Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST	PRXOVR	DEF					NA	NA	NA	N
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0001F	HEART FAILURE COMPOSITE	PRXOVR	DEF					NA	NA	NA	N
0001F	HEART FAILURE COMPOSITE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND	PRXOVR	DEF					NA	NA	NA	N
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0002F	TOBACCO USE; SMOKING; ASSESS	PRXOVR	DEF					NA	NA	NA	N
0002F	TOBACCO USE; SMOKING; ASSESS	MAXFEE	DEF					NA			N
0003A	ADM SARSCOV2 30MCG/0.3ML 3RD	PRXOVR	DEF					NA	NA	NA	N
0003A	ADM SARSCOV2 30MCG/0.3ML 3RD	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0003F	TOBACCO USE; NON-SMOKING	PRXOVR	DEF					NA	NA	NA	N
0003F	TOBACCO USE; NON-SMOKING	MAXFEE	DEF					NA			N
0004A	ADM SARSCOV2 30MCG/0.3ML BST	PRXOVR	DEF					NA	NA	NA	N
0004A	ADM SARSCOV2 30MCG/0.3ML BST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0004F	TOBACCO USE TXMNT COUNSELING	PRXOVR	DEF					NA	NA	NA	N
0004F	TOBACCO USE TXMNT COUNSELING	MAXFEE	DEF					NA			N
0005F	OSTEOARTHRITIS COMPOSITE	PRXOVR	DEF					NA	NA	NA	N
0005F	OSTEOARTHRITIS COMPOSITE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0006F	STATIN THERAPY; PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
0006F	STATIN THERAPY; PRESCRIBED	MAXFEE	DEF					NA			N
0007F	BETA-BLOCKER THX PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
0007F	BETA-BLOCKER THX PRESCRIBED	MAXFEE	DEF					NA			N
0008F	ACE INHIBITOR THX PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
0008F	ACE INHIBITOR THX PRESCRIBED	MAXFEE	DEF					NA			N
0009F	ASSESS ANGINAL SYMPTOM/LEVEL	PRXOVR	DEF					NA	NA	NA	N
0009F	ASSESS ANGINAL SYMPTOM/LEVEL	MAXFEE	DEF					NA			N
0010F	ASSESS ANGINAL SYMPTOM/LEVEL	PRXOVR	DEF					NA	NA	NA	N
0010F	ASSESS ANGINAL SYMPTOM/LEVEL	MAXFEE	DEF					NA			N
0011A	ADM SARSCOV2 100MCG/0.5ML1ST	PRXOVR	DEF					NA	NA	NA	N
0011A	ADM SARSCOV2 100MCG/0.5ML1ST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0011F	ORAL ANTIPLAT THX PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
0011F	ORAL ANTIPLAT THX PRESCRIBED	MAXFEE	DEF					NA			N
0012A	ADM SARSCOV2 100MCG/0.5ML2ND	PRXOVR	DEF					NA	NA	NA	N
0012A	ADM SARSCOV2 100MCG/0.5ML2ND	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0012F	CAP BACTERIAL ASSESS	PRXOVR	DEF					NA	NA	NA	N
0012F	CAP BACTERIAL ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0013A	ADM SARSCOV2 100MCG/0.5ML3RD	PRXOVR	DEF					NA	NA	NA	N
0013A	ADM SARSCOV2 100MCG/0.5ML3RD	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0014F	COMP PREOP ASSESS CAT SURG	PRXOVR	DEF					NA	NA	NA	N
0014F	COMP PREOP ASSESS CAT SURG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0015F	MELAN FOLLOW-UP COMPLETE	PRXOVR	DEF					NA	NA	NA	N
0015F	MELAN FOLLOW-UP COMPLETE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0041A	ADM SARSCOV2 5MCG/0.5ML 1ST	PRXOVR	DEF					NA	NA	NA	N
0041A	ADM SARSCOV2 5MCG/0.5ML 1ST	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0042A	ADM SARSCOV2 5MCG/0.5ML 2ND	PRXOVR	DEF					NA	NA	NA	N
0042A	ADM SARSCOV2 5MCG/0.5ML 2ND	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0044A	ADM SARSCOV2 5MCG/0.5ML BST	PRXOVR	DEF					NA	NA	NA	N
0044A	ADM SARSCOV2 5MCG/0.5ML BST	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0064A	ADM SARSCOV2 50MCG/0.25MLBST	PRXOVR	DEF					NA	NA	NA	N
0064A	ADM SARSCOV2 50MCG/0.25MLBST	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0071A	ADM SARSCV2 10MCG TRS-SUCR 1	PRXOVR	DEF					NA	NA	NA	N
0071A	ADM SARSCV2 10MCG TRS-SUCR 1	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0072A	ADM SARSCV2 10MCG TRS-SUCR 2	PRXOVR	DEF					NA	NA	NA	N
0072A	ADM SARSCV2 10MCG TRS-SUCR 2	MAXFEE	DEF					37.66	1/1/2022	12/31/2299	N
0081A	ADM SARSCV2 3MCG TRS-SUCR 1	PRXOVR	DEF					NA	NA	NA	N
0081A	ADM SARSCV2 3MCG TRS-SUCR 1	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0082A	ADM SARSCV2 3MCG TRS-SUCR 2	PRXOVR	DEF					NA	NA	NA	N
0082A	ADM SARSCV2 3MCG TRS-SUCR 2	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0083A	ADM SARSCV2 3MCG TRS-SUCR 3	PRXOVR	DEF					NA	NA	NA	N
0083A	ADM SARSCV2 3MCG TRS-SUCR 3	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0091A	ADM SARSCOV2 50 MCG/.5 ML1ST	PRXOVR	DEF					NA	NA	NA	N
0091A	ADM SARSCOV2 50 MCG/.5 ML1ST	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0092A	ADM SARSCOV2 50 MCG/.5 ML2ND	PRXOVR	DEF					NA	NA	NA	N
0092A	ADM SARSCOV2 50 MCG/.5 ML2ND	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0093A	ADM SARSCOV2 50 MCG/.5 ML3RD	PRXOVR	DEF					NA	NA	NA	N
0093A	ADM SARSCOV2 50 MCG/.5 ML3RD	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0094A	ADM SARSCOV2 50 MCG/.5 MLBST	PRXOVR	DEF					NA	NA	NA	N
0094A	ADM SARSCOV2 50 MCG/.5 MLBST	MAXFEE	DEF					37.66	3/29/2022	12/31/2299	N
0111A	ADM SARSCOV2 25MCG/0.25ML1ST	PRXOVR	DEF					NA	NA	NA	N
0111A	ADM SARSCOV2 25MCG/0.25ML1ST	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0112A	ADM SARSCOV2 25MCG/0.25ML2ND	PRXOVR	DEF					NA	NA	NA	N
0112A	ADM SARSCOV2 25MCG/0.25ML2ND	MAXFEE	DEF					37.66	6/17/2022	12/31/2299	N
0113A	ADM SARSCOV2 25MCG/0.25ML3RD	PRXOVR	DEF					NA	NA	NA	N
0113A	ADM SARSCOV2 25MCG/0.25ML3RD	MAXFEE	DEF					37.66	8/31/2022	12/31/2299	N
0124A	ADM SARSCV2 BVL 30MCG/.3ML A	PRXOVR	DEF					NA	NA	NA	N
0124A	ADM SARSCV2 BVL 30MCG/.3ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0134A	ADM SARSCV2 BVL 50MCG/.5ML A	PRXOVR	DEF					NA	NA	NA	N
0134A	ADM SARSCV2 BVL 50MCG/.5ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0144A	ADM SRSCV2 BVL 25MCG/.25ML A	PRXOVR	DEF					NA	NA	NA	N
0144A	ADM SRSCV2 BVL 25MCG/.25ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0154A	ADM SARSCV2 BVL 10MCG/.2ML A	PRXOVR	DEF					NA	NA	NA	N
0154A	ADM SARSCV2 BVL 10MCG/.2ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0164A	ADM SRSCV2 BVL 10MCG/0.2ML A	PRXOVR	DEF					NA	NA	NA	N
0164A	ADM SRSCV2 BVL 10MCG/0.2ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0173A	ADM SARSCV2 BVL 3MCG/0.2ML 3	PRXOVR	DEF					NA	NA	NA	N
0173A	ADM SARSCV2 BVL 3MCG/0.2ML 3	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0174A	ADM SARSCV2 BVL 3MCG/0.2ML A	PRXOVR	DEF					NA	NA	NA	N
0174A	ADM SARSCV2 BVL 3MCG/0.2ML A	MAXFEE	DEF					39.94	7/1/2023	12/31/2299	N
0500F	INITIAL PRENATAL CARE VISIT	PRXOVR	DEF					NA	NA	NA	N
0500F	INITIAL PRENATAL CARE VISIT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0501F	PRENATAL FLOW SHEET	PRXOVR	DEF					NA	NA	NA	N
0501F	PRENATAL FLOW SHEET	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0502F	SUBSEQUENT PRENATAL CARE	PRXOVR	DEF					NA	NA	NA	N
0502F	SUBSEQUENT PRENATAL CARE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0503F	POSTPARTUM CARE VISIT	PRXOVR	DEF					NA	NA	NA	N
0503F	POSTPARTUM CARE VISIT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0505F	HEMODIALYSIS PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0505F	HEMODIALYSIS PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0507F	PERITON DIALYSIS PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0507F	PERITON DIALYSIS PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0509F	URINE INCON PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0509F	URINE INCON PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0513F	ELEV BP PLAN OF CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0513F	ELEV BP PLAN OF CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0514F	CARE PLAN HGB DOCD ESA PT	PRXOVR	DEF					NA	NA	NA	N
0514F	CARE PLAN HGB DOCD ESA PT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0516F	ANEMIA PLAN OF CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0516F	ANEMIA PLAN OF CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0517F	GLAUCOMA PLAN OF CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0517F	GLAUCOMA PLAN OF CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0518F	FALL PLAN OF CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0518F	FALL PLAN OF CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0519F	PLAND CHEMO DOCD B/4 TXMNT	PRXOVR	DEF					NA	NA	NA	N
0519F	PLAND CHEMO DOCD B/4 TXMNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0520F	RAD DOS LIMTS B/4 3D RAD	PRXOVR	DEF					NA	NA	NA	N
0520F	RAD DOS LIMTS B/4 3D RAD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0521F	PLAN OF CARE 4 PAIN DOCD	PRXOVR	DEF					NA	NA	NA	N
0521F	PLAN OF CARE 4 PAIN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0525F	INITIAL VISIT FOR EPISODE	PRXOVR	DEF					NA	NA	NA	N
0525F	INITIAL VISIT FOR EPISODE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0526F	SUBS VISIT FOR EPISODE	PRXOVR	DEF					NA	NA	NA	N
0526F	SUBS VISIT FOR EPISODE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0528F	RCMND FLW-UP 10 YRS DOCD	PRXOVR	DEF					NA	NA	NA	N
0528F	RCMND FLW-UP 10 YRS DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0529F	INTRVL 3/>YR PTS CLNSCP DOCD	PRXOVR	DEF					NA	NA	NA	N
0529F	INTRVL 3/>YR PTS CLNSCP DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0535F	DYSPNEA MNGMNT PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0535F	DYSPNEA MNGMNT PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0540F	GLUCO MNGMNT PLAN DOCD	PRXOVR	DEF					NA	NA	NA	N
0540F	GLUCO MNGMNT PLAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0545F	FOLLOW UP CARE PLAN MDD DOCD	PRXOVR	DEF					NA	NA	NA	N
0545F	FOLLOW UP CARE PLAN MDD DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0550F	CYTOPATH REPORT NONGYN SPCMN	PRXOVR	DEF					NA	NA	NA	N
0550F	CYTOPATH REPORT NONGYN SPCMN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0551F	CYTOPATH REPORT NON ROUTINE	PRXOVR	DEF					NA	NA	NA	N
0551F	CYTOPATH REPORT NON ROUTINE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0555F	SYMPTOM MGMNT PLAN CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0555F	SYMPTOM MGMNT PLAN CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0556F	PLAN CARE LIPID CONTROL DOCD	PRXOVR	DEF					NA	NA	NA	N
0556F	PLAN CARE LIPID CONTROL DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0557F	PLAN CAREMNG ANGNL SYMPTDOCD	PRXOVR	DEF					NA	NA	NA	N
0557F	PLAN CAREMNG ANGNL SYMPTDOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0575F	HIV RNA PLAN CARE DOCD	PRXOVR	DEF					NA	NA	NA	N
0575F	HIV RNA PLAN CARE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0580F	MULTIDISCIPLINARY CARE PLAN	PRXOVR	DEF					NA	NA	NA	N
0580F	MULTIDISCIPLINARY CARE PLAN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0581F	PT TRNSFRD FROM ANESTH TO CC	PRXOVR	DEF					NA	NA	NA	N
0581F	PT TRNSFRD FROM ANESTH TO CC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0582F	NO TRNSFR FROM ANESTH TO CC	PRXOVR	DEF					NA	NA	NA	N
0582F	NO TRNSFR FROM ANESTH TO CC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0583F	TRANSFER CARE CHECKLIST USED	PRXOVR	DEF					NA	NA	NA	N
0583F	TRANSFER CARE CHECKLIST USED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
0584F	NO TRANSFERCARE CHKLIST USED	PRXOVR	DEF					NA	NA	NA	N
0584F	NO TRANSFERCARE CHKLIST USED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10004	FNA BX W/O IMG GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10004	FNA BX W/O IMG GDN EA ADDL	MAXFEE	FAC					35.24	1/1/2019	12/31/2299	N
10004	FNA BX W/O IMG GDN EA ADDL	MAXFEE	NFF					41.59	1/1/2019	12/31/2299	N
10005	FNA BX W/US GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10005	FNA BX W/US GDN 1ST LES	MAXFEE	FAC					21.95	1/1/2019	12/31/2299	N
10005	FNA BX W/US GDN 1ST LES	MAXFEE	NFF					57.36	1/1/2019	12/31/2299	N
10006	FNA BX W/US GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10006	FNA BX W/US GDN EA ADDL	MAXFEE	FAC					15.37	1/1/2019	12/31/2299	N
10006	FNA BX W/US GDN EA ADDL	MAXFEE	NFF					28.68	1/1/2019	12/31/2299	N
10007	FNA BX W/FLUOR GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10007	FNA BX W/FLUOR GDN 1ST LES	MAXFEE	FAC					28.10	1/1/2019	12/31/2299	N
10007	FNA BX W/FLUOR GDN 1ST LES	MAXFEE	NFF					126.77	1/1/2019	12/31/2299	N
10008	FNA BX W/FLUOR GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10008	FNA BX W/FLUOR GDN EA ADDL	MAXFEE	FAC					18.44	1/1/2019	12/31/2299	N
10008	FNA BX W/FLUOR GDN EA ADDL	MAXFEE	NFF					71.70	1/1/2019	12/31/2299	N
10009	FNA BX W/CT GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10009	FNA BX W/CT GDN 1ST LES	MAXFEE	FAC					34.24	1/1/2019	12/31/2299	N
10009	FNA BX W/CT GDN 1ST LES	MAXFEE	NFF					206.50	1/1/2019	12/31/2299	N
1000F	TOBACCO USE ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1000F	TOBACCO USE ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10010	FNA BX W/CT GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10010	FNA BX W/CT GDN EA ADDL	MAXFEE	FAC					25.68	1/1/2019	12/31/2299	N
10010	FNA BX W/CT GDN EA ADDL	MAXFEE	NFF					123.90	1/1/2019	12/31/2299	N
10011	FNA BX W/MR GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10011	FNA BX W/MR GDN 1ST LES	MANUAL	DEF					NA	NA	NA	N
10012	FNA BX W/MR GDN EA ADDL	PRXOVR	DEF					NA	NA	NA	N
10012	FNA BX W/MR GDN EA ADDL	MANUAL	DEF					NA	NA	NA	N
1001F	TOBACCO USE; NON-SMOKING	PRXOVR	DEF					NA	NA	NA	N
1001F	TOBACCO USE; NON-SMOKING	MAXFEE	DEF					NA			N
10021	FNA BX W/O IMG GDN 1ST LES	PRXOVR	DEF					NA	NA	NA	N
10021	FNA BX W/O IMG GDN 1ST LES	MAXFEE	FAC					49.77	1/1/2014	12/31/2299	N
10021	FNA BX W/O IMG GDN 1ST LES	MAXFEE	NFF					73.55	1/1/2014	12/31/2299	N
1002F	ASSESS ANGINAL SYMPTOM/LEVEL	PRXOVR	DEF					NA	NA	NA	N
1002F	ASSESS ANGINAL SYMPTOM/LEVEL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10030	GUIDE CATHET FLUID DRAINAGE	PRXOVR	DEF					NA	NA	NA	N
10030	GUIDE CATHET FLUID DRAINAGE	MAXFEE	FAC					119.43	1/1/2014	12/31/2299	N
10030	GUIDE CATHET FLUID DRAINAGE	MAXFEE	NFF					561.80	1/1/2014	12/31/2299	N
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
1004F	CLIN SYMP VOL OVRLD ASSESS	PRXOVR	DEF					NA	NA	NA	N
1004F	CLIN SYMP VOL OVRLD ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1005F	ASTHMA SYMPTOMS EVALUATE	PRXOVR	DEF					NA	NA	NA	N
1005F	ASTHMA SYMPTOMS EVALUATE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10060	DRAINAGE OF SKIN ABSCESS	PRXOVR	DEF					NA	NA	NA	N
10060	DRAINAGE OF SKIN ABSCESS	MAXFEE	FAC					56.90	1/1/2014	12/31/2299	N
10060	DRAINAGE OF SKIN ABSCESS	MAXFEE	NFF					72.81	1/1/2014	12/31/2299	N
10061	DRAINAGE OF SKIN ABSCESS	PRXOVR	DEF					NA	NA	NA	N
10061	DRAINAGE OF SKIN ABSCESS	MAXFEE	FAC					62.08	1/1/2014	12/31/2299	N
10061	DRAINAGE OF SKIN ABSCESS	MAXFEE	NFF					87.31	1/1/2014	12/31/2299	N
1006F	OSTEOARTHRITIS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1006F	OSTEOARTHRITIS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1007F	ANTI-INFLM/ANLGSC OTC ASSESS	PRXOVR	DEF					NA	NA	NA	N
1007F	ANTI-INFLM/ANLGSC OTC ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1008F	GI/RENAL RISK ASSESS	PRXOVR	DEF					NA	NA	NA	N
1008F	GI/RENAL RISK ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1010F	SEVERITY ANGINA BY ACTVTY	PRXOVR	DEF					NA	NA	NA	N
1010F	SEVERITY ANGINA BY ACTVTY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1011F	ANGINA PRESENT	PRXOVR	DEF					NA	NA	NA	N
1011F	ANGINA PRESENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10120	REMOVE FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
10120	REMOVE FOREIGN BODY	MAXFEE	FAC					41	1/1/2014	12/31/2299	N
10120	REMOVE FOREIGN BODY	MAXFEE	NFF					65.78	1/1/2014	12/31/2299	N
10121	REMOVE FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
10121	REMOVE FOREIGN BODY	MAXFEE	FAC					63.31	1/1/2014	12/31/2299	N
10121	REMOVE FOREIGN BODY	MAXFEE	NFF					106.80	1/1/2014	12/31/2299	N
1012F	ANGINA ABSENT	PRXOVR	DEF					NA	NA	NA	N
1012F	ANGINA ABSENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10140	DRAINAGE OF HEMATOMA/FLUID	PRXOVR	DEF					NA	NA	NA	N
10140	DRAINAGE OF HEMATOMA/FLUID	MAXFEE	FAC					55.17	1/1/2014	12/31/2299	N
10140	DRAINAGE OF HEMATOMA/FLUID	MAXFEE	NFF					84.47	1/1/2014	12/31/2299	N
1015F	COPD SYMPTOMS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1015F	COPD SYMPTOMS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
10160	PUNCTURE DRAINAGE OF LESION	PRXOVR	DEF					NA	NA	NA	N
10160	PUNCTURE DRAINAGE OF LESION	MAXFEE	FAC					38	1/1/2014	12/31/2299	N
10160	PUNCTURE DRAINAGE OF LESION	MAXFEE	NFF					55.67	1/1/2014	12/31/2299	N
10180	COMPLEX DRAINAGE WOUND	PRXOVR	DEF					NA	NA	NA	N
10180	COMPLEX DRAINAGE WOUND	MAXFEE	FAC					59.25	1/1/2014	12/31/2299	N
10180	COMPLEX DRAINAGE WOUND	MAXFEE	NFF					95.23	1/1/2014	12/31/2299	N
1018F	ASSESS DYSPNEA NOT PRESENT	PRXOVR	DEF					NA	NA	NA	N
1018F	ASSESS DYSPNEA NOT PRESENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1019F	ASSESS DYSPNEA PRESENT	PRXOVR	DEF					NA	NA	NA	N
1019F	ASSESS DYSPNEA PRESENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1022F	PNEUMO IMM STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1022F	PNEUMO IMM STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1026F	CO-MORBID CONDITION ASSESS	PRXOVR	DEF					NA	NA	NA	N
1026F	CO-MORBID CONDITION ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1030F	INFLUENZA IMM STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1030F	INFLUENZA IMM STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1031F	SMOKING & 2ND HAND ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1031F	SMOKING & 2ND HAND ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1032F	SMOKER/EXPOSED 2ND HND SMOKE	PRXOVR	DEF					NA	NA	NA	N
1032F	SMOKER/EXPOSED 2ND HND SMOKE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1033F	TOBACCO NONSMOKER NOR 2NDHND	PRXOVR	DEF					NA	NA	NA	N
1033F	TOBACCO NONSMOKER NOR 2NDHND	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1034F	CURRENT TOBACCO SMOKER	PRXOVR	DEF					NA	NA	NA	N
1034F	CURRENT TOBACCO SMOKER	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
1035F	SMOKELESS TOBACCO USER	PRXOVR	DEF					NA	NA	NA	N
1035F	SMOKELESS TOBACCO USER	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
1036F	TOBACCO NON-USER	PRXOVR	DEF					NA	NA	NA	N
1036F	TOBACCO NON-USER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1038F	PERSISTENT ASTHMA	PRXOVR	DEF					NA	NA	NA	N
1038F	PERSISTENT ASTHMA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1039F	INTERMITTENT ASTHMA	PRXOVR	DEF					NA	NA	NA	N
1039F	INTERMITTENT ASTHMA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1040F	DSM-5 INFO MDD DOCD	PRXOVR	DEF					NA	NA	NA	N
1040F	DSM-5 INFO MDD DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1050F	HISTORY OF MOLE CHANGES	PRXOVR	DEF					NA	NA	NA	N
1050F	HISTORY OF MOLE CHANGES	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1052F	TYPE LOCATION ACTIVITYASSESS	PRXOVR	DEF					NA	NA	NA	N
1052F	TYPE LOCATION ACTIVITYASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1055F	VISUAL FUNCT STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
1055F	VISUAL FUNCT STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1060F	DOC PERM/CONT/PAROX ATR FIB	PRXOVR	DEF					NA	NA	NA	N
1060F	DOC PERM/CONT/PAROX ATR FIB	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1061F	DOC LACK PERM&CONT&PAROX FIB	PRXOVR	DEF					NA	NA	NA	N
1061F	DOC LACK PERM&CONT&PAROX FIB	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1065F	ISCHM STROKE SYMP LT3 HRSB/4	PRXOVR	DEF					NA	NA	NA	N
1065F	ISCHM STROKE SYMP LT3 HRSB/4	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1066F	ISCHM STROKE SYMP GE3 HRSB/4	PRXOVR	DEF					NA	NA	NA	N
1066F	ISCHM STROKE SYMP GE3 HRSB/4	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1070F	ALARM SYMP ASSESSED-ABSENT	PRXOVR	DEF					NA	NA	NA	N
1070F	ALARM SYMP ASSESSED-ABSENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1071F	ALARM SYMP ASSESSED-1+ PRSNT	PRXOVR	DEF					NA	NA	NA	N
1071F	ALARM SYMP ASSESSED-1+ PRSNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1080F	DECIS MKR/ADVNCD PLAN DOC'D	PRXOVR	DEF					NA	NA	NA	N
1080F	DECIS MKR/ADVNCD PLAN DOC'D	MAXFEE	DEF					NA			N
1090F	PRES/ABSN URINE INCON ASSESS	PRXOVR	DEF					NA	NA	NA	N
1090F	PRES/ABSN URINE INCON ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1091F	URINE INCON CHARACTERIZED	PRXOVR	DEF					NA	NA	NA	N
1091F	URINE INCON CHARACTERIZED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11000	DEBRIDE INFECTED SKIN	PRXOVR	DEF					NA	NA	NA	N
11000	DEBRIDE INFECTED SKIN	MAXFEE	FAC					19.74	1/1/2014	12/31/2299	N
11000	DEBRIDE INFECTED SKIN	MAXFEE	NFF					34.34	1/1/2014	12/31/2299	N
11001	DEBRIDE INFECTED SKIN ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11001	DEBRIDE INFECTED SKIN ADD-ON	MAXFEE	FAC					10.02	1/1/2014	12/31/2299	N
11001	DEBRIDE INFECTED SKIN ADD-ON	MAXFEE	NFF					15.02	1/1/2014	12/31/2299	N
1100F	PTFALLS ASSESS-DOCD GE2>/YR	PRXOVR	DEF					NA	NA	NA	N
1100F	PTFALLS ASSESS-DOCD GE2>/YR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11010	DEBRIDE SKIN AT FX SITE	PRXOVR	DEF					NA	NA	NA	N
11010	DEBRIDE SKIN AT FX SITE	MAXFEE	FAC					126.27	1/1/2014	12/31/2299	N
11010	DEBRIDE SKIN AT FX SITE	MAXFEE	NFF					214.12	1/1/2014	12/31/2299	N
11011	DEBRIDE SKIN MUSC AT FX SITE	PRXOVR	DEF					NA	NA	NA	N
11011	DEBRIDE SKIN MUSC AT FX SITE	MAXFEE	FAC					126.63	1/1/2014	12/31/2299	N
11011	DEBRIDE SKIN MUSC AT FX SITE	MAXFEE	NFF					256.44	1/1/2014	12/31/2299	N
11012	DEB SKIN BONE AT FX SITE	PRXOVR	DEF					NA	NA	NA	N
11012	DEB SKIN BONE AT FX SITE	MAXFEE	FAC					199.72	1/1/2014	12/31/2299	N
11012	DEB SKIN BONE AT FX SITE	MAXFEE	NFF					360.03	1/1/2014	12/31/2299	N
1101F	PT FALLS ASSESS-DOCD LE1/YR	PRXOVR	DEF					NA	NA	NA	N
1101F	PT FALLS ASSESS-DOCD LE1/YR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11040	DEBRIDE SKIN; PARTIAL	PRXOVR	DEF					NA	NA	NA	N
11040	DEBRIDE SKIN; PARTIAL	MAXFEE	DEF					NA			N
11041	DEBRIDE SKIN; FULL	PRXOVR	DEF					NA	NA	NA	N
11041	DEBRIDE SKIN; FULL	MAXFEE	DEF					NA			N
11042	DEB SUBQ TISSUE 20 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
11042	DEB SUBQ TISSUE 20 SQ CM/<	MAXFEE	FAC					20.33	1/1/2014	12/31/2299	N
11042	DEB SUBQ TISSUE 20 SQ CM/<	MAXFEE	NFF					40.19	1/1/2014	12/31/2299	N
11043	DEB MUSC/FASCIA 20 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
11043	DEB MUSC/FASCIA 20 SQ CM/<	MAXFEE	FAC					74.18	1/1/2014	12/31/2299	N
11043	DEB MUSC/FASCIA 20 SQ CM/<	MAXFEE	NFF					124.70	1/1/2014	12/31/2299	N
11044	DEB BONE 20 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
11044	DEB BONE 20 SQ CM/<	MAXFEE	FAC					110.67	1/1/2014	12/31/2299	N
11044	DEB BONE 20 SQ CM/<	MAXFEE	NFF					172.73	1/1/2014	12/31/2299	N
11045	DEB SUBQ TISSUE ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11045	DEB SUBQ TISSUE ADD-ON	MAXFEE	FAC					9.23	1/1/2014	12/31/2299	N
11045	DEB SUBQ TISSUE ADD-ON	MAXFEE	NFF					15.55	1/1/2014	12/31/2299	N
11046	DEB MUSC/FASCIA ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11046	DEB MUSC/FASCIA ADD-ON	MAXFEE	FAC					18.65	1/1/2014	12/31/2299	N
11046	DEB MUSC/FASCIA ADD-ON	MAXFEE	NFF					27.23	1/1/2014	12/31/2299	N
11047	DEB BONE ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11047	DEB BONE ADD-ON	MAXFEE	FAC					35.03	1/1/2014	12/31/2299	N
11047	DEB BONE ADD-ON	MAXFEE	NFF					44.83	1/1/2014	12/31/2299	N
11055	TRIM SKIN LESION	PRXOVR	DEF					NA	NA	NA	N
11055	TRIM SKIN LESION	MAXFEE	FAC					9.35	1/1/2014	12/31/2299	N
11055	TRIM SKIN LESION	MAXFEE	NFF					23.34	1/1/2014	12/31/2299	N
11056	TRIM SKIN LESIONS 2 TO 4	PRXOVR	DEF					NA	NA	NA	N
11056	TRIM SKIN LESIONS 2 TO 4	MAXFEE	FAC					15.67	1/1/2014	12/31/2299	N
11056	TRIM SKIN LESIONS 2 TO 4	MAXFEE	NFF					28.90	1/1/2014	12/31/2299	N
11057	TRIM SKIN LESIONS OVER 4	PRXOVR	DEF					NA	NA	NA	N
11057	TRIM SKIN LESIONS OVER 4	MAXFEE	FAC					20.41	1/1/2014	12/31/2299	N
11057	TRIM SKIN LESIONS OVER 4	MAXFEE	NFF					35.53	1/1/2014	12/31/2299	N
11100	BIOPSY SKIN LESION	PRXOVR	DEF					NA	NA	NA	N
11100	BIOPSY SKIN LESION	MAXFEE	DEF					NA			N
11101	BIOPSY SKIN ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11101	BIOPSY SKIN ADD-ON	MAXFEE	DEF					NA			N
11102	TANGNTL BX SKIN SINGLE LES	PRXOVR	DEF					NA	NA	NA	N
11102	TANGNTL BX SKIN SINGLE LES	MAXFEE	FAC					24.30	1/1/2019	12/31/2299	N
11102	TANGNTL BX SKIN SINGLE LES	MAXFEE	NFF					47.20	1/1/2019	12/31/2299	N
11103	TANGNTL BX SKIN EA SEP/ADDL	PRXOVR	DEF					NA	NA	NA	N
11103	TANGNTL BX SKIN EA SEP/ADDL	MAXFEE	FAC					14.58	1/1/2019	12/31/2299	N
11103	TANGNTL BX SKIN EA SEP/ADDL	MAXFEE	NFF					28.32	1/1/2019	12/31/2299	N
11104	PUNCH BX SKIN SINGLE LESION	PRXOVR	DEF					NA	NA	NA	N
11104	PUNCH BX SKIN SINGLE LESION	MAXFEE	FAC					30.38	1/1/2019	12/31/2299	N
11104	PUNCH BX SKIN SINGLE LESION	MAXFEE	NFF					59	1/1/2019	12/31/2299	N
11105	PUNCH BX SKIN EA SEP/ADDL	PRXOVR	DEF					NA	NA	NA	N
11105	PUNCH BX SKIN EA SEP/ADDL	MAXFEE	FAC					8.02	1/1/2019	12/31/2299	N
11105	PUNCH BX SKIN EA SEP/ADDL	MAXFEE	NFF					32.45	1/1/2019	12/31/2299	N
11106	INCAL BX SKN SINGLE LES	PRXOVR	DEF					NA	NA	NA	N
11106	INCAL BX SKN SINGLE LES	MAXFEE	FAC					36.94	1/1/2019	12/31/2299	N
11106	INCAL BX SKN SINGLE LES	MAXFEE	NFF					71.74	1/1/2019	12/31/2299	N
11107	INCAL BX SKN EA SEP/ADDL	PRXOVR	DEF					NA	NA	NA	N
11107	INCAL BX SKN EA SEP/ADDL	MAXFEE	FAC					20.31	1/1/2019	12/31/2299	N
11107	INCAL BX SKN EA SEP/ADDL	MAXFEE	NFF					39.46	1/1/2019	12/31/2299	N
1110F	PT LFT INPT FAC W/IN 60 DAYS	PRXOVR	DEF					NA	NA	NA	N
1110F	PT LFT INPT FAC W/IN 60 DAYS	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
1111F	DSCHRG MED/CURRENT MED MERGE	PRXOVR	DEF					NA	NA	NA	N
1111F	DSCHRG MED/CURRENT MED MERGE	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
1116F	AURIC/PERI PAIN ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1116F	AURIC/PERI PAIN ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1118F	GERD SYMPS ASSESSED 12 MONTH	PRXOVR	DEF					NA	NA	NA	N
1118F	GERD SYMPS ASSESSED 12 MONTH	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1119F	INIT EVAL FOR CONDITION	PRXOVR	DEF					NA	NA	NA	N
1119F	INIT EVAL FOR CONDITION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11200	REMOVAL OF SKIN TAGS <W/15	PRXOVR	DEF					NA	NA	NA	N
11200	REMOVAL OF SKIN TAGS <W/15	MAXFEE	FAC					41.92	1/1/2014	12/31/2299	N
11200	REMOVAL OF SKIN TAGS <W/15	MAXFEE	NFF					54.08	1/1/2014	12/31/2299	N
11201	REMOVE SKIN TAGS ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11201	REMOVE SKIN TAGS ADD-ON	MAXFEE	FAC					9.96	1/1/2014	12/31/2299	N
11201	REMOVE SKIN TAGS ADD-ON	MAXFEE	NFF					13.28	1/1/2014	12/31/2299	N
1121F	SUBS EVAL FOR CONDITION	PRXOVR	DEF					NA	NA	NA	N
1121F	SUBS EVAL FOR CONDITION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1123F	ACP DISCUSS/DSCN MKR DOCD	PRXOVR	DEF					NA	NA	NA	N
1123F	ACP DISCUSS/DSCN MKR DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1124F	ACP DISCUSS-NO DSCNMKR DOCD	PRXOVR	DEF					NA	NA	NA	N
1124F	ACP DISCUSS-NO DSCNMKR DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1125F	AMNT PAIN NOTED PAIN PRSNT	PRXOVR	DEF					NA	NA	NA	N
1125F	AMNT PAIN NOTED PAIN PRSNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1126F	AMNT PAIN NOTED NONE PRSNT	PRXOVR	DEF					NA	NA	NA	N
1126F	AMNT PAIN NOTED NONE PRSNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1127F	NEW EPISODE FOR CONDITION	PRXOVR	DEF					NA	NA	NA	N
1127F	NEW EPISODE FOR CONDITION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1128F	SUBS EPISODE FOR CONDITION	PRXOVR	DEF					NA	NA	NA	N
1128F	SUBS EPISODE FOR CONDITION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11300	SHAVE SKIN LESION 0.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
11300	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	FAC					27.86	1/1/2014	12/31/2299	N
11300	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	NFF					40.48	1/1/2014	12/31/2299	N
11301	SHAVE SKIN LESION 0.6-1.0 CM	PRXOVR	DEF					NA	NA	NA	N
11301	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	FAC					33.08	1/1/2014	12/31/2299	N
11301	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	NFF					43.85	1/1/2014	12/31/2299	N
11302	SHAVE SKIN LESION 1.1-2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11302	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	FAC					40.59	1/1/2014	12/31/2299	N
11302	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	NFF					53.13	1/1/2014	12/31/2299	N
11303	SHAVE SKIN LESION >2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11303	SHAVE SKIN LESION >2.0 CM	MAXFEE	FAC					55.06	1/1/2014	12/31/2299	N
11303	SHAVE SKIN LESION >2.0 CM	MAXFEE	NFF					69.80	1/1/2014	12/31/2299	N
11305	SHAVE SKIN LESION 0.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
11305	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	FAC					30.62	1/1/2014	12/31/2299	N
11305	SHAVE SKIN LESION 0.5 CM/<	MAXFEE	NFF					41.20	1/1/2014	12/31/2299	N
11306	SHAVE SKIN LESION 0.6-1.0 CM	PRXOVR	DEF					NA	NA	NA	N
11306	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	FAC					36.85	1/1/2014	12/31/2299	N
11306	SHAVE SKIN LESION 0.6-1.0 CM	MAXFEE	NFF					46.86	1/1/2014	12/31/2299	N
11307	SHAVE SKIN LESION 1.1-2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11307	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	FAC					43.15	1/1/2014	12/31/2299	N
11307	SHAVE SKIN LESION 1.1-2.0 CM	MAXFEE	NFF					56.65	1/1/2014	12/31/2299	N
11308	SHAVE SKIN LESION >2.0 CM	PRXOVR	DEF					NA	NA	NA	N
11308	SHAVE SKIN LESION >2.0 CM	MAXFEE	FAC					59.10	1/1/2014	12/31/2299	N
11308	SHAVE SKIN LESION >2.0 CM	MAXFEE	NFF					74.85	1/1/2014	12/31/2299	N
1130F	BK PAIN & FXN ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1130F	BK PAIN & FXN ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1134F	EPSD BK PAIN FOR 6 WKS/<	PRXOVR	DEF					NA	NA	NA	N
1134F	EPSD BK PAIN FOR 6 WKS/<	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1135F	EPSD BK PAIN FOR >6 WKS	PRXOVR	DEF					NA	NA	NA	N
1135F	EPSD BK PAIN FOR >6 WKS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1136F	EPSD BK PAIN FOR 12 WKS/<	PRXOVR	DEF					NA	NA	NA	N
1136F	EPSD BK PAIN FOR 12 WKS/<	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1137F	EPSD BK PAIN FOR >12 WKS	PRXOVR	DEF					NA	NA	NA	N
1137F	EPSD BK PAIN FOR >12 WKS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11400	EXC TR-EXT B9+MARG 0.5 CM<	PRXOVR	DEF					NA	NA	NA	N
11400	EXC TR-EXT B9+MARG 0.5 CM<	MAXFEE	FAC					44.97	1/1/2014	12/31/2299	N
11400	EXC TR-EXT B9+MARG 0.5 CM<	MAXFEE	NFF					60.67	1/1/2014	12/31/2299	N
11401	EXC TR-EXT B9+MARG 0.6-1 CM	PRXOVR	DEF					NA	NA	NA	N
11401	EXC TR-EXT B9+MARG 0.6-1 CM	MAXFEE	FAC					55.84	1/1/2014	12/31/2299	N
11401	EXC TR-EXT B9+MARG 0.6-1 CM	MAXFEE	NFF					71.83	1/1/2014	12/31/2299	N
11402	EXC TR-EXT B9+MARG 1.1-2 CM	PRXOVR	DEF					NA	NA	NA	N
11402	EXC TR-EXT B9+MARG 1.1-2 CM	MAXFEE	FAC					56.86	1/1/2014	12/31/2299	N
11402	EXC TR-EXT B9+MARG 1.1-2 CM	MAXFEE	NFF					79.94	1/1/2014	12/31/2299	N
11403	EXC TR-EXT B9+MARG 2.1-3CM	PRXOVR	DEF					NA	NA	NA	N
11403	EXC TR-EXT B9+MARG 2.1-3CM	MAXFEE	FAC					65.99	1/1/2014	12/31/2299	N
11403	EXC TR-EXT B9+MARG 2.1-3CM	MAXFEE	NFF					87.35	1/1/2014	12/31/2299	N
11404	EXC TR-EXT B9+MARG 3.1-4 CM	PRXOVR	DEF					NA	NA	NA	N
11404	EXC TR-EXT B9+MARG 3.1-4 CM	MAXFEE	FAC					76.06	1/1/2014	12/31/2299	N
11404	EXC TR-EXT B9+MARG 3.1-4 CM	MAXFEE	NFF					100.48	1/1/2014	12/31/2299	N
11406	EXC TR-EXT B9+MARG >4.0 CM	PRXOVR	DEF					NA	NA	NA	N
11406	EXC TR-EXT B9+MARG >4.0 CM	MAXFEE	FAC					95.98	1/1/2014	12/31/2299	N
11406	EXC TR-EXT B9+MARG >4.0 CM	MAXFEE	NFF					132.81	1/1/2014	12/31/2299	N
11420	EXC H-F-NK-SP B9+MARG 0.5/<	PRXOVR	DEF					NA	NA	NA	N
11420	EXC H-F-NK-SP B9+MARG 0.5/<	MAXFEE	FAC					44.43	1/1/2014	12/31/2299	N
11420	EXC H-F-NK-SP B9+MARG 0.5/<	MAXFEE	NFF					60.23	1/1/2014	12/31/2299	N
11421	EXC H-F-NK-SP B9+MARG 0.6-1	PRXOVR	DEF					NA	NA	NA	N
11421	EXC H-F-NK-SP B9+MARG 0.6-1	MAXFEE	FAC					55.20	1/1/2014	12/31/2299	N
11421	EXC H-F-NK-SP B9+MARG 0.6-1	MAXFEE	NFF					77	1/1/2014	12/31/2299	N
11422	EXC H-F-NK-SP B9+MARG 1.1-2	PRXOVR	DEF					NA	NA	NA	N
11422	EXC H-F-NK-SP B9+MARG 1.1-2	MAXFEE	FAC					59.54	1/1/2014	12/31/2299	N
11422	EXC H-F-NK-SP B9+MARG 1.1-2	MAXFEE	NFF					79.42	1/1/2014	12/31/2299	N
11423	EXC H-F-NK-SP B9+MARG 2.1-3	PRXOVR	DEF					NA	NA	NA	N
11423	EXC H-F-NK-SP B9+MARG 2.1-3	MAXFEE	FAC					73.87	1/1/2014	12/31/2299	N
11423	EXC H-F-NK-SP B9+MARG 2.1-3	MAXFEE	NFF					97.96	1/1/2014	12/31/2299	N
11424	EXC H-F-NK-SP B9+MARG 3.1-4	PRXOVR	DEF					NA	NA	NA	N
11424	EXC H-F-NK-SP B9+MARG 3.1-4	MAXFEE	FAC					86.04	1/1/2014	12/31/2299	N
11424	EXC H-F-NK-SP B9+MARG 3.1-4	MAXFEE	NFF					112.42	1/1/2014	12/31/2299	N
11426	EXC H-F-NK-SP B9+MARG >4 CM	PRXOVR	DEF					NA	NA	NA	N
11426	EXC H-F-NK-SP B9+MARG >4 CM	MAXFEE	FAC					117.74	1/1/2014	12/31/2299	N
11426	EXC H-F-NK-SP B9+MARG >4 CM	MAXFEE	NFF					160.11	1/1/2014	12/31/2299	N
1150F	DOC PT RSK DEATH W/IN 1YR	PRXOVR	DEF					NA	NA	NA	N
1150F	DOC PT RSK DEATH W/IN 1YR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1151F	DOC NO PT RSK DEATH W/IN 1YR	PRXOVR	DEF					NA	NA	NA	N
1151F	DOC NO PT RSK DEATH W/IN 1YR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1152F	DOC ADVNCD DIS COMFORT 1ST	PRXOVR	DEF					NA	NA	NA	N
1152F	DOC ADVNCD DIS COMFORT 1ST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1153F	DOC ADVNCD DIS CMFRT NOT 1ST	PRXOVR	DEF					NA	NA	NA	N
1153F	DOC ADVNCD DIS CMFRT NOT 1ST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1157F	ADVNC CARE PLAN IN RCRD	PRXOVR	DEF					NA	NA	NA	N
1157F	ADVNC CARE PLAN IN RCRD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1158F	ADVNC CARE PLAN TLK DOCD	PRXOVR	DEF					NA	NA	NA	N
1158F	ADVNC CARE PLAN TLK DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1159F	MED LIST DOCD IN RCRD	PRXOVR	DEF					NA	NA	NA	N
1159F	MED LIST DOCD IN RCRD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11600	EXC TR-EXT MAL+MARG 0.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
11600	EXC TR-EXT MAL+MARG 0.5 CM/<	MAXFEE	FAC					64.48	1/1/2014	12/31/2299	N
11600	EXC TR-EXT MAL+MARG 0.5 CM/<	MAXFEE	NFF					88.69	1/1/2014	12/31/2299	N
11601	EXC TR-EXT MAL+MARG 0.6-1 CM	PRXOVR	DEF					NA	NA	NA	N
11601	EXC TR-EXT MAL+MARG 0.6-1 CM	MAXFEE	FAC					75.72	1/1/2014	12/31/2299	N
11601	EXC TR-EXT MAL+MARG 0.6-1 CM	MAXFEE	NFF					105.38	1/1/2014	12/31/2299	N
11602	EXC TR-EXT MAL+MARG 1.1-2 CM	PRXOVR	DEF					NA	NA	NA	N
11602	EXC TR-EXT MAL+MARG 1.1-2 CM	MAXFEE	FAC					81.59	1/1/2014	12/31/2299	N
11602	EXC TR-EXT MAL+MARG 1.1-2 CM	MAXFEE	NFF					113.51	1/1/2014	12/31/2299	N
11603	EXC TR-EXT MAL+MARG 2.1-3 CM	PRXOVR	DEF					NA	NA	NA	N
11603	EXC TR-EXT MAL+MARG 2.1-3 CM	MAXFEE	FAC					101.09	1/1/2014	12/31/2299	N
11603	EXC TR-EXT MAL+MARG 2.1-3 CM	MAXFEE	NFF					130.62	1/1/2014	12/31/2299	N
11604	EXC TR-EXT MAL+MARG 3.1-4 CM	PRXOVR	DEF					NA	NA	NA	N
11604	EXC TR-EXT MAL+MARG 3.1-4 CM	MAXFEE	FAC					105.48	1/1/2014	12/31/2299	N
11604	EXC TR-EXT MAL+MARG 3.1-4 CM	MAXFEE	NFF					137.37	1/1/2014	12/31/2299	N
11606	EXC TR-EXT MAL+MARG >4 CM	PRXOVR	DEF					NA	NA	NA	N
11606	EXC TR-EXT MAL+MARG >4 CM	MAXFEE	FAC					131.41	1/1/2014	12/31/2299	N
11606	EXC TR-EXT MAL+MARG >4 CM	MAXFEE	NFF					179.86	1/1/2014	12/31/2299	N
1160F	RVW MEDS BY RX/DR IN RCRD	PRXOVR	DEF					NA	NA	NA	N
1160F	RVW MEDS BY RX/DR IN RCRD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11620	EXC H-F-NK-SP MAL+MARG 0.5/<	PRXOVR	DEF					NA	NA	NA	N
11620	EXC H-F-NK-SP MAL+MARG 0.5/<	MAXFEE	FAC					65.52	1/1/2014	12/31/2299	N
11620	EXC H-F-NK-SP MAL+MARG 0.5/<	MAXFEE	NFF					89.81	1/1/2014	12/31/2299	N
11621	EXC S/N/H/F/G MAL+MRG 0.6-1	PRXOVR	DEF					NA	NA	NA	N
11621	EXC S/N/H/F/G MAL+MRG 0.6-1	MAXFEE	FAC					76.22	1/1/2014	12/31/2299	N
11621	EXC S/N/H/F/G MAL+MRG 0.6-1	MAXFEE	NFF					105.82	1/1/2014	12/31/2299	N
11622	EXC S/N/H/F/G MAL+MRG 1.1-2	PRXOVR	DEF					NA	NA	NA	N
11622	EXC S/N/H/F/G MAL+MRG 1.1-2	MAXFEE	FAC					89.13	1/1/2014	12/31/2299	N
11622	EXC S/N/H/F/G MAL+MRG 1.1-2	MAXFEE	NFF					123.12	1/1/2014	12/31/2299	N
11623	EXC S/N/H/F/G MAL+MRG 2.1-3	PRXOVR	DEF					NA	NA	NA	N
11623	EXC S/N/H/F/G MAL+MRG 2.1-3	MAXFEE	FAC					114.63	1/1/2014	12/31/2299	N
11623	EXC S/N/H/F/G MAL+MRG 2.1-3	MAXFEE	NFF					147.13	1/1/2014	12/31/2299	N
11624	EXC S/N/H/F/G MAL+MRG 3.1-4	PRXOVR	DEF					NA	NA	NA	N
11624	EXC S/N/H/F/G MAL+MRG 3.1-4	MAXFEE	FAC					127.50	1/1/2014	12/31/2299	N
11624	EXC S/N/H/F/G MAL+MRG 3.1-4	MAXFEE	NFF					175.74	1/1/2014	12/31/2299	N
11626	EXC S/N/H/F/G MAL+MRG >4 CM	PRXOVR	DEF					NA	NA	NA	N
11626	EXC S/N/H/F/G MAL+MRG >4 CM	MAXFEE	FAC					153.72	1/1/2014	12/31/2299	N
11626	EXC S/N/H/F/G MAL+MRG >4 CM	MAXFEE	NFF					211.54	1/1/2014	12/31/2299	N
1170F	FXNL STATUS ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1170F	FXNL STATUS ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11720	DEBRIDE NAIL 1-5	PRXOVR	DEF					NA	NA	NA	N
11720	DEBRIDE NAIL 1-5	MAXFEE	FAC					5.87	1/1/2014	12/31/2299	N
11720	DEBRIDE NAIL 1-5	MAXFEE	NFF					14.69	1/1/2014	12/31/2299	N
11721	DEBRIDE NAIL 6 OR MORE	PRXOVR	DEF					NA	NA	NA	N
11721	DEBRIDE NAIL 6 OR MORE	MAXFEE	FAC					14.20	1/1/2014	12/31/2299	N
11721	DEBRIDE NAIL 6 OR MORE	MAXFEE	NFF					28.86	1/1/2014	12/31/2299	N
11730	REMOVAL OF NAIL PLATE	PRXOVR	DEF					NA	NA	NA	N
11730	REMOVAL OF NAIL PLATE	MAXFEE	FAC					21.48	1/1/2014	12/31/2299	N
11730	REMOVAL OF NAIL PLATE	MAXFEE	NFF					49.14	1/1/2014	12/31/2299	N
11732	REMOVE NAIL PLATE ADD-ON	PRXOVR	DEF					NA	NA	NA	N
11732	REMOVE NAIL PLATE ADD-ON	MAXFEE	FAC					16.02	1/1/2014	12/31/2299	N
11732	REMOVE NAIL PLATE ADD-ON	MAXFEE	NFF					23.11	1/1/2014	12/31/2299	N
11740	DRAIN BLOOD FROM UNDER NAIL	PRXOVR	DEF					NA	NA	NA	N
11740	DRAIN BLOOD FROM UNDER NAIL	MAXFEE	FAC					14.32	1/1/2014	12/31/2299	N
11740	DRAIN BLOOD FROM UNDER NAIL	MAXFEE	NFF					21.69	1/1/2014	12/31/2299	N
11750	REMOVAL OF NAIL BED	PRXOVR	DEF					NA	NA	NA	N
11750	REMOVAL OF NAIL BED	MAXFEE	FAC					68.39	1/1/2014	12/31/2299	N
11750	REMOVAL OF NAIL BED	MAXFEE	NFF					104.25	1/1/2014	12/31/2299	N
11752	REMOVE NAIL BED/TIP	PRXOVR	DEF					NA	NA	NA	N
11752	REMOVE NAIL BED/TIP	MAXFEE	DEF					NA			N
11755	BIOPSY NAIL UNIT	PRXOVR	DEF					NA	NA	NA	N
11755	BIOPSY NAIL UNIT	MAXFEE	FAC					50.44	1/1/2014	12/31/2299	N
11755	BIOPSY NAIL UNIT	MAXFEE	NFF					65.78	1/1/2014	12/31/2299	N
1175F	FUNCTION STAT ASSESSED RVWD	PRXOVR	DEF					NA	NA	NA	N
1175F	FUNCTION STAT ASSESSED RVWD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11760	REPAIR OF NAIL BED	PRXOVR	DEF					NA	NA	NA	N
11760	REPAIR OF NAIL BED	MAXFEE	FAC					53.32	1/1/2014	12/31/2299	N
11760	REPAIR OF NAIL BED	MAXFEE	NFF					91.92	1/1/2014	12/31/2299	N
11762	RECONSTRUCTION OF NAIL BED	PRXOVR	DEF					NA	NA	NA	N
11762	RECONSTRUCTION OF NAIL BED	MAXFEE	FAC					105.46	1/1/2014	12/31/2299	N
11762	RECONSTRUCTION OF NAIL BED	MAXFEE	NFF					142.15	1/1/2014	12/31/2299	N
11765	EXCISION OF NAIL FOLD TOE	PRXOVR	DEF					NA	NA	NA	N
11765	EXCISION OF NAIL FOLD TOE	MAXFEE	FAC					34.26	1/1/2014	12/31/2299	N
11765	EXCISION OF NAIL FOLD TOE	MAXFEE	NFF					71.10	1/1/2014	12/31/2299	N
1180F	THROMBOEMB RISK ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1180F	THROMBOEMB RISK ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1181F	NEUROPSYCHIA SYMPTS ASSESSED	PRXOVR	DEF					NA	NA	NA	N
1181F	NEUROPSYCHIA SYMPTS ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1182F	NEUROPSYCHI SYMPT 1+PRESENT	PRXOVR	DEF					NA	NA	NA	N
1182F	NEUROPSYCHI SYMPT 1+PRESENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1183F	NEUROPSYCHIATRIC SYMP ABSENT	PRXOVR	DEF					NA	NA	NA	N
1183F	NEUROPSYCHIATRIC SYMP ABSENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
11900	INJECT SKIN LESIONS </W 7	PRXOVR	DEF					NA	NA	NA	N
11900	INJECT SKIN LESIONS </W 7	MAXFEE	FAC					18.82	1/1/2014	12/31/2299	N
11900	INJECT SKIN LESIONS </W 7	MAXFEE	NFF					34.24	1/1/2014	12/31/2299	N
11901	INJECT SKIN LESIONS >7	PRXOVR	DEF					NA	NA	NA	N
11901	INJECT SKIN LESIONS >7	MAXFEE	FAC					31.57	1/1/2014	12/31/2299	N
11901	INJECT SKIN LESIONS >7	MAXFEE	NFF					41.35	1/1/2014	12/31/2299	N
11950	TX CONTOUR DEFECTS 1 CC/<	PRXOVR	DEF					NA	NA	NA	N
11950	TX CONTOUR DEFECTS 1 CC/<	MAXFEE	FAC					34.44	1/1/2014	12/31/2299	N
11950	TX CONTOUR DEFECTS 1 CC/<	MAXFEE	NFF					44.44	1/1/2014	12/31/2299	N
11951	TX CONTOUR DEFECTS 1.1-5.0CC	PRXOVR	DEF					NA	NA	NA	N
11951	TX CONTOUR DEFECTS 1.1-5.0CC	MAXFEE	FAC					45.70	1/1/2014	12/31/2299	N
11951	TX CONTOUR DEFECTS 1.1-5.0CC	MAXFEE	NFF					62.96	1/1/2014	12/31/2299	N
11952	TX CONTOUR DEFECTS 5.1-10CC	PRXOVR	DEF					NA	NA	NA	N
11952	TX CONTOUR DEFECTS 5.1-10CC	MAXFEE	FAC					67.94	1/1/2014	12/31/2299	N
11952	TX CONTOUR DEFECTS 5.1-10CC	MAXFEE	NFF					88.91	1/1/2014	12/31/2299	N
11954	TX CONTOUR DEFECTS >10.0 CC	PRXOVR	DEF					NA	NA	NA	N
11954	TX CONTOUR DEFECTS >10.0 CC	MAXFEE	FAC					91.79	1/1/2014	12/31/2299	N
11954	TX CONTOUR DEFECTS >10.0 CC	MAXFEE	NFF					115.45	1/1/2014	12/31/2299	N
11960	INSERT TISSUE EXPANDER(S)	PRXOVR	DEF					NA	NA	NA	N
11960	INSERT TISSUE EXPANDER(S)	MAXFEE	DEF					522.51	7/1/2003	12/31/2299	N
11970	RPLCMT TISS XPNDR PERM IMPLT	PRXOVR	DEF					NA	NA	NA	E
11970	RPLCMT TISS XPNDR PERM IMPLT	MAXFEE	DEF					343.21	1/1/2000	12/31/2299	E
11971	RMVL TIS XPNDR WO INSJ IMPLT	PRXOVR	DEF					NA	NA	NA	N
11971	RMVL TIS XPNDR WO INSJ IMPLT	MAXFEE	FAC					112.21	1/1/2014	12/31/2299	N
11971	RMVL TIS XPNDR WO INSJ IMPLT	MAXFEE	NFF					205.86	1/1/2014	12/31/2299	N
11981	INSERTION DRUG DLVR IMPLANT	PRXOVR	DEF					NA	NA	NA	N
11981	INSERTION DRUG DLVR IMPLANT	MAXFEE	FAC					35.63	1/1/2014	12/31/2299	N
11981	INSERTION DRUG DLVR IMPLANT	MAXFEE	NFF					71.80	1/1/2014	12/31/2299	N
11982	REMOVE DRUG IMPLANT DEVICE	PRXOVR	DEF					NA	NA	NA	N
11982	REMOVE DRUG IMPLANT DEVICE	MAXFEE	FAC					47.15	1/1/2014	12/31/2299	N
11982	REMOVE DRUG IMPLANT DEVICE	MAXFEE	NFF					88.05	1/1/2014	12/31/2299	N
11983	REMOVE/INSERT DRUG IMPLANT	PRXOVR	DEF					NA	NA	NA	N
11983	REMOVE/INSERT DRUG IMPLANT	MAXFEE	FAC					104.67	1/1/2014	12/31/2299	N
11983	REMOVE/INSERT DRUG IMPLANT	MAXFEE	NFF					155.84	1/1/2014	12/31/2299	N
12001	RPR S/N/AX/GEN/TRNK 2.5CM/<	PRXOVR	DEF					NA	NA	NA	N
12001	RPR S/N/AX/GEN/TRNK 2.5CM/<	MAXFEE	FAC					29.39	1/1/2014	12/31/2299	N
12001	RPR S/N/AX/GEN/TRNK 2.5CM/<	MAXFEE	NFF					67.35	1/1/2014	12/31/2299	N
12002	RPR S/N/AX/GEN/TRNK2.6-7.5CM	PRXOVR	DEF					NA	NA	NA	N
12002	RPR S/N/AX/GEN/TRNK2.6-7.5CM	MAXFEE	FAC					37.23	1/1/2014	12/31/2299	N
12002	RPR S/N/AX/GEN/TRNK2.6-7.5CM	MAXFEE	NFF					77.98	1/1/2014	12/31/2299	N
12004	RPR S/N/AX/GEN/TRK7.6-12.5CM	PRXOVR	DEF					NA	NA	NA	N
12004	RPR S/N/AX/GEN/TRK7.6-12.5CM	MAXFEE	FAC					37.45	1/1/2014	12/31/2299	N
12004	RPR S/N/AX/GEN/TRK7.6-12.5CM	MAXFEE	NFF					96.45	1/1/2014	12/31/2299	N
12005	RPR S/N/A/GEN/TRK12.6-20.0CM	PRXOVR	DEF					NA	NA	NA	N
12005	RPR S/N/A/GEN/TRK12.6-20.0CM	MAXFEE	FAC					64.72	1/1/2014	12/31/2299	N
12005	RPR S/N/A/GEN/TRK12.6-20.0CM	MAXFEE	NFF					122.20	1/1/2014	12/31/2299	N
12006	RPR S/N/A/GEN/TRK20.1-30.0CM	PRXOVR	DEF					NA	NA	NA	N
12006	RPR S/N/A/GEN/TRK20.1-30.0CM	MAXFEE	FAC					83.78	1/1/2014	12/31/2299	N
12006	RPR S/N/A/GEN/TRK20.1-30.0CM	MAXFEE	NFF					156.01	1/1/2014	12/31/2299	N
12007	RPR S/N/AX/GEN/TRNK >30.0 CM	PRXOVR	DEF					NA	NA	NA	N
12007	RPR S/N/AX/GEN/TRNK >30.0 CM	MAXFEE	FAC					97.11	1/1/2014	12/31/2299	N
12007	RPR S/N/AX/GEN/TRNK >30.0 CM	MAXFEE	NFF					170.61	1/1/2014	12/31/2299	N
1200F	SEIZURE TYPE& FREQU DOCD	PRXOVR	DEF					NA	NA	NA	N
1200F	SEIZURE TYPE& FREQU DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
12020	CLOSURE OF SPLIT WOUND	PRXOVR	DEF					NA	NA	NA	N
12020	CLOSURE OF SPLIT WOUND	MAXFEE	FAC					66.03	1/1/2014	12/31/2299	N
12020	CLOSURE OF SPLIT WOUND	MAXFEE	NFF					109.03	1/1/2014	12/31/2299	N
12021	CLOSURE OF SPLIT WOUND	PRXOVR	DEF					NA	NA	NA	N
12021	CLOSURE OF SPLIT WOUND	MAXFEE	FAC					59.01	1/1/2014	12/31/2299	N
12021	CLOSURE OF SPLIT WOUND	MAXFEE	NFF					82.08	1/1/2014	12/31/2299	N
12031	INTMD RPR S/A/T/EXT 2.5 CM/<	PRXOVR	DEF					NA	NA	NA	N
12031	INTMD RPR S/A/T/EXT 2.5 CM/<	MAXFEE	FAC					85.58	1/1/2014	12/31/2299	N
12031	INTMD RPR S/A/T/EXT 2.5 CM/<	MAXFEE	NFF					103.33	1/1/2014	12/31/2299	N
12032	INTMD RPR S/A/T/EXT 2.6-7.5	PRXOVR	DEF					NA	NA	NA	N
12032	INTMD RPR S/A/T/EXT 2.6-7.5	MAXFEE	FAC					77.92	1/1/2014	12/31/2299	N
12032	INTMD RPR S/A/T/EXT 2.6-7.5	MAXFEE	NFF					143.77	1/1/2014	12/31/2299	N
12034	INTMD RPR S/TR/EXT 7.6-12.5	PRXOVR	DEF					NA	NA	NA	N
12034	INTMD RPR S/TR/EXT 7.6-12.5	MAXFEE	FAC					72.56	1/1/2014	12/31/2299	N
12034	INTMD RPR S/TR/EXT 7.6-12.5	MAXFEE	NFF					123.85	1/1/2014	12/31/2299	N
12035	INTMD RPR S/A/T/EXT 12.6-20	PRXOVR	DEF					NA	NA	NA	N
12035	INTMD RPR S/A/T/EXT 12.6-20	MAXFEE	FAC					85.39	1/1/2014	12/31/2299	N
12035	INTMD RPR S/A/T/EXT 12.6-20	MAXFEE	NFF					147.97	1/1/2014	12/31/2299	N
12036	INTMD RPR S/A/T/EXT 20.1-30	PRXOVR	DEF					NA	NA	NA	N
12036	INTMD RPR S/A/T/EXT 20.1-30	MAXFEE	FAC					98.87	1/1/2014	12/31/2299	N
12036	INTMD RPR S/A/T/EXT 20.1-30	MAXFEE	NFF					185.44	1/1/2014	12/31/2299	N
12037	INTMD RPR S/TR/EXT >30.0 CM	PRXOVR	DEF					NA	NA	NA	N
12037	INTMD RPR S/TR/EXT >30.0 CM	MAXFEE	FAC					124.14	1/1/2014	12/31/2299	N
12037	INTMD RPR S/TR/EXT >30.0 CM	MAXFEE	NFF					221.75	1/1/2014	12/31/2299	N
12041	INTMD RPR N-HF/GENIT 2.5CM/<	PRXOVR	DEF					NA	NA	NA	N
12041	INTMD RPR N-HF/GENIT 2.5CM/<	MAXFEE	FAC					54.68	1/1/2014	12/31/2299	N
12041	INTMD RPR N-HF/GENIT 2.5CM/<	MAXFEE	NFF					95.57	1/1/2014	12/31/2299	N
12042	INTMD RPR N-HF/GENIT2.6-7.5	PRXOVR	DEF					NA	NA	NA	N
12042	INTMD RPR N-HF/GENIT2.6-7.5	MAXFEE	FAC					69.97	1/1/2014	12/31/2299	N
12042	INTMD RPR N-HF/GENIT2.6-7.5	MAXFEE	NFF					112.31	1/1/2014	12/31/2299	N
12044	INTMD RPR N-HF/GENIT7.6-12.5	PRXOVR	DEF					NA	NA	NA	N
12044	INTMD RPR N-HF/GENIT7.6-12.5	MAXFEE	FAC					71.05	1/1/2014	12/31/2299	N
12044	INTMD RPR N-HF/GENIT7.6-12.5	MAXFEE	NFF					133.41	1/1/2014	12/31/2299	N
12045	INTMD RPR N-HF/GENIT12.6-20	PRXOVR	DEF					NA	NA	NA	N
12045	INTMD RPR N-HF/GENIT12.6-20	MAXFEE	FAC					92.56	1/1/2014	12/31/2299	N
12045	INTMD RPR N-HF/GENIT12.6-20	MAXFEE	NFF					160.11	1/1/2014	12/31/2299	N
12046	INTMD RPR N-HF/GENIT20.1-30	PRXOVR	DEF					NA	NA	NA	N
12046	INTMD RPR N-HF/GENIT20.1-30	MAXFEE	FAC					135.77	1/1/2014	12/31/2299	N
12046	INTMD RPR N-HF/GENIT20.1-30	MAXFEE	NFF					202.40	1/1/2014	12/31/2299	N
12047	INTMD RPR N-HF/GENIT >30.0CM	PRXOVR	DEF					NA	NA	NA	N
12047	INTMD RPR N-HF/GENIT >30.0CM	MAXFEE	FAC					158.61	1/1/2014	12/31/2299	N
12047	INTMD RPR N-HF/GENIT >30.0CM	MAXFEE	NFF					243.52	1/1/2014	12/31/2299	N
1205F	EPI ETIOL SYND RVWD AND DOCD	PRXOVR	DEF					NA	NA	NA	N
1205F	EPI ETIOL SYND RVWD AND DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1220F	PT SCREENED FOR DEPRESSION	PRXOVR	DEF					NA	NA	NA	N
1220F	PT SCREENED FOR DEPRESSION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
13100	CMPLX RPR TRUNK 1.1-2.5 CM	PRXOVR	DEF					NA	NA	NA	N
13100	CMPLX RPR TRUNK 1.1-2.5 CM	MAXFEE	FAC					69.97	1/1/2014	12/31/2299	N
13100	CMPLX RPR TRUNK 1.1-2.5 CM	MAXFEE	NFF					123.92	1/1/2014	12/31/2299	N
13120	CMPLX RPR S/A/L 1.1-2.5 CM	PRXOVR	DEF					NA	NA	NA	N
13120	CMPLX RPR S/A/L 1.1-2.5 CM	MAXFEE	FAC					82.72	1/1/2014	12/31/2299	N
13120	CMPLX RPR S/A/L 1.1-2.5 CM	MAXFEE	NFF					134.11	1/1/2014	12/31/2299	N
13121	CMPLX RPR S/A/L 2.6-7.5 CM	PRXOVR	DEF					NA	NA	NA	N
13121	CMPLX RPR S/A/L 2.6-7.5 CM	MAXFEE	FAC					93.73	1/1/2014	12/31/2299	N
13121	CMPLX RPR S/A/L 2.6-7.5 CM	MAXFEE	NFF					192.19	1/1/2014	12/31/2299	N
13122	CMPLX RPR S/A/L ADDL 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
13122	CMPLX RPR S/A/L ADDL 5 CM/>	MAXFEE	FAC					39.77	1/1/2014	12/31/2299	N
13122	CMPLX RPR S/A/L ADDL 5 CM/>	MAXFEE	NFF					65.60	1/1/2014	12/31/2299	N
13131	CMPLX RPR F/C/C/M/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
13131	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	FAC					92.73	1/1/2014	12/31/2299	N
13131	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	NFF					162.27	1/1/2014	12/31/2299	N
13132	CMPLX RPR F/C/C/M/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
13132	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	FAC					119.68	1/1/2014	12/31/2299	N
13132	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	NFF					270.46	1/1/2014	12/31/2299	N
13133	CMPLX RPR F/C/C/M/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
13133	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	FAC					63.09	1/1/2014	12/31/2299	N
13133	CMPLX RPR F/C/C/M/N/AX/G/H/F	MAXFEE	NFF					95.96	1/1/2014	12/31/2299	N
13160	LATE CLOSURE OF WOUND	PRXOVR	DEF					NA	NA	NA	N
13160	LATE CLOSURE OF WOUND	MAXFEE	DEF					427.63	7/1/2008	12/31/2299	N
1400F	PRKNS DIAG RVIEWED	PRXOVR	DEF					NA	NA	NA	N
1400F	PRKNS DIAG RVIEWED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
14020	TIS TRNFR S/A/L 10 SQ CM/<	PRXOVR	DEF					NA	NA	NA	N
14020	TIS TRNFR S/A/L 10 SQ CM/<	MAXFEE	FAC					211.18	1/1/2014	12/31/2299	N
14020	TIS TRNFR S/A/L 10 SQ CM/<	MAXFEE	NFF					317.79	1/1/2014	12/31/2299	N
14021	TIS TRNFR S/A/L 10.1-30 SQCM	PRXOVR	DEF					NA	NA	NA	N
14021	TIS TRNFR S/A/L 10.1-30 SQCM	MAXFEE	FAC					310.15	1/1/2014	12/31/2299	N
14021	TIS TRNFR S/A/L 10.1-30 SQCM	MAXFEE	NFF					452.14	1/1/2014	12/31/2299	N
14040	TIS TRNFR F/C/C/M/N/A/G/H/F	PRXOVR	DEF					NA	NA	NA	N
14040	TIS TRNFR F/C/C/M/N/A/G/H/F	MAXFEE	FAC					273.31	1/1/2014	12/31/2299	N
14040	TIS TRNFR F/C/C/M/N/A/G/H/F	MAXFEE	NFF					394.31	1/1/2014	12/31/2299	N
14041	TIS TRNFR F/C/C/M/N/A/G/H/F	PRXOVR	DEF					NA	NA	NA	N
14041	TIS TRNFR F/C/C/M/N/A/G/H/F	MAXFEE	FAC					366.14	1/1/2014	12/31/2299	N
14041	TIS TRNFR F/C/C/M/N/A/G/H/F	MAXFEE	NFF					527.88	1/1/2014	12/31/2299	N
14300	SKIN TISSUE REARRANGEMENT	PRXOVR	DEF					NA	NA	NA	N
14300	SKIN TISSUE REARRANGEMENT	MAXFEE	DEF					NA			N
14301	TIS TRNFR ANY 30.1-60 SQ CM	PRXOVR	DEF					NA	NA	NA	N
14301	TIS TRNFR ANY 30.1-60 SQ CM	MAXFEE	FAC					319.72	1/1/2014	12/31/2299	N
14301	TIS TRNFR ANY 30.1-60 SQ CM	MAXFEE	NFF					488.86	1/1/2014	12/31/2299	N
14302	TIS TRNFR ADDL 30 SQ CM	PRXOVR	DEF					NA	NA	NA	N
14302	TIS TRNFR ADDL 30 SQ CM	MAXFEE	DEF					127.72	1/1/2010	12/31/2299	N
14350	FILLETED FINGER/TOE FLAP	PRXOVR	DEF					NA	NA	NA	N
14350	FILLETED FINGER/TOE FLAP	MAXFEE	DEF					427.18	1/1/2000	12/31/2299	N
1450F	SYMPTOMS IMPROVED/CONSIST	PRXOVR	DEF					NA	NA	NA	N
1450F	SYMPTOMS IMPROVED/CONSIST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1451F	SYMPT SHOW CLIN IMPORT DROP	PRXOVR	DEF					NA	NA	NA	N
1451F	SYMPT SHOW CLIN IMPORT DROP	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1460F	QUAL CARD DIAG PRIOR 12 MONS	PRXOVR	DEF					NA	NA	NA	N
1460F	QUAL CARD DIAG PRIOR 12 MONS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1461F	NO QUAL CARD DIAG PRIOR12MON	PRXOVR	DEF					NA	NA	NA	N
1461F	NO QUAL CARD DIAG PRIOR12MON	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1490F	DEM SEVERITY CLASSIFIED MILD	PRXOVR	DEF					NA	NA	NA	N
1490F	DEM SEVERITY CLASSIFIED MILD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1491F	DEM SEVERITY CLASSIFIED MOD	PRXOVR	DEF					NA	NA	NA	N
1491F	DEM SEVERITY CLASSIFIED MOD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1493F	DEM SEVERITY CLASS SEVERE	PRXOVR	DEF					NA	NA	NA	N
1493F	DEM SEVERITY CLASS SEVERE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1494F	COGNIT ASSESSED AND REVIEWED	PRXOVR	DEF					NA	NA	NA	N
1494F	COGNIT ASSESSED AND REVIEWED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
15002	WOUND PREP TRK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15002	WOUND PREP TRK/ARM/LEG	MAXFEE	FAC					101.12	1/1/2014	12/31/2299	N
15002	WOUND PREP TRK/ARM/LEG	MAXFEE	NFF					180	1/1/2014	12/31/2299	N
15003	WOUND PREP ADDL 100 CM	PRXOVR	DEF					NA	NA	NA	N
15003	WOUND PREP ADDL 100 CM	MAXFEE	FAC					19.90	1/1/2014	12/31/2299	N
15003	WOUND PREP ADDL 100 CM	MAXFEE	NFF					38.79	1/1/2014	12/31/2299	N
15004	WOUND PREP F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15004	WOUND PREP F/N/HF/G	MAXFEE	FAC					125.45	1/1/2014	12/31/2299	N
15004	WOUND PREP F/N/HF/G	MAXFEE	NFF					217.41	1/1/2014	12/31/2299	N
15005	WND PREP F/N/HF/G ADDL CM	PRXOVR	DEF					NA	NA	NA	N
15005	WND PREP F/N/HF/G ADDL CM	MAXFEE	FAC					41.59	1/1/2014	12/31/2299	N
15005	WND PREP F/N/HF/G ADDL CM	MAXFEE	NFF					67.78	1/1/2014	12/31/2299	N
1500F	SYMPTOM&SIGN SYMM POLYNEURO	PRXOVR	DEF					NA	NA	NA	N
1500F	SYMPTOM&SIGN SYMM POLYNEURO	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1501F	NOT INITIAL EVAL FOR COND	PRXOVR	DEF					NA	NA	NA	N
1501F	NOT INITIAL EVAL FOR COND	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1502F	PT QUERIED PAIN FXN W/ INSTR	PRXOVR	DEF					NA	NA	NA	N
1502F	PT QUERIED PAIN FXN W/ INSTR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
1503F	PT QUERIED SYMP RESP INSUFF	PRXOVR	DEF					NA	NA	NA	N
1503F	PT QUERIED SYMP RESP INSUFF	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
15040	HARVEST CULTURED SKIN GRAFT	PRXOVR	DEF					NA	NA	NA	N
15040	HARVEST CULTURED SKIN GRAFT	MAXFEE	FAC					43.78	1/1/2014	12/31/2299	N
15040	HARVEST CULTURED SKIN GRAFT	MAXFEE	NFF					106.11	1/1/2014	12/31/2299	N
1504F	PT HAS RESP INSUFFICIENCY	PRXOVR	DEF					NA	NA	NA	N
1504F	PT HAS RESP INSUFFICIENCY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
15050	SKIN PINCH GRAFT	PRXOVR	DEF					NA	NA	NA	N
15050	SKIN PINCH GRAFT	MAXFEE	FAC					151.98	1/1/2014	12/31/2299	N
15050	SKIN PINCH GRAFT	MAXFEE	NFF					230.80	1/1/2014	12/31/2299	N
1505F	PT HAS NO RESP INSUFFICIENCY	PRXOVR	DEF					NA	NA	NA	N
1505F	PT HAS NO RESP INSUFFICIENCY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
15100	SKIN SPLT GRFT TRNK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15100	SKIN SPLT GRFT TRNK/ARM/LEG	MAXFEE	FAC					260.10	1/1/2014	12/31/2299	N
15100	SKIN SPLT GRFT TRNK/ARM/LEG	MAXFEE	NFF					387.90	1/1/2014	12/31/2299	N
15101	SKIN SPLT GRFT T/A/L ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15101	SKIN SPLT GRFT T/A/L ADD-ON	MAXFEE	FAC					44.66	1/1/2014	12/31/2299	N
15101	SKIN SPLT GRFT T/A/L ADD-ON	MAXFEE	NFF					90.21	1/1/2014	12/31/2299	N
15110	EPIDRM AUTOGRFT TRNK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15110	EPIDRM AUTOGRFT TRNK/ARM/LEG	MAXFEE	FAC					427.42	1/1/2014	12/31/2299	N
15110	EPIDRM AUTOGRFT TRNK/ARM/LEG	MAXFEE	NFF					563.28	1/1/2014	12/31/2299	N
15111	EPIDRM AUTOGRFT T/A/L ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15111	EPIDRM AUTOGRFT T/A/L ADD-ON	MAXFEE	FAC					70.86	1/1/2014	12/31/2299	N
15111	EPIDRM AUTOGRFT T/A/L ADD-ON	MAXFEE	NFF					89.81	1/1/2014	12/31/2299	N
15115	EPIDRM A-GRFT FACE/NCK/HF/G	PRXOVR	DEF					NA	NA	NA	N
15115	EPIDRM A-GRFT FACE/NCK/HF/G	MAXFEE	FAC					394.64	1/1/2014	12/31/2299	N
15115	EPIDRM A-GRFT FACE/NCK/HF/G	MAXFEE	NFF					530.72	1/1/2014	12/31/2299	N
15116	EPIDRM A-GRFT F/N/HF/G ADDL	PRXOVR	DEF					NA	NA	NA	N
15116	EPIDRM A-GRFT F/N/HF/G ADDL	MAXFEE	FAC					80.80	1/1/2014	12/31/2299	N
15116	EPIDRM A-GRFT F/N/HF/G ADDL	MAXFEE	NFF					116.67	1/1/2014	12/31/2299	N
15120	SKN SPLT A-GRFT FAC/NCK/HF/G	PRXOVR	DEF					NA	NA	NA	N
15120	SKN SPLT A-GRFT FAC/NCK/HF/G	MAXFEE	FAC					294.52	1/1/2014	12/31/2299	N
15120	SKN SPLT A-GRFT FAC/NCK/HF/G	MAXFEE	NFF					438.51	1/1/2014	12/31/2299	N
15121	SKN SPLT A-GRFT F/N/HF/G ADD	PRXOVR	DEF					NA	NA	NA	N
15121	SKN SPLT A-GRFT F/N/HF/G ADD	MAXFEE	FAC					78.39	1/1/2014	12/31/2299	N
15121	SKN SPLT A-GRFT F/N/HF/G ADD	MAXFEE	NFF					143.79	1/1/2014	12/31/2299	N
15130	DERM AUTOGRAFT TRNK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15130	DERM AUTOGRAFT TRNK/ARM/LEG	MAXFEE	FAC					329.32	1/1/2014	12/31/2299	N
15130	DERM AUTOGRAFT TRNK/ARM/LEG	MAXFEE	NFF					452.64	1/1/2014	12/31/2299	N
15131	DERM AUTOGRAFT T/A/L ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15131	DERM AUTOGRAFT T/A/L ADD-ON	MAXFEE	FAC					51.29	1/1/2014	12/31/2299	N
15131	DERM AUTOGRAFT T/A/L ADD-ON	MAXFEE	NFF					73.28	1/1/2014	12/31/2299	N
15135	DERM AUTOGRAFT FACE/NCK/HF/G	PRXOVR	DEF					NA	NA	NA	N
15135	DERM AUTOGRAFT FACE/NCK/HF/G	MAXFEE	FAC					431.19	1/1/2014	12/31/2299	N
15135	DERM AUTOGRAFT FACE/NCK/HF/G	MAXFEE	NFF					568.16	1/1/2014	12/31/2299	N
15136	DERM AUTOGRAFT F/N/HF/G ADD	PRXOVR	DEF					NA	NA	NA	N
15136	DERM AUTOGRAFT F/N/HF/G ADD	MAXFEE	FAC					67.75	1/1/2014	12/31/2299	N
15136	DERM AUTOGRAFT F/N/HF/G ADD	MAXFEE	NFF					68.65	1/1/2014	12/31/2299	N
15150	CULT SKIN GRFT T/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15150	CULT SKIN GRFT T/ARM/LEG	MAXFEE	FAC					426.46	1/1/2014	12/31/2299	N
15150	CULT SKIN GRFT T/ARM/LEG	MAXFEE	NFF					468.58	1/1/2014	12/31/2299	N
15151	CULT SKIN GRFT T/A/L ADDL	PRXOVR	DEF					NA	NA	NA	N
15151	CULT SKIN GRFT T/A/L ADDL	MAXFEE	FAC					83.01	1/1/2014	12/31/2299	N
15151	CULT SKIN GRFT T/A/L ADDL	MAXFEE	NFF					94.96	1/1/2014	12/31/2299	N
15152	CULT SKIN GRAFT T/A/L +%	PRXOVR	DEF					NA	NA	NA	N
15152	CULT SKIN GRAFT T/A/L +%	MAXFEE	FAC					88.04	1/1/2014	12/31/2299	N
15152	CULT SKIN GRAFT T/A/L +%	MAXFEE	NFF					116.67	1/1/2014	12/31/2299	N
15155	CULT SKIN GRAFT F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15155	CULT SKIN GRAFT F/N/HF/G	MAXFEE	FAC					449.68	1/1/2014	12/31/2299	N
15155	CULT SKIN GRAFT F/N/HF/G	MAXFEE	NFF					470.48	1/1/2014	12/31/2299	N
15156	CULT SKIN GRFT F/N/HFG ADD	PRXOVR	DEF					NA	NA	NA	N
15156	CULT SKIN GRFT F/N/HFG ADD	MAXFEE	FAC					93.23	1/1/2014	12/31/2299	N
15156	CULT SKIN GRFT F/N/HFG ADD	MAXFEE	NFF					123.73	1/1/2014	12/31/2299	N
15157	CULT EPIDERM GRFT F/N/HFG +%	PRXOVR	DEF					NA	NA	NA	N
15157	CULT EPIDERM GRFT F/N/HFG +%	MAXFEE	FAC					126.33	1/1/2014	12/31/2299	N
15157	CULT EPIDERM GRFT F/N/HFG +%	MAXFEE	NFF					136.75	1/1/2014	12/31/2299	N
15170	ACELL GRAFT TRUNK/ARMS/LEGS	PRXOVR	DEF					NA	NA	NA	N
15170	ACELL GRAFT TRUNK/ARMS/LEGS	MAXFEE	DEF					NA			N
15175	ACELLULAR GRAFT F/N/HF/G	PRXOVR	DEF					NA	NA	NA	N
15175	ACELLULAR GRAFT F/N/HF/G	MAXFEE	DEF					NA			N
15220	SKIN FULL GRAFT SCLP/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15220	SKIN FULL GRAFT SCLP/ARM/LEG	MAXFEE	FAC					253.53	1/1/2014	12/31/2299	N
15220	SKIN FULL GRAFT SCLP/ARM/LEG	MAXFEE	NFF					365.48	1/1/2014	12/31/2299	N
15221	SKIN FULL GRAFT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15221	SKIN FULL GRAFT ADD-ON	MAXFEE	FAC					46.98	1/1/2014	12/31/2299	N
15221	SKIN FULL GRAFT ADD-ON	MAXFEE	NFF					61.58	1/1/2014	12/31/2299	N
15240	SKIN FULL GRFT FACE/GENIT/HF	PRXOVR	DEF					NA	NA	NA	N
15240	SKIN FULL GRFT FACE/GENIT/HF	MAXFEE	FAC					305.78	1/1/2014	12/31/2299	N
15240	SKIN FULL GRFT FACE/GENIT/HF	MAXFEE	NFF					423.82	1/1/2014	12/31/2299	N
15241	SKIN FULL GRAFT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15241	SKIN FULL GRAFT ADD-ON	MAXFEE	FAC					73.14	1/1/2014	12/31/2299	N
15241	SKIN FULL GRAFT ADD-ON	MAXFEE	NFF					95.75	1/1/2014	12/31/2299	N
15271	SKIN SUB GRAFT TRNK/ARM/LEG	PRXOVR	DEF					NA	NA	NA	N
15271	SKIN SUB GRAFT TRNK/ARM/LEG	MAXFEE	FAC					41.67	1/1/2014	12/31/2299	N
15271	SKIN SUB GRAFT TRNK/ARM/LEG	MAXFEE	NFF					54.82	1/1/2014	12/31/2299	N
15272	SKIN SUB GRAFT T/A/L ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15272	SKIN SUB GRAFT T/A/L ADD-ON	MAXFEE	FAC					7.83	1/1/2014	12/31/2299	N
15272	SKIN SUB GRAFT T/A/L ADD-ON	MAXFEE	NFF					10.36	1/1/2014	12/31/2299	N
15273	SKIN SUB GRFT T/ARM/LG CHILD	PRXOVR	DEF					NA	NA	NA	N
15273	SKIN SUB GRFT T/ARM/LG CHILD	MAXFEE	FAC					84.29	1/1/2014	12/31/2299	N
15273	SKIN SUB GRFT T/ARM/LG CHILD	MAXFEE	NFF					113.46	1/1/2014	12/31/2299	N
15274	SKN SUB GRFT T/A/L CHILD ADD	PRXOVR	DEF					NA	NA	NA	N
15274	SKN SUB GRFT T/A/L CHILD ADD	MAXFEE	FAC					20.35	1/1/2014	12/31/2299	N
15274	SKN SUB GRFT T/A/L CHILD ADD	MAXFEE	NFF					26.49	1/1/2014	12/31/2299	N
15275	SKIN SUB GRAFT FACE/NK/HF/G	PRXOVR	DEF					NA	NA	NA	N
15275	SKIN SUB GRAFT FACE/NK/HF/G	MAXFEE	FAC					43.05	1/1/2014	12/31/2299	N
15275	SKIN SUB GRAFT FACE/NK/HF/G	MAXFEE	NFF					59.22	1/1/2014	12/31/2299	N
15276	SKIN SUB GRAFT F/N/HF/G ADDL	PRXOVR	DEF					NA	NA	NA	N
15276	SKIN SUB GRAFT F/N/HF/G ADDL	MAXFEE	FAC					9.05	1/1/2014	12/31/2299	N
15276	SKIN SUB GRAFT F/N/HF/G ADDL	MAXFEE	NFF					12.95	1/1/2014	12/31/2299	N
15277	SKN SUB GRFT F/N/HF/G CHILD	PRXOVR	DEF					NA	NA	NA	N
15277	SKN SUB GRFT F/N/HF/G CHILD	MAXFEE	FAC					76.32	1/1/2014	12/31/2299	N
15277	SKN SUB GRFT F/N/HF/G CHILD	MAXFEE	NFF					114.43	1/1/2014	12/31/2299	N
15278	SKN SUB GRFT F/N/HF/G CH ADD	PRXOVR	DEF					NA	NA	NA	N
15278	SKN SUB GRFT F/N/HF/G CH ADD	MAXFEE	FAC					23.60	1/1/2014	12/31/2299	N
15278	SKN SUB GRFT F/N/HF/G CH ADD	MAXFEE	NFF					31.37	1/1/2014	12/31/2299	N
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
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
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
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
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
15400	APPLY SKIN XENOGRAFT T/A/L	PRXOVR	DEF					NA	NA	NA	N
15400	APPLY SKIN XENOGRAFT T/A/L	MAXFEE	DEF					NA			N
15430	APPLY ACELLULAR XENOGRAFT	PRXOVR	DEF					NA	NA	NA	N
15430	APPLY ACELLULAR XENOGRAFT	MAXFEE	DEF					NA			N
15572	SKIN PEDICLE FLAP ARMS/LEGS	PRXOVR	DEF					NA	NA	NA	N
15572	SKIN PEDICLE FLAP ARMS/LEGS	MAXFEE	FAC					267.18	1/1/2014	12/31/2299	N
15572	SKIN PEDICLE FLAP ARMS/LEGS	MAXFEE	NFF					368.16	1/1/2014	12/31/2299	N
15574	PEDCLE FH/CH/CH/M/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
15574	PEDCLE FH/CH/CH/M/N/AX/G/H/F	MAXFEE	FAC					269.42	1/1/2014	12/31/2299	N
15574	PEDCLE FH/CH/CH/M/N/AX/G/H/F	MAXFEE	NFF					402.71	1/1/2014	12/31/2299	N
15610	DELAY FLAP ARMS/LEGS	PRXOVR	DEF					NA	NA	NA	N
15610	DELAY FLAP ARMS/LEGS	MAXFEE	FAC					125.30	1/1/2014	12/31/2299	N
15610	DELAY FLAP ARMS/LEGS	MAXFEE	NFF					160.75	1/1/2014	12/31/2299	N
15620	DELAY FLAP F/C/C/N/AX/G/H/F	PRXOVR	DEF					NA	NA	NA	N
15620	DELAY FLAP F/C/C/N/AX/G/H/F	MAXFEE	FAC					143.51	1/1/2014	12/31/2299	N
15620	DELAY FLAP F/C/C/N/AX/G/H/F	MAXFEE	NFF					193.62	1/1/2014	12/31/2299	N
15738	MUSCLE-SKIN GRAFT LEG	PRXOVR	DEF					NA	NA	NA	N
15738	MUSCLE-SKIN GRAFT LEG	MAXFEE	FAC					565.52	1/1/2014	12/31/2299	N
15738	MUSCLE-SKIN GRAFT LEG	MAXFEE	NFF					773.80	1/1/2014	12/31/2299	N
15740	ISLAND PEDICLE FLAP GRAFT	PRXOVR	DEF					NA	NA	NA	N
15740	ISLAND PEDICLE FLAP GRAFT	MAXFEE	FAC					409.46	1/1/2014	12/31/2299	N
15740	ISLAND PEDICLE FLAP GRAFT	MAXFEE	NFF					552.47	1/1/2014	12/31/2299	N
15750	NEUROVASCULAR PEDICLE FLAP	PRXOVR	DEF					NA	NA	NA	N
15750	NEUROVASCULAR PEDICLE FLAP	MAXFEE	DEF					622.70	1/1/2000	12/31/2299	N
15756	FREE MYO/SKIN FLAP MICROVASC	PRXOVR	DEF					NA	NA	NA	N
15756	FREE MYO/SKIN FLAP MICROVASC	MAXFEE	DEF					1749.79	1/1/2000	12/31/2299	N
15757	FREE SKIN FLAP MICROVASC	PRXOVR	DEF					NA	NA	NA	N
15757	FREE SKIN FLAP MICROVASC	MAXFEE	DEF					1753.10	1/1/2004	12/31/2299	N
15758	FREE FASCIAL FLAP MICROVASC	PRXOVR	DEF					NA	NA	NA	N
15758	FREE FASCIAL FLAP MICROVASC	MAXFEE	DEF					1749.93	1/1/2004	12/31/2299	N
15777	ACELLULAR DERM MATRIX IMPLT	PRXOVR	DEF					NA	NA	NA	N
15777	ACELLULAR DERM MATRIX IMPLT	MAXFEE	DEF					84.34	1/1/2012	12/31/2299	N
15786	ABRASION LESION SINGLE	PRXOVR	DEF					NA	NA	NA	N
15786	ABRASION LESION SINGLE	MAXFEE	FAC					89.90	1/1/2014	12/31/2299	N
15786	ABRASION LESION SINGLE	MAXFEE	NFF					117.94	1/1/2014	12/31/2299	N
15787	ABRASION LESIONS ADD-ON	PRXOVR	DEF					NA	NA	NA	N
15787	ABRASION LESIONS ADD-ON	MAXFEE	FAC					10.59	1/1/2014	12/31/2299	N
15787	ABRASION LESIONS ADD-ON	MAXFEE	NFF					23.46	1/1/2014	12/31/2299	N
15839	EXCISE EXCESS SKIN & TISSUE	PRXOVR	DEF					NA	NA	NA	E
15839	EXCISE EXCESS SKIN & TISSUE	MAXFEE	DEF					506.83	9/1/2013	12/31/2299	E
15851	REMOVAL SUTR/STAPLE REQ ANES	PRXOVR	DEF					NA	NA	NA	N
15851	REMOVAL SUTR/STAPLE REQ ANES	MAXFEE	FAC					32.43	1/1/2014	12/31/2299	N
15851	REMOVAL SUTR/STAPLE REQ ANES	MAXFEE	NFF					52.58	1/1/2014	12/31/2299	N
15852	DRESSING CHANGE NOT FOR BURN	PRXOVR	DEF					NA	NA	NA	N
15852	DRESSING CHANGE NOT FOR BURN	MAXFEE	DEF					40.24	1/1/2010	12/31/2299	N
15853	REMOVAL SUTR/STAPL XREQ ANES	PRXOVR	DEF					NA	NA	NA	N
15853	REMOVAL SUTR/STAPL XREQ ANES	MAXFEE	DEF					8.24	1/1/2023	12/31/2299	N
15854	REMOVAL SUTR&STAPL XREQ ANES	PRXOVR	DEF					NA	NA	NA	N
15854	REMOVAL SUTR&STAPL XREQ ANES	MAXFEE	DEF					11.66	1/1/2023	12/31/2299	N
15860	TEST FOR BLOOD FLOW IN GRAFT	PRXOVR	DEF					NA	NA	NA	N
15860	TEST FOR BLOOD FLOW IN GRAFT	MAXFEE	DEF					88.96	1/1/2000	12/31/2299	N
15999	UNLISTED PX EXC PRESSURE ULC	PRXOVR	DEF					NA	NA	NA	N
15999	UNLISTED PX EXC PRESSURE ULC	MANUAL	DEF					NA	NA	NA	N
16000	INITIAL TREATMENT OF BURN(S)	PRXOVR	DEF					NA	NA	NA	N
16000	INITIAL TREATMENT OF BURN(S)	MAXFEE	FAC					23.19	1/1/2014	12/31/2299	N
16000	INITIAL TREATMENT OF BURN(S)	MAXFEE	NFF					35.86	1/1/2014	12/31/2299	N
16020	DRESS/DEBRID P-THICK BURN S	PRXOVR	DEF					NA	NA	NA	N
16020	DRESS/DEBRID P-THICK BURN S	MAXFEE	FAC					31.27	1/1/2014	12/31/2299	N
16020	DRESS/DEBRID P-THICK BURN S	MAXFEE	NFF					52.82	1/1/2014	12/31/2299	N
16025	DRESS/DEBRID P-THICK BURN M	PRXOVR	DEF					NA	NA	NA	N
16025	DRESS/DEBRID P-THICK BURN M	MAXFEE	FAC					62.79	1/1/2014	12/31/2299	N
16025	DRESS/DEBRID P-THICK BURN M	MAXFEE	NFF					95.03	1/1/2014	12/31/2299	N
16030	DRESS/DEBRID P-THICK BURN L	PRXOVR	DEF					NA	NA	NA	N
16030	DRESS/DEBRID P-THICK BURN L	MAXFEE	FAC					46.90	1/1/2014	12/31/2299	N
16030	DRESS/DEBRID P-THICK BURN L	MAXFEE	NFF					79.78	1/1/2014	12/31/2299	N
16035	INCISION OF BURN SCAB INITI	PRXOVR	DEF					NA	NA	NA	N
16035	INCISION OF BURN SCAB INITI	MAXFEE	DEF					180.72	1/1/2010	12/31/2299	N
16036	ESCHAROTOMY ADDL INCISION	PRXOVR	DEF					NA	NA	NA	N
16036	ESCHAROTOMY ADDL INCISION	MAXFEE	DEF					65.13	1/1/2001	12/31/2299	N
17000	DESTRUCT PREMALG LESION	PRXOVR	DEF					NA	NA	NA	N
17000	DESTRUCT PREMALG LESION	MAXFEE	FAC					26.06	1/1/2014	12/31/2299	N
17000	DESTRUCT PREMALG LESION	MAXFEE	NFF					44.24	1/1/2014	12/31/2299	N
17003	DESTRUCT PREMALG LES 2-14	PRXOVR	DEF					NA	NA	NA	N
17003	DESTRUCT PREMALG LES 2-14	MAXFEE	FAC					2.24	12/31/2014	12/31/2299	N
17003	DESTRUCT PREMALG LES 2-14	MAXFEE	NFF					5.41	1/1/2017	12/31/2299	N
17004	DESTROY PREMAL LESIONS 15/>	PRXOVR	DEF					NA	NA	NA	N
17004	DESTROY PREMAL LESIONS 15/>	MAXFEE	FAC					88.51	12/31/2014	12/31/2299	N
17004	DESTROY PREMAL LESIONS 15/>	MAXFEE	NFF					132.38	1/1/2014	12/31/2299	N
17106	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17106	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					143.75	1/1/2014	12/31/2299	N
17106	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					200.56	1/1/2014	12/31/2299	N
17107	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17107	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					280.66	1/1/2014	12/31/2299	N
17107	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					355.56	1/1/2014	12/31/2299	N
17108	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17108	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					347.88	1/1/2014	12/31/2299	N
17108	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					457.35	1/1/2014	12/31/2299	N
17110	DESTRUCT B9 LESION 1-14	PRXOVR	DEF					NA	NA	NA	N
17110	DESTRUCT B9 LESION 1-14	MAXFEE	FAC					34.41	1/1/2014	12/31/2299	N
17110	DESTRUCT B9 LESION 1-14	MAXFEE	NFF					63.31	1/1/2014	12/31/2299	N
17111	DESTRUCT LESION 15 OR MORE	PRXOVR	DEF					NA	NA	NA	N
17111	DESTRUCT LESION 15 OR MORE	MAXFEE	FAC					42.37	1/1/2014	12/31/2299	N
17111	DESTRUCT LESION 15 OR MORE	MAXFEE	NFF					75.29	1/1/2014	12/31/2299	N
17250	CHEM CAUT OF GRANLTJ TISSUE	PRXOVR	DEF					NA	NA	NA	N
17250	CHEM CAUT OF GRANLTJ TISSUE	MAXFEE	FAC					19.44	1/1/2014	12/31/2299	N
17250	CHEM CAUT OF GRANLTJ TISSUE	MAXFEE	NFF					46.72	1/1/2014	12/31/2299	N
17260	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17260	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					47.79	1/1/2014	12/31/2299	N
17260	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					61.55	1/1/2014	12/31/2299	N
17261	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17261	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					41.11	1/1/2014	12/31/2299	N
17261	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					67.42	1/1/2014	12/31/2299	N
17262	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17262	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					66.09	1/1/2014	12/31/2299	N
17262	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					88.90	1/1/2014	12/31/2299	N
17263	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17263	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					78.35	1/1/2014	12/31/2299	N
17263	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					104.26	1/1/2014	12/31/2299	N
17264	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17264	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					89.48	1/1/2014	12/31/2299	N
17264	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					116.47	1/1/2014	12/31/2299	N
17266	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17266	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					94.77	1/1/2014	12/31/2299	N
17266	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					126.54	1/1/2014	12/31/2299	N
17270	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17270	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					50.92	1/1/2014	12/31/2299	N
17270	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					70.68	1/1/2014	12/31/2299	N
17271	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17271	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					62.15	1/1/2014	12/31/2299	N
17271	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					84.87	1/1/2014	12/31/2299	N
17272	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17272	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					76.47	1/1/2014	12/31/2299	N
17272	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					102.49	1/1/2014	12/31/2299	N
17273	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17273	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					90.93	1/1/2014	12/31/2299	N
17273	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					119.43	1/1/2014	12/31/2299	N
17274	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17274	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					110.93	1/1/2014	12/31/2299	N
17274	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					146.85	1/1/2014	12/31/2299	N
17276	DESTRUCTION OF SKIN LESIONS	PRXOVR	DEF					NA	NA	NA	N
17276	DESTRUCTION OF SKIN LESIONS	MAXFEE	FAC					131.76	1/1/2014	12/31/2299	N
17276	DESTRUCTION OF SKIN LESIONS	MAXFEE	NFF					174.73	1/1/2014	12/31/2299	N
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
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
20103	EXPLORE WOUND EXTREMITY	PRXOVR	DEF					NA	NA	NA	N
20103	EXPLORE WOUND EXTREMITY	MAXFEE	FAC					140.10	1/1/2014	12/31/2299	N
20103	EXPLORE WOUND EXTREMITY	MAXFEE	NFF					223.69	1/1/2014	12/31/2299	N
2010F	VITAL SIGNS RECORDED	PRXOVR	DEF					NA	NA	NA	N
2010F	VITAL SIGNS RECORDED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2014F	MENTAL STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
2014F	MENTAL STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2015F	ASTHMA IMPAIRMENT ASSESSED	PRXOVR	DEF					NA	NA	NA	N
2015F	ASTHMA IMPAIRMENT ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2016F	ASTHMA RISK ASSESSED	PRXOVR	DEF					NA	NA	NA	N
2016F	ASTHMA RISK ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2018F	HYDRATION STATUS ASSESS	PRXOVR	DEF					NA	NA	NA	N
2018F	HYDRATION STATUS ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2019F	DILATED MACUL EXAM DONE	PRXOVR	DEF					NA	NA	NA	N
2019F	DILATED MACUL EXAM DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20200	MUSCLE BIOPSY	PRXOVR	DEF					NA	NA	NA	N
20200	MUSCLE BIOPSY	MAXFEE	FAC					58.42	1/1/2014	12/31/2299	N
20200	MUSCLE BIOPSY	MAXFEE	NFF					98.65	1/1/2014	12/31/2299	N
20205	DEEP MUSCLE BIOPSY	PRXOVR	DEF					NA	NA	NA	N
20205	DEEP MUSCLE BIOPSY	MAXFEE	FAC					78.13	1/1/2014	12/31/2299	N
20205	DEEP MUSCLE BIOPSY	MAXFEE	NFF					124.38	1/1/2014	12/31/2299	N
20206	NEEDLE BIOPSY MUSCLE	PRXOVR	DEF					NA	NA	NA	N
20206	NEEDLE BIOPSY MUSCLE	MAXFEE	FAC					41.82	1/1/2014	12/31/2299	N
20206	NEEDLE BIOPSY MUSCLE	MAXFEE	NFF					99.66	1/1/2014	12/31/2299	N
2020F	DILATED FUNDUS EVAL DONE	PRXOVR	DEF					NA	NA	NA	N
2020F	DILATED FUNDUS EVAL DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2021F	DILAT MACULAR EXAM DONE	PRXOVR	DEF					NA	NA	NA	N
2021F	DILAT MACULAR EXAM DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20220	BONE BIOPSY TROCAR/NEEDLE	PRXOVR	DEF					NA	NA	NA	N
20220	BONE BIOPSY TROCAR/NEEDLE	MAXFEE	FAC					35.60	1/1/2014	12/31/2299	N
20220	BONE BIOPSY TROCAR/NEEDLE	MAXFEE	NFF					66.39	1/1/2014	12/31/2299	N
20225	BONE BIOPSY TROCAR/NEEDLE	PRXOVR	DEF					NA	NA	NA	N
20225	BONE BIOPSY TROCAR/NEEDLE	MAXFEE	FAC					80.50	1/1/2014	12/31/2299	N
20225	BONE BIOPSY TROCAR/NEEDLE	MAXFEE	NFF					226.13	1/1/2014	12/31/2299	N
2022F	DILAT RTA XM EVC RTNOPTHY	PRXOVR	DEF					NA	NA	NA	N
2022F	DILAT RTA XM EVC RTNOPTHY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20240	BONE BIOPSY OPEN SUPERFICIAL	PRXOVR	DEF					NA	NA	NA	N
20240	BONE BIOPSY OPEN SUPERFICIAL	MAXFEE	DEF					143.71	1/1/2000	12/31/2299	N
20245	BONE BIOPSY OPEN DEEP	PRXOVR	DEF					NA	NA	NA	N
20245	BONE BIOPSY OPEN DEEP	MAXFEE	DEF					343.50	7/1/2008	12/31/2299	N
2024F	7 FLD RTA PHOTO EVC RTNOPTHY	PRXOVR	DEF					NA	NA	NA	N
2024F	7 FLD RTA PHOTO EVC RTNOPTHY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2026F	EYE IMG VALID EVC RTNOPTHY	PRXOVR	DEF					NA	NA	NA	N
2026F	EYE IMG VALID EVC RTNOPTHY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2027F	OPTIC NERVE HEAD EVAL DONE	PRXOVR	DEF					NA	NA	NA	N
2027F	OPTIC NERVE HEAD EVAL DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2028F	FOOT EXAM PERFORMED	PRXOVR	DEF					NA	NA	NA	N
2028F	FOOT EXAM PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2029F	COMPLETE PHYS SKIN EXAM DONE	PRXOVR	DEF					NA	NA	NA	N
2029F	COMPLETE PHYS SKIN EXAM DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2030F	H2O STAT DOCD NORMAL	PRXOVR	DEF					NA	NA	NA	N
2030F	H2O STAT DOCD NORMAL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2031F	H2O STAT DOCD DEHYDRATED	PRXOVR	DEF					NA	NA	NA	N
2031F	H2O STAT DOCD DEHYDRATED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2035F	TYMP MEMB MOTION EXAMD	PRXOVR	DEF					NA	NA	NA	N
2035F	TYMP MEMB MOTION EXAMD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2040F	BK PN XM ON INIT VISIT DATE	PRXOVR	DEF					NA	NA	NA	N
2040F	BK PN XM ON INIT VISIT DATE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
2044F	DOC MNTL TST B/4 BK TRXMNT	PRXOVR	DEF					NA	NA	NA	N
2044F	DOC MNTL TST B/4 BK TRXMNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20500	INJECTION OF SINUS TRACT	PRXOVR	DEF					NA	NA	NA	N
20500	INJECTION OF SINUS TRACT	MAXFEE	FAC					67.40	1/1/2014	12/31/2299	N
20500	INJECTION OF SINUS TRACT	MAXFEE	NFF					92.92	1/1/2014	12/31/2299	N
20501	INJECT SINUS TRACT FOR X-RAY	PRXOVR	DEF					NA	NA	NA	N
20501	INJECT SINUS TRACT FOR X-RAY	MAXFEE	FAC					28	1/1/2014	12/31/2299	N
20501	INJECT SINUS TRACT FOR X-RAY	MAXFEE	NFF					49.45	1/1/2014	12/31/2299	N
2050F	WOUND CHAR SIZE ETC DOCD	PRXOVR	DEF					NA	NA	NA	N
2050F	WOUND CHAR SIZE ETC DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20520	REMOVAL OF FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
20520	REMOVAL OF FOREIGN BODY	MAXFEE	FAC					85.99	1/1/2014	12/31/2299	N
20520	REMOVAL OF FOREIGN BODY	MAXFEE	NFF					115.14	1/1/2014	12/31/2299	N
20525	REMOVAL OF FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
20525	REMOVAL OF FOREIGN BODY	MAXFEE	FAC					119.82	1/1/2014	12/31/2299	N
20525	REMOVAL OF FOREIGN BODY	MAXFEE	NFF					169.81	1/1/2014	12/31/2299	N
20550	INJ TENDON SHEATH/LIGAMENT	PRXOVR	DEF					NA	NA	NA	N
20550	INJ TENDON SHEATH/LIGAMENT	MAXFEE	FAC					32.70	1/1/2014	12/31/2299	N
20550	INJ TENDON SHEATH/LIGAMENT	MAXFEE	NFF					41.82	1/1/2014	12/31/2299	N
20551	INJ TENDON ORIGIN/INSERTION	PRXOVR	DEF					NA	NA	NA	N
20551	INJ TENDON ORIGIN/INSERTION	MAXFEE	FAC					33.71	1/1/2014	12/31/2299	N
20551	INJ TENDON ORIGIN/INSERTION	MAXFEE	NFF					44.53	1/1/2014	12/31/2299	N
20552	INJ TRIGGER POINT 1/2 MUSCL	PRXOVR	DEF					NA	NA	NA	N
20552	INJ TRIGGER POINT 1/2 MUSCL	MAXFEE	FAC					26.77	1/1/2014	12/31/2299	N
20552	INJ TRIGGER POINT 1/2 MUSCL	MAXFEE	NFF					42.08	1/1/2014	12/31/2299	N
20553	INJECT TRIGGER POINTS 3/>	PRXOVR	DEF					NA	NA	NA	N
20553	INJECT TRIGGER POINTS 3/>	MAXFEE	FAC					33.88	1/1/2014	12/31/2299	N
20553	INJECT TRIGGER POINTS 3/>	MAXFEE	NFF					44.53	1/1/2014	12/31/2299	N
20560	NDL INSJ W/O NJX 1 OR 2 MUSC	PRXOVR	DEF					NA	NA	NA	N
20560	NDL INSJ W/O NJX 1 OR 2 MUSC	MAXFEE	FAC					11.85	7/1/2021	12/31/2299	N
20560	NDL INSJ W/O NJX 1 OR 2 MUSC	MAXFEE	NFF					18.95	7/1/2021	12/31/2299	N
20561	NDL INSJ W/O NJX 3+ MUSC	PRXOVR	DEF					NA	NA	NA	N
20561	NDL INSJ W/O NJX 3+ MUSC	MAXFEE	FAC					17.87	7/1/2021	12/31/2299	N
20561	NDL INSJ W/O NJX 3+ MUSC	MAXFEE	NFF					27.81	7/1/2021	12/31/2299	N
20600	DRAIN/INJ JOINT/BURSA W/O US	PRXOVR	DEF					NA	NA	NA	N
20600	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	FAC					24.41	1/1/2014	12/31/2299	N
20600	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	NFF					36.77	1/1/2014	12/31/2299	N
20604	DRAIN/INJ JOINT/BURSA W/US	PRXOVR	DEF					NA	NA	NA	N
20604	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	FAC					36.16	1/1/2015	12/31/2299	N
20604	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	NFF					55.35	1/1/2015	12/31/2299	N
20605	DRAIN/INJ JOINT/BURSA W/O US	PRXOVR	DEF					NA	NA	NA	N
20605	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	FAC					36.82	1/1/2014	12/31/2299	N
20605	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	NFF					40.43	1/1/2014	12/31/2299	N
20606	DRAIN/INJ JOINT/BURSA W/US	PRXOVR	DEF					NA	NA	NA	N
20606	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	FAC					40.89	1/1/2015	12/31/2299	N
20606	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	NFF					60.87	1/1/2015	12/31/2299	N
2060F	PT TALK EVAL HLTHWKR RE MDD	PRXOVR	DEF					NA	NA	NA	N
2060F	PT TALK EVAL HLTHWKR RE MDD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
20610	DRAIN/INJ JOINT/BURSA W/O US	PRXOVR	DEF					NA	NA	NA	N
20610	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	FAC					28.41	1/1/2014	12/31/2299	N
20610	DRAIN/INJ JOINT/BURSA W/O US	MAXFEE	NFF					48.91	1/1/2014	12/31/2299	N
20611	DRAIN/INJ JOINT/BURSA W/US	PRXOVR	DEF					NA	NA	NA	N
20611	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	FAC					48.04	1/1/2015	12/31/2299	N
20611	DRAIN/INJ JOINT/BURSA W/US	MAXFEE	NFF					69.87	1/1/2015	12/31/2299	N
20612	ASPIRATE/INJ GANGLION CYST	PRXOVR	DEF					NA	NA	NA	N
20612	ASPIRATE/INJ GANGLION CYST	MAXFEE	FAC					29.98	1/1/2014	12/31/2299	N
20612	ASPIRATE/INJ GANGLION CYST	MAXFEE	NFF					38.40	1/1/2014	12/31/2299	N
20615	TREATMENT OF BONE CYST	PRXOVR	DEF					NA	NA	NA	N
20615	TREATMENT OF BONE CYST	MAXFEE	FAC					64.23	1/1/2014	12/31/2299	N
20615	TREATMENT OF BONE CYST	MAXFEE	NFF					88.18	1/1/2014	12/31/2299	N
20650	INSERT AND REMOVE BONE PIN	PRXOVR	DEF					NA	NA	NA	N
20650	INSERT AND REMOVE BONE PIN	MAXFEE	FAC					66.28	1/1/2014	12/31/2299	N
20650	INSERT AND REMOVE BONE PIN	MAXFEE	NFF					97.34	1/1/2014	12/31/2299	N
20660	APPLY REM FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20660	APPLY REM FIXATION DEVICE	MAXFEE	DEF					108.71	1/1/2004	12/31/2299	N
20665	REMOVAL OF FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20665	REMOVAL OF FIXATION DEVICE	MAXFEE	FAC					69.74	1/1/2014	12/31/2299	N
20665	REMOVAL OF FIXATION DEVICE	MAXFEE	NFF					95.93	1/1/2014	12/31/2299	N
20670	REMOVAL OF SUPPORT IMPLANT	PRXOVR	DEF					NA	NA	NA	N
20670	REMOVAL OF SUPPORT IMPLANT	MAXFEE	FAC					73.84	1/1/2014	12/31/2299	N
20670	REMOVAL OF SUPPORT IMPLANT	MAXFEE	NFF					166	1/1/2014	12/31/2299	N
20680	REMOVAL OF SUPPORT IMPLANT	PRXOVR	DEF					NA	NA	NA	N
20680	REMOVAL OF SUPPORT IMPLANT	MAXFEE	FAC					149.32	1/1/2014	12/31/2299	N
20680	REMOVAL OF SUPPORT IMPLANT	MAXFEE	NFF					272.23	1/1/2014	12/31/2299	N
20690	APPLY BONE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20690	APPLY BONE FIXATION DEVICE	MAXFEE	DEF					267.50	12/31/2014	12/31/2299	N
20692	APPLY BONE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20692	APPLY BONE FIXATION DEVICE	MAXFEE	DEF					504.11	12/31/2014	12/31/2299	N
20693	ADJUST BONE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20693	ADJUST BONE FIXATION DEVICE	MAXFEE	DEF					254.36	7/1/2008	12/31/2299	N
20694	REMOVE BONE FIXATION DEVICE	PRXOVR	DEF					NA	NA	NA	N
20694	REMOVE BONE FIXATION DEVICE	MAXFEE	FAC					131.29	1/1/2014	12/31/2299	N
20694	REMOVE BONE FIXATION DEVICE	MAXFEE	NFF					201.41	1/1/2014	12/31/2299	N
20696	COMP MULTIPLANE EXT FIXATION	PRXOVR	DEF					NA	NA	NA	N
20696	COMP MULTIPLANE EXT FIXATION	MAXFEE	DEF					793.95	1/1/2009	12/31/2299	N
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
20838	REPLANTATION FOOT COMPLETE	PRXOVR	DEF					NA	NA	NA	N
20838	REPLANTATION FOOT COMPLETE	MAXFEE	DEF					2142.08	1/1/2000	12/31/2299	N
20900	REMOVAL OF BONE FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20900	REMOVAL OF BONE FOR GRAFT	MAXFEE	FAC					126.70	1/1/2014	12/31/2299	N
20900	REMOVAL OF BONE FOR GRAFT	MAXFEE	NFF					226.45	1/1/2014	12/31/2299	N
20902	REMOVAL OF BONE FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20902	REMOVAL OF BONE FOR GRAFT	MAXFEE	DEF					276.60	9/1/2013	12/31/2299	N
20924	REMOVAL OF TENDON FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20924	REMOVAL OF TENDON FOR GRAFT	MAXFEE	DEF					329.88	1/1/2000	12/31/2299	N
20926	REMOVAL OF TISSUE FOR GRAFT	PRXOVR	DEF					NA	NA	NA	N
20926	REMOVAL OF TISSUE FOR GRAFT	MAXFEE	DEF					NA			N
20950	FLUID PRESSURE MUSCLE	PRXOVR	DEF					NA	NA	NA	N
20950	FLUID PRESSURE MUSCLE	MAXFEE	FAC					45.08	1/1/2014	12/31/2299	N
20950	FLUID PRESSURE MUSCLE	MAXFEE	NFF					110.84	1/1/2014	12/31/2299	N
20955	FIBULA BONE GRAFT MICROVASC	PRXOVR	DEF					NA	NA	NA	N
20955	FIBULA BONE GRAFT MICROVASC	MAXFEE	DEF					2021.90	1/1/2000	12/31/2299	N
20957	MT BONE GRAFT MICROVASC	PRXOVR	DEF					NA	NA	NA	N
20957	MT BONE GRAFT MICROVASC	MAXFEE	DEF					1844.51	4/1/2008	12/31/2299	N
20962	OTHER BONE GRAFT MICROVASC	PRXOVR	DEF					NA	NA	NA	N
20962	OTHER BONE GRAFT MICROVASC	MAXFEE	DEF					1900.53	1/1/2004	12/31/2299	N
20969	BONE/SKIN GRAFT MICROVASC	PRXOVR	DEF					NA	NA	NA	N
20969	BONE/SKIN GRAFT MICROVASC	MAXFEE	DEF					2249.66	1/1/2004	12/31/2299	N
20972	BONE/SKIN GRAFT METATARSAL	PRXOVR	DEF					NA	NA	NA	N
20972	BONE/SKIN GRAFT METATARSAL	MAXFEE	DEF					2160.77	4/1/2008	12/31/2299	N
20973	BONE/SKIN GRAFT GREAT TOE	PRXOVR	DEF					NA	NA	NA	N
20973	BONE/SKIN GRAFT GREAT TOE	MAXFEE	DEF					2333.22	1/1/2004	12/31/2299	N
20974	ELECTRICAL BONE STIMULATION	PRXOVR	DEF					NA	NA	NA	N
20974	ELECTRICAL BONE STIMULATION	MAXFEE	FAC					33.87	1/1/2014	12/31/2299	N
20974	ELECTRICAL BONE STIMULATION	MAXFEE	NFF					38.79	1/1/2014	12/31/2299	N
20975	ELECTRICAL BONE STIMULATION	PRXOVR	DEF					NA	NA	NA	N
20975	ELECTRICAL BONE STIMULATION	MAXFEE	DEF					144.52	12/15/2005	12/31/2299	N
20979	US BONE STIMULATION	PRXOVR	DEF					NA	NA	NA	N
20979	US BONE STIMULATION	MAXFEE	FAC					25.88	1/1/2014	12/31/2299	N
20979	US BONE STIMULATION	MAXFEE	NFF					36.97	1/1/2014	12/31/2299	N
20982	ABLATE BONE TUMOR(S) PERQ	PRXOVR	DEF					NA	NA	NA	N
20982	ABLATE BONE TUMOR(S) PERQ	MAXFEE	FAC					298.81	1/1/2014	12/31/2299	N
20982	ABLATE BONE TUMOR(S) PERQ	MAXFEE	NFF					2850.06	1/1/2014	12/31/2299	N
20983	ABLATE BONE TUMOR(S) PERQ	PRXOVR	DEF					NA	NA	NA	N
20983	ABLATE BONE TUMOR(S) PERQ	MAXFEE	FAC					318.22	1/1/2015	12/31/2299	N
20983	ABLATE BONE TUMOR(S) PERQ	MAXFEE	NFF					5181.80	1/1/2015	12/31/2299	N
20999	UNLISTED PX MUSCSKEL GENERAL	PRXOVR	DEF					NA	NA	NA	N
20999	UNLISTED PX MUSCSKEL GENERAL	MANUAL	DEF					NA	NA	NA	N
25270	REPAIR FOREARM TENDON/MUSCLE	PRXOVR	DEF					NA	NA	NA	N
25270	REPAIR FOREARM TENDON/MUSCLE	MAXFEE	DEF					378.28	7/1/2008	12/31/2299	N
26111	EXC HAND LES SC 1.5 CM/>	PRXOVR	DEF					NA	NA	NA	N
26111	EXC HAND LES SC 1.5 CM/>	MAXFEE	DEF					224.55	1/1/2010	12/31/2299	N
26113	EXC HAND TUM DEEP 1.5 CM/>	PRXOVR	DEF					NA	NA	NA	N
26113	EXC HAND TUM DEEP 1.5 CM/>	MAXFEE	DEF					295.31	1/1/2010	12/31/2299	N
26118	RAD RESECT HAND TUMOR 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
26118	RAD RESECT HAND TUMOR 3 CM/>	MAXFEE	DEF					583.18	1/1/2010	12/31/2299	N
27600	DECOMPRESSION OF LOWER LEG	PRXOVR	DEF					NA	NA	NA	N
27600	DECOMPRESSION OF LOWER LEG	MAXFEE	DEF					258.94	1/1/2004	12/31/2299	N
27601	DECOMPRESSION OF LOWER LEG	PRXOVR	DEF					NA	NA	NA	N
27601	DECOMPRESSION OF LOWER LEG	MAXFEE	DEF					259.67	1/1/2004	12/31/2299	N
27602	DECOMPRESSION OF LOWER LEG	PRXOVR	DEF					NA	NA	NA	N
27602	DECOMPRESSION OF LOWER LEG	MAXFEE	DEF					322.02	1/1/2004	12/31/2299	N
27603	DRAIN LOWER LEG LESION	PRXOVR	DEF					NA	NA	NA	N
27603	DRAIN LOWER LEG LESION	MAXFEE	FAC					137.91	1/1/2014	12/31/2299	N
27603	DRAIN LOWER LEG LESION	MAXFEE	NFF					213.16	1/1/2014	12/31/2299	N
27604	DRAIN LOWER LEG BURSA	PRXOVR	DEF					NA	NA	NA	N
27604	DRAIN LOWER LEG BURSA	MAXFEE	FAC					118.83	1/1/2014	12/31/2299	N
27604	DRAIN LOWER LEG BURSA	MAXFEE	NFF					188.72	1/1/2014	12/31/2299	N
27605	INCISION OF ACHILLES TENDON	PRXOVR	DEF					NA	NA	NA	N
27605	INCISION OF ACHILLES TENDON	MAXFEE	FAC					64.74	1/1/2014	12/31/2299	N
27605	INCISION OF ACHILLES TENDON	MAXFEE	NFF					122.69	1/1/2014	12/31/2299	N
27606	INCISION OF ACHILLES TENDON	PRXOVR	DEF					NA	NA	NA	N
27606	INCISION OF ACHILLES TENDON	MAXFEE	DEF					187.65	1/1/2000	12/31/2299	N
27607	TREAT LOWER LEG BONE LESION	PRXOVR	DEF					NA	NA	NA	N
27607	TREAT LOWER LEG BONE LESION	MAXFEE	DEF					413.86	1/1/2000	12/31/2299	N
27610	EXPLORE/TREAT ANKLE JOINT	PRXOVR	DEF					NA	NA	NA	N
27610	EXPLORE/TREAT ANKLE JOINT	MAXFEE	DEF					441.67	1/1/2000	12/31/2299	N
27612	EXPLORATION OF ANKLE JOINT	PRXOVR	DEF					NA	NA	NA	N
27612	EXPLORATION OF ANKLE JOINT	MAXFEE	DEF					418.87	1/1/2000	12/31/2299	N
27613	BIOPSY LOWER LEG SOFT TISSUE	PRXOVR	DEF					NA	NA	NA	N
27613	BIOPSY LOWER LEG SOFT TISSUE	MAXFEE	FAC					64.08	1/1/2014	12/31/2299	N
27613	BIOPSY LOWER LEG SOFT TISSUE	MAXFEE	NFF					113.96	1/1/2014	12/31/2299	N
27614	BIOPSY LOWER LEG SOFT TISSUE	PRXOVR	DEF					NA	NA	NA	N
27614	BIOPSY LOWER LEG SOFT TISSUE	MAXFEE	FAC					143.66	1/1/2014	12/31/2299	N
27614	BIOPSY LOWER LEG SOFT TISSUE	MAXFEE	NFF					235.21	1/1/2014	12/31/2299	N
27615	RESECT LEG/ANKLE TUM < 5 CM	PRXOVR	DEF					NA	NA	NA	N
27615	RESECT LEG/ANKLE TUM < 5 CM	MAXFEE	DEF					594.72	1/1/2000	12/31/2299	N
27616	RESECT LEG/ANKLE TUM 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
27616	RESECT LEG/ANKLE TUM 5 CM/>	MAXFEE	DEF					709.70	1/1/2010	12/31/2299	N
27618	EXC LEG/ANKLE TUM < 3 CM	PRXOVR	DEF					NA	NA	NA	N
27618	EXC LEG/ANKLE TUM < 3 CM	MAXFEE	FAC					134.31	1/1/2014	12/31/2299	N
27618	EXC LEG/ANKLE TUM < 3 CM	MAXFEE	NFF					218.24	1/1/2014	12/31/2299	N
27619	EXC LEG/ANKLE TUM DEEP <5 CM	PRXOVR	DEF					NA	NA	NA	N
27619	EXC LEG/ANKLE TUM DEEP <5 CM	MAXFEE	DEF					371.38	1/1/2000	12/31/2299	N
27620	EXPLORE/TREAT ANKLE JOINT	PRXOVR	DEF					NA	NA	NA	N
27620	EXPLORE/TREAT ANKLE JOINT	MAXFEE	DEF					335.53	1/1/2000	12/31/2299	N
27625	REMOVE ANKLE JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
27625	REMOVE ANKLE JOINT LINING	MAXFEE	DEF					464.99	1/1/2000	12/31/2299	N
27626	REMOVE ANKLE JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
27626	REMOVE ANKLE JOINT LINING	MAXFEE	DEF					505.94	1/1/2000	12/31/2299	N
27630	REMOVAL OF TENDON LESION	PRXOVR	DEF					NA	NA	NA	N
27630	REMOVAL OF TENDON LESION	MAXFEE	FAC					138.70	1/1/2014	12/31/2299	N
27630	REMOVAL OF TENDON LESION	MAXFEE	NFF					242.45	1/1/2014	12/31/2299	N
27632	EXC LEG/ANKLE LES SC 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
27632	EXC LEG/ANKLE LES SC 3 CM/>	MAXFEE	DEF					227.07	1/1/2010	12/31/2299	N
27634	EXC LEG/ANKLE TUM DEP 5 CM/>	PRXOVR	DEF					NA	NA	NA	N
27634	EXC LEG/ANKLE TUM DEP 5 CM/>	MAXFEE	DEF					370.56	1/1/2010	12/31/2299	N
27635	REMOVE LOWER LEG BONE LESION	PRXOVR	DEF					NA	NA	NA	N
27635	REMOVE LOWER LEG BONE LESION	MAXFEE	DEF					442.72	1/1/2000	12/31/2299	N
27637	REMOVE/GRAFT LEG BONE LESION	PRXOVR	DEF					NA	NA	NA	N
27637	REMOVE/GRAFT LEG BONE LESION	MAXFEE	DEF					517.21	1/1/2000	12/31/2299	N
27638	REMOVE/GRAFT LEG BONE LESION	PRXOVR	DEF					NA	NA	NA	N
27638	REMOVE/GRAFT LEG BONE LESION	MAXFEE	DEF					555.24	1/1/2000	12/31/2299	N
27640	PARTIAL REMOVAL OF TIBIA	PRXOVR	DEF					NA	NA	NA	N
27640	PARTIAL REMOVAL OF TIBIA	MAXFEE	DEF					611.78	1/1/2000	12/31/2299	N
27641	PARTIAL REMOVAL OF FIBULA	PRXOVR	DEF					NA	NA	NA	N
27641	PARTIAL REMOVAL OF FIBULA	MAXFEE	DEF					486.36	1/1/2000	12/31/2299	N
27645	RESECT TIBIA TUMOR	PRXOVR	DEF					NA	NA	NA	N
27645	RESECT TIBIA TUMOR	MAXFEE	DEF					728.84	1/1/2000	12/31/2299	N
27646	RESECT FIBULA TUMOR	PRXOVR	DEF					NA	NA	NA	N
27646	RESECT FIBULA TUMOR	MAXFEE	DEF					652.16	1/1/2000	12/31/2299	N
27647	RESECT TALUS/CALCANEUS TUM	PRXOVR	DEF					NA	NA	NA	N
27647	RESECT TALUS/CALCANEUS TUM	MAXFEE	DEF					600.42	1/1/2004	12/31/2299	N
27648	INJECTION FOR ANKLE X-RAY	PRXOVR	DEF					NA	NA	NA	N
27648	INJECTION FOR ANKLE X-RAY	MAXFEE	FAC					36.56	1/1/2014	12/31/2299	N
27648	INJECTION FOR ANKLE X-RAY	MAXFEE	NFF					72.18	1/1/2014	12/31/2299	N
27650	REPAIR ACHILLES TENDON	PRXOVR	DEF					NA	NA	NA	N
27650	REPAIR ACHILLES TENDON	MAXFEE	DEF					510.09	1/1/2000	12/31/2299	N
27652	REPAIR/GRAFT ACHILLES TENDON	PRXOVR	DEF					NA	NA	NA	N
27652	REPAIR/GRAFT ACHILLES TENDON	MAXFEE	DEF					558.63	1/1/2000	12/31/2299	N
27654	REPAIR OF ACHILLES TENDON	PRXOVR	DEF					NA	NA	NA	N
27654	REPAIR OF ACHILLES TENDON	MAXFEE	DEF					564.46	1/1/2000	12/31/2299	N
27656	REPAIR LEG FASCIA DEFECT	PRXOVR	DEF					NA	NA	NA	N
27656	REPAIR LEG FASCIA DEFECT	MAXFEE	FAC					138.08	1/1/2014	12/31/2299	N
27656	REPAIR LEG FASCIA DEFECT	MAXFEE	NFF					237.06	1/1/2014	12/31/2299	N
27658	REPAIR OF LEG TENDON EACH	PRXOVR	DEF					NA	NA	NA	N
27658	REPAIR OF LEG TENDON EACH	MAXFEE	DEF					265.52	1/1/2000	12/31/2299	N
27659	REPAIR OF LEG TENDON EACH	PRXOVR	DEF					NA	NA	NA	N
27659	REPAIR OF LEG TENDON EACH	MAXFEE	DEF					351.76	1/1/2000	12/31/2299	N
27664	REPAIR OF LEG TENDON EACH	PRXOVR	DEF					NA	NA	NA	N
27664	REPAIR OF LEG TENDON EACH	MAXFEE	DEF					243.59	1/1/2000	12/31/2299	N
27665	REPAIR OF LEG TENDON EACH	PRXOVR	DEF					NA	NA	NA	N
27665	REPAIR OF LEG TENDON EACH	MAXFEE	DEF					313.59	1/1/2000	12/31/2299	N
27675	REPAIR LOWER LEG TENDONS	PRXOVR	DEF					NA	NA	NA	N
27675	REPAIR LOWER LEG TENDONS	MAXFEE	DEF					378.12	1/1/2000	12/31/2299	N
27676	REPAIR LOWER LEG TENDONS	PRXOVR	DEF					NA	NA	NA	N
27676	REPAIR LOWER LEG TENDONS	MAXFEE	DEF					436.55	1/1/2000	12/31/2299	N
27680	RELEASE OF LOWER LEG TENDON	PRXOVR	DEF					NA	NA	NA	N
27680	RELEASE OF LOWER LEG TENDON	MAXFEE	DEF					281.92	1/1/2000	12/31/2299	N
27681	RELEASE OF LOWER LEG TENDONS	PRXOVR	DEF					NA	NA	NA	N
27681	RELEASE OF LOWER LEG TENDONS	MAXFEE	DEF					357.34	1/1/2000	12/31/2299	N
27685	REVISION OF LOWER LEG TENDON	PRXOVR	DEF					NA	NA	NA	N
27685	REVISION OF LOWER LEG TENDON	MAXFEE	FAC					171.13	1/1/2014	12/31/2299	N
27685	REVISION OF LOWER LEG TENDON	MAXFEE	NFF					294.53	1/1/2014	12/31/2299	N
27686	REVISE LOWER LEG TENDONS	PRXOVR	DEF					NA	NA	NA	N
27686	REVISE LOWER LEG TENDONS	MAXFEE	DEF					388.74	1/1/2000	12/31/2299	N
27687	REVISION OF CALF TENDON	PRXOVR	DEF					NA	NA	NA	N
27687	REVISION OF CALF TENDON	MAXFEE	DEF					326.57	1/1/2000	12/31/2299	N
27690	REVISE LOWER LEG TENDON	PRXOVR	DEF					NA	NA	NA	N
27690	REVISE LOWER LEG TENDON	MAXFEE	DEF					425.84	1/1/2000	12/31/2299	N
27691	REVISE LOWER LEG TENDON	PRXOVR	DEF					NA	NA	NA	N
27691	REVISE LOWER LEG TENDON	MAXFEE	DEF					497.85	1/1/2000	12/31/2299	N
27692	REVISE ADDITIONAL LEG TENDON	PRXOVR	DEF					NA	NA	NA	N
27692	REVISE ADDITIONAL LEG TENDON	MAXFEE	DEF					97.27	1/1/2010	12/31/2299	N
27695	REPAIR OF ANKLE LIGAMENT	PRXOVR	DEF					NA	NA	NA	N
27695	REPAIR OF ANKLE LIGAMENT	MAXFEE	DEF					385.22	1/1/2000	12/31/2299	N
27696	REPAIR OF ANKLE LIGAMENTS	PRXOVR	DEF					NA	NA	NA	N
27696	REPAIR OF ANKLE LIGAMENTS	MAXFEE	DEF					427.13	1/1/2000	12/31/2299	N
27698	REPAIR OF ANKLE LIGAMENT	PRXOVR	DEF					NA	NA	NA	N
27698	REPAIR OF ANKLE LIGAMENT	MAXFEE	DEF					535.87	1/1/2000	12/31/2299	N
27700	REVISION OF ANKLE JOINT	PRXOVR	DEF					NA	NA	NA	N
27700	REVISION OF ANKLE JOINT	MAXFEE	DEF					514.73	1/1/2000	12/31/2299	N
27702	RECONSTRUCT ANKLE JOINT	PRXOVR	DEF					NA	NA	NA	N
27702	RECONSTRUCT ANKLE JOINT	MAXFEE	DEF					809.52	1/1/2000	12/31/2299	N
27703	RECONSTRUCTION ANKLE JOINT	PRXOVR	DEF					NA	NA	NA	N
27703	RECONSTRUCTION ANKLE JOINT	MAXFEE	DEF					795.12	1/1/2000	12/31/2299	N
27704	REMOVAL OF ANKLE IMPLANT	PRXOVR	DEF					NA	NA	NA	N
27704	REMOVAL OF ANKLE IMPLANT	MAXFEE	DEF					373.86	1/1/2000	12/31/2299	N
27705	INCISION OF TIBIA	PRXOVR	DEF					NA	NA	NA	N
27705	INCISION OF TIBIA	MAXFEE	DEF					579.32	1/1/2000	12/31/2299	N
27707	INCISION OF FIBULA	PRXOVR	DEF					NA	NA	NA	N
27707	INCISION OF FIBULA	MAXFEE	DEF					264.26	1/1/2000	12/31/2299	N
27709	INCISION OF TIBIA & FIBULA	PRXOVR	DEF					NA	NA	NA	N
27709	INCISION OF TIBIA & FIBULA	MAXFEE	DEF					580.99	1/1/2000	12/31/2299	N
27720	REPAIR OF TIBIA	PRXOVR	DEF					NA	NA	NA	N
27720	REPAIR OF TIBIA	MAXFEE	DEF					682.02	1/1/2000	12/31/2299	N
27724	REPAIR/GRAFT OF TIBIA	PRXOVR	DEF					NA	NA	NA	N
27724	REPAIR/GRAFT OF TIBIA	MAXFEE	DEF					838.60	1/1/2000	12/31/2299	N
27725	REPAIR OF LOWER LEG	PRXOVR	DEF					NA	NA	NA	N
27725	REPAIR OF LOWER LEG	MAXFEE	DEF					676.95	1/1/2000	12/31/2299	N
27726	REPAIR FIBULA NONUNION	PRXOVR	DEF					NA	NA	NA	N
27726	REPAIR FIBULA NONUNION	MAXFEE	DEF					539.29	1/1/2008	12/31/2299	N
27730	REPAIR OF TIBIA EPIPHYSIS	PRXOVR	DEF					NA	NA	NA	N
27730	REPAIR OF TIBIA EPIPHYSIS	MAXFEE	DEF					335.41	1/1/2000	12/31/2299	N
27732	REPAIR OF FIBULA EPIPHYSIS	PRXOVR	DEF					NA	NA	NA	N
27732	REPAIR OF FIBULA EPIPHYSIS	MAXFEE	DEF					312.43	1/1/2000	12/31/2299	N
27734	REPAIR LOWER LEG EPIPHYSES	PRXOVR	DEF					NA	NA	NA	N
27734	REPAIR LOWER LEG EPIPHYSES	MAXFEE	DEF					441.71	1/1/2000	12/31/2299	N
27760	CLTX MEDIAL ANKLE FX	PRXOVR	DEF					NA	NA	NA	N
27760	CLTX MEDIAL ANKLE FX	MAXFEE	FAC					149.32	1/1/2014	12/31/2299	N
27760	CLTX MEDIAL ANKLE FX	MAXFEE	NFF					170.96	1/1/2014	12/31/2299	N
27762	CLTX MED ANKLE FX W/MNPJ	PRXOVR	DEF					NA	NA	NA	N
27762	CLTX MED ANKLE FX W/MNPJ	MAXFEE	FAC					234.89	1/1/2014	12/31/2299	N
27762	CLTX MED ANKLE FX W/MNPJ	MAXFEE	NFF					257.87	1/1/2014	12/31/2299	N
27766	OPTX MEDIAL ANKLE FX	PRXOVR	DEF					NA	NA	NA	N
27766	OPTX MEDIAL ANKLE FX	MAXFEE	DEF					444.71	1/1/2000	12/31/2299	N
27767	CLTX POST ANKLE FX	PRXOVR	DEF					NA	NA	NA	N
27767	CLTX POST ANKLE FX	MAXFEE	FAC					137.49	1/1/2014	12/31/2299	N
27767	CLTX POST ANKLE FX	MAXFEE	NFF					150.23	1/1/2014	12/31/2299	N
27768	CLTX POST ANKLE FX W/MNPJ	PRXOVR	DEF					NA	NA	NA	N
27768	CLTX POST ANKLE FX W/MNPJ	MAXFEE	DEF					235.69	1/1/2008	12/31/2299	N
27769	OPTX POST ANKLE FX	PRXOVR	DEF					NA	NA	NA	N
27769	OPTX POST ANKLE FX	MAXFEE	DEF					408.09	1/1/2008	12/31/2299	N
27786	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27786	TREATMENT OF ANKLE FRACTURE	MAXFEE	FAC					143.04	1/1/2014	12/31/2299	N
27786	TREATMENT OF ANKLE FRACTURE	MAXFEE	NFF					163.66	1/1/2014	12/31/2299	N
27788	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27788	TREATMENT OF ANKLE FRACTURE	MAXFEE	FAC					215.99	1/1/2014	12/31/2299	N
27788	TREATMENT OF ANKLE FRACTURE	MAXFEE	NFF					236.56	1/1/2014	12/31/2299	N
27792	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27792	TREATMENT OF ANKLE FRACTURE	MAXFEE	DEF					412.65	1/1/2000	12/31/2299	N
27808	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27808	TREATMENT OF ANKLE FRACTURE	MAXFEE	FAC					127.14	1/1/2014	12/31/2299	N
27808	TREATMENT OF ANKLE FRACTURE	MAXFEE	NFF					170.78	1/1/2014	12/31/2299	N
27810	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27810	TREATMENT OF ANKLE FRACTURE	MAXFEE	FAC					261.16	1/1/2014	12/31/2299	N
27810	TREATMENT OF ANKLE FRACTURE	MAXFEE	NFF					302.12	1/1/2014	12/31/2299	N
27814	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27814	TREATMENT OF ANKLE FRACTURE	MAXFEE	DEF					566.72	1/1/2000	12/31/2299	N
27816	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27816	TREATMENT OF ANKLE FRACTURE	MAXFEE	FAC					182.15	1/1/2014	12/31/2299	N
27816	TREATMENT OF ANKLE FRACTURE	MAXFEE	NFF					197.61	1/1/2014	12/31/2299	N
27818	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27818	TREATMENT OF ANKLE FRACTURE	MAXFEE	FAC					305.61	1/1/2014	12/31/2299	N
27818	TREATMENT OF ANKLE FRACTURE	MAXFEE	NFF					338.35	1/1/2014	12/31/2299	N
27822	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27822	TREATMENT OF ANKLE FRACTURE	MAXFEE	DEF					617.08	1/1/2000	12/31/2299	N
27823	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27823	TREATMENT OF ANKLE FRACTURE	MAXFEE	DEF					756.46	1/1/2000	12/31/2299	N
27824	TREAT LOWER LEG FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27824	TREAT LOWER LEG FRACTURE	MAXFEE	FAC					187.66	1/1/2014	12/31/2299	N
27824	TREAT LOWER LEG FRACTURE	MAXFEE	NFF					197.61	1/1/2014	12/31/2299	N
27825	TREAT LOWER LEG FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27825	TREAT LOWER LEG FRACTURE	MAXFEE	FAC					320.61	1/1/2014	12/31/2299	N
27825	TREAT LOWER LEG FRACTURE	MAXFEE	NFF					368.50	1/1/2014	12/31/2299	N
27826	TREAT LOWER LEG FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27826	TREAT LOWER LEG FRACTURE	MAXFEE	DEF					553.24	1/1/2000	12/31/2299	N
27827	TREAT LOWER LEG FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27827	TREAT LOWER LEG FRACTURE	MAXFEE	DEF					690.30	1/1/2000	12/31/2299	N
27828	TREAT LOWER LEG FRACTURE	PRXOVR	DEF					NA	NA	NA	N
27828	TREAT LOWER LEG FRACTURE	MAXFEE	DEF					799.39	1/1/2000	12/31/2299	N
27829	TREAT LOWER LEG JOINT	PRXOVR	DEF					NA	NA	NA	N
27829	TREAT LOWER LEG JOINT	MAXFEE	DEF					367.09	1/1/2000	12/31/2299	N
27840	TREAT ANKLE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
27840	TREAT ANKLE DISLOCATION	MAXFEE	DEF					184.31	7/1/2008	12/31/2299	N
27842	TREAT ANKLE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
27842	TREAT ANKLE DISLOCATION	MAXFEE	DEF					259.12	7/1/2008	12/31/2299	N
27846	TREAT ANKLE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
27846	TREAT ANKLE DISLOCATION	MAXFEE	DEF					503.39	1/1/2000	12/31/2299	N
27848	TREAT ANKLE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
27848	TREAT ANKLE DISLOCATION	MAXFEE	DEF					593.64	1/1/2000	12/31/2299	N
27860	FIXATION OF ANKLE JOINT	PRXOVR	DEF					NA	NA	NA	N
27860	FIXATION OF ANKLE JOINT	MAXFEE	DEF					109.59	1/1/2000	12/31/2299	N
27870	FUSION OF ANKLE JOINT OPEN	PRXOVR	DEF					NA	NA	NA	N
27870	FUSION OF ANKLE JOINT OPEN	MAXFEE	DEF					746.22	1/1/2000	12/31/2299	N
27871	FUSION OF TIBIOFIBULAR JOINT	PRXOVR	DEF					NA	NA	NA	N
27871	FUSION OF TIBIOFIBULAR JOINT	MAXFEE	DEF					473.96	1/1/2000	12/31/2299	N
27888	AMPUTATION OF FOOT AT ANKLE	PRXOVR	DEF					NA	NA	NA	N
27888	AMPUTATION OF FOOT AT ANKLE	MAXFEE	DEF					529.14	1/1/2000	12/31/2299	N
27889	AMPUTATION OF FOOT AT ANKLE	PRXOVR	DEF					NA	NA	NA	N
27889	AMPUTATION OF FOOT AT ANKLE	MAXFEE	DEF					505.91	1/1/2004	12/31/2299	N
27892	DECOMPRESSION OF LEG	PRXOVR	DEF					NA	NA	NA	N
27892	DECOMPRESSION OF LEG	MAXFEE	DEF					298.76	7/1/2008	12/31/2299	N
27893	DECOMPRESSION OF LEG	PRXOVR	DEF					NA	NA	NA	N
27893	DECOMPRESSION OF LEG	MAXFEE	DEF					297.44	7/1/2008	12/31/2299	N
27894	DECOMPRESSION OF LEG	PRXOVR	DEF					NA	NA	NA	N
27894	DECOMPRESSION OF LEG	MAXFEE	DEF					452.90	7/1/2008	12/31/2299	N
27899	UNLISTED PX LEG/ANKLE	PRXOVR	DEF					NA	NA	NA	N
27899	UNLISTED PX LEG/ANKLE	MANUAL	DEF					NA	NA	NA	N
28001	DRAINAGE OF BURSA OF FOOT	PRXOVR	DEF					NA	NA	NA	N
28001	DRAINAGE OF BURSA OF FOOT	MAXFEE	FAC					73.22	1/1/2014	12/31/2299	N
28001	DRAINAGE OF BURSA OF FOOT	MAXFEE	NFF					132.39	1/1/2014	12/31/2299	N
28002	TREATMENT OF FOOT INFECTION	PRXOVR	DEF					NA	NA	NA	N
28002	TREATMENT OF FOOT INFECTION	MAXFEE	FAC					131.81	1/1/2014	12/31/2299	N
28002	TREATMENT OF FOOT INFECTION	MAXFEE	NFF					210.98	1/1/2014	12/31/2299	N
28003	TREATMENT OF FOOT INFECTION	PRXOVR	DEF					NA	NA	NA	N
28003	TREATMENT OF FOOT INFECTION	MAXFEE	FAC					249.42	1/1/2014	12/31/2299	N
28003	TREATMENT OF FOOT INFECTION	MAXFEE	NFF					343.23	1/1/2014	12/31/2299	N
28005	TREAT FOOT BONE LESION	PRXOVR	DEF					NA	NA	NA	N
28005	TREAT FOOT BONE LESION	MAXFEE	DEF					365.18	1/1/2000	12/31/2299	N
28008	INCISION OF FOOT FASCIA	PRXOVR	DEF					NA	NA	NA	N
28008	INCISION OF FOOT FASCIA	MAXFEE	FAC					124.77	1/1/2014	12/31/2299	N
28008	INCISION OF FOOT FASCIA	MAXFEE	NFF					208.57	1/1/2014	12/31/2299	N
28010	INCISION OF TOE TENDON	PRXOVR	DEF					NA	NA	NA	N
28010	INCISION OF TOE TENDON	MAXFEE	FAC					157.84	1/1/2014	12/31/2299	N
28010	INCISION OF TOE TENDON	MAXFEE	NFF					178.02	1/1/2014	12/31/2299	N
28011	INCISION OF TOE TENDONS	PRXOVR	DEF					NA	NA	NA	N
28011	INCISION OF TOE TENDONS	MAXFEE	FAC					156.56	1/1/2014	12/31/2299	N
28011	INCISION OF TOE TENDONS	MAXFEE	NFF					176.20	1/1/2014	12/31/2299	N
28020	EXPLORATION OF FOOT JOINT	PRXOVR	DEF					NA	NA	NA	N
28020	EXPLORATION OF FOOT JOINT	MAXFEE	FAC					169.46	1/1/2014	12/31/2299	N
28020	EXPLORATION OF FOOT JOINT	MAXFEE	NFF					272.49	1/1/2014	12/31/2299	N
28022	EXPLORATION OF FOOT JOINT	PRXOVR	DEF					NA	NA	NA	N
28022	EXPLORATION OF FOOT JOINT	MAXFEE	FAC					129.36	1/1/2014	12/31/2299	N
28022	EXPLORATION OF FOOT JOINT	MAXFEE	NFF					214.47	1/1/2014	12/31/2299	N
28024	EXPLORATION OF TOE JOINT	PRXOVR	DEF					NA	NA	NA	N
28024	EXPLORATION OF TOE JOINT	MAXFEE	FAC					117.69	1/1/2014	12/31/2299	N
28024	EXPLORATION OF TOE JOINT	MAXFEE	NFF					199.34	1/1/2014	12/31/2299	N
28035	DECOMPRESSION OF TIBIA NERVE	PRXOVR	DEF					NA	NA	NA	N
28035	DECOMPRESSION OF TIBIA NERVE	MAXFEE	FAC					191.11	1/1/2014	12/31/2299	N
28035	DECOMPRESSION OF TIBIA NERVE	MAXFEE	NFF					306.77	1/1/2014	12/31/2299	N
28039	EXC FOOT/TOE TUM SC 1.5 CM/>	PRXOVR	DEF					NA	NA	NA	N
28039	EXC FOOT/TOE TUM SC 1.5 CM/>	MAXFEE	FAC					133.74	1/1/2014	12/31/2299	N
28039	EXC FOOT/TOE TUM SC 1.5 CM/>	MAXFEE	NFF					232.47	1/1/2014	12/31/2299	N
28041	EXC FOOT/TOE TUM DEP 1.5CM/>	PRXOVR	DEF					NA	NA	NA	N
28041	EXC FOOT/TOE TUM DEP 1.5CM/>	MAXFEE	DEF					244.43	1/1/2010	12/31/2299	N
28043	EXC FOOT/TOE TUM SC < 1.5 CM	PRXOVR	DEF					NA	NA	NA	N
28043	EXC FOOT/TOE TUM SC < 1.5 CM	MAXFEE	FAC					91.66	1/1/2014	12/31/2299	N
28043	EXC FOOT/TOE TUM SC < 1.5 CM	MAXFEE	NFF					157.96	1/1/2014	12/31/2299	N
28045	EXC FOOT/TOE TUM DEEP <1.5CM	PRXOVR	DEF					NA	NA	NA	N
28045	EXC FOOT/TOE TUM DEEP <1.5CM	MAXFEE	FAC					142.48	1/1/2014	12/31/2299	N
28045	EXC FOOT/TOE TUM DEEP <1.5CM	MAXFEE	NFF					245.77	1/1/2014	12/31/2299	N
28046	RESECT FOOT/TOE TUMOR < 3 CM	PRXOVR	DEF					NA	NA	NA	N
28046	RESECT FOOT/TOE TUMOR < 3 CM	MAXFEE	DEF					440.86	7/1/2008	12/31/2299	N
28047	RESECT FOOT/TOE TUMOR 3 CM/>	PRXOVR	DEF					NA	NA	NA	N
28047	RESECT FOOT/TOE TUMOR 3 CM/>	MAXFEE	DEF					517.03	1/1/2010	12/31/2299	N
28050	BIOPSY OF FOOT JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
28050	BIOPSY OF FOOT JOINT LINING	MAXFEE	FAC					120.12	1/1/2014	12/31/2299	N
28050	BIOPSY OF FOOT JOINT LINING	MAXFEE	NFF					235.17	1/1/2014	12/31/2299	N
28052	BIOPSY OF FOOT JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
28052	BIOPSY OF FOOT JOINT LINING	MAXFEE	FAC					121.18	1/1/2014	12/31/2299	N
28052	BIOPSY OF FOOT JOINT LINING	MAXFEE	NFF					219.41	1/1/2014	12/31/2299	N
28054	BIOPSY OF TOE JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
28054	BIOPSY OF TOE JOINT LINING	MAXFEE	FAC					86.15	1/1/2014	12/31/2299	N
28054	BIOPSY OF TOE JOINT LINING	MAXFEE	NFF					169.03	1/1/2014	12/31/2299	N
28055	NEURECTOMY FOOT	PRXOVR	DEF					NA	NA	NA	N
28055	NEURECTOMY FOOT	MAXFEE	DEF					230.33	1/1/2007	12/31/2299	N
28060	PARTIAL REMOVAL FOOT FASCIA	PRXOVR	DEF					NA	NA	NA	N
28060	PARTIAL REMOVAL FOOT FASCIA	MAXFEE	FAC					155.67	1/1/2014	12/31/2299	N
28060	PARTIAL REMOVAL FOOT FASCIA	MAXFEE	NFF					266.62	1/1/2014	12/31/2299	N
28062	REMOVAL OF FOOT FASCIA	PRXOVR	DEF					NA	NA	NA	N
28062	REMOVAL OF FOOT FASCIA	MAXFEE	FAC					217.99	1/1/2014	12/31/2299	N
28062	REMOVAL OF FOOT FASCIA	MAXFEE	NFF					362.63	1/1/2014	12/31/2299	N
28070	REMOVAL OF FOOT JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
28070	REMOVAL OF FOOT JOINT LINING	MAXFEE	FAC					148.12	1/1/2014	12/31/2299	N
28070	REMOVAL OF FOOT JOINT LINING	MAXFEE	NFF					263.90	1/1/2014	12/31/2299	N
28072	REMOVAL OF FOOT JOINT LINING	PRXOVR	DEF					NA	NA	NA	N
28072	REMOVAL OF FOOT JOINT LINING	MAXFEE	FAC					116.66	1/1/2014	12/31/2299	N
28072	REMOVAL OF FOOT JOINT LINING	MAXFEE	NFF					224.32	1/1/2014	12/31/2299	N
28080	REMOVAL OF FOOT LESION	PRXOVR	DEF					NA	NA	NA	N
28080	REMOVAL OF FOOT LESION	MAXFEE	FAC					127.88	1/1/2014	12/31/2299	N
28080	REMOVAL OF FOOT LESION	MAXFEE	NFF					215.30	1/1/2014	12/31/2299	N
28086	EXCISE FOOT TENDON SHEATH	PRXOVR	DEF					NA	NA	NA	N
28086	EXCISE FOOT TENDON SHEATH	MAXFEE	FAC					126.18	1/1/2014	12/31/2299	N
28086	EXCISE FOOT TENDON SHEATH	MAXFEE	NFF					235.95	1/1/2014	12/31/2299	N
28088	EXCISE FOOT TENDON SHEATH	PRXOVR	DEF					NA	NA	NA	N
28088	EXCISE FOOT TENDON SHEATH	MAXFEE	FAC					117.91	1/1/2014	12/31/2299	N
28088	EXCISE FOOT TENDON SHEATH	MAXFEE	NFF					220.55	1/1/2014	12/31/2299	N
28090	REMOVAL OF FOOT LESION	PRXOVR	DEF					NA	NA	NA	N
28090	REMOVAL OF FOOT LESION	MAXFEE	FAC					116.62	1/1/2014	12/31/2299	N
28090	REMOVAL OF FOOT LESION	MAXFEE	NFF					214.02	1/1/2014	12/31/2299	N
28092	REMOVAL OF TOE LESIONS	PRXOVR	DEF					NA	NA	NA	N
28092	REMOVAL OF TOE LESIONS	MAXFEE	FAC					94.15	1/1/2014	12/31/2299	N
28092	REMOVAL OF TOE LESIONS	MAXFEE	NFF					170.50	1/1/2014	12/31/2299	N
28100	REMOVAL OF ANKLE/HEEL LESION	PRXOVR	DEF					NA	NA	NA	N
28100	REMOVAL OF ANKLE/HEEL LESION	MAXFEE	FAC					173.07	1/1/2014	12/31/2299	N
28100	REMOVAL OF ANKLE/HEEL LESION	MAXFEE	NFF					298.49	1/1/2014	12/31/2299	N
28102	REMOVE/GRAFT FOOT LESION	PRXOVR	DEF					NA	NA	NA	N
28102	REMOVE/GRAFT FOOT LESION	MAXFEE	DEF					401.38	1/1/2000	12/31/2299	N
28103	REMOVE/GRAFT FOOT LESION	PRXOVR	DEF					NA	NA	NA	N
28103	REMOVE/GRAFT FOOT LESION	MAXFEE	DEF					338.23	1/1/2000	12/31/2299	N
28104	REMOVAL OF FOOT LESION	PRXOVR	DEF					NA	NA	NA	N
28104	REMOVAL OF FOOT LESION	MAXFEE	FAC					151.91	1/1/2014	12/31/2299	N
28104	REMOVAL OF FOOT LESION	MAXFEE	NFF					265.45	1/1/2014	12/31/2299	N
28106	REMOVE/GRAFT FOOT LESION	PRXOVR	DEF					NA	NA	NA	N
28106	REMOVE/GRAFT FOOT LESION	MAXFEE	DEF					364.71	1/1/2000	12/31/2299	N
28107	REMOVE/GRAFT FOOT LESION	PRXOVR	DEF					NA	NA	NA	N
28107	REMOVE/GRAFT FOOT LESION	MAXFEE	FAC					161.92	1/1/2014	12/31/2299	N
28107	REMOVE/GRAFT FOOT LESION	MAXFEE	NFF					286.03	1/1/2014	12/31/2299	N
28108	REMOVAL OF TOE LESIONS	PRXOVR	DEF					NA	NA	NA	N
28108	REMOVAL OF TOE LESIONS	MAXFEE	FAC					131.11	1/1/2014	12/31/2299	N
28108	REMOVAL OF TOE LESIONS	MAXFEE	NFF					230.20	1/1/2014	12/31/2299	N
28110	PART REMOVAL OF METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28110	PART REMOVAL OF METATARSAL	MAXFEE	FAC					114.81	1/1/2014	12/31/2299	N
28110	PART REMOVAL OF METATARSAL	MAXFEE	NFF					219.19	1/1/2014	12/31/2299	N
28111	PART REMOVAL OF METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28111	PART REMOVAL OF METATARSAL	MAXFEE	FAC					159.08	1/1/2014	12/31/2299	N
28111	PART REMOVAL OF METATARSAL	MAXFEE	NFF					283.13	1/1/2014	12/31/2299	N
28112	PART REMOVAL OF METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28112	PART REMOVAL OF METATARSAL	MAXFEE	FAC					131.94	1/1/2014	12/31/2299	N
28112	PART REMOVAL OF METATARSAL	MAXFEE	NFF					242.93	1/1/2014	12/31/2299	N
28113	PART REMOVAL OF METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28113	PART REMOVAL OF METATARSAL	MAXFEE	FAC					152.76	1/1/2014	12/31/2299	N
28113	PART REMOVAL OF METATARSAL	MAXFEE	NFF					260.61	1/1/2014	12/31/2299	N
28114	REMOVAL OF METATARSAL HEADS	PRXOVR	DEF					NA	NA	NA	N
28114	REMOVAL OF METATARSAL HEADS	MAXFEE	FAC					334.47	1/1/2014	12/31/2299	N
28114	REMOVAL OF METATARSAL HEADS	MAXFEE	NFF					521.13	1/1/2014	12/31/2299	N
28116	REVISION OF FOOT	PRXOVR	DEF					NA	NA	NA	N
28116	REVISION OF FOOT	MAXFEE	FAC					223.87	1/1/2014	12/31/2299	N
28116	REVISION OF FOOT	MAXFEE	NFF					359.34	1/1/2014	12/31/2299	N
28118	REMOVAL OF HEEL BONE	PRXOVR	DEF					NA	NA	NA	N
28118	REMOVAL OF HEEL BONE	MAXFEE	FAC					193.83	1/1/2014	12/31/2299	N
28118	REMOVAL OF HEEL BONE	MAXFEE	NFF					320.87	1/1/2014	12/31/2299	N
28119	REMOVAL OF HEEL SPUR	PRXOVR	DEF					NA	NA	NA	N
28119	REMOVAL OF HEEL SPUR	MAXFEE	FAC					175.67	1/1/2014	12/31/2299	N
28119	REMOVAL OF HEEL SPUR	MAXFEE	NFF					296.14	1/1/2014	12/31/2299	N
28120	PART REMOVAL OF ANKLE/HEEL	PRXOVR	DEF					NA	NA	NA	N
28120	PART REMOVAL OF ANKLE/HEEL	MAXFEE	FAC					184.81	1/1/2014	12/31/2299	N
28120	PART REMOVAL OF ANKLE/HEEL	MAXFEE	NFF					305.03	1/1/2014	12/31/2299	N
28122	PARTIAL REMOVAL OF FOOT BONE	PRXOVR	DEF					NA	NA	NA	N
28122	PARTIAL REMOVAL OF FOOT BONE	MAXFEE	FAC					250.34	1/1/2014	12/31/2299	N
28122	PARTIAL REMOVAL OF FOOT BONE	MAXFEE	NFF					336.54	1/1/2014	12/31/2299	N
28124	PARTIAL REMOVAL OF TOE	PRXOVR	DEF					NA	NA	NA	N
28124	PARTIAL REMOVAL OF TOE	MAXFEE	FAC					150.24	1/1/2014	12/31/2299	N
28124	PARTIAL REMOVAL OF TOE	MAXFEE	NFF					253.29	1/1/2014	12/31/2299	N
28126	PARTIAL REMOVAL OF TOE	PRXOVR	DEF					NA	NA	NA	N
28126	PARTIAL REMOVAL OF TOE	MAXFEE	FAC					113.47	1/1/2014	12/31/2299	N
28126	PARTIAL REMOVAL OF TOE	MAXFEE	NFF					211.61	1/1/2014	12/31/2299	N
28130	REMOVAL OF ANKLE BONE	PRXOVR	DEF					NA	NA	NA	N
28130	REMOVAL OF ANKLE BONE	MAXFEE	DEF					415.26	1/1/2000	12/31/2299	N
28140	REMOVAL OF METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28140	REMOVAL OF METATARSAL	MAXFEE	FAC					207.62	1/1/2014	12/31/2299	N
28140	REMOVAL OF METATARSAL	MAXFEE	NFF					334.63	1/1/2014	12/31/2299	N
28150	REMOVAL OF TOE	PRXOVR	DEF					NA	NA	NA	N
28150	REMOVAL OF TOE	MAXFEE	FAC					117.56	1/1/2014	12/31/2299	N
28150	REMOVAL OF TOE	MAXFEE	NFF					215.80	1/1/2014	12/31/2299	N
28153	PARTIAL REMOVAL OF TOE	PRXOVR	DEF					NA	NA	NA	N
28153	PARTIAL REMOVAL OF TOE	MAXFEE	FAC					118.85	1/1/2014	12/31/2299	N
28153	PARTIAL REMOVAL OF TOE	MAXFEE	NFF					215.10	1/1/2014	12/31/2299	N
28160	PARTIAL REMOVAL OF TOE	PRXOVR	DEF					NA	NA	NA	N
28160	PARTIAL REMOVAL OF TOE	MAXFEE	FAC					120.41	1/1/2014	12/31/2299	N
28160	PARTIAL REMOVAL OF TOE	MAXFEE	NFF					221.45	1/1/2014	12/31/2299	N
28171	RESECT TARSAL TUMOR	PRXOVR	DEF					NA	NA	NA	N
28171	RESECT TARSAL TUMOR	MAXFEE	DEF					466.15	1/1/2000	12/31/2299	N
28173	RESECT METATARSAL TUMOR	PRXOVR	DEF					NA	NA	NA	N
28173	RESECT METATARSAL TUMOR	MAXFEE	DEF					402.82	1/1/2000	12/31/2299	N
28175	RESECT PHALANX OF TOE TUMOR	PRXOVR	DEF					NA	NA	NA	N
28175	RESECT PHALANX OF TOE TUMOR	MAXFEE	DEF					318.73	1/1/2000	12/31/2299	N
28190	REMOVAL OF FOOT FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
28190	REMOVAL OF FOOT FOREIGN BODY	MAXFEE	FAC					70.64	1/1/2014	12/31/2299	N
28190	REMOVAL OF FOOT FOREIGN BODY	MAXFEE	NFF					152.19	1/1/2014	12/31/2299	N
28192	REMOVAL OF FOOT FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
28192	REMOVAL OF FOOT FOREIGN BODY	MAXFEE	FAC					109.97	1/1/2014	12/31/2299	N
28192	REMOVAL OF FOOT FOREIGN BODY	MAXFEE	NFF					197.93	1/1/2014	12/31/2299	N
28193	REMOVAL OF FOOT FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
28193	REMOVAL OF FOOT FOREIGN BODY	MAXFEE	FAC					136.58	1/1/2014	12/31/2299	N
28193	REMOVAL OF FOOT FOREIGN BODY	MAXFEE	NFF					240.59	1/1/2014	12/31/2299	N
28200	REPAIR OF FOOT TENDON	PRXOVR	DEF					NA	NA	NA	N
28200	REPAIR OF FOOT TENDON	MAXFEE	FAC					151.17	1/1/2014	12/31/2299	N
28200	REPAIR OF FOOT TENDON	MAXFEE	NFF					264.74	1/1/2014	12/31/2299	N
28202	REPAIR/GRAFT OF FOOT TENDON	PRXOVR	DEF					NA	NA	NA	N
28202	REPAIR/GRAFT OF FOOT TENDON	MAXFEE	FAC					214.78	1/1/2014	12/31/2299	N
28202	REPAIR/GRAFT OF FOOT TENDON	MAXFEE	NFF					347.52	1/1/2014	12/31/2299	N
28208	REPAIR OF FOOT TENDON	PRXOVR	DEF					NA	NA	NA	N
28208	REPAIR OF FOOT TENDON	MAXFEE	FAC					113.43	1/1/2014	12/31/2299	N
28208	REPAIR OF FOOT TENDON	MAXFEE	NFF					207.82	1/1/2014	12/31/2299	N
28210	REPAIR/GRAFT OF FOOT TENDON	PRXOVR	DEF					NA	NA	NA	N
28210	REPAIR/GRAFT OF FOOT TENDON	MAXFEE	FAC					204.53	1/1/2014	12/31/2299	N
28210	REPAIR/GRAFT OF FOOT TENDON	MAXFEE	NFF					327.76	1/1/2014	12/31/2299	N
28220	RELEASE OF FOOT TENDON	PRXOVR	DEF					NA	NA	NA	N
28220	RELEASE OF FOOT TENDON	MAXFEE	FAC					134.21	1/1/2014	12/31/2299	N
28220	RELEASE OF FOOT TENDON	MAXFEE	NFF					236.83	1/1/2014	12/31/2299	N
28222	RELEASE OF FOOT TENDONS	PRXOVR	DEF					NA	NA	NA	N
28222	RELEASE OF FOOT TENDONS	MAXFEE	FAC					191.72	1/1/2014	12/31/2299	N
28222	RELEASE OF FOOT TENDONS	MAXFEE	NFF					316.66	1/1/2014	12/31/2299	N
28225	RELEASE OF FOOT TENDON	PRXOVR	DEF					NA	NA	NA	N
28225	RELEASE OF FOOT TENDON	MAXFEE	FAC					97.99	1/1/2014	12/31/2299	N
28225	RELEASE OF FOOT TENDON	MAXFEE	NFF					186.22	1/1/2014	12/31/2299	N
28226	RELEASE OF FOOT TENDONS	PRXOVR	DEF					NA	NA	NA	N
28226	RELEASE OF FOOT TENDONS	MAXFEE	FAC					151.24	1/1/2014	12/31/2299	N
28226	RELEASE OF FOOT TENDONS	MAXFEE	NFF					227.73	1/1/2014	12/31/2299	N
28230	INCISION OF FOOT TENDON(S)	PRXOVR	DEF					NA	NA	NA	N
28230	INCISION OF FOOT TENDON(S)	MAXFEE	FAC					106.01	1/1/2014	12/31/2299	N
28230	INCISION OF FOOT TENDON(S)	MAXFEE	NFF					195.79	1/1/2014	12/31/2299	N
28232	INCISION OF TOE TENDON	PRXOVR	DEF					NA	NA	NA	N
28232	INCISION OF TOE TENDON	MAXFEE	FAC					85.12	1/1/2014	12/31/2299	N
28232	INCISION OF TOE TENDON	MAXFEE	NFF					148.18	1/1/2014	12/31/2299	N
28234	INCISION OF FOOT TENDON	PRXOVR	DEF					NA	NA	NA	N
28234	INCISION OF FOOT TENDON	MAXFEE	FAC					92.14	1/1/2014	12/31/2299	N
28234	INCISION OF FOOT TENDON	MAXFEE	NFF					149.51	1/1/2014	12/31/2299	N
28238	REVISION OF FOOT TENDON	PRXOVR	DEF					NA	NA	NA	N
28238	REVISION OF FOOT TENDON	MAXFEE	FAC					250.88	1/1/2014	12/31/2299	N
28238	REVISION OF FOOT TENDON	MAXFEE	NFF					405.66	1/1/2014	12/31/2299	N
28240	RELEASE OF BIG TOE	PRXOVR	DEF					NA	NA	NA	N
28240	RELEASE OF BIG TOE	MAXFEE	FAC					102.88	1/1/2014	12/31/2299	N
28240	RELEASE OF BIG TOE	MAXFEE	NFF					191.63	1/1/2014	12/31/2299	N
28250	REVISION OF FOOT FASCIA	PRXOVR	DEF					NA	NA	NA	N
28250	REVISION OF FOOT FASCIA	MAXFEE	FAC					172.83	1/1/2014	12/31/2299	N
28250	REVISION OF FOOT FASCIA	MAXFEE	NFF					289.36	1/1/2014	12/31/2299	N
28260	RELEASE OF MIDFOOT JOINT	PRXOVR	DEF					NA	NA	NA	N
28260	RELEASE OF MIDFOOT JOINT	MAXFEE	FAC					206.55	1/1/2014	12/31/2299	N
28260	RELEASE OF MIDFOOT JOINT	MAXFEE	NFF					345.17	1/1/2014	12/31/2299	N
28261	REVISION OF FOOT TENDON	PRXOVR	DEF					NA	NA	NA	N
28261	REVISION OF FOOT TENDON	MAXFEE	FAC					287.93	1/1/2014	12/31/2299	N
28261	REVISION OF FOOT TENDON	MAXFEE	NFF					454.44	1/1/2014	12/31/2299	N
28262	REVISION OF FOOT AND ANKLE	PRXOVR	DEF					NA	NA	NA	N
28262	REVISION OF FOOT AND ANKLE	MAXFEE	FAC					502.63	1/1/2014	12/31/2299	N
28262	REVISION OF FOOT AND ANKLE	MAXFEE	NFF					739.10	1/1/2014	12/31/2299	N
28264	RELEASE OF MIDFOOT JOINT	PRXOVR	DEF					NA	NA	NA	N
28264	RELEASE OF MIDFOOT JOINT	MAXFEE	FAC					350.12	1/1/2014	12/31/2299	N
28264	RELEASE OF MIDFOOT JOINT	MAXFEE	NFF					532.17	1/1/2014	12/31/2299	N
28270	RELEASE OF FOOT CONTRACTURE	PRXOVR	DEF					NA	NA	NA	N
28270	RELEASE OF FOOT CONTRACTURE	MAXFEE	FAC					119.64	1/1/2014	12/31/2299	N
28270	RELEASE OF FOOT CONTRACTURE	MAXFEE	NFF					216.39	1/1/2014	12/31/2299	N
28272	RELEASE OF TOE JOINT EACH	PRXOVR	DEF					NA	NA	NA	N
28272	RELEASE OF TOE JOINT EACH	MAXFEE	FAC					100.46	1/1/2014	12/31/2299	N
28272	RELEASE OF TOE JOINT EACH	MAXFEE	NFF					186.40	1/1/2014	12/31/2299	N
28280	FUSION OF TOES	PRXOVR	DEF					NA	NA	NA	N
28280	FUSION OF TOES	MAXFEE	FAC					122.89	1/1/2014	12/31/2299	N
28280	FUSION OF TOES	MAXFEE	NFF					220.73	1/1/2014	12/31/2299	N
28285	REPAIR OF HAMMERTOE	PRXOVR	DEF					NA	NA	NA	N
28285	REPAIR OF HAMMERTOE	MAXFEE	FAC					149.26	1/1/2014	12/31/2299	N
28285	REPAIR OF HAMMERTOE	MAXFEE	NFF					250.07	1/1/2014	12/31/2299	N
28286	REPAIR OF HAMMERTOE	PRXOVR	DEF					NA	NA	NA	N
28286	REPAIR OF HAMMERTOE	MAXFEE	FAC					130.75	1/1/2014	12/31/2299	N
28286	REPAIR OF HAMMERTOE	MAXFEE	NFF					233	1/1/2014	12/31/2299	N
28288	PARTIAL REMOVAL OF FOOT BONE	PRXOVR	DEF					NA	NA	NA	N
28288	PARTIAL REMOVAL OF FOOT BONE	MAXFEE	FAC					149.58	1/1/2014	12/31/2299	N
28288	PARTIAL REMOVAL OF FOOT BONE	MAXFEE	NFF					236.33	1/1/2014	12/31/2299	N
28289	CORRJ HALUX RIGDUS W/O IMPLT	PRXOVR	DEF					NA	NA	NA	N
28289	CORRJ HALUX RIGDUS W/O IMPLT	MAXFEE	FAC					192.02	1/1/2014	12/31/2299	N
28289	CORRJ HALUX RIGDUS W/O IMPLT	MAXFEE	NFF					308.66	1/1/2014	12/31/2299	N
28290	CORRECTION OF BUNION	PRXOVR	DEF					NA	NA	NA	N
28290	CORRECTION OF BUNION	MAXFEE	DEF					NA			N
28291	CORRJ HALUX RIGDUS W/IMPLT	PRXOVR	DEF					NA	NA	NA	N
28291	CORRJ HALUX RIGDUS W/IMPLT	MAXFEE	FAC					385.42	1/1/2017	12/31/2299	N
28291	CORRJ HALUX RIGDUS W/IMPLT	MAXFEE	NFF					577.83	1/1/2017	12/31/2299	N
28292	CORRECTION HALLUX VALGUS	PRXOVR	DEF					NA	NA	NA	N
28292	CORRECTION HALLUX VALGUS	MAXFEE	FAC					238.90	1/1/2014	12/31/2299	N
28292	CORRECTION HALLUX VALGUS	MAXFEE	NFF					380.12	1/1/2014	12/31/2299	N
28293	CORRECTION OF BUNION	PRXOVR	DEF					NA	NA	NA	N
28293	CORRECTION OF BUNION	MAXFEE	DEF					NA			N
28294	CORRECTION OF BUNION	PRXOVR	DEF					NA	NA	NA	N
28294	CORRECTION OF BUNION	MAXFEE	DEF					NA			N
28295	CORRECTION HALLUX VALGUS	PRXOVR	DEF					NA	NA	NA	N
28295	CORRECTION HALLUX VALGUS	MAXFEE	FAC					428.29	1/1/2017	12/31/2299	N
28295	CORRECTION HALLUX VALGUS	MAXFEE	NFF					736.14	1/1/2017	12/31/2299	N
28296	CORRECTION HALLUX VALGUS	PRXOVR	DEF					NA	NA	NA	N
28296	CORRECTION HALLUX VALGUS	MAXFEE	FAC					299.34	1/1/2014	12/31/2299	N
28296	CORRECTION HALLUX VALGUS	MAXFEE	NFF					465.32	1/1/2014	12/31/2299	N
28297	CORRECTION HALLUX VALGUS	PRXOVR	DEF					NA	NA	NA	N
28297	CORRECTION HALLUX VALGUS	MAXFEE	FAC					298.55	1/1/2014	12/31/2299	N
28297	CORRECTION HALLUX VALGUS	MAXFEE	NFF					485.50	1/1/2014	12/31/2299	N
28298	CORRECTION HALLUX VALGUS	PRXOVR	DEF					NA	NA	NA	N
28298	CORRECTION HALLUX VALGUS	MAXFEE	FAC					271.54	1/1/2014	12/31/2299	N
28298	CORRECTION HALLUX VALGUS	MAXFEE	NFF					439.67	1/1/2014	12/31/2299	N
28299	CORRECTION HALLUX VALGUS	PRXOVR	DEF					NA	NA	NA	N
28299	CORRECTION HALLUX VALGUS	MAXFEE	FAC					314.94	1/1/2014	12/31/2299	N
28299	CORRECTION HALLUX VALGUS	MAXFEE	NFF					492.81	1/1/2014	12/31/2299	N
28300	INCISION OF HEEL BONE	PRXOVR	DEF					NA	NA	NA	N
28300	INCISION OF HEEL BONE	MAXFEE	DEF					468.21	1/1/2000	12/31/2299	N
28302	INCISION OF ANKLE BONE	PRXOVR	DEF					NA	NA	NA	N
28302	INCISION OF ANKLE BONE	MAXFEE	DEF					491.15	1/1/2000	12/31/2299	N
28304	INCISION OF MIDFOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28304	INCISION OF MIDFOOT BONES	MAXFEE	FAC					267.67	1/1/2014	12/31/2299	N
28304	INCISION OF MIDFOOT BONES	MAXFEE	NFF					430.04	1/1/2014	12/31/2299	N
28305	INCISE/GRAFT MIDFOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28305	INCISE/GRAFT MIDFOOT BONES	MAXFEE	DEF					585.06	1/1/2000	12/31/2299	N
28306	INCISION OF METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28306	INCISION OF METATARSAL	MAXFEE	FAC					158.22	1/1/2014	12/31/2299	N
28306	INCISION OF METATARSAL	MAXFEE	NFF					289.03	1/1/2014	12/31/2299	N
28307	INCISION OF METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28307	INCISION OF METATARSAL	MAXFEE	FAC					182.96	1/1/2014	12/31/2299	N
28307	INCISION OF METATARSAL	MAXFEE	NFF					331.52	1/1/2014	12/31/2299	N
28308	INCISION OF METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28308	INCISION OF METATARSAL	MAXFEE	FAC					167.86	1/1/2014	12/31/2299	N
28308	INCISION OF METATARSAL	MAXFEE	NFF					294.45	1/1/2014	12/31/2299	N
28309	INCISION OF METATARSALS	PRXOVR	DEF					NA	NA	NA	N
28309	INCISION OF METATARSALS	MAXFEE	DEF					498.76	7/1/2008	12/31/2299	N
28310	REVISION OF BIG TOE	PRXOVR	DEF					NA	NA	NA	N
28310	REVISION OF BIG TOE	MAXFEE	FAC					148.37	1/1/2014	12/31/2299	N
28310	REVISION OF BIG TOE	MAXFEE	NFF					270.03	1/1/2014	12/31/2299	N
28312	REVISION OF TOE	PRXOVR	DEF					NA	NA	NA	N
28312	REVISION OF TOE	MAXFEE	FAC					136.68	1/1/2014	12/31/2299	N
28312	REVISION OF TOE	MAXFEE	NFF					254.26	1/1/2014	12/31/2299	N
28313	REPAIR DEFORMITY OF TOE	PRXOVR	DEF					NA	NA	NA	N
28313	REPAIR DEFORMITY OF TOE	MAXFEE	FAC					124.50	1/1/2014	12/31/2299	N
28313	REPAIR DEFORMITY OF TOE	MAXFEE	NFF					225.60	1/1/2014	12/31/2299	N
28315	REMOVAL OF SESAMOID BONE	PRXOVR	DEF					NA	NA	NA	N
28315	REMOVAL OF SESAMOID BONE	MAXFEE	FAC					145.32	1/1/2014	12/31/2299	N
28315	REMOVAL OF SESAMOID BONE	MAXFEE	NFF					251.99	1/1/2014	12/31/2299	N
28320	REPAIR OF FOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28320	REPAIR OF FOOT BONES	MAXFEE	DEF					479.41	1/1/2000	12/31/2299	N
28322	REPAIR OF METATARSALS	PRXOVR	DEF					NA	NA	NA	N
28322	REPAIR OF METATARSALS	MAXFEE	FAC					225.64	1/1/2014	12/31/2299	N
28322	REPAIR OF METATARSALS	MAXFEE	NFF					372.57	1/1/2014	12/31/2299	N
28340	RESECT ENLARGED TOE TISSUE	PRXOVR	DEF					NA	NA	NA	N
28340	RESECT ENLARGED TOE TISSUE	MAXFEE	FAC					225.08	1/1/2014	12/31/2299	N
28340	RESECT ENLARGED TOE TISSUE	MAXFEE	NFF					364.78	1/1/2014	12/31/2299	N
28341	RESECT ENLARGED TOE	PRXOVR	DEF					NA	NA	NA	N
28341	RESECT ENLARGED TOE	MAXFEE	FAC					273.11	1/1/2014	12/31/2299	N
28341	RESECT ENLARGED TOE	MAXFEE	NFF					432.44	1/1/2014	12/31/2299	N
28344	REPAIR EXTRA TOE(S)	PRXOVR	DEF					NA	NA	NA	N
28344	REPAIR EXTRA TOE(S)	MAXFEE	FAC					116.59	1/1/2014	12/31/2299	N
28344	REPAIR EXTRA TOE(S)	MAXFEE	NFF					241.18	1/1/2014	12/31/2299	N
28345	REPAIR WEBBED TOE(S)	PRXOVR	DEF					NA	NA	NA	N
28345	REPAIR WEBBED TOE(S)	MAXFEE	FAC					187.65	1/1/2014	12/31/2299	N
28345	REPAIR WEBBED TOE(S)	MAXFEE	NFF					313.60	1/1/2014	12/31/2299	N
28360	RECONSTRUCT CLEFT FOOT	PRXOVR	DEF					NA	NA	NA	N
28360	RECONSTRUCT CLEFT FOOT	MAXFEE	DEF					696.60	1/1/2000	12/31/2299	N
28400	TREATMENT OF HEEL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28400	TREATMENT OF HEEL FRACTURE	MAXFEE	FAC					134.85	1/1/2014	12/31/2299	N
28400	TREATMENT OF HEEL FRACTURE	MAXFEE	NFF					146.21	1/1/2014	12/31/2299	N
28405	TREATMENT OF HEEL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28405	TREATMENT OF HEEL FRACTURE	MAXFEE	FAC					220.08	1/1/2014	12/31/2299	N
28405	TREATMENT OF HEEL FRACTURE	MAXFEE	NFF					252.56	1/1/2014	12/31/2299	N
28406	TREATMENT OF HEEL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28406	TREATMENT OF HEEL FRACTURE	MAXFEE	DEF					351.06	1/1/2000	12/31/2299	N
28415	TREAT HEEL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28415	TREAT HEEL FRACTURE	MAXFEE	DEF					699.60	1/1/2000	12/31/2299	N
28420	TREAT/GRAFT HEEL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28420	TREAT/GRAFT HEEL FRACTURE	MAXFEE	DEF					836.10	1/1/2000	12/31/2299	N
28430	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28430	TREATMENT OF ANKLE FRACTURE	MAXFEE	FAC					125.52	1/1/2014	12/31/2299	N
28430	TREATMENT OF ANKLE FRACTURE	MAXFEE	NFF					139.71	1/1/2014	12/31/2299	N
28435	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28435	TREATMENT OF ANKLE FRACTURE	MAXFEE	FAC					160.41	1/1/2014	12/31/2299	N
28435	TREATMENT OF ANKLE FRACTURE	MAXFEE	NFF					198.75	1/1/2014	12/31/2299	N
28436	TREATMENT OF ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28436	TREATMENT OF ANKLE FRACTURE	MAXFEE	DEF					259.14	1/1/2000	12/31/2299	N
28445	TREAT ANKLE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28445	TREAT ANKLE FRACTURE	MAXFEE	DEF					633.24	7/1/2008	12/31/2299	N
28446	OSTEOCHONDRAL TALUS AUTOGRFT	PRXOVR	DEF					NA	NA	NA	N
28446	OSTEOCHONDRAL TALUS AUTOGRFT	MAXFEE	DEF					704.98	1/1/2008	12/31/2299	N
28450	TREAT MIDFOOT FRACTURE EACH	PRXOVR	DEF					NA	NA	NA	N
28450	TREAT MIDFOOT FRACTURE EACH	MAXFEE	FAC					99.74	1/1/2014	12/31/2299	N
28450	TREAT MIDFOOT FRACTURE EACH	MAXFEE	NFF					114.31	1/1/2014	12/31/2299	N
28455	TREAT MIDFOOT FRACTURE EACH	PRXOVR	DEF					NA	NA	NA	N
28455	TREAT MIDFOOT FRACTURE EACH	MAXFEE	FAC					141.43	1/1/2014	12/31/2299	N
28455	TREAT MIDFOOT FRACTURE EACH	MAXFEE	NFF					168.75	1/1/2014	12/31/2299	N
28456	TREAT MIDFOOT FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28456	TREAT MIDFOOT FRACTURE	MAXFEE	DEF					151.15	7/1/2008	12/31/2299	N
28465	TREAT MIDFOOT FRACTURE EACH	PRXOVR	DEF					NA	NA	NA	N
28465	TREAT MIDFOOT FRACTURE EACH	MAXFEE	DEF					380.08	1/1/2000	12/31/2299	N
28470	TREAT METATARSAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28470	TREAT METATARSAL FRACTURE	MAXFEE	FAC					111.07	1/1/2014	12/31/2299	N
28470	TREAT METATARSAL FRACTURE	MAXFEE	NFF					112.03	1/1/2014	12/31/2299	N
28475	TREAT METATARSAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28475	TREAT METATARSAL FRACTURE	MAXFEE	FAC					135.02	1/1/2014	12/31/2299	N
28475	TREAT METATARSAL FRACTURE	MAXFEE	NFF					158.40	1/1/2014	12/31/2299	N
28476	TREAT METATARSAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28476	TREAT METATARSAL FRACTURE	MAXFEE	DEF					196.75	1/1/2000	12/31/2299	N
28485	TREAT METATARSAL FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28485	TREAT METATARSAL FRACTURE	MAXFEE	DEF					311.70	1/1/2000	12/31/2299	N
28490	TREAT BIG TOE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28490	TREAT BIG TOE FRACTURE	MAXFEE	FAC					50.04	1/1/2014	12/31/2299	N
28490	TREAT BIG TOE FRACTURE	MAXFEE	NFF					69.35	1/1/2014	12/31/2299	N
28495	TREAT BIG TOE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28495	TREAT BIG TOE FRACTURE	MAXFEE	FAC					62.66	1/1/2014	12/31/2299	N
28495	TREAT BIG TOE FRACTURE	MAXFEE	NFF					85.35	1/1/2014	12/31/2299	N
28496	TREAT BIG TOE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28496	TREAT BIG TOE FRACTURE	MAXFEE	FAC					134.23	1/1/2014	12/31/2299	N
28496	TREAT BIG TOE FRACTURE	MAXFEE	NFF					201.30	1/1/2014	12/31/2299	N
28505	TREAT BIG TOE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28505	TREAT BIG TOE FRACTURE	MAXFEE	FAC					205.35	1/1/2014	12/31/2299	N
28505	TREAT BIG TOE FRACTURE	MAXFEE	NFF					299.75	1/1/2014	12/31/2299	N
28510	TREATMENT OF TOE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28510	TREATMENT OF TOE FRACTURE	MAXFEE	FAC					57.37	1/1/2014	12/31/2299	N
28510	TREATMENT OF TOE FRACTURE	MAXFEE	NFF					58.94	1/1/2014	12/31/2299	N
28515	TREATMENT OF TOE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28515	TREATMENT OF TOE FRACTURE	MAXFEE	FAC					68.03	1/1/2014	12/31/2299	N
28515	TREATMENT OF TOE FRACTURE	MAXFEE	NFF					76.67	1/1/2014	12/31/2299	N
28525	TREAT TOE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28525	TREAT TOE FRACTURE	MAXFEE	FAC					160.31	1/1/2014	12/31/2299	N
28525	TREAT TOE FRACTURE	MAXFEE	NFF					255.50	1/1/2014	12/31/2299	N
28530	TREAT SESAMOID BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28530	TREAT SESAMOID BONE FRACTURE	MAXFEE	FAC					53.40	1/1/2014	12/31/2299	N
28530	TREAT SESAMOID BONE FRACTURE	MAXFEE	NFF					61.96	1/1/2014	12/31/2299	N
28531	TREAT SESAMOID BONE FRACTURE	PRXOVR	DEF					NA	NA	NA	N
28531	TREAT SESAMOID BONE FRACTURE	MAXFEE	FAC					124.88	1/1/2014	12/31/2299	N
28531	TREAT SESAMOID BONE FRACTURE	MAXFEE	NFF					158.55	1/1/2014	12/31/2299	N
28540	TREAT FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28540	TREAT FOOT DISLOCATION	MAXFEE	FAC					76.42	1/1/2014	12/31/2299	N
28540	TREAT FOOT DISLOCATION	MAXFEE	NFF					101.75	1/1/2014	12/31/2299	N
28545	TREAT FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28545	TREAT FOOT DISLOCATION	MAXFEE	FAC					91.33	1/1/2014	12/31/2299	N
28545	TREAT FOOT DISLOCATION	MAXFEE	NFF					114.47	1/1/2014	12/31/2299	N
28546	TREAT FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28546	TREAT FOOT DISLOCATION	MAXFEE	FAC					179.06	1/1/2014	12/31/2299	N
28546	TREAT FOOT DISLOCATION	MAXFEE	NFF					256.80	1/1/2014	12/31/2299	N
28555	REPAIR FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28555	REPAIR FOOT DISLOCATION	MAXFEE	FAC					234.83	1/1/2014	12/31/2299	N
28555	REPAIR FOOT DISLOCATION	MAXFEE	NFF					357.36	1/1/2014	12/31/2299	N
28570	TREAT FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28570	TREAT FOOT DISLOCATION	MAXFEE	FAC					75.44	1/1/2014	12/31/2299	N
28570	TREAT FOOT DISLOCATION	MAXFEE	NFF					97.50	1/1/2014	12/31/2299	N
28575	TREAT FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28575	TREAT FOOT DISLOCATION	MAXFEE	FAC					147.95	1/1/2014	12/31/2299	N
28575	TREAT FOOT DISLOCATION	MAXFEE	NFF					174.51	1/1/2014	12/31/2299	N
28576	TREAT FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28576	TREAT FOOT DISLOCATION	MAXFEE	DEF					204.78	1/1/2000	12/31/2299	N
28585	REPAIR FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28585	REPAIR FOOT DISLOCATION	MAXFEE	FAC					242.56	1/1/2014	12/31/2299	N
28585	REPAIR FOOT DISLOCATION	MAXFEE	NFF					382.61	1/1/2014	12/31/2299	N
28600	TREAT FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28600	TREAT FOOT DISLOCATION	MAXFEE	FAC					71.57	1/1/2014	12/31/2299	N
28600	TREAT FOOT DISLOCATION	MAXFEE	NFF					106.41	1/1/2014	12/31/2299	N
28605	TREAT FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28605	TREAT FOOT DISLOCATION	MAXFEE	FAC					134.88	1/1/2014	12/31/2299	N
28605	TREAT FOOT DISLOCATION	MAXFEE	NFF					147.79	1/1/2014	12/31/2299	N
28606	TREAT FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28606	TREAT FOOT DISLOCATION	MAXFEE	DEF					251.31	1/1/2000	12/31/2299	N
28615	REPAIR FOOT DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28615	REPAIR FOOT DISLOCATION	MAXFEE	DEF					377.09	7/1/2008	12/31/2299	N
28630	TREAT TOE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28630	TREAT TOE DISLOCATION	MAXFEE	FAC					47.27	1/1/2014	12/31/2299	N
28630	TREAT TOE DISLOCATION	MAXFEE	NFF					78.34	1/1/2014	12/31/2299	N
28635	TREAT TOE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28635	TREAT TOE DISLOCATION	MAXFEE	FAC					62.35	1/1/2014	12/31/2299	N
28635	TREAT TOE DISLOCATION	MAXFEE	NFF					100.01	1/1/2014	12/31/2299	N
28636	TREAT TOE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28636	TREAT TOE DISLOCATION	MAXFEE	FAC					83.67	1/1/2014	12/31/2299	N
28636	TREAT TOE DISLOCATION	MAXFEE	NFF					152.21	1/1/2014	12/31/2299	N
28645	REPAIR TOE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28645	REPAIR TOE DISLOCATION	MAXFEE	FAC					223.19	1/1/2014	12/31/2299	N
28645	REPAIR TOE DISLOCATION	MAXFEE	NFF					295.15	1/1/2014	12/31/2299	N
28660	TREAT TOE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28660	TREAT TOE DISLOCATION	MAXFEE	FAC					35.81	1/1/2014	12/31/2299	N
28660	TREAT TOE DISLOCATION	MAXFEE	NFF					55.28	1/1/2014	12/31/2299	N
28665	TREAT TOE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28665	TREAT TOE DISLOCATION	MAXFEE	FAC					67.49	1/1/2014	12/31/2299	N
28665	TREAT TOE DISLOCATION	MAXFEE	NFF					87.53	1/1/2014	12/31/2299	N
28666	TREAT TOE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28666	TREAT TOE DISLOCATION	MAXFEE	DEF					146.18	1/1/2000	12/31/2299	N
28675	REPAIR OF TOE DISLOCATION	PRXOVR	DEF					NA	NA	NA	N
28675	REPAIR OF TOE DISLOCATION	MAXFEE	FAC					178.89	1/1/2014	12/31/2299	N
28675	REPAIR OF TOE DISLOCATION	MAXFEE	NFF					259.95	1/1/2014	12/31/2299	N
28705	FUSION OF FOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28705	FUSION OF FOOT BONES	MAXFEE	DEF					814.89	1/1/2000	12/31/2299	N
28715	FUSION OF FOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28715	FUSION OF FOOT BONES	MAXFEE	DEF					692.56	1/1/2000	12/31/2299	N
28725	FUSION OF FOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28725	FUSION OF FOOT BONES	MAXFEE	DEF					576.47	1/1/2000	12/31/2299	N
28730	FUSION OF FOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28730	FUSION OF FOOT BONES	MAXFEE	DEF					543.83	1/1/2000	12/31/2299	N
28735	FUSION OF FOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28735	FUSION OF FOOT BONES	MAXFEE	DEF					558.67	1/1/2000	12/31/2299	N
28737	REVISION OF FOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28737	REVISION OF FOOT BONES	MAXFEE	DEF					502.65	1/1/2000	12/31/2299	N
28740	FUSION OF FOOT BONES	PRXOVR	DEF					NA	NA	NA	N
28740	FUSION OF FOOT BONES	MAXFEE	FAC					219.02	1/1/2014	12/31/2299	N
28740	FUSION OF FOOT BONES	MAXFEE	NFF					355.33	1/1/2014	12/31/2299	N
28750	FUSION OF BIG TOE JOINT	PRXOVR	DEF					NA	NA	NA	N
28750	FUSION OF BIG TOE JOINT	MAXFEE	FAC					209.37	1/1/2014	12/31/2299	N
28750	FUSION OF BIG TOE JOINT	MAXFEE	NFF					333.72	1/1/2014	12/31/2299	N
28755	FUSION OF BIG TOE JOINT	PRXOVR	DEF					NA	NA	NA	N
28755	FUSION OF BIG TOE JOINT	MAXFEE	FAC					131.20	1/1/2014	12/31/2299	N
28755	FUSION OF BIG TOE JOINT	MAXFEE	NFF					241.30	1/1/2014	12/31/2299	N
28760	FUSION OF BIG TOE JOINT	PRXOVR	DEF					NA	NA	NA	N
28760	FUSION OF BIG TOE JOINT	MAXFEE	FAC					199.85	1/1/2014	12/31/2299	N
28760	FUSION OF BIG TOE JOINT	MAXFEE	NFF					338.59	1/1/2014	12/31/2299	N
28800	AMPUTATION OF MIDFOOT	PRXOVR	DEF					NA	NA	NA	N
28800	AMPUTATION OF MIDFOOT	MAXFEE	DEF					413.48	1/1/2000	12/31/2299	N
28805	AMPUTATION THRU METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28805	AMPUTATION THRU METATARSAL	MAXFEE	DEF					409.33	1/1/2000	12/31/2299	N
28810	AMPUTATION TOE & METATARSAL	PRXOVR	DEF					NA	NA	NA	N
28810	AMPUTATION TOE & METATARSAL	MAXFEE	DEF					289.23	1/1/2000	12/31/2299	N
28820	AMPUTATION OF TOE	PRXOVR	DEF					NA	NA	NA	N
28820	AMPUTATION OF TOE	MAXFEE	FAC					141.02	1/1/2014	12/31/2299	N
28820	AMPUTATION OF TOE	MAXFEE	NFF					253.19	1/1/2014	12/31/2299	N
28825	PARTIAL AMPUTATION OF TOE	PRXOVR	DEF					NA	NA	NA	N
28825	PARTIAL AMPUTATION OF TOE	MAXFEE	FAC					131.43	1/1/2014	12/31/2299	N
28825	PARTIAL AMPUTATION OF TOE	MAXFEE	NFF					245.62	1/1/2014	12/31/2299	N
28890	HI ENRGY ESWT PLANTAR FASCIA	PRXOVR	DEF					NA	NA	NA	N
28890	HI ENRGY ESWT PLANTAR FASCIA	MAXFEE	FAC					155.60	1/1/2014	12/31/2299	N
28890	HI ENRGY ESWT PLANTAR FASCIA	MAXFEE	NFF					245.55	1/1/2014	12/31/2299	N
28899	UNLISTED PX FOOT/TOES	PRXOVR	DEF					NA	NA	NA	N
28899	UNLISTED PX FOOT/TOES	MANUAL	DEF					NA	NA	NA	N
29345	APPLICATION OF LONG LEG CAST	PRXOVR	DEF					NA	NA	NA	N
29345	APPLICATION OF LONG LEG CAST	MAXFEE	FAC					48.77	1/1/2014	12/31/2299	N
29345	APPLICATION OF LONG LEG CAST	MAXFEE	NFF					76.15	1/1/2014	12/31/2299	N
29355	APPLICATION OF LONG LEG CAST	PRXOVR	DEF					NA	NA	NA	N
29355	APPLICATION OF LONG LEG CAST	MAXFEE	FAC					53.91	1/1/2014	12/31/2299	N
29355	APPLICATION OF LONG LEG CAST	MAXFEE	NFF					82.65	1/1/2014	12/31/2299	N
29358	APPLY LONG LEG CAST BRACE	PRXOVR	DEF					NA	NA	NA	N
29358	APPLY LONG LEG CAST BRACE	MAXFEE	FAC					83.54	12/31/2014	12/31/2299	N
29358	APPLY LONG LEG CAST BRACE	MAXFEE	NFF					148.81	1/1/2016	12/31/2299	N
29365	APPLICATION OF LONG LEG CAST	PRXOVR	DEF					NA	NA	NA	N
29365	APPLICATION OF LONG LEG CAST	MAXFEE	FAC					70.49	12/31/2014	12/31/2299	N
29365	APPLICATION OF LONG LEG CAST	MAXFEE	NFF					113.61	1/1/2016	12/31/2299	N
29405	APPLY SHORT LEG CAST	PRXOVR	DEF					NA	NA	NA	N
29405	APPLY SHORT LEG CAST	MAXFEE	FAC					47.61	12/31/2014	12/31/2299	N
29405	APPLY SHORT LEG CAST	MAXFEE	NFF					75.50	1/1/2016	12/31/2299	N
29425	APPLY SHORT LEG CAST	PRXOVR	DEF					NA	NA	NA	S
29425	APPLY SHORT LEG CAST	MAXFEE	FAC					45.18	12/31/2014	12/31/2299	S
29425	APPLY SHORT LEG CAST	MAXFEE	NFF					72.33	1/1/2016	12/31/2299	S
29435	APPLY SHORT LEG CAST	PRXOVR	DEF					NA	NA	NA	N
29435	APPLY SHORT LEG CAST	MAXFEE	FAC					47.02	1/1/2014	12/31/2299	N
29435	APPLY SHORT LEG CAST	MAXFEE	NFF					74.74	1/1/2014	12/31/2299	N
29440	ADDITION OF WALKER TO CAST	PRXOVR	DEF					NA	NA	NA	N
29440	ADDITION OF WALKER TO CAST	MAXFEE	FAC					12.01	1/1/2014	12/31/2299	N
29440	ADDITION OF WALKER TO CAST	MAXFEE	NFF					27.57	1/1/2014	12/31/2299	N
29445	APPLY RIGID LEG CAST	PRXOVR	DEF					NA	NA	NA	N
29445	APPLY RIGID LEG CAST	MAXFEE	FAC					80.32	1/1/2014	12/31/2299	N
29445	APPLY RIGID LEG CAST	MAXFEE	NFF					110.73	1/1/2014	12/31/2299	N
29450	APPLICATION OF LEG CAST	PRXOVR	DEF					NA	NA	NA	N
29450	APPLICATION OF LEG CAST	MAXFEE	FAC					53.34	1/1/2014	12/31/2299	N
29450	APPLICATION OF LEG CAST	MAXFEE	NFF					80.06	1/1/2014	12/31/2299	N
29505	APPLICATION LONG LEG SPLINT	PRXOVR	DEF					NA	NA	NA	N
29505	APPLICATION LONG LEG SPLINT	MAXFEE	FAC					39.96	12/31/2014	12/31/2299	N
29505	APPLICATION LONG LEG SPLINT	MAXFEE	NFF					76.39	1/1/2016	12/31/2299	N
29515	APPLICATION LOWER LEG SPLINT	PRXOVR	DEF					NA	NA	NA	N
29515	APPLICATION LOWER LEG SPLINT	MAXFEE	FAC					39.99	12/31/2014	12/31/2299	N
29515	APPLICATION LOWER LEG SPLINT	MAXFEE	NFF					66.19	1/1/2016	12/31/2299	N
29530	STRAPPING OF KNEE	PRXOVR	DEF					NA	NA	NA	N
29530	STRAPPING OF KNEE	MAXFEE	FAC					18.04	1/1/2014	12/31/2299	N
29530	STRAPPING OF KNEE	MAXFEE	NFF					26.09	1/1/2016	12/31/2299	N
29540	STRAPPING OF ANKLE AND/OR FT	PRXOVR	DEF					NA	NA	NA	N
29540	STRAPPING OF ANKLE AND/OR FT	MAXFEE	FAC					13.81	1/1/2014	12/31/2299	N
29540	STRAPPING OF ANKLE AND/OR FT	MAXFEE	NFF					22.52	1/1/2014	12/31/2299	N
29550	STRAPPING OF TOES	PRXOVR	DEF					NA	NA	NA	N
29550	STRAPPING OF TOES	MAXFEE	FAC					11.60	1/1/2014	12/31/2299	N
29550	STRAPPING OF TOES	MAXFEE	NFF					17.58	1/1/2016	12/31/2299	N
29580	APPLICATION OF PASTE BOOT	PRXOVR	DEF					NA	NA	NA	N
29580	APPLICATION OF PASTE BOOT	MAXFEE	FAC					21.68	1/1/2014	12/31/2299	N
29580	APPLICATION OF PASTE BOOT	MAXFEE	NFF					35.90	1/1/2014	12/31/2299	N
29581	APPLY MULTLAY COMPRS LWR LEG	PRXOVR	DEF					NA	NA	NA	N
29581	APPLY MULTLAY COMPRS LWR LEG	MAXFEE	FAC					8.68	1/1/2014	12/31/2299	N
29581	APPLY MULTLAY COMPRS LWR LEG	MAXFEE	NFF					26.55	1/1/2014	12/31/2299	N
29582	APPLY MULTLAY COMPRS UPR LEG	PRXOVR	DEF					NA	NA	NA	N
29582	APPLY MULTLAY COMPRS UPR LEG	MAXFEE	DEF					NA			N
29583	APPLY MULTLAY COMPRS UPR ARM	PRXOVR	DEF					NA	NA	NA	N
29583	APPLY MULTLAY COMPRS UPR ARM	MAXFEE	DEF					NA			N
29584	APPL MULTLAY COMPRS ARM/HAND	PRXOVR	DEF					NA	NA	NA	N
29584	APPL MULTLAY COMPRS ARM/HAND	MAXFEE	FAC					10.62	1/1/2014	12/31/2299	N
29584	APPL MULTLAY COMPRS ARM/HAND	MAXFEE	NFF					30.81	1/1/2014	12/31/2299	N
29590	APPLICATION OF FOOT SPLINT	PRXOVR	DEF					NA	NA	NA	N
29590	APPLICATION OF FOOT SPLINT	MAXFEE	DEF					NA			N
29700	REMOVAL/REVISION OF CAST	PRXOVR	DEF					NA	NA	NA	N
29700	REMOVAL/REVISION OF CAST	MAXFEE	FAC					14.29	1/1/2014	12/31/2299	N
29700	REMOVAL/REVISION OF CAST	MAXFEE	NFF					32.67	1/1/2014	12/31/2299	N
29705	REMOVAL/REVISION OF CAST	PRXOVR	DEF					NA	NA	NA	N
29705	REMOVAL/REVISION OF CAST	MAXFEE	FAC					21.01	1/1/2014	12/31/2299	N
29705	REMOVAL/REVISION OF CAST	MAXFEE	NFF					35.50	1/1/2014	12/31/2299	N
29730	WINDOWING OF CAST	PRXOVR	DEF					NA	NA	NA	N
29730	WINDOWING OF CAST	MAXFEE	FAC					20.24	1/1/2014	12/31/2299	N
29730	WINDOWING OF CAST	MAXFEE	NFF					34.84	1/1/2014	12/31/2299	N
29740	WEDGING OF CAST	PRXOVR	DEF					NA	NA	NA	N
29740	WEDGING OF CAST	MAXFEE	FAC					31.11	1/1/2014	12/31/2299	N
29740	WEDGING OF CAST	MAXFEE	NFF					50.89	1/1/2014	12/31/2299	N
29750	WEDGING OF CLUBFOOT CAST	PRXOVR	DEF					NA	NA	NA	N
29750	WEDGING OF CLUBFOOT CAST	MAXFEE	FAC					34.79	1/1/2014	12/31/2299	N
29750	WEDGING OF CLUBFOOT CAST	MAXFEE	NFF					54.28	1/1/2014	12/31/2299	N
29799	UNLISTED PX CASTING/STRPG	PRXOVR	DEF					NA	NA	NA	N
29799	UNLISTED PX CASTING/STRPG	MANUAL	DEF					NA	NA	NA	N
29891	ANKLE ARTHROSCOPY/SURGERY	PRXOVR	DEF					NA	NA	NA	N
29891	ANKLE ARTHROSCOPY/SURGERY	MAXFEE	DEF					478.91	1/1/2004	12/31/2299	N
29893	SCOPE PLANTAR FASCIOTOMY	PRXOVR	DEF					NA	NA	NA	N
29893	SCOPE PLANTAR FASCIOTOMY	MAXFEE	FAC					160.80	1/1/2014	12/31/2299	N
29893	SCOPE PLANTAR FASCIOTOMY	MAXFEE	NFF					276.58	1/1/2014	12/31/2299	N
29894	ANKLE ARTHROSCOPY/SURGERY	PRXOVR	DEF					NA	NA	NA	N
29894	ANKLE ARTHROSCOPY/SURGERY	MAXFEE	DEF					418.61	1/1/2000	12/31/2299	N
29895	ANKLE ARTHROSCOPY/SURGERY	PRXOVR	DEF					NA	NA	NA	N
29895	ANKLE ARTHROSCOPY/SURGERY	MAXFEE	DEF					408.21	1/1/2000	12/31/2299	N
29897	ANKLE ARTHROSCOPY/SURGERY	PRXOVR	DEF					NA	NA	NA	N
29897	ANKLE ARTHROSCOPY/SURGERY	MAXFEE	DEF					425.56	1/1/2000	12/31/2299	N
29898	ANKLE ARTHROSCOPY/SURGERY	PRXOVR	DEF					NA	NA	NA	N
29898	ANKLE ARTHROSCOPY/SURGERY	MAXFEE	DEF					482.68	1/1/2000	12/31/2299	N
29899	ANKLE ARTHROSCOPY/SURGERY	PRXOVR	DEF					NA	NA	NA	N
29899	ANKLE ARTHROSCOPY/SURGERY	MAXFEE	DEF					664.17	1/1/2004	12/31/2299	N
29904	SUBTALAR ARTHRO W/FB RMVL	PRXOVR	DEF					NA	NA	NA	N
29904	SUBTALAR ARTHRO W/FB RMVL	MAXFEE	DEF					364.72	1/1/2008	12/31/2299	N
29905	SUBTALAR ARTHRO W/EXC	PRXOVR	DEF					NA	NA	NA	N
29905	SUBTALAR ARTHRO W/EXC	MAXFEE	DEF					392.58	1/1/2008	12/31/2299	N
29906	SUBTALAR ARTHRO W/DEB	PRXOVR	DEF					NA	NA	NA	N
29906	SUBTALAR ARTHRO W/DEB	MAXFEE	DEF					413.58	1/1/2008	12/31/2299	N
29907	SUBTALAR ARTHRO W/FUSION	PRXOVR	DEF					NA	NA	NA	N
29907	SUBTALAR ARTHRO W/FUSION	MAXFEE	DEF					507.87	1/1/2008	12/31/2299	N
29999	UNLISTED PX ARTHROSCOPY	PRXOVR	DEF					NA	NA	NA	N
29999	UNLISTED PX ARTHROSCOPY	MANUAL	DEF					NA	NA	NA	N
3000F	BLOOD PRESS </= 140/90 MMHG	PRXOVR	DEF					NA	NA	NA	N
3000F	BLOOD PRESS </= 140/90 MMHG	MAXFEE	DEF					NA			N
3002F	BLOOD PRESSURE > 140/90 MMHG	PRXOVR	DEF					NA	NA	NA	N
3002F	BLOOD PRESSURE > 140/90 MMHG	MAXFEE	DEF					NA			N
3006F	CXR DOC REV	PRXOVR	DEF					NA	NA	NA	N
3006F	CXR DOC REV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3008F	BODY MASS INDEX DOCD	PRXOVR	DEF					NA	NA	NA	N
3008F	BODY MASS INDEX DOCD	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3011F	LIPID PANEL DOC REV	PRXOVR	DEF					NA	NA	NA	N
3011F	LIPID PANEL DOC REV	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3014F	SCREEN MAMMO DOC REV	PRXOVR	DEF					NA	NA	NA	N
3014F	SCREEN MAMMO DOC REV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3015F	CERV CANCER SCREEN DOCD	PRXOVR	DEF					NA	NA	NA	N
3015F	CERV CANCER SCREEN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3016F	PT SCRND UNHLTHY OH USE	PRXOVR	DEF					NA	NA	NA	N
3016F	PT SCRND UNHLTHY OH USE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3017F	COLORECTAL CA SCREEN DOC REV	PRXOVR	DEF					NA	NA	NA	N
3017F	COLORECTAL CA SCREEN DOC REV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3018F	PRE-PRXD RSK ET AL DOCD	PRXOVR	DEF					NA	NA	NA	N
3018F	PRE-PRXD RSK ET AL DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3019F	LVEF ASSESS PLANPOST DSCHRGE	PRXOVR	DEF					NA	NA	NA	N
3019F	LVEF ASSESS PLANPOST DSCHRGE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3020F	LVF ASSESS	PRXOVR	DEF					NA	NA	NA	N
3020F	LVF ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3021F	LVEF MOD/SEVER DEPRS SYST	PRXOVR	DEF					NA	NA	NA	N
3021F	LVEF MOD/SEVER DEPRS SYST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3022F	LVEF >=40% SYSTOLIC	PRXOVR	DEF					NA	NA	NA	N
3022F	LVEF >=40% SYSTOLIC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3023F	SPIROM DOC REV	PRXOVR	DEF					NA	NA	NA	N
3023F	SPIROM DOC REV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3025F	SPIROM FEV/FVC <70% W/COPD	PRXOVR	DEF					NA	NA	NA	N
3025F	SPIROM FEV/FVC <70% W/COPD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3027F	SPIROM FEV/FVC>=70%/W/OCOPD	PRXOVR	DEF					NA	NA	NA	N
3027F	SPIROM FEV/FVC>=70%/W/OCOPD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3028F	O2 SATURATION DOC REV	PRXOVR	DEF					NA	NA	NA	N
3028F	O2 SATURATION DOC REV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3035F	O2 SATURATION<=88%/PAO<=55	PRXOVR	DEF					NA	NA	NA	N
3035F	O2 SATURATION<=88%/PAO<=55	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3037F	O2 SATURATION >88%/PAO>55 HG	PRXOVR	DEF					NA	NA	NA	N
3037F	O2 SATURATION >88%/PAO>55 HG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3038F	PULM FX W/IN 12 MON B/4 SURG	PRXOVR	DEF					NA	NA	NA	N
3038F	PULM FX W/IN 12 MON B/4 SURG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3040F	FEV <40% PREDICTED VALUE	PRXOVR	DEF					NA	NA	NA	N
3040F	FEV <40% PREDICTED VALUE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3042F	FEV >=40% PREDICTED VALUE	PRXOVR	DEF					NA	NA	NA	N
3042F	FEV >=40% PREDICTED VALUE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3044F	HG A1C LEVEL LT 7.0%	PRXOVR	DEF					NA	NA	NA	N
3044F	HG A1C LEVEL LT 7.0%	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3045F	HG A1C LEVEL 7.0-9.0%	PRXOVR	DEF					NA	NA	NA	N
3045F	HG A1C LEVEL 7.0-9.0%	MAXFEE	DEF					NA			N
3046F	HEMOGLOBIN A1C LEVEL >9.0%	PRXOVR	DEF					NA	NA	NA	N
3046F	HEMOGLOBIN A1C LEVEL >9.0%	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3047F	HEMOGLOBIN A1C LEVEL = 9.0%	PRXOVR	DEF					NA	NA	NA	N
3047F	HEMOGLOBIN A1C LEVEL = 9.0%	MAXFEE	DEF					NA			N
3048F	LDL-C <100 MG/DL	PRXOVR	DEF					NA	NA	NA	N
3048F	LDL-C <100 MG/DL	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3049F	LDL-C 100-129 MG/DL	PRXOVR	DEF					NA	NA	NA	N
3049F	LDL-C 100-129 MG/DL	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3050F	LDL-C >= 130 MG/DL	PRXOVR	DEF					NA	NA	NA	N
3050F	LDL-C >= 130 MG/DL	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3055F	LVEF LESS THAN/EQUAL TO 35%	PRXOVR	DEF					NA	NA	NA	N
3055F	LVEF LESS THAN/EQUAL TO 35%	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3056F	LVEF GREATER THAN 35%	PRXOVR	DEF					NA	NA	NA	N
3056F	LVEF GREATER THAN 35%	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3060F	POS MICROALBUMINURIA REV	PRXOVR	DEF					NA	NA	NA	N
3060F	POS MICROALBUMINURIA REV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3061F	NEG MICROALBUMINURIA REV	PRXOVR	DEF					NA	NA	NA	N
3061F	NEG MICROALBUMINURIA REV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3062F	POS MACROALBUMINURIA REV	PRXOVR	DEF					NA	NA	NA	N
3062F	POS MACROALBUMINURIA REV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3066F	NEPHROPATHY DOC TX	PRXOVR	DEF					NA	NA	NA	N
3066F	NEPHROPATHY DOC TX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3072F	LOW RISK FOR RETINOPATHY	PRXOVR	DEF					NA	NA	NA	N
3072F	LOW RISK FOR RETINOPATHY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3073F	PRE-SURG EYE MEASURES DOCD	PRXOVR	DEF					NA	NA	NA	N
3073F	PRE-SURG EYE MEASURES DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3074F	SYST BP LT 130 MM HG	PRXOVR	DEF					NA	NA	NA	N
3074F	SYST BP LT 130 MM HG	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3075F	SYST BP GE 130 - 139MM HG	PRXOVR	DEF					NA	NA	NA	N
3075F	SYST BP GE 130 - 139MM HG	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3076F	SYST BP < 140 MM HG	PRXOVR	DEF					NA	NA	NA	N
3076F	SYST BP < 140 MM HG	MAXFEE	DEF					NA			N
3077F	SYST BP >= 140 MM HG	PRXOVR	DEF					NA	NA	NA	N
3077F	SYST BP >= 140 MM HG	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3078F	DIAST BP <80 MM HG	PRXOVR	DEF					NA	NA	NA	N
3078F	DIAST BP <80 MM HG	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3079F	DIAST BP 80-89 MM HG	PRXOVR	DEF					NA	NA	NA	N
3079F	DIAST BP 80-89 MM HG	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3080F	DIAST BP >= 90 MM HG	PRXOVR	DEF					NA	NA	NA	N
3080F	DIAST BP >= 90 MM HG	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
3082F	KT/V <1.2	PRXOVR	DEF					NA	NA	NA	N
3082F	KT/V <1.2	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3083F	KT/V =/> 1.2 & <1.7	PRXOVR	DEF					NA	NA	NA	N
3083F	KT/V =/> 1.2 & <1.7	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3084F	KT/V >= 1.7	PRXOVR	DEF					NA	NA	NA	N
3084F	KT/V >= 1.7	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3085F	SUICIDE RISK ASSESSED	PRXOVR	DEF					NA	NA	NA	N
3085F	SUICIDE RISK ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3088F	MDD MILD	PRXOVR	DEF					NA	NA	NA	N
3088F	MDD MILD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3089F	MDD MODERATE	PRXOVR	DEF					NA	NA	NA	N
3089F	MDD MODERATE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3090F	MDD SEVERE W/O PSYCH	PRXOVR	DEF					NA	NA	NA	N
3090F	MDD SEVERE W/O PSYCH	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3091F	MDD SEVERE W/PSYCH	PRXOVR	DEF					NA	NA	NA	N
3091F	MDD SEVERE W/PSYCH	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3092F	MDD IN REMISSION	PRXOVR	DEF					NA	NA	NA	N
3092F	MDD IN REMISSION	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3093F	DOC NEW DIAG 1ST/ADDL MDD	PRXOVR	DEF					NA	NA	NA	N
3093F	DOC NEW DIAG 1ST/ADDL MDD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3095F	CENTRAL DEXA RESULTS DOCD	PRXOVR	DEF					NA	NA	NA	N
3095F	CENTRAL DEXA RESULTS DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3096F	CENTRAL DEXA ORDERED	PRXOVR	DEF					NA	NA	NA	N
3096F	CENTRAL DEXA ORDERED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3100F	IMAGE TEST REF CAROT DIAM	PRXOVR	DEF					NA	NA	NA	N
3100F	IMAGE TEST REF CAROT DIAM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3110F	PRES/ABSN HMRHG/LESION DOCD	PRXOVR	DEF					NA	NA	NA	N
3110F	PRES/ABSN HMRHG/LESION DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3111F	CT/MRI BRAIN DONE W/IN 24HRS	PRXOVR	DEF					NA	NA	NA	N
3111F	CT/MRI BRAIN DONE W/IN 24HRS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3112F	CT/MRI BRAIN DONE 24 HRS	PRXOVR	DEF					NA	NA	NA	N
3112F	CT/MRI BRAIN DONE 24 HRS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3115F	QUANT RESULTS ACTIVITY &SYMP	PRXOVR	DEF					NA	NA	NA	N
3115F	QUANT RESULTS ACTIVITY &SYMP	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3117F	HF ASSESSMENT TOOL COMPLETED	PRXOVR	DEF					NA	NA	NA	N
3117F	HF ASSESSMENT TOOL COMPLETED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3118F	NY HEART ASSOC CLASS DOCD	PRXOVR	DEF					NA	NA	NA	N
3118F	NY HEART ASSOC CLASS DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3119F	NO EVAL ACTIVITY CLIN SYMP	PRXOVR	DEF					NA	NA	NA	N
3119F	NO EVAL ACTIVITY CLIN SYMP	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3120F	12-LEAD ECG PERFORMED	PRXOVR	DEF					NA	NA	NA	N
3120F	12-LEAD ECG PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3125F	ESOPH BX RPRT W/DYSPL INFO	PRXOVR	DEF					NA	NA	NA	N
3125F	ESOPH BX RPRT W/DYSPL INFO	MAXFEE	DEF					NA			N
3126F	ESOPH BX RPRT W/DYSPL INFO	PRXOVR	DEF					NA	NA	NA	N
3126F	ESOPH BX RPRT W/DYSPL INFO	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3130F	UPPER GI ENDOSCOPY PERFORMED	PRXOVR	DEF					NA	NA	NA	N
3130F	UPPER GI ENDOSCOPY PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3132F	DOC REF UPPER GI ENDOSCOPY	PRXOVR	DEF					NA	NA	NA	N
3132F	DOC REF UPPER GI ENDOSCOPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3140F	UPPER GI ENDO SHOWS BARRTTS	PRXOVR	DEF					NA	NA	NA	N
3140F	UPPER GI ENDO SHOWS BARRTTS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3141F	UPPER GI ENDO NOT BARRTTS	PRXOVR	DEF					NA	NA	NA	N
3141F	UPPER GI ENDO NOT BARRTTS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3142F	BARIUM SWALLOW TEST ORDERED	PRXOVR	DEF					NA	NA	NA	N
3142F	BARIUM SWALLOW TEST ORDERED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3150F	FORCEPS ESOPH BIOPSY DONE	PRXOVR	DEF					NA	NA	NA	N
3150F	FORCEPS ESOPH BIOPSY DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3155F	CYTOGEN TEST MARROW B/4 TX	PRXOVR	DEF					NA	NA	NA	N
3155F	CYTOGEN TEST MARROW B/4 TX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3160F	DOC FE+ STORES B/4 EPO THX	PRXOVR	DEF					NA	NA	NA	N
3160F	DOC FE+ STORES B/4 EPO THX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3170F	BASELIN FLO CYTOMETRY B/4 TX	PRXOVR	DEF					NA	NA	NA	N
3170F	BASELIN FLO CYTOMETRY B/4 TX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3200F	BARIUM SWALLOW TEST NOT REQ	PRXOVR	DEF					NA	NA	NA	N
3200F	BARIUM SWALLOW TEST NOT REQ	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3210F	GRP A STREP TEST PERFORMED	PRXOVR	DEF					NA	NA	NA	N
3210F	GRP A STREP TEST PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3215F	PT IMMUNITY TO HEP A DOCD	PRXOVR	DEF					NA	NA	NA	N
3215F	PT IMMUNITY TO HEP A DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3216F	PT IMMUNITY TO HEP B DOCD	PRXOVR	DEF					NA	NA	NA	N
3216F	PT IMMUNITY TO HEP B DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3218F	RNA TSTNG HEP C DOCD DONE	PRXOVR	DEF					NA	NA	NA	N
3218F	RNA TSTNG HEP C DOCD DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3220F	HEP C QUANT RNA TSTNG DOCD	PRXOVR	DEF					NA	NA	NA	N
3220F	HEP C QUANT RNA TSTNG DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3230F	NOTE HRING TST W/IN 6 MON	PRXOVR	DEF					NA	NA	NA	N
3230F	NOTE HRING TST W/IN 6 MON	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3250F	NONPRIM LOC ANAT BX SITE TUM	PRXOVR	DEF					NA	NA	NA	N
3250F	NONPRIM LOC ANAT BX SITE TUM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3260F	PT CAT/PN CAT/HIST GRD DOCD	PRXOVR	DEF					NA	NA	NA	N
3260F	PT CAT/PN CAT/HIST GRD DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3265F	RNA TSTNG HEPC VIR ORD/DOCD	PRXOVR	DEF					NA	NA	NA	N
3265F	RNA TSTNG HEPC VIR ORD/DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3266F	HEPC GN TSTNG DOCD B/4TXMNT	PRXOVR	DEF					NA	NA	NA	N
3266F	HEPC GN TSTNG DOCD B/4TXMNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3267F	PATH RPRT W/ PT PN CAT ET AL	PRXOVR	DEF					NA	NA	NA	N
3267F	PATH RPRT W/ PT PN CAT ET AL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3268F	PSA/T/GLSC DOCD B/4 TXMNT	PRXOVR	DEF					NA	NA	NA	N
3268F	PSA/T/GLSC DOCD B/4 TXMNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3269F	BONE SCN B/4 TXMNT/AFTR DX	PRXOVR	DEF					NA	NA	NA	N
3269F	BONE SCN B/4 TXMNT/AFTR DX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3270F	NO BONE SCN B/4 TXMNT/AFTRDX	PRXOVR	DEF					NA	NA	NA	N
3270F	NO BONE SCN B/4 TXMNT/AFTRDX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3271F	LOW RISK PROSTATE CANCER	PRXOVR	DEF					NA	NA	NA	N
3271F	LOW RISK PROSTATE CANCER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3272F	MED RISK PROSTATE CANCER	PRXOVR	DEF					NA	NA	NA	N
3272F	MED RISK PROSTATE CANCER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3273F	HIGH RISK PROSTATE CANCER	PRXOVR	DEF					NA	NA	NA	N
3273F	HIGH RISK PROSTATE CANCER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3274F	PROST CNCR RSK NOT LW/MD/HGH	PRXOVR	DEF					NA	NA	NA	N
3274F	PROST CNCR RSK NOT LW/MD/HGH	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3278F	SERUM LVLS CA/IPTH/LPD ORD	PRXOVR	DEF					NA	NA	NA	N
3278F	SERUM LVLS CA/IPTH/LPD ORD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3279F	HGB LVL >= 13 G/DL	PRXOVR	DEF					NA	NA	NA	N
3279F	HGB LVL >= 13 G/DL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3280F	HGB LVL 11-12.9 G/DL	PRXOVR	DEF					NA	NA	NA	N
3280F	HGB LVL 11-12.9 G/DL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3281F	HGB LVL <11 G/DL	PRXOVR	DEF					NA	NA	NA	N
3281F	HGB LVL <11 G/DL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3284F	IOP DOWN >15% OF PRE-SVC LVL	PRXOVR	DEF					NA	NA	NA	N
3284F	IOP DOWN >15% OF PRE-SVC LVL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3285F	IOP DOWN <15% OF PRE-SVC LVL	PRXOVR	DEF					NA	NA	NA	N
3285F	IOP DOWN <15% OF PRE-SVC LVL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3288F	FALL RISK ASSESSMENT DOCD	PRXOVR	DEF					NA	NA	NA	N
3288F	FALL RISK ASSESSMENT DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3290F	PT=D(RH)- AND UNSENSITIZED	PRXOVR	DEF					NA	NA	NA	N
3290F	PT=D(RH)- AND UNSENSITIZED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3291F	PT=D(RH)+ OR SENSITIZED	PRXOVR	DEF					NA	NA	NA	N
3291F	PT=D(RH)+ OR SENSITIZED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3292F	HIV TSTNG ASKED/DOCD/REVWD	PRXOVR	DEF					NA	NA	NA	N
3292F	HIV TSTNG ASKED/DOCD/REVWD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3293F	ABO RH BLOOD TYPING DOCD	PRXOVR	DEF					NA	NA	NA	N
3293F	ABO RH BLOOD TYPING DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3294F	GRP B STREP SCREENING DOCD	PRXOVR	DEF					NA	NA	NA	N
3294F	GRP B STREP SCREENING DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3300F	AJCC STAGE DOCD B/4 THXPY	PRXOVR	DEF					NA	NA	NA	N
3300F	AJCC STAGE DOCD B/4 THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3301F	CANCER STAGE DOCD METAST	PRXOVR	DEF					NA	NA	NA	N
3301F	CANCER STAGE DOCD METAST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3302F	AJCC STAGE 0 DOC'D	PRXOVR	DEF					NA	NA	NA	N
3302F	AJCC STAGE 0 DOC'D	MAXFEE	DEF					NA			N
3303F	AJCC STAGE IA DOC'D	PRXOVR	DEF					NA	NA	NA	N
3303F	AJCC STAGE IA DOC'D	MAXFEE	DEF					NA			N
3304F	AJCC STAGE IB DOC'D	PRXOVR	DEF					NA	NA	NA	N
3304F	AJCC STAGE IB DOC'D	MAXFEE	DEF					NA			N
3305F	AJCC STAGE IC DOC'D	PRXOVR	DEF					NA	NA	NA	N
3305F	AJCC STAGE IC DOC'D	MAXFEE	DEF					NA			N
3306F	AJCC STAGE IIA DOC'D	PRXOVR	DEF					NA	NA	NA	N
3306F	AJCC STAGE IIA DOC'D	MAXFEE	DEF					NA			N
3307F	AJCC STAGE IIB DOC'D	PRXOVR	DEF					NA	NA	NA	N
3307F	AJCC STAGE IIB DOC'D	MAXFEE	DEF					NA			N
3308F	AJCC STAGE IIC DOC'D	PRXOVR	DEF					NA	NA	NA	N
3308F	AJCC STAGE IIC DOC'D	MAXFEE	DEF					NA			N
3309F	AJCC STAGE IIIA DOC'D	PRXOVR	DEF					NA	NA	NA	N
3309F	AJCC STAGE IIIA DOC'D	MAXFEE	DEF					NA			N
3310F	AJCC STAGE IIIB DOC'D	PRXOVR	DEF					NA	NA	NA	N
3310F	AJCC STAGE IIIB DOC'D	MAXFEE	DEF					NA			N
3311F	AJCC STAGE IIIC DOC'D	PRXOVR	DEF					NA	NA	NA	N
3311F	AJCC STAGE IIIC DOC'D	MAXFEE	DEF					NA			N
3312F	AJCC STAGE IVA DOC'D	PRXOVR	DEF					NA	NA	NA	N
3312F	AJCC STAGE IVA DOC'D	MAXFEE	DEF					NA			N
3313F	AJCC STAGE IVB DOC'D	PRXOVR	DEF					NA	NA	NA	N
3313F	AJCC STAGE IVB DOC'D	MAXFEE	DEF					NA			N
3314F	AJCC STAGE IVC DOC'D	PRXOVR	DEF					NA	NA	NA	N
3314F	AJCC STAGE IVC DOC'D	MAXFEE	DEF					NA			N
3315F	ER+ OR PR+ BREAST CANCER	PRXOVR	DEF					NA	NA	NA	N
3315F	ER+ OR PR+ BREAST CANCER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3316F	ER- OR PR- BREAST CANCER	PRXOVR	DEF					NA	NA	NA	N
3316F	ER- OR PR- BREAST CANCER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3317F	PATH RPT MALIG CANCER DOCD	PRXOVR	DEF					NA	NA	NA	N
3317F	PATH RPT MALIG CANCER DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3318F	PATH RPT MALIG CANCER DOCD	PRXOVR	DEF					NA	NA	NA	N
3318F	PATH RPT MALIG CANCER DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3319F	X-RAY/CT/ULTRSND ET AL ORD	PRXOVR	DEF					NA	NA	NA	N
3319F	X-RAY/CT/ULTRSND ET AL ORD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3320F	NO XRAY/CT/ ET AL ORDD	PRXOVR	DEF					NA	NA	NA	N
3320F	NO XRAY/CT/ ET AL ORDD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3321F	AJCC CNCR 0/IA MELAN DOCD	PRXOVR	DEF					NA	NA	NA	N
3321F	AJCC CNCR 0/IA MELAN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3322F	MELANOMAAJCC STAGE 0 OR IA	PRXOVR	DEF					NA	NA	NA	N
3322F	MELANOMAAJCC STAGE 0 OR IA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3323F	CLIN NODE STGNG DOCDB/4 SURG	PRXOVR	DEF					NA	NA	NA	N
3323F	CLIN NODE STGNG DOCDB/4 SURG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3324F	MRI CT SCAN ORD RVWD RQSTD	PRXOVR	DEF					NA	NA	NA	N
3324F	MRI CT SCAN ORD RVWD RQSTD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3325F	PREOP ASSES 4 CATARACT SURG	PRXOVR	DEF					NA	NA	NA	N
3325F	PREOP ASSES 4 CATARACT SURG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3328F	PRFRMNC DOCD 2 WKS B/4 SURG	PRXOVR	DEF					NA	NA	NA	N
3328F	PRFRMNC DOCD 2 WKS B/4 SURG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3330F	IMAGING STUDY ORDERED (BKP)	PRXOVR	DEF					NA	NA	NA	N
3330F	IMAGING STUDY ORDERED (BKP)	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3331F	BK IMAGING TST NOT ORDERED	PRXOVR	DEF					NA	NA	NA	N
3331F	BK IMAGING TST NOT ORDERED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3340F	MAMMO ASSESS INC XRAY DOCD	PRXOVR	DEF					NA	NA	NA	N
3340F	MAMMO ASSESS INC XRAY DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3341F	MAMMO ASSESS NEGATIVE DOCD	PRXOVR	DEF					NA	NA	NA	N
3341F	MAMMO ASSESS NEGATIVE DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3342F	MAMMO ASSESS BENGN DOCD	PRXOVR	DEF					NA	NA	NA	N
3342F	MAMMO ASSESS BENGN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3343F	MAMMO PROBABLY BENGN DOCD	PRXOVR	DEF					NA	NA	NA	N
3343F	MAMMO PROBABLY BENGN DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3344F	MAMMO ASSESS SUSP DOCD	PRXOVR	DEF					NA	NA	NA	N
3344F	MAMMO ASSESS SUSP DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3345F	MAMMO ASSESS HGHLYMALIG DOC	PRXOVR	DEF					NA	NA	NA	N
3345F	MAMMO ASSESS HGHLYMALIG DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3350F	MAMMO BX PROVEN MALIG DOCD	PRXOVR	DEF					NA	NA	NA	N
3350F	MAMMO BX PROVEN MALIG DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3351F	NEG SCRN DEP SYMP BY DEPTOOL	PRXOVR	DEF					NA	NA	NA	N
3351F	NEG SCRN DEP SYMP BY DEPTOOL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3352F	NO SIG DEP SYMP BY DEP TOOL	PRXOVR	DEF					NA	NA	NA	N
3352F	NO SIG DEP SYMP BY DEP TOOL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3353F	MILD-MOD DEP SYMP BY DEPTOOL	PRXOVR	DEF					NA	NA	NA	N
3353F	MILD-MOD DEP SYMP BY DEPTOOL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3354F	CLIN SIG DEP SYM BY DEP TOOL	PRXOVR	DEF					NA	NA	NA	N
3354F	CLIN SIG DEP SYM BY DEP TOOL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3370F	AJCC BRST CNCR STAGE 0 DOCD	PRXOVR	DEF					NA	NA	NA	N
3370F	AJCC BRST CNCR STAGE 0 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3372F	AJCC BRST CNCR STAGE 1 DOCD	PRXOVR	DEF					NA	NA	NA	N
3372F	AJCC BRST CNCR STAGE 1 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3374F	AJCC BRST CNCR STAGE 1 DOCD	PRXOVR	DEF					NA	NA	NA	N
3374F	AJCC BRST CNCR STAGE 1 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3376F	AJCC BRSTCNCR STAGE 2 DOCD	PRXOVR	DEF					NA	NA	NA	N
3376F	AJCC BRSTCNCR STAGE 2 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3378F	AJCC BRSTCNCR STAGE 3 DOCD	PRXOVR	DEF					NA	NA	NA	N
3378F	AJCC BRSTCNCR STAGE 3 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3380F	AJCC BRSTCNCR STAGE 4 DOCD	PRXOVR	DEF					NA	NA	NA	N
3380F	AJCC BRSTCNCR STAGE 4 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3382F	AJCC CLN CNCR STAGE 0 DOCD	PRXOVR	DEF					NA	NA	NA	N
3382F	AJCC CLN CNCR STAGE 0 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3384F	AJCC CLN CNCR STAGE 1 DOCD	PRXOVR	DEF					NA	NA	NA	N
3384F	AJCC CLN CNCR STAGE 1 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3386F	AJCC CLN CNCR STAGE 2 DOCD	PRXOVR	DEF					NA	NA	NA	N
3386F	AJCC CLN CNCR STAGE 2 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3388F	AJCC CLN CNCR STAGE 3 DOCD	PRXOVR	DEF					NA	NA	NA	N
3388F	AJCC CLN CNCR STAGE 3 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3390F	AJCC CLN CNCR STAGE 4 DOCD	PRXOVR	DEF					NA	NA	NA	N
3390F	AJCC CLN CNCR STAGE 4 DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3394F	QUANT HER2 IHC EVAL BRST CX	PRXOVR	DEF					NA	NA	NA	N
3394F	QUANT HER2 IHC EVAL BRST CX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3395F	QUANT NONHER2 IHC BRST CX	PRXOVR	DEF					NA	NA	NA	N
3395F	QUANT NONHER2 IHC BRST CX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3450F	DYSPNEA SCRND NO-MILD DYSP	PRXOVR	DEF					NA	NA	NA	N
3450F	DYSPNEA SCRND NO-MILD DYSP	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3451F	DYSPNEA SCRND MOD-HIGH DYSP	PRXOVR	DEF					NA	NA	NA	N
3451F	DYSPNEA SCRND MOD-HIGH DYSP	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3452F	DYSPNEA NOT SCREENED	PRXOVR	DEF					NA	NA	NA	N
3452F	DYSPNEA NOT SCREENED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3455F	TB SCRNG DONE-INTERPD 6MON	PRXOVR	DEF					NA	NA	NA	N
3455F	TB SCRNG DONE-INTERPD 6MON	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3470F	RA DISEASE ACTIVITY LOW	PRXOVR	DEF					NA	NA	NA	N
3470F	RA DISEASE ACTIVITY LOW	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3471F	RA DISEASE ACTIVITY MOD	PRXOVR	DEF					NA	NA	NA	N
3471F	RA DISEASE ACTIVITY MOD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3472F	RA DISEASE ACTIVITY HIGH	PRXOVR	DEF					NA	NA	NA	N
3472F	RA DISEASE ACTIVITY HIGH	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3475F	DISEASE PROGN RA POOR DOCD	PRXOVR	DEF					NA	NA	NA	N
3475F	DISEASE PROGN RA POOR DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3476F	DISEASE PROGN RA GOOD DOCD	PRXOVR	DEF					NA	NA	NA	N
3476F	DISEASE PROGN RA GOOD DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3490F	HISTORY AIDS-DEFINING COND	PRXOVR	DEF					NA	NA	NA	N
3490F	HISTORY AIDS-DEFINING COND	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3491F	HIV UNSURE BABY OF HIV+MOMS	PRXOVR	DEF					NA	NA	NA	N
3491F	HIV UNSURE BABY OF HIV+MOMS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3492F	HISTORY CD4+ CELL COUNT <350	PRXOVR	DEF					NA	NA	NA	N
3492F	HISTORY CD4+ CELL COUNT <350	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3493F	NO HIST CD4+ CELL COUNT <350	PRXOVR	DEF					NA	NA	NA	N
3493F	NO HIST CD4+ CELL COUNT <350	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3494F	CD4+CELL COUNT <200CELLS/MM3	PRXOVR	DEF					NA	NA	NA	N
3494F	CD4+CELL COUNT <200CELLS/MM3	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3495F	CD4+CELL CNT 200-499 CELLS	PRXOVR	DEF					NA	NA	NA	N
3495F	CD4+CELL CNT 200-499 CELLS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3496F	CD4+ CELL COUNT >= 500 CELLS	PRXOVR	DEF					NA	NA	NA	N
3496F	CD4+ CELL COUNT >= 500 CELLS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3497F	CD4+ CELL PERCENTAGE <15%	PRXOVR	DEF					NA	NA	NA	N
3497F	CD4+ CELL PERCENTAGE <15%	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3498F	CD4+ CELL >=15% (HIV)	PRXOVR	DEF					NA	NA	NA	N
3498F	CD4+ CELL >=15% (HIV)	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3500F	CD4+CELL CNT/% DOCD AS DONE	PRXOVR	DEF					NA	NA	NA	N
3500F	CD4+CELL CNT/% DOCD AS DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3502F	HIV RNA VRL LD <LMTS QUANTIF	PRXOVR	DEF					NA	NA	NA	N
3502F	HIV RNA VRL LD <LMTS QUANTIF	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3503F	HIV RNA VRL LDNOT<LMTS QUNTF	PRXOVR	DEF					NA	NA	NA	N
3503F	HIV RNA VRL LDNOT<LMTS QUNTF	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3510F	DOC TB SCRNG-RSLTS INTERPD	PRXOVR	DEF					NA	NA	NA	N
3510F	DOC TB SCRNG-RSLTS INTERPD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3511F	CHLMYD/GONRH TSTS DOCD DONE	PRXOVR	DEF					NA	NA	NA	N
3511F	CHLMYD/GONRH TSTS DOCD DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3512F	SYPH SCRNG DOCD AS DONE	PRXOVR	DEF					NA	NA	NA	N
3512F	SYPH SCRNG DOCD AS DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3513F	HEP B SCRNG DOCD AS DONE	PRXOVR	DEF					NA	NA	NA	N
3513F	HEP B SCRNG DOCD AS DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3514F	HEP C SCRNG DOCD AS DONE	PRXOVR	DEF					NA	NA	NA	N
3514F	HEP C SCRNG DOCD AS DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3515F	PT HAS DOCD IMMUN TO HEP C	PRXOVR	DEF					NA	NA	NA	N
3515F	PT HAS DOCD IMMUN TO HEP C	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3517F	HBV ASSESS&RESULTS INTRP 1YR	PRXOVR	DEF					NA	NA	NA	N
3517F	HBV ASSESS&RESULTS INTRP 1YR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3520F	CDIFFICILE TESTING PERFORMED	PRXOVR	DEF					NA	NA	NA	N
3520F	CDIFFICILE TESTING PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3550F	LOW RSK THROMBOEMBOLISM	PRXOVR	DEF					NA	NA	NA	N
3550F	LOW RSK THROMBOEMBOLISM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3551F	INTRMED RSK THROMBOEMBOLISM	PRXOVR	DEF					NA	NA	NA	N
3551F	INTRMED RSK THROMBOEMBOLISM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3552F	HGH RISK FOR THROMBOEMBOLISM	PRXOVR	DEF					NA	NA	NA	N
3552F	HGH RISK FOR THROMBOEMBOLISM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3555F	PT INR MEASUREMENT PERFORMED	PRXOVR	DEF					NA	NA	NA	N
3555F	PT INR MEASUREMENT PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3570F	RPRT BONE SCINT XREF W XRAY	PRXOVR	DEF					NA	NA	NA	N
3570F	RPRT BONE SCINT XREF W XRAY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3572F	PT CONSID POSS RISK FX	PRXOVR	DEF					NA	NA	NA	N
3572F	PT CONSID POSS RISK FX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3573F	PT NOT CONSID POSS RISK FX	PRXOVR	DEF					NA	NA	NA	N
3573F	PT NOT CONSID POSS RISK FX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
36415	ROUTINE VENIPUNCTURE	PRXOVR	DEF					NA	NA	NA	N
36415	ROUTINE VENIPUNCTURE	MAXFEE	DEF					2.25	1/1/2018	12/31/2299	N
3650F	EEG ORDERED RVWD REQSTD	PRXOVR	DEF					NA	NA	NA	N
3650F	EEG ORDERED RVWD REQSTD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3700F	PSYCH DISORDERS ASSESSED	PRXOVR	DEF					NA	NA	NA	N
3700F	PSYCH DISORDERS ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3720F	COGNIT IMPAIRMENT ASSESSED	PRXOVR	DEF					NA	NA	NA	N
3720F	COGNIT IMPAIRMENT ASSESSED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3725F	SCREEN DEPRESSION PERFORMED	PRXOVR	DEF					NA	NA	NA	N
3725F	SCREEN DEPRESSION PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3750F	PTNOTRCVNGSTEROID>=10MG/DAY	PRXOVR	DEF					NA	NA	NA	N
3750F	PTNOTRCVNGSTEROID>=10MG/DAY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3751F	ELECTRODIAG POLYNEURO 6 MN	PRXOVR	DEF					NA	NA	NA	N
3751F	ELECTRODIAG POLYNEURO 6 MN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3752F	NO ELECTRODIAG POLYNEURO 6MN	PRXOVR	DEF					NA	NA	NA	N
3752F	NO ELECTRODIAG POLYNEURO 6MN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3753F	PT HAS SYMP&SIGNS NEUROPATHY	PRXOVR	DEF					NA	NA	NA	N
3753F	PT HAS SYMP&SIGNS NEUROPATHY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3754F	SCREENING TESTS DM DONE	PRXOVR	DEF					NA	NA	NA	N
3754F	SCREENING TESTS DM DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3755F	COG&BEHAV IMPRMNT SCRNG DONE	PRXOVR	DEF					NA	NA	NA	N
3755F	COG&BEHAV IMPRMNT SCRNG DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3756F	PT W/PSEUDOBULB AFFECT/ALS	PRXOVR	DEF					NA	NA	NA	N
3756F	PT W/PSEUDOBULB AFFECT/ALS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3757F	PT W/O PSEUDOBULBAFFECT/ALS	PRXOVR	DEF					NA	NA	NA	N
3757F	PT W/O PSEUDOBULBAFFECT/ALS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3758F	PT REF PULM FX TEST/PEAKFLOW	PRXOVR	DEF					NA	NA	NA	N
3758F	PT REF PULM FX TEST/PEAKFLOW	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3759F	PT SCRN DYSPHAG/WT LOSS/NUTR	PRXOVR	DEF					NA	NA	NA	N
3759F	PT SCRN DYSPHAG/WT LOSS/NUTR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3760F	PT W/DYSPHAG/WT LOSS/NUTR	PRXOVR	DEF					NA	NA	NA	N
3760F	PT W/DYSPHAG/WT LOSS/NUTR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3761F	PT W/O DYSPHAG/WT LOSS/NUTR	PRXOVR	DEF					NA	NA	NA	N
3761F	PT W/O DYSPHAG/WT LOSS/NUTR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3762F	PATIENT IS DYSARTHRIC	PRXOVR	DEF					NA	NA	NA	N
3762F	PATIENT IS DYSARTHRIC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3763F	PATIENT IS NOT DYSARTHRIC	PRXOVR	DEF					NA	NA	NA	N
3763F	PATIENT IS NOT DYSARTHRIC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3775F	ADENOMA DETECTED SCREENING	PRXOVR	DEF					NA	NA	NA	N
3775F	ADENOMA DETECTED SCREENING	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
3776F	ADENOMA NOT DETECT SCREENING	PRXOVR	DEF					NA	NA	NA	N
3776F	ADENOMA NOT DETECT SCREENING	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4000F	TOBACCO USE TXMNT COUNSELING	PRXOVR	DEF					NA	NA	NA	N
4000F	TOBACCO USE TXMNT COUNSELING	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
4001F	TOBACCO USE TXMNT PHARMACOL	PRXOVR	DEF					NA	NA	NA	N
4001F	TOBACCO USE TXMNT PHARMACOL	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
4002F	STATIN THERAPY RX	PRXOVR	DEF					NA	NA	NA	N
4002F	STATIN THERAPY RX	MAXFEE	DEF					NA			N
4003F	PT ED WRITE/ORAL PTS W/ HF	PRXOVR	DEF					NA	NA	NA	N
4003F	PT ED WRITE/ORAL PTS W/ HF	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4004F	PT TOBACCO SCREEN RCVD TLK	PRXOVR	DEF					NA	NA	NA	N
4004F	PT TOBACCO SCREEN RCVD TLK	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
4005F	PHARM THX FOR OP RXD	PRXOVR	DEF					NA	NA	NA	N
4005F	PHARM THX FOR OP RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4006F	BETA-BLOCKER THERAPY RX	PRXOVR	DEF					NA	NA	NA	N
4006F	BETA-BLOCKER THERAPY RX	MAXFEE	DEF					NA			N
4007F	AREDS/ANITOX VIT/MIN RX'D	PRXOVR	DEF					NA	NA	NA	N
4007F	AREDS/ANITOX VIT/MIN RX'D	MAXFEE	DEF					NA			N
4008F	BETA-BLOCKER THERAPY RXD/TKN	PRXOVR	DEF					NA	NA	NA	N
4008F	BETA-BLOCKER THERAPY RXD/TKN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4009F	ACE/ARB INHIBITOR THERAPY RX	PRXOVR	DEF					NA	NA	NA	N
4009F	ACE/ARB INHIBITOR THERAPY RX	MAXFEE	DEF					NA			N
4010F	ACE/ARB THERAPY RXD/TAKEN	PRXOVR	DEF					NA	NA	NA	N
4010F	ACE/ARB THERAPY RXD/TAKEN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4011F	ORAL ANTIPLATELET THERAPY RX	PRXOVR	DEF					NA	NA	NA	N
4011F	ORAL ANTIPLATELET THERAPY RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4012F	WARFARIN THERAPY RX	PRXOVR	DEF					NA	NA	NA	N
4012F	WARFARIN THERAPY RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4013F	STATIN THERAPY/CURRENTLY TKN	PRXOVR	DEF					NA	NA	NA	N
4013F	STATIN THERAPY/CURRENTLY TKN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4014F	WRITTEN DISCHARGE INSTR PRVD	PRXOVR	DEF					NA	NA	NA	N
4014F	WRITTEN DISCHARGE INSTR PRVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4015F	PERSIST ASTHMA MEDICINE CTRL	PRXOVR	DEF					NA	NA	NA	N
4015F	PERSIST ASTHMA MEDICINE CTRL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4016F	ANTI-INFLM/ANLGSC AGENT RX	PRXOVR	DEF					NA	NA	NA	N
4016F	ANTI-INFLM/ANLGSC AGENT RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4017F	GI PROPHYLAXIS FOR NSAID RX	PRXOVR	DEF					NA	NA	NA	N
4017F	GI PROPHYLAXIS FOR NSAID RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4018F	THERAPY EXERCISE JOINT RX	PRXOVR	DEF					NA	NA	NA	N
4018F	THERAPY EXERCISE JOINT RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4019F	DOC RECPT COUNSL VIT D/CALC+	PRXOVR	DEF					NA	NA	NA	N
4019F	DOC RECPT COUNSL VIT D/CALC+	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4025F	INHALED BRONCHODILATOR RX	PRXOVR	DEF					NA	NA	NA	N
4025F	INHALED BRONCHODILATOR RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4030F	OXYGEN THERAPY RX	PRXOVR	DEF					NA	NA	NA	N
4030F	OXYGEN THERAPY RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4033F	PULMONARY REHAB REC	PRXOVR	DEF					NA	NA	NA	N
4033F	PULMONARY REHAB REC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4035F	INFLUENZA IMM REC	PRXOVR	DEF					NA	NA	NA	N
4035F	INFLUENZA IMM REC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4037F	INFLUENZA IMM ORDER/ADMIN	PRXOVR	DEF					NA	NA	NA	N
4037F	INFLUENZA IMM ORDER/ADMIN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4040F	PNEUMOC VAC/ADMIN/RCVD	PRXOVR	DEF					NA	NA	NA	N
4040F	PNEUMOC VAC/ADMIN/RCVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4041F	DOC ORDER CEFAZOLIN/CEFUROX	PRXOVR	DEF					NA	NA	NA	N
4041F	DOC ORDER CEFAZOLIN/CEFUROX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4042F	DOC ANTIBIO NOT GIVEN	PRXOVR	DEF					NA	NA	NA	N
4042F	DOC ANTIBIO NOT GIVEN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4043F	DOC ORDER GIVEN STOP ANTIBIO	PRXOVR	DEF					NA	NA	NA	N
4043F	DOC ORDER GIVEN STOP ANTIBIO	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4044F	DOC ORDER GIVEN VTE PROPHYLX	PRXOVR	DEF					NA	NA	NA	N
4044F	DOC ORDER GIVEN VTE PROPHYLX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4045F	EMPIRIC ANTIBIOTIC RX	PRXOVR	DEF					NA	NA	NA	N
4045F	EMPIRIC ANTIBIOTIC RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4046F	DOC ANTIBIO GIVEN B/4 SURG	PRXOVR	DEF					NA	NA	NA	N
4046F	DOC ANTIBIO GIVEN B/4 SURG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4047F	DOC ANTIBIO GIVEN B/4 SURG	PRXOVR	DEF					NA	NA	NA	N
4047F	DOC ANTIBIO GIVEN B/4 SURG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4048F	DOC ANTIBIO GIVEN B/4 SURG	PRXOVR	DEF					NA	NA	NA	N
4048F	DOC ANTIBIO GIVEN B/4 SURG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4049F	DOC ORDER GIVEN STOP ANTIBIO	PRXOVR	DEF					NA	NA	NA	N
4049F	DOC ORDER GIVEN STOP ANTIBIO	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4050F	HT CARE PLAN DOC	PRXOVR	DEF					NA	NA	NA	N
4050F	HT CARE PLAN DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4051F	REFERRED FOR AN AV FISTULA	PRXOVR	DEF					NA	NA	NA	N
4051F	REFERRED FOR AN AV FISTULA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4052F	HEMODIALYSIS VIA AV FISTULA	PRXOVR	DEF					NA	NA	NA	N
4052F	HEMODIALYSIS VIA AV FISTULA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4053F	HEMODIALYSIS VIA AV GRAFT	PRXOVR	DEF					NA	NA	NA	N
4053F	HEMODIALYSIS VIA AV GRAFT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4054F	HEMODIALYSIS VIA CATHETER	PRXOVR	DEF					NA	NA	NA	N
4054F	HEMODIALYSIS VIA CATHETER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4055F	PT RCVNG PERITON DIALYSIS	PRXOVR	DEF					NA	NA	NA	N
4055F	PT RCVNG PERITON DIALYSIS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4056F	APPROP ORAL REHYD RECOMMD	PRXOVR	DEF					NA	NA	NA	N
4056F	APPROP ORAL REHYD RECOMMD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4058F	PED GASTRO ED GIVEN CAREGVR	PRXOVR	DEF					NA	NA	NA	N
4058F	PED GASTRO ED GIVEN CAREGVR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4060F	PSYCH SVCS PROVIDED	PRXOVR	DEF					NA	NA	NA	N
4060F	PSYCH SVCS PROVIDED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4062F	PT REFERRAL PSYCH DOCD	PRXOVR	DEF					NA	NA	NA	N
4062F	PT REFERRAL PSYCH DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4063F	ANTIDEPRES RXTHXPY NOT RXD	PRXOVR	DEF					NA	NA	NA	N
4063F	ANTIDEPRES RXTHXPY NOT RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4064F	ANTIDEPRESSANT RX	PRXOVR	DEF					NA	NA	NA	N
4064F	ANTIDEPRESSANT RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4065F	ANTIPSYCHOTIC RX	PRXOVR	DEF					NA	NA	NA	N
4065F	ANTIPSYCHOTIC RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4066F	ECT PROVIDED	PRXOVR	DEF					NA	NA	NA	N
4066F	ECT PROVIDED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4067F	PT REFERRAL FOR ECT DOCD	PRXOVR	DEF					NA	NA	NA	N
4067F	PT REFERRAL FOR ECT DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4069F	VTE PROPHYLAXIS RCVD	PRXOVR	DEF					NA	NA	NA	N
4069F	VTE PROPHYLAXIS RCVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4070F	DVT PROPHYLX RECVD DAY 2	PRXOVR	DEF					NA	NA	NA	N
4070F	DVT PROPHYLX RECVD DAY 2	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4073F	ORAL ANTIPLAT THX RX DISCHRG	PRXOVR	DEF					NA	NA	NA	N
4073F	ORAL ANTIPLAT THX RX DISCHRG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4075F	ANTICOAG THX RX AT DISCHRG	PRXOVR	DEF					NA	NA	NA	N
4075F	ANTICOAG THX RX AT DISCHRG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4077F	DOC T-PA ADMIN CONSIDERED	PRXOVR	DEF					NA	NA	NA	N
4077F	DOC T-PA ADMIN CONSIDERED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4079F	DOC REHAB SVCS CONSIDERED	PRXOVR	DEF					NA	NA	NA	N
4079F	DOC REHAB SVCS CONSIDERED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4084F	ASPIRIN RECVD W/IN 24 HRS	PRXOVR	DEF					NA	NA	NA	N
4084F	ASPIRIN RECVD W/IN 24 HRS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4086F	ASPIRIN/CLOPIDOGREL RXD	PRXOVR	DEF					NA	NA	NA	N
4086F	ASPIRIN/CLOPIDOGREL RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4090F	PT RCVNG EPO THXPY	PRXOVR	DEF					NA	NA	NA	N
4090F	PT RCVNG EPO THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4095F	PT NOT RCVNG EPO THXPY	PRXOVR	DEF					NA	NA	NA	N
4095F	PT NOT RCVNG EPO THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4100F	BIPHOS THXPY VEIN ORD/RECVD	PRXOVR	DEF					NA	NA	NA	N
4100F	BIPHOS THXPY VEIN ORD/RECVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4110F	INT MAM ART USED FOR CABG	PRXOVR	DEF					NA	NA	NA	N
4110F	INT MAM ART USED FOR CABG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4115F	BETA BLCKR ADMIN W/IN 24 HRS	PRXOVR	DEF					NA	NA	NA	N
4115F	BETA BLCKR ADMIN W/IN 24 HRS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4120F	ANTIBIOT RXD/GIVEN	PRXOVR	DEF					NA	NA	NA	N
4120F	ANTIBIOT RXD/GIVEN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4124F	ANTIBIOT NOT RXD/GIVEN	PRXOVR	DEF					NA	NA	NA	N
4124F	ANTIBIOT NOT RXD/GIVEN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4130F	TOPICAL PREP RX AOE	PRXOVR	DEF					NA	NA	NA	N
4130F	TOPICAL PREP RX AOE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4131F	SYST ANTIMICROBIAL THX RX	PRXOVR	DEF					NA	NA	NA	N
4131F	SYST ANTIMICROBIAL THX RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4132F	NO SYST ANTIMICROBIAL THX RX	PRXOVR	DEF					NA	NA	NA	N
4132F	NO SYST ANTIMICROBIAL THX RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4133F	ANTIHIST/DECONG RX/RECOM	PRXOVR	DEF					NA	NA	NA	N
4133F	ANTIHIST/DECONG RX/RECOM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4134F	NO ANTIHIST/DECONG RX/RECOM	PRXOVR	DEF					NA	NA	NA	N
4134F	NO ANTIHIST/DECONG RX/RECOM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4135F	SYSTEMIC CORTICOSTEROIDS RX	PRXOVR	DEF					NA	NA	NA	N
4135F	SYSTEMIC CORTICOSTEROIDS RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4136F	SYST CORTICOSTEROIDS NOT RX	PRXOVR	DEF					NA	NA	NA	N
4136F	SYST CORTICOSTEROIDS NOT RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4140F	INHALED CORTICOSTEROIDS RXD	PRXOVR	DEF					NA	NA	NA	N
4140F	INHALED CORTICOSTEROIDS RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4142F	CORTICOSTER SPARNG THRPY RXD	PRXOVR	DEF					NA	NA	NA	N
4142F	CORTICOSTER SPARNG THRPY RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4144F	ALT LONG-TERM CNTRL MED RXD	PRXOVR	DEF					NA	NA	NA	N
4144F	ALT LONG-TERM CNTRL MED RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4145F	2+ ANTI-HYPRTNSV AGENTS TKN	PRXOVR	DEF					NA	NA	NA	N
4145F	2+ ANTI-HYPRTNSV AGENTS TKN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4148F	HEP A VAC INJXN ADMIN/RECVD	PRXOVR	DEF					NA	NA	NA	N
4148F	HEP A VAC INJXN ADMIN/RECVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4149F	HEP B VAC INJXN ADMIN/RECVD	PRXOVR	DEF					NA	NA	NA	N
4149F	HEP B VAC INJXN ADMIN/RECVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4150F	PT RECVNG ANTIVIR TXMNT HEPC	PRXOVR	DEF					NA	NA	NA	N
4150F	PT RECVNG ANTIVIR TXMNT HEPC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4151F	PT NOT RECVNG ANTIV HEP C	PRXOVR	DEF					NA	NA	NA	N
4151F	PT NOT RECVNG ANTIV HEP C	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4152F	DOC'D PEGINTF/RIB THXY CONSD	PRXOVR	DEF					NA	NA	NA	N
4152F	DOC'D PEGINTF/RIB THXY CONSD	MAXFEE	DEF					NA			N
4153F	COMBO PEGINTF/RIB RX	PRXOVR	DEF					NA	NA	NA	N
4153F	COMBO PEGINTF/RIB RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4154F	HEP A VAC SERIES RECOMMENDED	PRXOVR	DEF					NA	NA	NA	N
4154F	HEP A VAC SERIES RECOMMENDED	MAXFEE	DEF					NA			N
4155F	HEP A VAC SERIES PREV RECVD	PRXOVR	DEF					NA	NA	NA	N
4155F	HEP A VAC SERIES PREV RECVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4156F	HEP B VAC SERIES RECOMMENDED	PRXOVR	DEF					NA	NA	NA	N
4156F	HEP B VAC SERIES RECOMMENDED	MAXFEE	DEF					NA			N
4157F	HEP B VAC SERIES PREV RECVD	PRXOVR	DEF					NA	NA	NA	N
4157F	HEP B VAC SERIES PREV RECVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4158F	PT EDU RE ALCOH DRNKNG DONE	PRXOVR	DEF					NA	NA	NA	N
4158F	PT EDU RE ALCOH DRNKNG DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4159F	CONTRCP TALK B/4 ANTIV TXMNT	PRXOVR	DEF					NA	NA	NA	N
4159F	CONTRCP TALK B/4 ANTIV TXMNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4163F	PT COUNS 4 TXMNT OPT PROST	PRXOVR	DEF					NA	NA	NA	N
4163F	PT COUNS 4 TXMNT OPT PROST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4164F	ADJV HRMNL THXPY RXD	PRXOVR	DEF					NA	NA	NA	N
4164F	ADJV HRMNL THXPY RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4165F	3D-CRT/IMRT RECEIVED	PRXOVR	DEF					NA	NA	NA	N
4165F	3D-CRT/IMRT RECEIVED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4167F	HD BED TILTED 1ST DAY VENT	PRXOVR	DEF					NA	NA	NA	N
4167F	HD BED TILTED 1ST DAY VENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4168F	PT CARE ICU&VENT W/IN 24HRS	PRXOVR	DEF					NA	NA	NA	N
4168F	PT CARE ICU&VENT W/IN 24HRS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4169F	NO PT CARE ICU/VENT IN 24HRS	PRXOVR	DEF					NA	NA	NA	N
4169F	NO PT CARE ICU/VENT IN 24HRS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4171F	PT RCVNG ESA THXPY	PRXOVR	DEF					NA	NA	NA	N
4171F	PT RCVNG ESA THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4172F	PT NOT RCVNG ESA THXPY	PRXOVR	DEF					NA	NA	NA	N
4172F	PT NOT RCVNG ESA THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4174F	COUNS POTENT GLAUC IMPCT	PRXOVR	DEF					NA	NA	NA	N
4174F	COUNS POTENT GLAUC IMPCT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4175F	VIS 20/40/> W/IN 90 DAYS	PRXOVR	DEF					NA	NA	NA	N
4175F	VIS 20/40/> W/IN 90 DAYS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4176F	TALK RE UV LIGHT PT/CRGVR	PRXOVR	DEF					NA	NA	NA	N
4176F	TALK RE UV LIGHT PT/CRGVR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4177F	TALK PT/CRGVR RE AREDS PREV	PRXOVR	DEF					NA	NA	NA	N
4177F	TALK PT/CRGVR RE AREDS PREV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4178F	ANTID GLBLN RCVD W/IN 26WKS	PRXOVR	DEF					NA	NA	NA	N
4178F	ANTID GLBLN RCVD W/IN 26WKS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4179F	TAMOXIFEN/AI PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
4179F	TAMOXIFEN/AI PRESCRIBED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4180F	ADJV THXPYRXD/RCVD COLON CA	PRXOVR	DEF					NA	NA	NA	N
4180F	ADJV THXPYRXD/RCVD COLON CA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4181F	CONFORMAL RADN THXPY RCVD	PRXOVR	DEF					NA	NA	NA	N
4181F	CONFORMAL RADN THXPY RCVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4182F	NO CONFORMAL RADN THXPY	PRXOVR	DEF					NA	NA	NA	N
4182F	NO CONFORMAL RADN THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4185F	CONTINUOUS PPI OR H2RA RCVD	PRXOVR	DEF					NA	NA	NA	N
4185F	CONTINUOUS PPI OR H2RA RCVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4186F	NO CONT PPI OR H2RA RCVD	PRXOVR	DEF					NA	NA	NA	N
4186F	NO CONT PPI OR H2RA RCVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4187F	ANTI RHEUM DRUGTHXPYRXD/GVN	PRXOVR	DEF					NA	NA	NA	N
4187F	ANTI RHEUM DRUGTHXPYRXD/GVN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4188F	APPROP ACE/ARB TSTNG DONE	PRXOVR	DEF					NA	NA	NA	N
4188F	APPROP ACE/ARB TSTNG DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4189F	APPROP DIGOXIN TSTNG DONE	PRXOVR	DEF					NA	NA	NA	N
4189F	APPROP DIGOXIN TSTNG DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4190F	APPROP DIURETIC TSTNG DONE	PRXOVR	DEF					NA	NA	NA	N
4190F	APPROP DIURETIC TSTNG DONE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4191F	APPROP ANTICONVULS TSTNG	PRXOVR	DEF					NA	NA	NA	N
4191F	APPROP ANTICONVULS TSTNG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4192F	PT NOT RCVNG GLUCOCO THXPY	PRXOVR	DEF					NA	NA	NA	N
4192F	PT NOT RCVNG GLUCOCO THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4193F	PT RCV <10MG DAILY PREDNISO	PRXOVR	DEF					NA	NA	NA	N
4193F	PT RCV <10MG DAILY PREDNISO	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4194F	PT RCV >=10MG DAILY PREDNISO	PRXOVR	DEF					NA	NA	NA	N
4194F	PT RCV >=10MG DAILY PREDNISO	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4195F	PT RCVNG ANTI-RHEUM THXPY RA	PRXOVR	DEF					NA	NA	NA	N
4195F	PT RCVNG ANTI-RHEUM THXPY RA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4196F	PTNOT RCVNG ANTI-RHM THXPYRA	PRXOVR	DEF					NA	NA	NA	N
4196F	PTNOT RCVNG ANTI-RHM THXPYRA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4200F	EXTERNAL BEAM TO PROST ONLY	PRXOVR	DEF					NA	NA	NA	N
4200F	EXTERNAL BEAM TO PROST ONLY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4201F	EXTRNL BEAM OTHER THAN PROST	PRXOVR	DEF					NA	NA	NA	N
4201F	EXTRNL BEAM OTHER THAN PROST	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4210F	ACE/ARB THXPY FOR MOS/>	PRXOVR	DEF					NA	NA	NA	N
4210F	ACE/ARB THXPY FOR MOS/>	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4220F	DIGOXIN THXPY FOR 6 MOS/>	PRXOVR	DEF					NA	NA	NA	N
4220F	DIGOXIN THXPY FOR 6 MOS/>	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4221F	DIURETIC THXPY FOR 6 MOS/>	PRXOVR	DEF					NA	NA	NA	N
4221F	DIURETIC THXPY FOR 6 MOS/>	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4230F	ANTICONV THXPY FOR 6 MOS/>	PRXOVR	DEF					NA	NA	NA	N
4230F	ANTICONV THXPY FOR 6 MOS/>	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4240F	INSTR XRCZ BACK PAIN 12 WKS	PRXOVR	DEF					NA	NA	NA	N
4240F	INSTR XRCZ BACK PAIN 12 WKS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4242F	SPRVSD XRCZ BACK PN >12 WKS	PRXOVR	DEF					NA	NA	NA	N
4242F	SPRVSD XRCZ BACK PN >12 WKS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4245F	PT INSTR NRML ACTIVITIES	PRXOVR	DEF					NA	NA	NA	N
4245F	PT INSTR NRML ACTIVITIES	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4248F	PT INSTR NO BD REST 4 DAYS/>	PRXOVR	DEF					NA	NA	NA	N
4248F	PT INSTR NO BD REST 4 DAYS/>	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4250F	WRMNG 4 SURG NORMOTHERMIA	PRXOVR	DEF					NA	NA	NA	N
4250F	WRMNG 4 SURG NORMOTHERMIA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4255F	ANESTH 60 MIN/> AS DOCD	PRXOVR	DEF					NA	NA	NA	N
4255F	ANESTH 60 MIN/> AS DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4256F	ANESTHE <60 MIN AS DOCD	PRXOVR	DEF					NA	NA	NA	N
4256F	ANESTHE <60 MIN AS DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4260F	WOUND SRFC CULTURETECH USED	PRXOVR	DEF					NA	NA	NA	N
4260F	WOUND SRFC CULTURETECH USED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4261F	TECH OTHER THAN SURFC CULTR	PRXOVR	DEF					NA	NA	NA	N
4261F	TECH OTHER THAN SURFC CULTR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4265F	WET-DRY DRESSINGS RX RECMD	PRXOVR	DEF					NA	NA	NA	N
4265F	WET-DRY DRESSINGS RX RECMD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4266F	NO WET-DRY DRSSINGS RX RECMD	PRXOVR	DEF					NA	NA	NA	N
4266F	NO WET-DRY DRSSINGS RX RECMD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4267F	COMPRSSION THXPY PRESCRIBED	PRXOVR	DEF					NA	NA	NA	N
4267F	COMPRSSION THXPY PRESCRIBED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4268F	PT ED RE COMP THXPY RCVD	PRXOVR	DEF					NA	NA	NA	N
4268F	PT ED RE COMP THXPY RCVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4269F	APPROPOS MTHD OFFLOADING RXD	PRXOVR	DEF					NA	NA	NA	N
4269F	APPROPOS MTHD OFFLOADING RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4270F	PT RCVNG ANTI R-VIRAL THXPY	PRXOVR	DEF					NA	NA	NA	N
4270F	PT RCVNG ANTI R-VIRAL THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4271F	PT RCVNG ANTI R-VIRAL THXPY	PRXOVR	DEF					NA	NA	NA	N
4271F	PT RCVNG ANTI R-VIRAL THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4274F	FLU IMMUNO ADMIND RCVD	PRXOVR	DEF					NA	NA	NA	N
4274F	FLU IMMUNO ADMIND RCVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4275F	HEP B VAC INJ ADMIN/RCVD	PRXOVR	DEF					NA	NA	NA	N
4275F	HEP B VAC INJ ADMIN/RCVD	MAXFEE	DEF					NA			N
4276F	POTENT ANTIVIR THXPY RXD	PRXOVR	DEF					NA	NA	NA	N
4276F	POTENT ANTIVIR THXPY RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4279F	PCP PROPHYLAXIS RXD	PRXOVR	DEF					NA	NA	NA	N
4279F	PCP PROPHYLAXIS RXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4280F	PCP PROPHYLAX RXD 3MON LOW %	PRXOVR	DEF					NA	NA	NA	N
4280F	PCP PROPHYLAX RXD 3MON LOW %	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4290F	PT SCRNED FOR INJ DRUG USE	PRXOVR	DEF					NA	NA	NA	N
4290F	PT SCRNED FOR INJ DRUG USE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4293F	PT SCRND HGH-RISK SEX BEHAV	PRXOVR	DEF					NA	NA	NA	N
4293F	PT SCRND HGH-RISK SEX BEHAV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4300F	PT RCVNG WARF THXPY	PRXOVR	DEF					NA	NA	NA	N
4300F	PT RCVNG WARF THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4301F	PT NOT RCVNG WARF THXPY	PRXOVR	DEF					NA	NA	NA	N
4301F	PT NOT RCVNG WARF THXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4305F	PT ED RE FT CARE INSPCT RCVD	PRXOVR	DEF					NA	NA	NA	N
4305F	PT ED RE FT CARE INSPCT RCVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4306F	PT TLK PSYCH & RX OPD ADDIC	PRXOVR	DEF					NA	NA	NA	N
4306F	PT TLK PSYCH & RX OPD ADDIC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4320F	PT TALK PSYCHSOC&RX OH DPND	PRXOVR	DEF					NA	NA	NA	N
4320F	PT TALK PSYCHSOC&RX OH DPND	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4322F	CRGVR PROV W/ ED ADDL RSRCS	PRXOVR	DEF					NA	NA	NA	N
4322F	CRGVR PROV W/ ED ADDL RSRCS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4324F	PT QUERIED PRKNS COMPLIC	PRXOVR	DEF					NA	NA	NA	N
4324F	PT QUERIED PRKNS COMPLIC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4325F	MED TXMNT OPTIONS RVWD W/PT	PRXOVR	DEF					NA	NA	NA	N
4325F	MED TXMNT OPTIONS RVWD W/PT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4326F	PT ASKED RE SYMP AUTO DYSFXN	PRXOVR	DEF					NA	NA	NA	N
4326F	PT ASKED RE SYMP AUTO DYSFXN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4328F	PT ASKED RE SLEEP DISTURB	PRXOVR	DEF					NA	NA	NA	N
4328F	PT ASKED RE SLEEP DISTURB	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4330F	CNSLNG EPI SPEC SFTY ISSUES	PRXOVR	DEF					NA	NA	NA	N
4330F	CNSLNG EPI SPEC SFTY ISSUES	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4340F	CNSLNG CHLDBRNG WOMEN EPI	PRXOVR	DEF					NA	NA	NA	N
4340F	CNSLNG CHLDBRNG WOMEN EPI	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4350F	CNSLNG PROVIDED SYMP MNGMNT	PRXOVR	DEF					NA	NA	NA	N
4350F	CNSLNG PROVIDED SYMP MNGMNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4400F	REHAB THXPY OPTIONS W/PT	PRXOVR	DEF					NA	NA	NA	N
4400F	REHAB THXPY OPTIONS W/PT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4450F	SELF-CARE ED PROVIDED TO PT	PRXOVR	DEF					NA	NA	NA	N
4450F	SELF-CARE ED PROVIDED TO PT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4470F	ICD COUNSELING PROVIDED	PRXOVR	DEF					NA	NA	NA	N
4470F	ICD COUNSELING PROVIDED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4480F	PT RCVNG ACE/ARB B-BLOCKERTX	PRXOVR	DEF					NA	NA	NA	N
4480F	PT RCVNG ACE/ARB B-BLOCKERTX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4481F	PT RCVNG ACE/ARB BLKER <3MOS	PRXOVR	DEF					NA	NA	NA	N
4481F	PT RCVNG ACE/ARB BLKER <3MOS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4500F	REF TO OUTPT CARD REHAB PROG	PRXOVR	DEF					NA	NA	NA	N
4500F	REF TO OUTPT CARD REHAB PROG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4510F	PREV CARDREHAB QUALCARDEVENT	PRXOVR	DEF					NA	NA	NA	N
4510F	PREV CARDREHAB QUALCARDEVENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4525F	NEUROPSYCHIA INTERVEN ORDER	PRXOVR	DEF					NA	NA	NA	N
4525F	NEUROPSYCHIA INTERVEN ORDER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4526F	NEUROPSYCHIA INTERVEN RCVD	PRXOVR	DEF					NA	NA	NA	N
4526F	NEUROPSYCHIA INTERVEN RCVD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4540F	DISEASE MODIF PHARMACOTHXPY	PRXOVR	DEF					NA	NA	NA	N
4540F	DISEASE MODIF PHARMACOTHXPY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4541F	PT OFFERED TX FOR PSEUDOBULB	PRXOVR	DEF					NA	NA	NA	N
4541F	PT OFFERED TX FOR PSEUDOBULB	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4550F	NONINVAS RESP SUPPORT TALK	PRXOVR	DEF					NA	NA	NA	N
4550F	NONINVAS RESP SUPPORT TALK	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4551F	NUTRITIONAL SUPPORT OFFERED	PRXOVR	DEF					NA	NA	NA	N
4551F	NUTRITIONAL SUPPORT OFFERED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4552F	PT REF FOR SPEECH LANG PATH	PRXOVR	DEF					NA	NA	NA	N
4552F	PT REF FOR SPEECH LANG PATH	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4553F	PT ASST RE END LIFE ISSUES	PRXOVR	DEF					NA	NA	NA	N
4553F	PT ASST RE END LIFE ISSUES	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4554F	PT RECVD INHAL ANESTHETIC	PRXOVR	DEF					NA	NA	NA	N
4554F	PT RECVD INHAL ANESTHETIC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4555F	PT RECVD NO INHAL ANESTHIC	PRXOVR	DEF					NA	NA	NA	N
4555F	PT RECVD NO INHAL ANESTHIC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4556F	PT W/3+ POST-OP NAUSEA&VOM	PRXOVR	DEF					NA	NA	NA	N
4556F	PT W/3+ POST-OP NAUSEA&VOM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4557F	PT W/O 3+ POST-OPNAUSEA&VOM	PRXOVR	DEF					NA	NA	NA	N
4557F	PT W/O 3+ POST-OPNAUSEA&VOM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4558F	PT RECVD 2 RX ANTI-EMET AGT	PRXOVR	DEF					NA	NA	NA	N
4558F	PT RECVD 2 RX ANTI-EMET AGT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4559F	1 BODYTEMP >=35.5CW/IN 30MIN	PRXOVR	DEF					NA	NA	NA	N
4559F	1 BODYTEMP >=35.5CW/IN 30MIN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4560F	ANESTH W/O GEN/NEURAX ANESTH	PRXOVR	DEF					NA	NA	NA	N
4560F	ANESTH W/O GEN/NEURAX ANESTH	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4561F	PT W/ CORONARY ARTERY STENT	PRXOVR	DEF					NA	NA	NA	N
4561F	PT W/ CORONARY ARTERY STENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4562F	PT W/O CORONARY ARTERY STENT	PRXOVR	DEF					NA	NA	NA	N
4562F	PT W/O CORONARY ARTERY STENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
4563F	PT RECVD ASPIRIN W/IN 24 HRS	PRXOVR	DEF					NA	NA	NA	N
4563F	PT RECVD ASPIRIN W/IN 24 HRS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5005F	PT COUNSLD ON EXAM FOR MOLES	PRXOVR	DEF					NA	NA	NA	N
5005F	PT COUNSLD ON EXAM FOR MOLES	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5010F	MACUL RESULT PHY/QHP MNG DM	PRXOVR	DEF					NA	NA	NA	N
5010F	MACUL RESULT PHY/QHP MNG DM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5015F	DOC FX & TEST/TXMNT FOR OP	PRXOVR	DEF					NA	NA	NA	N
5015F	DOC FX & TEST/TXMNT FOR OP	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5020F	TXMNTS 2 PHYS/QHP BY 1 MON	PRXOVR	DEF					NA	NA	NA	N
5020F	TXMNTS 2 PHYS/QHP BY 1 MON	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5050F	PLAN 2 MAIN DR BY 1 MONTH	PRXOVR	DEF					NA	NA	NA	N
5050F	PLAN 2 MAIN DR BY 1 MONTH	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5060F	FNDNGS MAMMO 2PT W/IN 3 DAYS	PRXOVR	DEF					NA	NA	NA	N
5060F	FNDNGS MAMMO 2PT W/IN 3 DAYS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5062F	MAMMO RESULT COM TO PT 5 DAY	PRXOVR	DEF					NA	NA	NA	N
5062F	MAMMO RESULT COM TO PT 5 DAY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5100F	RSK FX REF W/N 24 HRS XRAY	PRXOVR	DEF					NA	NA	NA	N
5100F	RSK FX REF W/N 24 HRS XRAY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5200F	EVAL APPROS SURG THXPY EPI	PRXOVR	DEF					NA	NA	NA	N
5200F	EVAL APPROS SURG THXPY EPI	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
5250F	ASTHMA DISCHARGE PLAN PRESNT	PRXOVR	DEF					NA	NA	NA	N
5250F	ASTHMA DISCHARGE PLAN PRESNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6005F	CARE LEVEL RATIONALE DOC	PRXOVR	DEF					NA	NA	NA	N
6005F	CARE LEVEL RATIONALE DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6010F	DYSPHAG TEST DONE B/4 EATING	PRXOVR	DEF					NA	NA	NA	N
6010F	DYSPHAG TEST DONE B/4 EATING	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6015F	DYSPHAG TEST DONE B/4 EATING	PRXOVR	DEF					NA	NA	NA	N
6015F	DYSPHAG TEST DONE B/4 EATING	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6020F	NPO (NOTHING-MOUTH) ORDERED	PRXOVR	DEF					NA	NA	NA	N
6020F	NPO (NOTHING-MOUTH) ORDERED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6030F	MAX STERILE BARRIERS FLWD	PRXOVR	DEF					NA	NA	NA	N
6030F	MAX STERILE BARRIERS FLWD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6040F	APPRO RAD DS DVCS TECHS DOCD	PRXOVR	DEF					NA	NA	NA	N
6040F	APPRO RAD DS DVCS TECHS DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6045F	RADXPS IN END RPRT4FLURO PXD	PRXOVR	DEF					NA	NA	NA	N
6045F	RADXPS IN END RPRT4FLURO PXD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6070F	PT ASKED/CNSLD AED EFFECTS	PRXOVR	DEF					NA	NA	NA	N
6070F	PT ASKED/CNSLD AED EFFECTS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6080F	PT/CAREGIVER QUERIED FALLS	PRXOVR	DEF					NA	NA	NA	N
6080F	PT/CAREGIVER QUERIED FALLS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6090F	PT/CAREGIVER COUNSEL SAFETY	PRXOVR	DEF					NA	NA	NA	N
6090F	PT/CAREGIVER COUNSEL SAFETY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6100F	VERIFY PT SITE PXD DOCD	PRXOVR	DEF					NA	NA	NA	N
6100F	VERIFY PT SITE PXD DOCD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6101F	SAFETY COUNSELING DEMENTIA	PRXOVR	DEF					NA	NA	NA	N
6101F	SAFETY COUNSELING DEMENTIA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6102F	SAFETY COUNSELING DEM ORDER	PRXOVR	DEF					NA	NA	NA	N
6102F	SAFETY COUNSELING DEM ORDER	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6110F	COUNSEL PROV DRIVING RISKS	PRXOVR	DEF					NA	NA	NA	N
6110F	COUNSEL PROV DRIVING RISKS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
6150F	PT NOTRCVNG1ST ANTITNF TXMNT	PRXOVR	DEF					NA	NA	NA	N
6150F	PT NOTRCVNG1ST ANTITNF TXMNT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
64450	NJX AA&/STRD OTHER PN/BRANCH	PRXOVR	DEF					NA	NA	NA	N
64450	NJX AA&/STRD OTHER PN/BRANCH	MAXFEE	FAC					25.34	1/1/2014	12/31/2299	N
64450	NJX AA&/STRD OTHER PN/BRANCH	MAXFEE	NFF					52.52	1/1/2014	12/31/2299	N
64455	NJX AA&/STRD PLTR COM DG NRV	PRXOVR	DEF					NA	NA	NA	N
64455	NJX AA&/STRD PLTR COM DG NRV	MAXFEE	FAC					24.64	1/1/2014	12/31/2299	N
64455	NJX AA&/STRD PLTR COM DG NRV	MAXFEE	NFF					37.78	1/1/2014	12/31/2299	N
64550	APPL SURFACE NEUROSTIMULATOR	PRXOVR	DEF					NA	NA	NA	N
64550	APPL SURFACE NEUROSTIMULATOR	MAXFEE	DEF					NA			N
64565	IMPLANT NEUROELECTRODES	PRXOVR	DEF					NA	NA	NA	N
64565	IMPLANT NEUROELECTRODES	MANUAL	DEF					NA	NA	NA	N
64575	OPN IMPLTJ NEA PERPH NERVE	PRXOVR	DEF					NA	NA	NA	N
64575	OPN IMPLTJ NEA PERPH NERVE	MAXFEE	DEF					194.32	7/1/2003	12/31/2299	N
64580	OPN IMPLTJ NEA NEUROMUSCULAR	PRXOVR	DEF					NA	NA	NA	N
64580	OPN IMPLTJ NEA NEUROMUSCULAR	MANUAL	DEF					NA	NA	NA	N
64585	REVISE/REMOVE NEUROELECTRODE	PRXOVR	DEF					NA	NA	NA	N
64585	REVISE/REMOVE NEUROELECTRODE	MANUAL	DEF					NA	NA	NA	N
64614	DESTROY NERVE EXTREM MUSC	PRXOVR	DEF					NA	NA	NA	N
64614	DESTROY NERVE EXTREM MUSC	MAXFEE	FAC					110.20	1/1/2014	12/31/2299	N
64614	DESTROY NERVE EXTREM MUSC	MAXFEE	NFF					136.19	1/1/2014	12/31/2299	N
64632	N BLOCK INJ COMMON DIGIT	PRXOVR	DEF					NA	NA	NA	N
64632	N BLOCK INJ COMMON DIGIT	MAXFEE	FAC					44.29	1/1/2014	12/31/2299	N
64632	N BLOCK INJ COMMON DIGIT	MAXFEE	NFF					60.27	1/1/2014	12/31/2299	N
64640	INJECTION TREATMENT OF NERVE	PRXOVR	DEF					NA	NA	NA	N
64640	INJECTION TREATMENT OF NERVE	MAXFEE	FAC					83.85	1/1/2014	12/31/2299	N
64640	INJECTION TREATMENT OF NERVE	MAXFEE	NFF					100.77	1/1/2014	12/31/2299	N
64702	REVISE FINGER/TOE NERVE	PRXOVR	DEF					NA	NA	NA	N
64702	REVISE FINGER/TOE NERVE	MAXFEE	DEF					230.87	1/1/2000	12/31/2299	N
64704	REVISE HAND/FOOT NERVE	PRXOVR	DEF					NA	NA	NA	N
64704	REVISE HAND/FOOT NERVE	MAXFEE	DEF					252.77	1/1/2000	12/31/2299	N
64708	REVISE ARM/LEG NERVE	PRXOVR	DEF					NA	NA	NA	N
64708	REVISE ARM/LEG NERVE	MAXFEE	DEF					349.22	1/1/2000	12/31/2299	N
64712	REVISION OF SCIATIC NERVE	PRXOVR	DEF					NA	NA	NA	N
64712	REVISION OF SCIATIC NERVE	MAXFEE	DEF					434.02	1/1/2000	12/31/2299	N
64722	RELIEVE PRESSURE ON NERVE(S)	PRXOVR	DEF					NA	NA	NA	N
64722	RELIEVE PRESSURE ON NERVE(S)	MAXFEE	DEF					265.76	1/1/2000	12/31/2299	N
64726	RELEASE FOOT/TOE NERVE	PRXOVR	DEF					NA	NA	NA	N
64726	RELEASE FOOT/TOE NERVE	MAXFEE	DEF					157.01	7/1/2008	12/31/2299	N
64727	INTERNAL NERVE REVISION	PRXOVR	DEF					NA	NA	NA	N
64727	INTERNAL NERVE REVISION	MAXFEE	DEF					160.14	1/1/2010	12/31/2299	N
64774	REMOVE SKIN NERVE LESION	PRXOVR	DEF					NA	NA	NA	N
64774	REMOVE SKIN NERVE LESION	MAXFEE	DEF					218.27	1/1/2000	12/31/2299	N
64776	REMOVE DIGIT NERVE LESION	PRXOVR	DEF					NA	NA	NA	N
64776	REMOVE DIGIT NERVE LESION	MAXFEE	DEF					216.02	1/1/2000	12/31/2299	N
64778	DIGIT NERVE SURGERY ADD-ON	PRXOVR	DEF					NA	NA	NA	N
64778	DIGIT NERVE SURGERY ADD-ON	MAXFEE	DEF					137.09	1/1/2016	12/31/2299	N
64782	REMOVE LIMB NERVE LESION	PRXOVR	DEF					NA	NA	NA	N
64782	REMOVE LIMB NERVE LESION	MAXFEE	DEF					286	1/1/2000	12/31/2299	N
64783	LIMB NERVE SURGERY ADD-ON	PRXOVR	DEF					NA	NA	NA	N
64783	LIMB NERVE SURGERY ADD-ON	MAXFEE	DEF					184.86	1/1/2000	12/31/2299	N
64784	REMOVE NERVE LESION	PRXOVR	DEF					NA	NA	NA	N
64784	REMOVE NERVE LESION	MAXFEE	DEF					425.81	1/1/2000	12/31/2299	N
64787	IMPLANT NERVE END	PRXOVR	DEF					NA	NA	NA	N
64787	IMPLANT NERVE END	MAXFEE	DEF					206.89	1/1/2000	12/31/2299	N
64788	REMOVE SKIN NERVE LESION	PRXOVR	DEF					NA	NA	NA	N
64788	REMOVE SKIN NERVE LESION	MAXFEE	DEF					222.92	1/1/2000	12/31/2299	N
64831	REPAIR OF DIGIT NERVE	PRXOVR	DEF					NA	NA	NA	N
64831	REPAIR OF DIGIT NERVE	MAXFEE	DEF					388.64	7/1/2008	12/31/2299	N
64832	REPAIR NERVE ADD-ON	PRXOVR	DEF					NA	NA	NA	N
64832	REPAIR NERVE ADD-ON	MAXFEE	DEF					199.83	1/1/2000	12/31/2299	N
64834	REPAIR OF HAND OR FOOT NERVE	PRXOVR	DEF					NA	NA	NA	N
64834	REPAIR OF HAND OR FOOT NERVE	MAXFEE	DEF					401.04	7/1/2008	12/31/2299	N
64837	REPAIR NERVE ADD-ON	PRXOVR	DEF					NA	NA	NA	N
64837	REPAIR NERVE ADD-ON	MAXFEE	DEF					291.07	1/1/2000	12/31/2299	N
64840	REPAIR OF LEG NERVE	PRXOVR	DEF					NA	NA	NA	N
64840	REPAIR OF LEG NERVE	MAXFEE	DEF					605.65	1/1/2000	12/31/2299	N
64856	REPAIR/TRANSPOSE NERVE	PRXOVR	DEF					NA	NA	NA	N
64856	REPAIR/TRANSPOSE NERVE	MAXFEE	DEF					609.99	1/1/2000	12/31/2299	N
64857	REPAIR ARM/LEG NERVE	PRXOVR	DEF					NA	NA	NA	N
64857	REPAIR ARM/LEG NERVE	MAXFEE	DEF					658.75	1/1/2000	12/31/2299	N
64859	NERVE SURGERY	PRXOVR	DEF					NA	NA	NA	N
64859	NERVE SURGERY	MAXFEE	DEF					208.06	1/1/2000	12/31/2299	N
64890	NERVE GRAFT HAND/FOOT </4 CM	PRXOVR	DEF					NA	NA	NA	N
64890	NERVE GRAFT HAND/FOOT </4 CM	MAXFEE	DEF					746.85	1/1/2000	12/31/2299	N
64891	NERVE GRAFT HAND/FOOT >4 CM	PRXOVR	DEF					NA	NA	NA	N
64891	NERVE GRAFT HAND/FOOT >4 CM	MAXFEE	DEF					710.14	1/1/2000	12/31/2299	N
64892	NERVE GRAFT ARM/LEG <4 CM	PRXOVR	DEF					NA	NA	NA	N
64892	NERVE GRAFT ARM/LEG <4 CM	MAXFEE	DEF					692.77	1/1/2000	12/31/2299	N
64893	NERVE GRAFT ARM/LEG >4 CM	PRXOVR	DEF					NA	NA	NA	N
64893	NERVE GRAFT ARM/LEG >4 CM	MAXFEE	DEF					783.58	1/1/2000	12/31/2299	N
64895	NERVE GRAFT HAND/FOOT </4 CM	PRXOVR	DEF					NA	NA	NA	N
64895	NERVE GRAFT HAND/FOOT </4 CM	MAXFEE	DEF					882.73	1/1/2000	12/31/2299	N
64896	NERVE GRAFT HAND/FOOT >4 CM	PRXOVR	DEF					NA	NA	NA	N
64896	NERVE GRAFT HAND/FOOT >4 CM	MAXFEE	DEF					999.35	1/1/2000	12/31/2299	N
64897	NERVE GRAFT ARM/LEG </4 CM	PRXOVR	DEF					NA	NA	NA	N
64897	NERVE GRAFT ARM/LEG </4 CM	MAXFEE	DEF					846.69	1/1/2000	12/31/2299	N
64898	NERVE GRAFT ARM/LEG >4 CM	PRXOVR	DEF					NA	NA	NA	N
64898	NERVE GRAFT ARM/LEG >4 CM	MAXFEE	DEF					922.89	1/1/2000	12/31/2299	N
64901	NERVE GRAFT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
64901	NERVE GRAFT ADD-ON	MAXFEE	DEF					522.34	1/1/2000	12/31/2299	N
64902	NERVE GRAFT ADD-ON	PRXOVR	DEF					NA	NA	NA	N
64902	NERVE GRAFT ADD-ON	MAXFEE	DEF					610.10	1/1/2000	12/31/2299	N
64905	NERVE PEDICLE TRANSFER	PRXOVR	DEF					NA	NA	NA	N
64905	NERVE PEDICLE TRANSFER	MAXFEE	DEF					612.91	1/1/2000	12/31/2299	N
64907	NERVE PEDICLE TRANSFER	PRXOVR	DEF					NA	NA	NA	N
64907	NERVE PEDICLE TRANSFER	MAXFEE	DEF					873.55	1/1/2000	12/31/2299	N
64910	NERVE REPAIR W/ALLOGRAFT	PRXOVR	DEF					NA	NA	NA	N
64910	NERVE REPAIR W/ALLOGRAFT	MAXFEE	DEF					400.36	4/1/2008	12/31/2299	N
64911	NEURORRAPHY W/VEIN AUTOGRAFT	PRXOVR	DEF					NA	NA	NA	N
64911	NEURORRAPHY W/VEIN AUTOGRAFT	MAXFEE	DEF					487.41	1/1/2007	12/31/2299	N
64912	NRV RPR W/NRV ALGRFT 1ST	PRXOVR	DEF					NA	NA	NA	N
64912	NRV RPR W/NRV ALGRFT 1ST	MAXFEE	DEF					620.99	1/1/2018	12/31/2299	N
64913	NRV RPR W/NRV ALGRFT EA ADDL	PRXOVR	DEF					NA	NA	NA	N
64913	NRV RPR W/NRV ALGRFT EA ADDL	MAXFEE	DEF					127.37	1/1/2018	12/31/2299	N
64999	UNLISTED PX NERVOUS SYSTEM	PRXOVR	DEF					NA	NA	NA	N
64999	UNLISTED PX NERVOUS SYSTEM	MANUAL	DEF					NA	NA	NA	N
7010F	PT INFO INTO RECALL SYSTEM	PRXOVR	DEF					NA	NA	NA	N
7010F	PT INFO INTO RECALL SYSTEM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
7020F	MAMMO ASSESS CAT IN DBASE	PRXOVR	DEF					NA	NA	NA	N
7020F	MAMMO ASSESS CAT IN DBASE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
7025F	PT INFOSYS ALARM 4 NXT MAMMO	PRXOVR	DEF					NA	NA	NA	N
7025F	PT INFOSYS ALARM 4 NXT MAMMO	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
73560	X-RAY EXAM OF KNEE 1 OR 2	PRXOVR	DEF					NA	NA	NA	N
73560	X-RAY EXAM OF KNEE 1 OR 2	MAXFEE	DEF					19.92	1/1/2018	12/31/2299	N
73560	X-RAY EXAM OF KNEE 1 OR 2	MAXFEE	DEF	26				6.97	1/1/2018	12/31/2299	N
73560	X-RAY EXAM OF KNEE 1 OR 2	MAXFEE	DEF	TC				12.95	1/1/2018	12/31/2299	N
73590	X-RAY EXAM OF LOWER LEG	PRXOVR	DEF					NA	NA	NA	N
73590	X-RAY EXAM OF LOWER LEG	MAXFEE	DEF					19.86	1/1/2018	12/31/2299	N
73590	X-RAY EXAM OF LOWER LEG	MAXFEE	DEF	26				6.95	1/1/2018	12/31/2299	N
73590	X-RAY EXAM OF LOWER LEG	MAXFEE	DEF	TC				12.91	1/1/2018	12/31/2299	N
73600	X-RAY EXAM OF ANKLE	PRXOVR	DEF					NA	NA	NA	N
73600	X-RAY EXAM OF ANKLE	MAXFEE	DEF					19.41	1/1/2018	12/31/2299	N
73600	X-RAY EXAM OF ANKLE	MAXFEE	DEF	26				6.79	1/1/2018	12/31/2299	N
73600	X-RAY EXAM OF ANKLE	MAXFEE	DEF	TC				12.62	1/1/2018	12/31/2299	N
73610	X-RAY EXAM OF ANKLE	PRXOVR	DEF					NA	NA	NA	N
73610	X-RAY EXAM OF ANKLE	MAXFEE	DEF					20.28	1/1/2018	12/31/2299	N
73610	X-RAY EXAM OF ANKLE	MAXFEE	DEF	26				7.10	1/1/2018	12/31/2299	N
73610	X-RAY EXAM OF ANKLE	MAXFEE	DEF	TC				13.18	1/1/2018	12/31/2299	N
73620	X-RAY EXAM OF FOOT	PRXOVR	DEF					NA	NA	NA	N
73620	X-RAY EXAM OF FOOT	MAXFEE	DEF					18.83	1/1/2018	12/31/2299	N
73620	X-RAY EXAM OF FOOT	MAXFEE	DEF	26				6.59	1/1/2018	12/31/2299	N
73620	X-RAY EXAM OF FOOT	MAXFEE	DEF	TC				12.24	1/1/2018	12/31/2299	N
73630	X-RAY EXAM OF FOOT	PRXOVR	DEF					NA	NA	NA	N
73630	X-RAY EXAM OF FOOT	MAXFEE	DEF					20.28	1/1/2018	12/31/2299	N
73630	X-RAY EXAM OF FOOT	MAXFEE	DEF	26				7.10	1/1/2018	12/31/2299	N
73630	X-RAY EXAM OF FOOT	MAXFEE	DEF	TC				13.18	1/1/2018	12/31/2299	N
73650	X-RAY EXAM OF HEEL	PRXOVR	DEF					NA	NA	NA	N
73650	X-RAY EXAM OF HEEL	MAXFEE	DEF					18.91	1/1/2018	12/31/2299	N
73650	X-RAY EXAM OF HEEL	MAXFEE	DEF	26				6.62	1/1/2018	12/31/2299	N
73650	X-RAY EXAM OF HEEL	MAXFEE	DEF	TC				12.29	1/1/2018	12/31/2299	N
73660	X-RAY EXAM OF TOE(S)	PRXOVR	DEF					NA	NA	NA	N
73660	X-RAY EXAM OF TOE(S)	MAXFEE	DEF					16.45	1/1/2018	12/31/2299	N
73660	X-RAY EXAM OF TOE(S)	MAXFEE	DEF	26				5.76	1/1/2018	12/31/2299	N
73660	X-RAY EXAM OF TOE(S)	MAXFEE	DEF	TC				10.69	1/1/2018	12/31/2299	N
73718	MRI LOWER EXTREMITY W/O DYE	PRXOVR	DEF					NA	NA	NA	N
73718	MRI LOWER EXTREMITY W/O DYE	MAXFEE	DEF					296.60	1/1/2018	12/31/2299	N
73718	MRI LOWER EXTREMITY W/O DYE	MAXFEE	DEF	26				59.32	1/1/2018	12/31/2299	N
73718	MRI LOWER EXTREMITY W/O DYE	MAXFEE	DEF	TC				237.28	1/1/2018	12/31/2299	N
73721	MRI JNT OF LWR EXTRE W/O DYE	PRXOVR	DEF					NA	NA	NA	N
73721	MRI JNT OF LWR EXTRE W/O DYE	MAXFEE	DEF					198.97	1/1/2018	12/31/2299	N
73721	MRI JNT OF LWR EXTRE W/O DYE	MAXFEE	DEF	26				49.74	1/1/2018	12/31/2299	N
73721	MRI JNT OF LWR EXTRE W/O DYE	MAXFEE	DEF	TC				149.23	1/1/2018	12/31/2299	N
76000	FLUOROSCOPY <1 HR PHYS/QHP	PRXOVR	DEF					NA	NA	NA	N
76000	FLUOROSCOPY <1 HR PHYS/QHP	MAXFEE	DEF					41.56	1/1/2018	12/31/2299	N
76000	FLUOROSCOPY <1 HR PHYS/QHP	MAXFEE	DEF	26				4.16	1/1/2018	12/31/2299	N
76000	FLUOROSCOPY <1 HR PHYS/QHP	MAXFEE	DEF	TC				37.40	1/1/2018	12/31/2299	N
76514	ECHO EXAM OF EYE THICKNESS	PRXOVR	DEF					NA	NA	NA	N
76514	ECHO EXAM OF EYE THICKNESS	MAXFEE	DEF					8.28	1/1/2018	12/31/2299	N
76514	ECHO EXAM OF EYE THICKNESS	MAXFEE	DEF	26				5.80	1/1/2018	12/31/2299	N
76514	ECHO EXAM OF EYE THICKNESS	MAXFEE	DEF	TC				2.48	1/1/2018	12/31/2299	N
76880	US EXAM; EXTREMITY	PRXOVR	DEF					NA	NA	NA	N
76880	US EXAM; EXTREMITY	MAXFEE	DEF					NA			N
76881	US COMPL JOINT R-T W/IMG	PRXOVR	DEF					NA	NA	NA	N
76881	US COMPL JOINT R-T W/IMG	MAXFEE	DEF					69.68	1/1/2018	12/31/2299	N
76881	US COMPL JOINT R-T W/IMG	MAXFEE	DEF	26				17.42	1/1/2018	12/31/2299	N
76881	US COMPL JOINT R-T W/IMG	MAXFEE	DEF	TC				52.26	1/1/2018	12/31/2299	N
76882	US LMTD JT/FCL EVL NVASC XTR	PRXOVR	DEF					NA	NA	NA	N
76882	US LMTD JT/FCL EVL NVASC XTR	MAXFEE	DEF					21.67	1/1/2018	12/31/2299	N
76882	US LMTD JT/FCL EVL NVASC XTR	MAXFEE	DEF	26				6.50	1/1/2018	12/31/2299	N
76882	US LMTD JT/FCL EVL NVASC XTR	MAXFEE	DEF	TC				15.17	1/1/2018	12/31/2299	N
76883	US NRV&ACC STRUX 1XTR COMPRE	PRXOVR	DEF					NA	NA	NA	N
76883	US NRV&ACC STRUX 1XTR COMPRE	MAXFEE	FAC					45.43	1/1/2023	12/31/2299	N
76883	US NRV&ACC STRUX 1XTR COMPRE	MAXFEE	NFF					55.08	1/1/2023	12/31/2299	N
76942	ECHO GUIDE FOR BIOPSY	PRXOVR	DEF					NA	NA	NA	N
76942	ECHO GUIDE FOR BIOPSY	MAXFEE	DEF					52.25	1/1/2018	12/31/2299	N
76942	ECHO GUIDE FOR BIOPSY	MAXFEE	DEF	26				15.68	1/1/2018	12/31/2299	N
76942	ECHO GUIDE FOR BIOPSY	MAXFEE	DEF	TC				36.58	1/1/2018	12/31/2299	N
77071	X-RAY STRESS VIEW	PRXOVR	DEF					NA	NA	NA	N
77071	X-RAY STRESS VIEW	MAXFEE	DEF					26.50	1/1/2018	12/31/2299	N
78300	BONE IMAGING LIMITED AREA	PRXOVR	DEF					NA	NA	NA	N
78300	BONE IMAGING LIMITED AREA	MAXFEE	DEF					123.72	1/1/2018	12/31/2299	N
78300	BONE IMAGING LIMITED AREA	MAXFEE	DEF	26				37.12	1/1/2018	12/31/2299	N
78300	BONE IMAGING LIMITED AREA	MAXFEE	DEF	TC				86.60	1/1/2018	12/31/2299	N
9001F	AORTIC ANEURYSM<5CM DIAM CT	PRXOVR	DEF					NA	NA	NA	N
9001F	AORTIC ANEURYSM<5CM DIAM CT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
9002F	AORTIC ANEURYSM 5-5.4CM DIAM	PRXOVR	DEF					NA	NA	NA	N
9002F	AORTIC ANEURYSM 5-5.4CM DIAM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
9003F	AORTIC ANRYSM5.5-5.9CM DIAM	PRXOVR	DEF					NA	NA	NA	N
9003F	AORTIC ANRYSM5.5-5.9CM DIAM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
9004F	AORTIC ANRYSM 6/> CM DIAM	PRXOVR	DEF					NA	NA	NA	N
9004F	AORTIC ANRYSM 6/> CM DIAM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
9005F	ASYMPT CAROT/VRTBRBAS STEN	PRXOVR	DEF					NA	NA	NA	N
9005F	ASYMPT CAROT/VRTBRBAS STEN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
9006F	SYMPT STEN-TIA/STRK<120DAYS	PRXOVR	DEF					NA	NA	NA	N
9006F	SYMPT STEN-TIA/STRK<120DAYS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
9007F	OTHER CAROT STEN 120 DAYS/>	PRXOVR	DEF					NA	NA	NA	N
9007F	OTHER CAROT STEN 120 DAYS/>	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
90471	IMMUNIZATION ADMIN	MAXFLT	DEF					NA	NA	NA	N
90471	IMMUNIZATION ADMIN	PRXOVR	DEF					NA	NA	NA	N
90472	IMMUNIZATION ADMIN EACH ADD	PRXOVR	DEF					NA	NA	NA	N
90472	IMMUNIZATION ADMIN EACH ADD	MAXFEE	DEF					9.85	1/1/2022	12/31/2299	N
90473	IMMUNE ADMIN ORAL/NASAL	MAXFLT	DEF					NA	NA	NA	N
90473	IMMUNE ADMIN ORAL/NASAL	PRXOVR	DEF					NA	NA	NA	N
90474	IMMUNE ADMIN ORAL/NASAL ADDL	PRXOVR	DEF					NA	NA	NA	N
90474	IMMUNE ADMIN ORAL/NASAL ADDL	MAXFEE	DEF					9.85	1/1/2022	12/31/2299	N
90653	IIV ADJUVANT VACCINE IM	PRXOVR	DEF					NA	NA	NA	N
90653	IIV ADJUVANT VACCINE IM	MAXFEE	VFC					0	10/1/2016	12/31/2299	N
90653	IIV ADJUVANT VACCINE IM	MAXFEE	DEF					59.53	11/1/2019	12/31/2299	N
90654	FLU VACC IIV3 NO PRESERV ID	PRXOVR	DEF					NA	NA	NA	N
90654	FLU VACC IIV3 NO PRESERV ID	MAXFEE	VFC					NA			N
90654	FLU VACC IIV3 NO PRESERV ID	MAXFEE	DEF					18.92	11/1/2013	12/31/2299	N
90656	IIV3 VACC NO PRSV 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90656	IIV3 VACC NO PRSV 0.5 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90656	IIV3 VACC NO PRSV 0.5 ML IM	MAXFEE	DEF					19.77	11/1/2018	12/31/2299	N
90658	IIV3 VACCINE SPLT 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90658	IIV3 VACCINE SPLT 0.5 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90658	IIV3 VACCINE SPLT 0.5 ML IM	MAXFEE	DEF					10.39	9/1/2013	12/31/2299	N
90660	LAIV3 VACCINE INTRANASAL	PRXOVR	DEF					NA	NA	NA	N
90660	LAIV3 VACCINE INTRANASAL	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90660	LAIV3 VACCINE INTRANASAL	MAXFEE	DEF					23.46	9/1/2013	12/31/2299	N
90662	IIV NO PRSV INCREASED AG IM	PRXOVR	DEF					NA	NA	NA	N
90662	IIV NO PRSV INCREASED AG IM	MAXFEE	VFC					NA			N
90662	IIV NO PRSV INCREASED AG IM	MAXFEE	DEF					69.94	10/1/2022	12/31/2299	N
90672	LAIV4 VACCINE INTRANASAL	PRXOVR	DEF					NA	NA	NA	N
90672	LAIV4 VACCINE INTRANASAL	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90672	LAIV4 VACCINE INTRANASAL	MAXFEE	DEF					26.88	2/1/2016	12/31/2299	N
90673	RIV3 VACCINE NO PRESERV IM	PRXOVR	DEF					NA	NA	NA	N
90673	RIV3 VACCINE NO PRESERV IM	MAXFEE	VFC					NA			N
90673	RIV3 VACCINE NO PRESERV IM	MAXFEE	DEF					40.61	10/1/2016	12/31/2299	N
90674	CCIIV4 VAC NO PRSV 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90674	CCIIV4 VAC NO PRSV 0.5 ML IM	MAXFEE	VFC					0	10/1/2016	12/31/2299	N
90674	CCIIV4 VAC NO PRSV 0.5 ML IM	MAXFEE	DEF					32.28	10/1/2022	12/31/2299	N
90682	RIV4 VACC RECOMBINANT DNA IM	PRXOVR	DEF					NA	NA	NA	N
90682	RIV4 VACC RECOMBINANT DNA IM	MAXFEE	VFC					0	11/1/2017	12/31/2299	N
90682	RIV4 VACC RECOMBINANT DNA IM	MAXFEE	DEF					69.94	10/1/2022	12/31/2299	N
90685	IIV4 VACC NO PRSV 0.25 ML IM	PRXOVR	DEF					NA	NA	NA	N
90685	IIV4 VACC NO PRSV 0.25 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90685	IIV4 VACC NO PRSV 0.25 ML IM	MAXFEE	DEF					21.64	10/1/2021	12/31/2299	N
90686	IIV4 VACC NO PRSV 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90686	IIV4 VACC NO PRSV 0.5 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90686	IIV4 VACC NO PRSV 0.5 ML IM	MAXFEE	DEF					21.52	10/1/2022	12/31/2299	N
90687	IIV4 VACCINE SPLT 0.25 ML IM	PRXOVR	DEF					NA	NA	NA	N
90687	IIV4 VACCINE SPLT 0.25 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90687	IIV4 VACCINE SPLT 0.25 ML IM	MAXFEE	DEF					10.24	10/1/2022	12/31/2299	N
90688	IIV4 VACCINE SPLT 0.5 ML IM	PRXOVR	DEF					NA	NA	NA	N
90688	IIV4 VACCINE SPLT 0.5 ML IM	MAXFEE	VFC					0	1/1/2016	12/31/2299	N
90688	IIV4 VACCINE SPLT 0.5 ML IM	MAXFEE	DEF					20.48	10/1/2022	12/31/2299	N
90694	VACC AIIV4 NO PRSRV 0.5ML IM	PRXOVR	DEF					NA	NA	NA	N
90694	VACC AIIV4 NO PRSRV 0.5ML IM	MAXFEE	VFC					0	1/1/2021	12/31/2299	N
90694	VACC AIIV4 NO PRSRV 0.5ML IM	MAXFEE	DEF					71.68	10/1/2022	12/31/2299	N
90756	CCIIV4 VACC ABX FREE IM	PRXOVR	DEF					NA	NA	NA	N
90756	CCIIV4 VACC ABX FREE IM	MAXFEE	VFC					NA			N
90756	CCIIV4 VACC ABX FREE IM	MAXFEE	DEF					30.58	10/1/2022	12/31/2299	N
90772	THER/PROPH/DIAG INJ; SC/IM	PRXOVR	DEF					NA	NA	NA	N
90772	THER/PROPH/DIAG INJ; SC/IM	MAXFEE	DEF					NA			N
91300	SARSCOV2 VAC 30MCG/0.3ML IM	PRXOVR	DEF					NA	NA	NA	N
91300	SARSCOV2 VAC 30MCG/0.3ML IM	MAXFEE	DEF					0.01	12/11/2020	12/31/2299	N
91301	SARSCOV2 VAC 100MCG/0.5ML IM	PRXOVR	DEF					NA	NA	NA	N
91301	SARSCOV2 VAC 100MCG/0.5ML IM	MAXFEE	DEF					0.01	12/18/2020	12/31/2299	N
91304	SARSCOV2 VAC 5MCG/0.5ML IM	PRXOVR	DEF					NA	NA	NA	N
91304	SARSCOV2 VAC 5MCG/0.5ML IM	MAXFEE	DEF					0.01	7/13/2022	12/31/2299	N
91306	SARSCOV2 VAC 50MCG/0.25ML IM	PRXOVR	DEF					NA	NA	NA	N
91306	SARSCOV2 VAC 50MCG/0.25ML IM	MAXFEE	DEF					0.01	10/20/2021	12/31/2299	N
91307	SARSCOV2 VAC 10 MCG TRS-SUCR	PRXOVR	DEF					NA	NA	NA	N
91307	SARSCOV2 VAC 10 MCG TRS-SUCR	MAXFEE	DEF					0.01	10/29/2021	12/31/2299	N
91308	SARSCOV2 VAC 3 MCG TRS-SUCR	PRXOVR	DEF					NA	NA	NA	N
91308	SARSCOV2 VAC 3 MCG TRS-SUCR	MAXFEE	DEF					0.01	6/17/2022	12/31/2299	N
91309	SARSCOV2 VAC 50MCG/0.5ML IM	PRXOVR	DEF					NA	NA	NA	N
91309	SARSCOV2 VAC 50MCG/0.5ML IM	MAXFEE	DEF					0.01	3/29/2022	12/31/2299	N
91311	SARSCOV2 VAC 25MCG/0.25ML IM	PRXOVR	DEF					NA	NA	NA	N
91311	SARSCOV2 VAC 25MCG/0.25ML IM	MAXFEE	DEF					0.01	6/17/2022	12/31/2299	N
91312	SARSCOV2 VAC BVL 30MCG/0.3ML	PRXOVR	DEF					NA	NA	NA	N
91312	SARSCOV2 VAC BVL 30MCG/0.3ML	MAXFEE	DEF					0.01	8/31/2022	12/31/2299	N
91313	SARSCOV2 VAC BVL 50MCG/0.5ML	PRXOVR	DEF					NA	NA	NA	N
91313	SARSCOV2 VAC BVL 50MCG/0.5ML	MAXFEE	DEF					0.01	8/31/2022	12/31/2299	N
91314	SARSCOV2 VAC BVL 25MCG/.25ML	PRXOVR	DEF					NA	NA	NA	N
91314	SARSCOV2 VAC BVL 25MCG/.25ML	MAXFEE	DEF					0.01	10/12/2022	12/31/2299	N
91315	SARSCOV2 VAC BVL 10MCG/0.2ML	PRXOVR	DEF					NA	NA	NA	N
91315	SARSCOV2 VAC BVL 10MCG/0.2ML	MAXFEE	DEF					0.01	10/12/2022	12/31/2299	N
91316	SARSCOV2 VAC BVL 10MCG/0.2ML	PRXOVR	DEF					NA	NA	NA	N
91316	SARSCOV2 VAC BVL 10MCG/0.2ML	MAXFEE	DEF					0.01	12/8/2022	12/31/2299	N
91317	SARSCOV2 VAC BVL 3MCG/0.2ML	PRXOVR	DEF					NA	NA	NA	N
91317	SARSCOV2 VAC BVL 3MCG/0.2ML	MAXFEE	DEF					0.01	12/8/2022	12/31/2299	N
93005	ELECTROCARDIOGRAM TRACING	PRXOVR	DEF					NA	NA	NA	N
93005	ELECTROCARDIOGRAM TRACING	MAXFEE	DEF					6.90	12/31/2014	12/31/2299	N
93010	ELECTROCARDIOGRAM REPORT	PRXOVR	DEF					NA	NA	NA	N
93010	ELECTROCARDIOGRAM REPORT	MAXFEE	DEF					7.90	1/1/2010	12/31/2299	N
93922	UPR/L XTREMITY ART 2 LEVELS	PRXOVR	DEF					NA	NA	NA	N
93922	UPR/L XTREMITY ART 2 LEVELS	MAXFEE	DEF					67.32	7/1/2008	12/31/2299	N
93922	UPR/L XTREMITY ART 2 LEVELS	MAXFEE	DEF	TC				53.86	12/31/2014	12/31/2299	N
93922	UPR/L XTREMITY ART 2 LEVELS	MAXFEE	DEF	26				13.46	12/31/2014	12/31/2299	N
93923	UPR/LXTR ART STDY 3+ LVLS	PRXOVR	DEF					NA	NA	NA	N
93923	UPR/LXTR ART STDY 3+ LVLS	MAXFEE	DEF					103.54	7/1/2008	12/31/2299	N
93923	UPR/LXTR ART STDY 3+ LVLS	MAXFEE	DEF	TC				82.83	12/31/2014	12/31/2299	N
93923	UPR/LXTR ART STDY 3+ LVLS	MAXFEE	DEF	26				20.71	12/31/2014	12/31/2299	N
93926	LOWER EXTREMITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93926	LOWER EXTREMITY STUDY	MAXFEE	DEF					85.53	7/26/2007	12/31/2299	N
93926	LOWER EXTREMITY STUDY	MAXFEE	DEF	TC				68.42	7/26/2007	12/31/2299	N
93926	LOWER EXTREMITY STUDY	MAXFEE	DEF	26				17.11	7/26/2007	12/31/2299	N
93970	EXTREMITY STUDY	PRXOVR	DEF					NA	NA	NA	N
93970	EXTREMITY STUDY	MAXFEE	DEF					142.52	1/1/2000	12/31/2299	N
93970	EXTREMITY STUDY	MAXFEE	DEF	TC				114.02	12/31/2014	12/31/2299	N
93970	EXTREMITY STUDY	MAXFEE	DEF	26				28.50	12/31/2014	12/31/2299	N
95851	RANGE OF MOTION MEASUREMENTS	PRXOVR	DEF					NA	NA	NA	S
95851	RANGE OF MOTION MEASUREMENTS	MAXFEE	FAC					3.94	1/1/2014	12/31/2299	S
95851	RANGE OF MOTION MEASUREMENTS	MAXFEE	NFF					10.51	1/1/2014	12/31/2299	S
95885	MUSC TST DONE W/NERV TST LIM	PRXOVR	DEF					NA	NA	NA	N
95885	MUSC TST DONE W/NERV TST LIM	MAXFEE	DEF					18.25	1/1/2012	12/31/2299	N
95885	MUSC TST DONE W/NERV TST LIM	MAXFEE	DEF	TC				12.25	1/1/2012	12/31/2299	N
95885	MUSC TST DONE W/NERV TST LIM	MAXFEE	DEF	26				6	1/1/2012	12/31/2299	N
95886	MUSC TEST DONE W/N TEST COMP	PRXOVR	DEF					NA	NA	NA	N
95886	MUSC TEST DONE W/N TEST COMP	MAXFEE	DEF					28.94	1/1/2012	12/31/2299	N
95886	MUSC TEST DONE W/N TEST COMP	MAXFEE	DEF	TC				12.91	1/1/2012	12/31/2299	N
95886	MUSC TEST DONE W/N TEST COMP	MAXFEE	DEF	26				16.04	1/1/2012	12/31/2299	N
95887	MUSC TST DONE W/N TST NONEXT	PRXOVR	DEF					NA	NA	NA	N
95887	MUSC TST DONE W/N TST NONEXT	MAXFEE	DEF					25.69	1/1/2012	12/31/2299	N
95887	MUSC TST DONE W/N TST NONEXT	MAXFEE	DEF	TC				13.12	1/1/2012	12/31/2299	N
95887	MUSC TST DONE W/N TST NONEXT	MAXFEE	DEF	26				12.57	1/1/2012	12/31/2299	N
95900	MOTOR NERVE CONDUCTION TEST	PRXOVR	DEF					NA	NA	NA	N
95900	MOTOR NERVE CONDUCTION TEST	MAXFEE	DEF					NA			N
95903	MOTOR NERVE CONDUCTION TEST	PRXOVR	DEF					NA	NA	NA	N
95903	MOTOR NERVE CONDUCTION TEST	MAXFEE	DEF					NA			N
95904	SENSE NERVE CONDUCTION TEST	PRXOVR	DEF					NA	NA	NA	N
95904	SENSE NERVE CONDUCTION TEST	MAXFEE	DEF					NA			N
95907	NVR CNDJ TST 1-2 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95907	NVR CNDJ TST 1-2 STUDIES	MAXFEE	DEF	26				27.93	1/1/2013	12/31/2299	N
95907	NVR CNDJ TST 1-2 STUDIES	MAXFEE	DEF	TC				22.08	1/1/2013	12/31/2299	N
95907	NVR CNDJ TST 1-2 STUDIES	MAXFEE	DEF					50	1/1/2013	12/31/2299	N
95908	NRV CNDJ TST 3-4 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95908	NRV CNDJ TST 3-4 STUDIES	MAXFEE	DEF	26				35.10	1/1/2013	12/31/2299	N
95908	NRV CNDJ TST 3-4 STUDIES	MAXFEE	DEF	TC				26.60	1/1/2013	12/31/2299	N
95908	NRV CNDJ TST 3-4 STUDIES	MAXFEE	DEF					61.69	1/1/2013	12/31/2299	N
95909	NRV CNDJ TST 5-6 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95909	NRV CNDJ TST 5-6 STUDIES	MAXFEE	DEF	26				41.86	1/1/2013	12/31/2299	N
95909	NRV CNDJ TST 5-6 STUDIES	MAXFEE	DEF	TC				32.10	1/1/2013	12/31/2299	N
95909	NRV CNDJ TST 5-6 STUDIES	MAXFEE	DEF					73.96	1/1/2013	12/31/2299	N
95910	NRV CNDJ TEST 7-8 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95910	NRV CNDJ TEST 7-8 STUDIES	MAXFEE	DEF	26				56.03	1/1/2013	12/31/2299	N
95910	NRV CNDJ TEST 7-8 STUDIES	MAXFEE	DEF	TC				41.37	1/1/2013	12/31/2299	N
95910	NRV CNDJ TEST 7-8 STUDIES	MAXFEE	DEF					97.40	1/1/2013	12/31/2299	N
95911	NRV CNDJ TEST 9-10 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95911	NRV CNDJ TEST 9-10 STUDIES	MAXFEE	DEF	26				69.79	1/1/2013	12/31/2299	N
95911	NRV CNDJ TEST 9-10 STUDIES	MAXFEE	DEF	TC				48.10	1/1/2013	12/31/2299	N
95911	NRV CNDJ TEST 9-10 STUDIES	MAXFEE	DEF					117.89	1/1/2013	12/31/2299	N
95912	NRV CNDJ TEST 11-12 STUDIES	PRXOVR	DEF					NA	NA	NA	N
95912	NRV CNDJ TEST 11-12 STUDIES	MAXFEE	DEF	26				83.96	1/1/2013	12/31/2299	N
95912	NRV CNDJ TEST 11-12 STUDIES	MAXFEE	DEF	TC				54.41	1/1/2013	12/31/2299	N
95912	NRV CNDJ TEST 11-12 STUDIES	MAXFEE	DEF					138.37	1/1/2013	12/31/2299	N
95913	NRV CNDJ TEST 13/> STUDIES	PRXOVR	DEF					NA	NA	NA	N
95913	NRV CNDJ TEST 13/> STUDIES	MAXFEE	DEF	TC				94.43	7/1/2019	12/31/2299	N
95913	NRV CNDJ TEST 13/> STUDIES	MAXFEE	DEF	26				141.65	7/1/2019	12/31/2299	N
95913	NRV CNDJ TEST 13/> STUDIES	MAXFEE	DEF					236.08	7/1/2019	12/31/2299	N
95937	NEUROMUSCULAR JUNCTION TEST	PRXOVR	DEF					NA	NA	NA	N
95937	NEUROMUSCULAR JUNCTION TEST	MAXFEE	DEF					33.82	1/1/2000	12/31/2299	N
95937	NEUROMUSCULAR JUNCTION TEST	MAXFEE	DEF	26				13.53	9/1/2013	12/31/2299	N
95937	NEUROMUSCULAR JUNCTION TEST	MAXFEE	DEF	TC				20.29	9/1/2013	12/31/2299	N
97001	PT EVALUATION	PRXOVR	DEF					NA	NA	NA	S
97001	PT EVALUATION	MAXFEE	DEF					NA			S
97002	PT RE-EVALUATION	PRXOVR	DEF					NA	NA	NA	S
97002	PT RE-EVALUATION	MAXFEE	DEF					NA			S
97003	OT EVALUATION	PRXOVR	DEF					NA	NA	NA	S
97003	OT EVALUATION	MAXFEE	DEF					NA			S
97004	OT RE-EVALUATION	PRXOVR	DEF					NA	NA	NA	S
97004	OT RE-EVALUATION	MAXFEE	DEF					NA			S
97012	MECHANICAL TRACTION THERAPY	PRXOVR	DEF					NA	NA	NA	S
97012	MECHANICAL TRACTION THERAPY	MAXFEE	DEF					12.13	1/1/2010	12/31/2299	S
97016	VASOPNEUMATIC DEVICE THERAPY	PRXOVR	DEF					NA	NA	NA	S
97016	VASOPNEUMATIC DEVICE THERAPY	MAXFEE	DEF					11.22	1/1/2010	12/31/2299	S
97018	PARAFFIN BATH THERAPY	PRXOVR	DEF					NA	NA	NA	S
97018	PARAFFIN BATH THERAPY	MAXFEE	DEF					4.81	1/1/2010	12/31/2299	S
97022	WHIRLPOOL THERAPY	PRXOVR	DEF					NA	NA	NA	S
97022	WHIRLPOOL THERAPY	MAXFEE	DEF					9.92	1/1/2010	12/31/2299	S
97024	DIATHERMY EG MICROWAVE	PRXOVR	DEF					NA	NA	NA	S
97024	DIATHERMY EG MICROWAVE	MAXFEE	DEF					4.07	1/1/2010	12/31/2299	S
97032	ELECTRICAL STIMULATION	PRXOVR	DEF					NA	NA	NA	S
97032	ELECTRICAL STIMULATION	MAXFEE	DEF					10.69	1/1/2010	12/31/2299	S
97034	CONTRAST BATH THERAPY	PRXOVR	DEF					NA	NA	NA	S
97034	CONTRAST BATH THERAPY	MAXFEE	DEF					8.87	1/1/2010	12/31/2299	S
97035	ULTRASOUND THERAPY	PRXOVR	DEF					NA	NA	NA	S
97035	ULTRASOUND THERAPY	MAXFEE	DEF					9.06	1/1/2010	12/31/2299	S
97036	HYDROTHERAPY	PRXOVR	DEF					NA	NA	NA	S
97036	HYDROTHERAPY	MAXFEE	DEF					14.02	1/1/2010	12/31/2299	S
97110	THERAPEUTIC EXERCISES	PRXOVR	DEF					NA	NA	NA	S
97110	THERAPEUTIC EXERCISES	MAXFEE	DEF					16.44	1/1/2010	12/31/2299	S
97124	MASSAGE THERAPY	PRXOVR	DEF					NA	NA	NA	S
97124	MASSAGE THERAPY	MAXFEE	DEF					13	1/1/2010	12/31/2299	S
97127	THER IVNTJ W/FOCUS COG FUNCJ	PRXOVR	DEF					NA	NA	NA	S
97127	THER IVNTJ W/FOCUS COG FUNCJ	MAXFEE	DEF					NA			S
97129	THER IVNTJ 1ST 15 MIN	PRXOVR	DEF					NA	NA	NA	S
97129	THER IVNTJ 1ST 15 MIN	MAXFEE	FAC					18.88	1/1/2020	12/31/2299	S
97129	THER IVNTJ 1ST 15 MIN	MAXFEE	NFF					19.15	1/1/2020	12/31/2299	S
97130	THER IVNTJ EA ADDL 15 MIN	PRXOVR	DEF					NA	NA	NA	S
97130	THER IVNTJ EA ADDL 15 MIN	MAXFEE	DEF					18.31	1/1/2020	12/31/2299	S
97140	MANUAL THERAPY 1/> REGIONS	PRXOVR	DEF					NA	NA	NA	S
97140	MANUAL THERAPY 1/> REGIONS	MAXFEE	DEF					15.36	1/1/2010	12/31/2299	S
97150	GROUP THERAPEUTIC PROCEDURES	PRXOVR	DEF					NA	NA	NA	S
97150	GROUP THERAPEUTIC PROCEDURES	MAXFEE	DEF					12.84	1/1/2010	12/31/2299	S
97161	PT EVAL LOW COMPLEX 20 MIN	PRXOVR	DEF					NA	NA	NA	S
97161	PT EVAL LOW COMPLEX 20 MIN	MAXFEE	DEF					63.15	1/1/2017	12/31/2299	S
97162	PT EVAL MOD COMPLEX 30 MIN	PRXOVR	DEF					NA	NA	NA	S
97162	PT EVAL MOD COMPLEX 30 MIN	MAXFEE	DEF					63.15	1/1/2017	12/31/2299	S
97163	PT EVAL HIGH COMPLEX 45 MIN	PRXOVR	DEF					NA	NA	NA	S
97163	PT EVAL HIGH COMPLEX 45 MIN	MAXFEE	DEF					63.15	1/1/2017	12/31/2299	S
97164	PT RE-EVAL EST PLAN CARE	PRXOVR	DEF					NA	NA	NA	S
97164	PT RE-EVAL EST PLAN CARE	MAXFEE	DEF					42.78	1/1/2017	12/31/2299	S
97165	OT EVAL LOW COMPLEX 30 MIN	PRXOVR	DEF					NA	NA	NA	S
97165	OT EVAL LOW COMPLEX 30 MIN	MAXFEE	DEF					61.31	1/1/2017	12/31/2299	S
97166	OT EVAL MOD COMPLEX 45 MIN	PRXOVR	DEF					NA	NA	NA	S
97166	OT EVAL MOD COMPLEX 45 MIN	MAXFEE	DEF					61.31	1/1/2017	12/31/2299	S
97167	OT EVAL HIGH COMPLEX 60 MIN	PRXOVR	DEF					NA	NA	NA	S
97167	OT EVAL HIGH COMPLEX 60 MIN	MAXFEE	DEF					61.31	1/1/2017	12/31/2299	S
97168	OT RE-EVAL EST PLAN CARE	PRXOVR	DEF					NA	NA	NA	S
97168	OT RE-EVAL EST PLAN CARE	MAXFEE	DEF					40.39	1/1/2017	12/31/2299	S
97530	THERAPEUTIC ACTIVITIES	PRXOVR	DEF					NA	NA	NA	S
97530	THERAPEUTIC ACTIVITIES	MAXFEE	DEF					17.64	1/1/2010	12/31/2299	S
97532	COGNITIVE SKILLS DEVELOPMENT	PRXOVR	DEF					NA	NA	NA	S
97532	COGNITIVE SKILLS DEVELOPMENT	MAXFEE	DEF					NA			S
97533	SENSORY INTEGRATION	PRXOVR	DEF					NA	NA	NA	S
97533	SENSORY INTEGRATION	MAXFEE	DEF					21.38	1/1/2010	12/31/2299	S
97535	SELF CARE MNGMENT TRAINING	PRXOVR	DEF					NA	NA	NA	S
97535	SELF CARE MNGMENT TRAINING	MAXFEE	DEF					21.39	1/1/2010	12/31/2299	S
97537	COMMUNITY/WORK REINTEGRATION	PRXOVR	DEF					NA	NA	NA	S
97537	COMMUNITY/WORK REINTEGRATION	MAXFEE	DEF					19.46	1/1/2010	12/31/2299	S
97597	RMVL DEVITAL TIS 20 CM/<	PRXOVR	DEF					NA	NA	NA	S
97597	RMVL DEVITAL TIS 20 CM/<	MAXFEE	FAC					9.90	1/1/2014	12/31/2299	S
97597	RMVL DEVITAL TIS 20 CM/<	MAXFEE	NFF					36.76	1/1/2014	12/31/2299	S
97598	RMVL DEVITAL TIS ADDL 20CM/<	PRXOVR	DEF					NA	NA	NA	S
97598	RMVL DEVITAL TIS ADDL 20CM/<	MAXFEE	FAC					10.19	1/1/2014	12/31/2299	S
97598	RMVL DEVITAL TIS ADDL 20CM/<	MAXFEE	NFF					23.77	1/1/2014	12/31/2299	S
97605	NEG PRESS WOUND TX <=50 CM	PRXOVR	DEF					NA	NA	NA	N
97605	NEG PRESS WOUND TX <=50 CM	MAXFEE	FAC					20.65	12/31/2014	12/31/2299	N
97605	NEG PRESS WOUND TX <=50 CM	MAXFEE	NFF					31.31	12/31/2014	12/31/2299	N
97606	NEG PRESS WOUND TX >50 CM	PRXOVR	DEF					NA	NA	NA	N
97606	NEG PRESS WOUND TX >50 CM	MAXFEE	FAC					22.84	12/31/2014	12/31/2299	N
97606	NEG PRESS WOUND TX >50 CM	MAXFEE	NFF					33.50	12/31/2014	12/31/2299	N
97607	NEG PRESS WND TX <=50 SQ CM	PRXOVR	DEF					NA	NA	NA	N
97607	NEG PRESS WND TX <=50 SQ CM	MAXFEE	FAC					20.65	1/1/2015	12/31/2299	N
97607	NEG PRESS WND TX <=50 SQ CM	MAXFEE	NFF					31.31	1/1/2015	12/31/2299	N
97608	NEG PRESS WOUND TX >50 CM	PRXOVR	DEF					NA	NA	NA	N
97608	NEG PRESS WOUND TX >50 CM	MAXFEE	FAC					22.84	1/1/2015	12/31/2299	N
97608	NEG PRESS WOUND TX >50 CM	MAXFEE	NFF					33.50	1/1/2015	12/31/2299	N
97750	PHYSICAL PERFORMANCE TEST	PRXOVR	DEF					NA	NA	NA	S
97750	PHYSICAL PERFORMANCE TEST	MAXFEE	DEF					18.47	1/1/2010	12/31/2299	S
97755	ASSISTIVE TECHNOLOGY ASSESS	PRXOVR	DEF					NA	NA	NA	S
97755	ASSISTIVE TECHNOLOGY ASSESS	MAXFEE	DEF					24.81	1/1/2010	12/31/2299	S
97760	ORTHOTIC MGMT&TRAING 1ST ENC	PRXOVR	DEF					NA	NA	NA	S
97760	ORTHOTIC MGMT&TRAING 1ST ENC	MAXFEE	DEF					29.97	12/31/2014	12/31/2299	S
97761	PROSTHETIC TRAING 1ST ENC	PRXOVR	DEF					NA	NA	NA	S
97761	PROSTHETIC TRAING 1ST ENC	MAXFEE	DEF					20.50	1/1/2010	12/31/2299	S
97762	C/O FOR ORTHOTIC/PROSTH USE	PRXOVR	DEF					NA	NA	NA	S
97762	C/O FOR ORTHOTIC/PROSTH USE	MAXFEE	DEF					NA			S
97763	ORTHC/PROSTC MGMT SBSQ ENC	PRXOVR	DEF					NA	NA	NA	S
97763	ORTHC/PROSTC MGMT SBSQ ENC	MAXFEE	DEF					37.24	1/1/2018	12/31/2299	S
99051	MED SERV EVE/WKEND/HOLIDAY	PRXOVR	DEF					NA	NA	NA	N
99051	MED SERV EVE/WKEND/HOLIDAY	MAXFEE	DEF					22	4/1/2006	12/31/2299	N
99183	HYPERBARIC OXYGEN THERAPY	PRXOVR	DEF					NA	NA	NA	N
99183	HYPERBARIC OXYGEN THERAPY	MAXFEE	FAC					41.86	1/1/2014	12/31/2299	N
99183	HYPERBARIC OXYGEN THERAPY	MAXFEE	NFF					93.83	1/1/2014	12/31/2299	N
99202	OFFICE O/P NEW SF 15-29 MIN	PRXOVR	DEF					NA	NA	NA	N
99202	OFFICE O/P NEW SF 15-29 MIN	MAXFEE	FAC					20.84	1/1/2016	12/31/2299	N
99202	OFFICE O/P NEW SF 15-29 MIN	MAXFEE	NFF					38.93	1/1/2016	12/31/2299	N
99203	OFFICE O/P NEW LOW 30-44 MIN	PRXOVR	DEF					NA	NA	NA	N
99203	OFFICE O/P NEW LOW 30-44 MIN	MAXFEE	FAC					32.94	1/1/2016	12/31/2299	N
99203	OFFICE O/P NEW LOW 30-44 MIN	MAXFEE	NFF					57.76	1/1/2016	12/31/2299	N
99204	OFFICE O/P NEW MOD 45-59 MIN	PRXOVR	DEF					NA	NA	NA	N
99204	OFFICE O/P NEW MOD 45-59 MIN	MAXFEE	FAC					56.15	1/1/2016	12/31/2299	N
99204	OFFICE O/P NEW MOD 45-59 MIN	MAXFEE	NFF					88.07	1/1/2016	12/31/2299	N
99205	OFFICE O/P NEW HI 60-74 MIN	PRXOVR	DEF					NA	NA	NA	N
99205	OFFICE O/P NEW HI 60-74 MIN	MAXFEE	FAC					72.01	1/1/2016	12/31/2299	N
99205	OFFICE O/P NEW HI 60-74 MIN	MAXFEE	NFF					110.67	1/1/2016	12/31/2299	N
99211	OFF/OP EST MAY X REQ PHY/QHP	PRXOVR	DEF					NA	NA	NA	N
99211	OFF/OP EST MAY X REQ PHY/QHP	MAXFEE	FAC					5.55	1/1/2016	12/31/2299	N
99211	OFF/OP EST MAY X REQ PHY/QHP	MAXFEE	NFF					14.50	1/1/2016	12/31/2299	N
99212	OFFICE O/P EST SF 10-19 MIN	PRXOVR	DEF					NA	NA	NA	N
99212	OFFICE O/P EST SF 10-19 MIN	MAXFEE	FAC					12.81	1/1/2016	12/31/2299	N
99212	OFFICE O/P EST SF 10-19 MIN	MAXFEE	NFF					26.73	1/1/2016	12/31/2299	N
99213	OFFICE O/P EST LOW 20-29 MIN	PRXOVR	DEF					NA	NA	NA	N
99213	OFFICE O/P EST LOW 20-29 MIN	MAXFEE	FAC					24.85	1/1/2016	12/31/2299	N
99213	OFFICE O/P EST LOW 20-29 MIN	MAXFEE	NFF					43.61	1/1/2016	12/31/2299	N
99214	OFFICE O/P EST MOD 30-39 MIN	PRXOVR	DEF					NA	NA	NA	N
99214	OFFICE O/P EST MOD 30-39 MIN	MAXFEE	FAC					39.90	1/1/2016	12/31/2299	N
99214	OFFICE O/P EST MOD 30-39 MIN	MAXFEE	NFF					66.14	1/1/2016	12/31/2299	N
99215	OFFICE O/P EST HI 40-54 MIN	PRXOVR	DEF					NA	NA	NA	N
99215	OFFICE O/P EST HI 40-54 MIN	MAXFEE	FAC					57.36	1/1/2016	12/31/2299	N
99215	OFFICE O/P EST HI 40-54 MIN	MAXFEE	NFF					89.63	1/1/2016	12/31/2299	N
99221	1ST HOSP IP/OBS SF/LOW 40	PRXOVR	DEF					NA	NA	NA	N
99221	1ST HOSP IP/OBS SF/LOW 40	MAXFEE	DEF					37.61	7/1/2008	12/31/2299	N
99222	1ST HOSP IP/OBS MODERATE 55	PRXOVR	DEF					NA	NA	NA	N
99222	1ST HOSP IP/OBS MODERATE 55	MAXFEE	DEF					55.71	1/1/2000	12/31/2299	N
99223	1ST HOSP IP/OBS HIGH 75	PRXOVR	DEF					NA	NA	NA	N
99223	1ST HOSP IP/OBS HIGH 75	MAXFEE	DEF					76.84	7/1/2008	12/31/2299	N
99231	SBSQ HOSP IP/OBS SF/LOW 25	PRXOVR	DEF					NA	NA	NA	N
99231	SBSQ HOSP IP/OBS SF/LOW 25	MAXFEE	DEF					17.49	1/1/2000	12/31/2299	N
99232	SBSQ HOSP IP/OBS MODERATE 35	PRXOVR	DEF					NA	NA	NA	N
99232	SBSQ HOSP IP/OBS MODERATE 35	MAXFEE	DEF					28.18	7/1/2008	12/31/2299	N
99233	SBSQ HOSP IP/OBS HIGH 50	PRXOVR	DEF					NA	NA	NA	N
99233	SBSQ HOSP IP/OBS HIGH 50	MAXFEE	DEF					40.28	7/1/2008	12/31/2299	N
99238	HOSP IP/OBS DSCHRG MGMT 30/<	PRXOVR	DEF					NA	NA	NA	N
99238	HOSP IP/OBS DSCHRG MGMT 30/<	MAXFEE	DEF					31.62	1/1/2000	12/31/2299	N
99241	OFFICE CONSULTATION	PRXOVR	DEF					NA	NA	NA	N
99241	OFFICE CONSULTATION	MAXFEE	DEF					NA			N
99242	OFF/OP CONSLTJ NEW/EST SF 20	PRXOVR	DEF					NA	NA	NA	N
99242	OFF/OP CONSLTJ NEW/EST SF 20	MAXFEE	FAC					23.66	1/1/2014	12/31/2299	N
99242	OFF/OP CONSLTJ NEW/EST SF 20	MAXFEE	NFF					39	1/1/2014	12/31/2299	N
99243	OFF/OP CNSLTJ NEW/EST LOW 30	PRXOVR	DEF					NA	NA	NA	N
99243	OFF/OP CNSLTJ NEW/EST LOW 30	MAXFEE	FAC					32.90	1/1/2014	12/31/2299	N
99243	OFF/OP CNSLTJ NEW/EST LOW 30	MAXFEE	NFF					53.41	1/1/2014	12/31/2299	N
99244	OFF/OP CNSLTJ NEW/EST MOD 40	PRXOVR	DEF					NA	NA	NA	N
99244	OFF/OP CNSLTJ NEW/EST MOD 40	MAXFEE	FAC					51.82	1/1/2014	12/31/2299	N
99244	OFF/OP CNSLTJ NEW/EST MOD 40	MAXFEE	NFF					78.63	1/1/2014	12/31/2299	N
99245	OFF/OP CONSLTJ NEW/EST HI 55	PRXOVR	DEF					NA	NA	NA	N
99245	OFF/OP CONSLTJ NEW/EST HI 55	MAXFEE	FAC					66.28	1/1/2014	12/31/2299	N
99245	OFF/OP CONSLTJ NEW/EST HI 55	MAXFEE	NFF					97.57	1/1/2014	12/31/2299	N
99251	INPATIENT CONSULTATION	PRXOVR	DEF					NA	NA	NA	N
99251	INPATIENT CONSULTATION	MAXFEE	DEF					NA			N
99252	IP/OBS CONSLTJ NEW/EST SF 35	PRXOVR	DEF					NA	NA	NA	N
99252	IP/OBS CONSLTJ NEW/EST SF 35	MAXFEE	DEF					36.96	1/1/2000	12/31/2299	N
99253	IP/OBS CNSLTJ NEW/EST LOW 45	PRXOVR	DEF					NA	NA	NA	N
99253	IP/OBS CNSLTJ NEW/EST LOW 45	MAXFEE	DEF					49.25	1/1/2000	12/31/2299	N
99254	IP/OBS CNSLTJ NEW/EST MOD 60	PRXOVR	DEF					NA	NA	NA	N
99254	IP/OBS CNSLTJ NEW/EST MOD 60	MAXFEE	DEF					69.17	7/1/2008	12/31/2299	N
99255	IP/OBS CONSLTJ NEW/EST HI 80	PRXOVR	DEF					NA	NA	NA	N
99255	IP/OBS CONSLTJ NEW/EST HI 80	MAXFEE	DEF					92.32	1/1/2000	12/31/2299	N
99304	1ST NF CARE SF/LOW MDM 25	PRXOVR	DEF					NA	NA	NA	N
99304	1ST NF CARE SF/LOW MDM 25	MAXFEE	DEF					34.05	7/1/2008	12/31/2299	N
99305	1ST NF CARE MODERATE MDM 35	PRXOVR	DEF					NA	NA	NA	N
99305	1ST NF CARE MODERATE MDM 35	MAXFEE	DEF					45.28	7/1/2008	12/31/2299	N
99306	1ST NF CARE HIGH MDM 45	PRXOVR	DEF					NA	NA	NA	N
99306	1ST NF CARE HIGH MDM 45	MAXFEE	DEF					55.71	1/1/2006	12/31/2299	N
99307	SBSQ NF CARE SF MDM 10	PRXOVR	DEF					NA	NA	NA	N
99307	SBSQ NF CARE SF MDM 10	MAXFEE	DEF					18.11	7/1/2008	12/31/2299	N
99308	SBSQ NF CARE LOW MDM 15	PRXOVR	DEF					NA	NA	NA	N
99308	SBSQ NF CARE LOW MDM 15	MAXFEE	DEF					29.76	7/1/2008	12/31/2299	N
99309	SBSQ NF CARE MODERATE MDM 30	PRXOVR	DEF					NA	NA	NA	N
99309	SBSQ NF CARE MODERATE MDM 30	MAXFEE	DEF					41.58	7/1/2008	12/31/2299	N
99310	SBSQ NF CARE HIGH MDM 45	PRXOVR	DEF					NA	NA	NA	N
99310	SBSQ NF CARE HIGH MDM 45	MAXFEE	DEF					51.54	7/1/2008	12/31/2299	N
99311	NURSING FAC CARE; SUBSEQ	PRXOVR	DEF					NA	NA	NA	N
99311	NURSING FAC CARE; SUBSEQ	MAXFEE	DEF					NA			N
99313	NURSING FAC CARE; SUBSEQ	PRXOVR	DEF					NA	NA	NA	N
99313	NURSING FAC CARE; SUBSEQ	MAXFEE	DEF					NA			N
99324	DOMICIL/R-HOME VISIT NEW PAT	PRXOVR	DEF					NA	NA	NA	N
99324	DOMICIL/R-HOME VISIT NEW PAT	MAXFEE	DEF					NA			N
99325	DOMICIL/R-HOME VISIT NEW PAT	PRXOVR	DEF					NA	NA	NA	N
99325	DOMICIL/R-HOME VISIT NEW PAT	MAXFEE	DEF					NA			N
99326	DOMICIL/R-HOME VISIT NEW PAT	PRXOVR	DEF					NA	NA	NA	N
99326	DOMICIL/R-HOME VISIT NEW PAT	MAXFEE	DEF					NA			N
99327	DOMICIL/R-HOME VISIT NEW PAT	PRXOVR	DEF					NA	NA	NA	N
99327	DOMICIL/R-HOME VISIT NEW PAT	MAXFEE	DEF					NA			N
99328	DOMICIL/R-HOME VISIT NEW PAT	PRXOVR	DEF					NA	NA	NA	N
99328	DOMICIL/R-HOME VISIT NEW PAT	MAXFEE	DEF					NA			N
99334	DOMICIL/R-HOME VISIT EST PAT	PRXOVR	DEF					NA	NA	NA	N
99334	DOMICIL/R-HOME VISIT EST PAT	MAXFEE	DEF					NA			N
99335	DOMICIL/R-HOME VISIT EST PAT	PRXOVR	DEF					NA	NA	NA	N
99335	DOMICIL/R-HOME VISIT EST PAT	MAXFEE	DEF					NA			N
99336	DOMICIL/R-HOME VISIT EST PAT	PRXOVR	DEF					NA	NA	NA	N
99336	DOMICIL/R-HOME VISIT EST PAT	MAXFEE	DEF					NA			N
99337	DOMICIL/R-HOME VISIT EST PAT	PRXOVR	DEF					NA	NA	NA	N
99337	DOMICIL/R-HOME VISIT EST PAT	MAXFEE	DEF					NA			N
99341	HOME/RES VST NEW SF MDM 15	PRXOVR	DEF					NA	NA	NA	N
99341	HOME/RES VST NEW SF MDM 15	MAXFEE	DEF					38.08	1/1/2000	12/31/2299	N
99342	HOME/RES VST NEW LOW MDM 30	PRXOVR	DEF					NA	NA	NA	N
99342	HOME/RES VST NEW LOW MDM 30	MAXFEE	DEF					52.98	1/1/2000	12/31/2299	N
99343	HOME VISIT NEW PATIENT	PRXOVR	DEF					NA	NA	NA	N
99343	HOME VISIT NEW PATIENT	MAXFEE	DEF					NA			N
99344	HOME/RES VST NEW MOD MDM 60	PRXOVR	DEF					NA	NA	NA	N
99344	HOME/RES VST NEW MOD MDM 60	MAXFEE	DEF					98.21	1/1/2000	12/31/2299	N
99345	HOME/RES VST NEW HIGH MDM 75	PRXOVR	DEF					NA	NA	NA	N
99345	HOME/RES VST NEW HIGH MDM 75	MAXFEE	DEF					118.60	7/1/2008	12/31/2299	N
99347	HOME/RES VST EST SF MDM 20	PRXOVR	DEF					NA	NA	NA	N
99347	HOME/RES VST EST SF MDM 20	MAXFEE	DEF					29.81	1/1/2000	12/31/2299	N
99348	HOME/RES VST EST LOW MDM 30	PRXOVR	DEF					NA	NA	NA	N
99348	HOME/RES VST EST LOW MDM 30	MAXFEE	DEF					44.64	1/1/2000	12/31/2299	N
99349	HOME/RES VST EST MOD MDM 40	PRXOVR	DEF					NA	NA	NA	N
99349	HOME/RES VST EST MOD MDM 40	MAXFEE	DEF					66.16	1/1/2000	12/31/2299	N
99350	HOME/RES VST EST HIGH MDM 60	PRXOVR	DEF					NA	NA	NA	N
99350	HOME/RES VST EST HIGH MDM 60	MAXFEE	DEF					96.09	7/1/2008	12/31/2299	N
99415	PROLNG CLIN STAFF SVC 1ST HR	PRXOVR	DEF					NA	NA	NA	N
99415	PROLNG CLIN STAFF SVC 1ST HR	MAXFEE	DEF					7.38	7/1/2021	12/31/2299	N
99416	PROLNG CLIN STAFF SVC EA ADD	PRXOVR	DEF					NA	NA	NA	N
99416	PROLNG CLIN STAFF SVC EA ADD	MAXFEE	DEF					3.79	7/1/2021	12/31/2299	N
99417	PROLNG OP E/M EACH 15 MIN	PRXOVR	DEF					NA	NA	NA	N
99417	PROLNG OP E/M EACH 15 MIN	MAXFEE	FAC					21.58	1/1/2021	12/31/2299	N
99417	PROLNG OP E/M EACH 15 MIN	MAXFEE	NFF					22.48	1/1/2021	12/31/2299	N
99418	PROLNG IP/OBS E/M EA 15 MIN	PRXOVR	DEF					NA	NA	NA	N
99418	PROLNG IP/OBS E/M EA 15 MIN	MAXFEE	DEF					30.03	1/1/2023	12/31/2299	N
99421	OL DIG E/M SVC 5-10 MIN	PRXOVR	DEF					NA	NA	NA	N
99421	OL DIG E/M SVC 5-10 MIN	MAXFEE	FAC					10.41	3/9/2020	12/31/2299	N
99421	OL DIG E/M SVC 5-10 MIN	MAXFEE	NFF					11.99	3/9/2020	12/31/2299	N
99422	OL DIG E/M SVC 11-20 MIN	PRXOVR	DEF					NA	NA	NA	N
99422	OL DIG E/M SVC 11-20 MIN	MAXFEE	FAC					21.38	3/9/2020	12/31/2299	N
99422	OL DIG E/M SVC 11-20 MIN	MAXFEE	NFF					24.02	3/9/2020	12/31/2299	N
99423	OL DIG E/M SVC 21+ MIN	PRXOVR	DEF					NA	NA	NA	N
99423	OL DIG E/M SVC 21+ MIN	MAXFEE	FAC					34.06	3/9/2020	12/31/2299	N
99423	OL DIG E/M SVC 21+ MIN	MAXFEE	NFF					38.81	3/9/2020	12/31/2299	N
99441	PHONE E/M PHYS/QHP 5-10 MIN	PRXOVR	DEF					NA	NA	NA	N
99441	PHONE E/M PHYS/QHP 5-10 MIN	MAXFEE	DEF					0	1/1/2008	12/31/2299	N
99442	PHONE E/M PHYS/QHP 11-20 MIN	PRXOVR	DEF					NA	NA	NA	N
99442	PHONE E/M PHYS/QHP 11-20 MIN	MAXFEE	DEF					0	1/1/2008	12/31/2299	N
A2001	INNOVAMATRIX AC; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2001	INNOVAMATRIX AC; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2002	MIRRAGEN ADV WND MAT PER SQ	PRXOVR	DEF					NA	NA	NA	N
A2002	MIRRAGEN ADV WND MAT PER SQ	MANUAL	DEF					NA	NA	NA	N
A2004	XCELLISTEM; 1 MG	PRXOVR	DEF					NA	NA	NA	N
A2004	XCELLISTEM; 1 MG	MANUAL	DEF					NA	NA	NA	N
A2005	MICROLYTE MATRIX; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2005	MICROLYTE MATRIX; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2006	NOVOSORB SYNPATH PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2006	NOVOSORB SYNPATH PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2007	RESTRATA; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2007	RESTRATA; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2008	THERAGENESIS; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2008	THERAGENESIS; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2009	SYMPHONY; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2009	SYMPHONY; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2010	APIS; PER SQUARE CENTIMETER	PRXOVR	DEF					NA	NA	NA	N
A2010	APIS; PER SQUARE CENTIMETER	MANUAL	DEF					NA	NA	NA	N
A2011	SUPRA SDRM; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2011	SUPRA SDRM; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2012	SUPRATHEL; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2012	SUPRATHEL; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2013	INNOVAMATRIX FS; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2013	INNOVAMATRIX FS; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2014	OMEZA COLLAG PER 100 MG	PRXOVR	DEF					NA	NA	NA	N
A2014	OMEZA COLLAG PER 100 MG	MANUAL	DEF					NA	NA	NA	N
A2015	PHOENIX WND MTRX; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2015	PHOENIX WND MTRX; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2016	PERMEADERM B; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2016	PERMEADERM B; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2017	PERMEADERM GLOVE; EACH	PRXOVR	DEF					NA	NA	NA	N
A2017	PERMEADERM GLOVE; EACH	MANUAL	DEF					NA	NA	NA	N
A2018	PERMEADERM C; PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2018	PERMEADERM C; PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A2019	KERECIS MARIGEN SHLD SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2019	KERECIS MARIGEN SHLD SQ CM	MANUAL	DEF					NA	NA	NA	N
A2020	AC5 WOUND SYSTEM	PRXOVR	DEF					NA	NA	NA	N
A2020	AC5 WOUND SYSTEM	MANUAL	DEF					NA	NA	NA	N
A2021	NEOMATRIX PER SQ CM	PRXOVR	DEF					NA	NA	NA	N
A2021	NEOMATRIX PER SQ CM	MANUAL	DEF					NA	NA	NA	N
A4100	SKIN SUB FDA CLRD AS DEV NOS	PRXOVR	DEF					NA	NA	NA	N
A4100	SKIN SUB FDA CLRD AS DEV NOS	MANUAL	DEF					NA	NA	NA	N
G0316	PROLONG INPT EVAL ADD15 M	PRXOVR	DEF					NA	NA	NA	N
G0316	PROLONG INPT EVAL ADD15 M	MAXFEE	FAC					23.29	1/1/2023	12/31/2299	N
G0316	PROLONG INPT EVAL ADD15 M	MAXFEE	NFF					24.25	1/1/2023	12/31/2299	N
G0317	PROLONG NURSIN FAC EVAL 15M	PRXOVR	DEF					NA	NA	NA	N
G0317	PROLONG NURSIN FAC EVAL 15M	MAXFEE	FAC					23.29	1/1/2023	12/31/2299	N
G0317	PROLONG NURSIN FAC EVAL 15M	MAXFEE	NFF					24.25	1/1/2023	12/31/2299	N
G0318	PROLONG HOME EVAL ADD 15M	PRXOVR	DEF					NA	NA	NA	N
G0318	PROLONG HOME EVAL ADD 15M	MAXFEE	FAC					22.81	1/1/2023	12/31/2299	N
G0318	PROLONG HOME EVAL ADD 15M	MAXFEE	NFF					23.77	1/1/2023	12/31/2299	N
G0406	INPT/TELE FOLLOW UP 15	PRXOVR	DEF					NA	NA	NA	N
G0406	INPT/TELE FOLLOW UP 15	MAXFEE	DEF					30.94	3/9/2020	12/31/2299	N
G0407	INPT/TELE FOLLOW UP 25	PRXOVR	DEF					NA	NA	NA	N
G0407	INPT/TELE FOLLOW UP 25	MAXFEE	DEF					57.02	3/9/2020	12/31/2299	N
G0408	INPT/TELE FOLLOW UP 35	PRXOVR	DEF					NA	NA	NA	N
G0408	INPT/TELE FOLLOW UP 35	MAXFEE	DEF					82.01	3/9/2020	12/31/2299	N
G0425	INPT/ED TELECONSULT30	PRXOVR	DEF					NA	NA	NA	N
G0425	INPT/ED TELECONSULT30	MAXFEE	DEF					79.27	3/9/2020	12/31/2299	N
G0426	INPT/ED TELECONSULT50	PRXOVR	DEF					NA	NA	NA	N
G0426	INPT/ED TELECONSULT50	MAXFEE	DEF					107.60	3/9/2020	12/31/2299	N
G0427	INPT/ED TELECONSULT70	PRXOVR	DEF					NA	NA	NA	N
G0427	INPT/ED TELECONSULT70	MAXFEE	DEF					159.60	3/9/2020	12/31/2299	N
G0515	COGNITIVE SKILLS DEVELOPMENT	PRXOVR	DEF					NA	NA	NA	S
G0515	COGNITIVE SKILLS DEVELOPMENT	MAXFEE	DEF					NA			S
G0913	IMPROVE VISUAL FUNCT	PRXOVR	DEF					NA	NA	NA	N
G0913	IMPROVE VISUAL FUNCT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G0914	SURVEY NOT COMPLETE	PRXOVR	DEF					NA	NA	NA	N
G0914	SURVEY NOT COMPLETE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G0915	NO IMPROVE VISUAL FUNCT	PRXOVR	DEF					NA	NA	NA	N
G0915	NO IMPROVE VISUAL FUNCT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G0916	SATISFY WITH CARE	PRXOVR	DEF					NA	NA	NA	N
G0916	SATISFY WITH CARE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G0917	CARE SURVEY NOT COMPLETE	PRXOVR	DEF					NA	NA	NA	N
G0917	CARE SURVEY NOT COMPLETE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G0918	NO SATISFY WITH CARE	PRXOVR	DEF					NA	NA	NA	N
G0918	NO SATISFY WITH CARE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G2010	REMOT IMAGE SUBMIT BY PT	PRXOVR	DEF					NA	NA	NA	N
G2010	REMOT IMAGE SUBMIT BY PT	MAXFEE	FAC					7.30	3/9/2020	12/31/2299	N
G2010	REMOT IMAGE SUBMIT BY PT	MAXFEE	NFF					9.42	3/9/2020	12/31/2299	N
G2012	BRIEF CHECK IN BY MD/QHP	PRXOVR	DEF					NA	NA	NA	N
G2012	BRIEF CHECK IN BY MD/QHP	MAXFEE	FAC					10.41	3/9/2020	12/31/2299	N
G2012	BRIEF CHECK IN BY MD/QHP	MAXFEE	NFF					11.46	3/9/2020	12/31/2299	N
G2212	PROLONG OUTPT/OFFICE VIS	PRXOVR	DEF					NA	NA	NA	N
G2212	PROLONG OUTPT/OFFICE VIS	MAXFEE	FAC					21.58	1/1/2021	12/31/2299	N
G2212	PROLONG OUTPT/OFFICE VIS	MAXFEE	NFF					22.48	1/1/2021	12/31/2299	N
G8395	LVEF>=40% DOC NORMAL OR MILD	PRXOVR	DEF					NA	NA	NA	N
G8395	LVEF>=40% DOC NORMAL OR MILD	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8396	LVEF NOT PERFORMED	PRXOVR	DEF					NA	NA	NA	N
G8396	LVEF NOT PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8397	DIL MACULA/FUNDUS EXAM/W DOC	PRXOVR	DEF					NA	NA	NA	N
G8397	DIL MACULA/FUNDUS EXAM/W DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8398	DIL MACULAR/FUNDUS NOT PERFO	PRXOVR	DEF					NA	NA	NA	N
G8398	DIL MACULAR/FUNDUS NOT PERFO	MAXFEE	DEF					NA			N
G8399	PT W/DXA RESULTS DOCUMENT	PRXOVR	DEF					NA	NA	NA	N
G8399	PT W/DXA RESULTS DOCUMENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8400	PT W/DXA NO RESULTS DOC	PRXOVR	DEF					NA	NA	NA	N
G8400	PT W/DXA NO RESULTS DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8404	LOW EXTEMITY NEUR EXAM DOCUM	PRXOVR	DEF					NA	NA	NA	N
G8404	LOW EXTEMITY NEUR EXAM DOCUM	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8405	LOW EXTEMITY NEUR NOT PERFOR	PRXOVR	DEF					NA	NA	NA	N
G8405	LOW EXTEMITY NEUR NOT PERFOR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8410	EVAL ON FOOT DOCUMENTED	PRXOVR	DEF					NA	NA	NA	N
G8410	EVAL ON FOOT DOCUMENTED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8415	EVAL ON FOOT NOT PERFORMED	PRXOVR	DEF					NA	NA	NA	N
G8415	EVAL ON FOOT NOT PERFORMED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8416	PT INELIG FOOTWEAR EVALUATIO	PRXOVR	DEF					NA	NA	NA	N
G8416	PT INELIG FOOTWEAR EVALUATIO	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8417	CALC BMI ABV UP PARAM F/U	PRXOVR	DEF					NA	NA	NA	N
G8417	CALC BMI ABV UP PARAM F/U	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
G8418	CALC BMI BLW LOW PARAM F/U	PRXOVR	DEF					NA	NA	NA	N
G8418	CALC BMI BLW LOW PARAM F/U	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
G8419	CALC BMI OUT NRM PARAM NOF/U	PRXOVR	DEF					NA	NA	NA	N
G8419	CALC BMI OUT NRM PARAM NOF/U	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
G8420	CALC BMI NORM PARAMETERS	PRXOVR	DEF					NA	NA	NA	N
G8420	CALC BMI NORM PARAMETERS	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
G8421	BMI NOT CALCULATED	PRXOVR	DEF					NA	NA	NA	N
G8421	BMI NOT CALCULATED	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8422	PT INELIG BMI CALCULATION	PRXOVR	DEF					NA	NA	NA	N
G8422	PT INELIG BMI CALCULATION	MAXFEE	DEF					NA			N
G8427	DOCREV CUR MEDS BY ELIG CLIN	PRXOVR	DEF					NA	NA	NA	N
G8427	DOCREV CUR MEDS BY ELIG CLIN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8428	CUR MEDS NOT DOCUMENT	PRXOVR	DEF					NA	NA	NA	N
G8428	CUR MEDS NOT DOCUMENT	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8430	DOC MED RSN NO MEDREC	PRXOVR	DEF					NA	NA	NA	N
G8430	DOC MED RSN NO MEDREC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8431	POS CLIN DEPRES SCRN F/U DOC	PRXOVR	DEF					NA	NA	NA	N
G8431	POS CLIN DEPRES SCRN F/U DOC	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
G8432	DEP SCR NOT DOC; RNG	PRXOVR	DEF					NA	NA	NA	N
G8432	DEP SCR NOT DOC; RNG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8433	SCR FOR DEP NOT CPT DOC RSN	PRXOVR	DEF					NA	NA	NA	N
G8433	SCR FOR DEP NOT CPT DOC RSN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8442	DOC PAIN AS NT PERF; NOT ELG	PRXOVR	DEF					NA	NA	NA	N
G8442	DOC PAIN AS NT PERF; NOT ELG	MAXFEE	DEF					NA			N
G8450	BETA-BLOC RX PT W/ABN LVEF	PRXOVR	DEF					NA	NA	NA	N
G8450	BETA-BLOC RX PT W/ABN LVEF	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8451	PT W/ABN LVEF INELIG B-BLOC	PRXOVR	DEF					NA	NA	NA	N
G8451	PT W/ABN LVEF INELIG B-BLOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8452	PT W/ABN LVEF B-BLOC NO RX	PRXOVR	DEF					NA	NA	NA	N
G8452	PT W/ABN LVEF B-BLOC NO RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8465	HIGH RISK RECURRENCE PRO CA	PRXOVR	DEF					NA	NA	NA	N
G8465	HIGH RISK RECURRENCE PRO CA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8473	ACE/ARB THXPY RX'D	PRXOVR	DEF					NA	NA	NA	N
G8473	ACE/ARB THXPY RX'D	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8474	ACE/ARB NOT RX'D; DOC REAS	PRXOVR	DEF					NA	NA	NA	N
G8474	ACE/ARB NOT RX'D; DOC REAS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8475	ACE/ARB THXPY NOT RX'D	PRXOVR	DEF					NA	NA	NA	N
G8475	ACE/ARB THXPY NOT RX'D	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8476	BP SYS <140 AND DIAS <90	PRXOVR	DEF					NA	NA	NA	N
G8476	BP SYS <140 AND DIAS <90	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8477	BP SYS>=140 AND/OR DIAS >=90	PRXOVR	DEF					NA	NA	NA	N
G8477	BP SYS>=140 AND/OR DIAS >=90	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8478	BP NOT PERFORMED/DOC	PRXOVR	DEF					NA	NA	NA	N
G8478	BP NOT PERFORMED/DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8482	FLU IMMUNIZE ORDER/ADMIN	PRXOVR	DEF					NA	NA	NA	N
G8482	FLU IMMUNIZE ORDER/ADMIN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8483	FLU IMM NO ADMIN DOC REA	PRXOVR	DEF					NA	NA	NA	N
G8483	FLU IMM NO ADMIN DOC REA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8484	FLU IMMUNIZE NO ADMIN	PRXOVR	DEF					NA	NA	NA	N
G8484	FLU IMMUNIZE NO ADMIN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8506	PT REC ACE/ARB	PRXOVR	DEF					NA	NA	NA	N
G8506	PT REC ACE/ARB	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8509	POS PAIN ASSESS NO F/U DOC	PRXOVR	DEF					NA	NA	NA	N
G8509	POS PAIN ASSESS NO F/U DOC	MAXFEE	DEF					NA			N
G8510	SCR DEP NEG; NO PLAN REQD	PRXOVR	DEF					NA	NA	NA	N
G8510	SCR DEP NEG; NO PLAN REQD	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
G8511	SCR DEP POS; NO PLAN DOC RNG	PRXOVR	DEF					NA	NA	NA	N
G8511	SCR DEP POS; NO PLAN DOC RNG	MAXFEE	DEF					0	10/1/2012	12/31/2299	N
G8535	ELD MALTREATMENT NOT DOC	PRXOVR	DEF					NA	NA	NA	N
G8535	ELD MALTREATMENT NOT DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8536	NO DOC ELDER MAL SCRN	PRXOVR	DEF					NA	NA	NA	N
G8536	NO DOC ELDER MAL SCRN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8539	DOC FUNCT AND CARE PLAN	PRXOVR	DEF					NA	NA	NA	N
G8539	DOC FUNCT AND CARE PLAN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8540	FOA NOT DOC AS BEING PERF	PRXOVR	DEF					NA	NA	NA	N
G8540	FOA NOT DOC AS BEING PERF	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8541	NO DOC CUR FUNCT ASSESS	PRXOVR	DEF					NA	NA	NA	N
G8541	NO DOC CUR FUNCT ASSESS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8542	DOC FUNCT NO DEFICIENCIES	PRXOVR	DEF					NA	NA	NA	N
G8542	DOC FUNCT NO DEFICIENCIES	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8543	CUR FUNCT ASSES; NO CARE PLN	PRXOVR	DEF					NA	NA	NA	N
G8543	CUR FUNCT ASSES; NO CARE PLN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8569	PROL INTUBATION REQ	PRXOVR	DEF					NA	NA	NA	N
G8569	PROL INTUBATION REQ	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8570	NO PROL INTUB REQ	PRXOVR	DEF					NA	NA	NA	N
G8570	NO PROL INTUB REQ	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8571	STER WD IFX 30 D POSTOP	PRXOVR	DEF					NA	NA	NA	N
G8571	STER WD IFX 30 D POSTOP	MAXFEE	DEF					NA			N
G8572	NO STER WD IFX	PRXOVR	DEF					NA	NA	NA	N
G8572	NO STER WD IFX	MAXFEE	DEF					NA			N
G8573	STK CABG	PRXOVR	DEF					NA	NA	NA	N
G8573	STK CABG	MAXFEE	DEF					NA			N
G8574	NO STRK CABG	PRXOVR	DEF					NA	NA	NA	N
G8574	NO STRK CABG	MAXFEE	DEF					NA			N
G8575	POSTOP REN FAIL	PRXOVR	DEF					NA	NA	NA	N
G8575	POSTOP REN FAIL	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8576	NO POSTOP REN FAIL	PRXOVR	DEF					NA	NA	NA	N
G8576	NO POSTOP REN FAIL	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8577	REOP REQ BLD GRFT OTH	PRXOVR	DEF					NA	NA	NA	N
G8577	REOP REQ BLD GRFT OTH	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8578	NO REOP REQ BLD GRFT OTH	PRXOVR	DEF					NA	NA	NA	N
G8578	NO REOP REQ BLD GRFT OTH	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8598	ASA/ANTIPLAT THER USED	PRXOVR	DEF					NA	NA	NA	N
G8598	ASA/ANTIPLAT THER USED	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8599	NO ASA/ANTIPLAT THER USE RNG	PRXOVR	DEF					NA	NA	NA	N
G8599	NO ASA/ANTIPLAT THER USE RNG	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8600	TPA INITI W/IN 4.5 HR	PRXOVR	DEF					NA	NA	NA	N
G8600	TPA INITI W/IN 4.5 HR	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8601	NO ELIG TPA INIT W/IN 4.5 HR	PRXOVR	DEF					NA	NA	NA	N
G8601	NO ELIG TPA INIT W/IN 4.5 HR	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8602	NO TPA INIT W/IN 4.5 HR	PRXOVR	DEF					NA	NA	NA	N
G8602	NO TPA INIT W/IN 4.5 HR	MAXFEE	DEF					0	1/1/2010	12/31/2299	N
G8627	SURG PROC W/IN 30 DAYS	PRXOVR	DEF					NA	NA	NA	N
G8627	SURG PROC W/IN 30 DAYS	MAXFEE	DEF					NA			N
G8628	NO SURG PROC W/IN 30 DAYS	PRXOVR	DEF					NA	NA	NA	N
G8628	NO SURG PROC W/IN 30 DAYS	MAXFEE	DEF					NA			N
G8633	PHARM THER OSTEO RX	PRXOVR	DEF					NA	NA	NA	N
G8633	PHARM THER OSTEO RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8635	NO PHARM THER OSTEO RX	PRXOVR	DEF					NA	NA	NA	N
G8635	NO PHARM THER OSTEO RX	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8647	RAFSCRS KI SCOR >= 0	PRXOVR	DEF					NA	NA	NA	N
G8647	RAFSCRS KI SCOR >= 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8648	RAFSCRS KI SCOR < 0	PRXOVR	DEF					NA	NA	NA	N
G8648	RAFSCRS KI SCOR < 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8649	RAFSCRS KI NO SCOR	PRXOVR	DEF					NA	NA	NA	N
G8649	RAFSCRS KI NO SCOR	MAXFEE	DEF					NA			N
G8650	RAFS CRS KI NO SCOR NO RSN	PRXOVR	DEF					NA	NA	NA	N
G8650	RAFS CRS KI NO SCOR NO RSN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8651	RAFSCRS HI SCOR >=0	PRXOVR	DEF					NA	NA	NA	N
G8651	RAFSCRS HI SCOR >=0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8652	RAFSCRS HI SCOR < 0	PRXOVR	DEF					NA	NA	NA	N
G8652	RAFSCRS HI SCOR < 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8653	RAFSCRS HI NO SCOR	PRXOVR	DEF					NA	NA	NA	N
G8653	RAFSCRS HI NO SCOR	MAXFEE	DEF					NA			N
G8654	RAFS CRS HI NO SCOR NO SURV	PRXOVR	DEF					NA	NA	NA	N
G8654	RAFS CRS HI NO SCOR NO SURV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8655	RAFSCRS LLFAI SCOR >= 0	PRXOVR	DEF					NA	NA	NA	N
G8655	RAFSCRS LLFAI SCOR >= 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8656	RAFSCRS LLFAI SCOR < 0	PRXOVR	DEF					NA	NA	NA	N
G8656	RAFSCRS LLFAI SCOR < 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8657	RAFSCRS LLFAI NO SCOR	PRXOVR	DEF					NA	NA	NA	N
G8657	RAFSCRS LLFAI NO SCOR	MAXFEE	DEF					NA			N
G8658	RAFSCRS LLFAI NO SCOR + SURV	PRXOVR	DEF					NA	NA	NA	N
G8658	RAFSCRS LLFAI NO SCOR + SURV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8659	RAFSCRS LBI SCOR >= 0	PRXOVR	DEF					NA	NA	NA	N
G8659	RAFSCRS LBI SCOR >= 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8660	RAFSCRS LBI SCOR < 0	PRXOVR	DEF					NA	NA	NA	N
G8660	RAFSCRS LBI SCOR < 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8661	RAFSCRS LBI NO SCOR	PRXOVR	DEF					NA	NA	NA	N
G8661	RAFSCRS LBI NO SCOR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8662	RAFS CRS LBI NO SCOR NO SURV	PRXOVR	DEF					NA	NA	NA	N
G8662	RAFS CRS LBI NO SCOR NO SURV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8663	RAFSCRS SI SCOR >= 0	PRXOVR	DEF					NA	NA	NA	N
G8663	RAFSCRS SI SCOR >= 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8664	RAFSCRS SI SCOR < 0	PRXOVR	DEF					NA	NA	NA	N
G8664	RAFSCRS SI SCOR < 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8665	RAFSCRS SI NO SCOR	PRXOVR	DEF					NA	NA	NA	N
G8665	RAFSCRS SI NO SCOR	MAXFEE	DEF					NA			N
G8666	RAFS CRS SI NO SCOR NO SURV	PRXOVR	DEF					NA	NA	NA	N
G8666	RAFS CRS SI NO SCOR NO SURV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8667	RAFSCRS EWH SCOR >= 0	PRXOVR	DEF					NA	NA	NA	N
G8667	RAFSCRS EWH SCOR >= 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8668	RAFSCRS EWH SCOR < 0	PRXOVR	DEF					NA	NA	NA	N
G8668	RAFSCRS EWH SCOR < 0	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8669	RAFSCRS	PRXOVR	DEF					NA	NA	NA	N
G8669	RAFSCRS	MAXFEE	DEF					NA			N
G8670	RAFS CRS EWH NO SCOR NO SURV	PRXOVR	DEF					NA	NA	NA	N
G8670	RAFS CRS EWH NO SCOR NO SURV	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8671	RAFSCRS GOI SCOR >= 0	PRXOVR	DEF					NA	NA	NA	N
G8671	RAFSCRS GOI SCOR >= 0	MAXFEE	DEF					NA			N
G8672	RAFSCRS GOI SCOR < 0	PRXOVR	DEF					NA	NA	NA	N
G8672	RAFSCRS GOI SCOR < 0	MAXFEE	DEF					NA			N
G8673	RAFSCRS GOI NO SCOR	PRXOVR	DEF					NA	NA	NA	N
G8673	RAFSCRS GOI NO SCOR	MAXFEE	DEF					NA			N
G8674	RAFSCRS NECK; NO MSR/NO FOTO	PRXOVR	DEF					NA	NA	NA	N
G8674	RAFSCRS NECK; NO MSR/NO FOTO	MAXFEE	DEF					NA			N
G8694	LVEF <=40%	PRXOVR	DEF					NA	NA	NA	N
G8694	LVEF <=40%	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8708	ANTIBIOTIC NOT PRES	PRXOVR	DEF					NA	NA	NA	N
G8708	ANTIBIOTIC NOT PRES	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8709	URI EP COMPETE DIAG	PRXOVR	DEF					NA	NA	NA	N
G8709	URI EP COMPETE DIAG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8710	PT PRES ANTIBIOTIC	PRXOVR	DEF					NA	NA	NA	N
G8710	PT PRES ANTIBIOTIC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8711	PRES ANTIBX ON/WITHIN 3 DAY	PRXOVR	DEF					NA	NA	NA	N
G8711	PRES ANTIBX ON/WITHIN 3 DAY	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8712	NOT PRES ANTIBIOTIC	PRXOVR	DEF					NA	NA	NA	N
G8712	NOT PRES ANTIBIOTIC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8721	PT; PN; HIST GRADE DOC	PRXOVR	DEF					NA	NA	NA	N
G8721	PT; PN; HIST GRADE DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8722	MED REAS PT; PN; NOT DOC	PRXOVR	DEF					NA	NA	NA	N
G8722	MED REAS PT; PN; NOT DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8723	SPEC SIT NOT PRIM TUMOR	PRXOVR	DEF					NA	NA	NA	N
G8723	SPEC SIT NOT PRIM TUMOR	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8724	PT; PN; HIST GRADE NOT DOC	PRXOVR	DEF					NA	NA	NA	N
G8724	PT; PN; HIST GRADE NOT DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8730	PAIN DOC POS AND PLAN	PRXOVR	DEF					NA	NA	NA	N
G8730	PAIN DOC POS AND PLAN	MAXFEE	DEF					NA			N
G8731	PAIN NEG NO PLAN	PRXOVR	DEF					NA	NA	NA	N
G8731	PAIN NEG NO PLAN	MAXFEE	DEF					NA			N
G8732	NO DOC OF PAIN	PRXOVR	DEF					NA	NA	NA	N
G8732	NO DOC OF PAIN	MAXFEE	DEF					NA			N
G8733	DOC POS ELDER MAL SCRN PLAN	PRXOVR	DEF					NA	NA	NA	N
G8733	DOC POS ELDER MAL SCRN PLAN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8734	DOC NEG ELD REQ	PRXOVR	DEF					NA	NA	NA	N
G8734	DOC NEG ELD REQ	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8735	ELD MAL SCRN POS NO PLAN	PRXOVR	DEF					NA	NA	NA	N
G8735	ELD MAL SCRN POS NO PLAN	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8749	NO SIGNS MELANOMA	PRXOVR	DEF					NA	NA	NA	N
G8749	NO SIGNS MELANOMA	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8752	SYS BP LESS 140	PRXOVR	DEF					NA	NA	NA	N
G8752	SYS BP LESS 140	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8753	SYS BP > OR = 140	PRXOVR	DEF					NA	NA	NA	N
G8753	SYS BP > OR = 140	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8754	DIAS BP LESS 90	PRXOVR	DEF					NA	NA	NA	N
G8754	DIAS BP LESS 90	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8755	DIAS BP > OR = 90	PRXOVR	DEF					NA	NA	NA	N
G8755	DIAS BP > OR = 90	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8756	NO BP MEASURE DOC	PRXOVR	DEF					NA	NA	NA	N
G8756	NO BP MEASURE DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8783	BP SCRN PERF REC INTERVAL	PRXOVR	DEF					NA	NA	NA	N
G8783	BP SCRN PERF REC INTERVAL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8785	BP SCRN NO PERF AT INTERVAL	PRXOVR	DEF					NA	NA	NA	N
G8785	BP SCRN NO PERF AT INTERVAL	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8797	SPECIMEN SITE NOT ESOPHAGUS	PRXOVR	DEF					NA	NA	NA	N
G8797	SPECIMEN SITE NOT ESOPHAGUS	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8798	SPECIMEN SITE NOT PROSTATE	PRXOVR	DEF					NA	NA	NA	N
G8798	SPECIMEN SITE NOT PROSTATE	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8806	PERF ULTRSND TO LCT PREG DOC	PRXOVR	DEF					NA	NA	NA	N
G8806	PERF ULTRSND TO LCT PREG DOC	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8807	NO TA TV ULTRASND	PRXOVR	DEF					NA	NA	NA	N
G8807	NO TA TV ULTRASND	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8808	ULTRASOUND NOT PERF; RNG	PRXOVR	DEF					NA	NA	NA	N
G8808	ULTRASOUND NOT PERF; RNG	MAXFEE	DEF					0	1/1/2016	12/31/2299	N
G8809	RH-IMMUNOGLOBULIN ORDER	PRXOVR	DEF					NA	NA	NA	N
G8809	RH-IMMUNOGLOBULIN ORDER	MAXFEE	DEF					NA			N
G8810	DOC REAS NO RH-IMMUNO	PRXOVR	D