Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
65205	REMOVE FOREIGN BODY FROM EYE	PRXOVR	DEF					NA	NA	NA	N
65205	REMOVE FOREIGN BODY FROM EYE	MAXFEE	FAC					26.15	1/1/2014	12/31/2299	N
65205	REMOVE FOREIGN BODY FROM EYE	MAXFEE	NFF					35.20	1/1/2014	12/31/2299	N
65210	REMOVE FOREIGN BODY FROM EYE	PRXOVR	DEF					NA	NA	NA	N
65210	REMOVE FOREIGN BODY FROM EYE	MAXFEE	FAC					29.41	1/1/2014	12/31/2299	N
65210	REMOVE FOREIGN BODY FROM EYE	MAXFEE	NFF					42.43	1/1/2014	12/31/2299	N
65220	REMOVE FOREIGN BODY FROM EYE	PRXOVR	DEF					NA	NA	NA	N
65220	REMOVE FOREIGN BODY FROM EYE	MAXFEE	FAC					20.64	1/1/2014	12/31/2299	N
65220	REMOVE FOREIGN BODY FROM EYE	MAXFEE	NFF					33.77	1/1/2014	12/31/2299	N
65222	REMOVE FOREIGN BODY FROM EYE	PRXOVR	DEF					NA	NA	NA	N
65222	REMOVE FOREIGN BODY FROM EYE	MAXFEE	FAC					31.47	1/1/2014	12/31/2299	N
65222	REMOVE FOREIGN BODY FROM EYE	MAXFEE	NFF					45.32	1/1/2014	12/31/2299	N
65430	CORNEAL SMEAR	PRXOVR	DEF					NA	NA	NA	N
65430	CORNEAL SMEAR	MAXFEE	FAC					64.64	1/1/2014	12/31/2299	N
65430	CORNEAL SMEAR	MAXFEE	NFF					78.12	1/1/2014	12/31/2299	N
67820	REVISE EYELASHES	PRXOVR	DEF					NA	NA	NA	N
67820	REVISE EYELASHES	MAXFEE	FAC					35.54	1/1/2014	12/31/2299	N
67820	REVISE EYELASHES	MAXFEE	NFF					37.03	1/1/2014	12/31/2299	N
67938	REMOVE EYELID FOREIGN BODY	PRXOVR	DEF					NA	NA	NA	N
67938	REMOVE EYELID FOREIGN BODY	MAXFEE	FAC					53.91	1/1/2014	12/31/2299	N
67938	REMOVE EYELID FOREIGN BODY	MAXFEE	NFF					108.47	1/1/2014	12/31/2299	N
68761	CLOSE TEAR DUCT OPENING	PRXOVR	DEF					NA	NA	NA	N
68761	CLOSE TEAR DUCT OPENING	MAXFEE	FAC					51.07	1/1/2014	12/31/2299	N
68761	CLOSE TEAR DUCT OPENING	MAXFEE	NFF					73.32	1/1/2014	12/31/2299	N
68801	DILATE TEAR DUCT OPENING	PRXOVR	DEF					NA	NA	NA	N
68801	DILATE TEAR DUCT OPENING	MAXFEE	FAC					45.87	1/1/2014	12/31/2299	N
68801	DILATE TEAR DUCT OPENING	MAXFEE	NFF					59.37	1/1/2014	12/31/2299	N
68810	PROBE NASOLACRIMAL DUCT	PRXOVR	DEF					NA	NA	NA	N
68810	PROBE NASOLACRIMAL DUCT	MAXFEE	FAC					86.87	1/1/2014	12/31/2299	N
68810	PROBE NASOLACRIMAL DUCT	MAXFEE	NFF					128.96	1/1/2014	12/31/2299	N
68840	EXPLORE/IRRIGATE TEAR DUCTS	PRXOVR	DEF					NA	NA	NA	N
68840	EXPLORE/IRRIGATE TEAR DUCTS	MAXFEE	FAC					61.50	1/1/2014	12/31/2299	N
68840	EXPLORE/IRRIGATE TEAR DUCTS	MAXFEE	NFF					73.74	1/1/2014	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
83861	MICROFLUID ANALY TEARS	PRXOVR	DEF					NA	NA	NA	N
83861	MICROFLUID ANALY TEARS	MAXFEE	DEF					16.86	4/1/2019	12/31/2299	N
92002	EYE EXAM NEW PATIENT	PRXOVR	DEF					NA	NA	NA	N
92002	EYE EXAM NEW PATIENT	MAXFEE	FAC					15.39	1/1/2016	12/31/2299	N
92002	EYE EXAM NEW PATIENT	MAXFEE	NFF					27.39	1/1/2016	12/31/2299	N
92004	EYE EXAM NEW PATIENT	PRXOVR	DEF					NA	NA	NA	S
92004	EYE EXAM NEW PATIENT	MAXFEE	FAC					31.78	1/1/2016	12/31/2299	S
92004	EYE EXAM NEW PATIENT	MAXFEE	NFF					49.19	1/1/2016	12/31/2299	S
92012	EYE EXAM ESTABLISH PATIENT	PRXOVR	DEF					NA	NA	NA	N
92012	EYE EXAM ESTABLISH PATIENT	MAXFEE	FAC					16.85	1/1/2016	12/31/2299	N
92012	EYE EXAM ESTABLISH PATIENT	MAXFEE	NFF					34.33	1/1/2016	12/31/2299	N
92014	EYE EXAM&TX ESTAB PT 1/>VST	PRXOVR	DEF					NA	NA	NA	S
92014	EYE EXAM&TX ESTAB PT 1/>VST	MAXFEE	FAC					30.04	1/1/2016	12/31/2299	S
92014	EYE EXAM&TX ESTAB PT 1/>VST	MAXFEE	NFF					45.09	1/1/2016	12/31/2299	S
92015	DETERMINE REFRACTIVE STATE	PRXOVR	DEF					NA	NA	NA	N
92015	DETERMINE REFRACTIVE STATE	MAXFEE	FAC					19.31	1/1/2014	12/31/2299	N
92015	DETERMINE REFRACTIVE STATE	MAXFEE	NFF					20.83	1/1/2014	12/31/2299	N
92020	SPECIAL EYE EVALUATION	PRXOVR	DEF					NA	NA	NA	N
92020	SPECIAL EYE EVALUATION	MAXFEE	FAC					10.18	1/1/2014	12/31/2299	N
92020	SPECIAL EYE EVALUATION	MAXFEE	NFF					12.16	1/1/2014	12/31/2299	N
92025	CORNEAL TOPOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
92025	CORNEAL TOPOGRAPHY	MAXFEE	DEF					10.88	1/1/2010	12/31/2299	N
92025	CORNEAL TOPOGRAPHY	MAXFEE	DEF	TC				4.35	1/1/2010	12/31/2299	N
92025	CORNEAL TOPOGRAPHY	MAXFEE	DEF	26				6.53	1/1/2010	12/31/2299	N
92060	SPECIAL EYE EVALUATION	PRXOVR	DEF					NA	NA	NA	N
92060	SPECIAL EYE EVALUATION	MAXFEE	DEF					19.85	1/1/2010	12/31/2299	N
92060	SPECIAL EYE EVALUATION	MAXFEE	DEF	TC				5.96	1/1/2010	12/31/2299	N
92060	SPECIAL EYE EVALUATION	MAXFEE	DEF	26				13.90	1/1/2010	12/31/2299	N
92065	ORTHOP TRAING PFRMD PHYS/QHP	PRXOVR	DEF					NA	NA	NA	Y
92065	ORTHOP TRAING PFRMD PHYS/QHP	MAXFEE	DEF					13.65	1/1/2010	12/31/2299	Y
92065	ORTHOP TRAING PFRMD PHYS/QHP	MAXFEE	DEF	TC				6.83	1/1/2010	12/31/2299	Y
92065	ORTHOP TRAING PFRMD PHYS/QHP	MAXFEE	DEF	26				6.83	1/1/2010	12/31/2299	Y
92066	ORTHOP TRAING SUPVJ PHYS/QHP	PRXOVR	DEF					NA	NA	NA	N
92066	ORTHOP TRAING SUPVJ PHYS/QHP	MAXFEE	DEF					18.61	1/1/2023	12/31/2299	N
92070	FITTING OF CONTACT LENS	PRXOVR	DEF					NA	NA	NA	Y
92070	FITTING OF CONTACT LENS	MAXFEE	DEF					NA			Y
92071	CONTACT LENS FITTING FOR TX	PRXOVR	DEF					NA	NA	NA	Y
92071	CONTACT LENS FITTING FOR TX	MAXFEE	FAC					8.97	1/1/2014	12/31/2299	Y
92071	CONTACT LENS FITTING FOR TX	MAXFEE	NFF					11.04	1/1/2014	12/31/2299	Y
92072	FIT CONTAC LENS FOR MANAGMNT	PRXOVR	DEF					NA	NA	NA	Y
92072	FIT CONTAC LENS FOR MANAGMNT	MAXFEE	FAC					29.07	1/1/2014	12/31/2299	Y
92072	FIT CONTAC LENS FOR MANAGMNT	MAXFEE	NFF					35.31	1/1/2014	12/31/2299	Y
92081	VISUAL FIELD EXAMINATION(S)	PRXOVR	DEF					NA	NA	NA	N
92081	VISUAL FIELD EXAMINATION(S)	MAXFEE	DEF					18.03	1/1/2010	12/31/2299	N
92081	VISUAL FIELD EXAMINATION(S)	MAXFEE	DEF	TC				9.01	12/31/2014	12/31/2299	N
92081	VISUAL FIELD EXAMINATION(S)	MAXFEE	DEF	26				9.02	12/31/2014	12/31/2299	N
92082	VISUAL FIELD EXAMINATION(S)	PRXOVR	DEF					NA	NA	NA	N
92082	VISUAL FIELD EXAMINATION(S)	MAXFEE	DEF					23.47	1/1/2010	12/31/2299	N
92082	VISUAL FIELD EXAMINATION(S)	MAXFEE	DEF	TC				11.73	12/31/2014	12/31/2299	N
92082	VISUAL FIELD EXAMINATION(S)	MAXFEE	DEF	26				11.74	12/31/2014	12/31/2299	N
92083	VISUAL FIELD EXAMINATION(S)	PRXOVR	DEF					NA	NA	NA	N
92083	VISUAL FIELD EXAMINATION(S)	MAXFEE	DEF					26.95	1/1/2010	12/31/2299	N
92083	VISUAL FIELD EXAMINATION(S)	MAXFEE	DEF	TC				13.47	12/31/2014	12/31/2299	N
92083	VISUAL FIELD EXAMINATION(S)	MAXFEE	DEF	26				13.48	12/31/2014	12/31/2299	N
92100	SERIAL TONOMETRY EXAM(S)	PRXOVR	DEF					NA	NA	NA	N
92100	SERIAL TONOMETRY EXAM(S)	MAXFEE	FAC					11.57	1/1/2014	12/31/2299	N
92100	SERIAL TONOMETRY EXAM(S)	MAXFEE	NFF					30.75	1/1/2014	12/31/2299	N
92120	TONOGRAPHY & EYE EVALUATION	PRXOVR	DEF					NA	NA	NA	N
92120	TONOGRAPHY & EYE EVALUATION	MAXFEE	DEF					NA			N
92130	WATER PROVOCATION TONOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
92130	WATER PROVOCATION TONOGRAPHY	MAXFEE	DEF					NA			N
92132	CMPTR OPHTH DX IMG ANT SEGMT	PRXOVR	DEF					NA	NA	NA	N
92132	CMPTR OPHTH DX IMG ANT SEGMT	MAXFEE	DEF					13.03	1/1/2011	12/31/2299	N
92132	CMPTR OPHTH DX IMG ANT SEGMT	MAXFEE	DEF	TC				5.21	1/1/2011	12/31/2299	N
92132	CMPTR OPHTH DX IMG ANT SEGMT	MAXFEE	DEF	26				7.82	1/1/2011	12/31/2299	N
92133	CMPTR OPHTH IMG OPTIC NERVE	PRXOVR	DEF					NA	NA	NA	N
92133	CMPTR OPHTH IMG OPTIC NERVE	MAXFEE	DEF					15.96	1/1/2011	12/31/2299	N
92133	CMPTR OPHTH IMG OPTIC NERVE	MAXFEE	DEF	TC				4.79	1/1/2011	12/31/2299	N
92133	CMPTR OPHTH IMG OPTIC NERVE	MAXFEE	DEF	26				11.17	1/1/2011	12/31/2299	N
92134	CPTR OPHTH DX IMG POST SEGMT	PRXOVR	DEF					NA	NA	NA	N
92134	CPTR OPHTH DX IMG POST SEGMT	MAXFEE	DEF					15.96	1/1/2011	12/31/2299	N
92134	CPTR OPHTH DX IMG POST SEGMT	MAXFEE	DEF	TC				4.79	1/1/2011	12/31/2299	N
92134	CPTR OPHTH DX IMG POST SEGMT	MAXFEE	DEF	26				11.17	1/1/2011	12/31/2299	N
92135	OPHTH DX IMAGING POST SEG	PRXOVR	DEF					NA	NA	NA	N
92135	OPHTH DX IMAGING POST SEG	MAXFEE	DEF					NA			N
92136	OPHTHALMIC BIOMETRY	PRXOVR	DEF					NA	NA	NA	N
92136	OPHTHALMIC BIOMETRY	MAXFEE	DEF					35.81	1/1/2010	12/31/2299	N
92136	OPHTHALMIC BIOMETRY	MAXFEE	DEF	TC				23.28	1/1/2010	12/31/2299	N
92136	OPHTHALMIC BIOMETRY	MAXFEE	DEF	26				12.53	1/1/2010	12/31/2299	N
92140	GLAUCOMA PROVOCATIVE TESTS	PRXOVR	DEF					NA	NA	NA	N
92140	GLAUCOMA PROVOCATIVE TESTS	MAXFEE	DEF					NA			N
92145	CORNEAL HYSTERESIS DETER	PRXOVR	DEF					NA	NA	NA	N
92145	CORNEAL HYSTERESIS DETER	MAXFEE	DEF					12.01	1/1/2015	12/31/2299	N
92145	CORNEAL HYSTERESIS DETER	MAXFEE	DEF	TC				5.02	1/1/2015	12/31/2299	N
92145	CORNEAL HYSTERESIS DETER	MAXFEE	DEF	26				6.99	1/1/2015	12/31/2299	N
92201	OPSCPY EXTND RTA DRAW UNI/BI	PRXOVR	DEF					NA	NA	NA	N
92201	OPSCPY EXTND RTA DRAW UNI/BI	MAXFEE	FAC					18.13	1/1/2020	12/31/2299	N
92201	OPSCPY EXTND RTA DRAW UNI/BI	MAXFEE	NFF					19.72	1/1/2020	12/31/2299	N
92202	OPSCPY EXTND ON/MAC DRAW	PRXOVR	DEF					NA	NA	NA	N
92202	OPSCPY EXTND ON/MAC DRAW	MAXFEE	FAC					11.71	1/1/2020	12/31/2299	N
92202	OPSCPY EXTND ON/MAC DRAW	MAXFEE	NFF					12.50	1/1/2020	12/31/2299	N
92225	SPECIAL EYE EXAM INITIAL	PRXOVR	DEF					NA	NA	NA	N
92225	SPECIAL EYE EXAM INITIAL	MAXFEE	DEF					NA			N
92226	SPECIAL EYE EXAM SUBSEQUENT	PRXOVR	DEF					NA	NA	NA	N
92226	SPECIAL EYE EXAM SUBSEQUENT	MAXFEE	DEF					NA			N
92227	IMG RTA DETCJ/MNTR DS STAFF	PRXOVR	DEF					NA	NA	NA	N
92227	IMG RTA DETCJ/MNTR DS STAFF	MAXFEE	DEF					5.06	1/1/2011	12/31/2299	N
92228	IMG RTA DETC/MNTR DS PHY/QHP	PRXOVR	DEF					NA	NA	NA	N
92228	IMG RTA DETC/MNTR DS PHY/QHP	MAXFEE	DEF					13.23	1/1/2011	12/31/2299	N
92228	IMG RTA DETC/MNTR DS PHY/QHP	MAXFEE	DEF	TC				5.29	1/1/2011	12/31/2299	N
92228	IMG RTA DETC/MNTR DS PHY/QHP	MAXFEE	DEF	26				7.94	1/1/2011	12/31/2299	N
92229	IMG RTA DETC/MNTR DS POC ALY	PRXOVR	DEF					NA	NA	NA	N
92229	IMG RTA DETC/MNTR DS POC ALY	MAXFEE	DEF					0	1/1/2021	12/31/2299	N
92230	EYE EXAM WITH PHOTOS	PRXOVR	DEF					NA	NA	NA	N
92230	EYE EXAM WITH PHOTOS	MAXFEE	FAC					13.38	1/1/2014	12/31/2299	N
92230	EYE EXAM WITH PHOTOS	MAXFEE	NFF					28.61	1/1/2014	12/31/2299	N
92235	FLUORESCEIN ANGRPH UNI/BI	PRXOVR	DEF					NA	NA	NA	N
92235	FLUORESCEIN ANGRPH UNI/BI	MAXFEE	DEF					46.74	1/1/2010	12/31/2299	N
92235	FLUORESCEIN ANGRPH UNI/BI	MAXFEE	DEF	TC				30.38	1/1/2010	12/31/2299	N
92235	FLUORESCEIN ANGRPH UNI/BI	MAXFEE	DEF	26				16.36	1/1/2010	12/31/2299	N
92240	ICG ANGIOGRAPHY UNI/BI	PRXOVR	DEF					NA	NA	NA	N
92240	ICG ANGIOGRAPHY UNI/BI	MAXFEE	DEF					94.11	1/1/2010	12/31/2299	N
92240	ICG ANGIOGRAPHY UNI/BI	MAXFEE	DEF	TC				75.29	1/1/2010	12/31/2299	N
92240	ICG ANGIOGRAPHY UNI/BI	MAXFEE	DEF	26				18.82	1/1/2010	12/31/2299	N
92242	FLUORESCEIN ICG ANGIOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
92242	FLUORESCEIN ICG ANGIOGRAPHY	MAXFEE	DEF	TC				127.33	1/1/2017	12/31/2299	N
92242	FLUORESCEIN ICG ANGIOGRAPHY	MAXFEE	DEF	26				43.66	1/1/2017	12/31/2299	N
92242	FLUORESCEIN ICG ANGIOGRAPHY	MAXFEE	DEF					170.99	1/1/2017	12/31/2299	N
92250	EYE EXAM WITH PHOTOS	PRXOVR	DEF					NA	NA	NA	N
92250	EYE EXAM WITH PHOTOS	MAXFEE	DEF					32.75	12/31/2014	12/31/2299	N
92250	EYE EXAM WITH PHOTOS	MAXFEE	DEF	TC				22.92	12/31/2014	12/31/2299	N
92250	EYE EXAM WITH PHOTOS	MAXFEE	DEF	26				9.83	12/31/2014	12/31/2299	N
92260	OPHTHALMOSCOPY/DYNAMOMETRY	PRXOVR	DEF					NA	NA	NA	N
92260	OPHTHALMOSCOPY/DYNAMOMETRY	MAXFEE	FAC					6.06	1/1/2014	12/31/2299	N
92260	OPHTHALMOSCOPY/DYNAMOMETRY	MAXFEE	NFF					11.45	1/1/2014	12/31/2299	N
92265	EYE MUSCLE EVALUATION	PRXOVR	DEF					NA	NA	NA	N
92265	EYE MUSCLE EVALUATION	MAXFEE	DEF					31.34	7/1/2008	12/31/2299	N
92265	EYE MUSCLE EVALUATION	MAXFEE	DEF	TC				15.67	7/1/2008	12/31/2299	N
92265	EYE MUSCLE EVALUATION	MAXFEE	DEF	26				15.67	7/1/2008	12/31/2299	N
92270	ELECTRO-OCULOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
92270	ELECTRO-OCULOGRAPHY	MAXFEE	DEF					33.03	7/1/2008	12/31/2299	N
92270	ELECTRO-OCULOGRAPHY	MAXFEE	DEF	TC				16.52	7/1/2008	12/31/2299	N
92270	ELECTRO-OCULOGRAPHY	MAXFEE	DEF	26				16.52	7/1/2008	12/31/2299	N
92273	FULL FIELD ERG W/I&R	PRXOVR	DEF					NA	NA	NA	N
92273	FULL FIELD ERG W/I&R	MAXFEE	DEF	26				13.19	1/1/2019	12/31/2299	N
92273	FULL FIELD ERG W/I&R	MAXFEE	DEF	TC				30.78	1/1/2019	12/31/2299	N
92273	FULL FIELD ERG W/I&R	MAXFEE	DEF					43.97	1/1/2019	12/31/2299	N
92274	MULTIFOCAL ERG W/I&R	PRXOVR	DEF					NA	NA	NA	N
92274	MULTIFOCAL ERG W/I&R	MAXFEE	DEF					30.78	1/1/2019	12/31/2299	N
92274	MULTIFOCAL ERG W/I&R	MAXFEE	DEF	26				12.31	1/1/2019	12/31/2299	N
92274	MULTIFOCAL ERG W/I&R	MAXFEE	DEF	TC				18.47	1/1/2019	12/31/2299	N
92275	ELECTRORETINOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
92275	ELECTRORETINOGRAPHY	MAXFEE	DEF					NA			N
92283	COLOR VISION EXAMINATION	PRXOVR	DEF					NA	NA	NA	N
92283	COLOR VISION EXAMINATION	MAXFEE	DEF					14.71	1/1/2010	12/31/2299	N
92283	COLOR VISION EXAMINATION	MAXFEE	DEF	TC				11.77	1/1/2010	12/31/2299	N
92283	COLOR VISION EXAMINATION	MAXFEE	DEF	26				2.94	1/1/2010	12/31/2299	N
92284	DX DARK ADAPTATION EXAM I&R	PRXOVR	DEF					NA	NA	NA	N
92284	DX DARK ADAPTATION EXAM I&R	MAXFEE	DEF					27.98	7/1/2008	12/31/2299	N
92284	DX DARK ADAPTATION EXAM I&R	MAXFEE	DEF	TC				22.38	7/1/2008	12/31/2299	N
92284	DX DARK ADAPTATION EXAM I&R	MAXFEE	DEF	26				5.60	7/1/2008	12/31/2299	N
92285	EYE PHOTOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
92285	EYE PHOTOGRAPHY	MAXFEE	DEF					15.98	1/1/2010	12/31/2299	N
92285	EYE PHOTOGRAPHY	MAXFEE	DEF	TC				11.99	1/1/2010	12/31/2299	N
92285	EYE PHOTOGRAPHY	MAXFEE	DEF	26				4	1/1/2010	12/31/2299	N
92286	INTERNAL EYE PHOTOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
92286	INTERNAL EYE PHOTOGRAPHY	MAXFEE	DEF					33.26	12/31/2014	12/31/2299	N
92286	INTERNAL EYE PHOTOGRAPHY	MAXFEE	DEF	TC				13.30	12/31/2014	12/31/2299	N
92286	INTERNAL EYE PHOTOGRAPHY	MAXFEE	DEF	26				19.95	12/31/2014	12/31/2299	N
92287	INTERNAL EYE PHOTOGRAPHY	PRXOVR	DEF					NA	NA	NA	N
92287	INTERNAL EYE PHOTOGRAPHY	MAXFEE	DEF					39.37	7/1/2008	12/31/2299	N
92310	CONTACT LENS FITTING	PRXOVR	DEF					NA	NA	NA	Y
92310	CONTACT LENS FITTING	MAXFEE	FAC					45.51	1/1/2014	12/31/2299	Y
92310	CONTACT LENS FITTING	MAXFEE	NFF					77.86	1/1/2014	12/31/2299	Y
92311	CONTACT LENS FITTING	PRXOVR	DEF					NA	NA	NA	Y
92311	CONTACT LENS FITTING	MAXFEE	FAC					17.42	1/1/2014	12/31/2299	Y
92311	CONTACT LENS FITTING	MAXFEE	NFF					34.80	1/1/2014	12/31/2299	Y
92312	CONTACT LENS FITTING	PRXOVR	DEF					NA	NA	NA	Y
92312	CONTACT LENS FITTING	MAXFEE	FAC					20.57	1/1/2014	12/31/2299	Y
92312	CONTACT LENS FITTING	MAXFEE	NFF					41.24	1/1/2014	12/31/2299	Y
92313	CONTACT LENS FITTING	PRXOVR	DEF					NA	NA	NA	Y
92313	CONTACT LENS FITTING	MAXFEE	FAC					29.51	1/1/2014	12/31/2299	Y
92313	CONTACT LENS FITTING	MAXFEE	NFF					42.80	1/1/2014	12/31/2299	Y
92314	PRESCRIPTION OF CONTACT LENS	PRXOVR	DEF					NA	NA	NA	Y
92314	PRESCRIPTION OF CONTACT LENS	MAXFEE	FAC					22.11	1/1/2014	12/31/2299	Y
92314	PRESCRIPTION OF CONTACT LENS	MAXFEE	NFF					49.33	1/1/2014	12/31/2299	Y
92315	RX CNTACT LENS APHAKIA 1 EYE	PRXOVR	DEF					NA	NA	NA	Y
92315	RX CNTACT LENS APHAKIA 1 EYE	MAXFEE	FAC					15.97	1/1/2014	12/31/2299	Y
92315	RX CNTACT LENS APHAKIA 1 EYE	MAXFEE	NFF					30.99	1/1/2014	12/31/2299	Y
92316	RX CNTACT LENS APHAKIA 2 EYE	PRXOVR	DEF					NA	NA	NA	Y
92316	RX CNTACT LENS APHAKIA 2 EYE	MAXFEE	FAC					23.60	1/1/2014	12/31/2299	Y
92316	RX CNTACT LENS APHAKIA 2 EYE	MAXFEE	NFF					37.06	1/1/2014	12/31/2299	Y
92317	RX CORNEOSCLERAL CNTACT LENS	PRXOVR	DEF					NA	NA	NA	Y
92317	RX CORNEOSCLERAL CNTACT LENS	MAXFEE	FAC					13.29	1/1/2014	12/31/2299	Y
92317	RX CORNEOSCLERAL CNTACT LENS	MAXFEE	NFF					25.93	1/1/2014	12/31/2299	Y
92325	MODIFICATION OF CONTACT LENS	PRXOVR	DEF					NA	NA	NA	Y
92325	MODIFICATION OF CONTACT LENS	MAXFEE	DEF					7.37	7/1/2008	12/31/2299	Y
92326	REPLACEMENT OF CONTACT LENS	PRXOVR	DEF					NA	NA	NA	Y
92326	REPLACEMENT OF CONTACT LENS	MAXFEE	DEF					28.49	1/1/2000	12/31/2299	Y
92330	FITTING OF ARTIFICIAL EYE	PRXOVR	DEF					NA	NA	NA	N
92330	FITTING OF ARTIFICIAL EYE	PADOLR	DEF					NA	NA	NA	N
92335	FITTING OF ARTIFICIAL EYE	PRXOVR	DEF					NA	NA	NA	N
92335	FITTING OF ARTIFICIAL EYE	PADOLR	DEF					NA	NA	NA	N
92340	FIT SPECTACLES MONOFOCAL	PRXOVR	DEF					NA	NA	NA	S
92340	FIT SPECTACLES MONOFOCAL	MAXFEE	FAC					10.04	1/1/2014	12/31/2299	S
92340	FIT SPECTACLES MONOFOCAL	MAXFEE	NFF					21.77	1/1/2014	12/31/2299	S
92341	FIT SPECTACLES BIFOCAL	PRXOVR	DEF					NA	NA	NA	S
92341	FIT SPECTACLES BIFOCAL	MAXFEE	FAC					13.96	1/1/2014	12/31/2299	S
92341	FIT SPECTACLES BIFOCAL	MAXFEE	NFF					26.97	1/1/2014	12/31/2299	S
92342	FIT SPECTACLES MULTIFOCAL	PRXOVR	DEF					NA	NA	NA	S
92342	FIT SPECTACLES MULTIFOCAL	MAXFEE	FAC					16.27	1/1/2014	12/31/2299	S
92342	FIT SPECTACLES MULTIFOCAL	MAXFEE	NFF					30.02	1/1/2014	12/31/2299	S
92352	FIT APHAKIA SPECTCL MONOFOCL	PRXOVR	DEF					NA	NA	NA	S
92352	FIT APHAKIA SPECTCL MONOFOCL	MAXFEE	FAC					7.44	1/1/2014	12/31/2299	S
92352	FIT APHAKIA SPECTCL MONOFOCL	MAXFEE	NFF					19.58	1/1/2014	12/31/2299	S
92353	FIT APHAKIA SPECTCL MULTIFOC	PRXOVR	DEF					NA	NA	NA	S
92353	FIT APHAKIA SPECTCL MULTIFOC	MAXFEE	FAC					11.31	1/1/2014	12/31/2299	S
92353	FIT APHAKIA SPECTCL MULTIFOC	MAXFEE	NFF					25.27	1/1/2014	12/31/2299	S
92354	FIT SPECTACLES SINGLE SYSTEM	PRXOVR	DEF					NA	NA	NA	Y
92354	FIT SPECTACLES SINGLE SYSTEM	MAXFEE	DEF					29.35	9/1/2013	12/31/2299	Y
92355	FIT SPECTACLES COMPOUND LENS	PRXOVR	DEF					NA	NA	NA	Y
92355	FIT SPECTACLES COMPOUND LENS	MAXFEE	DEF					25.65	9/1/2013	12/31/2299	Y
92358	APHAKIA PROSTH SERVICE TEMP	PRXOVR	DEF					NA	NA	NA	Y
92358	APHAKIA PROSTH SERVICE TEMP	MAXFEE	DEF					10.89	9/1/2013	12/31/2299	Y
92390	SUPPLY OF SPECTACLES	PRXOVR	DEF					NA	NA	NA	Y
92390	SUPPLY OF SPECTACLES	PADOLR	DEF					NA	NA	NA	Y
92395	SUPPLY OF SPECTACLES	PRXOVR	DEF					NA	NA	NA	Y
92395	SUPPLY OF SPECTACLES	MAXFEE	DEF					NA			Y
92499	UNLISTED OPH SVC/PROCEDURE	PRXOVR	DEF					NA	NA	NA	N
92499	UNLISTED OPH SVC/PROCEDURE	MANUAL	DEF					NA	NA	NA	N
95919	QUAN PUPLMTRY PHY/QHP UNI/BI	PRXOVR	DEF					NA	NA	NA	N
95919	QUAN PUPLMTRY PHY/QHP UNI/BI	MANUAL	DEF					NA	NA	NA	N
99172	OCULAR FUNCTION SCREEN	PRXOVR	DEF					NA	NA	NA	N
99172	OCULAR FUNCTION SCREEN	MAXFEE	FAC					8.07	1/1/2018	12/31/2299	N
99172	OCULAR FUNCTION SCREEN	MAXFEE	NFF					9.94	1/1/2018	12/31/2299	N
99173	VISUAL ACUITY SCREEN	PRXOVR	DEF					NA	NA	NA	N
99173	VISUAL ACUITY SCREEN	MAXFEE	DEF					2.40	1/1/2018	12/31/2299	N
99174	OCULAR INSTRUMNT SCREEN BIL	PRXOVR	DEF					NA	NA	NA	N
99174	OCULAR INSTRUMNT SCREEN BIL	MAXFEE	FAC					9.66	1/1/2018	12/31/2299	N
99174	OCULAR INSTRUMNT SCREEN BIL	MAXFEE	NFF					10.42	1/1/2018	12/31/2299	N
99177	OCULAR INSTRUMNT SCREEN BIL	PRXOVR	DEF					NA	NA	NA	N
99177	OCULAR INSTRUMNT SCREEN BIL	MAXFEE	FAC					9.66	1/1/2018	12/31/2299	N
99177	OCULAR INSTRUMNT SCREEN BIL	MAXFEE	NFF					10.42	1/1/2018	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
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
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
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
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
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
T1015	CLINIC SERVICE	UCCENC	UC7					NA	NA	NA	N
T1015	CLINIC SERVICE	PRXOVR	DEF					NA	NA	NA	N
V2500	CONTACT LENS PMMA SPHERICAL	PRXOVR	DEF					NA	NA	NA	Y
V2500	CONTACT LENS PMMA SPHERICAL	MAXFEE	DEF					31.06	4/13/1989	12/31/2299	Y
V2501	CNTCT LENS PMMA-TORIC/PRISM	PRXOVR	DEF					NA	NA	NA	Y
V2501	CNTCT LENS PMMA-TORIC/PRISM	MAXFEE	DEF					51.77	4/13/1989	12/31/2299	Y
V2502	CONTACT LENS PMMA BIFOCAL	PRXOVR	DEF					NA	NA	NA	Y
V2502	CONTACT LENS PMMA BIFOCAL	MAXFEE	DEF					51.77	4/13/1989	12/31/2299	Y
V2503	CNTCT LENS PMMA COLOR VISION	PRXOVR	DEF					NA	NA	NA	Y
V2503	CNTCT LENS PMMA COLOR VISION	MAXFEE	DEF					51.77	4/13/1989	12/31/2299	Y
V2510	CNTCT GAS PERMEABLE SPHERICL	PRXOVR	DEF					NA	NA	NA	Y
V2510	CNTCT GAS PERMEABLE SPHERICL	MAXFEE	DEF					50.22	1/1/2010	12/31/2299	Y
V2511	CNTCT TORIC PRISM BALLAST	PRXOVR	DEF					NA	NA	NA	Y
V2511	CNTCT TORIC PRISM BALLAST	MAXFEE	DEF					75.32	1/1/2010	12/31/2299	Y
V2512	CNTCT LENS GAS PERMBL BIFOCL	PRXOVR	DEF					NA	NA	NA	Y
V2512	CNTCT LENS GAS PERMBL BIFOCL	MAXFEE	DEF					100.42	1/1/2010	12/31/2299	Y
V2513	CONTACT LENS EXTENDED WEAR	PRXOVR	DEF					NA	NA	NA	Y
V2513	CONTACT LENS EXTENDED WEAR	MAXFEE	DEF					100.42	1/1/2010	12/31/2299	Y
V2520	CONTACT LENS HYDROPHILIC	PRXOVR	DEF					NA	NA	NA	Y
V2520	CONTACT LENS HYDROPHILIC	MAXFEE	DEF					60.26	1/1/2010	12/31/2299	Y
V2521	CNTCT LENS HYDROPHILIC TORIC	PRXOVR	DEF					NA	NA	NA	Y
V2521	CNTCT LENS HYDROPHILIC TORIC	MAXFEE	DEF					70.30	1/1/2010	12/31/2299	Y
V2522	CNTCT LENS HYDROPHIL BIFOCL	PRXOVR	DEF					NA	NA	NA	Y
V2522	CNTCT LENS HYDROPHIL BIFOCL	MAXFEE	DEF					77.65	4/13/1989	12/31/2299	Y
V2523	CNTCT LENS HYDROPHIL EXTEND	PRXOVR	DEF					NA	NA	NA	Y
V2523	CNTCT LENS HYDROPHIL EXTEND	MAXFEE	DEF					97	1/1/2010	12/31/2299	Y
V2524	CNTCT LENS HYDROPHIL PHOTOCH	PRXOVR	DEF					NA	NA	NA	Y
V2524	CNTCT LENS HYDROPHIL PHOTOCH	MAXFEE	DEF					97	1/1/2021	12/31/2299	Y
V2525	CL; HYDROPHILIC; DUAL FOCUS	PRXOVR	DEF					NA	NA	NA	Y
V2525	CL; HYDROPHILIC; DUAL FOCUS	MAXFEE	DEF					97	4/1/2022	12/31/2299	Y
V2530	CONTACT LENS GAS IMPERMEABLE	PRXOVR	DEF					NA	NA	NA	Y
V2530	CONTACT LENS GAS IMPERMEABLE	MAXFEE	DEF					116.62	1/1/2021	12/31/2299	Y
V2531	CONTACT LENS GAS PERMEABLE	PRXOVR	DEF					NA	NA	NA	Y
V2531	CONTACT LENS GAS PERMEABLE	MAXFEE	DEF					424.38	1/1/2021	12/31/2299	Y
V2599	CONTACT LENS/ES OTHER TYPE	PRXOVR	DEF					NA	NA	NA	Y
V2599	CONTACT LENS/ES OTHER TYPE	PADOLR	DEF					NA	NA	NA	Y
V2600	HAND HELD LOW VISION AIDS	PRXOVR	DEF					NA	NA	NA	Y
V2600	HAND HELD LOW VISION AIDS	PADOLR	DEF					NA	NA	NA	Y
V2610	SINGLE LENS SPECTACLE MOUNT	PRXOVR	DEF					NA	NA	NA	Y
V2610	SINGLE LENS SPECTACLE MOUNT	PADOLR	DEF					NA	NA	NA	Y
V2615	TELESCOP/OTHR COMPOUND LENS	PRXOVR	DEF					NA	NA	NA	Y
V2615	TELESCOP/OTHR COMPOUND LENS	PADOLR	DEF					NA	NA	NA	Y
V2623	PLASTIC EYE PROSTH CUSTOM	PRXOVR	DEF					NA	NA	NA	S
V2623	PLASTIC EYE PROSTH CUSTOM	MAXFEE	DEF					588.64	1/1/2010	12/31/2299	S
V2624	POLISHING ARTIFICAL EYE	PRXOVR	DEF					NA	NA	NA	S
V2624	POLISHING ARTIFICAL EYE	MAXFEE	DEF					38	1/1/2010	12/31/2299	S
V2625	ENLARGEMNT OF EYE PROSTHESIS	PRXOVR	DEF					NA	NA	NA	S
V2625	ENLARGEMNT OF EYE PROSTHESIS	MAXFEE	DEF					300.96	1/1/2010	12/31/2299	S
V2626	REDUCTION OF EYE PROSTHESIS	PRXOVR	DEF					NA	NA	NA	S
V2626	REDUCTION OF EYE PROSTHESIS	MAXFEE	DEF					124.54	1/1/2010	12/31/2299	S
V2627	SCLERAL COVER SHELL	PRXOVR	DEF					NA	NA	NA	S
V2627	SCLERAL COVER SHELL	MAXFEE	DEF					774.19	1/1/2010	12/31/2299	S
V2628	FABRICATION & FITTING	PRXOVR	DEF					NA	NA	NA	S
V2628	FABRICATION & FITTING	MAXFEE	DEF					189.93	1/1/2010	12/31/2299	S
V2629	PROSTHETIC EYE OTHER TYPE	PRXOVR	DEF					NA	NA	NA	S
V2629	PROSTHETIC EYE OTHER TYPE	MANUAL	DEF					NA	NA	NA	S
V2799	MISC VISION ITEM OR SERVICE	PRXOVR	DEF					NA	NA	NA	Y
V2799	MISC VISION ITEM OR SERVICE	PADOLR	DEF					NA	NA	NA	Y