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
00100 ANESTH SALIVARY GLAND PRXOVR DEF         NA NA NA N
00100 ANESTH SALIVARY GLAND ANESTH DEF         NA NA NA N
00102 ANESTH REPAIR OF CLEFT LIP PRXOVR DEF         NA NA NA N
00102 ANESTH REPAIR OF CLEFT LIP ANESTH DEF         NA NA NA N
00103 ANESTH BLEPHAROPLASTY PRXOVR DEF         NA NA NA N
00103 ANESTH BLEPHAROPLASTY ANESTH DEF         NA NA NA N
00104 ANESTH ELECTROSHOCK PRXOVR DEF         NA NA NA N
00104 ANESTH ELECTROSHOCK ANESTH DEF         NA NA 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
00120 ANESTH EAR SURGERY PRXOVR DEF         NA NA NA N
00120 ANESTH EAR SURGERY ANESTH DEF         NA NA NA N
00124 ANESTH EAR EXAM PRXOVR DEF         NA NA NA N
00124 ANESTH EAR EXAM ANESTH DEF         NA NA NA N
00126 ANESTH TYMPANOTOMY PRXOVR DEF         NA NA NA N
00126 ANESTH TYMPANOTOMY ANESTH DEF         NA NA 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
00140 ANESTH PROCEDURES ON EYE PRXOVR DEF         NA NA NA N
00140 ANESTH PROCEDURES ON EYE ANESTH DEF         NA NA NA N
00142 ANESTH LENS SURGERY PRXOVR DEF         NA NA NA N
00142 ANESTH LENS SURGERY ANESTH DEF         NA NA NA N
00144 ANESTH CORNEAL TRANSPLANT PRXOVR DEF         NA NA NA N
00144 ANESTH CORNEAL TRANSPLANT ANESTH DEF         NA NA NA N
00145 ANESTH VITREORETINAL SURG PRXOVR DEF         NA NA NA N
00145 ANESTH VITREORETINAL SURG ANESTH DEF         NA NA NA N
00147 ANESTH IRIDECTOMY PRXOVR DEF         NA NA NA N
00147 ANESTH IRIDECTOMY ANESTH DEF         NA NA NA N
00148 ANESTH EYE EXAM PRXOVR DEF         NA NA NA N
00148 ANESTH EYE EXAM ANESTH DEF         NA NA NA 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
00160 ANESTH NOSE/SINUS SURGERY PRXOVR DEF         NA NA NA N
00160 ANESTH NOSE/SINUS SURGERY ANESTH DEF         NA NA NA N
00162 ANESTH NOSE/SINUS SURGERY PRXOVR DEF         NA NA NA N
00162 ANESTH NOSE/SINUS SURGERY ANESTH DEF         NA NA NA N
00164 ANESTH BIOPSY OF NOSE PRXOVR DEF         NA NA NA N
00164 ANESTH BIOPSY OF NOSE ANESTH DEF         NA NA NA N
00170 ANESTH PROCEDURE ON MOUTH PRXOVR DEF         NA NA NA N
00170 ANESTH PROCEDURE ON MOUTH ANESTH DEF         NA NA NA N
00172 ANESTH CLEFT PALATE REPAIR PRXOVR DEF         NA NA NA N
00172 ANESTH CLEFT PALATE REPAIR ANESTH DEF         NA NA NA N
00174 ANESTH PHARYNGEAL SURGERY PRXOVR DEF         NA NA NA N
00174 ANESTH PHARYNGEAL SURGERY ANESTH DEF         NA NA NA N
00176 ANESTH PHARYNGEAL SURGERY PRXOVR DEF         NA NA NA N
00176 ANESTH PHARYNGEAL SURGERY ANESTH DEF         NA NA NA N
00190 ANESTH FACE/SKULL BONE SURG PRXOVR DEF         NA NA NA N
00190 ANESTH FACE/SKULL BONE SURG ANESTH DEF         NA NA NA N
00192 ANESTH FACIAL BONE SURGERY PRXOVR DEF         NA NA NA N
00192 ANESTH FACIAL BONE SURGERY ANESTH DEF         NA NA NA N
00210 ANESTH CRANIAL SURG NOS PRXOVR DEF         NA NA NA N
00210 ANESTH CRANIAL SURG NOS ANESTH DEF         NA NA NA N
00211 ANESTH CRAN SURG HEMOTOMA PRXOVR DEF         NA NA NA N
00211 ANESTH CRAN SURG HEMOTOMA ANESTH DEF         NA NA NA N
00212 ANESTH SKULL DRAINAGE PRXOVR DEF         NA NA NA N
00212 ANESTH SKULL DRAINAGE ANESTH DEF         NA NA NA N
00214 ANESTH SKULL DRAINAGE PRXOVR DEF         NA NA NA N
00214 ANESTH SKULL DRAINAGE ANESTH DEF         NA NA NA N
00215 ANESTH SKULL REPAIR/FRACT PRXOVR DEF         NA NA NA N
00215 ANESTH SKULL REPAIR/FRACT ANESTH DEF         NA NA NA N
00216 ANESTH HEAD VESSEL SURGERY PRXOVR DEF         NA NA NA N
00216 ANESTH HEAD VESSEL SURGERY ANESTH DEF         NA NA NA N
00218 ANESTH SPECIAL HEAD SURGERY PRXOVR DEF         NA NA NA N
00218 ANESTH SPECIAL HEAD SURGERY ANESTH DEF         NA NA NA N
00220 ANESTH INTRCRN NERVE PRXOVR DEF         NA NA NA N
00220 ANESTH INTRCRN NERVE ANESTH DEF         NA NA NA N
00222 ANESTH HEAD NERVE SURGERY PRXOVR DEF         NA NA NA N
00222 ANESTH HEAD NERVE SURGERY ANESTH DEF         NA NA NA N
00300 ANESTH HEAD/NECK/PTRUNK PRXOVR DEF         NA NA NA N
00300 ANESTH HEAD/NECK/PTRUNK ANESTH DEF         NA NA NA N
00320 ANESTH NECK ORGAN 1YR/> PRXOVR DEF         NA NA NA N
00320 ANESTH NECK ORGAN 1YR/> ANESTH DEF         NA NA NA N
00322 ANESTH BIOPSY OF THYROID PRXOVR DEF         NA NA NA N
00322 ANESTH BIOPSY OF THYROID ANESTH DEF         NA NA NA N
00326 ANESTH LARYNX/TRACH < 1 YR PRXOVR DEF         NA NA NA N
00326 ANESTH LARYNX/TRACH < 1 YR ANESTH DEF         NA NA NA N
00350 ANESTH NECK VESSEL SURGERY PRXOVR DEF         NA NA NA N
00350 ANESTH NECK VESSEL SURGERY ANESTH DEF         NA NA NA N
00352 ANESTH NECK VESSEL SURGERY PRXOVR DEF         NA NA NA N
00352 ANESTH NECK VESSEL SURGERY ANESTH DEF         NA NA NA N
00400 ANESTH SKIN EXT/PER/ATRUNK PRXOVR DEF         NA NA NA N
00400 ANESTH SKIN EXT/PER/ATRUNK ANESTH DEF         NA NA NA N
00402 ANESTH SURGERY OF BREAST PRXOVR DEF         NA NA NA N
00402 ANESTH SURGERY OF BREAST ANESTH DEF         NA NA NA N
00404 ANESTH SURGERY OF BREAST PRXOVR DEF         NA NA NA N
00404 ANESTH SURGERY OF BREAST ANESTH DEF         NA NA NA N
00406 ANESTH SURGERY OF BREAST PRXOVR DEF         NA NA NA N
00406 ANESTH SURGERY OF BREAST ANESTH DEF         NA NA NA N
00410 ANESTH CORRECT HEART RHYTHM PRXOVR DEF         NA NA NA N
00410 ANESTH CORRECT HEART RHYTHM ANESTH DEF         NA NA NA N
00450 ANESTH SURGERY OF SHOULDER PRXOVR DEF         NA NA NA N
00450 ANESTH SURGERY OF SHOULDER ANESTH DEF         NA NA NA N
00452 ANESTH SURGERY OF SHOULDER PRXOVR DEF         NA NA NA N
00452 ANESTH SURGERY OF SHOULDER ANESTH DEF         NA NA NA N
00454 ANESTH COLLAR BONE BIOPSY PRXOVR DEF         NA NA NA N
00454 ANESTH COLLAR BONE BIOPSY ANESTH DEF         NA NA NA N
00470 ANESTH REMOVAL OF RIB PRXOVR DEF         NA NA NA N
00470 ANESTH REMOVAL OF RIB ANESTH DEF         NA NA NA N
00472 ANESTH CHEST WALL REPAIR PRXOVR DEF         NA NA NA N
00472 ANESTH CHEST WALL REPAIR ANESTH DEF         NA NA NA N
00474 ANESTH SURGERY OF RIB PRXOVR DEF         NA NA NA N
00474 ANESTH SURGERY OF RIB ANESTH DEF         NA NA NA N
00500 ANESTH ESOPHAGEAL SURGERY PRXOVR DEF         NA NA NA N
00500 ANESTH ESOPHAGEAL SURGERY ANESTH DEF         NA NA NA 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
00520 ANESTH CHEST PROCEDURE PRXOVR DEF         NA NA NA N
00520 ANESTH CHEST PROCEDURE ANESTH DEF         NA NA NA N
00522 ANESTH CHEST LINING BIOPSY PRXOVR DEF         NA NA NA N
00522 ANESTH CHEST LINING BIOPSY ANESTH DEF         NA NA NA N
00524 ANESTH CHEST DRAINAGE PRXOVR DEF         NA NA NA N
00524 ANESTH CHEST DRAINAGE ANESTH DEF         NA NA NA N
00528 ANES MEDIASCPY & DX THORSCPY PRXOVR DEF         NA NA NA N
00528 ANES MEDIASCPY & DX THORSCPY ANESTH DEF         NA NA NA N
00529 ANES MEDSCPY&THORSCPY 1 LUNG PRXOVR DEF         NA NA NA N
00529 ANES MEDSCPY&THORSCPY 1 LUNG ANESTH DEF         NA NA NA 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
00530 ANESTH PACEMAKER INSERTION PRXOVR DEF         NA NA NA N
00530 ANESTH PACEMAKER INSERTION ANESTH DEF         NA NA NA N
00532 ANESTH VASCULAR ACCESS PRXOVR DEF         NA NA NA N
00532 ANESTH VASCULAR ACCESS ANESTH DEF         NA NA NA N
00534 ANESTH CARDIOVERTER/DEFIB PRXOVR DEF         NA NA NA N
00534 ANESTH CARDIOVERTER/DEFIB ANESTH DEF         NA NA NA N
00536 ANESTHESIA; ELECTROPHYS PROC. PRXOVR DEF         NA NA NA N
00536 ANESTHESIA; ELECTROPHYS PROC. ANESTH DEF         NA NA NA N
00537 ANESTH CARDIAC ELECTROPHYS PRXOVR DEF         NA NA NA N
00537 ANESTH CARDIAC ELECTROPHYS ANESTH DEF         NA NA NA N
00539 ANESTH TRACH-BRONCH RECONST PRXOVR DEF         NA NA NA N
00539 ANESTH TRACH-BRONCH RECONST ANESTH DEF         NA NA NA 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
00540 ANESTH CHEST SURGERY PRXOVR DEF         NA NA NA N
00540 ANESTH CHEST SURGERY ANESTH DEF         NA NA NA N
00541 ANESTH ONE LUNG VENTILATION PRXOVR DEF         NA NA NA N
00541 ANESTH ONE LUNG VENTILATION ANESTH DEF         NA NA NA N
00542 ANESTHESIA REMOVAL PLEURA PRXOVR DEF         NA NA NA N
00542 ANESTHESIA REMOVAL PLEURA ANESTH DEF         NA NA NA N
00544 ANESTH; CHEST LINING REMOVAL PRXOVR DEF         NA NA NA N
00544 ANESTH; CHEST LINING REMOVAL ANESTH DEF         NA NA NA N
00546 ANESTH LUNG CHEST WALL SURG PRXOVR DEF         NA NA NA N
00546 ANESTH LUNG CHEST WALL SURG ANESTH DEF         NA NA NA N
00548 ANESTH TRACHEA BRONCHI SURG PRXOVR DEF         NA NA NA N
00548 ANESTH TRACHEA BRONCHI SURG ANESTH DEF         NA NA NA 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
00550 ANESTH STERNAL DEBRIDEMENT PRXOVR DEF         NA NA NA N
00550 ANESTH STERNAL DEBRIDEMENT ANESTH DEF         NA NA NA N
00560 ANESTH HEART SURG W/O PUMP PRXOVR DEF         NA NA NA N
00560 ANESTH HEART SURG W/O PUMP ANESTH DEF         NA NA NA N
00561 ANESTH HEART SURG <1 YR PRXOVR DEF         NA NA NA N
00561 ANESTH HEART SURG <1 YR ANESTH DEF         NA NA NA N
00562 ANESTH HRT SURG W/PMP AGE 1+ PRXOVR DEF         NA NA NA N
00562 ANESTH HRT SURG W/PMP AGE 1+ ANESTH DEF         NA NA NA N
00563 ANESTH HEART SURG W/ARREST PRXOVR DEF         NA NA NA N
00563 ANESTH HEART SURG W/ARREST ANESTH DEF         NA NA NA N
00566 ANESTH CABG W/O PUMP PRXOVR DEF         NA NA NA N
00566 ANESTH CABG W/O PUMP ANESTH DEF         NA NA NA N
00567 ANESTH CABG W/PUMP PRXOVR DEF         NA NA NA N
00567 ANESTH CABG W/PUMP ANESTH DEF         NA NA NA N
00580 ANESTH HEART/LUNG TRANSPLNT PRXOVR DEF         NA NA NA N
00580 ANESTH HEART/LUNG TRANSPLNT MANUAL DEF         NA NA NA N
00600 ANESTH SPINE CORD SURGERY PRXOVR DEF         NA NA NA N
00600 ANESTH SPINE CORD SURGERY ANESTH DEF         NA NA NA N
00604 ANESTH SITTING PROCEDURE PRXOVR DEF         NA NA NA N
00604 ANESTH SITTING PROCEDURE ANESTH DEF         NA NA NA N
00620 ANESTH SPINE CORD SURGERY PRXOVR DEF         NA NA NA N
00620 ANESTH SPINE CORD SURGERY ANESTH DEF         NA NA NA N
00622 ANESTH REMOVAL OF NERVES PRXOVR DEF         NA NA NA N
00622 ANESTH REMOVAL OF NERVES ANESTH DEF         NA NA NA N
00625 ANES SPINE TRANTHOR W/O VENT PRXOVR DEF         NA NA NA N
00625 ANES SPINE TRANTHOR W/O VENT ANESTH DEF         NA NA NA N
00626 ANES SPINE TRANSTHOR W/VENT PRXOVR DEF         NA NA NA N
00626 ANES SPINE TRANSTHOR W/VENT ANESTH DEF         NA NA NA N
00630 ANESTH SPINE CORD SURGERY PRXOVR DEF         NA NA NA N
00630 ANESTH SPINE CORD SURGERY ANESTH DEF         NA NA NA N
00632 ANESTH REMOVAL OF NERVES PRXOVR DEF         NA NA NA N
00632 ANESTH REMOVAL OF NERVES ANESTH DEF         NA NA NA N
00634 ANESTH FOR CHEMONUCLEOLYSIS PRXOVR DEF         NA NA NA N
00634 ANESTH FOR CHEMONUCLEOLYSIS ANESTH DEF         NA NA NA N
00635 ANESTH LUMBAR PUNCTURE PRXOVR DEF         NA NA NA N
00635 ANESTH LUMBAR PUNCTURE ANESTH DEF         NA NA NA N
00640 ANESTH SPINE MANIPULATION PRXOVR DEF         NA NA NA N
00640 ANESTH SPINE MANIPULATION ANESTH DEF         NA NA NA 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
00670 ANESTH SPINE CORD SURGERY PRXOVR DEF         NA NA NA N
00670 ANESTH SPINE CORD SURGERY ANESTH DEF         NA NA NA N
00700 ANESTH ABDOMINAL WALL SURG PRXOVR DEF         NA NA NA N
00700 ANESTH ABDOMINAL WALL SURG ANESTH DEF         NA NA NA N
00702 ANESTH FOR LIVER BIOPSY PRXOVR DEF         NA NA NA N
00702 ANESTH FOR LIVER BIOPSY ANESTH DEF         NA NA NA 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
00730 ANESTH ABDOMINAL WALL SURG PRXOVR DEF         NA NA NA N
00730 ANESTH ABDOMINAL WALL SURG ANESTH DEF         NA NA NA N
00731 ANES UPR GI NDSC PX NOS PRXOVR DEF         NA NA NA N
00731 ANES UPR GI NDSC PX NOS ANESTH DEF         NA NA NA N
00732 ANES UPR GI NDSC PX ERCP PRXOVR DEF         NA NA NA N
00732 ANES UPR GI NDSC PX ERCP ANESTH DEF         NA NA NA 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
00740 ANESTH UPPER GI VISUALIZE PRXOVR DEF         NA NA NA N
00740 ANESTH UPPER GI VISUALIZE ANESTH DEF         NA NA NA 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
00750 ANES HRNA RPR UPR ABD NOS PRXOVR DEF         NA NA NA N
00750 ANES HRNA RPR UPR ABD NOS ANESTH DEF         NA NA NA N
00752 ANES HRNA RPR LMBR&VNT&/DEHS PRXOVR DEF         NA NA NA N
00752 ANES HRNA RPR LMBR&VNT&/DEHS ANESTH DEF         NA NA NA N
00754 ANES HRNA RPR OMPHALOCELE PRXOVR DEF         NA NA NA N
00754 ANES HRNA RPR OMPHALOCELE ANESTH DEF         NA NA NA N
00756 ANES HRNA RPR DIPHRG HRNA PRXOVR DEF         NA NA NA N
00756 ANES HRNA RPR DIPHRG HRNA ANESTH DEF         NA NA NA N
00770 ANES PX MAJ ABD BLOOD VESSEL PRXOVR DEF         NA NA NA N
00770 ANES PX MAJ ABD BLOOD VESSEL ANESTH DEF         NA NA NA N
00790 ANES IPER UPR ABD NOS PRXOVR DEF         NA NA NA N
00790 ANES IPER UPR ABD NOS ANESTH DEF         NA NA NA N
00792 ANES IPER UPR ABD PRTL HPTC PRXOVR DEF         NA NA NA N
00792 ANES IPER UPR ABD PRTL HPTC ANESTH DEF         NA NA NA N
00794 ANES IPER UPR ABD PNCRTECT PRXOVR DEF         NA NA NA N
00794 ANES IPER UPR ABD PNCRTECT ANESTH DEF         NA NA NA N
00796 ANES IPER UPR ABD LVR TRNSPL PRXOVR DEF         NA NA NA N
00796 ANES IPER UPR ABD LVR TRNSPL ANESTH DEF         NA NA NA N
00797 ANES IPER UPR ABD GSTR PX MO PRXOVR DEF         NA NA NA E
00797 ANES IPER UPR ABD GSTR PX MO ANESTH DEF         NA NA NA E
00800 ANESTH ABDOMINAL WALL SURG PRXOVR DEF         NA NA NA N
00800 ANESTH ABDOMINAL WALL SURG ANESTH DEF         NA NA NA N
00802 ANESTH FAT LAYER REMOVAL PRXOVR DEF         NA NA NA N
00802 ANESTH FAT LAYER REMOVAL ANESTH DEF         NA NA NA N
00806 ANESTH LAPAROSCOPIC PROCEDURES PRXOVR DEF         NA NA NA N
00806 ANESTH LAPAROSCOPIC PROCEDURES ANESTH DEF         NA NA NA N
00810 ANESTH LOW INTESTINE SCOPE PRXOVR DEF         NA NA NA N
00810 ANESTH LOW INTESTINE SCOPE ANESTH DEF         NA NA NA N
00811 ANES LWR INTST NDSC NOS PRXOVR DEF         NA NA NA N
00811 ANES LWR INTST NDSC NOS ANESTH DEF         NA NA NA N
00812 ANES LWR INTST SCR COLSC PRXOVR DEF         NA NA NA N
00812 ANES LWR INTST SCR COLSC ANESTH DEF         NA NA NA N
00813 ANES UPR LWR GI NDSC PX PRXOVR DEF         NA NA NA N
00813 ANES UPR LWR GI NDSC PX ANESTH DEF         NA NA NA 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
00820 ANESTH ABDOMINAL WALL SURG PRXOVR DEF         NA NA NA N
00820 ANESTH ABDOMINAL WALL SURG ANESTH DEF         NA NA NA 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
00830 ANESTH REPAIR OF HERNIA PRXOVR DEF         NA NA NA N
00830 ANESTH REPAIR OF HERNIA ANESTH DEF         NA NA NA N
00832 ANESTH REPAIR OF HERNIA PRXOVR DEF         NA NA NA N
00832 ANESTH REPAIR OF HERNIA ANESTH DEF         NA NA NA N
00834 ANESTH HERNIA REPAIR < 1 YR PRXOVR DEF         NA NA NA N
00834 ANESTH HERNIA REPAIR < 1 YR ANESTH DEF         NA NA NA N
00836 ANESTH HERNIA REPAIR PREEMIE PRXOVR DEF         NA NA NA N
00836 ANESTH HERNIA REPAIR PREEMIE ANESTH DEF         NA NA NA 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
00840 ANESTH SURG LOWER ABDOMEN PRXOVR DEF         NA NA NA N
00840 ANESTH SURG LOWER ABDOMEN ANESTH DEF         NA NA NA N
00842 ANESTH AMNIOCENTESIS PRXOVR DEF         NA NA NA N
00842 ANESTH AMNIOCENTESIS ANESTH DEF         NA NA NA N
00844 ANESTH PELVIS SURGERY PRXOVR DEF         NA NA NA N
00844 ANESTH PELVIS SURGERY ANESTH DEF         NA NA NA N
00846 ANESTH HYSTERECTOMY PRXOVR DEF         NA NA NA N
00846 ANESTH HYSTERECTOMY ANESTH DEF         NA NA NA N
00848 ANESTH PELVIC ORGAN SURG PRXOVR DEF         NA NA NA N
00848 ANESTH PELVIC ORGAN SURG ANESTH DEF         NA NA NA N
00850 ANESTH; CESAREAN SECTION PRXOVR DEF         NA NA NA N
00850 ANESTH; CESAREAN SECTION ANESTH DEF         NA NA NA N
00851 ANESTH TUBAL LIGATION PRXOVR DEF         NA NA NA N
00851 ANESTH TUBAL LIGATION ANESTH DEF         NA NA NA N
00855 ANESTH; HYSTERECTOMY PRXOVR DEF         NA NA NA N
00855 ANESTH; HYSTERECTOMY ANESTH DEF         NA NA NA N
00857 ANALGESIA; LABOR & C-SECTION PRXOVR DEF         NA NA NA N
00857 ANALGESIA; LABOR & C-SECTION ANESTH DEF         NA NA NA N
00860 ANESTH SURGERY OF ABDOMEN PRXOVR DEF         NA NA NA N
00860 ANESTH SURGERY OF ABDOMEN ANESTH DEF         NA NA NA N
00862 ANESTH KIDNEY/URETER SURG PRXOVR DEF         NA NA NA N
00862 ANESTH KIDNEY/URETER SURG ANESTH DEF         NA NA NA N
00864 ANESTH REMOVAL OF BLADDER PRXOVR DEF         NA NA NA N
00864 ANESTH REMOVAL OF BLADDER ANESTH DEF         NA NA NA N
00865 ANESTH REMOVAL OF PROSTATE PRXOVR DEF         NA NA NA N
00865 ANESTH REMOVAL OF PROSTATE ANESTH DEF         NA NA NA N
00866 ANESTH REMOVAL OF ADRENAL PRXOVR DEF         NA NA NA N
00866 ANESTH REMOVAL OF ADRENAL ANESTH DEF         NA NA NA N
00868 ANESTH KIDNEY TRANSPLANT PRXOVR DEF         NA NA NA N
00868 ANESTH KIDNEY TRANSPLANT ANESTH DEF         NA NA NA N
00869 ANESTH; VASECTOMY PRXOVR DEF         NA NA NA N
00869 ANESTH; VASECTOMY ANESTH DEF         NA NA NA N
00870 ANESTH BLADDER STONE SURG PRXOVR DEF         NA NA NA N
00870 ANESTH BLADDER STONE SURG ANESTH DEF         NA NA NA N
00872 ANESTH KIDNEY STONE DESTRUCT PRXOVR DEF         NA NA NA N
00872 ANESTH KIDNEY STONE DESTRUCT ANESTH DEF         NA NA NA N
00873 ANESTH KIDNEY STONE DESTRUCT PRXOVR DEF         NA NA NA N
00873 ANESTH KIDNEY STONE DESTRUCT ANESTH DEF         NA NA NA N
00880 ANESTH ABDOMEN VESSEL SURG PRXOVR DEF         NA NA NA N
00880 ANESTH ABDOMEN VESSEL SURG ANESTH DEF         NA NA NA N
00882 ANESTH MAJOR VEIN LIGATION PRXOVR DEF         NA NA NA N
00882 ANESTH MAJOR VEIN LIGATION ANESTH DEF         NA NA NA N
00884 ANESTH; MAJOR VEIN REVISION PRXOVR DEF         NA NA NA N
00884 ANESTH; MAJOR VEIN REVISION ANESTH DEF         NA NA NA N
00902 ANESTH ANORECTAL SURGERY PRXOVR DEF         NA NA NA N
00902 ANESTH ANORECTAL SURGERY ANESTH DEF         NA NA NA N
00904 ANESTH PERINEAL SURGERY PRXOVR DEF         NA NA NA N
00904 ANESTH PERINEAL SURGERY ANESTH DEF         NA NA NA N
00906 ANESTH REMOVAL OF VULVA PRXOVR DEF         NA NA NA N
00906 ANESTH REMOVAL OF VULVA ANESTH DEF         NA NA NA N
00908 ANESTH REMOVAL OF PROSTATE PRXOVR DEF         NA NA NA N
00908 ANESTH REMOVAL OF PROSTATE ANESTH DEF         NA NA NA N
00910 ANESTH BLADDER SURGERY PRXOVR DEF         NA NA NA N
00910 ANESTH BLADDER SURGERY ANESTH DEF         NA NA NA N
00912 ANESTH BLADDER TUMOR SURG PRXOVR DEF         NA NA NA N
00912 ANESTH BLADDER TUMOR SURG ANESTH DEF         NA NA NA N
00914 ANESTH REMOVAL OF PROSTATE PRXOVR DEF         NA NA NA N
00914 ANESTH REMOVAL OF PROSTATE ANESTH DEF         NA NA NA N
00916 ANESTH BLEEDING CONTROL PRXOVR DEF         NA NA NA N
00916 ANESTH BLEEDING CONTROL ANESTH DEF         NA NA NA N
00918 ANESTH STONE REMOVAL PRXOVR DEF         NA NA NA N
00918 ANESTH STONE REMOVAL ANESTH DEF         NA NA NA 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
00920 ANESTH GENITALIA SURGERY PRXOVR DEF         NA NA NA N
00920 ANESTH GENITALIA SURGERY ANESTH DEF         NA NA NA N
00921 ANESTH VASECTOMY PRXOVR DEF         NA NA NA N
00921 ANESTH VASECTOMY ANESTH DEF         NA NA NA N
00922 ANESTH SPERM DUCT SURGERY PRXOVR DEF         NA NA NA N
00922 ANESTH SPERM DUCT SURGERY ANESTH DEF         NA NA NA N
00924 ANESTH TESTIS EXPLORATION PRXOVR DEF         NA NA NA N
00924 ANESTH TESTIS EXPLORATION ANESTH DEF         NA NA NA N
00926 ANESTH REMOVAL OF TESTIS PRXOVR DEF         NA NA NA N
00926 ANESTH REMOVAL OF TESTIS ANESTH DEF         NA NA NA N
00928 ANESTH REMOVAL OF TESTIS PRXOVR DEF         NA NA NA N
00928 ANESTH REMOVAL OF TESTIS ANESTH DEF         NA NA NA 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
00930 ANESTH TESTIS SUSPENSION PRXOVR DEF         NA NA NA N
00930 ANESTH TESTIS SUSPENSION ANESTH DEF         NA NA NA N
00932 ANESTH AMPUTATION OF PENIS PRXOVR DEF         NA NA NA N
00932 ANESTH AMPUTATION OF PENIS ANESTH DEF         NA NA NA N
00934 ANESTH PENIS NODES REMOVAL PRXOVR DEF         NA NA NA N
00934 ANESTH PENIS NODES REMOVAL ANESTH DEF         NA NA NA N
00936 ANESTH PENIS NODES REMOVAL PRXOVR DEF         NA NA NA N
00936 ANESTH PENIS NODES REMOVAL ANESTH DEF         NA NA NA N
00938 ANESTH INSERT PENIS DEVICE PRXOVR DEF         NA NA NA N
00938 ANESTH INSERT PENIS DEVICE ANESTH DEF         NA NA NA 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
00940 ANESTH VAGINAL PROCEDURES PRXOVR DEF         NA NA NA N
00940 ANESTH VAGINAL PROCEDURES ANESTH DEF         NA NA NA N
00942 ANESTH SURG ON VAG/URETHRAL PRXOVR DEF         NA NA NA N
00942 ANESTH SURG ON VAG/URETHRAL ANESTH DEF         NA NA NA N
00944 ANESTH VAGINAL HYSTERECTOMY PRXOVR DEF         NA NA NA N
00944 ANESTH VAGINAL HYSTERECTOMY ANESTH DEF         NA NA NA N
00946 ANESTH; VAGINAL DELIVERY PRXOVR DEF         NA NA NA N
00946 ANESTH; VAGINAL DELIVERY ANESTH DEF         NA NA NA N
00948 ANESTH REPAIR OF CERVIX PRXOVR DEF         NA NA NA N
00948 ANESTH REPAIR OF CERVIX ANESTH DEF         NA NA NA 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
00950 ANESTH VAGINAL ENDOSCOPY PRXOVR DEF         NA NA NA N
00950 ANESTH VAGINAL ENDOSCOPY ANESTH DEF         NA NA NA N
00952 ANESTH HYSTEROSCOPE/GRAPH PRXOVR DEF         NA NA NA N
00952 ANESTH HYSTEROSCOPE/GRAPH ANESTH DEF         NA NA NA N
00955 ANALGESIA; VAGINAL DELIVERY PRXOVR DEF         NA NA NA N
00955 ANALGESIA; VAGINAL DELIVERY ANESTH DEF         NA NA NA N
01112 ANESTH BONE ASPIRATE/BX PRXOVR DEF         NA NA NA N
01112 ANESTH BONE ASPIRATE/BX ANESTH DEF         NA NA NA 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
01120 ANESTH PELVIS SURGERY PRXOVR DEF         NA NA NA N
01120 ANESTH PELVIS SURGERY ANESTH DEF         NA NA NA 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
01130 ANESTH BODY CAST PROCEDURE PRXOVR DEF         NA NA NA N
01130 ANESTH BODY CAST PROCEDURE ANESTH DEF         NA NA NA 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
01140 ANESTH AMPUTATION AT PELVIS PRXOVR DEF         NA NA NA N
01140 ANESTH AMPUTATION AT PELVIS ANESTH DEF         NA NA NA N
01150 ANESTH PELVIC TUMOR SURGERY PRXOVR DEF         NA NA NA N
01150 ANESTH PELVIC TUMOR SURGERY ANESTH DEF         NA NA NA N
01160 ANESTH PELVIS PROCEDURE PRXOVR DEF         NA NA NA N
01160 ANESTH PELVIS PROCEDURE ANESTH DEF         NA NA NA N
01170 ANESTH PELVIS SURGERY PRXOVR DEF         NA NA NA N
01170 ANESTH PELVIS SURGERY ANESTH DEF         NA NA NA N
01173 ANESTH FX REPAIR PELVIS PRXOVR DEF         NA NA NA N
01173 ANESTH FX REPAIR PELVIS ANESTH DEF         NA NA NA N
01180 ANESTH PELVIS NERVE REMOVAL PRXOVR DEF         NA NA NA N
01180 ANESTH PELVIS NERVE REMOVAL ANESTH DEF         NA NA NA N
01190 ANESTH PELVIS NERVE REMOVAL PRXOVR DEF         NA NA NA N
01190 ANESTH PELVIS NERVE REMOVAL ANESTH DEF         NA NA NA N
01200 ANESTH HIP JOINT PROCEDURE PRXOVR DEF         NA NA NA N
01200 ANESTH HIP JOINT PROCEDURE ANESTH DEF         NA NA NA N
01202 ANESTH ARTHROSCOPY OF HIP PRXOVR DEF         NA NA NA N
01202 ANESTH ARTHROSCOPY OF HIP ANESTH DEF         NA NA NA N
01210 ANESTH HIP JOINT SURGERY PRXOVR DEF         NA NA NA N
01210 ANESTH HIP JOINT SURGERY ANESTH DEF         NA NA NA N
01212 ANESTH HIP DISARTICULATION PRXOVR DEF         NA NA NA N
01212 ANESTH HIP DISARTICULATION ANESTH DEF         NA NA NA N
01214 ANESTH HIP ARTHROPLASTY PRXOVR DEF         NA NA NA N
01214 ANESTH HIP ARTHROPLASTY ANESTH DEF         NA NA NA N
01215 ANESTH REVISE HIP REPAIR PRXOVR DEF         NA NA NA N
01215 ANESTH REVISE HIP REPAIR ANESTH DEF         NA NA NA N
01220 ANESTH PROCEDURE ON FEMUR PRXOVR DEF         NA NA NA N
01220 ANESTH PROCEDURE ON FEMUR ANESTH DEF         NA NA NA N
01230 ANESTH SURGERY OF FEMUR PRXOVR DEF         NA NA NA N
01230 ANESTH SURGERY OF FEMUR ANESTH DEF         NA NA NA N
01232 ANESTH AMPUTATION OF FEMUR PRXOVR DEF         NA NA NA N
01232 ANESTH AMPUTATION OF FEMUR ANESTH DEF         NA NA NA N
01234 ANESTH RADICAL FEMUR SURG PRXOVR DEF         NA NA NA N
01234 ANESTH RADICAL FEMUR SURG ANESTH DEF         NA NA NA N
01250 ANESTH UPPER LEG SURGERY PRXOVR DEF         NA NA NA N
01250 ANESTH UPPER LEG SURGERY ANESTH DEF         NA NA NA N
01260 ANESTH UPPER LEG VEINS SURG PRXOVR DEF         NA NA NA N
01260 ANESTH UPPER LEG VEINS SURG ANESTH DEF         NA NA NA N
01270 ANESTH THIGH ARTERIES SURG PRXOVR DEF         NA NA NA N
01270 ANESTH THIGH ARTERIES SURG ANESTH DEF         NA NA NA N
01272 ANESTH FEMORAL ARTERY SURG PRXOVR DEF         NA NA NA N
01272 ANESTH FEMORAL ARTERY SURG ANESTH DEF         NA NA NA N
01274 ANESTH FEMORAL EMBOLECTOMY PRXOVR DEF         NA NA NA N
01274 ANESTH FEMORAL EMBOLECTOMY ANESTH DEF         NA NA NA N
01320 ANESTH KNEE AREA SURGERY PRXOVR DEF         NA NA NA N
01320 ANESTH KNEE AREA SURGERY ANESTH DEF         NA NA NA N
01340 ANESTH KNEE AREA PROCEDURE PRXOVR DEF         NA NA NA N
01340 ANESTH KNEE AREA PROCEDURE ANESTH DEF         NA NA NA N
01360 ANESTH KNEE AREA SURGERY PRXOVR DEF         NA NA NA N
01360 ANESTH KNEE AREA SURGERY ANESTH DEF         NA NA NA N
01380 ANESTH KNEE JOINT PROCEDURE PRXOVR DEF         NA NA NA N
01380 ANESTH KNEE JOINT PROCEDURE ANESTH DEF         NA NA NA N
01382 ANESTH DX KNEE ARTHROSCOPY PRXOVR DEF         NA NA NA N
01382 ANESTH DX KNEE ARTHROSCOPY ANESTH DEF         NA NA NA N
01390 ANESTH KNEE AREA PROCEDURE PRXOVR DEF         NA NA NA N
01390 ANESTH KNEE AREA PROCEDURE ANESTH DEF         NA NA NA N
01392 ANESTH KNEE AREA SURGERY PRXOVR DEF         NA NA NA N
01392 ANESTH KNEE AREA SURGERY ANESTH DEF         NA NA NA N
01400 ANESTH KNEE JOINT SURGERY PRXOVR DEF         NA NA NA N
01400 ANESTH KNEE JOINT SURGERY ANESTH DEF         NA NA NA N
01402 ANESTH KNEE ARTHROPLASTY PRXOVR DEF         NA NA NA N
01402 ANESTH KNEE ARTHROPLASTY ANESTH DEF         NA NA NA N
01404 ANESTH AMPUTATION AT KNEE PRXOVR DEF         NA NA NA N
01404 ANESTH AMPUTATION AT KNEE ANESTH DEF         NA NA NA N
01420 ANESTH KNEE JOINT CASTING PRXOVR DEF         NA NA NA N
01420 ANESTH KNEE JOINT CASTING ANESTH DEF         NA NA NA N
01430 ANESTH KNEE VEINS SURGERY PRXOVR DEF         NA NA NA N
01430 ANESTH KNEE VEINS SURGERY ANESTH DEF         NA NA NA N
01432 ANESTH KNEE VESSEL SURG PRXOVR DEF         NA NA NA N
01432 ANESTH KNEE VESSEL SURG ANESTH DEF         NA NA NA N
01440 ANESTH KNEE ARTERIES SURG PRXOVR DEF         NA NA NA N
01440 ANESTH KNEE ARTERIES SURG ANESTH DEF         NA NA NA N
01442 ANESTH KNEE ARTERY SURG PRXOVR DEF         NA NA NA N
01442 ANESTH KNEE ARTERY SURG ANESTH DEF         NA NA NA N
01444 ANESTH KNEE ARTERY REPAIR PRXOVR DEF         NA NA NA N
01444 ANESTH KNEE ARTERY REPAIR ANESTH DEF         NA NA NA N
01462 ANESTH LOWER LEG PROCEDURE PRXOVR DEF         NA NA NA N
01462 ANESTH LOWER LEG PROCEDURE ANESTH DEF         NA NA NA N
01464 ANESTH ANKLE/FT ARTHROSCOPY PRXOVR DEF         NA NA NA N
01464 ANESTH ANKLE/FT ARTHROSCOPY ANESTH DEF         NA NA NA N
01470 ANESTH LOWER LEG SURGERY PRXOVR DEF         NA NA NA N
01470 ANESTH LOWER LEG SURGERY ANESTH DEF         NA NA NA N
01472 ANESTH ACHILLES TENDON SURG PRXOVR DEF         NA NA NA N
01472 ANESTH ACHILLES TENDON SURG ANESTH DEF         NA NA NA N
01474 ANESTH LOWER LEG SURGERY PRXOVR DEF         NA NA NA N
01474 ANESTH LOWER LEG SURGERY ANESTH DEF         NA NA NA N
01480 ANESTH LOWER LEG BONE SURG PRXOVR DEF         NA NA NA N
01480 ANESTH LOWER LEG BONE SURG ANESTH DEF         NA NA NA N
01482 ANESTH RADICAL LEG SURGERY PRXOVR DEF         NA NA NA N
01482 ANESTH RADICAL LEG SURGERY ANESTH DEF         NA NA NA N
01484 ANESTH LOWER LEG REVISION PRXOVR DEF         NA NA NA N
01484 ANESTH LOWER LEG REVISION ANESTH DEF         NA NA NA N
01486 ANESTH ANKLE REPLACEMENT PRXOVR DEF         NA NA NA N
01486 ANESTH ANKLE REPLACEMENT ANESTH DEF         NA NA NA N
01490 ANESTH LOWER LEG CASTING PRXOVR DEF         NA NA NA N
01490 ANESTH LOWER LEG CASTING ANESTH DEF         NA NA NA N
01500 ANESTH LEG ARTERIES SURG PRXOVR DEF         NA NA NA N
01500 ANESTH LEG ARTERIES SURG ANESTH DEF         NA NA NA N
01502 ANESTH LWR LEG EMBOLECTOMY PRXOVR DEF         NA NA NA N
01502 ANESTH LWR LEG EMBOLECTOMY ANESTH DEF         NA NA NA N
01520 ANESTH LOWER LEG VEIN SURG PRXOVR DEF         NA NA NA N
01520 ANESTH LOWER LEG VEIN SURG ANESTH DEF         NA NA NA N
01522 ANESTH LOWER LEG VEIN SURG PRXOVR DEF         NA NA NA N
01522 ANESTH LOWER LEG VEIN SURG ANESTH DEF         NA NA NA N
01610 ANESTH SURGERY OF SHOULDER PRXOVR DEF         NA NA NA N
01610 ANESTH SURGERY OF SHOULDER ANESTH DEF         NA NA NA N
01620 ANESTH SHOULDER PROCEDURE PRXOVR DEF         NA NA NA N
01620 ANESTH SHOULDER PROCEDURE ANESTH DEF         NA NA NA N
01622 ANES DX SHOULDER ARTHROSCOPY PRXOVR DEF         NA NA NA N
01622 ANES DX SHOULDER ARTHROSCOPY ANESTH DEF         NA NA NA N
01630 ANESTH SURGERY OF SHOULDER PRXOVR DEF         NA NA NA N
01630 ANESTH SURGERY OF SHOULDER ANESTH DEF         NA NA NA N
01632 ANESTH; SURGERY OF SHOULDER PRXOVR DEF         NA NA NA N
01632 ANESTH; SURGERY OF SHOULDER ANESTH DEF         NA NA NA N
01634 ANESTH SHOULDER JOINT AMPUT PRXOVR DEF         NA NA NA N
01634 ANESTH SHOULDER JOINT AMPUT ANESTH DEF         NA NA NA N
01636 ANESTH FOREQUARTER AMPUT PRXOVR DEF         NA NA NA N
01636 ANESTH FOREQUARTER AMPUT ANESTH DEF         NA NA NA N
01638 ANESTH SHOULDER REPLACEMENT PRXOVR DEF         NA NA NA N
01638 ANESTH SHOULDER REPLACEMENT ANESTH DEF         NA NA NA N
01650 ANESTH SHOULDER ARTERY SURG PRXOVR DEF         NA NA NA N
01650 ANESTH SHOULDER ARTERY SURG ANESTH DEF         NA NA NA N
01652 ANESTH SHOULDER VESSEL SURG PRXOVR DEF         NA NA NA N
01652 ANESTH SHOULDER VESSEL SURG ANESTH DEF         NA NA NA N
01654 ANESTH SHOULDER VESSEL SURG PRXOVR DEF         NA NA NA N
01654 ANESTH SHOULDER VESSEL SURG ANESTH DEF         NA NA NA N
01656 ANESTH ARM-LEG VESSEL SURG PRXOVR DEF         NA NA NA N
01656 ANESTH ARM-LEG VESSEL SURG ANESTH DEF         NA NA NA N
01670 ANESTH SHOULDER VEIN SURG PRXOVR DEF         NA NA NA N
01670 ANESTH SHOULDER VEIN SURG ANESTH DEF         NA NA NA N
01680 ANESTH SHOULDER CASTING PRXOVR DEF         NA NA NA N
01680 ANESTH SHOULDER CASTING ANESTH DEF         NA NA NA N
01682 ANESTH AIRPLANE CAST PRXOVR DEF         NA NA NA N
01682 ANESTH AIRPLANE CAST ANESTH DEF         NA NA NA N
01710 ANESTH ELBOW AREA SURGERY PRXOVR DEF         NA NA NA N
01710 ANESTH ELBOW AREA SURGERY ANESTH DEF         NA NA NA N
01712 ANESTH UPPR ARM TENDON SURG PRXOVR DEF         NA NA NA N
01712 ANESTH UPPR ARM TENDON SURG ANESTH DEF         NA NA NA N
01714 ANESTH UPPR ARM TENDON SURG PRXOVR DEF         NA NA NA N
01714 ANESTH UPPR ARM TENDON SURG ANESTH DEF         NA NA NA N
01716 ANESTH BICEPS TENDON REPAIR PRXOVR DEF         NA NA NA N
01716 ANESTH BICEPS TENDON REPAIR ANESTH DEF         NA NA NA N
01730 ANESTH UPPR ARM PROCEDURE PRXOVR DEF         NA NA NA N
01730 ANESTH UPPR ARM PROCEDURE ANESTH DEF         NA NA NA N
01732 ANESTH DX ELBOW ARTHROSCOPY PRXOVR DEF         NA NA NA N
01732 ANESTH DX ELBOW ARTHROSCOPY ANESTH DEF         NA NA NA N
01740 ANESTH UPPER ARM SURGERY PRXOVR DEF         NA NA NA N
01740 ANESTH UPPER ARM SURGERY ANESTH DEF         NA NA NA N
01742 ANESTH HUMERUS SURGERY PRXOVR DEF         NA NA NA N
01742 ANESTH HUMERUS SURGERY ANESTH DEF         NA NA NA N
01744 ANESTH HUMERUS REPAIR PRXOVR DEF         NA NA NA N
01744 ANESTH HUMERUS REPAIR ANESTH DEF         NA NA NA N
01756 ANESTH RADICAL HUMERUS SURG PRXOVR DEF         NA NA NA N
01756 ANESTH RADICAL HUMERUS SURG ANESTH DEF         NA NA NA N
01758 ANESTH HUMERAL LESION SURG PRXOVR DEF         NA NA NA N
01758 ANESTH HUMERAL LESION SURG ANESTH DEF         NA NA NA N
01760 ANESTH ELBOW REPLACEMENT PRXOVR DEF         NA NA NA N
01760 ANESTH ELBOW REPLACEMENT ANESTH DEF         NA NA NA N
01770 ANESTH UPPR ARM ARTERY SURG PRXOVR DEF         NA NA NA N
01770 ANESTH UPPR ARM ARTERY SURG ANESTH DEF         NA NA NA N
01772 ANESTH UPPR ARM EMBOLECTOMY PRXOVR DEF         NA NA NA N
01772 ANESTH UPPR ARM EMBOLECTOMY ANESTH DEF         NA NA NA N
01780 ANESTH UPPER ARM VEIN SURG PRXOVR DEF         NA NA NA N
01780 ANESTH UPPER ARM VEIN SURG ANESTH DEF         NA NA NA N
01782 ANESTH UPPR ARM VEIN REPAIR PRXOVR DEF         NA NA NA N
01782 ANESTH UPPR ARM VEIN REPAIR ANESTH DEF         NA NA NA N
01810 ANESTH LOWER ARM SURGERY PRXOVR DEF         NA NA NA N
01810 ANESTH LOWER ARM SURGERY ANESTH DEF         NA NA NA N
01820 ANESTH LOWER ARM PROCEDURE PRXOVR DEF         NA NA NA N
01820 ANESTH LOWER ARM PROCEDURE ANESTH DEF         NA NA NA N
01829 ANESTH DX WRIST ARTHROSCOPY PRXOVR DEF         NA NA NA N
01829 ANESTH DX WRIST ARTHROSCOPY ANESTH DEF         NA NA NA N
01830 ANESTH LOWER ARM SURGERY PRXOVR DEF         NA NA NA N
01830 ANESTH LOWER ARM SURGERY ANESTH DEF         NA NA NA N
01832 ANESTH WRIST REPLACEMENT PRXOVR DEF         NA NA NA N
01832 ANESTH WRIST REPLACEMENT ANESTH DEF         NA NA NA N
01840 ANESTH LWR ARM ARTERY SURG PRXOVR DEF         NA NA NA N
01840 ANESTH LWR ARM ARTERY SURG ANESTH DEF         NA NA NA N
01842 ANESTH LWR ARM EMBOLECTOMY PRXOVR DEF         NA NA NA N
01842 ANESTH LWR ARM EMBOLECTOMY ANESTH DEF         NA NA NA N
01844 ANESTH VASCULAR SHUNT SURG PRXOVR DEF         NA NA NA N
01844 ANESTH VASCULAR SHUNT SURG ANESTH DEF         NA NA NA N
01850 ANESTH LOWER ARM VEIN SURG PRXOVR DEF         NA NA NA N
01850 ANESTH LOWER ARM VEIN SURG ANESTH DEF         NA NA NA N
01852 ANESTH LWR ARM VEIN REPAIR PRXOVR DEF         NA NA NA N
01852 ANESTH LWR ARM VEIN REPAIR ANESTH DEF         NA NA NA N
01860 ANESTH LOWER ARM CASTING PRXOVR DEF         NA NA NA N
01860 ANESTH LOWER ARM CASTING ANESTH DEF         NA NA NA N
01904 ANESTH; SKULL X-RAY INJECT PRXOVR DEF         NA NA NA N
01904 ANESTH; SKULL X-RAY INJECT ANESTH DEF         NA NA NA N
01905 ANES; SPINE INJECT; X-RAY/RE PRXOVR DEF         NA NA NA N
01905 ANES; SPINE INJECT; X-RAY/RE ANESTH DEF         NA NA NA N
01906 ANESTH; LUMBAR MYELOGRAPHY PRXOVR DEF         NA NA NA N
01906 ANESTH; LUMBAR MYELOGRAPHY ANESTH DEF         NA NA NA N
01908 ANESTH; CERVICAL MYELOGRAPHY PRXOVR DEF         NA NA NA N
01908 ANESTH; CERVICAL MYELOGRAPHY ANESTH DEF         NA NA NA N
01910 ANESTH; SKULL MYELOGRAPHY PRXOVR DEF         NA NA NA N
01910 ANESTH; SKULL MYELOGRAPHY ANESTH DEF         NA NA NA N
01912 ANESTH; LUMBAR DISKOGRAPHY PRXOVR DEF         NA NA NA N
01912 ANESTH; LUMBAR DISKOGRAPHY ANESTH DEF         NA NA NA N
01914 ANESTH; CERVICAL DISKOGRAPHY PRXOVR DEF         NA NA NA N
01914 ANESTH; CERVICAL DISKOGRAPHY ANESTH DEF         NA NA NA N
01916 ANESTH DX ARTERIOGRAPHY PRXOVR DEF         NA NA NA N
01916 ANESTH DX ARTERIOGRAPHY ANESTH DEF         NA NA NA N
01918 ANESTH; LIMB ARTERIOGRAM PRXOVR DEF         NA NA NA N
01918 ANESTH; LIMB ARTERIOGRAM ANESTH DEF         NA NA NA N
01920 ANESTH CATHETERIZE HEART PRXOVR DEF         NA NA NA N
01920 ANESTH CATHETERIZE HEART ANESTH DEF         NA NA NA N
01921 ANESTH; VESSEL SURGERY PRXOVR DEF         NA NA NA N
01921 ANESTH; VESSEL SURGERY ANESTH DEF         NA NA NA N
01922 ANESTH CAT OR MRI SCAN PRXOVR DEF         NA NA NA N
01922 ANESTH CAT OR MRI SCAN ANESTH DEF         NA NA NA N
01924 ANES THER INTERVEN RAD ARTRL PRXOVR DEF         NA NA NA N
01924 ANES THER INTERVEN RAD ARTRL ANESTH DEF         NA NA NA N
01925 ANES THER INTERVEN RAD CARD PRXOVR DEF         NA NA NA N
01925 ANES THER INTERVEN RAD CARD ANESTH DEF         NA NA NA N
01926 ANES TX INTERV RAD HRT/CRAN PRXOVR DEF         NA NA NA N
01926 ANES TX INTERV RAD HRT/CRAN ANESTH DEF         NA NA NA N
01930 ANES THER INTERVEN RAD VEIN PRXOVR DEF         NA NA NA N
01930 ANES THER INTERVEN RAD VEIN ANESTH DEF         NA NA NA N
01931 ANES THER INTERVEN RAD TIPS PRXOVR DEF         NA NA NA N
01931 ANES THER INTERVEN RAD TIPS ANESTH DEF         NA NA NA N
01932 ANES TX INTERV RAD TH VEIN PRXOVR DEF         NA NA NA N
01932 ANES TX INTERV RAD TH VEIN ANESTH DEF         NA NA NA N
01933 ANES TX INTERV RAD CRAN VEIN PRXOVR DEF         NA NA NA N
01933 ANES TX INTERV RAD CRAN VEIN ANESTH DEF         NA NA NA N
01935 ANESTH PERC IMG DX SP PROC PRXOVR DEF         NA NA NA N
01935 ANESTH PERC IMG DX SP PROC ANESTH DEF         NA NA NA N
01936 ANESTH PERC IMG TX SP PROC PRXOVR DEF         NA NA NA N
01936 ANESTH PERC IMG TX SP PROC ANESTH DEF         NA NA NA N
01937 ANES DRG/ASPIR CRV/THRC PRXOVR DEF         NA NA NA N
01937 ANES DRG/ASPIR CRV/THRC ANESTH DEF         NA NA NA N
01938 ANES DRG/ASPIR LMBR/SAC PRXOVR DEF         NA NA NA N
01938 ANES DRG/ASPIR LMBR/SAC ANESTH DEF         NA NA NA N
01939 ANES NULYT AGT CRV/THRC PRXOVR DEF         NA NA NA N
01939 ANES NULYT AGT CRV/THRC ANESTH DEF         NA NA NA N
01940 ANES NULYT AGT LMBR/SAC PRXOVR DEF         NA NA NA N
01940 ANES NULYT AGT LMBR/SAC ANESTH DEF         NA NA NA N
01941 ANES NEUROMD/NTRVRT CRV/THRC PRXOVR DEF         NA NA NA N
01941 ANES NEUROMD/NTRVRT CRV/THRC ANESTH DEF         NA NA NA N
01942 ANES NEUROMD/NTRVRT LMBR/SAC PRXOVR DEF         NA NA NA N
01942 ANES NEUROMD/NTRVRT LMBR/SAC ANESTH DEF         NA NA NA N
01951 ANESTH BURN LESS 4 PERCENT PRXOVR DEF         NA NA NA N
01951 ANESTH BURN LESS 4 PERCENT ANESTH DEF         NA NA NA N
01952 ANESTH BURN 4-9 PERCENT PRXOVR DEF         NA NA NA N
01952 ANESTH BURN 4-9 PERCENT ANESTH DEF         NA NA NA N
01953 ANESTH BURN EACH 9 PERCENT PRXOVR DEF         NA NA NA N
01953 ANESTH BURN EACH 9 PERCENT ANESTH DEF         NA NA NA N
01958 ANES XTRNL CEPHALIC VERSION PRXOVR DEF         NA NA NA N
01958 ANES XTRNL CEPHALIC VERSION ANESTH DEF         NA NA NA N
01960 ANES VAGINAL DELIVERY ONLY PRXOVR DEF         NA NA NA N
01960 ANES VAGINAL DELIVERY ONLY ANESTH DEF         NA NA NA N
01961 ANES CESAREAN DELIVERY ONLY PRXOVR DEF         NA NA NA N
01961 ANES CESAREAN DELIVERY ONLY ANESTH DEF         NA NA NA N
01962 ANES URGENT HYSTERECTOMY PRXOVR DEF         NA NA NA N
01962 ANES URGENT HYSTERECTOMY ANESTH DEF         NA NA NA N
01963 ANES CESAREAN HYSTERECTOMY PRXOVR DEF         NA NA NA N
01963 ANES CESAREAN HYSTERECTOMY ANESTH DEF         NA NA NA N
01964 ANESTH; ABORTION PROCEDURES PRXOVR DEF         NA NA NA N
01964 ANESTH; ABORTION PROCEDURES ANESTH DEF         NA NA NA N
01965 ANES INCOMPL/MISSED AB PX PRXOVR DEF         NA NA NA N
01965 ANES INCOMPL/MISSED AB PX ANESTH DEF         NA NA NA N
01966 ANES INDUCED ABORTION PX PRXOVR DEF         NA NA NA N
01966 ANES INDUCED ABORTION PX ANESTH DEF         NA NA NA N
01967 NEURAXL LBR ANES VAG DLVR PRXOVR DEF         NA NA NA N
01967 NEURAXL LBR ANES VAG DLVR ANESTH DEF         NA NA NA N
01968 ANES/ANALG CS DLVR NEURAXIAL PRXOVR DEF         NA NA NA N
01968 ANES/ANALG CS DLVR NEURAXIAL ANESTH DEF         NA NA NA N
01969 ANES C HYST FLWG NEURAXIAL PRXOVR DEF         NA NA NA N
01969 ANES C HYST FLWG NEURAXIAL ANESTH DEF         NA NA NA N
01990 SUPPORT FOR ORGAN DONOR PRXOVR DEF         NA NA NA N
01990 SUPPORT FOR ORGAN DONOR ANESTH DEF         NA NA NA N
01991 ANESTH NERVE BLOCK/INJ PRXOVR DEF         NA NA NA N
01991 ANESTH NERVE BLOCK/INJ ANESTH DEF         NA NA NA N
01992 ANESTH N BLOCK/INJ PRONE PRXOVR DEF         NA NA NA N
01992 ANESTH N BLOCK/INJ PRONE ANESTH DEF         NA NA NA N
01995 REGIONAL ANESTHESIA LIMB PRXOVR DEF         NA NA NA N
01995 REGIONAL ANESTHESIA LIMB ANESTH DEF         NA NA NA N
01996 HOSP MANAGE CONT DRUG ADMIN PRXOVR DEF         NA NA NA N
01996 HOSP MANAGE CONT DRUG ADMIN ANESTH DEF         NA NA NA N
01999 UNLISTED ANES PROCEDURE PRXOVR DEF         NA NA NA N
01999 UNLISTED ANES PROCEDURE MANUAL DEF         NA NA NA 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
0423U PSYC GENOMIC ALYS PNL 26 GEN PRXOVR DEF         NA NA NA N
0423U PSYC GENOMIC ALYS PNL 26 GEN MAXFEE DEF         0 1/1/2024 12/31/2299 N
0429U HPV OROP SWAB 14 HI-RISK TYP PRXOVR DEF         NA NA NA N
0429U HPV OROP SWAB 14 HI-RISK TYP MAXFEE DEF         0 1/1/2024 12/31/2299 N
0437U PSYC ANXIETY DO MRNA 15 BMRK PRXOVR DEF         NA NA NA N
0437U PSYC ANXIETY DO MRNA 15 BMRK MAXFEE DEF         0 1/1/2024 12/31/2299 N
0438U RX METAB ADVRS VRNT ALYS 33 PRXOVR DEF         NA NA NA N
0438U RX METAB ADVRS VRNT ALYS 33 MAXFEE DEF         0 1/1/2024 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
09999 MODIFIER CODE MAXFEE DEF         NA     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         37.55 1/1/2024 12/31/2299 N
10005 FNA BX W/US GDN 1ST LES MAXFEE NFF         71.12 1/1/2024 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         28.02 1/1/2024 12/31/2299 N
10006 FNA BX W/US GDN EA ADDL MAXFEE NFF         30.80 1/1/2024 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         46.20 1/1/2024 12/31/2299 N
10007 FNA BX W/FLUOR GDN 1ST LES MAXFEE NFF         156.08 1/1/2024 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         61.49 1/1/2024 12/31/2299 N
10009 FNA BX W/CT GDN 1ST LES MAXFEE NFF         234.81 1/1/2024 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         40.32 1/1/2024 12/31/2299 N
10010 FNA BX W/CT GDN EA ADDL MAXFEE NFF         137.74 1/1/2024 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         77.23 1/1/2024 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 IMG GID FLU COLL DRG SFT TIS PRXOVR DEF         NA NA NA N
10030 IMG GID FLU COLL DRG SFT TIS MAXFEE FAC         119.43 1/1/2014 12/31/2299 N
10030 IMG GID FLU COLL DRG SFT TIS MAXFEE NFF         561.80 1/1/2014 12/31/2299 N
10035 PLMT SFT TISS LOCLZJ DEV 1ST PRXOVR DEF         NA NA NA N
10035 PLMT SFT TISS LOCLZJ DEV 1ST MAXFEE FAC         70.14 1/1/2016 12/31/2299 N
10035 PLMT SFT TISS LOCLZJ DEV 1ST MAXFEE NFF         393.82 1/1/2024 12/31/2299 N
10036 PLMT SFT TISS LOCLZJ DEV EA PRXOVR DEF         NA NA NA N
10036 PLMT SFT TISS LOCLZJ DEV EA MAXFEE FAC         35.34 1/1/2016 12/31/2299 N
10036 PLMT SFT TISS LOCLZJ DEV EA MAXFEE NFF         328.76 1/1/2024 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         65.24 1/1/2024 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 I&D ABSCESS SIMPLE/SINGLE PRXOVR DEF         NA NA NA N
10060 I&D ABSCESS SIMPLE/SINGLE MAXFEE FAC         59.75 1/1/2024 12/31/2299 N
10060 I&D ABSCESS SIMPLE/SINGLE MAXFEE NFF         76.45 1/1/2024 12/31/2299 N
10061 I&D ABSCESS COMP/MULTIPLE PRXOVR DEF         NA NA NA N
10061 I&D ABSCESS COMP/MULTIPLE MAXFEE FAC         93.44 1/1/2024 12/31/2299 N
10061 I&D ABSCESS COMP/MULTIPLE MAXFEE NFF         109.36 1/1/2024 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 I&D PILONIDAL CYST SIMPLE PRXOVR DEF         NA NA NA N
10080 I&D PILONIDAL CYST SIMPLE MAXFEE FAC         53.47 1/1/2024 12/31/2299 N
10080 I&D PILONIDAL CYST SIMPLE MAXFEE NFF         133.41 1/1/2024 12/31/2299 N
10081 I&D PILONIDAL CYST COMP PRXOVR DEF         NA NA NA N
10081 I&D PILONIDAL CYST COMP MAXFEE FAC         87.38 1/1/2024 12/31/2299 N
10081 I&D PILONIDAL CYST COMP MAXFEE NFF         181.17 1/1/2024 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 INC&RMVL FB SUBQ TISS SMPL PRXOVR DEF         NA NA NA N
10120 INC&RMVL FB SUBQ TISS SMPL MAXFEE FAC         52.60 1/1/2024 12/31/2299 N
10120 INC&RMVL FB SUBQ TISS SMPL MAXFEE NFF         77.17 1/1/2024 12/31/2299 N
10121 INC&RMVL FB SUBQ TISS COMP PRXOVR DEF         NA NA NA N
10121 INC&RMVL FB SUBQ TISS COMP MAXFEE FAC         93.61 1/1/2024 12/31/2299 N
10121 INC&RMVL FB SUBQ TISS COMP MAXFEE NFF         136.52 1/1/2024 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 I&D HMTMA SEROMA/FLUID COLLJ PRXOVR DEF         NA NA NA N
10140 I&D HMTMA SEROMA/FLUID COLLJ MAXFEE FAC         60.04 1/1/2024 12/31/2299 N
10140 I&D HMTMA SEROMA/FLUID COLLJ MAXFEE NFF         88.69 1/1/2024 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 PNXR ASPIR ABSC HMTMA BULLA PRXOVR DEF         NA NA NA N
10160 PNXR ASPIR ABSC HMTMA BULLA MAXFEE FAC         48.28 1/1/2024 12/31/2299 N
10160 PNXR ASPIR ABSC HMTMA BULLA MAXFEE NFF         66.45 1/1/2024 12/31/2299 N
10180 I&D COMPLEX PO WOUND INFCTJ PRXOVR DEF         NA NA NA N
10180 I&D COMPLEX PO WOUND INFCTJ MAXFEE FAC         91.02 1/1/2024 12/31/2299 N
10180 I&D COMPLEX PO WOUND INFCTJ MAXFEE NFF         136.35 1/1/2024 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 DBRDMT ECZ/INFECTED SKIN<10% PRXOVR DEF         NA NA NA N
11000 DBRDMT ECZ/INFECTED SKIN<10% MAXFEE FAC         20.73 1/1/2024 12/31/2299 N
11000 DBRDMT ECZ/INFECTED SKIN<10% MAXFEE NFF         36.06 1/1/2024 12/31/2299 N
11001 DBRDMT ECZ/INFCT SKN EA ADDL PRXOVR DEF         NA NA NA N
11001 DBRDMT ECZ/INFCT SKN EA ADDL MAXFEE FAC         10.52 1/1/2024 12/31/2299 N
11001 DBRDMT ECZ/INFCT SKN EA ADDL MAXFEE NFF         15.77 1/1/2024 12/31/2299 N
11004 DBRDMT SKIN XTRNL GENT&PER PRXOVR DEF         NA NA NA N
11004 DBRDMT SKIN XTRNL GENT&PER MAXFEE DEF         436.33 1/1/2024 12/31/2299 N
11005 DBRDMT SKIN ABDOMINAL WALL PRXOVR DEF         NA NA NA N
11005 DBRDMT SKIN ABDOMINAL WALL MAXFEE DEF         593.90 1/1/2024 12/31/2299 N
11006 DBRDMT SKIN XTRNL GENT PER PRXOVR DEF         NA NA NA N
11006 DBRDMT SKIN XTRNL GENT PER MAXFEE DEF         549.43 1/1/2024 12/31/2299 N
11008 RMV PRSTC MTRL/MESH ABD WALL PRXOVR DEF         NA NA NA N
11008 RMV PRSTC MTRL/MESH 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         140.68 1/1/2024 12/31/2299 N
11010 DEBRIDE SKIN AT FX SITE MAXFEE NFF         234.98 1/1/2024 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         151.06 1/1/2024 12/31/2299 N
11011 DEBRIDE SKIN MUSC AT FX SITE MAXFEE NFF         269.26 1/1/2024 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         211.79 1/1/2024 12/31/2299 N
11012 DEB SKIN BONE AT FX SITE MAXFEE NFF         378.03 1/1/2024 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 DBRDMT SUBQ TIS 1ST 20SQCM/< PRXOVR DEF         NA NA NA N
11042 DBRDMT SUBQ TIS 1ST 20SQCM/< MAXFEE FAC         30.46 1/1/2024 12/31/2299 N
11042 DBRDMT SUBQ TIS 1ST 20SQCM/< MAXFEE NFF         66.97 1/1/2024 12/31/2299 N
11043 DBRDMT MUSC&/FSCA 1ST 20/< PRXOVR DEF         NA NA NA N
11043 DBRDMT MUSC&/FSCA 1ST 20/< MAXFEE FAC         78.04 1/1/2024 12/31/2299 N
11043 DBRDMT MUSC&/FSCA 1ST 20/< MAXFEE NFF         130.94 1/1/2024 12/31/2299 N
11044 DBRDMT BONE 1ST 20 SQ CM/< PRXOVR DEF         NA NA NA N
11044 DBRDMT BONE 1ST 20 SQ CM/< MAXFEE FAC         116.20 1/1/2024 12/31/2299 N
11044 DBRDMT BONE 1ST 20 SQ CM/< MAXFEE NFF         181.37 1/1/2024 12/31/2299 N
11045 DBRDMT SUBQ TISS EACH ADDL PRXOVR DEF         NA NA NA N
11045 DBRDMT SUBQ TISS EACH ADDL MAXFEE FAC         13.33 1/1/2024 12/31/2299 N
11045 DBRDMT SUBQ TISS EACH ADDL MAXFEE NFF         20.94 1/1/2024 12/31/2299 N
11046 DBRDMT MUSC&/FSCA EA ADDL PRXOVR DEF         NA NA NA N
11046 DBRDMT MUSC&/FSCA EA ADDL MAXFEE FAC         28.21 1/1/2024 12/31/2299 N
11046 DBRDMT MUSC&/FSCA EA ADDL MAXFEE NFF         37.72 1/1/2024 12/31/2299 N
11047 DBRDMT BONE EACH ADDL PRXOVR DEF         NA NA NA N
11047 DBRDMT BONE EACH ADDL MAXFEE FAC         49.32 1/1/2024 12/31/2299 N
11047 DBRDMT BONE EACH ADDL MAXFEE NFF         61.77 1/1/2024 12/31/2299 N
11055 PARING/CUTG B9 HYPRKER LES 1 PRXOVR DEF         NA NA NA N
11055 PARING/CUTG B9 HYPRKER LES 1 MAXFEE FAC         9.82 1/1/2024 12/31/2299 N
11055 PARING/CUTG B9 HYPRKER LES 1 MAXFEE NFF         37.38 1/1/2024 12/31/2299 N
11056 PARNG/CUTG B9 HYPRKR LES 2-4 PRXOVR DEF         NA NA NA N
11056 PARNG/CUTG B9 HYPRKR LES 2-4 MAXFEE FAC         16.45 1/1/2024 12/31/2299 N
11056 PARNG/CUTG B9 HYPRKR LES 2-4 MAXFEE NFF         42.74 1/1/2024 12/31/2299 N
11057 PARNG/CUTG B9 HYPRKR LES >4 PRXOVR DEF         NA NA NA N
11057 PARNG/CUTG B9 HYPRKR LES >4 MAXFEE FAC         21.43 1/1/2024 12/31/2299 N
11057 PARNG/CUTG B9 HYPRKR LES >4 MAXFEE NFF         46.89 1/1/2024 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         25.52 1/1/2024 12/31/2299 N
11102 TANGNTL BX SKIN SINGLE LES MAXFEE NFF         52.78 1/1/2024 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         15.31 1/1/2024 12/31/2299 N
11103 TANGNTL BX SKIN EA SEP/ADDL MAXFEE NFF         29.74 1/1/2024 12/31/2299 N
11104 PUNCH BX SKIN SINGLE LESION PRXOVR DEF         NA NA NA N
11104 PUNCH BX SKIN SINGLE LESION MAXFEE FAC         31.09 1/1/2024 12/31/2299 N
11104 PUNCH BX SKIN SINGLE LESION MAXFEE NFF         65.58 1/1/2024 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         12.98 1/1/2024 12/31/2299 N
11105 PUNCH BX SKIN EA SEP/ADDL MAXFEE NFF         34.07 1/1/2024 12/31/2299 N
11106 INCAL BX SKN SINGLE LES PRXOVR DEF         NA NA NA N
11106 INCAL BX SKN SINGLE LES MAXFEE FAC         38.78 1/1/2024 12/31/2299 N
11106 INCAL BX SKN SINGLE LES MAXFEE NFF         81.15 1/1/2024 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         24.10 1/1/2024 12/31/2299 N
11107 INCAL BX SKN EA SEP/ADDL MAXFEE NFF         46.86 1/1/2024 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 RMVL SKIN TAGS UP TO&INC 15 PRXOVR DEF         NA NA NA N
11200 RMVL SKIN TAGS UP TO&INC 15 MAXFEE FAC         44.02 1/1/2024 12/31/2299 N
11200 RMVL SKIN TAGS UP TO&INC 15 MAXFEE NFF         56.78 1/1/2024 12/31/2299 N
11201 RMVL SKIN TAGS EA ADDL 10 PRXOVR DEF         NA NA NA N
11201 RMVL SKIN TAGS EA ADDL 10 MAXFEE FAC         10.46 1/1/2024 12/31/2299 N
11201 RMVL SKIN TAGS EA ADDL 10 MAXFEE NFF         13.94 1/1/2024 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         52.95 1/1/2024 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         34.73 1/1/2024 12/31/2299 N
11301 SHAVE SKIN LESION 0.6-1.0 CM MAXFEE NFF         63.33 1/1/2024 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         42.62 1/1/2024 12/31/2299 N
11302 SHAVE SKIN LESION 1.1-2.0 CM MAXFEE NFF         71.64 1/1/2024 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         78.90 1/1/2024 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         55.55 1/1/2024 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         38.69 1/1/2024 12/31/2299 N
11306 SHAVE SKIN LESION 0.6-1.0 CM MAXFEE NFF         63.68 1/1/2024 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         45.31 1/1/2024 12/31/2299 N
11307 SHAVE SKIN LESION 1.1-2.0 CM MAXFEE NFF         72.85 1/1/2024 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         78.59 1/1/2024 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         60.39 1/1/2024 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         40.59 1/1/2024 12/31/2299 N
11311 SHAVE SKIN LESION 0.6-1.0 CM MAXFEE NFF         71.12 1/1/2024 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         49.48 1/1/2024 12/31/2299 N
11312 SHAVE SKIN LESION 1.1-2.0 CM MAXFEE NFF         80.46 1/1/2024 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         66.49 1/1/2024 12/31/2299 N
11313 SHAVE SKIN LESION >2.0 CM MAXFEE NFF         93.96 1/1/2024 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         47.22 1/1/2024 12/31/2299 N
11400 EXC TR-EXT B9+MARG 0.5 CM< MAXFEE NFF         66.10 1/1/2024 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         58.63 1/1/2024 12/31/2299 N
11401 EXC TR-EXT B9+MARG 0.6-1 CM MAXFEE NFF         80.81 1/1/2024 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         59.70 1/1/2024 12/31/2299 N
11402 EXC TR-EXT B9+MARG 1.1-2 CM MAXFEE NFF         88.94 1/1/2024 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         75.27 1/1/2024 12/31/2299 N
11403 EXC TR-EXT B9+MARG 2.1-3CM MAXFEE NFF         101.92 1/1/2024 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         83.40 1/1/2024 12/31/2299 N
11404 EXC TR-EXT B9+MARG 3.1-4 CM MAXFEE NFF         115.93 1/1/2024 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         126.49 1/1/2024 12/31/2299 N
11406 EXC TR-EXT B9+MARG >4.0 CM MAXFEE NFF         164.55 1/1/2024 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         46.65 1/1/2024 12/31/2299 N
11420 EXC H-F-NK-SP B9+MARG 0.5/< MAXFEE NFF         65.93 1/1/2024 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         57.96 1/1/2024 12/31/2299 N
11421 EXC H-F-NK-SP B9+MARG 0.6-1 MAXFEE NFF         82.54 1/1/2024 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         68.70 1/1/2024 12/31/2299 N
11422 EXC H-F-NK-SP B9+MARG 1.1-2 MAXFEE NFF         92.57 1/1/2024 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         78.90 1/1/2024 12/31/2299 N
11423 EXC H-F-NK-SP B9+MARG 2.1-3 MAXFEE NFF         105.55 1/1/2024 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         90.34 1/1/2024 12/31/2299 N
11424 EXC H-F-NK-SP B9+MARG 3.1-4 MAXFEE NFF         120.95 1/1/2024 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         138.43 1/1/2024 12/31/2299 N
11426 EXC H-F-NK-SP B9+MARG >4 CM MAXFEE NFF         171.65 1/1/2024 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         55.18 1/1/2024 12/31/2299 N
11440 EXC FACE-MM B9+MARG 0.5 CM/< MAXFEE NFF         74.06 1/1/2024 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         67.37 1/1/2024 12/31/2299 N
11441 EXC FACE-MM B9+MARG 0.6-1 CM MAXFEE NFF         89.98 1/1/2024 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         74.23 1/1/2024 12/31/2299 N
11442 EXC FACE-MM B9+MARG 1.1-2 CM MAXFEE NFF         99.67 1/1/2024 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         91.56 1/1/2024 12/31/2299 N
11443 EXC FACE-MM B9+MARG 2.1-3 CM MAXFEE NFF         119.04 1/1/2024 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         114.72 1/1/2024 12/31/2299 N
11444 EXC FACE-MM B9+MARG 3.1-4 CM MAXFEE NFF         146.04 1/1/2024 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         162.48 1/1/2024 12/31/2299 N
11446 EXC FACE-MM B9+MARG >4 CM MAXFEE NFF         198.64 1/1/2024 12/31/2299 N
11450 EXC SKN HDRDNT AX SMPL/NTRM PRXOVR DEF         NA NA NA N
11450 EXC SKN HDRDNT AX SMPL/NTRM MAXFEE FAC         134.62 1/1/2024 12/31/2299 N
11450 EXC SKN HDRDNT AX SMPL/NTRM MAXFEE NFF         227.02 1/1/2024 12/31/2299 N
11451 EXC SKN HDRDNT AX COMPLEX PRXOVR DEF         NA NA NA N
11451 EXC SKN HDRDNT AX COMPLEX MAXFEE FAC         169.40 1/1/2024 12/31/2299 N
11451 EXC SKN HDRDNT AX COMPLEX MAXFEE NFF         275.12 1/1/2024 12/31/2299 N
11462 EXC SKN HDRDNT ING SMPL/NTRM PRXOVR DEF         NA NA NA N
11462 EXC SKN HDRDNT ING SMPL/NTRM MAXFEE FAC         131.15 1/1/2024 12/31/2299 N
11462 EXC SKN HDRDNT ING SMPL/NTRM MAXFEE NFF         220.27 1/1/2024 12/31/2299 N
11463 EXC SKN HDRDNT ING COMPLEX PRXOVR DEF         NA NA NA N
11463 EXC SKN HDRDNT ING COMPLEX MAXFEE FAC         171.13 1/1/2024 12/31/2299 N
11463 EXC SKN HDRDNT ING COMPLEX MAXFEE NFF         279.79 1/1/2024 12/31/2299 N
11470 EXC SKN H/P/P/U SMPL/NTRM PRXOVR DEF         NA NA NA N
11470 EXC SKN H/P/P/U SMPL/NTRM MAXFEE FAC         146.56 1/1/2024 12/31/2299 N
11470 EXC SKN H/P/P/U SMPL/NTRM MAXFEE NFF         237.75 1/1/2024 12/31/2299 N
11471 EXC SKN H/P/P/U COMPLEX PRXOVR DEF         NA NA NA N
11471 EXC SKN H/P/P/U COMPLEX MAXFEE FAC         180.47 1/1/2024 12/31/2299 N
11471 EXC SKN H/P/P/U COMPLEX MAXFEE NFF         284.47 1/1/2024 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         67.70 1/1/2024 12/31/2299 N
11600 EXC TR-EXT MAL+MARG 0.5 CM/< MAXFEE NFF         102.26 1/1/2024 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         79.51 1/1/2024 12/31/2299 N
11601 EXC TR-EXT MAL+MARG 0.6-1 CM MAXFEE NFF         117.84 1/1/2024 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         85.67 1/1/2024 12/31/2299 N
11602 EXC TR-EXT MAL+MARG 1.1-2 CM MAXFEE NFF         125.62 1/1/2024 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         106.14 1/1/2024 12/31/2299 N
11603 EXC TR-EXT MAL+MARG 2.1-3 CM MAXFEE NFF         142.93 1/1/2024 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         110.75 1/1/2024 12/31/2299 N
11604 EXC TR-EXT MAL+MARG 3.1-4 CM MAXFEE NFF         159.36 1/1/2024 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         161.27 1/1/2024 12/31/2299 N
11606 EXC TR-EXT MAL+MARG >4 CM MAXFEE NFF         229.79 1/1/2024 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         68.80 1/1/2024 12/31/2299 N
11620 EXC H-F-NK-SP MAL+MARG 0.5/< MAXFEE NFF         102.61 1/1/2024 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         80.03 1/1/2024 12/31/2299 N
11621 EXC S/N/H/F/G MAL+MRG 0.6-1 MAXFEE NFF         118.18 1/1/2024 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         93.59 1/1/2024 12/31/2299 N
11622 EXC S/N/H/F/G MAL+MRG 1.1-2 MAXFEE NFF         129.78 1/1/2024 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         120.36 1/1/2024 12/31/2299 N
11623 EXC S/N/H/F/G MAL+MRG 2.1-3 MAXFEE NFF         154.49 1/1/2024 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         133.88 1/1/2024 12/31/2299 N
11624 EXC S/N/H/F/G MAL+MRG 3.1-4 MAXFEE NFF         184.53 1/1/2024 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         161.41 1/1/2024 12/31/2299 N
11626 EXC S/N/H/F/G MAL+MRG >4 CM MAXFEE NFF         222.12 1/1/2024 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         72.29 1/1/2024 12/31/2299 N
11640 EXC F/E/E/N/L MAL+MRG 0.5CM< MAXFEE NFF         105.03 1/1/2024 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         113.16 1/1/2024 12/31/2299 N
11641 EXC F/E/E/N/L MAL+MRG 0.6-1 MAXFEE NFF         130.02 1/1/2024 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         115.61 1/1/2024 12/31/2299 N
11642 EXC F/E/E/N/L MAL+MRG 1.1-2 MAXFEE NFF         154.29 1/1/2024 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         133.36 1/1/2024 12/31/2299 N
11643 EXC F/E/E/N/L MAL+MRG 2.1-3 MAXFEE NFF         182.13 1/1/2024 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         165.23 1/1/2024 12/31/2299 N
11644 EXC F/E/E/N/L MAL+MRG 3.1-4 MAXFEE NFF         226.05 1/1/2024 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         212.59 1/1/2024 12/31/2299 N
11646 EXC F/E/E/N/L MAL+MRG >4 CM MAXFEE NFF         294.35 1/1/2024 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         7.44 1/1/2024 12/31/2299 N
11720 DEBRIDE NAIL 1-5 MAXFEE NFF         16.61 1/1/2024 12/31/2299 N
11721 DEBRIDE NAIL 6 OR MORE PRXOVR DEF         NA NA NA N
11721 DEBRIDE NAIL 6 OR MORE MAXFEE FAC         14.91 1/1/2024 12/31/2299 N
11721 DEBRIDE NAIL 6 OR MORE MAXFEE NFF         30.30 1/1/2024 12/31/2299 N
11730 REMOVAL OF NAIL PLATE PRXOVR DEF         NA NA NA N
11730 REMOVAL OF NAIL PLATE MAXFEE FAC         27.17 1/1/2024 12/31/2299 N
11730 REMOVAL OF NAIL PLATE MAXFEE NFF         59.35 1/1/2024 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         24.27 1/1/2024 12/31/2299 N
11740 DRAIN BLOOD FROM UNDER NAIL PRXOVR DEF         NA NA NA N
11740 DRAIN BLOOD FROM UNDER NAIL MAXFEE FAC         15.92 1/1/2024 12/31/2299 N
11740 DRAIN BLOOD FROM UNDER NAIL MAXFEE NFF         29.42 1/1/2024 12/31/2299 N
11750 REMOVAL OF NAIL BED PRXOVR DEF         NA NA NA N
11750 REMOVAL OF NAIL BED MAXFEE FAC         71.81 1/1/2024 12/31/2299 N
11750 REMOVAL OF NAIL BED MAXFEE NFF         109.46 1/1/2024 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         69.07 1/1/2024 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         56.58 1/1/2024 12/31/2299 N
11760 REPAIR OF NAIL BED MAXFEE NFF         97.42 1/1/2024 12/31/2299 N
11762 RECONSTRUCTION OF NAIL BED PRXOVR DEF         NA NA NA N
11762 RECONSTRUCTION OF NAIL BED MAXFEE FAC         110.73 1/1/2024 12/31/2299 N
11762 RECONSTRUCTION OF NAIL BED MAXFEE NFF         149.85 1/1/2024 12/31/2299 N
11765 EXCISION OF NAIL FOLD TOE PRXOVR DEF         NA NA NA N
11765 EXCISION OF NAIL FOLD TOE MAXFEE FAC         46.55 1/1/2024 12/31/2299 N
11765 EXCISION OF NAIL FOLD TOE MAXFEE NFF         85.65 1/1/2024 12/31/2299 N
11770 REMOVE PILONIDAL CYST SIMPLE PRXOVR DEF         NA NA NA N
11770 REMOVE PILONIDAL CYST SIMPLE MAXFEE FAC         112.84 1/1/2024 12/31/2299 N
11770 REMOVE PILONIDAL CYST SIMPLE MAXFEE NFF         188.95 1/1/2024 12/31/2299 N
11771 REMOVE PILONIDAL CYST EXTEN PRXOVR DEF         NA NA NA N
11771 REMOVE PILONIDAL CYST EXTEN MAXFEE FAC         232.53 1/1/2024 12/31/2299 N
11771 REMOVE PILONIDAL CYST EXTEN MAXFEE NFF         329.11 1/1/2024 12/31/2299 N
11772 REMOVE PILONIDAL CYST COMPL PRXOVR DEF         NA NA NA N
11772 REMOVE PILONIDAL CYST COMPL MAXFEE FAC         300.04 1/1/2024 12/31/2299 N
11772 REMOVE PILONIDAL CYST COMPL MAXFEE NFF         404.90 1/1/2024 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         19.76 1/1/2024 12/31/2299 N
11900 INJECT SKIN LESIONS </W 7 MAXFEE NFF         35.95 1/1/2024 12/31/2299 N
11901 INJECT SKIN LESIONS >7 PRXOVR DEF         NA NA NA N
11901 INJECT SKIN LESIONS >7 MAXFEE FAC         33.15 1/1/2024 12/31/2299 N
11901 INJECT SKIN LESIONS >7 MAXFEE NFF         43.42 1/1/2024 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         125.10 1/1/2024 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         143.88 1/1/2024 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         43.43 1/1/2024 12/31/2299 N
11950 TX CONTOUR DEFECTS 1 CC/< PRXOVR DEF         NA NA NA N
11950 TX CONTOUR DEFECTS 1 CC/< MAXFEE FAC         36.16 1/1/2024 12/31/2299 N
11950 TX CONTOUR DEFECTS 1 CC/< MAXFEE NFF         46.66 1/1/2024 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         47.99 1/1/2024 12/31/2299 N
11951 TX CONTOUR DEFECTS 1.1-5.0CC MAXFEE NFF         66.11 1/1/2024 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         71.34 1/1/2024 12/31/2299 N
11952 TX CONTOUR DEFECTS 5.1-10CC MAXFEE NFF         93.36 1/1/2024 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         121.22 1/1/2024 12/31/2299 N
11960 INSERT TISSUE EXPANDER(S) PRXOVR DEF         NA NA NA N
11960 INSERT TISSUE EXPANDER(S) MAXFEE DEF         548.64 1/1/2024 12/31/2299 N
11970 RPLCMT TISS XPNDR PERM IMPLT PRXOVR DEF         NA NA NA E
11970 RPLCMT TISS XPNDR PERM IMPLT MAXFEE DEF         360.37 1/1/2024 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 DEF         281 1/1/2024 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         52.05 1/1/2024 12/31/2299 N
11976 REMOVE CONTRACEPTIVE CAPSULE MAXFEE NFF         91.17 1/1/2024 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         55.37 1/1/2024 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         37.41 1/1/2024 12/31/2299 N
11981 INSERTION DRUG DLVR IMPLANT MAXFEE NFF         75.39 1/1/2024 12/31/2299 N
11982 REMOVE DRUG IMPLANT DEVICE PRXOVR DEF         NA NA NA N
11982 REMOVE DRUG IMPLANT DEVICE MAXFEE FAC         49.51 1/1/2024 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         146.38 1/1/2024 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         30.86 1/1/2024 12/31/2299 N
12001 RPR S/N/AX/GEN/TRNK 2.5CM/< MAXFEE NFF         70.72 1/1/2024 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         39.09 1/1/2024 12/31/2299 N
12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM MAXFEE NFF         81.88 1/1/2024 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         39.32 1/1/2024 12/31/2299 N
12004 RPR S/N/AX/GEN/TRK7.6-12.5CM MAXFEE NFF         101.27 1/1/2024 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         67.96 1/1/2024 12/31/2299 N
12005 RPR S/N/A/GEN/TRK12.6-20.0CM MAXFEE NFF         128.31 1/1/2024 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         87.97 1/1/2024 12/31/2299 N
12006 RPR S/N/A/GEN/TRK20.1-30.0CM MAXFEE NFF         163.81 1/1/2024 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         101.97 1/1/2024 12/31/2299 N
12007 RPR S/N/AX/GEN/TRNK >30.0 CM MAXFEE NFF         179.14 1/1/2024 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         34.73 1/1/2024 12/31/2299 N
12011 RPR F/E/E/N/L/M 2.5 CM/< MAXFEE NFF         77.95 1/1/2024 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         41.80 1/1/2024 12/31/2299 N
12013 RPR F/E/E/N/L/M 2.6-5.0 CM MAXFEE NFF         91.41 1/1/2024 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         54.08 1/1/2024 12/31/2299 N
12014 RPR F/E/E/N/L/M 5.1-7.5 CM MAXFEE NFF         109.86 1/1/2024 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         71.78 1/1/2024 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 TX SUPFC WND DEHSN SMPL CLSR PRXOVR DEF         NA NA NA N
12020 TX SUPFC WND DEHSN SMPL CLSR MAXFEE FAC         95.52 1/1/2024 12/31/2299 N
12020 TX SUPFC WND DEHSN SMPL CLSR MAXFEE NFF         155.38 1/1/2024 12/31/2299 N
12021 TX SUPFC WND DEHSN W/PACKING PRXOVR DEF         NA NA NA N
12021 TX SUPFC WND DEHSN W/PACKING MAXFEE FAC         71.81 1/1/2024 12/31/2299 N
12021 TX SUPFC WND DEHSN W/PACKING MAXFEE NFF         91.36 1/1/2024 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         89.86 1/1/2024 12/31/2299 N
12031 INTMD RPR S/A/T/EXT 2.5 CM/< MAXFEE NFF         136.70 1/1/2024 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         95.52 1/1/2024 12/31/2299 N
12032 INTMD RPR S/A/T/EXT 2.6-7.5 MAXFEE NFF         156.25 1/1/2024 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         103.82 1/1/2024 12/31/2299 N
12034 INTMD RPR S/TR/EXT 7.6-12.5 MAXFEE NFF         173.03 1/1/2024 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         122.68 1/1/2024 12/31/2299 N
12035 INTMD RPR S/A/T/EXT 12.6-20 MAXFEE NFF         201.58 1/1/2024 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         144.66 1/1/2024 12/31/2299 N
12036 INTMD RPR S/A/T/EXT 20.1-30 MAXFEE NFF         224.77 1/1/2024 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         167.50 1/1/2024 12/31/2299 N
12037 INTMD RPR S/TR/EXT >30.0 CM MAXFEE NFF         250.90 1/1/2024 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         72.85 1/1/2024 12/31/2299 N
12041 INTMD RPR N-HF/GENIT 2.5CM/< MAXFEE NFF         137.22 1/1/2024 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         98.80 1/1/2024 12/31/2299 N
12042 INTMD RPR N-HF/GENIT2.6-7.5 MAXFEE NFF         160.40 1/1/2024 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         107.97 1/1/2024 12/31/2299 N
12044 INTMD RPR N-HF/GENIT7.6-12.5 MAXFEE NFF         197.08 1/1/2024 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 FAC         138.08 1/1/2024 12/31/2299 N
12045 INTMD RPR N-HF/GENIT12.6-20 MAXFEE NFF         211.10 1/1/2024 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         163.69 1/1/2024 12/31/2299 N
12046 INTMD RPR N-HF/GENIT20.1-30 MAXFEE NFF         261.45 1/1/2024 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         181.86 1/1/2024 12/31/2299 N
12047 INTMD RPR N-HF/GENIT >30.0CM MAXFEE NFF         285.85 1/1/2024 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         85.48 1/1/2024 12/31/2299 N
12051 INTMD RPR FACE/MM 2.5 CM/< MAXFEE NFF         147.08 1/1/2024 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         100.53 1/1/2024 12/31/2299 N
12052 INTMD RPR FACE/MM 2.6-5.0 CM MAXFEE NFF         163.17 1/1/2024 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         108.32 1/1/2024 12/31/2299 N
12053 INTMD RPR FACE/MM 5.1-7.5 CM MAXFEE NFF         188.61 1/1/2024 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         110.92 1/1/2024 12/31/2299 N
12054 INTMD RPR FACE/MM 7.6-12.5CM MAXFEE NFF         200.03 1/1/2024 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         151.75 1/1/2024 12/31/2299 N
12055 INTMD RPR FACE/MM 12.6-20 CM MAXFEE NFF         261.45 1/1/2024 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         195.87 1/1/2024 12/31/2299 N
12056 INTMD RPR FACE/MM 20.1-30.0 MAXFEE NFF         300.56 1/1/2024 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         213.52 1/1/2024 12/31/2299 N
12057 INTMD RPR FACE/MM >30.0 CM MAXFEE NFF         319.06 1/1/2024 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         101.23 1/1/2024 12/31/2299 N
13100 CMPLX RPR TRUNK 1.1-2.5 CM MAXFEE NFF         176.49 1/1/2024 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         125.45 1/1/2024 12/31/2299 N
13101 CMPLX RPR TRUNK 2.6-7.5 CM MAXFEE NFF         205.91 1/1/2024 12/31/2299 N
13102 CMPLX RPR TRUNK ADDL 5CM/< PRXOVR DEF         NA NA NA N
13102 CMPLX RPR TRUNK ADDL 5CM/< MAXFEE FAC         36.69 1/1/2024 12/31/2299 N
13102 CMPLX RPR TRUNK ADDL 5CM/< MAXFEE NFF         60.39 1/1/2024 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         118.01 1/1/2024 12/31/2299 N
13120 CMPLX RPR S/A/L 1.1-2.5 CM MAXFEE NFF         184.11 1/1/2024 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         129.78 1/1/2024 12/31/2299 N
13121 CMPLX RPR S/A/L 2.6-7.5 CM MAXFEE NFF         219.92 1/1/2024 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         41.76 1/1/2024 12/31/2299 N
13122 CMPLX RPR S/A/L ADDL 5 CM/> MAXFEE NFF         68.88 1/1/2024 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         122.16 1/1/2024 12/31/2299 N
13131 CMPLX RPR F/C/C/M/N/AX/G/H/F MAXFEE NFF         200.55 1/1/2024 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         152.79 1/1/2024 12/31/2299 N
13132 CMPLX RPR F/C/C/M/N/AX/G/H/F MAXFEE NFF         283.98 1/1/2024 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         66.24 1/1/2024 12/31/2299 N
13133 CMPLX RPR F/C/C/M/N/AX/G/H/F MAXFEE NFF         100.76 1/1/2024 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         140.68 1/1/2024 12/31/2299 N
13151 CMPLX RPR E/N/E/L 1.1-2.5 CM MAXFEE NFF         218.54 1/1/2024 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         169.40 1/1/2024 12/31/2299 N
13152 CMPLX RPR E/N/E/L 2.6-7.5 CM MAXFEE NFF         327.06 1/1/2024 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         71.46 1/1/2024 12/31/2299 N
13153 CMPLX RPR E/N/E/L ADDL 5CM/< MAXFEE NFF         110.58 1/1/2024 12/31/2299 N
13160 SEC CLSR SURG WND/DEHSN XTN PRXOVR DEF         NA NA NA N
13160 SEC CLSR SURG WND/DEHSN XTN MAXFEE DEF         449.01 1/1/2024 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         255.40 1/1/2024 12/31/2299 N
14000 TIS TRNFR TRUNK 10 SQ CM/< MAXFEE NFF         325.65 1/1/2024 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         331.88 1/1/2024 12/31/2299 N
14001 TIS TRNFR TRUNK 10.1-30SQCM MAXFEE NFF         414.76 1/1/2024 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         286.02 1/1/2024 12/31/2299 N
14020 TIS TRNFR S/A/L 10 SQ CM/< MAXFEE NFF         358.52 1/1/2024 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         358.35 1/1/2024 12/31/2299 N
14021 TIS TRNFR S/A/L 10.1-30 SQCM MAXFEE NFF         474.75 1/1/2024 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         314.75 1/1/2024 12/31/2299 N
14040 TIS TRNFR F/C/C/M/N/A/G/H/F MAXFEE NFF         414.03 1/1/2024 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         384.45 1/1/2024 12/31/2299 N
14041 TIS TRNFR F/C/C/M/N/A/G/H/F MAXFEE NFF         554.27 1/1/2024 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         340.75 1/1/2024 12/31/2299 N
14060 TIS TRNFR E/N/E/L 10 SQ CM/< MAXFEE NFF         463.52 1/1/2024 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         445.57 1/1/2024 12/31/2299 N
14061 TIS TRNFR E/N/E/L10.1-30SQCM MAXFEE NFF         641.80 1/1/2024 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         440.71 1/1/2024 12/31/2299 N
14301 TIS TRNFR ANY 30.1-60 SQ CM MAXFEE NFF         555.43 1/1/2024 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         134.11 1/1/2024 12/31/2299 N
14350 FILLETED FINGER/TOE FLAP PRXOVR DEF         NA NA NA N
14350 FILLETED FINGER/TOE FLAP MAXFEE DEF         448.54 1/1/2024 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         111.61 1/1/2024 12/31/2299 N
15002 WOUND PREP TRK/ARM/LEG MAXFEE NFF         189 1/1/2024 12/31/2299 N
15003 WOUND PREP ADDL 100 CM PRXOVR DEF         NA NA NA N
15003 WOUND PREP ADDL 100 CM MAXFEE FAC         23.19 1/1/2024 12/31/2299 N
15003 WOUND PREP ADDL 100 CM MAXFEE NFF         40.73 1/1/2024 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         132.72 1/1/2024 12/31/2299 N
15004 WOUND PREP F/N/HF/G MAXFEE NFF         228.28 1/1/2024 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         46.37 1/1/2024 12/31/2299 N
15005 WND PREP F/N/HF/G ADDL CM MAXFEE NFF         71.17 1/1/2024 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         62.99 1/1/2024 12/31/2299 N
15040 HARVEST CULTURED SKIN GRAFT MAXFEE NFF         137.22 1/1/2024 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 PINCH GRAFT UP TO 2 CM DIAM PRXOVR DEF         NA NA NA N
15050 PINCH GRAFT UP TO 2 CM DIAM MAXFEE FAC         236.54 1/1/2024 12/31/2299 N
15050 PINCH GRAFT UP TO 2 CM DIAM MAXFEE NFF         307.31 1/1/2024 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         365.96 1/1/2024 12/31/2299 N
15100 SKIN SPLT GRFT TRNK/ARM/LEG MAXFEE NFF         448.33 1/1/2024 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         57.28 1/1/2024 12/31/2299 N
15101 SKIN SPLT GRFT T/A/L ADD-ON MAXFEE NFF         97.77 1/1/2024 12/31/2299 N
15110 EPIDRM AUTOGRFT TRNK/ARM/LEG PRXOVR DEF         NA NA NA N
15110 EPIDRM AUTOGRFT TRNK/ARM/LEG MAXFEE FAC         448.79 1/1/2024 12/31/2299 N
15110 EPIDRM AUTOGRFT TRNK/ARM/LEG MAXFEE NFF         591.44 1/1/2024 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         74.40 1/1/2024 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         414.37 1/1/2024 12/31/2299 N
15115 EPIDRM A-GRFT FACE/NCK/HF/G MAXFEE NFF         557.26 1/1/2024 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         84.84 1/1/2024 12/31/2299 N
15116 EPIDRM A-GRFT F/N/HF/G ADDL MAXFEE NFF         122.50 1/1/2024 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         351.26 1/1/2024 12/31/2299 N
15120 SKN SPLT A-GRFT FAC/NCK/HF/G MAXFEE NFF         460.44 1/1/2024 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         82.31 1/1/2024 12/31/2299 N
15121 SKN SPLT A-GRFT F/N/HF/G ADD MAXFEE NFF         150.98 1/1/2024 12/31/2299 N
15130 DERM AUTOGRAFT TRNK/ARM/LEG PRXOVR DEF         NA NA NA N
15130 DERM AUTOGRAFT TRNK/ARM/LEG MAXFEE FAC         345.79 1/1/2024 12/31/2299 N
15130 DERM AUTOGRAFT TRNK/ARM/LEG MAXFEE NFF         475.27 1/1/2024 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         53.85 1/1/2024 12/31/2299 N
15131 DERM AUTOGRAFT T/A/L ADD-ON MAXFEE NFF         76.94 1/1/2024 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         452.75 1/1/2024 12/31/2299 N
15135 DERM AUTOGRAFT FACE/NCK/HF/G MAXFEE NFF         596.57 1/1/2024 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         447.78 1/1/2024 12/31/2299 N
15150 CULT SKIN GRFT T/ARM/LEG MAXFEE NFF         492.01 1/1/2024 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         87.16 1/1/2024 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         92.44 1/1/2024 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         472.16 1/1/2024 12/31/2299 N
15155 CULT SKIN GRAFT F/N/HF/G MAXFEE NFF         494 1/1/2024 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         97.89 1/1/2024 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 FTH GRF FR TRNK 20 SQ CM/< PRXOVR DEF         NA NA NA N
15200 FTH GRF FR TRNK 20 SQ CM/< MAXFEE FAC         342.26 1/1/2024 12/31/2299 N
15200 FTH GRF FR TRNK 20 SQ CM/< MAXFEE NFF         430.33 1/1/2024 12/31/2299 N
15201 FTH GRF FR TRNK EACH ADDL PRXOVR DEF         NA NA NA N
15201 FTH GRF FR TRNK EACH ADDL MAXFEE FAC         53.87 1/1/2024 12/31/2299 N
15201 FTH GRF FR TRNK EACH ADDL MAXFEE NFF         72.85 1/1/2024 12/31/2299 N
15220 FTH GRF FR S/A/L 20 SQ CM/< PRXOVR DEF         NA NA NA N
15220 FTH GRF FR S/A/L 20 SQ CM/< MAXFEE FAC         308.52 1/1/2024 12/31/2299 N
15220 FTH GRF FR S/A/L 20 SQ CM/< MAXFEE NFF         392.96 1/1/2024 12/31/2299 N
15221 FTH GRF FR S/A/L EACH ADDL PRXOVR DEF         NA NA NA N
15221 FTH GRF FR S/A/L EACH ADDL MAXFEE FAC         49.33 1/1/2024 12/31/2299 N
15221 FTH GRF FR S/A/L EACH ADDL MAXFEE NFF         67.83 1/1/2024 12/31/2299 N
15240 FTH GR FR F/C/C/M/N/AX/G/H/F PRXOVR DEF         NA NA NA N
15240 FTH GR FR F/C/C/M/N/AX/G/H/F MAXFEE FAC         402.13 1/1/2024 12/31/2299 N
15240 FTH GR FR F/C/C/M/N/AX/G/H/F MAXFEE NFF         473.93 1/1/2024 12/31/2299 N
15241 FTH GR F/C/C/M/N/AX/G/H/F EA PRXOVR DEF         NA NA NA N
15241 FTH GR F/C/C/M/N/AX/G/H/F EA MAXFEE FAC         76.80 1/1/2024 12/31/2299 N
15241 FTH GR F/C/C/M/N/AX/G/H/F EA MAXFEE NFF         100.54 1/1/2024 12/31/2299 N
15260 FTH GRF FR N/E/E/L 20 SQCM/< PRXOVR DEF         NA NA NA N
15260 FTH GRF FR N/E/E/L 20 SQCM/< MAXFEE FAC         426.52 1/1/2024 12/31/2299 N
15260 FTH GRF FR N/E/E/L 20 SQCM/< MAXFEE NFF         507.68 1/1/2024 12/31/2299 N
15261 FTH GRF FR N/E/E/L EACH ADDL PRXOVR DEF         NA NA NA N
15261 FTH GRF FR N/E/E/L EACH ADDL MAXFEE FAC         107.31 1/1/2024 12/31/2299 N
15261 FTH GRF FR N/E/E/L EACH ADDL MAXFEE NFF         137.81 1/1/2024 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         43.75 1/1/2024 12/31/2299 N
15271 SKIN SUB GRAFT TRNK/ARM/LEG MAXFEE NFF         79.94 1/1/2024 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         9 1/1/2024 12/31/2299 N
15272 SKIN SUB GRAFT T/A/L ADD-ON MAXFEE NFF         12.98 1/1/2024 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         100.71 1/1/2024 12/31/2299 N
15273 SKIN SUB GRFT T/ARM/LG CHILD MAXFEE NFF         163.86 1/1/2024 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         23.19 1/1/2024 12/31/2299 N
15274 SKN SUB GRFT T/A/L CHILD ADD MAXFEE NFF         43.43 1/1/2024 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         47.41 1/1/2024 12/31/2299 N
15275 SKIN SUB GRAFT FACE/NK/HF/G MAXFEE NFF         82.19 1/1/2024 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         12.98 1/1/2024 12/31/2299 N
15276 SKIN SUB GRAFT F/N/HF/G ADDL MAXFEE NFF         16.79 1/1/2024 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         114.72 1/1/2024 12/31/2299 N
15277 SKN SUB GRFT F/N/HF/G CHILD MAXFEE NFF         179.78 1/1/2024 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         28.90 1/1/2024 12/31/2299 N
15278 SKN SUB GRFT F/N/HF/G CH ADD MAXFEE NFF         50.18 1/1/2024 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         374.10 1/1/2024 12/31/2299 N
15570 SKIN PEDICLE FLAP TRUNK MAXFEE NFF         468.57 1/1/2024 12/31/2299 N
15572 SKIN PEDICLE FLAP ARMS/LEGS PRXOVR DEF         NA NA NA N
15572 SKIN PEDICLE FLAP ARMS/LEGS MAXFEE FAC         373.06 1/1/2024 12/31/2299 N
15572 SKIN PEDICLE FLAP ARMS/LEGS MAXFEE NFF         448.67 1/1/2024 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         376.34 1/1/2024 12/31/2299 N
15574 PEDCLE FH/CH/CH/M/N/AX/G/H/F MAXFEE NFF         451.61 1/1/2024 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         330.32 1/1/2024 12/31/2299 N
15576 PEDICLE E/N/E/L/NTRORAL MAXFEE NFF         401.43 1/1/2024 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         108.90 1/1/2024 12/31/2299 N
15600 DELAY FLAP TRUNK MAXFEE NFF         174.42 1/1/2024 12/31/2299 N
15610 DELAY FLAP ARMS/LEGS PRXOVR DEF         NA NA NA N
15610 DELAY FLAP ARMS/LEGS MAXFEE FAC         131.57 1/1/2024 12/31/2299 N
15610 DELAY FLAP ARMS/LEGS MAXFEE NFF         188.95 1/1/2024 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         166.11 1/1/2024 12/31/2299 N
15620 DELAY FLAP F/C/C/N/AX/G/H/F MAXFEE NFF         229.96 1/1/2024 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         174.07 1/1/2024 12/31/2299 N
15630 DELAY FLAP EYE/NOS/EAR/LIP MAXFEE NFF         236.71 1/1/2024 12/31/2299 N
15650 TRANSFER SKIN PEDICLE FLAP PRXOVR DEF         NA NA NA N
15650 TRANSFER SKIN PEDICLE FLAP MAXFEE FAC         193.97 1/1/2024 12/31/2299 N
15650 TRANSFER SKIN PEDICLE FLAP MAXFEE NFF         262.49 1/1/2024 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         523.91 1/1/2024 12/31/2299 N
15731 FOREHEAD FLAP W/VASC PEDICLE MAXFEE NFF         632.47 1/1/2024 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         770.16 1/1/2024 12/31/2299 N
15734 MUSCLE-SKIN GRAFT TRUNK MAXFEE NFF         1020.18 1/1/2024 12/31/2299 N
15736 MUSCLE-SKIN GRAFT ARM PRXOVR DEF         NA NA NA N
15736 MUSCLE-SKIN GRAFT ARM MAXFEE FAC         670.03 1/1/2024 12/31/2299 N
15736 MUSCLE-SKIN GRAFT ARM MAXFEE NFF         911.87 1/1/2024 12/31/2299 N
15738 MUSCLE-SKIN GRAFT LEG PRXOVR DEF         NA NA NA N
15738 MUSCLE-SKIN GRAFT LEG MAXFEE FAC         652.16 1/1/2024 12/31/2299 N
15738 MUSCLE-SKIN GRAFT LEG MAXFEE NFF         812.49 1/1/2024 12/31/2299 N
15740 ISLAND PEDICLE FLAP GRAFT PRXOVR DEF         NA NA NA N
15740 ISLAND PEDICLE FLAP GRAFT MAXFEE FAC         429.93 1/1/2024 12/31/2299 N
15740 ISLAND PEDICLE FLAP GRAFT MAXFEE NFF         580.09 1/1/2024 12/31/2299 N
15750 NEUROVASCULAR PEDICLE FLAP PRXOVR DEF         NA NA NA N
15750 NEUROVASCULAR PEDICLE FLAP MAXFEE DEF         653.84 1/1/2024 12/31/2299 N
15756 FREE MYO/SKIN FLAP MICROVASC PRXOVR DEF         NA NA NA N
15756 FREE MYO/SKIN FLAP MICROVASC MAXFEE DEF         1837.28 1/1/2024 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         355.06 1/1/2024 12/31/2299 N
15760 COMPOSITE SKIN GRAFT MAXFEE NFF         463.31 1/1/2024 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         417.14 1/1/2024 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         152.36 1/1/2024 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         406.39 1/1/2024 12/31/2299 N
15773 GRFG AUTOL FAT LIPO 25 CC/< MAXFEE NFF         483.78 1/1/2024 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         147.59 1/1/2024 12/31/2299 N
15777 ACELLULAR DERM MATRIX IMPLT PRXOVR DEF         NA NA NA N
15777 ACELLULAR DERM MATRIX IMPLT MAXFEE DEF         109.70 1/1/2024 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         94.40 1/1/2024 12/31/2299 N
15786 ABRASION LESION SINGLE MAXFEE NFF         123.84 1/1/2024 12/31/2299 N
15787 ABRASION LESIONS ADD-ON PRXOVR DEF         NA NA NA N
15787 ABRASION LESIONS ADD-ON MAXFEE FAC         11.12 1/1/2024 12/31/2299 N
15787 ABRASION LESIONS ADD-ON MAXFEE NFF         24.63 1/1/2024 12/31/2299 N
15823 REVISION OF UPPER EYELID PRXOVR DEF         NA NA NA E
15823 REVISION OF UPPER EYELID MAXFEE DEF         356.56 1/1/2024 12/31/2299 E
15830 EXC SKIN ABD PRXOVR DEF         NA NA NA E
15830 EXC SKIN ABD MAXFEE DEF         692.79 1/1/2024 12/31/2299 E
15839 EXCISE EXCESS SKIN & TISSUE PRXOVR DEF         NA NA NA E
15839 EXCISE EXCESS SKIN & TISSUE MAXFEE DEF         532.17 1/1/2024 12/31/2299 E
15840 NERVE PALSY FASCIAL GRAFT PRXOVR DEF         NA NA NA N
15840 NERVE PALSY FASCIAL GRAFT MAXFEE DEF         774.81 1/1/2024 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         1824.52 1/1/2024 12/31/2299 N
15845 SKIN AND MUSCLE REPAIR FACE PRXOVR DEF         NA NA NA N
15845 SKIN AND MUSCLE REPAIR FACE MAXFEE DEF         740.53 1/1/2024 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         34.05 1/1/2024 12/31/2299 N
15851 REMOVAL SUTR/STAPLE REQ ANES MAXFEE NFF         55.37 1/1/2024 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         329.80 1/1/2024 12/31/2299 N
15922 REMOVAL OF TAIL BONE ULCER PRXOVR DEF         NA NA NA N
15922 REMOVAL OF TAIL BONE ULCER MAXFEE DEF         462 1/1/2024 12/31/2299 N
15931 REMOVE SACRUM PRESSURE SORE PRXOVR DEF         NA NA NA N
15931 REMOVE SACRUM PRESSURE SORE MAXFEE DEF         368.57 1/1/2024 12/31/2299 N
15933 REMOVE SACRUM PRESSURE SORE PRXOVR DEF         NA NA NA N
15933 REMOVE SACRUM PRESSURE SORE MAXFEE DEF         517.13 1/1/2024 12/31/2299 N
15934 REMOVE SACRUM PRESSURE SORE PRXOVR DEF         NA NA NA N
15934 REMOVE SACRUM PRESSURE SORE MAXFEE DEF         582.54 1/1/2024 12/31/2299 N
15935 REMOVE SACRUM PRESSURE SORE PRXOVR DEF         NA NA NA N
15935 REMOVE SACRUM PRESSURE SORE MAXFEE DEF         738.89 1/1/2024 12/31/2299 N
15936 REMOVE SACRUM PRESSURE SORE PRXOVR DEF         NA NA NA N
15936 REMOVE SACRUM PRESSURE SORE MAXFEE DEF         648.10 1/1/2024 12/31/2299 N
15937 REMOVE SACRUM PRESSURE SORE PRXOVR DEF         NA NA NA N
15937 REMOVE SACRUM PRESSURE SORE MAXFEE DEF         786.33 1/1/2024 12/31/2299 N
15940 REMOVE HIP PRESSURE SORE PRXOVR DEF         NA NA NA N
15940 REMOVE HIP PRESSURE SORE MAXFEE DEF         383.30 1/1/2024 12/31/2299 N
15941 REMOVE HIP PRESSURE SORE PRXOVR DEF         NA NA NA N
15941 REMOVE HIP PRESSURE SORE MAXFEE DEF         543.19 1/1/2024 12/31/2299 N
15944 REMOVE HIP PRESSURE SORE PRXOVR DEF         NA NA NA N
15944 REMOVE HIP PRESSURE SORE MAXFEE DEF         594.41 1/1/2024 12/31/2299 N
15945 REMOVE HIP PRESSURE SORE PRXOVR DEF         NA NA NA N
15945 REMOVE HIP PRESSURE SORE MAXFEE DEF         677.70 1/1/2024 12/31/2299 N
15946 REMOVE HIP PRESSURE SORE PRXOVR DEF         NA NA NA N
15946 REMOVE HIP PRESSURE SORE MAXFEE DEF         1082.40 1/1/2024 12/31/2299 N
15950 REMOVE THIGH PRESSURE SORE PRXOVR DEF         NA NA NA N
15950 REMOVE THIGH PRESSURE SORE MAXFEE DEF         326.34 1/1/2024 12/31/2299 N
15951 REMOVE THIGH PRESSURE SORE PRXOVR DEF         NA NA NA N
15951 REMOVE THIGH PRESSURE SORE MAXFEE DEF         532.93 1/1/2024 12/31/2299 N
15952 REMOVE THIGH PRESSURE SORE PRXOVR DEF         NA NA NA N
15952 REMOVE THIGH PRESSURE SORE MAXFEE DEF         532.08 1/1/2024 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         915.68 1/1/2024 12/31/2299 N
15958 REMOVE THIGH PRESSURE SORE PRXOVR DEF         NA NA NA N
15958 REMOVE THIGH PRESSURE SORE MAXFEE DEF         922.68 1/1/2024 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         24.35 1/1/2024 12/31/2299 N
16000 INITIAL TREATMENT OF BURN(S) MAXFEE NFF         38.93 1/1/2024 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         32.83 1/1/2024 12/31/2299 N
16020 DRESS/DEBRID P-THICK BURN S MAXFEE NFF         55.46 1/1/2024 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         65.93 1/1/2024 12/31/2299 N
16025 DRESS/DEBRID P-THICK BURN M MAXFEE NFF         99.78 1/1/2024 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         66.97 1/1/2024 12/31/2299 N
16030 DRESS/DEBRID P-THICK BURN L MAXFEE NFF         101.57 1/1/2024 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         27.86 1/1/2024 12/31/2299 N
17000 DESTRUCT PREMALG LESION MAXFEE NFF         46.45 1/1/2024 12/31/2299 N
17003 DESTRUCT PREMALG LES 2-14 PRXOVR DEF         NA NA NA N
17003 DESTRUCT PREMALG LES 2-14 MAXFEE FAC         2.08 1/1/2024 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         150.94 1/1/2024 12/31/2299 N
17106 DESTRUCTION OF SKIN LESIONS MAXFEE NFF         210.59 1/1/2024 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         365.27 1/1/2024 12/31/2299 N
17108 DESTRUCTION OF SKIN LESIONS MAXFEE NFF         480.22 1/1/2024 12/31/2299 N
17110 DESTRUCT B9 LESION 1-14 PRXOVR DEF         NA NA NA N
17110 DESTRUCT B9 LESION 1-14 MAXFEE FAC         36.13 1/1/2024 12/31/2299 N
17110 DESTRUCT B9 LESION 1-14 MAXFEE NFF         66.48 1/1/2024 12/31/2299 N
17111 DESTRUCT LESION 15 OR MORE PRXOVR DEF         NA NA NA N
17111 DESTRUCT LESION 15 OR MORE MAXFEE FAC         44.49 1/1/2024 12/31/2299 N
17111 DESTRUCT LESION 15 OR MORE MAXFEE NFF         79.05 1/1/2024 12/31/2299 N
17250 CHEM CAUT OF GRANLTJ TISSUE PRXOVR DEF         NA NA NA N
17250 CHEM CAUT OF GRANLTJ TISSUE MAXFEE FAC         20.41 1/1/2024 12/31/2299 N
17250 CHEM CAUT OF GRANLTJ TISSUE MAXFEE NFF         49.06 1/1/2024 12/31/2299 N
17260 DSTRJ MAL LES T/A/L 0.5 CM/< PRXOVR DEF         NA NA NA N
17260 DSTRJ MAL LES T/A/L 0.5 CM/< MAXFEE FAC         50.18 1/1/2024 12/31/2299 N
17260 DSTRJ MAL LES T/A/L 0.5 CM/< MAXFEE NFF         64.63 1/1/2024 12/31/2299 N
17261 DSTRJ MAL LES T/A/L .6-1.0CM PRXOVR DEF         NA NA NA N
17261 DSTRJ MAL LES T/A/L .6-1.0CM MAXFEE FAC         43.43 1/1/2024 12/31/2299 N
17261 DSTRJ MAL LES T/A/L .6-1.0CM MAXFEE NFF         75.79 1/1/2024 12/31/2299 N
17262 DSTRJ MAL LES T/A/L 1.1-2.0 PRXOVR DEF         NA NA NA N
17262 DSTRJ MAL LES T/A/L 1.1-2.0 MAXFEE FAC         69.39 1/1/2024 12/31/2299 N
17262 DSTRJ MAL LES T/A/L 1.1-2.0 MAXFEE NFF         93.35 1/1/2024 12/31/2299 N
17263 DSTRJ MAL LES T/A/L 2.1-3.0 PRXOVR DEF         NA NA NA N
17263 DSTRJ MAL LES T/A/L 2.1-3.0 MAXFEE FAC         82.27 1/1/2024 12/31/2299 N
17263 DSTRJ MAL LES T/A/L 2.1-3.0 MAXFEE NFF         109.47 1/1/2024 12/31/2299 N
17264 DSTRJ MAL LES T/A/L 3.1-4.0 PRXOVR DEF         NA NA NA N
17264 DSTRJ MAL LES T/A/L 3.1-4.0 MAXFEE FAC         93.95 1/1/2024 12/31/2299 N
17264 DSTRJ MAL LES T/A/L 3.1-4.0 MAXFEE NFF         122.29 1/1/2024 12/31/2299 N
17266 DSTRJ MAL LES T/A/L >4.0 CM PRXOVR DEF         NA NA NA N
17266 DSTRJ MAL LES T/A/L >4.0 CM MAXFEE FAC         99.51 1/1/2024 12/31/2299 N
17266 DSTRJ MAL LES T/A/L >4.0 CM MAXFEE NFF         132.87 1/1/2024 12/31/2299 N
17270 DSTR MAL LES S/N/H/F/G .5 /< PRXOVR DEF         NA NA NA N
17270 DSTR MAL LES S/N/H/F/G .5 /< MAXFEE FAC         53.47 1/1/2024 12/31/2299 N
17270 DSTR MAL LES S/N/H/F/G .5 /< MAXFEE NFF         76.14 1/1/2024 12/31/2299 N
17271 DSTR MAL LES S/N/H/F/G 0.6-1 PRXOVR DEF         NA NA NA N
17271 DSTR MAL LES S/N/H/F/G 0.6-1 MAXFEE FAC         65.26 1/1/2024 12/31/2299 N
17271 DSTR MAL LES S/N/H/F/G 0.6-1 MAXFEE NFF         89.11 1/1/2024 12/31/2299 N
17272 DSTR MAL LES S/N/H/F/G 1.1-2 PRXOVR DEF         NA NA NA N
17272 DSTR MAL LES S/N/H/F/G 1.1-2 MAXFEE FAC         80.29 1/1/2024 12/31/2299 N
17272 DSTR MAL LES S/N/H/F/G 1.1-2 MAXFEE NFF         107.61 1/1/2024 12/31/2299 N
17273 DSTR MAL LES S/N/H/F/G 2.1-3 PRXOVR DEF         NA NA NA N
17273 DSTR MAL LES S/N/H/F/G 2.1-3 MAXFEE FAC         95.48 1/1/2024 12/31/2299 N
17273 DSTR MAL LES S/N/H/F/G 2.1-3 MAXFEE NFF         125.40 1/1/2024 12/31/2299 N
17274 DSTR MAL LES S/N/H/F/G 3.1-4 PRXOVR DEF         NA NA NA N
17274 DSTR MAL LES S/N/H/F/G 3.1-4 MAXFEE FAC         116.48 1/1/2024 12/31/2299 N
17274 DSTR MAL LES S/N/H/F/G 3.1-4 MAXFEE NFF         154.19 1/1/2024 12/31/2299 N
17276 DSTR MAL LES S/N/H/F/G >4.0 PRXOVR DEF         NA NA NA N
17276 DSTR MAL LES S/N/H/F/G >4.0 MAXFEE FAC         138.35 1/1/2024 12/31/2299 N
17276 DSTR MAL LES S/N/H/F/G >4.0 MAXFEE NFF         183.47 1/1/2024 12/31/2299 N
17280 DSTR MAL LS F/E/E/N/L/M .5/< PRXOVR DEF         NA NA NA N
17280 DSTR MAL LS F/E/E/N/L/M .5/< MAXFEE FAC         58.12 1/1/2024 12/31/2299 N
17280 DSTR MAL LS F/E/E/N/L/M .5/< MAXFEE NFF         77.13 1/1/2024 12/31/2299 N
17281 DSTR MAL LS F/E/E/N/L/M .6-1 PRXOVR DEF         NA NA NA N
17281 DSTR MAL LS F/E/E/N/L/M .6-1 MAXFEE FAC         77.32 1/1/2024 12/31/2299 N
17281 DSTR MAL LS F/E/E/N/L/M .6-1 MAXFEE NFF         103.53 1/1/2024 12/31/2299 N
17282 DSTR MAL LS F/E/E/N/L/M1.1-2 PRXOVR DEF         NA NA NA N
17282 DSTR MAL LS F/E/E/N/L/M1.1-2 MAXFEE FAC         93.54 1/1/2024 12/31/2299 N
17282 DSTR MAL LS F/E/E/N/L/M1.1-2 MAXFEE NFF         124.35 1/1/2024 12/31/2299 N
17283 DSTR MAL LS F/E/E/N/L/M2.1-3 PRXOVR DEF         NA NA NA N
17283 DSTR MAL LS F/E/E/N/L/M2.1-3 MAXFEE FAC         114.94 1/1/2024 12/31/2299 N
17283 DSTR MAL LS F/E/E/N/L/M2.1-3 MAXFEE NFF         152.88 1/1/2024 12/31/2299 N
17284 DSTR MAL LS F/E/E/N/L/M3.1-4 PRXOVR DEF         NA NA NA N
17284 DSTR MAL LS F/E/E/N/L/M3.1-4 MAXFEE FAC         137.92 1/1/2024 12/31/2299 N
17284 DSTR MAL LS F/E/E/N/L/M3.1-4 MAXFEE NFF         181.68 1/1/2024 12/31/2299 N
17286 DSTR MAL LS F/E/E/N/L/M>4.0 PRXOVR DEF         NA NA NA N
17286 DSTR MAL LS F/E/E/N/L/M>4.0 MAXFEE FAC         183 1/1/2024 12/31/2299 N
17286 DSTR MAL LS F/E/E/N/L/M>4.0 MAXFEE NFF         242.21 1/1/2024 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         201.69 1/1/2024 12/31/2299 N
17311 MOHS 1 STAGE H/N/HF/G MAXFEE NFF         391.82 1/1/2024 12/31/2299 N
17312 MOHS ADDL STAGE PRXOVR DEF         NA NA NA N
17312 MOHS ADDL STAGE MAXFEE FAC         109.03 1/1/2024 12/31/2299 N
17312 MOHS ADDL STAGE MAXFEE NFF         234.71 1/1/2024 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         180.90 1/1/2024 12/31/2299 N
17313 MOHS 1 STAGE T/A/L MAXFEE NFF         357.54 1/1/2024 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         101.30 1/1/2024 12/31/2299 N
17314 MOHS ADDL STAGE T/A/L MAXFEE NFF         217.57 1/1/2024 12/31/2299 N
17315 MOHS SURG ADDL BLOCK PRXOVR DEF         NA NA NA N
17315 MOHS SURG ADDL BLOCK MAXFEE FAC         36.19 1/1/2024 12/31/2299 N
17315 MOHS SURG ADDL BLOCK MAXFEE NFF         46.89 1/1/2024 12/31/2299 N
17340 CRYOTHERAPY OF SKIN PRXOVR DEF         NA NA NA N
17340 CRYOTHERAPY OF SKIN MAXFEE FAC         32.52 1/1/2024 12/31/2299 N
17340 CRYOTHERAPY OF SKIN MAXFEE NFF         33.25 1/1/2024 12/31/2299 N
17360 SKIN PEEL THERAPY PRXOVR DEF         NA NA NA N
17360 SKIN PEEL THERAPY MAXFEE FAC         65.28 1/1/2024 12/31/2299 N
17360 SKIN PEEL THERAPY MAXFEE NFF         86.08 1/1/2024 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 PUNCTURE ASPIR CYST BREAST PRXOVR DEF         NA NA NA N
19000 PUNCTURE ASPIR CYST BREAST MAXFEE FAC         29.35 1/1/2024 12/31/2299 N
19000 PUNCTURE ASPIR CYST BREAST MAXFEE NFF         63.24 1/1/2024 12/31/2299 N
19001 PUNCTURE ASPIR CYST BRST EA PRXOVR DEF         NA NA NA N
19001 PUNCTURE ASPIR CYST BRST EA MAXFEE FAC         16.21 1/1/2024 12/31/2299 N
19001 PUNCTURE ASPIR CYST BRST EA MAXFEE NFF         20.74 1/1/2024 12/31/2299 N
19020 MASTOTOMY EXPL DRG ABSC DP PRXOVR DEF         NA NA NA N
19020 MASTOTOMY EXPL DRG ABSC DP MAXFEE FAC         161.09 1/1/2024 12/31/2299 N
19020 MASTOTOMY EXPL DRG ABSC DP MAXFEE NFF         245.19 1/1/2024 12/31/2299 N
19030 NJX PX ONLY MAM DUCTO/GLCTO PRXOVR DEF         NA NA NA N
19030 NJX PX ONLY MAM DUCTO/GLCTO MAXFEE FAC         38.07 1/1/2024 12/31/2299 N
19030 NJX PX ONLY MAM DUCTO/GLCTO MAXFEE NFF         85.48 1/1/2024 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         40.39 1/1/2024 12/31/2299 N
19100 BX BREAST PERCUT W/O IMAGE MAXFEE NFF         80.46 1/1/2024 12/31/2299 N
19101 BIOPSY OF BREAST OPEN PRXOVR DEF         NA NA NA N
19101 BIOPSY OF BREAST OPEN MAXFEE FAC         115.59 1/1/2024 12/31/2299 N
19101 BIOPSY OF BREAST OPEN MAXFEE NFF         183.57 1/1/2024 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         181.69 1/1/2024 12/31/2299 N
19110 NIPPLE EXPLORATION MAXFEE NFF         254.70 1/1/2024 12/31/2299 N
19112 EXCISE BREAST DUCT FISTULA PRXOVR DEF         NA NA NA N
19112 EXCISE BREAST DUCT FISTULA MAXFEE FAC         166.63 1/1/2024 12/31/2299 N
19112 EXCISE BREAST DUCT FISTULA MAXFEE NFF         241.73 1/1/2024 12/31/2299 N
19120 REMOVAL OF BREAST LESION PRXOVR DEF         NA NA NA N
19120 REMOVAL OF BREAST LESION MAXFEE FAC         215.08 1/1/2024 12/31/2299 N
19120 REMOVAL OF BREAST LESION MAXFEE NFF         268.89 1/1/2024 12/31/2299 N
19125 EXCISION BREAST LESION PRXOVR DEF         NA NA NA N
19125 EXCISION BREAST LESION MAXFEE FAC         238.61 1/1/2024 12/31/2299 N
19125 EXCISION BREAST LESION MAXFEE NFF         296.58 1/1/2024 12/31/2299 N
19126 EXCISION ADDL BREAST LESION PRXOVR DEF         NA NA NA N
19126 EXCISION ADDL BREAST LESION MAXFEE DEF         124.72 1/1/2024 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         186.29 1/1/2024 12/31/2299 N
19282 PERQ DEVICE BREAST EA IMAG PRXOVR DEF         NA NA NA N
19282 PERQ DEVICE BREAST EA IMAG MAXFEE FAC         39.27 1/1/2024 12/31/2299 N
19282 PERQ DEVICE BREAST EA IMAG MAXFEE NFF         127.85 1/1/2024 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         210.81 1/1/2024 12/31/2299 N
19284 PERQ DEV BREAST ADD STRTCTC PRXOVR DEF         NA NA NA N
19284 PERQ DEV BREAST ADD STRTCTC MAXFEE FAC         39.53 1/1/2024 12/31/2299 N
19284 PERQ DEV BREAST ADD STRTCTC MAXFEE NFF         152.89 1/1/2024 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         33.94 1/1/2024 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         165.97 1/1/2024 12/31/2299 N
19296 PLACE PO BREAST CATH FOR RAD MAXFEE NFF         3124.23 1/1/2024 12/31/2299 N
19297 PLACE BREAST CATH FOR RAD PRXOVR DEF         NA NA NA N
19297 PLACE BREAST CATH FOR RAD MAXFEE DEF         74.31 1/1/2024 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         229.22 1/1/2024 12/31/2299 N
19300 REMOVAL OF BREAST TISSUE MAXFEE NFF         315.40 1/1/2024 12/31/2299 N
19301 PARTIAL MASTECTOMY PRXOVR DEF         NA NA NA N
19301 PARTIAL MASTECTOMY MAXFEE DEF         341.57 1/1/2024 12/31/2299 N
19302 P-MASTECTOMY W/LN REMOVAL PRXOVR DEF         NA NA NA N
19302 P-MASTECTOMY W/LN REMOVAL MAXFEE DEF         505.60 1/1/2024 12/31/2299 N
19303 MAST SIMPLE COMPLETE PRXOVR DEF         NA NA NA N
19303 MAST SIMPLE COMPLETE MAXFEE DEF         552.73 1/1/2024 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         632.47 1/1/2024 12/31/2299 N
19306 MAST RAD URBAN TYPE PRXOVR DEF         NA NA NA N
19306 MAST RAD URBAN TYPE MAXFEE DEF         660.80 1/1/2024 12/31/2299 N
19307 MAST MOD RAD PRXOVR DEF         NA NA NA N
19307 MAST MOD RAD MAXFEE DEF         667.46 1/1/2024 12/31/2299 N
19316 SUSPENSION OF BREAST PRXOVR DEF         NA NA NA E
19316 SUSPENSION OF BREAST MAXFEE DEF         459.62 1/1/2024 12/31/2299 E
19318 BREAST REDUCTION PRXOVR DEF         NA NA NA E
19318 BREAST REDUCTION MAXFEE DEF         765.75 1/1/2024 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         371.60 1/1/2024 12/31/2299 E
19328 RMVL INTACT BREAST IMPLANT PRXOVR DEF         NA NA NA N
19328 RMVL INTACT BREAST IMPLANT MAXFEE DEF         283.77 1/1/2024 12/31/2299 N
19330 RMVL RUPTURED BREAST IMPLANT PRXOVR DEF         NA NA NA N
19330 RMVL RUPTURED BREAST IMPLANT MAXFEE DEF         345.39 1/1/2024 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         479.16 1/1/2024 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         457.13 1/1/2024 12/31/2299 N
19350 BREAST RECONSTRUCTION MAXFEE NFF         610.74 1/1/2024 12/31/2299 N
19355 CORRECT INVERTED NIPPLE(S) PRXOVR DEF         NA NA NA E
19355 CORRECT INVERTED NIPPLE(S) MAXFEE DEF         396.80 1/1/2024 12/31/2299 E
19357 TISS XPNDR PLMT BRST RCNSTJ PRXOVR DEF         NA NA NA N
19357 TISS XPNDR PLMT BRST RCNSTJ MAXFEE DEF         877.18 1/1/2024 12/31/2299 N
19361 BRST RCNSTJ LATSMS DRSI FLAP PRXOVR DEF         NA NA NA N
19361 BRST RCNSTJ LATSMS DRSI FLAP MAXFEE DEF         1103.28 1/1/2024 12/31/2299 N
19364 BRST RCNSTJ FREE FLAP PRXOVR DEF         NA NA NA N
19364 BRST RCNSTJ FREE FLAP MAXFEE DEF         1578.55 1/1/2024 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         1298.89 1/1/2024 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         409.02 1/1/2024 12/31/2299 N
19371 PERI-IMPLT CAPSLC BRST COMPL PRXOVR DEF         NA NA NA N
19371 PERI-IMPLT CAPSLC BRST COMPL MAXFEE DEF         494.47 1/1/2024 12/31/2299 N
19380 REVJ RECONSTRUCTED BREAST PRXOVR DEF         NA NA NA E
19380 REVJ RECONSTRUCTED BREAST MAXFEE DEF         445.23 1/1/2024 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         436.43 1/1/2024 12/31/2299 N
20101 EXPLORE WOUND CHEST PRXOVR DEF         NA NA NA N
20101 EXPLORE WOUND CHEST MAXFEE FAC         108.84 1/1/2024 12/31/2299 N
20101 EXPLORE WOUND CHEST MAXFEE NFF         312.50 1/1/2024 12/31/2299 N
20102 EXPLORE WOUND ABDOMEN PRXOVR DEF         NA NA NA N
20102 EXPLORE WOUND ABDOMEN MAXFEE FAC         134.35 1/1/2024 12/31/2299 N
20102 EXPLORE WOUND ABDOMEN MAXFEE NFF         325.82 1/1/2024 12/31/2299 N
20103 EXPLORE WOUND EXTREMITY PRXOVR DEF         NA NA NA N
20103 EXPLORE WOUND EXTREMITY MAXFEE FAC         176.49 1/1/2024 12/31/2299 N
20103 EXPLORE WOUND EXTREMITY MAXFEE NFF         293.29 1/1/2024 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         723.72 1/1/2024 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 SUPERFICIAL PRXOVR DEF         NA NA NA N
20200 MUSCLE BIOPSY SUPERFICIAL MAXFEE FAC         61.34 1/1/2024 12/31/2299 N
20200 MUSCLE BIOPSY SUPERFICIAL MAXFEE NFF         114.90 1/1/2024 12/31/2299 N
20205 DEEP MUSCLE BIOPSY PRXOVR DEF         NA NA NA N
20205 DEEP MUSCLE BIOPSY MAXFEE FAC         82.04 1/1/2024 12/31/2299 N
20205 DEEP MUSCLE BIOPSY MAXFEE NFF         159.19 1/1/2024 12/31/2299 N
20206 BIOPSY MUSCLE PERQ NEEDLE PRXOVR DEF         NA NA NA N
20206 BIOPSY MUSCLE PERQ NEEDLE MAXFEE FAC         43.91 1/1/2024 12/31/2299 N
20206 BIOPSY MUSCLE PERQ NEEDLE MAXFEE NFF         119.39 1/1/2024 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/NDL SUPFC PRXOVR DEF         NA NA NA N
20220 BONE BIOPSY TROCAR/NDL SUPFC MAXFEE FAC         43.95 1/1/2024 12/31/2299 N
20220 BONE BIOPSY TROCAR/NDL SUPFC MAXFEE NFF         124.24 1/1/2024 12/31/2299 N
20225 BONE BIOPSY TROCAR/NDL DEEP PRXOVR DEF         NA NA NA N
20225 BONE BIOPSY TROCAR/NDL DEEP MAXFEE FAC         84.53 1/1/2024 12/31/2299 N
20225 BONE BIOPSY TROCAR/NDL DEEP MAXFEE NFF         237.44 1/1/2024 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         143.62 1/1/2024 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 BIOPSY VRT BDY OPEN THORACIC PRXOVR DEF         NA NA NA N
20250 BIOPSY VRT BDY OPEN THORACIC MAXFEE DEF         284.07 1/1/2024 12/31/2299 N
20251 BIOPSY VRT BDY OPEN LMBR/CRV PRXOVR DEF         NA NA NA N
20251 BIOPSY VRT BDY OPEN LMBR/CRV MAXFEE DEF         323.30 1/1/2024 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         97.57 1/1/2024 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         29.40 1/1/2024 12/31/2299 N
20501 INJECT SINUS TRACT FOR X-RAY MAXFEE NFF         76.48 1/1/2024 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         90.29 1/1/2024 12/31/2299 N
20520 REMOVAL OF FOREIGN BODY MAXFEE NFF         120.90 1/1/2024 12/31/2299 N
20525 REMOVAL OF FOREIGN BODY PRXOVR DEF         NA NA NA N
20525 REMOVAL OF FOREIGN BODY MAXFEE FAC         126.32 1/1/2024 12/31/2299 N
20525 REMOVAL OF FOREIGN BODY MAXFEE NFF         242.42 1/1/2024 12/31/2299 N
20526 THER INJECTION CARP TUNNEL PRXOVR DEF         NA NA NA N
20526 THER INJECTION CARP TUNNEL MAXFEE FAC         35.01 1/1/2024 12/31/2299 N
20526 THER INJECTION CARP TUNNEL MAXFEE NFF         46.76 1/1/2024 12/31/2299 N
20527 INJ DUPUYTREN CORD W/ENZYME PRXOVR DEF         NA NA NA N
20527 INJ DUPUYTREN CORD W/ENZYME MAXFEE FAC         33.40 1/1/2024 12/31/2299 N
20527 INJ DUPUYTREN CORD W/ENZYME MAXFEE NFF         44.64 1/1/2024 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         43.91 1/1/2024 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         46.76 1/1/2024 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         28.11 1/1/2024 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         46.76 1/1/2024 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         207.67 1/1/2024 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         19.90 1/1/2024 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         29.20 1/1/2024 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         25.63 1/1/2024 12/31/2299 N
20600 DRAIN/INJ JOINT/BURSA W/O US MAXFEE NFF         38.61 1/1/2024 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         58.12 1/1/2024 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         42.45 1/1/2024 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         63.91 1/1/2024 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         29.83 1/1/2024 12/31/2299 N
20610 DRAIN/INJ JOINT/BURSA W/O US MAXFEE NFF         51.36 1/1/2024 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         73.36 1/1/2024 12/31/2299 N
20612 ASPIRATE/INJ GANGLION CYST PRXOVR DEF         NA NA NA N
20612 ASPIRATE/INJ GANGLION CYST MAXFEE FAC         31.48 1/1/2024 12/31/2299 N
20612 ASPIRATE/INJ GANGLION CYST MAXFEE NFF         40.32 1/1/2024 12/31/2299 N
20615 TREATMENT OF BONE CYST PRXOVR DEF         NA NA NA N
20615 TREATMENT OF BONE CYST MAXFEE FAC         81.50 1/1/2024 12/31/2299 N
20615 TREATMENT OF BONE CYST MAXFEE NFF         129.78 1/1/2024 12/31/2299 N
20650 INSERT AND REMOVE BONE PIN PRXOVR DEF         NA NA NA N
20650 INSERT AND REMOVE BONE PIN MAXFEE FAC         82.37 1/1/2024 12/31/2299 N
20650 INSERT AND REMOVE BONE PIN MAXFEE NFF         114.72 1/1/2024 12/31/2299 N
20660 APPLY REM FIXATION DEVICE PRXOVR DEF         NA NA NA N
20660 APPLY REM FIXATION DEVICE MAXFEE DEF         123.20 1/1/2024 12/31/2299 N
20661 APPLICATION HALO CRANIAL PRXOVR DEF         NA NA NA N
20661 APPLICATION HALO CRANIAL MAXFEE DEF         262.66 1/1/2024 12/31/2299 N
20662 APPLICATION HALO PELVIC PRXOVR DEF         NA NA NA N
20662 APPLICATION HALO PELVIC MAXFEE DEF         355.35 1/1/2024 12/31/2299 N
20663 APPLICATION HALO FEMORAL PRXOVR DEF         NA NA NA N
20663 APPLICATION HALO FEMORAL MAXFEE DEF         285.65 1/1/2024 12/31/2299 N
20664 APPL HALO CRANIAL 6+PINS PRXOVR DEF         NA NA NA N
20664 APPL HALO CRANIAL 6+PINS MAXFEE DEF         455.07 1/1/2024 12/31/2299 N
20665 RMVL TONGS/HALO ANTHR INDIV PRXOVR DEF         NA NA NA N
20665 RMVL TONGS/HALO ANTHR INDIV MAXFEE FAC         73.23 1/1/2024 12/31/2299 N
20665 RMVL TONGS/HALO ANTHR INDIV MAXFEE NFF         95.93 1/1/2014 12/31/2299 N
20670 REMOVAL IMPLANT SUPERFICIAL PRXOVR DEF         NA NA NA N
20670 REMOVAL IMPLANT SUPERFICIAL MAXFEE FAC         77.53 1/1/2024 12/31/2299 N
20670 REMOVAL IMPLANT SUPERFICIAL MAXFEE NFF         187.05 1/1/2024 12/31/2299 N
20680 REMOVAL OF IMPLANT DEEP PRXOVR DEF         NA NA NA N
20680 REMOVAL OF IMPLANT DEEP MAXFEE FAC         214.39 1/1/2024 12/31/2299 N
20680 REMOVAL OF IMPLANT DEEP MAXFEE NFF         311.11 1/1/2024 12/31/2299 N
20690 APPL UNIPLN UNI EXT FIXJ SYS PRXOVR DEF         NA NA NA N
20690 APPL UNIPLN UNI EXT FIXJ SYS MAXFEE DEF         305.92 1/1/2024 12/31/2299 N
20692 APPL MLTPLN UNI EXT FIXJ SYS PRXOVR DEF         NA NA NA N
20692 APPL MLTPLN UNI EXT FIXJ SYS MAXFEE DEF         573.25 1/1/2024 12/31/2299 N
20693 ADJMT/REVJ EXT FIXJ SYS ANES PRXOVR DEF         NA NA NA N
20693 ADJMT/REVJ EXT FIXJ SYS ANES MAXFEE DEF         267.08 1/1/2024 12/31/2299 N
20694 RMVL EXT FIXJ SYS UNDER ANES PRXOVR DEF         NA NA NA N
20694 RMVL EXT FIXJ SYS UNDER ANES MAXFEE FAC         174.24 1/1/2024 12/31/2299 N
20694 RMVL EXT FIXJ SYS UNDER ANES MAXFEE NFF         221.31 1/1/2024 12/31/2299 N
20696 APP MLTPLN UNI XTRNL FIX 1ST PRXOVR DEF         NA NA NA N
20696 APP MLTPLN UNI XTRNL FIX 1ST MAXFEE DEF         833.65 1/1/2024 12/31/2299 N
20697 APP MLTPLN UNI XTRNL FIX XCH PRXOVR DEF         NA NA NA N
20697 APP MLTPLN UNI XTRNL FIX XCH MAXFEE DEF         977.63 1/1/2024 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         133.04 1/1/2024 12/31/2299 N
20900 REMOVAL OF BONE FOR GRAFT MAXFEE NFF         237.77 1/1/2024 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         245.39 1/1/2024 12/31/2299 N
20912 REMOVE CARTILAGE FOR GRAFT PRXOVR DEF         NA NA NA N
20912 REMOVE CARTILAGE FOR GRAFT MAXFEE DEF         321.59 1/1/2024 12/31/2299 N
20920 REMOVAL OF FASCIA FOR GRAFT PRXOVR DEF         NA NA NA N
20920 REMOVAL OF FASCIA FOR GRAFT MAXFEE DEF         266.70 1/1/2024 12/31/2299 N
20922 REMOVAL OF FASCIA FOR GRAFT PRXOVR DEF         NA NA NA N
20922 REMOVAL OF FASCIA FOR GRAFT MAXFEE FAC         249.86 1/1/2024 12/31/2299 N
20922 REMOVAL OF FASCIA FOR GRAFT MAXFEE NFF         330.78 1/1/2024 12/31/2299 N
20924 REMOVAL OF TENDON FOR GRAFT PRXOVR DEF         NA NA NA N
20924 REMOVAL OF TENDON FOR GRAFT MAXFEE DEF         346.37 1/1/2024 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         47.33 1/1/2024 12/31/2299 N
20950 FLUID PRESSURE MUSCLE MAXFEE NFF         138.95 1/1/2024 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         1913.75 1/1/2024 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         1995.56 1/1/2024 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         2268.81 1/1/2024 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         35.56 1/1/2024 12/31/2299 N
20974 ELECTRICAL BONE STIMULATION MAXFEE NFF         41.53 1/1/2024 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         38.82 1/1/2024 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         97.42 1/1/2024 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         132.54 1/1/2024 12/31/2299 N
21011 EXC FACE LES SC <2 CM MAXFEE NFF         193.45 1/1/2024 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         192.48 1/1/2024 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         205.74 1/1/2024 12/31/2299 N
21013 EXC FACE TUM DEEP < 2 CM MAXFEE NFF         277.20 1/1/2024 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         297.76 1/1/2024 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         358.18 1/1/2024 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         602.81 1/1/2024 12/31/2299 N
21025 EXCISION OF BONE LOWER JAW PRXOVR DEF         NA NA NA N
21025 EXCISION OF BONE LOWER JAW MAXFEE FAC         415.56 1/1/2024 12/31/2299 N
21025 EXCISION OF BONE LOWER JAW MAXFEE NFF         542.79 1/1/2024 12/31/2299 N
21026 EXCISION OF FACIAL BONE(S) PRXOVR DEF         NA NA NA N
21026 EXCISION OF FACIAL BONE(S) MAXFEE FAC         217.85 1/1/2024 12/31/2299 N
21026 EXCISION OF FACIAL BONE(S) MAXFEE NFF         274.08 1/1/2024 12/31/2299 N
21029 CONTOUR OF FACE BONE LESION PRXOVR DEF         NA NA NA N
21029 CONTOUR OF FACE BONE LESION MAXFEE FAC         335.86 1/1/2024 12/31/2299 N
21029 CONTOUR OF FACE BONE LESION MAXFEE NFF         448.58 1/1/2024 12/31/2299 N
21030 EXCISE MAX/ZYGOMA B9 TUMOR PRXOVR DEF         NA NA NA N
21030 EXCISE MAX/ZYGOMA B9 TUMOR MAXFEE FAC         209.87 1/1/2024 12/31/2299 N
21030 EXCISE MAX/ZYGOMA B9 TUMOR MAXFEE NFF         285.95 1/1/2024 12/31/2299 N
21031 REMOVE EXOSTOSIS MANDIBLE PRXOVR DEF         NA NA NA N
21031 REMOVE EXOSTOSIS MANDIBLE MAXFEE FAC         139.97 1/1/2024 12/31/2299 N
21031 REMOVE EXOSTOSIS MANDIBLE MAXFEE NFF         200.71 1/1/2024 12/31/2299 N
21032 REMOVE EXOSTOSIS MAXILLA PRXOVR DEF         NA NA NA N
21032 REMOVE EXOSTOSIS MAXILLA MAXFEE FAC         141.88 1/1/2024 12/31/2299 N
21032 REMOVE EXOSTOSIS MAXILLA MAXFEE NFF         204.30 1/1/2024 12/31/2299 N
21034 EXCISE MAX/ZYGOMA MAL TUMOR PRXOVR DEF         NA NA NA N
21034 EXCISE MAX/ZYGOMA MAL TUMOR MAXFEE FAC         576.89 1/1/2024 12/31/2299 N
21034 EXCISE MAX/ZYGOMA MAL TUMOR MAXFEE NFF         673.65 1/1/2024 12/31/2299 N
21040 EXCISE MANDIBLE LESION PRXOVR DEF         NA NA NA N
21040 EXCISE MANDIBLE LESION MAXFEE FAC         186.01 1/1/2024 12/31/2299 N
21040 EXCISE MANDIBLE LESION MAXFEE NFF         240.86 1/1/2024 12/31/2299 N
21044 REMOVAL OF JAW BONE LESION PRXOVR DEF         NA NA NA N
21044 REMOVAL OF JAW BONE LESION MAXFEE DEF         598.07 1/1/2024 12/31/2299 N
21045 EXTENSIVE JAW SURGERY PRXOVR DEF         NA NA NA N
21045 EXTENSIVE JAW SURGERY MAXFEE DEF         831.25 1/1/2024 12/31/2299 N
21046 REMOVE MANDIBLE CYST COMPLEX PRXOVR DEF         NA NA NA N
21046 REMOVE MANDIBLE CYST COMPLEX MAXFEE DEF         644.26 1/1/2024 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         798.44 1/1/2024 12/31/2299 N
21048 REMOVE MAXILLA CYST COMPLEX PRXOVR DEF         NA NA NA N
21048 REMOVE MAXILLA CYST COMPLEX MAXFEE DEF         663.05 1/1/2024 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         756.48 1/1/2024 12/31/2299 N
21050 REMOVAL OF JAW JOINT PRXOVR DEF         NA NA NA N
21050 REMOVAL OF JAW JOINT MAXFEE DEF         638.42 1/1/2024 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         423.24 1/1/2024 12/31/2299 N
21073 MNPJ OF TMJ W/ANESTH PRXOVR DEF         NA NA NA N
21073 MNPJ OF TMJ W/ANESTH MAXFEE FAC         137.83 1/1/2024 12/31/2299 N
21073 MNPJ OF TMJ W/ANESTH MAXFEE NFF         227.92 1/1/2024 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         781.77 1/1/2024 12/31/2299 N
21079 PREPARE FACE/ORAL PROSTHESIS MAXFEE NFF         1076.85 1/1/2024 12/31/2299 N
21080 PREPARE FACE/ORAL PROSTHESIS PRXOVR DEF         NA NA NA N
21080 PREPARE FACE/ORAL PROSTHESIS MAXFEE FAC         901.74 1/1/2024 12/31/2299 N
21080 PREPARE FACE/ORAL PROSTHESIS MAXFEE NFF         1229.94 1/1/2024 12/31/2299 N
21081 PREPARE FACE/ORAL PROSTHESIS PRXOVR DEF         NA NA NA N
21081 PREPARE FACE/ORAL PROSTHESIS MAXFEE FAC         812.81 1/1/2024 12/31/2299 N
21081 PREPARE FACE/ORAL PROSTHESIS MAXFEE NFF         1108.99 1/1/2024 12/31/2299 N
21082 PREPARE FACE/ORAL PROSTHESIS PRXOVR DEF         NA NA NA N
21082 PREPARE FACE/ORAL PROSTHESIS MAXFEE FAC         695.66 1/1/2024 12/31/2299 N
21082 PREPARE FACE/ORAL PROSTHESIS MAXFEE NFF         979.60 1/1/2024 12/31/2299 N
21083 PREPARE FACE/ORAL PROSTHESIS PRXOVR DEF         NA NA NA N
21083 PREPARE FACE/ORAL PROSTHESIS MAXFEE FAC         671.50 1/1/2024 12/31/2299 N
21083 PREPARE FACE/ORAL PROSTHESIS MAXFEE NFF         945.55 1/1/2024 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         322.49 1/1/2024 12/31/2299 N
21085 PREPARE FACE/ORAL PROSTHESIS MAXFEE NFF         423.06 1/1/2024 12/31/2299 N
21086 PREPARE FACE/ORAL PROSTHESIS PRXOVR DEF         NA NA NA N
21086 PREPARE FACE/ORAL PROSTHESIS MAXFEE FAC         884.47 1/1/2024 12/31/2299 N
21086 PREPARE FACE/ORAL PROSTHESIS MAXFEE NFF         1203.52 1/1/2024 12/31/2299 N
21087 PREPARE FACE/ORAL PROSTHESIS PRXOVR DEF         NA NA NA N
21087 PREPARE FACE/ORAL PROSTHESIS MAXFEE FAC         867.89 1/1/2024 12/31/2299 N
21087 PREPARE FACE/ORAL PROSTHESIS MAXFEE NFF         1182 1/1/2024 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         213.39 1/1/2024 12/31/2299 N
21100 MAXILLOFACIAL FIXATION MAXFEE NFF         321.67 1/1/2024 12/31/2299 N
21110 INTERDENTAL FIXATION PRXOVR DEF         NA NA NA N
21110 INTERDENTAL FIXATION MAXFEE DEF         546.15 1/1/2024 12/31/2299 N
21116 INJECTION JAW JOINT X-RAY PRXOVR DEF         NA NA NA N
21116 INJECTION JAW JOINT X-RAY MAXFEE FAC         31.08 1/1/2024 12/31/2299 N
21116 INJECTION JAW JOINT X-RAY MAXFEE NFF         115.07 1/1/2024 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         283.20 1/1/2024 12/31/2299 N
21121 RECONSTRUCTION OF CHIN MAXFEE NFF         385.49 1/1/2024 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         546.15 1/1/2024 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         481.40 1/1/2024 12/31/2299 N
21138 REDUCTION OF FOREHEAD PRXOVR DEF         NA NA NA N
21138 REDUCTION OF FOREHEAD MAXFEE DEF         594.71 1/1/2024 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         898.35 1/1/2024 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         934.01 1/1/2024 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         970.36 1/1/2024 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         957.67 1/1/2024 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         993.67 1/1/2024 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         1485.98 1/1/2024 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         1346.63 1/1/2024 12/31/2299 N
21175 RECONSTRUCT ORBIT/FOREHEAD PRXOVR DEF         NA NA NA N
21175 RECONSTRUCT ORBIT/FOREHEAD MAXFEE DEF         1626.28 1/1/2024 12/31/2299 N
21179 RECONSTRUCT ENTIRE FOREHEAD PRXOVR DEF         NA NA NA N
21179 RECONSTRUCT ENTIRE FOREHEAD MAXFEE DEF         1103.91 1/1/2024 12/31/2299 N
21180 RECONSTRUCT ENTIRE FOREHEAD PRXOVR DEF         NA NA NA N
21180 RECONSTRUCT ENTIRE FOREHEAD MAXFEE DEF         1235.27 1/1/2024 12/31/2299 N
21181 CONTOUR CRANIAL BONE LESION PRXOVR DEF         NA NA NA N
21181 CONTOUR CRANIAL BONE LESION MAXFEE DEF         485.44 1/1/2024 12/31/2299 N
21182 RECONSTRUCT CRANIAL BONE PRXOVR DEF         NA NA NA N
21182 RECONSTRUCT CRANIAL BONE MAXFEE DEF         1599.78 1/1/2024 12/31/2299 N
21183 RECONSTRUCT CRANIAL BONE PRXOVR DEF         NA NA NA N
21183 RECONSTRUCT CRANIAL BONE MAXFEE DEF         1735.98 1/1/2024 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         1101.70 1/1/2024 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         827.40 1/1/2024 12/31/2299 N
21194 RECONST LWR JAW W/GRAFT PRXOVR DEF         NA NA NA N
21194 RECONST LWR JAW W/GRAFT MAXFEE DEF         968.01 1/1/2024 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         840.30 1/1/2024 12/31/2299 N
21196 RECONST LWR JAW W/FIXATION PRXOVR DEF         NA NA NA N
21196 RECONST LWR JAW W/FIXATION MAXFEE DEF         922.72 1/1/2024 12/31/2299 N
21198 RECONSTR LWR JAW SEGMENT PRXOVR DEF         NA NA NA N
21198 RECONSTR LWR JAW SEGMENT MAXFEE DEF         807.32 1/1/2024 12/31/2299 N
21199 RECONSTR LWR JAW W/ADVANCE PRXOVR DEF         NA NA NA N
21199 RECONSTR LWR JAW W/ADVANCE MAXFEE DEF         805.93 1/1/2024 12/31/2299 N
21206 RECONSTRUCT UPPER JAW BONE PRXOVR DEF         NA NA NA N
21206 RECONSTRUCT UPPER JAW BONE MAXFEE DEF         690.40 1/1/2024 12/31/2299 N
21208 AUGMENTATION OF FACIAL BONES PRXOVR DEF         NA NA NA N
21208 AUGMENTATION OF FACIAL BONES MAXFEE FAC         589.20 1/1/2024 12/31/2299 N
21208 AUGMENTATION OF FACIAL BONES MAXFEE NFF         863.77 1/1/2024 12/31/2299 N
21209 REDUCTION OF FACIAL BONES PRXOVR DEF         NA NA NA N
21209 REDUCTION OF FACIAL BONES MAXFEE FAC         316.48 1/1/2024 12/31/2299 N
21209 REDUCTION OF FACIAL BONES MAXFEE NFF         421.68 1/1/2024 12/31/2299 N
21210 FACE BONE GRAFT PRXOVR DEF         NA NA NA N
21210 FACE BONE GRAFT MAXFEE FAC         594.12 1/1/2024 12/31/2299 N
21210 FACE BONE GRAFT MAXFEE NFF         925.37 1/1/2024 12/31/2299 N
21215 LOWER JAW BONE GRAFT PRXOVR DEF         NA NA NA N
21215 LOWER JAW BONE GRAFT MAXFEE FAC         624.27 1/1/2024 12/31/2299 N
21215 LOWER JAW BONE GRAFT MAXFEE NFF         2181.75 1/1/2024 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         300.07 1/1/2024 12/31/2299 N
21235 EAR CARTILAGE GRAFT MAXFEE NFF         427.54 1/1/2024 12/31/2299 N
21240 RECONSTRUCTION OF JAW JOINT PRXOVR DEF         NA NA NA N
21240 RECONSTRUCTION OF JAW JOINT MAXFEE DEF         821.88 1/1/2024 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         704.18 1/1/2024 12/31/2299 N
21245 RECONSTRUCTION OF JAW PRXOVR DEF         NA NA NA N
21245 RECONSTRUCTION OF JAW MAXFEE FAC         469.78 1/1/2024 12/31/2299 N
21245 RECONSTRUCTION OF JAW MAXFEE NFF         660.32 1/1/2024 12/31/2299 N
21246 RECONSTRUCTION OF JAW PRXOVR DEF         NA NA NA N
21246 RECONSTRUCTION OF JAW MAXFEE DEF         604.86 1/1/2024 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         478.71 1/1/2024 12/31/2299 N
21248 RECONSTRUCTION OF JAW MAXFEE NFF         668.85 1/1/2024 12/31/2299 N
21249 RECONSTRUCTION OF JAW PRXOVR DEF         NA NA NA N
21249 RECONSTRUCTION OF JAW MAXFEE FAC         760.22 1/1/2024 12/31/2299 N
21249 RECONSTRUCTION OF JAW MAXFEE NFF         1021.81 1/1/2024 12/31/2299 N
21255 RECONSTRUCT LOWER JAW BONE PRXOVR DEF         NA NA NA N
21255 RECONSTRUCT LOWER JAW BONE MAXFEE DEF         965.25 1/1/2024 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         956.66 1/1/2024 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         1006.99 1/1/2024 12/31/2299 N
21268 REVISE EYE SOCKETS PRXOVR DEF         NA NA NA N
21268 REVISE EYE SOCKETS MAXFEE DEF         1188.58 1/1/2024 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 FAC         411.54 1/1/2024 12/31/2299 N
21270 AUGMENTATION CHEEK BONE MAXFEE NFF         539.79 1/1/2014 12/31/2299 N
21270 AUGMENTATION CHEEK BONE MAXFEE NFF         566.78 1/1/2024 12/31/2299 N
21275 REVISION ORBITOFACIAL BONES PRXOVR DEF         NA NA NA N
21275 REVISION ORBITOFACIAL BONES MAXFEE DEF         611.19 1/1/2024 12/31/2299 N
21280 REVISION OF EYELID PRXOVR DEF         NA NA NA N
21280 REVISION OF EYELID MAXFEE DEF         372.18 1/1/2024 12/31/2299 N
21282 REVISION OF EYELID PRXOVR DEF         NA NA NA N
21282 REVISION OF EYELID MAXFEE DEF         239.45 1/1/2024 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         60.21 1/1/2024 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         55.52 1/1/2024 12/31/2299 N
21320 CLSD TX NSL FX W/MNPJ&STABLJ MAXFEE NFF         116.45 1/1/2024 12/31/2299 N
21325 OPEN TX NOSE FX UNCOMPLICATD PRXOVR DEF         NA NA NA N
21325 OPEN TX NOSE FX UNCOMPLICATD MAXFEE DEF         276.45 1/1/2024 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         339.11 1/1/2024 12/31/2299 N
21335 OPEN TX NOSE & SEPTAL FX PRXOVR DEF         NA NA NA N
21335 OPEN TX NOSE & SEPTAL FX MAXFEE DEF         525.93 1/1/2024 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         360.19 1/1/2024 12/31/2299 N
21337 CLOSED TX SEPTAL&NOSE FX PRXOVR DEF         NA NA NA N
21337 CLOSED TX SEPTAL&NOSE FX MAXFEE FAC         153.65 1/1/2024 12/31/2299 N
21337 CLOSED TX SEPTAL&NOSE FX MAXFEE NFF         216.98 1/1/2024 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         452.74 1/1/2024 12/31/2299 N
21339 OPEN NASOETHMOID FX W/ FIXJ PRXOVR DEF         NA NA NA N
21339 OPEN NASOETHMOID FX W/ FIXJ MAXFEE DEF         495.06 1/1/2024 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         666.04 1/1/2024 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         865.13 1/1/2024 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 FAC         350.02 1/1/2024 12/31/2299 N
21345 CLOSED TX NOSE/JAW FX MAXFEE NFF         447.76 1/1/2014 12/31/2299 N
21345 CLOSED TX NOSE/JAW FX MAXFEE NFF         470.15 1/1/2024 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         575.17 1/1/2024 12/31/2299 N
21347 OPN TX NASOMAX FX MULTPLE PRXOVR DEF         NA NA NA N
21347 OPN TX NASOMAX FX MULTPLE MAXFEE DEF         660.47 1/1/2024 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         167.84 1/1/2024 12/31/2299 N
21355 PERQ TX MALAR FRACTURE MAXFEE NFF         229.79 1/1/2024 12/31/2299 N
21356 OPN TX DPRSD ZYGOMATIC ARCH PRXOVR DEF         NA NA NA N
21356 OPN TX DPRSD ZYGOMATIC ARCH MAXFEE FAC         207.29 1/1/2024 12/31/2299 N
21356 OPN TX DPRSD ZYGOMATIC ARCH MAXFEE NFF         280.83 1/1/2024 12/31/2299 N
21360 OPN TX DPRSD MALAR FRACTURE PRXOVR DEF         NA NA NA N
21360 OPN TX DPRSD MALAR FRACTURE MAXFEE DEF         394.33 1/1/2024 12/31/2299 N
21365 OPN TX COMPLX MALAR FX PRXOVR DEF         NA NA NA N
21365 OPN TX COMPLX MALAR FX MAXFEE DEF         780.78 1/1/2024 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         860.53 1/1/2024 12/31/2299 N
21385 OPN TX ORBIT FX TRANSANTRAL PRXOVR DEF         NA NA NA N
21385 OPN TX ORBIT FX TRANSANTRAL MAXFEE DEF         528.14 1/1/2024 12/31/2299 N
21386 OPN TX ORBIT FX PERIORBITAL PRXOVR DEF         NA NA NA N
21386 OPN TX ORBIT FX PERIORBITAL MAXFEE DEF         528.26 1/1/2024 12/31/2299 N
21387 OPN TX ORBIT FX COMBINED PRXOVR DEF         NA NA NA N
21387 OPN TX ORBIT FX COMBINED MAXFEE DEF         505.17 1/1/2024 12/31/2299 N
21390 OPN TX ORBIT PERIORBTL IMPLT PRXOVR DEF         NA NA NA N
21390 OPN TX ORBIT PERIORBTL IMPLT MAXFEE DEF         611.23 1/1/2024 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         653.81 1/1/2024 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         84.44 1/1/2024 12/31/2299 N
21400 CLOSED TX ORBIT W/O MANIPULJ MAXFEE NFF         108.49 1/1/2024 12/31/2299 N
21401 CLOSED TX ORBIT W/MANIPULJ PRXOVR DEF         NA NA NA N
21401 CLOSED TX ORBIT W/MANIPULJ MAXFEE FAC         167.67 1/1/2024 12/31/2299 N
21401 CLOSED TX ORBIT W/MANIPULJ MAXFEE NFF         263.36 1/1/2024 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         366.35 1/1/2024 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         459.15 1/1/2024 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         603.88 1/1/2024 12/31/2299 N
21421 TREAT MOUTH ROOF FRACTURE PRXOVR DEF         NA NA NA N
21421 TREAT MOUTH ROOF FRACTURE MAXFEE FAC         280.49 1/1/2024 12/31/2299 N
21421 TREAT MOUTH ROOF FRACTURE MAXFEE NFF         333.09 1/1/2024 12/31/2299 N
21422 TREAT MOUTH ROOF FRACTURE PRXOVR DEF         NA NA NA N
21422 TREAT MOUTH ROOF FRACTURE MAXFEE DEF         496.59 1/1/2024 12/31/2299 N
21423 TREAT MOUTH ROOF FRACTURE PRXOVR DEF         NA NA NA N
21423 TREAT MOUTH ROOF FRACTURE MAXFEE DEF         569.86 1/1/2024 12/31/2299 N
21431 TREAT CRANIOFACIAL FRACTURE PRXOVR DEF         NA NA NA N
21431 TREAT CRANIOFACIAL FRACTURE MAXFEE DEF         393.83 1/1/2024 12/31/2299 N
21432 TREAT CRANIOFACIAL FRACTURE PRXOVR DEF         NA NA NA N
21432 TREAT CRANIOFACIAL FRACTURE MAXFEE DEF         435.38 1/1/2024 12/31/2299 N
21433 TREAT CRANIOFACIAL FRACTURE PRXOVR DEF         NA NA NA N
21433 TREAT CRANIOFACIAL FRACTURE MAXFEE DEF         1232.77 1/1/2024 12/31/2299 N
21435 TREAT CRANIOFACIAL FRACTURE PRXOVR DEF         NA NA NA N
21435 TREAT CRANIOFACIAL FRACTURE MAXFEE DEF         874.97 1/1/2024 12/31/2299 N
21436 TREAT CRANIOFACIAL FRACTURE PRXOVR DEF         NA NA NA N
21436 TREAT CRANIOFACIAL FRACTURE MAXFEE DEF         1227.69 1/1/2024 12/31/2299 N
21440 TREAT DENTAL RIDGE FRACTURE PRXOVR DEF         NA NA NA N
21440 TREAT DENTAL RIDGE FRACTURE MAXFEE FAC         288.27 1/1/2024 12/31/2299 N
21440 TREAT DENTAL RIDGE FRACTURE MAXFEE NFF         359.39 1/1/2024 12/31/2299 N
21445 TREAT DENTAL RIDGE FRACTURE PRXOVR DEF         NA NA NA N
21445 TREAT DENTAL RIDGE FRACTURE MAXFEE FAC         336.55 1/1/2024 12/31/2299 N
21445 TREAT DENTAL RIDGE FRACTURE MAXFEE NFF         418.05 1/1/2024 12/31/2299 N
21450 TREAT LOWER JAW FRACTURE PRXOVR DEF         NA NA NA N
21450 TREAT LOWER JAW FRACTURE MAXFEE FAC         250.90 1/1/2024 12/31/2299 N
21450 TREAT LOWER JAW FRACTURE MAXFEE NFF         309.55 1/1/2024 12/31/2299 N
21451 TREAT LOWER JAW FRACTURE PRXOVR DEF         NA NA NA N
21451 TREAT LOWER JAW FRACTURE MAXFEE FAC         334.64 1/1/2024 12/31/2299 N
21451 TREAT LOWER JAW FRACTURE MAXFEE NFF         401.43 1/1/2024 12/31/2299 N
21452 TREAT LOWER JAW FRACTURE PRXOVR DEF         NA NA NA N
21452 TREAT LOWER JAW FRACTURE MAXFEE FAC         243.11 1/1/2024 12/31/2299 N
21452 TREAT LOWER JAW FRACTURE MAXFEE NFF         394.34 1/1/2024 12/31/2299 N
21453 TREAT LOWER JAW FRACTURE PRXOVR DEF         NA NA NA N
21453 TREAT LOWER JAW FRACTURE MAXFEE FAC         486.39 1/1/2024 12/31/2299 N
21453 TREAT LOWER JAW FRACTURE MAXFEE NFF         571.87 1/1/2024 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         548.34 1/1/2024 12/31/2299 N
21461 TREAT LOWER JAW FRACTURE MAXFEE NFF         984.08 1/1/2024 12/31/2299 N
21462 TREAT LOWER JAW FRACTURE PRXOVR DEF         NA NA NA N
21462 TREAT LOWER JAW FRACTURE MAXFEE FAC         611.15 1/1/2024 12/31/2299 N
21462 TREAT LOWER JAW FRACTURE MAXFEE NFF         1050.65 1/1/2024 12/31/2299 N
21465 TREAT LOWER JAW FRACTURE PRXOVR DEF         NA NA NA N
21465 TREAT LOWER JAW FRACTURE MAXFEE DEF         576.70 1/1/2024 12/31/2299 N
21470 TREAT LOWER JAW FRACTURE PRXOVR DEF         NA NA NA N
21470 TREAT LOWER JAW FRACTURE MAXFEE DEF         876.96 1/1/2024 12/31/2299 N
21480 RESET DISLOCATED JAW PRXOVR DEF         NA NA NA N
21480 RESET DISLOCATED JAW MAXFEE FAC         20.50 1/1/2024 12/31/2299 N
21480 RESET DISLOCATED JAW MAXFEE NFF         73.02 1/1/2024 12/31/2299 N
21485 RESET DISLOCATED JAW PRXOVR DEF         NA NA NA N
21485 RESET DISLOCATED JAW MAXFEE FAC         415.97 1/1/2024 12/31/2299 N
21485 RESET DISLOCATED JAW MAXFEE NFF         509.92 1/1/2024 12/31/2299 N
21490 REPAIR DISLOCATED JAW PRXOVR DEF         NA NA NA N
21490 REPAIR DISLOCATED JAW MAXFEE DEF         524.55 1/1/2024 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         500.98 1/1/2024 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         171.30 1/1/2024 12/31/2299 N
21501 DRAIN NECK/CHEST LESION MAXFEE NFF         252.28 1/1/2024 12/31/2299 N
21502 DRAIN CHEST LESION PRXOVR DEF         NA NA NA N
21502 DRAIN CHEST LESION MAXFEE DEF         354.15 1/1/2024 12/31/2299 N
21510 DRAINAGE OF BONE LESION PRXOVR DEF         NA NA NA N
21510 DRAINAGE OF BONE LESION MAXFEE DEF         289.41 1/1/2024 12/31/2299 N
21550 BIOPSY OF NECK/CHEST PRXOVR DEF         NA NA NA N
21550 BIOPSY OF NECK/CHEST MAXFEE FAC         79.60 1/1/2024 12/31/2299 N
21550 BIOPSY OF NECK/CHEST MAXFEE NFF         138.77 1/1/2024 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         259.27 1/1/2024 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         426.54 1/1/2024 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         157.81 1/1/2024 12/31/2299 N
21555 EXC NECK LES SC < 3 CM MAXFEE NFF         226.33 1/1/2024 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         273.39 1/1/2024 12/31/2299 N
21557 RESECT NECK THORAX TUMOR<5CM PRXOVR DEF         NA NA NA N
21557 RESECT NECK THORAX TUMOR<5CM MAXFEE DEF         502.27 1/1/2024 12/31/2299 N
21558 RESECT NECK TUMOR 5 CM/> PRXOVR DEF         NA NA NA N
21558 RESECT NECK TUMOR 5 CM/> MAXFEE DEF         802.42 1/1/2024 12/31/2299 N
21600 PARTIAL REMOVAL OF RIB PRXOVR DEF         NA NA NA N
21600 PARTIAL REMOVAL OF RIB MAXFEE DEF         361.50 1/1/2024 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         620.15 1/1/2024 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         371.40 1/1/2024 12/31/2299 N
21630 EXTENSIVE STERNUM SURGERY PRXOVR DEF         NA NA NA N
21630 EXTENSIVE STERNUM SURGERY MAXFEE DEF         903.88 1/1/2024 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         660.43 1/1/2024 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         291.75 1/1/2024 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         769.46 1/1/2024 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         546.42 1/1/2024 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         448.68 1/1/2024 12/31/2299 N
21811 OPTX OF RIB FX W/FIXJ SCOPE MAXFEE NFF         463.58 1/1/2024 12/31/2299 N
21812 TREATMENT OF RIB FRACTURE PRXOVR DEF         NA NA NA N
21812 TREATMENT OF RIB FRACTURE MAXFEE FAC         536.94 1/1/2024 12/31/2299 N
21812 TREATMENT OF RIB FRACTURE MAXFEE NFF         551.85 1/1/2024 12/31/2299 N
21813 TREATMENT OF RIB FRACTURE PRXOVR DEF         NA NA NA N
21813 TREATMENT OF RIB FRACTURE MAXFEE FAC         733.01 1/1/2024 12/31/2299 N
21813 TREATMENT OF RIB FRACTURE MAXFEE NFF         744.60 1/1/2024 12/31/2299 N
21820 TREAT STERNUM FRACTURE PRXOVR DEF         NA NA NA N
21820 TREAT STERNUM FRACTURE MAXFEE FAC         75.44 1/1/2024 12/31/2299 N
21820 TREAT STERNUM FRACTURE MAXFEE NFF         79.12 1/1/2024 12/31/2299 N
21825 TREAT STERNUM FRACTURE PRXOVR DEF         NA NA NA N
21825 TREAT STERNUM FRACTURE MAXFEE DEF         423.93 1/1/2024 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         87.44 1/1/2024 12/31/2299 N
21920 BIOPSY SOFT TISSUE OF BACK MAXFEE NFF         134.27 1/1/2024 12/31/2299 N
21925 BIOPSY SOFT TISSUE OF BACK PRXOVR DEF         NA NA NA N
21925 BIOPSY SOFT TISSUE OF BACK MAXFEE FAC         193.97 1/1/2024 12/31/2299 N
21925 BIOPSY SOFT TISSUE OF BACK MAXFEE NFF         256.61 1/1/2024 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         187.22 1/1/2024 12/31/2299 N
21930 EXC BACK LES SC < 3 CM MAXFEE NFF         261.63 1/1/2024 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         271.94 1/1/2024 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         391.10 1/1/2024 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         432.15 1/1/2024 12/31/2299 N
21935 RESECT BACK TUM < 5 CM PRXOVR DEF         NA NA NA N
21935 RESECT BACK TUM < 5 CM MAXFEE DEF         727.06 1/1/2024 12/31/2299 N
21936 RESECT BACK TUM 5 CM/> PRXOVR DEF         NA NA NA N
21936 RESECT BACK TUM 5 CM/> MAXFEE DEF         837.60 1/1/2024 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         599.70 1/1/2024 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         594.57 1/1/2024 12/31/2299 N
22100 REMOVE PART OF NECK VERTEBRA PRXOVR DEF         NA NA NA N
22100 REMOVE PART OF NECK VERTEBRA MAXFEE DEF         498.46 1/1/2024 12/31/2299 N
22101 REMOVE PART THORAX VERTEBRA PRXOVR DEF         NA NA NA N
22101 REMOVE PART THORAX VERTEBRA MAXFEE DEF         516.11 1/1/2024 12/31/2299 N
22102 REMOVE PART LUMBAR VERTEBRA PRXOVR DEF         NA NA NA N
22102 REMOVE PART LUMBAR VERTEBRA MAXFEE DEF         452.99 1/1/2024 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         650.51 1/1/2024 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         597.90 1/1/2024 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         1492.38 1/1/2024 12/31/2299 N
22207 INCIS SPINE 3 COLUMN LUMBAR PRXOVR DEF         NA NA NA N
22207 INCIS SPINE 3 COLUMN LUMBAR MAXFEE DEF         1472.96 1/1/2024 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         380.13 1/1/2024 12/31/2299 N
22210 INCIS 1 VERTEBRAL SEG CERV PRXOVR DEF         NA NA NA N
22210 INCIS 1 VERTEBRAL SEG CERV MAXFEE DEF         1093.81 1/1/2024 12/31/2299 N
22212 INCIS 1 VERTEBRAL SEG THORAC PRXOVR DEF         NA NA NA N
22212 INCIS 1 VERTEBRAL SEG THORAC MAXFEE DEF         1043.49 1/1/2024 12/31/2299 N
22214 INCIS 1 VERTEBRAL SEG LUMBAR PRXOVR DEF         NA NA NA N
22214 INCIS 1 VERTEBRAL SEG LUMBAR MAXFEE DEF         997.15 1/1/2024 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         1081.23 1/1/2024 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         970.21 1/1/2024 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         1047.80 1/1/2024 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         152.96 1/1/2024 12/31/2299 N
22310 CLOSED TX VERT FX W/O MANJ MAXFEE NFF         160.23 1/1/2024 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         395.90 1/1/2024 12/31/2299 N
22315 CLOSED TX VERT FX W/MANJ MAXFEE NFF         453.34 1/1/2024 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         1126.81 1/1/2024 12/31/2299 N
22319 TREAT ODONTOID FX W/GRAFT PRXOVR DEF         NA NA NA N
22319 TREAT ODONTOID FX W/GRAFT MAXFEE DEF         1272.13 1/1/2024 12/31/2299 N
22325 TREAT SPINE FRACTURE PRXOVR DEF         NA NA NA N
22325 TREAT SPINE FRACTURE MAXFEE DEF         787.04 1/1/2024 12/31/2299 N
22326 TREAT NECK SPINE FRACTURE PRXOVR DEF         NA NA NA N
22326 TREAT NECK SPINE FRACTURE MAXFEE DEF         1019.58 1/1/2024 12/31/2299 N
22327 TREAT THORAX SPINE FRACTURE PRXOVR DEF         NA NA NA N
22327 TREAT THORAX SPINE FRACTURE MAXFEE DEF         997.19 1/1/2024 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         99.40 1/1/2024 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         1373.12 1/1/2024 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         1358.92 1/1/2024 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         3199.34 1/1/2024 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         1163.16 1/1/2024 12/31/2299 N
22533 ARTHRD LAT XTRCVTRY TQ LMBR PRXOVR DEF         NA NA NA N
22533 ARTHRD LAT XTRCVTRY TQ LMBR MAXFEE DEF         1085.69 1/1/2024 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         275.02 1/1/2024 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         1374.27 1/1/2024 12/31/2299 N
22551 ARTHRD ANT NTRBDY CERVICAL PRXOVR DEF         NA NA NA N
22551 ARTHRD ANT NTRBDY CERVICAL MAXFEE DEF         1193.41 1/1/2024 12/31/2299 N
22552 ARTHRD ANT NTRBD CERVICAL EA PRXOVR DEF         NA NA NA N
22552 ARTHRD ANT NTRBD CERVICAL EA MAXFEE DEF         278.74 1/1/2024 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         1273.84 1/1/2024 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         1198.47 1/1/2024 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         1148.18 1/1/2024 12/31/2299 N
22590 ARTHRD PST TQ CRANIOCERVICAL PRXOVR DEF         NA NA NA N
22590 ARTHRD PST TQ CRANIOCERVICAL MAXFEE DEF         1179.23 1/1/2024 12/31/2299 N
22595 ARTHRD PST TQ ATLAS-AXIS PRXOVR DEF         NA NA NA N
22595 ARTHRD PST TQ ATLAS-AXIS MAXFEE DEF         1148.56 1/1/2024 12/31/2299 N
22600 ARTHRD PST TQ 1NTRSPC CRV PRXOVR DEF         NA NA NA N
22600 ARTHRD PST TQ 1NTRSPC CRV MAXFEE DEF         961.96 1/1/2024 12/31/2299 N
22610 ARTHRD PST TQ 1NTRSPC THRC PRXOVR DEF         NA NA NA N
22610 ARTHRD PST TQ 1NTRSPC THRC MAXFEE DEF         944.65 1/1/2024 12/31/2299 N
22612 ARTHRD PST TQ 1NTRSPC LUMBAR PRXOVR DEF         NA NA NA N
22612 ARTHRD PST TQ 1NTRSPC LUMBAR MAXFEE DEF         1172.57 1/1/2024 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         1120.74 1/1/2024 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         949.77 1/1/2024 12/31/2299 N
22634 ARTHRD CMBN 1NTRSPC EA ADDL PRXOVR DEF         NA NA NA N
22634 ARTHRD CMBN 1NTRSPC EA ADDL MAXFEE DEF         253.32 1/1/2024 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         1083.45 1/1/2024 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         1667.99 1/1/2024 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         1831.60 1/1/2024 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         1283.56 1/1/2024 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         1402.47 1/1/2024 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         1682.82 1/1/2024 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         653.50 1/1/2024 12/31/2299 N
22836 ANT THRC VRT BODY TETHRG <7 PRXOVR DEF         NA NA NA N
22836 ANT THRC VRT BODY TETHRG <7 MAXFEE DEF         1310.77 1/1/2024 12/31/2299 N
22840 INSERT SPINE FIXATION DEVICE PRXOVR DEF         NA NA NA N
22840 INSERT SPINE FIXATION DEVICE MAXFEE DEF         468.81 1/1/2024 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         469.08 1/1/2024 12/31/2299 N
22843 INSERT SPINE FIXATION DEVICE PRXOVR DEF         NA NA NA N
22843 INSERT SPINE FIXATION DEVICE MAXFEE DEF         585.02 1/1/2024 12/31/2299 N
22844 INSERT SPINE FIXATION DEVICE PRXOVR DEF         NA NA NA N
22844 INSERT SPINE FIXATION DEVICE MAXFEE DEF         714.88 1/1/2024 12/31/2299 N
22845 INSERT SPINE FIXATION DEVICE PRXOVR DEF         NA NA NA N
22845 INSERT SPINE FIXATION DEVICE MAXFEE DEF         449.31 1/1/2024 12/31/2299 N
22846 INSERT SPINE FIXATION DEVICE PRXOVR DEF         NA NA NA N
22846 INSERT SPINE FIXATION DEVICE MAXFEE DEF         540.17 1/1/2024 12/31/2299 N
22847 INSERT SPINE FIXATION DEVICE PRXOVR DEF         NA NA NA N
22847 INSERT SPINE FIXATION DEVICE MAXFEE DEF         600.18 1/1/2024 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         822.60 1/1/2024 12/31/2299 N
22850 REMOVE SPINE FIXATION DEVICE PRXOVR DEF         NA NA NA N
22850 REMOVE SPINE FIXATION DEVICE MAXFEE DEF         535.68 1/1/2024 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         535.84 1/1/2024 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         633.09 1/1/2024 12/31/2299 N
22856 TOT DISC ARTHRP 1NTRSPC CRV PRXOVR DEF         NA NA NA N
22856 TOT DISC ARTHRP 1NTRSPC CRV MAXFEE DEF         1283.71 1/1/2024 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         516.67 1/1/2024 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         1551.52 1/1/2024 12/31/2299 N
22864 RMVL TOT ARTHRP 1NTRSPC CRV PRXOVR DEF         NA NA NA N
22864 RMVL TOT ARTHRP 1NTRSPC CRV MAXFEE DEF         1454.81 1/1/2024 12/31/2299 N
22867 INSJ STABLJ DEV W/DCMPRN PRXOVR DEF         NA NA NA N
22867 INSJ STABLJ DEV W/DCMPRN MAXFEE DEF         833.91 1/1/2024 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         291.73 1/1/2024 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         385.76 1/1/2024 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         172.17 1/1/2024 12/31/2299 N
22902 EXC ABD LES SC < 3 CM MAXFEE NFF         246.92 1/1/2024 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         253.55 1/1/2024 12/31/2299 N
22904 RADICAL RESECT ABD TUMOR<5CM PRXOVR DEF         NA NA NA N
22904 RADICAL RESECT ABD TUMOR<5CM MAXFEE DEF         606.69 1/1/2024 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         786.18 1/1/2024 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         190.34 1/1/2024 12/31/2299 N
23000 REMOVAL OF CALCIUM DEPOSITS MAXFEE NFF         299.52 1/1/2024 12/31/2299 N
23020 RELEASE SHOULDER JOINT PRXOVR DEF         NA NA NA N
23020 RELEASE SHOULDER JOINT MAXFEE DEF         475.19 1/1/2024 12/31/2299 N
23030 DRAIN SHOULDER LESION PRXOVR DEF         NA NA NA N
23030 DRAIN SHOULDER LESION MAXFEE FAC         131.33 1/1/2024 12/31/2299 N
23030 DRAIN SHOULDER LESION MAXFEE NFF         230.48 1/1/2024 12/31/2299 N
23031 DRAIN SHOULDER BURSA PRXOVR DEF         NA NA NA N
23031 DRAIN SHOULDER BURSA MAXFEE FAC         112.65 1/1/2024 12/31/2299 N
23031 DRAIN SHOULDER BURSA MAXFEE NFF         221.48 1/1/2024 12/31/2299 N
23035 DRAIN SHOULDER BONE LESION PRXOVR DEF         NA NA NA N
23035 DRAIN SHOULDER BONE LESION MAXFEE DEF         466.47 1/1/2024 12/31/2299 N
23040 EXPLORATORY SHOULDER SURGERY PRXOVR DEF         NA NA NA N
23040 EXPLORATORY SHOULDER SURGERY MAXFEE DEF         541.20 1/1/2024 12/31/2299 N
23044 EXPLORATORY SHOULDER SURGERY PRXOVR DEF         NA NA NA N
23044 EXPLORATORY SHOULDER SURGERY MAXFEE DEF         419.24 1/1/2024 12/31/2299 N
23065 BIOPSY SHOULDER TISSUES PRXOVR DEF         NA NA NA N
23065 BIOPSY SHOULDER TISSUES MAXFEE FAC         82.02 1/1/2024 12/31/2299 N
23065 BIOPSY SHOULDER TISSUES MAXFEE NFF         117.14 1/1/2024 12/31/2299 N
23066 BIOPSY SHOULDER TISSUES PRXOVR DEF         NA NA NA N
23066 BIOPSY SHOULDER TISSUES MAXFEE FAC         187.74 1/1/2024 12/31/2299 N
23066 BIOPSY SHOULDER TISSUES MAXFEE NFF         293.12 1/1/2024 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         241.03 1/1/2024 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         400.46 1/1/2024 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         169.75 1/1/2024 12/31/2299 N
23075 EXC SHOULDER LES SC < 3 CM MAXFEE NFF         271.49 1/1/2024 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         336.70 1/1/2024 12/31/2299 N
23077 RESECT SHOULDER TUMOR < 5 CM PRXOVR DEF         NA NA NA N
23077 RESECT SHOULDER TUMOR < 5 CM MAXFEE DEF         696.87 1/1/2024 12/31/2299 N
23078 RESECT SHOULDER TUMOR 5 CM/> PRXOVR DEF         NA NA NA N
23078 RESECT SHOULDER TUMOR 5 CM/> MAXFEE DEF         818.30 1/1/2024 12/31/2299 N
23100 BIOPSY OF SHOULDER JOINT PRXOVR DEF         NA NA NA N
23100 BIOPSY OF SHOULDER JOINT MAXFEE DEF         376.94 1/1/2024 12/31/2299 N
23101 SHOULDER JOINT SURGERY PRXOVR DEF         NA NA NA N
23101 SHOULDER JOINT SURGERY MAXFEE DEF         350.94 1/1/2024 12/31/2299 N
23105 REMOVE SHOULDER JOINT LINING PRXOVR DEF         NA NA NA N
23105 REMOVE SHOULDER JOINT LINING MAXFEE DEF         505.66 1/1/2024 12/31/2299 N
23106 INCISION OF COLLARBONE JOINT PRXOVR DEF         NA NA NA N
23106 INCISION OF COLLARBONE JOINT MAXFEE DEF         322.75 1/1/2024 12/31/2299 N
23107 EXPLORE TREAT SHOULDER JOINT PRXOVR DEF         NA NA NA N
23107 EXPLORE TREAT SHOULDER JOINT MAXFEE DEF         524.58 1/1/2024 12/31/2299 N
23120 PARTIAL REMOVAL COLLAR BONE PRXOVR DEF         NA NA NA N
23120 PARTIAL REMOVAL COLLAR BONE MAXFEE DEF         357.62 1/1/2024 12/31/2299 N
23125 REMOVAL OF COLLAR BONE PRXOVR DEF         NA NA NA N
23125 REMOVAL OF COLLAR BONE MAXFEE DEF         516.09 1/1/2024 12/31/2299 N
23130 REMOVE SHOULDER BONE PART PRXOVR DEF         NA NA NA N
23130 REMOVE SHOULDER BONE PART MAXFEE DEF         431.41 1/1/2024 12/31/2299 N
23140 REMOVAL OF BONE LESION PRXOVR DEF         NA NA NA N
23140 REMOVAL OF BONE LESION MAXFEE DEF         330.82 1/1/2024 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         443.52 1/1/2024 12/31/2299 N
23155 REMOVAL OF HUMERUS LESION PRXOVR DEF         NA NA NA N
23155 REMOVAL OF HUMERUS LESION MAXFEE DEF         559.40 1/1/2024 12/31/2299 N
23156 REMOVAL OF HUMERUS LESION PRXOVR DEF         NA NA NA N
23156 REMOVAL OF HUMERUS LESION MAXFEE DEF         477.70 1/1/2024 12/31/2299 N
23170 REMOVE COLLAR BONE LESION PRXOVR DEF         NA NA NA N
23170 REMOVE COLLAR BONE LESION MAXFEE DEF         354.88 1/1/2024 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         532.48 1/1/2024 12/31/2299 N
23180 REMOVE COLLAR BONE LESION PRXOVR DEF         NA NA NA N
23180 REMOVE COLLAR BONE LESION MAXFEE DEF         413.73 1/1/2024 12/31/2299 N
23182 REMOVE SHOULDER BLADE LESION PRXOVR DEF         NA NA NA N
23182 REMOVE SHOULDER BLADE LESION MAXFEE DEF         464.65 1/1/2024 12/31/2299 N
23184 REMOVE HUMERUS LESION PRXOVR DEF         NA NA NA N
23184 REMOVE HUMERUS LESION MAXFEE DEF         560.43 1/1/2024 12/31/2299 N
23190 PARTIAL REMOVAL OF SCAPULA PRXOVR DEF         NA NA NA N
23190 PARTIAL REMOVAL OF SCAPULA MAXFEE DEF         390.93 1/1/2024 12/31/2299 N
23195 REMOVAL OF HEAD OF HUMERUS PRXOVR DEF         NA NA NA N
23195 REMOVAL OF HEAD OF HUMERUS MAXFEE DEF         543.20 1/1/2024 12/31/2299 N
23200 RESECT CLAVICLE TUMOR PRXOVR DEF         NA NA NA N
23200 RESECT CLAVICLE TUMOR MAXFEE DEF         770.68 1/1/2024 12/31/2299 N
23210 RESECT SCAPULA TUMOR PRXOVR DEF         NA NA NA N
23210 RESECT SCAPULA TUMOR MAXFEE DEF         904.09 1/1/2024 12/31/2299 N
23220 RESECT PROX HUMERUS TUMOR PRXOVR DEF         NA NA NA N
23220 RESECT PROX HUMERUS TUMOR MAXFEE DEF         992.34 1/1/2024 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         85.65 1/1/2024 12/31/2299 N
23330 REMOVE SHOULDER FOREIGN BODY MAXFEE NFF         156.94 1/1/2024 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         362.37 1/1/2024 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         25.27 1/1/2024 12/31/2299 N
23350 INJECTION FOR SHOULDER X-RAY MAXFEE NFF         87.73 1/1/2024 12/31/2299 N
23395 MUSCLE TRANSFER SHOULDER/ARM PRXOVR DEF         NA NA NA N
23395 MUSCLE TRANSFER SHOULDER/ARM MAXFEE DEF         785.56 1/1/2024 12/31/2299 N
23397 MUSCLE TRANSFERS PRXOVR DEF         NA NA NA N
23397 MUSCLE TRANSFERS MAXFEE DEF         863.69 1/1/2024 12/31/2299 N
23400 FIXATION OF SHOULDER BLADE PRXOVR DEF         NA NA NA N
23400 FIXATION OF SHOULDER BLADE MAXFEE DEF         680.31 1/1/2024 12/31/2299 N
23405 INCISION OF TENDON & MUSCLE PRXOVR DEF         NA NA NA N
23405 INCISION OF TENDON & MUSCLE MAXFEE DEF         454.72 1/1/2024 12/31/2299 N
23406 INCISE TENDON(S) & MUSCLE(S) PRXOVR DEF         NA NA NA N
23406 INCISE TENDON(S) & MUSCLE(S) MAXFEE DEF         587.99 1/1/2024 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         453.11 1/1/2024 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         511.88 1/1/2024 12/31/2299 N
23440 REMOVE/TRANSPLANT TENDON PRXOVR DEF         NA NA NA N
23440 REMOVE/TRANSPLANT TENDON MAXFEE DEF         524.02 1/1/2024 12/31/2299 N
23450 REPAIR SHOULDER CAPSULE PRXOVR DEF         NA NA NA N
23450 REPAIR SHOULDER CAPSULE MAXFEE DEF         748.34 1/1/2024 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         840.95 1/1/2024 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         857.40 1/1/2024 12/31/2299 N
23466 REPAIR SHOULDER CAPSULE PRXOVR DEF         NA NA NA N
23466 REPAIR SHOULDER CAPSULE MAXFEE DEF         847.98 1/1/2024 12/31/2299 N
23470 RECONSTRUCT SHOULDER JOINT PRXOVR DEF         NA NA NA N
23470 RECONSTRUCT SHOULDER JOINT MAXFEE DEF         961.92 1/1/2024 12/31/2299 N
23472 RECONSTRUCT SHOULDER JOINT PRXOVR DEF         NA NA NA N
23472 RECONSTRUCT SHOULDER JOINT MAXFEE DEF         1045.09 1/1/2024 12/31/2299 N
23473 REVIS RECONST SHOULDER JOINT PRXOVR DEF         NA NA NA N
23473 REVIS RECONST SHOULDER JOINT MAXFEE DEF         1197.09 1/1/2024 12/31/2299 N
23474 REVIS RECONST SHOULDER JOINT PRXOVR DEF         NA NA NA N
23474 REVIS RECONST SHOULDER JOINT MAXFEE DEF         1294.22 1/1/2024 12/31/2299 N
23480 REVISION OF COLLAR BONE PRXOVR DEF         NA NA NA N
23480 REVISION OF COLLAR BONE MAXFEE DEF         526.87 1/1/2024 12/31/2299 N
23485 REVISION OF COLLAR BONE PRXOVR DEF         NA NA NA N
23485 REVISION OF COLLAR BONE MAXFEE DEF         718.45 1/1/2024 12/31/2299 N
23490 REINFORCE CLAVICLE PRXOVR DEF         NA NA NA N
23490 REINFORCE CLAVICLE MAXFEE DEF         615.79 1/1/2024 12/31/2299 N
23491 REINFORCE SHOULDER BONES PRXOVR DEF         NA NA NA N
23491 REINFORCE SHOULDER BONES MAXFEE DEF         773.60 1/1/2024 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         108.18 1/1/2024 12/31/2299 N
23500 CLTX CLAVICULAR FX W/O MNPJ MAXFEE NFF         115.76 1/1/2024 12/31/2299 N
23505 CLTX CLAVICULAR FX W/MNPJ PRXOVR DEF         NA NA NA N
23505 CLTX CLAVICULAR FX W/MNPJ MAXFEE FAC         184.37 1/1/2024 12/31/2299 N
23505 CLTX CLAVICULAR FX W/MNPJ MAXFEE NFF         191.55 1/1/2024 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         415.39 1/1/2024 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         123.72 1/1/2024 12/31/2299 N
23520 CLTX STRNCLAV DISLC W/O MNPJ MAXFEE NFF         125.45 1/1/2024 12/31/2299 N
23525 CLTX STRNCLAV DISLC W/MNPJ PRXOVR DEF         NA NA NA N
23525 CLTX STRNCLAV DISLC W/MNPJ MAXFEE FAC         188.61 1/1/2024 12/31/2299 N
23525 CLTX STRNCLAV DISLC W/MNPJ MAXFEE NFF         206.08 1/1/2024 12/31/2299 N
23530 OPTX STRNCLAV DISLC AQT/CHRN PRXOVR DEF         NA NA NA N
23530 OPTX STRNCLAV DISLC AQT/CHRN MAXFEE DEF         396.65 1/1/2024 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         439.39 1/1/2024 12/31/2299 N
23540 CLTX ACROMCLAV DISLC WO MNPJ PRXOVR DEF         NA NA NA N
23540 CLTX ACROMCLAV DISLC WO MNPJ MAXFEE FAC         122.51 1/1/2024 12/31/2299 N
23540 CLTX ACROMCLAV DISLC WO MNPJ MAXFEE NFF         124.41 1/1/2024 12/31/2299 N
23545 CLTX ACROMCLAV DISLC W/MNPJ PRXOVR DEF         NA NA NA N
23545 CLTX ACROMCLAV DISLC W/MNPJ MAXFEE FAC         164.38 1/1/2024 12/31/2299 N
23545 CLTX ACROMCLAV DISLC W/MNPJ MAXFEE NFF         183.07 1/1/2024 12/31/2299 N
23550 OPTX ACROMCLV DISLC AQT/CHRN PRXOVR DEF         NA NA NA N
23550 OPTX ACROMCLV DISLC AQT/CHRN MAXFEE DEF         439.35 1/1/2024 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         456.03 1/1/2024 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         122.34 1/1/2024 12/31/2299 N
23570 CLTX SCAPULAR FX W/O MNPJ MAXFEE NFF         125.97 1/1/2024 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         197.60 1/1/2024 12/31/2299 N
23575 CLTX SCAP FX W/MNPJ +-TRACTJ MAXFEE NFF         213.87 1/1/2024 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         503 1/1/2024 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         173.86 1/1/2024 12/31/2299 N
23600 CLTX PROX HUMRL FX W/O MNPJ MAXFEE NFF         179.40 1/1/2024 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         267.44 1/1/2024 12/31/2299 N
23605 CLTX PRX HMRL FX MNPJ+-TRACT MAXFEE NFF         292.12 1/1/2024 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         564.89 1/1/2024 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         161.07 1/1/2024 12/31/2299 N
23620 CLTX GR HMRL TBRS FX WO MNPJ MAXFEE NFF         163.46 1/1/2024 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         203.75 1/1/2024 12/31/2299 N
23625 CLTX GR HMRL TBRS FX W/MNPJ MAXFEE NFF         238.75 1/1/2024 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         444.62 1/1/2024 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         157.80 1/1/2024 12/31/2299 N
23650 CLTX SHO DSLC W/MNPJ WO ANES MAXFEE NFF         170.27 1/1/2024 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         216.36 1/1/2024 12/31/2299 N
23660 OPTX ACUTE SHOULDER DISLC PRXOVR DEF         NA NA NA N
23660 OPTX ACUTE SHOULDER DISLC MAXFEE DEF         448.61 1/1/2024 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         227.75 1/1/2024 12/31/2299 N
23665 CLTX SHO DSLC FX GR HMRL TBR MAXFEE NFF         242.26 1/1/2024 12/31/2299 N
23670 OPTX SHO DISLC FX PRXOVR DEF         NA NA NA N
23670 OPTX SHO DISLC FX MAXFEE DEF         485.66 1/1/2024 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         259.55 1/1/2024 12/31/2299 N
23675 CLTX SHO DISLC NECK FX MNPJ MAXFEE NFF         304.34 1/1/2024 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         606.72 1/1/2024 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         936.42 1/1/2024 12/31/2299 N
23920 DISARTICULATION SHOULDER PRXOVR DEF         NA NA NA N
23920 DISARTICULATION SHOULDER MAXFEE DEF         815.99 1/1/2024 12/31/2299 N
23921 DISARTICULATION SHO SEC CLSR PRXOVR DEF         NA NA NA N
23921 DISARTICULATION SHO SEC CLSR MAXFEE DEF         293.34 1/1/2024 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         110.74 1/1/2024 12/31/2299 N
23930 I&D UPR A/E DP ABSC/HMTMA MAXFEE NFF         188.78 1/1/2024 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         82.37 1/1/2024 12/31/2299 N
23931 I&D UPR A/E BURSA MAXFEE NFF         158.50 1/1/2024 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         341.47 1/1/2024 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         359.39 1/1/2024 12/31/2299 N
24006 ARTHRT ELBW CAPSL EXC RLS PRXOVR DEF         NA NA NA N
24006 ARTHRT ELBW CAPSL EXC RLS MAXFEE DEF         474.95 1/1/2024 12/31/2299 N
24065 BIOPSY ARM/ELBOW SOFT TISSUE PRXOVR DEF         NA NA NA N
24065 BIOPSY ARM/ELBOW SOFT TISSUE MAXFEE FAC         89.89 1/1/2024 12/31/2299 N
24065 BIOPSY ARM/ELBOW SOFT TISSUE MAXFEE NFF         135.66 1/1/2024 12/31/2299 N
24066 BIOPSY ARM/ELBOW SOFT TISSUE PRXOVR DEF         NA NA NA N
24066 BIOPSY ARM/ELBOW SOFT TISSUE MAXFEE FAC         216.12 1/1/2024 12/31/2299 N
24066 BIOPSY ARM/ELBOW SOFT TISSUE MAXFEE NFF         322.53 1/1/2024 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         233.82 1/1/2024 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         402.08 1/1/2024 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         170.09 1/1/2024 12/31/2299 N
24075 EXC ARM/ELBOW LES SC < 3 CM MAXFEE NFF         280.14 1/1/2024 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         298.80 1/1/2024 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         632.14 1/1/2024 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         754.06 1/1/2024 12/31/2299 N
24100 ARTHRT ELBW SYNOVIAL BX ONLY PRXOVR DEF         NA NA NA N
24100 ARTHRT ELBW SYNOVIAL BX ONLY MAXFEE DEF         267.95 1/1/2024 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         375.83 1/1/2024 12/31/2299 N
24102 ARTHRT ELBOW W/SYNOVECTOMY PRXOVR DEF         NA NA NA N
24102 ARTHRT ELBOW W/SYNOVECTOMY MAXFEE DEF         486.24 1/1/2024 12/31/2299 N
24105 EXCISION OLECRANON BURSA PRXOVR DEF         NA NA NA N
24105 EXCISION OLECRANON BURSA MAXFEE DEF         217.25 1/1/2024 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         438.99 1/1/2024 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         501.97 1/1/2024 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         623.10 1/1/2024 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         365.38 1/1/2024 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         371.83 1/1/2024 12/31/2299 N
24134 SEQUESTRECTOMY SHFT/DSTL HUM PRXOVR DEF         NA NA NA N
24134 SEQUESTRECTOMY SHFT/DSTL HUM MAXFEE DEF         552.76 1/1/2024 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         420.15 1/1/2024 12/31/2299 N
24140 PARTIAL EXC BONE HUMERUS PRXOVR DEF         NA NA NA N
24140 PARTIAL EXC BONE HUMERUS MAXFEE DEF         551.43 1/1/2024 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         424.42 1/1/2024 12/31/2299 N
24147 PRTL EXC BONE OLECRN PROCESS PRXOVR DEF         NA NA NA N
24147 PRTL EXC BONE OLECRN PROCESS MAXFEE DEF         427.75 1/1/2024 12/31/2299 N
24149 RADICAL RESECTION OF ELBOW PRXOVR DEF         NA NA NA N
24149 RADICAL RESECTION OF ELBOW MAXFEE DEF         758.01 1/1/2024 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         791.27 1/1/2024 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         641.43 1/1/2024 12/31/2299 N
24164 REMOVAL PROSTH RADIAL HEAD PRXOVR DEF         NA NA NA N
24164 REMOVAL PROSTH RADIAL HEAD MAXFEE DEF         373.23 1/1/2024 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         72.68 1/1/2024 12/31/2299 N
24200 RMVL FB UPPER ARM/ELBW SUBQ MAXFEE NFF         114.03 1/1/2024 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         188.95 1/1/2024 12/31/2299 N
24201 RMVL FB UPPER ARM/ELBW DEEP MAXFEE NFF         285.16 1/1/2024 12/31/2299 N
24220 INJECTION PX FOR ELBOW ARTHG PRXOVR DEF         NA NA NA N
24220 INJECTION PX FOR ELBOW ARTHG MAXFEE FAC         43.81 1/1/2024 12/31/2299 N
24220 INJECTION PX FOR ELBOW ARTHG MAXFEE NFF         100.88 1/1/2024 12/31/2299 N
24300 MNPJ ELBOW UNDER ANES PRXOVR DEF         NA NA NA N
24300 MNPJ ELBOW UNDER ANES MAXFEE DEF         266.83 1/1/2024 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         519.99 1/1/2024 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         331.58 1/1/2024 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         276.91 1/1/2024 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         371.45 1/1/2024 12/31/2299 N
24340 TENODESIS BICEPS TDN AT ELBW PRXOVR DEF         NA NA NA N
24340 TENODESIS BICEPS TDN AT ELBW MAXFEE DEF         429.22 1/1/2024 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         428.38 1/1/2024 12/31/2299 N
24342 REPAIR OF RUPTURED TENDON PRXOVR DEF         NA NA NA N
24342 REPAIR OF RUPTURED TENDON MAXFEE DEF         597.45 1/1/2024 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         489.47 1/1/2024 12/31/2299 N
24344 RECONSTRUCT ELBOW LAT LIGMNT PRXOVR DEF         NA NA NA N
24344 RECONSTRUCT ELBOW LAT LIGMNT MAXFEE DEF         740.04 1/1/2024 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         489.47 1/1/2024 12/31/2299 N
24346 RECONSTRUCT ELBOW MED LIGMNT PRXOVR DEF         NA NA NA N
24346 RECONSTRUCT ELBOW MED LIGMNT MAXFEE DEF         740.04 1/1/2024 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         278.79 1/1/2024 12/31/2299 N
24358 REPAIR ELBOW W/DEB OPEN PRXOVR DEF         NA NA NA N
24358 REPAIR ELBOW W/DEB OPEN MAXFEE DEF         327.74 1/1/2024 12/31/2299 N
24359 REPAIR ELBOW DEB/ATTCH OPEN PRXOVR DEF         NA NA NA N
24359 REPAIR ELBOW DEB/ATTCH OPEN MAXFEE DEF         403.59 1/1/2024 12/31/2299 N
24360 RECONSTRUCT ELBOW JOINT PRXOVR DEF         NA NA NA N
24360 RECONSTRUCT ELBOW JOINT MAXFEE DEF         730.87 1/1/2024 12/31/2299 N
24361 RECONSTRUCT ELBOW JOINT PRXOVR DEF         NA NA NA N
24361 RECONSTRUCT ELBOW JOINT MAXFEE DEF         766.79 1/1/2024 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         1101.10 1/1/2024 12/31/2299 N
24365 RECONSTRUCT HEAD OF RADIUS PRXOVR DEF         NA NA NA N
24365 RECONSTRUCT HEAD OF RADIUS MAXFEE DEF         455.47 1/1/2024 12/31/2299 N
24366 RECONSTRUCT HEAD OF RADIUS PRXOVR DEF         NA NA NA N
24366 RECONSTRUCT HEAD OF RADIUS MAXFEE DEF         544.62 1/1/2024 12/31/2299 N
24370 REVISE RECONST ELBOW JOINT PRXOVR DEF         NA NA NA N
24370 REVISE RECONST ELBOW JOINT MAXFEE DEF         1129.37 1/1/2024 12/31/2299 N
24371 REVISE RECONST ELBOW JOINT PRXOVR DEF         NA NA NA N
24371 REVISE RECONST ELBOW JOINT MAXFEE DEF         1302.49 1/1/2024 12/31/2299 N
24400 REVISION OF HUMERUS PRXOVR DEF         NA NA NA N
24400 REVISION OF HUMERUS MAXFEE DEF         574.77 1/1/2024 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         754.26 1/1/2024 12/31/2299 N
24430 REPAIR OF HUMERUS PRXOVR DEF         NA NA NA N
24430 REPAIR OF HUMERUS MAXFEE DEF         766.53 1/1/2024 12/31/2299 N
24435 REPAIR HUMERUS WITH GRAFT PRXOVR DEF         NA NA NA N
24435 REPAIR HUMERUS WITH GRAFT MAXFEE DEF         801.35 1/1/2024 12/31/2299 N
24470 REVISION OF ELBOW JOINT PRXOVR DEF         NA NA NA N
24470 REVISION OF ELBOW JOINT MAXFEE DEF         466.56 1/1/2024 12/31/2299 N
24495 DECOMPRESSION OF FOREARM PRXOVR DEF         NA NA NA N
24495 DECOMPRESSION OF FOREARM MAXFEE DEF         419.26 1/1/2024 12/31/2299 N
24498 REINFORCE HUMERUS PRXOVR DEF         NA NA NA N
24498 REINFORCE HUMERUS MAXFEE DEF         645.09 1/1/2024 12/31/2299 N
24500 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24500 TREAT HUMERUS FRACTURE MAXFEE FAC         173.90 1/1/2024 12/31/2299 N
24500 TREAT HUMERUS FRACTURE MAXFEE NFF         188.43 1/1/2024 12/31/2299 N
24505 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24505 TREAT HUMERUS FRACTURE MAXFEE FAC         284.52 1/1/2024 12/31/2299 N
24505 TREAT HUMERUS FRACTURE MAXFEE NFF         310.09 1/1/2024 12/31/2299 N
24515 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24515 TREAT HUMERUS FRACTURE MAXFEE DEF         613.37 1/1/2024 12/31/2299 N
24516 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24516 TREAT HUMERUS FRACTURE MAXFEE DEF         618.31 1/1/2024 12/31/2299 N
24530 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24530 TREAT HUMERUS FRACTURE MAXFEE FAC         182.72 1/1/2024 12/31/2299 N
24530 TREAT HUMERUS FRACTURE MAXFEE NFF         202.99 1/1/2024 12/31/2299 N
24535 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24535 TREAT HUMERUS FRACTURE MAXFEE FAC         294.67 1/1/2024 12/31/2299 N
24535 TREAT HUMERUS FRACTURE MAXFEE NFF         366.19 1/1/2024 12/31/2299 N
24538 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24538 TREAT HUMERUS FRACTURE MAXFEE DEF         508.96 1/1/2024 12/31/2299 N
24545 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24545 TREAT HUMERUS FRACTURE MAXFEE DEF         584.77 1/1/2024 12/31/2299 N
24546 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24546 TREAT HUMERUS FRACTURE MAXFEE DEF         745.71 1/1/2024 12/31/2299 N
24560 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24560 TREAT HUMERUS FRACTURE MAXFEE FAC         153.65 1/1/2024 12/31/2299 N
24560 TREAT HUMERUS FRACTURE MAXFEE NFF         173.55 1/1/2024 12/31/2299 N
24565 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24565 TREAT HUMERUS FRACTURE MAXFEE FAC         260.26 1/1/2024 12/31/2299 N
24565 TREAT HUMERUS FRACTURE MAXFEE NFF         285.68 1/1/2024 12/31/2299 N
24566 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24566 TREAT HUMERUS FRACTURE MAXFEE DEF         410.37 1/1/2024 12/31/2299 N
24575 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24575 TREAT HUMERUS FRACTURE MAXFEE DEF         529.28 1/1/2024 12/31/2299 N
24576 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24576 TREAT HUMERUS FRACTURE MAXFEE FAC         163.17 1/1/2024 12/31/2299 N
24576 TREAT HUMERUS FRACTURE MAXFEE NFF         183.07 1/1/2024 12/31/2299 N
24577 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24577 TREAT HUMERUS FRACTURE MAXFEE FAC         283.11 1/1/2024 12/31/2299 N
24577 TREAT HUMERUS FRACTURE MAXFEE NFF         311.30 1/1/2024 12/31/2299 N
24579 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24579 TREAT HUMERUS FRACTURE MAXFEE DEF         582.61 1/1/2024 12/31/2299 N
24582 TREAT HUMERUS FRACTURE PRXOVR DEF         NA NA NA N
24582 TREAT HUMERUS FRACTURE MAXFEE DEF         450.63 1/1/2024 12/31/2299 N
24586 TREAT ELBOW FRACTURE PRXOVR DEF         NA NA NA N
24586 TREAT ELBOW FRACTURE MAXFEE DEF         837.89 1/1/2024 12/31/2299 N
24587 TREAT ELBOW FRACTURE PRXOVR DEF         NA NA NA N
24587 TREAT ELBOW FRACTURE MAXFEE DEF         809.84 1/1/2024 12/31/2299 N
24600 TREAT ELBOW DISLOCATION PRXOVR DEF         NA NA NA N
24600 TREAT ELBOW DISLOCATION MAXFEE FAC         176.49 1/1/2024 12/31/2299 N
24600 TREAT ELBOW DISLOCATION MAXFEE NFF         195.56 1/1/2024 12/31/2299 N
24605 TREAT ELBOW DISLOCATION PRXOVR DEF         NA NA NA N
24605 TREAT ELBOW DISLOCATION MAXFEE DEF         255.89 1/1/2024 12/31/2299 N
24615 TREAT ELBOW DISLOCATION PRXOVR DEF         NA NA NA N
24615 TREAT ELBOW DISLOCATION MAXFEE DEF         528.44 1/1/2024 12/31/2299 N
24620 TREAT ELBOW FRACTURE PRXOVR DEF         NA NA NA N
24620 TREAT ELBOW FRACTURE MAXFEE DEF         317.60 1/1/2024 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         45.39 1/1/2024 12/31/2299 N
24640 TREAT ELBOW DISLOCATION MAXFEE NFF         71.58 1/1/2024 12/31/2299 N
24650 TREAT RADIUS FRACTURE PRXOVR DEF         NA NA NA N
24650 TREAT RADIUS FRACTURE MAXFEE FAC         130.25 1/1/2024 12/31/2299 N
24650 TREAT RADIUS FRACTURE MAXFEE NFF         141.62 1/1/2024 12/31/2299 N
24655 TREAT RADIUS FRACTURE PRXOVR DEF         NA NA NA N
24655 TREAT RADIUS FRACTURE MAXFEE FAC         217.22 1/1/2024 12/31/2299 N
24655 TREAT RADIUS FRACTURE MAXFEE NFF         236.42 1/1/2024 12/31/2299 N
24665 TREAT RADIUS FRACTURE PRXOVR DEF         NA NA NA N
24665 TREAT RADIUS FRACTURE MAXFEE DEF         445.85 1/1/2024 12/31/2299 N
24666 TREAT RADIUS FRACTURE PRXOVR DEF         NA NA NA N
24666 TREAT RADIUS FRACTURE MAXFEE DEF         564.06 1/1/2024 12/31/2299 N
24670 TREAT ULNAR FRACTURE PRXOVR DEF         NA NA NA N
24670 TREAT ULNAR FRACTURE MAXFEE FAC         140.02 1/1/2024 12/31/2299 N
24670 TREAT ULNAR FRACTURE MAXFEE NFF         154.91 1/1/2024 12/31/2299 N
24675 TREAT ULNAR FRACTURE PRXOVR DEF         NA NA NA N
24675 TREAT ULNAR FRACTURE MAXFEE FAC         243.88 1/1/2024 12/31/2299 N
24675 TREAT ULNAR FRACTURE MAXFEE NFF         265.40 1/1/2024 12/31/2299 N
24685 TREAT ULNAR FRACTURE PRXOVR DEF         NA NA NA N
24685 TREAT ULNAR FRACTURE MAXFEE DEF         497.12 1/1/2024 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         731.51 1/1/2024 12/31/2299 N
24900 AMPUTATION OF UPPER ARM PRXOVR DEF         NA NA NA N
24900 AMPUTATION OF UPPER ARM MAXFEE DEF         507.63 1/1/2024 12/31/2299 N
24920 AMPUTATION OF UPPER ARM PRXOVR DEF         NA NA NA N
24920 AMPUTATION OF UPPER ARM MAXFEE DEF         489.43 1/1/2024 12/31/2299 N
24925 AMPUTATION FOLLOW-UP SURGERY PRXOVR DEF         NA NA NA N
24925 AMPUTATION FOLLOW-UP SURGERY MAXFEE DEF         385.98 1/1/2024 12/31/2299 N
24930 AMPUTATION FOLLOW-UP SURGERY PRXOVR DEF         NA NA NA N
24930 AMPUTATION FOLLOW-UP SURGERY MAXFEE DEF         542.39 1/1/2024 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         229.55 1/1/2024 12/31/2299 N
25001 INCISE FLEXOR CARPI RADIALIS PRXOVR DEF         NA NA NA N
25001 INCISE FLEXOR CARPI RADIALIS MAXFEE DEF         223.21 1/1/2024 12/31/2299 N
25020 DECOMPRESS FOREARM 1 SPACE PRXOVR DEF         NA NA NA N
25020 DECOMPRESS FOREARM 1 SPACE MAXFEE DEF         389.84 1/1/2024 12/31/2299 N
25023 DECOMPRESS FOREARM 1 SPACE PRXOVR DEF         NA NA NA N
25023 DECOMPRESS FOREARM 1 SPACE MAXFEE DEF         686.24 1/1/2024 12/31/2299 N
25024 DECOMPRESS FOREARM 2 SPACES PRXOVR DEF         NA NA NA N
25024 DECOMPRESS FOREARM 2 SPACES MAXFEE DEF         520.25 1/1/2024 12/31/2299 N
25025 DECOMPRESS FOREARM 2 SPACES PRXOVR DEF         NA NA NA N
25025 DECOMPRESS FOREARM 2 SPACES MAXFEE DEF         842.09 1/1/2024 12/31/2299 N
25028 DRAINAGE OF FOREARM LESION PRXOVR DEF         NA NA NA N
25028 DRAINAGE OF FOREARM LESION MAXFEE DEF         365.96 1/1/2024 12/31/2299 N
25031 DRAINAGE OF FOREARM BURSA PRXOVR DEF         NA NA NA N
25031 DRAINAGE OF FOREARM BURSA MAXFEE DEF         267.23 1/1/2024 12/31/2299 N
25035 TREAT FOREARM BONE LESION PRXOVR DEF         NA NA NA N
25035 TREAT FOREARM BONE LESION MAXFEE DEF         467.04 1/1/2024 12/31/2299 N
25040 EXPLORE/TREAT WRIST JOINT PRXOVR DEF         NA NA NA N
25040 EXPLORE/TREAT WRIST JOINT MAXFEE DEF         385.38 1/1/2024 12/31/2299 N
25065 BIOPSY FOREARM SOFT TISSUES PRXOVR DEF         NA NA NA N
25065 BIOPSY FOREARM SOFT TISSUES MAXFEE FAC         89.47 1/1/2024 12/31/2299 N
25065 BIOPSY FOREARM SOFT TISSUES MAXFEE NFF         133.58 1/1/2024 12/31/2299 N
25066 BIOPSY FOREARM SOFT TISSUES PRXOVR DEF         NA NA NA N
25066 BIOPSY FOREARM SOFT TISSUES MAXFEE DEF         252.96 1/1/2024 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         244.65 1/1/2024 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         303.71 1/1/2024 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         162.65 1/1/2024 12/31/2299 N
25075 EXC FOREARM LES SC < 3 CM MAXFEE NFF         272.70 1/1/2024 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         321.70 1/1/2024 12/31/2299 N
25077 RESECT FOREARM/WRIST TUM<3CM PRXOVR DEF         NA NA NA N
25077 RESECT FOREARM/WRIST TUM<3CM MAXFEE DEF         561.19 1/1/2024 12/31/2299 N
25078 RESECT FORARM/WRIST TUM 3CM> PRXOVR DEF         NA NA NA N
25078 RESECT FORARM/WRIST TUM 3CM> MAXFEE DEF         657.74 1/1/2024 12/31/2299 N
25085 INCISION OF WRIST CAPSULE PRXOVR DEF         NA NA NA N
25085 INCISION OF WRIST CAPSULE MAXFEE DEF         322.36 1/1/2024 12/31/2299 N
25100 BIOPSY OF WRIST JOINT PRXOVR DEF         NA NA NA N
25100 BIOPSY OF WRIST JOINT MAXFEE DEF         252.81 1/1/2024 12/31/2299 N
25101 EXPLORE/TREAT WRIST JOINT PRXOVR DEF         NA NA NA N
25101 EXPLORE/TREAT WRIST JOINT MAXFEE DEF         298.77 1/1/2024 12/31/2299 N
25105 REMOVE WRIST JOINT LINING PRXOVR DEF         NA NA NA N
25105 REMOVE WRIST JOINT LINING MAXFEE DEF         375.77 1/1/2024 12/31/2299 N
25107 REMOVE WRIST JOINT CARTILAGE PRXOVR DEF         NA NA NA N
25107 REMOVE WRIST JOINT CARTILAGE MAXFEE DEF         363.79 1/1/2024 12/31/2299 N
25109 EXCISE TENDON FOREARM/WRIST PRXOVR DEF         NA NA NA N
25109 EXCISE TENDON FOREARM/WRIST MAXFEE DEF         301.12 1/1/2024 12/31/2299 N
25110 REMOVE WRIST TENDON LESION PRXOVR DEF         NA NA NA N
25110 REMOVE WRIST TENDON LESION MAXFEE DEF         246.60 1/1/2024 12/31/2299 N
25111 REMOVE WRIST TENDON LESION PRXOVR DEF         NA NA NA N
25111 REMOVE WRIST TENDON LESION MAXFEE DEF         205.03 1/1/2024 12/31/2299 N
25112 REREMOVE WRIST TENDON LESION PRXOVR DEF         NA NA NA N
25112 REREMOVE WRIST TENDON LESION MAXFEE DEF         254.40 1/1/2024 12/31/2299 N
25115 REMOVE WRIST/FOREARM LESION PRXOVR DEF         NA NA NA N
25115 REMOVE WRIST/FOREARM LESION MAXFEE DEF         534.42 1/1/2024 12/31/2299 N
25116 REMOVE WRIST/FOREARM LESION PRXOVR DEF         NA NA NA N
25116 REMOVE WRIST/FOREARM LESION MAXFEE DEF         467.85 1/1/2024 12/31/2299 N
25118 EXCISE WRIST TENDON SHEATH PRXOVR DEF         NA NA NA N
25118 EXCISE WRIST TENDON SHEATH MAXFEE DEF         284.31 1/1/2024 12/31/2299 N
25119 PARTIAL REMOVAL OF ULNA PRXOVR DEF         NA NA NA N
25119 PARTIAL REMOVAL OF ULNA MAXFEE DEF         394.25 1/1/2024 12/31/2299 N
25120 REMOVAL OF FOREARM LESION PRXOVR DEF         NA NA NA N
25120 REMOVAL OF FOREARM LESION MAXFEE DEF         402.23 1/1/2024 12/31/2299 N
25125 REMOVE/GRAFT FOREARM LESION PRXOVR DEF         NA NA NA N
25125 REMOVE/GRAFT FOREARM LESION MAXFEE DEF         456.45 1/1/2024 12/31/2299 N
25126 REMOVE/GRAFT FOREARM LESION PRXOVR DEF         NA NA NA N
25126 REMOVE/GRAFT FOREARM LESION MAXFEE DEF         465.37 1/1/2024 12/31/2299 N
25130 REMOVAL OF WRIST LESION PRXOVR DEF         NA NA NA N
25130 REMOVAL OF WRIST LESION MAXFEE DEF         290.36 1/1/2024 12/31/2299 N
25135 REMOVE & GRAFT WRIST LESION PRXOVR DEF         NA NA NA N
25135 REMOVE & GRAFT WRIST LESION MAXFEE DEF         373.32 1/1/2024 12/31/2299 N
25136 REMOVE & GRAFT WRIST LESION PRXOVR DEF         NA NA NA N
25136 REMOVE & GRAFT WRIST LESION MAXFEE DEF         322.10 1/1/2024 12/31/2299 N
25145 REMOVE FOREARM BONE LESION PRXOVR DEF         NA NA NA N
25145 REMOVE FOREA