA	NA	NA	N
23065	BIOPSY SHOULDER TISSUES	MAXFEE	FAC					59.27	1/1/2014	12/31/2299	N
23065	BIOPSY SHOULDER TISSUES	MAXFEE	NFF					87.10	1/1/2014	12/31/2299	N
23066	BIOPSY SHOULDER TISSUES	PRXOVR	DEF					NA	NA	NA	N
23066	BIOPSY SHOULDER TISSUES	MAXFEE	FAC					130.14	1/1/2014	12/31/2299	N
23066	BIOPSY SHOULDER TISSUES	MAXFEE	NFF					239.83	1/1/2014	12/31/2299	N
23071	EXC SHOULDER LES SC 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
23071	EXC SHOULDER LES SC 3 CM/>	MAXFEE	DEF					229.55	1/1/2010	12/31/2299	N
23073	EXC SHOULDER TUM DEEP 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
23073	EXC SHOULDER TUM DEEP 5 CM/>	MAXFEE	DEF					381.39	1/1/2010	12/31/2299	N
23075	EXC SHOULDER LES SC < 3 CM	PRXOVR	DEF					NA	NA	NA	N
23075	EXC SHOULDER LES SC < 3 CM	MAXFEE	FAC					114.82	1/1/2014	12/31/2299	N
23075	EXC SHOULDER LES SC < 3 CM	MAXFEE	NFF					206.24	1/1/2014	12/31/2299	N
23076	EXC SHOULDER TUM DEEP < 5 CM	PRXOVR	DEF					NA	NA	NA	N
23076	EXC SHOULDER TUM DEEP < 5 CM	MAXFEE	DEF					320.67	1/1/2000	12/31/2299	N
23077	RESECT SHOULDER TUMOR < 5 CM	PRXOVR	DEF					NA	NA	NA	N
23077	RESECT SHOULDER TUMOR < 5 CM	MAXFEE	DEF					663.69	1/1/2000	12/31/2299	N
23078	RESECT SHOULDER TUMOR 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
23078	RESECT SHOULDER TUMOR 5 CM/>	MAXFEE	DEF					779.33	1/1/2010	12/31/2299	N
23100	BIOPSY OF SHOULDER JOINT	PRXOVR	DEF					NA	NA	NA	N
23100	BIOPSY OF SHOULDER JOINT	MAXFEE	DEF					358.99	1/1/2000	12/31/2299	N
23101	SHOULDER JOINT SURGERY	PRXOVR	DEF					NA	NA	NA	N
23101	SHOULDER JOINT SURGERY	MAXFEE	DEF					334.23	1/1/2000	12/31/2299	N
23105	REMOVE SHOULDER JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
23105	REMOVE SHOULDER JOINT LINING	MAXFEE	DEF					481.58	1/1/2000	12/31/2299	N
23106	INCISION OF COLLARBONE JOINT	PRXOVR	DEF					NA	NA	NA	N
23106	INCISION OF COLLARBONE JOINT	MAXFEE	DEF					307.38	1/1/2000	12/31/2299	N
23107	EXPLORE TREAT SHOULDER JOINT	PRXOVR	DEF					NA	NA	NA	N
23107	EXPLORE TREAT SHOULDER JOINT	MAXFEE	DEF					499.60	1/1/2000	12/31/2299	N
23120	PARTIAL REMOVAL COLLAR BONE	PRXOVR	DEF					NA	NA	NA	N
23120	PARTIAL REMOVAL COLLAR BONE	MAXFEE	DEF					340.59	1/1/2000	12/31/2299	N
23125	REMOVAL OF COLLAR BONE	PRXOVR	DEF					NA	NA	NA	N
23125	REMOVAL OF COLLAR BONE	MAXFEE	DEF					491.51	1/1/2000	12/31/2299	N
23130	REMOVE SHOULDER BONE PART	PRXOVR	DEF					NA	NA	NA	N
23130	REMOVE SHOULDER BONE PART	MAXFEE	DEF					410.87	1/1/2000	12/31/2299	N
23140	REMOVAL OF BONE LESION	PRXOVR	DEF					NA	NA	NA	N
23140	REMOVAL OF BONE LESION	MAXFEE	DEF					315.07	1/1/2000	12/31/2299	N
23145	REMOVAL OF BONE LESION	PRXOVR	DEF					NA	NA	NA	N
23145	REMOVAL OF BONE LESION	MAXFEE	DEF					479.73	1/1/2000	12/31/2299	N
23146	REMOVAL OF BONE LESION	PRXOVR	DEF					NA	NA	NA	N
23146	REMOVAL OF BONE LESION	MAXFEE	DEF					380.01	1/1/2000	12/31/2299	N
23150	REMOVAL OF HUMERUS LESION	PRXOVR	DEF					NA	NA	NA	N
23150	REMOVAL OF HUMERUS LESION	MAXFEE	DEF					422.40	1/1/2000	12/31/2299	N
23155	REMOVAL OF HUMERUS LESION	PRXOVR	DEF					NA	NA	NA	N
23155	REMOVAL OF HUMERUS LESION	MAXFEE	DEF					532.76	1/1/2000	12/31/2299	N
23156	REMOVAL OF HUMERUS LESION	PRXOVR	DEF					NA	NA	NA	N
23156	REMOVAL OF HUMERUS LESION	MAXFEE	DEF					454.95	1/1/2000	12/31/2299	N
23170	REMOVE COLLAR BONE LESION	PRXOVR	DEF					NA	NA	NA	N
23170	REMOVE COLLAR BONE LESION	MAXFEE	DEF					337.98	1/1/2000	12/31/2299	N
23172	REMOVE SHOULDER BLADE LESION	PRXOVR	DEF					NA	NA	NA	N
23172	REMOVE SHOULDER BLADE LESION	MAXFEE	DEF					347.43	1/1/2000	12/31/2299	N
23174	REMOVE HUMERUS LESION	PRXOVR	DEF					NA	NA	NA	N
23174	REMOVE HUMERUS LESION	MAXFEE	DEF					507.12	1/1/2000	12/31/2299	N
23180	REMOVE COLLAR BONE LESION	PRXOVR	DEF					NA	NA	NA	N
23180	REMOVE COLLAR BONE LESION	MAXFEE	DEF					394.03	7/1/2008	12/31/2299	N
23182	REMOVE SHOULDER BLADE LESION	PRXOVR	DEF					NA	NA	NA	N
23182	REMOVE SHOULDER BLADE LESION	MAXFEE	DEF					442.52	1/1/2000	12/31/2299	N
23184	REMOVE HUMERUS LESION	PRXOVR	DEF					NA	NA	NA	N
23184	REMOVE HUMERUS LESION	MAXFEE	DEF					533.74	1/1/2000	12/31/2299	N
23190	PARTIAL REMOVAL OF SCAPULA	PRXOVR	DEF					NA	NA	NA	N
23190	PARTIAL REMOVAL OF SCAPULA	MAXFEE	DEF					372.31	1/1/2000	12/31/2299	N
23195	REMOVAL OF HEAD OF HUMERUS	PRXOVR	DEF					NA	NA	NA	N
23195	REMOVAL OF HEAD OF HUMERUS	MAXFEE	DEF					517.33	1/1/2000	12/31/2299	N
23200	RESECT CLAVICLE TUMOR	PRXOVR	DEF					NA	NA	NA	N
23200	RESECT CLAVICLE TUMOR	MAXFEE	DEF					588.83	1/1/2000	12/31/2299	N
23210	RESECT SCAPULA TUMOR	PRXOVR	DEF					NA	NA	NA	N
23210	RESECT SCAPULA TUMOR	MAXFEE	DEF					600.15	1/1/2000	12/31/2299	N
23220	RESECT PROX HUMERUS TUMOR	PRXOVR	DEF					NA	NA	NA	N
23220	RESECT PROX HUMERUS TUMOR	MAXFEE	DEF					737.57	1/1/2000	12/31/2299	N
23221	PARTIAL REMOVAL OF HUMERUS	PRXOVR	DEF					NA	NA	NA	N
23221	PARTIAL REMOVAL OF HUMERUS	MAXFEE	DEF					NA			N
23222	PARTIAL REMOVAL OF HUMERUS	PRXOVR	DEF					NA	NA	NA	N
23222	PARTIAL REMOVAL OF HUMERUS	MAXFEE	DEF					NA			N
23330	REMOVE SHOULDER FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
23330	REMOVE SHOULDER FOREIGN BODY	MAXFEE	FAC					57.82	1/1/2014	12/31/2299	N
23330	REMOVE SHOULDER FOREIGN BODY	MAXFEE	NFF					118.07	1/1/2014	12/31/2299	N
23331	REMOVE SHOULDER FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
23331	REMOVE SHOULDER FOREIGN BODY	MAXFEE	DEF					NA			N
23332	REMOVE SHOULDER FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
23332	REMOVE SHOULDER FOREIGN BODY	MAXFEE	DEF					NA			N
23333	REMOVE SHOULDER FB DEEP	PRXOVR	DEF					NA	NA	NA	N
23333	REMOVE SHOULDER FB DEEP	MAXFEE	DEF					345.11	1/1/2014	12/31/2299	N
23334	SHOULDER PROSTHESIS REMOVAL	PRXOVR	DEF					NA	NA	NA	N
23334	SHOULDER PROSTHESIS REMOVAL	MAXFEE	DEF					818.78	1/1/2014	12/31/2299	N
23335	SHOULDER PROSTHESIS REMOVAL	PRXOVR	DEF					NA	NA	NA	N
23335	SHOULDER PROSTHESIS REMOVAL	MAXFEE	DEF					977.91	1/1/2014	12/31/2299	N
23350	INJECTION FOR SHOULDER X-RAY	PRXOVR	DEF					NA	NA	NA	N
23350	INJECTION FOR SHOULDER X-RAY	MAXFEE	FAC					17.58	1/1/2014	12/31/2299	N
23350	INJECTION FOR SHOULDER X-RAY	MAXFEE	NFF					45.99	1/1/2014	12/31/2299	N
23395	MUSCLE TRANSFER SHOULDER/ARM	PRXOVR	DEF					NA	NA	NA	N
23395	MUSCLE TRANSFER SHOULDER/ARM	MAXFEE	DEF					748.15	1/1/2000	12/31/2299	N
23397	MUSCLE TRANSFERS	PRXOVR	DEF					NA	NA	NA	N
23397	MUSCLE TRANSFERS	MAXFEE	DEF					822.56	1/1/2000	12/31/2299	N
23400	FIXATION OF SHOULDER BLADE	PRXOVR	DEF					NA	NA	NA	N
23400	FIXATION OF SHOULDER BLADE	MAXFEE	DEF					647.91	1/1/2000	12/31/2299	N
23405	INCISION OF TENDON & MUSCLE	PRXOVR	DEF					NA	NA	NA	N
23405	INCISION OF TENDON & MUSCLE	MAXFEE	DEF					433.07	1/1/2000	12/31/2299	N
23406	INCISE TENDON(S) & MUSCLE(S)	PRXOVR	DEF					NA	NA	NA	N
23406	INCISE TENDON(S) & MUSCLE(S)	MAXFEE	DEF					559.99	1/1/2000	12/31/2299	N
23410	REPAIR ROTATOR CUFF ACUTE	PRXOVR	DEF					NA	NA	NA	N
23410	REPAIR ROTATOR CUFF ACUTE	MAXFEE	DEF					643.37	1/1/2000	12/31/2299	N
23412	REPAIR ROTATOR CUFF CHRONIC	PRXOVR	DEF					NA	NA	NA	N
23412	REPAIR ROTATOR CUFF CHRONIC	MAXFEE	DEF					726.05	1/1/2000	12/31/2299	N
23415	RELEASE OF SHOULDER LIGAMENT	PRXOVR	DEF					NA	NA	NA	N
23415	RELEASE OF SHOULDER LIGAMENT	MAXFEE	DEF					431.53	1/1/2000	12/31/2299	N
23420	REPAIR OF SHOULDER	PRXOVR	DEF					NA	NA	NA	N
23420	REPAIR OF SHOULDER	MAXFEE	DEF					759.12	1/1/2000	12/31/2299	N
23430	REPAIR BICEPS TENDON	PRXOVR	DEF					NA	NA	NA	N
23430	REPAIR BICEPS TENDON	MAXFEE	DEF					487.50	1/1/2000	12/31/2299	N
23440	REMOVE/TRANSPLANT TENDON	PRXOVR	DEF					NA	NA	NA	N
23440	REMOVE/TRANSPLANT TENDON	MAXFEE	DEF					499.07	1/1/2000	12/31/2299	N
23450	REPAIR SHOULDER CAPSULE	PRXOVR	DEF					NA	NA	NA	N
23450	REPAIR SHOULDER CAPSULE	MAXFEE	DEF					712.70	1/1/2000	12/31/2299	N
23455	REPAIR SHOULDER CAPSULE	PRXOVR	DEF					NA	NA	NA	N
23455	REPAIR SHOULDER CAPSULE	MAXFEE	DEF					807.16	1/1/2000	12/31/2299	N
23460	REPAIR SHOULDER CAPSULE	PRXOVR	DEF					NA	NA	NA	N
23460	REPAIR SHOULDER CAPSULE	MAXFEE	DEF					800.90	1/1/2000	12/31/2299	N
23462	REPAIR SHOULDER CAPSULE	PRXOVR	DEF					NA	NA	NA	N
23462	REPAIR SHOULDER CAPSULE	MAXFEE	DEF					823.31	1/1/2000	12/31/2299	N
23465	REPAIR SHOULDER CAPSULE	PRXOVR	DEF					NA	NA	NA	N
23465	REPAIR SHOULDER CAPSULE	MAXFEE	DEF					816.57	1/1/2004	12/31/2299	N
23466	REPAIR SHOULDER CAPSULE	PRXOVR	DEF					NA	NA	NA	N
23466	REPAIR SHOULDER CAPSULE	MAXFEE	DEF					807.60	1/1/2000	12/31/2299	N
23470	RECONSTRUCT SHOULDER JOINT	PRXOVR	DEF					NA	NA	NA	N
23470	RECONSTRUCT SHOULDER JOINT	MAXFEE	DEF					916.11	1/1/2000	12/31/2299	N
23472	RECONSTRUCT SHOULDER JOINT	PRXOVR	DEF					NA	NA	NA	N
23472	RECONSTRUCT SHOULDER JOINT	MAXFEE	DEF					995.32	1/1/2000	12/31/2299	N
23473	REVIS RECONST SHOULDER JOINT	PRXOVR	DEF					NA	NA	NA	N
23473	REVIS RECONST SHOULDER JOINT	MAXFEE	DEF					1140.09	1/1/2013	12/31/2299	N
23474	REVIS RECONST SHOULDER JOINT	PRXOVR	DEF					NA	NA	NA	N
23474	REVIS RECONST SHOULDER JOINT	MAXFEE	DEF					1232.59	1/1/2013	12/31/2299	N
23480	REVISION OF COLLAR BONE	PRXOVR	DEF					NA	NA	NA	N
23480	REVISION OF COLLAR BONE	MAXFEE	DEF					501.78	1/1/2000	12/31/2299	N
23485	REVISION OF COLLAR BONE	PRXOVR	DEF					NA	NA	NA	N
23485	REVISION OF COLLAR BONE	MAXFEE	DEF					684.24	1/1/2000	12/31/2299	N
23490	REINFORCE CLAVICLE	PRXOVR	DEF					NA	NA	NA	N
23490	REINFORCE CLAVICLE	MAXFEE	DEF					586.47	1/1/2000	12/31/2299	N
23491	REINFORCE SHOULDER BONES	PRXOVR	DEF					NA	NA	NA	N
23491	REINFORCE SHOULDER BONES	MAXFEE	DEF					736.76	1/1/2000	12/31/2299	N
23500	CLTX CLAVICULAR FX W/O MNPJ	PRXOVR	DEF					NA	NA	NA	N
23500	CLTX CLAVICULAR FX W/O MNPJ	MAXFEE	FAC					99.67	1/1/2014	12/31/2299	N
23500	CLTX CLAVICULAR FX W/O MNPJ	MAXFEE	NFF					109.88	1/1/2014	12/31/2299	N
23505	CLTX CLAVICULAR FX W/MNPJ	PRXOVR	DEF					NA	NA	NA	N
23505	CLTX CLAVICULAR FX W/MNPJ	MAXFEE	FAC					175.59	1/1/2014	12/31/2299	N
23505	CLTX CLAVICULAR FX W/MNPJ	MAXFEE	NFF					182.43	1/1/2014	12/31/2299	N
23515	OPTX CLAVICULAR FX W/INT FIX	PRXOVR	DEF					NA	NA	NA	N
23515	OPTX CLAVICULAR FX W/INT FIX	MAXFEE	DEF					395.61	1/1/2000	12/31/2299	N
23520	CLTX STRNCLAV DISLC W/O MNPJ	PRXOVR	DEF					NA	NA	NA	N
23520	CLTX STRNCLAV DISLC W/O MNPJ	MAXFEE	FAC					102.26	1/1/2014	12/31/2299	N
23520	CLTX STRNCLAV DISLC W/O MNPJ	MAXFEE	NFF					112.14	1/1/2014	12/31/2299	N
23525	CLTX STRNCLAV DISLC W/MNPJ	PRXOVR	DEF					NA	NA	NA	N
23525	CLTX STRNCLAV DISLC W/MNPJ	MAXFEE	FAC					152.72	1/1/2014	12/31/2299	N
23525	CLTX STRNCLAV DISLC W/MNPJ	MAXFEE	NFF					168.76	1/1/2014	12/31/2299	N
23530	OPTX STRNCLAV DISLC AQT/CHRN	PRXOVR	DEF					NA	NA	NA	N
23530	OPTX STRNCLAV DISLC AQT/CHRN	MAXFEE	DEF					377.76	1/1/2000	12/31/2299	N
23532	OPTX STRCLV DSLC AQ/CHRN GRF	PRXOVR	DEF					NA	NA	NA	N
23532	OPTX STRCLV DSLC AQ/CHRN GRF	MAXFEE	DEF					418.47	1/1/2000	12/31/2299	N
23540	CLTX ACROMCLAV DISLC WO MNPJ	PRXOVR	DEF					NA	NA	NA	N
23540	CLTX ACROMCLAV DISLC WO MNPJ	MAXFEE	FAC					102.15	1/1/2014	12/31/2299	N
23540	CLTX ACROMCLAV DISLC WO MNPJ	MAXFEE	NFF					112.76	1/1/2014	12/31/2299	N
23545	CLTX ACROMCLAV DISLC W/MNPJ	PRXOVR	DEF					NA	NA	NA	N
23545	CLTX ACROMCLAV DISLC W/MNPJ	MAXFEE	FAC					122.42	1/1/2014	12/31/2299	N
23545	CLTX ACROMCLAV DISLC W/MNPJ	MAXFEE	NFF					152.62	1/1/2014	12/31/2299	N
23550	OPTX ACROMCLV DISLC AQT/CHRN	PRXOVR	DEF					NA	NA	NA	N
23550	OPTX ACROMCLV DISLC AQT/CHRN	MAXFEE	DEF					418.43	1/1/2000	12/31/2299	N
23552	OPTX ACRCLV DSLC AQ/CHRN GRF	PRXOVR	DEF					NA	NA	NA	N
23552	OPTX ACRCLV DSLC AQ/CHRN GRF	MAXFEE	DEF					434.31	1/1/2000	12/31/2299	N
23570	CLTX SCAPULAR FX W/O MNPJ	PRXOVR	DEF					NA	NA	NA	N
23570	CLTX SCAPULAR FX W/O MNPJ	MAXFEE	FAC					99.80	1/1/2014	12/31/2299	N
23570	CLTX SCAPULAR FX W/O MNPJ	MAXFEE	NFF					115.42	1/1/2014	12/31/2299	N
23575	CLTX SCAP FX W/MNPJ +-TRACTJ	PRXOVR	DEF					NA	NA	NA	N
23575	CLTX SCAP FX W/MNPJ +-TRACTJ	MAXFEE	FAC					149.16	1/1/2014	12/31/2299	N
23575	CLTX SCAP FX W/MNPJ +-TRACTJ	MAXFEE	NFF					198.12	1/1/2014	12/31/2299	N
23585	OPTX SCAPULAR FX W/INT FIXJ	PRXOVR	DEF					NA	NA	NA	N
23585	OPTX SCAPULAR FX W/INT FIXJ	MAXFEE	DEF					461.23	1/1/2000	12/31/2299	N
23600	CLTX PROX HUMRL FX W/O MNPJ	PRXOVR	DEF					NA	NA	NA	N
23600	CLTX PROX HUMRL FX W/O MNPJ	MAXFEE	FAC					165.58	1/1/2014	12/31/2299	N
23600	CLTX PROX HUMRL FX W/O MNPJ	MAXFEE	NFF					170.86	1/1/2014	12/31/2299	N
23605	CLTX PRX HMRL FX MNPJ+-TRACT	PRXOVR	DEF					NA	NA	NA	N
23605	CLTX PRX HMRL FX MNPJ+-TRACT	MAXFEE	FAC					254.70	1/1/2014	12/31/2299	N
23605	CLTX PRX HMRL FX MNPJ+-TRACT	MAXFEE	NFF					278.21	1/1/2014	12/31/2299	N
23615	OPTX PROX HUMRL FX W/INT FIX	PRXOVR	DEF					NA	NA	NA	N
23615	OPTX PROX HUMRL FX W/INT FIX	MAXFEE	DEF					537.99	1/1/2000	12/31/2299	N
23616	OPTX PRX HMRL FX FIX RPR RPL	PRXOVR	DEF					NA	NA	NA	N
23616	OPTX PRX HMRL FX FIX RPR RPL	MAXFEE	DEF					1091.07	1/1/2010	12/31/2299	N
23620	CLTX GR HMRL TBRS FX WO MNPJ	PRXOVR	DEF					NA	NA	NA	N
23620	CLTX GR HMRL TBRS FX WO MNPJ	MAXFEE	FAC					153.40	1/1/2014	12/31/2299	N
23620	CLTX GR HMRL TBRS FX WO MNPJ	MAXFEE	NFF					155.68	1/1/2014	12/31/2299	N
23625	CLTX GR HMRL TBRS FX W/MNPJ	PRXOVR	DEF					NA	NA	NA	N
23625	CLTX GR HMRL TBRS FX W/MNPJ	MAXFEE	FAC					194.05	1/1/2014	12/31/2299	N
23625	CLTX GR HMRL TBRS FX W/MNPJ	MAXFEE	NFF					227.38	1/1/2014	12/31/2299	N
23630	OPTX GR HMRL TBRS FX INT FIX	PRXOVR	DEF					NA	NA	NA	N
23630	OPTX GR HMRL TBRS FX INT FIX	MAXFEE	DEF					423.45	1/1/2000	12/31/2299	N
23650	CLTX SHO DSLC W/MNPJ WO ANES	PRXOVR	DEF					NA	NA	NA	N
23650	CLTX SHO DSLC W/MNPJ WO ANES	MAXFEE	FAC					150.29	1/1/2014	12/31/2299	N
23650	CLTX SHO DSLC W/MNPJ WO ANES	MAXFEE	NFF					159.63	1/1/2014	12/31/2299	N
23655	CLTX SHO DSLC W/MNPJ W/ANES	PRXOVR	DEF					NA	NA	NA	N
23655	CLTX SHO DSLC W/MNPJ W/ANES	MAXFEE	DEF					206.06	1/1/2000	12/31/2299	N
23660	OPTX ACUTE SHOULDER DISLC	PRXOVR	DEF					NA	NA	NA	N
23660	OPTX ACUTE SHOULDER DISLC	MAXFEE	DEF					427.25	1/1/2000	12/31/2299	N
23665	CLTX SHO DSLC FX GR HMRL TBR	PRXOVR	DEF					NA	NA	NA	N
23665	CLTX SHO DSLC FX GR HMRL TBR	MAXFEE	FAC					216.90	1/1/2014	12/31/2299	N
23665	CLTX SHO DSLC FX GR HMRL TBR	MAXFEE	NFF					230.72	1/1/2014	12/31/2299	N
23670	OPTX SHO DISLC FX	PRXOVR	DEF					NA	NA	NA	N
23670	OPTX SHO DISLC FX	MAXFEE	DEF					462.53	1/1/2000	12/31/2299	N
23675	CLTX SHO DISLC NECK FX MNPJ	PRXOVR	DEF					NA	NA	NA	N
23675	CLTX SHO DISLC NECK FX MNPJ	MAXFEE	FAC					214.26	1/1/2014	12/31/2299	N
23675	CLTX SHO DISLC NECK FX MNPJ	MAXFEE	NFF					289.85	1/1/2014	12/31/2299	N
23680	OPTX SHO DISLC NECK FX FIXJ	PRXOVR	DEF					NA	NA	NA	N
23680	OPTX SHO DISLC NECK FX FIXJ	MAXFEE	DEF					577.83	1/1/2000	12/31/2299	N
23700	MNPJ ANES SHO JT FIXJ APRATS	PRXOVR	DEF					NA	NA	NA	N
23700	MNPJ ANES SHO JT FIXJ APRATS	MAXFEE	DEF					160.22	1/1/2010	12/31/2299	N
23800	ARTHRODESIS GLENOHUMERAL JT	PRXOVR	DEF					NA	NA	NA	N
23800	ARTHRODESIS GLENOHUMERAL JT	MAXFEE	DEF					808.09	1/1/2000	12/31/2299	N
23802	ARTHRD GLENOHUMERAL JT W/GRF	PRXOVR	DEF					NA	NA	NA	N
23802	ARTHRD GLENOHUMERAL JT W/GRF	MAXFEE	DEF					839.78	1/1/2000	12/31/2299	N
23900	INTERTHORACOSCPLR AMPUTATION	PRXOVR	DEF					NA	NA	NA	N
23900	INTERTHORACOSCPLR AMPUTATION	MAXFEE	DEF					891.83	1/1/2000	12/31/2299	N
23920	DISARTICULATION SHOULDER	PRXOVR	DEF					NA	NA	NA	N
23920	DISARTICULATION SHOULDER	MAXFEE	DEF					777.13	1/1/2000	12/31/2299	N
23921	DISARTICULATION SHO SEC CLSR	PRXOVR	DEF					NA	NA	NA	N
23921	DISARTICULATION SHO SEC CLSR	MAXFEE	DEF					279.37	1/1/2000	12/31/2299	N
23929	UNLISTED PROCEDURE SHOULDER	PRXOVR	DEF					NA	NA	NA	N
23929	UNLISTED PROCEDURE SHOULDER	MANUAL	DEF					NA	NA	NA	N
23930	I&D UPR A/E DP ABSC/HMTMA	PRXOVR	DEF					NA	NA	NA	N
23930	I&D UPR A/E DP ABSC/HMTMA	MAXFEE	FAC					76.07	1/1/2014	12/31/2299	N
23930	I&D UPR A/E DP ABSC/HMTMA	MAXFEE	NFF					136.91	1/1/2014	12/31/2299	N
23931	I&D UPR A/E BURSA	PRXOVR	DEF					NA	NA	NA	N
23931	I&D UPR A/E BURSA	MAXFEE	FAC					63.58	1/1/2014	12/31/2299	N
23931	I&D UPR A/E BURSA	MAXFEE	NFF					127.31	1/1/2014	12/31/2299	N
23935	INC DP OPN B1 CRTX HUM/ELBW	PRXOVR	DEF					NA	NA	NA	N
23935	INC DP OPN B1 CRTX HUM/ELBW	MAXFEE	DEF					325.21	1/1/2000	12/31/2299	N
24000	ARTHRT ELBW EXPL DRG/RMVL FB	PRXOVR	DEF					NA	NA	NA	N
24000	ARTHRT ELBW EXPL DRG/RMVL FB	MAXFEE	DEF					342.28	1/1/2000	12/31/2299	N
24006	ARTHRT ELBW CAPSL EXC RLS	PRXOVR	DEF					NA	NA	NA	N
24006	ARTHRT ELBW CAPSL EXC RLS	MAXFEE	DEF					452.33	1/1/2004	12/31/2299	N
24065	BIOPSY ARM/ELBOW SOFT TISSUE	PRXOVR	DEF					NA	NA	NA	N
24065	BIOPSY ARM/ELBOW SOFT TISSUE	MAXFEE	FAC					85.61	1/1/2014	12/31/2299	N
24065	BIOPSY ARM/ELBOW SOFT TISSUE	MAXFEE	NFF					119.96	1/1/2014	12/31/2299	N
24066	BIOPSY ARM/ELBOW SOFT TISSUE	PRXOVR	DEF					NA	NA	NA	N
24066	BIOPSY ARM/ELBOW SOFT TISSUE	MAXFEE	FAC					169.73	1/1/2014	12/31/2299	N
24066	BIOPSY ARM/ELBOW SOFT TISSUE	MAXFEE	NFF					232.04	1/1/2014	12/31/2299	N
24071	EXC ARM/ELBOW LES SC 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
24071	EXC ARM/ELBOW LES SC 3 CM/>	MAXFEE	DEF					222.69	1/1/2010	12/31/2299	N
24073	EX ARM/ELBOW TUM DEEP 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
24073	EX ARM/ELBOW TUM DEEP 5 CM/>	MAXFEE	DEF					382.93	1/1/2010	12/31/2299	N
24075	EXC ARM/ELBOW LES SC < 3 CM	PRXOVR	DEF					NA	NA	NA	N
24075	EXC ARM/ELBOW LES SC < 3 CM	MAXFEE	FAC					132.43	1/1/2014	12/31/2299	N
24075	EXC ARM/ELBOW LES SC < 3 CM	MAXFEE	NFF					180.55	1/1/2014	12/31/2299	N
24076	EX ARM/ELBOW TUM DEEP < 5 CM	PRXOVR	DEF					NA	NA	NA	N
24076	EX ARM/ELBOW TUM DEEP < 5 CM	MAXFEE	DEF					284.57	1/1/2000	12/31/2299	N
24077	RAD RESCJ TUM TISS A/E <5CM	PRXOVR	DEF					NA	NA	NA	N
24077	RAD RESCJ TUM TISS A/E <5CM	MAXFEE	DEF					602.04	1/1/2000	12/31/2299	N
24079	RAD RESCJ TUM TISS A/E 5 CM+	PRXOVR	DEF					NA	NA	NA	N
24079	RAD RESCJ TUM TISS A/E 5 CM+	MAXFEE	DEF					718.15	1/1/2010	12/31/2299	N
24100	ARTHRT ELBW SYNOVIAL BX ONLY	PRXOVR	DEF					NA	NA	NA	N
24100	ARTHRT ELBW SYNOVIAL BX ONLY	MAXFEE	DEF					255.19	1/1/2000	12/31/2299	N
24101	ARTHRT ELBW JT EXPL BX RMVL	PRXOVR	DEF					NA	NA	NA	N
24101	ARTHRT ELBW JT EXPL BX RMVL	MAXFEE	DEF					357.93	1/1/2000	12/31/2299	N
24102	ARTHRT ELBOW W/SYNOVECTOMY	PRXOVR	DEF					NA	NA	NA	N
24102	ARTHRT ELBOW W/SYNOVECTOMY	MAXFEE	DEF					463.09	1/1/2000	12/31/2299	N
24105	EXCISION OLECRANON BURSA	PRXOVR	DEF					NA	NA	NA	N
24105	EXCISION OLECRANON BURSA	MAXFEE	DEF					206.90	1/1/2000	12/31/2299	N
24110	EXC/CURTG B1 CST/B9 TUM HUM	PRXOVR	DEF					NA	NA	NA	N
24110	EXC/CURTG B1 CST/B9 TUM HUM	MAXFEE	DEF					418.09	1/1/2000	12/31/2299	N
24115	EXC/CRTG B1 CST/TUM HUM AGRF	PRXOVR	DEF					NA	NA	NA	N
24115	EXC/CRTG B1 CST/TUM HUM AGRF	MAXFEE	DEF					478.07	1/1/2000	12/31/2299	N
24116	EXC/CRTG B1 CST/TUM HUM ALGR	PRXOVR	DEF					NA	NA	NA	N
24116	EXC/CRTG B1 CST/TUM HUM ALGR	MAXFEE	DEF					593.43	1/1/2000	12/31/2299	N
24120	EXC/CRTG B1 CST/B9 TUM RDS	PRXOVR	DEF					NA	NA	NA	N
24120	EXC/CRTG B1 CST/B9 TUM RDS	MAXFEE	DEF					347.98	1/1/2000	12/31/2299	N
24125	EXC/CRTG B1 CST/TUM RDS AGRF	PRXOVR	DEF					NA	NA	NA	N
24125	EXC/CRTG B1 CST/TUM RDS AGRF	MAXFEE	DEF					367.94	1/1/2000	12/31/2299	N
24126	EXC/CRTG B1 CST/TUM RDS ALGR	PRXOVR	DEF					NA	NA	NA	N
24126	EXC/CRTG B1 CST/TUM RDS ALGR	MAXFEE	DEF					422.73	1/1/2000	12/31/2299	N
24130	EXCISION RADIAL HEAD	PRXOVR	DEF					NA	NA	NA	N
24130	EXCISION RADIAL HEAD	MAXFEE	DEF					354.12	1/1/2000	12/31/2299	N
24134	SEQUESTRECTOMY SHFT/DSTL HUM	PRXOVR	DEF					NA	NA	NA	N
24134	SEQUESTRECTOMY SHFT/DSTL HUM	MAXFEE	DEF					526.44	1/1/2000	12/31/2299	N
24136	SEQUESTRECTOMY RADIAL H/N	PRXOVR	DEF					NA	NA	NA	N
24136	SEQUESTRECTOMY RADIAL H/N	MAXFEE	DEF					436.18	1/1/2000	12/31/2299	N
24138	SEQUESTRECTOMY OLECRN PROCES	PRXOVR	DEF					NA	NA	NA	N
24138	SEQUESTRECTOMY OLECRN PROCES	MAXFEE	DEF					400.14	1/1/2000	12/31/2299	N
24140	PARTIAL EXC BONE HUMERUS	PRXOVR	DEF					NA	NA	NA	N
24140	PARTIAL EXC BONE HUMERUS	MAXFEE	DEF					525.17	1/1/2000	12/31/2299	N
24145	PRTL EXC BONE RADIAL H/N	PRXOVR	DEF					NA	NA	NA	N
24145	PRTL EXC BONE RADIAL H/N	MAXFEE	DEF					404.21	1/1/2000	12/31/2299	N
24147	PRTL EXC BONE OLECRN PROCESS	PRXOVR	DEF					NA	NA	NA	N
24147	PRTL EXC BONE OLECRN PROCESS	MAXFEE	DEF					407.38	1/1/2000	12/31/2299	N
24149	RADICAL RESECTION OF ELBOW	PRXOVR	DEF					NA	NA	NA	N
24149	RADICAL RESECTION OF ELBOW	MAXFEE	DEF					721.91	4/1/2008	12/31/2299	N
24150	RAD RESCJ TUM DSTL/SHFT HUM	PRXOVR	DEF					NA	NA	NA	N
24150	RAD RESCJ TUM DSTL/SHFT HUM	MAXFEE	DEF					746.75	1/1/2004	12/31/2299	N
24151	EXTENSIVE HUMERUS SURGERY	PRXOVR	DEF					NA	NA	NA	N
24151	EXTENSIVE HUMERUS SURGERY	MAXFEE	DEF					NA			N
24152	RAD RESECTION TUM RADIAL H/N	PRXOVR	DEF					NA	NA	NA	N
24152	RAD RESECTION TUM RADIAL H/N	MAXFEE	DEF					468.76	4/1/2008	12/31/2299	N
24153	EXTENSIVE RADIUS SURGERY	PRXOVR	DEF					NA	NA	NA	N
24153	EXTENSIVE RADIUS SURGERY	MAXFEE	DEF					NA			N
24155	RESECTION OF ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24155	RESECTION OF ELBOW JOINT	MAXFEE	DEF					605.47	1/1/2000	12/31/2299	N
24160	RMVL PROSTHHUMRL&ULNAR CMPNT	PRXOVR	DEF					NA	NA	NA	N
24160	RMVL PROSTHHUMRL&ULNAR CMPNT	MAXFEE	DEF					356.83	1/1/2000	12/31/2299	N
24164	REMOVAL PROSTH RADIAL HEAD	PRXOVR	DEF					NA	NA	NA	N
24164	REMOVAL PROSTH RADIAL HEAD	MAXFEE	DEF					325.17	1/1/2000	12/31/2299	N
24200	RMVL FB UPPER ARM/ELBW SUBQ	PRXOVR	DEF					NA	NA	NA	N
24200	RMVL FB UPPER ARM/ELBW SUBQ	MAXFEE	FAC					48.76	1/1/2014	12/31/2299	N
24200	RMVL FB UPPER ARM/ELBW SUBQ	MAXFEE	NFF					74.09	1/1/2014	12/31/2299	N
24201	RMVL FB UPPER ARM/ELBW DEEP	PRXOVR	DEF					NA	NA	NA	N
24201	RMVL FB UPPER ARM/ELBW DEEP	MAXFEE	FAC					171.72	1/1/2014	12/31/2299	N
24201	RMVL FB UPPER ARM/ELBW DEEP	MAXFEE	NFF					225.02	1/1/2014	12/31/2299	N
24220	INJECTION PX FOR ELBOW ARTHG	PRXOVR	DEF					NA	NA	NA	N
24220	INJECTION PX FOR ELBOW ARTHG	MAXFEE	FAC					41.72	1/1/2014	12/31/2299	N
24220	INJECTION PX FOR ELBOW ARTHG	MAXFEE	NFF					70.16	1/1/2014	12/31/2299	N
24300	MNPJ ELBOW UNDER ANES	PRXOVR	DEF					NA	NA	NA	N
24300	MNPJ ELBOW UNDER ANES	MAXFEE	DEF					254.12	4/1/2008	12/31/2299	N
24301	MUSC/TDN TRANSFER UPR A/E 1	PRXOVR	DEF					NA	NA	NA	N
24301	MUSC/TDN TRANSFER UPR A/E 1	MAXFEE	DEF					495.23	1/1/2000	12/31/2299	N
24305	TENDON LNGTH UPR A/E EA TDN	PRXOVR	DEF					NA	NA	NA	N
24305	TENDON LNGTH UPR A/E EA TDN	MAXFEE	DEF					315.79	7/1/2008	12/31/2299	N
24310	TNOT OPN ELBW TO SHO EA TDN	PRXOVR	DEF					NA	NA	NA	N
24310	TNOT OPN ELBW TO SHO EA TDN	MAXFEE	DEF					263.72	1/1/2000	12/31/2299	N
24320	TENOPLASTY ELBOW TO SHO 1	PRXOVR	DEF					NA	NA	NA	N
24320	TENOPLASTY ELBOW TO SHO 1	MAXFEE	DEF					540.28	1/1/2000	12/31/2299	N
24330	FLEXOR-PLASTY ELBOW	PRXOVR	DEF					NA	NA	NA	N
24330	FLEXOR-PLASTY ELBOW	MAXFEE	DEF					499.04	1/1/2000	12/31/2299	N
24331	FLEXOR-PLASTY ELBW W/ADVMNT	PRXOVR	DEF					NA	NA	NA	N
24331	FLEXOR-PLASTY ELBW W/ADVMNT	MAXFEE	DEF					549.74	1/1/2000	12/31/2299	N
24332	TENOLYSIS TRICEPS	PRXOVR	DEF					NA	NA	NA	N
24332	TENOLYSIS TRICEPS	MAXFEE	DEF					353.76	4/1/2008	12/31/2299	N
24340	TENODESIS BICEPS TDN AT ELBW	PRXOVR	DEF					NA	NA	NA	N
24340	TENODESIS BICEPS TDN AT ELBW	MAXFEE	DEF					408.78	1/1/2000	12/31/2299	N
24341	RPR TDN/MUSC UPR A/E EACH	PRXOVR	DEF					NA	NA	NA	N
24341	RPR TDN/MUSC UPR A/E EACH	MAXFEE	DEF					407.98	1/1/2004	12/31/2299	N
24342	REPAIR OF RUPTURED TENDON	PRXOVR	DEF					NA	NA	NA	N
24342	REPAIR OF RUPTURED TENDON	MAXFEE	DEF					569	1/1/2000	12/31/2299	N
24343	REPR ELBOW LAT LIGMNT W/TISS	PRXOVR	DEF					NA	NA	NA	N
24343	REPR ELBOW LAT LIGMNT W/TISS	MAXFEE	DEF					466.16	4/1/2008	12/31/2299	N
24344	RECONSTRUCT ELBOW LAT LIGMNT	PRXOVR	DEF					NA	NA	NA	N
24344	RECONSTRUCT ELBOW LAT LIGMNT	MAXFEE	DEF					704.80	4/1/2008	12/31/2299	N
24345	REPR ELBW MED LIGMNT W/TISSU	PRXOVR	DEF					NA	NA	NA	N
24345	REPR ELBW MED LIGMNT W/TISSU	MAXFEE	DEF					466.16	1/1/2004	12/31/2299	N
24346	RECONSTRUCT ELBOW MED LIGMNT	PRXOVR	DEF					NA	NA	NA	N
24346	RECONSTRUCT ELBOW MED LIGMNT	MAXFEE	DEF					704.80	4/1/2008	12/31/2299	N
24350	REPAIR OF TENNIS ELBOW	PRXOVR	DEF					NA	NA	NA	N
24350	REPAIR OF TENNIS ELBOW	MAXFEE	DEF					NA			N
24351	REPAIR OF TENNIS ELBOW	PRXOVR	DEF					NA	NA	NA	N
24351	REPAIR OF TENNIS ELBOW	MAXFEE	DEF					NA			N
24352	REPAIR OF TENNIS ELBOW	PRXOVR	DEF					NA	NA	NA	N
24352	REPAIR OF TENNIS ELBOW	MAXFEE	DEF					NA			N
24354	REPAIR OF TENNIS ELBOW	PRXOVR	DEF					NA	NA	NA	N
24354	REPAIR OF TENNIS ELBOW	MAXFEE	DEF					NA			N
24356	REVISION OF TENNIS ELBOW	PRXOVR	DEF					NA	NA	NA	N
24356	REVISION OF TENNIS ELBOW	MAXFEE	DEF					NA			N
24357	REPAIR ELBOW PERC	PRXOVR	DEF					NA	NA	NA	N
24357	REPAIR ELBOW PERC	MAXFEE	DEF					265.51	1/1/2008	12/31/2299	N
24358	REPAIR ELBOW W/DEB OPEN	PRXOVR	DEF					NA	NA	NA	N
24358	REPAIR ELBOW W/DEB OPEN	MAXFEE	DEF					312.13	1/1/2008	12/31/2299	N
24359	REPAIR ELBOW DEB/ATTCH OPEN	PRXOVR	DEF					NA	NA	NA	N
24359	REPAIR ELBOW DEB/ATTCH OPEN	MAXFEE	DEF					384.37	1/1/2008	12/31/2299	N
24360	RECONSTRUCT ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24360	RECONSTRUCT ELBOW JOINT	MAXFEE	DEF					696.07	1/1/2000	12/31/2299	N
24361	RECONSTRUCT ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24361	RECONSTRUCT ELBOW JOINT	MAXFEE	DEF					730.28	1/1/2000	12/31/2299	N
24362	RECONSTRUCT ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24362	RECONSTRUCT ELBOW JOINT	MAXFEE	DEF					719.05	1/1/2000	12/31/2299	N
24363	REPLACE ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24363	REPLACE ELBOW JOINT	MAXFEE	DEF					1048.67	1/1/2000	12/31/2299	N
24365	RECONSTRUCT HEAD OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
24365	RECONSTRUCT HEAD OF RADIUS	MAXFEE	DEF					433.78	1/1/2000	12/31/2299	N
24366	RECONSTRUCT HEAD OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
24366	RECONSTRUCT HEAD OF RADIUS	MAXFEE	DEF					518.69	1/1/2000	12/31/2299	N
24370	REVISE RECONST ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24370	REVISE RECONST ELBOW JOINT	MAXFEE	DEF					1075.59	1/1/2013	12/31/2299	N
24371	REVISE RECONST ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24371	REVISE RECONST ELBOW JOINT	MAXFEE	DEF					1240.47	1/1/2013	12/31/2299	N
24400	REVISION OF HUMERUS	PRXOVR	DEF					NA	NA	NA	N
24400	REVISION OF HUMERUS	MAXFEE	DEF					547.40	1/1/2000	12/31/2299	N
24410	REVISION OF HUMERUS	PRXOVR	DEF					NA	NA	NA	N
24410	REVISION OF HUMERUS	MAXFEE	DEF					775.28	1/1/2000	12/31/2299	N
24420	REVISION OF HUMERUS	PRXOVR	DEF					NA	NA	NA	N
24420	REVISION OF HUMERUS	MAXFEE	DEF					718.34	1/1/2000	12/31/2299	N
24430	REPAIR OF HUMERUS	PRXOVR	DEF					NA	NA	NA	N
24430	REPAIR OF HUMERUS	MAXFEE	DEF					730.03	1/1/2000	12/31/2299	N
24435	REPAIR HUMERUS WITH GRAFT	PRXOVR	DEF					NA	NA	NA	N
24435	REPAIR HUMERUS WITH GRAFT	MAXFEE	DEF					763.19	1/1/2000	12/31/2299	N
24470	REVISION OF ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24470	REVISION OF ELBOW JOINT	MAXFEE	DEF					444.34	1/1/2000	12/31/2299	N
24495	DECOMPRESSION OF FOREARM	PRXOVR	DEF					NA	NA	NA	N
24495	DECOMPRESSION OF FOREARM	MAXFEE	DEF					399.05	1/1/2000	12/31/2299	N
24498	REINFORCE HUMERUS	PRXOVR	DEF					NA	NA	NA	N
24498	REINFORCE HUMERUS	MAXFEE	DEF					614.37	1/1/2000	12/31/2299	N
24500	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24500	TREAT HUMERUS FRACTURE	MAXFEE	FAC					158.78	1/1/2014	12/31/2299	N
24500	TREAT HUMERUS FRACTURE	MAXFEE	NFF					174.10	1/1/2014	12/31/2299	N
24505	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24505	TREAT HUMERUS FRACTURE	MAXFEE	FAC					270.97	1/1/2014	12/31/2299	N
24505	TREAT HUMERUS FRACTURE	MAXFEE	NFF					295.32	1/1/2014	12/31/2299	N
24515	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24515	TREAT HUMERUS FRACTURE	MAXFEE	DEF					584.16	1/1/2000	12/31/2299	N
24516	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24516	TREAT HUMERUS FRACTURE	MAXFEE	DEF					588.87	1/1/2000	12/31/2299	N
24530	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24530	TREAT HUMERUS FRACTURE	MAXFEE	FAC					171	1/1/2014	12/31/2299	N
24530	TREAT HUMERUS FRACTURE	MAXFEE	NFF					193.32	1/1/2014	12/31/2299	N
24535	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24535	TREAT HUMERUS FRACTURE	MAXFEE	FAC					266.26	1/1/2014	12/31/2299	N
24535	TREAT HUMERUS FRACTURE	MAXFEE	NFF					348.75	1/1/2014	12/31/2299	N
24538	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24538	TREAT HUMERUS FRACTURE	MAXFEE	DEF					484.72	1/1/2000	12/31/2299	N
24545	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24545	TREAT HUMERUS FRACTURE	MAXFEE	DEF					556.92	1/1/2000	12/31/2299	N
24546	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24546	TREAT HUMERUS FRACTURE	MAXFEE	DEF					710.20	1/1/2000	12/31/2299	N
24560	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24560	TREAT HUMERUS FRACTURE	MAXFEE	FAC					117.72	1/1/2014	12/31/2299	N
24560	TREAT HUMERUS FRACTURE	MAXFEE	NFF					161.08	1/1/2014	12/31/2299	N
24565	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24565	TREAT HUMERUS FRACTURE	MAXFEE	FAC					247.87	1/1/2014	12/31/2299	N
24565	TREAT HUMERUS FRACTURE	MAXFEE	NFF					272.08	1/1/2014	12/31/2299	N
24566	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24566	TREAT HUMERUS FRACTURE	MAXFEE	DEF					390.83	1/1/2000	12/31/2299	N
24575	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24575	TREAT HUMERUS FRACTURE	MAXFEE	DEF					504.08	1/1/2000	12/31/2299	N
24576	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24576	TREAT HUMERUS FRACTURE	MAXFEE	FAC					152.18	1/1/2014	12/31/2299	N
24576	TREAT HUMERUS FRACTURE	MAXFEE	NFF					169.46	1/1/2014	12/31/2299	N
24577	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24577	TREAT HUMERUS FRACTURE	MAXFEE	FAC					269.63	1/1/2014	12/31/2299	N
24577	TREAT HUMERUS FRACTURE	MAXFEE	NFF					296.48	1/1/2014	12/31/2299	N
24579	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24579	TREAT HUMERUS FRACTURE	MAXFEE	DEF					554.87	1/1/2000	12/31/2299	N
24582	TREAT HUMERUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24582	TREAT HUMERUS FRACTURE	MAXFEE	DEF					429.17	1/1/2000	12/31/2299	N
24586	TREAT ELBOW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24586	TREAT ELBOW FRACTURE	MAXFEE	DEF					797.99	1/1/2000	12/31/2299	N
24587	TREAT ELBOW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24587	TREAT ELBOW FRACTURE	MAXFEE	DEF					771.28	1/1/2000	12/31/2299	N
24600	TREAT ELBOW DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
24600	TREAT ELBOW DISLOCATION	MAXFEE	FAC					167.80	1/1/2014	12/31/2299	N
24600	TREAT ELBOW DISLOCATION	MAXFEE	NFF					186.25	1/1/2014	12/31/2299	N
24605	TREAT ELBOW DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
24605	TREAT ELBOW DISLOCATION	MAXFEE	DEF					243.70	7/1/2008	12/31/2299	N
24615	TREAT ELBOW DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
24615	TREAT ELBOW DISLOCATION	MAXFEE	DEF					503.28	1/1/2000	12/31/2299	N
24620	TREAT ELBOW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24620	TREAT ELBOW FRACTURE	MAXFEE	DEF					302.48	1/1/2000	12/31/2299	N
24635	TREAT ELBOW FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24635	TREAT ELBOW FRACTURE	MAXFEE	DEF					630.21	1/1/2010	12/31/2299	N
24640	TREAT ELBOW DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
24640	TREAT ELBOW DISLOCATION	MAXFEE	FAC					43.23	1/1/2014	12/31/2299	N
24640	TREAT ELBOW DISLOCATION	MAXFEE	NFF					68.17	1/1/2014	12/31/2299	N
24650	TREAT RADIUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24650	TREAT RADIUS FRACTURE	MAXFEE	FAC					124.05	1/1/2014	12/31/2299	N
24650	TREAT RADIUS FRACTURE	MAXFEE	NFF					134.88	1/1/2014	12/31/2299	N
24655	TREAT RADIUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24655	TREAT RADIUS FRACTURE	MAXFEE	FAC					206.88	1/1/2014	12/31/2299	N
24655	TREAT RADIUS FRACTURE	MAXFEE	NFF					225.16	1/1/2014	12/31/2299	N
24665	TREAT RADIUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24665	TREAT RADIUS FRACTURE	MAXFEE	DEF					424.62	1/1/2000	12/31/2299	N
24666	TREAT RADIUS FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24666	TREAT RADIUS FRACTURE	MAXFEE	DEF					537.20	1/1/2000	12/31/2299	N
24670	TREAT ULNAR FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24670	TREAT ULNAR FRACTURE	MAXFEE	FAC					133.35	1/1/2014	12/31/2299	N
24670	TREAT ULNAR FRACTURE	MAXFEE	NFF					147.53	1/1/2014	12/31/2299	N
24675	TREAT ULNAR FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24675	TREAT ULNAR FRACTURE	MAXFEE	FAC					232.27	1/1/2014	12/31/2299	N
24675	TREAT ULNAR FRACTURE	MAXFEE	NFF					252.76	1/1/2014	12/31/2299	N
24685	TREAT ULNAR FRACTURE	PRXOVR	DEF					NA	NA	NA	N
24685	TREAT ULNAR FRACTURE	MAXFEE	DEF					473.45	1/1/2000	12/31/2299	N
24800	FUSION OF ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24800	FUSION OF ELBOW JOINT	MAXFEE	DEF					584.58	1/1/2000	12/31/2299	N
24802	FUSION/GRAFT OF ELBOW JOINT	PRXOVR	DEF					NA	NA	NA	N
24802	FUSION/GRAFT OF ELBOW JOINT	MAXFEE	DEF					696.68	1/1/2000	12/31/2299	N
24900	AMPUTATION OF UPPER ARM	PRXOVR	DEF					NA	NA	NA	N
24900	AMPUTATION OF UPPER ARM	MAXFEE	DEF					483.46	1/1/2000	12/31/2299	N
24920	AMPUTATION OF UPPER ARM	PRXOVR	DEF					NA	NA	NA	N
24920	AMPUTATION OF UPPER ARM	MAXFEE	DEF					466.12	1/1/2000	12/31/2299	N
24925	AMPUTATION FOLLOW-UP SURGERY	PRXOVR	DEF					NA	NA	NA	N
24925	AMPUTATION FOLLOW-UP SURGERY	MAXFEE	DEF					367.60	1/1/2000	12/31/2299	N
24930	AMPUTATION FOLLOW-UP SURGERY	PRXOVR	DEF					NA	NA	NA	N
24930	AMPUTATION FOLLOW-UP SURGERY	MAXFEE	DEF					516.56	1/1/2000	12/31/2299	N
24931	AMPUTATE UPPER ARM & IMPLANT	PRXOVR	DEF					NA	NA	NA	N
24931	AMPUTATE UPPER ARM & IMPLANT	MAXFEE	DEF					646.48	1/1/2000	12/31/2299	N
24935	REVISION OF AMPUTATION	PRXOVR	DEF					NA	NA	NA	N
24935	REVISION OF AMPUTATION	MAXFEE	DEF					792.29	1/1/2000	12/31/2299	N
24940	REVISION OF UPPER ARM	PRXOVR	DEF					NA	NA	NA	N
24940	REVISION OF UPPER ARM	MANUAL	DEF					NA	NA	NA	N
24999	UNLISTED PX HUMERUS/ELBOW	PRXOVR	DEF					NA	NA	NA	N
24999	UNLISTED PX HUMERUS/ELBOW	MANUAL	DEF					NA	NA	NA	N
25000	INCISION OF TENDON SHEATH	PRXOVR	DEF					NA	NA	NA	N
25000	INCISION OF TENDON SHEATH	MAXFEE	DEF					218.62	7/1/2008	12/31/2299	N
25001	INCISE FLEXOR CARPI RADIALIS	PRXOVR	DEF					NA	NA	NA	N
25001	INCISE FLEXOR CARPI RADIALIS	MAXFEE	DEF					212.58	4/1/2008	12/31/2299	N
25020	DECOMPRESS FOREARM 1 SPACE	PRXOVR	DEF					NA	NA	NA	N
25020	DECOMPRESS FOREARM 1 SPACE	MAXFEE	DEF					331.42	7/1/2008	12/31/2299	N
25023	DECOMPRESS FOREARM 1 SPACE	PRXOVR	DEF					NA	NA	NA	N
25023	DECOMPRESS FOREARM 1 SPACE	MAXFEE	DEF					623.68	7/1/2008	12/31/2299	N
25024	DECOMPRESS FOREARM 2 SPACES	PRXOVR	DEF					NA	NA	NA	N
25024	DECOMPRESS FOREARM 2 SPACES	MAXFEE	DEF					495.48	1/1/2002	12/31/2299	N
25025	DECOMPRESS FOREARM 2 SPACES	PRXOVR	DEF					NA	NA	NA	N
25025	DECOMPRESS FOREARM 2 SPACES	MAXFEE	DEF					801.99	1/1/2002	12/31/2299	N
25028	DRAINAGE OF FOREARM LESION	PRXOVR	DEF					NA	NA	NA	N
25028	DRAINAGE OF FOREARM LESION	MAXFEE	DEF					289.25	7/1/2008	12/31/2299	N
25031	DRAINAGE OF FOREARM BURSA	PRXOVR	DEF					NA	NA	NA	N
25031	DRAINAGE OF FOREARM BURSA	MAXFEE	DEF					254.50	7/1/2008	12/31/2299	N
25035	TREAT FOREARM BONE LESION	PRXOVR	DEF					NA	NA	NA	N
25035	TREAT FOREARM BONE LESION	MAXFEE	DEF					444.80	7/1/2008	12/31/2299	N
25040	EXPLORE/TREAT WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25040	EXPLORE/TREAT WRIST JOINT	MAXFEE	DEF					367.03	1/1/2000	12/31/2299	N
25065	BIOPSY FOREARM SOFT TISSUES	PRXOVR	DEF					NA	NA	NA	N
25065	BIOPSY FOREARM SOFT TISSUES	MAXFEE	FAC					85.21	1/1/2014	12/31/2299	N
25065	BIOPSY FOREARM SOFT TISSUES	MAXFEE	NFF					114.14	1/1/2014	12/31/2299	N
25066	BIOPSY FOREARM SOFT TISSUES	PRXOVR	DEF					NA	NA	NA	N
25066	BIOPSY FOREARM SOFT TISSUES	MAXFEE	DEF					240.91	7/1/2008	12/31/2299	N
25071	EXC FOREARM LES SC 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
25071	EXC FOREARM LES SC 3 CM/>	MAXFEE	DEF					233	1/1/2010	12/31/2299	N
25073	EXC FOREARM TUM DEEP 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
25073	EXC FOREARM TUM DEEP 3 CM/>	MAXFEE	DEF					289.25	1/1/2010	12/31/2299	N
25075	EXC FOREARM LES SC < 3 CM	PRXOVR	DEF					NA	NA	NA	N
25075	EXC FOREARM LES SC < 3 CM	MAXFEE	FAC					120.43	1/1/2014	12/31/2299	N
25075	EXC FOREARM LES SC < 3 CM	MAXFEE	NFF					209.10	1/1/2014	12/31/2299	N
25076	EXC FOREARM TUM DEEP < 3 CM	PRXOVR	DEF					NA	NA	NA	N
25076	EXC FOREARM TUM DEEP < 3 CM	MAXFEE	DEF					306.38	7/1/2008	12/31/2299	N
25077	RESECT FOREARM/WRIST TUM<3CM	PRXOVR	DEF					NA	NA	NA	N
25077	RESECT FOREARM/WRIST TUM<3CM	MAXFEE	DEF					534.47	1/1/2000	12/31/2299	N
25078	RESECT FORARM/WRIST TUM 3CM>	PRXOVR	DEF					NA	NA	NA	N
25078	RESECT FORARM/WRIST TUM 3CM>	MAXFEE	DEF					626.42	1/1/2010	12/31/2299	N
25085	INCISION OF WRIST CAPSULE	PRXOVR	DEF					NA	NA	NA	N
25085	INCISION OF WRIST CAPSULE	MAXFEE	DEF					307.01	1/1/2000	12/31/2299	N
25100	BIOPSY OF WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25100	BIOPSY OF WRIST JOINT	MAXFEE	DEF					240.77	1/1/2000	12/31/2299	N
25101	EXPLORE/TREAT WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25101	EXPLORE/TREAT WRIST JOINT	MAXFEE	DEF					284.54	1/1/2000	12/31/2299	N
25105	REMOVE WRIST JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
25105	REMOVE WRIST JOINT LINING	MAXFEE	DEF					357.88	1/1/2000	12/31/2299	N
25107	REMOVE WRIST JOINT CARTILAGE	PRXOVR	DEF					NA	NA	NA	N
25107	REMOVE WRIST JOINT CARTILAGE	MAXFEE	DEF					346.47	1/1/2000	12/31/2299	N
25109	EXCISE TENDON FOREARM/WRIST	PRXOVR	DEF					NA	NA	NA	N
25109	EXCISE TENDON FOREARM/WRIST	MAXFEE	DEF					286.78	4/1/2008	12/31/2299	N
25110	REMOVE WRIST TENDON LESION	PRXOVR	DEF					NA	NA	NA	N
25110	REMOVE WRIST TENDON LESION	MAXFEE	DEF					234.86	7/1/2008	12/31/2299	N
25111	REMOVE WRIST TENDON LESION	PRXOVR	DEF					NA	NA	NA	N
25111	REMOVE WRIST TENDON LESION	MAXFEE	DEF					195.27	1/1/2000	12/31/2299	N
25112	REREMOVE WRIST TENDON LESION	PRXOVR	DEF					NA	NA	NA	N
25112	REREMOVE WRIST TENDON LESION	MAXFEE	DEF					242.29	1/1/2000	12/31/2299	N
25115	REMOVE WRIST/FOREARM LESION	PRXOVR	DEF					NA	NA	NA	N
25115	REMOVE WRIST/FOREARM LESION	MAXFEE	DEF					508.97	7/1/2008	12/31/2299	N
25116	REMOVE WRIST/FOREARM LESION	PRXOVR	DEF					NA	NA	NA	N
25116	REMOVE WRIST/FOREARM LESION	MAXFEE	DEF					445.57	1/1/2000	12/31/2299	N
25118	EXCISE WRIST TENDON SHEATH	PRXOVR	DEF					NA	NA	NA	N
25118	EXCISE WRIST TENDON SHEATH	MAXFEE	DEF					270.77	1/1/2000	12/31/2299	N
25119	PARTIAL REMOVAL OF ULNA	PRXOVR	DEF					NA	NA	NA	N
25119	PARTIAL REMOVAL OF ULNA	MAXFEE	DEF					375.48	1/1/2000	12/31/2299	N
25120	REMOVAL OF FOREARM LESION	PRXOVR	DEF					NA	NA	NA	N
25120	REMOVAL OF FOREARM LESION	MAXFEE	DEF					383.08	1/1/2000	12/31/2299	N
25125	REMOVE/GRAFT FOREARM LESION	PRXOVR	DEF					NA	NA	NA	N
25125	REMOVE/GRAFT FOREARM LESION	MAXFEE	DEF					434.71	1/1/2000	12/31/2299	N
25126	REMOVE/GRAFT FOREARM LESION	PRXOVR	DEF					NA	NA	NA	N
25126	REMOVE/GRAFT FOREARM LESION	MAXFEE	DEF					443.21	1/1/2000	12/31/2299	N
25130	REMOVAL OF WRIST LESION	PRXOVR	DEF					NA	NA	NA	N
25130	REMOVAL OF WRIST LESION	MAXFEE	DEF					276.53	1/1/2000	12/31/2299	N
25135	REMOVE & GRAFT WRIST LESION	PRXOVR	DEF					NA	NA	NA	N
25135	REMOVE & GRAFT WRIST LESION	MAXFEE	DEF					355.54	1/1/2000	12/31/2299	N
25136	REMOVE & GRAFT WRIST LESION	PRXOVR	DEF					NA	NA	NA	N
25136	REMOVE & GRAFT WRIST LESION	MAXFEE	DEF					306.76	1/1/2000	12/31/2299	N
25145	REMOVE FOREARM BONE LESION	PRXOVR	DEF					NA	NA	NA	N
25145	REMOVE FOREARM BONE LESION	MAXFEE	DEF					388.79	7/1/2008	12/31/2299	N
25150	PARTIAL REMOVAL OF ULNA	PRXOVR	DEF					NA	NA	NA	N
25150	PARTIAL REMOVAL OF ULNA	MAXFEE	DEF					400.26	1/1/2000	12/31/2299	N
25151	PARTIAL REMOVAL OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25151	PARTIAL REMOVAL OF RADIUS	MAXFEE	DEF					428.45	7/1/2008	12/31/2299	N
25170	RESECT RADIUS/ULNAR TUMOR	PRXOVR	DEF					NA	NA	NA	N
25170	RESECT RADIUS/ULNAR TUMOR	MAXFEE	DEF					601.21	1/1/2004	12/31/2299	N
25210	REMOVAL OF WRIST BONE	PRXOVR	DEF					NA	NA	NA	N
25210	REMOVAL OF WRIST BONE	MAXFEE	DEF					312.75	1/1/2000	12/31/2299	N
25215	REMOVAL OF WRIST BONES	PRXOVR	DEF					NA	NA	NA	N
25215	REMOVAL OF WRIST BONES	MAXFEE	DEF					471.11	1/1/2000	12/31/2299	N
25230	PARTIAL REMOVAL OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25230	PARTIAL REMOVAL OF RADIUS	MAXFEE	DEF					306.27	1/1/2000	12/31/2299	N
25240	PARTIAL REMOVAL OF ULNA	PRXOVR	DEF					NA	NA	NA	N
25240	PARTIAL REMOVAL OF ULNA	MAXFEE	DEF					311.85	1/1/2000	12/31/2299	N
25246	INJECTION FOR WRIST X-RAY	PRXOVR	DEF					NA	NA	NA	N
25246	INJECTION FOR WRIST X-RAY	MAXFEE	FAC					44.85	1/1/2014	12/31/2299	N
25246	INJECTION FOR WRIST X-RAY	MAXFEE	NFF					59.35	1/1/2014	12/31/2299	N
25248	REMOVE FOREARM FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
25248	REMOVE FOREARM FOREIGN BODY	MAXFEE	DEF					292.67	7/1/2008	12/31/2299	N
25250	REMOVAL OF WRIST PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
25250	REMOVAL OF WRIST PROSTHESIS	MAXFEE	DEF					352.23	1/1/2000	12/31/2299	N
25251	REMOVAL OF WRIST PROSTHESIS	PRXOVR	DEF					NA	NA	NA	N
25251	REMOVAL OF WRIST PROSTHESIS	MAXFEE	DEF					515.52	1/1/2000	12/31/2299	N
25259	MANIPULATE WRIST W/ANESTHES	PRXOVR	DEF					NA	NA	NA	N
25259	MANIPULATE WRIST W/ANESTHES	MAXFEE	DEF					251.13	1/1/2002	12/31/2299	N
25260	REPAIR FOREARM TENDON/MUSCLE	PRXOVR	DEF					NA	NA	NA	N
25260	REPAIR FOREARM TENDON/MUSCLE	MAXFEE	DEF					448.64	7/1/2008	12/31/2299	N
25263	REPAIR FOREARM TENDON/MUSCLE	PRXOVR	DEF					NA	NA	NA	N
25263	REPAIR FOREARM TENDON/MUSCLE	MAXFEE	DEF					446.53	7/1/2008	12/31/2299	N
25265	REPAIR FOREARM TENDON/MUSCLE	PRXOVR	DEF					NA	NA	NA	N
25265	REPAIR FOREARM TENDON/MUSCLE	MAXFEE	DEF					543.43	1/1/2000	12/31/2299	N
25270	REPAIR FOREARM TENDON/MUSCLE	PRXOVR	DEF					NA	NA	NA	N
25270	REPAIR FOREARM TENDON/MUSCLE	MAXFEE	DEF					378.28	7/1/2008	12/31/2299	N
25272	REPAIR FOREARM TENDON/MUSCLE	PRXOVR	DEF					NA	NA	NA	N
25272	REPAIR FOREARM TENDON/MUSCLE	MAXFEE	DEF					417.80	7/1/2008	12/31/2299	N
25274	REPAIR FOREARM TENDON/MUSCLE	PRXOVR	DEF					NA	NA	NA	N
25274	REPAIR FOREARM TENDON/MUSCLE	MAXFEE	DEF					476.11	7/1/2008	12/31/2299	N
25275	REPAIR FOREARM TENDON SHEATH	PRXOVR	DEF					NA	NA	NA	N
25275	REPAIR FOREARM TENDON SHEATH	MAXFEE	DEF					449.87	1/1/2002	12/31/2299	N
25280	REVISE WRIST/FOREARM TENDON	PRXOVR	DEF					NA	NA	NA	N
25280	REVISE WRIST/FOREARM TENDON	MAXFEE	DEF					418.87	7/1/2008	12/31/2299	N
25290	INCISE WRIST/FOREARM TENDON	PRXOVR	DEF					NA	NA	NA	N
25290	INCISE WRIST/FOREARM TENDON	MAXFEE	DEF					414.39	7/1/2008	12/31/2299	N
25295	RELEASE WRIST/FOREARM TENDON	PRXOVR	DEF					NA	NA	NA	N
25295	RELEASE WRIST/FOREARM TENDON	MAXFEE	DEF					394.13	7/1/2008	12/31/2299	N
25300	FUSION OF TENDONS AT WRIST	PRXOVR	DEF					NA	NA	NA	N
25300	FUSION OF TENDONS AT WRIST	MAXFEE	DEF					460.43	1/1/2000	12/31/2299	N
25301	FUSION OF TENDONS AT WRIST	PRXOVR	DEF					NA	NA	NA	N
25301	FUSION OF TENDONS AT WRIST	MAXFEE	DEF					427.70	1/1/2000	12/31/2299	N
25310	TRANSPLANT FOREARM TENDON	PRXOVR	DEF					NA	NA	NA	N
25310	TRANSPLANT FOREARM TENDON	MAXFEE	DEF					461.54	1/1/2000	12/31/2299	N
25312	TRANSPLANT FOREARM TENDON	PRXOVR	DEF					NA	NA	NA	N
25312	TRANSPLANT FOREARM TENDON	MAXFEE	DEF					518.09	1/1/2000	12/31/2299	N
25315	REVISE PALSY HAND TENDON(S)	PRXOVR	DEF					NA	NA	NA	N
25315	REVISE PALSY HAND TENDON(S)	MAXFEE	DEF					542.70	1/1/2000	12/31/2299	N
25316	REVISE PALSY HAND TENDON(S)	PRXOVR	DEF					NA	NA	NA	N
25316	REVISE PALSY HAND TENDON(S)	MAXFEE	DEF					689.93	1/1/2000	12/31/2299	N
25320	REPAIR/REVISE WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25320	REPAIR/REVISE WRIST JOINT	MAXFEE	DEF					543.67	1/1/2000	12/31/2299	N
25332	REVISE WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25332	REVISE WRIST JOINT	MAXFEE	DEF					592.86	1/1/2000	12/31/2299	N
25335	REALIGNMENT OF HAND	PRXOVR	DEF					NA	NA	NA	N
25335	REALIGNMENT OF HAND	MAXFEE	DEF					670.68	1/1/2000	12/31/2299	N
25337	RECONSTRUCT ULNA/RADIOULNAR	PRXOVR	DEF					NA	NA	NA	N
25337	RECONSTRUCT ULNA/RADIOULNAR	MAXFEE	DEF					535.85	1/1/2004	12/31/2299	N
25350	REVISION OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25350	REVISION OF RADIUS	MAXFEE	DEF					490.15	1/1/2000	12/31/2299	N
25355	REVISION OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25355	REVISION OF RADIUS	MAXFEE	DEF					550.48	1/1/2000	12/31/2299	N
25360	REVISION OF ULNA	PRXOVR	DEF					NA	NA	NA	N
25360	REVISION OF ULNA	MAXFEE	DEF					476.30	7/1/2008	12/31/2299	N
25365	REVISE RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25365	REVISE RADIUS & ULNA	MAXFEE	DEF					647.82	1/1/2000	12/31/2299	N
25370	REVISE RADIUS OR ULNA	PRXOVR	DEF					NA	NA	NA	N
25370	REVISE RADIUS OR ULNA	MAXFEE	DEF					687.47	1/1/2000	12/31/2299	N
25375	REVISE RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25375	REVISE RADIUS & ULNA	MAXFEE	DEF					687.83	1/1/2000	12/31/2299	N
25390	SHORTEN RADIUS OR ULNA	PRXOVR	DEF					NA	NA	NA	N
25390	SHORTEN RADIUS OR ULNA	MAXFEE	DEF					561.73	1/1/2000	12/31/2299	N
25391	LENGTHEN RADIUS OR ULNA	PRXOVR	DEF					NA	NA	NA	N
25391	LENGTHEN RADIUS OR ULNA	MAXFEE	DEF					709.84	1/1/2000	12/31/2299	N
25392	SHORTEN RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25392	SHORTEN RADIUS & ULNA	MAXFEE	DEF					739.11	1/1/2000	12/31/2299	N
25393	LENGTHEN RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25393	LENGTHEN RADIUS & ULNA	MAXFEE	DEF					824.20	1/1/2000	12/31/2299	N
25394	REPAIR CARPAL BONE SHORTEN	PRXOVR	DEF					NA	NA	NA	N
25394	REPAIR CARPAL BONE SHORTEN	MAXFEE	DEF					524.80	4/1/2008	12/31/2299	N
25400	REPAIR RADIUS OR ULNA	PRXOVR	DEF					NA	NA	NA	N
25400	REPAIR RADIUS OR ULNA	MAXFEE	DEF					628.19	1/1/2000	12/31/2299	N
25405	REPAIR/GRAFT RADIUS OR ULNA	PRXOVR	DEF					NA	NA	NA	N
25405	REPAIR/GRAFT RADIUS OR ULNA	MAXFEE	DEF					766.77	1/1/2000	12/31/2299	N
25415	REPAIR RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25415	REPAIR RADIUS & ULNA	MAXFEE	DEF					707.21	1/1/2000	12/31/2299	N
25420	REPAIR/GRAFT RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25420	REPAIR/GRAFT RADIUS & ULNA	MAXFEE	DEF					873.89	1/1/2000	12/31/2299	N
25425	REPAIR/GRAFT RADIUS OR ULNA	PRXOVR	DEF					NA	NA	NA	N
25425	REPAIR/GRAFT RADIUS OR ULNA	MAXFEE	DEF					775.05	1/1/2000	12/31/2299	N
25426	REPAIR/GRAFT RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25426	REPAIR/GRAFT RADIUS & ULNA	MAXFEE	DEF					799.26	1/1/2000	12/31/2299	N
25430	VASC GRAFT INTO CARPAL BONE	PRXOVR	DEF					NA	NA	NA	N
25430	VASC GRAFT INTO CARPAL BONE	MAXFEE	DEF					463.17	4/1/2008	12/31/2299	N
25431	REPAIR NONUNION CARPAL BONE	PRXOVR	DEF					NA	NA	NA	N
25431	REPAIR NONUNION CARPAL BONE	MAXFEE	DEF					459.10	4/1/2008	12/31/2299	N
25440	REPAIR/GRAFT WRIST BONE	PRXOVR	DEF					NA	NA	NA	N
25440	REPAIR/GRAFT WRIST BONE	MAXFEE	DEF					543.07	1/1/2000	12/31/2299	N
25441	RECONSTRUCT WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25441	RECONSTRUCT WRIST JOINT	MAXFEE	DEF					667.28	1/1/2000	12/31/2299	N
25442	RECONSTRUCT WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25442	RECONSTRUCT WRIST JOINT	MAXFEE	DEF					506.58	1/1/2000	12/31/2299	N
25443	RECONSTRUCT WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25443	RECONSTRUCT WRIST JOINT	MAXFEE	DEF					557.32	1/1/2000	12/31/2299	N
25444	RECONSTRUCT WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25444	RECONSTRUCT WRIST JOINT	MAXFEE	DEF					597.73	1/1/2000	12/31/2299	N
25445	RECONSTRUCT WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25445	RECONSTRUCT WRIST JOINT	MAXFEE	DEF					562.28	1/1/2000	12/31/2299	N
25446	WRIST REPLACEMENT	PRXOVR	DEF					NA	NA	NA	N
25446	WRIST REPLACEMENT	MAXFEE	DEF					947.54	1/1/2000	12/31/2299	N
25447	REPAIR WRIST JOINTS	PRXOVR	DEF					NA	NA	NA	N
25447	REPAIR WRIST JOINTS	MAXFEE	DEF					555.51	1/1/2000	12/31/2299	N
25449	REMOVE WRIST JOINT IMPLANT	PRXOVR	DEF					NA	NA	NA	N
25449	REMOVE WRIST JOINT IMPLANT	MAXFEE	DEF					641.34	1/1/2000	12/31/2299	N
25450	REVISION OF WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25450	REVISION OF WRIST JOINT	MAXFEE	DEF					407.16	1/1/2000	12/31/2299	N
25455	REVISION OF WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25455	REVISION OF WRIST JOINT	MAXFEE	DEF					509.31	1/1/2000	12/31/2299	N
25490	REINFORCE RADIUS	PRXOVR	DEF					NA	NA	NA	N
25490	REINFORCE RADIUS	MAXFEE	DEF					533.47	1/1/2000	12/31/2299	N
25491	REINFORCE ULNA	PRXOVR	DEF					NA	NA	NA	N
25491	REINFORCE ULNA	MAXFEE	DEF					552.83	1/1/2000	12/31/2299	N
25492	REINFORCE RADIUS AND ULNA	PRXOVR	DEF					NA	NA	NA	N
25492	REINFORCE RADIUS AND ULNA	MAXFEE	DEF					675.50	1/1/2000	12/31/2299	N
25500	TREAT FRACTURE OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25500	TREAT FRACTURE OF RADIUS	MAXFEE	FAC					131.33	1/1/2014	12/31/2299	N
25500	TREAT FRACTURE OF RADIUS	MAXFEE	NFF					144.59	1/1/2014	12/31/2299	N
25505	TREAT FRACTURE OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25505	TREAT FRACTURE OF RADIUS	MAXFEE	FAC					243.33	1/1/2014	12/31/2299	N
25505	TREAT FRACTURE OF RADIUS	MAXFEE	NFF					266.73	1/1/2014	12/31/2299	N
25515	TREAT FRACTURE OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25515	TREAT FRACTURE OF RADIUS	MAXFEE	DEF					459.78	1/1/2000	12/31/2299	N
25520	TREAT FRACTURE OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25520	TREAT FRACTURE OF RADIUS	MAXFEE	FAC					337.07	1/1/2014	12/31/2299	N
25520	TREAT FRACTURE OF RADIUS	MAXFEE	NFF					348.77	1/1/2014	12/31/2299	N
25525	TREAT FRACTURE OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25525	TREAT FRACTURE OF RADIUS	MAXFEE	DEF					638.28	1/1/2000	12/31/2299	N
25526	TREAT FRACTURE OF RADIUS	PRXOVR	DEF					NA	NA	NA	N
25526	TREAT FRACTURE OF RADIUS	MAXFEE	DEF					708.38	1/1/2000	12/31/2299	N
25530	TREAT FRACTURE OF ULNA	PRXOVR	DEF					NA	NA	NA	N
25530	TREAT FRACTURE OF ULNA	MAXFEE	FAC					124.61	1/1/2014	12/31/2299	N
25530	TREAT FRACTURE OF ULNA	MAXFEE	NFF					138.83	1/1/2014	12/31/2299	N
25535	TREAT FRACTURE OF ULNA	PRXOVR	DEF					NA	NA	NA	N
25535	TREAT FRACTURE OF ULNA	MAXFEE	FAC					239.31	1/1/2014	12/31/2299	N
25535	TREAT FRACTURE OF ULNA	MAXFEE	NFF					263.91	1/1/2014	12/31/2299	N
25545	TREAT FRACTURE OF ULNA	PRXOVR	DEF					NA	NA	NA	N
25545	TREAT FRACTURE OF ULNA	MAXFEE	DEF					456.93	1/1/2000	12/31/2299	N
25560	TREAT FRACTURE RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25560	TREAT FRACTURE RADIUS & ULNA	MAXFEE	FAC					130.32	1/1/2014	12/31/2299	N
25560	TREAT FRACTURE RADIUS & ULNA	MAXFEE	NFF					141.95	1/1/2014	12/31/2299	N
25565	TREAT FRACTURE RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25565	TREAT FRACTURE RADIUS & ULNA	MAXFEE	FAC					273.52	1/1/2014	12/31/2299	N
25565	TREAT FRACTURE RADIUS & ULNA	MAXFEE	NFF					305.99	1/1/2014	12/31/2299	N
25574	TREAT FRACTURE RADIUS & ULNA	PRXOVR	DEF					NA	NA	NA	N
25574	TREAT FRACTURE RADIUS & ULNA	MAXFEE	DEF					415.50	1/1/2000	12/31/2299	N
25575	TREAT FRACTURE RADIUS/ULNA	PRXOVR	DEF					NA	NA	NA	N
25575	TREAT FRACTURE RADIUS/ULNA	MAXFEE	DEF					574.96	1/1/2000	12/31/2299	N
25600	TREAT FRACTURE RADIUS/ULNA	PRXOVR	DEF					NA	NA	NA	N
25600	TREAT FRACTURE RADIUS/ULNA	MAXFEE	FAC					163.39	1/1/2014	12/31/2299	N
25600	TREAT FRACTURE RADIUS/ULNA	MAXFEE	NFF					168.65	1/1/2014	12/31/2299	N
25605	TREAT FRACTURE RADIUS/ULNA	PRXOVR	DEF					NA	NA	NA	N
25605	TREAT FRACTURE RADIUS/ULNA	MAXFEE	FAC					262.79	1/1/2014	12/31/2299	N
25605	TREAT FRACTURE RADIUS/ULNA	MAXFEE	NFF					297.20	1/1/2014	12/31/2299	N
25606	TREAT FX DISTAL RADIAL	PRXOVR	DEF					NA	NA	NA	N
25606	TREAT FX DISTAL RADIAL	MAXFEE	DEF					371.88	7/1/2008	12/31/2299	N
25607	TREAT FX RAD EXTRA-ARTICUL	PRXOVR	DEF					NA	NA	NA	N
25607	TREAT FX RAD EXTRA-ARTICUL	MAXFEE	DEF					393.56	1/1/2007	12/31/2299	N
25608	TREAT FX RAD INTRA-ARTICUL	PRXOVR	DEF					NA	NA	NA	N
25608	TREAT FX RAD INTRA-ARTICUL	MAXFEE	DEF					451.14	1/1/2007	12/31/2299	N
25609	TREAT FX RADIAL 3+ FRAG	PRXOVR	DEF					NA	NA	NA	N
25609	TREAT FX RADIAL 3+ FRAG	MAXFEE	DEF					576.28	1/1/2007	12/31/2299	N
25611	TREAT FRACTURE RADIUS/ULNA	PRXOVR	DEF					NA	NA	NA	N
25611	TREAT FRACTURE RADIUS/ULNA	MAXFEE	DEF					NA			N
25620	TREAT FRACTURE RADIUS/ULNA	PRXOVR	DEF					NA	NA	NA	N
25620	TREAT FRACTURE RADIUS/ULNA	MAXFEE	DEF					NA			N
25622	TREAT WRIST BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25622	TREAT WRIST BONE FRACTURE	MAXFEE	FAC					135.31	1/1/2014	12/31/2299	N
25622	TREAT WRIST BONE FRACTURE	MAXFEE	NFF					152.53	1/1/2014	12/31/2299	N
25624	TREAT WRIST BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25624	TREAT WRIST BONE FRACTURE	MAXFEE	FAC					227.88	1/1/2014	12/31/2299	N
25624	TREAT WRIST BONE FRACTURE	MAXFEE	NFF					251.08	1/1/2014	12/31/2299	N
25628	TREAT WRIST BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25628	TREAT WRIST BONE FRACTURE	MAXFEE	DEF					433.45	1/1/2000	12/31/2299	N
25630	TREAT WRIST BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25630	TREAT WRIST BONE FRACTURE	MAXFEE	FAC					142.15	1/1/2014	12/31/2299	N
25630	TREAT WRIST BONE FRACTURE	MAXFEE	NFF					156.50	1/1/2014	12/31/2299	N
25635	TREAT WRIST BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25635	TREAT WRIST BONE FRACTURE	MAXFEE	FAC					208.56	1/1/2014	12/31/2299	N
25635	TREAT WRIST BONE FRACTURE	MAXFEE	NFF					236.43	1/1/2014	12/31/2299	N
25645	TREAT WRIST BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25645	TREAT WRIST BONE FRACTURE	MAXFEE	DEF					386.41	1/1/2000	12/31/2299	N
25650	TREAT WRIST BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25650	TREAT WRIST BONE FRACTURE	MAXFEE	FAC					164.57	1/1/2014	12/31/2299	N
25650	TREAT WRIST BONE FRACTURE	MAXFEE	NFF					173.33	1/1/2014	12/31/2299	N
25651	PIN ULNAR STYLOID FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25651	PIN ULNAR STYLOID FRACTURE	MAXFEE	DEF					275.29	4/1/2008	12/31/2299	N
25652	TREAT FRACTURE ULNAR STYLOID	PRXOVR	DEF					NA	NA	NA	N
25652	TREAT FRACTURE ULNAR STYLOID	MAXFEE	DEF					405.88	4/1/2008	12/31/2299	N
25660	TREAT WRIST DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
25660	TREAT WRIST DISLOCATION	MAXFEE	DEF					210.54	7/1/2008	12/31/2299	N
25670	TREAT WRIST DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
25670	TREAT WRIST DISLOCATION	MAXFEE	DEF					416.34	1/1/2000	12/31/2299	N
25671	PIN RADIOULNAR DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
25671	PIN RADIOULNAR DISLOCATION	MAXFEE	DEF					334.75	1/1/2002	12/31/2299	N
25675	TREAT WRIST DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
25675	TREAT WRIST DISLOCATION	MAXFEE	FAC					189.72	1/1/2014	12/31/2299	N
25675	TREAT WRIST DISLOCATION	MAXFEE	NFF					208.99	1/1/2014	12/31/2299	N
25676	TREAT WRIST DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
25676	TREAT WRIST DISLOCATION	MAXFEE	DEF					425.15	1/1/2000	12/31/2299	N
25680	TREAT WRIST FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25680	TREAT WRIST FRACTURE	MAXFEE	DEF					243.02	1/1/2000	12/31/2299	N
25685	TREAT WRIST FRACTURE	PRXOVR	DEF					NA	NA	NA	N
25685	TREAT WRIST FRACTURE	MAXFEE	DEF					510.32	1/1/2000	12/31/2299	N
25690	TREAT WRIST DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
25690	TREAT WRIST DISLOCATION	MAXFEE	DEF					290.35	1/1/2000	12/31/2299	N
25695	TREAT WRIST DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
25695	TREAT WRIST DISLOCATION	MAXFEE	DEF					428.23	1/1/2000	12/31/2299	N
25800	FUSION OF WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25800	FUSION OF WRIST JOINT	MAXFEE	DEF					563.99	1/1/2000	12/31/2299	N
25805	FUSION/GRAFT OF WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25805	FUSION/GRAFT OF WRIST JOINT	MAXFEE	DEF					648.63	1/1/2000	12/31/2299	N
25810	FUSION/GRAFT OF WRIST JOINT	PRXOVR	DEF					NA	NA	NA	N
25810	FUSION/GRAFT OF WRIST JOINT	MAXFEE	DEF					611.08	1/1/2000	12/31/2299	N
25820	FUSION OF HAND BONES	PRXOVR	DEF					NA	NA	NA	N
25820	FUSION OF HAND BONES	MAXFEE	DEF					440.80	1/1/2000	12/31/2299	N
25825	FUSE HAND BONES WITH GRAFT	PRXOVR	DEF					NA	NA	NA	N
25825	FUSE HAND BONES WITH GRAFT	MAXFEE	DEF					545.70	1/1/2000	12/31/2299	N
25830	FUSION RADIOULNAR JNT/ULNA	PRXOVR	DEF					NA	NA	NA	N
25830	FUSION RADIOULNAR JNT/ULNA	MAXFEE	DEF					550.38	1/1/2004	12/31/2299	N
25900	AMPUTATION OF FOREARM	PRXOVR	DEF					NA	NA	NA	N
25900	AMPUTATION OF FOREARM	MAXFEE	DEF					472.89	1/1/2000	12/31/2299	N
25905	AMPUTATION OF FOREARM	PRXOVR	DEF					NA	NA	NA	N
25905	AMPUTATION OF FOREARM	MAXFEE	DEF					482.70	1/1/2000	12/31/2299	N
25907	AMPUTATION FOLLOW-UP SURGERY	PRXOVR	DEF					NA	NA	NA	N
25907	AMPUTATION FOLLOW-UP SURGERY	MAXFEE	DEF					416	7/1/2008	12/31/2299	N
25909	AMPUTATION FOLLOW-UP SURGERY	PRXOVR	DEF					NA	NA	NA	N
25909	AMPUTATION FOLLOW-UP SURGERY	MAXFEE	DEF					463.08	7/1/2008	12/31/2299	N
25915	AMPUTATION OF FOREARM	PRXOVR	DEF					NA	NA	NA	N
25915	AMPUTATION OF FOREARM	MAXFEE	DEF					911.48	1/1/2000	12/31/2299	N
25920	AMPUTATE HAND AT WRIST	PRXOVR	DEF					NA	NA	NA	N
25920	AMPUTATE HAND AT WRIST	MAXFEE	DEF					439.82	1/1/2000	12/31/2299	N
25922	AMPUTATE HAND AT WRIST	PRXOVR	DEF					NA	NA	NA	N
25922	AMPUTATE HAND AT WRIST	MAXFEE	DEF					370.15	1/1/2000	12/31/2299	N
25924	AMPUTATION FOLLOW-UP SURGERY	PRXOVR	DEF					NA	NA	NA	N
25924	AMPUTATION FOLLOW-UP SURGERY	MAXFEE	DEF					438.83	1/1/2000	12/31/2299	N
25927	AMPUTATION OF HAND	PRXOVR	DEF					NA	NA	NA	N
25927	AMPUTATION OF HAND	MAXFEE	DEF					447.05	1/1/2000	12/31/2299	N
25929	AMPUTATION FOLLOW-UP SURGERY	PRXOVR	DEF					NA	NA	NA	N
25929	AMPUTATION FOLLOW-UP SURGERY	MAXFEE	DEF					345.56	1/1/2000	12/31/2299	N
25931	AMPUTATION FOLLOW-UP SURGERY	PRXOVR	DEF					NA	NA	NA	N
25931	AMPUTATION FOLLOW-UP SURGERY	MAXFEE	DEF					415.32	7/1/2008	12/31/2299	N
25999	UNLISTED PX FOREARM/WRIST	PRXOVR	DEF					NA	NA	NA	N
25999	UNLISTED PX FOREARM/WRIST	MANUAL	DEF					NA	NA	NA	N
26010	DRAINAGE OF FINGER ABSCESS	PRXOVR	DEF					NA	NA	NA	N
26010	DRAINAGE OF FINGER ABSCESS	MAXFEE	FAC					48.31	1/1/2014	12/31/2299	N
26010	DRAINAGE OF FINGER ABSCESS	MAXFEE	NFF					104.48	1/1/2014	12/31/2299	N
26011	DRAINAGE OF FINGER ABSCESS	PRXOVR	DEF					NA	NA	NA	N
26011	DRAINAGE OF FINGER ABSCESS	MAXFEE	FAC					64.23	1/1/2014	12/31/2299	N
26011	DRAINAGE OF FINGER ABSCESS	MAXFEE	NFF					147.52	1/1/2014	12/31/2299	N
26020	DRAIN HAND TENDON SHEATH	PRXOVR	DEF					NA	NA	NA	N
26020	DRAIN HAND TENDON SHEATH	MAXFEE	DEF					246.30	1/1/2000	12/31/2299	N
26025	DRAINAGE OF PALM BURSA	PRXOVR	DEF					NA	NA	NA	N
26025	DRAINAGE OF PALM BURSA	MAXFEE	DEF					282.23	1/1/2000	12/31/2299	N
26030	DRAINAGE OF PALM BURSAS	PRXOVR	DEF					NA	NA	NA	N
26030	DRAINAGE OF PALM BURSAS	MAXFEE	DEF					355.16	1/1/2000	12/31/2299	N
26034	TREAT HAND BONE LESION	PRXOVR	DEF					NA	NA	NA	N
26034	TREAT HAND BONE LESION	MAXFEE	DEF					310.79	1/1/2000	12/31/2299	N
26035	DECOMPRESS FINGERS/HAND	PRXOVR	DEF					NA	NA	NA	N
26035	DECOMPRESS FINGERS/HAND	MAXFEE	DEF					428.35	7/1/2008	12/31/2299	N
26037	DECOMPRESS FINGERS/HAND	PRXOVR	DEF					NA	NA	NA	N
26037	DECOMPRESS FINGERS/HAND	MAXFEE	DEF					400.57	1/1/2004	12/31/2299	N
26040	RELEASE PALM CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
26040	RELEASE PALM CONTRACTURE	MAXFEE	DEF					189.75	1/1/2000	12/31/2299	N
26045	RELEASE PALM CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
26045	RELEASE PALM CONTRACTURE	MAXFEE	DEF					321.44	1/1/2000	12/31/2299	N
26055	INCISE FINGER TENDON SHEATH	PRXOVR	DEF					NA	NA	NA	N
26055	INCISE FINGER TENDON SHEATH	MAXFEE	FAC					138.01	1/1/2014	12/31/2299	N
26055	INCISE FINGER TENDON SHEATH	MAXFEE	NFF					247.58	1/1/2014	12/31/2299	N
26060	INCISION OF FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26060	INCISION OF FINGER TENDON	MAXFEE	DEF					140.24	7/1/2008	12/31/2299	N
26070	EXPLORE/TREAT HAND JOINT	PRXOVR	DEF					NA	NA	NA	N
26070	EXPLORE/TREAT HAND JOINT	MAXFEE	DEF					192.19	1/1/2000	12/31/2299	N
26075	EXPLORE/TREAT FINGER JOINT	PRXOVR	DEF					NA	NA	NA	N
26075	EXPLORE/TREAT FINGER JOINT	MAXFEE	DEF					230.58	1/1/2000	12/31/2299	N
26080	EXPLORE/TREAT FINGER JOINT	PRXOVR	DEF					NA	NA	NA	N
26080	EXPLORE/TREAT FINGER JOINT	MAXFEE	DEF					219.06	1/1/2000	12/31/2299	N
26100	BIOPSY HAND JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
26100	BIOPSY HAND JOINT LINING	MAXFEE	DEF					203.80	1/1/2000	12/31/2299	N
26105	BIOPSY FINGER JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
26105	BIOPSY FINGER JOINT LINING	MAXFEE	DEF					247.48	1/1/2000	12/31/2299	N
26110	BIOPSY FINGER JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
26110	BIOPSY FINGER JOINT LINING	MAXFEE	DEF					201.36	1/1/2000	12/31/2299	N
26111	EXC HAND LES SC 1.5 CM/>	PRXOVR	DEF					NA	NA	NA	N
26111	EXC HAND LES SC 1.5 CM/>	MAXFEE	DEF					224.55	1/1/2010	12/31/2299	N
26113	EXC HAND TUM DEEP 1.5 CM/>	PRXOVR	DEF					NA	NA	NA	N
26113	EXC HAND TUM DEEP 1.5 CM/>	MAXFEE	DEF					295.31	1/1/2010	12/31/2299	N
26115	EXC HAND LES SC < 1.5 CM	PRXOVR	DEF					NA	NA	NA	N
26115	EXC HAND LES SC < 1.5 CM	MAXFEE	FAC					115.26	1/1/2014	12/31/2299	N
26115	EXC HAND LES SC < 1.5 CM	MAXFEE	NFF					191.69	1/1/2014	12/31/2299	N
26116	EXC HAND TUM DEEP < 1.5 CM	PRXOVR	DEF					NA	NA	NA	N
26116	EXC HAND TUM DEEP < 1.5 CM	MAXFEE	DEF					281.11	1/1/2000	12/31/2299	N
26117	RAD RESECT HAND TUMOR < 3 CM	PRXOVR	DEF					NA	NA	NA	N
26117	RAD RESECT HAND TUMOR < 3 CM	MAXFEE	DEF					413.89	1/1/2000	12/31/2299	N
26118	RAD RESECT HAND TUMOR 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
26118	RAD RESECT HAND TUMOR 3 CM/>	MAXFEE	DEF					583.18	1/1/2010	12/31/2299	N
26121	RELEASE PALM CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
26121	RELEASE PALM CONTRACTURE	MAXFEE	DEF					469.15	1/1/2000	12/31/2299	N
26123	RELEASE PALM CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
26123	RELEASE PALM CONTRACTURE	MAXFEE	DEF					534.62	1/1/2000	12/31/2299	N
26125	RELEASE PALM CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
26125	RELEASE PALM CONTRACTURE	MAXFEE	DEF					197.47	1/1/2000	12/31/2299	N
26130	REMOVE WRIST JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
26130	REMOVE WRIST JOINT LINING	MAXFEE	DEF					323.95	12/15/2005	12/31/2299	N
26135	REVISE FINGER JOINT EACH	PRXOVR	DEF					NA	NA	NA	N
26135	REVISE FINGER JOINT EACH	MAXFEE	DEF					364.64	1/1/2000	12/31/2299	N
26140	REVISE FINGER JOINT EACH	PRXOVR	DEF					NA	NA	NA	N
26140	REVISE FINGER JOINT EACH	MAXFEE	DEF					325.60	1/1/2000	12/31/2299	N
26145	TENDON EXCISION PALM/FINGER	PRXOVR	DEF					NA	NA	NA	N
26145	TENDON EXCISION PALM/FINGER	MAXFEE	DEF					340.53	1/1/2000	12/31/2299	N
26160	REMOVE TENDON SHEATH LESION	PRXOVR	DEF					NA	NA	NA	N
26160	REMOVE TENDON SHEATH LESION	MAXFEE	FAC					118.89	1/1/2014	12/31/2299	N
26160	REMOVE TENDON SHEATH LESION	MAXFEE	NFF					254.34	1/1/2014	12/31/2299	N
26170	REMOVAL OF PALM TENDON EACH	PRXOVR	DEF					NA	NA	NA	N
26170	REMOVAL OF PALM TENDON EACH	MAXFEE	DEF					232.60	1/1/2000	12/31/2299	N
26180	REMOVAL OF FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26180	REMOVAL OF FINGER TENDON	MAXFEE	DEF					273.20	1/1/2000	12/31/2299	N
26185	REMOVE FINGER BONE	PRXOVR	DEF					NA	NA	NA	N
26185	REMOVE FINGER BONE	MAXFEE	DEF					273.84	7/1/2008	12/31/2299	N
26200	REMOVE HAND BONE LESION	PRXOVR	DEF					NA	NA	NA	N
26200	REMOVE HAND BONE LESION	MAXFEE	DEF					308.01	1/1/2000	12/31/2299	N
26205	REMOVE/GRAFT BONE LESION	PRXOVR	DEF					NA	NA	NA	N
26205	REMOVE/GRAFT BONE LESION	MAXFEE	DEF					423.45	1/1/2000	12/31/2299	N
26210	REMOVAL OF FINGER LESION	PRXOVR	DEF					NA	NA	NA	N
26210	REMOVAL OF FINGER LESION	MAXFEE	DEF					280.55	1/1/2000	12/31/2299	N
26215	REMOVE/GRAFT FINGER LESION	PRXOVR	DEF					NA	NA	NA	N
26215	REMOVE/GRAFT FINGER LESION	MAXFEE	DEF					383.15	1/1/2000	12/31/2299	N
26230	PARTIAL REMOVAL OF HAND BONE	PRXOVR	DEF					NA	NA	NA	N
26230	PARTIAL REMOVAL OF HAND BONE	MAXFEE	DEF					322.11	1/1/2000	12/31/2299	N
26235	PARTIAL REMOVAL FINGER BONE	PRXOVR	DEF					NA	NA	NA	N
26235	PARTIAL REMOVAL FINGER BONE	MAXFEE	DEF					315.98	1/1/2000	12/31/2299	N
26236	PARTIAL REMOVAL FINGER BONE	PRXOVR	DEF					NA	NA	NA	N
26236	PARTIAL REMOVAL FINGER BONE	MAXFEE	DEF					279.45	1/1/2000	12/31/2299	N
26250	EXTENSIVE HAND SURGERY	PRXOVR	DEF					NA	NA	NA	N
26250	EXTENSIVE HAND SURGERY	MAXFEE	DEF					407.58	1/1/2000	12/31/2299	N
26255	EXTENSIVE HAND SURGERY	PRXOVR	DEF					NA	NA	NA	N
26255	EXTENSIVE HAND SURGERY	MAXFEE	DEF					NA			N
26260	RESECT PROX FINGER TUMOR	PRXOVR	DEF					NA	NA	NA	N
26260	RESECT PROX FINGER TUMOR	MAXFEE	DEF					395.78	1/1/2000	12/31/2299	N
26261	EXTENSIVE FINGER SURGERY	PRXOVR	DEF					NA	NA	NA	N
26261	EXTENSIVE FINGER SURGERY	MAXFEE	DEF					NA			N
26262	RESECT DISTAL FINGER TUMOR	PRXOVR	DEF					NA	NA	NA	N
26262	RESECT DISTAL FINGER TUMOR	MAXFEE	DEF					321.78	1/1/2000	12/31/2299	N
26320	REMOVAL OF IMPLANT FROM HAND	PRXOVR	DEF					NA	NA	NA	N
26320	REMOVAL OF IMPLANT FROM HAND	MAXFEE	DEF					231.16	1/1/2000	12/31/2299	N
26340	MANIPULATE FINGER W/ANESTH	PRXOVR	DEF					NA	NA	NA	N
26340	MANIPULATE FINGER W/ANESTH	MAXFEE	DEF					191.40	1/1/2002	12/31/2299	N
26341	MANIPULAT PALM CORD POST INJ	PRXOVR	DEF					NA	NA	NA	N
26341	MANIPULAT PALM CORD POST INJ	MAXFEE	FAC					25.60	1/1/2014	12/31/2299	N
26341	MANIPULAT PALM CORD POST INJ	MAXFEE	NFF					35.37	1/1/2014	12/31/2299	N
26350	REPAIR FINGER/HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26350	REPAIR FINGER/HAND TENDON	MAXFEE	DEF					427.55	7/1/2008	12/31/2299	N
26352	REPAIR/GRAFT HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26352	REPAIR/GRAFT HAND TENDON	MAXFEE	DEF					481.12	7/1/2008	12/31/2299	N
26356	REPAIR FINGER/HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26356	REPAIR FINGER/HAND TENDON	MAXFEE	DEF					601.09	7/1/2008	12/31/2299	N
26357	REPAIR FINGER/HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26357	REPAIR FINGER/HAND TENDON	MAXFEE	DEF					509.42	7/1/2008	12/31/2299	N
26358	REPAIR/GRAFT HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26358	REPAIR/GRAFT HAND TENDON	MAXFEE	DEF					541.23	7/1/2008	12/31/2299	N
26370	REPAIR FINGER/HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26370	REPAIR FINGER/HAND TENDON	MAXFEE	DEF					462.28	7/1/2008	12/31/2299	N
26372	REPAIR/GRAFT HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26372	REPAIR/GRAFT HAND TENDON	MAXFEE	DEF					531.67	7/1/2008	12/31/2299	N
26373	REPAIR FINGER/HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26373	REPAIR FINGER/HAND TENDON	MAXFEE	DEF					506.12	7/1/2008	12/31/2299	N
26390	REVISE HAND/FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26390	REVISE HAND/FINGER TENDON	MAXFEE	DEF					504.41	1/1/2000	12/31/2299	N
26392	REPAIR/GRAFT HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26392	REPAIR/GRAFT HAND TENDON	MAXFEE	DEF					571.80	7/1/2008	12/31/2299	N
26410	REPAIR HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26410	REPAIR HAND TENDON	MAXFEE	DEF					342.10	7/1/2008	12/31/2299	N
26412	REPAIR/GRAFT HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26412	REPAIR/GRAFT HAND TENDON	MAXFEE	DEF					408.23	7/1/2008	12/31/2299	N
26415	EXCISION HAND/FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26415	EXCISION HAND/FINGER TENDON	MAXFEE	DEF					441.40	1/1/2000	12/31/2299	N
26416	GRAFT HAND OR FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26416	GRAFT HAND OR FINGER TENDON	MAXFEE	DEF					531.38	1/1/2000	12/31/2299	N
26418	REPAIR FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26418	REPAIR FINGER TENDON	MAXFEE	DEF					342.22	7/1/2008	12/31/2299	N
26420	REPAIR/GRAFT FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26420	REPAIR/GRAFT FINGER TENDON	MAXFEE	DEF					426.53	7/1/2008	12/31/2299	N
26426	REPAIR FINGER/HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26426	REPAIR FINGER/HAND TENDON	MAXFEE	DEF					402.91	7/1/2008	12/31/2299	N
26428	REPAIR/GRAFT FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26428	REPAIR/GRAFT FINGER TENDON	MAXFEE	DEF					442.88	7/1/2008	12/31/2299	N
26432	REPAIR FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26432	REPAIR FINGER TENDON	MAXFEE	DEF					296.19	7/1/2008	12/31/2299	N
26433	REPAIR FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26433	REPAIR FINGER TENDON	MAXFEE	DEF					318.85	7/1/2008	12/31/2299	N
26434	REPAIR/GRAFT FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26434	REPAIR/GRAFT FINGER TENDON	MAXFEE	DEF					371.80	7/1/2008	12/31/2299	N
26437	REALIGNMENT OF TENDONS	PRXOVR	DEF					NA	NA	NA	N
26437	REALIGNMENT OF TENDONS	MAXFEE	DEF					365.05	7/1/2008	12/31/2299	N
26440	RELEASE PALM/FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26440	RELEASE PALM/FINGER TENDON	MAXFEE	DEF					378.74	7/1/2008	12/31/2299	N
26442	RELEASE PALM & FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26442	RELEASE PALM & FINGER TENDON	MAXFEE	DEF					536.19	7/1/2008	12/31/2299	N
26445	RELEASE HAND/FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26445	RELEASE HAND/FINGER TENDON	MAXFEE	DEF					355.63	7/1/2008	12/31/2299	N
26449	RELEASE FOREARM/HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26449	RELEASE FOREARM/HAND TENDON	MAXFEE	DEF					505.02	7/1/2008	12/31/2299	N
26450	INCISION OF PALM TENDON	PRXOVR	DEF					NA	NA	NA	N
26450	INCISION OF PALM TENDON	MAXFEE	DEF					232.82	7/1/2008	12/31/2299	N
26455	INCISION OF FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26455	INCISION OF FINGER TENDON	MAXFEE	DEF					230.86	7/1/2008	12/31/2299	N
26460	INCISE HAND/FINGER TENDON	PRXOVR	DEF					NA	NA	NA	N
26460	INCISE HAND/FINGER TENDON	MAXFEE	DEF					224.02	7/1/2008	12/31/2299	N
26471	FUSION OF FINGER TENDONS	PRXOVR	DEF					NA	NA	NA	N
26471	FUSION OF FINGER TENDONS	MAXFEE	DEF					357.49	7/1/2008	12/31/2299	N
26474	FUSION OF FINGER TENDONS	PRXOVR	DEF					NA	NA	NA	N
26474	FUSION OF FINGER TENDONS	MAXFEE	DEF					347.94	7/1/2008	12/31/2299	N
26476	TENDON LENGTHENING	PRXOVR	DEF					NA	NA	NA	N
26476	TENDON LENGTHENING	MAXFEE	DEF					337.78	7/1/2008	12/31/2299	N
26477	TENDON SHORTENING	PRXOVR	DEF					NA	NA	NA	N
26477	TENDON SHORTENING	MAXFEE	DEF					340.31	7/1/2008	12/31/2299	N
26478	LENGTHENING OF HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26478	LENGTHENING OF HAND TENDON	MAXFEE	DEF					368.63	7/1/2008	12/31/2299	N
26479	SHORTENING OF HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26479	SHORTENING OF HAND TENDON	MAXFEE	DEF					363.90	7/1/2008	12/31/2299	N
26480	TRANSPLANT HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26480	TRANSPLANT HAND TENDON	MAXFEE	DEF					451.05	7/1/2008	12/31/2299	N
26483	TRANSPLANT/GRAFT HAND TENDON	PRXOVR	DEF					NA	NA	NA	N
26483	TRANSPLANT/GRAFT HAND TENDON	MAXFEE	DEF					508.17	1/1/2000	12/31/2299	N
26485	TRANSPLANT PALM TENDON	PRXOVR	DEF					NA	NA	NA	N
26485	TRANSPLANT PALM TENDON	MAXFEE	DEF					481.58	7/1/2008	12/31/2299	N
26489	TRANSPLANT/GRAFT PALM TENDON	PRXOVR	DEF					NA	NA	NA	N
26489	TRANSPLANT/GRAFT PALM TENDON	MAXFEE	DEF					473.48	7/1/2008	12/31/2299	N
26490	REVISE THUMB TENDON	PRXOVR	DEF					NA	NA	NA	N
26490	REVISE THUMB TENDON	MAXFEE	DEF					475.94	1/1/2000	12/31/2299	N
26492	TENDON TRANSFER WITH GRAFT	PRXOVR	DEF					NA	NA	NA	N
26492	TENDON TRANSFER WITH GRAFT	MAXFEE	DEF					535.15	1/1/2000	12/31/2299	N
26494	HAND TENDON/MUSCLE TRANSFER	PRXOVR	DEF					NA	NA	NA	N
26494	HAND TENDON/MUSCLE TRANSFER	MAXFEE	DEF					468.11	1/1/2000	12/31/2299	N
26496	REVISE THUMB TENDON	PRXOVR	DEF					NA	NA	NA	N
26496	REVISE THUMB TENDON	MAXFEE	DEF					530.74	1/1/2000	12/31/2299	N
26497	FINGER TENDON TRANSFER	PRXOVR	DEF					NA	NA	NA	N
26497	FINGER TENDON TRANSFER	MAXFEE	DEF					528.15	1/1/2000	12/31/2299	N
26498	FINGER TENDON TRANSFER	PRXOVR	DEF					NA	NA	NA	N
26498	FINGER TENDON TRANSFER	MAXFEE	DEF					746.70	1/1/2000	12/31/2299	N
26499	REVISION OF FINGER	PRXOVR	DEF					NA	NA	NA	N
26499	REVISION OF FINGER	MAXFEE	DEF					492.52	1/1/2000	12/31/2299	N
26500	HAND TENDON RECONSTRUCTION	PRXOVR	DEF					NA	NA	NA	N
26500	HAND TENDON RECONSTRUCTION	MAXFEE	DEF					366.51	7/1/2008	12/31/2299	N
26502	HAND TENDON RECONSTRUCTION	PRXOVR	DEF					NA	NA	NA	N
26502	HAND TENDON RECONSTRUCTION	MAXFEE	DEF					407.96	7/1/2008	12/31/2299	N
26504	HAND TENDON RECONSTRUCTION	PRXOVR	DEF					NA	NA	NA	N
26504	HAND TENDON RECONSTRUCTION	MAXFEE	DEF					NA			N
26508	RELEASE THUMB CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
26508	RELEASE THUMB CONTRACTURE	MAXFEE	DEF					372.79	7/1/2008	12/31/2299	N
26510	THUMB TENDON TRANSFER	PRXOVR	DEF					NA	NA	NA	N
26510	THUMB TENDON TRANSFER	MAXFEE	DEF					350.45	7/1/2008	12/31/2299	N
26516	FUSION OF KNUCKLE JOINT	PRXOVR	DEF					NA	NA	NA	N
26516	FUSION OF KNUCKLE JOINT	MAXFEE	DEF					409.86	7/1/2008	12/31/2299	N
26517	FUSION OF KNUCKLE JOINTS	PRXOVR	DEF					NA	NA	NA	N
26517	FUSION OF KNUCKLE JOINTS	MAXFEE	DEF					488.16	1/1/2000	12/31/2299	N
26518	FUSION OF KNUCKLE JOINTS	PRXOVR	DEF					NA	NA	NA	N
26518	FUSION OF KNUCKLE JOINTS	MAXFEE	DEF					478.90	7/1/2008	12/31/2299	N
26520	RELEASE KNUCKLE CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
26520	RELEASE KNUCKLE CONTRACTURE	MAXFEE	DEF					395.08	7/1/2008	12/31/2299	N
26525	RELEASE FINGER CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
26525	RELEASE FINGER CONTRACTURE	MAXFEE	DEF					397.47	7/1/2008	12/31/2299	N
26530	REVISE KNUCKLE JOINT	PRXOVR	DEF					NA	NA	NA	N
26530	REVISE KNUCKLE JOINT	MAXFEE	DEF					365.43	1/1/2000	12/31/2299	N
26531	REVISE KNUCKLE WITH IMPLANT	PRXOVR	DEF					NA	NA	NA	N
26531	REVISE KNUCKLE WITH IMPLANT	MAXFEE	DEF					451.83	1/1/2000	12/31/2299	N
26535	REVISE FINGER JOINT	PRXOVR	DEF					NA	NA	NA	N
26535	REVISE FINGER JOINT	MAXFEE	DEF					293.50	1/1/2000	12/31/2299	N
26536	REVISE/IMPLANT FINGER JOINT	PRXOVR	DEF					NA	NA	NA	N
26536	REVISE/IMPLANT FINGER JOINT	MAXFEE	DEF					414.77	1/1/2000	12/31/2299	N
26540	REPAIR HAND JOINT	PRXOVR	DEF					NA	NA	NA	N
26540	REPAIR HAND JOINT	MAXFEE	DEF					392.72	1/1/2000	12/31/2299	N
26541	REPAIR HAND JOINT WITH GRAFT	PRXOVR	DEF					NA	NA	NA	N
26541	REPAIR HAND JOINT WITH GRAFT	MAXFEE	DEF					512.27	1/1/2000	12/31/2299	N
26542	REPAIR HAND JOINT WITH GRAFT	PRXOVR	DEF					NA	NA	NA	N
26542	REPAIR HAND JOINT WITH GRAFT	MAXFEE	DEF					397	7/1/2008	12/31/2299	N
26545	RECONSTRUCT FINGER JOINT	PRXOVR	DEF					NA	NA	NA	N
26545	RECONSTRUCT FINGER JOINT	MAXFEE	DEF					403.60	7/1/2008	12/31/2299	N
26546	REPAIR NONUNION HAND	PRXOVR	DEF					NA	NA	NA	N
26546	REPAIR NONUNION HAND	MAXFEE	DEF					547.07	7/1/2008	12/31/2299	N
26548	RECONSTRUCT FINGER JOINT	PRXOVR	DEF					NA	NA	NA	N
26548	RECONSTRUCT FINGER JOINT	MAXFEE	DEF					443.63	7/1/2008	12/31/2299	N
26550	CONSTRUCT THUMB REPLACEMENT	PRXOVR	DEF					NA	NA	NA	N
26550	CONSTRUCT THUMB REPLACEMENT	MAXFEE	DEF					1160.06	1/1/2000	12/31/2299	N
26551	GREAT TOE-HAND TRANSFER	PRXOVR	DEF					NA	NA	NA	N
26551	GREAT TOE-HAND TRANSFER	MAXFEE	DEF					2401.82	1/1/2004	12/31/2299	N
26553	SINGLE TRANSFER TOE-HAND	PRXOVR	DEF					NA	NA	NA	N
26553	SINGLE TRANSFER TOE-HAND	MAXFEE	DEF					2333.88	1/1/2004	12/31/2299	N
26554	DOUBLE TRANSFER TOE-HAND	PRXOVR	DEF					NA	NA	NA	N
26554	DOUBLE TRANSFER TOE-HAND	MAXFEE	DEF					2806.93	1/1/2004	12/31/2299	N
26555	POSITIONAL CHANGE OF FINGER	PRXOVR	DEF					NA	NA	NA	N
26555	POSITIONAL CHANGE OF FINGER	MAXFEE	DEF					898.32	1/1/2000	12/31/2299	N
26556	TOE JOINT TRANSFER	PRXOVR	DEF					NA	NA	NA	N
26556	TOE JOINT TRANSFER	MAXFEE	DEF					2378.60	1/1/2000	12/31/2299	N
26560	REPAIR OF WEB FINGER	PRXOVR	DEF					NA	NA	NA	N
26560	REPAIR OF WEB FINGER	MAXFEE	DEF					323.42	7/1/2008	12/31/2299	N
26561	REPAIR OF WEB FINGER	PRXOVR	DEF					NA	NA	NA	N
26561	REPAIR OF WEB FINGER	MAXFEE	DEF					587.18	1/1/2000	12/31/2299	N
26562	REPAIR OF WEB FINGER	PRXOVR	DEF					NA	NA	NA	N
26562	REPAIR OF WEB FINGER	MAXFEE	DEF					732.38	7/1/2008	12/31/2299	N
26565	CORRECT METACARPAL FLAW	PRXOVR	DEF					NA	NA	NA	N
26565	CORRECT METACARPAL FLAW	MAXFEE	DEF					394.39	7/1/2008	12/31/2299	N
26567	CORRECT FINGER DEFORMITY	PRXOVR	DEF					NA	NA	NA	N
26567	CORRECT FINGER DEFORMITY	MAXFEE	DEF					397.28	7/1/2008	12/31/2299	N
26568	LENGTHEN METACARPAL/FINGER	PRXOVR	DEF					NA	NA	NA	N
26568	LENGTHEN METACARPAL/FINGER	MAXFEE	DEF					519.54	7/1/2008	12/31/2299	N
26580	REPAIR HAND DEFORMITY	PRXOVR	DEF					NA	NA	NA	N
26580	REPAIR HAND DEFORMITY	MAXFEE	DEF					949.66	1/1/2000	12/31/2299	N
26585	REPAIR FINGER DEFORMITY	PRXOVR	DEF					NA	NA	NA	N
26585	REPAIR FINGER DEFORMITY	MAXFEE	DEF					NA			N
26587	RECONSTRUCT EXTRA FINGER	PRXOVR	DEF					NA	NA	NA	N
26587	RECONSTRUCT EXTRA FINGER	MAXFEE	DEF					543.79	7/1/2003	12/31/2299	N
26590	REPAIR FINGER DEFORMITY	PRXOVR	DEF					NA	NA	NA	N
26590	REPAIR FINGER DEFORMITY	MAXFEE	DEF					923.52	1/1/2000	12/31/2299	N
26591	REPAIR MUSCLES OF HAND	PRXOVR	DEF					NA	NA	NA	N
26591	REPAIR MUSCLES OF HAND	MAXFEE	DEF					264.69	7/1/2008	12/31/2299	N
26593	RELEASE MUSCLES OF HAND	PRXOVR	DEF					NA	NA	NA	N
26593	RELEASE MUSCLES OF HAND	MAXFEE	DEF					345.62	7/1/2008	12/31/2299	N
26596	EXCISION CONSTRICTING TISSUE	PRXOVR	DEF					NA	NA	NA	N
26596	EXCISION CONSTRICTING TISSUE	MAXFEE	DEF					477.78	1/1/2000	12/31/2299	N
26597	RELEASE OF SCAR CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
26597	RELEASE OF SCAR CONTRACTURE	MAXFEE	DEF					NA			N
26600	TREAT METACARPAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
26600	TREAT METACARPAL FRACTURE	MAXFEE	FAC					129.36	1/1/2014	12/31/2299	N
26600	TREAT METACARPAL FRACTURE	MAXFEE	NFF					135.20	1/1/2014	12/31/2299	N
26605	TREAT METACARPAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
26605	TREAT METACARPAL FRACTURE	MAXFEE	FAC					151.50	1/1/2014	12/31/2299	N
26605	TREAT METACARPAL FRACTURE	MAXFEE	NFF					164.80	1/1/2014	12/31/2299	N
26607	TREAT METACARPAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
26607	TREAT METACARPAL FRACTURE	MAXFEE	DEF					264.67	1/1/2000	12/31/2299	N
26608	TREAT METACARPAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
26608	TREAT METACARPAL FRACTURE	MAXFEE	DEF					262.66	1/1/2004	12/31/2299	N
26615	TREAT METACARPAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
26615	TREAT METACARPAL FRACTURE	MAXFEE	DEF					289.97	1/1/2000	12/31/2299	N
26641	TREAT THUMB DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
26641	TREAT THUMB DISLOCATION	MAXFEE	FAC					147.22	1/1/2014	12/31/2299	N
26641	TREAT THUMB DISLOCATION	MAXFEE	NFF					165.57	1/1/2014	12/31/2299	N
26645	TREAT THUMB FRACTURE	PRXOVR	DEF					NA	NA	NA	N
26645	TREAT THUMB FRACTURE	MAXFEE	FAC					178.85	1/1/2014	12/31/2299	N
26645	TREAT THUMB FRACTURE	MAXFEE	NFF					200.09	1/1/2014	12/31/2299	N
26650	TREAT THUMB FRACTURE	PRXOVR	DEF					NA	NA	NA	N
26650	TREAT THUMB FRACTURE	MAXFEE	DEF					283.18	1/1/2000	12/31/2299	N
26665	TREAT THUMB FRACTURE	PRXOVR	DEF					NA	NA	NA	N
26665	TREAT THUMB FRACTURE	MAXFEE	DEF					391.97	1/1/2000	12/31/2299	N
26670	TREAT HAND DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
26670	TREAT HAND DISLOCATION	MAXFEE	FAC					152.93	1/1/2014	12/31/2299	N
26670	TREAT HAND DISLOCATION	MAXFEE	NFF					171.56	1/1/2014	12/31/2299	N
26675	TREAT HAND DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
26675	TREAT HAND DISLOCATION	MAXFEE	FAC					199.09	1/1/2014	12/31/2299	N
26675	TREAT HAND DISLOCATION	MAXFEE	NFF					259.93	1/1/2014	12/31/2299	N
26676	PIN HAND DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
26676	PIN HAND DISLOCATION	MAXFEE	DEF					296.01	1/1/2000	12/31/2299	N
26685	TREAT HAND DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
26685	TREAT HAND DISLOCATION	MAXFEE	DEF					361.05	1/1/2000	12/31/2299	N
26686	TREAT HAND DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
26686	TREAT HAND DISLOCATION	MAXFEE	DEF					398.51	1/1/2000	12/31/2299	N
26700	TREAT KNUCKLE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
26700	TREAT KNUCKLE DISLOCATION	MAXFEE	FAC					139.87	1/1/2014	12/31/2299	N
26700	TREAT KNUCKLE DISLOCATION	MAXFEE	NFF					145.42	1/1/2014	12/31/2299	N
26705	TREAT KNUCKLE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
26705	TREAT KNUCKLE DISLOCATION	MAXFEE	FAC					173.54	1/1/2014	12/31/2299	N
26705	TREAT KNUCKLE DISLOCATION	MAXFEE	NFF					191.75	1/1/2014	12/31/2299	N
26706	PIN KNUCKLE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
26706	PIN KNUCKLE DISLOCATION	MAXFEE	DEF					271.76	1/1/2000	12/31/2299	N
26715	TREAT KNUCKLE DISLOCATION