[Federal Register: September 8, 1998 (Volume 63, Number 173)] [Proposed Rules] [Page 47701-47750] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr08se98-37] [[pp. 47701-47750]] Medicare Program; Prospective Payment System for Hospital Outpatient Services [[Continued from page 47700]] [[Page 47700]] 82585... A Assay cryofibrinogen... ......... ......... ......... ........... ........... 82595... A Assay cryoglobulin..... ......... ......... ......... ........... ........... 82600... A Assay cyanide.......... ......... ......... ......... ........... ........... 82607... A Vitamin B-12........... ......... ......... ......... ........... ........... 82608... A B-12 binding capacity.. ......... ......... ......... ........... ........... 82615... A Test for urine cystines ......... ......... ......... ........... ........... 82626... A Dehydroepiandrosterone. ......... ......... ......... ........... ........... 82627... A Dehydroepiandrosterone. ......... ......... ......... ........... ........... 82633... A Desoxycorticoster one. ......... ......... ......... ........... ........... 82634... A Deoxycortisol.......... ......... ......... ......... ........... ........... 82638... A Assay dibucaine number. ......... ......... ......... ........... ........... 82646... A Assay of ......... ......... ......... ........... ........... dihydrocodeinone. 82649... A Assay of dihydromorphin ......... ......... ......... ........... ........... one. 82651... A Dihydrotestosterone ......... ......... ......... ........... ........... assay. 82652... A Assay, dihydroxyvitamin ......... ......... ......... ........... ........... D. 82654... A Assay of dimethadione.. ......... ......... ......... ........... ........... 82664... A Electrophoretic test... ......... ......... ......... ........... ........... 82666... A Epiandrosterone assay.. ......... ......... ......... ........... ........... 82668... A Erythropoietin......... ......... ......... ......... ........... ........... 82670... A Estradiol.............. ......... ......... ......... ........... ........... 82671... A Estrogens assay........ ......... ......... ......... ........... ........... 82672... A Estrogen assay......... ......... ......... ......... ........... ........... 82677... A Estriol................ ......... ......... ......... ........... ........... 82679... A Estrone................ ......... ......... ......... ........... ........... 82690... A Ethchlorvynol.......... ......... ......... ......... ........... ........... 82693... A Ethylene glycol........ ......... ......... ......... ........... ........... 82696... A Etiocholanolone........ ......... ......... ......... ........... ........... 82705... A Fats/lipids, feces, ......... ......... ......... ........... ........... qualitative. 82710... A Fats/lipids, feces, ......... ......... ......... ........... ........... quantitative. 82715... A Fecal fat assay........ ......... ......... ......... ........... ........... 82725... A Assay blood fatty acids ......... ......... ......... ........... ........... 82728... A Assay ferritin......... ......... ......... ......... ........... ........... 82735... A Assay fluoride......... ......... ......... ......... ........... ........... 82742... A Assay of flurazepam.... ......... ......... ......... ........... ........... 82746... A Blood folic acid serum. ......... ......... ......... ........... ........... 82747... A Folic acid, RBC........ ......... ......... ......... ........... ........... 82757... A Assay semen fructose... ......... ......... ......... ........... ........... 82759... A RBC galactokinase assay ......... ......... ......... ........... ........... 82760... A Assay galactose........ ......... ......... ......... ........... ........... 82775... A Assay galactose ......... ......... ......... ........... ........... transferase. 82776... A Galactose transferase ......... ......... ......... ........... ........... test. 82784... A Assay gammaglobulin IgM ......... ......... ......... ........... ........... 82785... A Assay, gammaglobulin ......... ......... ......... ........... ........... IgE. 82787... A IgG1, 2, 3 and 4....... ......... ......... ......... ........... ........... 82800... A Blood pH............... ......... ......... ......... ........... ........... 82803... A Blood gases: pH, pO2 & ......... ......... ......... ........... ........... pCO2. 82805... A Blood gases W/02 ......... ......... ......... ........... ........... saturation. 82810... A Blood gases, O2 sat ......... ......... ......... ........... ........... only. 82820... A Hemoglobin-oxygen ......... ......... ......... ........... ........... affinity. 82926... A Assay gastric acid..... ......... ......... ......... ........... ........... 82928... A Assay gastric acid..... ......... ......... ......... ........... ........... 82938... A Gastrin test........... ......... ......... ......... ........... ........... 82941... A Assay of gastrin....... ......... ......... ......... ........... ........... 82943... A Assay of glucagon...... ......... ......... ......... ........... ........... 82946... A Glucagon tolerance test ......... ......... ......... ........... ........... 82947... A Assay quantitative, ......... ......... ......... ........... ........... glucose. 82948... A Reagent strip/blood ......... ......... ......... ........... ........... glucose. 82950... A Glucose test........... ......... ......... ......... ........... ........... 82951... A Glucose tolerance test ......... ......... ......... ........... ........... (GTT). 82952... A GTT-added samples...... ......... ......... ......... ........... ........... 82953... A Glucose-tolbutamide ......... ......... ......... ........... ........... test. 82955... A Assay G6PD enzyme...... ......... ......... ......... ........... ........... 82960... A Test for G6PD enzyme... ......... ......... ......... ........... ........... 82962... A Glucose blood test..... ......... ......... ......... ........... ........... 82963... A Glucosidase assay...... ......... ......... ......... ........... ........... 82965... A Assay GDH enzyme....... ......... ......... ......... ........... ........... 82975... A Assay glutamine........ ......... ......... ......... ........... ........... 82977... A Assay of GGT........... ......... ......... ......... ........... ........... 82978... A Glutathione assay...... ......... ......... ......... ........... ........... 82979... A Assay RBC glutathione ......... ......... ......... ........... ........... enzyme. 82980... A Assay of glutethimide.. ......... ......... ......... ........... ........... 82985... A Glycated protein....... ......... ......... ......... ........... ........... 83001... A Gonadotropin (FSH)..... ......... ......... ......... ........... ........... 83002... A Gonadotropin (LH)...... ......... ......... ......... ........... ........... 83003... A Assay growth hormone ......... ......... ......... ........... ........... (HGH). [[Page 47701]] 83008... A Assay guanosine........ ......... ......... ......... ........... ........... 83010... A Quant assay haptoglobin ......... ......... ......... ........... ........... 83012... A Assay haptoglobins..... ......... ......... ......... ........... ........... 83015... A Heavy metal screen..... ......... ......... ......... ........... ........... 83018... A Quantitative screen, ......... ......... ......... ........... ........... metals. 83019... A Breath isotope test.... ......... ......... ......... ........... ........... 83020... A Assay hemoglobin....... ......... ......... ......... ........... ........... 83026... A Hemoglobin, copper ......... ......... ......... ........... ........... sulfate. 83030... A Fetal hemoglobin assay. ......... ......... ......... ........... ........... 83033... A Fetal fecal hemoglobin ......... ......... ......... ........... ........... assay. 83036... A Glycated hemoglobin ......... ......... ......... ........... ........... test. 83045... A Blood methemoglobin ......... ......... ......... ........... ........... test. 83050... A Blood methemoglobin ......... ......... ......... ........... ........... assay. 83051... A Assay plasma hemoglobin ......... ......... ......... ........... ........... 83055... A Blood sulfhemoglobin ......... ......... ......... ........... ........... test. 83060... A Blood sulfhemoglobin ......... ......... ......... ........... ........... assay. 83065... A Hemoglobin heat assay.. ......... ......... ......... ........... ........... 83068... A Hemoglobin stability ......... ......... ......... ........... ........... screen. 83069... A Assay urine hemoglobin. ......... ......... ......... ........... ........... 83070... A Qualt assay hemosiderin ......... ......... ......... ........... ........... 83071... A Quant assay of ......... ......... ......... ........... ........... hemosiderin. 83088... A Assay histamine........ ......... ......... ......... ........... ........... 83150... A Assay for HVA.......... ......... ......... ......... ........... ........... 83491... A Assay of ......... ......... ......... ........... ........... corticosteroids. 83497... A Assay 5-HIAA........... ......... ......... ......... ........... ........... 83498... A Assay of progesterone.. ......... ......... ......... ........... ........... 83499... A Assay of progesterone.. ......... ......... ......... ........... ........... 83500... A Assay free ......... ......... ......... ........... ........... hydroxyproline. 83505... A Assay total ......... ......... ......... ........... ........... hydroxyproline. 83516... A Immunoassay, non ......... ......... ......... ........... ........... antibody. 83518... A Immunoassay, dipstick.. ......... ......... ......... ........... ........... 83519... A Immunoassay nonantibody ......... ......... ......... ........... ........... 83520... A Immunoassay, RIA....... ......... ......... ......... ........... ........... 83525... A Assay of insulin....... ......... ......... ......... ........... ........... 83527... A Assay of insulin....... ......... ......... ......... ........... ........... 83528... A Assay intrinsic factor. ......... ......... ......... ........... ........... 83540... A Assay iron............. ......... ......... ......... ........... ........... 83550... A Iron binding test...... ......... ......... ......... ........... ........... 83570... A Assay IDH enzyme....... ......... ......... ......... ........... ........... 83582... A Assay ketogenic ......... ......... ......... ........... ........... steroids. 83586... A Assay 17-(17- ......... ......... ......... ........... ........... KS)ketosteroids. 83593... A Fractionation ......... ......... ......... ........... ........... ketosteroids. 83605... A Lactic acid assay...... ......... ......... ......... ........... ........... 83615... A Lactate (LD) (LDH) ......... ......... ......... ........... ........... enzyme. 83625... A Assay LDH enzymes...... ......... ......... ......... ........... ........... 83632... A Placental lactogen..... ......... ......... ......... ........... ........... 83633... A Test urine for lactose. ......... ......... ......... ........... ........... 83634... A Assay urine for lactose ......... ......... ......... ........... ........... 83655... A Assay for lead......... ......... ......... ......... ........... ........... 83661... A Assay L/S ratio........ ......... ......... ......... ........... ........... 83662... A L/S ratio, foam ......... ......... ......... ........... ........... stability. 83670... A Assay LAP enzyme....... ......... ......... ......... ........... ........... 83690... A Assay lipase........... ......... ......... ......... ........... ........... 83715... A Assay blood ......... ......... ......... ........... ........... lipoproteins. 83717... A Assay blood ......... ......... ......... ........... ........... lipoproteins. 83718... A Blood lipoprotein assay ......... ......... ......... ........... ........... 83719... A Blood lipoprotein assay ......... ......... ......... ........... ........... 83721... A Blood lipoprotein assay ......... ......... ......... ........... ........... 83727... A LRH hormone assay...... ......... ......... ......... ........... ........... 83735... A Assay magnesium........ ......... ......... ......... ........... ........... 83775... A Assay of md enzyme..... ......... ......... ......... ........... ........... 83785... A Assay of manganese..... ......... ......... ......... ........... ........... 83805... A Assay of meprobamate... ......... ......... ......... ........... ........... 83825... A Assay mercury.......... ......... ......... ......... ........... ........... 83835... A Assay metanephrines.... ......... ......... ......... ........... ........... 83840... A Assay methadone........ ......... ......... ......... ........... ........... 83857... A Assay methemalbumin.... ......... ......... ......... ........... ........... 83858... A Assay methsuximide..... ......... ......... ......... ........... ........... 83864... A Mucopolysaccharides.... ......... ......... ......... ........... ........... 83866... A Mucopolysaccharides ......... ......... ......... ........... ........... screen. 83872... A Assay synovial fluid ......... ......... ......... ........... ........... mucin. 83873... A Assay, CSF protein..... ......... ......... ......... ........... ........... 83874... A Myoglobin.............. ......... ......... ......... ........... ........... 83883... A Nephelometry, not ......... ......... ......... ........... ........... specified. 83885... A Assay for nickel....... ......... ......... ......... ........... ........... [[Page 47702]] 83887... A Assay nicotine......... ......... ......... ......... ........... ........... 83890... A Molecular diagnostics.. ......... ......... ......... ........... ........... 83892... A Molecular diagnostics.. ......... ......... ......... ........... ........... 83894... A Molecular diagnostics.. ......... ......... ......... ........... ........... 83896... A Molecular diagnostics.. ......... ......... ......... ........... ........... 83898... A Molecular diagnostics.. ......... ......... ......... ........... ........... 83902... A Molecular diagnostics.. ......... ......... ......... ........... ........... 83912... A Genetic examination.... ......... ......... ......... ........... ........... 83915... A Assay nucleotidase..... ......... ......... ......... ........... ........... 83916... A Oligoclonal bands...... ......... ......... ......... ........... ........... 83918... A Assay organic acids.... ......... ......... ......... ........... ........... 83925... A Opiates................ ......... ......... ......... ........... ........... 83930... A Assay blood osmolality. ......... ......... ......... ........... ........... 83935... A Assay urine osmolality. ......... ......... ......... ........... ........... 83937... A Assay for osteocalcin.. ......... ......... ......... ........... ........... 83945... A Assay oxalate.......... ......... ......... ......... ........... ........... 83970... A Assay of parathormone.. ......... ......... ......... ........... ........... 83986... A Assay body fluid ......... ......... ......... ........... ........... acidity. 83992... A Assay for phencyclidine ......... ......... ......... ........... ........... 84022... A Assay of phenothiazine. ......... ......... ......... ........... ........... 84030... A Assay blood PKU........ ......... ......... ......... ........... ........... 84035... A Assay phenylketones.... ......... ......... ......... ........... ........... 84060... A Assay acid phosphatase. ......... ......... ......... ........... ........... 84061... A Phosphatase, forensic ......... ......... ......... ........... ........... exam. 84066... A Assay prostate ......... ......... ......... ........... ........... phosphatase. 84075... A Assay alkaline ......... ......... ......... ........... ........... phosphatase. 84078... A Assay alkaline ......... ......... ......... ........... ........... phosphatase. 84080... A Assay alkaline ......... ......... ......... ........... ........... phosphatases. 84081... A Amniotic fluid enzyme ......... ......... ......... ........... ........... test. 84085... A Assay RBC PG6D enzyme.. ......... ......... ......... ........... ........... 84087... A Assay phosphohexose ......... ......... ......... ........... ........... enzymes. 84100... A Assay phosphorus....... ......... ......... ......... ........... ........... 84105... A Assay urine phosphorus. ......... ......... ......... ........... ........... 84106... A Test for ......... ......... ......... ........... ........... porphobilinogen. 84110... A Assay porphobilinogen.. ......... ......... ......... ........... ........... 84119... A Test urine for ......... ......... ......... ........... ........... porphyrins. 84120... A Assay urine porphyrins. ......... ......... ......... ........... ........... 84126... A Assay feces porphyrins. ......... ......... ......... ........... ........... 84127... A Porphyrins, feces...... ......... ......... ......... ........... ........... 84132... A Assay serum potassium.. ......... ......... ......... ........... ........... 84133... A Assay urine potassium.. ......... ......... ......... ........... ........... 84134... A Prealbumin............. ......... ......... ......... ........... ........... 84135... A Assay pregnanediol..... ......... ......... ......... ........... ........... 84138... A Assay pregnanetriol.... ......... ......... ......... ........... ........... 84140... A Assay for pregnenolone. ......... ......... ......... ........... ........... 84143... A Assay/17- ......... ......... ......... ........... ........... hydroxypregnenolone. 84144... A Assay progesterone..... ......... ......... ......... ........... ........... 84146... A Assay for prolactin.... ......... ......... ......... ........... ........... 84150... A Assay of prostaglandin. ......... ......... ......... ........... ........... 84153... A Prostate specific ......... ......... ......... ........... ........... antigen. 84155... A Assay protein.......... ......... ......... ......... ........... ........... 84160... A Assay serum protein.... ......... ......... ......... ........... ........... 84165... A Assay serum proteins... ......... ......... ......... ........... ........... 84181... A Western blot test...... ......... ......... ......... ........... ........... 84182... A Protein, western blot ......... ......... ......... ........... ........... test. 84202... A Assay RBC ......... ......... ......... ........... ........... protoporphyrin. 84203... A Test RBC protoporphyrin ......... ......... ......... ........... ........... 84206... A Assay of proinsulin.... ......... ......... ......... ........... ........... 84207... A Assay vitamin B-6...... ......... ......... ......... ........... ........... 84210... A Assay pyruvate......... ......... ......... ......... ........... ........... 84220... A Assay pyruvate kinase.. ......... ......... ......... ........... ........... 84228... A Assay quinine.......... ......... ......... ......... ........... ........... 84233... A Assay estrogen......... ......... ......... ......... ........... ........... 84234... A Assay progesterone..... ......... ......... ......... ........... ........... 84235... A Assay endocrine hormone ......... ......... ......... ........... ........... 84238... A Assay non-endocrine ......... ......... ......... ........... ........... receptor. 84244... A Assay of renin......... ......... ......... ......... ........... ........... 84252... A Assay vitamin B-2...... ......... ......... ......... ........... ........... 84255... A Assay selenium......... ......... ......... ......... ........... ........... 84260... A Assay serotonin........ ......... ......... ......... ........... ........... 84270... A Sex hormone globulin ......... ......... ......... ........... ........... (SHBG). 84275... A Assay sialic acid...... ......... ......... ......... ........... ........... 84285... A Assay silica........... ......... ......... ......... ........... ........... 84295... A Assay serum sodium..... ......... ......... ......... ........... ........... 84300... A Assay urine sodium..... ......... ......... ......... ........... ........... [[Page 47703]] 84305... A Somatomedin............ ......... ......... ......... ........... ........... 84307... A Somatostatin........... ......... ......... ......... ........... ........... 84311... A Spectrophotometry...... ......... ......... ......... ........... ........... 84315... A Body fluid specific ......... ......... ......... ........... ........... gravity. 84375... A Chromatogram assay, ......... ......... ......... ........... ........... sugars. 84392... A Assay urine sulfate.... ......... ......... ......... ........... ........... 84402... A Testosterone........... ......... ......... ......... ........... ........... 84403... A Assay total ......... ......... ......... ........... ........... testosterone. 84425... A Assay vitamin B-1...... ......... ......... ......... ........... ........... 84430... A Assay thiocyanate...... ......... ......... ......... ........... ........... 84432... A Thyroglobulin.......... ......... ......... ......... ........... ........... 84436... A Assay, total thyroxine. ......... ......... ......... ........... ........... 84437... A Assay neonatal ......... ......... ......... ........... ........... thyroxine. 84439... A Assay, free thyroxine.. ......... ......... ......... ........... ........... 84442... A Thyroid activity (TBG) ......... ......... ......... ........... ........... assay. 84443... A Assay thyroid stim ......... ......... ......... ........... ........... hormone. 84445... A Thyroid immunoglobulins ......... ......... ......... ........... ........... TSI. 84446... A Assay vitamin E........ ......... ......... ......... ........... ........... 84449... A Assay for transcortin.. ......... ......... ......... ........... ........... 84450... A Transferase (AST) ......... ......... ......... ........... ........... (SGOT). 84460... A Alanine amino (ALT) ......... ......... ......... ........... ........... (SGPT). 84466... A Transferrin............ ......... ......... ......... ........... ........... 84478... A Assay triglycerides.... ......... ......... ......... ........... ........... 84479... A Assay thyroid (t-3 or t- ......... ......... ......... ........... ........... 4). 84480... A Assay triiodothyronine ......... ......... ......... ........... ........... (t-3). 84481... A Free assay (FT-3)...... ......... ......... ......... ........... ........... 84482... A T3 reverse............. ......... ......... ......... ........... ........... 84484... A Troponin, quant........ ......... ......... ......... ........... ........... 84485... A Assay duodenal fluid ......... ......... ......... ........... ........... trypsin. 84488... A Test feces for trypsin. ......... ......... ......... ........... ........... 84490... A Assay feces for trypsin ......... ......... ......... ........... ........... 84510... A Assay tyrosine......... ......... ......... ......... ........... ........... 84512... A Troponin, qual......... ......... ......... ......... ........... ........... 84520... A Assay urea nitrogen.... ......... ......... ......... ........... ........... 84525... A Urea nitrogen semi- ......... ......... ......... ........... ........... quant. 84540... A Assay urine urea-N..... ......... ......... ......... ........... ........... 84545... A Urea-N clearance test.. ......... ......... ......... ........... ........... 84550... A Assay blood uric acid.. ......... ......... ......... ........... ........... 84560... A Assay urine uric acid.. ......... ......... ......... ........... ........... 84577... A Assay feces ......... ......... ......... ........... ........... urobilinogen. 84578... A Test urine urobilinogen ......... ......... ......... ........... ........... 84580... A Assay urine ......... ......... ......... ........... ........... urobilinogen. 84583... A Assay urine ......... ......... ......... ........... ........... urobilinogen. 84585... A Assay urine VMA........ ......... ......... ......... ........... ........... 84586... A VIP assay.............. ......... ......... ......... ........... ........... 84588... A Assay vasopressin...... ......... ......... ......... ........... ........... 84590... A Assay vitamin-A........ ......... ......... ......... ........... ........... 84597... A Assay vitamin-K........ ......... ......... ......... ........... ........... 84600... A Assay for volatiles.... ......... ......... ......... ........... ........... 84620... A Xylose tolerance test.. ......... ......... ......... ........... ........... 84630... A Assay zinc............. ......... ......... ......... ........... ........... 84681... A Assay C-peptide........ ......... ......... ......... ........... ........... 84702... A Chorionic gonadotropin ......... ......... ......... ........... ........... test. 84703... A Chorionic gonadotropin ......... ......... ......... ........... ........... assay. 84830... A Ovulation tests........ ......... ......... ......... ........... ........... 84999... A Clinical chemistry test ......... ......... ......... ........... ........... 85002... A Bleeding time test..... ......... ......... ......... ........... ........... 85007... A Differential WBC count. ......... ......... ......... ........... ........... 85008... A Nondifferential WBC ......... ......... ......... ........... ........... count. 85009... A Differential WBC count. ......... ......... ......... ........... ........... 85013... A Hematocrit............. ......... ......... ......... ........... ........... 85014... A Hematocrit............. ......... ......... ......... ........... ........... 85018... A Hemoglobin............. ......... ......... ......... ........... ........... 85021... A Automated hemogram..... ......... ......... ......... ........... ........... 85022... A Automated hemogram..... ......... ......... ......... ........... ........... 85023... A Automated hemogram..... ......... ......... ......... ........... ........... 85024... A Automated hemogram..... ......... ......... ......... ........... ........... 85025... A Automated hemogram..... ......... ......... ......... ........... ........... 85027... A Automated hemogram..... ......... ......... ......... ........... ........... 85029... A Automated hemogram..... ......... ......... ......... ........... ........... 85030... A Automated hemogram..... ......... ......... ......... ........... ........... 85031... A Manual hemogram, ......... ......... ......... ........... ........... complete cbc. 85041... A Red blood cell (RBC) ......... ......... ......... ........... ........... count. 85044... A Reticulocyte count..... ......... ......... ......... ........... ........... 85045... A Reticulocyte count..... ......... ......... ......... ........... ........... [[Page 47704]] 85048... A White blood cell (WBC) ......... ......... ......... ........... ........... count. 85060... X Blood smear 882 0.39 $20.57 $11.75 $4.11 interpretation. 85095... T Bone marrow aspiration. 121 0.67 $35.26 $21.02 $7.05 85097... X Bone marrow 882 0.39 $20.57 $11.75 $4.11 interpretation. 85102... T Bone marrow biopsy..... 121 0.67 $35.26 $21.02 $7.05 85130... A Chromogenic substrate ......... ......... ......... ........... ........... assay. 85170... A Blood clot retraction.. ......... ......... ......... ........... ........... 85175... A Blood clot lysis time.. ......... ......... ......... ........... ........... 85210... A Blood clot factor II ......... ......... ......... ........... ........... test. 85220... A Blood clot factor V ......... ......... ......... ........... ........... test. 85230... A Blood clot factor VII ......... ......... ......... ........... ........... test. 85240... A Blood clot factor VIII ......... ......... ......... ........... ........... test. 85244... A Blood clot factor VIII ......... ......... ......... ........... ........... test. 85245... A Blood clot factor VIII ......... ......... ......... ........... ........... test. 85246... A Blood clot factor VIII ......... ......... ......... ........... ........... test. 85247... A Blood clot factor VIII ......... ......... ......... ........... ........... test. 85250... A Blood clot factor IX ......... ......... ......... ........... ........... test. 85260... A Blood clot factor X ......... ......... ......... ........... ........... test. 85270... A Blood clot factor XI ......... ......... ......... ........... ........... test. 85280... A Blood clot factor XII ......... ......... ......... ........... ........... test. 85290... A Blood clot factor XIII ......... ......... ......... ........... ........... test. 85291... A Blood clot factor XIII ......... ......... ......... ........... ........... test. 85292... A Blood clot factor assay ......... ......... ......... ........... ........... 85293... A Blood clot factor assay ......... ......... ......... ........... ........... 85300... A Antithrombin III test.. ......... ......... ......... ........... ........... 85301... A Antithrombin III test.. ......... ......... ......... ........... ........... 85302... A Blood clot inhibitor ......... ......... ......... ........... ........... antigen. 85303... A Blood clot inhibitor ......... ......... ......... ........... ........... test. 85305... A Blood clot inhibitor ......... ......... ......... ........... ........... assay. 85306... A Blood clot inhibitor ......... ......... ......... ........... ........... test. 85335... A Factor inhibitor test.. ......... ......... ......... ........... ........... 85337... A Thrombomodulin......... ......... ......... ......... ........... ........... 85345... A Coagulation time....... ......... ......... ......... ........... ........... 85347... A Coagulation time....... ......... ......... ......... ........... ........... 85348... A Coagulation time....... ......... ......... ......... ........... ........... 85360... A Euglobulin lysis....... ......... ......... ......... ........... ........... 85362... A Fibrin degradation ......... ......... ......... ........... ........... products. 85366... A Fibrinogen test........ ......... ......... ......... ........... ........... 85370... A Fibrinogen test........ ......... ......... ......... ........... ........... 85378... A Fibrin degradation..... ......... ......... ......... ........... ........... 85379... A Fibrin degradation..... ......... ......... ......... ........... ........... 85384... A Fibrinogen............. ......... ......... ......... ........... ........... 85385... A Fibrinogen............. ......... ......... ......... ........... ........... 85390... A Fibrinolysins screen... ......... ......... ......... ........... ........... 85400... A Fibrinolytic plasmin... ......... ......... ......... ........... ........... 85410... A Fibrinolytic ......... ......... ......... ........... ........... antiplasmin. 85415... A Fibrinolytic ......... ......... ......... ........... ........... plasminogen. 85420... A Fibrinolytic ......... ......... ......... ........... ........... plasminogen. 85421... A Fibrinolytic ......... ......... ......... ........... ........... plasminogen. 85441... A Heinz bodies; direct... ......... ......... ......... ........... ........... 85445... A Heinz bodies; induced.. ......... ......... ......... ........... ........... 85460... A Hemoglobin, fetal...... ......... ......... ......... ........... ........... 85461... A Hemoglobin, fetal...... ......... ......... ......... ........... ........... 85475... A Hemolysin.............. ......... ......... ......... ........... ........... 85520... A Heparin assay.......... ......... ......... ......... ........... ........... 85525... A Heparin................ ......... ......... ......... ........... ........... 85530... A Heparin-protamine ......... ......... ......... ........... ........... tolerance. 85535... A Iron stain, blood cells ......... ......... ......... ........... ........... 85540... A Wbc alkaline ......... ......... ......... ........... ........... phosphatase. 85547... A RBC mechanical ......... ......... ......... ........... ........... fragility. 85549... A Muramidase............. ......... ......... ......... ........... ........... 85555... A RBC osmotic fragility.. ......... ......... ......... ........... ........... 85557... A RBC osmotic fragility.. ......... ......... ......... ........... ........... 85576... A Blood platelet ......... ......... ......... ........... ........... aggregation. 85585... A Blood platelet ......... ......... ......... ........... ........... estimation. 85590... A Platelet manual count.. ......... ......... ......... ........... ........... 85595... A Platelet count, ......... ......... ......... ........... ........... automated. 85597... A Platelet neutralization ......... ......... ......... ........... ........... 85610... A Prothrombin time....... ......... ......... ......... ........... ........... 85611... A Prothrombin test....... ......... ......... ......... ........... ........... 85612... A Viper venom prothrombin ......... ......... ......... ........... ........... time. 85613... A Russell viper venom, ......... ......... ......... ........... ........... diluted. 85635... A Reptilase test......... ......... ......... ......... ........... ........... 85651... A Rbc sed rate, nonauto.. ......... ......... ......... ........... ........... 85652... A Rbc sed rate, auto..... ......... ......... ......... ........... ........... [[Page 47705]] 85660... A RBC sickle cell test... ......... ......... ......... ........... ........... 85670... A Thrombin time, plasma.. ......... ......... ......... ........... ........... 85675... A Thrombin time, titer... ......... ......... ......... ........... ........... 85705... A Thromboplastin ......... ......... ......... ........... ........... inhibition. 85730... A Thromboplastin time, ......... ......... ......... ........... ........... partial. 85732... A Thromboplastin time, ......... ......... ......... ........... ........... partial. 85810... A Blood viscosity ......... ......... ......... ........... ........... examination. 85999... A Hematology procedure... ......... ......... ......... ........... ........... 86000... A Agglutinins; febrile... ......... ......... ......... ........... ........... 86003... A Allergen specific IgE.. ......... ......... ......... ........... ........... 86005... A Allergen specific IgE.. ......... ......... ......... ........... ........... 86021... A WBC antibody ......... ......... ......... ........... ........... identification. 86022... A Platelet antibodies.... ......... ......... ......... ........... ........... 86023... A Immunoglobulin assay... ......... ......... ......... ........... ........... 86038... A Antinuclear antibodies. ......... ......... ......... ........... ........... 86039... A Antinuclear antibodies ......... ......... ......... ........... ........... (ANA). 86060... A Antistreptolysin O ......... ......... ......... ........... ........... titer. 86063... A Antistreptolysin O ......... ......... ......... ........... ........... screen. 86077... X Physician blood bank 882 0.39 $20.57 $11.75 $4.11 service. 86078... X Physician blood bank 882 0.39 $20.57 $11.75 $4.11 service. 86079... X Physician blood bank 882 0.39 $20.57 $11.75 $4.11 service. 86140... A C-reactive protein..... ......... ......... ......... ........... ........... 86147... A Cardiolipin antibody... ......... ......... ......... ........... ........... 86148... A Phospholipid antibody.. ......... ......... ......... ........... ........... 86155... A Chemotaxis assay....... ......... ......... ......... ........... ........... 86156... A Cold agglutinin screen. ......... ......... ......... ........... ........... 86157... A Cold agglutinin, titer. ......... ......... ......... ........... ........... 86160... A Complement, antigen.... ......... ......... ......... ........... ........... 86161... A Complement/function ......... ......... ......... ........... ........... activity. 86162... A Complement, total ......... ......... ......... ........... ........... (CH50). 86171... A Complement fixation, ......... ......... ......... ........... ........... each. 86185... A Counterimmunoelectropho ......... ......... ......... ........... ........... resis. 86215... A Deoxyribonuclease, ......... ......... ......... ........... ........... antibody. 86225... A DNA antibody........... ......... ......... ......... ........... ........... 86226... A DNA antibody, single ......... ......... ......... ........... ........... strand. 86235... A Nuclear antigen ......... ......... ......... ........... ........... antibody. 86243... A Fc receptor............ ......... ......... ......... ........... ........... 86255... A Fluorescent antibody; ......... ......... ......... ........... ........... screen. 86256... A Fluorescent antibody; ......... ......... ......... ........... ........... titer. 86277... A Growth hormone antibody ......... ......... ......... ........... ........... 86280... A Hemagglutination ......... ......... ......... ........... ........... inhibition. 86308... A Heterophile antibodies. ......... ......... ......... ........... ........... 86309... A Heterophile antibodies. ......... ......... ......... ........... ........... 86310... A Heterophile antibodies. ......... ......... ......... ........... ........... 86316... A Immunoassay, tumor ......... ......... ......... ........... ........... antigen. 86317... A Immunoassay, infectious ......... ......... ......... ........... ........... agent. 86318... A Immunoassay, infectious ......... ......... ......... ........... ........... agent. 86320... A Serum ......... ......... ......... ........... ........... immunoelectrophoresis. 86325... A Other ......... ......... ......... ........... ........... immunoelectrophoresis. 86327... A Immunoelectrophoresis ......... ......... ......... ........... ........... assay. 86329... A Immunodiffusion........ ......... ......... ......... ........... ........... 86331... A Immunodiffusion ......... ......... ......... ........... ........... ouchterlony. 86332... A Immune complex assay... ......... ......... ......... ........... ........... 86334... A Immunofixation ......... ......... ......... ........... ........... procedure. 86337... A Insulin antibodies..... ......... ......... ......... ........... ........... 86340... A Intrinsic factor ......... ......... ......... ........... ........... antibody. 86341... A Islet cell antibody.... ......... ......... ......... ........... ........... 86343... A Leukocyte histamine ......... ......... ......... ........... ........... release. 86344... A Leukocyte phagocytosis. ......... ......... ......... ........... ........... 86353... A Lymphocyte ......... ......... ......... ........... ........... transformation. 86359... A T cells, total count... ......... ......... ......... ........... ........... 86360... A T cell absolute count/ ......... ......... ......... ........... ........... ratio. 86361... A T cell absolute count.. ......... ......... ......... ........... ........... 86376... A Microsomal antibody.... ......... ......... ......... ........... ........... 86378... A Migration inhibitory ......... ......... ......... ........... ........... factor. 86382... A Neutralization test, ......... ......... ......... ........... ........... viral. 86384... A Nitroblue tetrazolium ......... ......... ......... ........... ........... dye. 86403... A Particle agglutination ......... ......... ......... ........... ........... test. 86406... A Particle agglutination ......... ......... ......... ........... ........... test. 86430... A Rheumatoid factor test. ......... ......... ......... ........... ........... 86431... A Rheumatoid factor, ......... ......... ......... ........... ........... quant. 86485... X Skin test, candida..... 861 0.13 $6.86 $3.62 $1.37 86490... X Coccidioidomycosis skin 861 0.13 $6.86 $3.62 $1.37 test. 86510... X Histoplasmosis skin 861 0.13 $6.86 $3.62 $1.37 test. 86580... X TB intradermal test.... 861 0.13 $6.86 $3.62 $1.37 [[Page 47706]] 86585... X TB tine test........... 861 0.13 $6.86 $3.62 $1.37 86586... X Skin test, unlisted.... 861 0.13 $6.86 $3.62 $1.37 86588... A Streptocollus, direct ......... ......... ......... ........... ........... screen. 86590... A Streptokinase, antibody ......... ......... ......... ........... ........... 86592... A Blood serology, ......... ......... ......... ........... ........... qualitative. 86593... A Blood serology, ......... ......... ......... ........... ........... quantitative. 86602... A Antinomyces antibody... ......... ......... ......... ........... ........... 86603... A Adenovirus, antibody... ......... ......... ......... ........... ........... 86606... A Aspergillus antibody... ......... ......... ......... ........... ........... 86609... A Bacterium, antibody.... ......... ......... ......... ........... ........... 86612... A Blastomyces, antibody.. ......... ......... ......... ........... ........... 86615... A Bordetella antibody.... ......... ......... ......... ........... ........... 86617... A Lyme disease antibody.. ......... ......... ......... ........... ........... 86618... A Lyme disease antibody.. ......... ......... ......... ........... ........... 86619... A Borrelia antibody...... ......... ......... ......... ........... ........... 86622... A Brucella, antibody..... ......... ......... ......... ........... ........... 86625... A Campylobacter, antibody ......... ......... ......... ........... ........... 86628... A Candida, antibody...... ......... ......... ......... ........... ........... 86631... A Chlamydia, antibody.... ......... ......... ......... ........... ........... 86632... A Chlamydia, IgM, ......... ......... ......... ........... ........... antibody. 86635... A Coccidioides, antibody. ......... ......... ......... ........... ........... 86638... A Q fever antibody....... ......... ......... ......... ........... ........... 86641... A Cryptococcus antibody.. ......... ......... ......... ........... ........... 86644... A CMV antibody........... ......... ......... ......... ........... ........... 86645... A CMV antibody, IgM...... ......... ......... ......... ........... ........... 86648... A Diphtheria antibody.... ......... ......... ......... ........... ........... 86651... A Encephalitis antibody.. ......... ......... ......... ........... ........... 86652... A Encephalitis antibody.. ......... ......... ......... ........... ........... 86653... A Encephalitis, antibody. ......... ......... ......... ........... ........... 86654... A Encephalitis, antibody. ......... ......... ......... ........... ........... 86658... A Enterovirus, antibody.. ......... ......... ......... ........... ........... 86663... A Epstein-barr antibody.. ......... ......... ......... ........... ........... 86664... A Epstein-barr antibody.. ......... ......... ......... ........... ........... 86665... A Epstein-barr, antibody. ......... ......... ......... ........... ........... 86668... A Francisella tularensis. ......... ......... ......... ........... ........... 86671... A Fungus, antibody....... ......... ......... ......... ........... ........... 86674... A Giardia lamblia........ ......... ......... ......... ........... ........... 86677... A Helicobacter pylori.... ......... ......... ......... ........... ........... 86682... A Helminth, antibody..... ......... ......... ......... ........... ........... 86684... A Hemophilus influenza... ......... ......... ......... ........... ........... 86687... A HTLV I................. ......... ......... ......... ........... ........... 86688... A HTLV-II................ ......... ......... ......... ........... ........... 86689... A HTLV/HIV confirmatory ......... ......... ......... ........... ........... test. 86692... A Hepatitis, delta agent. ......... ......... ......... ........... ........... 86694... A Herpes simplex test.... ......... ......... ......... ........... ........... 86695... A Herpes simplex test.... ......... ......... ......... ........... ........... 86698... A Histoplasma............ ......... ......... ......... ........... ........... 86701... A HIV-1.................. ......... ......... ......... ........... ........... 86702... A HIV-2.................. ......... ......... ......... ........... ........... 86703... A HIV-1/HIV-2, single ......... ......... ......... ........... ........... assay. 86704... A Hep b core ab test, igg ......... ......... ......... ........... ........... & m. 86705... A Hep b core ab test, igm ......... ......... ......... ........... ........... 86706... A Hepatitis b surface ab ......... ......... ......... ........... ........... test. 86707... A Hepatitis be ab test... ......... ......... ......... ........... ........... 86708... A Hep a ab test, igg & m. ......... ......... ......... ........... ........... 86709... A Hep a ab test, igm..... ......... ......... ......... ........... ........... 86710... A Influenza virus........ ......... ......... ......... ........... ........... 86713... A Legionella............. ......... ......... ......... ........... ........... 86717... A Leishmania............. ......... ......... ......... ........... ........... 86720... A Leptospira............. ......... ......... ......... ........... ........... 86723... A Listeria monocytogenes. ......... ......... ......... ........... ........... 86727... A Lymph choriomeningitis. ......... ......... ......... ........... ........... 86729... A Lympho venereum........ ......... ......... ......... ........... ........... 86732... A Mucormycosis........... ......... ......... ......... ........... ........... 86735... A Mumps.................. ......... ......... ......... ........... ........... 86738... A Mycoplasma............. ......... ......... ......... ........... ........... 86741... A Neisseria meningitidis. ......... ......... ......... ........... ........... 86744... A Nocardia............... ......... ......... ......... ........... ........... 86747... A Parvovirus............. ......... ......... ......... ........... ........... 86750... A Malaria................ ......... ......... ......... ........... ........... 86753... A Protozoa, not elsewhere ......... ......... ......... ........... ........... 86756... A Respiratory virus...... ......... ......... ......... ........... ........... 86759... A Rotavirus.............. ......... ......... ......... ........... ........... 86762... A Rubella................ ......... ......... ......... ........... ........... 86765... A Rubeola................ ......... ......... ......... ........... ........... [[Page 47707]] 86768... A Salmonella............. ......... ......... ......... ........... ........... 86771... A Shigella............... ......... ......... ......... ........... ........... 86774... A Tetanus................ ......... ......... ......... ........... ........... 86777... A Toxoplasma............. ......... ......... ......... ........... ........... 86778... A Toxoplasma, IgM........ ......... ......... ......... ........... ........... 86781... A Treponema pallidum ......... ......... ......... ........... ........... confirm. 86784... A Trichinella............ ......... ......... ......... ........... ........... 86787... A Varicella-zoster....... ......... ......... ......... ........... ........... 86790... A Virus, not specified... ......... ......... ......... ........... ........... 86793... A Yersinia............... ......... ......... ......... ........... ........... 86800... A Thyroglobulin antibody. ......... ......... ......... ........... ........... 86803... A Hepatitis c ab test.... ......... ......... ......... ........... ........... 86804... A Hep c ab test, confirm. ......... ......... ......... ........... ........... 86805... A Lymphocytotoxicity ......... ......... ......... ........... ........... assay. 86806... A Lymphocytotoxicity ......... ......... ......... ........... ........... assay. 86807... A Cytotoxic antibody ......... ......... ......... ........... ........... screening. 86808... A Cytotoxic antibody ......... ......... ......... ........... ........... screening. 86812... A HLA typing, A, B, or C. ......... ......... ......... ........... ........... 86813... A HLA typing, A, B, or C. ......... ......... ......... ........... ........... 86816... A HLA typing, DR/DQ...... ......... ......... ......... ........... ........... 86817... A HLA typing, DR/DQ...... ......... ......... ......... ........... ........... 86821... A Lymphocyte culture, ......... ......... ......... ........... ........... mixed. 86822... A Lymphocyte culture, ......... ......... ......... ........... ........... primed. 86849... A Immunology procedure... ......... ......... ......... ........... ........... 86850... A RBC antibody screen.... ......... ......... ......... ........... ........... 86860... A RBC antibody elution... ......... ......... ......... ........... ........... 86870... A RBC antibody ......... ......... ......... ........... ........... identification. 86880... A Coombs test............ ......... ......... ......... ........... ........... 86885... A Coombs test............ ......... ......... ......... ........... ........... 86886... A Coombs test............ ......... ......... ......... ........... ........... 86890... A Autologous blood ......... ......... ......... ........... ........... process. 86891... A Autologous blood, op ......... ......... ......... ........... ........... salvage. 86900... A Blood typing, ABO...... ......... ......... ......... ........... ........... 86901... A Blood typing, Rh (D)... ......... ......... ......... ........... ........... 86903... A Blood typing, antigen ......... ......... ......... ........... ........... screen. 86904... A Blood typing, patient ......... ......... ......... ........... ........... serum. 86905... A Blood typing, RBC ......... ......... ......... ........... ........... antigens. 86906... A Blood typing, Rh ......... ......... ......... ........... ........... phenotype. 86910... E Blood typing, paternity ......... ......... ......... ........... ........... test. 86911... E Blood typing, antigen ......... ......... ......... ........... ........... system. 86915... A Bone marrow............ ......... ......... ......... ........... ........... 86920... A Compatibility test..... ......... ......... ......... ........... ........... 86921... A Compatibility test..... ......... ......... ......... ........... ........... 86922... A Compatibility test..... ......... ......... ......... ........... ........... 86927... A Plasma, fresh frozen... ......... ......... ......... ........... ........... 86930... A Frozen blood prep...... ......... ......... ......... ........... ........... 86931... A Frozen blood thaw...... ......... ......... ......... ........... ........... 86932... A Frozen blood, freeze/ ......... ......... ......... ........... ........... thaw. 86940... A Hemolysins/agglutinins ......... ......... ......... ........... ........... auto. 86941... A Hemolysins/agglutinins. ......... ......... ......... ........... ........... 86945... A Blood product/ ......... ......... ......... ........... ........... irradiation. 86950... A Leukacyte transfusion.. ......... ......... ......... ........... ........... 86965... A Pooling blood platelets ......... ......... ......... ........... ........... 86970... A RBC pretreatment....... ......... ......... ......... ........... ........... 86971... A RBC pretreatment....... ......... ......... ......... ........... ........... 86972... A RBC pretreatment....... ......... ......... ......... ........... ........... 86975... A RBC pretreatment, serum ......... ......... ......... ........... ........... 86976... A RBC pretreatment, serum ......... ......... ......... ........... ........... 86977... A RBC pretreatment, serum ......... ......... ......... ........... ........... 86978... A RBC pretreatment, serum ......... ......... ......... ........... ........... 86985... A Split blood or products ......... ......... ......... ........... ........... 86999... A Transfusion procedure.. ......... ......... ......... ........... ........... 87001... A Small animal ......... ......... ......... ........... ........... inoculation. 87003... A Small animal ......... ......... ......... ........... ........... inoculation. 87015... A Specimen concentration. ......... ......... ......... ........... ........... 87040... A Blood culture for ......... ......... ......... ........... ........... bacteria. 87045... A Stool culture for ......... ......... ......... ........... ........... bacteria. 87060... A Nose/throat ......... ......... ......... ........... ........... culture,bacteria. 87070... A Culture specimen, ......... ......... ......... ........... ........... bacteria. 87072... A Culture of specimen by ......... ......... ......... ........... ........... kit. 87075... A Culture specimen, ......... ......... ......... ........... ........... bacteria. 87076... A Bacteria identification ......... ......... ......... ........... ........... 87081... A Bacteria culture screen ......... ......... ......... ........... ........... 87082... A Culture of specimen by ......... ......... ......... ........... ........... kit. 87083... A Culture of specimen by ......... ......... ......... ........... ........... kit. [[Page 47708]] 87084... A Culture of specimen by ......... ......... ......... ........... ........... kit. 87085... A Culture of specimen by ......... ......... ......... ........... ........... kit. 87086... A Urine culture, colony ......... ......... ......... ........... ........... count. 87087... A Urine bacteria culture. ......... ......... ......... ........... ........... 87088... A Urine bacteria culture. ......... ......... ......... ........... ........... 87101... A Skin fungus culture.... ......... ......... ......... ........... ........... 87102... A Fungus isolation ......... ......... ......... ........... ........... culture. 87103... A Blood fungus culture... ......... ......... ......... ........... ........... 87106... A Fungus identification.. ......... ......... ......... ........... ........... 87109... A Mycoplasma culture..... ......... ......... ......... ........... ........... 87110... A Culture, chlamydia..... ......... ......... ......... ........... ........... 87116... A Mycobacteria culture... ......... ......... ......... ........... ........... 87117... A Mycobacteria culture... ......... ......... ......... ........... ........... 87118... A Mycobacteria ......... ......... ......... ........... ........... identification. 87140... A Culture typing, ......... ......... ......... ........... ........... fluorescent. 87143... A Culture typing, GLC ......... ......... ......... ........... ........... method. 87145... A Culture typing, phage ......... ......... ......... ........... ........... method. 87147... A Culture typing, ......... ......... ......... ........... ........... serologic. 87151... A Culture typing, ......... ......... ......... ........... ........... serologic. 87155... A Culture typing, ......... ......... ......... ........... ........... precipitin. 87158... A Culture typing, added ......... ......... ......... ........... ........... method. 87163... A Special microbiology ......... ......... ......... ........... ........... culture. 87164... A Dark field examination. ......... ......... ......... ........... ........... 87166... A Dark field examination. ......... ......... ......... ........... ........... 87174... A Endotoxin, bacterial... ......... ......... ......... ........... ........... 87175... A Assay, endotoxin, ......... ......... ......... ........... ........... bacterial. 87176... A Endotoxin, bacterial... ......... ......... ......... ........... ........... 87177... A Ova and parasites ......... ......... ......... ........... ........... smears. 87181... A Antibiotic sensitivity, ......... ......... ......... ........... ........... each. 87184... A Antibiotic sensitivity, ......... ......... ......... ........... ........... each. 87186... A Antibiotic sensitivity, ......... ......... ......... ........... ........... MIC. 87187... A Antibiotic sensitivity, ......... ......... ......... ........... ........... MBC. 87188... A Antibiotic sensitivity, ......... ......... ......... ........... ........... each. 87190... A TB antibiotic ......... ......... ......... ........... ........... sensitivity. 87192... A Antibiotic sensitivity, ......... ......... ......... ........... ........... each. 87197... A Bactericidal level, ......... ......... ......... ........... ........... serum. 87205... A Smear, stain & ......... ......... ......... ........... ........... interpret. 87206... A Smear, stain & ......... ......... ......... ........... ........... interpret. 87207... A Smear, stain & ......... ......... ......... ........... ........... interpret. 87208... A Smear, stain & ......... ......... ......... ........... ........... interpret. 87210... A Smear, stain & ......... ......... ......... ........... ........... interpret. 87211... A Smear, stain & ......... ......... ......... ........... ........... interpret. 87220... A Tissue exam for fungi.. ......... ......... ......... ........... ........... 87230... A Assay, toxin or ......... ......... ......... ........... ........... antitoxin. 87250... A Virus inoculation for ......... ......... ......... ........... ........... test. 87252... A Virus inoculation for ......... ......... ......... ........... ........... test. 87253... A Virus inoculation for ......... ......... ......... ........... ........... test. 87260... A Adenovirus ag, dfa..... ......... ......... ......... ........... ........... 87265... A Pertussis ag, dfa...... ......... ......... ......... ........... ........... 87270... A Chylmd trach ag, dfa... ......... ......... ......... ........... ........... 87272... A Cryptosporidum ag, dfa. ......... ......... ......... ........... ........... 87274... A Herpes simplex ag, dfa. ......... ......... ......... ........... ........... 87276... A Influenza ag, dfa...... ......... ......... ......... ........... ........... 87278... A Legion pneumo ag, dfa.. ......... ......... ......... ........... ........... 87280... A Resp syncytial ag, dfa. ......... ......... ......... ........... ........... 87285... A Trepon pallidum ag, dfa ......... ......... ......... ........... ........... 87290... A Varicella ag, dfa...... ......... ......... ......... ........... ........... 87299... A Ag detection nos, dfa.. ......... ......... ......... ........... ........... 87301... A Adenovirus ag, eia..... ......... ......... ......... ........... ........... 87320... A Chylmd trach ag, eia... ......... ......... ......... ........... ........... 87324... A Clostridium ag, eia.... ......... ......... ......... ........... ........... 87328... A Cryptospor ag, eia..... ......... ......... ......... ........... ........... 87332... A Cytomegalovirus ag, eia ......... ......... ......... ........... ........... 87335... A E coli 0157 ag, eia.... ......... ......... ......... ........... ........... 87340... A Hepatitis b surface ag, ......... ......... ......... ........... ........... eia. 87350... A Hepatitis b ag, eia.... ......... ......... ......... ........... ........... 87380... A Hepatitis delta ag, eia ......... ......... ......... ........... ........... 87385... A Histoplasma capsul ag, ......... ......... ......... ........... ........... eia. 87390... A Hiv-1 ag, eia.......... ......... ......... ......... ........... ........... 87391... A Hiv-2 ag, eia.......... ......... ......... ......... ........... ........... 87420... A Resp syncytial ag, eia. ......... ......... ......... ........... ........... 87425... A Rotavirus ag, eia...... ......... ......... ......... ........... ........... 87430... A Strep a ag, eia........ ......... ......... ......... ........... ........... 87449... A Ag detect nos, eia, ......... ......... ......... ........... ........... mult. 87450... A Ag detect nos, eia, ......... ......... ......... ........... ........... single. [[Page 47709]] 87470... A Bartonella, dna, dir ......... ......... ......... ........... ........... probe. 87471... A Bartonella, dna, amp ......... ......... ......... ........... ........... probe. 87472... A Bartonella, dna, quant. ......... ......... ......... ........... ........... 87475... A Lyme dis, dna, dir ......... ......... ......... ........... ........... probe. 87476... A Lyme dis, dna, amp ......... ......... ......... ........... ........... probe. 87477... A Lyme dis, dna, quant... ......... ......... ......... ........... ........... 87480... A Candida, dna, dir probe ......... ......... ......... ........... ........... 87481... A Candida, dna, amp probe ......... ......... ......... ........... ........... 87482... A Candida, dna, quant.... ......... ......... ......... ........... ........... 87485... A Chylmd pneum, dna, dir ......... ......... ......... ........... ........... probe. 87486... A Chylmd pneum, dna, amp ......... ......... ......... ........... ........... probe. 87487... A Chylmd pneum, dna, ......... ......... ......... ........... ........... quant. 87490... A Chylmd trach, dna, dir ......... ......... ......... ........... ........... probe. 87491... A Chylmd trach, dna, amp ......... ......... ......... ........... ........... probe. 87492... A Chylmd trach, dna, ......... ......... ......... ........... ........... quant. 87495... A Cytomeg, dna, dir probe ......... ......... ......... ........... ........... 87496... A Cytomeg, dna, amp probe ......... ......... ......... ........... ........... 87497... A Cytomeg, dna, quant.... ......... ......... ......... ........... ........... 87510... A Gardner vag, dna, dir ......... ......... ......... ........... ........... probe. 87511... A Gardner vag, dna, amp ......... ......... ......... ........... ........... probe. 87512... A Gardner vag, dna, quant ......... ......... ......... ........... ........... 87515... A Hepatitis b, dna, dir ......... ......... ......... ........... ........... probe. 87516... A Hepatitis b, dna, amp ......... ......... ......... ........... ........... probe. 87517... A Hepatitis b, dna, quant ......... ......... ......... ........... ........... 87520... A Hepatitis c, rna, dir ......... ......... ......... ........... ........... probe. 87521... A Hepatitis c, rna, amp ......... ......... ......... ........... ........... probe. 87522... A Hepatitis c, rna, quant ......... ......... ......... ........... ........... 87525... A Hepatitis g, dna, dir ......... ......... ......... ........... ........... probe. 87526... A Hepatitis g, dna, amp ......... ......... ......... ........... ........... probe. 87527... A Hepatitis g, dna, quant ......... ......... ......... ........... ........... 87528... A Hsv, dna, dir probe.... ......... ......... ......... ........... ........... 87529... A Hsv, dna, amp probe.... ......... ......... ......... ........... ........... 87530... A Hsv, dna, quant........ ......... ......... ......... ........... ........... 87531... A Hhv-6, dna, dir probe.. ......... ......... ......... ........... ........... 87532... A Hhv-6, dna, amp probe.. ......... ......... ......... ........... ........... 87533... A Hhv-6, dna, quant...... ......... ......... ......... ........... ........... 87534... A Hiv-1, dna, dir probe.. ......... ......... ......... ........... ........... 87535... A Hiv-1, dna, amp probe.. ......... ......... ......... ........... ........... 87536... A Hiv-1, dna, quant...... ......... ......... ......... ........... ........... 87537... A Hiv-2, dna, dir probe.. ......... ......... ......... ........... ........... 87538... A Hiv-2, dna, amp probe.. ......... ......... ......... ........... ........... 87539... A Hiv-2, dna, quant...... ......... ......... ......... ........... ........... 87540... A Legion pneumo, dna, dir ......... ......... ......... ........... ........... prob. 87541... A Legion pneumo, dna, amp ......... ......... ......... ........... ........... prob. 87542... A Legion pneumo, dna, ......... ......... ......... ........... ........... quant. 87550... A Mycobacteria, dna, dir ......... ......... ......... ........... ........... probe. 87551... A Mycobacteria, dna, amp ......... ......... ......... ........... ........... probe. 87552... A Mycobacteria, dna, ......... ......... ......... ........... ........... quant. 87555... A M.tuberculo, dna, dir ......... ......... ......... ........... ........... probe. 87556... A M.tuberculo, dna, amp ......... ......... ......... ........... ........... probe. 87557... A M.tuberculo, dna, quant ......... ......... ......... ........... ........... 87560... A M.avium-intra, dna, dir ......... ......... ......... ........... ........... prob. 87561... A M.avium-intra, dna, amp ......... ......... ......... ........... ........... prob. 87562... A M.avium-intra, dna, ......... ......... ......... ........... ........... quant. 87580... A M.pneumon, dna, dir ......... ......... ......... ........... ........... probe. 87581... A M.pneumon, dna, amp ......... ......... ......... ........... ........... probe. 87582... A M.pneumon, dna, quant.. ......... ......... ......... ........... ........... 87590... A N.gonorrhoeae, dna, dir ......... ......... ......... ........... ........... prob. 87591... A N.gonorrhoeae, dna, amp ......... ......... ......... ........... ........... prob. 87592... A N.gonorrhoeae, dna, ......... ......... ......... ........... ........... quant. 87620... A Hpv, dna, dir probe.... ......... ......... ......... ........... ........... 87621... A Hpv, dna, amp probe.... ......... ......... ......... ........... ........... 87622... A Hpv, dna, quant........ ......... ......... ......... ........... ........... 87650... A Strep a, dna, dir probe ......... ......... ......... ........... ........... 87651... A Strep a, dna, amp probe ......... ......... ......... ........... ........... 87652... A Strep a, dna, quant.... ......... ......... ......... ........... ........... 87797... A Detect agent nos, dna, ......... ......... ......... ........... ........... dir. 87798... A Detect agent nos, dna, ......... ......... ......... ........... ........... amp. 87799... A Detect agent nos, dna, ......... ......... ......... ........... ........... quant. 87810... A Chylmd trach assay w/ ......... ......... ......... ........... ........... optic. 87850... A N. gonorrhoeae assay w/ ......... ......... ......... ........... ........... optic. 87880... A Strep a assay w/optic.. ......... ......... ......... ........... ........... 87899... A Agent nos assay w/optic ......... ......... ......... ........... ........... 87999... A Microbiology procedure. ......... ......... ......... ........... ........... 88000... E Autopsy (necropsy), ......... ......... ......... ........... ........... gross. [[Page 47710]] 88005... E Autopsy (necropsy), ......... ......... ......... ........... ........... gross. 88007... E Autopsy (necropsy), ......... ......... ......... ........... ........... gross. 88012... E Autopsy (necropsy), ......... ......... ......... ........... ........... gross. 88014... E Autopsy (necropsy), ......... ......... ......... ........... ........... gross. 88016... E Autopsy (necropsy), ......... ......... ......... ........... ........... gross. 88020... E Autopsy (necropsy), ......... ......... ......... ........... ........... complete. 88025... E Autopsy (necropsy), ......... ......... ......... ........... ........... complete. 88027... E Autopsy (necropsy), ......... ......... ......... ........... ........... complete. 88028... E Autopsy (necropsy), ......... ......... ......... ........... ........... complete. 88029... E Autopsy (necropsy), ......... ......... ......... ........... ........... complete. 88036... E Limited autopsy........ ......... ......... ......... ........... ........... 88037... E Limited autopsy........ ......... ......... ......... ........... ........... 88040... E Forensic autopsy ......... ......... ......... ........... ........... (necropsy). 88045... E Coroner's autopsy ......... ......... ......... ........... ........... (necropsy). 88099... E Necropsy (autopsy) ......... ......... ......... ........... ........... procedure. 88104... X Cytopathology, fluids.. 882 0.39 $20.57 $11.75 $4.11 88106... X Cytopathology, fluids.. 882 0.39 $20.57 $11.75 $4.11 88107... X Cytopathology, fluids.. 882 0.39 $20.57 $11.75 $4.11 88108... X Cytopath, concentrate 882 0.39 $20.57 $11.75 $4.11 tech. 88125... X Forensic cytopathology. 881 0.20 $10.77 $6.78 $2.15 88130... A Sex chromatin ......... ......... ......... ........... ........... identification. 88140... A Sex chromatin ......... ......... ......... ........... ........... identification. 88141... N Cytopath cerv/vag ......... ......... ......... ........... ........... interpret. 88142... A Cytopath cerv/vag thin ......... ......... ......... ........... ........... layer. 88150... A Cytopath cerv/vag...... ......... ......... ......... ........... ........... 88152... A Cytopath cerv/vag auto. ......... ......... ......... ........... ........... 88155... A Cytopath cerv/vag index ......... ......... ......... ........... ........... 88156... A Cytopath cerv/vag tbs.. ......... ......... ......... ........... ........... 88158... A Cytopath cerv/vag tbs ......... ......... ......... ........... ........... auto. 88160... X Cytopath smear, other 882 0.39 $20.57 $11.75 $4.11 source. 88161... X Cytopath smear, other 882 0.39 $20.57 $11.75 $4.11 source. 88162... X Cytopath smear, other 882 0.39 $20.57 $11.75 $4.11 source. 88170... T Fine needle aspiration. 121 0.67 $35.26 $21.02 $7.05 88171... T Fine needle aspiration. 121 0.67 $35.26 $21.02 $7.05 88172... X Evaluation of smear.... 882 0.39 $20.57 $11.75 $4.11 88173... X Interpretation of smear 882 0.39 $20.57 $11.75 $4.11 88180... X Cell marker study...... 882 0.39 $20.57 $11.75 $4.11 88182... X Cell marker study...... 882 0.39 $20.57 $11.75 $4.11 88199... X Cytopathology procedure 881 0.20 $10.77 $6.78 $2.15 88230... A Tissue culture, ......... ......... ......... ........... ........... lymphocyte. 88233... A Tissue culture, skin/ ......... ......... ......... ........... ........... biopsy. 88235... A Tissue culture, ......... ......... ......... ........... ........... placenta. 88237... A Tissue culture, bone ......... ......... ......... ........... ........... marrow. 88239... A Tissue culture, other.. ......... ......... ......... ........... ........... 88245... A Chromosome analysis.... ......... ......... ......... ........... ........... 88248... A Chromosome analysis.... ......... ......... ......... ........... ........... 88250... A Chromosome analysis.... ......... ......... ......... ........... ........... 88260... A Chromosome analysis: 5 ......... ......... ......... ........... ........... cells. 88261... A Chromosome analysis: 5 ......... ......... ......... ........... ........... cells. 88262... A Chromosome count:15-20 ......... ......... ......... ........... ........... cells. 88263... A Chromosome analysis:45 ......... ......... ......... ........... ........... cells. 88267... A Chromosome ......... ......... ......... ........... ........... analysis:placenta. 88269... A Chromosome ......... ......... ......... ........... ........... analysis:amniotic. 88280... A Chromosome karyotype ......... ......... ......... ........... ........... study. 88283... A Chromosome banding ......... ......... ......... ........... ........... study. 88285... A Chromosome count: ......... ......... ......... ........... ........... additional. 88289... A Chromosome study: ......... ......... ......... ........... ........... additional. 88299... A Cytogenetic study...... ......... ......... ......... ........... ........... 88300... X Surg path, gross....... 881 0.20 $10.77 $6.78 $2.15 88302... X Tissue exam by 882 0.39 $20.57 $11.75 $4.11 pathologist. 88304... X Tissue exam by 882 0.39 $20.57 $11.75 $4.11 pathologist. 88305... X Tissue exam by 882 0.39 $20.57 $11.75 $4.11 pathologist. 88307... X Tissue exam by 883 0.65 $34.28 $20.34 $6.86 pathologist. 88309... X Tissue exam by 883 0.65 $34.28 $20.34 $6.86 pathologist. 88311... X Decalcify tissue....... 881 0.20 $10.77 $6.78 $2.15 88312... X Special stains......... 882 0.39 $20.57 $11.75 $4.11 88313... X Special stains......... 881 0.20 $10.77 $6.78 $2.15 88314... X Histochemical stain.... 882 0.39 $20.57 $11.75 $4.11 88318... X Chemical histochemistry 882 0.39 $20.57 $11.75 $4.11 88319... X Enzyme histochemistry.. 882 0.39 $20.57 $11.75 $4.11 88321... X Microslide consultation 882 0.39 $20.57 $11.75 $4.11 88323... X Microslide consultation 882 0.39 $20.57 $11.75 $4.11 88325... X Comprehensive review of 882 0.39 $20.57 $11.75 $4.11 data. 88329... X Pathology consult in 882 0.39 $20.57 $11.75 $4.11 surgery. 88331... X Pathology consult in 882 0.39 $20.57 $11.75 $4.11 surgery. [[Page 47711]] 88332... X Pathology consult in 882 0.39 $20.57 $11.75 $4.11 surgery. 88342... X Immunocytochemistry.... 882 0.39 $20.57 $11.75 $4.11 88346... X Immunofluorescent study 882 0.39 $20.57 $11.75 $4.11 88347... X Immunofluorescent study 882 0.39 $20.57 $11.75 $4.11 88348... X Electron microscopy.... 883 0.65 $34.28 $20.34 $6.86 88349... X Scanning electron 883 0.65 $34.28 $20.34 $6.86 microscopy. 88355... X Analysis, skeletal 883 0.65 $34.28 $20.34 $6.86 muscle. 88356... X Analysis, nerve........ 883 0.65 $34.28 $20.34 $6.86 88358... X Analysis, tumor........ 883 0.65 $34.28 $20.34 $6.86 88362... X Nerve teasing 883 0.65 $34.28 $20.34 $6.86 preparations. 88365... X Tissue hybridization... 883 0.65 $34.28 $20.34 $6.86 88371... A Protein, western blot ......... ......... ......... ........... ........... tissue. 88372... A Protein analysis w/ ......... ......... ......... ........... ........... probe. 88399... X Surgical pathology 881 0.20 $10.77 $6.78 $2.15 procedure. 89050... A Body fluid cell count.. ......... ......... ......... ........... ........... 89051... A Body fluid cell count.. ......... ......... ......... ........... ........... 89060... A Exam,synovial fluid ......... ......... ......... ........... ........... crystals. 89100... X Sample intestinal 928 3.11 $164.55 $83.85 $32.91 contents. 89105... X Sample intestinal 928 3.11 $164.55 $83.85 $32.91 contents. 89125... A Specimen fat stain..... ......... ......... ......... ........... ........... 89130... X Sample stomach contents 928 3.11 $164.55 $83.85 $32.91 89132... X Sample stomach contents 928 3.11 $164.55 $83.85 $32.91 89135... X Sample stomach contents 928 3.11 $164.55 $83.85 $32.91 89136... X Sample stomach contents 928 3.11 $164.55 $83.85 $32.91 89140... X Sample stomach contents 928 3.11 $164.55 $83.85 $32.91 89141... X Sample stomach contents 928 3.11 $164.55 $83.85 $32.91 89160... A Exam feces for meat ......... ......... ......... ........... ........... fibers. 89190... A Nasal smear for ......... ......... ......... ........... ........... eosinophils. 89250... A Fertilization of oocyte ......... ......... ......... ........... ........... 89251... A Culture oocyte w/ ......... ......... ......... ........... ........... embryos. 89252... A Assist oocyte ......... ......... ......... ........... ........... fertilization. 89253... A Embryo hatching........ ......... ......... ......... ........... ........... 89254... A Oocyte identification.. ......... ......... ......... ........... ........... 89255... A Prepare embryo for ......... ......... ......... ........... ........... transfer. 89256... A Prepare cryopreserved ......... ......... ......... ........... ........... embryo. 89257... A Sperm identification... ......... ......... ......... ........... ........... 89258... A Cryopreservation, ......... ......... ......... ........... ........... embryo. 89259... A Cryopreservation, sperm ......... ......... ......... ........... ........... 89260... A Sperm isolation, simple ......... ......... ......... ........... ........... 89261... A Sperm isolation, ......... ......... ......... ........... ........... complex. 89300... A Semen analysis......... ......... ......... ......... ........... ........... 89310... A Semen analysis......... ......... ......... ......... ........... ........... 89320... A Semen analysis......... ......... ......... ......... ........... ........... 89325... A Sperm antibody test.... ......... ......... ......... ........... ........... 89329... A Sperm evaluation test.. ......... ......... ......... ........... ........... 89330... A Evaluation, cervical ......... ......... ......... ........... ........... mucus. 89350... X Sputum specimen 881 0.20 $10.77 $6.78 $2.15 collection. 89355... A Exam feces for starch.. ......... ......... ......... ........... ........... 89360... X Collect sweat for test. 881 0.20 $10.77 $6.78 $2.15 89365... A Water load test........ ......... ......... ......... ........... ........... 89399... X Pathology lab procedure 881 0.20 $10.77 $6.78 $2.15 90700... X DTaP immunization...... 901 0.07 $3.92 $2.49 0.78 90701... X DTP immunization....... 901 0.07 $3.92 $2.49 0.78 90702... X DT immunization........ 901 0.07 $3.92 $2.49 0.78 90703... X Tetanus immunization... 901 0.07 $3.92 $2.49 0.78 90704... X Mumps immunization..... 901 0.07 $3.92 $2.49 0.78 90705... X Measles immunization... 901 0.07 $3.92 $2.49 0.78 90706... X Rubella immunization... 901 0.07 $3.92 $2.49 0.78 90707... X MMR virus immunization. 902 1.78 $94.03 $41.58 $18.81 90708... X Measles-rubella 901 0.07 $3.92 $2.49 0.78 immunization. 90709... X Rubella & mumps 901 0.07 $3.92 $2.49 0.78 immunization. 90710... X Combined vaccine....... 901 0.07 $3.92 $2.49 0.78 90711... X Combined vaccine....... 901 0.07 $3.92 $2.49 0.78 90712... X Oral poliovirus 902 1.78 $94.03 $41.58 $18.81 immunization. 90713... X Poliomyelitis 902 1.78 $94.03 $41.58 $18.81 immunization. 90714... X Typhoid immunization... 901 0.07 $3.92 $2.49 0.78 90716... X Chicken pox vaccine.... 902 1.78 $94.03 $41.58 $18.81 90717... X Yellow fever 902 1.78 $94.03 $41.58 $18.81 immunization. 90718... X Td immunization........ 901 0.07 $3.92 $2.49 0.78 90719... X Diphtheria immunization 901 0.07 $3.92 $2.49 0.78 90720... X DTP/HIB vaccine........ 902 1.78 $94.03 $41.58 $18.81 90721... X Dtap/hib vaccine....... 903 1.17 $61.71 $25.76 $12.34 90724... X Influenza immunization. 901 0.07 $3.92 $2.49 0.78 90725... X Cholera immunization... 901 0.07 $3.92 $2.49 0.78 90726... X Rabies immunization.... 903 1.17 $61.71 $25.76 $12.34 [[Page 47712]] 90727... X Plague immunization.... 903 1.17 $61.71 $25.76 $12.34 90728... X BCG immunization....... 903 1.17 $61.71 $25.76 $12.34 90730... X Hepatitis A vaccine.... 901 0.07 $3.92 $2.49 0.78 90732... X Pneumococcal 901 0.07 $3.92 $2.49 0.78 immunization. 90733... X Meningococcal 902 1.78 $94.03 $41.58 $18.81 immunization. 90735... X Encephalitis virus 903 1.17 $61.71 $25.76 $12.34 vaccine. 90737... X Influenza B 902 1.78 $94.03 $41.58 $18.81 immunization. 90741... X Passive immunization, 902 1.78 $94.03 $41.58 $18.81 ISG. 90742... X Special passive 903 1.17 $61.71 $25.76 $12.34 immunization. 90744... X Hepatitis B vaccine, 902 1.78 $94.03 $41.58 $18.81 under 11. 90745... X Hepatitis B vaccine, 11- 902 1.78 $94.03 $41.58 $18.81 19. 90746... X Hepatitis B vaccine, 902 1.78 $94.03 $41.58 $18.81 over 20. 90747... X Hepatitis B vaccine, 902 1.78 $94.03 $41.58 $18.81 ill pat. 90748... X Hepatitis b/hib vaccine 901 0.07 $3.92 $2.49 0.78 90749... X Immunization procedure. 901 0.07 $3.92 $2.49 0.78 90780... X IV infusion therapy, 1 906 1.46 $77.38 $42.49 $15.48 hour. 90781... X IV infusion, additional 906 1.46 $77.38 $42.49 $15.48 hour. 90782... X Injection (SC)/(IM).... 907 0.85 $45.05 $11.98 $9.01 90783... X Injection (IA)......... 907 0.85 $45.05 $11.98 $9.01 90784... X Injection (IV)......... 907 0.85 $45.05 $11.98 $9.01 90788... X Injection of antibiotic 907 0.85 $45.05 $11.98 $9.01 90799... X Therapeutic/diag 907 0.85 $45.05 $11.98 $9.01 injection. 90801... S Psy dx interview....... 092 1.57 $83.25 $21.92 $16.65 90802... S Intac psy dx interview. 092 1.57 $83.25 $21.92 $16.65 90804... S Psytx, office (20-30).. 091 1.19 $62.69 $15.37 $12.54 90805... S Psytx, office (20-30) w/ 091 1.19 $62.69 $15.37 $12.54 e&m. 90806... S Psytx, office (45-50).. 092 1.57 $83.25 $21.92 $16.65 90807... S Psytx, office (45-50) w/ 092 1.57 $83.25 $21.92 $16.65 e&m. 90808... S Psytx, office (75-80).. 092 1.57 $83.25 $21.92 $16.65 90809... S Psytx, office (75-80) w/ 092 1.57 $83.25 $21.92 $16.65 e&m. 90810... S Intac psytx, office (20- 091 1.19 $62.69 $15.37 $12.54 30). 90811... S Intac psytx, off 20-30 091 1.19 $62.69 $15.37 $12.54 w/e&m. 90812... S Intac psytx, office (45- 092 1.57 $83.25 $21.92 $16.65 50). 90813... S Intac psytx, off 45-50 092 1.57 $83.25 $21.92 $16.65 w/e&m. 90814... S Intac psytx, office (75- 092 1.57 $83.25 $21.92 $16.65 80). 90815... S Intac psytx, off 75-80 092 1.57 $83.25 $21.92 $16.65 w/e&m. 90816... S Psytx, hosp (20-30).... 091 1.19 $62.69 $15.37 $12.54 90817... S Psytx, hosp (20-30) w/ 091 1.19 $62.69 $15.37 $12.54 e&m. 90818... S Psytx, hosp (45-50).... 092 1.57 $83.25 $21.92 $16.65 90819... S Psytx, hosp (45-50) w/ 092 1.57 $83.25 $21.92 $16.65 e&m. 90821... S Psytx, hosp (75-80).... 092 1.57 $83.25 $21.92 $16.65 90822... S Psytx, hosp (75-80) w/ 092 1.57 $83.25 $21.92 $16.65 e&m. 90823... S Intac psytx, hosp (20- 091 1.19 $62.69 $15.37 $12.54 30). 90824... S Intac psytx, hsp 20-30 091 1.19 $62.69 $15.37 $12.54 w/e&m. 90826... S Intac psytx, hosp (45- 092 1.57 $83.25 $21.92 $16.65 50). 90827... S Intac psytx, hsp 45-50 092 1.57 $83.25 $21.92 $16.65 w/e&m. 90828... S Intac psytx, hosp (75- 092 1.57 $83.25 $21.92 $16.65 80). 90829... S Intac psytx, hsp 75-80 092 1.57 $83.25 $21.92 $16.65 w/e&m. 90845... S Psychoanalysis......... 092 1.57 $83.25 $21.92 $16.65 90846... S Family psytx w/o 093 1.54 $81.29 $20.11 $16.26 patient. 90847... S Family psytx w/patient. 093 1.54 $81.29 $20.11 $16.26 90849... S Multiple family group 094 1.24 $65.62 $20.11 $13.12 psytx. 90853... S Group psychotherapy.... 094 1.24 $65.62 $20.11 $13.12 90857... S Intac group psytx...... 094 1.24 $65.62 $20.11 $13.12 90862... X Medication management.. 090 0.85 $45.05 $12.43 $9.01 90865... S Narcosynthesis......... 092 1.57 $83.25 $21.92 $16.65 90870... S Electroconvulsive 919 3.17 $167.49 $80.00 $33.50 therapy. 90871... S Electroconvulsive 919 3.17 $167.49 $80.00 $33.50 therapy. 90875... E Psychophysiological ......... ......... ......... ........... ........... therapy. 90876... E Psychophysiological ......... ......... ......... ........... ........... therapy. 90880... S Hypnotherapy........... 092 1.57 $83.25 $21.92 $16.65 90882... E Environmental ......... ......... ......... ........... ........... manipulation. 90885... N Psy evaluation of ......... ......... ......... ........... ........... records. 90887... N Consultation with ......... ......... ......... ........... ........... family. 90889... N Preparation of report.. ......... ......... ......... ........... ........... 90899... S Psychiatric service/ 091 1.19 $62.69 $15.37 $12.54 therapy. 90901... S Biofeedback, any method 920 1.17 $61.71 $29.61 $12.34 90911... S Biofeedback peri/uro/ 920 1.17 $61.71 $29.61 $12.34 rectal. 90918... A ESRD related services, ......... ......... ......... ........... ........... month. 90919... A ESRD related services, ......... ......... ......... ........... ........... month. 90920... A ESRD related services, ......... ......... ......... ........... ........... month. 90921... A ESRD related services, ......... ......... ......... ........... ........... month. 90922... A ESRD related services, ......... ......... ......... ........... ........... day. 90923... A Esrd related services, ......... ......... ......... ........... ........... day. 90924... A Esrd related services, ......... ......... ......... ........... ........... day. [[Page 47713]] 90925... A Esrd related services, ......... ......... ......... ........... ........... day. 90935... S Hemodialysis, one 926 4.28 $226.25 $69.83 $45.25 evaluation. 90937... S Hemodialysis, repeated 926 4.28 $226.25 $69.83 $45.25 eval. 90945... S Dialysis, one 926 4.28 $226.25 $69.83 $45.25 evaluation. 90947... S Dialysis, repeated eval 926 4.28 $226.25 $69.83 $45.25 90989... E Dialysis training/ ......... ......... ......... ........... ........... complete. 90993... N Dialysis training/ ......... ......... ......... ........... ........... incomplete. 90997... S Hemoperfusion.......... 926 4.28 $226.25 $69.83 $45.25 90999... S Dialysis procedure..... 926 4.28 $226.25 $69.83 $45.25 91000... X Esophageal intubation.. 928 3.11 $164.55 $83.85 $32.91 91010... X Esophagus motility 928 3.11 $164.55 $83.85 $32.91 study. 91011... X Esophagus motility 928 3.11 $164.55 $83.85 $32.91 study. 91012... X Esophagus motility 928 3.11 $164.55 $83.85 $32.91 study. 91020... X Gastric motility....... 928 3.11 $164.55 $83.85 $32.91 91030... X Acid perfusion of 928 3.11 $164.55 $83.85 $32.91 esophagus. 91032... X Esophagus, acid reflux 928 3.11 $164.55 $83.85 $32.91 test. 91033... X Prolonged acid reflux 928 3.11 $164.55 $83.85 $32.91 test. 91052... X Gastric analysis test.. 928 3.11 $164.55 $83.85 $32.91 91055... X Gastric intubation for 928 3.11 $164.55 $83.85 $32.91 smear. 91060... X Gastric saline load 928 3.11 $164.55 $83.85 $32.91 test. 91065... X Breath hydrogen test... 928 3.11 $164.55 $83.85 $32.91 91100... X Pass intestine bleeding 928 3.11 $164.55 $83.85 $32.91 tube. 91105... X Gastric intubation 928 3.11 $164.55 $83.85 $32.91 treatment. 91122... N Anal pressure record... ......... ......... ......... ........... ........... 91299... X Gastroenterology 928 3.11 $164.55 $83.85 $32.91 procedure. 92002... V Eye exam, new patient.. 913 ......... ......... ........... ........... 92004... V Eye exam, new patient.. 915 ......... ......... ........... ........... 92012... V Eye exam established pt 913 ......... ......... ........... ........... 92014... V Eye exam & treatment... 915 ......... ......... ........... ........... 92015... E Refraction............. ......... ......... ......... ........... ........... 92018... T New eye exam & 676 6.30 $333.01 $140.35 $66.6 treatment. 92019... T Eye exam & treatment... 676 6.30 $333.01 $140.35 $66.6 92020... N Special eye evaluation. ......... ......... ......... ........... ........... 92060... X Special eye evaluation. 930 1.02 $53.87 $22.83 $10.77 92065... X Orthoptic/pleoptic 930 1.02 $53.87 $22.83 $10.77 training. 92070... N Fitting of contact lens ......... ......... ......... ........... ........... 92081... X Visual field 930 1.02 $53.87 $22.83 $10.77 examination(s). 92082... X Visual field 930 1.02 $53.87 $22.83 $10.77 examination(s). 92083... X Visual field 930 1.02 $53.87 $22.83 $10.77 examination(s). 92100... N Serial tonometry ......... ......... ......... ........... ........... exam(s). 92120... X Tonography & eye 931 0.74 $39.18 $21.47 $7.84 evaluation. 92130... X Water provocation 931 0.74 $39.18 $21.47 $7.84 tonography. 92140... X Glaucoma provocative 930 1.02 $53.87 $22.83 $10.77 tests. 92225... N Special eye exam, ......... ......... ......... ........... ........... initial. 92226... N Special eye exam, ......... ......... ......... ........... ........... subsequent. 92230... X Eye exam with photos... 931 0.74 $39.18 $21.47 $7.84 92235... X Eye exam with photos... 932 2.52 $133.21 $65.09 $26.64 92240... X Icg angiography........ 931 0.74 $39.18 $21.47 $7.84 92250... X Eye exam with photos... 931 0.74 $39.18 $21.47 $7.84 92260... N Ophthalmoscopy/ ......... ......... ......... ........... ........... dynamometry. 92265... X Eye muscle evaluation.. 932 2.52 $133.21 $65.09 $26.64 92270... X Electro-oculography.... 932 2.52 $133.21 $65.09 $26.64 92275... X Electroretinography.... 981 1.46 $77.38 $41.81 $15.48 92283... X Color vision 930 1.02 $53.87 $22.83 $10.77 examination. 92284... X Dark adaptation eye 930 1.02 $53.87 $22.83 $10.77 exam. 92285... X Eye photography........ 930 1.02 $53.87 $22.83 $10.77 92286... X Internal eye 932 2.52 $133.21 $65.09 $26.64 photography. 92287... X Internal eye 932 2.52 $133.21 $65.09 $26.64 photography. 92310... E Contact lens fitting... ......... ......... ......... ........... ........... 92311... X Contact lens fitting... 936 0.52 $27.42 $9.49 $5.48 92312... X Contact lens fitting... 936 0.52 $27.42 $9.49 $5.48 92313... X Contact lens fitting... 936 0.52 $27.42 $9.49 $5.48 92314... E Prescription of contact ......... ......... ......... ........... ........... lens. 92315... X Prescription of contact 936 0.52 $27.42 $9.49 $5.48 lens. 92316... X Prescription of contact 936 0.52 $27.42 $9.49 $5.48 lens. 92317... X Prescription of contact 936 0.52 $27.42 $9.49 $5.48 lens. 92325... X Modification of contact 936 0.52 $27.42 $9.49 $5.48 lens. 92326... X Replacement of contact 936 0.52 $27.42 $9.49 $5.48 lens. 92330... X Fitting of artificial 936 0.52 $27.42 $9.49 $5.48 eye. 92335... N Fitting of artificial ......... ......... ......... ........... ........... eye. 92340... E Fitting of spectacles.. ......... ......... ......... ........... ........... 92341... E Fitting of spectacles.. ......... ......... ......... ........... ........... 92342... E Fitting of spectacles.. ......... ......... ......... ........... ........... 92352... X Special spectacles 936 0.52 $27.42 $9.49 $5.48 fitting. 92353... X Special spectacles 936 0.52 $27.42 $9.49 $5.48 fitting. [[Page 47714]] 92354... X Special spectacles 936 0.52 $27.42 $9.49 $5.48 fitting. 92355... X Special spectacles 936 0.52 $27.42 $9.49 $5.48 fitting. 92358... X Eye prosthesis service. 936 0.52 $27.42 $9.49 $5.48 92370... E Repair & adjust ......... ......... ......... ........... ........... spectacles. 92371... X Repair & adjust 936 0.52 $27.42 $9.49 $5.48 spectacles. 92390... E Supply of spectacles... ......... ......... ......... ........... ........... 92391... E Supply of contact ......... ......... ......... ........... ........... lenses. 92392... E Supply of low vision ......... ......... ......... ........... ........... aids. 92393... E Supply of artificial ......... ......... ......... ........... ........... eye. 92395... E Supply of spectacles... ......... ......... ......... ........... ........... 92396... E Supply of contact ......... ......... ......... ........... ........... lenses. 92499... X Eye service or 931 0.74 $39.18 $21.47 $7.84 procedure. 92502... T Ear and throat 311 1.43 $75.42 $20.57 $15.08 examination. 92504... N Ear microscopy ......... ......... ......... ........... ........... examination. 92506... A Speech & hearing ......... ......... ......... ........... ........... evaluation. 92507... A Speech/hearing therapy. ......... ......... ......... ........... ........... 92508... A Speech/hearing therapy. ......... ......... ......... ........... ........... 92510... A Rehab for ear implant.. ......... ......... ......... ........... ........... 92511... T Nasopharyngos-......... 331 0.69 $36.24 $14.01 $7.25 copy................... 92512... X Nasal function studies. 940 3.04 $160.63 $51.98 $32.13 92516... X Facial nerve function 940 3.04 $160.63 $51.98 $32.13 test. 92520... X Laryngeal function 940 3.04 $160.63 $51.98 $32.13 studies. 92525... A Oral function ......... ......... ......... ........... ........... evaluation. 92526... A Oral function therapy.. ......... ......... ......... ........... ........... 92531... N Spontaneous nystagmus ......... ......... ......... ........... ........... study. 92532... N Positional nystagmus ......... ......... ......... ........... ........... study. 92533... N Caloric vestibular test ......... ......... ......... ........... ........... 92534... N Optokinetic nystagmus.. ......... ......... ......... ........... ........... 92541... X Spontaneous nystagmus 940 3.04 $160.63 $51.98 $32.13 test. 92542... X Positional nystagmus 940 3.04 $160.63 $51.98 $32.13 test. 92543... X Caloric vestibular test 940 3.04 $160.63 $51.98 $32.13 92544... X Optokinetic nystagmus 940 3.04 $160.63 $51.98 $32.13 test. 92545... X Oscillating tracking 940 3.04 $160.63 $51.98 $32.13 test. 92546... X Sinusoidal rotational 940 3.04 $160.63 $51.98 $32.13 test. 92547... X Supplemental electrical 940 3.04 $160.63 $51.98 $32.13 test. 92548... X Posturography.......... 940 3.04 $160.63 $51.98 $32.13 92551... E Pure tone hearing test, ......... ......... ......... ........... ........... air. 92552... X Pure tone audiometry, 941 0.74 $39.18 $13.56 $7.84 air. 92553... X Audiometry, air & bone. 941 0.74 $39.18 $13.56 $7.84 92555... X Speech threshold 941 0.74 $39.18 $13.56 $7.84 audiometry. 92556... X Speech audiometry, 941 0.74 $39.18 $13.56 $7.84 complete. 92557... X Comprehensive hearing 942 1.48 $78.36 $22.15 $15.67 test. 92559... E Group audiometric ......... ......... ......... ........... ........... testing. 92560... E Bekesy audiometry, ......... ......... ......... ........... ........... screen. 92561... X Bekesy audiometry, 942 1.48 $78.36 $22.15 $15.67 diagnosis. 92562... X Loudness balance test.. 942 1.48 $78.36 $22.15 $15.67 92563... X Tone decay hearing test 942 1.48 $78.36 $22.15 $15.67 92564... X Sisi hearing test...... 942 1.48 $78.36 $22.15 $15.67 92565... X Stenger test, pure tone 942 1.48 $78.36 $22.15 $15.67 92567... X Tympanometry........... 941 0.74 $39.18 $13.56 $7.84 92568... X Acoustic reflex testing 942 1.48 $78.36 $22.15 $15.67 92569... X Acoustic reflex decay 942 1.48 $78.36 $22.15 $15.67 test. 92571... X Filtered speech hearing 942 1.48 $78.36 $22.15 $15.67 test. 92572... X Staggered spondaic word 942 1.48 $78.36 $22.15 $15.67 test. 92573... X Lombard test........... 942 1.48 $78.36 $22.15 $15.67 92575... X Sensorineural acuity 942 1.48 $78.36 $22.15 $15.67 test. 92576... X Synthetic sentence test 942 1.48 $78.36 $22.15 $15.67 92577... X Stenger test, speech... 942 1.48 $78.36 $22.15 $15.67 92579... X Visual audiometry (vra) 942 1.48 $78.36 $22.15 $15.67 92582... X Conditioning play 942 1.48 $78.36 $22.15 $15.67 audiometry. 92583... X Select picture 942 1.48 $78.36 $22.15 $15.67 audiometry. 92584... X Electrocochleography... 940 3.04 $160.63 $51.98 $32.13 92585... X Auditory evoked 982 1.39 $73.46 $38.87 $14.69 potential. 92587... X Evoked auditory test... 940 3.04 $160.63 $51.98 $32.13 92588... X Evoked auditory test... 940 3.04 $160.63 $51.98 $32.13 92589... X Auditory function 942 1.48 $78.36 $22.15 $15.67 test(s). 92590... E Hearing aid exam, one ......... ......... ......... ........... ........... ear. 92591... E Hearing aid exam, both ......... ......... ......... ........... ........... ears. 92592... E Hearing aid check, one ......... ......... ......... ........... ........... ear. 92593... E Hearing aid check, both ......... ......... ......... ........... ........... ears. 92594... E Electro hearing aid ......... ......... ......... ........... ........... test, one. 92595... E Electro hearing aid ......... ......... ......... ........... ........... test, both. 92596... X Ear protector 942 1.48 $78.36 $22.15 $15.67 evaluation. 92597... A Oral speech device eval ......... ......... ......... ........... ........... [[Page 47715]] 92598... A Modify oral speech ......... ......... ......... ........... ........... device. 92599... X ENT procedure/service.. 941 0.74 $39.18 $13.56 $7.84 92950... S Heart/lung 947 4.07 $215.48 $109.61 $43.10 resuscitation(CPR. 92953... S Temporary external 947 4.07 $215.48 $109.61 $43.10 pacing. 92960... S Heart electroconversion 947 4.07 $215.48 $109.61 $43.10 92970... C Cardioassist, internal. ......... ......... ......... ........... ........... 92971... C Cardioassist, external. ......... ......... ......... ........... ........... 92975... C Dissolve clot, heart ......... ......... ......... ........... ........... vessel. 92977... C Dissolve clot, heart ......... ......... ......... ........... ........... vessel. 92978... C Intravas us, heart (add- ......... ......... ......... ........... ........... on). 92979... C Intravas us, heart (add- ......... ......... ......... ........... ........... on). 92980... C Insert intracoronary ......... ......... ......... ........... ........... stent. 92981... C Insert intracoronary ......... ......... ......... ........... ........... stent. 92982... C Coronary artery ......... ......... ......... ........... ........... dilation. 92984... C Coronary artery ......... ......... ......... ........... ........... dilation. 92986... C Revision of aortic ......... ......... ......... ........... ........... valve. 92987... C Revision of mitral ......... ......... ......... ........... ........... valve. 92990... C Revision of pulmonary ......... ......... ......... ........... ........... valve. 92992... C Revision of heart ......... ......... ......... ........... ........... chamber. 92993... C Revision of heart ......... ......... ......... ........... ........... chamber. 92995... C Coronary atherectomy... ......... ......... ......... ........... ........... 92996... C Coronary atherectomy... ......... ......... ......... ........... ........... 92997... C Pul art balloon repair, ......... ......... ......... ........... ........... perc. 92998... C Pul art balloon repair, ......... ......... ......... ........... ........... perc. 93000... N Electrocardiogram, ......... ......... ......... ........... ........... complete. 93005... X Electrocardiogram, 950 0.35 $18.61 $15.82 $3.72 tracing. 93010... N Electrocardiogram ......... ......... ......... ........... ........... report. 93012... X Transmission of ecg.... 956 1.11 $58.77 $55.82 $11.75 93014... N Report on transmitted ......... ......... ......... ........... ........... ecg. 93015... N Cardiovascular stress ......... ......... ......... ........... ........... test. 93016... N Cardiovascular stress ......... ......... ......... ........... ........... test. 93017... X Cardiovascular stress 949 1.46 $77.38 $62.83 $15.48 test. 93018... N Cardiovascular stress ......... ......... ......... ........... ........... test. 93024... X Cardiac drug stress 949 1.46 $77.38 $62.83 $15.48 test. 93040... N Rhythm ECG with report. ......... ......... ......... ........... ........... 93041... X Rhythm ECG, tracing.... 950 0.35 $18.61 $15.82 $3.72 93042... N Rhythm ECG, report..... ......... ......... ......... ........... ........... 93224... X ECG monitor/report, 24 956 1.11 $58.77 $55.82 $11.75 hrs. 93225... X ECG monitor/record, 24 956 1.11 $58.77 $55.82 $11.75 hrs. 93226... X ECG monitor/report, 24 956 1.11 $58.77 $55.82 $11.75 hrs. 93227... N ECG monitor/review, 24 ......... ......... ......... ........... ........... hrs. 93230... X ECG monitor/report, 24 956 1.11 $58.77 $55.82 $11.75 hrs. 93231... X Ecg monitor/record, 24 956 1.11 $58.77 $55.82 $11.75 hrs. 93232... X ECG monitor/report, 24 956 1.11 $58.77 $55.82 $11.75 hrs. 93233... N ECG monitor/review, 24 ......... ......... ......... ........... ........... hrs. 93235... X ECG monitor/report, 24 956 1.11 $58.77 $55.82 $11.75 hrs. 93236... X ECG monitor/report, 24 956 1.11 $58.77 $55.82 $11.75 hrs. 93237... N ECG monitor/review, 24 ......... ......... ......... ........... ........... hrs. 93268... X ECG record/review...... 956 1.11 $58.77 $55.82 $11.75 93270... X ECG recording.......... 956 1.11 $58.77 $55.82 $11.75 93271... X Ecg/monitoring and 956 1.11 $58.77 $55.82 $11.75 anaylysis. 93272... N Ecg/review,interpret ......... ......... ......... ........... ........... only. 93278... X ECG/signal-averaged.... 956 1.11 $58.77 $55.82 $11.75 93303... X Echo transthoracic..... 957 2.83 $149.86 $117.07 $29.97 93304... X Echo transthoracic..... 957 2.83 $149.86 $117.07 $29.97 93307... X Echo exam of heart..... 957 2.83 $149.86 $117.07 $29.97 93308... X Echo exam of heart..... 957 2.83 $149.86 $117.07 $29.97 93312... X Echo transesophageal... 957 2.83 $149.86 $117.07 $29.97 93313... X Echo transesophageal... 957 2.83 $149.86 $117.07 $29.97 93314... N Echo transesophageal... ......... ......... ......... ........... ........... 93315... X Echo transesophageal... 957 2.83 $149.86 $117.07 $29.97 93316... X Echo transesophageal... 957 2.83 $149.86 $117.07 $29.97 93317... N Echo transesophageal... ......... ......... ......... ........... ........... 93320... X Doppler echo exam, 957 2.83 $149.86 $117.07 $29.97 heart. 93321... X Doppler echo exam, 957 2.83 $149.86 $117.07 $29.97 heart. 93325... X Doppler color flow..... 957 2.83 $149.86 $117.07 $29.97 93350... X Echo transthoracic..... 957 2.83 $149.86 $117.07 $29.97 93501... T Right heart 958 26.11 $1,381.03 $659.47 $276.21 catheterization. 93503... T Insert/place heart 958 26.11 $1,381.03 $659.47 $276.21 catheter. 93505... T Biopsy of heart lining. 958 26.11 $1,381.03 $659.47 $276.21 93508... T Cath placement, 343 9.52 $503.44 $224.87 $100.69 angiography. 93510... T Left heart 958 26.11 $1,381.03 $659.47 $276.21 catheterization. 93511... T Left heart 958 26.11 $1,381.03 $659.47 $276.21 catheterization. 93514... T Left heart 958 26.11 $1,381.03 $659.47 $276.21 catheterization. 93524... T Left heart 958 26.11 $1,381.03 $659.47 $276.21 catheterization. [[Page 47716]] 93526... T Rt & Lt heart catheters 958 26.11 $1,381.03 $659.47 $276.21 93527... T Rt & Lt heart catheters 958 26.11 $1,381.03 $659.47 $276.21 93528... T Rt & Lt heart catheters 958 26.11 $1,381.03 $659.47 $276.21 93529... T Rt, Lt heart 958 26.11 $1,381.03 $659.47 $276.21 catheterization. 93530... T Rt heart cath, 958 26.11 $1,381.03 $659.47 $276.21 congenital. 93531... T R & l heart cath, 958 26.11 $1,381.03 $659.47 $276.21 congenital. 93532... T R & l heart cath, 958 26.11 $1,381.03 $659.47 $276.21 congenital. 93533... T R & l heart cath, 958 26.11 $1,381.03 $659.47 $276.21 congenital. 93536... T Insert circulation assi 958 26.11 $1,381.03 $659.47 $276.21 93539... N Injection, cardiac cath ......... ......... ......... ........... ........... 93540... N Injection, cardiac cath ......... ......... ......... ........... ........... 93541... N Injection for lung ......... ......... ......... ........... ........... angiogram. 93542... N Injection for heart x- ......... ......... ......... ........... ........... rays. 93543... N Injection for heart x- ......... ......... ......... ........... ........... rays. 93544... N Injection for ......... ......... ......... ........... ........... aortography. 93545... N Injection for coronary ......... ......... ......... ........... ........... xrays. 93555... N Imaging, cardiac cath.. ......... ......... ......... ........... ........... 93556... N Imaging, cardiac cath.. ......... ......... ......... ........... ........... 93561... N Cardiac output ......... ......... ......... ........... ........... measurement. 93562... N Cardiac output ......... ......... ......... ........... ........... measurement. 93600... S Bundle of His recording 960 4.24 $224.29 $144.41 $44.86 93602... S Intra-atrial recording. 960 4.24 $224.29 $144.41 $44.86 93603... S Right ventricular 960 4.24 $224.29 $144.41 $44.86 recording. 93607... S Right ventricular 960 4.24 $224.29 $144.41 $44.86 recording. 93609... S Mapping of tachycardia. 960 4.24 $224.29 $144.41 $44.86 93610... S Intra-atrial pacing.... 960 4.24 $224.29 $144.41 $44.86 93612... S Intraventricular pacing 960 4.24 $224.29 $144.41 $44.86 93615... S Esophageal recording... 960 4.24 $224.29 $144.41 $44.86 93616... S Esophageal recording... 960 4.24 $224.29 $144.41 $44.86 93618... S Heart rhythm pacing.... 960 4.24 $224.29 $144.41 $44.86 93619... S Electrophysiology 960 4.24 $224.29 $144.41 $44.86 evaluation. 93620... S Electrophysiology 960 4.24 $224.29 $144.41 $44.86 evaluation. 93621... S Electrophysiology 960 4.24 $224.29 $144.41 $44.86 evaluation. 93622... S Electrophysiology 960 4.24 $224.29 $144.41 $44.86 evaluation. 93623... S Stimulation, pacing 960 4.24 $224.29 $144.41 $44.86 heart. 93624... S Electrophysiologic 960 4.24 $224.29 $144.41 $44.86 study. 93631... S Heart pacing, mapping.. 960 4.24 $224.29 $144.41 $44.86 93640... S Evaluation heart device 960 4.24 $224.29 $144.41 $44.86 93641... S Electrophysiology 960 4.24 $224.29 $144.41 $44.86 evaluation. 93642... S Electrophysiology 960 4.24 $224.29 $144.41 $44.86 evaluation. 93650... S Ablate heart dysrhythm 960 4.24 $224.29 $144.41 $44.86 focus. 93651... S Ablate heart dysrhythm 960 4.24 $224.29 $144.41 $44.86 focus. 93652... S Ablate heart dysrhythm 960 4.24 $224.29 $144.41 $44.86 focus. 93660... S Tilt table evaluation.. 960 4.24 $224.29 $144.41 $44.86 93720... X Total body 967 1.70 $90.11 $57.40 $18.02 plethysmography. 93721... X Plethysmography tracing 967 1.70 $90.11 $57.40 $18.02 93722... N Plethysmography report. ......... ......... ......... ........... ........... 93724... S Analyze pacemaker 960 4.24 $224.29 $144.41 $44.86 system. 93731... X Analyze pacemaker 966 0.39 $20.57 $12.43 $4.11 system. 93732... X Analyze pacemaker 966 0.39 $20.57 $12.43 $4.11 system. 93733... X Telephone analysis, 966 0.39 $20.57 $12.43 $4.11 pacemaker. 93734... X Analyze pacemaker 966 0.39 $20.57 $12.43 $4.11 system. 93735... X Analyze pacemaker 966 0.39 $20.57 $12.43 $4.11 system. 93736... X Telephone analysis, 966 0.39 $20.57 $12.43 $4.11 pacemaker. 93737... X Analyze cardio/ 966 0.39 $20.57 $12.43 $4.11 defibrillator. 93738... X Analyze cardio/ 966 0.39 $20.57 $12.43 $4.11 defibrillator. 93740... X Temperature gradient 967 1.70 $90.11 $57.40 $18.02 studies. 93760... E Cephalic thermogram.... ......... ......... ......... ........... ........... 93762... E Peripheral thermogram.. ......... ......... ......... ........... ........... 93770... N Measure venous pressure ......... ......... ......... ........... ........... 93784... E Ambulatory BP ......... ......... ......... ........... ........... monitoring. 93786... E Ambulatory BP recording ......... ......... ......... ........... ........... 93788... E Ambulatory BP analysis. ......... ......... ......... ........... ........... 93790... E Review/report BP ......... ......... ......... ........... ........... recording. 93797... X Cardiac rehab.......... 948 0.81 $43.10 $16.95 $8.62 93798... X Cardiac rehab/monitor.. 948 0.81 $43.10 $16.95 $8.62 93799... X Cardiovascular 967 1.70 $90.11 $57.40 $18.02 procedure. 93875... X Extracranial study..... 968 2.37 $125.37 $79.55 $25.07 93880... X Extracranial study..... 968 2.37 $125.37 $79.55 $25.07 93882... X Extracranial study..... 968 2.37 $125.37 $79.55 $25.07 93886... X Intracranial study..... 968 2.37 $125.37 $79.55 $25.07 93888... X Intracranial study..... 968 2.37 $125.37 $79.55 $25.07 93922... X Extremity study........ 967 1.70 $90.11 $57.40 $18.02 93923... X Extremity study........ 967 1.70 $90.11 $57.40 $18.02 93924... X Extremity study........ 967 1.70 $90.11 $57.40 $18.02 [[Page 47717]] 93925... X Lower extremity study.. 968 2.37 $125.37 $79.55 $25.07 93926... X Lower extremity study.. 968 2.37 $125.37 $79.55 $25.07 93930... X Upper extremity study.. 968 2.37 $125.37 $79.55 $25.07 93931... X Upper extremity study.. 968 2.37 $125.37 $79.55 $25.07 93965... X Extremity study........ 967 1.70 $90.11 $57.40 $18.02 93970... X Extremity study........ 968 2.37 $125.37 $79.55 $25.07 93971... X Extremity study........ 968 2.37 $125.37 $79.55 $25.07 93975... X Vascular study......... 968 2.37 $125.37 $79.55 $25.07 93976... X Vascular study......... 968 2.37 $125.37 $79.55 $25.07 93978... X Vascular study......... 968 2.37 $125.37 $79.55 $25.07 93979... X Vascular study......... 968 2.37 $125.37 $79.55 $25.07 93980... X Penile vascular study.. 968 2.37 $125.37 $79.55 $25.07 93981... X Penile vascular study.. 968 2.37 $125.37 $79.55 $25.07 93990... X Doppler flow testing... 968 2.37 $125.37 $79.55 $25.07 94010... X Breathing capacity test 971 0.78 $41.14 $21.47 $8.23 94060... X Evaluation of wheezing. 971 0.78 $41.14 $21.47 $8.23 94070... S Evaluation of wheezing. 973 1.89 $99.90 $55.82 $19.98 94150... N Vital capacity test.... ......... ......... ......... ........... ........... 94200... X Lung function test (MBC/ 971 0.78 $41.14 $21.47 $8.23 MVV). 94240... X Residual lung capacity. 972 1.02 $53.87 $29.38 $10.77 94250... X Expired gas collection. 971 0.78 $41.14 $21.47 $8.23 94260... X Thoracic gas volume.... 971 0.78 $41.14 $21.47 $8.23 94350... X Lung nitrogen washout 972 1.02 $53.87 $29.38 $10.77 curve. 94360... X Measure airflow 971 0.78 $41.14 $21.47 $8.23 resistance. 94370... X Breath airway closing 972 1.02 $53.87 $29.38 $10.77 volume. 94375... X Respiratory flow volume 971 0.78 $41.14 $21.47 $8.23 loop. 94400... X CO2 breathing response 971 0.78 $41.14 $21.47 $8.23 curve. 94450... X Hypoxia response curve. 971 0.78 $41.14 $21.47 $8.23 94620... S Pulmonary stress 973 1.89 $99.90 $55.82 $19.98 testing. 94640... S Airway inhalation 976 0.44 $23.30 $14.92 $4.66 treatment. 94642... S Aerosol inhalation 976 0.44 $23.30 $14.92 $4.66 treatment. 94650... S Pressure breathing 976 0.44 $23.30 $14.92 $4.66 (IPPB). 94651... S Pressure breathing 976 0.44 $23.30 $14.92 $4.66 (IPPB). 94652... C Pressure breathing ......... ......... ......... ........... ........... (IPPB). 94656... C Initial ventilator mgmt ......... ......... ......... ........... ........... 94657... S Cont. ventilator....... 976 0.44 $23.30 $14.92 $4.66 94660... S Pos airway pressure, 976 0.44 $23.30 $14.92 $4.66 CPAP. 94662... S Neg pressure 976 0.44 $23.30 $14.92 $4.66 ventilation,cnp. 94664... S Aerosol or vapor 976 0.44 $23.30 $14.92 $4.66 inhalations. 94665... S Aerosol or vapor 976 0.44 $23.30 $14.92 $4.66 inhalations. 94667... S Chest wall manipulation 976 0.44 $23.30 $14.92 $4.66 94668... S Chest wall manipulation 976 0.44 $23.30 $14.92 $4.66 94680... X Exhaled air analysis: 972 1.02 $53.87 $29.38 $10.77 O2. 94681... X Exhaled air analysis: 972 1.02 $53.87 $29.38 $10.77 O2,CO2. 94690... X Exhaled air analysis... 972 1.02 $53.87 $29.38 $10.77 94720... X Monoxide diffusing 972 1.02 $53.87 $29.38 $10.77 capacity. 94725... X Membrane diffusion 972 1.02 $53.87 $29.38 $10.77 capacity. 94750... S Pulmonary compliance 973 1.89 $99.90 $55.82 $19.98 study. 94760... N Measure blood oxygen ......... ......... ......... ........... ........... level. 94761... N Measure blood oxygen ......... ......... ......... ........... ........... level. 94762... X Measure blood oxygen 971 0.78 $41.14 $21.47 $8.23 level. 94770... X Exhaled carbon dioxide 971 0.78 $41.14 $21.47 $8.23 test. 94772... S Breath recording, 973 1.89 $99.90 $55.82 $19.98 infant. 94799... X Pulmonary service/ 971 0.78 $41.14 $21.47 $8.23 procedure. 95004... X Allergy skin tests..... 977 0.63 $33.30 $12.66 $6.66 95010... X Sensitivity skin tests. 977 0.63 $33.30 $12.66 $6.66 95015... X Sensitivity skin tests. 977 0.63 $33.30 $12.66 $6.66 95024... X Allergy skin tests..... 977 0.63 $33.30 $12.66 $6.66 95027... X Skin end point 977 0.63 $33.30 $12.66 $6.66 titration. 95028... X Allergy skin tests..... 977 0.63 $33.30 $12.66 $6.66 95044... X Allergy patch tests.... 977 0.63 $33.30 $12.66 $6.66 95052... X Photo patch test....... 977 0.63 $33.30 $12.66 $6.66 95056... X Photosensitivity tests. 977 0.63 $33.30 $12.66 $6.66 95060... X Eye allergy tests...... 977 0.63 $33.30 $12.66 $6.66 95065... X Nose allergy test...... 977 0.63 $33.30 $12.66 $6.66 95070... S Bronchial allergy tests 973 1.89 $99.90 $55.82 $19.98 95071... S Bronchial allergy tests 973 1.89 $99.90 $55.82 $19.98 95075... X Ingestion challenge 928 3.11 $164.55 $83.85 $32.91 test. 95078... X Provocative testing.... 977 0.63 $33.30 $12.66 $6.66 95115... X Immunotherapy, one 978 0.31 $16.65 $3.39 $3.33 injection. 95117... X Immunotherapy 978 0.31 $16.65 $3.39 $3.33 injections. 95120... E Immunotherapy, one ......... ......... ......... ........... ........... injection. 95125... E Immunotherapy, many ......... ......... ......... ........... ........... antigens. 95130... E Immunotherapy, insect ......... ......... ......... ........... ........... venom. 95131... E Immunotherapy, insect ......... ......... ......... ........... ........... venoms. [[Page 47718]] 95132... E Immunotherapy, insect ......... ......... ......... ........... ........... venoms. 95133... E Immunotherapy, insect ......... ......... ......... ........... ........... venoms. 95134... E Immunotherapy, insect ......... ......... ......... ........... ........... venoms. 95144... X Antigen therapy 978 0.31 $16.65 $3.39 $3.33 services. 95145... X Antigen therapy 978 0.31 $16.65 $3.39 $3.33 services. 95146... X Antigen therapy 978 0.31 $16.65 $3.39 $3.33 services. 95147... X Antigen therapy 978 0.31 $16.65 $3.39 $3.33 services. 95148... X Antigen therapy 978 0.31 $16.65 $3.39 $3.33 services. 95149... X Antigen therapy 901 0.07 $3.92 $2.49 $.78 services. 95165... X Antigen therapy 978 0.31 $16.65 $3.39 $3.33 services. 95170... X Antigen therapy 901 0.07 $3.92 $2.49 $.78 services. 95180... X Rapid desensitization.. 977 0.63 $33.30 $12.66 $6.66 95199... X Allergy immunology 977 0.63 $33.30 $12.66 $6.66 services. 95805... S Multiple sleep latency 979 10.17 $537.72 $288.83 $107.54 test. 95806... S Sleep study, unattended 979 10.17 $537.72 $288.83 $107.54 95807... S Sleep study, attended.. 979 10.17 $537.72 $288.83 $107.54 95808... S Polysomnography, 1-3... 979 10.17 $537.72 $288.83 $107.54 95810... S Polysomnography, 4 or 979 10.17 $537.72 $288.83 $107.54 more. 95811... S Polysomnography w/cpap. 979 10.17 $537.72 $288.83 $107.54 95812... S Electroencephalogram 979 10.17 $537.72 $288.83 $107.54 (EEG). 95813... S Electroencephalogram 979 10.17 $537.72 $288.83 $107.54 (EEG). 95816... X Electroencephalogram 980 2.15 $113.62 $57.86 $22.72 (EEG). 95819... X Electroencephalogram 980 2.15 $113.62 $57.86 $22.72 (EEG). 95822... X Sleep 980 2.15 $113.62 $57.86 $22.72 electroencephalogram. 95824... X Electroencephalography. 980 2.15 $113.62 $57.86 $22.72 95827... S Night 979 10.17 $537.72 $288.83 $107.54 electroencephalogram. 95829... X Surgery 980 2.15 $113.62 $57.86 $22.72 electrocorticogram. 95830... N Insert electrodes for ......... ......... ......... ........... ........... EEG. 95831... N Limb muscle testing, ......... ......... ......... ........... ........... manual. 95832... N Hand muscle testing, ......... ......... ......... ........... ........... manual. 95833... N Body muscle testing, ......... ......... ......... ........... ........... manual. 95834... N Body muscle testing, ......... ......... ......... ........... ........... manual. 95851... N Range of motion ......... ......... ......... ........... ........... measurements. 95852... N Range of motion ......... ......... ......... ........... ........... measurements. 95857... X Tensilon test.......... 981 1.46 $77.38 $41.81 $15.48 95858... X Tensilon test & myogram 982 1.39 $73.46 $38.87 $14.69 95860... X Muscle test, one limb.. 982 1.39 $73.46 $38.87 $14.69 95861... X Muscle test, two limbs. 982 1.39 $73.46 $38.87 $14.69 95863... X Muscle test, 3 limbs... 982 1.39 $73.46 $38.87 $14.69 95864... X Muscle test, 4 limbs... 982 1.39 $73.46 $38.87 $14.69 95867... X Muscle test, head or 981 1.46 $77.38 $41.81 $15.48 neck. 95868... X Muscle test, head or 982 1.39 $73.46 $38.87 $14.69 neck. 95869... X Muscle test, thor 981 1.46 $77.38 $41.81 $15.48 paraspinal. 95870... X Muscle test, non- 981 1.46 $77.38 $41.81 $15.48 paraspinal. 95872... X Muscle test, one fiber. 982 1.39 $73.46 $38.87 $14.69 95875... X Limb exercise test..... 982 1.39 $73.46 $38.87 $14.69 95900... X Motor nerve conduction 981 1.46 $77.38 $41.81 $15.48 test. 95903... X Motor nerve conduction 982 1.39 $73.46 $38.87 $14.69 test. 95904... X Sense nerve conduction 982 1.39 $73.46 $38.87 $14.69 test. 95920... C Intraoperative nerve ......... ......... ......... ........... ........... testing. 95921... X Autonomic nervous func 981 1.46 $77.38 $41.81 $15.48 test. 95922... X Autonomic nervous func 981 1.46 $77.38 $41.81 $15.48 test. 95923... X Autonomic nervous func 981 1.46 $77.38 $41.81 $15.48 test. 95925... X Somatosensory testing.. 982 1.39 $73.46 $38.87 $14.69 95926... X Somatosensory testing.. 981 1.46 $77.38 $41.81 $15.48 95927... X Somatosensory testing.. 981 1.46 $77.38 $41.81 $15.48 95930... X Visual evoked potential 981 1.46 $77.38 $41.81 $15.48 test. 95933... X Blink reflex test...... 981 1.46 $77.38 $41.81 $15.48 95934... X `h' reflex test........ 981 1.46 $77.38 $41.81 $15.48 95936... X `h' reflex test........ 981 1.46 $77.38 $41.81 $15.48 95937... X Neuromuscular junction 981 1.46 $77.38 $41.81 $15.48 test. 95950... X Ambulatory eeg 981 1.46 $77.38 $41.81 $15.48 monitoring. 95951... S EEG monitoring/ 979 10.17 $537.72 $288.83 $107.54 videorecord. 95953... S EEG monitoring/computer 979 10.17 $537.72 $288.83 $107.54 95954... S EEG monitoring/giving 979 10.17 $537.72 $288.83 $107.54 drugs. 95955... X EEG during surgery..... 980 2.15 $113.62 $57.86 $22.72 95956... N EEG monitoring/cable/ ......... ......... ......... ........... ........... radio. 95957... N EEG digital analysis... ......... ......... ......... ........... ........... 95958... S EEG monitoring/function 979 10.17 $537.72 $288.83 $107.54 test. 95961... C Electrode stimulation, ......... ......... ......... ........... ........... brain. 95962... C Electrode stimulation, ......... ......... ......... ........... ........... brain. 95999... N Neurological procedure. ......... ......... ......... ........... ........... 96100... X Psychological testing.. 089 2.54 $134.19 $37.29 $26.84 96105... X Assessment of aphasia.. 089 2.54 $134.19 $37.29 $26.84 96110... X Developmental test, lim 089 2.54 $134.19 $37.29 $26.84 [[Page 47719]] 96111... X Developmental test, 089 2.54 $134.19 $37.29 $26.84 extend. 96115... X Neurobehavior status 089 2.54 $134.19 $37.29 $26.84 exam. 96117... X Neuropsych test battery 089 2.54 $134.19 $37.29 $26.84 96400... S Chemotherapy, (SC)/(IM) 987 0.65 $34.28 $13.33 $6.86 96405... S Intralesional chemo 987 0.65 $34.28 $13.33 $6.86 admin. 96406... S Intralesional chemo 987 0.65 $34.28 $13.33 $6.86 admin. 96408... S Chemotherapy, push 988 4.15 $219.40 $97.63 $43.88 technique. 96410... S Chemotherapy, infusion 988 4.15 $219.40 $97.63 $43.88 method. 96412... S Chemotherapy, infusion 988 4.15 $219.40 $97.63 $43.88 method. 96414... S Chemotherapy, infusion 989 1.72 $91.09 $40.68 $18.22 method. 96420... S Chemotherapy, push 988 4.15 $219.40 $97.63 $43.88 technique. 96422... S Chemotherapy, infusion 988 4.15 $219.40 $97.63 $43.88 method. 96423... S Chemotherapy, infusion 988 4.15 $219.40 $97.63 $43.88 method. 96425... S Chemotherapy, infusion 989 1.72 $91.09 $40.68 $18.22 method. 96440... S Chemotherapy, 989 1.72 $91.09 $40.68 $18.22 intracavitary. 96445... S Chemotherapy, 989 1.72 $91.09 $40.68 $18.22 intracavitary. 96450... S Chemotherapy, into CNS. 989 1.72 $91.09 $40.68 $18.22 96520... E Pump refilling, ......... ......... ......... ........... ........... maintenance. 96530... E Pump refilling, ......... ......... ......... ........... ........... maintenance. 96542... S Chemotherapy injection. 989 1.72 $91.09 $40.68 $18.22 96545... N Provide chemotherapy ......... ......... ......... ........... ........... agent. 96549... S Chemotherapy, 987 0.65 $34.28 $13.33 $6.86 unspecified. 96900... S Ultraviolet light 990 0.43 $22.53 $8.14 $4.51 therapy. 96902... N Trichogram............. ......... ......... ......... ........... ........... 96910... S Photochemotherapy with 990 0.43 $22.53 $8.14 $4.51 UV-B. 96912... S Photochemotherapy with 990 0.43 $22.53 $8.14 $4.51 UV-A. 96913... S Photochemotherapy, UV-A 990 0.43 $22.53 $8.14 $4.51 or B. 96999... S Dermatological 990 0.43 $22.53 $8.14 $4.51 procedure. 97001... A Pt evaluation.......... ......... ......... ......... ........... ........... 97002... A Pt re-evaluation....... ......... ......... ......... ........... ........... 97003... A Ot evaluation.......... ......... ......... ......... ........... ........... 97004... A Ot re-evaluation....... ......... ......... ......... ........... ........... 97010... A Hot or cold packs ......... ......... ......... ........... ........... therapy. 97012... A Mechanical traction ......... ......... ......... ........... ........... therapy. 97014... A Electric stimulation ......... ......... ......... ........... ........... therapy. 97016... A Vasopneumatic device ......... ......... ......... ........... ........... therapy. 97018... A Paraffin bath therapy.. ......... ......... ......... ........... ........... 97020... A Microwave therapy...... ......... ......... ......... ........... ........... 97022... A Whirlpool therapy...... ......... ......... ......... ........... ........... 97024... A Diathermy treatment.... ......... ......... ......... ........... ........... 97026... A Infrared therapy....... ......... ......... ......... ........... ........... 97028... A Ultraviolet therapy.... ......... ......... ......... ........... ........... 97032... A Electrical stimulation. ......... ......... ......... ........... ........... 97033... A Electric current ......... ......... ......... ........... ........... therapy. 97034... A Contrast bath therapy.. ......... ......... ......... ........... ........... 97035... A Ultrasound therapy..... ......... ......... ......... ........... ........... 97036... A Hydrotherapy........... ......... ......... ......... ........... ........... 97039... A Physical therapy ......... ......... ......... ........... ........... treatment. 97110... A Therapeutic exercises.. ......... ......... ......... ........... ........... 97112... A Neuromuscular ......... ......... ......... ........... ........... reeducation. 97113... A Aquatic therapy/ ......... ......... ......... ........... ........... exercises. 97116... A Gait training therapy.. ......... ......... ......... ........... ........... 97122... A Manual traction therapy ......... ......... ......... ........... ........... 97124... A Massage therapy........ ......... ......... ......... ........... ........... 97139... A Physical medicine ......... ......... ......... ........... ........... procedure. 97150... A Group therapeutic ......... ......... ......... ........... ........... procedures. 97250... S Myofascial release..... 997 0.69 $36.24 $7.25 $7.25 97260... S Regional manipulation.. 997 0.69 $36.24 $7.25 $7.25 97261... S Supplemental 997 0.69 $36.24 $7.25 $7.25 manipulations. 97265... A Joint mobilization..... ......... ......... ......... ........... ........... 97504... A Orthotic training...... ......... ......... ......... ........... ........... 97520... A Prosthetic training.... ......... ......... ......... ........... ........... 97530... A Therapeutic activities. ......... ......... ......... ........... ........... 97535... A Self care mngment ......... ......... ......... ........... ........... training. 97537... A Community/work ......... ......... ......... ........... ........... reintegration. 97542... A Wheelchair mngement ......... ......... ......... ........... ........... training. 97545... A Work hardening......... ......... ......... ......... ........... ........... 97546... A Work hardening......... ......... ......... ......... ........... ........... 97703... A Prosthetic checkout.... ......... ......... ......... ........... ........... 97750... A Physical performance ......... ......... ......... ........... ........... test. 97770... A Cognitive skills ......... ......... ......... ........... ........... development. 97780... E Acupuncture w/o stim... ......... ......... ......... ........... ........... 97781... E Acupuncture w/stim..... ......... ......... ......... ........... ........... 97799... A Physical medicine ......... ......... ......... ........... ........... procedure. 98925... S Osteopathic 997 0.69 $36.24 $7.25 $7.25 manipulation. [[Page 47720]] 98926... S Osteopathic 997 0.69 $36.24 $7.25 $7.25 manipulation. 98927... S Osteopathic 997 0.69 $36.24 $7.25 $7.25 manipulation. 98928... S Osteopathic 997 0.69 $36.24 $7.25 $7.25 manipulation. 98929... S Osteopathic 997 0.69 $36.24 $7.25 $7.25 manipulation. 98940... S Chiropractic 997 0.69 $36.24 $7.25 $7.25 manipulation. 98941... S Chiropractic 997 0.69 $36.24 $7.25 $7.25 manipulation. 98942... S Chiropractic 997 0.69 $36.24 $7.25 $7.25 manipulation. 98943... E Chiropractic ......... ......... ......... ........... ........... manipulation. 99000... E Specimen handling...... ......... ......... ......... ........... ........... 99001... N Specimen handling...... ......... ......... ......... ........... ........... 99002... E Device handling........ ......... ......... ......... ........... ........... 99024... N Post-op follow-up visit ......... ......... ......... ........... ........... 99025... N Initial surgical ......... ......... ......... ........... ........... evaluation. 99050... E Medical services after ......... ......... ......... ........... ........... hrs. 99052... E Medical services at ......... ......... ......... ........... ........... night. 99054... E Medical services, ......... ......... ......... ........... ........... unusual hrs. 99056... E Non-office medical ......... ......... ......... ........... ........... services. 99058... N Office emergency care.. ......... ......... ......... ........... ........... 99070... E Special supplies....... ......... ......... ......... ........... ........... 99071... E Patient education ......... ......... ......... ........... ........... materials. 99075... E Medical testimony...... ......... ......... ......... ........... ........... 99078... S Group health education. 921 ......... ......... ........... ........... 99080... E Special reports or ......... ......... ......... ........... ........... forms. 99082... E Unusual physician ......... ......... ......... ........... ........... travel. 99090... E Computer data analysis. ......... ......... ......... ........... ........... 99100... N Special anesthesia ......... ......... ......... ........... ........... service. 99116... N Anesthesia with ......... ......... ......... ........... ........... hypothermia. 99135... N Special anesthesia ......... ......... ......... ........... ........... procedure. 99140... N Emergency anesthesia... ......... ......... ......... ........... ........... 99141... N Sedation, iv/im or ......... ......... ......... ........... ........... inhalant. 99142... N Sedation, oral/rectal/ ......... ......... ......... ........... ........... nasal. 99175... N Induction of vomiting.. ......... ......... ......... ........... ........... 99183... S Hyperbaric oxygen 969 2.65 $140.06 $141.70 $28.01 therapy. 99185... N Regional hypothermia... ......... ......... ......... ........... ........... 99186... N Total body hypothermia. ......... ......... ......... ........... ........... 99190... C Special pump services.. ......... ......... ......... ........... ........... 99191... C Special pump services.. ......... ......... ......... ........... ........... 99192... C Special pump services.. ......... ......... ......... ........... ........... 99195... X Phlebotomy............. 999 0.43 $22.53 $10.85 $4.51 99199... N Special service or ......... ......... ......... ........... ........... report. 99201... V Office/outpatient 911 ......... ......... ........... ........... visit, new. 99202... V Office/outpatient 911 ......... ......... ........... ........... visit, new. 99203... V Office/outpatient 913 ......... ......... ........... ........... visit, new. 99204... V Office/outpatient 915 ......... ......... ........... ........... visit, new. 99205... V Office/outpatient 915 ......... ......... ........... ........... visit, new. 99211... V Office/outpatient 911 ......... ......... ........... ........... visit, est. 99212... V Office/outpatient 911 ......... ......... ........... ........... visit, est. 99213... V Office/outpatient 913 ......... ......... ........... ........... visit, est. 99214... V Office/outpatient 915 ......... ......... ........... ........... visit, est. 99215... V Office/outpatient 915 ......... ......... ........... ........... visit, est. 99217... N Observation care ......... ......... ......... ........... ........... discharge. 99218... N Observation care....... ......... ......... ......... ........... ........... 99219... N Observation care....... ......... ......... ......... ........... ........... 99220... N Observation care....... ......... ......... ......... ........... ........... 99221... E Initial hospital care.. ......... ......... ......... ........... ........... 99222... E Initial hospital care.. ......... ......... ......... ........... ........... 99223... E Initial hospital care.. ......... ......... ......... ........... ........... 99231... E Subsequent hospital ......... ......... ......... ........... ........... care. 99232... E Subsequent hospital ......... ......... ......... ........... ........... care. 99233... E Subsequent hospital ......... ......... ......... ........... ........... care. 99234... C Observ/hosp same date.. ......... ......... ......... ........... ........... 99235... C Observ/hosp same date.. ......... ......... ......... ........... ........... 99236... C Observ/hosp same date.. ......... ......... ......... ........... ........... 99238... E Hospital discharge day. ......... ......... ......... ........... ........... 99239... E Hospital discharge day. ......... ......... ......... ........... ........... 99241... V Office consultation.... 911 ......... ......... ........... ........... 99242... V Office consultation.... 911 ......... ......... ........... ........... 99243... V Office consultation.... 913 ......... ......... ........... ........... 99244... V Office consultation.... 915 ......... ......... ........... ........... 99245... V Office consultation.... 915 ......... ......... ........... ........... 99251... C Initial inpatient ......... ......... ......... ........... ........... consult. 99252... C Initial inpatient ......... ......... ......... ........... ........... consult. 99253... C Initial inpatient ......... ......... ......... ........... ........... consult. 99254... C Initial inpatient ......... ......... ......... ........... ........... consult. 99255... C Initial inpatient ......... ......... ......... ........... ........... consult. [[Page 47721]] 99261... C Follow-up inpatient ......... ......... ......... ........... ........... consult. 99262... C Follow-up inpatient ......... ......... ......... ........... ........... consult. 99263... C Follow-up inpatient ......... ......... ......... ........... ........... consult. 99271... V Confirmatory 911 ......... ......... ........... ........... consultation. 99272... V Confirmatory 911 ......... ......... ........... ........... consultation. 99273... V Confirmatory 913 ......... ......... ........... ........... consultation. 99274... V Confirmatory 915 ......... ......... ........... ........... consultation. 99275... V Confirmatory 915 ......... ......... ........... ........... consultation. 99281... V Emergency dept visit... 951 ......... ......... ........... ........... 99282... V Emergency dept visit... 951 ......... ......... ........... ........... 99283... V Emergency dept visit... 953 ......... ......... ........... ........... 99284... V Emergency dept visit... 955 ......... ......... ........... ........... 99285... V Emergency dept visit... 955 ......... ......... ........... ........... 99288... E Direct advanced life ......... ......... ......... ........... ........... support. 99291... S Critical care, first 900 7.44 $393.74 $144.87 $78.75 hour. 99292... N Critical care, addl 30 ......... ......... ......... ........... ........... min. 99295... C Neonatal critical care. ......... ......... ......... ........... ........... 99296... C Neonatal critical care. ......... ......... ......... ........... ........... 99297... C Neonatal critical care. ......... ......... ......... ........... ........... 99301... E Nursing facility care.. ......... ......... ......... ........... ........... 99302... E Nursing facility care.. ......... ......... ......... ........... ........... 99303... E Nursing facility care.. ......... ......... ......... ........... ........... 99311... E Nursing facility care, ......... ......... ......... ........... ........... subseq. 99312... E Nursing facility care, ......... ......... ......... ........... ........... subseq. 99313... E Nursing facility care, ......... ......... ......... ........... ........... subseq. 99315... E Nursing fac discharge ......... ......... ......... ........... ........... day. 99316... E Nursing fac discharge ......... ......... ......... ........... ........... day. 99321... N Rest home visit, new ......... ......... ......... ........... ........... patient. 99322... N Rest home visit, new ......... ......... ......... ........... ........... patient. 99323... N Rest home visit, new ......... ......... ......... ........... ........... patient. 99331... N Rest home visit, estab ......... ......... ......... ........... ........... pat. 99332... N Rest home visit, estab ......... ......... ......... ........... ........... pat. 99333... N Rest home visit, estab ......... ......... ......... ........... ........... pat. 99341... N Home visit, new patient ......... ......... ......... ........... ........... 99342... N Home visit, new patient ......... ......... ......... ........... ........... 99343... N Home visit, new patient ......... ......... ......... ........... ........... 99344... N Home visit, new patient ......... ......... ......... ........... ........... 99345... N Home visit, new patient ......... ......... ......... ........... ........... 99347... N Home visit, estab ......... ......... ......... ........... ........... patient. 99348... N Home visit, estab ......... ......... ......... ........... ........... patient. 99349... N Home visit, estab ......... ......... ......... ........... ........... patient. 99350... N Home visit, estab ......... ......... ......... ........... ........... patient. 99354... N Prolonged service, ......... ......... ......... ........... ........... office. 99355... N Prolonged service, ......... ......... ......... ........... ........... office. 99356... C Prolonged service, ......... ......... ......... ........... ........... inpatient. 99357... C Prolonged service, ......... ......... ......... ........... ........... inpatient. 99358... N Prolonged serv, w/o ......... ......... ......... ........... ........... contact. 99359... N Prolonged serv, w/o ......... ......... ......... ........... ........... contact. 99360... E Physician standby ......... ......... ......... ........... ........... services. 99361... E Physician/team ......... ......... ......... ........... ........... conference. 99362... E Physician/team ......... ......... ......... ........... ........... conference. 99371... E Physician phone ......... ......... ......... ........... ........... consultation. 99372... E Physician phone ......... ......... ......... ........... ........... consultation. 99373... E Physician phone ......... ......... ......... ........... ........... consultation. 99374... E Home health care ......... ......... ......... ........... ........... supervision. 99375... E Home health care ......... ......... ......... ........... ........... supervision. 99377... E Hospice care ......... ......... ......... ........... ........... supervision. 99378... E Hospice care ......... ......... ......... ........... ........... supervision. 99379... E Nursing fac care ......... ......... ......... ........... ........... supervision. 99380... E Nursing fac care ......... ......... ......... ........... ........... supervision. 99381... E Preventive visit, new, ......... ......... ......... ........... ........... infant. 99382... E Preventive visit, new, ......... ......... ......... ........... ........... age 1-4. 99383... E Preventive visit, new, ......... ......... ......... ........... ........... age 5-11. 99384... E Preventive visit, new, ......... ......... ......... ........... ........... 12-17. 99385... E Preventive visit, new, ......... ......... ......... ........... ........... 18-39. 99386... E Preventive visit, new, ......... ......... ......... ........... ........... 40-64. 99387... E Preventive visit, new, ......... ......... ......... ........... ........... 65 & over. 99391... E Preventive visit, est, ......... ......... ......... ........... ........... infant. 99392... E Preventive visit, est, ......... ......... ......... ........... ........... age 1-4. 99393... E Preventive visit, est, ......... ......... ......... ........... ........... age 5-11. 99394... E Preventive visit, est, ......... ......... ......... ........... ........... 12-17. 99395... E Preventive visit, est, ......... ......... ......... ........... ........... 18-39. 99396... E Preventive visit, est, ......... ......... ......... ........... ........... 40-64. 99397... E Preventive visit, est, ......... ......... ......... ........... ........... 65 & over. 99401... E Preventive counseling, ......... ......... ......... ........... ........... indiv. [[Page 47722]] 99402... E Preventive counseling, ......... ......... ......... ........... ........... indiv. 99403... E Preventive counseling, ......... ......... ......... ........... ........... indiv. 99404... E Preventive counseling, ......... ......... ......... ........... ........... indiv. 99411... E Preventive counseling, ......... ......... ......... ........... ........... group. 99412... E Preventive counseling, ......... ......... ......... ........... ........... group. 99420... E Health risk assessment ......... ......... ......... ........... ........... test. 99429... E Unlisted preventive ......... ......... ......... ........... ........... service. 99431... N Initial care, normal ......... ......... ......... ........... ........... newborn. 99432... N Newborn care not in ......... ......... ......... ........... ........... hospital. 99433... C Normal newborn care, ......... ......... ......... ........... ........... hospital. 99435... E Hospital NB discharge ......... ......... ......... ........... ........... day. 99436... N Attendance, birth...... ......... ......... ......... ........... ........... 99440... S Newborn resuscitation.. 947 4.07 $215.48 $109.61 $43.10 99450... E Life/disability ......... ......... ......... ........... ........... evaluation. 99455... N Disability examination. ......... ......... ......... ........... ........... 99456... N Disability examination. ......... ......... ......... ........... ........... 99499... N Unlisted E/M service... ......... ......... ......... ........... ........... A0021... E Outside state ambulance ......... ......... ......... ........... ........... serv. A0030... A Air ambulance service.. ......... ......... ......... ........... ........... A0040... A Helicopter ambulance ......... ......... ......... ........... ........... service. A0050... A Water amb service ......... ......... ......... ........... ........... emergency. A0080... E Noninterest escort in ......... ......... ......... ........... ........... non er. A0090... E Interest escort in non ......... ......... ......... ........... ........... er. A0100... E Nonemergency transport ......... ......... ......... ........... ........... taxi. A0110... E Nonemergency transport ......... ......... ......... ........... ........... bus. A0120... E Noner transport mini- ......... ......... ......... ........... ........... bus. A0130... E Noner transport wheelch ......... ......... ......... ........... ........... van. A0140... E Nonemergency transport ......... ......... ......... ........... ........... air. A0160... E Noner transport case ......... ......... ......... ........... ........... worker. A0170... E Noner transport parking ......... ......... ......... ........... ........... fees. A0180... E Noner transport lodgng ......... ......... ......... ........... ........... recip. A0190... E Noner transport meals ......... ......... ......... ........... ........... recip. A0200... E Noner transport lodgng ......... ......... ......... ........... ........... escrt. A0210... E Noner transport meals ......... ......... ......... ........... ........... escort. A0225... A Neonatal emergency ......... ......... ......... ........... ........... transport. A0300... A Ambulance basic non- ......... ......... ......... ........... ........... emer all. A0302... A Ambulance basic ......... ......... ......... ........... ........... emergeny all. A0304... A Amb adv non-er no serv ......... ......... ......... ........... ........... all. A0306... A Amb adv non-er spec ......... ......... ......... ........... ........... serv all. A0308... A Amb adv er no spec serv ......... ......... ......... ........... ........... all. A0310... A Amb adv er spec serv ......... ......... ......... ........... ........... all. A0320... A Amb basic non-er + ......... ......... ......... ........... ........... supplies. A0322... A Amb basic emerg + ......... ......... ......... ........... ........... supplies. A0324... A Adv non-er serv sep ......... ......... ......... ........... ........... mileage. A0326... A Adv non-er no serv sep ......... ......... ......... ........... ........... mile. A0328... A Adv er no serv sep ......... ......... ......... ........... ........... mileage. A0330... A Adv er spec serv sep ......... ......... ......... ........... ........... mile. A0340... A Amb basic non-er + ......... ......... ......... ........... ........... mileage. A0342... A Ambul basic emer + ......... ......... ......... ........... ........... mileage. A0344... A Amb adv non-er no serv ......... ......... ......... ........... ........... +mile. A0346... A Amb adv non-er serv + ......... ......... ......... ........... ........... mile. A0348... A Adv emer no spec serv + ......... ......... ......... ........... ........... mile. A0350... A Adv emer spec serv + ......... ......... ......... ........... ........... mileage. A0360... A Basic non-er sep mile & ......... ......... ......... ........... ........... supp. A0362... A Basic emer sep mile & ......... ......... ......... ........... ........... supply. A0364... A Adv non-er no serv sep ......... ......... ......... ........... ........... mi & su. A0366... A Adv non-er serv sep mil ......... ......... ......... ........... ........... & supp. A0368... A Adv er no serv sep mile ......... ......... ......... ........... ........... & supp. A0370... A Adv er spec serv sep mi ......... ......... ......... ........... ........... & supp. A0380... A Basic life support ......... ......... ......... ........... ........... mileage. A0382... A Basic support routine ......... ......... ......... ........... ........... suppls. A0384... A Bls defibrillation ......... ......... ......... ........... ........... supplies. A0390... A Advanced life support ......... ......... ......... ........... ........... mileage. A0392... A Als defibrillation ......... ......... ......... ........... ........... supplies. A0394... A Als IV drug therapy ......... ......... ......... ........... ........... supplies. A0396... A Als esophageal intub ......... ......... ......... ........... ........... suppls. A0398... A Als routine disposble ......... ......... ......... ........... ........... suppls. A0420... A Ambulance waiting 1/2 ......... ......... ......... ........... ........... hr. A0422... A Ambulance 02 life ......... ......... ......... ........... ........... sustaining. A0424... A Extra ambulance ......... ......... ......... ........... ........... attendant. A0888... E Noncovered ambulance ......... ......... ......... ........... ........... mileage. A0999... A Unlisted ambulance ......... ......... ......... ........... ........... service. A4206... A 1 CC sterile syringe & ......... ......... ......... ........... ........... needle. A4207... A 2 CC sterile syringe & ......... ......... ......... ........... ........... needle. A4208... A 3 CC sterile syringe & ......... ......... ......... ........... ........... needle. [[Page 47723]] A4209... A 5+ CC sterile syringe & ......... ......... ......... ........... ........... needle. A4210... E Nonneedle injection ......... ......... ......... ........... ........... device. A4211... A Supp for self-adm ......... ......... ......... ........... ........... injections. A4212... A Non coring needle or ......... ......... ......... ........... ........... stylet. A4213... A 20+ CC syringe only.... ......... ......... ......... ........... ........... A4214... A 30 CC sterile water/ ......... ......... ......... ........... ........... saline. A4215... A Sterile needle......... ......... ......... ......... ........... ........... A4220... A Infusion pump refill ......... ......... ......... ........... ........... kit. A4221... A Maint drug infus cath ......... ......... ......... ........... ........... per wk. A4222... A Drug infusion pump ......... ......... ......... ........... ........... supplies. A4230... E Infus insulin pump non ......... ......... ......... ........... ........... needl. A4231... E Infusion insulin pump ......... ......... ......... ........... ........... needle. A4232... E Syringe w/needle ......... ......... ......... ........... ........... insulin 3cc. A4244... A Alcohol or peroxide per ......... ......... ......... ........... ........... pint. A4245... A Alcohol wipes per box.. ......... ......... ......... ........... ........... A4246... A Betadine/phisohex ......... ......... ......... ........... ........... solution. A4247... A Betadine/iodine swabs/ ......... ......... ......... ........... ........... wipes. A4250... E Urine reagent strips/ ......... ......... ......... ........... ........... tablets. A4253... A Blood glucose/reagent ......... ......... ......... ........... ........... strips. A4254... A Battery for glucose ......... ......... ......... ........... ........... monitor. A4255... A Glucose monitor ......... ......... ......... ........... ........... platforms. A4256... A Calibrator solution/ ......... ......... ......... ........... ........... chips. A4258... A Lancet device each..... ......... ......... ......... ........... ........... A4259... A Lancets per box........ ......... ......... ......... ........... ........... A4260... E Levonorgestrel implant. ......... ......... ......... ........... ........... A4262... N Temporary tear duct ......... ......... ......... ........... ........... plug. A4263... A Permanent tear duct ......... ......... ......... ........... ........... plug. A4265... A Paraffin............... ......... ......... ......... ........... ........... A4270... A Disposable endoscope ......... ......... ......... ........... ........... sheath. A4300... A Cath impl vasc access ......... ......... ......... ........... ........... portal. A4301... A Implantable access syst ......... ......... ......... ........... ........... perc. A4305... A Drug delivery system ......... ......... ......... ........... ........... >=50 ML. A4306... A Drug delivery system ......... ......... ......... ........... ........... <=5 ML. A4310... A Insert tray w/o bag/ ......... ......... ......... ........... ........... cath. A4311... A Catheter w/o bag 2-way ......... ......... ......... ........... ........... latex. A4312... A Cath w/o bag 2-way ......... ......... ......... ........... ........... silicone. A4313... A Catheter w/bag 3-way... ......... ......... ......... ........... ........... A4314... A Cath w/drainage 2-way ......... ......... ......... ........... ........... latex. A4315... A Cath w/drainage 2-way ......... ......... ......... ........... ........... silcne. A4316... A Cath w/drainage 3-way.. ......... ......... ......... ........... ........... A4320... A Irrigation tray........ ......... ......... ......... ........... ........... A4321... A Cath therapeutic irrig ......... ......... ......... ........... ........... agent. A4322... A Irrigation syringe..... ......... ......... ......... ........... ........... A4323... A Saline irrigation ......... ......... ......... ........... ........... solution. A4326... A Male external catheter. ......... ......... ......... ........... ........... A4327... A Fem urinary collect dev ......... ......... ......... ........... ........... cup. A4328... A Fem urinary collect ......... ......... ......... ........... ........... pouch. A4329... A External catheter start ......... ......... ......... ........... ........... set. A4330... A Stool collection pouch. ......... ......... ......... ........... ........... A4335... A Incontinence supply.... ......... ......... ......... ........... ........... A4338... A Indwelling catheter ......... ......... ......... ........... ........... latex. A4340... A Indwelling catheter ......... ......... ......... ........... ........... special. A4344... A Cath indw foley 2 way ......... ......... ......... ........... ........... silicn. A4346... A Cath indw foley 3 way.. ......... ......... ......... ........... ........... A4347... A Male external catheter. ......... ......... ......... ........... ........... A4351... A Straight tip urine ......... ......... ......... ........... ........... catheter. A4352... A Coude tip urinary ......... ......... ......... ........... ........... catheter. A4353... A Intermittent urinary ......... ......... ......... ........... ........... cath. A4354... A Cath insertion tray w/ ......... ......... ......... ........... ........... bag. A4355... A Bladder irrigation ......... ......... ......... ........... ........... tubing. A4356... A Ext ureth clmp or compr ......... ......... ......... ........... ........... dvc. A4357... A Bedside drainage bag... ......... ......... ......... ........... ........... A4358... A Urinary leg bag........ ......... ......... ......... ........... ........... A4359... A Urinary suspensory w/o ......... ......... ......... ........... ........... leg b. A4361... A Ostomy face plate...... ......... ......... ......... ........... ........... A4362... A Solid skin barrier..... ......... ......... ......... ........... ........... A4363... A Liquid skin barrier.... ......... ......... ......... ........... ........... A4364... A Ostomy/cath adhesive... ......... ......... ......... ........... ........... A4365... A Ostomy adhesive remover ......... ......... ......... ........... ........... wipe. A4367... A Ostomy belt............ ......... ......... ......... ........... ........... A4368... A Ostomy filter.......... ......... ......... ......... ........... ........... A4397... A Irrigation supply ......... ......... ......... ........... ........... sleeve. A4398... A Ostomy irrigation bag.. ......... ......... ......... ........... ........... A4399... A Ostomy irrig cone/cath ......... ......... ......... ........... ........... w brs. A4400... A Ostomy irrigation set.. ......... ......... ......... ........... ........... [[Page 47724]] A4402... A Lubricant per ounce.... ......... ......... ......... ........... ........... A4404... A Ostomy ring each....... ......... ......... ......... ........... ........... A4421... A Ostomy supply misc..... ......... ......... ......... ........... ........... A4454... A Tape all types all ......... ......... ......... ........... ........... sizes. A4455... A Adhesive remover per ......... ......... ......... ........... ........... ounce. A4460... A Elastic compression ......... ......... ......... ........... ........... bandage. A4462... A Abdmnl drssng holder/ ......... ......... ......... ........... ........... binder. A4465... A Non-elastic extremity ......... ......... ......... ........... ........... binder. A4470... A Gravlee jet washer..... ......... ......... ......... ........... ........... A4480... A Vabra aspirator........ ......... ......... ......... ........... ........... A4481... A Tracheostoma filter.... ......... ......... ......... ........... ........... A4490... E Above knee surgical ......... ......... ......... ........... ........... stocking. A4495... E Thigh length surg ......... ......... ......... ........... ........... stocking. A4500... E Below knee surgical ......... ......... ......... ........... ........... stocking. A4510... E Full length surg ......... ......... ......... ........... ........... stocking. A4550... E Surgical trays......... ......... ......... ......... ........... ........... A4554... E Disposable underpads... ......... ......... ......... ........... ........... A4556... A Electrodes............. ......... ......... ......... ........... ........... A4557... A Lead wires............. ......... ......... ......... ........... ........... A4558... A Conductive paste or gel ......... ......... ......... ........... ........... A4560... A Pessary................ ......... ......... ......... ........... ........... A4565... A Slings................. ......... ......... ......... ........... ........... A4570... A Splint................. ......... ......... ......... ........... ........... A4572... A Rib belt............... ......... ......... ......... ........... ........... A4575... E Hyperbaric o2 chamber ......... ......... ......... ........... ........... disps. A4580... A Cast supplies (plaster) ......... ......... ......... ........... ........... A4590... A Special casting ......... ......... ......... ........... ........... material. A4595... A TENS suppl 2 lead per ......... ......... ......... ........... ........... month. A4611... A Heavy duty battery..... ......... ......... ......... ........... ........... A4612... A Battery cables......... ......... ......... ......... ........... ........... A4613... A Battery charger........ ......... ......... ......... ........... ........... A4615... A Cannula nasal.......... ......... ......... ......... ........... ........... A4616... A Tubing (oxygen) per ......... ......... ......... ........... ........... foot. A4617... A Mouth piece............ ......... ......... ......... ........... ........... A4618... A Breathing circuits..... ......... ......... ......... ........... ........... A4619... A Face tent.............. ......... ......... ......... ........... ........... A4620... A Variable concentration ......... ......... ......... ........... ........... mask. A4621... A Tracheotomy mask or ......... ......... ......... ........... ........... collar. A4622... A Tracheostomy or ......... ......... ......... ........... ........... larngectomy. A4623... A Tracheostomy inner ......... ......... ......... ........... ........... cannula. A4624... A Tracheal suction tube.. ......... ......... ......... ........... ........... A4625... A Trach care kit for new ......... ......... ......... ........... ........... trach. A4626... A Tracheostomy cleaning ......... ......... ......... ........... ........... brush. A4627... E Spacer bag/reservoir... ......... ......... ......... ........... ........... A4628... A Oropharyngeal suction ......... ......... ......... ........... ........... cath. A4629... A Tracheostomy care kit.. ......... ......... ......... ........... ........... A4630... A Repl bat t.e.n.s. own ......... ......... ......... ........... ........... by pt. A4631... A Wheelchair battery..... ......... ......... ......... ........... ........... A4635... A Underarm crutch pad.... ......... ......... ......... ........... ........... A4636... A Handgrip for cane etc.. ......... ......... ......... ........... ........... A4637... A Repl tip cane/crutch/ ......... ......... ......... ........... ........... walker. A4640... A Alternating pressure ......... ......... ......... ........... ........... pad. A4641... N Diagnostic imaging ......... ......... ......... ........... ........... agent. A4642... N Satumomab pendetide per ......... ......... ......... ........... ........... dose. A4643... N High dose contrast MRI. ......... ......... ......... ........... ........... A4644... N Contrast 100-199 MGs ......... ......... ......... ........... ........... iodine. A4645... N Contrast 200-299 MGs ......... ......... ......... ........... ........... iodine. A4646... N Contrast 300-399 MGs ......... ......... ......... ........... ........... iodine. A4647... N Supp-paramagnetic contr ......... ......... ......... ........... ........... mat. A4649... A Surgical supplies...... ......... ......... ......... ........... ........... A4650... A Supp esrd centrifuge... ......... ......... ......... ........... ........... A4655... A Esrd syringe/needle.... ......... ......... ......... ........... ........... A4660... A Esrd blood pressure ......... ......... ......... ........... ........... device. A4663... A Esrd blood pressure ......... ......... ......... ........... ........... cuff. A4670... E Auto blood pressure ......... ......... ......... ........... ........... monitor. A4680... A Activated carbon ......... ......... ......... ........... ........... filters. A4690... A Dialyzers.............. ......... ......... ......... ........... ........... A4700... A Standard dialysate ......... ......... ......... ........... ........... solution. A4705... A Bicarb dialysate ......... ......... ......... ........... ........... solution. A4712... A Sterile water.......... ......... ......... ......... ........... ........... A4714... A Treated water for ......... ......... ......... ........... ........... dialysis. A4730... A Fistula cannulation set ......... ......... ......... ........... ........... dial. A4735... A Local/topical ......... ......... ......... ........... ........... anesthetics. A4740... A Esrd shunt accessory... ......... ......... ......... ........... ........... A4750... A Arterial or venous ......... ......... ......... ........... ........... tubing. [[Page 47725]] A4755... A Arterial and venous ......... ......... ......... ........... ........... tubing. A4760... A Standard testing ......... ......... ......... ........... ........... solution. A4765... A Dialysate concentrate.. ......... ......... ......... ........... ........... A4770... A Blood testing supplies. ......... ......... ......... ........... ........... A4771... A Blood clotting time ......... ......... ......... ........... ........... tube. A4772... A Dextrostick/glucose ......... ......... ......... ........... ........... strips. A4773... A Hemostix............... ......... ......... ......... ........... ........... A4774... A Ammonia test paper..... ......... ......... ......... ........... ........... A4780... A Esrd sterilizing agent. ......... ......... ......... ........... ........... A4790... A Esrd cleansing agents.. ......... ......... ......... ........... ........... A4800... A Heparin/antidote ......... ......... ......... ........... ........... dialysis. A4820... A Supplies hemodialysis ......... ......... ......... ........... ........... kit. A4850... A Rubber tipped hemostats ......... ......... ......... ........... ........... A4860... A Disposable catheter ......... ......... ......... ........... ........... caps. A4870... A Plumbing/electrical ......... ......... ......... ........... ........... work. A4880... A Water storage tanks.... ......... ......... ......... ........... ........... A4890... A Contracts/repair/ ......... ......... ......... ........... ........... maintenance. A4900... A Capd supply kit........ ......... ......... ......... ........... ........... A4901... A Capd supply kit........ ......... ......... ......... ........... ........... A4905... A Ipd supply kit......... ......... ......... ......... ........... ........... A4910... A Esrd nonmedical ......... ......... ......... ........... ........... supplies. A4912... A Gomco drain bottle..... ......... ......... ......... ........... ........... A4913... A Esrd supply............ ......... ......... ......... ........... ........... A4914... A Preparation kit........ ......... ......... ......... ........... ........... A4918... A Venous pressure clamp.. ......... ......... ......... ........... ........... A4919... A Supp dialysis dialyzer ......... ......... ......... ........... ........... holde. A4920... A Harvard pressure clamp. ......... ......... ......... ........... ........... A4921... A Measuring cylinder..... ......... ......... ......... ........... ........... A4927... A Gloves................. ......... ......... ......... ........... ........... A5051... A Pouch clsd w barr ......... ......... ......... ........... ........... attached. A5052... A Clsd ostomy pouch w/o ......... ......... ......... ........... ........... barr. A5053... A Clsd ostomy pouch ......... ......... ......... ........... ........... faceplate. A5054... A Clsd ostomy pouch w/ ......... ......... ......... ........... ........... flange. A5055... A Stoma cap.............. ......... ......... ......... ........... ........... A5061... A Pouch drainable w ......... ......... ......... ........... ........... barrier at. A5062... A Drnble ostomy pouch w/o ......... ......... ......... ........... ........... barr. A5063... A Drain ostomy pouch w/ ......... ......... ......... ........... ........... flange. A5064... E Drain ostomy pouch w/ ......... ......... ......... ........... ........... fceplte. A5065... E Drain ostomy pouch on ......... ......... ......... ........... ........... fcplte. A5071... A Urinary pouch w/barrier ......... ......... ......... ........... ........... A5072... A Urinary pouch w/o ......... ......... ......... ........... ........... barrier. A5073... A Urinary pouch on barr w/ ......... ......... ......... ........... ........... flng. A5074... E Urinary pouch w/ ......... ......... ......... ........... ........... faceplate. A5075... E Urinary pouch on ......... ......... ......... ........... ........... faceplate. A5081... A Continent stoma plug... ......... ......... ......... ........... ........... A5082... A Continent stoma ......... ......... ......... ........... ........... catheter. A5093... A Ostomy accessory convex ......... ......... ......... ........... ........... inse. A5102... A Bedside drain btl w/wo ......... ......... ......... ........... ........... tube. A5105... A Urinary suspensory..... ......... ......... ......... ........... ........... A5112... A Urinary leg bag........ ......... ......... ......... ........... ........... A5113... A Latex leg strap........ ......... ......... ......... ........... ........... A5114... A Foam/fabric leg strap.. ......... ......... ......... ........... ........... A5119... A Skin barrier wipes box ......... ......... ......... ........... ........... pr 50. A5121... A Solid skin barrier 6x6. ......... ......... ......... ........... ........... A5122... A Solid skin barrier 8x8. ......... ......... ......... ........... ........... A5123... A Skin barrier with ......... ......... ......... ........... ........... flange. A5126... A Adhesive disc/foam pad. ......... ......... ......... ........... ........... A5131... A Appliance cleaner...... ......... ......... ......... ........... ........... A5149... A Incontinence/ostomy ......... ......... ......... ........... ........... supply. A5500... A Diab shoe for density ......... ......... ......... ........... ........... insert. A5501... A Diabetic custom molded ......... ......... ......... ........... ........... shoe. A5502... A Diabetic shoe density ......... ......... ......... ........... ........... insert. A5503... A Diabetic shoe w/roller/ ......... ......... ......... ........... ........... rockr. A5504... A Diabetic shoe with ......... ......... ......... ........... ........... wedge. A5505... A Diab shoe w/metatarsal ......... ......... ......... ........... ........... bar. A5506... A Diabetic shoe w/off set ......... ......... ......... ........... ........... heel. A5507... A Modification diabetic ......... ......... ......... ........... ........... shoe. A6020... A Collagen dressing cover ......... ......... ......... ........... ........... ea. A6025... E Silicone gel sheet, ......... ......... ......... ........... ........... each. A6154... A Wound pouch each....... ......... ......... ......... ........... ........... A6196... A Alginate dressing <=16 ......... ......... ......... ........... ........... sq in. A6197... A Alginate drsg >16 <=48 ......... ......... ......... ........... ........... sq in. A6198... A Alginate dressing > 48 ......... ......... ......... ........... ........... sq in. A6199... A Alginate drsg wound ......... ......... ......... ........... ........... filler. A6203... A Composite drsg <= 16 sq ......... ......... ......... ........... ........... in. [[Page 47726]] A6204... A Composite drsg >16<=48 ......... ......... ......... ........... ........... sq in. A6205... A Composite drsg > 48 sq ......... ......... ......... ........... ........... in. A6206... A Contact layer <= 16 sq ......... ......... ......... ........... ........... in. A6207... A Contact layer >16<= 48 ......... ......... ......... ........... ........... sq in. A6208... A Contact layer > 48 sq ......... ......... ......... ........... ........... in. A6209... A Foam drsg <=16 sq in w/ ......... ......... ......... ........... ........... o bdr. A6210... A Foam drg >16<=48 sq in ......... ......... ......... ........... ........... w/o b. A6211... A Foam drg > 48 sq in w/o ......... ......... ......... ........... ........... brdr. A6212... A Foam drg <=16 sq in w/ ......... ......... ......... ........... ........... border. A6213... A Foam drg >16<=48 sq in ......... ......... ......... ........... ........... w/bdr. A6214... A Foam drg > 48 sq in w/ ......... ......... ......... ........... ........... border. A6215... A Foam dressing wound ......... ......... ......... ........... ........... filler. A6216... A Non-sterile gauze<=16 ......... ......... ......... ........... ........... sq in. A6217... A Non-sterile ......... ......... ......... ........... ........... gauze>16<=48 sq. A6218... A Non-sterile gauze > 48 ......... ......... ......... ........... ........... sq in. A6219... A Gauze <= 16 sq in w/ ......... ......... ......... ........... ........... border. A6220... A Gauze >16 <=48 sq in w/ ......... ......... ......... ........... ........... bordr. A6221... A Gauze > 48 sq in w/ ......... ......... ......... ........... ........... border. A6222... A Gauze <=16 in no w/sal ......... ......... ......... ........... ........... w/o b. A6223... A Gauze >16<=48 no w/sal ......... ......... ......... ........... ........... w/o b. A6224... A Gauze > 48 in no w/sal ......... ......... ......... ........... ........... w/o b. A6228... A Gauze <= 16 sq in water/ ......... ......... ......... ........... ........... sal. A6229... A Gauze >16<=48 sq in ......... ......... ......... ........... ........... watr/sal. A6230... A Gauze > 48 sq in water/ ......... ......... ......... ........... ........... salne. A6234... A Hydrocolld drg <=16 w/o ......... ......... ......... ........... ........... bdr. A6235... A Hydrocolld drg >16<=48 ......... ......... ......... ........... ........... w/o b. A6236... A Hydrocolld drg > 48 in ......... ......... ......... ........... ........... w/o b. A6237... A Hydrocolld drg <=16 in ......... ......... ......... ........... ........... w/bdr. A6238... A Hydrocolld drg >16<=48 ......... ......... ......... ........... ........... w/bdr. A6239... A Hydrocolld drg > 48 in ......... ......... ......... ........... ........... w/bdr. A6240... A Hydrocolld drg filler ......... ......... ......... ........... ........... paste. A6241... A Hydrocolloid drg filler ......... ......... ......... ........... ........... dry. A6242... A Hydrogel drg <=16 in w/ ......... ......... ......... ........... ........... o bdr. A6243... A Hydrogel drg >16<=48 w/ ......... ......... ......... ........... ........... o bdr. A6244... A Hydrogel drg >48 in w/o ......... ......... ......... ........... ........... bdr. A6245... A Hydrogel drg <= 16 in w/ ......... ......... ......... ........... ........... bdr. A6246... A Hydrogel drg >16<=48 in ......... ......... ......... ........... ........... w/b. A6247... A Hydrogel drg > 48 sq in ......... ......... ......... ........... ........... w/b. A6248... A Hydrogel drsg gel ......... ......... ......... ........... ........... filler. A6250... A Skin seal protect ......... ......... ......... ........... ........... moisturizr. A6251... A Absorpt drg <=16 sq in ......... ......... ......... ........... ........... w/o b. A6252... A Absorpt drg >16 <=48 w/ ......... ......... ......... ........... ........... o bdr. A6253... A Absorpt drg > 48 sq in ......... ......... ......... ........... ........... w/o b. A6254... A Absorpt drg <=16 sq in ......... ......... ......... ........... ........... w/bdr. A6255... A Absorpt drg >16<=48 in ......... ......... ......... ........... ........... w/bdr. A6256... A Absorpt drg > 48 sq in ......... ......... ......... ........... ........... w/bdr. A6257... A Transparent film <= 16 ......... ......... ......... ........... ........... sq in. A6258... A Transparent film ......... ......... ......... ........... ........... >16<=48 in. A6259... A Transparent film > 48 ......... ......... ......... ........... ........... sq in. A6260... A Wound cleanser any type/ ......... ......... ......... ........... ........... size. A6261... A Wound filler gel/paste/ ......... ......... ......... ........... ........... oz. A6262... A Wound filler dry form/ ......... ......... ......... ........... ........... gram. A6263... A Non-sterile elastic ......... ......... ......... ........... ........... gauze/yd. A6264... A Non-sterile no elastic ......... ......... ......... ........... ........... gauze. A6265... A Tape per 18 sq inches.. ......... ......... ......... ........... ........... A6266... A Impreg gauze no h20/sal/ ......... ......... ......... ........... ........... yard. A6402... A Sterile gauze <= 16 sq ......... ......... ......... ........... ........... in. A6403... A Sterile gauze>16 <= 48 ......... ......... ......... ........... ........... sq in. A6404... A Sterile gauze > 48 sq ......... ......... ......... ........... ........... in. A6405... A Sterile elastic gauze/ ......... ......... ......... ........... ........... yd. A6406... A Sterile non-elastic ......... ......... ......... ........... ........... gauze/yd. A9150... E Misc/exper non- ......... ......... ......... ........... ........... prescript dru. A9160... E Podiatrist non-covered ......... ......... ......... ........... ........... servi. A9170... E Chiropractor non- ......... ......... ......... ........... ........... covered ser. A9190... E Misc/expe personal ......... ......... ......... ........... ........... comfort i. A9270... E Non-covered item or ......... ......... ......... ........... ........... service. A9300... E Exercise equipment..... ......... ......... ......... ........... ........... A9500... N Technetium TC 99m ......... ......... ......... ........... ........... sestamibi. A9502... N Technetium TC99M ......... ......... ......... ........... ........... tetrofosmin. A9503... N Technetium TC 99m ......... ......... ......... ........... ........... medronate. A9505... N Thallous chloride TL ......... ......... ......... ........... ........... 201/mci. A9600... N Strontium-89 chloride.. ......... ......... ......... ........... ........... B4034... A Enter feed supkit syr ......... ......... ......... ........... ........... by day. B4035... A Enteral feed supp pump ......... ......... ......... ........... ........... per d. B4036... A Enteral feed sup kit ......... ......... ......... ........... ........... grav by. [[Page 47727]] B4081... A Enteral ng tubing w/ ......... ......... ......... ........... ........... stylet. B4082... A Enteral ng tubing w/o ......... ......... ......... ........... ........... stylet. B4083... A Enteral stomach tube ......... ......... ......... ........... ........... levine. B4084... A Gastrostomy/jejunostomy ......... ......... ......... ........... ........... tubi. B4085... A Gastrostomy tube w/ring ......... ......... ......... ........... ........... each. B4150... A Enteral formulae ......... ......... ......... ........... ........... category i. B4151... A Enteral formulae ......... ......... ......... ........... ........... category i-. B4152... A Enteral formulae ......... ......... ......... ........... ........... category ii. B4153... A Enteral formulae ......... ......... ......... ........... ........... category ii. B4154... A Enteral formulae ......... ......... ......... ........... ........... category IV. B4155... A Enteral formulae ......... ......... ......... ........... ........... category v. B4156... A Enteral formulae ......... ......... ......... ........... ........... category vi. B4164... A Parenteral 50% dextrose ......... ......... ......... ........... ........... solu. B4168... A Parenteral sol amino ......... ......... ......... ........... ........... acid 3.. B4172... A Parenteral sol amino ......... ......... ......... ........... ........... acid 5.. B4176... A Parenteral sol amino ......... ......... ......... ........... ........... acid 7-. B4178... A Parenteral sol amino ......... ......... ......... ........... ........... acid >. B4180... A Parenteral sol carb > ......... ......... ......... ........... ........... 50%. B4184... A Parenteral sol lipids ......... ......... ......... ........... ........... 10%. B4186... A Parenteral sol lipids ......... ......... ......... ........... ........... 20%. B4189... A Parenteral sol amino ......... ......... ......... ........... ........... acid &. B4193... A Parenteral sol 52-73 gm ......... ......... ......... ........... ........... prot. B4197... A Parenteral sol 74-100 ......... ......... ......... ........... ........... gm pro. B4199... A Parenteral sol > 100gm ......... ......... ......... ........... ........... prote. B4216... A Parenteral nutrition ......... ......... ......... ........... ........... additiv. B4220... A Parenteral supply kit ......... ......... ......... ........... ........... premix. B4222... A Parenteral supply kit ......... ......... ......... ........... ........... homemi. B4224... A Parenteral ......... ......... ......... ........... ........... administration ki. B5000... A Parenteral sol renal- ......... ......... ......... ........... ........... amirosy. B5100... A Parenteral sol hepatic- ......... ......... ......... ........... ........... fream. B5200... A Parenteral sol stres- ......... ......... ......... ........... ........... brnch c. B9000... A Enter infusion pump w/o ......... ......... ......... ........... ........... alrm. B9002... A Enteral infusion pump w/ ......... ......... ......... ........... ........... ala. B9004... A Parenteral infus pump ......... ......... ......... ........... ........... portab. B9006... A Parenteral infus pump ......... ......... ......... ........... ........... statio. B9998... A Enteral supp not ......... ......... ......... ........... ........... otherwise c. B9999... A Parenteral supp not ......... ......... ......... ........... ........... othrws c. D0120... E Periodic oral ......... ......... ......... ........... ........... evaluation. D0140... E Limit oral eval problm ......... ......... ......... ........... ........... focus. D0150... S Comprehensve oral 031 1.33 $70.52 $14.10 $14.10 evaluation. D0160... E Extensv oral eval prob ......... ......... ......... ........... ........... focus. D0210... E Intraor complete film ......... ......... ......... ........... ........... series. D0220... E Intraoral periapical ......... ......... ......... ........... ........... first f. D0230... E Intraoral periapical ea ......... ......... ......... ........... ........... add. D0240... S Intraoral occlusal film 031 1.33 $70.52 $14.10 $14.10 D0250... S Extraoral first film... 031 1.33 $70.52 $14.10 $14.10 D0260... S Extraoral ea additional 031 1.33 $70.52 $14.10 $14.10 film. D0270... S Dental bitewing single 031 1.33 $70.52 $14.10 $14.10 film. D0272... S Dental bitewings two 031 1.33 $70.52 $14.10 $14.10 films. D0274... S Dental bitewings four 031 1.33 $70.52 $14.10 $14.10 films. D0290... E Dental film skull/ ......... ......... ......... ........... ........... facial bon. D0310... E Dental saliography..... ......... ......... ......... ........... ........... D0320... E Dental tmj arthrogram ......... ......... ......... ........... ........... incl i. D0321... E Dental other tmj films. ......... ......... ......... ........... ........... D0322... E Dental tomographic ......... ......... ......... ........... ........... survey. D0330... E Dental panoramic film.. ......... ......... ......... ........... ........... D0340... E Dental cephalometric ......... ......... ......... ........... ........... film. D0415... E Bacteriologic study.... ......... ......... ......... ........... ........... D0425... E Caries susceptibility ......... ......... ......... ........... ........... test. D0460... S Pulp vitality test..... 031 1.33 $70.52 $14.10 $14.10 D0470... E Diagnostic casts....... ......... ......... ......... ........... ........... D0471... S Diagnostic photographs. 031 1.33 $70.52 $14.10 $14.10 D0501... S Histopathologic 031 1.33 $70.52 $14.10 $14.10 examinations. D0502... S Other oral pathology 031 1.33 $70.52 $14.10 $14.10 procedu. D0999... S Unspecified diagnostic 031 1.33 $70.52 $14.10 $14.10 proce. D1110... E Dental prophylaxis ......... ......... ......... ........... ........... adult. D1120... E Dental prophylaxis ......... ......... ......... ........... ........... child. D1201... E Topical fluor w prophy ......... ......... ......... ........... ........... child. D1203... E Topical fluor w/o ......... ......... ......... ........... ........... prophy chi. D1204... E Topical fluor w/o ......... ......... ......... ........... ........... prophy adu. D1205... E Topical fluoride w/ ......... ......... ......... ........... ........... prophy a. D1310... E Nutri counsel-control ......... ......... ......... ........... ........... caries. D1320... E Tobacco counseling..... ......... ......... ......... ........... ........... D1330... E Oral hygiene ......... ......... ......... ........... ........... instruction. D1351... E Dental sealant per ......... ......... ......... ........... ........... tooth. [[Page 47728]] D1510... S Space maintainer fxd 031 1.33 $70.52 $14.10 $14.10 unilat. D1515... S Fixed bilat space 031 1.33 $70.52 $14.10 $14.10 maintainer. D1520... S Remove unilat space 031 1.33 $70.52 $14.10 $14.10 maintain. D1525... S Remove bilat space 031 1.33 $70.52 $14.10 $14.10 maintain. D1550... S Recement space 031 1.33 $70.52 $14.10 $14.10 maintainer. D2110... E Amalgam one surface ......... ......... ......... ........... ........... primary. D2120... E Amalgam two surfaces ......... ......... ......... ........... ........... primary. D2130... E Amalgam three surfaces ......... ......... ......... ........... ........... prima. D2131... E Amalgam four/more surf ......... ......... ......... ........... ........... prima. D2140... E Amalgam one surface ......... ......... ......... ........... ........... permanen. D2150... E Amalgam two surfaces ......... ......... ......... ........... ........... permane. D2160... E Amalgam three surfaces ......... ......... ......... ........... ........... perma. D2161... E Amalgam 4 or > surfaces ......... ......... ......... ........... ........... perm. D2210... E Silcate cement per ......... ......... ......... ........... ........... restorat. D2330... E Resin one surface- ......... ......... ......... ........... ........... anterior. D2331... E Resin two surfaces- ......... ......... ......... ........... ........... anterior. D2332... E Resin three surfaces- ......... ......... ......... ........... ........... anterio. D2335... E Resin 4/> surf or w ......... ......... ......... ........... ........... incis an. D2336... E Composite resin crown.. ......... ......... ......... ........... ........... D2380... E Resin one surf poster ......... ......... ......... ........... ........... primar. D2381... E Resin two surf poster ......... ......... ......... ........... ........... primar. D2382... E Resin three/more surf ......... ......... ......... ........... ........... post p. D2385... E Resin one surf poster ......... ......... ......... ........... ........... perman. D2386... E Resin two surf poster ......... ......... ......... ........... ........... perman. D2387... E Resin three/more surf ......... ......... ......... ........... ........... post p. D2410... E Dental gold foil one ......... ......... ......... ........... ........... surface. D2420... E Dental gold foil two ......... ......... ......... ........... ........... surface. D2430... E Dental gold foil three ......... ......... ......... ........... ........... surfa. D2510... E Dental inlay metalic 1 ......... ......... ......... ........... ........... surf. D2520... E Dental inlay metallic 2 ......... ......... ......... ........... ........... surf. D2530... E Dental inlay metl 3/ ......... ......... ......... ........... ........... more sur. D2543... E Dental onlay metallic 3 ......... ......... ......... ........... ........... surf. D2544... E Dental onlay metl 4/ ......... ......... ......... ........... ........... more sur. D2610... E Inlay porcelain/ceramic ......... ......... ......... ........... ........... 1 su. D2620... E Inlay porcelain/ceramic ......... ......... ......... ........... ........... 2 su. D2630... E Dental onlay porc 3/ ......... ......... ......... ........... ........... more sur. D2642... E Dental onlay porcelin 2 ......... ......... ......... ........... ........... surf. D2643... E Dental onlay porcelin 3 ......... ......... ......... ........... ........... surf. D2644... E Dental onlay porc 4/ ......... ......... ......... ........... ........... more sur. D2650... E Inlay composite/resin ......... ......... ......... ........... ........... one su. D2651... E Inlay composite/resin ......... ......... ......... ........... ........... two su. D2652... E Dental inlay resin 3/ ......... ......... ......... ........... ........... mre sur. D2662... E Dental onlay resin 2 ......... ......... ......... ........... ........... surface. D2663... E Dental onlay resin 3 ......... ......... ......... ........... ........... surface. D2664... E Dental onlay resin 4/ ......... ......... ......... ........... ........... mre sur. D2710... E Crown resin laboratory. ......... ......... ......... ........... ........... D2720... E Crown resin w/ high ......... ......... ......... ........... ........... noble me. D2721... E Crown resin w/ base ......... ......... ......... ........... ........... metal. D2722... E Crown resin w/ noble ......... ......... ......... ........... ........... metal. D2740... E Crown porcelain/ceramic ......... ......... ......... ........... ........... subs. D2750... E Crown porcelain w/ h ......... ......... ......... ........... ........... noble m. D2751... E Crown porcelain fused ......... ......... ......... ........... ........... base m. D2752... E Crown porcelain w/ ......... ......... ......... ........... ........... noble met. D2790... E Crown full cast high ......... ......... ......... ........... ........... noble m. D2791... E Crown full cast base ......... ......... ......... ........... ........... metal. D2792... E Crown full cast noble ......... ......... ......... ........... ........... metal. D2810... E Crown 3/4 cast metallic ......... ......... ......... ........... ........... D2910... E Dental recement inlay.. ......... ......... ......... ........... ........... D2920... E Dental recement crown.. ......... ......... ......... ........... ........... D2930... E Prefab stnlss steel ......... ......... ......... ........... ........... crwn pri. D2931... E Prefab stnlss steel ......... ......... ......... ........... ........... crown pe. D2932... E Prefabricated resin ......... ......... ......... ........... ........... crown. D2933... E Prefab stainless steel ......... ......... ......... ........... ........... crown. D2940... E Dental sedative filling ......... ......... ......... ........... ........... D2950... E Core build-up incl any ......... ......... ......... ........... ........... pins. D2951... E Tooth pin retention.... ......... ......... ......... ........... ........... D2952... E Post and core cast + ......... ......... ......... ........... ........... crown. D2954... E Prefab post/core + ......... ......... ......... ........... ........... crown. D2955... E Post removal........... ......... ......... ......... ........... ........... D2960... E Laminate labial veneer. ......... ......... ......... ........... ........... D2961... E Lab labial veneer resin ......... ......... ......... ........... ........... D2962... E Lab labial veneer ......... ......... ......... ........... ........... porcelain. D2970... S Temporary-fractured 031 1.33 $70.52 $14.10 $14.10 tooth. D2980... E Crown repair........... ......... ......... ......... ........... ........... D2999... S Dental unspec 031 1.33 $70.52 $14.10 $14.10 restorative pr. [[Page 47729]] D3110... E Pulp cap direct........ ......... ......... ......... ........... ........... D3120... E Pulp cap indirect...... ......... ......... ......... ........... ........... D3220... E Therapeutic pulpotomy.. ......... ......... ......... ........... ........... D3230... E Pulpal therapy anterior ......... ......... ......... ........... ........... prim. D3240... E Pulpal therapy ......... ......... ......... ........... ........... posterior pri. D3310... E Anterior............... ......... ......... ......... ........... ........... D3320... E Root canal therapy 2 ......... ......... ......... ........... ........... canals. D3330... E Root canal therapy 3 ......... ......... ......... ........... ........... canals. D3346... E Retreat root canal ......... ......... ......... ........... ........... anterior. D3347... E Retreat root canal ......... ......... ......... ........... ........... bicuspid. D3348... E Retreat root canal ......... ......... ......... ........... ........... molar. D3351... E Apexification/recalc ......... ......... ......... ........... ........... initial. D3352... E Apexification/recalc ......... ......... ......... ........... ........... interim. D3353... E Apexification/recalc ......... ......... ......... ........... ........... final. D3410... E Apicoect/perirad surg ......... ......... ......... ........... ........... anter. D3421... E Root surgery bicuspid.. ......... ......... ......... ........... ........... D3425... E Root surgery molar..... ......... ......... ......... ........... ........... D3426... E Root surgery ea add ......... ......... ......... ........... ........... root. D3430... E Retrograde filling..... ......... ......... ......... ........... ........... D3450... E Root amputation........ ......... ......... ......... ........... ........... D3460... S Endodontic endosseous 031 1.33 $70.52 $14.10 $14.10 implan. D3470... E Intentional ......... ......... ......... ........... ........... replantation. D3910... E Isolation-tooth w rubb ......... ......... ......... ........... ........... dam. D3920... E Tooth splitting........ ......... ......... ......... ........... ........... D3950... E Canal prep/fitting of ......... ......... ......... ........... ........... dowel. D3960... E Bleaching of discolored ......... ......... ......... ........... ........... toot. D3999... S Endodontic procedure... 031 1.33 $70.52 $14.10 $14.10 D4210... E Gingivectomy/plasty per ......... ......... ......... ........... ........... quad. D4211... E Gingivectomy/plasty per ......... ......... ......... ........... ........... toot. D4220... E Gingival curettage per ......... ......... ......... ........... ........... quadr. D4240... E Gingival flap proc w/ ......... ......... ......... ........... ........... planin. D4249... E Crown lengthen hard ......... ......... ......... ........... ........... tissue. D4250... S Mucogingival surg per 031 1.33 $70.52 $14.10 $14.10 quadra. D4260... S Osseous surgery per 031 1.33 $70.52 $14.10 $14.10 quadrant. D4263... S Bone replce graft first 031 1.33 $70.52 $14.10 $14.10 site. D4264... S Bone replce graft each 031 1.33 $70.52 $14.10 $14.10 add. D4266... E Guided tiss regen ......... ......... ......... ........... ........... resorble. D4267... E Guided tiss regen ......... ......... ......... ........... ........... nonresorb. D4270... S Pedicle soft tissue 031 1.33 $70.52 $14.10 $14.10 graft pr. D4271... S Free soft tissue graft 031 1.33 $70.52 $14.10 $14.10 proc. D4273... S Subepithelial tissue 031 1.33 $70.52 $14.10 $14.10 graft. D4274... E Distal/proximal wedge ......... ......... ......... ........... ........... proc. D4320... E Provision splnt ......... ......... ......... ........... ........... intracoronal. D4321... E Provisional splint ......... ......... ......... ........... ........... extracoro. D4341... E Periodontal scaling & ......... ......... ......... ........... ........... root. D4355... S Full mouth debridement. 031 1.33 $70.52 $14.10 $14.10 D4381... S Localized chemo 031 1.33 $70.52 $14.10 $14.10 delivery. D4910... E Periodontal maint ......... ......... ......... ........... ........... procedures. D4920... E Unscheduled dressing ......... ......... ......... ........... ........... change. D4999... E Unspecified periodontal ......... ......... ......... ........... ........... proc. D5110... E Dentures complete ......... ......... ......... ........... ........... maxillary. D5120... E Dentures complete ......... ......... ......... ........... ........... mandible. D5130... E Dentures immediat ......... ......... ......... ........... ........... maxillary. D5140... E Dentures immediat ......... ......... ......... ........... ........... mandible. D5211... E Dentures maxill part ......... ......... ......... ........... ........... resin. D5212... E Dentures mand part ......... ......... ......... ........... ........... resin. D5213... E Dentures maxill part ......... ......... ......... ........... ........... metal. D5214... E Dentures mandibl part ......... ......... ......... ........... ........... metal. D5281... E Removable partial ......... ......... ......... ........... ........... denture. D5410... E Dentures adjust cmplt ......... ......... ......... ........... ........... maxil. D5411... E Dentures adjust cmplt ......... ......... ......... ........... ........... mand. D5421... E Dentures adjust part ......... ......... ......... ........... ........... maxill. D5422... E Dentures adjust part ......... ......... ......... ........... ........... mandbl. D5510... E Dentur repr broken ......... ......... ......... ........... ........... compl bas. D5520... E Replace denture teeth ......... ......... ......... ........... ........... complt. D5610... E Dentures repair resin ......... ......... ......... ........... ........... base. D5620... E Rep part denture cast ......... ......... ......... ........... ........... frame. D5630... E Rep partial denture ......... ......... ......... ........... ........... clasp. D5640... E Replace part denture ......... ......... ......... ........... ........... teeth. D5650... E Add tooth to partial ......... ......... ......... ........... ........... denture. D5660... E Add clasp to partial ......... ......... ......... ........... ........... denture. D5710... E Dentures rebase cmplt ......... ......... ......... ........... ........... maxil. D5711... E Dentures rebase cmplt ......... ......... ......... ........... ........... mand. D5720... E Dentures rebase part ......... ......... ......... ........... ........... maxill. D5721... E Dentures rebase part ......... ......... ......... ........... ........... mandbl. [[Page 47730]] D5730... E Denture reln cmplt ......... ......... ......... ........... ........... maxil ch. D5731... E Denture reln cmplt mand ......... ......... ......... ........... ........... chr. D5740... E Denture reln part maxil ......... ......... ......... ........... ........... chr. D5741... E Denture reln part mand ......... ......... ......... ........... ........... chr. D5750... E Denture reln cmplt max ......... ......... ......... ........... ........... lab. D5751... E Denture reln cmplt mand ......... ......... ......... ........... ........... lab. D5760... E Denture reln part maxil ......... ......... ......... ........... ........... lab. D5761... E Denture reln part mand ......... ......... ......... ........... ........... lab. D5810... E Denture interm cmplt ......... ......... ......... ........... ........... maxill. D5811... E Denture interm cmplt ......... ......... ......... ........... ........... mandbl. D5820... E Denture interm part ......... ......... ......... ........... ........... maxill. D5821... E Denture interm part ......... ......... ......... ........... ........... mandbl. D5850... E Denture tiss conditn ......... ......... ......... ........... ........... maxill. D5851... E Denture tiss condtin ......... ......... ......... ........... ........... mandbl. D5860... E Overdenture complete... ......... ......... ......... ........... ........... D5861... E Overdenture partial.... ......... ......... ......... ........... ........... D5862... E Precision attachment... ......... ......... ......... ........... ........... D5899... E Removable prosthodontic ......... ......... ......... ........... ........... proc. D5911... S Facial moulage 031 1.33 $70.52 $14.10 $14.10 sectional. D5912... S Facial moulage complete 031 1.33 $70.52 $14.10 $14.10 D5913... E Nasal prosthesis....... ......... ......... ......... ........... ........... D5914... E Auricular prosthesis... ......... ......... ......... ........... ........... D5915... E Orbital prosthesis..... ......... ......... ......... ........... ........... D5916... E Ocular prosthesis...... ......... ......... ......... ........... ........... D5919... E Facial prosthesis...... ......... ......... ......... ........... ........... D5922... E Nasal septal prosthesis ......... ......... ......... ........... ........... D5923... E Ocular prosthesis ......... ......... ......... ........... ........... interim. D5924... E Cranial prosthesis..... ......... ......... ......... ........... ........... D5925... E Facial augmentation ......... ......... ......... ........... ........... implant. D5926... E Replacement nasal ......... ......... ......... ........... ........... prosthesis. D5927... E Auricular replacement.. ......... ......... ......... ........... ........... D5928... E Orbital replacement.... ......... ......... ......... ........... ........... D5929... E Facial replacement..... ......... ......... ......... ........... ........... D5931... E Surgical obturator..... ......... ......... ......... ........... ........... D5932... E Postsurgical obturator. ......... ......... ......... ........... ........... D5933... E Refitting of obturator. ......... ......... ......... ........... ........... D5934... E Mandibular flange ......... ......... ......... ........... ........... prosthesis. D5935... E Mandibular denture ......... ......... ......... ........... ........... prosth. D5936... E Temp obturator ......... ......... ......... ........... ........... prosthesis. D5937... E Trismus appliance...... ......... ......... ......... ........... ........... D5951... E Feeding aid............ ......... ......... ......... ........... ........... D5952... E Pediatric speech aid... ......... ......... ......... ........... ........... D5953... E Adult speech aid....... ......... ......... ......... ........... ........... D5954... E Superimposed prosthesis ......... ......... ......... ........... ........... D5955... E Palatal lift prosthesis ......... ......... ......... ........... ........... D5958... E Intraoral con def inter ......... ......... ......... ........... ........... plt. D5959... E Intraoral con def mod ......... ......... ......... ........... ........... palat. D5960... E Modify speech aid ......... ......... ......... ........... ........... prosthesis. D5982... E Surgical stent......... ......... ......... ......... ........... ........... D5983... S Radiation applicator... 031 1.33 $70.52 $14.10 $14.10 D5984... S Radiation shield....... 031 1.33 $70.52 $14.10 $14.10 D5985... S Radiation cone locator. 031 1.33 $70.52 $14.10 $14.10 D5986... E Fluoride applicator.... ......... ......... ......... ........... ........... D5987... S Commissure splint...... 031 1.33 $70.52 $14.10 $14.10 D5988... E Surgical splint........ ......... ......... ......... ........... ........... D5999... E Maxillofacial ......... ......... ......... ........... ........... prosthesis. D6010... E Odontics endosteal ......... ......... ......... ........... ........... implant. D6020... E Odontics abutment ......... ......... ......... ........... ........... placement. D6040... E Odontics eposteal ......... ......... ......... ........... ........... implant. D6050... E Odontics transosteal ......... ......... ......... ........... ........... implnt. D6055... E Implant connecting bar. ......... ......... ......... ........... ........... D6080... E Implant maintenance.... ......... ......... ......... ........... ........... D6090... E Repair implant......... ......... ......... ......... ........... ........... D6095... E Odontics repr abutment. ......... ......... ......... ........... ........... D6100... E Removal of implant..... ......... ......... ......... ........... ........... D6199... E Implant procedure...... ......... ......... ......... ........... ........... D6210... E Prosthodont high noble ......... ......... ......... ........... ........... metal. D6211... E Bridge base metal cast. ......... ......... ......... ........... ........... D6212... E Bridge noble metal cast ......... ......... ......... ........... ........... D6240... E Bridge porcelain high ......... ......... ......... ........... ........... noble. D6241... E Bridge porcelain base ......... ......... ......... ........... ........... metal. D6242... E Bridge porcelain nobel ......... ......... ......... ........... ........... metal. D6250... E Bridge resin w/high ......... ......... ......... ........... ........... noble. D6251... E Bridge resin base metal ......... ......... ......... ........... ........... D6252... E Bridge resin w/noble ......... ......... ......... ........... ........... metal. [[Page 47731]] D6520... E Dental retainer two ......... ......... ......... ........... ........... surfaces. D6530... E Retainer metallic 3+ ......... ......... ......... ........... ........... surface. D6543... E Dental retainr onlay 3 ......... ......... ......... ........... ........... surf. D6544... E Dental retainr onlay 4/ ......... ......... ......... ........... ........... more. D6545... E Dental retainr cast ......... ......... ......... ........... ........... metl. D6720... E Retain crown resin w hi ......... ......... ......... ........... ........... nble. D6721... E Crown resin w/base ......... ......... ......... ........... ........... metal. D6722... E Crown resin w/noble ......... ......... ......... ........... ........... metal. D6750... E Crown porcelain high ......... ......... ......... ........... ........... noble. D6751... E Crown porcelain base ......... ......... ......... ........... ........... metal. D6752... E Crown porcelain noble ......... ......... ......... ........... ........... metal. D6780... E Crown 3/4 high noble ......... ......... ......... ........... ........... metal. D6790... E Crown full high noble ......... ......... ......... ........... ........... metal. D6791... E Crown full base metal ......... ......... ......... ........... ........... cast. D6792... E Crown full noble metal ......... ......... ......... ........... ........... cast. D6920... S Dental connector bar... 031 1.33 $70.52 $14.10 $14.10 D6930... E Dental recement bridge. ......... ......... ......... ........... ........... D6940... E Stress breaker......... ......... ......... ......... ........... ........... D6950... E Precision attachment... ......... ......... ......... ........... ........... D6970... E Post & core plus ......... ......... ......... ........... ........... retainer. D6971... E Cast post bridge ......... ......... ......... ........... ........... retainer. D6972... E Prefab post & core plus ......... ......... ......... ........... ........... reta. D6973... E Core build up for ......... ......... ......... ........... ........... retainer. D6975... E Coping metal........... ......... ......... ......... ........... ........... D6980... E Bridge repair.......... ......... ......... ......... ........... ........... D6999... E Fixed prosthodontic ......... ......... ......... ........... ........... proc. D7110... S Oral surgery single 031 1.33 $70.52 $14.10 $14.10 tooth. D7120... S Each add tooth 031 1.33 $70.52 $14.10 $14.10 extraction. D7130... S Tooth root removal..... 031 1.33 $70.52 $14.10 $14.10 D7210... S Rem imp tooth w mucoper 031 1.33 $70.52 $14.10 $14.10 flp. D7220... S Impact tooth remov soft 031 1.33 $70.52 $14.10 $14.10 tiss. D7230... S Impact tooth remov part 031 1.33 $70.52 $14.10 $14.10 bony. D7240... S Impact tooth remov comp 031 1.33 $70.52 $14.10 $14.10 bony. D7241... S Impact tooth rem bony w/ 031 1.33 $70.52 $14.10 $14.10 comp. D7250... S Tooth root removal..... 031 1.33 $70.52 $14.10 $14.10 D7260... S Oral antral fistula 031 1.33 $70.52 $14.10 $14.10 closure. D7270... E Tooth reimplantation... ......... ......... ......... ........... ........... D7272... E Tooth transplantation.. ......... ......... ......... ........... ........... D7280... E Exposure impact tooth ......... ......... ......... ........... ........... orthod. D7281... E Exposure tooth aid ......... ......... ......... ........... ........... eruption. D7285... E Biopsy of oral tissue ......... ......... ......... ........... ........... hard. D7286... E Biopsy of oral tissue ......... ......... ......... ........... ........... soft. D7290... E Repositioning of teeth. ......... ......... ......... ........... ........... D7291... S Transseptal fiberotomy. 031 1.33 $70.52 $14.10 $14.10 D7310... E Alveoplasty w/ ......... ......... ......... ........... ........... extraction. D7320... E Alveoplasty w/o ......... ......... ......... ........... ........... extraction. D7340... E Vestibuloplasty ridge ......... ......... ......... ........... ........... extens. D7350... E Vestibuloplasty exten ......... ......... ......... ........... ........... graft. D7410... E Rad exc lesion up to ......... ......... ......... ........... ........... 1.25 cm. D7420... E Lesion > 1.25 cm....... ......... ......... ......... ........... ........... D7430... E Exc benign tumor to ......... ......... ......... ........... ........... 1.25 cm. D7431... E Benign tumor exc > 1.25 ......... ......... ......... ........... ........... cm. D7440... E Malig tumor exc to 1.25 ......... ......... ......... ........... ........... cm. D7441... E Malig tumor > 1.25 cm.. ......... ......... ......... ........... ........... D7450... E Rem odontogen cyst to ......... ......... ......... ........... ........... 1.25cm. D7451... E Rem odontogen cyst > ......... ......... ......... ........... ........... 1.25 cm. D7460... E Rem nonodonto cyst to ......... ......... ......... ........... ........... 1.25cm. D7461... E Rem nonodonto cyst > ......... ......... ......... ........... ........... 1.25 cm. D7465... E Lesion destruction..... ......... ......... ......... ........... ........... D7470... E Rem exostosis maxilla/ ......... ......... ......... ........... ........... mandib. D7480... E Partial ostectomy...... ......... ......... ......... ........... ........... D7490... E Mandible resection..... ......... ......... ......... ........... ........... D7510... E I&d absc intraoral soft ......... ......... ......... ........... ........... tiss. D7520... E I&d abscess extraoral.. ......... ......... ......... ........... ........... D7530... E Removal fb skin/areolar ......... ......... ......... ........... ........... tiss. D7540... E Removal of fb reaction. ......... ......... ......... ........... ........... D7550... E Removal of sloughed off ......... ......... ......... ........... ........... bone. D7560... E Maxillary sinusotomy... ......... ......... ......... ........... ........... D7610... E Maxilla open reduct ......... ......... ......... ........... ........... simple. D7620... E Clsd reduct simpl ......... ......... ......... ........... ........... maxilla fx. D7630... E Open red simpl mandible ......... ......... ......... ........... ........... fx. D7640... E Clsd red simpl mandible ......... ......... ......... ........... ........... fx. D7650... E Open red simp malar/ ......... ......... ......... ........... ........... zygom fx. D7660... E Clsd red simp malar/ ......... ......... ......... ........... ........... zygom fx. D7670... E Open red simple ......... ......... ......... ........... ........... alveolus fx. [[Page 47732]] D7680... E Reduct simple facial ......... ......... ......... ........... ........... bone fx. D7710... E Maxilla open reduct ......... ......... ......... ........... ........... compound. D7720... E Clsd reduct compd ......... ......... ......... ........... ........... maxilla fx. D7730... E Open reduct compd ......... ......... ......... ........... ........... mandble fx. D7740... E Clsd reduct compd ......... ......... ......... ........... ........... mandble fx. D7750... E Open red comp malar/ ......... ......... ......... ........... ........... zygma fx. D7760... E Clsd red comp malar/ ......... ......... ......... ........... ........... zygma fx. D7770... E Open reduc compd ......... ......... ......... ........... ........... alveolus fx. D7780... E Reduct compnd facial ......... ......... ......... ........... ........... bone fx. D7810... E Tmj open reduct- ......... ......... ......... ........... ........... dislocation. D7820... E Closed tmp manipulation ......... ......... ......... ........... ........... D7830... E Tmj manipulation under ......... ......... ......... ........... ........... anest. D7840... E Removal of tmj condyle. ......... ......... ......... ........... ........... D7850... E Tmj meniscectomy....... ......... ......... ......... ........... ........... D7852... E Tmj repair of joint ......... ......... ......... ........... ........... disc. D7854... E Tmj excisn of joint ......... ......... ......... ........... ........... membrane. D7856... E Tmj cutting of a muscle ......... ......... ......... ........... ........... D7858... E Tmj reconstruction..... ......... ......... ......... ........... ........... D7860... E Tmj cutting into joint. ......... ......... ......... ........... ........... D7865... E Tmj reshaping ......... ......... ......... ........... ........... components. D7870... E Tmj aspiration joint ......... ......... ......... ........... ........... fluid. D7872... E Tmj diagnostic ......... ......... ......... ........... ........... arthroscopy. D7873... E Tmj arthroscopy lysis ......... ......... ......... ........... ........... adhesn. D7874... E Tmj arthroscopy disc ......... ......... ......... ........... ........... reposit. D7875... E Tmj arthroscopy ......... ......... ......... ........... ........... synovectomy. D7876... E Tmj arthroscopy ......... ......... ......... ........... ........... discectomy. D7877... E Tmj arthroscopy ......... ......... ......... ........... ........... debridement. D7880... E Occlusal orthotic ......... ......... ......... ........... ........... appliance. D7899... E Tmj unspecified therapy ......... ......... ......... ........... ........... D7910... E Dent sutur recent wnd ......... ......... ......... ........... ........... to 5cm. D7911... E Dental suture wound to ......... ......... ......... ........... ........... 5 cm. D7912... E Suture complicate wnd > ......... ......... ......... ........... ........... 5 cm. D7920... E Dental skin graft...... ......... ......... ......... ........... ........... D7940... S Reshaping bone 031 1.33 $70.52 $14.10 $14.10 orthognathic. D7941... E Bone cutting ramus ......... ......... ......... ........... ........... closed. D7942... E Bone cutting ramus open ......... ......... ......... ........... ........... D7943... E Cutting ramus open w/ ......... ......... ......... ........... ........... graft. D7944... E Bone cutting segmented. ......... ......... ......... ........... ........... D7945... E Bone cutting body ......... ......... ......... ........... ........... mandible. D7946... E Reconstruction maxilla ......... ......... ......... ........... ........... total. D7947... E Reconstruct maxilla ......... ......... ......... ........... ........... segment. D7948... E Reconstruct midface no ......... ......... ......... ........... ........... graft. D7949... E Reconstruct midface w/ ......... ......... ......... ........... ........... graft. D7950... E Mandible graft......... ......... ......... ......... ........... ........... D7955... E Repair maxillofacial ......... ......... ......... ........... ........... defects. D7960... E Frenulectomy/ ......... ......... ......... ........... ........... frenulotomy. D7970... E Excision hyperplastic ......... ......... ......... ........... ........... tissue. D7971... E Excision pericoronal ......... ......... ......... ........... ........... gingiva. D7980... E Sialolithotomy......... ......... ......... ......... ........... ........... D7981... E Excision of salivary ......... ......... ......... ........... ........... gland. D7982... E Sialodochoplasty....... ......... ......... ......... ........... ........... D7983... E Closure of salivary ......... ......... ......... ........... ........... fistula. D7990... E Emergency tracheotomy.. ......... ......... ......... ........... ........... D7991... E Dental coronoidectomy.. ......... ......... ......... ........... ........... D7995... E Synthetic graft facial ......... ......... ......... ........... ........... bones. D7996... E Implant mandible for ......... ......... ......... ........... ........... augment. D7999... E Oral surgery procedure. ......... ......... ......... ........... ........... D8010... E Limited dental tx ......... ......... ......... ........... ........... primary. D8020... E Limited dental tx ......... ......... ......... ........... ........... transition. D8030... E Limited dental tx ......... ......... ......... ........... ........... adolescent. D8040... E Limited dental tx adult ......... ......... ......... ........... ........... D8050... E Intercep dental tx ......... ......... ......... ........... ........... primary. D8060... E Intercep dental tx ......... ......... ......... ........... ........... transitn. D8070... E Compre dental tx ......... ......... ......... ........... ........... transition. D8080... E Compre dental tx ......... ......... ......... ........... ........... adolescent. D8090... E Compre dental tx adult. ......... ......... ......... ........... ........... D8210... E Orthodontic rem ......... ......... ......... ........... ........... appliance tx. D8220... E Fixed appliance therapy ......... ......... ......... ........... ........... habt. D8660... E Preorthodontic tx visit ......... ......... ......... ........... ........... D8670... E Periodic orthodontc tx ......... ......... ......... ........... ........... visit. D8680... E Orthodontic retention.. ......... ......... ......... ........... ........... D8690... E Orthodontic treatment.. ......... ......... ......... ........... ........... D8999... E Orthodontic procedure.. ......... ......... ......... ........... ........... D9110... N Tx dental pain minor ......... ......... ......... ........... ........... proc. D9210... E Dent anesthesia w/o ......... ......... ......... ........... ........... surgery. [[Page 47733]] D9211... E Regional block ......... ......... ......... ........... ........... anesthesia. D9212... E Trigeminal block ......... ......... ......... ........... ........... anesthesia. D9215... E Local anesthesia....... ......... ......... ......... ........... ........... D9220... E General anesthesia..... ......... ......... ......... ........... ........... D9221... E General anesthesia ea ......... ......... ......... ........... ........... ad 15m. D9230... N Analgesia.............. ......... ......... ......... ........... ........... D9240... E Intravenous sedation... ......... ......... ......... ........... ........... D9310... E Dental consultation.... ......... ......... ......... ........... ........... D9410... E Dental house call...... ......... ......... ......... ........... ........... D9420... E Hospital call.......... ......... ......... ......... ........... ........... D9430... E Office visit during ......... ......... ......... ........... ........... hours. D9440... E Office visit after ......... ......... ......... ........... ........... hours. D9610... E Dent therapeutic drug ......... ......... ......... ........... ........... inject. D9630... S Other drugs/medicaments 031 1.33 $70.52 $14.10 $14.10 D9910... E Dent appl desensitizing ......... ......... ......... ........... ........... med. D9920... E Behavior management.... ......... ......... ......... ........... ........... D9930... S Treatment of 031 1.33 $70.52 $14.10 $14.10 complications. D9940... S Dental occlusal guard.. 031 1.33 $70.52 $14.10 $14.10 D9941... E Fabrication athletic ......... ......... ......... ........... ........... guard. D9950... S Occlusion analysis..... 031 1.33 $70.52 $14.10 $14.10 D9951... S Limited occlusal 031 1.33 $70.52 $14.10 $14.10 adjustment. D9952... S Complete occlusal 031 1.33 $70.52 $14.10 $14.10 adjustment. D9970... E Enamel microabrasion... ......... ......... ......... ........... ........... D9999... E Adjunctive procedure... ......... ......... ......... ........... ........... E0100... A Cane adjust/fixed with ......... ......... ......... ........... ........... tip. E0105... A Cane adjust/fixed quad/ ......... ......... ......... ........... ........... 3 pro. E0110... A Crutch forearm pair.... ......... ......... ......... ........... ........... E0111... A Crutch forearm each.... ......... ......... ......... ........... ........... E0112... A Crutch underarm pair ......... ......... ......... ........... ........... wood. E0113... A Crutch underarm each ......... ......... ......... ........... ........... wood. E0114... A Crutch underarm pair no ......... ......... ......... ........... ........... wood. E0116... A Crutch underarm each no ......... ......... ......... ........... ........... wood. E0130... A Walker rigid adjust/ ......... ......... ......... ........... ........... fixed ht. E0135... A Walker folding adjust/ ......... ......... ......... ........... ........... fixed. E0141... A Rigid walker wheeled wo ......... ......... ......... ........... ........... seat. E0142... A Walker rigid wheeled ......... ......... ......... ........... ........... with se. E0143... A Walker folding wheeled ......... ......... ......... ........... ........... w/o s. E0145... A Walker whled seat/ ......... ......... ......... ........... ........... crutch att. E0146... A Folding walker wheels w ......... ......... ......... ........... ........... seat. E0147... A Walker variable wheel ......... ......... ......... ........... ........... resist. E0153... A Forearm crutch platform ......... ......... ......... ........... ........... atta. E0154... A Walker platform ......... ......... ......... ........... ........... attachment. E0155... A Walker rigd pick-up/ ......... ......... ......... ........... ........... wheel at. E0156... A Walker seat attachment. ......... ......... ......... ........... ........... E0157... A Walker crutch ......... ......... ......... ........... ........... attachment. E0158... A Walker leg extensions.. ......... ......... ......... ........... ........... E0159... A Brake for wheeled ......... ......... ......... ........... ........... walker. E0160... A Sitz type bath or ......... ......... ......... ........... ........... equipment. E0161... A Sitz bath/equipment w/ ......... ......... ......... ........... ........... faucet. E0162... A Sitz bath chair........ ......... ......... ......... ........... ........... E0163... A Commode chair stationry ......... ......... ......... ........... ........... fxd. E0164... A Commode chair mobile ......... ......... ......... ........... ........... fixed a. E0165... A Commode chair stationry ......... ......... ......... ........... ........... det. E0166... A Commode chair mobile ......... ......... ......... ........... ........... detach. E0167... A Commode chair pail or ......... ......... ......... ........... ........... pan. E0175... A Commode chair foot rest ......... ......... ......... ........... ........... E0176... A Air pressre pad/cushion ......... ......... ......... ........... ........... nonp. E0177... A Water press pad/cushion ......... ......... ......... ........... ........... nonp. E0178... A Gel pressre pad/cushion ......... ......... ......... ........... ........... nonp. E0179... A Dry pressre pad/cushion ......... ......... ......... ........... ........... nonp. E0180... A Press pad alternating w ......... ......... ......... ........... ........... pump. E0181... A Press pad alternating w/ ......... ......... ......... ........... ........... pum. E0182... A Pressure pad ......... ......... ......... ........... ........... alternating pum. E0184... A Dry pressure mattress.. ......... ......... ......... ........... ........... E0185... A Gel pressure mattress ......... ......... ......... ........... ........... pad. E0186... A Air pressure mattress.. ......... ......... ......... ........... ........... E0187... A Water pressure mattress ......... ......... ......... ........... ........... E0188... E Synthetic sheepskin pad ......... ......... ......... ........... ........... E0189... E Lambswool sheepskin pad ......... ......... ......... ........... ........... E0191... A Protector heel or elbow ......... ......... ......... ........... ........... E0192... A Pad wheelchr low press/ ......... ......... ......... ........... ........... posit. E0193... A Powered air flotation ......... ......... ......... ........... ........... bed. E0194... A Air fluidized bed...... ......... ......... ......... ........... ........... E0196... A Gel pressure mattress.. ......... ......... ......... ........... ........... E0197... A Air pressure pad for ......... ......... ......... ........... ........... mattres. [[Page 47734]] E0198... A Water pressure pad for ......... ......... ......... ........... ........... mattr. E0199... A Dry pressure pad for ......... ......... ......... ........... ........... mattres. E0200... A Heat lamp without stand ......... ......... ......... ........... ........... E0202... A Phototherapy light w/ ......... ......... ......... ........... ........... photom. E0205... A Heat lamp with stand... ......... ......... ......... ........... ........... E0210... A Electric heat pad ......... ......... ......... ........... ........... standard. E0215... A Electric heat pad moist ......... ......... ......... ........... ........... E0217... A Water circ heat pad w ......... ......... ......... ........... ........... pump. E0218... A Water circ cold pad w ......... ......... ......... ........... ........... pump. E0220... A Hot water bottle....... ......... ......... ......... ........... ........... E0225... A Hydrocollator unit..... ......... ......... ......... ........... ........... E0230... A Ice cap or collar...... ......... ......... ......... ........... ........... E0235... A Paraffin bath unit ......... ......... ......... ........... ........... portable. E0236... A Pump for water ......... ......... ......... ........... ........... circulating p. E0238... A Heat pad non-electric ......... ......... ......... ........... ........... moist. E0239... A Hydrocollator unit ......... ......... ......... ........... ........... portable. E0241... E Bath tub wall rail..... ......... ......... ......... ........... ........... E0242... E Bath tub rail floor.... ......... ......... ......... ........... ........... E0243... E Toilet rail............ ......... ......... ......... ........... ........... E0244... E Toilet seat raised..... ......... ......... ......... ........... ........... E0245... E Tub stool or bench..... ......... ......... ......... ........... ........... E0246... A Transfer tub rail ......... ......... ......... ........... ........... attachment. E0249... A Pad water circulating ......... ......... ......... ........... ........... heat u. E0250... A Hosp bed fixed ht w/ ......... ......... ......... ........... ........... mattres. E0251... A Hosp bed fixd ht w/o ......... ......... ......... ........... ........... mattres. E0255... A Hospital bed var ht w/ ......... ......... ......... ........... ........... mattr. E0256... A Hospital bed var ht w/o ......... ......... ......... ........... ........... matt. E0260... A Hosp bed semi-electr w/ ......... ......... ......... ........... ........... matt. E0261... A Hosp bed semi-electr w/ ......... ......... ......... ........... ........... o mat. E0265... A Hosp bed total electr w/ ......... ......... ......... ........... ........... mat. E0266... A Hosp bed total elec w/o ......... ......... ......... ........... ........... matt. E0270... A Hospital bed ......... ......... ......... ........... ........... institutional t. E0271... A Mattress innerspring... ......... ......... ......... ........... ........... E0272... A Mattress foam rubber... ......... ......... ......... ........... ........... E0273... A Bed board.............. ......... ......... ......... ........... ........... E0274... A Over-bed table......... ......... ......... ......... ........... ........... E0275... A Bed pan standard....... ......... ......... ......... ........... ........... E0276... A Bed pan fracture....... ......... ......... ......... ........... ........... E0277... A Powered pres-redu air ......... ......... ......... ........... ........... mattrs. E0280... A Bed cradle............. ......... ......... ......... ........... ........... E0290... A Hosp bed fx ht w/o ......... ......... ......... ........... ........... rails w/m. E0291... A Hosp bed fx ht w/o rail ......... ......... ......... ........... ........... w/o. E0292... A Hosp bed var ht w/o ......... ......... ......... ........... ........... rail w/o. E0293... A Hosp bed var ht w/o ......... ......... ......... ........... ........... rail w/. E0294... A Hosp bed semi-elect w/ ......... ......... ......... ........... ........... mattr. E0295... A Hosp bed semi-elect w/o ......... ......... ......... ........... ........... matt. E0296... A Hosp bed total elect w/ ......... ......... ......... ........... ........... matt. E0297... A Hosp bed total elect w/ ......... ......... ......... ........... ........... o mat. E0305... A Rails bed side half ......... ......... ......... ........... ........... length. E0310... A Rails bed side full ......... ......... ......... ........... ........... length. E0315... A Bed accessory brd/tbl/ ......... ......... ......... ........... ........... supprt. E0325... A Urinal male jug-type... ......... ......... ......... ........... ........... E0326... A Urinal female jug-type. ......... ......... ......... ........... ........... E0350... A Control unit bowel ......... ......... ......... ........... ........... system. E0352... A Disposable pack w/bowel ......... ......... ......... ........... ........... syst. E0370... A Air elevator for heel.. ......... ......... ......... ........... ........... E0371... A Nonpower mattress ......... ......... ......... ........... ........... overlay. E0372... A Powered air mattress ......... ......... ......... ........... ........... overlay. E0373... A Nonpowered pressure ......... ......... ......... ........... ........... mattress. E0424... A Stationary compressed ......... ......... ......... ........... ........... gas 02. E0425... A Gas system stationary ......... ......... ......... ........... ........... compre. E0430... A Oxygen system gas ......... ......... ......... ........... ........... portable. E0431... A Portable gaseous 02.... ......... ......... ......... ........... ........... E0434... A Portable liquid 02..... ......... ......... ......... ........... ........... E0435... A Oxygen system liquid ......... ......... ......... ........... ........... portabl. E0439... A Stationary liquid 02... ......... ......... ......... ........... ........... E0440... A Oxygen system liquid ......... ......... ......... ........... ........... station. E0441... A Oxygen contents gas per/ ......... ......... ......... ........... ........... unit. E0442... A Oxygen contents liq per/ ......... ......... ......... ........... ........... unit. E0443... A Port 02 contents gas/ ......... ......... ......... ........... ........... unit. E0444... A Port 02 contents liq/ ......... ......... ......... ........... ........... unit. E0450... A Volume vent stationary/ ......... ......... ......... ........... ........... porta. E0452... A Intermit assis device w ......... ......... ......... ........... ........... cpap. E0453... A Ventilator 12 hrs/less ......... ......... ......... ........... ........... per d. E0455... A Oxygen tent excl croup/ ......... ......... ......... ........... ........... ped t. [[Page 47735]] E0457... A Chest shell............ ......... ......... ......... ........... ........... E0459... A Chest wrap............. ......... ......... ......... ........... ........... E0460... A Neg press vent portabl/ ......... ......... ......... ........... ........... statn. E0462... A Rocking bed w/ or w/o ......... ......... ......... ........... ........... side r. E0480... A Percussor elect/pneum ......... ......... ......... ........... ........... home m. E0500... A Ippb all types......... ......... ......... ......... ........... ........... E0550... A Humidif extens supple w ......... ......... ......... ........... ........... ippb. E0555... A Humidifier for use w/ ......... ......... ......... ........... ........... regula. E0560... A Humidifier supplemental ......... ......... ......... ........... ........... w/ i. E0565... A Compressor air power ......... ......... ......... ........... ........... source. E0570... A Nebulizer with ......... ......... ......... ........... ........... compression. E0575... A Nebulizer ultrasonic... ......... ......... ......... ........... ........... E0580... A Nebulizer for use w/ ......... ......... ......... ........... ........... regulat. E0585... A Nebulizer w/ compressor ......... ......... ......... ........... ........... & he. E0600... A Suction pump portab hom ......... ......... ......... ........... ........... modl. E0601... A Cont airway pressure ......... ......... ......... ........... ........... device. E0605... A Vaporizer room type.... ......... ......... ......... ........... ........... E0606... A Drainage board postural ......... ......... ......... ........... ........... E0607... A Blood glucose monitor ......... ......... ......... ........... ........... home. E0608... A Apnea monitor.......... ......... ......... ......... ........... ........... E0609... A Blood gluc mon w/ ......... ......... ......... ........... ........... special fea. E0610... A Pacemaker monitr ......... ......... ......... ........... ........... audible/vis. E0615... A Pacemaker monitr ......... ......... ......... ........... ........... digital/vis. E0621... A Patient lift sling or ......... ......... ......... ........... ........... seat. E0625... A Patient lift bathroom ......... ......... ......... ........... ........... or toi. E0627... A Seat lift incorp lift- ......... ......... ......... ........... ........... chair. E0628... A Seat lift for pt furn- ......... ......... ......... ........... ........... electr. E0629... A Seat lift for pt furn- ......... ......... ......... ........... ........... non-el. E0630... A Patient lift hydraulic. ......... ......... ......... ........... ........... E0635... A Patient lift electric.. ......... ......... ......... ........... ........... E0650... A Pneuma compresor non- ......... ......... ......... ........... ........... segment. E0651... A Pneum compressor ......... ......... ......... ........... ........... segmental. E0652... A Pneum compres w/cal ......... ......... ......... ........... ........... pressure. E0655... A Pneumatic appliance ......... ......... ......... ........... ........... half arm. E0660... A Pneumatic appliance ......... ......... ......... ........... ........... full leg. E0665... A Pneumatic appliance ......... ......... ......... ........... ........... full arm. E0666... A Pneumatic appliance ......... ......... ......... ........... ........... half leg. E0667... A Seg pneumatic appl full ......... ......... ......... ........... ........... leg. E0668... A Seg pneumatic appl full ......... ......... ......... ........... ........... arm. E0669... A Seg pneumatic appli ......... ......... ......... ........... ........... half leg. E0671... A Pressure pneum appl ......... ......... ......... ........... ........... full leg. E0672... A Pressure pneum appl ......... ......... ......... ........... ........... full arm. E0673... A Pressure pneum appl ......... ......... ......... ........... ........... half leg. E0690... A Ultraviolet cabinet.... ......... ......... ......... ........... ........... E0700... A Safety equipment....... ......... ......... ......... ........... ........... E0710... A Restraints any type.... ......... ......... ......... ........... ........... E0720... A Tens two lead.......... ......... ......... ......... ........... ........... E0730... A Tens four lead......... ......... ......... ......... ........... ........... E0731... A Conductive garment for ......... ......... ......... ........... ........... tens/. E0740... A Incontinence treatment ......... ......... ......... ........... ........... systm. E0744... A Neuromuscular stim for ......... ......... ......... ........... ........... scoli. E0745... A Neuromuscular stim for ......... ......... ......... ........... ........... shock. E0746... A Electromyograph ......... ......... ......... ........... ........... biofeedback. E0747... A Elec osteogen stim not ......... ......... ......... ........... ........... spine. E0748... A Elec osteogen stim ......... ......... ......... ........... ........... spinal. E0749... A Elec osteogen stim ......... ......... ......... ........... ........... implanted. E0751... A Pulse generator or ......... ......... ......... ........... ........... receiver. E0753... A Neurostimul electrodes/ ......... ......... ......... ........... ........... leads. E0755... A Electronic salivary ......... ......... ......... ........... ........... reflex s. E0760... A Osteogen ultrasound ......... ......... ......... ........... ........... stimltor. E0776... A Iv pole................ ......... ......... ......... ........... ........... E0781... A External ambulatory ......... ......... ......... ........... ........... infus pu. E0782... A Non-programble infusion ......... ......... ......... ........... ........... pump. E0783... A Programmable infusion ......... ......... ......... ........... ........... pump. E0784... A Ext amb infusn pump ......... ......... ......... ........... ........... insulin. E0791... A Parenteral infusion ......... ......... ......... ........... ........... pump sta. E0840... A Tract frame attach ......... ......... ......... ........... ........... headboard. E0850... A Traction stand free ......... ......... ......... ........... ........... standing. E0855... A Cervical traction ......... ......... ......... ........... ........... equipment. E0860... A Tract equip cervical ......... ......... ......... ........... ........... tract. E0870... A Tract frame attach ......... ......... ......... ........... ........... footboard. E0880... A Trac stand free stand ......... ......... ......... ........... ........... extrem. E0890... A Traction frame attach ......... ......... ......... ........... ........... pelvic. E0900... A Trac stand free stand ......... ......... ......... ........... ........... pelvic. E0910... A Trapeze bar attached to ......... ......... ......... ........... ........... bed. [[Page 47736]] E0920... A Fracture frame attached ......... ......... ......... ........... ........... to b. E0930... A Fracture frame free ......... ......... ......... ........... ........... standing. E0935... A Exercise device passive ......... ......... ......... ........... ........... moti. E0940... A Trapeze bar free ......... ......... ......... ........... ........... standing. E0941... A Gravity assisted ......... ......... ......... ........... ........... traction de. E0942... A Cervical head harness/ ......... ......... ......... ........... ........... halter. E0943... A Cervical pillow........ ......... ......... ......... ........... ........... E0944... A Pelvic belt/harness/ ......... ......... ......... ........... ........... boot. E0945... A Belt/harness extremity. ......... ......... ......... ........... ........... E0946... A Fracture frame dual w ......... ......... ......... ........... ........... cross. E0947... A Fracture frame ......... ......... ......... ........... ........... attachmnts pe. E0948... A Fracture frame ......... ......... ......... ........... ........... attachmnts ce. E0950... A Tray................... ......... ......... ......... ........... ........... E0951... A Loop heel.............. ......... ......... ......... ........... ........... E0952... A Loop tie............... ......... ......... ......... ........... ........... E0953... A Pneumatic tire......... ......... ......... ......... ........... ........... E0954... A Wheelchair semi- ......... ......... ......... ........... ........... pneumatic ca. E0958... A Whlchr att-conv 1 arm ......... ......... ......... ........... ........... drive. E0959... A Amputee adapter........ ......... ......... ......... ........... ........... E0961... A Wheelchair brake ......... ......... ......... ........... ........... extension. E0962... A Wheelchair 1 inch ......... ......... ......... ........... ........... cushion. E0963... A Wheelchair 2 inch ......... ......... ......... ........... ........... cushion. E0964... A Wheelchair 3 inch ......... ......... ......... ........... ........... cushion. E0965... A Wheelchair 4 inch ......... ......... ......... ........... ........... cushion. E0966... A Wheelchair head rest ......... ......... ......... ........... ........... extensi. E0967... A Wheelchair hand rims... ......... ......... ......... ........... ........... E0968... A Wheelchair commode seat ......... ......... ......... ........... ........... E0969... A Wheelchair narrowing ......... ......... ......... ........... ........... device. E0970... A Wheelchair no. 2 ......... ......... ......... ........... ........... footplates. E0971... A Wheelchair anti-tipping ......... ......... ......... ........... ........... devi. E0972... A Transfer board or ......... ......... ......... ........... ........... device. E0973... A Wheelchair adjustabl ......... ......... ......... ........... ........... height. E0974... A Wheelchair grade-aid... ......... ......... ......... ........... ........... E0975... A Wheelchair reinforced ......... ......... ......... ........... ........... seat u. E0976... A Wheelchair reinforced ......... ......... ......... ........... ........... back u. E0977... A Wheelchair wedge ......... ......... ......... ........... ........... cushion. E0978... A Wheelchair belt w/ ......... ......... ......... ........... ........... airplane b. E0979... A Wheelchair belt with ......... ......... ......... ........... ........... velcro. E0980... A Wheelchair safety vest. ......... ......... ......... ........... ........... E0990... A Whellchair elevating ......... ......... ......... ........... ........... leg res. E0991... A Wheelchair upholstry ......... ......... ......... ........... ........... seat. E0992... A Wheelchair solid seat ......... ......... ......... ........... ........... insert. E0993... A Wheelchair back ......... ......... ......... ........... ........... upholstery. E0994... A Wheelchair arm rest.... ......... ......... ......... ........... ........... E0995... A Wheelchair calf rest... ......... ......... ......... ........... ........... E0996... A Wheelchair tire solid.. ......... ......... ......... ........... ........... E0997... A Wheelchair caster w/ a ......... ......... ......... ........... ........... fork. E0998... A Wheelchair caster w/o a ......... ......... ......... ........... ........... fork. E0999... A Wheelchr pneumatic tire ......... ......... ......... ........... ........... w/wh. E1000... A Wheelchair tire ......... ......... ......... ........... ........... pneumatic ca. E1001... A Wheelchair wheel....... ......... ......... ......... ........... ........... E1031... A Rollabout chair with ......... ......... ......... ........... ........... casters. E1050... A Whelchr fxd full length ......... ......... ......... ........... ........... arms. E1060... A Wheelchair detachable ......... ......... ......... ........... ........... arms. E1065... A Wheelchair power ......... ......... ......... ........... ........... attachment. E1066... A Wheelchair battery ......... ......... ......... ........... ........... charger. E1069... A Wheelchair deep cycle ......... ......... ......... ........... ........... batter. E1070... A Wheelchair detachable ......... ......... ......... ........... ........... foot r. E1083... A Hemi-wheelchair fixed ......... ......... ......... ........... ........... arms. E1084... A Hemi-wheelchair ......... ......... ......... ........... ........... detachable a. E1085... A Hemi-wheelchair fixed ......... ......... ......... ........... ........... arms. E1086... A Hemi-wheelchair ......... ......... ......... ........... ........... detachable a. E1087... A Wheelchair lightwt ......... ......... ......... ........... ........... fixed arm. E1088... A Wheelchair lightweight ......... ......... ......... ........... ........... det a. E1089... A Wheelchair lightwt ......... ......... ......... ........... ........... fixed arm. E1090... A Wheelchair lightweight ......... ......... ......... ........... ........... det a. E1091... A Wheelchair youth....... ......... ......... ......... ........... ........... E1092... A Wheelchair wide w/ leg ......... ......... ......... ........... ........... rests. E1093... A Wheelchair wide w/ foot ......... ......... ......... ........... ........... rest. E1100... A Whchr s-recl fxd arm ......... ......... ......... ........... ........... leg res. E1110... A Wheelchair semi-recl ......... ......... ......... ........... ........... detach. E1130... A Whlchr stand fxd arm ft ......... ......... ......... ........... ........... rest. E1140... A Wheelchair standard ......... ......... ......... ........... ........... detach a. E1150... A Wheelchair standard w/ ......... ......... ......... ........... ........... leg r. E1160... A Wheelchair fixed arms.. ......... ......... ......... ........... ........... [[Page 47737]] E1170... A Whlchr ampu fxd arm leg ......... ......... ......... ........... ........... rest. E1171... A Wheelchair amputee w/o ......... ......... ......... ........... ........... leg r. E1172... A Wheelchair amputee ......... ......... ......... ........... ........... detach ar. E1180... A Wheelchair amputee w/ ......... ......... ......... ........... ........... foot r. E1190... A Wheelchair amputee w/ ......... ......... ......... ........... ........... leg re. E1195... A Wheelchair amputee ......... ......... ......... ........... ........... heavy dut. E1200... A Wheelchair amputee ......... ......... ......... ........... ........... fixed arm. E1210... A Whlchr moto ful arm leg ......... ......... ......... ........... ........... rest. E1211... A Wheelchair motorized w/ ......... ......... ......... ........... ........... det. E1212... A Wheelchair motorized w ......... ......... ......... ........... ........... full. E1213... A Wheelchair motorized w/ ......... ......... ......... ........... ........... det. E1220... A Whlchr special size/ ......... ......... ......... ........... ........... constrc. E1221... A Wheelchair spec size w ......... ......... ......... ........... ........... foot. E1222... A Wheelchair spec size w/ ......... ......... ......... ........... ........... leg. E1223... A Wheelchair spec size w ......... ......... ......... ........... ........... foot. E1224... A Wheelchair spec size w/ ......... ......... ......... ........... ........... leg. E1225... A Wheelchair spec sz semi- ......... ......... ......... ........... ........... recl. E1226... A Wheelchair spec sz full- ......... ......... ......... ........... ........... recl. E1227... A Wheelchair spec sz spec ......... ......... ......... ........... ........... ht a. E1228... A Wheelchair spec sz spec ......... ......... ......... ........... ........... ht b. E1230... A Power operated vehicle. ......... ......... ......... ........... ........... E1240... A Whchr litwt det arm leg ......... ......... ......... ........... ........... rest. E1250... A Wheelchair lightwt ......... ......... ......... ........... ........... fixed arm. E1260... A Wheelchair lightwt foot ......... ......... ......... ........... ........... rest. E1270... A Wheelchair lightweight ......... ......... ......... ........... ........... leg r. E1280... A Whchr h-duty det arm ......... ......... ......... ........... ........... leg res. E1285... A Wheelchair heavy duty ......... ......... ......... ........... ........... fixed. E1290... A Wheelchair hvy duty ......... ......... ......... ........... ........... detach a. E1295... A Wheelchair heavy duty ......... ......... ......... ........... ........... fixed. E1296... A Wheelchair special seat ......... ......... ......... ........... ........... heig. E1297... A Wheelchair special seat ......... ......... ......... ........... ........... dept. E1298... A Wheelchair spec seat ......... ......... ......... ........... ........... depth/w. E1300... A Whirlpool portable..... ......... ......... ......... ........... ........... E1310... A Whirlpool non-portable. ......... ......... ......... ........... ........... E1340... A Repair for DME, per 15 ......... ......... ......... ........... ........... min. E1353... A Oxygen supplies ......... ......... ......... ........... ........... regulator. E1355... A Oxygen supplies stand/ ......... ......... ......... ........... ........... rack. E1372... A Oxy suppl heater for ......... ......... ......... ........... ........... nebuliz. E1375... A Oxygen suppl nebulizer ......... ......... ......... ........... ........... porta. E1377... A Oxygen concentrator to ......... ......... ......... ........... ........... 244 c. E1378... A Oxygen concentrator to ......... ......... ......... ........... ........... 488 c. E1379... A Oxygen concentrator to ......... ......... ......... ........... ........... 732 c. E1380... A Oxygen concentrator to ......... ......... ......... ........... ........... 976 c. E1381... A Oxygen concentrat to ......... ......... ......... ........... ........... 1220 cu. E1382... A Oxygen concentrat to ......... ......... ......... ........... ........... 1464 cu. E1383... A Oxygen concentrat to ......... ......... ......... ........... ........... 1708 cu. E1384... A Oxygen concentrat to ......... ......... ......... ........... ........... 1952 cu. E1385... A Oxygen concentrator > ......... ......... ......... ........... ........... 1952 c. E1399... A Durable medical ......... ......... ......... ........... ........... equipment mi. E1400... A Oxygen concentrator < 2 ......... ......... ......... ........... ........... lite. E1401... A Oxygen concentrator 2-3 ......... ......... ......... ........... ........... lite. E1402... A Oxygen concentrator 3-4 ......... ......... ......... ........... ........... lite. E1403... A Oxygen concentrator 4-5 ......... ......... ......... ........... ........... lite. E1404... A Oxygen concentrator > 5 ......... ......... ......... ........... ........... lite. E1405... A O2/water vapor enrich w/ ......... ......... ......... ........... ........... heat. E1406... A O2/water vapor enrich w/ ......... ......... ......... ........... ........... o he. E1510... A Kidney dialysate ......... ......... ......... ........... ........... delivry sys. E1520... A Heparin infusion pump ......... ......... ......... ........... ........... for di. E1530... A Air bubble detector for ......... ......... ......... ........... ........... dial. E1540... A Pressure alarm for ......... ......... ......... ........... ........... dialysis. E1550... A Bath conductivity meter ......... ......... ......... ........... ........... E1560... A Blood leak detector for ......... ......... ......... ........... ........... dial. E1570... A Adjustable chair for ......... ......... ......... ........... ........... esrd pt. E1575... A Transducer protector/ ......... ......... ......... ........... ........... fluid b. E1580... A Unipuncture control ......... ......... ......... ........... ........... system. E1590... A Hemodialysis machine... ......... ......... ......... ........... ........... E1592... A Auto interm peritoneal ......... ......... ......... ........... ........... dialy. E1594... A Cycler dialysis machine ......... ......... ......... ........... ........... E1600... A Deliv/install equip for ......... ......... ......... ........... ........... dial. E1610... A Reverse osmosis water ......... ......... ......... ........... ........... purifi. E1615... A Deionizer water ......... ......... ......... ........... ........... purification. E1620... A Blood pump for dialysis ......... ......... ......... ........... ........... E1625... A Water softening system. ......... ......... ......... ........... ........... E1630... A Reciprocating ......... ......... ......... ........... ........... peritoneal dia. E1632... A Wearable artificial ......... ......... ......... ........... ........... kidney. [[Page 47738]] E1635... A Compact travel ......... ......... ......... ........... ........... hemodialyzer. E1636... A Sorbent cartridges for ......... ......... ......... ........... ........... dialy. E1640... A Replacement components ......... ......... ......... ........... ........... for d. E1699... A Dialysis equipment ......... ......... ......... ........... ........... unspecifi. E1700... A Jaw motion rehab system ......... ......... ......... ........... ........... E1701... A Repl cushions for jaw ......... ......... ......... ........... ........... motion. E1702... A Repl measr scales jaw ......... ......... ......... ........... ........... motion. E1800... A Adjust elbow ext/flex ......... ......... ......... ........... ........... device. E1805... A Adjust wrist ext/flex ......... ......... ......... ........... ........... device. E1810... A Adjust knee ext/flex ......... ......... ......... ........... ........... device. E1815... A Adjust ankle ext/flex ......... ......... ......... ........... ........... device. E1820... A Soft interface material ......... ......... ......... ........... ........... E1825... A Adjust finger ext/flex ......... ......... ......... ........... ........... devc. E1830... A Adjust toe ext/flex ......... ......... ......... ........... ........... device. G0001... N Drawing blood for ......... ......... ......... ........... ........... specimen. G0002... N Temporary urinary ......... ......... ......... ........... ........... catheter. G0004... X ECG transm phys review 956 1.11 $58.77 $55.82 $11.75 & int. G0005... X ECG 24 hour recording.. 956 1.11 $58.77 $55.82 $11.75 G0006... X ECG transmission & 956 1.11 $58.77 $55.82 $11.75 analysis. G0007... N ECG phy review & ......... ......... ......... ........... ........... interpret. G0008... X Admin influenza virus 901 0.07 $3.92 $2.49 $0.78 vac. G0009... X Admin pneumococcal 901 0.07 $3.92 $2.49 $0.78 vaccine. G0010... X Admin hepatitis b 902 1.78 $94.03 $41.58 $18.81 vaccine. G0015... X Post symptom ECG 956 1.11 $58.77 $55.82 $11.75 tracing. G0016... N Post symptom ECG md ......... ......... ......... ........... ........... review. G0025... X Collagen skin test kit. 881 0.20 $10.77 $6.78 $2.15 G0026... A Fecal leukocyte ......... ......... ......... ........... ........... examination. G0027... A Semen analysis......... ......... ......... ......... ........... ........... G0030... S PET imaging prev PET 760 17.91 $947.13 $419.46 $189.43 single. G0031... S PET imaging prev PET 760 17.91 $947.13 $419.46 $189.43 multple. G0032... S PET follow SPECT 78464 760 17.91 $947.13 $419.46 $189.43 singl. G0033... S PET follow SPECT 78464 760 17.91 $947.13 $419.46 $189.43 mult. G0034... S PET follow SPECT 76865 760 17.91 $947.13 $419.46 $189.43 singl. G0035... S PET follow SPECT 78465 760 17.91 $947.13 $419.46 $189.43 mult. G0036... S PET follow cornry angio 760 17.91 $947.13 $419.46 $189.43 sing. G0037... S PET follow cornry angio 760 17.91 $947.13 $419.46 $189.43 mult. G0038... S PET follow myocard perf 760 17.91 $947.13 $419.46 $189.43 sing. G0039... S PET follow myocard perf 760 17.91 $947.13 $419.46 $189.43 mult. G0040... S PET follow stress echo 760 17.91 $947.13 $419.46 $189.43 singl. G0041... S PET follow stress echo 760 17.91 $947.13 $419.46 $189.43 mult. G0042... S PET follow ventriculogm 760 17.91 $947.13 $419.46 $189.43 sing. G0043... S PET follow ventriculogm 760 17.91 $947.13 $419.46 $189.43 mult. G0044... S PET following rest ECG 760 17.91 $947.13 $419.46 $189.43 singl. G0045... S PET following rest ECG 760 17.91 $947.13 $419.46 $189.43 mult. G0046... S PET follow stress ECG 760 17.91 $947.13 $419.46 $189.43 singl. G0047... S PET follow stress ECG 760 17.91 $947.13 $419.46 $189.43 mult. G0050... S Residual urine by 747 1.65 $87.17 $54.69 $17.43 ultrasound. G0101... V CA screen;pelvic/breast 913 ......... ......... ........... ........... exam. G0104... T CA screen;flexi 446 2.59 $137.12 $65.09 $27.42 sigmoidscope. G0105... T Colorectal scrn; hi 426 6.85 $362.40 $187.81 $72.48 risk ind. G0106... S Colon CA screen;barium 736 1.85 $97.95 $54.24 $19.59 enema. G0107... A CA screen; fecal blood ......... ......... ......... ........... ........... test. G0110... A Nett pulm-rehab educ; ......... ......... ......... ........... ........... ind. G0111... A Nett pulm-rehab educ; ......... ......... ......... ........... ........... group. G0112... A Nett;nutrition guid, ......... ......... ......... ........... ........... initial. G0113... A Nett;nutrition ......... ......... ......... ........... ........... guid,subseqnt. G0114... A Nett; psychosocial ......... ......... ......... ........... ........... consult. G0115... A Nett; psychological ......... ......... ......... ........... ........... testing. G0116... A Nett; psychosocial ......... ......... ......... ........... ........... counsel. G0120... S Colon ca scrn; barium 736 1.85 $97.95 $54.24 $19.59 enema. G0121... E Colon ca scrn; barium ......... ......... ......... ........... ........... enema. G0122... E Colon ca scrn; barium ......... ......... ......... ........... ........... enema. J0120... N Tetracyclin injection.. ......... ......... ......... ........... ........... J0150... N Injection adenosine 6 ......... ......... ......... ........... ........... MG. J0170... N Adrenalin epinephrin ......... ......... ......... ........... ........... inject. J0190... N Inj biperiden lactate/5 ......... ......... ......... ........... ........... mg. J0205... N Alglucerase injection.. ......... ......... ......... ........... ........... J0207... N Amifostine............. ......... ......... ......... ........... ........... J0210... N Methyldopate hcl ......... ......... ......... ........... ........... injection. J0256... N Alpha 1-proteinase 500 ......... ......... ......... ........... ........... MG. J0270... E Alprostadil for ......... ......... ......... ........... ........... injection. J0280... N Aminophyllin 250 MG inj ......... ......... ......... ........... ........... J0290... N Ampicillin 500 MG inj.. ......... ......... ......... ........... ........... J0295... N Ampicillin sodium per ......... ......... ......... ........... ........... 1.5 gm. J0300... N Amobarbital 125 MG inj. ......... ......... ......... ........... ........... [[Page 47739]] J0330... N Succinycholine chloride ......... ......... ......... ........... ........... inj. J0340... N Nandrolon ......... ......... ......... ........... ........... phenpropionate inj. J0350... N Injection anistreplase ......... ......... ......... ........... ........... 30 u. J0360... N Hydralazine hcl ......... ......... ......... ........... ........... injection. J0380... N Inj metaraminol ......... ......... ......... ........... ........... bitartrate. J0390... N Chloroquine injection.. ......... ......... ......... ........... ........... J0400... N Inj trimethaphan ......... ......... ......... ........... ........... camsylate. J0460... N Atropine sulfate ......... ......... ......... ........... ........... injection. J0470... N Dimecaprol injection... ......... ......... ......... ........... ........... J0475... N Baclofen 10 MG ......... ......... ......... ........... ........... injection. J0500... N Dicyclomine injection.. ......... ......... ......... ........... ........... J0510... N Benzquinamide injection ......... ......... ......... ........... ........... J0515... N Inj benztropine ......... ......... ......... ........... ........... mesylate. J0520... N Bethanechol chloride ......... ......... ......... ........... ........... inject. J0530... N Penicillin g benzathine ......... ......... ......... ........... ........... inj. J0540... N Penicillin g benzathine ......... ......... ......... ........... ........... inj. J0550... N Penicillin g benzathine ......... ......... ......... ........... ........... inj. J0560... N Penicillin g benzathine ......... ......... ......... ........... ........... inj. J0570... N Penicillin g benzathine ......... ......... ......... ........... ........... inj. J0580... N Penicillin g benzathine ......... ......... ......... ........... ........... inj. J0585... N Botulinum toxin a per ......... ......... ......... ........... ........... unit. J0590... N Ethylnorepinephrine hcl ......... ......... ......... ........... ........... inj. J0600... N Edetate calcium ......... ......... ......... ........... ........... disodium inj. J0610... N Calcium gluconate ......... ......... ......... ........... ........... injection. J0620... N Calcium glycer & lact/ ......... ......... ......... ........... ........... 10 ML. J0630... N Calcitonin salmon ......... ......... ......... ........... ........... injection. J0635... N Calcitriol injection... ......... ......... ......... ........... ........... J0640... X Leucovorin calcium 064 4.17 $220.38 $140.12 $44.08 injection. J0670... N Inj mepivacaine HCL/10 ......... ......... ......... ........... ........... ml. J0690... N Cefazolin sodium ......... ......... ......... ........... ........... injection. J0694... N Cefoxitin sodium ......... ......... ......... ........... ........... injection. J0695... N Cefonocid sodium ......... ......... ......... ........... ........... injection. J0696... N Ceftriaxone sodium ......... ......... ......... ........... ........... injection. J0697... N Sterile cefuroxime ......... ......... ......... ........... ........... injection. J0698... N Cefotaxime sodium ......... ......... ......... ........... ........... injection. J0702... N Betamethasone acet&sod ......... ......... ......... ........... ........... phosp. J0704... N Betamethasone sod phosp/ ......... ......... ......... ........... ........... 4 MG. J0710... N Cephapirin sodium ......... ......... ......... ........... ........... injection. J0713... N Inj ceftazidime per 500 ......... ......... ......... ........... ........... mg. J0715... N Ceftizoxime sodium / ......... ......... ......... ........... ........... 500 MG. J0720... N Chloramphenicol sodium ......... ......... ......... ........... ........... injec. J0725... N Chorionic gonadotropin/ ......... ......... ......... ........... ........... 1000u. J0730... N Chlorpheniramin maleate ......... ......... ......... ........... ........... inj. J0735... N Clonidine hydrochloride ......... ......... ......... ........... ........... J0740... N Cidofovir injection.... ......... ......... ......... ........... ........... J0743... N Cilastatin sodium ......... ......... ......... ........... ........... injection. J0745... N Inj codeine phosphate / ......... ......... ......... ........... ........... 30 MG. J0760... N Colchicine injection... ......... ......... ......... ........... ........... J0770... N Colistimethate sodium ......... ......... ......... ........... ........... inj. J0780... N Prochlorperazine ......... ......... ......... ........... ........... injection. J0800... N Corticotropin injection ......... ......... ......... ........... ........... J0810... N Cortisone injection.... ......... ......... ......... ........... ........... J0835... N Inj cosyntropin per ......... ......... ......... ........... ........... 0.25 MG. J0850... N Cytomegalovirus imm IV / ......... ......... ......... ........... ........... vial. J0895... N Deferoxamine mesylate ......... ......... ......... ........... ........... inj. J0900... N Testosterone enanthate ......... ......... ......... ........... ........... inj. J0945... N Brompheniramine maleate ......... ......... ......... ........... ........... inj. J0970... N Estradiol valerate ......... ......... ......... ........... ........... injection. J1000... N Depo-estradiol ......... ......... ......... ........... ........... cypionate inj. J1020... N Methylprednisolone 20 ......... ......... ......... ........... ........... MG inj. J1030... N Methylprednisolone 40 ......... ......... ......... ........... ........... MG inj. J1040... N Methylprednisolone 80 ......... ......... ......... ........... ........... MG inj. J1050... N Medroxyprogesterone inj ......... ......... ......... ........... ........... J1055... E Medrxyprogester acetate ......... ......... ......... ........... ........... inj. J1060... N Testosterone cypionate ......... ......... ......... ........... ........... 1 ML. J1070... N Testosterone cypionat ......... ......... ......... ........... ........... 100 MG. J1080... N Testosterone cypionat ......... ......... ......... ........... ........... 200 MG. J1090... N Testosterone cypionate ......... ......... ......... ........... ........... 50 MG. J1095... N Inj dexamethasone ......... ......... ......... ........... ........... acetate. J1100... N Dexamethosone sodium ......... ......... ......... ........... ........... phos. J1110... N Inj dihydroergotamine ......... ......... ......... ........... ........... mesylt. J1120... N Acetazolamid sodium ......... ......... ......... ........... ........... injectio. J1160... N Digoxin injection...... ......... ......... ......... ........... ........... J1165... N Phenytoin sodium ......... ......... ......... ........... ........... injection. J1170... N Hydromorphone injection ......... ......... ......... ........... ........... [[Page 47740]] J1180... N Dyphylline injection... ......... ......... ......... ........... ........... J1190... N Dexrazoxane HCl ......... ......... ......... ........... ........... injection. J1200... N Diphenhydramine hcl ......... ......... ......... ........... ........... injectio. J1205... N Chlorothiazide sodium ......... ......... ......... ........... ........... inj. J1212... N Dimethyl sulfoxide 50% ......... ......... ......... ........... ........... 50 ML. J1230... N Methadone injection.... ......... ......... ......... ........... ........... J1240... N Dimenhydrinate ......... ......... ......... ........... ........... injection. J1245... N Dipyridamole injection. ......... ......... ......... ........... ........... J1250... N Inj dobutamine HCL/250 ......... ......... ......... ........... ........... mg. J1320... N Amitriptyline injection ......... ......... ......... ........... ........... J1325... N Epoprostenol injection. ......... ......... ......... ........... ........... J1330... N Ergonovine maleate ......... ......... ......... ........... ........... injection. J1362... N Erythromycin glucep / ......... ......... ......... ........... ........... 250 MG. J1364... N Erythro lactobionate / ......... ......... ......... ........... ........... 500 MG. J1380... N Estradiol valerate 10 ......... ......... ......... ........... ........... MG inj. J1390... N Estradiol valerate 20 ......... ......... ......... ........... ........... MG inj. J1410... N Inj estrogen conjugate ......... ......... ......... ........... ........... 25 MG. J1435... N Injection estrone per 1 ......... ......... ......... ........... ........... MG. J1436... N Etidronate disodium inj ......... ......... ......... ........... ........... J1440... N Filgrastim 300 mcg ......... ......... ......... ........... ........... injeciton. J1441... N Filgrastim 480 mcg ......... ......... ......... ........... ........... injection. J1455... N Foscarnet sodium ......... ......... ......... ........... ........... injection. J1460... N Gamma globulin 1 CC inj ......... ......... ......... ........... ........... J1470... N Gamma globulin 2 CC inj ......... ......... ......... ........... ........... J1480... N Gamma globulin 3 CC inj ......... ......... ......... ........... ........... J1490... N Gamma globulin 4 CC inj ......... ......... ......... ........... ........... J1500... N Gamma globulin 5 CC inj ......... ......... ......... ........... ........... J1510... N Gamma globulin 6 CC inj ......... ......... ......... ........... ........... J1520... N Gamma globulin 7 CC inj ......... ......... ......... ........... ........... J1530... N Gamma globulin 8 CC inj ......... ......... ......... ........... ........... J1540... N Gamma globulin 9 CC inj ......... ......... ......... ........... ........... J1550... N Gamma globulin 10 CC ......... ......... ......... ........... ........... inj. J1560... N Gamma globulin > 10 CC ......... ......... ......... ........... ........... inj. J1561... N Immune globulin 500 mg. ......... ......... ......... ........... ........... J1562... N Immune globulin 5 gms.. ......... ......... ......... ........... ........... J1565... N RSV-ivig............... ......... ......... ......... ........... ........... J1570... N Ganciclovir sodium ......... ......... ......... ........... ........... injection. J1580... N Garamycin gentamicin ......... ......... ......... ........... ........... inj. J1600... N Gold sodium thiomaleate ......... ......... ......... ........... ........... inj. J1610... N Glucagon hydrochloride/ ......... ......... ......... ........... ........... 1 MG. J1620... N Gonadorelin hydroch/ ......... ......... ......... ........... ........... 100 mcg. J1626... N Granisetron HCl ......... ......... ......... ........... ........... injection. J1630... N Haloperidol injection.. ......... ......... ......... ........... ........... J1631... N Haloperidol decanoate ......... ......... ......... ........... ........... inj. J1642... N Inj heparin sodium per ......... ......... ......... ........... ........... 10 u. J1644... N Inj heparin sodium per ......... ......... ......... ........... ........... 1000u. J1645... N Dalteparin sodium...... ......... ......... ......... ........... ........... J1650... N Inj enoxaparin sodium ......... ......... ......... ........... ........... 30 mg. J1670... N Tetanus immune globulin ......... ......... ......... ........... ........... inj. J1690... N Prednisolone tebutate ......... ......... ......... ........... ........... inj. J1700... N Hydrocortisone acetate ......... ......... ......... ........... ........... inj. J1710... N Hydrocortisone sodium ......... ......... ......... ........... ........... ph inj. J1720... N Hydrocortisone sodium ......... ......... ......... ........... ........... succ i. J1730... N Diazoxide injection.... ......... ......... ......... ........... ........... J1739... N Hydroxyprogesterone cap ......... ......... ......... ........... ........... 125. J1741... N Hydroxyprogesterone cap ......... ......... ......... ........... ........... 250. J1742... N Ibutilide fumarate ......... ......... ......... ........... ........... injection. J1760... N Iron dextran 2 CC inj.. ......... ......... ......... ........... ........... J1770... N Iron dextran 5 CC inj.. ......... ......... ......... ........... ........... J1780... N Iron dextran 10 CC inj. ......... ......... ......... ........... ........... J1785... N Injection imiglucerase / ......... ......... ......... ........... ........... unit. J1790... N Droperidol injection... ......... ......... ......... ........... ........... J1800... N Propranolol injection.. ......... ......... ......... ........... ........... J1810... N Droperidol/fentanyl inj ......... ......... ......... ........... ........... J1820... N Insulin injection...... ......... ......... ......... ........... ........... J1825... N Interferon beta-1a..... ......... ......... ......... ........... ........... J1830... N Interferon beta-1b / ......... ......... ......... ........... ........... .25 MG. J1840... N Kanamycin sulfate 500 ......... ......... ......... ........... ........... MG inj. J1850... N Kanamycin sulfate 75 MG ......... ......... ......... ........... ........... inj. J1885... N Ketorolac tromethamine ......... ......... ......... ........... ........... inj. J1890... N Cephalothin sodium ......... ......... ......... ........... ........... injection. J1910... N Kutapressin injection.. ......... ......... ......... ........... ........... J1930... N Propiomazine injection. ......... ......... ......... ........... ........... J1940... N Furosemide injection... ......... ......... ......... ........... ........... J1950... X Leuprolide acetate / 064 4.17 $220.38 $140.12 $44.08 3.75 MG. [[Page 47741]] J1955... N Inj levocarnitine per 1 ......... ......... ......... ........... ........... gm. J1960... N Levorphanol tartrate ......... ......... ......... ........... ........... inj. J1970... N Methotrimeprazine ......... ......... ......... ........... ........... injection. J1980... N Hyoscyamine sulfate inj ......... ......... ......... ........... ........... J1990... N Chlordiazepoxide ......... ......... ......... ........... ........... injection. J2000... N Lidocaine injection.... ......... ......... ......... ........... ........... J2010... N Lincomycin injection... ......... ......... ......... ........... ........... J2060... N Lorazepam injection.... ......... ......... ......... ........... ........... J2150... N Mannitol injection..... ......... ......... ......... ........... ........... J2175... N Meperidine hydrochl / ......... ......... ......... ........... ........... 100 MG. J2180... N Meperidine/promethazine ......... ......... ......... ........... ........... inj. J2210... N Methylergonovin maleate ......... ......... ......... ........... ........... inj. J2240... N Metocurine iodide ......... ......... ......... ........... ........... injection. J2250... N Inj midazolam ......... ......... ......... ........... ........... hydrochloride. J2260... N Inj milrinone lactate / ......... ......... ......... ........... ........... 5 ML. J2270... N Morphine sulfate ......... ......... ......... ........... ........... injection. J2275... N Morphine sulfate ......... ......... ......... ........... ........... injection. J2300... N Inj nalbuphine ......... ......... ......... ........... ........... hydrochloride. J2310... N Inj naloxone ......... ......... ......... ........... ........... hydrochloride. J2320... N Nandrolone decanoate 50 ......... ......... ......... ........... ........... MG. J2321... N Nandrolone decanoate ......... ......... ......... ........... ........... 100 MG. J2322... N Nandrolone decanoate ......... ......... ......... ........... ........... 200 MG. J2330... N Thiothixene injection.. ......... ......... ......... ........... ........... J2350... N Niacinamide/niacin ......... ......... ......... ........... ........... injection. J2360... N Orphenadrine injection. ......... ......... ......... ........... ........... J2370... N Phenylephrine hcl ......... ......... ......... ........... ........... injection. J2400... N Chloroprocaine hcl ......... ......... ......... ........... ........... injection. J2405... N Ondansetron hcl ......... ......... ......... ........... ........... injection. J2410... N Oxymorphone hcl ......... ......... ......... ........... ........... injection. J2430... N Pamidronate disodium / ......... ......... ......... ........... ........... 30 MG. J2440... N Papaverin hcl injection ......... ......... ......... ........... ........... J2460... N Oxytetracycline ......... ......... ......... ........... ........... injection. J2480... N Hydrochlorides of opium ......... ......... ......... ........... ........... inj. J2510... N Penicillin g procaine ......... ......... ......... ........... ........... inj. J2512... N Inj pentagastrin per 2 ......... ......... ......... ........... ........... ML. J2515... N Pentobarbital sodium ......... ......... ......... ........... ........... inj. J2540... N Penicillin g potassium ......... ......... ......... ........... ........... inj. J2545... A Pentamidine isethionte/ ......... ......... ......... ........... ........... 300mg. J2550... N Promethazine hcl ......... ......... ......... ........... ........... injection. J2560... N Phenobarbital sodium ......... ......... ......... ........... ........... inj. J2590... N Oxytocin injection..... ......... ......... ......... ........... ........... J2597... N Inj desmopressin ......... ......... ......... ........... ........... acetate. J2640... N Prednisolone sodium ph ......... ......... ......... ........... ........... inj. J2650... N Prednisolone acetate ......... ......... ......... ........... ........... inj. J2670... N Totazoline hcl ......... ......... ......... ........... ........... injection. J2675... N Inj progesterone per 50 ......... ......... ......... ........... ........... MG. J2680... N Fluphenazine decanoate ......... ......... ......... ........... ........... 25 MG. J2690... N Procainamide hcl ......... ......... ......... ........... ........... injection. J2700... N Oxacillin sodium ......... ......... ......... ........... ........... injeciton. J2710... N Neostigmine methylslfte ......... ......... ......... ........... ........... inj. J2720... N Inj protamine sulfate/ ......... ......... ......... ........... ........... 10 MG. J2725... N Inj protirelin per 250 ......... ......... ......... ........... ........... mcg. J2730... N Pralidoxime chloride ......... ......... ......... ........... ........... inj. J2760... N Phentolaine mesylate ......... ......... ......... ........... ........... inj. J2765... N Metoclopramide hcl ......... ......... ......... ........... ........... injection. J2790... N Rho d immune globulin ......... ......... ......... ........... ........... inj. J2800... N Methocarbamol injection ......... ......... ......... ........... ........... J2810... N Inj theophylline per 40 ......... ......... ......... ........... ........... MG. J2820... N Sargramostim injection. ......... ......... ......... ........... ........... J2860... N Secobarbital sodium inj ......... ......... ......... ........... ........... J2910... N Aurothioglucose ......... ......... ......... ........... ........... injeciton. J2912... N Sodium chloride ......... ......... ......... ........... ........... injection. J2920... N Methylprednisolone ......... ......... ......... ........... ........... injection. J2930... N Methylprednisolone ......... ......... ......... ........... ........... injection. J2950... N Promazine hcl injeciton ......... ......... ......... ........... ........... J2970... N Methicillin sodium ......... ......... ......... ........... ........... injection. J2995... N Inj streptokinase / ......... ......... ......... ........... ........... 250000 IU. J2996... N Alteplase recombinant ......... ......... ......... ........... ........... inj. J3000... N Streptomycin injection. ......... ......... ......... ........... ........... J3010... N Fentanyl citrate ......... ......... ......... ........... ........... injeciton. J3030... N Sumatriptan succinate / ......... ......... ......... ........... ........... 6 MG. J3070... N Pentazocine hcl ......... ......... ......... ........... ........... injeciton. J3080... N Chlorprothixene ......... ......... ......... ........... ........... injection. J3105... N Terbutaline sulfate inj ......... ......... ......... ........... ........... J3120... N Testosterone enanthate ......... ......... ......... ........... ........... inj. [[Page 47742]] J3130... N Testosterone enanthate ......... ......... ......... ........... ........... inj. J3140... N Testosterone suspension ......... ......... ......... ........... ........... inj. J3150... N Testosteron propionate ......... ......... ......... ........... ........... inj. J3230... N Chlorpromazine hcl ......... ......... ......... ........... ........... injection. J3240... N Thyrotropin injection.. ......... ......... ......... ........... ........... J3250... N Trimethobenzamide hcl ......... ......... ......... ........... ........... inj. J3260... N Tobramycin sulfate ......... ......... ......... ........... ........... injection. J3265... N Injection torsemide 10 ......... ......... ......... ........... ........... mg/ml. J3270... N Imipramine hcl ......... ......... ......... ........... ........... injection. J3280... N Thiethylperazine ......... ......... ......... ........... ........... maleate inj. J3301... N Triamcinolone acetonide ......... ......... ......... ........... ........... inj. J3302... N Triamcinolone diacetate ......... ......... ......... ........... ........... inj. J3303... N Triamcinolone ......... ......... ......... ........... ........... hexacetonl inj. J3305... N Inj trimetrexate ......... ......... ......... ........... ........... glucoronate. J3310... N Perphenazine injeciton. ......... ......... ......... ........... ........... J3320... N Spectinomycn di-hcl inj ......... ......... ......... ........... ........... J3350... N Urea injection......... ......... ......... ......... ........... ........... J3360... N Diazepam injection..... ......... ......... ......... ........... ........... J3364... N Urokinase 5000 IU ......... ......... ......... ........... ........... injection. J3365... N Urokinase 250,000 IU ......... ......... ......... ........... ........... inj. J3370... E Vancomycin hcl ......... ......... ......... ........... ........... injeciton. J3390... N Methoxamine injection.. ......... ......... ......... ........... ........... J3400... N Triflupromazine hcl inj ......... ......... ......... ........... ........... J3410... N Hydroxyzine hcl ......... ......... ......... ........... ........... injeciton. J3420... N Vitamin b12 injection.. ......... ......... ......... ........... ........... J3430... N Vitamin k phytonadione ......... ......... ......... ........... ........... inj. J3450... N Mephentermine sulfate ......... ......... ......... ........... ........... inj. J3470... N Hyaluronidase injection ......... ......... ......... ........... ........... J3475... N Inj magnesium sulfate.. ......... ......... ......... ........... ........... J3480... N Inj potassium chloride. ......... ......... ......... ........... ........... J3490... N Drugs unclassified ......... ......... ......... ........... ........... injection. J3520... E Edetate disodium per ......... ......... ......... ........... ........... 150 mg. J3530... N Nasal vaccine ......... ......... ......... ........... ........... inhalation. J3535... E Metered dose inhaler ......... ......... ......... ........... ........... drug. J3570... E Laetrile amygdalin vit ......... ......... ......... ........... ........... B17. J7030... A Normal saline solution ......... ......... ......... ........... ........... infus. J7040... A Normal saline solution ......... ......... ......... ........... ........... infus. J7042... A 5% dextrose/normal ......... ......... ......... ........... ........... saline. J7050... A Normal saline solution ......... ......... ......... ........... ........... infus. J7051... A Sterile saline/water... ......... ......... ......... ........... ........... J7060... A 5% dextrose/water...... ......... ......... ......... ........... ........... J7070... A D5w infusion........... ......... ......... ......... ........... ........... J7100... A Dextran 40 infusion.... ......... ......... ......... ........... ........... J7110... A Dextran 75 infusion.... ......... ......... ......... ........... ........... J7120... A Ringers lactate ......... ......... ......... ........... ........... infusion. J7130... A Hypertonic saline ......... ......... ......... ........... ........... solution. J7190... N Factor viii............ ......... ......... ......... ........... ........... J7191... N Factor VIII (porcine).. ......... ......... ......... ........... ........... J7192... N Factor viii recombinant ......... ......... ......... ........... ........... J7194... N Factor ix complex...... ......... ......... ......... ........... ........... J7196... N Othr hemophilia clot ......... ......... ......... ........... ........... factors. J7197... N Antithrombin iii ......... ......... ......... ........... ........... injection. J7300... E Intraut copper ......... ......... ......... ........... ........... contraceptive. J7310... N Ganciclovir long act ......... ......... ......... ........... ........... implant. J7500... N Azathiop po tab 50mg ......... ......... ......... ........... ........... 100s ea. J7501... N Azathioprine parenteral ......... ......... ......... ........... ........... J7503... N Cyclosporine parenteral ......... ......... ......... ........... ........... J7504... N Lymphocyte immune ......... ......... ......... ........... ........... globulin. J7505... N Monoclonal antibodies.. ......... ......... ......... ........... ........... J7506... N Prednisone oral........ ......... ......... ......... ........... ........... J7507... N Tacrolimus oral per 1 ......... ......... ......... ........... ........... MG. J7508... N Tacrolimus oral per 5 ......... ......... ......... ........... ........... MG. J7509... N Methylprednisolone oral ......... ......... ......... ........... ........... J7510... N Prednisolone oral per 5 ......... ......... ......... ........... ........... mg. J7599... N Immunosuppressive drug ......... ......... ......... ........... ........... noc. J7610... A Acetylcysteine 10% ......... ......... ......... ........... ........... injection. J7615... A Acetylcysteine 20% ......... ......... ......... ........... ........... injection. J7620... A Albuterol sulfate .083%/ ......... ......... ......... ........... ........... ml. J7625... A Albuterol sulfate .5% ......... ......... ......... ........... ........... inj. J7627... A Bitolterolmesylate ......... ......... ......... ........... ........... inhal sol. J7630... A Cromolyn sodium ......... ......... ......... ........... ........... injeciton. J7640... A Epinephrine injection.. ......... ......... ......... ........... ........... J7645... A Ipratropium bromide ......... ......... ......... ........... ........... .02%/ml. J7650... A Isoetharine hcl .1% inj ......... ......... ......... ........... ........... J7651... A Isoetharine hcl .125% ......... ......... ......... ........... ........... inj. [[Page 47743]] J7652... A Isoetharine hcl .167% ......... ......... ......... ........... ........... inj. J7653... A Isoetharine hcl .2%/ ......... ......... ......... ........... ........... inj. J7654... A Isoetharine hcl .25% ......... ......... ......... ........... ........... inj. J7655... A Isoetharine hcl 1% inj. ......... ......... ......... ........... ........... J7660... A Isoproterenol hcl .5% ......... ......... ......... ........... ........... inj. J7665... A Isoproterenol hcl 1% ......... ......... ......... ........... ........... inj. J7670... A Metaproterenol sulfate ......... ......... ......... ........... ........... .4%. J7672... A Metaproterenol sulfate ......... ......... ......... ........... ........... .6%. J7675... A Metaproterenol sulfate ......... ......... ......... ........... ........... 5%. J7699... A Inhalation solution for ......... ......... ......... ........... ........... DME. J7799... A Non-inhalation drug for ......... ......... ......... ........... ........... DME. J8499... E Oral prescrip drug non ......... ......... ......... ........... ........... chemo. J8530... N Cyclophosphamide oral ......... ......... ......... ........... ........... 25 MG. J8560... N Etoposide oral 50 MG... ......... ......... ......... ........... ........... J8600... N Melphalan oral 2 MG.... ......... ......... ......... ........... ........... J8610... X Methotrexate oral 2.5 061 1.04 $54.85 $36.61 $10.97 MG. J8999... X Oral prescription drug 061 1.04 $54.85 $36.61 $10.97 chemo. J9000... X Doxorubic hcl 10 MG vl 062 1.69 $89.13 $36.61 $17.83 chemo. J9015... X Aldesleukin/single use 061 1.04 $54.85 $36.61 $10.97 vial. J9020... X Asparaginase injection. 062 1.69 $89.13 $36.61 $17.83 J9031... X Bcg live intravesical 063 2.89 $152.79 $110.97 $30.56 vac. J9040... X Bleomycin sulfate 063 2.89 $152.79 $110.97 $30.56 injection. J9045... X Carboplatin injection.. 063 2.89 $152.79 $110.97 $30.56 J9050... X Carmus bischl nitro inj 063 2.89 $152.79 $110.97 $30.56 J9060... X Cisplatin 10 MG 062 1.69 $89.13 $36.61 $17.83 injeciton. J9062... X Cisplatin 50 MG 063 2.89 $152.79 $110.97 $30.56 injeciton. J9065... X Inj cladribine per 1 MG 062 1.69 $89.13 $36.61 $17.83 J9070... X Cyclophosphamide 100 MG 061 1.04 $54.85 $36.61 $10.97 inj. J9080... X Cyclophosphamide 200 MG 061 1.04 $54.85 $36.61 $10.97 inj. J9090... X Cyclophosphamide 500 MG 061 1.04 $54.85 $36.61 $10.97 inj. J9091... X Cyclophosphamide 1.0 062 1.69 $89.13 $36.61 $17.83 grm inj. J9092... X Cyclophosphamide 2.0 062 1.69 $89.13 $36.61 $17.83 grm inj. J9093... X Cyclophosphamide 061 1.04 $54.85 $36.61 $10.97 lyophilized. J9094... X Cyclophosphamide 061 1.04 $54.85 $36.61 $10.97 lyophilized. J9095... X Cyclophosphamide 061 1.04 $54.85 $36.61 $10.97 lyophilized. J9096... X Cyclophosphamide 062 1.69 $89.13 $36.61 $17.83 lyophilized. J9097... X Cyclophosphamide 062 1.69 $89.13 $36.61 $17.83 lyophilized. J9100... X Cytarabine hcl 100 MG 061 1.04 $54.85 $36.61 $10.97 inj. J9110... X Cytarabine hcl 500 MG 061 1.04 $54.85 $36.61 $10.97 inj. J9120... X Dactinomycin 061 1.04 $54.85 $36.61 $10.97 actinomycin d. J9130... X Dacarbazine 10 MG inj.. 061 1.04 $54.85 $36.61 $10.97 J9140... X Dacarbazine 200 MG inj. 061 1.04 $54.85 $36.61 $10.97 J9150... X Daunorubicin........... 062 1.69 $89.13 $36.61 $17.83 J9165... X Diethylstilbestrol 061 1.04 $54.85 $36.61 $10.97 injection. J9170... X Docetaxel.............. 061 1.04 $54.85 $36.61 $10.97 J9181... X Etoposide 10 MG inj.... 061 1.04 $54.85 $36.61 $10.97 J9182... X Etoposide 100 MG inj... 063 2.89 $152.79 $110.97 $30.56 J9185... X Fludarabine phosphate 063 2.89 $152.79 $110.97 $30.56 inj. J9190... X Fluorouracil injection. 061 1.04 $54.85 $36.61 $10.97 J9200... X Floxuridine injection.. 063 2.89 $152.79 $110.97 $30.56 J9201... X Gemcitabine HCl........ 061 1.04 $54.85 $36.61 $10.97 J9202... X Goserelin acetate 063 2.89 $152.79 $110.97 $30.56 implant. J9206... X Irinotecan injection... 061 1.04 $54.85 $36.61 $10.97 J9208... X Ifosfomide injection... 063 2.89 $152.79 $110.97 $30.56 J9209... X Mesna injection........ 063 2.89 $152.79 $110.97 $30.56 J9211... X Idarubicin hcl 062 1.69 $89.13 $36.61 $17.83 injeciton. J9213... X Interferon alfa-2a inj. 062 1.69 $89.13 $36.61 $17.83 J9214... X Interferon alfa-2b inj. 061 1.04 $54.85 $36.61 $10.97 J9215... X Interferon alfa-n3 inj. 061 1.04 $54.85 $36.61 $10.97 J9216... X Interferon gamma 1-b 063 2.89 $152.79 $110.97 $30.56 inj. J9217... X Leuprolide acetate 064 4.17 $220.38 $140.12 $44.08 suspnsion. J9218... X Leuprolide acetate 061 1.04 $54.85 $36.61 $10.97 injeciton. J9230... X Mechlorethamine hcl inj 061 1.04 $54.85 $36.61 $10.97 J9245... X Inj melphalan hydrochl 064 4.17 $220.38 $140.12 $44.08 50 MG. J9250... X Methotrexate sodium inj 061 1.04 $54.85 $36.61 $10.97 J9260... X Methotrexate sodium inj 061 1.04 $54.85 $36.61 $10.97 J9265... X Paclitaxel injection... 062 1.69 $89.13 $36.61 $17.83 J9266... X Pegaspargase/singl dose 061 1.04 $54.85 $36.61 $10.97 vial. J9268... X Pentostatin injection.. 062 1.69 $89.13 $36.61 $17.83 J9270... X Plicamycin 063 2.89 $152.79 $110.97 $30.56 (mithramycin) inj. J9280... X Mitomycin 5 MG inj..... 063 2.89 $152.79 $110.97 $30.56 J9290... X Mitomycin 20 MG inj.... 064 4.17 $220.38 $140.12 $44.08 J9291... X Mitomycin 40 MG inj.... 064 4.17 $220.38 $140.12 $44.08 J9293... X Mitoxantrone hydrochl / 064 4.17 $220.38 $140.12 $44.08 5 MG. J9320... X Streptozocin injection. 063 2.89 $152.79 $110.97 $30.56 [[Page 47744]] J9340... X Thiotepa injection..... 063 2.89 $152.79 $110.97 $30.56 J9350... X Topotecan.............. 061 1.04 $54.85 $36.61 $10.97 J9360... X Vinblastine sulfate inj 061 1.04 $54.85 $36.61 $10.97 J9370... X Vincristine sulfate 1 062 1.69 $89.13 $36.61 $17.83 MG inj. J9375... X Vincristine sulfate 2 063 2.89 $152.79 $110.97 $30.56 MG inj. J9380... X Vincristine sulfate 5 063 2.89 $152.79 $110.97 $30.56 MG inj. J9390... X Vinorelbine tartrate/10 061 1.04 $54.85 $36.61 $10.97 mg. J9600... X Porfimer sodium........ 061 1.04 $54.85 $36.61 $10.97 J9999... X Chemotherapy drug...... 061 1.04 $54.85 $36.61 $10.97 K0001... A Standard wheelchair.... ......... ......... ......... ........... ........... K0002... A Stnd hemi (low seat) ......... ......... ......... ........... ........... whlchr. K0003... A Lightweight wheelchair. ......... ......... ......... ........... ........... K0004... A High strength ltwt ......... ......... ......... ........... ........... whlchr. K0005... A Ultralightweight ......... ......... ......... ........... ........... wheelchair. K0006... A Heavy duty wheelchair.. ......... ......... ......... ........... ........... K0007... A Extra heavy duty ......... ......... ......... ........... ........... wheelchair. K0008... A Cstm manual wheelchair/ ......... ......... ......... ........... ........... base. K0009... A Other manual wheelchair/ ......... ......... ......... ........... ........... base. K0010... A Stnd wt frame power ......... ......... ......... ........... ........... whlchr. K0011... A Stnd wt pwr whlchr w ......... ......... ......... ........... ........... control. K0012... A Ltwt portbl power ......... ......... ......... ........... ........... whlchr. K0013... A Custom power whlchr ......... ......... ......... ........... ........... base. K0014... A Other power whlchr base ......... ......... ......... ........... ........... K0015... A Detach non-adjus hght ......... ......... ......... ........... ........... armrst. K0016... A Detach adjust armrst ......... ......... ......... ........... ........... cmplete. K0017... A Detach adjust armrest ......... ......... ......... ........... ........... base. K0018... A Detach adjust armrst ......... ......... ......... ........... ........... upper. K0019... A Arm pad each........... ......... ......... ......... ........... ........... K0020... A Fixed adjust armrest ......... ......... ......... ........... ........... pair. K0021... A Anti-tipping device ......... ......... ......... ........... ........... each. K0022... A Reinforced back ......... ......... ......... ........... ........... upholstery. K0023... A Planr back insrt foam w/ ......... ......... ......... ........... ........... strp. K0024... A Plnr back insrt foam w/ ......... ......... ......... ........... ........... hrdwr. K0025... A Hook-on headrest ......... ......... ......... ........... ........... extension. K0026... A Back upholst lgtwt ......... ......... ......... ........... ........... whlchr. K0027... A Back upholst other ......... ......... ......... ........... ........... whlchr. K0028... A Fully reclining back... ......... ......... ......... ........... ........... K0029... A Reinforced seat ......... ......... ......... ........... ........... upholstery. K0030... A Solid plnr seat sngl ......... ......... ......... ........... ........... dnsfoam. K0031... A Safety belt/pelvic ......... ......... ......... ........... ........... strap. K0032... A Seat uphols lgtwt ......... ......... ......... ........... ........... whlchr. K0033... A Seat upholstery other ......... ......... ......... ........... ........... whlchr. K0034... A Heel loop each......... ......... ......... ......... ........... ........... K0035... A Heel loop with ankle ......... ......... ......... ........... ........... strap. K0036... A Toe loop each.......... ......... ......... ......... ........... ........... K0037... A High mount flip-up ......... ......... ......... ........... ........... footrest. K0038... A Leg strap each......... ......... ......... ......... ........... ........... K0039... A Leg strap h style each. ......... ......... ......... ........... ........... K0040... A Adjustable angle ......... ......... ......... ........... ........... footplate. K0041... A Large size footplate ......... ......... ......... ........... ........... each. K0042... A Standard size footplate ......... ......... ......... ........... ........... each. K0043... A Ftrst lower extension ......... ......... ......... ........... ........... tube. K0044... A Ftrst upper hanger ......... ......... ......... ........... ........... bracket. K0045... A Footrest complete ......... ......... ......... ........... ........... assembly. K0046... A Elevat legrst low ......... ......... ......... ........... ........... extension. K0047... A Elevat legrst up hangr ......... ......... ......... ........... ........... brack. K0048... A Elevate legrest ......... ......... ......... ........... ........... complete. K0049... A Calf pad each.......... ......... ......... ......... ........... ........... K0050... A Ratchet assembly....... ......... ......... ......... ........... ........... K0051... A Cam relese assem ftrst/ ......... ......... ......... ........... ........... lgrst. K0052... A Swingaway detach ......... ......... ......... ........... ........... footrest. K0053... A Elevate footrest ......... ......... ......... ........... ........... articulate. K0054... A Seat wdth 10-12/15/17/ ......... ......... ......... ........... ........... 20 wc. K0055... A Seat dpth 15/17/18 ltwt ......... ......... ......... ........... ........... wc. K0056... A Seat ht <17 or <=21 ......... ......... ......... ........... ........... ltwt wc. K0057... A Seat wdth 19/20 hvy dty ......... ......... ......... ........... ........... wc. K0058... A Seat dpth 17/18 power ......... ......... ......... ........... ........... wc. K0059... A Plastic coated handrim ......... ......... ......... ........... ........... each. K0060... A Steel handrim each..... ......... ......... ......... ........... ........... K0061... A Aluminum handrim each.. ......... ......... ......... ........... ........... K0062... A Handrim 8-10 vert/obliq ......... ......... ......... ........... ........... proj. K0063... A Hndrm 12-16 vert/obliq ......... ......... ......... ........... ........... proj. K0064... A Zero pressure tube flat ......... ......... ......... ........... ........... free. K0065... A Spoke protectors....... ......... ......... ......... ........... ........... K0066... A Solid tire any size ......... ......... ......... ........... ........... each. [[Page 47745]] K0067... A Pneumatic tire any size ......... ......... ......... ........... ........... each. K0068... A Pneumatic tire tube ......... ......... ......... ........... ........... each. K0069... A Rear whl complete solid ......... ......... ......... ........... ........... tire. K0070... A Rear whl compl pneum ......... ......... ......... ........... ........... tire. K0071... A Front castr compl pneum ......... ......... ......... ........... ........... tire. K0072... A Frnt cstr cmpl sem- ......... ......... ......... ........... ........... pneum tir. K0073... A Caster pin lock each... ......... ......... ......... ........... ........... K0074... A Pneumatic caster tire ......... ......... ......... ........... ........... each. K0075... A Semi-pneumatic caster ......... ......... ......... ........... ........... tire. K0076... A Solid caster tire each. ......... ......... ......... ........... ........... K0077... A Front caster assem ......... ......... ......... ........... ........... complete. K0078... A Pneumatic caster tire ......... ......... ......... ........... ........... tube. K0079... A Wheel lock extension ......... ......... ......... ........... ........... pair. K0080... A Anti-rollback device ......... ......... ......... ........... ........... pair. K0081... A Wheel lock assembly ......... ......... ......... ........... ........... complete. K0082... A 22 nf deep cycl acid ......... ......... ......... ........... ........... battery. K0083... A 22 nf gel cell battery ......... ......... ......... ........... ........... each. K0084... A Grp 24 deep cycl acid ......... ......... ......... ........... ........... battry. K0085... A Group 24 gel cell ......... ......... ......... ........... ........... battery. K0086... A U-1 lead acid battery ......... ......... ......... ........... ........... each. K0087... A U-1 gel cell battery ......... ......... ......... ........... ........... each. K0088... A Battry chrgr acid/gel ......... ......... ......... ........... ........... cell. K0089... A Battery charger dual ......... ......... ......... ........... ........... mode. K0090... A Rear tire power ......... ......... ......... ........... ........... wheelchair. K0091... A Rear tire tube power ......... ......... ......... ........... ........... whlchr. K0092... A Rear assem cmplt powr ......... ......... ......... ........... ........... whlchr. K0093... A Rear zero pressure tire ......... ......... ......... ........... ........... tube. K0094... A Wheel tire for power ......... ......... ......... ........... ........... base. K0095... A Wheel tire tube each ......... ......... ......... ........... ........... base. K0096... A Wheel assem powr base ......... ......... ......... ........... ........... complt. K0097... A Wheel zero presure tire ......... ......... ......... ........... ........... tube. K0098... A Drive belt power ......... ......... ......... ........... ........... wheelchair. K0099... A Front caster power ......... ......... ......... ........... ........... whelchair. K0100... A Amputee adapter pair... ......... ......... ......... ........... ........... K0101... A One-arm drive ......... ......... ......... ........... ........... attachment. K0102... A Crutch and cane holder. ......... ......... ......... ........... ........... K0103... A Transfer board < 25''.. ......... ......... ......... ........... ........... K0104... A Cylinder tank carrier.. ......... ......... ......... ........... ........... K0105... A Iv hanger.............. ......... ......... ......... ........... ........... K0106... A Arm trough each........ ......... ......... ......... ........... ........... K0107... A Wheelchair tray........ ......... ......... ......... ........... ........... K0108... A Other accessories...... ......... ......... ......... ........... ........... K0109... A Customize whlchr base ......... ......... ......... ........... ........... frame. K0112... A Trunk vest supprt innr ......... ......... ......... ........... ........... frame. K0113... A Trunk vest suprt w/o ......... ......... ......... ........... ........... inr frm. K0114... A Whlchr back suprt inr ......... ......... ......... ........... ........... frame. K0115... A Back module orthotic ......... ......... ......... ........... ........... system. K0116... A Back & seat modul ......... ......... ......... ........... ........... orthot sys. K0119... N Azathioprine oral tab ......... ......... ......... ........... ........... 50 MG. K0120... N Azathioprine prentrl ......... ......... ......... ........... ........... 100 MG. K0121... N Cyclosporine oral 25 MG ......... ......... ......... ........... ........... K0122... N Cyclosporine prentrl ......... ......... ......... ........... ........... 250 MG. K0123... N Imun/antitymocyt glob ......... ......... ......... ........... ........... 250 MG. K0137... A Skin barrier liquid per ......... ......... ......... ........... ........... oz. K0138... A Skin barrier paste per ......... ......... ......... ........... ........... oz. K0139... A Skin barrier powder per ......... ......... ......... ........... ........... oz. K0168... A Disposable nebulizer ......... ......... ......... ........... ........... set. K0169... A Disposable nebulizer ......... ......... ......... ........... ........... small. K0170... A Non disposable ......... ......... ......... ........... ........... nebulizer set. K0171... A Filtered nebulizer set. ......... ......... ......... ........... ........... K0172... A Disposable nebulizer ......... ......... ......... ........... ........... unfill. K0173... A Disposable nebulizer ......... ......... ......... ........... ........... prefill. K0174... A Reservoir bottle w ......... ......... ......... ........... ........... nebulizer. K0175... A Disposable corrugated ......... ......... ......... ........... ........... tubing. K0176... A Non dispos corrugated ......... ......... ......... ........... ........... tubing. K0177... A Water collec dev w ......... ......... ......... ........... ........... nebulizer. K0178... A Disposbl filter w ......... ......... ......... ........... ........... compressor. K0179... A Non-dispos filter w/ ......... ......... ......... ........... ........... compress. K0180... A Aerosol mask with ......... ......... ......... ........... ........... nebulizer. K0181... A Dome & mouthpiece w/ ......... ......... ......... ........... ........... nebuliz. K0182... A Water distilled w/ ......... ......... ......... ........... ........... nebulizer. K0183... A Nasal application with ......... ......... ......... ........... ........... cpap. K0184... A Nasal pillows/seals ......... ......... ......... ........... ........... pair. K0185... A Headgear with cpap ......... ......... ......... ........... ........... device. K0186... A Chin strap with cpap ......... ......... ......... ........... ........... device. [[Page 47746]] K0187... A Tubing with cpap device ......... ......... ......... ........... ........... K0188... A Filter disposable with ......... ......... ......... ........... ........... cpap. K0189... A Filter non-disposable w/ ......... ......... ......... ........... ........... cpap. K0190... A Disposable canister w/ ......... ......... ......... ........... ........... pump. K0191... A Non-disposbl canister w/ ......... ......... ......... ........... ........... pump. K0192... A Tubing used w/ suction ......... ......... ......... ........... ........... pump. K0193... A Airway pressure dev/w ......... ......... ......... ........... ........... hmdfer. K0194... A Assist device w/ ......... ......... ......... ........... ........... humidifier. K0195... A Elevating whlchair leg ......... ......... ......... ........... ........... rests. K0268... A Humidifier with cpap ......... ......... ......... ........... ........... device. K0269... A Aerosol compressor cpap ......... ......... ......... ........... ........... dev. K0270... A Ultrasonic generator w ......... ......... ......... ........... ........... nebul. K0277... A Skin barrier solid 4x4 ......... ......... ......... ........... ........... equiv. K0278... A Skin barrier with ......... ......... ......... ........... ........... flange. K0279... A Skin barrier extended ......... ......... ......... ........... ........... wear. K0280... A Extension drainage ......... ......... ......... ........... ........... tubing. K0281... A Lubricant catheter ......... ......... ......... ........... ........... insertion. K0283... A Saline solution ......... ......... ......... ........... ........... dispenser. K0284... A External infusion pump ......... ......... ......... ........... ........... reuse. K0400... A Skin support attachment ......... ......... ......... ........... ........... each. K0401... A Diabetic deluxe shoe... ......... ......... ......... ........... ........... K0407... A Urinary cath skin ......... ......... ......... ........... ........... attachment. K0408... A Urinary cath leg strap. ......... ......... ......... ........... ........... K0409... A Sterile H2O irrigation ......... ......... ......... ........... ........... solut. K0410... A Male ext cath w/adh ......... ......... ......... ........... ........... coating. K0411... A Male ext cath w/adh ......... ......... ......... ........... ........... strip. K0412... N Mycophenolate mofetil ......... ......... ......... ........... ........... 25o mg. K0415... N RX antiemetic drg, oral ......... ......... ......... ........... ........... NOS. K0416... N Rx antiemetic ......... ......... ......... ........... ........... drg,rectal NOS. K0417... A Mech infus pump sht trm ......... ......... ......... ........... ........... drug. K0418... N Oral cyclosporin....... ......... ......... ......... ........... ........... K0419... A Drainable plstic pch w ......... ......... ......... ........... ........... fcplt. K0420... A Drainable rubber pch w ......... ......... ......... ........... ........... fcplt. K0421... A drainable plstic pch w/ ......... ......... ......... ........... ........... o fp. K0422... A Drainable rubber pch w/ ......... ......... ......... ........... ........... o fp. K0423... A Urinary plstic pouch w ......... ......... ......... ........... ........... fcplt. K0424... A Urinary rubber pouch w ......... ......... ......... ........... ........... fcplt. K0425... A Urinary plstic pouch w/ ......... ......... ......... ........... ........... o fp. K0426... A Urinary hvy plstc pch w/ ......... ......... ......... ........... ........... o fp. K0427... A Urinary rubber pouch w/ ......... ......... ......... ........... ........... o fp. K0428... A Ostomy faceplt/silicone ......... ......... ......... ........... ........... ring. K0429... A Skin barrier solid ext ......... ......... ......... ........... ........... wear. K0430... A Skin barrier w flang ex ......... ......... ......... ........... ........... wear. K0431... A Closed pouch w st wear ......... ......... ......... ........... ........... bar. K0432... A Drainable pch w ex wear ......... ......... ......... ........... ........... bar. K0433... A Drainable pch w st wear ......... ......... ......... ........... ........... bar. K0434... A Drainable pch ex wear ......... ......... ......... ........... ........... convex. K0435... A Urinary pouch w ex wear ......... ......... ......... ........... ........... bar. K0436... A Urinary pouch w st wear ......... ......... ......... ........... ........... bar. K0437... A Urine pch w ex wear bar ......... ......... ......... ........... ........... conv. K0438... A Ostomy pouch liq ......... ......... ......... ........... ........... deodorant. K0439... A Ostomy pouch solid ......... ......... ......... ........... ........... deodorant. K0440... A Nasal prosthesis....... ......... ......... ......... ........... ........... K0441... A Midfacial prosthesis... ......... ......... ......... ........... ........... K0442... A Orbital prosthesis..... ......... ......... ......... ........... ........... K0443... A Upper facial prosthesis ......... ......... ......... ........... ........... K0444... A Hemi-facial prosthesis. ......... ......... ......... ........... ........... K0445... S Auricular prosthesis... 031 1.33 $70.52 $14.10 $14.10 K0446... A Partial facial ......... ......... ......... ........... ........... prosthesis. K0447... A Nasal septal prosthesis ......... ......... ......... ........... ........... K0448... A Unspec maxillofacial ......... ......... ......... ........... ........... prosth. K0449... A Repair maxillofacial ......... ......... ......... ........... ........... prosth. K0450... A Liq adhes for facial ......... ......... ......... ........... ........... prosth. K0451... A Adhesive remover wipes. ......... ......... ......... ........... ........... K0452... A Wheelchair bearings.... ......... ......... ......... ........... ........... K0453... N Amphotericin B......... ......... ......... ......... ........... ........... K0455... A Pump uninterrupted ......... ......... ......... ........... ........... infusion. K0501... A Aerosol compressor for ......... ......... ......... ........... ........... svneb. K0503... A Acetylcysteine inh sol ......... ......... ......... ........... ........... u d. K0504... A Albuterol inh sol con.. ......... ......... ......... ........... ........... K0505... A Albuterol inh sol u d.. ......... ......... ......... ........... ........... K0506... A Atropine inh sol con... ......... ......... ......... ........... ........... K0507... A Atropine inh sol u d... ......... ......... ......... ........... ........... K0508... A Bitolterol mes inh sol ......... ......... ......... ........... ........... con. K0509... A Bitolterol mes inh sol ......... ......... ......... ........... ........... u d. [[Page 47747]] K0511... A Cromolyn sodium inh sol ......... ......... ......... ........... ........... u d. K0512... A Dexamethasone inh sol ......... ......... ......... ........... ........... con. K0513... A Dexamethasone inh sol u ......... ......... ......... ........... ........... d. K0514... A Dornase alpha inh sol u ......... ......... ......... ........... ........... d. K0515... A Glycopyrrolate inh sol ......... ......... ......... ........... ........... con. K0516... A Glycopyrrolate inh sol ......... ......... ......... ........... ........... u d. K0518... A Ipratropium brom inh ......... ......... ......... ........... ........... sol u d. K0519... A Isoetharine HCl inh sol ......... ......... ......... ........... ........... con. K0520... A Isoetharine HCl inh sol ......... ......... ......... ........... ........... u d. K0521... A IsoproterenolHCl inh ......... ......... ......... ........... ........... sol con. K0522... A IsoproterenolHCl inh ......... ......... ......... ........... ........... sol u d. K0523... A Metaproterenol inh sol ......... ......... ......... ........... ........... con. K0524... A Metaproterenol inh sol ......... ......... ......... ........... ........... u d. K0525... A Terbutaline SO4 inh sol ......... ......... ......... ........... ........... con. K0526... A Terbutaline SO4 inh sol ......... ......... ......... ........... ........... u d. K0527... A Triamcinolone inh sol ......... ......... ......... ........... ........... con. K0528... A Triamcinolone inh sol u ......... ......... ......... ........... ........... d. K0529... A Sterile H20 or nss w lv ......... ......... ......... ........... ........... neb. K0530... A Nebulizer not used w ......... ......... ......... ........... ........... oxygen. L0100... A Cerv craniosten helmet ......... ......... ......... ........... ........... mold. L0110... A Cerv craniostenosis hel ......... ......... ......... ........... ........... non-. L0120... A Cerv flexible non- ......... ......... ......... ........... ........... adjustable. L0130... A Flex thermoplastic ......... ......... ......... ........... ........... collar mo. L0140... A Cervical semi-rigid ......... ......... ......... ........... ........... adjustab. L0150... A Cerv semi-rig adj ......... ......... ......... ........... ........... molded chn. L0160... A Cerv semi-rig wire occ/ ......... ......... ......... ........... ........... mand. L0170... A Cervical collar molded ......... ......... ......... ........... ........... to pt. L0172... A Cerv col thermplas foam ......... ......... ......... ........... ........... 2 pi. L0174... A Cerv col foam 2 piece w ......... ......... ......... ........... ........... thor. L0180... A Cer post col occ/man ......... ......... ......... ........... ........... sup adj. L0190... A Cerv collar supp adj ......... ......... ......... ........... ........... cerv ba. L0200... A Cerv col supp adj bar & ......... ......... ......... ........... ........... thor. L0210... A Thoracic rib belt...... ......... ......... ......... ........... ........... L0220... A Thor rib belt custom ......... ......... ......... ........... ........... fabrica. L0300... A TLSO flex surgical ......... ......... ......... ........... ........... support. L0310... A Tlso flexible custom ......... ......... ......... ........... ........... fabrica. L0315... A Tlso flex elas rigid ......... ......... ......... ........... ........... post pa. L0317... A Tlso flex hypext elas ......... ......... ......... ........... ........... post p. L0320... A Tlso a-p contrl w apron ......... ......... ......... ........... ........... frnt. L0330... A Tlso ant-pos-lateral ......... ......... ......... ........... ........... control. L0340... A Tlso a-p-l-rotary with ......... ......... ......... ........... ........... apron. L0350... A Tlso flex compress ......... ......... ......... ........... ........... jacket cu. L0360... A Tlso flex compress ......... ......... ......... ........... ........... jacket mo. L0370... A Tlso a-p-l-rotary ......... ......... ......... ........... ........... hyperexten. L0380... A Tlso a-p-l-rot w/ pos ......... ......... ......... ........... ........... extens. L0390... A Tlso a-p-l control ......... ......... ......... ........... ........... molded. L0400... A Tlso a-p-l w interface ......... ......... ......... ........... ........... mater. L0410... A Tlso a-p-l two piece ......... ......... ......... ........... ........... constr. L0420... A Tlso a-p-l 2 piece w ......... ......... ......... ........... ........... interfa. L0430... A Tlso a-p-l w interface ......... ......... ......... ........... ........... custm. L0440... A Tlso a-p-l overlap frnt ......... ......... ......... ........... ........... cust. L0500... A Lso flex surgical ......... ......... ......... ........... ........... support. L0510... A Lso flexible custom ......... ......... ......... ........... ........... fabricat. L0515... A Lso flex elas w/ rig ......... ......... ......... ........... ........... post pa. L0520... A Lso a-p-l control with ......... ......... ......... ........... ........... apron. L0530... A Lso ant-pos control w ......... ......... ......... ........... ........... apron. L0540... A Lso lumbar flexion a-p- ......... ......... ......... ........... ........... l. L0550... A Lso a-p-l control ......... ......... ......... ........... ........... molded. L0560... A Lso a-p-l w interface.. ......... ......... ......... ........... ........... L0565... A Lso a-p-l control ......... ......... ......... ........... ........... custom. L0600... A Sacroiliac flex surg ......... ......... ......... ........... ........... support. L0610... A Sacroiliac flexible ......... ......... ......... ........... ........... custm fa. L0620... A Sacroiliac semi-rig w ......... ......... ......... ........... ........... apron. L0700... A Ctlso a-p-l control ......... ......... ......... ........... ........... molded. L0710... A Ctlso a-p-l control w/ ......... ......... ......... ........... ........... inter. L0810... A Halo cervical into jckt ......... ......... ......... ........... ........... vest. L0820... A Halo cervical into body ......... ......... ......... ........... ........... jack. L0830... A Halo cerv into ......... ......... ......... ........... ........... milwaukee typ. L0860... A Magnetic resonanc image ......... ......... ......... ........... ........... comp. L0900... A Torso/ptosis support... ......... ......... ......... ........... ........... L0910... A Torso & ptosis supp ......... ......... ......... ........... ........... custm fa. L0920... A Torso/pendulous abd ......... ......... ......... ........... ........... support. L0930... A Pendulous abdomen supp ......... ......... ......... ........... ........... custm. L0940... A Torso/postsurgical ......... ......... ......... ........... ........... support. L0950... A Post surg support ......... ......... ......... ........... ........... custom fab. [[Page 47748]] L0960... A Post surgical support ......... ......... ......... ........... ........... pads. L0970... A Tlso corset front...... ......... ......... ......... ........... ........... L0972... A Lso corset front....... ......... ......... ......... ........... ........... L0974... A Tlso full corset....... ......... ......... ......... ........... ........... L0976... A Lso full corset........ ......... ......... ......... ........... ........... L0978... A Axillary crutch ......... ......... ......... ........... ........... extension. L0980... A Peroneal straps pair... ......... ......... ......... ........... ........... L0982... A Stocking supp grips set ......... ......... ......... ........... ........... of f. L0984... A Protective body sock ......... ......... ......... ........... ........... each. L0999... A Add to spinal orthosis ......... ......... ......... ........... ........... NOS. L1000... A Ctlso milwauke initial ......... ......... ......... ........... ........... model. L1010... A Ctlso axilla sling..... ......... ......... ......... ........... ........... L1020... A Kyphosis pad........... ......... ......... ......... ........... ........... L1025... A Kyphosis pad floating.. ......... ......... ......... ........... ........... L1030... A Lumbar bolster pad..... ......... ......... ......... ........... ........... L1040... A Lumbar or lumbar rib ......... ......... ......... ........... ........... pad. L1050... A Sternal pad............ ......... ......... ......... ........... ........... L1060... A Thoracic pad........... ......... ......... ......... ........... ........... L1070... A Trapezius sling........ ......... ......... ......... ........... ........... L1080... A Outrigger.............. ......... ......... ......... ........... ........... L1085... A Outrigger bil w/ vert ......... ......... ......... ........... ........... extens. L1090... A Lumbar sling........... ......... ......... ......... ........... ........... L1100... A Ring flange plastic/ ......... ......... ......... ........... ........... leather. L1110... A Ring flange plas/ ......... ......... ......... ........... ........... leather mol. L1120... A Covers for upright each ......... ......... ......... ........... ........... L1200... A Furnsh initial orthosis ......... ......... ......... ........... ........... only. L1210... A Lateral thoracic ......... ......... ......... ........... ........... extension. L1220... A Anterior thoracic ......... ......... ......... ........... ........... extension. L1230... A Milwaukee type ......... ......... ......... ........... ........... superstructur. L1240... A Lumbar derotation pad.. ......... ......... ......... ........... ........... L1250... A Anterior asis pad...... ......... ......... ......... ........... ........... L1260... A Anterior thoracic ......... ......... ......... ........... ........... derotation. L1270... A Abdominal pad.......... ......... ......... ......... ........... ........... L1280... A Rib gusset (elastic) ......... ......... ......... ........... ........... each. L1290... A Lateral trochanteric ......... ......... ......... ........... ........... pad. L1300... A Body jacket mold to ......... ......... ......... ........... ........... patient. L1310... A Post-operative body ......... ......... ......... ........... ........... jacket. L1499... A Spinal orthosis NOS.... ......... ......... ......... ........... ........... L1500... A Thkao mobility frame... ......... ......... ......... ........... ........... L1510... A Thkao standing frame... ......... ......... ......... ........... ........... L1520... A Thkao swivel walker.... ......... ......... ......... ........... ........... L1600... A Abduct hip flex frejka ......... ......... ......... ........... ........... w cvr. L1610... A Abduct hip flex frejka ......... ......... ......... ........... ........... covr. L1620... A Abduct hip flex pavlik ......... ......... ......... ........... ........... harne. L1630... A Abduct control hip semi- ......... ......... ......... ........... ........... flex. L1640... A Pelv band/spread bar ......... ......... ......... ........... ........... thigh c. L1650... A HO abduction hip ......... ......... ......... ........... ........... adjustable. L1660... A HO abduction static ......... ......... ......... ........... ........... plastic. L1680... A Pelvic & hip control ......... ......... ......... ........... ........... thigh c. L1685... A Post-op hip abduct ......... ......... ......... ........... ........... custom fa. L1686... A HO post-op hip ......... ......... ......... ........... ........... abduction. L1700... A Leg perthes orth ......... ......... ......... ........... ........... toronto typ. L1710... A Legg perthes orth ......... ......... ......... ........... ........... newington. L1720... A Legg perthes orthosis ......... ......... ......... ........... ........... trilat. L1730... A Legg perthes orth ......... ......... ......... ........... ........... scottish r. L1750... A Legg perthes sling..... ......... ......... ......... ........... ........... L1755... A Legg perthes patten ......... ......... ......... ........... ........... bottom t. L1800... A Knee orthoses elas w ......... ......... ......... ........... ........... stays. L1810... A Ko elastic with joints. ......... ......... ......... ........... ........... L1815... A Elastic with condylar ......... ......... ......... ........... ........... pads. L1820... A Ko elas w/ condyle pads ......... ......... ......... ........... ........... & jo. L1825... A Ko elastic knee cap.... ......... ......... ......... ........... ........... L1830... A Ko immobilizer canvas ......... ......... ......... ........... ........... longit. L1832... A KO adj jnt pos rigid ......... ......... ......... ........... ........... support. L1834... A Ko w/0 joint rigid ......... ......... ......... ........... ........... molded to. L1840... A Ko derot ant cruciate ......... ......... ......... ........... ........... custom. L1843... A KO single upright ......... ......... ......... ........... ........... custom fit. L1844... A Ko w/adj jt rot cntrl ......... ......... ......... ........... ........... molded. L1845... A Ko w/ adj flex/ext ......... ......... ......... ........... ........... rotat cus. L1846... A Ko w adj flex/ext rotat ......... ......... ......... ........... ........... mold. L1850... A Ko swedish type........ ......... ......... ......... ........... ........... L1855... A Ko plas doub upright ......... ......... ......... ........... ........... jnt mol. L1858... A Ko polycentric ......... ......... ......... ........... ........... pneumatic pad. L1860... A Ko supracondylar socket ......... ......... ......... ........... ........... mold. L1870... A Ko doub upright lacers ......... ......... ......... ........... ........... molde. [[Page 47749]] L1880... A Ko doub upright cuffs/ ......... ......... ......... ........... ........... lacers. L1885... A Knee upright w/ ......... ......... ......... ........... ........... resistance. L1900... A Afo sprng wir drsflx ......... ......... ......... ........... ........... calf bd. L1902... A Afo ankle gauntlet..... ......... ......... ......... ........... ........... L1904... A Afo molded ankle ......... ......... ......... ........... ........... gauntlet. L1906... A Afo multiligamentus ......... ......... ......... ........... ........... ankle su. L1910... A Afo sing bar clasp ......... ......... ......... ........... ........... attach sh. L1920... A Afo sing upright w/ ......... ......... ......... ........... ........... adjust s. L1930... A Afo plastic............ ......... ......... ......... ........... ........... L1940... A Afo molded to patient ......... ......... ......... ........... ........... plasti. L1945... A Afo molded plas rig ant ......... ......... ......... ........... ........... tib. L1950... A Afo spiral molded to pt ......... ......... ......... ........... ........... plas. L1960... A Afo pos solid ank ......... ......... ......... ........... ........... plastic mo. L1970... A Afo plastic molded w/ ......... ......... ......... ........... ........... ankle j. L1980... A Afo sing solid stirrup ......... ......... ......... ........... ........... calf. L1990... A Afo doub solid stirrup ......... ......... ......... ........... ........... calf. L2000... A Kafo sing fre stirr thi/ ......... ......... ......... ........... ........... calf. L2010... A Kafo sng solid stirrup ......... ......... ......... ........... ........... w/o j. L2020... A Kafo dbl solid stirrup ......... ......... ......... ........... ........... band/. L2030... A Kafo dbl solid stirrup ......... ......... ......... ........... ........... w/o j. L2035... A KAFO plastic pediatric ......... ......... ......... ........... ........... size. L2036... A Kafo plas doub free ......... ......... ......... ........... ........... knee mol. L2037... A Kafo plas sing free ......... ......... ......... ........... ........... knee mol. L2038... A Kafo w/o joint multi- ......... ......... ......... ........... ........... axis an. L2039... A KAFO, plstic, medlat ......... ......... ......... ........... ........... rotat con. L2040... A Hkafo torsion bil rot ......... ......... ......... ........... ........... straps. L2050... A Hkafo torsion cable hip ......... ......... ......... ........... ........... pelv. L2060... A Hkafo torsion ball ......... ......... ......... ........... ........... bearing j. L2070... A Hkafo torsion unilat ......... ......... ......... ........... ........... rot str. L2080... A Hkafo unilat torsion ......... ......... ......... ........... ........... cable. L2090... A Hkafo unilat torsion ......... ......... ......... ........... ........... ball br. L2102... A Afo tibial fx cast ......... ......... ......... ........... ........... plstr mol. L2104... A Afo tib fx cast ......... ......... ......... ........... ........... synthetic mo. L2106... A Afo tib fx cast plaster ......... ......... ......... ........... ........... mold. L2108... A Afo tib fx cast molded ......... ......... ......... ........... ........... to pt. L2112... A Afo tibial fracture ......... ......... ......... ........... ........... soft. L2114... A Afo tib fx semi-rigid.. ......... ......... ......... ........... ........... L2116... A Afo tibial fracture ......... ......... ......... ........... ........... rigid. L2122... A Kafo fem fx cast ......... ......... ......... ........... ........... plaster mol. L2124... A Kafo fem fx cast ......... ......... ......... ........... ........... synthet mol. L2126... A Kafo fem fx cast ......... ......... ......... ........... ........... thermoplas. L2128... A Kafo fem fx cast molded ......... ......... ......... ........... ........... to p. L2132... A Kafo femoral fx cast ......... ......... ......... ........... ........... soft. L2134... A Kafo fem fx cast semi- ......... ......... ......... ........... ........... rigid. L2136... A Kafo femoral fx cast ......... ......... ......... ........... ........... rigid. L2180... A Plas shoe insert w ank ......... ......... ......... ........... ........... joint. L2182... A Drop lock knee......... ......... ......... ......... ........... ........... L2184... A Limited motion knee ......... ......... ......... ........... ........... joint. L2186... A Adj motion knee jnt ......... ......... ......... ........... ........... lerman t. L2188... A Quadrilateral brim..... ......... ......... ......... ........... ........... L2190... A Waist belt............. ......... ......... ......... ........... ........... L2192... A Pelvic band & belt ......... ......... ......... ........... ........... thigh fla. L2200... A Limited ankle motion ea ......... ......... ......... ........... ........... jnt. L2210... A Dorsiflexion assist ......... ......... ......... ........... ........... each joi. L2220... A Dorsi & plantar flex ......... ......... ......... ........... ........... ass/res. L2230... A Split flat caliper ......... ......... ......... ........... ........... stirr & p. L2240... A Round caliper and plate ......... ......... ......... ........... ........... atta. L2250... A Foot plate molded ......... ......... ......... ........... ........... stirrup at. L2260... A Reinforced solid ......... ......... ......... ........... ........... stirrup. L2265... A Long tongue stirrup.... ......... ......... ......... ........... ........... L2270... A Varus/valgus strap ......... ......... ......... ........... ........... padded/li. L2275... A Plastic mod low ext pad/ ......... ......... ......... ........... ........... line. L2280... A Molded inner boot...... ......... ......... ......... ........... ........... L2300... A Abduction bar jointed ......... ......... ......... ........... ........... adjust. L2310... A Abduction bar-straight. ......... ......... ......... ........... ........... L2320... A Non-molded lacer....... ......... ......... ......... ........... ........... L2330... A Lacer molded to patient ......... ......... ......... ........... ........... mode. L2335... A Anterior swing band.... ......... ......... ......... ........... ........... L2340... A Pre-tibial shell molded ......... ......... ......... ........... ........... to p. L2350... A Prosthetic type socket ......... ......... ......... ........... ........... molde. L2360... A Extended steel shank... ......... ......... ......... ........... ........... L2370... A Patten bottom.......... ......... ......... ......... ........... ........... L2375... A Torsion ank & half ......... ......... ......... ........... ........... solid sti. L2380... A Torsion straight knee ......... ......... ......... ........... ........... joint. L2385... A Straight knee joint ......... ......... ......... ........... ........... heavy du. [[Continued on page 47751]]