20 Miss. Code R. § 2-II

Current through June 25, 2024

Section 20-2-II - GUIDELINES

A. Rental or purchase of supplies or equipment over the amount of $300.00 per item requires Prior Authorization.

B.Transportation Services Including Ambulance (A0021-A0999)

1. Transportation service codes include ground and air ambulance, non-emergency transportation (taxi, bus, automobile, wheelchair van), and ancillary transportation-related fees.

2. No exemption for air ambulance according to the Airline Deregulation Act (ADA) is allowed based on the rules and regulations of the 2019 MWCC Fee Schedule.

3. Modifiers are required when reporting transportation services. Modifiers are single digits used to identify origin and destination. The first modifier identifies the transport place of origin and the second modifier the destination. Origin and destination modifiers are as follows:

D. Diagnostic or therapeutic site other than "P" or "H" when these are used as origin codes;

E. Residential, domiciliary, custodial facility (other than 1819 facility);

G. Hospital-based ESRD facility;

H. Hospital;

I. Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport;

J. Free-standing ESRD facility;

N Skilled nursing facility (SNF);

P. Physician's office;

R. Residence;

S. Scene of accident or acute event; and

X. Intermediate stop at physician's office on way to hospital (includes HMO non-hospital facility, clinic, etc. destination code only).

Note: Modifier X can only be used as a destination code in the second position of a modifier.

4. Transportation codes can also be found in the S codes. See S0207, S0208, S0209, and S0215.

C.Medical and Surgical Supplies (A4206-A9286)

1. These A codes include a wide variety of medical, surgical, and some DME related supplies and services.

2. For rules related to DME supplies, accessories, maintenance, and repair, see F. Durable Medical Equipment below.

D.Administrative, Miscellaneous, and Investigational (A9150-A9999)

1. These A codes include non-prescription drugs, exercise equipment, radiopharmaceutical diagnostic imaging agents, as well as other miscellaneous supplies.

E.Enteral and Parenteral Therapy (B4034-B9999)

1. B codes include supplies, formulae, nutrition solutions and infusion pumps.

F.Outpatient PPS (C1713-C9899)

1. C codes include drugs, biologicals, and devices used by hospitals.

2. These codes are only used for facility (technical) services.

G.Durable Medical Equipment (DME) (E0100-E8002)

1. E codes include durable medical equipment such as canes, crutches, walkers, commodes, decubitus care, bath and toilet aids, hospital beds, oxygen and related respiratory equipment, monitoring equipment, pacemakers, patient lifts, safety equipment, restraints, traction equipment, fracture frames, wheelchairs, and artificial kidney machines.

2. All durable medical equipment shall have prior authorization from the payer before obtaining the equipment. The payer has the choice of vendor for purchase or rental of DME.

3. If an injured/ill employee is receiving DME items for both compensable and non-compensable medical conditions, only those items that apply to the work related injury should be listed on claims and invoices submitted to the employer.

4. If the rental price for DME exceeds or equals the total purchase price, the employer shall purchase instead of renting equipment. The vendor shall make the payer aware of the price options.

5. When rental payments total the purchase price, the equipment is considered purchased and no additional reimbursement is made.

6. The return of rented equipment is the dual responsibility of the injured worker and the DME supplier. The employer is not responsible for additional rental periods solely due to delay in equipment return.

7. For codes E0676, E0935, and E0936 the MAR listed is per day.

8. Codes reported with modifier RR are reimbursed at ten (10) percent of the maximum allowed amount when reported with the NU modifier. Codes in the Fee Schedule with the RR modifier are reimbursed at the listed fee and should not be billed with the NU or UE modifier.

H.Procedures/Professional Services (Temporary) (G0008- G9987)

1. G codes identify professional health care procedures and services that would otherwise be reported using CPT codes.

2. Procedures and professional services identified by G codes may have a corresponding CPT code. When both a G code and CPT code describe the same procedure, the CPT code is required for reporting purposes.

3. G codes also include procedures and professional services that do not currently have a valid CPT code. In such cases, the applicable G code should be used for reporting purposes.

I.Drugs and Biologicals (J0120-J9999)

1. J codes include drugs that ordinarily cannot be self-administered, chemotherapy drugs, immunosuppressive drugs, inhalation solutions, and other miscellaneous drugs and solutions.

2. These codes report only the costs associated with provision of the drug. Administration including injection, infusion, or inhalation is reported separately using the applicable CPT code(s).

3. Additional codes for drugs and biologicals may be found in the Q codes and S codes.

J.Temporary Codes (K0001-K0900)

1. K codes are temporary codes used to report durable medical equipment that do not yet have a permanent national code.

2. For rules related to DME supplies, accessories, maintenance, and repair, see F. Durable Medical Equipment above.

K.Orthotic Procedures and Devices (L0112-L4631) and Prosthetic Procedures (L5000-L9900)

1. L codes include orthotic and prosthetic procedures and devices as well as scoliosis equipment, orthopedic shoes, and prosthetic implants.

2. The payer shall only pay for orthotics and prosthetics prescribed by the treating physician for a compensable injury/illness. Prior authorization must be obtained from the payer.

3. For orthotics, prosthetics and supplies that are not listed in the Fee Schedule, use CPT code 99070. Reimbursement may not exceed a twenty percent (20%) mark-up of the provider's cost and an invoice may be required by the payer before reimbursement is made for items without an allowable amount in the Fee Schedule.

L.Medical Services (M0075-M1071)

1. M codes include office services, cellular therapy, prolotherapy, intragastric hypothermia, IV chelation therapy, and fabric wrapping of an abdominal aneurysm.

2. These codes are not reimbursed as they represent services for which the therapeutic efficacy has not been established, the procedure is considered experimental, or the procedure has been replaced with a more effective treatment modality.

M.Pathology and Laboratory Services (P2028-P9615)

1. P codes include chemistry, toxicology, and microbiology tests, screening Papanicolaou procedures, and various blood products.

2. Blood and blood product codes report the supply of the blood or blood product only.

3. The administration of blood or blood product is reported separately.

4. Code 36430 for transfusion of blood or blood components is reported only once per encounter regardless of the number of units provided.

N.Temporary Codes (Q0035-Q9992)

1. Q codes include temporary codes developed for reporting services and supplies that do not have a permanent national HCPCS code or CPT code. Included in this section are codes for:

a. Oral anti-emetic drugs;

b. Casting supplies;

c. Splint supplies;

d. Low osmolar contrast;

e. High osmolar contrast; and

f. Other supplies/services.

2. Cast supplies and splints should be reported with the appropriate code from Q4001-Q4051. These codes report the cost of the supply only.

3. Cast supplies and splints are reported in addition to the CPT code for fracture management.

4. Cast supplies and splints are reported in addition to CPT codes for application of the cast or splint.

5. Refer to CPT for rules related to reporting fracture management and cast application.

O.Diagnostic Radiology Services (R0070-R0075)

1. R codes are used for the transportation of portable x-ray and/or EKG equipment.

2. Only a single reasonable transportation charge is allowed for each trip to a single location.

3. When more than one patient receives x-ray or EKG services at the same location, the maximum allowable reimbursement transport charge is divided among all patients.

P.Temporary National Codes (Non-Medicare) (S0012-S9999)

1. Mississippi uses S codes with modified descriptions to report home health services.

2. See J codes for reporting rules related to drugs and biologicals.

Q.Vision Services (V2020-V2799)

1. These V codes include vision-related supplies, including spectacles, lenses, contact lenses, prostheses, intraocular lenses, and miscellaneous lenses.

R.Hearing Services (V5008V5364)

1. These V codes include hearing tests and related supplies and equipment, speech-language pathology screenings, and repair of augmentative communicative systems.

S.Facility Fee

1. The facility fee for outpatient services is the APC Amount.

	Code	Mod	Description	Amount	APC Amount
	A0021		OUTSIDE STATE AMBULANCE SERV	15.26
	A0080		NONINTEREST ESCORT IN NON ER	0.00
	A0090		INTEREST ESCORT IN NON ER	0.00
	A0100		NONEMERGENCY TRANSPORT TAXI	0.00
	A0110		NONEMERGENCY TRANSPORT BUS	0.00
	A0120		NONER TRANSPORT MINI-BUS	0.00
	A0130		NONER TRANSPORT WHEELCH VAN	0.00
	A0140		NONEMERGENCY TRANSPORT AIR	0.00
	A0160		NONER TRANSPORT CASE WORKER	0.14
	A0170		TRANSPORT PARKING FEES/TOLLS	0.00
	A0180		NONER TRANSPORT LODGNG RECIP	0.00
	A0190		NONER TRANSPORT MEALS RECIP	0.00
	A0200		NONER TRANSPORT LODGNG ESCRT	0.00
	A0210		NONER TRANSPORT MEALS ESCORT	0.00
	A0225		NEONATAL EMERGENCY TRANSPORT	1361.49
	A0380		BASIC LIFE SUPPORT MILEAGE	0.49
	A0382		BASIC SUPPORT ROUTINE SUPPLS	0.00
	A0384		BLS DEFIBRILLATION SUPPLIES	6.63
	A0390		ADVANCED LIFE SUPPORT MILEAG	4.61
	A0392		ALS DEFIBRILLATION SUPPLIES	17.23
	A0394		ALS IV DRUG THERAPY SUPPLIES	0.00
	A0396		ALS ESOPHAGEAL INTUB SUPPLS	17.23
	A0398		ALS ROUTINE DISPOSBLE SUPPLS	0.00
	A0420		AMBULANCE WAITING 1/2 HR	BR
	A0422		AMBULANCE 02 LIFE SUSTAINING	0.00
	A0424		EXTRA AMBULANCE ATTENDANT	BR
	A0425		GROUND MILEAGE	8.38
	A0426		ALS 1	348.36
	A0427		ALS1-EMERGENCY	551.56
	A0428		BLS	290.30
	A0429		BLS-EMERGENCY	464.48
	A0430		FIXED WING AIR TRANSPORT	9978.53
	A0431		ROTARY WING AIR TRANSPORT	11482.73
	A0432		PI VOLUNTEER AMBULANCE CO	BR
	A0433		ALS 2	BR
	A0434		SPECIALTY CARE TRANSPORT	BR
	A0435		FIXED WING AIR MILEAGE	30.01
	A0436		ROTARY WING AIR MILEAGE	80.14
	A0888		NONCOVERED AMBULANCE MILEAGE	BR
	A0998		AMBULANCE RESPONSE/TREATMENT	BR
	A0999		UNLISTED AMBULANCE SERVICE	BR
	A4206		1 CC STERILE SYRINGE&NEEDLE	0.00
	A4207		2 CC STERILE SYRINGE&NEEDLE	0.00
	A4208		3 CC STERILE SYRINGE&NEEDLE	0.00
	A4209		5+ CC STERILE SYRINGE&NEEDLE	0.00
	A4210		NONNEEDLE INJECTION DEVICE	0.00
	A4211		SUPP FOR SELF-ADM INJECTIONS	0.00
	A4212		NON CORING NEEDLE OR STYLET	0.00
	A4213		20+ CC SYRINGE ONLY	0.00
	A4215		STERILE NEEDLE	0.00
	A4216		STERILE WATER/SALINE, 10 ML	0.56
	A4217		STERILE WATER/SALINE, 500 ML	3.58
	A4218		STERILE SALINE OR WATER	0.00
	A4220		INFUSION PUMP REFILL KIT	0.00
	A4221		SUPP NON-INSULIN INF CATH/WK	25.49
	A4222		INFUSION SUPPLIES WITH PUMP	50.74
	A4223		INFUSION SUPPLIES W/O PUMP	0.00
	A4224		SUPPLY INSULIN INF CATH/WK	25.49
	A4225		SUP/EXT INSULIN INF PUMP SYR	3.17
	A4230		INFUS INSULIN PUMP NON NEEDL	0.00
	A4231		INFUSION INSULIN PUMP NEEDLE	0.00
	A4232		SYRINGE W/NEEDLE INSULIN 3CC	0.00
	A4233	NU	ALKALIN BATT FOR GLUCOSE MON	0.56
	A4234	NU	J-CELL BATT FOR GLUCOSE MON	2.60
	A4235	NU	LITHIUM BATT FOR GLUCOSE MON	1.10
	A4236	NU	SILVR OXIDE BATT GLUCOSE MON	1.28
	A4244		ALCOHOL OR PEROXIDE PER PINT	0.00
	A4245		ALCOHOL WIPES PER BOX	0.00
	A4246		BETADINE/PHISOHEX SOLUTION	0.00
	A4247		BETADINE/IODINE SWABS/WIPES	0.00
	A4248		CHLORHEXIDINE ANTISEPT	0.00
	A4250		URINE REAGENT STRIPS/TABLETS	16.30
	A4252		BLOOD KETONE TEST OR STRIP	0.00
	A4253	NU	BLOOD GLUCOSE/REAGENT STRIPS	9.15
	A4255		GLUCOSE MONITOR PLATFORMS	5.21
	A4256		CALIBRATOR SOLUTION/CHIPS	3.72
	A4257		REPLACE LENSSHIELD CARTRIDGE	16.16
	A4258		LANCET DEVICE EACH	2.33
	A4259		LANCETS PER BOX	0.00
	A4261		CERVICAL CAP CONTRACEPTIVE	0.00
	A4262		TEMPORARY TEAR DUCT PLUG	29.27
	A4263		PERMANENT TEAR DUCT PLUG	71.82
	A4264		INTRATUBAL OCCLUSION DEVICE	0.00
	A4265		PARAFFIN	4.31
	A4266		DIAPHRAGM	0.00
	A4267		MALE CONDOM	0.00
	A4268		FEMALE CONDOM	0.00
	A4269		SPERMICIDE	0.00
	A4270		DISPOSABLE ENDOSCOPE SHEATH	0.00
	A4280		BRST PRSTHS ADHSV ATTCHMNT	6.77
	A4281		REPLACEMENT BREASTPUMP TUBE	0.00
	A4282		REPLACEMENT BREASTPUMP ADPT	0.00
	A4283		REPLACEMENT BREASTPUMP CAP	0.00
	A4284		REPLCMNT BREAST PUMP SHIELD	0.00
	A4285		REPLCMNT BREAST PUMP BOTTLE	0.00
	A4286		REPLCMNT BREASTPUMP LOK RING	0.00
	A4290		SACRAL NERVE STIM TEST LEAD	0.00
	A4300		CATH IMPL VASC ACCESS PORTAL	0.00
	A4301		IMPLANTABLE ACCESS SYST PERC	0.00
	A4305		DRUG DELIVERY SYSTEM >=50 ML	85.14
	A4306		DRUG DELIVERY SYSTEM <=50 ML	76.62
	A4310		INSERT TRAY W/O BAG/CATH	8.32
	A4311		CATHETER W/O BAG 2-WAY LATEX	18.77
	A4312		CATH W/O BAG 2-WAY SILICONE	22.85
	A4313		CATHETER W/BAG 3-WAY	23.46
	A4314		CATH W/DRAINAGE 2-WAY LATEX	27.21
	A4315		CATH W/DRAINAGE 2-WAY SILCNE	33.41
	A4316		CATH W/DRAINAGE 3-WAY	35.97
	A4320		IRRIGATION TRAY	5.75
	A4321		CATH THERAPEUTIC IRRIG AGENT	BR
	A4322		IRRIGATION SYRINGE	3.84
	A4326		MALE EXTERNAL CATHETER	13.66
	A4327		FEM URINARY COLLECT DEV CUP	56.50
	A4328		FEM URINARY COLLECT POUCH	13.22
	A4330		STOOL COLLECTION POUCH	7.71
	A4331		EXTENSION DRAINAGE TUBING	4.03
	A4332		LUBE STERILE PACKET	0.14
	A4333		URINARY CATH ANCHOR DEVICE	2.81
	A4334		URINARY CATH LEG STRAP	BR
	A4335		INCONTINENCE SUPPLY	BR
	A4336		URETHRAL INSERT	1.83
	A4337		INCONTINENT RECTAL INSERT	BR
	A4338		INDWELLING CATHETER LATEX	15.53
	A4340		INDWELLING CATHETER SPECIAL	34.19
	A4344		CATH INDW FOLEY 2 WAY SILICN	18.55
	A4346		CATH INDW FOLEY 3 WAY	21.98
	A4349		DISPOSABLE MALE EXTERNAL CAT	2.55
	A4351		STRAIGHT TIP URINE CATHETER	2.12
	A4352		COUDE TIP URINARY CATHETER	8.14
	A4353		INTERMITTENT URINARY CATH	8.87
	A4354		CATH INSERTION TRAY W/BAG	14.95
	A4355		BLADDER IRRIGATION TUBING	11.30
	A4356		EXT URETH CLMP OR COMPR DVC	52.70
	A4357		BEDSIDE DRAINAGE BAG	10.45
	A4358		URINARY LEG OR ABDOMEN BAG	7.50
	A4360		DISPOSABLE EXT URETHRAL DEV	0.56
	A4361		OSTOMY FACE PLATE	23.27
	A4362		SOLID SKIN BARRIER	3.73
	A4363		OSTOMY CLAMP, REPLACEMENT	2.55
	A4364		ADHESIVE, LIQUID OR EQUAL	3.73
	A4366		OSTOMY VENT	1.64
	A4367		OSTOMY BELT	7.92
	A4368		OSTOMY FILTER	0.32
	A4369		SKIN BARRIER LIQUID PER OZ	3.07
	A4371		SKIN BARRIER POWDER PER OZ	4.61
	A4372		SKIN BARRIER SOLID 4X4 EQUIV	5.31
	A4373		SKIN BARRIER WITH FLANGE	7.94
	A4375		DRAINABLE PLASTIC PCH W FCPL	21.75
	A4376		DRAINABLE RUBBER PCH W FCPLT	60.27
	A4377		DRAINABLE PLSTIC PCH W/O FP	5.43
	A4378		DRAINABLE RUBBER PCH W/O FP	38.94
	A4379		URINARY PLASTIC POUCH W FCPL	19.02
	A4380		URINARY RUBBER POUCH W FCPLT	47.28
	A4381		URINARY PLASTIC POUCH W/O FP	5.86
	A4382		URINARY HVY PLSTC PCH W/O FP	31.17
	A4383		URINARY RUBBER POUCH W/O FP	35.71
	A4384		OSTOMY FACEPLT/SILICONE RING	12.18
	A4385		OST SKN BARRIER SLD EXT WEAR	6.46
	A4387		OST CLSD POUCH W ATT ST BARR	2.85
	A4388		DRAINABLE PCH W EX WEAR BARR	5.52
	A4389		DRAINABLE PCH W ST WEAR BARR	7.88
	A4390		DRAINABLE PCH EX WEAR CONVEX	12.17
	A4391		URINARY POUCH W EX WEAR BARR	8.95
	A4392		URINARY POUCH W ST WEAR BARR	10.35
	A4393		URINE PCH W EX WEAR BAR CONV	11.45
	A4394		OSTOMY POUCH LIQ DEODORANT	3.28
	A4395		OSTOMY POUCH SOLID DEODORANT	0.06
	A4396		PERISTOMAL HERNIA SUPPRT BLT	51.27
	A4397		IRRIGATION SUPPLY SLEEVE	5.52
	A4398		OSTOMY IRRIGATION BAG	17.51
	A4399		OSTOMY IRRIG CONE/CATH W BRS	13.66
	A4400		OSTOMY IRRIGATION SET	52.61
	A4402		LUBRICANT PER OUNCE	1.72
	A4404		OSTOMY RING EACH	1.85
	A4405		NONPECTIN BASED OSTOMY PASTE	4.32
	A4406		PECTIN BASED OSTOMY PASTE	7.25
	A4407		EXT WEAR OST SKN BARR <=4SQ"	11.10
	A4408		EXT WEAR OST SKN BARR >4SQ"	12.51
	A4409		OST SKN BARR CONVEX <=4 SQ I	7.88
	A4410		OST SKN BARR EXTND >4 SQ	11.45
	A4411		OST SKN BARR EXTND =4SQ	6.46
	A4412		OST POUCH DRAIN HIGH OUTPUT	3.42
	A4413		2 PC DRAINABLE OST POUCH	6.97
	A4414		OST SKNBAR W/O CONV<=4 SQ IN	6.24
	A4415		OST SKN BARR W/O CONV >4 SQI	7.59
	A4416		OST PCH CLSD W BARRIER/FILTR	3.49
	A4417		OST PCH W BAR/BLTINCONV/FLTR	4.72
	A4418		OST PCH CLSD W/O BAR W FILTR	2.30
	A4419		OST PCH FOR BAR W FLANGE/FLT	2.19
	A4420		OST PCH CLSD FOR BAR W LK FL	BR
	A4421		OSTOMY SUPPLY MISC	BR
	A4422		OST POUCH ABSORBENT MATERIAL	0.14
	A4423		OST PCH FOR BAR W LK FL/FLTR	2.35
	A4424		OST PCH DRAIN W BAR & FILTER	6.03
	A4425		OST PCH DRAIN FOR BARRIER FL	4.53
	A4426		OST PCH DRAIN 2 PIECE SYSTEM	3.45
	A4427		OST PCH DRAIN/BARR LK FLNG/F	3.52
	A4428		URINE OST POUCH W FAUCET/TAP	8.25
	A4429		URINE OST POUCH W BLTINCONV	10.44
	A4430		OST URINE PCH W B/BLTIN CONV	10.78
	A4431		OST PCH URINE W BARRIER/TAPV	7.88
	A4432		OS PCH URINE W BAR/FANGE/TAP	4.54
	A4433		URINE OST PCH BAR W LOCK FLN	4.25
	A4434		OST PCH URINE W LOCK FLNG/FT	4.76
	A4435		1PC OST PCH DRAIN HGH OUTPUT	7.30
	A4450		NON-WATERPROOF TAPE	0.12
	A4452		WATERPROOF TAPE	0.36
	A4455		ADHESIVE REMOVER PER OUNCE	1.82
	A4456		ADHESIVE REMOVER, WIPES	0.31
	A4458		REUSABLE ENEMA BAG	BR
	A4459		MANUAL PUMP ENEMA, REUSABLE	BR
	A4461		SURGICL DRESS HOLD NON-REUSE	4.18
	A4463		SURGICAL DRESS HOLDER REUSE	16.85
	A4465		NON-ELASTIC EXTREMITY BINDER	22.34
	A4467		BELT STRAP SLEEV GRMNT COVER	42.56
	A4470		GRAVLEE JET WASHER	5.23
	A4480		VABRA ASPIRATOR	42.56
	A4481		TRACHEOSTOMA FILTER	0.47
	A4483		MOISTURE EXCHANGER	BR
	A4490		ABOVE KNEE SURGICAL STOCKING	22.84
	A4495		THIGH LENGTH SURG STOCKING	22.84
	A4500		BELOW KNEE SURGICAL STOCKING	22.84
	A4510		FULL LENGTH SURG STOCKING	81.57
	A4520		INCONTINENCE GARMENT ANYTYPE	BR
	A4550		SURGICAL TRAYS	32.63
	A4553		NONDISP UNDERPADS, ALL SIZES	8.32
	A4554		DISPOSABLE UNDERPADS	0.40
	A4555		CA TX E-STIM ELECTR/TRANSDUC	BR
	A4556		ELECTRODES, PAIR	13.07
	A4557		LEAD WIRES, PAIR	17.40
	A4558		CONDUCTIVE GEL OR PASTE	6.24
	A4559		COUPLING GEL OR PASTE	0.12
	A4561		PESSARY RUBBER, ANY TYPE	26.08
	A4562		PESSARY, NON RUBBER, ANY TYPE	64.83
	A4563		VAG INSER RECTAL CONTROL SYS	141.17
	A4565		SLINGS	9.75
	A4566		SHOULD SLING/VEST/ABRESTRAIN	BR
	A4570		SPLINT	37.25
	A4575		HYPERBARIC O2 CHAMBER DISPS	BR
	A4580		CAST SUPPLIES (PLASTER)	90.45
	A4590		SPECIAL CASTING MATERIAL	79.82
	A4595		TENS SUP PL 2 LEAD PER MONTH	24.28
	A4600		SLEEVE, INTER LIMB COMP DEV	BR
	A4601		LITH ION NON PROSTH RECHARGE	BR
	A4602	NU	REPLACE LITHIUM BATTERY 1.5V	4.72
	A4604	NU	TUBING WITH HEATING ELEMENT	60.28
	A4605	NU	TRACH SUCTION CATH CLOSE SYS	20.77
	A4606		OXYGEN PROBE USED W OXIMETER	BR
	A4608		TRANSTRACHEAL OXYGEN CATH	63.48
	A4611	NU	HEAVY DUTY BATTERY	648.36
	A4612	NU	BATTERY CABLES	211.93
	A4613	NU	BATTERY CHARGER	576.47
	A4614		HAND-HELD PEFR METER	30.12
	A4615		CANNULA NASAL	0.92
	A4616		TUBING (OXYGEN) PER FOOT	0.08
	A4617		MOUTH PIECE	3.93
	A4618	NU	BREATHING CIRCUITS	9.57
	A4619	NU	FACE TENT	2.28
	A4620		VARIABLE CONCENTRATION MASK	0.80
	A4623		TRACHEOSTOMY INNER CANNULA	7.05
	A4624	NU	TRACHEAL SUCTION TUBE	2.84
	A4625		TRACH CARE KIT FOR NEW TRACH	7.45
	A4626		TRACHEOSTOMY CLEANING BRUSH	4.03
	A4627		SPACER BAG/RESERVOIR	42.56
	A4628	NU	OROPHARYNGEAL SUCTION CATH	4.74
	A4629		TRACHEOSTOMY CARE KIT	5.89
	A4630	NU	REPL BAT T.E.N.S. OWN BY PT	7.91
	A4633	NU	UVL REPLACEMENT BULB	51.96
	A4634		REPLACEMENT BULB TH LIGHTBOX	BR
	A4635	NU	UNDERARM CRUTCH PAD	6.48
	A4636	NU	HANDGRIP FOR CANE ETC	4.33
	A4637	NU	REPL TIP CANE/CRUTCH/WALKER	2.29
	A4638	NU	REPL BATT PULSE GEN SYS	0.00
	A4639	RR	INFRARED HT SYS REPLCMNT PAD	36.38
	A4640	NU	ALTERNATING PRESSURE PAD	65.21
	A4641		RADIOPHARM DX AGENT NOC	BR
	A4642		IN111 SATUMOMAB	BR
	A4648		IMPLANTABLE TISSUE MARKER	BR
	A4649		SURGICAL SUPPLIES	BR
	A4650		IMPLANT RADIATION DOSIMETER	BR
	A4651		CALIBRATED MICROCAP TUBE	BR
	A4652		MICROCAPILLARY TUBE SEALANT	BR
	A4653		PD CATHETER ANCHOR BELT	BR
	A4657		SYRINGE W/WO NEEDLE	0.00
	A4660		SPHYG/BP APP W CUFF AND STET	37.25
	A4663		DIALYSIS BLOOD PRESSURE CUFF	57.46
	A4670		AUTOMATIC BP MONITOR, DIAL	119.46
	A4671		DISPOSABLE CYCLER SET	BR
	A4672		DRAINAGE EXT LINE, DIALYSIS	BR
	A4673		EXT LINE W EASY LOCK CONNECT	BR
	A4674		CHEM/ANTISEPT SOLUTION, 8OZ	BR
	A4680		ACTIVATED CARBON FILTER, EA	266.02
	A4690		DIALYZER, EACH	200.27
	A4706		BICARBONATE CONC SOL PER GAL	BR
	A4707		BICARBONATE CONC POW PER PAC	BR
	A4708		ACETATE CONC SOL PER GALLON	BR
	A4709		ACID CONC SOL PER GALLON	BR
	A4714		TREATED WATER PER GALLON	BR
	A4719		"Y SET" TUBING	BR
	A4720		DIALYSAT SOL FLD VOL > 249CC	BR
	A4721		DIALYSAT SOL FLD VOL > 999CC	BR
	A4722		DIALYS SOL FLD VOL > 1999CC	BR
	A4723		DIALYS SOL FLD VOL > 2999CC	BR
	A4724		DIALYS SOL FLD VOL > 3999CC	BR
	A4725		DIALYS SOL FLD VOL > 4999CC	BR
	A4726		DIALYS SOL FLD VOL > 5999CC	BR
	A4728		DIALYSATE SOLUTION, NON-DEX	BR
	A4730		FISTULA CANNULATION SET, EA	BR
	A4736		TOPICAL ANESTHETIC, PER GRAM	BR
	A4737		INJ ANESTHETIC PER 10 ML	BR
	A4740		SHUNT ACCESSORY	BR
	A4750		ART OR VENOUS BLOOD TUBING	69.17
	A4755		COMB ART/VENOUS BLOOD TUBING	BR
	A4760		DIALYSATE SOL TEST KIT, EACH	BR
	A4765		DIALYSATE CONC POW PER PACK	BR
	A4766		DIALYSATE CONC SOL ADD 10 ML	BR
	A4770		BLOOD COLLECTION TUBE/VACUUM	BR
	A4771		SERUM CLOTTING TIME TUBE	BR
	A4772		BLOOD GLUCOSE TEST STRIPS	21.34
	A4773		OCCULT BLOOD TEST STRIPS	156.62
	A4774		AMMONIA TEST STRIPS	BR
	A4802		PROTAMINE SULFATE PER 50 MG	4.03
	A4860		DISPOSABLE CATHETER TIPS	BR
	A4870		PLUMB/ELEC WK HM HEMO EQUIP	BR
	A4890		REPAIR/MAINT CONT HEMO EQUIP	BR
	A4911		DRAIN BAG/BOTTLE	BR
	A4913		MISC DIALYSIS SUPPLIES NOC	BR
	A4918		VENOUS PRESSURE CLAMP	BR
	A4927		NON-STERILE GLOVES	7.58
	A4928		SURGICAL MASK	0.00
	A4929		TOURNIQUET FOR DIALYSIS, EA	0.40
	A4930		STERILE, GLOVES PER PAIR	0.00
	A4931		REUSABLE ORAL THERMOMETER	0.00
	A4932		REUSABLE RECTAL THERMOMETER	0.00
	A5051		POUCH CLSD W BARR ATTACHED	2.62
	A5052		CLSD OSTOMY POUCH W/O BARR	1.88
	A5053		CLSD OSTOMY POUCH FACEPLATE	1.87
	A5054		CLSD OSTOMY POUCH W/FLANGE	2.28
	A5055		STOMA CAP	1.66
	A5056		1 PC OST POUCH W FILTER	5.92
	A5057		1 PC OST POU W BUILT-IN CONV	12.17
	A5061		POUCH DRAINABLE W BARRIER AT	4.47
	A5062		DRNBLE OSTOMY POUCH W/O BARR	2.83
	A5063		DRAIN OSTOMY POUCH W/FLANGE	3.42
	A5071		URINARY POUCH W/BARRIER	7.61
	A5072		URINARY POUCH W/O BARRIER	3.99
	A5073		URINARY POUCH ON BARR W/FLNG	3.42
	A5081		STOMA PLUG OR SEAL, ANY TYPE	3.58
	A5082		CONTINENT STOMA CATHETER	12.82
	A5083		STOMA ABSORPTIVE COVER	0.81
	A5093		OSTOMY ACCESSORY CONVEX INSE	2.38
	A5102		BEDSIDE DRAIN BTL W/WO TUBE	28.59
	A5105		URINARY SUSPENSORY	51.65
	A5112		URINARY LEG BAG	43.85
	A5113		LATEX LEG STRAP	5.97
	A5114		FOAM/FABRIC LEG STRAP	9.64
	A5120		SKIN BARRIER, WIPE OR SWAB	0.52
	A5121		SOLID SKIN BARRIER 6X6	9.44
	A5122		SOLID SKIN BARRIER 8X8	16.27
	A5126		DISK/FOAM PAD +OR- ADHESIVE	1.66
	A5131		APPLIANCE CLEANER	20.08
	A5200		PERCUTANEOUS CATHETER ANCHOR	14.32
	A5500		DIAB SHOE FOR DENSITY INSERT	80.53
	A5501		DIABETIC CUSTOM MOLDED SHOE	241.55
	A5503		DIABETIC SHOE W/ROLLER/ROCKR	39.86
	A5504		DIABETIC SHOE WITH WEDGE	39.86
	A5505		DIAB SHOE W/METATARSAL BAR	39.86
	A5506		DIABETIC SHOE W/OFF SET HEEL	39.86
	A5507		MODIFICATION DIABETIC SHOE	39.86
	A5508		DIABETIC DELUXE SHOE	BR
	A5510		COMPRESSION FORM SHOE INSERT	BR
	A5512		MULTI DEN INSERT DIRECT FORM	32.85
	A5513		MULTI DEN INSERT CUSTOM MOLD	49.02
	A5514		MULT DEN INSERT DIR CARV/CAM	49.02
	A6000		WOUND WARMING WOUND COVER	0.00
	A6010		COLLAGEN BASED WOUND FILLER	39.23
	A6011		COLLAGEN GEL/PASTE WOUND FIL	2.89
	A6021		COLLAGEN DRESSING <=16 SQ IN	26.62
	A6022		COLLAGEN DRSG>16<=48 SQ IN	26.62
	A6023		COLLAGEN DRESSING >48 SQ IN	241.03
	A6024		COLLAGEN DSG WOUND FILLER	7.84
	A6025		SILICONE GEL SHEET, EACH	29.45
	A6154		WOUND POUCH EACH	18.22
	A6196		ALGINATE DRESSING <=16 SQ IN	9.32
	A6197		ALGINATE DRSG >16 <=48 SQ IN	20.82
	A6198		ALGINATE DRESSING > 48 SQ IN	BR
	A6199		ALGINATE DRSG WOUND FILLER	6.70
	A6203		COMPOSITE DRSG <= 16 SQ IN	4.27
	A6204		COMPOSITE DRSG >16<=48 SQ IN	7.89
	A6205		COMPOSITE DRSG > 48 SQ IN	BR
	A6206		CONTACT LAYER <= 16 SQ IN	14.63
	A6207		CONTACT LAYER >16<= 48 SQ IN	9.30
	A6208		CONTACT LAYER > 48 SQ IN	BR
	A6209		FOAM DRSG <=16 SQ IN W/O BDR	9.46
	A6210		FOAM DRG >16<=48 SQ IN W/O B	25.23
	A6211		FOAM DRG > 48 SQ IN W/O BRDR	37.20
	A6212		FOAM DRG <=16 SQ IN W/BORDER	12.30
	A6213		FOAM DRG >16<=48 SQ IN W/BDR	24.63
	A6214		FOAM DRG > 48 SQ IN W/BORDER	13.04
	A6215		FOAM DRESSING WOUND FILLER	BR
	A6216		NON-STERILE GAUZE<=16 SQ IN	0.06
	A6217		NON-STERILE GAUZE>16<=48 SQ	BR
	A6218		NON-STERILE GAUZE > 48 SQ IN	0.97
	A6219		GAUZE <= 16 SQ IN W/BORDER	1.21
	A6220		GAUZE >16 <=48 SQ IN W/BORDR	3.28
	A6221		GAUZE > 48 SQ IN W/BORDER	BR
	A6222		GAUZE <=16 IN NO W/SAL W/O B	2.71
	A6223		GAUZE >16<=48 NO W/SAL W/O B	3.07
	A6224		GAUZE > 48 IN NO W/SAL W/O B	4.57
	A6228		GAUZE <= 16 SQ IN WATER/SAL	5.32
	A6229		GAUZE >16<=48 SQ IN WATR/SAL	4.57
	A6230		GAUZE > 48 SQ IN WATER/SALNE	1.96
	A6231		HYDROGEL DSG<=16 SQ IN	5.94
	A6232		HYDROGEL DSG>16<=48 SQ IN	8.69
	A6233		HYDROGEL DRESSING >48 SQ IN	24.29
	A6234		HYDROCOLLD DRG <=16 W/O BDR	8.28
	A6235		HYDROCOLLD DRG >16<=48 W/O B	21.31
	A6236		HYDROCOLLD DRG > 48 IN W/O B	34.52
	A6237		HYDROCOLLD DRG <=16 IN W/BDR	10.02
	A6238		HYDROCOLLD DRG >16<=48 W/BDR	28.88
	A6239		HYDROCOLLD DRG > 48 IN W/BDR	BR
	A6240		HYDROCOLLD DRG FILLER PASTE	15.51
	A6241		HYDROCOLLOID DRG FILLER DRY	3.26
	A6242		HYDROGEL DRG <=16 IN W/O BDR	7.68
	A6243		HYDROGEL DRG >16<=48 W/O BDR	15.61
	A6244		HYDROGEL DRG >48 IN W/O BDR	49.75
	A6245		HYDROGEL DRG <= 16 IN W/BDR	9.21
	A6246		HYDROGEL DRG >16<=48 IN W/B	12.58
	A6247		HYDROGEL DRG > 48 SQ IN W/B	30.12
	A6248		HYDROGEL DRSG GEL FILLER	20.58
	A6250		SKIN SEAL PROTECT MOISTURIZR	BR
	A6251		ABSORPT DRG <=16 SQ IN W/O B	2.52
	A6252		ABSORPT DRG >16 <=48 W/O BDR	4.13
	A6253		ABSORPT DRG > 48 SQ IN W/O B	8.02
	A6254		ABSORPT DRG <=16 SQ IN W/BDR	1.52
	A6255		ABSORPT DRG >16<=48 IN W/BDR	3.85
	A6256		ABSORPT DRG > 48 SQ IN W/BDR	BR
	A6257		TRANSPARENT FILM <= 16 SQ IN	1.95
	A6258		TRANSPARENT FILM >16<=48 IN	5.46
	A6259		TRANSPARENT FILM > 48 SQ IN	13.85
	A6260		WOUND CLEANSER ANY TYPE/SIZE	0.42
	A6261		WOUND FILLER GEL/PASTE /OZ	5.32
	A6262		WOUND FILLER DRY FORM / GRAM	6.03
	A6266		IMPREG GAUZE NO H20/SAL/YARD	2.43
	A6402		STERILE GAUZE <= 16 SQ IN	0.14
	A6403		STERILE GAUZE>16 <= 48 SQ IN	0.54
	A6404		STERILE GAUZE > 48 SQ IN	0.53
	A6407		PACKING STRIPS, NON-IMPREG	2.38
	A6410		STERILE EYE PAD	0.48
	A6411		NON-STERILE EYE PAD	0.00
	A6412		OCCLUSIVE EYE PATCH	0.39
	A6413		ADHESIVE BANDAGE, FIRST-AID	0.00
	A6441		PAD BAND W>=3" GREATER THAN 5"/YD	0.87
	A6442		CONFORM BAND N/S W<3"/YD	0.20
	A6443		CONFORM BAND N/S W>=3"GREATER THAN 5"/YD	0.35
	A6444		CONFORM BAND N/S W>=5"/YD	0.70
	A6445		CONFORM BAND S W <3"/YD	0.41
	A6446		CONFORM BAND S W>=3" GREATER THAN 5"/YD	0.51
	A6447		CONFORM BAND S W >=5"/YD	0.87
	A6448		LT COMPRES BAND <3"/YD	1.46
	A6449		LT COMPRES BAND >=3" GREATER THAN 5"/YD	2.22
	A6450		LT COMPRES BAND >=5"/YD	BR
	A6451		MOD COMPRES BAND W>=3"GREATER THAN 5"/YD	BR
	A6452		HIGH COMPRES BAND W>=3"GREATER THAN 5"YD	7.48
	A6453		SELF-ADHER BAND W <3"/YD	0.79
	A6454		SELF-ADHER BAND W>=3" GREATER THAN 5"/YD	0.99
	A6455		SELF-ADHER BAND >=5"/YD	1.77
	A6456		ZINC PASTE BAND W >=3"GREATER THAN 5"/YD	1.61
	A6457		TUBULAR DRESSING	1.44
	A6460		SYNTHETIC DRSG <= 16 SQ IN	BR
	A6461		SYNTHETIC DRSG >16<=48 SQ IN	BR
	A6501		COMPRES BURNGARMENT BODYSUIT	BR
	A6502		COMPRES BURNGARMENT CHINSTRP	BR
	A6503		COMPRES BURNGARMENT FACEHOOD	BR
	A6504		CMPRSBURNGARMENT GLOVE-WRIST	BR
	A6505		CMPRSBURNGARMENT GLOVE-ELBOW	BR
	A6506		CMPRSBURNGRMNT GLOVE-AXILLA	BR
	A6507		CMPRS BURNGARMENT FOOT-KNEE	BR
	A6508		CMPRS BURNGARMENT FOOT-THIGH	BR
	A6509		COMPRES BURN GARMENT JACKET	BR
	A6510		COMPRES BURN GARMENT LEOTARD	BR
	A6511		COMPRES BURN GARMENT PANTY	BR
	A6512		COMPRES BURN GARMENT, NOC	BR
	A6513		COMPRESS BURN MASK FACE/NECK	BR
	A6530		COMPRESSION STOCKING BK18-30	49.73
	A6531		COMPRESSION STOCKING BK30-40	61.29
	A6532		COMPRESSION STOCKING BK40-50	86.37
	A6533		GC STOCKING THIGHLNGTH 18-30	43.18
	A6534		GC STOCKING THIGHLNGTH 30-40	57.58
	A6535		GC STOCKING THIGHLNGTH 40-50	91.60
	A6536		GC STOCKING FULL LNGTH 18-30	91.60
	A6537		GC STOCKING FULL LNGTH 30-40	104.69
	A6538		GC STOCKING FULL LNGTH 40-50	143.94
	A6539		GC STOCKING WAISTLNGTH 18-30	200.21
	A6540		GC STOCKING WAISTLNGTH 30-40	108.61
	A6541		GC STOCKING WAISTLNGTH 40-50	146.56
	A6544		GC STOCKING GARTER BELT	52.34
	A6545		GRAD COMP NON-ELASTIC BK	120.69
	A6549		G COMPRESSION STOCKING	0.00
	A6550		NEG PRES WOUND THER DRSG SET	29.88
	A7000	NU	DISPOSABLE CANISTER FOR PUMP	10.88
	A7001	NU	NONDISPOSABLE PUMP CANISTER	37.38
	A7002	NU	TUBING USED W SUCTION PUMP	4.13
	A7003	NU	NEBULIZER ADMINISTRATION SET	2.63
	A7004	NU	DISPOSABLE NEBULIZER SML VOL	1.72
	A7005	NU	NONDISPOSABLE NEBULIZER SET	23.61
	A7006	NU	FILTERED NEBULIZER ADMIN SET	10.31
	A7007	NU	LG VOL NEBULIZER DISPOSABLE	4.66
	A7008	NU	DISPOSABLE NEBULIZER PREFILL	11.84
	A7009	NU	NEBULIZER RESERVOIR BOTTLE	52.45
	A7010	NU	DISPOSABLE CORRUGATED TUBING	21.78
	A7012	NU	NEBULIZER WATER COLLEC DEVIC	4.06
	A7013	NU	DISPOSABLE COMPRESSOR FILTER	0.77
	A7014	NU	COMPRESSOR NONDISPOS FILTER	4.76
	A7015	NU	AEROSOL MASK USED W NEBULIZE	1.94
	A7016	NU	NEBULIZER DOME & MOUTHPIECE	8.73
	A7017	NU	NEBULIZER NOT USED W OXYGEN	153.57
	A7018		WATER DISTILLED W/NEBULIZER	0.40
	A7020	NU	INTERFACE, COUGH STIM DEVICE	18.34
	A7025	RR	REPLACE CHEST COMPRESS VEST	55.10
	A7026	NU	REPLACE CHST CMPRSS SYS HOSE	36.40
	A7027	NU	COMBINATION ORAL/NASAL MASK	189.57
	A7028	NU	REPL ORAL CUSHION COMBO MASK	51.43
	A7029	NU	REPL NASAL PILLOW COMB MASK	22.00
	A7030	NU	CPAP FULL FACE MASK	156.23
	A7031	NU	REPLACEMENT FACEMASK INTERFA	58.33
	A7032	NU	REPLACEMENT NASAL CUSHION	33.44
	A7033	NU	REPLACEMENT NASAL PILLOWS	24.78
	A7034	NU	NASAL APPLICATION DEVICE	97.53
	A7035	NU	POS AIRWAY PRESS HEADGEAR	31.10
	A7036	NU	POS AIRWAY PRESS CHINSTRAP	14.91
	A7037	NU	POS AIRWAY PRESSURE TUBING	29.33
	A7038	NU	POS AIRWAY PRESSURE FILTER	4.20
	A7039	NU	FILTER, NON DISPOSABLE W PAP	10.74
	A7040		ONE WAY CHEST DRAIN VALVE	51.51
	A7041		WATER SEAL DRAIN CONTAINER	96.80
	A7044	NU	PAP ORAL INTERFACE	115.54
	A7045	NU	REPL EXHALATION PORT FOR PAP	17.83
	A7046	NU	REPL WATER CHAMBER, PAP DEV	18.60
	A7047	NU	RESP SUCTION ORAL INTERFACE	153.13
	A7048		VACUUM DRAIN BOTTLE/TUBE KIT	53.88
	A7501		TRACHEOSTOMA VALVE W DIAPHRA	133.01
	A7502		REPLACEMENT DIAPHRAGM/FPLATE	63.23
	A7503		HMES FILTER HOLDER OR CAP	14.37
	A7504		TRACHEOSTOMA HMES FILTER	0.87
	A7505		HMES OR TRACH VALVE HOUSING	5.94
	A7506		HMES/TRACHVALVE ADHESIVEDISK	0.42
	A7507		INTEGRATED FILTER & HOLDER	3.15
	A7508		HOUSING & INTEGRATED ADHESIV	3.63
	A7509		HEAT & MOISTURE EXCHANGE SYS	1.79
	A7520		TRACH/LARYN TUBE NON-CUFFED	60.14
	A7521		TRACH/LARYN TUBE CUFFED	59.58
	A7522		TRACH/LARYN TUBE STAINLESS	57.20
	A7523		TRACHEOSTOMY SHOWER PROTECT	BR
	A7524		TRACHEOSTOMA STENT/STUD/BTTN	98.04
	A7525		TRACHEOSTOMY MASK	2.62
	A7526		TRACHEOSTOMY TUBE COLLAR	4.29
	A7527		TRACH/LARYN TUBE PLUG/STOP	4.53
	A8000	NU	SOFT PROTECT HELMET PREFAB	194.24
	A8001	NU	HARD PROTECT HELMET PREFAB	194.24
	A8002	NU	SOFT PROTECT HELMET CUSTOM	BR
	A8003	NU	HARD PROTECT HELMET CUSTOM	BR
	A8004	NU	REPL SOFT INTERFACE, HELMET	BR
	A9150		MISC/EXPER NON-PRESCRIPT DRU	BR
	A9152		SINGLE VITAMIN NOS	BR
	A9153		MULTI-VITAMIN NOS	BR
	A9155		ARTIFICIAL SALIVA	BR
	A9180		LICE TREATMENT, TOPICAL	BR
	A9270		NON-COVERED ITEM OR SERVICE	BR
	A9272		DISP WOUND SUCT, DRSG/ACCESS	BR
	A9273		HOT/COLD BOTLE/CAP/COL/WRAP	BR
	A9274		EXT AMB INSULIN DELIVERY SYS	BR
	A9275		DISP HOME GLUCOSE MONITOR	BR
	A9276		DISPOSABLE SENSOR, CGM SYS	BR
	A9277		EXTERNAL TRANSMITTER, CGM	BR
	A9278		EXTERNAL RECEIVER, CGM SYS	BR
	A9279		MONITORING FEATURE/DEVICENOC	BR
	A9280		ALERT DEVICE, NOC	BR
	A9281		REACHING/GRABBING DEVICE	BR
	A9282		WIG ANY TYPE	BR
	A9283		FOOT PRESS OFF LOAD SUPP DEV	BR
	A9284		NON-ELECTRONIC SPIROMETER	BR
	A9285		INVERSION EVERSION COR DEVIC	BR
	A9286		ANY HYGIENIC ITEM, DEVICE	0.32
	A9300		EXERCISE EQUIPMENT	BR
	A9500		TC99M SESTAMIBI	BR
	A9501		TECHNETIUM TC-99M TEBOROXIME	BR
	A9502		TC99M TETROFOSMIN	BR
	A9503		TC99M MEDRONATE	BR
	A9504		TC99M APCITIDE	BR
	A9505		TL201 THALLIUM	BR
	A9507		IN111 CAPROMAB	BR
	A9508		I131 IODOBENGUATE, DX	BR
	A9509		IODINE I-123 SOD IODIDE MIL	BR
	A9510		TC99M DISOFENIN	BR
	A9512		TC99M PERTECHNETATE	BR
	A9513		LUTETIUM LU 177 DOTATAT THER	BR	357.49
	A9515		CHOLINE C-11	4607.04
	A9516		IODINE I-123 SOD IODIDE MIC	BR
	A9517		I131 IODIDE CAP, RX	BR	29.48
	A9520		TC99 TILMANOCEPT DIAG 0.5MCI	0.00
	A9521		TC99M EXAMETAZIME	BR
	A9524		I131 SERUM ALBUMIN, DX	BR
	A9526		NITROGEN N-13 AMMONIA	BR
	A9527		IODINE I-125 SODIUM IODIDE	BR	53.78
	A9528		IODINE I-131 IODIDE CAP, DX	146.49
	A9529		I131 IODIDE SOL, DX	BR
	A9530		I131 IODIDE SOL, RX	BR	19.27
	A9531		I131 MAX 100UCI	BR
	A9532		I125 SERUM ALBUMIN, DX	255.27
	A9536		TC99M DEPREOTIDE	BR
	A9537		TC99M MEBROFENIN	BR
	A9538		TC99M PYROPHOSPHATE	BR
	A9539		TC99M PENTETATE	BR
	A9540		TC99M MAA	BR
	A9541		TC99M SULFUR COLLOID	BR
	A9542		IN111 IBRITUMOMAB, DX	BR
	A9543		Y90 IBRITUMOMAB, RX	BR	67696.91
	A9546		CO57/58	BR
	A9547		IN111 OXYQUINOLINE	1032.23
	A9548		IN111 PENTETATE	1505.43
	A9550		TC99M GLUCEPTATE	BR
	A9551		TC99M SUCCIMER	BR
	A9552		F18 FDG	BR
	A9553		CR51 CHROMATE	BR
	A9554		I125 IOTHALAMATE, DX	BR
	A9555		RB82 RUBIDIUM	BR
	A9556		GA67 GALLIUM	34.10
	A9557		TC99M BICISATE	BR
	A9558		XE133 XENON 10MCI	BR
	A9559		CO57 CYANO	BR
	A9560		TC99M LABELED RBC	BR
	A9561		TC99M OXIDRONATE	BR
	A9562		TC99M MERTIATIDE	BR
	A9563		P32 NA PHOSPHATE	BR	1036.64
	A9564		P32 CHROMIC PHOSPHATE	188.44
	A9566		TC99M FANOLESOMAB	BR
	A9567		TECHNETIUM TC-99M AEROSOL	BR
	A9568		TECHNETIUM TC99M ARCITUMOMAB	BR
	A9569		TECHNETIUM TC-99M AUTO WBC	BR
	A9570		INDIUM IN-111 AUTO WBC	BR
	A9571		INDIUM IN-111 AUTO PLATELET	BR
	A9572		INDIUM IN-111 PENTETREOTIDE	BR
	A9575		INJ GADOTERATE MEGLUMI 0.1ML	0.00
	A9576		INJ PROHANCE MULTIPACK	1.82
	A9577		INJ MULTIHANCE	2.37
	A9578		INJ MULTIHANCE MULTIPACK	2.22
	A9579		GAD-BASE MR CONTRAST NOS, 1ML	2.09
	A9580		SODIUM FLUORIDE F-18	BR
	A9581		GADOXETATE DISODIUM INJ	15.50
	A9582		IODINE I-123 IOBENGUANE	0.00
	A9583		GADOFOSVESET TRISODIUM INJ	35.64
	A9584		IODINE I-123 IOFLUPANE	BR
	A9585		GADOBUTROL INJECTION	0.43
	A9586		FLORBETAPIR F18	BR	4300.96
	A9587		GALLIUM GA-68	125.34	94.77
	A9588		FLUCICLOVINE F-18	460.72	553.16
	A9589		INSTI HEXAMINOLEVULINATE HCL	BR
	A9597		PET, DX, FOR TUMOR ID, NOC	BR
	A9598		PET DX FOR NON-TUMOR ID, NOC	BR
	A9600		SR89 STRONTIUM	475.92	2123.84
	A9604		SM 153 LEXIDRONAM	4457.22	20803.31
	A9606		RADIUM RA223 DICHLORIDE THER	0.00	194.11
	A9698		NON-RAD CONTRAST MATERIALNOC	BR
	A9699		RADIOPHARM RX AGENT NOC	BR
	A9700		ECHOCARDIOGRAPHY CONTRAST	BR
	A9900		SUPPLY/ACCESSORY/SERVICE	BR
	A9901		DELIVERY/SET UP/DISPENSING	BR
	A9999		DME SUPPLY OR ACCESSORY, NOS	BR
	B4034		ENTER FEED SUPKIT SYR BY DAY	5.41
	B4035		ENTERAL FEED SUPP PUMP PER D	10.00
	B4036		ENTERAL FEED SUP KIT GRAV BY	7.19
	B4081		ENTERAL NG TUBING W/ STYLET	21.89
	B4082		ENTERAL NG TUBING W/O STYLET	16.02
	B4083		ENTERAL STOMACH TUBE LEVINE	2.43
	B4087		GASTRO/JEJUNO TUBE, STD	37.03
	B4088		GASTRO/JEJUNO TUBE, LOW-PRO	39.78
	B4100		FOOD THICKENER ORAL	BR
	B4102		EF ADULT FLUIDS AND ELECTRO	BR
	B4103		EF PED FLUID AND ELECTROLYTE	BR
	B4104		ADDITIVE FOR ENTERAL FORMULA	BR
	B4105		ENZYME CARTRIDGE ENTERAL NUT	BR
	B4149		EF BLENDERIZED FOODS	1.53
	B4150		EF COMPLET W/INTACT NUTRIENT	0.63
	B4152		EF CALORIE DENSE>/=1.5KCAL	0.52
	B4153		EF HYDROLYZED/AMINO ACIDS	1.84
	B4154		EF SPEC METABOLIC NONINHERIT	1.11
	B4155		EF INCOMPLETE/MODULAR	0.99
	B4157		EF SPECIAL METABOLIC INHERIT	BR
	B4158		EF PED COMPLETE INTACT NUT	BR
	B4159		EF PED COMPLETE SOY BASED	BR
	B4160		EF PED CALORIC DENSE>/=0.7KC	BR
	B4161		EF PED HYDROLYZED/AMINO ACID	BR
	B4162		EF PED SPECMETABOLIC INHERIT	BR
	B4164		PARENTERAL 50% DEXTROSE SOLU	22.35
	B4168		PARENTERAL SOL AMINO ACID 3.	32.59
	B4172		PARENTERAL SOL AMINO ACID 5.	131.78
	B4176		PARENTERAL SOL AMINO ACID 7-	63.05
	B4178		PARENTERAL SOL AMINO ACID >	75.67
	B4180		PARENTERAL SOL CARB > 50%	32.09
	B4185		PARENTERAL SOL 10 GM LIPIDS	14.77
	B4189		PARENTERAL SOL AMINO ACID &	233.78
	B4193		PARENTERAL SOL 52-73 GM PROT	302.07
	B4197		PARENTERAL SOL 74-100 GM PRO	367.77
	B4199		PARENTERAL SOL > 100GM PROTE	420.23
	B4216		PARENTERAL NUTRITION ADDITIV	10.15
	B4220		PARENTERAL SUPPLY KIT PREMIX	10.53
	B4222		PARENTERAL SUPPLY KIT HOMEMI	12.99
	B4224		PARENTERAL ADMINISTRATION KI	32.88
	B5000		PARENTERAL SOL RENAL-AMIROSY	15.64
	B5100		PARENTERAL SOLUTION HEPATIC	6.11
	B5200		PARENTERAL SOL HEPATIC FREAM	BR
	B9002	NU	ENTER NUTR INF PUMP ANY TYPE	1089.51
	B9004	NU	PARENTERAL INFUS PUMP PORTAB	3318.43
	B9006	NU	PARENTERAL INFUS PUMP STATIO	3318.43
	B9998		ENTERAL SUPP NOT OTHERWISE C	BR
	B9999		PARENTERAL SUPP NOT OTHRWS C	BR
	C1713		ANCHOR/SCREW BN/BN, TIS/BN	0.00
	C1714		CATH, TRANS ATHERECTOMY, DIR	0.00
	C1715		BRACHYTHERAPY NEEDLE	0.00
	C1716		BRACHYTX, NON-STR, GOLD-198	0.00	122.53
	C1717		BRACHYTX, NON-STR, HDR IR-192	0.00	412.91
	C1719		BRACHYTX, NS, NON-HDRIR-192	0.00	120.59
	C1721		AICD, DUAL CHAMBER	0.00
	C1722		AICD, SINGLE CHAMBER	0.00
	C1724		CATH, TRANS ATHEREC, ROTATION	0.00
	C1725		CATH, TRANSLUMIN NON-LASER	0.00
	C1726		CATH, BAL DIL, NON-VASCULAR	0.00
	C1727		CATH, BAL TIS DIS, NON-VAS	0.00
	C1728		CATH, BRACHYTX SEED ADM	0.00
	C1729		CATH, DRAINAGE	0.00
	C1730		CATH, EP, 19 OR FEW ELECT	0.00
	C1731		CATH, EP, 20 OR MORE ELEC	0.00
	C1732		CATH, EP, DIAG/ABL, 3D/VECT	0.00
	C1733		CATH, EP, OTHR THAN COOL-TIP	0.00
	C1749		ENDO, COLON, RETRO IMAGING	0.00
	C1750		CATH, HEMODIALYSIS, LONG-TERM	0.00
	C1751		CATH, INF, PER/CENT/MIDLINE	0.00
	C1752		CATH, HEMODIALYSIS, SHORT-TERM	0.00
	C1753		CATH, INTRAVAS ULTRASOUND	0.00
	C1754		CATHETER, INTRADISCAL	0.00
	C1755		CATHETER, INTRASPINAL	0.00
	C1756		CATH, PACING, TRANSESOPH	0.00
	C1757		CATH, THROMBECTOMY/EMBOLECT	0.00
	C1758		CATHETER, URETERAL	0.00
	C1759		CATH, INTRA ECHOCARDIOGRAPHY	0.00
	C1760		CLOSURE DEV, VASC	0.00
	C1762		CONN TISS, HUMAN(INC FASCIA)	0.00
	C1763		CONN TISS, NON-HUMAN	0.00
	C1764		EVENT RECORDER, CARDIAC	0.00
	C1765		ADHESION BARRIER	0.00
	C1766		INTRO/SHEATH, STRBLE, NON-PEEL	0.00
	C1767		GENERATOR, NEURO NON-RECHARG	0.00
	C1768		GRAFT, VASCULAR	0.00
	C1769		GUIDE WIRE	0.00
	C1770		IMAGING COIL, MR, INSERTABLE	0.00
	C1771		REP DEV, URINARY, W/SLING	0.00
	C1772		INFUSION PUMP, PROGRAMMABLE	0.00
	C1773		RET DEV, INSERTABLE	0.00
	C1776		JOINT DEVICE (IMPLANTABLE)	0.00
	C1777		LEAD, AICD, ENDO SINGLE COIL	0.00
	C1778		LEAD, NEUROSTIMULATOR	0.00
	C1779		LEAD, PMKR, TRANSVENOUS VDD	0.00
	C1780		LENS, INTRAOCULAR (NEW TECH)	0.00
	C1781		MESH (IMPLANTABLE)	0.00
	C1782		MORCELLATOR	0.00
	C1783		OCULAR IMP, AQUEOUS DRAIN DE	0.00
	C1784		OCULAR DEV, INTRAOP, DET RET	0.00
	C1785		PMKR, DUAL, RATE-RESP	0.00
	C1786		PMKR, SINGLE, RATE-RESP	0.00
	C1787		PATIENT PROGR, NEUROSTIM	0.00
	C1788		PORT, INDWELLING, IMP	0.00
	C1789		PROSTHESIS, BREAST, IMP	0.00
	C1813		PROSTHESIS, PENILE, INFLATAB	0.00
	C1814		RETINAL TAMP, SILICONE OIL	0.00
	C1815		PROS, URINARY SPH, IMP	0.00
	C1816		RECEIVER/TRANSMITTER, NEURO	0.00
	C1817		SEPTAL DEFECT IMP SYS	0.00
	C1818		INTEGRATED KERATOPROSTHESIS	0.00
	C1819		TISSUE LOCALIZATION-EXCISION	0.00
	C1820		GENERATOR NEURO RECHG BAT SY	0.00
	C1821		INTERSPINOUS IMPLANT	0.00
	C1822		GEN, NEURO, HF, RECHG BAT	BR
	C1823		GEN, NEURO, TRANS SEN/STIM	BR
	C1830		POWER BONE MARROW BX NEEDLE	0.00
	C1840		TELESCOPIC INTRAOCULAR LENS	0.00
	C1841		RETINAL PROSTH INT/EXT COMP	BR
	C1842		RETINAL PROSTH, ADD-ON	BR
	C1874		STENT, COATED/COV W/DEL SYS	0.00
	C1875		STENT, COATED/COV W/O DEL SY	0.00
	C1876		STENT, NON-COA/NON-COV W/DEL	0.00
	C1877		STENT, NON-COAT/COV W/O DEL	0.00
	C1878		MATRL FOR VOCAL CORD	0.00
	C1880		VENA CAVA FILTER	0.00
	C1881		DIALYSIS ACCESS SYSTEM	0.00
	C1882		AICD, OTHER THAN SING/DUAL	0.00
	C1883		ADAPT/EXT, PACING/NEURO LEAD	0.00
	C1884		EMBOLIZATION PROTECT SYST	0.00
	C1885		CATH, TRANSLUMIN ANGIO LASER	0.00
	C1886		CATHETER, ABLATION	0.00
	C1887		CATHETER, GUIDING	0.00
	C1888		ENDOVAS NON-CARDIAC ABL CATH	0.00
	C1889		IMPLANT/INSERT DEVICE, NOC	BR
	C1890		NO DEVICE W/DEV-INTENSIVE PX	BR
	C1891		INFUSION PUMP, NON-PROG, PERM	0.00
	C1892		INTRO/SHEATH, FIXED, PEEL-AWAY	0.00
	C1893		INTRO/SHEATH, FIXED, NON-PEEL	0.00
	C1894		INTRO/SHEATH, NON-LASER	0.00
	C1895		LEAD, AICD, ENDO DUAL COIL	0.00
	C1896		LEAD, AICD, NON SING/DUAL	0.00
	C1897		LEAD, NEUROSTIM TEST KIT	0.00
	C1898		LEAD, PMKR, OTHER THAN TRANS	0.00
	C1899		LEAD, PMKR/AICD COMBINATION	0.00
	C1900		LEAD, CORONARY VENOUS	0.00
	C2613		LUNG BX PLUG W/DEL SYS	BR
	C2614		PROBE, PERC LUMB DISC	0.00
	C2615		SEALANT, PULMONARY, LIQUID	0.00
	C2616		BRACHYTX, NON-STR, YTTRIUM-90	0.00	23608.75
	C2617		STENT, NON-COR, TEM W/O DEL	0.00
	C2618		PROBE/NEEDLE, CRYO	0.00
	C2619		PMKR, DUAL, NON RATE-RESP	0.00
	C2620		PMKR, SINGLE, NON RATE-RESP	0.00
	C2621		PMKR, OTHER THAN SING/DUAL	0.00
	C2622		PROSTHESIS, PENILE, NON-INF	0.00
	C2623		CATH, TRANSLUMIN, DRUG-COAT	BR
	C2624		WIRELESS PRESSURE SENSOR	BR
	C2625		STENT, NON-COR, TEM W/DEL SY	0.00
	C2626		INFUSION PUMP, NON-PROG, TEMP	0.00
	C2627		CATH, SUPRAPUBIC/CYSTOSCOPIC	0.00
	C2628		CATHETER, OCCLUSION	0.00
	C2629		INTRO/SHEATH, LASER	0.00
	C2630		CATH, EP, COOL-TIP	0.00
	C2631		REP DEV, URINARY, W/O SLING	0.00
	C2634		BRACHYTX, NON-STR, HA, I-125	0.00	196.80
	C2635		BRACHYTX, NON-STR, HA, P-103	0.00	38.51
	C2636		BRACHY LINEAR, NON-STR, P-103	0.00	70.05
	C2637		BRACHY, NON-STR, YTTERBIUM-169	0.00
	C2638		BRACHYTX, STRANDED, I-125	0.00	51.69
	C2639		BRACHYTX, NON-STRANDED, I-125	0.00	49.71
	C2640		BRACHYTX, STRANDED, P-103	0.00	106.03
	C2641		BRACHYTX, NON-STRANDED, P-103	0.00	85.38
	C2642		BRACHYTX, STRANDED, C-131	0.00	113.51
	C2643		BRACHYTX, NON-STRANDED, C-131	0.00	111.27
	C2644		BRACHYTX CESIUM-131 CHLORIDE	BR	17.79
	C2645		BRACHYTX PLANAR, P-103	BR	6.66
	C2698		BRACHYTX, STRANDED, NOS	0.00	51.69
	C2699		BRACHYTX, NON-STRANDED, NOS	0.00	38.51
	C5271		LOW COST SKIN SUBSTITUTE APP	BR	685.70
	C5272		LOW COST SKIN SUBSTITUTE APP	BR
	C5273		LOW COST SKIN SUBSTITUTE APP	BR	2199.52
	C5274		LOW COST SKIN SUBSTITUTE APP	BR
	C5275		LOW COST SKIN SUBSTITUTE APP	BR	685.70
	C5276		LOW COST SKIN SUBSTITUTE APP	BR
	C5277		LOW COST SKIN SUBSTITUTE APP	BR	685.70
	C5278		LOW COST SKIN SUBSTITUTE APP	BR
	C8900		MRA W/CONT, ABD	0.00	547.95
	C8901		MRA W/O CONT, ABD	0.00	327.40
	C8902		MRA W/O FOL W/CONT, ABD	0.00	547.95
	C8903		MRI W/CONT, BREAST, UNI	0.00	286.47
	C8905		MRI W/O FOL W/CONT, BRST, UN	0.00	547.95
	C8906		MRI W/CONT, BREAST, BI	0.00	547.95
	C8908		MRI W/O FOL W/CONT, BREAST,	0.00	547.95
	C8909		MRA W/CONT, CHEST	0.00	547.95
	C8910		MRA W/O CONT, CHEST	0.00	327.40
	C8911		MRA W/O FOL W/CONT, CHEST	0.00	547.95
	C8912		MRA W/CONT, LWR EXT	0.00	547.95
	C8913		MRA W/O CONT, LWR EXT	0.00	327.40
	C8914		MRA W/O FOL W/CONT, LWR EXT	0.00	547.95
	C8918		MRA W/CONT, PELVIS	0.00	547.95
	C8919		MRA W/O CONT, PELVIS	0.00	327.40
	C8920		MRA W/O FOL W/CONT, PELVIS	0.00	547.95
	C8921		TTE W OR W/O FOL W/CONT, COM	0.00	982.29
	C8922		TTE W OR W/O FOL W/CONT, F/U	0.00	982.29
	C8923		2D TTE W OR W/O FOL W/CON, CO	0.00	982.29
	C8924		2D TTE W OR W/O FOL W/CON, FU	0.00	547.95
	C8925		2D TEE W OR W/O FOL W/CON, IN	0.00	982.29
	C8926		TEE W OR W/O FOL W/CONT, CONG	0.00	982.29
	C8927		TEE W OR W/O FOL W/CONT, MON	0.00	982.29
	C8928		TTE W OR W/O FOL W/CON, STRES	0.00	982.29
	C8929		TTE W OR WO FOL WCON, DOPPLER	0.00	982.29
	C8930		TTE W OR W/O CONTR, CONT ECG	0.00	982.29
	C8931		MRA, W/DYE, SPINAL CANAL	0.00	547.95
	C8932		MRA, W/O DYE, SPINAL CANAL	0.00	327.40
	C8933		MRA, W/O&W/DYE, SPINAL CANAL	0.00	547.95
	C8934		MRA, W/DYE, UPPER EXTREMITY	0.00	547.95
	C8935		MRA, W/O DYE, UPPER EXTR	0.00	327.40
	C8936		MRA, W/O&W/DYE, UPPER EXTR	0.00	547.95
	C8937		CAD BREAST MRI	BR
	C8957		PROLONGED IV INF, REQ PUMP	0.00	409.50
	C9035		INJECTION, ARISTADA INITIO	BR	4.05
	C9036		INJECTION, PATISIRAN	BR	138.95
	C9037		INJECTION, RISPERIDONE	BR	13.89
	C9038		INJ MOGAMULIZUMAB-KPKC	BR	277.16
	C9039		INJECTION, PLAZOMICIN	BR	4.61
	C9113		INJ PANTOPRAZOLE SODIUM, VIA	0.00
	C9132		KCENTRA, PER I.U.	BR	2.75
	C9248		INJ, CLEVIDIPINE BUTYRATE	0.00	3.95
	C9250		ARTISS FIBRIN SEALANT	0.00	222.72
	C9254		INJECTION, LACOSAMIDE	0.00
	C9257		BEVACIZUMAB INJECTION	0.00	2.88
	C9285		PATCH, LIDOCAINE/TETRACAINE	0.00
	C9290		INJ, BUPIVACAINE LIPOSOME	0.00
	C9293		INJECTION, GLUCARPIDASE	0.00	444.74
	C9352		NEURAGEN NERVE GUIDE, PER CM	0.00
	C9353		NEURAWRAP NERVE PROTECTOR, CM	0.00
	C9354		VERITAS COLLAGEN MATRIX, CM2	0.00
	C9355		NEUROMATRIX NERVE CUFF, CM	0.00
	C9356		TENOGLIDE TENDON PROT, CM2	0.00
	C9358		SURGIMEND, FETAL	0.00
	C9359		IMPLNT, BON VOID FILLER-PUTTY	0.00
	C9360		SURGIMEND, NEONATAL	0.00
	C9361		NEUROMEND NERVE WRAP	0.00
	C9362		IMPLNT, BON VOID FILLER-STRIP	0.00
	C9363		INTEGRA MESHED BIL WOUND MAT	0.00
	C9364		PORCINE IMPLANT, PERMACOL	0.00
	C9399		UNCLASSIFIED DRUGS OR BIOLOG	0.00
	C9407		IODINE I-131 IOBENGUANE, DX	BR	441.71
	C9408		IODINE I-131 IOBENGUANE, TX	BR	441.71
	C9447		INJ, PHENYLEPHRINE KETOROLAC	0.00	672.01
	C9460		INJECTION, CANGRELOR	0.00	21.95
	C9462		INJECTION, DELAFLOXACIN	BR	0.64
	C9482		SOTALOL HYDROCHLORIDE IV	BR	14.18
	C9488		CONIVAPTAN HCL	BR	45.54
J1	C9600		PERC DRUG-EL COR STENT SING	0.00	17440.05
	C9601		PERC DRUG-EL COR STENT BRAN	0.00
J1	C9602		PERC D-E COR STENT ATHER S	0.00	26888.04
	C9603		PERC D-E COR STENT ATHER BR	0.00
J1	C9604		PERC D-E COR REVASC T CABG S	0.00	17440.05
	C9605		PERC D-E COR REVASC T CABG B	0.00
	C9606		PERC D-E COR REVASC W AMI S	0.00	20948.17
J1	C9607		PERC D-E COR REVASC CHRO SIN	0.00	26888.04
	C9608		PERC D-E COR REVASC CHRO ADD	0.00
	C9725		PLACE ENDORECTAL APP	0.00	1057.74
	C9726		RXT BREAST APPL PLACE/REMOV	0.00
J1	C9727		INSERT PALATE IMPLANTS	0.00	2543.11
	C9728		PLACE DEVICE/MARKER, NON PRO	0.00	1692.53
	C9733		NON-OPHTHALMIC FVA	0.00	547.95
J1	C9734		U/S TRTMT, NOT LEIOMYOMATA	0.00	19120.53
	C9738		BLUE LIGHT CYSTO IMAG AGENT	BR
J1	C9739		CYSTOSCOPY PROSTATIC IMP 1-3	BR	7926.90
J1	C9740		CYSTO IM PL 4 OR MORE	BR	13305.84
J1	C9745		NASAL ENDO EUSTACHIAN TUBE	BR	8765.29
J1	C9746		TRANS IMP BALLOON CONT	BR	26963.98
J1	C9747		ABLATION, HIFU, PROSTATE	BR	7926.90
J1	C9749		REPAIR NASAL STENOSIS W/IMP	BR	8765.29
	C9751		MICROWAVE BRONCH, 3D, EBUS	BR	11715.71
J1	C9752		INTRAOSSEOUS DES LUMB/SACRUM	BR	19120.53
	C9753		INTRAOSSEOUS DESTRUCT ADD'L	BR
J1	C9754		PERC AV FISTULA, DIRECT	BR	17440.05
J1	C9755		RF MAGNETIC-GUIDE AV FISTULA	BR	17440.05
	C9898		INPNT STAY RADIOLABELED ITEM	0.00
	C9899		INPT IMPLANT PROS DEV, NO COV	0.00
	E0100	NU	CANE ADJUST/FIXED WITH TIP	20.63
	E0105	NU	CANE ADJUST/FIXED QUAD/3 PRO	56.55
	E0110	NU	CRUTCH FOREARM PAIR	84.68
	E0111	NU	CRUTCH FOREARM EACH	52.11
	E0112	NU	CRUTCH UNDERARM PAIR WOOD	42.61
	E0113	NU	CRUTCH UNDERARM EACH WOOD	24.34
	E0114	NU	CRUTCH UNDERARM PAIR NO WOOD	54.34
	E0116	NU	CRUTCH UNDERARM EACH NO WOOD	30.31
	E0117	NU	UNDERARM SPRINGASSIST CRUTCH	303.28
	E0118		CRUTCH SUBSTITUTE	1138.46
	E0130	NU	WALKER RIGID ADJUST/FIXED HT	53.97
	E0135	NU	WALKER FOLDING ADJUST/FIXED	59.65
	E0140	NU	WALKER W TRUNK SUPPORT	317.61
	E0141	NU	RIGID WHEELED WALKER ADJ/FIX	82.50
	E0143	NU	WALKER FOLDING WHEELED W/O S	79.65
	E0144	NU	ENCLOSED WALKER W REAR SEAT	956.71
	E0147	NU	WALKER VARIABLE WHEEL RESIST	502.73
	E0148	NU	HEAVYDUTY WALKER NO WHEELS	107.14
	E0149	NU	HEAVY DUTY WHEELED WALKER	275.31
	E0153	NU	FOREARM CRUTCH PLATFORM ATTA	79.90
	E0154	NU	WALKER PLATFORM ATTACHMENT	61.10
	E0155	NU	WALKER WHEEL ATTACHMENT, PAIR	24.44
	E0156	NU	WALKER SEAT ATTACHMENT	21.50
	E0157	NU	WALKER CRUTCH ATTACHMENT	64.45
	E0158	NU	WALKER LEG EXTENDERS SET OF4	25.09
	E0159	NU	BRAKE FOR WHEELED WALKER	16.69
	E0160	NU	SITZ TYPE BATH OR EQUIPMENT	34.43
	E0161	NU	SITZ BATH/EQUIPMENT W/FAUCET	28.28
	E0162	NU	SITZ BATH CHAIR	167.76
	E0163	NU	COMMODE CHAIR WITH FIXED ARM	85.46
	E0165	NU	COMMODE CHAIR WITH DETACHARM	256.99
	E0167	NU	COMMODE CHAIR PAIL OR PAN	12.69
	E0168	NU	HEAVYDUTY/WIDE COMMODE CHAIR	149.31
	E0170	RR	COMMODE CHAIR ELECTRIC	179.60
	E0171	RR	COMMODE CHAIR NON-ELECTRIC	32.99
	E0172		SEAT LIFT MECHANISM TOILET	0.00
	E0175	NU	COMMODE CHAIR FOOT REST	76.26
	E0181	NU	PRESS PAD ALTERNATING W/ PUM	370.73
	E0182	NU	REPLACE PUMP, ALT PRESS PAD	370.73
	E0184	NU	DRY PRESSURE MATTRESS	197.90
	E0185	NU	GEL PRESSURE MATTRESS PAD	246.91
	E0186	NU	AIR PRESSURE MATTRESS	196.58
	E0187	NU	WATER PRESSURE MATTRESS	215.01
	E0188	NU	SYNTHETIC SHEEPSKIN PAD	28.36
	E0189	NU	LAMBSWOOL SHEEPSKIN PAD	50.86
	E0190	NU	POSITIONING CUSHION	79.80
	E0191	NU	PROTECTOR HEEL OR ELBOW	11.06
	E0193	RR	POWERED AIR FLOTATION BED	751.33
	E0194	NU	AIR FLUIDIZED BED	42347.42
	E0196	NU	GEL PRESSURE MATTRESS	529.54
	E0197	NU	AIR PRESSURE PAD FOR MATTRES	431.14
	E0198	NU	WATER PRESSURE PAD FOR MATTR	234.34
	E0199	NU	DRY PRESSURE PAD FOR MATTRES	31.38
	E0200	NU	HEAT LAMP WITHOUT STAND	77.59
	E0202	RR	PHOTOTHERAPY LIGHT W/ PHOTOM	72.09
	E0203		THERAPEUTIC LIGHTBOX TABLETP	BR
	E0205	NU	HEAT LAMP WITH STAND	189.92
	E0210	NU	ELECTRIC HEAT PAD STANDARD	32.21
	E0215	NU	ELECTRIC HEAT PAD MOIST	69.33
	E0217	NU	WATER CIRC HEAT PAD W PUMP	568.51
	E0218	NU	FLUID CIRC COLD PAD W PUMP	1895.41
	E0221		INFRARED HEATING PAD SYSTEM	0.00
	E0225	NU	HYDROCOLLATOR UNIT	447.48
	E0231		WOUND WARMING DEVICE	BR
	E0232		WARMING CARD FOR NWT	BR
	E0235	NU	PARAFFIN BATH UNIT PORTABLE	814.80
	E0236	NU	PUMP FOR WATER CIRCULATING P	4298.82
	E0239	NU	HYDROCOLLATOR UNIT PORTABLE	517.92
	E0240	NU	BATH/SHOWER CHAIR	103.72
	E0241		BATH TUB WALL RAIL	73.00
	E0242		BATH TUB RAIL FLOOR	55.16
	E0243		TOILET RAIL	74.19
	E0244		TOILET SEAT RAISED	66.51
	E0245		TUB STOOL OR BENCH	74.49
	E0246		TRANSFER TUB RAIL ATTACHMENT	77.30
	E0247	NU	TRANS BENCH W/WO COMM OPEN	129.81
	E0248	NU	HDTRANS BENCH W/WO COMM OPEN	186.01
	E0249	NU	PAD WATER CIRCULATING HEAT U	97.49
	E0250	NU	HOSP BED FIXED HT W/ MATTRES	1849.69
	E0251	NU	HOSP BED FIXD HT W/O MATTRES	1852.78
	E0255	NU	HOSPITAL BED VAR HT W/ MATTR	1606.51
	E0256	NU	HOSPITAL BED VAR HT W/O MATT	787.51
	E0260	NU	HOSP BED SEMI-ELECTR W/ MATT	1852.89
	E0261	NU	HOSP BED SEMI-ELECTR W/O MAT	1694.19
	E0265	NU	HOSP BED TOTAL ELECTR W/ MAT	2065.00
	E0266	NU	HOSP BED TOTAL ELEC W/O MATT	1834.67
	E0270	NU	HOSPITAL BED INSTITUTIONAL T	0.00
	E0271	NU	MATTRESS INNERSPRING	159.61
	E0272	NU	MATTRESS FOAM RUBBER	160.18
	E0273	NU	BED BOARD	26.57
	E0274	NU	OVER-BED TABLE	370.51
	E0275	NU	BED PAN STANDARD	16.26
	E0276	NU	BED PAN FRACTURE	14.06
	E0277	NU	POWERED PRES-REDU AIR MATTRS	7846.78
	E0280	NU	BED CRADLE	32.23
	E0290	NU	HOSP BED FX HT W/O RAILS W/M	791.38
	E0291	NU	HOSP BED FX HT W/O RAIL W/O	635.11
	E0292	NU	HOSP BED VAR HT NO SR W/MATT	671.60
	E0293	NU	HOSP BED VAR HT NO SR NO MAT	571.35
	E0294	NU	HOSP BED SEMI-ELECT W/ MATTR	1429.04
	E0295	NU	HOSP BED SEMI-ELECT W/O MATT	1146.21
	E0296	NU	HOSP BED TOTAL ELECT W/ MATT	1384.20
	E0297	NU	HOSP BED TOTAL ELECT W/O MAT	5006.93
	E0300	NU	ENCLOSED PED CRIB HOSP GRADE	2268.47
	E0301	NU	HD HOSP BED, 350-600 LBS	3177.45
	E0302	NU	EX HD HOSP BED > 600 LBS	21286.79
	E0303	NU	HOSP BED HVY DTY XTRA WIDE	3473.75
	E0304	NU	HOSP BED XTRA HVY DTY X WIDE	8938.55
	E0305	NU	RAILS BED SIDE HALF LENGTH	201.21
	E0310	NU	RAILS BED SIDE FULL LENGTH	146.55
	E0315		BED ACCESSORY BRD/TBL/SUPPRT	BR
	E0316	NU	BED SAFETY ENCLOSURE	4107.67
	E0325	NU	URINAL MALE JUG-TYPE	10.69
	E0326	NU	URINAL FEMALE JUG-TYPE	11.25
	E0328		PED HOSPITAL BED, MANUAL	BR
	E0329		PED HOSPITAL BED SEMI/ELECT	BR
	E0350	NU	CONTROL UNIT BOWEL SYSTEM	BR
	E0352		DISPOSABLE PACK W/BOWEL SYST	BR
	E0370		AIR ELEVATOR FOR HEEL	BR
	E0371	RR	NONPOWER MATTRESS OVERLAY	300.22
	E0372	RR	POWERED AIR MATTRESS OVERLAY	342.51
	E0373	RR	NONPOWERED PRESSURE MATTRESS	377.40
	E0424	RR	STATIONARY COMPRESSED GAS 02	134.71
	E0425		GAS SYSTEM STATIONARY COMPRE	30.46
	E0430		OXYGEN SYSTEM GAS PORTABLE	3.06
	E0431	RR	PORTABLE GASEOUS 02	67.36
	E0433	RR	PORTABLE LIQUID OXYGEN SYS	67.36
	E0434	RR	PORTABLE LIQUID 02	67.36
	E0435		OXYGEN SYSTEM LIQUID PORTABL	BR
	E0439	RR	STATIONARY LIQUID 02	134.71
	E0440		OXYGEN SYSTEM LIQUID STATION	14.97
	E0441		STATIONARY O2 CONTENTS, GAS	64.20
	E0442		STATIONARY O2 CONTENTS, LIQ	64.20
	E0443		PORTABLE 02 CONTENTS, GAS	61.69
	E0444		PORTABLE 02 CONTENTS, LIQUID	61.69
	E0445		OXIMETER NON-INVASIVE	BR
	E0446		TOPICAL OX DELIVER SYS, NOS	BR
	E0447		PORT O2 CONT, LIQ OVER 4 LPM	92.54
	E0455	NU	OXYGEN TENT EXCL CROUP/PED T	1694.08
	E0457	NU	CHEST SHELL	569.74
	E0459	NU	CHEST WRAP	471.89
	E0462	NU	ROCKING BED W/ OR W/O SIDE R	3079.39
	E0465	RR	HOME VENT INVASIVE INTERFACE	934.17
	E0466	RR	HOME VENT NON-INVASIVE INTER	934.17
	E0467	RR	HOME VENT MULTI-FUNCTION	1122.96
	E0470	NU	RAD W/O BACKUP NON-INV INTFC	3229.03
	E0471	NU	RAD W/BACKUP NON INV INTRFC	7516.14
	E0472	NU	RAD W BACKUP INVASIVE INTRFC	6799.63
	E0480	NU	PERCUSSOR ELECT/PNEUM HOME M	734.18
	E0481		INTRPULMNRY PERCUSS VENT SYS	BR
	E0482	RR	COUGH STIMULATING DEVICE	443.68
	E0483	NU	HI FREQ CHEST WALL OSCIL SYS	15763.14
	E0484	NU	NON-ELEC OSCILLATORY PEP DVC	42.53
	E0485	NU	ORAL DEVICE/APPLIANCE PREFAB	212.65
	E0486	NU	ORAL DEVICE/APPLIANCE CUSFAB	6917.19
	E0487	NU	ELECTRONIC SPIROMETER	0.00
	E0500	NU	IPPB ALL TYPES	1651.45
	E0550	NU	HUMIDIF EXTENS SUPPLE W IPPB	847.05
	E0555	NU	HUMIDIFIER FOR USE W/ REGULA	6.58
	E0560	NU	HUMIDIFIER SUPPLEMENTAL W/ I	168.59
	E0561	NU	HUMIDIFIER NONHEATED W PAP	92.05
	E0562	NU	HUMIDIFIER HEATED USED W PAP	223.90
	E0565	NU	COMPRESSOR AIR POWER SOURCE	899.94
	E0570	NU	NEBULIZER WITH COMPRESSION	341.14
	E0572	NU	AEROSOL COMPRESSOR ADJUST PR	340.81
	E0574	NU	ULTRASONIC GENERATOR W SVNEB	1373.38
	E0575	NU	NEBULIZER ULTRASONIC	479.28
	E0580	NU	NEBULIZER FOR USE W/ REGULAT	131.71
	E0585	NU	NEBULIZER W/ COMPRESSOR & HE	1070.13
	E0600	NU	SUCTION PUMP PORTAB HOM MODL	794.14
	E0601	NU	CONT AIRWAY PRESSURE DEVICE	1482.38
	E0602	NU	MANUAL BREAST PUMP	33.98
	E0603	NU	ELECTRIC BREAST PUMP	319.24
	E0604	NU	HOSP GRADE ELEC BREAST PUMP	952.62
	E0605	NU	VAPORIZER ROOM TYPE	30.42
	E0606	NU	DRAINAGE BOARD POSTURAL	242.39
	E0607	NU	BLOOD GLUCOSE MONITOR HOME	76.93
	E0610	NU	PACEMAKER MONITR AUDIBLE/VIS	273.86
	E0615	NU	PACEMAKER MONITR DIGITAL/VIS	551.28
	E0616		CARDIAC EVENT RECORDER	BR
	E0617	RR	AUTOMATIC EXT DEFIBRILLATOR	388.68
	E0618	RR	APNEA MONITOR	322.81
	E0619	RR	APNEA MONITOR W RECORDER	0.00
	E0620	NU	CAP BLD SKIN PIERCING LASER	923.66
	E0621	NU	PATIENT LIFT SLING OR SEAT	99.89
	E0625	NU	PATIENT LIFT BATHROOM OR TOI	0.00
	E0627	NU	SEAT LIFT MECH, ELECTRIC ANY	330.47
	E0629	NU	SEAT LIFT MECH, NON-ELECTRIC	328.89
	E0630	NU	PATIENT LIFT HYDRAULIC	1324.78
	E0635	NU	PATIENT LIFT ELECTRIC	2301.15
	E0636	NU	PT SUPPORT & POSITIONING SYS	9777.31
	E0637	NU	COMBINATION SIT TO STAND SYS	4384.85
	E0638	NU	STANDING FRAME SYS	3010.84
	E0639	RR	MOVEABLE PATIENT LIFT SYSTEM	128.44
	E0640	RR	FIXED PATIENT LIFT SYSTEM	128.44
	E0641		MULTI-POSITION STND FRAM SYS	BR
	E0642		DYNAMIC STANDING FRAME	BR
	E0650	NU	PNEUMA COMPRESOR NON-SEGMENT	704.85
	E0651	NU	PNEUM COMPRESSOR SEGMENTAL	1057.44
	E0652	NU	PNEUM COMPRES W/CAL PRESSURE	5188.38
	E0655	NU	PNEUMATIC APPLIANCE HALF ARM	105.63
	E0656	NU	SEGMENTAL PNEUMATIC TRUNK	670.49
	E0657	NU	SEGMENTAL PNEUMATIC CHEST	868.05
	E0660	NU	PNEUMATIC APPLIANCE FULL LEG	183.94
	E0665	NU	PNEUMATIC APPLIANCE FULL ARM	134.08
	E0666	NU	PNEUMATIC APPLIANCE HALF LEG	135.15
	E0667	NU	SEG PNEUMATIC APPL FULL LEG	316.86
	E0668	NU	SEG PNEUMATIC APPL FULL ARM	432.45
	E0669	NU	SEG PNEUMATIC APPLI HALF LEG	211.07
	E0670	NU	SEG PNEUM INT LEGS/TRUNK	1276.02
	E0671	NU	PRESSURE PNEUM APPL FULL LEG	478.23
	E0672	NU	PRESSURE PNEUM APPL FULL ARM	371.57
	E0673	NU	PRESSURE PNEUM APPL HALF LEG	308.76
	E0675	NU	PNEUMATIC COMPRESSION DEVICE	7867.54
	E0676		INTER LIMB COMPRESS DEV NOS	24.16
	E0691	NU	UVL PNL 2 SQ FT OR LESS	1034.61
	E0692	NU	UVL SYS PANEL 4 FT	1299.20
	E0693	NU	UVL SYS PANEL 6 FT	1601.54
	E0694	NU	UVL MD CABINET SYS 6 FT	5097.55
	E0700		SAFETY EQUIPMENT	BR
	E0705	NU	TRANSFER DEVICE	63.48
	E0710		RESTRAINTS ANY TYPE	BR
	E0720	NU	TENS TWO LEAD	BR
	E0730	NU	TENS FOUR LEAD	249.38
	E0731	NU	CONDUCTIVE GARMENT FOR TENS/	250.04
	E0740	NU	NON-IMPLANT PELV FLR E-STIM	688.34
	E0744	NU	NEUROMUSCULAR STIM FOR SCOLI	2022.09
	E0745	NU	NEUROMUSCULAR STIM FOR SHOCK	1266.37
	E0746	NU	ELECTROMYOGRAPH BIOFEEDBACK	688.23
	E0747	NU	ELEC OSTEOGEN STIM NOT SPINE	4508.88
	E0748	NU	ELEC OSTEOGEN STIM SPINAL	4479.68
	E0749	RR	ELEC OSTEOGEN STIM IMPLANTED	327.41
	E0755		ELECTRONIC SALIVARY REFLEX S	BR
	E0760	NU	OSTEOGEN ULTRASOUND STIMLTOR	3722.53
	E0761		NONTHERM ELECTROMGNTC DEVICE	BR
	E0762	NU	TRANS ELEC JT STIM DEV SYS	1841.11
	E0764	NU	FUNCTIONAL NEUROMUSCULARSTIM	1629.15
	E0765	NU	NERVE STIMULATOR FOR TX N&V	96.87
	E0766		ELEC STIM CANCER TREATMENT	0.00
	E0769		ELECTRIC WOUND TREATMENT DEV	BR
	E0770	NU	FUNCTIONAL ELECTRIC STIM NOS	8406.69
	E0776	NU	IV POLE	154.40
	E0779	RR	AMB INFUSION PUMP MECHANICAL	17.35
	E0780	NU	MECH AMB INFUSION PUMP <8HRS	11.91
	E0781	RR	EXTERNAL AMBULATORY INFUS PU	258.71
	E0782	NU	NON-PROGRAMBLE INFUSION PUMP	4943.35
	E0783	NU	PROGRAMMABLE INFUSION PUMP	9426.22
	E0784	NU	EXT AMB INFUSN PUMP INSULIN	8407.56
	E0785		REPLACEMENT IMPL PUMP CATHET	499.27
	E0786	NU	IMPLANTABLE PUMP REPLACEMENT	9194.70
	E0791	NU	PARENTERAL INFUSION PUMP STA	3176.35
	E0830		AMBULATORY TRACTION DEVICE	BR
	E0840	NU	TRACT FRAME ATTACH HEADBOARD	84.36
	E0849	NU	CERVICAL PNEUM TRAC EQUIP	789.83
	E0850	NU	TRACTION STAND FREE STANDING	120.95
	E0855	NU	CERVICAL TRACTION EQUIPMENT	743.75
	E0856	NU	CERVIC COLLAR W AIR BLADDERS	739.63
	E0860	NU	TRACT EQUIP CERVICAL TRACT	44.37
	E0870	NU	TRACT FRAME ATTACH FOOTBOARD	113.83
	E0880	NU	TRAC STAND FREE STAND EXTREM	122.87
	E0890	NU	TRACTION FRAME ATTACH PELVIC	117.83
	E0900	NU	TRAC STAND FREE STAND PELVIC	125.40
	E0910	NU	TRAPEZE BAR ATTACHED TO BED	264.60
	E0911	RR	HD TRAPEZE BAR ATTACH TO BED	47.18
	E0912	RR	HD TRAPEZE BAR FREE STANDING	100.37
	E0920	NU	FRACTURE FRAME ATTACHED TO B	487.60
	E0930	RR	FRACTURE FRAME FREE STANDING	44.70
	E0935	RR	CONT PAS MOTION EXERCISE DEV	22.26
	E0936	RR	CPM DEVICE, OTHER THAN KNEE	24.16
	E0940	NU	TRAPEZE BAR FREE STANDING	370.51
	E0941	RR	GRAVITY ASSISTED TRACTION DE	42.47
	E0942	NU	CERVICAL HEAD HARNESS/HALTER	19.41
	E0944	NU	PELVIC BELT/HARNESS/BOOT	45.17
	E0945	NU	BELT/HARNESS EXTREMITY	43.38
	E0946	RR	FRACTURE FRAME DUAL W CROSS	57.90
	E0947	NU	FRACTURE FRAME ATTACHMNTS PE	593.53
	E0948	NU	FRACTURE FRAME ATTACHMNTS CE	589.58
	E0950	NU	TRAY	103.16
	E0951	NU	LOOP HEEL	16.06
	E0952	NU	TOE LOOP/HOLDER, EACH	18.80
	E0953	NU	W/C LATERAL THIGH/KNEE SUP	97.82
	E0954	NU	FOOT BOX, ANY TYPE EACH FOOT	58.80
	E0955	NU	CUSHIONED HEADREST	271.41
	E0956	NU	W/C LATERAL TRUNK/HIP SUPPOR	97.82
	E0957	NU	W/C MEDIAL THIGH SUPPORT	141.54
	E0958	NU	WHLCHR ATT- CONV 1 ARM DRIVE	635.44
	E0959	NU	AMPUTEE ADAPTER	48.24
	E0960	NU	W/C SHOULDER HARNESS/STRAPS	90.29
	E0961	NU	WHEELCHAIR BRAKE EXTENSION	25.31
	E0966	NU	WHEELCHAIR HEAD REST EXTENSI	69.85
	E0967	NU	MAN WC RIM/PROJECTION REP EA	75.62
	E0968	NU	WHEELCHAIR COMMODE SEAT	189.24
	E0969	NU	WHEELCHAIR NARROWING DEVICE	180.34
	E0970	NU	WHEELCHAIR NO. 2 FOOTPLATES	52.34
	E0971	NU	WHEELCHAIR ANTI-TIPPING DEVI	40.85
	E0973	NU	W/CH ACCESS DET ADJ ARMREST	96.99
	E0974	NU	W/CH ACCESS ANTI-ROLLBACK	83.70
	E0978	NU	W/C ACC, SAF BELT PELV STRAP	42.37
	E0980	NU	WHEELCHAIR SAFETY VEST	37.51
	E0981	NU	SEAT UPHOLSTERY, REPLACEMENT	42.65
	E0982	NU	BACK UPHOLSTERY, REPLACEMENT	46.62
	E0983	NU	ADD PWR JOYSTICK	9772.82
	E0984	NU	ADD PWR TILLER	2018.84
	E0985	NU	W/C SEAT LIFT MECHANISM	193.83
	E0986	NU	MAN W/C PUSH-RIM POWR SYSTEM	7590.29
	E0988	RR	LEVER-ACTIVATED WHEEL DRIVE	344.67
	E0990	NU	WHEELCHAIR ELEVATING LEG RES	99.05
	E0992	NU	WHEELCHAIR SOLID SEAT INSERT	96.05
	E0994	NU	WHEELCHAIR ARM REST	17.26
	E0995	NU	WC CALF REST, PAD REPLACEMNT	27.50
	E1002	NU	PWR SEAT TILT	7442.08
	E1003	NU	PWR SEAT RECLINE	3509.01
	E1004	NU	PWR SEAT RECLINE MECH	5763.40
	E1005	NU	PWR SEAT RECLINE PWR	4211.61
	E1006	NU	PWR SEAT COMBO W/O SHEAR	5158.62
	E1007	NU	PWR SEAT COMBO W/SHEAR	12765.40
	E1008	NU	PWR SEAT COMBO PWR SHEAR	10956.06
	E1009	NU	ADD MECH LEG ELEVATION	0.00
	E1010	NU	ADD PWR LEG ELEVATION	2548.59
	E1011	NU	PED WC MODIFY WIDTH ADJUSTM	0.00
	E1012	RR	CTR MOUNT PWR ELEV LEG REST	113.51
	E1014	NU	RECLINING BACK ADD PED W/C	425.52
	E1015	NU	SHOCK ABSORBER FOR MAN W/C	128.58
	E1016	NU	SHOCK ABSORBER FOR POWER W/C	133.32
	E1017	NU	HD SHCK ABSRBR FOR HD MAN WC	0.00
	E1018	NU	HD SHCK ABSRBER FOR HD POWWC	0.00
	E1020	NU	RESIDUAL LIMB SUPPORT SYSTEM	295.63
	E1028	NU	W/C MANUAL SWINGAWAY	279.82
	E1029	NU	W/C VENT TRAY FIXED	494.90
	E1030	NU	W/C VENT TRAY GIMBALED	828.91
	E1031	NU	ROLLABOUT CHAIR WITH CASTERS	588.07
	E1035	RR	PATIENT TRANSFER SYSTEM <300	663.00
	E1036	RR	PATIENT TRANSFER SYSTEM >300	945.89
	E1037	NU	TRANSPORT CHAIR, PED SIZE	1474.21
	E1038	NU	TRANSPORT CHAIR PT WT<=300LB	292.66
	E1039	NU	TRANSPORT CHAIR PT WT >300LB	484.37
	E1050	NU	WHELCHR FXD FULL LENGTH ARMS	1060.51
	E1060	NU	WHEELCHAIR DETACHABLE ARMS	3175.91
	E1070	NU	WHEELCHAIR DETACHABLE FOOT R	3131.18
	E1083	NU	HEMI-WHEELCHAIR FIXED ARMS	2549.41
	E1084	NU	HEMI-WHEELCHAIR DETACHABLE A	2644.05
	E1085	NU	HEMI-WHEELCHAIR FIXED ARMS	335.28
	E1086	NU	HEMI-WHEELCHAIR DETACHABLE A	2205.40
	E1087	NU	WHEELCHAIR LIGHTWT FIXED ARM	1301.93
	E1088	NU	WHEELCHAIR LIGHTWEIGHT DET A	3913.84
	E1089	NU	WHEELCHAIR LIGHTWT FIXED ARM	543.01
	E1090	NU	WHEELCHAIR LIGHTWEIGHT DET A	3599.42
	E1092	NU	WHEELCHAIR WIDE W/ LEG RESTS	3474.64
	E1093	NU	WHEELCHAIR WIDE W/ FOOT REST	4327.98
	E1100	NU	WHCHR S-RECL FXD ARM LEG RES	1096.79
	E1110	NU	WHEELCHAIR SEMI-RECL DETACH	879.96
	E1130	NU	WHLCHR STAND FXD ARM FT REST	242.51
	E1140	NU	WHEELCHAIR STANDARD DETACH A	2034.78
	E1150	NU	WHEELCHAIR STANDARD W/ LEG R	2122.35
	E1160	NU	WHEELCHAIR FIXED ARMS	1281.28
	E1161	NU	MANUAL ADULT WC W TILTINSPAC	4447.25
	E1170	NU	WHLCHR AMPU FXD ARM LEG REST	943.79
	E1171	NU	WHEELCHAIR AMPUTEE W/O LEG R	847.15
	E1172	NU	WHEELCHAIR AMPUTEE DETACH AR	1035.19
	E1180	NU	WHEELCHAIR AMPUTEE W/ FOOT R	1071.02
	E1190	NU	WHEELCHAIR AMPUTEE W/ LEG RE	1105.24
	E1195	NU	WHEELCHAIR AMPUTEE HEAVY DUT	1232.24
	E1200	NU	WHEELCHAIR AMPUTEE FIXED ARM	919.63
	E1220		WHLCHR SPECIAL SIZE/CONSTRC	BR
	E1221	NU	WHEELCHAIR SPEC SIZE W FOOT	502.09
	E1222	NU	WHEELCHAIR SPEC SIZE W/ LEG	716.30
	E1223	NU	WHEELCHAIR SPEC SIZE W FOOT	635.11
	E1224	NU	WHEELCHAIR SPEC SIZE W/ LEG	857.62
	E1225	NU	MANUAL SEMI-RECLINING BACK	531.30
	E1226	NU	MANUAL FULLY RECLINING BACK	513.08
	E1227	NU	WHEELCHAIR SPEC SZ SPEC HT A	319.51
	E1228	NU	WHEELCHAIR SPEC SZ SPEC HT B	233.15
	E1229		PEDIATRIC WHEELCHAIR NOS	BR
	E1230	NU	POWER OPERATED VEHICLE	2213.56
	E1231	NU	RIGID PED W/C TILT-IN-SPACE	0.00
	E1232	NU	FOLDING PED WC TILT-IN-SPACE	2626.00
	E1233	NU	RIG PED WC TLTNSPC W/O SEAT	3924.66
	E1234	NU	FLD PED WC TLTNSPC W/O SEAT	2978.85
	E1235	NU	RIGID PED WC ADJUSTABLE	3291.78
	E1236	NU	FOLDING PED WC ADJUSTABLE	2166.48
	E1237	NU	RGD PED WC ADJSTABL W/O SEAT	2647.69
	E1238	NU	FLD PED WC ADJSTABL W/O SEAT	5170.48
	E1239		PED POWER WHEELCHAIR NOS	BR
	E1240	NU	WHCHR LITWT DET ARM LEG REST	3237.75
	E1250	NU	WHEELCHAIR LIGHTWT FIXED ARM	800.05
	E1260	NU	WHEELCHAIR LIGHTWT FOOT REST	2712.96
	E1270	NU	WHEELCHAIR LIGHTWEIGHT LEG R	834.27
	E1280	NU	WHCHR H-DUTY DET ARM LEG RES	3640.62
	E1285	NU	WHEELCHAIR HEAVY DUTY FIXED	1205.10
	E1290	NU	WHEELCHAIR HVY DUTY DETACH A	583.21
	E1295	NU	WHEELCHAIR HEAVY DUTY FIXED	1283.62
	E1296	NU	WHEELCHAIR SPECIAL SEAT HEIG	566.08
	E1297	NU	WHEELCHAIR SPECIAL SEAT DEPT	120.45
	E1298	NU	WHEELCHAIR SPEC SEAT DEPTH/W	487.80
	E1300	NU	WHIRLPOOL PORTABLE	BR
	E1310	NU	WHIRLPOOL NON-PORTABLE	2472.48
	E1352		O2 FLOW REG POS INSPIR PRESS	BR
	E1353	NU	OXYGEN SUPPLIES REGULATOR	0.00
	E1354		WHEELED CART, PORT CYL/CONC	BR
	E1355	NU	OXYGEN SUPPLIES STAND/RACK	0.00
	E1356		BATT PACK/CART, PORT CONC	BR
	E1357		BATTERY CHARGER, PORT CONC	BR
	E1358		DC POWER ADAPTER, PORT CONC	BR
	E1372	NU	OXY SUPPL HEATER FOR NEBULIZ	145.76
	E1390	NU	OXYGEN CONCENTRATOR	3705.89
	E1391	RR	OXYGEN CONCENTRATOR, DUAL	134.71
	E1392	RR	PORTABLE OXYGEN CONCENTRATOR	67.36
	E1399		DURABLE MEDICAL EQUIPMENT MI	BR
	E1405	NU	O2/WATER VAPOR ENRICH W/HEAT	3017.66
	E1406	NU	O2/WATER VAPOR ENRICH W/O HE	BR
	E1500		CENTRIFUGE	BR
	E1510	NU	KIDNEY DIALYSATE DELIVRY SYS	929.65
	E1520	NU	HEPARIN INFUSION PUMP	0.00
	E1530	NU	REPLACEMENT AIR BUBBLE DETEC	0.00
	E1540	NU	REPLACEMENT PRESSURE ALARM	0.00
	E1550	NU	BATH CONDUCTIVITY METER	0.00
	E1560	NU	REPLACE BLOOD LEAK DETECTOR	BR
	E1570	NU	ADJUSTABLE CHAIR FOR ESRD PT	BR
	E1575	NU	TRANSDUCER PROTECT/FLD BAR	BR
	E1580	NU	UNIPUNCTURE CONTROL SYSTEM	BR
	E1590	NU	HEMODIALYSIS MACHINE	BR
	E1592		AUTO INTERM PERITONEAL DIALY	BR
	E1594	NU	CYCLER DIALYSIS MACHINE	8400.62
	E1600		DELI/INSTALL CHRG HEMO EQUIP	0.00
	E1610	NU	REVERSE OSMOSIS H2O PURI SYS	346.21
	E1615		DEIONIZER H2O PURI SYSTEM	BR
	E1620		REPLACEMENT BLOOD PUMP	BR
	E1625		WATER SOFTENING SYSTEM	BR
	E1630		RECIPROCATING PERITONEAL DIA	BR
	E1632		WEARABLE ARTIFICIAL KIDNEY	BR
	E1634		PERITONEAL DIALYSIS CLAMP	BR
	E1635	NU	COMPACT TRAVEL HEMODIALYZER	0.00
	E1636		SORBENT CARTRIDGES PER 10	0.00
	E1637		HEMOSTATS FOR DIALYSIS, EACH	BR
	E1639		SCALE, EACH	BR
	E1699		DIALYSIS EQUIPMENT NOC	BR
	E1700	NU	JAW MOTION REHAB SYSTEM	514.19
	E1701		REPL CUSHIONS FOR JAW MOTION	10.37
	E1702		REPL MEASR SCALES JAW MOTION	22.08
	E1800	RR	ADJUST ELBOW EXT/FLEX DEVICE	119.89
	E1801	RR	SPS ELBOW DEVICE	133.11
	E1802	RR	ADJST FOREARM PRO/SUP DEVICE	376.28
	E1805	RR	ADJUST WRIST EXT/FLEX DEVICE	123.66
	E1806	RR	SPS WRIST DEVICE	109.24
	E1810	RR	ADJUST KNEE EXT/FLEX DEVICE	121.93
	E1811	RR	SPS KNEE DEVICE	138.39
	E1812	NU	KNEE EXT/FLEX W ACT RES CTRL	20646.82
	E1815	RR	ADJUST ANKLE EXT/FLEX DEVICE	123.66
	E1816	RR	SPS ANKLE DEVICE	140.53
	E1818	RR	SPS FOREARM DEVICE	143.51
	E1820	NU	SOFT INTERFACE MATERIAL	94.12
	E1821	NU	REPLACEMENT INTERFACE SPSD	121.17
	E1825	RR	ADJUST FINGER EXT/FLEX DEVC	123.66
	E1830	RR	ADJUST TOE EXT/FLEX DEVICE	123.66
	E1831	RR	STATIC STR TOE DEV EXT/FLEX	76.08
	E1840	RR	ADJ SHOULDER EXT/FLEX DEVICE	386.19
	E1841	RR	STATIC STR SHLDR DEV ROM ADJ	521.57
	E1902		AAC NON-ELECTRONIC BOARD	0.00
	E2000	RR	GASTRIC SUCTION PUMP HME MDL	53.46
	E2100	NU	BLD GLUCOSE MONITOR W VOICE	740.55
	E2101	NU	BLD GLUCOSE MONITOR W LANCE	217.10
	E2120	RR	PULSE GEN SYS TX ENDOLYMP FL	326.44
	E2201	NU	MAN W/CH ACC SEAT W>=20"<24"	375.68
	E2202	NU	SEAT WIDTH 24-27 IN	507.25
	E2203	NU	FRAME DEPTH LESS THAN 22 IN	495.04
	E2204	NU	FRAME DEPTH 22 TO 25 IN	851.97
	E2205	NU	MANUAL WC ACCESSORY, HANDRIM	36.95
	E2206	NU	MAN WC WHL LOCK COMP REPL EA	43.31
	E2207	NU	CRUTCH AND CANE HOLDER	49.91
	E2208	NU	CYLINDER TANK CARRIER	117.88
	E2209	NU	ARM TROUGH EACH	106.34
	E2210	NU	WHEELCHAIR BEARINGS	6.51
	E2211	NU	PNEUMATIC PROPULSION TIRE	37.76
	E2212	NU	PNEUMATIC PROP TIRE TUBE	6.63
	E2213	NU	PNEUMATIC PROP TIRE INSERT	33.01
	E2214	NU	PNEUMATIC CASTER TIRE EACH	34.68
	E2215	NU	PNEUMATIC CASTER TIRE TUBE	10.88
	E2216	NU	FOAM FILLED PROPULSION TIRE	0.00
	E2217	NU	FOAM FILLED CASTER TIRE EACH	0.00
	E2218	NU	FOAM PROPULSION TIRE EACH	0.00
	E2219	NU	FOAM CASTER TIRE ANY SIZE EA	40.95
	E2220	NU	SOLID PROPULS TIRE, REPL, EA	31.63
	E2221	NU	SOLID CASTER TIRE REPL, EACH	28.57
	E2222	NU	SOLID CASTER INTEG WHL, REPL	23.71
	E2224	NU	PROPULSION WHL EXCL TIRE REP	100.39
	E2225	NU	CASTER WHEEL EXCLUDES TIRE	19.79
	E2226	NU	CASTER FORK REPLACEMENT ONLY	42.32
	E2227	NU	GEAR REDUCTION DRIVE WHEEL	1976.96
	E2228	NU	MWC ACC, WHEELCHAIR BRAKE	1048.47
	E2230		MANUAL STANDING SYSTEM	BR
	E2231	NU	SOLID SEAT SUPPORT BASE	160.91
	E2291		PLANAR BACK FOR PED SIZE WC	BR
	E2292		PLANAR SEAT FOR PED SIZE WC	BR
	E2293		CONTOUR BACK FOR PED SIZE WC	BR
	E2294		CONTOUR SEAT FOR PED SIZE WC	BR
	E2295		PED DYNAMIC SEATING FRAME	BR
	E2300		PWR SEAT ELEVATION SYS	BR
	E2301		PWR STANDING	BR
	E2310	NU	ELECTRO CONNECT BTW CONTROL	2016.48
	E2311	NU	ELECTRO CONNECT BTW 2 SYS	3760.50
	E2312	NU	MINI-PROP REMOTE JOYSTICK	3436.17
	E2313	NU	PWC HARNESS, EXPAND CONTROL	597.06
	E2321	NU	HAND INTERFACE JOYSTICK	1714.48
	E2322	NU	MULT MECH SWITCHES	1126.99
	E2323	NU	SPECIAL JOYSTICK HANDLE	72.45
	E2324	NU	CHIN CUP INTERFACE	46.64
	E2325	NU	SIP AND PUFF INTERFACE	1596.42
	E2326	NU	BREATH TUBE KIT	478.82
	E2327	NU	HEAD CONTROL INTERFACE MECH	2087.69
	E2328	NU	HEAD/EXTREMITY CONTROL INTER	6218.40
	E2329	NU	HEAD CONTROL NONPROPORTIONAL	1411.25
	E2330	NU	HEAD CONTROL PROXIMITY SWITC	5117.94
	E2331		ATTENDANT CONTROL	BR
	E2340	NU	W/C WDTH 20-23 IN SEAT FRAME	412.61
	E2341	NU	W/C WDTH 24-27 IN SEAT FRAME	618.96
	E2342	NU	W/C DPTH 20-21 IN SEAT FRAME	515.81
	E2343	NU	W/C DPTH 22-25 IN SEAT FRAME	825.30
	E2351	NU	ELECTRONIC SGD INTERFACE	741.79
	E2358		GR 34 NONSEALED LEADACID	BR
	E2359	NU	GR34 SEALED LEADACID BATTERY	200.51
	E2360	NU	22NF NONSEALED LEADACID	109.96
	E2361	NU	22NF SEALED LEADACID BATTERY	139.42
	E2362	NU	GR24 NONSEALED LEADACID	105.91
	E2363	NU	GR24 SEALED LEADACID BATTERY	184.59
	E2364	NU	U1NONSEALED LEADACID BATTERY	109.96
	E2365	NU	U1 SEALED LEADACID BATTERY	111.31
	E2366	NU	BATTERY CHARGER, SINGLE MODE	261.61
	E2367	NU	BATTERY CHARGER, DUAL MODE	421.36
	E2368	NU	PWR WC DRIVEWHEEL MOTOR REPL	612.31
	E2369	NU	PWR WC DRIVEWHEEL GEAR REPL	526.69
	E2370	NU	PWR WC DR WH MOTOR/GEAR COMB	998.93
	E2371	NU	GR27 SEALED LEADACID BATTERY	158.67
	E2372	NU	GR27 NON-SEALED LEADACID	0.00
	E2373	NU	HAND/CHIN CTRL SPEC JOYSTICK	1255.85
	E2374	NU	HAND/CHIN CTRL STD JOYSTICK	831.02
	E2375	NU	NON-EXPANDABLE CONTROLLER	1002.68
	E2376	NU	EXPANDABLE CONTROLLER, REPL	1530.58
	E2377	NU	EXPANDABLE CONTROLLER, INITL	739.52
	E2378	RR	PW ACTUATOR REPLACEMENT	58.92
	E2381	NU	PNEUM DRIVE WHEEL TIRE	75.59
	E2382	NU	TUBE, PNEUM WHEEL DRIVE TIRE	20.69
	E2383	NU	INSERT, PNEUM WHEEL DRIVE	153.06
	E2384	NU	PNEUMATIC CASTER TIRE	80.30
	E2385	NU	TUBE, PNEUMATIC CASTER TIRE	49.48
	E2386	NU	FOAM FILLED DRIVE WHEEL TIRE	149.35
	E2387	NU	FOAM FILLED CASTER TIRE	66.97
	E2388	NU	FOAM DRIVE WHEEL TIRE	51.86
	E2389	NU	FOAM CASTER TIRE	28.54
	E2390	NU	SOLID DRIVE WHEEL TIRE	44.42
	E2391	NU	SOLID CASTER TIRE	20.86
	E2392	NU	SOLID CASTER TIRE, INTEGRATE	53.46
	E2394	NU	DRIVE WHEEL EXCLUDES TIRE	76.18
	E2395	NU	CASTER WHEEL EXCLUDES TIRE	54.13
	E2396	NU	CASTER FORK	65.99
	E2397	NU	PWC ACC, LITH-BASED BATTERY	476.82
	E2402	RR	NEG PRESS WOUND THERAPY PUMP	1203.27
	E2500	NU	SGD DIGITIZED PRE-REC <=8MIN	450.24
	E2502	NU	SGD PREREC MSG >8MIN <=20MIN	1376.80
	E2504	NU	SGD PREREC MSG>20MIN <=40MIN	1816.20
	E2506	NU	SGD PREREC MSG > 40 MIN	2663.09
	E2508	NU	SGD SPELLING PHYS CONTACT	4118.03
	E2510	NU	SGD W MULTI METHODS MSG/ACCS	7792.82
	E2511	NU	SGD SFTWRE PRGRM FOR PC/PDA	0.00
	E2512	NU	SGD ACCESSORY, MOUNTING SYS	0.00
	E2599		SGD ACCESSORY NOC	BR
	E2601	NU	GEN W/C CUSHION WDTH < 22 IN	60.69
	E2602	NU	GEN W/C CUSHION WDTH >=22 IN	118.48
	E2603	NU	SKIN PROTECT WC CUS WD <22IN	150.42
	E2604	NU	SKIN PROTECT WC CUS WD>=22IN	186.98
	E2605	NU	POSITION WC CUSH WDTH <22 IN	267.13
	E2606	NU	POSITION WC CUSH WDTH>=22 IN	416.73
	E2607	NU	SKIN PRO/POS WC CUS WD <22IN	287.64
	E2608	NU	SKIN PRO/POS WC CUS WD>=22IN	345.43
	E2609		CUSTOM FABRICATE W/C CUSHION	BR
	E2610		POWERED W/C CUSHION	BR
	E2611	NU	GEN USE BACK CUSH WDTH <22IN	309.97
	E2612	NU	GEN USE BACK CUSH WDTH>=22IN	419.32
	E2613	NU	POSITION BACK CUSH WD <22IN	390.05
	E2614	NU	POSITION BACK CUSH WD>=22IN	547.45
	E2615	NU	POS BACK POST/LAT WDTH <22IN	448.86
	E2616	NU	POS BACK POST/LAT WDTH>=22IN	603.94
	E2617		CUSTOM FAB W/C BACK CUSHION	BR
	E2619	NU	REPLACE COVER W/C SEAT CUSH	53.08
	E2620	NU	WC PLANAR BACK CUSH WD <22IN	543.51
	E2621	NU	WC PLANAR BACK CUSH WD>=22IN	570.38
	E2622	NU	ADJ SKIN PRO W/C CUS WD<22IN	340.10
	E2623	NU	ADJ SKIN PRO WC CUS WD>=22IN	431.57
	E2624	NU	ADJ SKIN PRO/POS CUS<22IN	344.11
	E2625	NU	ADJ SKIN PRO/POS WC CUS>=22	431.25
	E2626	NU	SEO MOBILE ARM SUP ATT TO WC	715.16
	E2627	NU	ARM SUPP ATT TO WC RANCHO TY	969.99
	E2628	NU	MOBILE ARM SUPPORTS RECLININ	859.68
	E2629	NU	FRICTION DAMPENING ARM SUPP	1087.90
	E2630	NU	MONOSUSPENSION ARM/HAND SUPP	760.76
	E2631	NU	ELEVAT PROXIMAL ARM SUPPORT	258.68
	E2632	NU	OFFSET/LAT ROCKER ARM W/ELA	177.75
	E2633	NU	MOBILE ARM SUPPORT SUPINATOR	139.51
	E8000		POSTERIOR GAIT TRAINER	BR
	E8001		UPRIGHT GAIT TRAINER	BR
	E8002		ANTERIOR GAIT TRAINER	BR
	G0008		ADMIN INFLUENZA VIRUS VAC	34.03	53.79
	G0009		ADMIN PNEUMOCOCCAL VACCINE	35.75	53.79
	G0010		ADMIN HEPATITIS B VACCINE	38.31	53.79
	G0027		SEMEN ANALYSIS	7.95
	G0068		ADM OF INFUSION DRUG IN HOME	152.63
	G0069		ADM OF IMMUNE DRUG IN HOME	238.25
	G0070		ADM OF CHEMO DRUG IN HOME	259.67
	G0071		COMM SVCS BY RHC/FQHC 5 MIN	15.61
	G0076		CARE MANAG H VST NEW PT 20 M	63.70
	G0077		CARE MANAG H VST NEW PT 30 M	91.66
	G0078		CARE MANAG H VST NEW PT 45 M	149.60
	G0079		CARE MANAG H VST NEW PT 60 M	210.02
	G0080		CARE MANAG H VST NEW PT 75 M	255.23
	G0081		CARE MAN H V EXT PT 20 MI	63.70
	G0082		CARE MAN H V EXT PT 30 M	96.58
	G0083		CARE MAN H V EXT PT 45 M	148.78
	G0084		CARE MAN H V EXT PT 60 M	206.33
	G0085		CARE MAN H V EXT PT 75 M	255.23
	G0086		CARE MAN HOME CARE PLAN 30 M	89.18
	G0087		CARE MAN HOME CARE PLAN 60 M	125.36
	G0101		CA SCREEN;PELVIC/BREAST EXAM	45.21	108.47
	G0102		PROSTATE CA SCREENING; DRE	25.89
	G0103		PSA SCREENING	22.48
	G0104		CA SCREEN; FLEXI SIGMOIDSCOPE	200.57	1057.74
	G0105		COLORECTAL SCRN; HI RISK IND	376.89	1057.74
	G0106		COLON CA SCREEN;BARIUM ENEMA	266.73	286.47
	G0108		DIAB MANAGE TRN PER INDIV	64.11
	G0109		DIAB MANAGE TRN IND/GROUP	17.68
	G0117		GLAUCOMA SCRN HGH RISK DIREC	64.94	45.61
	G0118		GLAUCOMA SCRN HGH RISK DIREC	48.50	45.61
	G0120		COLON CA SCRN; BARIUM ENEMA	265.50	547.95
	G0121		COLON CA SCRN NOT HI RSK IND	377.30	1057.74
	G0122		COLON CA SCRN; BARIUM ENEMA	336.61
	G0123		SCREEN CERV/VAG THIN LAYER	24.76
	G0124		SCREEN C/V THIN LAYER BY MD	37.00
	G0127		TRIM NAIL(S)	27.95	79.38
	G0128		CORF SKILLED NURSING SERVICE	9.04
	G0129		PARTIAL HOSP PROG SERVICE	BR
	G0130		SINGLE ENERGY X-RAY STUDY	40.69	159.76
	G0141		SCR C/V CYTO, AUTOSYS AND MD	37.00
	G0143		SCR C/V CYTO, THINLAYER, RESCR	29.76
	G0144		SCR C/V CYTO, THINLAYER, RESCR	48.37
	G0145		SCR C/V CYTO, THINLAYER, RESCR	32.38
	G0147		SCR C/V CYTO, AUTOMATED SYS	16.49
	G0148		SCR C/V CYTO, AUTOSYS, RESCR	35.13
	G0151		HHCP-SERV OF PT, EA 15 MIN	See Rule
	G0152		HHCP-SERV OF OT, EA 15 MIN	See Rule
	G0153		HHCP-SVS OF S/L PATH, EA 15MN	See Rule
	G0155		HHCP-SVS OF CSW, EA 15 MIN	See Rule
	G0156		HHCP-SVS OF AIDE, EA 15 MIN	See Rule
	G0157		HHC PT ASSISTANT EA 15	BR
	G0158		HHC OT ASSISTANT EA 15	BR
	G0159		HHC PT MAINT EA 15 MIN	BR
	G0160		HHC OCCUP THERAPY EA 15	BR
	G0161		HHC SLP EA 15 MIN	BR
	G0162		HHC RN E&M PLAN SVS, 15 MIN	See Rule
	G0166		EXTRNL COUNTERPULSE, PER TX	132.35	151.20
	G0168		WOUND CLOSURE BY ADHESIVE	110.98
	G0175		OPPS SERVICE, SCHED TEAM CONF	BR	511.73
	G0176		OPPS/PHP;ACTIVITY THERAPY	BR
	G0177		OPPS/PHP; TRAIN & EDUC SERV	BR
	G0179		MD RECERTIFICATION HHA PT	47.68
	G0180		MD CERTIFICATION HHA PATIENT	61.65
	G0181		HOME HEALTH CARE SUPERVISION	124.95
	G0182		HOSPICE CARE SUPERVISION	124.95
	G0186		DSTRY EYE LESN, FDR VSSL TECH	BR	704.58
	G0219		PET IMG WHOLBOD MELANO NONCO	BR
	G0235		PET NOT OTHERWISE SPECIFIED	BR
	G0237		THERAPEUTIC PROCD STRG ENDUR	11.10	45.61
	G0238		OTH RESP PROC, INDIV	11.51	45.61
	G0239		OTH RESP PROC, GROUP	14.38	45.61
	G0245		INITIAL FOOT EXAM PT LOPS	77.26	164.51
	G0246		FOLLOWUP EVAL OF FOOT PT LOP	45.62	164.51
	G0247		ROUTINE FOOTCARE PT W LOPS	89.18	250.56
	G0248		DEMONSTRATE USE HOME INR MON	83.02	164.51
	G0249		PROVIDE INR TEST MATER/EQUIP	83.43	164.51
	G0250		MD INR TEST REVIE INTER MGMT	10.69
	G0252		PET IMAGING INITIAL DX	87.29
	G0255		CURRENT PERCEP THRESHOLD TST	BR
	G0257		UNSCHED DIALYSIS ESRD PT HOS	BR	868.66
	G0259		INJECT FOR SACROILIAC JOINT	BR
	G0260		INJ FOR SACROILIAC JT ANESTH	BR	850.31
	G0268		REMOVAL OF IMPACTED WAX MD	57.53
	G0269		OCCLUSIVE DEVICE IN VEIN ART	BR
	G0270		MNT SUBS TX FOR CHANGE DX	37.41
	G0271		GROUP MNT 2 OR MORE 30 MINS	19.73
J1	G0276		PILD/PLACEBO CONTROL CLIN TR	0.00	10775.65
	G0277		HBOT, FULL BODY CHAMBER, 30M	127.41	162.45
	G0278		ILIAC ART ANGIO, CARDIAC CATH	16.44
	G0279		TOMOSYNTHESIS, MAMMO	63.70
	G0281		ELEC STIM UNATTEND FOR PRESS	22.68
	G0282		ELECT STIM WOUND CARE NOT PD	22.68	60.67
	G0283		ELEC STIM OTHER THAN WOUND	22.68
	G0288		RECON, CTA FOR SURG PLAN	41.51
	G0289		ARTHRO, LOOSE BODY + CHONDRO	103.16
	G0293		NON-COV SURG PROC, CLIN TRIAL	BR	45.61
	G0294		NON-COV PROC, CLINICAL TRIAL	BR	45.61
	G0295		ELECTROMAGNETIC THERAPY ONC	BR
	G0296		VISIT TO DETERM LDCT ELIG	33.29	108.47
	G0297		LDCT FOR LUNG CA SCREEN	274.96	88.47
	G0299		HHS/HOSPICE OF RN EA 15 MIN	0.00
	G0300		HHS/HOSPICE OF LPN EA 15 MIN	0.00
	G0302		PRE-OP SERVICE LVRS COMPLETE	BR	646.48
	G0303		PRE-OP SERVICE LVRS 10-15DOS	BR	193.05
	G0304		PRE-OP SERVICE LVRS 1-9 DOS	BR	646.48
	G0305		POST OP SERVICE LVRS MIN 6	BR	646.48
	G0306		CBC/DIFFWBC W/O PLATELET	9.49
	G0307		CBC WITHOUT PLATELET	7.90
	G0328		FECAL BLOOD SCRN IMMUNOASSAY	19.86
	G0329		ELECTROMAGNTIC TX FOR ULCERS	12.74
	G0333		DISPENSE FEE INITIAL 30 DAY	BR
	G0337		HOSPICE EVALUATION PREELECTI	84.25
	G0339		ROBOT LIN-RADSURG COM, FIRST	BR
	G0340		ROBT LIN-RADSURG FRACTX 2-5	BR
	G0341		PERCUTANEOUS ISLET CELLTRANS	2447.92
	G0342		LAPAROSCOPY ISLET CELL TRANS	831.45
	G0343		LAPAROTOMY ISLET CELL TRANSP	1373.16
	G0365		VESSEL MAPPING HEMO ACCESS	224.40	159.76
	G0372		MD SERVICE REQUIRED FOR PMD	10.28
	G0378		HOSPITAL OBSERVATION PER HR	BR
	G0379		DIRECT REFER HOSPITAL OBSERV	BR	745.93
	G0380		LEV 1 HOSP TYPE B ED VISIT	BR	110.53
	G0381		LEV 2 HOSP TYPE B ED VISIT	BR	131.83
	G0382		LEV 3 HOSP TYPE B ED VISIT	BR	232.40
	G0383		LEV 4 HOSP TYPE B ED VISIT	BR	307.29
	G0384		LEV 5 HOSP TYPE B ED VISIT	BR	456.20
	G0390		TRAUMA RESPONS W/HOSP CRITI	BR	1342.40
	G0396		ALCOHOL/SUBS INTERV 15-30MN	41.51	47.40
	G0397		ALCOHOL/SUBS INTERV >30 MIN	77.67	108.47
	G0398		HOME SLEEP TEST/TYPE 2 PORTA	BR	193.05
	G0399		HOME SLEEP TEST/TYPE 3 PORTA	BR	193.05
	G0400		HOME SLEEP TEST/TYPE 4 PORTA	BR	193.05
	G0402		INITIAL PREVENTIVE EXAM	192.76	164.51
	G0403		EKG FOR INITIAL PREVENT EXAM	19.73
	G0404		EKG TRACING FOR INITIAL PREV	9.86	24.38
	G0405		EKG INTERPRET & REPORT PREVE	9.86
	G0406		INPT/TELE FOLLOW UP 15	44.80
	G0407		INPT/TELE FOLLOW UP 25	83.43
	G0408		INPT/TELE FOLLOW UP 35	120.01
	G0409		CORF RELATED SERV 15 MINS EA	18.91
	G0410		GRP PSYCH PARTIAL HOSP 45-50	BR
	G0411		INTER ACTIVE GRP PSYCH PARTI	BR
	G0412		OPEN TX ILIAC SPINE UNI/BIL	855.70
J1	G0413		PELVIC RING FRACTURE UNI/BIL	1263.00	5184.51
	G0414		PELVIC RING FX TREAT INT FIX	1188.20
	G0415		OPEN TX POST PELVIC FXCTURE	1630.85
	G0416		PROSTATE BIOPSY, ANY MTHD	440.59	389.39
	G0420		ED SVC CKD IND PER SESSION	128.23
	G0421		ED SVC CKD GRP PER SESSION	30.00
	G0422		INTENS CARDIAC REHAB W/EXERC	134.81	167.77
	G0423		INTENS CARDIAC REHAB NO EXER	134.81	167.77
	G0424		PULMONARY REHAB W EXER	34.11	79.38
	G0425		INPT/ED TELECONSULT30	115.49
	G0426		INPT/ED TELECONSULT50	157.00
	G0427		INPT/ED TELECONSULT70	233.04
	G0428		COLLAGEN MENISCUS IMPLANT	BR
	G0429		DERMAL FILLER INJECTION(S)	115.08	2199.52
	G0432		EIA HIV-1/HIV-2 SCREEN	21.53
	G0433		ELISA HIV-1/HIV-2 SCREEN	20.12
	G0435		ORAL HIV-1/HIV-2 SCREEN	14.65
	G0438		PPPS, INITIAL VISIT	198.92
	G0439		PPPS, SUBSEQ VISIT	134.81
	G0442		ANNUAL ALCOHOL SCREEN 15 MIN	20.96	47.40
	G0443		BRIEF ALCOHOL MISUSE COUNSEL	30.42	108.47
	G0444		DEPRESSION SCREEN ANNUAL	20.96	47.40
	G0445		HIGH INTEN BEH COUNS STD 30M	32.06	108.47
	G0446		INTENS BEHAVE THER CARDIO DX	30.42	47.40
	G0447		BEHAVIOR COUNSEL OBESITY 15M	30.00	108.47
	G0448		PLACE PERM PACING CARDIOVERT	BR
	G0451		DEVLOPMENT TEST INTERPT&REP	11.51	108.47
	G0452		MOLECULAR PATHOLOGY INTERPR	85.12
	G0453		CONT INTRAOP NEURO MONITOR	38.23
	G0454		MD DOCUMENT VISIT BY NPP	10.69
	G0455		FECAL MICROBIOTA PREP INSTIL	149.60	1081.40
	G0458		LDR PROSTATE BRACHY COMP RAT	BR
	G0459		TELEHEALTH INPT PHARM MGMT	47.68
	G0460		AUTOLOGOUS PRP FOR ULCERS	BR	2199.52
	G0463		HOSPITAL OUTPT CLINIC VISIT	0.00	164.51
	G0466		FQHC VISIT NEW PATIENT	0.00
	G0467		FQHC VISIT, ESTAB PT	0.00
	G0468		FQHC VISIT, IPPE OR AWV	0.00
	G0469		FQHC VISIT, MH NEW PT	0.00
	G0470		FQHC VISIT, MH ESTAB PT	0.00
	G0471		VEN BLOOD COLL SNF/HHA	0.00
	G0472		HEP C SCREEN HIGH RISK/OTHER	50.99
	G0473		GROUP BEHAVE COUNS 2-10	14.79	108.47
	G0475		HIV COMBINATION ASSAY	BR
	G0476		HPV COMBO ASSAY CA SCREEN	BR
	G0480		DRUG TEST DEF 1-7 CLASSES	0.00
	G0481		DRUG TEST DEF 8-14 CLASSES	0.00
	G0482		DRUG TEST DEF 15-21 CLASSES	0.00
	G0483		DRUG TEST DEF 22+ CLASSES	0.00
	G0490		HOME VISIT RN, LPN BY RHC/FQ	BR
	G0491		DIALYSIS ACU KIDNEY NO ESRD	130.37
	G0492		MD/OTH EVAL ACUT KID NO ESRD	BR
	G0493		RN CARE EA 15 MIN HH/HOSPICE	36.23
	G0494		LPN CARE EA 15MIN HH/HOSPICE	7.17
	G0495		RN CARE TRAIN/EDU IN HH	64.87
	G0496		LPN CARE TRAIN/EDU IN HH	11.27
	G0498		CHEMO EXTEND IV INFUS W/PUMP	153.90	409.50
	G0499		HEPB SCREEN HIGH RISK INDIV	34.55
	G0500		MOD SEDAT ENDO SERVICE >5YRS	66.99
	G0501		RESOURCE-INTEN SVC DURING OV	BR
	G0506		COMP ASSES CARE PLAN CCM SVC	72.34
	G0508		CRIT CARE TELEHEA CONSULT 60	242.49
	G0509		CRIT CARE TELEHEA CONSULT 50	228.93
	G0511		CCM/BHI BY RHC/FQHC 20MIN MO	76.44
	G0512		COCM BY RHC/FQHC 60 MIN MO	166.46
	G0513		PROLONG PREV SVCS, FIRST 30M	75.21
	G0514		PROLONG PREV SVCS, ADDL 30M	75.21
	G0515		COGNITIVE SKILLS DEVELOPMENT	37.41
	G0516		INSERT DRUG DEL IMPLANT, >=4	280.31	494.39
	G0517		REMOVE DRUG IMPLANT	302.50	494.39
	G0518		REMOVE W INSERT DRUG IMPLANT	528.54	494.39
	G0659		DRUG TEST DEF SIMPLE ALL CL	71.12
	G0913		IMPROVE VISUAL FUNCT	BR
	G0914		SURVEY NOT COMPLETE	BR
	G0915		NO IMPROVE VISUAL FUNCT	BR
	G0916		SATISFY WITH CARE	BR
	G0917		SATISFY SURVEY NOT COMPLETE	BR
	G0918		NO SATISFY WITH CARE	BR
	G2000		BLINDED CONV. TX MDD CLIN TR	BR	646.48
	G2010		REMOT IMAGE SUBMIT BY PT	14.38
	G2011		ALCOHOL/SUB ABUSE ASSESS	19.32	24.38
	G2012		BRIEF CHECK IN BY MD/QHP	16.86
	G6001		ECHO GUIDANCE RADIOTHERAPY	BR
	G6002		STEREOSCOPIC X-RAY GUIDANCE	BR
	G6003		RADIATION TREATMENT DELIVERY	BR
	G6004		RADIATION TREATMENT DELIVERY	BR
	G6005		RADIATION TREATMENT DELIVERY	BR
	G6006		RADIATION TREATMENT DELIVERY	BR
	G6007		RADIATION TREATMENT DELIVERY	BR
	G6008		RADIATION TREATMENT DELIVERY	BR
	G6009		RADIATION TREATMENT DELIVERY	BR
	G6010		RADIATION TREATMENT DELIVERY	BR
	G6011		RADIATION TREATMENT DELIVERY	BR
	G6012		RADIATION TREATMENT DELIVERY	BR
	G6013		RADIATION TREATMENT DELIVERY	BR
	G6014		RADIATION TREATMENT DELIVERY	BR
	G6015		RADIATION TX DELIVERY IMRT	BR
	G6016		DELIVERY COMP IMRT	BR
	G6017		INTRAFRACTION TRACK MOTION	0.00
	J0120		TETRACYCLIN INJECTION	0.00
	J0129		ABATACEPT INJECTION	47.64	73.29
	J0130		ABCIXIMAB INJECTION	1226.69
	J0131		ACETAMINOPHEN INJECTION	BR
	J0132		ACETYLCYSTEINE INJECTION	2.07
	J0133		ACYCLOVIR INJECTION	0.09
	J0135		ADALIMUMAB INJECTION	1347.06	1833.34
	J0153		ADENOSINE INJ 1MG	1.16
	J0171		ADRENALIN EPINEPHRINE INJECT	0.15
	J0178		AFLIBERCEPT INJECTION	1184.37	1368.22
	J0180		AGALSIDASE BETA INJECTION	191.43	253.00
	J0185		INJ., APREPITANT, 1 MG	BR	2.99
	J0190		INJ BIPERIDEN LACTATE/5 MG	BR
	J0200		ALATROFLOXACIN MESYLATE	BR
	J0202		INJECTION, ALEMTUZUMAB	2106.39	2672.53
	J0205		ALGLUCERASE INJECTION	37.45
	J0207		AMIFOSTINE	456.45	1391.24
	J0210		METHYLDOPATE HCL INJECTION	47.51
	J0215		ALEFACEPT	31.41
	J0220		ALGLUCOSIDASE ALFA INJECTION	249.68	200.42
	J0221		LUMIZYME INJECTION	185.54	236.00
	J0256		ALPHA 1 PROTEINASE INHIBITOR	5.55	6.46
	J0257		GLASSIA INJECTION	5.16	6.67
	J0270		ALPROSTADIL FOR INJECTION	9.21
	J0275		ALPROSTADIL URETHRAL SUPPOS	BR
	J0278		AMIKACIN SULFATE INJECTION	1.40
	J0280		AMINOPHYLLIN 250 MG INJ	10.72
	J0282		AMIODARONE HCL	7.39
	J0285		AMPHOTERICIN B	23.58
	J0287		AMPHOTERICIN B LIPID COMPLEX	15.73	11.46
	J0288		AMPHO B CHOLESTERYL SULFATE	41.47
	J0289		AMPHOTERICIN B LIPOSOME INJ	21.96	31.51
	J0290		AMPICILLIN 500 MG INJ	1.72
	J0295		AMPICILLIN SULBACTAM 1.5 GM	2.75
	J0300		AMOBARBITAL 125 MG INJ	14.09	80.40
	J0330		SUCCINYCHOLINE CHLORIDE INJ	18.44
	J0348		ANIDULAFUNGIN INJECTION	0.70
	J0350		INJECTION ANISTREPLASE 30 U	BR
	J0360		HYDRALAZINE HCL INJECTION	12.68
	J0364		APOMORPHINE HYDROCHLORIDE	3.62
	J0365		APROTONIN, 10, 000 KIU	31.33
	J0380		INJ METARAMINOL BITARTRATE	1.21
	J0390		CHLOROQUINE INJECTION	BR
	J0395		ARBUTAMINE HCL INJECTION	BR
	J0400		ARIPIPRAZOLE INJECTION	1.84
	J0401		INJ ARIPIPRAZOLE EXT REL 1MG	5.13	7.77
	J0456		AZITHROMYCIN	4.30
	J0461		ATROPINE SULFATE INJECTION	0.06
	J0470		DIMECAPROL INJECTION	46.76
	J0475		BACLOFEN 10 MG INJECTION	200.46	241.04
	J0476		BACLOFEN INTRATHECAL TRIAL	92.28
	J0480		BASILIXIMAB	3633.38	5222.21
	J0485		BELATACEPT INJECTION	4.59	5.38
	J0490		BELIMUMAB INJECTION	50.08	62.71
	J0500		DICYCLOMINE INJECTION	69.76
	J0515		INJ BENZTROPINE MESYLATE	24.55
	J0517		INJ., BENRALIZUMAB, 1 MG	BR	237.20
	J0520		BETHANECHOL CHLORIDE INJECT	BR
	J0558		PENG BENZATHINE/PROCAINE INJ	7.96	15.57
	J0561		PENICILLIN G BENZATHINE INJ	10.06	19.67
	J0565		INJ, BEZLOTOXUMAB, 10 MG	BR	56.93
	J0567		INJ., CERLIPONASE ALFA 1 MG	BR	132.94
	J0570		BUPRENORPHINE IMPLANT 74.2MG	BR	1803.27
	J0571		BUPRENORPHINE ORAL 1MG	BR
	J0572		BUPREN/NAL UP TO 3MG BUPRENO	BR
	J0573		BUPREN/NAL 3.1 TO 6MG BUPREN	BR
	J0574		BUPREN/NAL 6.1 TO 10MG BUPRE	BR
	J0575		BUPREN/NAL OVER 10MG BUPRENO	BR
	J0583		BIVALIRUDIN	3.63
	J0584		INJECTION, BUROSUMAB-TWZA 1M	BR	501.83
	J0585		INJECTION, ONABOTULINUMTOXINA	6.92	8.71
	J0586		ABOBOTULINUMTOXINA	9.54	12.12
	J0587		INJ, RIMABOTULINUMTOXINB	14.02	17.04
	J0588		INCOBOTULINUMTOXIN A	5.76	7.21
	J0592		BUPRENORPHINE HYDROCHLORIDE	3.61
	J0594		BUSULFAN INJECTION	40.07	15.37
	J0595		BUTORPHANOL TARTRATE 1 MG	2.89
	J0596		INJECTION, RUCONEST	BR	39.00
	J0597		C-1 ESTERASE, BERINERT	55.96	69.46
	J0598		C-1 ESTERASE, CINRYZE	65.80	76.71
	J0599		INJ., HAEGARDA 10 UNITS	BR	13.73
	J0600		EDETATE CALCIUM DISODIUM INJ	6757.62	7944.08
	J0604		CINACALCET, ESRD ON DIALYSIS	3.91
	J0606		INJ, ETELCALCETIDE, 0.1 MG	11.98	4.09
	J0610		CALCIUM GLUCONATE INJECTION	3.74
	J0620		CALCIUM GLYCER & LACT/10 ML	9.21
	J0630		CALCITONIN SALMON INJECTION	2413.14	3764.56
	J0636		INJ CALCITRIOL PER 0.1 MCG	0.42
	J0637		CASPOFUNGIN ACETATE	15.63	14.23
	J0638		CANAKINUMAB INJECTION	111.27	157.60
	J0640		LEUCOVORIN CALCIUM INJECTION	4.63
	J0641		LEVOLEUCOVORIN INJECTION	1.95	0.17
	J0670		INJ MEPIVACAINE HCL/10 ML	2.38
	J0690		CEFAZOLIN SODIUM INJECTION	1.08
	J0692		CEFEPIME HCL FOR INJECTION	3.03
	J0694		CEFOXITIN SODIUM INJECTION	5.91
	J0695		INJ CEFTOLOZANE TAZOBACTAM	BR	7.70
	J0696		CEFTRIAXONE SODIUM INJECTION	0.94
	J0697		STERILE CEFUROXIME INJECTION	2.92
	J0698		CEFOTAXIME SODIUM INJECTION	28.80
	J0702		BETAMETHASONE ACET&SOD PHOSP	7.05
	J0706		CAFFEINE CITRATE INJECTION	1.51
	J0710		CEPHAPIRIN SODIUM INJECTION	BR
	J0712		CEFTAROLINE FOSAMIL INJ	2.74	4.13
	J0713		INJ CEFTAZIDIME PER 500 MG	2.90
	J0714		CEFTAZIDIME AND AVIBACTAM	BR	119.61
	J0715		CEFTIZOXIME SODIUM / 500 MG	BR
	J0716		CENTRUROIDES IMMUNE F(AB)	BR	6521.78
	J0717		CERTOLIZUMAB PEGOL INJ 1MG	7.81	11.20
	J0720		CHLORAMPHENICOL SODIUM INJEC	38.33
	J0725		CHORIONIC GONADOTROPIN/1000U	24.41	32.09
	J0735		CLONIDINE HYDROCHLORIDE	13.94
	J0740		CIDOFOVIR INJECTION	684.73	742.30
	J0743		CILASTATIN SODIUM INJECTION	5.49
	J0744		CIPROFLOXACIN IV	1.23
	J0745		INJ CODEINE PHOSPHATE /30 MG	1.21
	J0770		COLISTIMETHATE SODIUM INJ	12.56
	J0775		COLLAGENASE, CLOST HIST INJ	46.45	63.99
	J0780		PROCHLORPERAZINE INJECTION	15.81
	J0795		CORTICORELIN OVINE TRIFLUTAL	9.33	12.68
	J0800		CORTICOTROPIN INJECTION	4322.60
	J0834		INJ., COSYNTROPIN, 0.25 MG	53.74
	J0840		CROTALIDAE POLY IMMUNE FAB	3071.72	4673.60
	J0841		INJ CROTALIDAE IM F(AB')2 EQ	BR	1784.37
	J0850		CYTOMEGALOVIRUS IMM IV /VIAL	1286.15	1603.40
	J0875		INJECTION, DALBAVANCIN	17.62	19.25
	J0878		DAPTOMYCIN INJECTION	0.97	0.59
	J0881		DARBEPOETIN ALFA, NON-ESRD	5.01	5.44
	J0882		DARBEPOETIN ALFA, ESRD USE	5.01	5.44
	J0883		ARGATROBAN NONESRD USE 1MG	BR	1.45
	J0884		ARGATROBAN ESRD DIALYSIS 1MG	BR	1.45
	J0885		EPOETIN ALFA, NON-ESRD	14.90	16.97
	J0887		EPOETIN BETA ESRD USE	BR
	J0888		EPOETIN BETA NON ESRD	BR
	J0890		PEGINESATIDE INJECTION	BR
	J0894		DECITABINE INJECTION	26.30	17.94
	J0895		DEFEROXAMINE MESYLATE INJ	18.13
	J0897		DENOSUMAB INJECTION	18.71	26.43
	J0945		BROMPHENIRAMINE MALEATE INJ	4.61
	J1000		DEPO-ESTRADIOL CYPIONATE INJ	16.67
	J1020		METHYLPREDNISOLONE 20 MG INJ	5.43
	J1030		METHYLPREDNISOLONE 40 MG INJ	5.20
	J1040		METHYLPREDNISOLONE 80 MG INJ	10.07
	J1050		MEDROXYPROGESTERONE ACETATE	0.43
	J1071		INJ TESTOSTERONE CYPIONATE	0.04
	J1094		INJ DEXAMETHASONE ACETATE	1.84
	J1095		INJECTION, DEXAMETHASONE 9%	BR	1.57
	J1100		DEXAMETHASONE SODIUM PHOS	0.17
	J1110		INJ DIHYDROERGOTAMINE MESYLT	92.70
	J1120		ACETAZOLAMID SODIUM INJECTIO	25.07
	J1130		INJ DICLOFENAC SODIUM 0.5MG	BR
	J1160		DIGOXIN INJECTION	5.53
	J1162		DIGOXIN IMMUNE FAB (OVINE)	3192.18	5236.59
	J1165		PHENYTOIN SODIUM INJECTION	0.80
	J1170		HYDROMORPHONE INJECTION	2.49
	J1180		DYPHYLLINE INJECTION	BR
	J1190		DEXRAZOXANE HCL INJECTION	201.46	313.77
	J1200		DIPHENHYDRAMINE HCL INJECTIO	0.59
	J1205		CHLOROTHIAZIDE SODIUM INJ	139.93
	J1212		DIMETHYL SULFOXIDE 50% 50 ML	262.77	769.08
	J1230		METHADONE INJECTION	12.39
	J1240		DIMENHYDRINATE INJECTION	7.52
	J1245		DIPYRIDAMOLE INJECTION	0.99
	J1250		INJ DOBUTAMINE HCL/250 MG	6.69
	J1260		DOLASETRON MESYLATE	18.44
	J1265		DOPAMINE INJECTION	0.73
	J1267		DORIPENEM INJECTION	0.97
	J1270		INJECTION, DOXERCALCIFEROL	1.12
	J1290		ECALLANTIDE INJECTION	488.83	679.67
	J1300		ECULIZUMAB INJECTION	260.82	327.28
	J1301		INJECTION, EDARAVONE, 1 MG	BR	27.21
	J1320		AMITRIPTYLINE INJECTION	BR
	J1322		ELOSULFASE ALFA, INJECTION	BR	336.48
	J1324		ENFUVIRTIDE INJECTION	368.64
	J1325		EPOPROSTENOL INJECTION	18.69
	J1327		EPTIFIBATIDE INJECTION	25.37	21.68
	J1330		ERGONOVINE MALEATE INJECTION	BR
	J1335		ERTAPENEM INJECTION	50.29
	J1364		ERYTHRO LACTOBIONATE /500 MG	58.46	111.99
	J1380		ESTRADIOL VALERATE 10 MG INJ	12.41
	J1410		INJ ESTROGEN CONJUGATE 25 MG	275.85	438.65
	J1428		INJ, ETEPLIRSEN, 10 MG	176.93	238.57
	J1430		ETHANOLAMINE OLEATE 100 MG	488.11	630.62
	J1435		INJECTION ESTRONE PER 1 MG	0.40
	J1436		ETIDRONATE DISODIUM INJ	BR
	J1438		ETANERCEPT INJECTION	6140.60	916.67
	J1439		INJ FERRIC CARBOXYMALTOS 1MG	1.28	1.54
	J1442		INJ FILGRASTIM EXCL BIOSIMIL	1.22	1.43
	J1443		INJ FERRIC PYROPHOSPHATE CIT	BR
	J1447		INJ TBO FILGRASTIM 1 MICROG	0.93	0.83
	J1450		FLUCONAZOLE	5.83
	J1451		FOMEPIZOLE, 15 MG	8.46	12.15
	J1452		INTRAOCULAR FOMIVIRSEN NA	BR
	J1453		FOSAPREPITANT INJECTION	2.08	2.99
	J1454		INJ FOSNETUPITANT, PALONOSET	BR	751.92
	J1455		FOSCARNET SODIUM INJECTION	82.97	116.82
	J1457		GALLIUM NITRATE INJECTION	1.61
	J1458		GALSULFASE INJECTION	440.16	554.46
	J1459		INJ IVIG PRIVIGEN 500 MG	46.21	57.25
	J1460		GAMMA GLOBULIN 1 CC INJ	40.40	56.76
	J1555		INJ CUVITRU, 100 MG	BR	19.32
	J1556		INJ, IMM GLOB BIVIGAM, 500MG	46.94	100.13
	J1557		GAMMAPLEX INJECTION	45.07	65.16
	J1559		HIZENTRA INJECTION	10.23	14.36
	J1560		GAMMA GLOBULIN > 10 CC INJ	404.06	567.60
	J1561		GAMUNEX-C/GAMMAKED	50.45	56.96
	J1562		VIVAGLOBIN, INJ	11.27
	J1566		IMMUNE GLOBULIN, POWDER	42.15	61.22
	J1568		OCTAGAM INJECTION	51.27	50.37
	J1569		GAMMAGARD LIQUID INJECTION	46.04	59.96
	J1570		GANCICLOVIR SODIUM INJECTION	79.94
	J1571		HEPAGAM B IM INJECTION	67.41	91.36
	J1572		FLEBOGAMMA INJECTION	47.54	48.84
	J1573		HEPAGAM B INTRAVENOUS, INJ	BR	91.36
	J1575		HYQVIA 100MG IMMUNEGLOBULIN	13.09	20.13
	J1580		GARAMYCIN GENTAMICIN INJ	1.52
	J1595		INJECTION GLATIRAMER ACETATE	289.87	276.29
	J1599		IVIG NON-LYOPHILIZED, NOS	BR
	J1600		GOLD SODIUM THIOMALEATE INJ	36.86
	J1602		GOLIMUMAB FOR IV USE 1MG	29.42	33.13
	J1610		GLUCAGON HYDROCHLORIDE/1 MG	239.11	312.28
	J1620		GONADORELIN HYDROCH/ 100 MCG	BR
	J1626		GRANISETRON HCL INJECTION	0.52
	J1627		INJ, GRANISETRON, XR, 0.1 MG	BR	4.53
	J1628		INJ., GUSELKUMAB, 1 MG	BR	139.04
	J1630		HALOPERIDOL INJECTION	1.84
	J1631		HALOPERIDOL DECANOATE INJ	24.50
	J1640		HEMIN, 1 MG	26.29	32.63
	J1642		INJ HEPARIN SODIUM PER 10 U	0.22
	J1644		INJ HEPARIN SODIUM PER 1000U	0.25
	J1645		DALTEPARIN SODIUM	18.84
	J1650		INJ ENOXAPARIN SODIUM	1.38
	J1652		FONDAPARINUX SODIUM	3.06
	J1655		TINZAPARIN SODIUM INJECTION	4.43
	J1670		TETANUS IMMUNE GLOBULIN INJ	486.58	594.42
	J1675		HISTRELIN ACETATE	1.21
	J1700		HYDROCORTISONE ACETATE INJ	BR
	J1710		HYDROCORTISONE SODIUM PH INJ	BR
	J1720		HYDROCORTISONE SODIUM SUCC I	9.06
	J1726		MAKENA, 10 MG	36.86	34.88
	J1729		INJ HYDROXYPROGST CAPOAT NOS	1.65
	J1730		DIAZOXIDE INJECTION	122.40
	J1740		IBANDRONATE SODIUM INJECTION	130.88	78.73
	J1741		IBUPROFEN INJECTION	BR
	J1742		IBUTILIDE FUMARATE INJECTION	113.85	334.38
	J1743		IDURSULFASE INJECTION	627.79	770.94
	J1744		ICATIBANT INJECTION	0.00	516.02
	J1745		INFLIXIMAB NOT BIOSIMIL 10MG	96.52	108.84
	J1746		INJ., IBALIZUMAB-UIYK, 10 MG	BR	83.27
	J1750		INJ IRON DEXTRAN	14.73	19.34
	J1756		IRON SUCROSE INJECTION	0.32
	J1786		IMUGLUCERASE INJECTION	50.73	59.81
	J1790		DROPERIDOL INJECTION	7.37
	J1800		PROPRANOLOL INJECTION	3.49
	J1810		DROPERIDOL/FENTANYL INJ	BR
	J1815		INSULIN INJECTION	0.96
	J1817		INSULIN FOR INSULIN PUMP USE	10.10
	J1826		INTERFERON BETA-1A INJ	1738.00	3956.08
	J1830		INTERFERON BETA-1B / .25 MG	BR	526.56
	J1833		INJECTION, ISAVUCONAZONIUM	BR	1.06
	J1835		ITRACONAZOLE INJECTION	22.05
	J1840		KANAMYCIN SULFATE 500 MG INJ	44.24
	J1850		KANAMYCIN SULFATE 75 MG INJ	1.21
	J1885		KETOROLAC TROMETHAMINE INJ	0.84
	J1890		CEPHALOTHIN SODIUM INJECTION	BR
	J1930		LANREOTIDE INJECTION	58.18	83.45
	J1931		LARONIDASE INJECTION	35.56	44.33
	J1940		FUROSEMIDE INJECTION	3.49
	J1942		ARIPIPRAZOLE LAUROXIL 1MG	BR	3.65
	J1945		LEPIRUDIN	180.79
	J1950		LEUPROLIDE ACETATE /3.75 MG	1122.10	1688.36
	J1953		LEVETIRACETAM INJECTION	0.24
	J1955		INJ LEVOCARNITINE PER 1 GM	21.06
	J1956		LEVOFLOXACIN INJECTION	2.89
	J1960		LEVORPHANOL TARTRATE INJ	3.62
	J1980		HYOSCYAMINE SULFATE INJ	29.45
	J1990		CHLORDIAZEPOXIDE INJECTION	24.96
	J2001		LIDOCAINE INJECTION	0.02
	J2010		LINCOMYCIN INJECTION	13.54
	J2020		LINEZOLID INJECTION	28.64
	J2060		LORAZEPAM INJECTION	0.92
	J2062		LOXAPINE FOR INHALATION 1 MG	BR	20.89
	J2150		MANNITOL INJECTION	1.94
	J2170		MECASERMIN INJECTION	8.46
	J2175		MEPERIDINE HYDROCHL /100 MG	5.47
	J2180		MEPERIDINE/PROMETHAZINE INJ	71.89
	J2182		INJECTION, MEPOLIZUMAB, 1MG	BR	41.89
	J2185		MEROPENEM	1.59
	J2186		INJ., MEROPENEM, VABORBACTAM	BR	2.36
	J2210		METHYLERGONOVIN MALEATE INJ	5.94
	J2212		METHYLNALTREXONE INJECTION	0.00
	J2248		MICAFUNGIN SODIUM INJECTION	1.17
	J2250		INJ MIDAZOLAM HYDROCHLORIDE	0.16
	J2260		INJ MILRINONE LACTATE / 5 MG	4.03
	J2265		MINOCYCLINE HYDROCHLORIDE	0.00	2.34
	J2270		MORPHINE SULFATE INJECTION	1.47
	J2274		INJ MORPHINE PF EPID ITHC	10.35
	J2278		ZICONOTIDE INJECTION	8.67	10.98
	J2280		INJ, MOXIFLOXACIN 100 MG	11.08
	J2300		INJ NALBUPHINE HYDROCHLORIDE	2.87
	J2310		INJ NALOXONE HYDROCHLORIDE	33.81
	J2315		NALTREXONE, DEPOT FORM	3.85	4.61
	J2320		NANDROLONE DECANOATE 50 MG	55.30	30.80
	J2323		NATALIZUMAB INJECTION	20.55	28.02
	J2325		NESIRITIDE INJECTION	36.24	106.22
	J2326		INJ, NUSINERSEN, 0.1MG	1152.03	1564.45
	J2350		INJECTION, OCRELIZUMAB, 1 MG	BR	81.47
	J2353		OCTREOTIDE INJECTION, DEPOT	191.71	280.99
	J2354		OCTREOTIDE INJ, NON-DEPOT	1.48
	J2355		OPRELVEKIN INJECTION	530.35	232.85
	J2357		OMALIZUMAB INJECTION	36.20	52.61
	J2358		OLANZAPINE LONG-ACTING INJ	3.52
	J2360		ORPHENADRINE INJECTION	6.89
	J2370		PHENYLEPHRINE HCL INJECTION	9.21
	J2400		CHLOROPROCAINE HCL INJECTION	27.56
	J2405		ONDANSETRON HCL INJECTION	0.12
	J2407		INJECTION, ORITAVANCIN	30.94	33.59
	J2410		OXYMORPHONE HCL INJECTION	3.43
	J2425		PALIFERMIN INJECTION	19.82	28.71
	J2426		PALIPERIDONE PALMITATE INJ	10.49	15.54
	J2430		PAMIDRONATE DISODIUM /30 MG	13.98
	J2440		PAPAVERIN HCL INJECTION	2.76
	J2460		OXYTETRACYCLINE INJECTION	BR
	J2469		PALONOSETRON HCL	25.93	21.22
	J2501		PARICALCITOL	1.15
	J2502		INJ, PASIREOTIDE LONG ACTING	BR	412.19
	J2503		PEGAPTANIB SODIUM INJECTION	1251.59
	J2504		PEGADEMASE BOVINE, 25 IU	339.91	522.50
	J2505		INJECTION, PEGFILGRASTIM 6MG	4624.03	6648.16
	J2507		PEGLOTICASE INJECTION	1646.88	3352.68
	J2510		PENICILLIN G PROCAINE INJ	27.21
	J2513		PENTASTARCH 10% SOLUTION	BR
	J2515		PENTOBARBITAL SODIUM INJ	50.34	68.57
	J2540		PENICILLIN G POTASSIUM INJ	1.15
	J2543		PIPERACILLIN/TAZOBACTAM	3.13
	J2545		PENTAMIDINE NON-COMP UNIT	137.39
	J2547		INJECTION, PERAMIVIR	BR	2.29
	J2550		PROMETHAZINE HCL INJECTION	1.98
	J2560		PHENOBARBITAL SODIUM INJ	35.27
	J2562		PLERIXAFOR INJECTION	371.89	469.27
	J2590		OXYTOCIN INJECTION	13.83
	J2597		INJ DESMOPRESSIN ACETATE	16.33	17.69
	J2650		PREDNISOLONE ACETATE INJ	BR
	J2670		TOTAZOLINE HCL INJECTION	BR
	J2675		INJ PROGESTERONE PER 50 MG	1.17
	J2680		FLUPHENAZINE DECANOATE 25 MG	26.90
	J2690		PROCAINAMIDE HCL INJECTION	55.74
	J2700		OXACILLIN SODIUM INJECITON	2.18
	J2704		INJ, PROPOFOL, 10 MG	0.15
	J2710		NEOSTIGMINE METHYLSLFTE INJ	10.78
	J2720		INJ PROTAMINE SULFATE/10 MG	1.41
	J2724		PROTEIN C CONCENTRATE	18.28	21.49
	J2725		INJ PROTIRELIN PER 250 MCG	BR
	J2730		PRALIDOXIME CHLORIDE INJ	103.48
	J2760		PHENTOLAINE MESYLATE INJ	460.80	539.09
	J2765		METOCLOPRAMIDE HCL INJECTION	0.85
	J2770		QUINUPRISTIN/DALFOPRISTIN	401.19	593.22
	J2778		RANIBIZUMAB INJECTION	468.26	516.85
	J2780		RANITIDINE HYDROCHLORIDE INJ	1.28
	J2783		RASBURICASE	280.09	397.34
	J2785		REGADENOSON INJECTION	65.28
	J2786		INJECTION, RESLIZUMAB, 1MG	BR	13.26
	J2787		RIBOFLAVIN 5'PHOS OPTH<=3ML	BR
	J2788		RHO D IMMUNE GLOBULIN 50 MCG	29.46
	J2790		RHO D IMMUNE GLOBULIN INJ	101.14
	J2791		RHOPHYLAC INJECTION	5.72
	J2792		RHO(D) IMMUNE GLOBULIN H, SD	24.42	39.45
	J2793		RILONACEPT INJECTION	27.75
	J2794		RISPERIDONE, LONG ACTING	8.80	13.36
	J2795		ROPIVACAINE HCL INJECTION	0.09
	J2796		ROMIPLOSTIM INJECTION	71.40	101.68
	J2797		INJ., ROLAPITANT, 0.5 MG	BR	1.33
	J2800		METHOCARBAMOL INJECTION	52.21
	J2805		SINCALIDE INJECTION	111.23
	J2810		INJ THEOPHYLLINE PER 40 MG	0.35
	J2820		SARGRAMOSTIM INJECTION	41.40	55.32
	J2840		INJ SEBELIPASE ALFA 1 MG	494.12	768.40
	J2850		INJ SECRETIN SYNTHETIC HUMAN	39.63	49.39
	J2860		INJECTION, SILTUXIMAB	BR	135.44
	J2910		AUROTHIOGLUCOSE INJECITON	BR
	J2916		NA FERRIC GLUCONATE COMPLEX	3.10
	J2920		METHYLPREDNISOLONE INJECTION	3.50
	J2930		METHYLPREDNISOLONE INJECTION	4.96
	J2940		SOMATREM INJECTION	BR
	J2941		SOMATROPIN INJECTION	695.26
	J2950		PROMAZINE HCL INJECTION	BR
	J2993		RETEPLASE INJECTION	2588.57	717.07
	J2995		INJ STREPTOKINASE /250000 IU	88.58
	J2997		ALTEPLASE RECOMBINANT	90.22	124.60
	J3000		STREPTOMYCIN INJECTION	14.31
	J3010		FENTANYL CITRATE INJECTION	0.59
	J3030		SUMATRIPTAN SUCCINATE / 6 MG	101.35
	J3060		INJ, TALIGLUCERASE ALFA 10 U	46.58	57.28
	J3070		PENTAZOCINE INJECTION	149.75
	J3090		INJ TEDIZOLID PHOSPHATE	1.47	2.02
	J3095		TELAVANCIN INJECTION	6.39	7.89
	J3101		TENECTEPLASE INJECTION	113.45	172.97
	J3105		TERBUTALINE SULFATE INJ	1.03
	J3110		TERIPARATIDE INJECTION	9.66
	J3121		INJ TESTOSTERO ENANTHATE 1MG	0.05
	J3145		TESTOSTERONE UNDECANOATE 1MG	BR	1.93
	J3230		CHLORPROMAZINE HCL INJECTION	23.20
	J3240		THYROTROPIN INJECTION	1729.70	2348.10
	J3243		TIGECYCLINE INJECTION	2.93	2.66
	J3245		INJ., TILDRAKIZUMAB, 1 MG	BR
	J3246		TIROFIBAN HCL	10.07	10.96
	J3250		TRIMETHOBENZAMIDE HCL INJ	28.66
	J3260		TOBRAMYCIN SULFATE INJECTION	3.24
	J3262		TOCILIZUMAB INJECTION	4.83	7.00
	J3265		INJECTION TORSEMIDE 10 MG/ML	BR
	J3280		THIETHYLPERAZINE MALEATE INJ	5.64
	J3285		TREPROSTINIL INJECTION	73.96	93.90
	J3300		TRIAMCINOLONE A INJ PRS-FREE	4.53	5.47
	J3301		TRIAMCINOLONE ACET INJ NOS	2.18
	J3302		TRIAMCINOLONE DIACETATE INJ	1.73
	J3303		TRIAMCINOLONE HEXACETONL INJ	9.21
	J3304		INJ TRIAMCINOLONE ACE XR 1MG	BR	26.81
	J3305		INJ TRIMETREXATE GLUCORONATE	BR
	J3310		PERPHENAZINE INJECITON	BR
	J3315		TRIPTORELIN PAMOATE	288.66	347.18
	J3316		INJ., TRIPTORELIN XR 3.75 MG	BR	4082.77
	J3320		SPECTINOMYCN DI-HCL INJ	BR
	J3350		UREA INJECTION	BR
	J3355		UROFOLLITROPIN, 75 IU	73.68
	J3357		USTEKINUMAB SUB CU INJ, 1 MG	206.53	261.35
	J3358		USTEKINUMAB, IV INJECT, 1 MG	BR	17.31
	J3360		DIAZEPAM INJECTION	8.02
	J3364		UROKINASE 5000 IU INJECTION	BR
	J3365		UROKINASE 250, 000 IU INJ	BR
	J3370		VANCOMYCIN HCL INJECTION	4.67
	J3380		INJECTION, VEDOLIZUMAB	20.56	28.46
	J3385		VELAGLUCERASE ALFA	414.15	490.78
	J3396		VERTEPORFIN INJECTION	13.26	15.59
	J3397		INJ., VESTRONIDASE ALFA-VJBK	BR	310.65
	J3398		INJ LUXTURNA 1 BILLION VEC G	BR	4176.93
	J3400		TRIFLUPROMAZINE HCL INJ	BR
	J3410		HYDROXYZINE HCL INJECTION	2.64
	J3411		THIAMINE HCL 100 MG	3.89
	J3415		PYRIDOXINE HCL 100 MG	11.92
	J3420		VITAMIN B12 INJECTION	3.18
	J3430		VITAMIN K PHYTONADIONE INJ	3.31
	J3465		INJECTION, VORICONAZOLE	4.69
	J3470		HYALURONIDASE INJECTION	27.65
	J3471		OVINE, UP TO 999 USP UNITS	0.38
	J3472		OVINE, 1000 USP UNITS	132.47
	J3473		HYALURONIDASE RECOMBINANT	0.43
	J3475		INJ MAGNESIUM SULFATE	0.27
	J3480		INJ POTASSIUM CHLORIDE	0.17
	J3485		ZIDOVUDINE	1.81
	J3486		ZIPRASIDONE MESYLATE	18.81
	J3489		ZOLEDRONIC ACID 1MG	33.25
	J3490		DRUGS UNCLASSIFIED INJECTION	BR
	J3520		EDETATE DISODIUM PER 150 MG	3.23
	J3530		NASAL VACCINE INHALATION	BR
	J3535		METERED DOSE INHALER DRUG	BR
	J3570		LAETRILE AMYGDALIN VIT B17	BR
	J3590		UNCLASSIFIED BIOLOGICS	BR
	J3591		ESRD ON DIALYSI DRUG/BIO NOC	BR
	J7030		NORMAL SALINE SOLUTION INFUS	2.26
	J7040		NORMAL SALINE SOLUTION INFUS	1.14
	J7042		5% DEXTROSE/NORMAL SALINE	0.71
	J7050		NORMAL SALINE SOLUTION INFUS	0.55
	J7060		5% DEXTROSE/WATER	2.22
	J7070		D5W INFUSION	4.32
	J7100		DEXTRAN 40 INFUSION	18.42
	J7110		DEXTRAN 75 INFUSION	BR
	J7120		RINGERS LACTATE INFUSION	2.20
	J7121		5% DEXTROSE IN LAC RINGERS	18.44
	J7131		HYPERTONIC SALINE SOL	BR
	J7170		INJ., EMICIZUMAB-KXWH 0.5 MG	BR	69.01
	J7175		INJ, FACTOR X, (HUMAN), 1IU	BR	10.19
	J7177		INJ., FIBRYGA, 1 MG	BR	1.52
	J7178		INJ HUMAN FIBRINOGEN CON NOS	0.00	1.66
	J7179		VONVENDI INJ 1 IU VWF:RCO	24.10	2.78
	J7180		FACTOR XIII ANTI-HEM FACTOR	9.39	11.66
	J7181		FACTOR XIII RECOMB A-SUBUNIT	BR	21.04
	J7182		FACTOR VIII RECOMB NOVOEIGHT	1.75	1.89
	J7183		WILATE INJECTION	1.21	1.45
	J7185		XYNTHA INJ	1.48	1.73
	J7186		ANTIHEMOPHILIC VIII/VWF COMP	1.17	1.42
	J7187		HUMATE-P, INJ	1.21	1.60
	J7188		FACTOR VIII RECOMB OBIZUR	BR	4.33
	J7189		FACTOR VIIA	2.38	2.95
	J7190		FACTOR VIII	1.16	1.53
	J7191		FACTOR VIII (PORCINE)	BR
	J7192		FACTOR VIII RECOMBINANT NOS	1.42	1.85
	J7193		FACTOR IX NON-RECOMBINANT	1.33	1.62
	J7194		FACTOR IX COMPLEX	1.47	2.02
	J7195		FACTOR IX RECOMBINANT NOS	1.75	2.13
	J7196		ANTITHROMBIN RECOMBINANT	BR	146.76
	J7197		ANTITHROMBIN III INJECTION	4.37	4.97
	J7198		ANTI-INHIBITOR	2.30	2.84
	J7199		HEMOPHILIA CLOT FACTOR NOC	BR
	J7200		FACTOR IX RECOMBINAN RIXUBIS	1.50	1.86
	J7201		FACTOR IX ALPROLIX RECOMB	3.39	4.26
	J7202		FACTOR IX IDELVION INJ	BR	6.12
	J7203		FACTOR IX RECOMB GLY REBINYN	BR	5.18
	J7205		FACTOR VIII FC FUSION RECOMB	2.28	2.86
	J7207		FACTOR VIII PEGYLATED RECOMB	BR	2.40
	J7209		FACTOR VIII NUWIQ RECOMB 1IU	2.26	1.91
	J7210		INJ, AFSTYLA, 1 I.U.	5.13	1.93
	J7211		INJ, KOVALTRY, 1 I.U.	2.63	1.80
	J7296		KYLEENA, 19.5 MG	1331.75
	J7297		LILETTA, 52 MG	0.00
	J7298		MIRENA, 52 MG	0.00
	J7300		INTRAUT COPPER CONTRACEPTIVE	921.49
	J7301		SKYLA, 13.5 MG	0.00
	J7303		CONTRACEPTIVE VAGINAL RING	138.24
	J7304		CONTRACEPTIVE HORMONE PATCH	BR
	J7306		LEVONORGESTREL IMPLANT SYS	875.33
	J7307		ETONOGESTREL IMPLANT SYSTEM	BR
	J7308		AMINOLEVULINIC ACID HCL TOP	353.39	574.52
	J7309		METHYL AMINOLEVULINATE, TOP	BR
	J7310		GANCICLOVIR LONG ACT IMPLANT	19072.65
	J7311		FLUOCINOLONE ACETONIDE IMPLT	24340.23	28602.17
	J7312		DEXAMETHASONE INTRA IMPLANT	242.93	284.13
	J7313		FLUOCINOL ACET INTRAVIT IMP	593.03	696.74
	J7315		OPHTHALMIC MITOMYCIN	BR
	J7316		INJ, OCRIPLASMIN, 0.125 MG	1264.39	1486.64
	J7318		INJ, DUROLANE 1 MG	390.00	24.46
	J7320		GENVISC 850, INJ, 1MG	14.81	10.22
	J7321		HYALGAN SUPARTZ VISCO-3 DOSE	106.44	113.48
	J7322		HYMOVIS INJECTION 1 MG	28.80	27.34
	J7323		EUFLEXXA INJ PER DOSE	180.10	200.26
	J7324		ORTHOVISC INJ PER DOSE	203.58	208.61
	J7325		SYNVISC OR SYNVISC-ONE	15.85	16.85
	J7326		GEL-ONE	1013.74	1502.19
	J7327		MONOVISC INJ PER DOSE	1129.41	1123.56
	J7328		GELSYN-3 INJECTION 0.1 MG	BR	3.09
	J7329		INJ, TRIVISC 1 MG	BR	9.93
	J7330		CULTURED CHONDROCYTES IMPLNT	BR
	J7336		CAPSAICIN 8% PATCH	3.49	4.47
	J7340		CARBIDOPA LEVODOPA ENT 100ML	BR
	J7342		CIPROFLOXACIN OTIC SUSP 6 MG	BR	42.55
	J7345		AMINOLEVULINIC ACID, 10% GEL	BR	1.95
	J7500		AZATHIOPRINE ORAL 50MG	0.43
	J7501		AZATHIOPRINE PARENTERAL	77.31	339.23
	J7502		CYCLOSPORINE ORAL 100 MG	4.06
	J7503		TACROL ENVARSUS EX REL ORAL	BR
	J7504		LYMPHOCYTE IMMUNE GLOBULIN	1373.32	2933.89
	J7505		MONOCLONAL ANTIBODIES	1081.09
	J7507		TACROLIMUS IMME REL ORAL 1MG	1.03
	J7508		TACROL ASTAGRAF EX REL ORAL	0.47
	J7509		METHYLPREDNISOLONE ORAL	0.39
	J7510		PREDNISOLONE ORAL PER 5 MG	0.15
	J7511		ANTITHYMOCYTE GLOBULN RABBIT	776.69	1038.48
	J7512		PREDNISONE IR OR DR ORAL 1MG	0.02
	J7513		DACLIZUMAB, PARENTERAL	466.66
	J7515		CYCLOSPORINE ORAL 25 MG	1.18
	J7516		CYCLOSPORIN PARENTERAL 250MG	51.57
	J7517		MYCOPHENOLATE MOFETIL ORAL	1.22
	J7518		MYCOPHENOLIC ACID	3.69
	J7520		SIROLIMUS, ORAL	11.68
	J7525		TACROLIMUS INJECTION	198.63	292.54
	J7527		ORAL EVEROLIMUS	9.05
	J7599		IMMUNOSUPPRESSIVE DRUG NOC	BR
	J7604		ACETYLCYSTEINE COMP UNIT	BR
	J7605		ARFORMOTEROL NON-COMP UNIT	9.98
	J7606		FORMOTEROL FUMARATE, INH	11.36
	J7607		LEVALBUTEROL COMP CON	BR
	J7608		ACETYLCYSTEINE NON-COMP UNIT	4.86
	J7609		ALBUTEROL COMP UNIT	BR
	J7610		ALBUTEROL COMP CON	BR
	J7611		ALBUTEROL NON-COMP CON	0.14
	J7612		LEVALBUTEROL NON-COMP CON	0.34
	J7613		ALBUTEROL NON-COMP UNIT	0.06
	J7614		LEVALBUTEROL NON-COMP UNIT	0.09
	J7615		LEVALBUTEROL COMP UNIT	13.83
	J7620		ALBUTEROL IPRATROP NON-COMP	0.18
	J7622		BECLOMETHASONE COMP UNIT	BR
	J7624		BETAMETHASONE COMP UNIT	BR
	J7626		BUDESONIDE NON-COMP UNIT	6.42
	J7627		BUDESONIDE COMP UNIT	7.37
	J7628		BITOLTEROL MESYLATE COMP CON	BR
	J7629		BITOLTEROL MESYLATE COMP UNT	BR
	J7631		CROMOLYN SODIUM NONCOMP UNIT	0.97
	J7632		CROMOLYN SODIUM COMP UNIT	0.40
	J7633		BUDESONIDE NON-COMP CON	BR
	J7634		BUDESONIDE COMP CON	BR
	J7635		ATROPINE COMP CON	BR
	J7636		ATROPINE COMP UNIT	BR
	J7637		DEXAMETHASONE COMP CON	BR
	J7638		DEXAMETHASONE COMP UNIT	BR
	J7639		DORNASE ALFA NON-COMP UNIT	47.09
	J7640		FORMOTEROL COMP UNIT	BR
	J7641		FLUNISOLIDE COMP UNIT	12.48
	J7642		GLYCOPYRROLATE COMP CON	BR
	J7643		GLYCOPYRROLATE COMP UNIT	BR
	J7644		IPRATROPIUM BROMIDE NON-COMP	0.25
	J7645		IPRATROPIUM BROMIDE COMP	BR
	J7647		ISOETHARINE COMP CON	BR
	J7648		ISOETHARINE NON-COMP CON	BR
	J7649		ISOETHARINE NON-COMP UNIT	BR
	J7650		ISOETHARINE COMP UNIT	BR
	J7657		ISOPROTERENOL COMP CON	BR
	J7658		ISOPROTERENOL NON-COMP CON	BR
	J7659		ISOPROTERENOL NON-COMP UNIT	BR
	J7660		ISOPROTERENOL COMP UNIT	BR
	J7665		MANNITOL FOR INHALER	0.81
	J7667		METAPROTERENOL COMP CON	BR
	J7668		METAPROTERENOL NON-COMP CON	BR
	J7669		METAPROTERENOL NON-COMP UNIT	BR
	J7670		METAPROTERENOL COMP UNIT	BR
	J7674		METHACHOLINE CHLORIDE, NEB	0.62
	J7676		PENTAMIDINE COMP UNIT DOSE	BR
	J7680		TERBUTALINE SULF COMP CON	15.70
	J7681		TERBUTALINE SULF COMP UNIT	15.70
	J7682		TOBRAMYCIN NON-COMP UNIT	67.17
	J7683		TRIAMCINOLONE COMP CON	35.94
	J7684		TRIAMCINOLONE COMP UNIT	BR
	J7685		TOBRAMYCIN COMP UNIT	168.10
	J7686		TREPROSTINIL, NON-COMP UNIT	611.73
	J7699		INHALATION SOLUTION FOR DME	BR
	J7799		NON-INHALATION DRUG FOR DME	BR
	J7999		COMPOUNDED DRUG, NOC	BR
	J8498		ANTIEMETIC RECTAL/SUPP NOS	BR
	J8499		ORAL PRESCRIP DRUG NON CHEMO	BR
	J8501		ORAL APREPITANT	12.32
	J8510		ORAL BUSULFAN	14.91
	J8515		CABERGOLINE, ORAL 0.25MG	16.91
	J8520		CAPECITABINE, ORAL, 150 MG	6.33
	J8521		CAPECITABINE, ORAL, 500 MG	20.11
	J8530		CYCLOPHOSPHAMIDE ORAL 25 MG	4.44
	J8540		ORAL DEXAMETHASONE	0.15
	J8560		ETOPOSIDE ORAL 50 MG	82.88	107.58
	J8562		ORAL FLUDARABINE PHOSPHATE	BR	115.62
	J8565		GEFITINIB ORAL	64.42
	J8597		ANTIEMETIC DRUG ORAL NOS	BR
	J8600		MELPHALAN ORAL 2 MG	13.55	17.04
	J8610		METHOTREXATE ORAL 2.5 MG	1.67
	J8650		NABILONE ORAL	18.92
	J8655		ORAL NETUPITANT, PALONOSETRO	596.80	401.61
	J8670		ROLAPITANT, ORAL, 1MG	BR	1.86
	J8700		TEMOZOLOMIDE	4.37
	J8705		TOPOTECAN ORAL	122.20
	J8999		ORAL PRESCRIPTION DRUG CHEMO	BR
	J9000		DOXORUBICIN HCL INJECTION	3.74
	J9015		ALDESLEUKIN INJECTION	4317.48	5876.17
	J9017		ARSENIC TRIOXIDE INJECTION	71.58	109.21
	J9019		ERWINAZE INJECTION	469.50	589.05
	J9020		ASPARAGINASE, NOS	72.48
	J9022		INJ, ATEZOLIZUMAB, 10 MG	BR	110.42
	J9023		INJECTION, AVELUMAB, 10 MG	BR	116.17
	J9025		AZACITIDINE INJECTION	3.61	1.86
	J9027		CLOFARABINE INJECTION	167.09	134.80
	J9031		BCG LIVE INTRAVESICAL VAC	149.49	199.16
	J9032		INJECTION, BELINOSTAT, 10MG	39.26	54.30
	J9033		INJ., TREANDA 1 MG	29.69	42.98
	J9034		INJ., BENDEKA 1 MG	BR	33.84
	J9035		BEVACIZUMAB INJECTION	85.57	115.27
	J9039		INJECTION, BLINATUMOMAB	BR	156.42
	J9040		BLEOMYCIN SULFATE INJECTION	25.61
	J9041		INJ., VELCADE 0.1 MG	56.48	64.77
	J9042		BRENTUXIMAB VEDOTIN INJ	150.30	222.55
	J9043		CABAZITAXEL INJECTION	178.43	239.00
	J9044		INJ, BORTEZOMIB, NOS, 0.1 MG	BR	50.65
	J9045		CARBOPLATIN INJECTION	4.39
	J9047		INJECTION, CARFILZOMIB, 1 MG	37.30	51.55
	J9050		CARMUSTINE INJECTION	3886.50	5754.33
	J9055		CETUXIMAB INJECTION	65.00	86.01
	J9057		INJ., COPANLISIB, 1 MG	BR	110.00
	J9060		CISPLATIN 10 MG INJECTION	1.87
	J9065		INJ CLADRIBINE PER 1 MG	21.18	31.06
	J9070		CYCLOPHOSPHAMIDE 100 MG INJ	58.80	53.71
	J9098		CYTARABINE LIPOSOME INJ	702.22	892.28
	J9100		CYTARABINE HCL 100 MG INJ	1.07
	J9120		DACTINOMYCIN INJECTION	1401.60	2066.64
	J9130		DACARBAZINE 100 MG INJ	4.57
	J9145		INJECTION, DARATUMUMAB 10 MG	BR	74.27
	J9150		DAUNORUBICIN INJECTION	31.97	68.41
	J9151		DAUNORUBICIN CITRATE INJ	7.15	0.45
	J9153		INJ DAUNORUBICIN, CYTARABINE	BR	270.25
	J9155		DEGARELIX INJECTION	4.41	5.40
	J9160		DENILEUKIN DIFTITOX INJ	1567.07
	J9165		DIETHYLSTILBESTROL INJECTION	BR
	J9171		DOCETAXEL INJECTION	3.13	1.91
	J9173		INJ., DURVALUMAB, 10 MG	BR	104.87
	J9175		ELLIOTTS B SOLUTION PER ML	7.29
	J9176		INJECTION, ELOTUZUMAB, 1MG	BR	9.09
	J9178		INJ, EPIRUBICIN HCL, 2 MG	1.94
	J9179		ERIBULIN MESYLATE INJECTION	126.14	163.74
	J9181		ETOPOSIDE INJECTION	0.77
	J9185		FLUDARABINE PHOSPHATE INJ	81.40
	J9190		FLUOROURACIL INJECTION	2.18
	J9200		FLOXURIDINE INJECTION	84.06
	J9201		GEMCITABINE HCL INJECTION	10.53
	J9202		GOSERELIN ACETATE IMPLANT	334.19	711.71
	J9203		GEMTUZUMAB OZOGAMICIN 0.1 MG	460.79	275.50
	J9205		INJ IRINOTECAN LIPOSOME 1 MG	BR	64.82
	J9206		IRINOTECAN INJECTION	5.04
	J9207		IXABEPILONE INJECTION	88.75	109.19
	J9208		IFOSFAMIDE INJECTION	37.36
	J9209		MESNA INJECTION	5.01
	J9211		IDARUBICIN HCL INJECTION	47.17
	J9212		INTERFERON ALFACON-1 INJ	7.65
	J9213		INTERFERON ALFA-2A INJ	42.28	240.45
	J9214		INTERFERON ALFA-2B INJ	28.87	48.33
	J9215		INTERFERON ALFA-N3 INJ	20.53
	J9216		INTERFERON GAMMA 1-B INJ	360.36
	J9217		LEUPROLIDE ACETATE SUSPNSION	305.11	335.34
	J9218		LEUPROLIDE ACETATE INJECITON	19.52
	J9219		LEUPROLIDE ACETATE IMPLANT	BR
	J9225		VANTAS IMPLANT	3632.70	5196.81
	J9226		SUPPRELIN LA IMPLANT	28734.47	45247.21
	J9228		IPILIMUMAB INJECTION	168.21	214.28
	J9229		INJ INOTUZUMAB OZOGAM 0.1 MG	BR	3135.74
	J9230		MECHLORETHAMINE HCL INJ	291.97	454.52
	J9245		INJ MELPHALAN HYDROCHL 50 MG	1937.56	1142.58
	J9250		METHOTREXATE SODIUM INJ	0.28
	J9260		METHOTREXATE SODIUM INJ	2.79
	J9261		NELARABINE INJECTION	178.91	215.87
	J9262		INJ, OMACETAXINE MEP, 0.01MG	BR	4.22
	J9263		OXALIPLATIN	0.46
	J9264		PACLITAXEL PROTEIN BOUND	12.12	16.85
	J9266		PEGASPARGASE INJECTION	10819.55	21386.86
	J9267		PACLITAXEL INJECTION	0.18
	J9268		PENTOSTATIN INJECTION	1957.72	2864.61
	J9270		PLICAMYCIN (MITHRAMYCIN) INJ	BR	8.69
	J9271		INJ PEMBROLIZUMAB	55.19	69.56
	J9280		MITOMYCIN INJECTION	129.97	177.60
	J9285		INJ, OLARATUMAB, 10 MG	BR	72.48
	J9293		MITOXANTRONE HYDROCHL / 5 MG	33.06	39.17
	J9295		INJECTION, NECITUMUMAB, 1 MG	BR	7.96
	J9299		INJECTION, NIVOLUMAB	30.64	39.05
	J9301		OBINUTUZUMAB INJ	66.87	91.76
	J9302		OFATUMUMAB INJECTION	61.03	83.06
	J9303		PANITUMUMAB INJECTION	124.89	162.88
	J9305		PEMETREXED INJECTION	74.60	96.71
	J9306		INJECTION, PERTUZUMAB, 1 MG	12.64	17.32
	J9307		PRALATREXATE INJECTION	267.86	392.25
	J9308		INJECTION, RAMUCIRUMAB	65.25	81.83
	J9311		INJ RITUXIMAB, HYALURONIDASE	BR	66.22
	J9312		INJ., RITUXIMAB, 10 MG	BR	135.46
	J9315		ROMIDEPSIN INJECTION	361.53	449.83
	J9320		STREPTOZOCIN INJECTION	386.54	491.86
	J9325		INJ TALIMOGENE LAHERPAREPVEC	BR	71.07
	J9328		TEMOZOLOMIDE INJECTION	8.14	14.85
	J9330		TEMSIROLIMUS INJECTION	76.98	93.09
	J9340		THIOTEPA INJECTION	1645.11	1081.45
	J9351		TOPOTECAN INJECTION	2.42
	J9352		INJECTION TRABECTEDIN 0.1MG	BR	426.89
	J9354		INJ, ADO-TRASTUZUMAB EMT 1MG	35.28	44.33
	J9355		TRASTUZUMAB INJECTION	108.12	151.93
	J9357		VALRUBICIN INJECTION	1345.82	1890.19
	J9360		VINBLASTINE SULFATE INJ	3.60
	J9370		VINCRISTINE SULFATE 1 MG INJ	7.84
	J9371		INJ, VINCRISTINE SUL LIP 1MG	2802.61	4141.61
	J9390		VINORELBINE TARTRATE INJ	13.29
	J9395		INJECTION, FULVESTRANT	113.04	138.44
	J9400		INJ, ZIV-AFLIBERCEPT, 1MG	9.92	11.48
	J9600		PORFIMER SODIUM INJECTION	2738.35	30131.79
	J9999		CHEMOTHERAPY DRUG	BR
	K0001	NU	STANDARD WHEELCHAIR	740.14
	K0002	NU	STND HEMI (LOW SEAT) WHLCHR	961.90
	K0003	NU	LIGHTWEIGHT WHEELCHAIR	1186.08
	K0004	NU	HIGH STRENGTH LTWT WHLCHR	1570.95
	K0005	NU	ULTRALIGHTWEIGHT WHEELCHAIR	1915.78
	K0006	NU	HEAVY DUTY WHEELCHAIR	1534.72
	K0007	NU	EXTRA HEAVY DUTY WHEELCHAIR	2117.06
	K0008		CSTM MANUAL WHEELCHAIR/BASE	BR
	K0009	RR	OTHER MANUAL WHEELCHAIR/BASE	77.05
	K0010	NU	STND WT FRAME POWER WHLCHR	4501.52
	K0011	NU	STND WT PWR WHLCHR W CONTROL	BR
	K0012	NU	LTWT PORTBL POWER WHLCHR	3433.71
	K0013		CUSTOM POWER WHLCHR BASE	BR
	K0014		OTHER POWER WHLCHR BASE	BR
	K0015	NU	DETACH NON-ADJ HT ARMRST REP	186.21
	K0017	NU	DETACH ADJUST ARMREST BASE	46.86
	K0018	NU	DETACH ADJUST ARMRST UPPER	26.32
	K0019	NU	ARM PAD REPL, EACH	15.37
	K0020	NU	FIXED ADJUST ARMREST PAIR	44.07
	K0037	NU	HI MOUNT FLIP-UP FOOTREST EA	39.21
	K0038	NU	LEG STRAP EACH	22.77
	K0039	NU	LEG STRAP H STYLE EACH	49.80
	K0040	NU	ADJUSTABLE ANGLE FOOTPLATE	66.70
	K0041	NU	LARGE SIZE FOOTPLATE EACH	48.32
	K0042	NU	STANDARD SIZE FTPLATE REP EA	29.49
	K0043	NU	FTRST LOWR EXTEN TUBE REP EA	18.41
	K0044	NU	FTRST UPR HANGER BRAC REP EA	15.84
	K0045	NU	FTRST COMPL ASSEMBLY REPL EA	53.08
	K0046	NU	ELEV LGRST LWR EXTEN REPL EA	18.47
	K0047	NU	ELEV LEGRST UPR HANGR REP EA	69.08
	K0050	NU	RATCHET ASSEMBLY REPLACEMENT	30.53
	K0051	NU	CAM REL ASM FT/LEGRST REP EA	48.91
	K0052	NU	SWINGAWAY DETACH FTREST REPL	82.58
	K0053	NU	ELEVATE FOOTREST ARTICULATE	91.98
	K0056	NU	SEAT HT <17 OR >=21 LTWT WC	98.55
	K0065	NU	SPOKE PROTECTORS	46.05
	K0069	NU	RR WHL COMPL SOL TIRE REP EA	103.55
	K0070	NU	RR WHL COMPL PNE TIRE REP EA	246.32
	K0071	NU	FR CSTR COMP PNE TIRE REP EA	113.21
	K0072	NU	FR CSTR SEMI-PNE TIRE REP EA	68.16
	K0073	NU	CASTER PIN LOCK EACH	36.07
	K0077	NU	FR CSTR ASMB SOL TIRE REP EA	60.99
	K0098	NU	DRIVE BELT FOR PWC, REPL	25.25
	K0105	NU	IV HANGER	103.03
	K0108		W/C COMPONENT-ACCESSORY NOS	BR
	K0195	RR	ELEVATING WHLCHAIR LEG RESTS	15.02
	K0455	RR	PUMP UNINTERRUPTED INFUSION	247.54
	K0462		TEMPORARY REPLACEMENT EQPMNT	BR
	K0552		SUP/EXT NON-INS INF PUMP SYR	2.59
	K0553		THER CGM SUPPLY ALLOWANCE	231.20
	K0554	NU	THER CGM RECEIVER/MONITOR	243.22
	K0601	NU	REPL BATT SILVER OXIDE 1.5 V	1.13
	K0602	NU	REPL BATT SILVER OXIDE 3 V	6.42
	K0603	NU	REPL BATT ALKALINE 1.5 V	0.58
	K0604	NU	REPL BATT LITHIUM 3.6 V	6.17
	K0605	NU	REPL BATT LITHIUM 4.5 V	14.78
	K0606	RR	AED GARMENT W ELEC ANALYSIS	2609.55
	K0607	NU	REPL BATT FOR AED	205.35
	K0608	NU	REPL GARMENT FOR AED	139.46
	K0609		REPL ELECTRODE FOR AED	835.30
	K0669		SEAT/BACK CUS NO DMEPDAC VER	BR
	K0672		REMOVABLE SOFT INTERFACE LE	76.19
	K0730	NU	CTRL DOSE INH DRUG DELIV SYS	1821.95
	K0733	NU	12-24HR SEALED LEAD ACID	28.89
	K0738	RR	PORTABLE GAS OXYGEN SYSTEM	60.62
	K0739		REPAIR/SVC DME NON-OXYGEN EQ	36.18
	K0740		REPAIR/SVC OXYGEN EQUIPMENT	BR
	K0743		PORTABLE HOME SUCTION PUMP	BR
	K0744		ABSORP DRG <= 16 SUC PUMP	BR
	K0745		ABSORP DRG >16<=48 SUC PUMP	BR
	K0746		ABSORP DRG >48 SUC PUMP	BR
	K0800	NU	POV GROUP 1 STD UP TO 300LBS	974.60
	K0801	NU	POV GROUP 1 HD 301-450 LBS	1657.29
	K0802	NU	POV GROUP 1 VHD 451-600 LBS	2021.50
	K0806	NU	POV GROUP 2 STD UP TO 300LBS	1312.95
	K0807	NU	POV GROUP 2 HD 301-450 LBS	2012.14
	K0808	NU	POV GROUP 2 VHD 451-600 LBS	3111.89
	K0812		POWER OPERATED VEHICLE NOC	BR
	K0813	RR	PWC GP 1 STD PORT SEAT/BACK	286.60
	K0814	RR	PWC GP 1 STD PORT CAP CHAIR	336.15
	K0815	RR	PWC GP 1 STD SEAT/BACK	378.19
	K0816	RR	PWC GP 1 STD CAP CHAIR	357.86
	K0820	RR	PWC GP 2 STD PORT SEAT/BACK	301.02
	K0821	RR	PWC GP 2 STD PORT CAP CHAIR	354.09
	K0822	RR	PWC GP 2 STD SEAT/BACK	410.29
	K0823	RR	PWC GP 2 STD CAP CHAIR	402.16
	K0824	RR	PWC GP 2 HD SEAT/BACK	528.79
	K0825	RR	PWC GP 2 HD CAP CHAIR	486.36
	K0826	RR	PWC GP 2 VHD SEAT/BACK	766.04
	K0827	RR	PWC GP VHD CAP CHAIR	659.47
	K0828	RR	PWC GP 2 XTRA HD SEAT/BACK	891.65
	K0829	RR	PWC GP 2 XTRA HD CAP CHAIR	841.86
	K0830		PWC GP2 STD SEAT ELEVATE S/B	BR
	K0831		PWC GP2 STD SEAT ELEVATE CAP	BR
	K0835	RR	PWC GP2 STD SING POW OPT S/B	429.70
	K0836	RR	PWC GP2 STD SING POW OPT CAP	445.64
	K0837	RR	PWC GP 2 HD SING POW OPT S/B	526.91
	K0838	RR	PWC GP 2 HD SING POW OPT CAP	469.70
	K0839	RR	PWC GP2 VHD SING POW OPT S/B	689.00
	K0840	RR	PWC GP2 XHD SING POW OPT S/B	1049.28
	K0841	RR	PWC GP2 STD MULT POW OPT S/B	467.24
	K0842	RR	PWC GP2 STD MULT POW OPT CAP	466.98
	K0843	RR	PWC GP2 HD MULT POW OPT S/B	559.23
	K0848	RR	PWC GP 3 STD SEAT/BACK	707.97
	K0849	RR	PWC GP 3 STD CAP CHAIR	680.65
	K0850	RR	PWC GP 3 HD SEAT/BACK	821.20
	K0851	RR	PWC GP 3 HD CAP CHAIR	789.59
	K0852	RR	PWC GP 3 VHD SEAT/BACK	948.84
	K0853	RR	PWC GP 3 VHD CAP CHAIR	974.71
	K0854	RR	PWC GP 3 XHD SEAT/BACK	1291.28
	K0855	RR	PWC GP 3 XHD CAP CHAIR	1219.80
	K0856	RR	PWC GP3 STD SING POW OPT S/B	759.91
	K0857	RR	PWC GP3 STD SING POW OPT CAP	775.14
	K0858	RR	PWC GP3 HD SING POW OPT S/B	942.83
	K0859	RR	PWC GP3 HD SING POW OPT CAP	899.17
	K0860	RR	PWC GP3 VHD SING POW OPT S/B	1346.96
	K0861	RR	PWC GP3 STD MULT POW OPT S/B	761.12
	K0862	RR	PWC GP3 HD MULT POW OPT S/B	942.83
	K0863	RR	PWC GP3 VHD MULT POW OPT S/B	1346.96
	K0864	RR	PWC GP3 XHD MULT POW OPT S/B	1602.88
	K0868		PWC GP 4 STD SEAT/BACK	BR
	K0869		PWC GP 4 STD CAP CHAIR	BR
	K0870		PWC GP 4 HD SEAT/BACK	BR
	K0871		PWC GP 4 VHD SEAT/BACK	BR
	K0877		PWC GP4 STD SING POW OPT S/B	BR
	K0878		PWC GP4 STD SING POW OPT CAP	BR
	K0879		PWC GP4 HD SING POW OPT S/B	BR
	K0880		PWC GP4 VHD SING POW OPT S/B	BR
	K0884		PWC GP4 STD MULT POW OPT S/B	BR
	K0885		PWC GP4 STD MULT POW OPT CAP	BR
	K0886		PWC GP4 HD MULT POW S/B	BR
	K0890		PWC GP5 PED SING POW OPT S/B	BR
	K0891		PWC GP5 PED MULT POW OPT S/B	BR
	K0898		POWER WHEELCHAIR NOC	BR
	K0899		POW MOBIL DEV NO DMEPDAC	BR
	K0900		CSTM DME OTHER THAN WHEELCHR	BR
	L0112		CRANIAL CERVICAL ORTHOSIS	1397.19
	L0113		CRANIAL CERVICAL TORTICOLLIS	284.69
	L0120		CERV FLEX N/ADJ FOAM PRE OTS	27.93
	L0130		FLEX THERMOPLASTIC COLLAR MO	201.95
	L0140		CERVICAL SEMI-RIGID ADJUSTAB	69.69
	L0150		CERV SEMI-RIG ADJ MOLDED CHN	116.21
	L0160		CERV SR WIRE OCC/MAN PRE OTS	165.46
	L0170		CERVICAL COLLAR MOLDED TO PT	700.18
	L0172		CERV COL SR FOAM 2PC PRE OTS	141.96
	L0174		CERV SR 2PC THOR EXT PRE OTS	255.03
	L0180		CER POST COL OCC/MAN SUP ADJ	346.84
	L0190		CERV COLLAR SUPP ADJ CERV BA	522.12
	L0200		CERV COL SUPP ADJ BAR & THOR	479.42
	L0220		THOR RIB BELT CUSTOM FABRICA	113.70
	L0450		TLSO FLEX TRUNK/THOR PRE OTS	187.71
	L0452		TLSO FLEX CUSTOM FAB THORACI	BR
	L0454		TLSO TRNK SJ-T9 PRE CST	346.21
	L0455		TLSO FLEX TRNK SJ-T9 PRE OTS	346.21
	L0456		TLSO FLEX TRNK SJ-SS PRE CST	992.85
	L0457		TLSO FLEX TRNK SJ-SS PRE OTS	992.85
	L0458		TLSO 2MOD SYMPHIS-XIPHO PRE	890.29
	L0460		TLSO 2 SHL SYMPHYS-STERN CST	1002.11
	L0462		TLSO 3MOD SACRO-SCAP PRE	1246.43
	L0464		TLSO 4MOD SACRO-SCAP PRE	1483.85
	L0466		TLSO R FRAM SOFT ANT PRE CST	381.56
	L0467		TLSO R FRAM SOFT PRE OTS	381.56
	L0468		TLSO RIG FRAM PELVIC PRE CST	478.39
	L0469		TLSO RIG FRAM PELVIC PRE OTS	478.39
	L0470		TLSO RIGID FRAME PRE SUBCLAV	681.07
	L0472		TLSO RIGID FRAME HYPEREX PRE	427.51
	L0480		TLSO RIGID PLASTIC CUSTOM FA	1321.96
	L0482		TLSO RIGID LINED CUSTOM FAB	1515.46
	L0484		TLSO RIGID PLASTIC CUST FAB	1766.99
	L0486		TLSO RIGIDLINED CUST FAB TWO	1750.42
	L0488		TLSO RIGID LINED PRE ONE PIE	1002.11
	L0490		TLSO RIGID PLASTIC PRE ONE	282.38
	L0491		TLSO 2 PIECE RIGID SHELL	766.64
	L0492		TLSO 3 PIECE RIGID SHELL	496.86
	L0621		SIO FLEX PELVIC/SACR PRE OTS	89.02
	L0622		SIO FLEX PELVISACRAL CUSTOM	241.37
	L0623		SIO RIG PNL PELV/SAC PRE OTS	BR
	L0624		SIO PANEL CUSTOM	BR
	L0625		LO FLEX L1-BELOW L5 PRE OTS	55.02
	L0626		LO SAG RIG PNL STAYS PRE CST	77.82
	L0627		LO SAG RI AN/POS PNL PRE CST	410.36
	L0628		LSO FLEX NO RI STAYS PRE OTS	83.72
	L0629		LSO FLEX W/RIGID STAYS CUST	BR
	L0630		LSO R POST PNL SJ-T9 PRE CST	161.65
	L0631		LSO SAG R AN/POS PNL PRE CST	1024.80
	L0632		LSO SAG RIGID FRAME CUST	BR
	L0633		LSO SC R POS/LAT PNL PRE CST	286.26
	L0634		LSO FLEXION CONTROL CUSTOM	BR
	L0635		LSO SAGIT RIGID PANEL PREFAB	1061.52
	L0636		LSO SAGITTAL RIGID PANEL CUS	1566.34
	L0637		LSO SC R ANT/POS PNL PRE CST	1358.99
	L0638		LSO SAG-CORONAL PANEL CUSTOM	1316.62
	L0639		LSO S/C SHELL/PANEL PREFAB	1358.99
	L0640		LSO S/C SHELL/PANEL CUSTOM	1044.59
	L0641		LO RIG POS PNL L1-L5 PRE OTS	77.82
	L0642		LO SAG RI AN/POS PNL PRE OTS	410.36
	L0643		LSO SAG CTR RIGI POS PRE OTS	161.65
	L0648		LSO SAG R AN/POS PNL PRE OTS	1024.80
	L0649		LSO SC R POS/LAT PNL PRE OTS	286.26
	L0650		LSO SC R ANT/POS PNL PRE OTS	1358.99
	L0651		LSO SAG-CO SHELL PNL PRE OTS	1358.99
	L0700		CTLSO A-P-L CONTROL MOLDED	2149.29
	L0710		CTLSO A-P-L CONTROL W/ INTER	2346.09
	L0810		HALO CERVICAL INTO JCKT VEST	2492.38
	L0820		HALO CERVICAL INTO BODY JACK	2016.22
	L0830		HALO CERV INTO MILWAUKEE TYP	2911.21
	L0859		MRI COMPATIBLE SYSTEM	1130.99
	L0861		HALO REPL LINER/INTERFACE	215.17
	L0970		TLSO CORSET FRONT	106.11
	L0972		LSO CORSET FRONT	108.46
	L0974		TLSO FULL CORSET	221.61
	L0976		LSO FULL CORSET	197.93
	L0978		AXILLARY CRUTCH EXTENSION	178.71
	L0980		PERONEAL STRAPS PAIR PRE OTS	16.21
	L0982		STOCKING SUP GRIPS 4 PRE OTS	17.67
	L0984		PROTECT BODY SOCK EA PRE OTS	56.37
	L0999		ADD TO SPINAL ORTHOSIS NOS	BR
	L1000		CTLSO MILWAUKE INITIAL MODEL	1884.83
	L1001		CTLSO INFANT IMMOBILIZER	BR
	L1005		TENSION BASED SCOLIOSIS ORTH	3195.11
	L1010		CTLSO AXILLA SLING	75.91
	L1020		KYPHOSIS PAD	103.71
	L1025		KYPHOSIS PAD FLOATING	117.87
	L1030		LUMBAR BOLSTER PAD	78.74
	L1040		LUMBAR OR LUMBAR RIB PAD	94.78
	L1050		STERNAL PAD	82.05
	L1060		THORACIC PAD	92.56
	L1070		TRAPEZIUS SLING	94.65
	L1080		OUTRIGGER	65.58
	L1085		OUTRIGGER BIL W/ VERT EXTENS	182.18
	L1090		LUMBAR SLING	85.10
	L1100		RING FLANGE PLASTIC/LEATHER	150.22
	L1110		RING FLANGE PLAS/LEATHER MOL	254.44
	L1120		COVERS FOR UPRIGHT EACH	40.53
	L1200		FURNSH INITIAL ORTHOSIS ONLY	1613.41
	L1210		LATERAL THORACIC EXTENSION	242.92
	L1220		ANTERIOR THORACIC EXTENSION	205.68
	L1230		MILWAUKEE TYPE SUPERSTRUCTUR	527.74
	L1240		LUMBAR DEROTATION PAD	90.82
	L1250		ANTERIOR ASIS PAD	89.43
	L1260		ANTERIOR THORACIC DEROTATION	91.91
	L1270		ABDOMINAL PAD	91.80
	L1280		RIB GUSSET (ELASTIC) EACH	81.82
	L1290		LATERAL TROCHANTERIC PAD	92.77
	L1300		BODY JACKET MOLD TO PATIENT	1550.80
	L1310		POST-OPERATIVE BODY JACKET	1595.77
	L1499		SPINAL ORTHOSIS NOS	BR
	L1600		HO FLEX FREJKA W/COV PRE CST	119.63
	L1610		HO FREJKA COV ONLY PRE CST	40.75
	L1620		HO FLEX PAVLIK HARNS PRE CST	134.21
	L1630		ABDUCT CONTROL HIP SEMI-FLEX	160.16
	L1640		PELV BAND/SPREAD BAR THIGH C	428.38
	L1650		HO ABDUCTION HIP ADJUSTABLE	227.19
	L1652		HO BI THIGHCUFFS W SPRDR BAR	355.86
	L1660		HO ABDUCTION STATIC PLASTIC	158.88
	L1680		PELVIC & HIP CONTROL THIGH C	1306.22
	L1685		POST-OP HIP ABDUCT CUSTOM FA	1378.29
	L1686		HO POST-OP HIP ABDUCTION	924.64
	L1690		COMBINATION BILATERAL HO	1930.40
	L1700		LEG PERTHES ORTH TORONTO TYP	1605.97
	L1710		LEGG PERTHES ORTH NEWINGTON	1887.72
	L1720		LEGG PERTHES ORTHOSIS TRILAT	1394.46
	L1730		LEGG PERTHES ORTH SCOTTISH R	1052.08
	L1755		LEGG PERTHES PATTEN BOTTOM T	1531.34
	L1810		KO ELASTIC WITH JOINTS	120.86
	L1812		KO ELASTIC W/JOINTS PRE OTS	120.86
	L1820		KO ELAS W/ CONDYLE PADS & JO	120.37
	L1830		KO IMMOB CANVAS LONG PRE OTS	100.69
	L1831		KNEE ORTH POS LOCKING JOINT	293.79
	L1832		KO ADJ JNT POS R SUP PRE CST	752.57
	L1833		KO ADJ JNT POS R SUP PRE OTS	752.57
	L1834		KO W/0 JOINT RIGID MOLDED TO	885.39
	L1836		KO RIGID W/O JOINTS PRE OTS	133.19
	L1840		KO DEROT ANT CRUCIATE CUSTOM	930.69
	L1843		KO SINGLE UPRIGHT PRE CST	895.70
	L1844		KO W/ADJ JT ROT CNTRL MOLDED	1552.04
	L1845		KO DOUBLE UPRIGHT PRE CST	935.02
	L1846		KO W ADJ FLEX/EXT ROTAT MOLD	1186.39
	L1847		KO DBL UPRIGHT W/AIR PRE CST	574.19
	L1848		KO DBL UPRIGHT W/AIR PRE OTS	574.19
	L1850		KO SWEDISH TYPE PRE OTS	267.23
	L1851		KO SINGLE UPRIGHT PREFAB OTS	895.70
	L1852		KO DOUBLE UPRIGHT PREFAB OTS	935.02
	L1860		KO SUPRACONDYLAR SOCKET MOLD	1036.47
	L1900		AFO SPRNG WIR DRSFLX CALF BD	280.79
	L1902		AFO ANKLE GAUNTLET PRE OTS	76.26
	L1904		AFO MOLDED ANKLE GAUNTLET	436.56
	L1906		AFO MULTILIG ANK SUP PRE OTS	127.58
	L1907		AFO SUPRAMALLEOLAR CUSTOM	561.71
	L1910		AFO SING BAR CLASP ATTACH SH	248.27
	L1920		AFO SING UPRIGHT W/ ADJUST S	324.56
	L1930		AFO PLASTIC	219.62
	L1932		AFO RIG ANT TIB PREFAB TCF/=	890.81
	L1940		AFO MOLDED TO PATIENT PLASTI	496.32
	L1945		AFO MOLDED PLAS RIG ANT TIB	911.44
	L1950		AFO SPIRAL MOLDED TO PT PLAS	691.50
	L1951		AFO SPIRAL PREFABRICATED	838.37
	L1960		AFO POS SOLID ANK PLASTIC MO	514.59
	L1970		AFO PLASTIC MOLDED W/ANKLE J	761.12
	L1971		AFO W/ANKLE JOINT, PREFAB	467.91
	L1980		AFO SING SOLID STIRRUP CALF	340.72
	L1990		AFO DOUB SOLID STIRRUP CALF	437.78
	L2000		KAFO SING FRE STIRR THI/CALF	941.65
	L2005		KAFO SNG/DBL MECHANICAL ACT	4090.63
	L2010		KAFO SNG SOLID STIRRUP W/O J	858.40
	L2020		KAFO DBL SOLID STIRRUP BAND/	1084.03
	L2030		KAFO DBL SOLID STIRRUP W/O J	940.49
	L2034		KAFO PLA SIN UP W/WO K/A CUS	2049.75
	L2035		KAFO PLASTIC PEDIATRIC SIZE	172.93
	L2036		KAFO PLAS DOUB FREE KNEE MOL	1722.45
	L2037		KAFO PLAS SING FREE KNEE MOL	1587.34
	L2038		KAFO W/O JOINT MULTI-AXIS AN	1327.34
	L2040		HKAFO TORSION BIL ROT STRAPS	169.55
	L2050		HKAFO TORSION CABLE HIP PELV	451.52
	L2060		HKAFO TORSION BALL BEARING J	579.50
	L2070		HKAFO TORSION UNILAT ROT STR	166.47
	L2080		HKAFO UNILAT TORSION CABLE	355.02
	L2090		HKAFO UNILAT TORSION BALL BR	437.59
	L2106		AFO TIB FX CAST PLASTER MOLD	631.23
	L2108		AFO TIB FX CAST MOLDED TO PT	991.93
	L2112		AFO TIBIAL FRACTURE SOFT	470.99
	L2114		AFO TIB FX SEMI-RIGID	538.86
	L2116		AFO TIBIAL FRACTURE RIGID	709.96
	L2126		KAFO FEM FX CAST THERMOPLAS	1263.22
	L2128		KAFO FEM FX CAST MOLDED TO P	1591.93
	L2132		KAFO FEMORAL FX CAST SOFT	748.91
	L2134		KAFO FEM FX CAST SEMI-RIGID	897.91
	L2136		KAFO FEMORAL FX CAST RIGID	1097.90
	L2180		PLAS SHOE INSERT W ANK JOINT	108.72
	L2182		DROP LOCK KNEE	85.09
	L2184		LIMITED MOTION KNEE JOINT	153.34
	L2186		ADJ MOTION KNEE JNT LERMAN T	169.92
	L2188		QUADRILATERAL BRIM	370.72
	L2190		WAIST BELT	96.29
	L2192		PELVIC BAND & BELT THIGH FLA	331.02
	L2200		LIMITED ANKLE MOTION EA JNT	44.14
	L2210		DORSIFLEXION ASSIST EACH JOI	71.62
	L2220		DORSI & PLANTAR FLEX ASS/RES	82.23
	L2230		SPLIT FLAT CALIPER STIRR & P	71.23
	L2232		ROCKER BOTTOM, CONTACT AFO	96.45
	L2240		ROUND CALIPER AND PLATE ATTA	77.65
	L2250		FOOT PLATE MOLDED STIRRUP AT	329.88
	L2260		REINFORCED SOLID STIRRUP	186.10
	L2265		LONG TONGUE STIRRUP	109.33
	L2270		VARUS/VALGUS STRAP PADDED/LI	49.86
	L2275		PLASTIC MOD LOW EXT PAD/LINE	121.32
	L2280		MOLDED INNER BOOT	450.67
	L2300		ABDUCTION BAR JOINTED ADJUST	254.40
	L2310		ABDUCTION BAR-STRAIGHT	114.21
	L2320		NON-MOLDED LACER	191.02
	L2330		LACER MOLDED TO PATIENT MODE	364.54
	L2335		ANTERIOR SWING BAND	214.45
	L2340		PRE-TIBIAL SHELL MOLDED TO P	506.05
	L2350		PROSTHETIC TYPE SOCKET MOLDE	827.24
	L2360		EXTENDED STEEL SHANK	48.03
	L2370		PATTEN BOTTOM	238.32
	L2375		TORSION ANK & HALF SOLID STI	104.90
	L2380		TORSION STRAIGHT KNEE JOINT	114.29
	L2385		STRAIGHT KNEE JOINT HEAVY DU	124.35
	L2387		ADD LE POLY KNEE CUSTOM KAFO	168.75
	L2390		OFFSET KNEE JOINT EACH	101.63
	L2395		OFFSET KNEE JOINT HEAVY DUTY	155.16
	L2397		SUSPENSION SLEEVE LOWER EXT	108.81
	L2405		KNEE JOINT DROP LOCK EA JNT	87.04
	L2415		KNEE JOINT CAM LOCK EACH JOI	121.28
	L2425		KNEE DISC/DIAL LOCK/ADJ FLEX	143.09
	L2430		KNEE JNT RATCHET LOCK EA JNT	143.09
	L2492		KNEE LIFT LOOP DROP LOCK RIN	94.67
	L2500		THI/GLUT/ISCHIA WGT BEARING	292.88
	L2510		TH/WGHT BEAR QUAD-LAT BRIM M	784.16
	L2520		TH/WGHT BEAR QUAD-LAT BRIM C	427.69
	L2525		TH/WGHT BEAR NAR M-L BRIM MO	1467.30
	L2526		TH/WGHT BEAR NAR M-L BRIM CU	790.89
	L2530		THIGH/WGHT BEAR LACER NON-MO	218.13
	L2540		THIGH/WGHT BEAR LACER MOLDED	392.50
	L2550		THIGH/WGHT BEAR HIGH ROLL CU	266.64
	L2570		HIP CLEVIS TYPE 2 POSIT JNT	589.59
	L2580		PELVIC CONTROL PELVIC SLING	558.90
	L2600		HIP CLEVIS/THRUST BEARING FR	190.67
	L2610		HIP CLEVIS/THRUST BEARING LO	225.46
	L2620		PELVIC CONTROL HIP HEAVY DUT	248.23
	L2622		HIP JOINT ADJUSTABLE FLEXION	284.70
	L2624		HIP ADJ FLEX EXT ABDUCT CONT	387.04
	L2627		PLASTIC MOLD RECIPRO HIP & C	1594.58
	L2628		METAL FRAME RECIPRO HIP & CA	1873.12
	L2630		PELVIC CONTROL BAND & BELT U	229.89
	L2640		PELVIC CONTROL BAND & BELT B	311.99
	L2650		PELV & THOR CONTROL GLUTEAL	111.41
	L2660		THORACIC CONTROL THORACIC BA	173.03
	L2670		THORAC CONT PARASPINAL UPRIG	158.36
	L2680		THORAC CONT LAT SUPPORT UPRI	145.28
	L2750		PLATING CHROME/NICKEL PR BAR	77.60
	L2755		CARBON GRAPHITE LAMINATION	130.47
	L2760		EXTENSION PER EXTENSION PER	56.41
	L2768		ORTHO SIDEBAR DISCONNECT	130.07
	L2780		NON-CORROSIVE FINISH	66.73
	L2785		DROP LOCK RETAINER EACH	39.23
	L2795		KNEE CONTROL FULL KNEECAP	78.89
	L2800		KNEE CAP MEDIAL OR LATERAL P	99.03
	L2810		KNEE CONTROL CONDYLAR PAD	72.51
	L2820		SOFT INTERFACE BELOW KNEE SE	80.62
	L2830		SOFT INTERFACE ABOVE KNEE SE	90.66
	L2840		TIBIAL LENGTH SOCK FX OR EQU	50.60
	L2850		FEMORAL LGTH SOCK FX OR EQUA	57.48
	L2861		TORSION MECHANISM KNEE/ANKLE	BR
	L2999		LOWER EXTREMITY ORTHOSIS NOS	BR
	L3000		FT INSERT UCB BERKELEY SHELL	313.60
	L3001		FOOT INSERT REMOV MOLDED SPE	132.02
	L3002		FOOT INSERT PLASTAZOTE OR EQ	161.22
	L3003		FOOT INSERT SILICONE GEL EAC	173.93
	L3010		FOOT LONGITUDINAL ARCH SUPPO	173.93
	L3020		FOOT LONGITUD/METATARSAL SUP	198.06
	L3030		FOOT ARCH SUPPORT REMOV PREM	76.19
	L3031		FOOT LAMIN/PREPREG COMPOSITE	122.25
	L3040		FT ARCH SUPRT PREMOLD LONGIT	46.99
	L3050		FOOT ARCH SUPP PREMOLD METAT	46.99
	L3060		FOOT ARCH SUPP LONGITUD/META	73.63
	L3070		ARCH SUPRT ATT TO SHO LONGIT	31.74
	L3080		ARCH SUPP ATT TO SHOE METATA	31.74
	L3090		ARCH SUPP ATT TO SHOE LONG/M	40.63
	L3100		HALLUS-VALGUS NT DYN PRE OTS	43.14
	L3140		ABDUCTION ROTATION BAR SHOE	88.89
	L3150		ABDUCT ROTATION BAR W/O SHOE	81.27
	L3160		SHOE STYLED POSITIONING DEV	BR
	L3170		FOOT PLAS HEEL STABI PRE OTS	50.79
	L3201		OXFORD W SUPINAT/PRONAT INF	52.13
	L3202		OXFORD W/ SUPINAT/PRONATOR C	58.49
	L3203		OXFORD W/ SUPINATOR/PRONATOR	58.53
	L3204		HIGHTOP W/ SUPP/PRONATOR INF	57.47
	L3206		HIGHTOP W/ SUPP/PRONATOR CHI	55.26
	L3207		HIGHTOP W/ SUPP/PRONATOR JUN	74.51
	L3208		SURGICAL BOOT EACH INFANT	43.62
	L3209		SURGICAL BOOT EACH CHILD	30.88
	L3211		SURGICAL BOOT EACH JUNIOR	42.59
	L3212		BENESCH BOOT PAIR INFANT	47.51
	L3213		BENESCH BOOT PAIR CHILD	57.58
	L3214		BENESCH BOOT PAIR JUNIOR	61.20
	L3215		ORTHOPEDIC FTWEAR LADIES OXF	101.12
	L3216		ORTHOPED LADIES SHOES DPTH I	101.36
	L3217		LADIES SHOES HIGHTOP DEPTH I	266.06
	L3219		ORTHOPEDIC MENS SHOES OXFORD	107.62
	L3221		ORTHOPEDIC MENS SHOES DPTH I	117.01
	L3222		MENS SHOES HIGHTOP DEPTH INL	170.26
	L3224		WOMAN'S SHOE OXFORD BRACE	54.60
	L3225		MAN'S SHOE OXFORD BRACE	62.80
	L3230		CUSTOM SHOES DEPTH INLAY	160.75
	L3250		CUSTOM MOLD SHOE REMOV PROST	319.24
	L3251		SHOE MOLDED TO PT SILICONE S	36.64
	L3252		SHOE MOLDED PLASTAZOTE CUST	319.33
	L3253		SHOE MOLDED PLASTAZOTE CUST	71.96
	L3254		ORTH FOOT NON-STNDARD SIZE/W	BR
	L3255		ORTH FOOT NON-STANDARD SIZE/	BR
	L3257		ORTH FOOT ADD CHARGE SPLIT S	63.85
	L3260		AMBULATORY SURGICAL BOOT EAC	37.25
	L3265		PLASTAZOTE SANDAL EACH	26.59
	L3300		SHO LIFT TAPER TO METATARSAL	52.04
	L3310		SHOE LIFT ELEV HEEL/SOLE NEO	81.27
	L3320		SHOE LIFT ELEV HEEL/SOLE COR	154.25
	L3330		LIFTS ELEVATION METAL EXTENS	564.95
	L3332		SHOE LIFTS TAPERED TO ONE-HA	73.63
	L3334		SHOE LIFTS ELEVATION HEEL /I	38.09
	L3340		SHOE WEDGE SACH	85.08
	L3350		SHOE HEEL WEDGE	22.82
	L3360		SHOE SOLE WEDGE OUTSIDE SOLE	35.55
	L3370		SHOE SOLE WEDGE BETWEEN SOLE	49.52
	L3380		SHOE CLUBFOOT WEDGE	49.52
	L3390		SHOE OUTFLARE WEDGE	49.52
	L3400		SHOE METATARSAL BAR WEDGE RO	40.63
	L3410		SHOE METATARSAL BAR BETWEEN	92.70
	L3420		FULL SOLE/HEEL WEDGE BTWEEN	54.58
	L3430		SHO HEEL COUNT PLAST REINFOR	159.97
	L3440		HEEL LEATHER REINFORCED	76.19
	L3450		SHOE HEEL SACH CUSHION TYPE	105.35
	L3455		SHOE HEEL NEW LEATHER STANDA	40.63
	L3460		SHOE HEEL NEW RUBBER STANDAR	34.26
	L3465		SHOE HEEL THOMAS WITH WEDGE	58.39
	L3470		SHOE HEEL THOMAS EXTEND TO B	62.19
	L3480		SHOE HEEL PAD & DEPRESS FOR	62.19
	L3485		SHOE HEEL PAD REMOVABLE FOR	35.12
	L3500		ORTHO SHOE ADD LEATHER INSOL	29.23
	L3510		ORTHOPEDIC SHOE ADD RUB INSL	29.23
	L3520		O SHOE ADD FELT W LEATH INSL	31.74
	L3530		ORTHO SHOE ADD HALF SOLE	31.74
	L3540		ORTHO SHOE ADD FULL SOLE	50.79
	L3550		O SHOE ADD STANDARD TOE TAP	8.90
	L3560		O SHOE ADD HORSESHOE TOE TAP	22.82
	L3570		O SHOE ADD INSTEP EXTENSION	85.08
	L3580		O SHOE ADD INSTEP VELCRO CLO	64.75
	L3590		O SHOE CONVERT TO SOF COUNTE	53.33
	L3595		ORTHO SHOE ADD MARCH BAR	41.89
	L3600		TRANS SHOE CALIP PLATE EXIST	76.19
	L3610		TRANS SHOE CALIPER PLATE NEW	100.29
	L3620		TRANS SHOE SOLID STIRRUP EXI	76.19
	L3630		TRANS SHOE SOLID STIRRUP NEW	100.29
	L3640		SHOE DENNIS BROWNE SPLINT BO	43.14
	L3649		ORTHOPEDIC SHOE MODIFICA NOS	BR
	L3650		SO 8 ABD RESTRAINT PRE OTS	54.38
	L3660		SO 8 AB RSTR CAN/WEB PRE OTS	93.37
	L3670		SO ACRO/CLAV CAN WEB PRE OTS	130.14
	L3671		SO CAP DESIGN W/O JNTS CF	818.60
	L3674		SO AIRPLANE W/WO JOINT CF	1073.89
	L3675		SO VEST CANVAS/WEB PRE OTS	159.44
	L3677		SO HARD PLAS STABILI PRE CST	159.55
	L3678		SO HARD PLAS STABILI PRE OTS	BR
	L3702		EO W/O JOINTS CF	262.34
	L3710		EO ELAS W/METAL JNTS PRE OTS	131.72
	L3720		FOREARM/ARM CUFFS FREE MOTIO	657.16
	L3730		FOREARM/ARM CUFFS EXT/FLEX A	865.06
	L3740		CUFFS ADJ LOCK W/ ACTIVE CON	972.20
	L3760		EO ADJ JT PREFAB CUSTOM FIT	454.32
	L3761		EO, ADJ LOCK JOINT PREFAB OT	908.66
	L3762		EO RIGID W/O JOINTS PRE OTS	97.70
	L3763		EWHO RIGID W/O JNTS CF	721.31
	L3764		EWHO W/JOINT(S) CF	719.35
	L3765		EWHFO RIGID W/O JNTS CF	1164.93
	L3766		EWHFO W/JOINT(S) CF	1233.58
	L3806		WHFO W/JOINT(S) CUSTOM FAB	412.68
	L3807		WHFO W/O JOINTS PRE CST	227.19
	L3808		WHFO, RIGID W/O JOINTS	303.45
	L3809		WHFO W/O JOINTS PRE OTS	227.19
	L3891		TORSION MECHANISM WRIST/ELBO	BR
	L3900		HINGE EXTENSION/FLEX WRIST/F	1419.25
	L3901		HINGE EXT/FLEX WRIST FINGER	1591.36
	L3904		WHFO ELECTRIC CUSTOM FITTED	3239.54
	L3905		WHO W/NONTORSION JNT(S) CF	900.97
	L3906		WHO W/O JOINTS CF	383.26
	L3908		WHO COCK-UP NONMOLDE PRE OTS	54.43
	L3912		HFO FLEXION GLOVE PRE OTS	87.31
	L3913		HFO W/O JOINTS CF	246.07
	L3915		WHO NONTORSION JNTS PRE CST	482.95
	L3916		WHO NONTORSION JNTS PRE OTS	482.95
	L3917		METACARP FX ORTHOSIS PRE CST	95.98
	L3918		METACARP FX ORTHOSIS PRE OTS	95.98
	L3919		HO W/O JOINTS CF	246.07
	L3921		HFO W/JOINT(S) CF	291.79
	L3923		HFO WITHOUT JOINTS PRE CST	79.02
	L3924		HFO WITHOUT JOINTS PRE OTS	79.02
	L3925		FO PIP DIP JNT/SPRNG PRE OTS	47.99
	L3927		FO PIP DIP NO JT SPR PRE OTS	31.79
	L3929		HFO NONTORSION JNTS PRE CST	76.48
	L3930		HFO NONTORSION JNTS PRE OTS	76.48
	L3931		WHFO NONTORSION JOINT PREFAB	185.02
	L3933		FO W/O JOINTS CF	193.85
	L3935		FO NONTORSION JOINT CF	200.73
	L3956		ADD JOINT UPPER EXT ORTHOSIS	BR
	L3960		SEWHO AIRPLAN DESIG ABDU POS	748.86
	L3961		SEWHO CAP DESIGN W/O JNTS CF	1526.40
	L3962		SEWHO ERBS PALSEY DESIGN ABD	779.73
	L3967		SEWHO AIRPLANE W/O JNTS CF	1802.16
	L3971		SEWHO CAP DESIGN W/JNT(S) CF	1710.64
	L3973		SEWHO AIRPLANE W/JNT(S) CF	1802.16
	L3975		SEWHFO CAP DESIGN W/O JNT CF	1526.40
	L3976		SEWHFO AIRPLANE W/O JNTS CF	1526.40
	L3977		SEWHFO CAP DESGN W/JNT(S) CF	1710.64
	L3978		SEWHFO AIRPLANE W/JNT(S) CF	1802.16
	L3980		UP EXT FX ORTHOS HUMERAL NOS	280.85
	L3981		UE FX ORTH SHOUL CAP FOREARM	914.47
	L3982		UPPER EXT FX ORTHOSIS RAD/UL	346.98
	L3984		UPPER EXT FX ORTHOSIS WRIST	370.38
	L3995		SOCK FRACTURE OR EQUAL EACH	31.08
	L3999		UPPER LIMB ORTHOSIS NOS	BR
	L4000		REPL GIRDLE MILWAUKEE ORTH	1211.11
	L4002		REPLACE STRAP, ANY ORTHOSIS	BR
	L4010		REPLACE TRILATERAL SOCKET BR	681.54
	L4020		REPLACE QUADLAT SOCKET BRIM	851.30
	L4030		REPLACE SOCKET BRIM CUST FIT	468.72
	L4040		REPLACE MOLDED THIGH LACER	378.96
	L4045		REPLACE NON-MOLDED THIGH LAC	304.54
	L4050		REPLACE MOLDED CALF LACER	383.28
	L4055		REPLACE NON-MOLDED CALF LACE	248.19
	L4060		REPLACE HIGH ROLL CUFF	295.04
	L4070		REPLACE PROX & DIST UPRIGHT	281.48
	L4080		REPL MET BAND KAFO-AFO PROX	99.24
	L4090		REPL MET BAND KAFO-AFO CALF/	87.83
	L4100		REPL LEATH CUFF KAFO PROX TH	99.07
	L4110		REPL LEATH CUFF KAFO-AFO CAL	78.73
	L4130		REPLACE PRETIBIAL SHELL	541.85
	L4205		ORTHO DVC REPAIR PER 15 MIN	35.72
	L4210		ORTH DEV REPAIR/REPL MINOR P	BR
	L4350		ANKLE CONTROL ORTHO PRE OTS	97.62
	L4360		PNEUMAT WALKING BOOT PRE CST	273.12
	L4361		PNEUMA/VAC WALK BOOT PRE OTS	273.12
	L4370		PNEUM FULL LEG SPLNT PRE OTS	175.27
	L4386		NON-PNEUM WALK BOOT PRE CST	158.27
	L4387		NON-PNEUM WALK BOOT PRE OTS	158.27
	L4392		REPLACE AFO SOFT INTERFACE	23.51
	L4394		REPLACE FOOT DROP SPINT	17.16
	L4396		STATIC OR DYNAMI AFO PRE CST	167.56
	L4397		STATIC OR DYNAMI AFO PRE OTS	167.56
	L4398		FOOT DROP SPLINT PRE OTS	77.11
	L4631		AFO, WALK BOOT TYPE, CUS FAB	1489.72
	L5000		SHO INSERT W ARCH TOE FILLER	523.44
	L5010		MOLD SOCKET ANK HGT W/ TOE F	1264.23
	L5020		TIBIAL TUBERCLE HGT W/ TOE F	2146.94
	L5050		ANK SYMES MOLD SCKT SACH FT	2374.90
	L5060		SYMES MET FR LEATH SOCKET AR	2731.84
	L5100		MOLDED SOCKET SHIN SACH FOOT	2380.15
	L5105		PLAST SOCKET JTS/THGH LACER	3436.01
	L5150		MOLD SCKT EXT KNEE SHIN SACH	3473.33
	L5160		MOLD SOCKET BENT KNEE SHIN S	3777.87
	L5200		KNE SING AXIS FRIC SHIN SACH	3617.85
	L5210		NO KNEE/ANKLE JOINTS W/ FT B	2400.08
	L5220		NO KNEE JOINT WITH ARTIC ALI	2728.13
	L5230		FEM FOCAL DEFIC CONSTANT FRI	3762.62
	L5250		HIP CANAD SING AXI CONS FRIC	5131.88
	L5270		TILT TABLE LOCKING HIP SING	5109.11
	L5280		HEMIPELVECT CANAD SING AXIS	5069.99
	L5301		BK MOLD SOCKET SACH FT ENDO	2720.67
	L5312		KNEE DISART, SACH FT, ENDO	3894.45
	L5321		AK OPEN END SACH	3943.68
	L5331		HIP DISART CANADIAN SACH FT	5025.03
	L5341		HEMIPELVECTOMY CANADIAN SACH	5231.09
	L5400		POSTOP DRESS & 1 CAST CHG BK	1346.96
	L5410		POSTOP DSG BK EA ADD CAST CH	413.25
	L5420		POSTOP DSG & 1 CAST CHG AK/D	1650.65
	L5430		POSTOP DSG AK EA ADD CAST CH	497.72
	L5450		POSTOP APP NON-WGT BEAR DSG	404.91
	L5460		POSTOP APP NON-WGT BEAR DSG	539.48
	L5500		INIT BK PTB PLASTER DIRECT	1270.30
	L5505		INIT AK ISCHAL PLSTR DIRECT	1756.87
	L5510		PREP BK PTB PLASTER MOLDED	1439.97
	L5520		PERP BK PTB THERMOPLS DIRECT	1422.35
	L5530		PREP BK PTB THERMOPLS MOLDED	1708.37
	L5535		PREP BK PTB OPEN END SOCKET	1677.29
	L5540		PREP BK PTB LAMINATED SOCKET	1790.19
	L5560		PREP AK ISCHIAL PLAST MOLDED	1922.35
	L5570		PREP AK ISCHIAL DIRECT FORM	1998.57
	L5580		PREP AK ISCHIAL THERMO MOLD	2333.19
	L5585		PREP AK ISCHIAL OPEN END	2871.37
	L5590		PREP AK ISCHIAL LAMINATED	2377.68
	L5595		HIP DISARTIC SACH THERMOPLS	4200.49
	L5600		HIP DISART SACH LAMINAT MOLD	4515.33
	L5610		ABOVE KNEE HYDRACADENCE	2047.77
	L5611		AK 4 BAR LINK W/FRIC SWING	1593.57
	L5613		AK 4 BAR LING W/HYDRAUL SWIG	2491.51
	L5614		4-BAR LINK ABOVE KNEE W/SWNG	1687.82
	L5616		AK UNIV MULTIPLEX SYS FRICT	1346.39
	L5617		AK/BK SELF-ALIGNING UNIT EA	559.62
	L5618		TEST SOCKET SYMES	296.06
	L5620		TEST SOCKET BELOW KNEE	274.98
	L5622		TEST SOCKET KNEE DISARTICULA	358.57
	L5624		TEST SOCKET ABOVE KNEE	359.58
	L5626		TEST SOCKET HIP DISARTICULAT	471.58
	L5628		TEST SOCKET HEMIPELVECTOMY	504.24
	L5629		BELOW KNEE ACRYLIC SOCKET	314.33
	L5630		SYME TYP EXPANDABL WALL SCKT	443.89
	L5631		AK/KNEE DISARTIC ACRYLIC SOC	434.58
	L5632		SYMES TYPE PTB BRIM DESIGN S	242.54
	L5634		SYMES TYPE POSTER OPENING SO	300.86
	L5636		SYMES TYPE MEDIAL OPENING SO	252.02
	L5637		BELOW KNEE TOTAL CONTACT	285.73
	L5638		BELOW KNEE LEATHER SOCKET	497.74
	L5639		BELOW KNEE WOOD SOCKET	1108.93
	L5640		KNEE DISARTICULAT LEATHER SO	632.45
	L5642		ABOVE KNEE LEATHER SOCKET	612.80
	L5643		HIP FLEX INNER SOCKET EXT FR	1539.44
	L5644		ABOVE KNEE WOOD SOCKET	584.19
	L5645		BK FLEX INNER SOCKET EXT FRA	789.18
	L5646		BELOW KNEE CUSHION SOCKET	541.92
	L5647		BELOW KNEE SUCTION SOCKET	786.77
	L5648		ABOVE KNEE CUSHION SOCKET	651.18
	L5649		ISCH CONTAINMT/NARROW M-L SO	2359.61
	L5650		TOT CONTACT AK/KNEE DISART S	482.85
	L5651		AK FLEX INNER SOCKET EXT FRA	1187.80
	L5652		SUCTION SUSP AK/KNEE DISART	431.22
	L5653		KNEE DISART EXPAND WALL SOCK	575.64
	L5654		SOCKET INSERT SYMES	328.02
	L5655		SOCKET INSERT BELOW KNEE	277.98
	L5656		SOCKET INSERT KNEE ARTICULAT	372.90
	L5658		SOCKET INSERT ABOVE KNEE	359.62
	L5661		MULTI-DUROMETER SYMES	601.90
	L5665		MULTI-DUROMETER BELOW KNEE	506.43
	L5666		BELOW KNEE CUFF SUSPENSION	69.23
	L5668		BK MOLDED DISTAL CUSHION	111.67
	L5670		BK MOLDED SUPRACONDYLAR SUSP	268.38
	L5671		BK/AK LOCKING MECHANISM	568.74
	L5672		BK REMOVABLE MEDIAL BRIM SUS	294.93
	L5673		SOCKET INSERT W LOCK MECH	703.29
	L5676		BK KNEE JOINTS SINGLE AXIS P	358.41
	L5677		BK KNEE JOINTS POLYCENTRIC P	487.67
	L5678		BK JOINT COVERS PAIR	39.27
	L5679		SOCKET INSERT W/O LOCK MECH	586.05
	L5680		BK THIGH LACER NON-MOLDED	327.83
	L5681		INTL CUSTM CONG/LATYP INSERT	1315.68
	L5682		BK THIGH LACER GLUT/ISCHIA M	618.56
	L5683		INITIAL CUSTOM SOCKET INSERT	1315.68
	L5684		BK FORK STRAP	47.60
	L5685		BELOW KNEE SUS/SEAL SLEEVE	128.11
	L5686		BK BACK CHECK	50.53
	L5688		BK WAIST BELT WEBBING	60.42
	L5690		BK WAIST BELT PADDED AND LIN	96.78
	L5692		AK PELVIC CONTROL BELT LIGHT	131.43
	L5694		AK PELVIC CONTROL BELT PAD/L	179.43
	L5695		AK SLEEVE SUSP NEOPRENE/EQUA	165.64
	L5696		AK/KNEE DISARTIC PELVIC JOIN	183.00
	L5697		AK/KNEE DISARTIC PELVIC BAND	79.40
	L5698		AK/KNEE DISARTIC SILESIAN BA	129.84
	L5699		SHOULDER HARNESS	233.90
	L5700		REPLACE SOCKET BELOW KNEE	2833.89
	L5701		REPLACE SOCKET ABOVE KNEE	3403.30
	L5702		REPLACE SOCKET HIP	4305.66
	L5703		SYMES ANKLE W/O (SACH) FOOT	2228.23
	L5704		CUSTOM SHAPE COVER BK	530.16
	L5705		CUSTOM SHAPE COVER AK	947.31
	L5706		CUSTOM SHAPE CVR KNEE DISART	928.60
	L5707		CUSTOM SHAPE CVR HIP DISART	1224.21
	L5710		KNE-SHIN EXO SNG AXI MNL LOC	369.90
	L5711		KNEE-SHIN EXO MNL LOCK ULTRA	516.97
	L5712		KNEE-SHIN EXO FRICT SWG & ST	433.17
	L5714		KNEE-SHIN EXO VARIABLE FRICT	444.93
	L5716		KNEE-SHIN EXO MECH STANCE PH	720.87
	L5718		KNEE-SHIN EXO FRCT SWG & STA	901.02
	L5722		KNEE-SHIN PNEUM SWG FRCT EXO	951.89
	L5724		KNEE-SHIN EXO FLUID SWING PH	1492.93
	L5726		KNEE-SHIN EXT JNTS FLD SWG E	1720.56
	L5728		KNEE-SHIN FLUID SWG & STANCE	2353.50
	L5780		KNEE-SHIN PNEUM/HYDRA PNEUM	1132.41
	L5781		LOWER LIMB PROS VACUUM PUMP	4002.03
	L5782		HD LOW LIMB PROS VACUUM PUMP	4219.06
	L5785		EXOSKELETAL BK ULTRALT MATER	636.55
	L5790		EXOSKELETAL AK ULTRA-LIGHT M	711.17
	L5795		EXOSKEL HIP ULTRA-LIGHT MATE	1415.95
	L5810		ENDOSKEL KNEE-SHIN MNL LOCK	481.54
	L5811		ENDO KNEE-SHIN MNL LCK ULTRA	721.35
	L5812		ENDO KNEE-SHIN FRCT SWG & ST	559.12
	L5814		ENDO KNEE-SHIN HYDRAL SWG PH	3714.67
	L5816		ENDO KNEE-SHIN POLYC MCH STA	846.23
	L5818		ENDO KNEE-SHIN FRCT SWG & ST	949.83
	L5822		ENDO KNEE-SHIN PNEUM SWG FRC	1684.30
	L5824		ENDO KNEE-SHIN FLUID SWING P	1516.81
	L5826		MINIATURE KNEE JOINT	3123.55
	L5828		ENDO KNEE-SHIN FLUID SWG/STA	2793.09
	L5830		ENDO KNEE-SHIN PNEUM/SWG PHA	1876.81
	L5840		MULTI-AXIAL KNEE/SHIN SYSTEM	3470.23
	L5845		KNEE-SHIN SYS STANCE FLEXION	1792.78
	L5848		KNEE-SHIN SYS HYDRAUL STANCE	1075.53
	L5850		ENDO AK/HIP KNEE EXTENS ASSI	126.53
	L5855		MECH HIP EXTENSION ASSIST	339.99
	L5856		ELEC KNEE-SHIN SWING/STANCE	24010.98
	L5857		ELEC KNEE-SHIN SWING ONLY	8519.97
	L5858		STANCE PHASE ONLY	18589.18
	L5859		KNEE-SHIN PRO FLEX/EXT CONT	14512.42
	L5910		ENDO BELOW KNEE ALIGNABLE SY	358.22
	L5920		ENDO AK/HIP ALIGNABLE SYSTEM	524.80
	L5925		ABOVE KNEE MANUAL LOCK	443.12
	L5930		HIGH ACTIVITY KNEE FRAME	3366.61
	L5940		ENDO BK ULTRA-LIGHT MATERIAL	496.13
	L5950		ENDO AK ULTRA-LIGHT MATERIAL	775.73
	L5960		ENDO HIP ULTRA-LIGHT MATERIA	953.51
	L5961		ENDO POLY HIP, PNEU/HYD/ROT	4546.73
	L5962		BELOW KNEE FLEX COVER SYSTEM	627.51
	L5964		ABOVE KNEE FLEX COVER SYSTEM	926.29
	L5966		HIP FLEXIBLE COVER SYSTEM	1180.32
	L5968		MULTIAXIAL ANKLE W DORSIFLEX	3634.71
	L5969		AK/FT POWER ASST INCL MOTORS	BR
	L5970		FOOT EXTERNAL KEEL SACH FOOT	200.87
	L5971		SACH FOOT, REPLACEMENT	200.87
	L5972		FLEXIBLE KEEL FOOT	375.21
	L5973		ANK-FOOT SYS DORS-PLANT FLEX	17208.35
	L5974		FOOT SINGLE AXIS ANKLE/FOOT	230.49
	L5975		COMBO ANKLE/FOOT PROSTHESIS	463.72
	L5976		ENERGY STORING FOOT	553.91
	L5978		FT PROSTH MULTIAXIAL ANKL/FT	288.64
	L5979		MULTI-AXIAL ANKLE/FT PROSTH	2256.84
	L5980		FLEX FOOT SYSTEM	3667.21
	L5981		FLEX-WALK SYS LOW EXT PROSTH	2962.61
	L5982		EXOSKELETAL AXIAL ROTATION U	571.80
	L5984		ENDOSKELETAL AXIAL ROTATION	563.45
	L5985		LWR EXT DYNAMIC PROSTH PYLON	282.44
	L5986		MULTI-AXIAL ROTATION UNIT	626.77
	L5987		SHANK FT W VERT LOAD PYLON	7195.28
	L5988		VERTICAL SHOCK REDUCING PYLO	1998.12
	L5990		USER ADJUSTABLE HEEL HEIGHT	1814.60
	L5999		LOWR EXTREMITY PROSTHES NOS	BR
	L6000		PART HAND THUMB REM	1314.18
	L6010		PART HAND LITTLE/RING	1462.46
	L6020		PART HAND NO FINGERS	1363.52
	L6026		PART HAND MYO EXCLU TERM DEV	4944.33
	L6050		WRST MLD SCK FLX HNG TRI PAD	1878.87
	L6055		WRST MOLD SOCK W/EXP INTERFA	2618.67
	L6100		ELB MOLD SOCK FLEX HINGE PAD	1903.59
	L6110		ELBOW MOLD SOCK SUSPENSION T	2019.07
	L6120		ELBOW MOLD DOUB SPLT SOC STE	2352.94
	L6130		ELBOW STUMP ACTIVATED LOCK H	2560.44
	L6200		ELBOW MOLD OUTSID LOCK HINGE	2698.29
	L6205		ELBOW MOLDED W/ EXPAND INTER	3601.79
	L6250		ELBOW INTER LOC ELBOW FORARM	2827.18
	L6300		SHLDER DISART INT LOCK ELBOW	3684.93
	L6310		SHOULDER PASSIVE RESTOR COMP	3181.78
	L6320		SHOULDER PASSIVE RESTOR CAP	1738.13
	L6350		THORACIC INTERN LOCK ELBOW	3874.14
	L6360		THORACIC PASSIVE RESTOR COMP	3484.18
	L6370		THORACIC PASSIVE RESTOR CAP	2084.82
	L6380		POSTOP DSG CAST CHG WRST/ELB	1208.11
	L6382		POSTOP DSG CAST CHG ELB DIS/	1817.54
	L6384		POSTOP DSG CAST CHG SHLDER/T	2514.38
	L6386		POSTOP EA CAST CHG & REALIGN	397.20
	L6388		POSTOP APPLICAT RIGID DSG ON	434.82
	L6400		BELOW ELBOW PROSTH TISS SHAP	2295.05
	L6450		ELB DISART PROSTH TISS SHAP	3066.13
	L6500		ABOVE ELBOW PROSTH TISS SHAP	3207.81
	L6550		SHLDR DISAR PROSTH TISS SHAP	3855.84
	L6570		SCAP THORAC PROSTH TISS SHAP	4329.07
	L6580		WRIST/ELBOW BOWDEN CABLE MOL	1652.75
	L6582		WRIST/ELBOW BOWDEN CBL DIR F	1496.95
	L6584		ELBOW FAIR LEAD CABLE MOLDED	2347.60
	L6586		ELBOW FAIR LEAD CABLE DIR FO	2196.98
	L6588		SHDR FAIR LEAD CABLE MOLDED	2886.77
	L6590		SHDR FAIR LEAD CABLE DIRECT	2741.98
	L6600		POLYCENTRIC HINGE PAIR	185.53
	L6605		SINGLE PIVOT HINGE PAIR	183.19
	L6610		FLEXIBLE METAL HINGE PAIR	175.92
	L6611		ADDITIONAL SWITCH, EXT POWER	411.79
	L6615		DISCONNECT LOCKING WRIST UNI	189.55
	L6616		DISCONNECT INSERT LOCKING WR	70.24
	L6620		FLEXION/EXTENSION WRIST UNIT	303.27
	L6621		FLEX/EXT WRIST W/WO FRICTION	2287.76
	L6623		SPRING-ASS ROT WRST W/ LATCH	845.94
	L6624		FLEX/EXT/ROTATION WRIST UNIT	3766.86
	L6625		ROTATION WRST W/ CABLE LOCK	601.05
	L6628		QUICK DISCONN HOOK ADAPTER O	473.82
	L6629		LAMINATION COLLAR W/ COUPLIN	144.71
	L6630		STAINLESS STEEL ANY WRIST	213.17
	L6632		LATEX SUSPENSION SLEEVE EACH	74.03
	L6635		LIFT ASSIST FOR ELBOW	174.21
	L6637		NUDGE CONTROL ELBOW LOCK	371.57
	L6638		ELEC LOCK ON MANUAL PW ELBOW	2501.26
	L6640		SHOULDER ABDUCTION JOINT PAI	330.10
	L6641		EXCURSION AMPLIFIER PULLEY T	158.67
	L6642		EXCURSION AMPLIFIER LEVER TY	215.07
	L6645		SHOULDER FLEXION-ABDUCTION J	396.99
	L6646		MULTIPO LOCKING SHOULDER JNT	3154.67
	L6647		SHOULDER LOCK ACTUATOR	519.35
	L6648		EXT PWRD SHLDER LOCK/UNLOCK	3253.57
	L6650		SHOULDER UNIVERSAL JOINT	412.17
	L6655		STANDARD CONTROL CABLE EXTRA	81.00
	L6660		HEAVY DUTY CONTROL CABLE	90.79
	L6665		TEFLON OR EQUAL CABLE LINING	45.55
	L6670		HOOK TO HAND CABLE ADAPTER	50.37
	L6672		HARNESS CHEST/SHLDER SADDLE	199.87
	L6675		HARNESS FIGURE OF 8 SING CON	118.78
	L6676		HARNESS FIGURE OF 8 DUAL CON	137.30
	L6677		UE TRIPLE CONTROL HARNESS	296.75
	L6680		TEST SOCK WRIST DISART/BEL E	229.47
	L6682		TEST SOCK ELBW DISART/ABOVE	253.71
	L6684		TEST SOCKET SHLDR DISART/THO	344.76
	L6686		SUCTION SOCKET	778.55
	L6687		FRAME TYP SOCKET BEL ELBOW/W	570.51
	L6688		FRAME TYP SOCK ABOVE ELB/DIS	567.07
	L6689		FRAME TYP SOCKET SHOULDER DI	679.43
	L6690		FRAME TYP SOCK INTERSCAP-THO	740.38
	L6691		REMOVABLE INSERT EACH	342.67
	L6692		SILICONE GEL INSERT OR EQUAL	553.12
	L6693		LOCKINGELBOW FOREARM CNTRBAL	2839.58
	L6694		ELBOW SOCKET INS USE W/LOCK	703.29
	L6695		ELBOW SOCKET INS USE W/O LCK	586.05
	L6696		CUS ELBO SKT IN FOR CON/ATYP	1315.68
	L6697		CUS ELBO SKT IN NOT CON/ATYP	1315.68
	L6698		BELOW/ABOVE ELBOW LOCK MECH	568.74
	L6703		TERM DEV, PASSIVE HAND MITT	359.56
	L6704		TERM DEV, SPORT/REC/WORK ATT	579.24
	L6706		TERM DEV MECH HOOK VOL OPEN	345.11
	L6707		TERM DEV MECH HOOK VOL CLOSE	1272.02
	L6708		TERM DEV MECH HAND VOL OPEN	831.56
	L6709		TERM DEV MECH HAND VOL CLOSE	1198.30
	L6711		PED TERM DEV, HOOK, VOL OPEN	672.45
	L6712		PED TERM DEV, HOOK, VOL CLOS	1238.14
	L6713		PED TERM DEV, HAND, VOL OPEN	1562.61
	L6714		PED TERM DEV, HAND, VOL CLOS	1323.57
	L6715		TERM DEVICE, MULTI ART DIGIT	3157.83
	L6721		HOOK/HAND, HVY DTY, VOL OPEN	2352.48
	L6722		HOOK/HAND, HVY DTY, VOL CLOS	2028.00
	L6805		TERM DEV MODIFIER WRIST UNIT	336.52
	L6810		TERM DEV PRECISION PINCH DEV	190.74
	L6880		ELEC HAND IND ART DIGITS	23897.62
	L6881		TERM DEV AUTO GRASP FEATURE	4089.09
	L6882		MICROPROCESSOR CONTROL UPLMB	3101.81
	L6883		REPLC SOCKT BELOW E/W DISA	1569.55
	L6884		REPLC SOCKT ABOVE ELBOW DISA	2329.54
	L6885		REPLC SOCKT SHLDR DIS/INTERC	3484.18
	L6890		PREFAB GLOVE FOR TERM DEVICE	168.23
	L6895		CUSTOM GLOVE FOR TERM DEVICE	618.87
	L6900		HAND RESTORAT THUMB/1 FINGER	1766.11
	L6905		HAND RESTORATION MULTIPLE FI	1756.07
	L6910		HAND RESTORATION NO FINGERS	1501.61
	L6915		HAND RESTORATION REPLACMNT G	757.09
	L6920		WRIST DISARTICUL SWITCH CTRL	6600.83
	L6925		WRIST DISART MYOELECTRONIC C	8885.87
	L6930		BELOW ELBOW SWITCH CONTROL	6641.76
	L6935		BELOW ELBOW MYOELECTRONIC CT	9023.76
	L6940		ELBOW DISARTICULATION SWITCH	8677.90
	L6945		ELBOW DISART MYOELECTRONIC C	10603.35
	L6950		ABOVE ELBOW SWITCH CONTROL	9863.66
	L6955		ABOVE ELBOW MYOELECTRONIC CT	11813.07
	L6960		SHLDR DISARTIC SWITCH CONTRO	13381.27
	L6965		SHLDR DISARTIC MYOELECTRONIC	14271.61
	L6970		INTERSCAPULAR-THOR SWITCH CT	14871.25
	L6975		INTERSCAP-THOR MYOELECTRONIC	16264.34
	L7007		ADULT ELECTRIC HAND	3403.48
	L7008		PEDIATRIC ELECTRIC HAND	5356.72
	L7009		ADULT ELECTRIC HOOK	3472.63
	L7040		PREHENSILE ACTUATOR	2788.38
	L7045		PEDIATRIC ELECTRIC HOOK	1598.67
	L7170		ELECTRONIC ELBOW HOSMER SWIT	7360.91
	L7180		ELECTRONIC ELBOW SEQUENTIAL	32310.29
	L7181		ELECTRONIC ELBO SIMULTANEOUS	40076.58
	L7185		ELECTRON ELBOW ADOLESCENT SW	7269.00
	L7186		ELECTRON ELBOW CHILD SWITCH	8748.94
	L7190		ELBOW ADOLESCENT MYOELECTRON	7634.93
	L7191		ELBOW CHILD MYOELECTRONIC CT	9142.12
	L7259		ELECTRONIC WRIST ROTATOR ANY	3161.01
	L7360		SIX VOLT BAT OTTO BOCK/EQ EA	236.01
	L7362		BATTERY CHRGR SIX VOLT OTTO	247.81
	L7364		TWELVE VOLT BATTERY UTAH/EQU	394.13
	L7366		BATTERY CHRGR 12 VOLT UTAH/E	530.90
	L7367		REPLACEMNT LITHIUM IONBATTER	389.39
	L7368		LITHIUM ION BATTERY CHARGER	504.80
	L7400		ADD UE PROST BE/WD, ULTLITE	306.56
	L7401		ADD UE PROST A/E ULTLITE MAT	343.20
	L7402		ADD UE PROST S/D ULTLITE MAT	370.58
	L7403		ADD UE PROST B/E ACRYLIC	368.36
	L7404		ADD UE PROST A/E ACRYLIC	555.91
	L7405		ADD UE PROST S/D ACRYLIC	727.07
	L7499		UPPER EXTREMITY PROSTHES NOS	BR
	L7510		PROSTHETIC DEVICE REPAIR REP	BR
	L7520		REPAIR PROSTHESIS PER 15 MIN	51.08
	L7600		PROSTHETIC DONNING SLEEVE	BR
	L7700		PROS SOC INSERT GASKET/SEAL	111.63
	L7900		MALE VACUUM ERECTION SYSTEM	555.95
	L7902		TENSION RING, VAC ERECT DEV	BR
	L8000		MASTECTOMY BRA	43.50
	L8001		BREAST PROSTHESIS BRA & FORM	125.45
	L8002		BRST PRSTH BRA & BILAT FORM	165.03
	L8010		MASTECTOMY SLEEVE	88.30
	L8015		EXT BREASTPROSTHESIS GARMENT	59.95
	L8020		MASTECTOMY FORM	225.49
	L8030		BREAST PROSTHES W/O ADHESIVE	326.16
	L8031		BREAST PROSTHESIS W ADHESIVE	326.16
	L8032		REUSABLE NIPPLE PROSTHESIS	39.18
	L8035		CUSTOM BREAST PROSTHESIS	3664.41
	L8039		BREAST PROSTHESIS NOS	0.00
	L8040		NASAL PROSTHESIS	2417.69
	L8041		MIDFACIAL PROSTHESIS	2914.07
	L8042		ORBITAL PROSTHESIS	3274.21
	L8043		UPPER FACIAL PROSTHESIS	3667.13
	L8044		HEMI-FACIAL PROSTHESIS	4060.02
	L8045		AURICULAR PROSTHESIS	2542.50
	L8046		PARTIAL FACIAL PROSTHESIS	2619.38
	L8047		NASAL SEPTAL PROSTHESIS	1342.41
	L8048		UNSPEC MAXILLOFACIAL PROSTH	BR
	L8049		REPAIR MAXILLOFACIAL PROSTH	BR
	L8300		TRUSS SINGLE W/ STANDARD PAD	96.33
	L8310		TRUSS DOUBLE W/ STANDARD PAD	148.12
	L8320		TRUSS ADDITION TO STD PAD WA	64.69
	L8330		TRUSS ADD TO STD PAD SCROTAL	64.12
	L8400		SHEATH BELOW KNEE	18.75
	L8410		SHEATH ABOVE KNEE	21.33
	L8415		SHEATH UPPER LIMB	21.20
	L8417		PROS SHEATH/SOCK W GEL CUSHN	75.21
	L8420		PROSTHETIC SOCK MULTI PLY BK	24.79
	L8430		PROSTHETIC SOCK MULTI PLY AK	27.25
	L8435		PROS SOCK MULTI PLY UPPER LM	24.46
	L8440		SHRINKER BELOW KNEE	51.86
	L8460		SHRINKER ABOVE KNEE	72.17
	L8465		SHRINKER UPPER LIMB	64.33
	L8470		PROS SOCK SINGLE PLY BK	6.60
	L8480		PROS SOCK SINGLE PLY AK	9.10
	L8485		PROS SOCK SINGLE PLY UPPER L	11.00
	L8499		UNLISTED MISC PROSTHETIC SER	BR
	L8500		ARTIFICIAL LARYNX	652.75
	L8501		TRACHEOSTOMY SPEAKING VALVE	144.97
	L8505		ARTIFICIAL LARYNX, ACCESSORY	BR
	L8507		TRACH-ESOPH VOICE PROS PT IN	41.90
	L8509		TRACH-ESOPH VOICE PROS MD IN	109.25
	L8510		VOICE AMPLIFIER	252.77
	L8511		INDWELLING TRACH INSERT	72.75
	L8512		GEL CAP FOR TRACH VOICE PROS	2.19
	L8513		TRACH PROS CLEANING DEVICE	5.22
	L8514		REPL TRACH PUNCTURE DILATOR	94.32
	L8515		GEL CAP APP DEVICE FOR TRACH	63.12
	L8600		IMPLANT BREAST SILICONE/EQ	617.63
	L8603		COLLAGEN IMP URINARY 2.5 ML	433.76
	L8604		DEXTRANOMER/HYALURONIC ACID	BR
	L8605		INJ BULKING AGENT ANAL CANAL	716.39
	L8606		SYNTHETIC IMPLNT URINARY 1ML	227.69
	L8607		INJ VOCAL CORD BULKING AGENT	42.91
	L8608		ARG II EXT COM/SUP/ACC MISC	BR
	L8609		ARTIFICIAL CORNEA	6516.84
	L8610		OCULAR IMPLANT	633.54
	L8612		AQUEOUS SHUNT PROSTHESIS	668.19
	L8613		OSSICULAR IMPLANT	299.16
	L8614		COCHLEAR DEVICE	18935.62
	L8615		COCH IMPLANT HEADSET REPLACE	451.11
	L8616		COCH IMPLANT MICROPHONE REPL	105.07
	L8617		COCH IMPLANT TRANS COIL REPL	91.80
	L8618		COCH IMPLANT TRAN CABLE REPL	26.22
	L8619		COCH IMP EXT PROC/CONTR RPLC	8122.67
	L8621		REPL ZINC AIR BATTERY	0.61
	L8622		REPL ALKALINE BATTERY	0.32
	L8623		LITH ION BATT CID, NON-EARLVL	64.69
	L8624		LITH ION BATT CID, EAR LEVEL	161.27
	L8625		CHARGER COCH IMPL/AOI BATTRY	188.91
	L8627		CID EXT SPEECH PROCESS REPL	6885.33
	L8628		CID EXT CONTROLLER REPL	1237.36
	L8629		CID TRANSMIT COIL AND CABLE	179.09
	L8630		METACARPOPHALANGEAL IMPLANT	333.22
	L8631		MCP JOINT RE PL 2 PC OR MORE	2236.30
	L8641		METATARSAL JOINT IMPLANT	361.67
	L8642		HALLUX IMPLANT	296.88
	L8658		INTERPHALANGEAL JOINT SPACER	310.27
	L8659		INTERPHALANGEAL JOINT REPL	1930.08
	L8670		VASCULAR GRAFT, SYNTHETIC	550.58
	L8679		IMP NEUROSTI PLS GN ANY TYPE	8345.84
	L8680		IMPLT NEUROSTIM ELCTR EACH	825.93
	L8681		PT PRGRM FOR IMPLT NEUROSTIM	1129.71
	L8682		IMPLT NEUROSTIM RADIOFQ REC	5962.94
	L8683		RADIOFQ TRSMTR FOR IMPLT NEU	5248.73
	L8684		RADIOF TRSMTR IMPLT SCRL NEU	689.26
	L8685		IMPLT NROSTM PLS GEN SNG REC	7942.48
	L8686		IMPLT NROSTM PLS GEN SNG NON	12557.08
	L8687		IMPLT NROSTM PLS GEN DUA REC	10336.57
	L8688		IMPLT NROSTM PLS GEN DUA NON	6595.65
	L8689		EXTERNAL RECHARG SYS INTERN	1725.30
	L8690		AUD OSSEO DEV, INT/EXT COMP	4758.18
	L8691		AOI SND PROC REPL EXCL ACTUA	1722.52
	L8692		NON-OSSEOINTEGRATED SND PROC	BR
	L8693		AUD OSSEO DEV, ABUTMENT	1516.65
	L8694		AOI TRANSDUCER/ACTUATOR REPL	944.60
	L8695		EXTERNAL RECHARG SYS EXTERN	16.66
	L8696		EXT ANTENNA PHREN NERVE STIM	216.81
	L8698		MISC USED WITH TOT ART HEART	BR
	L8699		PROSTHETIC IMPLANT NOS	BR
	L8701		POW UE ROM DEV EWH UPRT CUST	BR
	L8702		POW UE ROM DEV EWHF UPRT CUS	BR
	L9900		O&P SUPPLY/ACCESSORY/SERVICE	BR
	M0075		CELLULAR THERAPY	0.00
	M0076		PROLOTHERAPY	0.00
	M0100		INTRAGASTRIC HYPOTHERMIA	0.00
	M0300		IV CHELATIONTHERAPY	0.00
	M0301		FABRIC WRAPPING OF ANEURYSM	0.00
	M1000		PAIN SCR AS MOD TO SEVR	0.00
	M1001		PLN TO ADRS PAIN DOC	0.00
	M1002		PLN TO ADRS PAIN NOT DOC	0.00
	M1003		TB SCR 12 MO PRI FST BIO DZ	0.00
	M1004		DOC MED RSN NO SRN TB	0.00
	M1005		TB SCR NO PERF	0.00
	M1006		DZ NOT ASES, NO RSN	0.00
	M1007		>=50% TOTAL PT OUTPT RA ENCT	0.00
	M1008		GREATER THAN 50% TOTAL PT OUTPT RA ENCTS	0.00
	M1009		PT TX AND FINAL EVAL COMP	0.00
	M1010		PT TX AND FINAL EVAL COMP	0.00
	M1011		PT TX AND FINAL EVAL COMP	0.00
	M1012		PT TX AND FINAL EVAL COMP	0.00
	M1013		PT TX AND FINAL EVAL COMP	0.00
	M1014		PT TX AND FINAL EVAL COMP	0.00
	M1015		PT TX AND FINAL EVAL COMP	0.00
	M1016		PT DX MEOP OR SUR STERI	0.00
	M1017		PT ADMT TO PALITVE SERV	0.00
	M1018		PT DX HST CR PT SK LG CR SCR	0.00
	M1019		ADL PT MJ DEP DS RS 12 PHQGREATER THAN 5	0.00
	M1020		ADL PT MJ DEP DS NO RS 12 MO	0.00
	M1021		PT UC IN PP	0.00
	M1022		PT HOSPICE DURING PERF PD	0.00
	M1023		ADL PT MJ DEP DS RS 6 PHQGREATER THAN 5	0.00
	M1024		ADL PT MJ DEP DS NO RS 6 MO	0.00
	M1025		PT HOSPICE DURING PERF PD	0.00
	M1026		PT HOSPICE DURING PERF PD	0.00
	M1027		IMG HEAD (CT OR MRI) OBTND	0.00
	M1028		DOC OF PT PRM HDA DX AND OTR	0.00
	M1029		DOC SYSM RSN IMG HD	0.00
	M1030		PT CLIN IND IMG HD	0.00
	M1031		PT CLIN IND IMG HD	0.00
	M1032		ADT TKNG PHARMTHRY FOR OUD	0.00
	M1033		PHARMTHRY FOR OUD AFR 6.30	0.00
	M1034		ADT 180 DYS PHARMTHRY OUD	0.00
	M1035		ADT PD OUT MAT PR 180 DYS TX	0.00
	M1036		ADT NO 180 DYS PHARMTHRY OUD	0.00
	M1037		PT DX LUM SP REG CACR	0.00
	M1038		PT DX LUM SP REG FRACT	0.00
	M1039		PT DX LUM SP REG INF	0.00
	M1040		PT DX LUM IDI OR CONG SCOL	0.00
	M1041		PT CR FT INF LM OR PT ID SL	0.00
	M1042		FTL ST MEA SCO OT ODI 3 MO	0.00
	M1043		FTL ST MEA SCO NO OT ODI	0.00
	M1044		FTL ST MEA ODI 3 MO	0.00
	M1045		FSM WTH SCR OKS PRE AND POST	0.00
	M1046		FSM WTH SCR NO OKS PRE AND P	0.00
	M1047		FS MSRD OKS PRE AND POST	0.00
	M1048		FSM WTH SCR ODI PRE AND POST	0.00
	M1049		FSM WTH SCR NO ODI PRE AND P	0.00
	M1050		FS MSRD ODI PRE AND POST	0.00
	M1051		PT W/CANCER SCOLIOSIS	0.00
	M1052		LG PN NT MSR VAS SCL PRE/PST	0.00
	M1053		PRE AND POST VAS WTHN 3 MOS	0.00
	M1054		PT UC IN PP	0.00
	M1055		ASPIRIN USED	0.00
	M1056		PRESC ANTICO MED IN PP	0.00
	M1057		ASPIRIN NOT USED, NO RSN	0.00
	M1058		PT PRM NURS HM RES IN PP	0.00
	M1059		PT NO PRM NURS HM RES IN PP	0.00
	M1060		PT DIED IN PP	0.00
	M1061		PT PREG	0.00
	M1062		PT IMCOMPRMD	0.00
	M1063		PT REC HG DOS IMSUP THPY	0.00
	M1064		SHING VAC DOC ADM OR PV REC	0.00
	M1065		SHING VAC NO ADM CLINC RSN	0.00
	M1066		SHING VAC NO DOC NO RSN	0.00
	M1067		HSPC PT PRV TIME MEAM PER	0.00
	M1068		PT NOT AMBULATORY	0.00
	M1069		PT SCR FT FALL RSK	0.00
	M1070		PT NOT SCRN FUT FALL NO RSN	0.00
	M1071		PT HAD ADD'L SP PCR PERF	0.00
	P2028		CEPHALIN FLOCULATION TEST	BR
	P2029		CONGO RED BLOOD TEST	BR
	P2031		HAIR ANALYSIS	BR
	P2033		BLOOD THYMOL TURBIDITY	BR
	P2038		BLOOD MUCOPROTEIN	7.65
	P3000		SCREEN PAP BY TECH W MD SUPV	16.11
	P3001		SCREENING PAP SMEAR BY PHYS	36.01
	P7001		CULTURE BACTERIAL URINE	16.58
	P9010		WHOLE BLOOD FOR TRANSFUSION	51.54	157.88
	P9011		BLOOD SPLIT UNIT	73.68	179.01
	P9012		CRYOPRECIPITATE EACH UNIT	BR	70.15
	P9016		RBC LEUKOCYTES REDUCED	BR	262.39
	P9017		PLASMA 1 DONOR FRZ W/IN 8 HR	BR	101.57
	P9019		PLATELETS, EACH UNIT	BR	153.30
	P9020		PLAELET RICH PLASMA UNIT	BR	177.83
	P9021		RED BLOOD CELLS UNIT	BR	198.97
	P9022		WASHED RED BLOOD CELLS UNIT	BR	505.42
	P9023		FROZEN PLASMA, POOLED, SD	BR	107.86
	P9031		PLATELETS LEUKOCYTES REDUCED	BR	193.99
	P9032		PLATELETS, IRRADIATED	BR	244.11
	P9033		PLATELETS LEUKOREDUCED IRRAD	BR	237.34
	P9034		PLATELETS, PHERESIS	BR	478.65
	P9035		PLATELET PHERES LEUKOREDUCED	BR	690.55
	P9036		PLATELET PHERESIS IRRADIATED	BR	785.13
	P9037		PLATE PHERES LEUKOREDU IRRAD	BR	887.40
	P9038		RBC IRRADIATED	BR	314.33
	P9039		RBC DEGLYCEROLIZED	BR	470.22
	P9040		RBC LEUKOREDUCED IRRADIATED	BR	362.92
	P9041		ALBUMIN (HUMAN), 5%, 50ML	10.98	14.90
	P9043		PLASMA PROTEIN FRACT, 5%, 50ML	16.91	38.27
	P9044		CRYOPRECIPITATEREDUCEDPLASMA	BR	126.00
	P9045		ALBUMIN (HUMAN), 5%, 250 ML	54.90	74.48
	P9046		ALBUMIN (HUMAN), 25%, 20 ML	22.64	29.79
	P9047		ALBUMIN (HUMAN), 25%, 50ML	53.79	74.48
	P9048		PLASMAPROTEIN FRACT, 5%, 250ML	34.22	109.31
	P9050		GRANULOCYTES, PHERESIS UNIT	BR	2176.90
	P9051		BLOOD, L/R, CMV-NEG	BR	249.83
	P9052		PLATELETS, HLA-M, L/R, UNIT	BR	1199.66
	P9053		PLT, PHER, L/R CMV-NEG, IRR	BR	699.08
	P9054		BLOOD, L/R, FROZ/DEGLY/WASH	BR	423.69
	P9055		PLT, APH/PHER, L/R, CMV-NEG	BR	631.99
	P9056		BLOOD, L/R, IRRADIATED	BR	320.17
	P9057		RBC, FRZ/DEG/WSH, L/R, IRRAD	BR	318.80
	P9058		RBC, L/R, CMV-NEG, IRRAD	BR	325.59
	P9059		PLASMA, FRZ BETWEEN 8-24HOUR	BR	108.86
	P9060		FR FRZ PLASMA DONOR RETESTED	BR	89.19
	P9070		PATHOGEN REDUCED PLASMA POOL	BR	58.83
	P9071		PATHOGEN REDUCED PLASMA SING	BR	111.26
	P9073		PLATELETS PHERESIS PATH REDU	BR	887.40
	P9100		PATHOGEN TEST FOR PLATELETS	BR	36.21
	P9603		ONE-WAY ALLOW PRORATED MILES	BR
	P9604		ONE-WAY ALLOW PRORATED TRIP	10.60
	P9612		CATHETERIZE FOR URINE SPEC	26.57
	P9615		URINE SPECIMEN COLLECT MULT	BR
	Q0035		CARDIOKYMOGRAPHY	22.80	45.61
	Q0081		INFUSION THER OTHER THAN CHE	BR
	Q0083		CHEMO BY OTHER THAN INFUSION	BR
	Q0084		CHEMOTHERAPY BY INFUSION	414.28
	Q0085		CHEMO BY BOTH INFUSION AND O	BR
	Q0091		OBTAINING SCREEN PAP SMEAR	49.20	24.38
	Q0092		SET UP PORT XRAY EQUIPMENT	27.20
	Q0111		WET MOUNTS/ W PREPARATIONS	16.49
	Q0112		POTASSIUM HYDROXIDE PREPS	6.41
	Q0113		PINWORM EXAMINATIONS	5.23
	Q0114		FERN TEST	10.71
	Q0115		POST-COITAL MUCOUS EXAM	27.50
	Q0138		FERUMOXYTOL, NON-ESRD	0.92	1.43
	Q0139		FERUMOXYTOL, ESRD USE	0.92	1.43
	Q0144		AZITHROMYCIN DIHYDRATE, ORAL	33.16
	Q0161		CHLORPROMAZINE HCL 5MG ORAL	0.00
	Q0162		ONDANSETRON ORAL	0.03
	Q0163		DIPHENHYDRAMINE HCL 50MG	0.28
	Q0164		PROCHLORPERAZINE MALEATE 5MG	0.05
	Q0166		GRANISETRON HCL 1 MG ORAL	1.44
	Q0167		DRONABINOL 2.5MG ORAL	1.81
	Q0169		PROMETHAZINE HCL 12.5MG ORAL	0.03
	Q0173		TRIMETHOBENZAMIDE HCL 250MG	0.81
	Q0174		THIETHYLPERAZINE MALEATE10MG	0.81
	Q0175		PERPHENAZINE 4MG ORAL	0.81
	Q0177		HYDROXYZINE PAMOATE 25MG	1.84
	Q0180		DOLASETRON MESYLATE ORAL	123.48
	Q0181		UNSPECIFIED ORAL ANTI-EMETIC	BR
	Q0477		PWR MODULE PT CABLE LVAD RPL	853.64
	Q0478		POWER ADAPTER, COMBO VAD	202.18
	Q0479		POWER MODULE COMBO VAD, REP	13183.85
	Q0480		DRIVER PNEUMATIC VAD, REP	99092.11
	Q0481		MICROPRCSR CU ELEC VAD, REP	15987.38
	Q0482		MICROPRCSR CU COMBO VAD, REP	5007.55
	Q0483		MONITOR ELEC VAD, REP	20628.82
	Q0484		MONITOR ELEC OR COMB VAD REP	4006.06
	Q0485		MONITOR CABLE ELEC VAD, REP	386.78
	Q0486		MON CABLE ELEC/PNEUM VAD REP	321.90
	Q0487		LEADS ANY TYPE VAD, REP ONLY	375.57
	Q0488		PWR PACK BASE ELEC VAD, REP	BR
	Q0489		PWR PCK BASE COMBO VAD, REP	17884.05
	Q0490		EMR PWR SOURCE ELEC VAD, REP	773.59
	Q0491		EMR PWR SOURCE COMBO VAD REP	1216.13
	Q0492		EMR PWR CBL ELEC VAD, REP	98.01
	Q0493		EMR PWR CBL COMBO VAD, REP	278.94
	Q0494		EMR HD PMP ELEC/COMBO, REP	236.05
	Q0495		CHARGER ELEC/COMBO VAD, REP	4595.79
	Q0496		BATTERY ELEC/COMBO VAD, REP	1649.51
	Q0497		BAT CLPS ELEC/COMB VAD, REP	515.05
	Q0498		HOLSTER ELEC/COMBO VAD, REP	565.13
	Q0499		BELT/VEST ELEC/COMBO VAD REP	183.62
	Q0500		FILTERS ELEC/COMBO VAD, REP	33.61
	Q0501		SHWR COV ELEC/COMBO VAD, REP	561.87
	Q0502		MOBILITY CART PNEUM VAD, REP	715.34
	Q0503		BATTERY PNEUM VAD REPLACEMNT	1430.70
	Q0504		PWR ADPT PNEUM VAD, REP VEH	754.93
	Q0506		LITH-ION BATT ELEC/PNEUM VAD	939.74
	Q0507		MISC SUP/ACC EXT VAD	BR
	Q0508		MIS SUP/ACC IMP VAD	BR
	Q0509		MIS SUP/AC IMP VAD NOPAY MED	BR
	Q0510		DISPENS FEE IMMUNOSUPRESSIVE	BR
	Q0511		SUP FEE ANTIEM, ANTICA, IMMUNO	BR
	Q0512		PX SUP FEE ANTI-CAN SUB PRES	BR
	Q0513		DISP FEE INHAL DRUGS/30 DAYS	BR
	Q0514		DISP FEE INHAL DRUGS/90 DAYS	BR
	Q0515		SERMORELIN ACETATE INJECTION	1.61
	Q1004		NTIOL CATEGORY 4	BR
	Q1005		NTIOL CATEGORY 5	BR
	Q2004		BLADDER CALCULI IRRIG SOL	17.31
	Q2009		FOSPHENYTOIN INJ PE	24.88
	Q2017		TENIPOSIDE, 50 MG	266.55	3669.24
	Q2026		RADIESSE INJECTION	BR	672.94
	Q2028		INJ, SCULPTRA, 0.5MG	0.00	4.66
	Q2034		AGRIFLU VACCINE	BR
	Q2035		AFLURIA VACC, 3 YRS & >, IM	14.42
	Q2036		FLULAVAL VACC, 3 YRS & >, IM	BR
	Q2037		FLUVIRIN VACC, 3 YRS & >, IM	24.85
	Q2038		FLUZONE VACC, 3 YRS & >, IM	24.85
	Q2039		INFLUENZA VIRUS VACCINE, NOS	BR
	Q2041		AXICABTAGENE CILOLEUCEL CAR+	BR	561439.60
	Q2042		TISAGENLECLEUCEL CAR-POS T	BR	623931.39
	Q2043		SIPULEUCEL-T AUTO CD54+	40319.18	60515.14
	Q2049		IMPORTED LIPODOX INJ	716.88	667.97
	Q2050		DOXORUBICIN INJ 10MG	477.80	541.49
	Q2052		IVIG DEMO, SERVICES/SUPPLIES	0.00
	Q3001		BRACHYTHERAPY RADIOELEMENTS	BR
	Q3014		TELEHEALTH FACILITY FEE	BR
	Q3027		INJ BETA INTERFERON IM 1 MCG	46.27	76.15
	Q3028		INJ BETA INTERFERON SQ 1 MCG	BR
	Q3031		COLLAGEN SKIN TEST	BR
	Q4001		CAST SUP BODY CAST PLASTER	55.43
	Q4002		CAST SUP BODY CAST FIBERGLAS	209.42
	Q4003		CAST SUP SHOULDER CAST PLSTR	39.79
	Q4004		CAST SUP SHOULDER CAST FBRGL	137.78
	Q4005		CAST SUP LONG ARM ADULT PLST	14.67
	Q4006		CAST SUP LONG ARM ADULT FBRG	33.07
	Q4007		CAST SUP LONG ARM PED PLSTER	7.34
	Q4008		CAST SUP LONG ARM PED FBRGLS	16.52
	Q4009		CAST SUP SHT ARM ADULT PLSTR	9.80
	Q4010		CAST SUP SHT ARM ADULT FBRGL	22.04
	Q4011		CAST SUP SHT ARM PED PLASTER	4.88
	Q4012		CAST SUP SHT ARM PED FBRGLAS	11.04
	Q4013		CAST SUP GAUNTLET PLASTER	17.83
	Q4014		CAST SUP GAUNTLET FIBERGLASS	30.06
	Q4015		CAST SUP GAUNTLET PED PLSTER	8.93
	Q4016		CAST SUP GAUNTLET PED FBRGLS	15.04
	Q4017		CAST SUP LNG ARM SPLINT PLST	10.31
	Q4018		CAST SUP LNG ARM SPLINT FBRG	16.43
	Q4019		CAST SUP LNG ARM SPLNT PED P	5.17
	Q4020		CAST SUP LNG ARM SPLNT PED F	8.24
	Q4021		CAST SUP SHT ARM SPLINT PLST	7.63
	Q4022		CAST SUP SHT ARM SPLINT FBRG	13.76
	Q4023		CAST SUP SHT ARM SPLNT PED P	3.84
	Q4024		CAST SUP SHT ARM SPLNT PED F	6.90
	Q4025		CAST SUP HIP SPICA PLASTER	42.77
	Q4026		CAST SUP HIP SPICA FIBERGLAS	133.58
	Q4027		CAST SUP HIP SPICA PED PLSTR	21.41
	Q4028		CAST SUP HIP SPICA PED FBRGL	66.84
	Q4029		CAST SUP LONG LEG PLASTER	32.73
	Q4030		CAST SUP LONG LEG FIBERGLASS	86.13
	Q4031		CAST SUP LNG LEG PED PLASTER	16.35
	Q4032		CAST SUP LNG LEG PED FBRGLS	43.07
	Q4033		CAST SUP LNG LEG CYLINDER PL	30.53
	Q4034		CAST SUP LNG LEG CYLINDER FB	75.89
	Q4035		CAST SUP LNGLEG CYLNDR PED P	15.26
	Q4036		CAST SUP LNGLEG CYLNDR PED F	37.97
	Q4037		CAST SUP SHRT LEG PLASTER	18.60
	Q4038		CAST SUP SHRT LEG FIBERGLASS	46.63
	Q4039		CAST SUP SHRT LEG PED PLSTER	9.33
	Q4040		CAST SUP SHRT LEG PED FBRGLS	23.32
	Q4041		CAST SUP LNG LEG SPLNT PLSTR	22.64
	Q4042		CAST SUP LNG LEG SPLNT FBRGL	38.64
	Q4043		CAST SUP LNG LEG SPLNT PED P	11.33
	Q4044		CAST SUP LNG LEG SPLNT PED F	19.34
	Q4045		CAST SUP SHT LEG SPLNT PLSTR	13.15
	Q4046		CAST SUP SHT LEG SPLNT FBRGL	21.13
	Q4047		CAST SUP SHT LEG SPLNT PED P	6.55
	Q4048		CAST SUP SHT LEG SPLNT PED F	10.57
	Q4049		FINGER SPLINT, STATIC	2.39
	Q4050		CAST SUPPLIES UNLISTED	BR
	Q4051		SPLINT SUPPLIES MISC	BR
	Q4074		ILOPROST NON-COMP UNIT DOSE	123.55
	Q4081		EPOETIN ALFA, 100 UNITS ESRD	1.37
	Q4082		DRUG/BIO NOC PART B DRUG CAP	BR
	Q4100		SKIN SUBSTITUTE, NOS	BR
	Q4101		APLIGRAF	34.56
	Q4102		OASIS WOUND MATRIX	11.82
	Q4103		OASIS BURN MATRIX	BR
	Q4104		INTEGRA BMWD	35.25
	Q4105		INTEGRA DRT OR OMNIGRAFT	140.29
	Q4106		DERMAGRAFT	36.38
	Q4107		GRAFTJACKET	109.59
	Q4108		INTEGRA MATRIX	39.45
	Q4110		PRIMATRIX	61.53
	Q4111		GAMMAGRAFT	7.66
	Q4112		CYMETRA INJECTABLE	247.73
	Q4113		GRAFTJACKET XPRESS	247.73
	Q4114		INTEGRA FLOWABLE WOUND MATRI	1746.92
	Q4115		ALLOSKIN	10.59
	Q4116		ALLODERM	36.06
	Q4117		HYALOMATRIX	BR
	Q4118		MATRISTEM MICROMATRIX	BR
	Q4121		THERASKIN	42.60
	Q4122		DERMACELL	BR
	Q4123		ALLOSKIN	24.63
	Q4124		OASIS TRI-LAYER WOUND MATRIX	BR
	Q4125		ARTHROFLEX	BR
	Q4126		MEMODERM/DERMA/TRANZ/INTEGUP	BR
	Q4127		TALYMED	BR
	Q4128		FLEXHD/ALLOPATCHHD/MATRIXHD	BR
	Q4130		STRATTICE TM	BR
	Q4132		GRAFIX CORE, GRAFIXPL CORE	BR
	Q4133		GRAFIX STRAVIX PRIME PL SQCM	BR
	Q4134		HMATRIX	BR
	Q4135		MEDISKIN	BR
	Q4136		EZDERM	BR
	Q4137		AMNIOEXCEL BIODEXCEL 1SQ CM	0.00
	Q4138		BIODFENCE DRYFLEX, 1CM	0.00
	Q4139		AMNIO OR BIODMATRIX, INJ 1CC	0.00
	Q4140		BIODFENCE 1CM	0.00
	Q4141		ALLOSKIN AC, 1 CM	0.00
	Q4142		XCM BIOLOGIC TISS MATRIX 1CM	0.00
	Q4143		REPRIZA, 1CM	0.00
	Q4145		EPIFIX, INJ, 1MG	0.00
	Q4146		TENSIX, 1CM	0.00
	Q4147		ARCHITECT ECM PX FX 1 SQ CM	0.00
	Q4148		NEOX NEOX RT OR CLARIX CORD	0.00
	Q4149		EXCELLAGEN, 0.1 CC	0.00
	Q4150		ALLOWRAP DS OR DRY 1 SQ CM	0.00
	Q4151		AMNIOBAND, GUARDIAN 1 SQ CM	0.00
	Q4152		DERMAPURE 1 SQUARE CM	0.00
	Q4153		DERMAVEST, PLURIVEST SQ CM	0.00
	Q4154		BIOVANCE 1 SQUARE CM	0.00
	Q4155		NEOXFLO OR CLARIXFLO 1 MG	0.00
	Q4156		NEOX 100 OR CLARIX 100	0.00
	Q4157		REVITALON 1 SQUARE CM	0.00
	Q4158		KERECIS OMEGA3, PER SQ CM	0.00
	Q4159		AFFINITY1 SQUARE CM	0.00
	Q4160		NUSHIELD 1 SQUARE CM	0.00
	Q4161		BIO-CONNEKT PER SQUARE CM	0.00
	Q4162		WNDEX FLW, BIOSKN FLW, 0.5CC	0.00
	Q4163		WOUNDEX, BIOSKIN, PER SQ CM	0.00
	Q4164		HELICOLL, PER SQUARE CM	0.00
	Q4165		KERAMATRIX, PER SQUARE CM	0.00
	Q4166		CYTAL, PER SQUARE CENTIMETER	29.37
	Q4167		TRUSKIN, PER SQ CENTIMETER	BR
	Q4168		AMNIOBAND, 1 MG	BR
	Q4169		ARTACENT WOUND, PER SQ CM	189.24
	Q4170		CYGNUS, PER SQ CM	522.04
	Q4171		INTERFYL, 1 MG	97.88
	Q4173		PALINGEN OR PALINGEN XPLUS	228.40
	Q4174		PALINGEN OR PROMATRX	649.29
	Q4175		MIRODERM	BR
	Q4176		NEOPATCH, PER SQ CENTIMETER	BR
	Q4177		FLOWERAMNIOFLO, 0.1 CC	BR
	Q4178		FLOWERAMNIOPATCH, PER SQ CM	155.63
	Q4179		FLOWERDERM, PER SQ CM	BR
	Q4180		REVITA, PER SQ CM	BR
	Q4181		AMNIO WOUND, PER SQUARE CM	BR
	Q4182		TRANSCYTE, PER SQ CENTIMETER	BR
	Q4183		SURGIGRAFT, 1 SQ CM	BR
	Q4184		CELLESTA, 1 SQ CM	BR
	Q4185		CELLESTA FLOWAB AMNION 0.5CC	BR
	Q4186		EPIFIX 1 SQ CM	BR
	Q4187		EPICORD 1 SQ CM	BR
	Q4188		AMNIOARMOR 1 SQ CM	BR
	Q4189		ARTACENT AC, 1 MG	BR
	Q4190		ARTACENT AC 1 SQ CM	BR
	Q4191		RESTORIGIN 1 SQ CM	BR
	Q4192		RESTORIGIN, 1 CC	BR
	Q4193		COLL-E-DERM 1 SQ CM	BR
	Q4194		NOVACHOR 1 SQ CM	BR
	Q4195		PURAPLY 1 SQ CM	BR	171.51
	Q4196		PURAPLY AM 1 SQ CM	BR	171.51
	Q4197		PURAPLY XT 1 SQ CM	BR
	Q4198		GENESIS AMNIO MEMBRANE 1SQCM	BR
	Q4200		SKIN TE 1 SQ CM	BR
	Q4201		MATRION 1 SQ CM	BR
	Q4202		KEROXX (2.5G/CC), 1CC	BR
	Q4203		DERMA-GIDE, 1 SQ CM	BR
	Q4204		XWRAP 1 SQ CM	BR
	Q5001		HOSPICE OR HOME HLTH IN HOME	See Home Health Rules
	Q5002		HOSPICE/HOME HLTH IN ASST LV	See Home Health Rules
	Q5003		HOSPICE IN LT/NON-SKILLED NF	See Home Health Rules
	Q5004		HOSPICE IN SNF	See Home Health Rules
	Q5005		HOSPICE, INPATIENT HOSPITAL	See Home Health Rules
	Q5006		HOSPICE IN HOSPICE FACILITY	See Home Health Rules
	Q5007		HOSPICE IN LTCH	See Home Health Rules
	Q5008		HOSPICE IN INPATIENT PSYCH	See Home Health Rules
	Q5009		HOSPICE/HOME HLTH, PLACE NOS	See Home Health Rules
	Q5010		HOSPICE HOME CARE IN HOSPICE	See Home Health Rules
	Q5101		INJECTION, ZARXIO	1.08	0.90
	Q5103		INJECTION, INFLECTRA	BR	81.33
	Q5104		INJECTION, RENFLEXIS	BR	87.90
	Q5105		INJ RETACRIT ESRD ON DIALYSI	BR	1.61
	Q5106		INJ RETACRIT NON-ESRD USE	BR	16.13
	Q5107		INJ MVASI 10 MG	BR
	Q5108		INJECTION, FULPHILA	BR	508.86
	Q5109		INJECTION, IXIFI, 10 MG	BR
	Q5110		NIVESTYM	BR	1.07
	Q5111		INJECTION, UDENYCA 0.5 MG	BR
	Q9950		INJ SULF HEXA LIPID MICROSPH	36.61	30.17
	Q9951		LOCM >= 400 MG/ML IODINE, 1ML	BR
	Q9953		INJ FE-BASED MR CONTRAST, 1ML	BR
	Q9954		ORAL MR CONTRAST, 100 ML	BR
	Q9955		INJ PERFLEXANE LIP MICROS, ML	BR
	Q9956		INJ OCTAFLUOROPROPANE MIC, ML	38.65
	Q9957		INJ PERFLUTREN LIP MICROS, ML	57.99
	Q9958		HOCM <=149 MG/ML IODINE, 1ML	0.09
	Q9959		HOCM 150-199MG/ML IODINE, 1ML	BR
	Q9960		HOCM 200-249MG/ML IODINE, 1ML	0.21
	Q9961		HOCM 250-299MG/ML IODINE, 1ML	0.22
	Q9962		HOCM 300-349MG/ML IODINE, 1ML	BR
	Q9963		HOCM 350-399MG/ML IODINE, 1ML	0.21
	Q9964		HOCM>= 400MG/ML IODINE, 1ML	BR
	Q9965		LOCM 100-199MG/ML IODINE, 1ML	0.97
	Q9966		LOCM 200-299MG/ML IODINE, 1ML	0.19
	Q9967		LOCM 300-399MG/ML IODINE, 1ML	0.14
	Q9968		VISUALIZATION ADJUNCT	BR	6.06
	Q9969		NON-HEU TC-99M ADD-ON/DOSE	BR	14.20
	Q9982		FLUTEMETAMOL F18 DIAGNOSTIC	2695.22
	Q9983		FLORBETABEN F18 DIAGNOSTIC	2580.81
	Q9991		BUPRENORPH XR 100 MG OR LESS	BR	2378.22
	Q9992		BUPRENORPHINE XR OVER 100 MG	BR	2378.22
	R0070		TRANSPORT PORTABLE X-RAY	0.00
	R0075		TRANSPORT PORT X-RAY MULTIPL	0.00
	R0076		TRANSPORT PORTABLE EKG	0.00
	S0012		BUTORPHANOL TARTRATE, NASAL	65.75
	S0014		TACRINE HYDROCHLORIDE, 10 MG	2.31
	S0017		INJECTION, AMINOCAPROIC ACID	44.01
	S0020		INJECTION, BUPIVICAINE HYDRO	BR
	S0021		INJECTION, CEFOPERAZONE SOD	BR
	S0023		INJECTION, CIMETIDINE HYDROC	10.56
	S0028		INJECTION, FAMOTIDINE, 20 MG	7.04
	S0030		INJECTION, METRONIDAZOLE	13.21
	S0032		INJECTION, NAFCILLIN SODIUM	87.10
	S0034		INJECTION, OFLOXACIN, 400 MG	BR
	S0039		INJECTION, SULFAMETHOXAZOLE	BR
	S0040		INJECTION, TICARCILLIN DISOD	12.30
	S0073		INJECTION, AZTREONAM, 500 MG	52.81
	S0074		INJECTION, CEFOTETAN DISODIU	BR
	S0077		INJECTION, CLINDAMYCIN PHOSP	13.21
	S0078		INJECTION, FOSPHENYTOIN SODI	151.12
	S0080		INJECTION, PENTAMIDINE ISETH	142.60
	S0081		INJECTION, PIPERACILLIN SODI	1.54
	S0088		IMATINIB 100 MG	BR
	S0090		SILDENAFIL CITRATE, 25 MG	95.05
	S0091		GRANISETRON 1MG	66.02
	S0092		HYDROMORPHONE 250 MG	189.25
	S0093		MORPHINE 500 MG	4.88
	S0104		ZIDOVUDINE, ORAL, 100 MG	1.54
	S0106		BUPROPION HCL SR 60 TABLETS	93.83
	S0108		MERCAPTOPURINE 50 MG	3.08
	S0109		METHADONE ORAL 5MG	0.54
	S0117		TRETINOIN TOPICAL 5 G	BR
	S0119		ONDANSETRON 4 MG	22.00
	S0122		INJ MENOTROPINS 75 IU	161.60
	S0126		INJ FOLLITROPIN ALFA 75 IU	1291.94
	S0128		INJ FOLLITROPIN BETA 75 IU	1973.34
	S0132		INJ GANIRELIX ACETAT 250 MCG	114.40
	S0136		CLOZAPINE, 25 MG	1.16
	S0137		DIDANOSINE, 25 MG	BR
	S0138		FINASTERIDE, 5 MG	2.31
	S0139		MINOXIDIL, 10 MG	0.77
	S0140		SAQUINAVIR, 200 MG	1.54
	S0142		COLISTIMETHATE INH SOL MG	BR
	S0145		PEG INTERFERON ALFA-2A/180	BR
	S0148		PEG INTERFERON ALFA-2B/10	BR
	S0155		EPOPROSTENOL DILUTANT	BR
	S0156		EXEMESTANE, 25 MG	7.31
	S0157		BECAPLERMIN GEL 1%, 0.5 GM	15.00
	S0160		DEXTROAMPHETAMINE	35.20
	S0164		INJECTION PANTROPRAZOLE	15.85
	S0166		INJ OLANZAPINE 2.5MG	5.00
	S0169		CALCITROL	1.16
	S0170		ANASTROZOLE 1 MG	11.44
	S0171		BUMETANIDE 0.5 MG	4.10
	S0172		CHLORAMBUCIL 2 MG	1.92
	S0174		DOLASETRON 50 MG	44.60
	S0175		FLUTAMIDE 125 MG	1.92
	S0176		HYDROXYUREA 500 MG	1.16
	S0177		LEVAMISOLE 50 MG	4.23
	S0178		LOMUSTINE 10 MG	21.91
	S0179		MEGESTROL 20 MG	0.38
	S0182		PROCARBAZINE, ORAL	44.22
	S0183		PROCHLORPERAZINE 5 MG	0.38
	S0187		TAMOXIFEN 10 MG	1.92
	S0189		TESTOSTERONE PELLET 75 MG	BR
	S0190		MIFEPRISTONE, ORAL, 200 MG	132.05
	S0191		MISOPROSTOL, ORAL, 200 MCG	7.04
	S0194		VITAMIN SUP PL 100 CAPS	BR
	S0197		PRENATAL VITAMINS 30 DAY	BR
	S0199		MED ABORTION INC ALL EX DRUG	BR
	S0201		PARTIAL HOSPITALIZATION SERV	BR
	S0207		PARAMEDICINTERCEP NONHOSPALS	BR
	S0208		PARAMED INTRCEPT NONVOL	BR
	S0209		WC VAN MILEAGE PER MI	BR
	S0215		NONEMERG TRANSP MILEAGE	BR
	S0220		MEDICAL CONFERENCE BY PHYSIC	BR
	S0221		MEDICAL CONFERENCE, 60 MIN	BR
	S0250		COMP GERIATR ASSMT TEAM	BR
	S0255		HOSPICE REFER VISIT NONMD	BR
	S0257		END OF LIFE COUNSELING	BR
	S0260		H&P FOR SURGERY	BR
	S0265		GENETIC COUNSEL 15 MINS	BR
	S0270		HOME STD CASE RATE 30 DAYS	BR
	S0271		HOME HOSPICE CASE 30 DAYS	BR
	S0272		HOME EPISODIC CASE 30 DAYS	BR
	S0273		MD HOME VISIT OUTSIDE CAP	BR
	S0274		NURSE PRACTR VISIT OUTS CAP	BR
	S0280		MEDICAL HOME, INITIAL PLAN	BR
	S0281		MEDICAL HOME, MAINTENANCE	BR
	S0285		CNSLT BEFORE SCREEN COLONOSC	170.90
	S0302		COMPLETED EPSDT	BR
	S0310		HOSPITALIST VISIT	BR
	S0311		COMP MGMT CARE COORD ADV ILL	BR
	S0315		DISEASE MANAGEMENT PROGRAM	BR
	S0316		FOLLOW-UP/REASSESSMENT	BR
	S0317		DISEASE MGMT PER DIEM	BR
	S0320		RN TELEPHONE CALLS TO DMP	BR
	S0340		LIFESTYLE MOD 1ST STAGE	BR
	S0341		LIFESTYLE MOD 2 OR 3 STAGE	BR
	S0342		LIFESTYLE MOD 4TH STAGE	BR
	S0353		CANCER TREATMENTPLAN INITIAL	BR
	S0354		CANCER TREATMENT PLAN CHANGE	BR
	S0390		ROUT FOOT CARE PER VISIT	BR
	S0395		IMPRESSION CASTING FT	BR
	S0400		GLOBAL ESWL KIDNEY	BR
	S0500		DISPOS CONT LENS	BR
	S0504		SINGL PRSCRP LENS	BR
	S0506		BIFOC PRSCP LENS	BR
	S0508		TRIFOC PRSCRP LENS	BR
	S0510		NON-PRSCRP LENS	BR
	S0512		DAILY CONT LENS	BR
	S0514		COLOR CONT LENS	BR
	S0515		SCLERAL LENS LIQUID BANDAGE	BR
	S0516		SAFETY FRAMES	BR
	S0518		SUNGLASS FRAMES	BR
	S0580		POLYCARB LENS	BR
	S0581		NONSTND LENS	BR
	S0590		MISC INTEGRAL LENS SERV	BR
	S0592		COMP CONT LENS EVAL	BR
	S0595		NEW LENSES IN PTS OLD FRAME	BR
	S0596		PHAKIC IOL REFRACTIVE ERROR	BR
	S0601		SCREENING PROCTOSCOPY	BR
	S0610		ANNUAL GYNECOLOGICAL EXAMINA	BR
	S0612		ANNUAL GYNECOLOGICAL EXAMINA	BR
	S0613		ANN BREAST EXAM	BR
	S0618		AUDIOMETRY FOR HEARING AID	BR
	S0620		ROUTINE OPHTHALMOLOGICAL EXA	BR
	S0621		ROUTINE OPHTHALMOLOGICAL EXA	BR
	S0622		PHYS EXAM FOR COLLEGE	BR
	S0630		REMOVAL OF SUTURES	BR
	S0800		LASER IN SITU KERATOMILEUSIS	BR
	S0810		PHOTOREFRACTIVE KERATECTOMY	BR
	S0812		PHOTOTHERAP KERATECT	BR
	S1001		DELUXE ITEM	BR
	S1002		CUSTOM ITEM	BR
	S1015		IV TUBING EXTENSION SET	BR
	S1016		NON-PVC INTRAVENOUS ADMINIST	BR
	S1030		GLUC MONITOR PURCHASE	BR
	S1031		GLUC MONITOR RENTAL	BR
	S1034		ART PANCREAS SYSTEM	BR
	S1035		ART PANCREAS INV DISP SENSOR	BR
	S1036		ART PANCREAS EXT TRANSMITTER	BR
	S1037		ART PANCREAS EXT RECEIVER	BR
	S1040		CRANIAL REMOLDING ORTHOSIS	BR
	S1090		MOMETASONE SINUS IMPLANT	BR
	S2053		TRANSPLANTATION OF SMALL INT	BR
	S2054		TRANSPLANTATION OF MULTIVISC	BR
	S2055		HARVESTING OF DONOR MULTIVIS	BR
	S2060		LOBAR LUNG TRANSPLANTATION	BR
	S2061		DONOR LOBECTOMY (LUNG)	BR
	S2065		SIMULT PANC KIDN TRANS	BR
	S2066		BREAST GAP FLAP RECONST	BR
	S2067		BREAST "STACKED" DIEP/GAP	BR
	S2068		BREAST DIEP OR SIEA FLAP	BR
	S2070		CYSTO LASER TX URETERAL CALC	BR
	S2079		LAP ESOPHAGOMYOTOMY	BR
	S2080		LAUP	BR
	S2083		ADJUSTMENT GASTRIC BAND	BR
	S2095		TRANSCATH EMBOLIZ MICROSPHER	BR
	S2102		ISLET CELL TISSUE TRANSPLANT	BR
	S2103		ADRENAL TISSUE TRANSPLANT	BR
	S2107		ADOPTIVE IMMUNOTHERAPY	BR
	S2112		KNEE ARTHROSCP HARV	BR
	S2115		PERIACETABULAR OSTEOTOMY	BR
	S2117		ARTHROEREISIS, SUBTALAR	BR
	S2118		TOTAL HIP RESURFACING	BR
	S2120		LOW DENSITY LIPOPROTEIN(LDL)	BR
	S2140		CORD BLOOD HARVESTING	BR
	S2142		CORD BLOOD-DERIVED STEM-CELL	BR
	S2150		BMT HARV/TRANS PL 28 D PKG	BR
	S2152		SOLID ORGAN TRANSPL PKG	BR
	S2202		ECHOSCLEROTHERAPY	BR
	S2205		MINIMALLY INVASIVE DIRECT CO	BR
	S2206		MINIMALLY INVASIVE DIRECT CO	BR
	S2207		MINIMALLY INVASIVE DIRECT CO	BR
	S2208		MINIMALLY INVASIVE DIRECT CO	BR
	S2209		MINIMALLY INVASIVE DIRECT CO	BR
	S2225		MYRINGOTOMY LASER-ASSIST	BR
	S2230		IMPLANT SEMI-IMP HEAR	BR
	S2235		IMPLANT AUDITORY BRAIN IMP	BR
	S2260		INDUCED ABORTION 17-24 WEEKS	BR
	S2265		INDUCED ABORTION 25-28 WKS	BR
	S2266		INDUCED ABORTION 29-31 WKS	BR
	S2267		INDUCED ABORTION 32 OR MORE	BR
	S2300		ARTHROSCOPY, SHOULDER, SURGI	BR
	S2325		HIP CORE DECOMPRESSION	BR
	S2340		CHEMODENERVATION OF ABDUCTOR	BR
	S2341		CHEMODENERV ADDUCT VOCAL	BR
	S2342		NASAL ENDOSCOP PO DEBRID	BR
	S2348		DECOMPRESS DISC RF LUMBAR	BR
	S2350		DISKECTOMY, ANTERIOR, WITH D	BR
	S2351		DISKECTOMY, ANTERIOR, WITH D	BR
	S2400		FETAL SURG CONGEN HERNIA	BR
	S2401		FETAL SURG URIN TRAC OBSTR	BR
	S2402		FETAL SURG CONG CYST MALF	BR
	S2403		FETAL SURG PULMON SEQUEST	BR
	S2404		FETAL SURG MYELOMENINGO	BR
	S2405		FETAL SURG SACROCOC TERATOMA	BR
	S2409		FETAL SURG NOC	BR
	S2411		FETOSCOP LASER THER TTTS	BR
	S2900		ROBOTIC SURGICAL SYSTEM	BR
	S3000		BILAT DIL RETINAL EXAM	BR
	S3005		EVAL SELF-ASSESS DEPRESSION	BR
	S3600		STAT LAB	BR
	S3601		STAT LAB HOME/NF	BR
	S3620		NEWBORN METABOLIC SCREENING	BR
	S3630		EOSINOPHIL BLOOD COUNT	BR
	S3645		HIV-1 ANTIBODY TESTING OF OR	BR
	S3650		SALIVA TEST, HORMONE LEVEL;	BR
	S3652		SALIVA TEST, HORMONE LEVEL;	BR
	S3655		ANTISPERM ANTIBODIES TEST	BR
	S3708		GASTROINTESTINAL FAT ABSORPT	BR
	S3722		DOSE OPTIMIZATION AUC - 5FU	BR
	S3800		GENETIC TESTING ALS	BR
	S3840		DNA ANALYSIS RET-ONCOGENE	BR
	S3841		GENE TEST RETINOBLASTOMA	BR
	S3842		GENE TEST HIPPEL-LINDAU	BR
	S3844		DNA ANALYSIS DEAFNESS	BR
	S3845		GENE TEST ALPHA-THALASSEMIA	BR
	S3846		GENE TEST BETA-THALASSEMIA	BR
	S3849		GENE TEST NIEMANN-PICK	BR
	S3850		GENE TEST SICKLE CELL	BR
	S3852		DNA ANALYSIS APOE ALZHEIMER	BR
	S3853		GENE TEST MYO MUSCLR DYST	BR
	S3854		GENE PROFILE PANEL BREAST	3323.01
	S3861		GENETIC TEST BRUGADA	BR
	S3865		COMP GENET TEST HYP CARDIOMY	BR
	S3866		SPEC GENE TEST HYP CARDIOMY	BR
	S3870		CGH TEST DEVELOPMENTAL DELAY	BR
	S3900		SURFACE EMG	BR
	S3902		BALLISTOCARDIOGRAM	BR
	S3904		MASTERS TWO STEP	BR
	S4005		INTERIM LABOR FACILITY GLOBA	BR
	S4011		IVF PACKAGE	BR
	S4013		COMPL GIFT CASE RATE	BR
	S4014		COMPL ZIFT CASE RATE	BR
	S4015		COMPLETE IVF NOS CASE RATE	BR
	S4016		FROZEN IVF CASE RATE	BR
	S4017		IVF CANC A STIM CASE RATE	BR
	S4018		F EMB TRNS CANC CASE RATE	BR
	S4020		IVF CANC A ASPIR CASE RATE	BR
	S4021		IVF CANC P ASPIR CASE RATE	BR
	S4022		ASST OOCYTE FERT CASE RATE	BR
	S4023		INCOMPL DONOR EGG CASE RATE	BR
	S4025		DONOR SERV IVF CASE RATE	BR
	S4026		PROCURE DONOR SPERM	BR
	S4027		STORE PREV FROZ EMBRYOS	BR
	S4028		MICROSURG EPI SPERM ASP	BR
	S4030		SPERM PROCURE INIT VISIT	BR
	S4031		SPERM PROCURE SUBS VISIT	BR
	S4035		STIMULATED IUI CASE RATE	BR
	S4037		CRYO EMBRYO TRANSF CASE RATE	BR
	S4040		MONIT STORE CRYO EMBRYO 30 D	BR
	S4042		OVULATION MGMT PER CYCLE	BR
	S4981		INSERT LEVONORGESTREL IUS	BR
	S4989		CONTRACEPT IUD	BR
	S4990		NICOTINE PATCH LEGEND	BR
	S4991		NICOTINE PATCH NONLEGEND	BR
	S4993		CONTRACEPTIVE PILLS FOR BC	BR
	S4995		SMOKING CESSATION GUM	BR
	S5000		PRESCRIPTION DRUG, GENERIC	BR
	S5001		PRESCRIPTION DRUG, BRAND NAME	BR
	S5010		5% DEXTROSE AND 0.45% SALINE	BR
	S5012		5% DEXTROSE WITH POTASSIUM	BR
	S5013		5%DEXTROSE/0.45%SALINE1000ML	BR
	S5014		D5W/0.45NS W KCL AND MGS04	BR
	S5035		HIT ROUTINE DEVICE MAINT	BR
	S5036		HIT DEVICE REPAIR	BR
	S5100		ADULT DAYCARE SERVICES 15MIN	BR
	S5101		ADULT DAY CARE PER HALF DAY	BR
	S5102		ADULT DAY CARE PER DIEM	BR
	S5105		CENTERBASED DAY CARE PERDIEM	BR
	S5108		HOMECARE TRAIN PT 15 MIN	BR
	S5109		HOMECARE TRAIN PT SESSION	BR
	S5110		FAMILY HOMECARE TRAINING 15M	BR
	S5111		FAMILY HOMECARE TRAIN/SESSIO	BR
	S5115		NONFAMILY HOMECARE TRAIN/15M	BR
	S5116		NONFAMILY HC TRAIN/SESSION	BR
	S5120		CHORE SERVICES PER 15 MIN	BR
	S5121		CHORE SERVICES PER DIEM	BR
	S5125		ATTENDANT CARE SERVICE /15M	BR
	S5126		ATTENDANT CARE SERVICE /DIEM	BR
	S5130		HOMAKER SERVICE NOS PER 15M	BR
	S5131		HOMEMAKER SERVICE NOS /DIEM	BR
	S5135		ADULT COMPANIONCARE PER 15M	BR
	S5136		ADULT COMPANIONCARE PER DIEM	BR
	S5140		ADULT FOSTER CARE PER DIEM	BR
	S5141		ADULT FOSTER CARE PER MONTH	BR
	S5145		CHILD FOSTERCARE TH PER DIEM	BR
	S5146		THER FOSTERCARE CHILD /MONTH	BR
	S5150		UNSKILLED RESPITE CARE /15M	See Home Health Rules
	S5151		UNSKILLED RESPITECARE /DIEM	See Home Health Rules
	S5160		EMER RESPONSE SYS INSTAL&TST	BR
	S5161		EMER RSPNS SYS SERV PERMONTH	BR
	S5162		EMER RSPNS SYSTEM PURCHASE	BR
	S5165		HOME MODIFICATIONS PER SERV	BR
	S5170		HOMEDELIVERED PREPARED MEAL	BR
	S5175		LAUNDRY SERV, EXT, PROF, /ORDER	BR
	S5180		HH RESPIRATORY THRPY IN EVAL	BR
	S5181		HH RESPIRATORY THRPY NOS/DAY	BR
	S5185		MED REMINDER SERV PER MONTH	BR
	S5190		WELLNESS ASSESSMENT BY NONPH	BR
	S5199		PERSONAL CARE ITEM NOS EACH	BR
	S5497		HIT CATH CARE NOC	BR
	S5498		HIT SIMPLE CATH CARE	BR
	S5501		HIT COMPLEX CATH CARE	BR
	S5502		HIT INTERIM CATH CARE	BR
	S5517		HIT DECLOTTING KIT	BR
	S5518		HIT CATH REPAIR KIT	BR
	S5520		HIT PICC INSERT KIT	BR
	S5521		HIT MIDLINE CATH INSERT KIT	BR
	S5522		HIT PICC INSERT NO SUPP	BR
	S5523		HIP MIDLINE CATH INSERT KIT	BR
	S5550		INSULIN RAPID 5 U	BR
	S5551		INSULIN MOST RAPID 5 U	BR
	S5552		INSULIN INTERMED 5 U	BR
	S5553		INSULIN LONG ACTING 5 U	BR
	S5560		INSULIN REUSE PEN 1.5 ML	BR
	S5561		INSULIN REUSE PEN 3 ML	BR
	S5565		INSULIN CARTRIDGE 150 U	BR
	S5566		INSULIN CARTRIDGE 300 U	BR
	S5570		INSULIN DISPOS PEN 1.5 ML	BR
	S5571		INSULIN DISPOS PEN 3 ML	BR
	S8030		TANTALUM RING APPLICATION	BR
	S8035		MAGNETIC SOURCE IMAGING	BR
	S8037		MRCP	BR
	S8040		TOPOGRAPHIC BRAIN MAPPING	BR
	S8042		MRI LOW FIELD	BR
	S8055		US GUIDANCE FETAL REDUCT	BR
	S8080		SCINTIMAMMOGRAPHY	BR
	S8085		FLUORINE-18 FLUORODEOXYGLUCO	BR
	S8092		ELECTRON BEAM COMPUTED TOMOG	BR
	S8096		PORTABLE PEAK FLOW METER	BR
	S8097		ASTHMA KIT	BR
	S8100		SPACER WITHOUT MASK	BR
	S8101		SPACER WITH MASK	BR
	S8110		PEAK EXPIRATORY FLOW RATE (P	BR
	S8120		O2 CONTENTS GAS CUBIC FT	BR
	S8121		O2 CONTENTS LIQUID LB	BR
	S8130		INTERFERENTIAL STIM 2 CHAN	BR
	S8131		INTERFERENTIAL STIM 4 CHAN	BR
	S8185		FLUTTER DEVICE	BR
	S8186		SWIVEL ADAPTOR	BR
	S8189		TRACH SUPPLY NOC	BR
	S8210		MUCUS TRAP	BR
	S8265		HABERMAN FEEDER	BR
	S8270		ENURESIS ALARM	BR
	S8301		INFECT CONTROL SUPPLIES NOS	BR
	S8415		SUPPLIES FOR HOME DELIVERY	BR
	S8420		CUSTOM GRADIENT SLEEV/GLOV	BR
	S8421		READY GRADIENT SLEEV/GLOV	BR
	S8422		CUSTOM GRAD SLEEVE MED	BR
	S8423		CUSTOM GRAD SLEEVE HEAVY	BR
	S8424		READY GRADIENT SLEEVE	BR
	S8425		CUSTOM GRAD GLOVE MED	BR
	S8426		CUSTOM GRAD GLOVE HEAVY	BR
	S8427		READY GRADIENT GLOVE	BR
	S8428		READY GRADIENT GAUNTLET	BR
	S8429		GRADIENT PRESSURE WRAP	BR
	S8430		PADDING FOR COMPRSSN BDG	BR
	S8431		COMPRESSION BANDAGE	BR
	S8450		SPLINT DIGIT	BR
	S8451		SPLINT WRIST OR ANKLE	BR
	S8452		SPLINT ELBOW	BR
	S8460		CAMISOLE POST-MAST	BR
	S8490		100 INSULIN SYRINGES	BR
	S8930		AURICULAR ELECTROSTIMULATION	BR
	S8940		HIPPOTHERAPY PER SESSION	BR
	S8948		LOW-LEVEL LASER TRMT 15 MIN	BR
	S8950		COMPLEX LYMPHEDEMA THERAPY,	BR
	S8990		PT OR MANIP FOR MAINT	BR
	S8999		RESUSCITATION BAG	BR
	S9001		HOME UTERINE MONITOR WITH OR	BR
	S9007		ULTRAFILTRATION MONITOR	BR
	S9024		PARANASAL SINUS ULTRASOUND	BR
	S9025		OMNICARDIOGRAM/CARDIOINTEGRA	BR
	S9034		ESWL FOR GALLSTONES	BR
	S9055		PROCUREN OR OTHER GROWTH FAC	BR
	S9056		COMA STIMULATION PER DIEM	BR
	S9061		MEDICAL SUPPLIES AND EQUIPME	BR
	S9083		URGENT CARE CENTER GLOBAL	BR
	S9088		SERVICES PROVIDED IN URGENT	BR
	S9090		VERTEBRAL AXIAL DECOMPRESSIO	BR
	S9097		HOME VISIT WOUND CARE	BR
	S9098		HOME PHOTOTHERAPY VISIT	BR
	S9110		TELEMONITORING/HOME PER MNTH	BR
	S9117		BACK SCHOOL VISIT	BR
	S9122		HOME HEALTH AIDE OR CERTIFIE	55.00
	S9123		NURSING CARE IN HOME RN	125.00
	S9124		NURSING CARE, IN THE HOME; B	BR
	S9125		RESPITE CARE, IN THE HOME, P	See Home Health Rules
	S9126		HOSPICE CARE, IN THE HOME, P	See Home Health Rules
	S9127		SOCIAL WORK VISIT, IN THE HO	125.00
	S9128		SPEECH THERAPY, IN THE HOME,	125.00
	S9129		OCCUPATIONAL THERAPY, IN THE	125.00
	S9131		PT IN THE HOME PER DIEM	125.00
	S9140		DIABETIC MANAGEMENT PROGRAM,	BR
	S9141		DIABETIC MANAGEMENT PROGRAM,	BR
	S9145		INSULIN PUMP INITIATION	BR
	S9150		EVALUATION BY OCULARIST	BR
	S9152		SPEECH THERAPY, RE-EVAL	BR
	S9208		HOME MGMT PRETERM LABOR	BR
	S9209		HOME MGMT PPROM	BR
	S9211		HOME MGMT GEST HYPERTENSION	BR
	S9212		HM POSTPAR HYPER PER DIEM	BR
	S9213		HM PREECLAMP PER DIEM	BR
	S9214		HM GEST DM PER DIEM	BR
	S9325		HIT PAIN MGMT PER DIEM	BR
	S9326		HIT CONT PAIN PER DIEM	BR
	S9327		HIT INT PAIN PER DIEM	BR
	S9328		HIT PAIN IMP PUMP DIEM	BR
	S9329		HIT CHEMO PER DIEM	BR
	S9330		HIT CONT CHEM DIEM	BR
	S9331		HIT INTERMIT CHEMO DIEM	BR
	S9335		HT HEMODIALYSIS DIEM	BR
	S9336		HIT CONT ANTICOAG DIEM	BR
	S9338		HIT IMMUNOTHERAPY DIEM	BR
	S9339		HIT PERITON DIALYSIS DIEM	BR
	S9340		HIT ENTERAL PER DIEM	BR
	S9341		HIT ENTERAL GRAV DIEM	BR
	S9342		HIT ENTERAL PUMP DIEM	BR
	S9343		HIT ENTERAL BOLUS NURS	BR
	S9345		HIT ANTI-HEMOPHIL DIEM	BR
	S9346		HIT ALPHA-1-PROTEINAS DIEM	BR
	S9347		HIT LONGTERM INFUSION DIEM	BR
	S9348		HIT SYMPATHOMIM DIEM	BR
	S9349		HIT TOCOLYSIS DIEM	BR
	S9351		HIT CONT ANTIEMETIC DIEM	BR
	S9353		HIT CONT INSULIN DIEM	BR
	S9355		HIT CHELATION DIEM	BR
	S9357		HIT ENZYME REPLACE DIEM	BR
	S9359		HIT ANTI-TNF PER DIEM	BR
	S9361		HIT DIURETIC INFUS DIEM	BR
	S9363		HIT ANTI-SPASMOTIC DIEM	BR
	S9364		HIT TPN TOTAL DIEM	BR
	S9365		HIT TPN 1 LITER DIEM	BR
	S9366		HIT TPN 2 LITER DIEM	BR
	S9367		HIT TPN 3 LITER DIEM	BR
	S9368		HIT TPN OVER 3L DIEM	BR
	S9370		HT INJ ANTIEMETIC DIEM	BR
	S9372		HT INJ ANTICOAG DIEM	BR
	S9373		HIT HYDRA TOTAL DIEM	BR
	S9374		HIT HYDRA 1 LITER DIEM	BR
	S9375		HIT HYDRA 2 LITER DIEM	BR
	S9376		HIT HYDRA 3 LITER DIEM	BR
	S9377		HIT HYDRA OVER 3L DIEM	BR
	S9379		HIT NOC PER DIEM	BR
	S9381		HIT HIGH RISK/ESCORT	BR
	S9401		ANTICOAG CLINIC PER SESSION	BR
	S9430		PHARMACY COMP/DISP SERV	see page 75
	S9433		MEDICAL FOOD ORAL 100% NUTR	BR
	S9434		MOD SOLID FOOD SUPPL	BR
	S9435		MEDICAL FOODS FOR INBORN ERR	BR
	S9436		LAMAZE CLASS	BR
	S9437		CHILDBIRTH REFRESHER CLASS	BR
	S9438		CESAREAN BIRTH CLASS	BR
	S9439		VBAC CLASS	BR
	S9441		ASTHMA EDUCATION	BR
	S9442		BIRTHING CLASS	BR
	S9443		LACTATION CLASS	BR
	S9444		PARENTING CLASS	BR
	S9445		PT EDUCATION NOC INDIVID	BR
	S9446		PT EDUCATION NOC GROUP	BR
	S9447		INFANT SAFETY CLASS	BR
	S9449		WEIGHT MGMT CLASS	BR
	S9451		EXERCISE CLASS	BR
	S9452		NUTRITION CLASS	BR
	S9453		SMOKING CESSATION CLASS	BR
	S9454		STRESS MGMT CLASS	BR
	S9455		DIABETIC MANAGEMENT PROGRAM,	BR
	S9460		DIABETIC MANAGEMENT PROGRAM,	BR
	S9465		DIABETIC MANAGEMENT PROGRAM,	BR
	S9470		NUTRITIONAL COUNSELING, DIET	BR
	S9472		CARDIAC REHABILITATION PROGR	BR
	S9473		PULMONARY REHABILITATION PRO	BR
	S9474		ENTEROSTOMAL THERAPY BY A RE	BR
	S9475		AMBULATORY SETTING SUBSTANCE	BR
	S9476		VESTIBULAR REHAB PER DIEM	BR
	S9480		INTENSIVE OUTPATIENT PSYCHIA	BR
	S9482		FAMILY STABILIZATION 15 MIN	BR
	S9484		CRISIS INTERVENTION PER HOUR	BR
	S9485		CRISIS INTERVENTION MENTAL H	BR
	S9490		HIT CORTICOSTEROID/DIEM	BR
	S9494		HIT ANTIBIOTIC TOTAL DIEM	BR
	S9497		HIT ANTIBIOTIC Q3H DIEM	BR
	S9500		HIT ANTIBIOTIC Q24H DIEM	BR
	S9501		HIT ANTIBIOTIC Q12H DIEM	BR
	S9502		HIT ANTIBIOTIC Q8H DIEM	BR
	S9503		HIT ANTIBIOTIC Q6H DIEM	BR
	S9504		HIT ANTIBIOTIC Q4H DIEM	BR
	S9529		VENIPUNCTURE HOME/SNF	BR
	S9537		HT HEM HORM INJ DIEM	BR
	S9538		HIT BLOOD PRODUCTS DIEM	BR
	S9542		HT INJ NOC PER DIEM	BR
	S9558		HT INJ GROWTH HORM DIEM	BR
	S9559		HIT INJ INTERFERON DIEM	BR
	S9560		HT INJ HORMONE DIEM	BR
	S9562		HT INJ PALIVIZUMAB DIEM	BR
	S9590		HT IRRIGATION DIEM	BR
	S9810		HT PHARM PER HOUR	BR
	S9900		CHRISTIAN SCI PRACT VISIT	BR
	S9901		CHRISTIAN SCI NURSE VISIT	BR
	S9960		AIR AMBULANC NONEMERG FIXED	BR
	S9961		AIR AMBULAN NONEMERG ROTARY	BR
	S9970		HEALTH CLUB MEMBERSHIP YR	BR
	S9975		TRANSPLANT RELATED PER DIEM	BR
	S9976		LODGING PER DIEM	BR
	S9977		MEALS PER DIEM	BR
	S9981		MED RECORD COPY ADMIN	BR
	S9982		MED RECORD COPY PER PAGE	BR
	S9986		NOT MEDICALLY NECESSARY SVC	BR
	S9988		SERV PART OF PHASE I TRIAL	BR
	S9989		SERVICES OUTSIDE US	BR
	S9990		SERVICES PROVIDED AS PART OF	BR
	S9991		SERVICES PROVIDED AS PART OF	BR
	S9992		TRANSPORTATION COSTS TO AND	BR
	S9994		LODGING COSTS (E.G. HOTEL CH	BR
	S9996		MEALS FOR CLINICAL TRIAL PAR	BR
	S9999		SALES TAX	BR
	V2020		VISION SVCS FRAMES PURCHASES	87.69
	V2025		EYEGLASSES DELUX FRAMES	BR
	V2100		LENS SPHER SINGLE PLANO 4.00	42.63
	V2101		SINGLE VISN SPHERE 4.12-7.00	44.91
	V2102		SINGL VISN SPHERE 7.12-20.00	63.69
	V2103		SPHEROCYLINDR 4.00D/12-2.00D	37.00
	V2104		SPHEROCYLINDR 4.00D/2.12-4D	40.99
	V2105		SPHEROCYLINDER 4.00D/4.25-6D	50.18
	V2106		SPHEROCYLINDER 4.00D/>6.00D	50.92
	V2107		SPHEROCYLINDER 4.25D/12-2D	53.52
	V2108		SPHEROCYLINDER 4.25D/2.12-4D	51.91
	V2109		SPHEROCYLINDER 4.25D/4.25-6D	59.66
	V2110		SPHEROCYLINDER 4.25D/OVER 6D	69.64
	V2111		SPHEROCYLINDR 7.25D/.25-2.25	61.38
	V2112		SPHEROCYLINDR 7.25D/2.25-4D	60.58
	V2113		SPHEROCYLINDR 7.25D/4.25-6D	83.69
	V2114		SPHEROCYLINDER OVER 12.00D	74.02
	V2115		LENS LENTICULAR BIFOCAL	80.48
	V2118		LENS ANISEIKONIC SINGLE	79.78
	V2121		LENTICULAR LENS, SINGLE	82.37
	V2199		LENS SINGLE VISION NOT OTH C	BR
	V2200		LENS SPHER BIFOC PLANO 4.00D	55.78
	V2201		LENS SPHERE BIFOCAL 4.12-7.0	60.79
	V2202		LENS SPHERE BIFOCAL 7.12-20.	71.53
	V2203		LENS SPHCYL BIFOCAL 4.00D/.1	56.28
	V2204		LENS SPHCY BIFOCAL 4.00D/2.1	61.02
	V2205		LENS SPHCY BIFOCAL 4.00D/4.2	66.95
	V2206		LENS SPHCY BIFOCAL 4.00D/OVE	81.51
	V2207		LENS SPHCY BIFOCAL 4.25-7D/.	68.04
	V2208		LENS SPHCY BIFOCAL 4.25-7/2.	68.87
	V2209		LENS SPHCY BIFOCAL 4.25-7/4.	75.75
	V2210		LENS SPHCY BIFOCAL 4.25-7/OV	97.46
	V2211		LENS SPHCY BIFO 7.25-12/.25-	83.11
	V2212		LENS SPHCYL BIFO 7.25-12/2.2	90.43
	V2213		LENS SPHCYL BIFO 7.25-12/4.2	92.74
	V2214		LENS SPHCYL BIFOCAL OVER 12.	99.41
	V2215		LENS LENTICULAR BIFOCAL	107.57
	V2218		LENS ANISEIKONIC BIFOCAL	110.06
	V2219		LENS BIFOCAL SEG WIDTH OVER	48.44
	V2220		LENS BIFOCAL ADD OVER 3.25D	39.29
	V2221		LENTICULAR LENS, BIFOCAL	104.96
	V2299		LENS BIFOCAL SPECIALITY	BR
	V2300		LENS SPHERE TRIFOCAL 4.00D	72.44
	V2301		LENS SPHERE TRIFOCAL 4.12-7.	84.01
	V2302		LENS SPHERE TRIFOCAL 7.12-20	92.03
	V2303		LENS SPHCY TRIFOCAL 4.0/.12-	76.25
	V2304		LENS SPHCY TRIFOCAL 4.0/2.25	79.78
	V2305		LENS SPHCY TRIFOCAL 4.0/4.25	97.85
	V2306		LENS SPHCYL TRIFOCAL 4.00/>6	91.22
	V2307		LENS SPHCY TRIFOCAL 4.25-7/.	90.45
	V2308		LENS SPHC TRIFOCAL 4.25-7/2.	96.53
	V2309		LENS SPHC TRIFOCAL 4.25-7/4.	112.93
	V2310		LENS SPHC TRIFOCAL 4.25-7/>6	124.22
	V2311		LENS SPHC TRIFO 7.25-12/.25-	118.29
	V2312		LENS SPHC TRIFO 7.25-12/2.25	104.28
	V2313		LENS SPHC TRIFO 7.25-12/4.25	142.34
	V2314		LENS SPHCYL TRIFOCAL OVER 12	155.91
	V2315		LENS LENTICULAR TRIFOCAL	173.10
	V2318		LENS ANISEIKONIC TRIFOCAL	159.60
	V2319		LENS TRIFOCAL SEG WIDTH > 28	54.03
	V2320		LENS TRIFOCAL ADD OVER 3.25D	57.00
	V2321		LENTICULAR LENS, TRIFOCAL	170.61
	V2399		LENS TRIFOCAL SPECIALITY	BR
	V2410		LENS VARIAB ASPHERICITY SING	97.56
	V2430		LENS VARIABLE ASPHERICITY BI	127.01
	V2499		VARIABLE ASPHERICITY LENS	BR
	V2500		CONTACT LENS PMMA SPHERICAL	88.43
	V2501		CNTCT LENS PMMA-TORIC/PRISM	134.71
	V2502		CONTACT LENS PMMA BIFOCAL	165.95
	V2503		CNTCT LENS PMMA COLOR VISION	158.79
	V2510		CNTCT GAS PERMEABLE SPHERICL	120.71
	V2511		CNTCT TORIC PRISM BALLAST	173.45
	V2512		CNTCT LENS GAS PERMBL BIFOCL	204.95
	V2513		CONTACT LENS EXTENDED WEAR	172.06
	V2520		CONTACT LENS HYDROPHILIC	113.47
	V2521		CNTCT LENS HYDROPHILIC TORIC	197.55
	V2522		CNTCT LENS HYDROPHIL BIFOCL	192.25
	V2523		CNTCT LENS HYDROPHIL EXTEND	163.83
	V2530		CONTACT LENS GAS IMPERMEABLE	242.66
	V2531		CONTACT LENS GAS PERMEABLE	595.73
	V2599		CONTACT LENS/ES OTHER TYPE	BR
	V2600		HAND HELD LOW VISION AIDS	BR
	V2610		SINGLE LENS SPECTACLE MOUNT	BR
	V2615		TELESCOP/OTHR COMPOUND LENS	BR
	V2623		PLASTIC EYE PROSTH CUSTOM	976.61
	V2624		POLISHING ARTIFICAL EYE	66.23
	V2625		ENLARGEMNT OF EYE PROSTHESIS	429.02
	V2626		REDUCTION OF EYE PROSTHESIS	272.18
	V2627		SCLERAL COVER SHELL	1558.28
	V2628		FABRICATION & FITTING	356.28
	V2629		PROSTHETIC EYE OTHER TYPE	BR
	V2630		ANTER CHAMBER INTRAOCUL LENS	129.50
	V2631		IRIS SUPPORT INTRAOCLR LENS	129.50
	V2632		POST CHMBR INTRAOCULAR LENS	129.50
	V2700		BALANCE LENS	47.66
	V2702		DELUXE LENS FEATURE	BR
	V2710		GLASS/PLASTIC SLAB OFF PRISM	69.76
	V2715		PRISM LENS/ES	12.65
	V2718		FRESNELL PRISM PRESS-ON LENS	31.06
	V2730		SPECIAL BASE CURVE	22.95
	V2744		TINT PHOTOCHROMATIC LENS/ES	23.79
	V2745		TINT, ANY COLOR/SOLID/GRAD	13.50
	V2750		ANTI-REFLECTIVE COATING	27.69
	V2755		UV LENS/ES	20.01
	V2756		EYE GLASS CASE	BR
	V2760		SCRATCH RESISTANT COATING	17.42
	V2761		MIRROR COATING	47.89
	V2762		POLARIZATION, ANY LENS	65.59
	V2770		OCCLUDER LENS/ES	22.51
	V2780		OVERSIZE LENS/ES	18.18
	V2781		PROGRESSIVE LENS PER LENS	BR
	V2782		LENS, 1.54-1.65 P/1.60-1.79G	70.82
	V2783		LENS, >= 1.66 P/>=1.80 G	79.86
	V2784		LENS POLYCARB OR EQUAL	51.93
	V2785		CORNEAL TISSUE PROCESSING	BR
	V2786		OCCUPATIONAL MULTIFOCAL LENS	BR
	V2787		ASTIGMATISM-CORRECT FUNCTION	BR
	V2788		PRESBYOPIA-CORRECT FUNCTION	BR
	V2790		AMNIOTIC MEMBRANE	BR
	V2797		VIS ITEM/SVC IN OTHER CODE	BR
	V2799		MISC VISION ITEM OR SERVICE	BR
	V5008		HEARING SCREENING	49.70
	V5010		ASSESSMENT FOR HEARING AID	91.94
	V5011		HEARING AID FITTING/CHECKING	165.70
	V5014		HEARING AID REPAIR/MODIFYING	159.58
	V5020		CONFORMITY EVALUATION	106.40
	V5030		BODY-WORN HEARING AID AIR	1277.15
	V5040		BODY-WORN HEARING AID BONE	627.72
	V5050		HEARING AID MONAURAL IN EAR	1596.10
	V5060		BEHIND EAR HEARING AID	2389.21
	V5070		GLASSES AIR CONDUCTION	337.01
	V5080		GLASSES BONE CONDUCTION	846.75
	V5090		HEARING AID DISPENSING FEE	292.69
	V5095		IMPLANT MID EAR HEARING PROS	BR
	V5100		BODY-WORN BILAT HEARING AID	1436.20
	V5110		HEARING AID DISPENSING FEE	532.01
	V5120		BODY-WORN BINAUR HEARING AID	1754.26
	V5130		IN EAR BINAURAL HEARING AID	3192.41
	V5140		BEHIND EAR BINAUR HEARING AI	4363.17
	V5150		GLASSES BINAURAL HEARING AID	1402.80
	V5160		DISPENSING FEE BINAURAL	638.47
	V5171		HEARING AID MONAURAL ITE	BR
	V5172		HEARING AID MONAURAL ITC	BR
	V5181		HEARING AID MONAURAL BTE	BR
	V5190		HEARING AID MONAURAL GLASSES	965.13
	V5200		DISP FEE CONTRALATERAL MONAU	425.63
	V5211		HEARING AID BINAURAL ITE/ITE	BR
	V5212		HEARING AID BINAURAL ITE/ITC	BR
	V5213		HEARING AID BINAURAL ITE/BTE	BR
	V5214		HEARING AID BINAURAL ITC/ITC	BR
	V5215		HEARING AID BINAURAL ITC/BTE	BR
	V5221		HEARING AID BINAURAL BTE/BTE	BR
	V5230		HEARING AID BINAURAL GLASSES	1052.90
	V5240		DISP FEE CONTRALATERAL BINAU	691.68
	V5241		DISPENSING FEE, MONAURAL	BR
	V5242		HEARING AID, MONAURAL, CIC	BR
	V5243		HEARING AID, MONAURAL, ITC	BR
	V5244		HEARING AID, PROG, MON, CIC	BR
	V5245		HEARING AID, PROG, MON, ITC	BR
	V5246		HEARING AID, PROG, MON, ITE	BR
	V5247		HEARING AID, PROG, MON, BTE	BR
	V5248		HEARING AID, BINAURAL, CIC	BR
	V5249		HEARING AID, BINAURAL, ITC	BR
	V5250		HEARING AID, PROG, BIN, CIC	BR
	V5251		HEARING AID, PROG, BIN, ITC	BR
	V5252		HEARING AID, PROG, BIN, ITE	BR
	V5253		HEARING AID, PROG, BIN, BTE	BR
	V5254		HEARING ID, DIGIT, MON, CIC	BR
	V5255		HEARING AID, DIGIT, MON, ITC	BR
	V5256		HEARING AID, DIGIT, MON, ITE	BR
	V5257		HEARING AID, DIGIT, MON, BTE	BR
	V5258		HEARING AID, DIGIT, BIN, CIC	BR
	V5259		HEARING AID, DIGIT, BIN, ITC	BR
	V5260		HEARING AID, DIGIT, BIN, ITE	BR
	V5261		HEARING AID, DIGIT, BIN, BTE	BR
	V5262		HEARING AID, DISP, MONAURAL	BR
	V5263		HEARING AID, DISP, BINAURAL	BR
	V5264		EAR MOLD/INSERT	BR
	V5265		EAR MOLD/INSERT, DISP	BR
	V5266		BATTERY FOR HEARING DEVICE	BR
	V5267		HEARING AID SUP/ACCESS/DEV	BR
	V5268		ALD TELEPHONE AMPLIFIER	BR
	V5269		ALERTING DEVICE, ANY TYPE	BR
	V5270		ALD, TV AMPLIFIER, ANY TYPE	BR
	V5271		ALD, TV CAPTION DECODER	BR
	V5272		TDD	BR
	V5273		ALD FOR COCHLEAR IMPLANT	BR
	V5274		ALD UNSPECIFIED	BR
	V5275		EAR IMPRESSION	BR
	V5281		ALD FM/DM SYSTEM, MONAURAL	BR
	V5282		ALD FM/DM SYSTEM BINAURAL	BR
	V5283		ALD NECK, LOOP IND RECEIVER	BR
	V5284		ALD FM/DM EAR LEVEL RECEIVER	BR
	V5285		ALD FM/DM AUD INPUT RECEIVER	BR
	V5286		ALD BLU TOOTH FM/DM RECEIVER	BR
	V5287		ALD FM/DM RECEIVER, NOS	BR
	V5288		ALD FM/DM TRANSMITTER ALD	BR
	V5289		ALD FM/DM ADAPT/BOOT COUPLIN	BR
	V5290		ALD TRANSMITTER MICROPHONE	BR
	V5298		HEARING AID NOC	BR
	V5299		HEARING SERVICE	BR
	V5336		REPAIR COMMUNICATION DEVICE	BR
	V5362		SPEECH SCREENING	BR
	V5363		LANGUAGE SCREENING	BR
	V5364		DYSPHAGIA SCREENING	BR

20 Miss. Code. R. § 2-II

Amended 6/14/2017

Amended 6/15/2019.