Medi-Cal: Medi-Cal Rates Information

Medi-Cal Rates Information

Medi-Cal Rates as of 03/15/2023 (Codes 94799 thru 99600)

Medi-Cal Rates are updated and effective as of the 15th of the month and published to the Medi-Cal website on the 16th of the month

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Proc Type	Proc Code	Procedure Description	Unit Value	Basic Rate	Child Rate	ER Rate	Conv Ind	ER Ind	Cut-back Ind	Prof %	Rental Rate	Non-Physn. Med.Prac.Ind
N	94799	UNLISTED PULMONARY SVC/PX	0.00	$0.00	---	--	007	1	0	0.00	$0.00	Y
N	95004	PERCUT ALLERGY SKIN TESTS	0.19	$1.90	$2.07	$2.36	053	1	1	0.00	$0.00	Y
P	95004	PERCUT ALLERGY SKIN TESTS	0.19	$1.90	$2.07	--	052	0	1	0.00	$0.00	Y
N	95012	EXHALED NITRIC OXIDE MEAS	22.87	$18.75	---	--	007	0	0	0.00	$0.00	Y
N	95017	PERQ & ICUT ALLG TEST VENOMS	9.45	$7.75	---	$9.83	007	1	0	0.00	$0.00	Y
N	95018	PERQ&IC ALLG TEST DRUGS/BIOL	23.65	$19.39	---	$24.60	007	1	0	0.00	$0.00	Y
N	95024	ICUT ALLERGY TEST DRUG/BUG	0.28	$2.80	$3.05	$3.48	053	1	1	0.00	$0.00	Y
P	95024	ICUT ALLERGY TEST DRUG/BUG	0.28	$2.80	$3.05	--	052	0	1	0.00	$0.00	Y
P	95027	ICUT ALLERGY TITRATE-AIRBORN	0.28	$2.80	$3.05	--	052	0	1	0.00	$0.00	Y
N	95027	ICUT ALLERGY TITRATE-AIRBORN	0.28	$2.80	$3.05	$3.48	053	1	1	0.00	$0.00	Y
N	95028	ICUT ALLERGY TEST-DELAYED	0.42	$4.20	$4.58	$5.22	053	1	1	0.00	$0.00	Y
P	95028	ICUT ALLERGY TEST-DELAYED	0.42	$4.20	$4.58	--	052	0	1	0.00	$0.00	Y
N	95044	PATCH/APPLIC TEST(S)(SPECIFY # OF TESTS)	0.37	$3.70	$4.04	$4.60	053	1	0	0.00	$0.00	Y
N	95052	PHOTO PATCH TEST(S)(SPECIFY # OF TESTS)	0.46	$4.60	$5.02	$5.71	053	1	0	0.00	$0.00	Y
N	95056	PHOTOSENSITIVITY TESTS	0.32	$3.20	$3.49	$3.97	053	1	1	0.00	$0.00	Y
N	95060	EYE ALLERGY TESTS	0.65	$6.50	$7.09	$8.07	053	1	1	0.00	$0.00	Y
N	95065	NOSE ALLERGY TEST	0.41	$4.10	$4.47	$5.09	053	1	1	0.00	$0.00	Y
N	95070	BRONCHIAL ALLERGY TESTS	4.12	$41.20	$44.95	$51.17	053	1	1	0.00	$0.00	Y
N	95076	INGEST CHALLENGE INI 120 MIN	124.44	$102.04	---	--	007	0	0	0.00	$0.00	Y
N	95079	INGEST CHALLENGE ADDL 60 MIN	86.06	$70.57	---	--	007	0	0	0.00	$0.00	Y
N	95115	IMMUNOTHERAPY ONE INJECTION	0.49	$4.90	$5.35	$6.09	001	1	0	0.00	$0.00	Y
N	95117	PROF SVC,ALLERGEN IMMUNOTHERAPY,2 OR MOR	9.45	$9.45	---	--	009	0	0	0.00	$0.00	Y
N	95144	ANTIGEN THERAPY SERVICES	11.22	$9.20	---	--	007	0	0	0.00	$0.00	N
N	95170	ANTIGEN THERAPY SERVICES	10.47	$8.59	---	$10.89	007	1	1	0.00	$0.00	N
N	95180	RAPID DESENSITIZATION	6.10	$61.00	$66.55	$75.76	053	1	1	0.00	$0.00	Y
N	95199	UNLISTED ALL/IMMLG SVC/PX	0.51	$5.10	$5.56	$6.33	053	1	1	0.00	$0.00	Y
N	95700	EEG CONT REC W/VID EEG TECH	296.98	$243.52	---	--	007	0	0	0.00	$0.00	Y
N	95705	EEG W/O VID 2-12 HR UNMNTR	270.57	$221.87	---	--	007	0	0	0.00	$0.00	Y
N	95706	EEG WO VID 2-12HR INTMT MNTR	402.35	$329.93	---	--	007	0	0	0.00	$0.00	Y
N	95707	EEG W/O VID 2-12HR CONT MNTR	780.43	$639.95	---	--	007	0	0	0.00	$0.00	Y
N	95708	EEG WO VID EA 12-26HR UNMNTR	323.25	$265.07	---	--	007	0	0	0.00	$0.00	Y
N	95709	EEG W/O VID EA 12-26HR INTMT	718.07	$588.82	---	--	007	0	0	0.00	$0.00	Y
N	95710	EEG W/O VID EA 12-26HR CONT	1247.78	$1023.18	---	--	007	0	0	0.00	$0.00	Y
N	95711	VEEG 2-12 HR UNMONITORED	270.57	$221.87	---	--	007	0	0	0.00	$0.00	Y
N	95712	VEEG 2-12 HR INTMT MNTR	455.03	$373.12	---	--	007	0	0	0.00	$0.00	Y
N	95713	VEEG 2-12 HR CONT MNTR	889.74	$729.59	---	--	007	0	0	0.00	$0.00	Y
N	95714	VEEG EA 12-26 HR UNMNTR	323.25	$265.07	---	--	007	0	0	0.00	$0.00	Y
N	95715	VEEG EA 12-26HR INTMT MNTR	796.64	$653.24	---	--	007	0	0	0.00	$0.00	Y
N	95716	VEEG EA 12-26HR CONT MNTR	1426.55	$1169.77	---	--	007	0	0	0.00	$0.00	Y
N	95717	EEG PHYS/QHP 2-12 HR W/O VID	109.59	$89.87	---	--	007	0	0	0.00	$0.00	Y
N	95718	EEG PHYS/QHP 2-12 HR W/VEEG	144.41	$118.42	---	--	007	0	0	0.00	$0.00	Y
N	95719	EEG PHYS/QHP EA INCR W/O VID	169.57	$139.05	---	--	007	0	0	0.00	$0.00	Y
N	95720	EEG PHY/QHP EA INCR W/VEEG	223.53	$183.30	---	--	007	0	0	0.00	$0.00	Y
N	95721	EEG PHY/QHP>36<60 HR W/O VID	225.57	$184.97	---	--	007	0	0	0.00	$0.00	Y
N	95722	EEG PHY/QHP>36<60 HR W/VEEG	273.51	$224.28	---	--	007	0	0	0.00	$0.00	Y
N	95723	EEG PHY/QHP>60<84 HR W/O VID	279.46	$229.16	---	--	007	0	0	0.00	$0.00	Y
N	95724	EEG PHY/QHP>60<84 HR W/VEEG	349.37	$286.49	---	--	007	0	0	0.00	$0.00	Y
N	95725	EEG PHY/QHP>84 HR W/O VID	319.14	$261.70	---	--	007	0	0	0.00	$0.00	Y
N	95726	EEG PHY/QHP>84 HR W/VEEG	441.52	$362.05	---	--	007	0	0	0.00	$0.00	Y
N	95782	POLYSOM <6 YRS 4/> PARAMTRS	1154.29	$946.52	---	$1200.46	007	1	0	0.11	$0.00	Y
N	95783	POLYSOM <6 YRS CPAP/BILVL	1231.49	$1009.82	---	$1280.75	007	1	0	0.12	$0.00	Y
N	95800	SLP STDY UNATTENDED	0.00	$0.00	---	--	007	0	0	0.18	$0.00	Y
N	95801	SLP STDY UNATND W/ANAL	0.00	$0.00	---	--	007	0	0	0.47	$0.00	Y
N	95805	MULTIPLE SLEEP LATENCY TEST	238.68	$195.72	---	$248.23	007	1	0	0.35	$0.00	Y
N	95806	SLEEP STUDY UNATT&RESP EFFT	0.00	$0.00	---	--	007	0	0	0.45	$0.00	Y
N	95807	SLEEP STUDY ATTENDED	257.67	$211.29	---	$267.98	007	1	0	0.39	$0.00	Y
N	95808	POLYSOM ANY AGE 1-3> PARAM	285.18	$233.85	---	$296.59	007	1	0	0.45	$0.00	Y
N	95810	POLYSOM 6/> YRS 4/> PARAM	424.48	$348.07	---	$441.46	007	1	0	0.45	$0.00	Y
N	95811	POLYSOM 6/>YRS CPAP 4/> PARM	436.24	$357.72	---	$453.69	007	1	0	0.47	$0.00	Y
N	95812	EEG 41-60 MINUTES	99.78	$81.82	---	$103.77	007	1	1	0.51	$0.00	Y
N	95813	EEG EXTND MNTR 61-119 MIN	135.78	$111.34	---	$141.21	007	1	1	0.60	$0.00	Y
N	95816	EEG AWAKE AND DROWSY	92.17	$75.58	---	$95.86	007	1	1	0.48	$0.00	Y
N	95819	EEG AWAKE AND ASLEEP	79.28	$65.01	---	$82.45	007	1	1	0.53	$0.00	Y
N	95822	EEG COMA OR SLEEP ONLY	79.28	$65.01	---	$82.45	007	1	1	0.46	$0.00	Y
N	95824	EEG CEREBRAL DEATH ONLY	49.78	$40.82	---	$51.77	007	1	0	0.75	$0.00	Y
N	95829	SURGERY ELECTROCORTICOGRAM	271.32	$222.48	---	$282.17	007	1	0	0.97	$0.00	Y
N	95830	INSERT ELECTRODES FOR EEG	96.76	$79.34	---	$100.63	007	1	1	0.00	$0.00	Y
N	95836	ECOG IMPLTD BRN NPGT <30 D	113.12	$92.76	---	--	007	0	0	0.00	$0.00	Y
N	95851	RANGE OF MOTION MEASUREMENTS	18.12	$14.86	---	$18.84	007	1	1	0.00	$0.00	Y
P	95851	RANGE OF MOTION MEASUREMENTS	18.12	$14.86	---	--	019	0	1	0.00	$0.00	Y
N	95852	RANGE OF MOTION MEASUREMENTS	9.98	$8.18	---	$10.38	007	1	1	0.00	$0.00	Y
N	95857	CHOLINESTERASE CHALLENGE	36.24	$29.72	---	$37.69	007	1	1	0.00	$0.00	Y
N	95860	MUSCLE TEST ONE LIMB	80.00	$65.60	---	$83.20	007	1	1	0.81	$0.00	Y
N	95861	MUSCLE TEST 2 LIMBS	120.00	$98.40	---	$124.80	007	1	1	0.78	$0.00	Y
N	95863	MUSCLE TEST 3 LIMBS	135.91	$111.45	---	$141.35	007	1	1	0.77	$0.00	Y
N	95864	MUSCLE TEST 4 LIMBS	200.00	$164.00	---	$208.00	007	1	1	0.67	$0.00	Y
N	95865	MUSCLE TEST LARYNX	121.76	$99.84	---	--	007	0	0	0.75	$0.00	Y
N	95866	MUSCLE TEST HEMIDIAPHRAGM	81.06	$66.47	---	--	007	0	0	0.75	$0.00	Y
N	95867	MUSCLE TEST CRAN NERV UNILAT	58.82	$48.23	---	$61.17	007	1	1	0.67	$0.00	Y
N	95868	MUSCLE TEST CRAN NERVE BILAT	99.28	$81.41	---	$103.25	007	1	1	0.79	$0.00	Y
N	95869	MUSCLE TEST THOR PARASPINAL	32.00	$26.24	---	$33.28	007	1	1	0.75	$0.00	Y
N	95870	MUSCLE TEST NONPARASPINAL	24.70	$20.25	---	$25.69	007	1	0	0.76	$0.00	Y
N	95872	MUSCLE TEST ONE FIBER	89.33	$73.25	---	$92.90	007	1	1	0.77	$0.00	Y
N	95873	GUIDE NERV DESTR ELEC STIM	29.87	$24.49	---	--	007	0	0	0.77	$0.00	Y
N	95874	GUIDE NERV DESTR NEEDLE EMG	30.28	$24.83	---	--	007	0	0	0.77	$0.00	Y
N	95875	LIMB EXERCISE TEST	62.41	$51.18	---	$64.91	007	1	1	0.77	$0.00	Y
N	95885	MUSC TST DONE W/NERV TST LIM	60.78	$49.84	---	$63.21	007	1	1	0.30	$0.00	Y
N	95886	MUSC TEST DONE W/N TEST COMP	93.71	$76.84	---	$97.46	007	1	1	0.52	$0.00	Y
N	95887	MUSC TST DONE W/N TST NONEXT	83.94	$68.83	---	$87.30	007	1	1	0.46	$0.00	Y
N	95905	MOTOR &/ SENS NRVE CNDJ TEST	86.34	$70.80	---	--	007	0	1	0.74	$0.00	Y
N	95907	NVR CNDJ TST 1-2 STUDIES	100.99	$82.81	---	--	007	0	0	0.53	$0.00	Y
N	95908	NRV CNDJ TST 3-4 STUDIES	124.62	$102.19	---	--	007	0	0	0.54	$0.00	Y
N	95909	NRV CNDJ TST 5-6 STUDIES	149.20	$122.34	---	--	007	0	0	0.54	$0.00	Y
N	95910	NRV CNDJ TEST 7-8 STUDIES	196.28	$160.95	---	--	007	0	0	0.55	$0.00	Y
N	95911	NRV CNDJ TEST 9-10 STUDIES	237.26	$194.55	---	--	007	0	0	0.57	$0.00	Y
N	95912	NRV CNDJ TEST 11-12 STUDIES	277.48	$227.53	---	--	007	0	0	0.58	$0.00	Y
N	95913	NRV CNDJ TEST 13/> STUDIES	321.28	$263.45	---	--	007	0	0	0.06	$0.00	Y
N	95924	ANS PARASYMP & SYMP W/TILT	157.10	$128.82	---	--	007	0	0	0.57	$0.00	Y
N	95925	SHORTLATENCY SOMATOSENSORY, UPPER LIMBS	103.35	$84.75	---	$107.48	007	1	1	0.55	$0.00	Y
N	95926	SHLATENCY SOMATOSENSORY EVOK STUDY LL	123.15	$123.15	---	--	009	0	1	0.55	$0.00	Y
N	95927	SHLATENCY SOMATOSENORY STUDY TRUNK OR H	123.15	$123.15	---	--	009	0	1	0.55	$0.00	Y
N	95928	C MOTOR EVOKED UPPR LIMBS	186.77	$153.15	---	$194.24	007	1	1	0.55	$0.00	Y
N	95929	C MOTOR EVOKED LWR LIMBS	194.77	$159.69	---	$202.56	007	1	1	0.55	$0.00	Y
N	95930	VISUAL EVOKED POTENTIAL (VEP) TESTING CE	42.00	$34.44	---	$43.68	007	1	1	0.79	$0.00	Y
N	95937	NEUROMUSCULAR JUNCTION TEST	27.18	$22.29	---	$28.27	007	1	1	0.75	$0.00	Y
N	95938	*12SOMATOSENSORY TESTING	326.42	$267.67	---	$339.48	007	1	1	0.14	$0.00	Y
N	95939	C MOTOR EVOKED UPR&LWR LIMBS	506.75	$415.54	---	$527.02	007	1	1	0.23	$0.00	Y
N	95940	IONM IN OPERATNG ROOM 15 MIN	32.99	$27.05	---	--	007	0	0	0.00	$0.00	Y
N	95941	IONM REMOTE/>1 PT OR PER HR	0.00	$0.00	---	--	007	0	0	0.00	$0.00	N
N	95955	EEG DURING SURGERY	135.56	$111.16	---	$140.98	007	1	0	0.50	$0.00	Y
N	95957	EEG DIGITAL ANALYSIS	141.89	$116.35	---	$147.57	007	1	1	0.42	$0.00	Y
N	95958	EEG MONITORING/FUNCTION TEST	301.54	$247.26	---	$313.60	007	1	0	0.80	$0.00	Y
N	95965	MEG SPONTANEOUS	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	95966	MEG EVOKED SINGLE	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	95967	MEG EVOKED EACH ADDL	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	95970	ANALYZE NEUROSTIM NO PROG	24.13	$19.79	---	$25.10	007	1	0	0.00	$0.00	Y
N	95971	ANALYZE NEUROSTIM SIMPLE	41.12	$33.72	---	$42.76	007	1	0	0.00	$0.00	Y
N	95972	ANALYZE NEUROSTIM COMPLEX	78.94	$64.73	---	$82.10	007	1	0	0.00	$0.00	Y
N	95976	ALYS SMPL CN NPGT PRGRMG	42.71	$35.02	---	--	007	0	0	0.00	$0.00	Y
N	95977	ALYS CPLX CN NPGT PRGRMG	56.76	$46.54	---	--	007	0	0	0.00	$0.00	Y
N	95983	ALYS BRN NPGT PRGRMG 15 MIN	53.56	$43.92	---	--	007	0	0	0.00	$0.00	Y
N	95984	ALYS BRN NPGT PRGRMG ADDL 15	46.70	$38.29	---	--	007	0	0	0.00	$0.00	Y
N	95990	SPIN/BRAIN PUMP REFIL & MAIN	60.39	$49.52	---	--	007	0	0	0.00	$0.00	Y
N	95991	SPIN/BRAIN PUMP REFIL & MAIN	88.79	$72.81	---	--	007	0	0	0.00	$0.00	Y
N	95992	CANALITH REPOSITIONING PROC	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	95999	UNLISTED NEUROLOGICAL DX PX	0.00	$0.00	---	--	007	1	1	0.00	$0.00	Y
N	96020	FUNCTIONAL BRAIN MAPPING	172.32	$141.30	---	--	007	0	0	1.00	$0.00	Y
N	96105	ASSESSMENT OF APHASIA (INCLUDES ASSESSME	62.44	$51.20	---	$64.94	007	1	1	0.00	$0.00	Y
Q	96105	ASSESSMENT OF APHASIA (INCLUDES ASSESSME	51.20	$51.20	---	--	009	0	0	0.00	$0.00	N
Q	96110	DEVELOPMENTAL SCREEN	54.90	$54.90	---	--	009	0	0	0.00	$0.00	N
N	96110	DEVELOPMENTAL SCREEN	5.49	$54.90	$59.90	--	001	0	1	0.00	$0.00	Y
E	96110	DEVELOPMENTAL TEST LIM	6.37	$6.37	---	--	009	0	0	0.00	$0.00	Y
N	96112	DEVEL TST PHYS/QHP 1ST HR	142.16	$116.57	---	--	007	0	0	0.00	$0.00	Y
Q	96112	DEVEL TST PHYS/QHP 1ST HR	142.16	$116.57	---	--	007	0	0	0.00	$0.00	N
Q	96113	DEVEL TST PHYS/QHP EA ADDL	63.26	$51.87	---	--	007	0	0	0.00	$0.00	N
N	96113	DEVEL TST PHYS/QHP EA ADDL	63.26	$51.87	---	--	007	0	0	0.00	$0.00	Y
N	96116	NUBHVL XM PHYS/QHP 1ST HR	5.62	$56.20	$61.31	$69.80	053	1	1	0.00	$0.00	Y
Q	96116	NUBHVL XM PHYS/QHP 1ST HR	56.20	$56.20	---	--	009	0	0	0.00	$0.00	N
Q	96121	NUBHVL XM PHY/QHP EA ADDL HR	85.57	$70.17	---	--	007	0	0	0.00	$0.00	N
N	96121	NUBHVL XM PHY/QHP EA ADDL HR	85.57	$70.17	---	--	007	0	0	0.00	$0.00	Y
N	96125	COGNITIVE TEST BY HC PRO	91.47	$91.47	---	--	009	0	0	0.00	$0.00	Y
N	96127	BRIEF EMOTIONAL/BEHAV ASSMT	5.87	$4.81	---	--	007	0	0	0.00	$0.00	Y
Q	96127	BRIEF EMOTIONAL/BEHAV ASSMT	5.87	$4.81	---	--	007	0	0	0.00	$0.00	N
Q	96130	PSYCL TST EVAL PHYS/QHP 1ST	121.46	$99.60	---	--	007	0	0	0.00	$0.00	N
N	96130	PSYCL TST EVAL PHYS/QHP 1ST	121.46	$99.60	---	--	007	0	0	0.00	$0.00	Y
E	96130	PSYCL TST EVAL PHYS/QHP 1ST	257.63	$257.63	---	--	009	0	0	0.00	$0.00	Y
N	96131	PSYCL TST EVAL PHYS/QHP EA	92.45	$75.81	---	--	007	0	0	0.00	$0.00	Y
Q	96131	PSYCL TST EVAL PHYS/QHP EA	92.45	$75.81	---	--	007	0	0	0.00	$0.00	N
Q	96132	NRPSYC TST EVAL PHYS/QHP 1ST	138.25	$113.37	---	--	007	0	0	0.00	$0.00	N
N	96132	NRPSYC TST EVAL PHYS/QHP 1ST	138.25	$113.37	---	--	007	0	0	0.00	$0.00	Y
N	96133	NRPSYC TST EVAL PHYS/QHP EA	105.40	$86.43	---	--	007	0	0	0.00	$0.00	Y
Q	96133	NRPSYC TST EVAL PHYS/QHP EA	105.40	$86.43	---	--	007	0	0	0.00	$0.00	N
Q	96136	PSYCL/NRPSYC TST PHY/QHP 1ST	51.07	$41.88	---	--	007	0	0	0.00	$0.00	N
N	96136	PSYCL/NRPSYC TST PHY/QHP 1ST	51.07	$41.88	---	--	007	0	0	0.00	$0.00	Y
N	96137	PSYCL/NRPSYC TST PHY/QHP EA	47.57	$39.01	---	--	007	0	0	0.00	$0.00	Y
Q	96137	PSYCL/NRPSYC TST PHY/QHP EA	47.57	$39.01	---	--	007	0	0	0.00	$0.00	N
Q	96138	PSYCL/NRPSYC TECH 1ST	43.52	$35.69	---	--	007	0	0	0.00	$0.00	N
N	96138	PSYCL/NRPSYC TECH 1ST	43.52	$35.69	---	--	007	0	0	0.00	$0.00	Y
N	96139	PSYCL/NRPSYC TST TECH EA	43.52	$35.69	---	--	007	0	0	0.00	$0.00	N
Q	96139	PSYCL/NRPSYC TST TECH EA	43.52	$35.69	---	--	007	0	0	0.00	$0.00	N
Q	96146	PSYCL/NRPSYC TST AUTO RESULT	2.24	$1.84	---	--	007	0	0	0.00	$0.00	N
N	96146	PSYCL/NRPSYC TST AUTO RESULT	2.24	$1.84	---	--	007	0	0	0.00	$0.00	Y
N	96156	HLTH BHV ASSMT/REASSESSMENT	102.80	$84.30	---	--	007	0	0	0.00	$0.00	Y
Q	96156	HLTH BHV ASSMT/REASSESSMENT	102.80	$84.30	---	--	007	0	0	0.00	$0.00	N
E	96156	PSYCHOSOCIAL EVALUATION	12.94	$12.94	---	--	009	0	0	0.00	$0.00	Y
E	96158	PSYCHOLOGY/COUNSELING TREATMENT	47.45	$47.45	---	--	009	0	0	0.00	$0.00	Y
Q	96158	HLTH BHV IVNTJ INDIV 1ST 30	70.28	$57.63	---	--	007	0	0	0.00	$0.00	N
N	96158	HLTH BHV IVNTJ INDIV 1ST 30	70.28	$57.63	---	--	007	0	0	0.00	$0.00	Y
N	96159	HLTH BHV IVNTJ INDIV EA ADDL	24.52	$20.11	---	--	007	0	0	0.00	$0.00	Y
Q	96159	HLTH BHV IVNTJ INDIV EA ADDL	24.52	$20.11	---	--	007	0	0	0.00	$0.00	N
E	96159	PSYCHOLOGY/COUNSELING TREATMENT	12.94	$12.94	---	--	009	0	0	0.00	$0.00	Y
E	96164	PSYCHOLOGY/COUNSELING TREATMENT	10.50	$10.50	---	--	009	0	0	0.00	$0.00	Y
Q	96164	HLTH BHV IVNTJ GRP 1ST 30	10.39	$8.52	---	--	007	0	0	0.00	$0.00	N
N	96164	HLTH BHV IVNTJ GRP 1ST 30	10.38	$8.52	---	--	007	0	0	0.00	$0.00	Y
N	96165	HLTH BHV IVNTJ GRP EA ADDL	4.89	$4.01	---	--	007	0	0	0.00	$0.00	Y
Q	96165	HLTH BHV IVNTJ GRP EA ADDL	4.89	$4.01	---	--	007	0	0	0.00	$0.00	N
E	96165	PSYCHOLOGY/COUNSELING TREATMENT	2.16	$2.16	---	--	009	0	0	0.00	$0.00	Y
Q	96167	HLTH BHV IVNTJ FAM 1ST 30	75.40	$61.83	---	--	007	0	0	0.00	$0.00	N
N	96167	HLTH BHV IVNTJ FAM 1ST 30	75.40	$61.83	---	--	007	0	0	0.00	$0.00	Y
N	96168	HLTH BHV IVNTJ FAM EA ADDL	26.76	$21.95	---	--	007	0	0	0.00	$0.00	Y
Q	96168	HLTH BHV IVNTJ FAM EA ADDL	26.77	$21.95	---	--	007	0	0	0.00	$0.00	N
Q	96170	HLTH BHV IVNTJ FAM WO PT 1ST	85.72	$70.29	---	--	007	0	0	0.00	$0.00	N
N	96170	HLTH BHV IVNTJ FAM WO PT 1ST	85.71	$70.29	---	--	007	0	0	0.00	$0.00	Y
N	96171	HLTH BHV IVNTJ FAM W/O PT EA	31.15	$25.55	---	--	007	0	0	0.00	$0.00	Y
Q	96171	HLTH BHV IVNTJ FAM W/O PT EA	31.16	$25.55	---	--	007	0	0	0.00	$0.00	N
Q	96202	MLT FAM GRP BHV TRAIN 1ST 60	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	96202	MLT FAM GRP BHV TRAIN 1ST 60	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	96203	MLT FAM GRP BHV TRAIN EA ADD	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
Q	96203	MLT FAM GRP BHV TRAIN EA ADD	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	96360	HYDRATION IV INFUSION INIT	5.13	$51.30	$55.97	$63.71	053	1	0	0.00	$0.00	Y
N	96361	HYDRATE IV INFUSION ADD-ON	1.46	$14.60	$15.93	$18.13	053	1	0	0.00	$0.00	Y
N	96365	THER/PROPH/DIAG IV INF INIT	76.34	$62.60	---	$79.39	007	1	0	0.00	$0.00	Y
N	96366	THER/PROPH/DIAG IV INF ADDON	23.50	$19.27	---	$24.44	007	1	0	0.00	$0.00	Y
N	96367	TX/PROPH/DG ADDL SEQ IV INF	37.86	$31.05	---	$39.37	007	1	0	0.00	$0.00	Y
N	96368	THER/DIAG CONCURRENT INF	21.90	$17.96	---	$22.78	007	1	0	0.00	$0.00	Y
N	96369	SC THER INFUSION UP TO 1 HR	168.79	$138.41	---	$175.54	007	1	0	0.00	$0.00	Y
N	96370	SC THER INFUSION ADDL HR	16.50	$13.53	---	$17.16	007	1	0	0.00	$0.00	Y
N	96371	SC THER INFUSION RESET PUMP	82.60	$67.73	---	$85.90	007	1	0	0.00	$0.00	Y
N	96372	THER/PROPH/DIAG INJ SC/IM	22.86	$18.75	---	$23.77	007	1	0	0.00	$0.00	Y
N	96373	THER/PROPH/DIAG INJ IA	19.39	$15.90	---	$20.17	007	1	0	0.00	$0.00	Y
N	96374	THER/PROPH/DIAG INJ IV PUSH	60.75	$49.82	---	$63.18	007	1	0	0.00	$0.00	Y
N	96375	TX/PRO/DX INJ NEW DRUG ADDON	25.96	$21.29	---	$27.00	007	1	0	0.00	$0.00	Y
N	96377	APPLICATON ON-BODY INJECTOR	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	96379	UNL THER/PROP/DIAG INJ/INF	0.00	$0.00	---	--	007	1	0	0.00	$0.00	Y
N	96401	CHEMO ANTI-NEOPL SQ/IM	13.00	$10.66	---	$13.52	007	1	0	0.00	$0.00	Y
N	96402	CHEMO HORMON ANTINEOPL SQ/IM	13.00	$10.66	---	$13.52	007	1	0	0.00	$0.00	Y
N	96405	CHEMO INTRALESIONAL UP TO 7	47.94	$39.31	---	$49.86	007	1	0	0.00	$0.00	Y
N	96406	CHEMO INTRALESIONAL OVER 7	63.10	$51.74	---	$65.62	007	1	0	0.00	$0.00	Y
N	96409	CHEMO IV PUSH SNGL DRUG	21.90	$17.96	---	$22.78	007	1	0	0.00	$0.00	Y
N	96411	CHEMO IV PUSH ADDL DRUG	21.90	$17.96	---	$22.78	007	1	0	0.00	$0.00	Y
N	96413	CHEMO IV INFUSION 1 HR	34.87	$28.59	---	$36.26	007	1	0	0.00	$0.00	Y
N	96415	CHEMO IV INFUSION ADDL HR	26.21	$21.49	---	--	007	0	0	0.00	$0.00	Y
N	96416	CHEMO PROLONG INFUSE W/PUMP	56.33	$46.19	---	$58.58	007	1	0	0.00	$0.00	Y
N	96417	CHEMO IV INFUS EACH ADDL SEQ	34.87	$28.59	---	$36.26	007	1	0	0.00	$0.00	Y
N	96420	CHEMO IA PUSH TECNIQUE	51.43	$42.17	---	$53.49	007	1	0	0.00	$0.00	Y
N	96422	CHEMO IA INFUSION UP TO 1 HR	45.30	$37.15	---	$47.11	007	1	0	0.00	$0.00	Y
N	96423	CHEMO IA INFUSE EACH ADDL HR	20.39	$16.72	---	--	007	0	0	0.00	$0.00	Y
N	96425	CHEMOTHERAPY INFUSION METHOD	186.63	$153.04	---	$194.10	007	1	0	0.00	$0.00	Y
N	96440	CHEMOTHERAPY INTRACAVITARY	202.90	$166.38	---	$211.02	007	1	0	0.00	$0.00	Y
N	96446	CHEMOTX ADMN PRTL CAVITY	151.54	$124.26	---	$157.60	007	1	0	0.00	$0.00	Y
N	96450	CHEMOTHERAPY INTO CNS	159.32	$130.64	---	$165.69	007	1	0	0.00	$0.00	Y
N	96521	REFILL/MAINT PORTABLE PUMP	20.16	$16.53	---	--	007	0	1	0.00	$0.00	Y
N	96522	REFILL/MAINT PUMP/RESVR SYST	34.23	$28.07	---	$35.60	007	1	1	0.00	$0.00	Y
N	96523	IRRIG DRUG DELIVERY DEVICE	0.00	$0.00	---	--	007	1	0	0.00	$0.00	Y
N	96542	CHEMOTHERAPY INJECTION	104.29	$85.52	---	$108.46	007	1	0	0.00	$0.00	Y
N	96549	UNLISTED CHEMOTHERAPY PX	0.00	$0.00	---	--	007	1	1	0.00	$0.00	Y
N	96567	PHOTODYNAMIC TX SKIN	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	96573	PDT DSTR PRMLG LES PHYS/QHP	214.62	$175.99	---	--	007	0	0	0.00	$0.00	Y
N	96574	DBRDMT PRMLG LES W/PDT	274.79	$225.33	---	--	007	0	0	0.00	$0.00	Y
N	96900	ULTRAVIOLET LIGHT THERAPY	9.02	$7.40	---	$9.38	007	1	1	0.00	$0.00	Y
N	96910	PHOTOCHEMOTHERAPY WITH UV-B	30.00	$24.60	---	$31.20	007	1	1	0.00	$0.00	Y
N	96912	PHOTOCHEMOTHERAPY WITH UV-A	19.46	$15.96	---	$20.24	007	1	1	0.00	$0.00	Y
N	96913	PHOTOCHEMOTHERAPY UV-A OR B	39.79	$32.63	---	$41.38	007	1	0	0.00	$0.00	Y
N	96920	LASER TX SKIN < 250 SQ CM	151.57	$124.29	---	--	007	0	0	0.00	$0.00	Y
N	96921	LASER TX SKIN 250-500 SQ CM	162.40	$133.17	---	--	007	0	0	0.00	$0.00	Y
N	96922	LASER TX SKIN >500 SQ CM	222.13	$182.15	---	--	007	0	0	0.00	$0.00	Y
N	96999	UNLISTED SPEC DERM SVC/PX	0.00	$0.00	---	--	007	1	1	0.00	$0.00	Y
N	97010	APPLICATION	12.00	$9.84	---	$12.48	007	1	1	0.00	$0.00	Y
P	97010	APPLICATION	12.00	$9.84	---	--	019	0	1	0.00	$0.00	Y
P	97012	MECHANICAL TRACTION THERAPY	13.59	$11.14	---	--	019	0	1	0.00	$0.00	Y
N	97012	MECHANICAL TRACTION THERAPY	13.59	$11.14	---	$14.13	007	1	1	0.00	$0.00	Y
N	97014	ELECTRIC STIMULATION THERAPY	13.59	$11.14	---	$14.13	007	1	1	0.00	$0.00	Y
P	97014	ELECTRIC STIMULATION THERAPY	13.59	$11.14	---	--	019	0	1	0.00	$0.00	Y
P	97016	VASOPNEUMATIC DEVICE THERAPY	13.59	$11.14	---	--	019	0	1	0.00	$0.00	Y
N	97016	VASOPNEUMATIC DEVICE THERAPY	13.59	$11.14	---	$14.13	007	1	1	0.00	$0.00	Y
N	97018	PARAFFIN BATH THERAPY	12.00	$9.84	---	$12.48	007	1	1	0.00	$0.00	Y
P	97018	PARAFFIN BATH THERAPY	12.00	$9.84	---	--	019	0	1	0.00	$0.00	Y
P	97022	WHIRLPOOL THERAPY	13.59	$11.14	---	--	019	0	1	0.00	$0.00	Y
N	97022	WHIRLPOOL THERAPY	13.59	$11.14	---	$14.13	007	1	1	0.00	$0.00	Y
N	97024	DIATHERMY EG MICROWAVE	12.00	$9.84	---	$12.48	007	1	1	0.00	$0.00	Y
P	97024	DIATHERMY EG MICROWAVE	12.00	$9.84	---	--	019	0	1	0.00	$0.00	Y
P	97026	INFRARED THERAPY	12.00	$9.84	---	--	019	0	1	0.00	$0.00	Y
N	97026	INFRARED THERAPY	12.00	$9.84	---	$12.48	007	1	1	0.00	$0.00	Y
N	97028	ULTRAVIOLET THERAPY	12.00	$9.84	---	$12.48	007	1	1	0.00	$0.00	Y
P	97028	ULTRAVIOLET THERAPY	12.00	$9.84	---	--	019	0	1	0.00	$0.00	Y
P	97032	APPLICATION A MODALITY TO ONE/MORE AREA	10.56	$8.66	---	--	019	0	1	0.00	$0.00	Y
N	97032	APPLICATION TO ONE OR MORE AREAS	10.56	$8.66	---	$10.98	007	1	1	0.00	$0.00	Y
N	97033	APPLICATION A MODALITY TO ONE/MORE AREA	11.20	$9.18	---	$11.65	007	1	1	0.00	$0.00	Y
P	97033	APPLICATION MODALITY TO ONE/MORE AREA	11.20	$9.18	---	--	019	0	1	0.00	$0.00	Y
P	97034	APPLICATION MODALITY TO ONE/MORE AREA	9.55	$7.83	---	--	019	0	1	0.00	$0.00	Y
N	97034	APPLICATION MODALITY TO ONE/MORE AREA	9.55	$7.83	---	$9.93	007	1	1	0.00	$0.00	Y
N	97035	APPLICATION MODALITY TO ONE/MORE AREA	9.06	$7.43	---	$9.42	007	1	1	0.00	$0.00	Y
P	97035	APPLICATION MODALITY TO ONE/MORE AREA	9.06	$7.43	---	--	019	0	1	0.00	$0.00	Y
P	97036	APPLICATION MODALITY TO 1/MORE AREA	13.59	$11.14	---	--	019	1	1	0.00	$0.00	Y
N	97036	APPLICATION MODALITY TO ONE/MORE AREA	13.59	$11.14	---	$14.13	007	1	1	0.00	$0.00	Y
N	97039	UNLISTED MODALITY	17.40	$14.27	---	$18.10	007	1	1	0.00	$0.00	Y
P	97039	UNLISTED MODALITY	17.40	$14.27	---	--	007	0	1	0.00	$0.00	Y
P	97110	THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M	13.37	$10.96	---	--	019	0	1	0.00	$0.00	Y
N	97110	THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M	13.37	$10.96	---	$13.90	007	1	1	0.00	$0.00	Y
E	97110	THERAPEUTIC PROC, 1 OR MORE AREAS,EA 15M	6.37	$6.37	---	--	009	0	0	0.00	$0.00	Y
N	97112	NEUROMUSCULAR REEDUCATION	14.90	$12.22	---	$15.50	007	1	1	0.00	$0.00	Y
P	97112	NEUROMUSCULAR REEDUCATION	14.90	$12.22	---	--	019	0	1	0.00	$0.00	Y
P	97113	THERAPEUTIC PROC ONE/MORE AREA 15 MIN	16.99	$13.93	---	--	019	0	1	0.00	$0.00	Y
N	97113	THERAPEUTIC PROC ONE/MORE AREA 15 MIN	16.99	$13.93	---	$17.67	007	1	1	0.00	$0.00	Y
N	97116	THERAPEUTIC PROCEDURE, GAIT TRAINING	13.76	$11.28	---	$14.31	007	1	1	0.00	$0.00	Y
P	97116	THERAPEUTIC PROCEDURE, GAIT TRAINING	13.76	$11.28	---	--	019	0	1	0.00	$0.00	Y
P	97124	THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M	12.55	$10.29	---	--	019	0	1	0.00	$0.00	Y
N	97124	THERAPEUTIC PROC,1 OR MORE AREAS,EA 15 M	12.55	$10.29	---	$13.05	007	1	1	0.00	$0.00	Y
N	97129	THER IVNTJ 1ST 15 MIN	25.34	$20.78	---	--	007	0	0	0.00	$0.00	Y
Q	97129	THER IVNTJ 1ST 15 MIN	25.34	$20.78	---	--	007	0	0	0.00	$0.00	N
Q	97130	THER IVNTJ EA ADDL 15 MIN	24.19	$19.84	---	--	007	0	0	0.00	$0.00	N
N	97130	THER IVNTJ EA ADDL 15 MIN	24.19	$19.84	---	--	007	0	0	0.00	$0.00	Y
N	97139	UNLISTED THERAPEUTIC PX	9.33	$7.65	---	$9.70	007	1	1	0.00	$0.00	Y
P	97139	UNLISTED THERAPEUTIC PX	9.33	$7.65	---	--	019	0	1	0.00	$0.00	Y
P	97140	MANUAL THERAPY 1/> REGIONS	27.09	$22.21	---	--	019	1	0	0.00	$0.00	Y
N	97140	MANUAL THERAPY 1/> REGIONS	27.09	$22.21	---	$28.17	007	1	0	0.00	$0.00	Y
E	97150	PT OR OT GROUP TREATMENT	13.54	$13.54	---	--	009	0	0	0.00	$0.00	Y
E	97163	PT EVALUATION	135.56	$135.56	---	--	009	0	0	0.00	$0.00	Y
E	97164	PT RE-EVALUATION	94.14	$94.14	---	--	009	0	0	0.00	$0.00	Y
E	97167	OT EVALUATION	125.74	$125.74	---	--	009	0	0	0.00	$0.00	Y
E	97168	OT RE-EVALUATION	87.32	$87.32	---	--	009	0	0	0.00	$0.00	Y
N	97530	THERAPEUTIC ACTIVITIES	13.59	$11.14	---	$14.13	007	1	1	0.00	$0.00	Y
N	97533	SENSORY INTEGRATION	29.48	$24.17	---	$30.66	007	1	1	0.00	$0.00	Y
E	97533	Q&M TREATMENT	12.34	$12.34	---	--	009	0	0	0.00	$0.00	Y
E	97535	ADL ASSISTANCE	5.31	$5.31	---	--	009	0	0	0.00	$0.00	Y
N	97597	RMVL DEVITAL TIS 20 CM/<	51.35	$42.11	---	$53.40	007	1	0	0.00	$0.00	Y
P	97597	RMVL DEVITAL TIS 20 CM/<	51.35	$42.11	---	--	019	1	0	0.00	$0.00	Y
P	97598	RMVL DEVITAL TIS ADDL 20CM/<	65.21	$53.47	---	--	019	1	0	0.00	$0.00	Y
N	97598	RMVL DEVITAL TIS ADDL 20CM/<	65.21	$53.47	---	$67.82	007	1	0	0.00	$0.00	Y
N	97750	PHYSICAL PERFORMANCE TEST OR MEASUREMENT	14.02	$11.50	---	$14.58	007	1	0	0.00	$0.00	Y
N	97799	UNLISTED PHYSCL MED/REHAB PX	0.00	$0.00	---	--	007	1	1	0.00	$0.00	Y
N	97802	MEDICAL NUTRITION INDIV IN	30.35	$30.35	---	$30.35	009	1	1	0.00	$0.00	Y
T	97802	MED NUTRTN TX;INITIAL ASSMNT PER 15MIN	30.35	$30.35	---	--	009	0	0	0.00	$0.00	Y
T	97803	MED NUTRTN TX;RE-ASSMNT EACH 15MINS	26.11	$26.11	---	--	009	0	0	0.00	$0.00	Y
N	97803	MED NUTRITION INDIV SUBSEQ	26.11	$26.11	---	$26.11	009	1	1	0.00	$0.00	Y
N	97804	MEDICAL NUTRITION GROUP	13.91	$13.91	---	$13.91	009	1	1	0.00	$0.00	Y
T	97804	MED NUTRITION TX EACH 30 MIN	13.91	$13.91	---	--	009	0	0	0.00	$0.00	Y
P	97810	ACUPUNCT W/O STIMUL 15 MIN	7.06	$5.79	---	--	019	1	1	0.00	$0.00	Y
N	97810	ACUPUNCT W/O STIMUL 15 MIN	7.06	$5.79	---	$7.34	007	1	1	0.00	$0.00	Y
N	97811	ACUPUNCT W/O STIMUL ADDL 15M	7.06	$5.79	---	$7.34	007	1	1	0.00	$0.00	Y
P	97811	ACUPUNCT W/O STIMUL ADDL 15M	7.06	$5.79	---	--	019	1	1	0.00	$0.00	Y
P	97813	ACUPUNCT W/STIMUL 15 MIN	7.06	$5.79	---	--	019	1	1	0.00	$0.00	Y
N	97813	ACUPUNCT W/STIMUL 15 MIN	7.06	$5.79	---	$7.34	007	1	1	0.00	$0.00	Y
N	97814	ACUPUNCT W/STIMUL ADDL 15M	7.06	$5.79	---	$7.34	007	1	1	0.00	$0.00	Y
P	97814	ACUPUNCT W/STIMUL ADDL 15M	7.06	$5.79	---	--	019	1	1	0.00	$0.00	Y
N	98925	OSTEOPATH MANJ 1-2 REGIONS	27.57	$27.57	---	--	009	0	0	0.00	$0.00	N
N	98926	OSTEOPATH MANJ 3-4 REGIONS	39.54	$39.54	---	--	009	0	0	0.00	$0.00	N
1	98940	CHIROPRACT MANJ 1-2 REGIONS	16.72	$16.72	---	--	009	0	0	0.00	$0.00	N
1	98941	CHIROPRACT MANJ 3-4 REGIONS	16.72	$16.72	---	--	009	0	0	0.00	$0.00	N
1	98942	CHIROPRACTIC MANJ 5 REGIONS	16.72	$16.72	---	--	009	0	0	0.00	$0.00	N
N	98960	SELF-MGMT EDUC & TRAIN 1 PT	32.51	$26.66	---	--	007	0	0	0.00	$0.00	Y
N	98961	SELF-MGMT EDUC/TRAIN 2-4 PT	15.44	$12.66	---	--	007	0	0	0.00	$0.00	Y
N	98962	SELF-MGMT EDUC/TRAIN 5-8 PT	11.54	$9.46	---	--	007	0	0	0.00	$0.00	Y
N	98978	REM THER MNTR DEV SPLY CBT	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	99000	SPECIMEN HANDLING OFFICE-LAB	4.43	$3.63	---	--	007	0	0	0.00	$0.00	Y
1	99056	OUT OF OFFICE CALL	7.50	$7.50	---	--	009	0	1	0.00	$0.00	N
N	99070	SPECIAL SUPPLIES PHYS/QHP	0.00	$0.00	---	--	009	0	0	0.00	$0.00	Y
P	99070	SPECIAL SUPPLIES PHYS/QHP	0.00	$0.00	---	--	009	0	0	0.00	$0.00	Y
N	99082	TRAVEL TIME / MEDICAL PER HOUR	50.40	$50.40	---	--	009	0	0	0.00	$0.00	N
N	99091	COLLECT/REVIEW DATA FROM PT	48.32	$48.32	---	--	009	0	0	0.00	$0.00	Y
N	99151	MOD SED SAME PHYS/QHP <5 YRS	4.97	$69.63	---	--	002	0	0	0.00	$0.00	Y
N	99152	MOD SED SAME PHYS/QHP 5/>YRS	3.33	$46.65	---	--	002	0	0	0.00	$0.00	Y
N	99153	MOD SED SAME PHYS/QHP EA	0.72	$10.09	---	--	002	0	0	0.00	$0.00	Y
N	99155	MOD SED OTH PHYS/QHP <5 YRS	5.59	$78.32	---	--	002	0	0	0.00	$0.00	Y
N	99156	MOD SED OTH PHYS/QHP 5/>YRS	4.54	$63.61	---	--	002	0	0	0.00	$0.00	Y
N	99157	MOD SED OTHER PHYS/QHP EA	3.44	$48.19	---	--	002	0	0	0.00	$0.00	Y
N	99170	ANOGENITAL EXAM CHILD	10.88	$108.80	$118.70	$135.13	001	1	0	0.00	$0.00	Y
E	99173	VISUAL ACUITY SCREEN	4.03	$4.03	---	--	009	0	0	0.00	$0.00	Y
N	99183	HYPERBARIC OXYGEN THERAPY	113.29	$92.90	---	$117.82	007	1	0	0.00	$0.00	Y
N	99184	HYPOTHERMIA ILL NEONATE	242.80	$199.10	---	--	007	0	0	0.00	$0.00	Y
N	99188	APP TOPICAL FLUORIDE VARNISH	18.00	$18.00	---	--	009	0	0	0.00	$0.00	Y
N	99195	PHLEBOTOMY	20.00	$16.40	---	$20.80	007	1	0	0.00	$0.00	Y
N	99199	UNLISTED SPECIAL SVC PX/RPRT	0.00	$0.00	---	--	007	1	0	0.00	$0.00	Y
N	99202	OFFICE O/P NEW SF 15-29 MIN	3.43	$34.30	$37.42	$42.60	001	1	1	0.00	$0.00	Y
P	99202	OFFICE O/P NEW SF 15-29 MIN	3.43	$34.30	$37.42	--	052	0	1	0.00	$0.00	Y
1	99202	OFFICE O/P NEW SF 15-29 MIN	34.30	$34.30	---	$34.30	009	1	0	0.00	$0.00	Y
1	99203	OFFICE O/P NEW LOW 30-44 MIN	57.20	$57.20	---	$57.20	009	1	0	0.00	$0.00	Y
P	99203	OFFICE O/P NEW LOW 30-44 MIN	5.72	$57.20	$62.41	--	052	0	1	0.00	$0.00	Y
N	99203	OFFICE O/P NEW LOW 30-44 MIN	5.72	$57.20	$62.41	$71.04	001	1	1	0.00	$0.00	Y
N	99204	OFFICE O/P NEW MOD 45-59 MIN	6.89	$68.90	$75.17	$85.57	001	1	1	0.00	$0.00	Y
P	99204	OFFICE O/P NEW MOD 45-59 MIN	6.89	$68.90	$75.17	--	052	1	1	0.00	$0.00	Y
1	99204	OFFICE O/P NEW MOD 45-59 MIN	68.90	$68.90	---	$68.90	009	1	0	0.00	$0.00	Y
1	99205	OFFICE O/P NEW HI 60-74 MIN	82.70	$82.70	---	$82.70	009	1	0	0.00	$0.00	Y
P	99205	OFFICE O/P NEW HI 60-74 MIN	8.27	$82.70	$90.23	--	052	1	1	0.00	$0.00	Y
N	99205	OFFICE O/P NEW HI 60-74 MIN	8.27	$82.70	$90.23	$102.71	001	1	1	0.00	$0.00	Y
N	99211	OFFICE O/P EST MINIMAL PROB	1.20	$12.00	$13.09	$14.90	001	1	1	0.00	$0.00	Y
P	99211	OFFICE O/P EST MINIMAL PROB	1.20	$12.00	$13.09	--	052	0	1	0.00	$0.00	Y
1	99211	OFFICE O/P EST MINIMAL PROB	12.00	$12.00	---	$12.00	009	1	0	0.00	$0.00	Y
1	99212	OFFICE O/P EST SF 10-19 MIN	11.41	$11.41	---	$11.41	009	1	0	0.00	$0.00	Y
P	99212	OFFICE O/P EST SF 10-19 MIN	1.81	$18.10	$19.75	--	052	0	1	0.00	$0.00	Y
N	99212	OFFICE O/P EST SF 10-19 MIN	1.81	$18.10	$19.75	$22.48	001	1	1	0.00	$0.00	Y
N	99213	OFFICE O/P EST LOW 20-29 MIN	2.40	$24.00	$26.18	$29.81	001	1	1	0.00	$0.00	Y
P	99213	OFFICE O/P EST LOW 20-29 MIN	2.40	$24.00	$26.18	--	052	0	1	0.00	$0.00	Y
1	99213	OFFICE O/P EST LOW 20-29 MIN	24.00	$24.00	---	$24.00	009	1	0	0.00	$0.00	Y
1	99214	OFFICE O/P EST MOD 30-39 MIN	37.50	$37.50	---	$37.50	009	1	0	0.00	$0.00	Y
P	99214	OFFICE O/P EST MOD 30-39 MIN	3.75	$37.50	$40.91	--	052	1	1	0.00	$0.00	Y
N	99214	OFFICE O/P EST MOD 30-39 MIN	3.75	$37.50	$40.91	$46.58	001	1	1	0.00	$0.00	Y
N	99215	OFFICE O/P EST HI 40-54 MIN	5.72	$57.20	$62.41	$71.04	001	1	1	0.00	$0.00	Y
P	99215	OFFICE O/P EST HI 40-54 MIN	5.72	$57.20	$62.41	--	052	1	1	0.00	$0.00	Y
1	99215	OFFICE O/P EST HI 40-54 MIN	57.20	$57.20	---	$57.20	009	1	0	0.00	$0.00	Y
P	99221	1ST HOSP IP/OBS SF/LOW 40	3.43	$34.30	$37.42	--	052	0	0	0.00	$0.00	Y
N	99221	1ST HOSP IP/OBS SF/LOW 40	3.43	$34.30	$37.42	$42.60	001	1	0	0.00	$0.00	Y
N	99222	1ST HOSP IP/OBS MODERATE 55	7.32	$73.20	$79.86	$90.91	001	1	0	0.00	$0.00	Y
P	99222	1ST HOSP IP/OBS MODERATE 55	7.32	$73.20	$79.86	--	052	0	0	0.00	$0.00	Y
P	99223	1ST HOSP IP/OBS HIGH 75	8.01	$80.10	$87.39	--	052	0	0	0.00	$0.00	Y
N	99223	1ST HOSP IP/OBS HIGH 75	8.01	$80.10	$87.39	$99.48	001	1	0	0.00	$0.00	Y
N	99231	SBSQ HOSP IP/OBS SF/LOW 25	2.75	$27.50	$30.00	$34.16	001	1	0	0.00	$0.00	Y
P	99231	SBSQ HOSP IP/OBS SF/LOW 25	2.75	$27.50	$30.00	--	052	0	0	0.00	$0.00	Y
P	99232	SBSQ HOSP IP/OBS MODERATE 35	3.78	$37.80	$41.24	--	052	0	0	0.00	$0.00	Y
N	99232	SBSQ HOSP IP/OBS MODERATE 35	3.78	$37.80	$41.24	$46.95	001	1	0	0.00	$0.00	Y
N	99233	SBSQ HOSP IP/OBS HIGH 50	4.58	$45.80	$49.97	$56.88	001	1	0	0.00	$0.00	Y
P	99233	SBSQ HOSP IP/OBS HIGH 50	4.58	$45.80	$49.97	--	052	1	0	0.00	$0.00	Y
N	99234	HOSP IP/OBS SM DT SF/LOW 45	7.47	$74.70	$81.50	$92.78	001	1	0	0.00	$0.00	Y
N	99235	HOSP IP/OBS SAME DATE MOD 70	10.35	$103.50	$112.92	$128.55	001	1	0	0.00	$0.00	Y
N	99236	HOSP IP/OBS SAME DATE HI 85	12.46	$124.60	$135.94	$154.75	001	1	0	0.00	$0.00	Y
N	99238	HOSP IP/OBS DSCHRG MGMT 30/<	3.76	$37.60	$41.02	$46.70	001	1	0	0.00	$0.00	Y
P	99238	HOSP IP/OBS DSCHRG MGMT 30/<	3.76	$37.60	$41.02	--	052	1	0	0.00	$0.00	Y
V	99238	HOSP DISCHARGE DAY MGMT;30 MIN OR LESS	3.76	$37.60	$41.02	$46.70	001	1	0	0.00	$0.00	Y
V	99239	HOSP DISCHARGE DAY MAN MORE THAN 30 MIN	5.34	$53.40	$58.26	$66.32	001	1	0	0.00	$0.00	Y
P	99239	HOSP IP/OBS DSCHRG MGMT >30	5.34	$53.40	$58.26	--	052	1	0	0.00	$0.00	Y
N	99239	HOSP IP/OBS DSCHRG MGMT >30	5.34	$53.40	$58.26	$66.32	001	1	0	0.00	$0.00	Y
N	99242	OFF/OP CONSLTJ NEW/EST SF 20	4.72	$47.20	$51.50	$58.62	053	1	1	0.00	$0.00	Y
P	99242	OFF/OP CONSLTJ NEW/EST SF 20	4.72	$47.20	$51.50	--	052	0	1	0.00	$0.00	Y
1	99242	OFF/OP CONSLTJ NEW/EST SF 20	47.20	$47.20	---	$47.20	009	1	0	0.00	$0.00	Y
1	99243	OFF/OP CNSLTJ NEW/EST LOW 30	59.50	$59.50	---	$59.50	009	1	0	0.00	$0.00	Y
P	99243	OFF/OP CNSLTJ NEW/EST LOW 30	5.95	$59.50	$64.91	--	052	0	1	0.00	$0.00	Y
N	99243	OFF/OP CNSLTJ NEW/EST LOW 30	5.95	$59.50	$64.91	$73.90	053	1	1	0.00	$0.00	Y
N	99244	OFF/OP CNSLTJ NEW/EST MOD 40	8.14	$81.40	$88.81	$101.10	053	1	1	0.00	$0.00	Y
P	99244	OFF/OP CNSLTJ NEW/EST MOD 40	8.14	$81.40	$88.81	--	052	1	1	0.00	$0.00	Y
P	99245	OFF/OP CONSLTJ NEW/EST HI 55	10.22	$102.20	$111.50	--	052	1	1	0.00	$0.00	Y
N	99245	OFF/OP CONSLTJ NEW/EST HI 55	10.22	$102.20	$111.50	$126.93	053	1	1	0.00	$0.00	Y
V	99251	INPATIENT CONSULTATION	33.98	$27.86	---	--	007	0	1	0.00	$0.00	Y
V	99252	INPATIENT CONSULTATION	39.59	$32.46	---	--	007	0	1	0.00	$0.00	Y
N	99252	IP/OBS CONSLTJ NEW/EST SF 35	39.59	$32.46	---	--	007	0	1	0.00	$0.00	Y
P	99252	IP/OBS CONSLTJ NEW/EST SF 35	39.59	$32.46	---	--	019	0	1	0.00	$0.00	Y
P	99253	IP/OBS CNSLTJ NEW/EST LOW 45	56.63	$46.44	---	--	019	0	1	0.00	$0.00	Y
N	99253	IP/OBS CNSLTJ NEW/EST LOW 45	56.63	$46.44	---	--	007	0	1	0.00	$0.00	Y
V	99253	INPATIENT CONSULTATION	56.63	$46.44	---	--	007	0	1	0.00	$0.00	Y
V	99254	INPATIENT CONSULTATION	79.28	$65.01	---	--	007	0	1	0.00	$0.00	Y
N	99254	IP/OBS CNSLTJ NEW/EST MOD 60	79.28	$65.01	---	--	007	0	1	0.00	$0.00	Y
P	99254	IP/OBS CNSLTJ NEW/EST MOD 60	79.28	$65.01	---	--	019	0	1	0.00	$0.00	Y
P	99255	IP/OBS CONSLTJ NEW/EST HI 80	105.18	$86.25	---	--	019	0	1	0.00	$0.00	Y
N	99255	IP/OBS CONSLTJ NEW/EST HI 80	105.18	$86.25	---	--	007	0	1	0.00	$0.00	Y
V	99255	INPATIENT CONSULTATION	105.18	$86.25	---	--	007	0	1	0.00	$0.00	Y
N	99281	EMR DPT VST MAYX REQ PHY/QHP	14.60	$15.18	---	$15.18	017	1	0	0.00	$0.00	Y
P	99281	EMR DPT VST MAYX REQ PHY/QHP	12.61	$10.34	---	--	019	0	0	0.00	$0.00	Y
P	99282	EMERGENCY DEPT VISIT SF MDM	23.42	$19.20	---	--	019	0	0	0.00	$0.00	Y
N	99282	EMERGENCY DEPT VISIT SF MDM	23.44	$24.38	---	$24.38	017	1	0	0.00	$0.00	Y
N	99283	EMERGENCY DEPT VISIT LOW MDM	42.88	$44.60	---	$44.60	017	1	0	0.00	$0.00	Y
P	99283	EMERGENCY DEPT VISIT LOW MDM	42.83	$35.12	---	--	019	0	0	0.00	$0.00	Y
P	99284	EMERGENCY DEPT VISIT MOD MDM	65.65	$53.83	---	--	019	0	0	0.00	$0.00	Y
N	99284	EMERGENCY DEPT VISIT MOD MDM	65.72	$68.35	---	$68.35	017	1	0	0.00	$0.00	Y
N	99285	EMERGENCY DEPT VISIT HI MDM	103.92	$108.08	---	$108.08	017	1	0	0.00	$0.00	Y
P	99285	EMERGENCY DEPT VISIT HI MDM	131.81	$108.08	---	--	019	1	0	0.00	$0.00	Y
N	99291	CRITICAL CARE FIRST HOUR	12.16	$121.60	$132.67	$151.03	001	1	0	0.00	$0.00	Y
N	99292	CRITICAL CARE ADDL 30 MIN	5.89	$58.90	$64.26	$73.15	001	1	0	0.00	$0.00	Y
N	99304	1ST NF CARE SF/LOW MDM 25	3.78	$37.80	$41.24	--	001	0	0	0.00	$0.00	Y
P	99304	1ST NF CARE SF/LOW MDM 25	3.78	$37.80	$41.24	--	052	0	0	0.00	$0.00	Y
P	99305	1ST NF CARE MODERATE MDM 35	4.69	$46.90	$51.17	--	052	0	0	0.00	$0.00	Y
N	99305	1ST NF CARE MODERATE MDM 35	4.69	$46.90	$51.17	--	001	0	0	0.00	$0.00	Y
N	99306	1ST NF CARE HIGH MDM 45	7.21	$72.10	$78.66	--	001	0	0	0.00	$0.00	Y
P	99306	1ST NF CARE HIGH MDM 45	7.21	$72.10	$78.66	--	052	0	0	0.00	$0.00	Y
P	99307	SBSQ NF CARE SF MDM 10	1.37	$13.70	$14.95	--	052	0	0	0.00	$0.00	Y
N	99307	SBSQ NF CARE SF MDM 10	1.37	$13.70	$14.95	--	001	0	0	0.00	$0.00	Y
N	99308	SBSQ NF CARE LOW MDM 15	2.75	$27.50	$30.00	--	001	0	0	0.00	$0.00	Y
P	99308	SBSQ NF CARE LOW MDM 15	2.75	$27.50	$30.00	--	052	0	0	0.00	$0.00	Y
P	99309	SBSQ NF CARE MODERATE MDM 30	4.00	$40.00	$43.64	--	052	0	0	0.00	$0.00	Y
N	99309	SBSQ NF CARE MODERATE MDM 30	4.00	$40.00	$43.64	--	001	0	0	0.00	$0.00	Y
N	99310	SBSQ NF CARE HIGH MDM 45	5.20	$52.00	$56.73	--	001	0	0	0.00	$0.00	Y
P	99310	SBSQ NF CARE HIGH MDM 45	5.20	$52.00	$56.73	--	052	0	0	0.00	$0.00	Y
P	99315	NF DSCHRG MGMT 30 MIN/LESS	3.84	$38.40	$41.89	--	052	1	0	0.00	$0.00	Y
N	99315	NF DSCHRG MGMT 30 MIN/LESS	3.84	$38.40	$41.89	$47.69	001	1	0	0.00	$0.00	Y
N	99316	NF DSCHRG MGMT 30 MIN+	4.66	$46.60	$50.84	$57.88	001	1	0	0.00	$0.00	Y
P	99316	NF DSCHRG MGMT 30 MIN+	4.66	$46.60	$50.84	--	052	1	0	0.00	$0.00	Y
P	99341	HOME/RES VST NEW SF MDM 15	3.67	$36.70	$40.04	--	052	0	0	0.00	$0.00	Y
N	99341	HOME/RES VST NEW SF MDM 15	4.12	$41.20	$44.95	$51.17	001	1	0	0.00	$0.00	Y
V	99341	HOME VISIT NEW PATIENT	4.12	$41.20	$44.95	$51.17	001	1	0	0.00	$0.00	Y
V	99342	HOME VISIT NEW PATIENT	4.92	$49.20	$53.68	$61.11	001	1	0	0.00	$0.00	Y
N	99342	HOME/RES VST NEW LOW MDM 30	4.92	$49.20	$53.68	$61.11	001	1	0	0.00	$0.00	Y
P	99342	HOME/RES VST NEW LOW MDM 30	4.38	$43.80	$47.79	--	052	0	0	0.00	$0.00	Y
V	99343	HOME VISIT NEW PATIENT	6.29	$62.90	$68.62	$78.12	001	1	0	0.00	$0.00	Y
V	99344	HOME VISIT NEW PATIENT	7.70	$77.00	$84.01	$95.63	001	1	0	0.00	$0.00	Y
P	99344	HOME/RES VST NEW MOD MDM 60	6.86	$68.60	$74.84	--	052	0	0	0.00	$0.00	Y
N	99344	HOME/RES VST NEW MOD MDM 60	7.70	$77.00	$84.01	$95.63	001	1	0	0.00	$0.00	Y
N	99345	HOME/RES VST NEW HIGH MDM 75	9.43	$94.30	$102.88	$117.12	001	1	0	0.00	$0.00	Y
P	99345	HOME/RES VST NEW HIGH MDM 75	8.40	$84.00	$91.64	--	052	0	0	0.00	$0.00	Y
V	99345	HOME VISIT NEW PATIENT	9.43	$94.30	$102.88	$117.12	001	1	0	0.00	$0.00	Y
V	99347	HOME VISIT EST PATIENT	2.52	$25.20	$27.49	$31.30	001	1	0	0.00	$0.00	Y
P	99347	HOME/RES VST EST SF MDM 20	2.24	$22.40	$24.44	--	052	0	0	0.00	$0.00	Y
N	99347	HOME/RES VST EST SF MDM 20	2.52	$25.20	$27.49	$31.30	001	1	0	0.00	$0.00	Y
N	99348	HOME/RES VST EST LOW MDM 30	3.43	$34.30	$37.42	$42.60	001	1	0	0.00	$0.00	Y
P	99348	HOME/RES VST EST LOW MDM 30	3.06	$30.60	$33.38	--	052	0	0	0.00	$0.00	Y
V	99348	HOME VISIT EST PATIENT	3.43	$34.30	$37.42	$42.60	001	1	0	0.00	$0.00	Y
V	99349	HOME VISIT EST PATIENT	5.16	$51.60	$56.30	$64.09	001	1	0	0.00	$0.00	Y
P	99349	HOME/RES VST EST MOD MDM 40	4.60	$46.00	$50.19	--	052	0	0	0.00	$0.00	Y
N	99349	HOME/RES VST EST MOD MDM 40	5.16	$51.60	$56.30	$64.09	001	1	0	0.00	$0.00	Y
N	99350	HOME/RES VST EST HIGH MDM 60	8.01	$80.10	$87.39	$99.48	001	1	0	0.00	$0.00	Y
P	99350	HOME/RES VST EST HIGH MDM 60	7.14	$71.40	$77.90	--	052	0	0	0.00	$0.00	Y
V	99350	HOME VISIT EST PATIENT	8.01	$80.10	$87.39	$99.48	001	1	0	0.00	$0.00	Y
1	99358	PROLONG SERVICE W/O CONTA	42.20	$42.20	---	--	009	0	0	0.00	$0.00	Y
1	99359	PROLONG SERVICE W/O CONTA	21.10	$21.10	---	--	009	0	0	0.00	$0.00	Y
N	99360	PHYSICIAN STANDBY SERV, REQ PROL ATTENDA	2.55	$25.50	$27.82	$31.67	053	1	0	0.00	$0.00	Y
N	99366	TEAM CONF W/PAT BY HC PRO	37.24	$30.54	---	--	007	0	0	0.00	$0.00	Y
Q	99366	TEAM CONF W/PAT BY HC PRO	18.98	$18.98	---	--	009	0	0	0.00	$0.00	N
V	99366	TEAM CONF W/PAT BY HC PRO	37.24	$30.54	---	--	007	0	0	0.00	$0.00	Y
V	99368	TEAM CONF W/O PAT BY HC PRO	34.54	$28.32	---	--	007	0	0	0.00	$0.00	Y
Q	99368	TEAM CONF W/O PAT BY HC PRO	18.98	$18.98	---	--	009	0	0	0.00	$0.00	N
N	99368	TEAM CONF W/O PAT BY HC PRO	34.54	$28.32	---	--	007	0	0	0.00	$0.00	Y
N	99381	INIT PM E/M NEW PAT INFANT	37.46	$45.33	$45.33	--	031	0	0	0.00	$0.00	Y
N	99382	INIT PM E/M NEW PAT 1-4 YRS	38.95	$47.13	$47.13	--	031	0	0	0.00	$0.00	Y
N	99383	PREV VISIT NEW AGE 5-11	45.31	$54.83	$54.83	--	031	0	0	0.00	$0.00	Y
N	99384	PREV VISIT NEW AGE 12-17	54.36	$65.78	$65.78	--	031	0	0	0.00	$0.00	Y
N	99385	PREV VISIT NEW AGE 18-39	11.41	$114.10	$124.48	--	001	0	0	0.00	$0.00	Y
N	99386	PREV VISIT NEW AGE 40-64	0.00	$0.00	---	--	001	0	0	0.00	$0.00	Y
N	99387	INIT PM E/M NEW PAT 65+ YRS	0.00	$0.00	---	--	001	1	1	0.00	$0.00	Y
N	99391	PER PM REEVAL EST PAT INFANT	28.67	$34.69	$34.69	--	031	0	0	0.00	$0.00	Y
N	99392	PREV VISIT EST AGE 1-4	30.90	$37.39	$37.39	--	031	0	0	0.00	$0.00	Y
N	99393	PREV VISIT EST AGE 5-11	36.24	$43.85	$43.85	--	031	0	0	0.00	$0.00	Y
N	99394	PREV VISIT EST AGE 12-17	45.31	$54.83	$54.83	--	031	0	0	0.00	$0.00	Y
N	99395	PREV VISIT EST AGE 18-39	10.29	$102.90	$112.26	--	001	0	0	0.00	$0.00	Y
N	99396	PREV VISIT EST AGE 40-64	0.00	$0.00	---	--	001	0	0	0.00	$0.00	Y
N	99397	PER PM REEVAL EST PAT 65+ YR	0.00	$0.00	---	--	001	1	1	0.00	$0.00	Y
E	99401	PREVENTIVE COUNSELING INDIV	12.94	$12.94	---	--	009	0	0	0.00	$0.00	Y
N	99406	BEHAV CHNG SMOKING 310 MIN	12.70	$10.41	---	--	007	0	0	0.00	$0.00	Y
Q	99406	BEHAV CHNG SMOKING 3 10 MIN	12.70	$10.41	---	--	007	0	0	0.00	$0.00	N
Q	99407	BEHAV CHNG SMOKING > 10 MIN)	24.30	$19.93	---	--	007	0	0	0.00	$0.00	N
N	99407	BEHAV CHNG SMOKING > 10 MIN	24.30	$19.93	---	--	007	0	0	0.00	$0.00	Y
N	99415	PROLNG CLIN STAFF SVC 1ST HR	8.11	$8.11	---	--	009	0	0	0.00	$0.00	Y
N	99416	PROLNG CLIN STAFF SVC EA ADD	4.49	$4.49	---	--	009	0	0	0.00	$0.00	Y
N	99417	PROLNG OP E/M EACH 15 MIN	28.38	$28.38	---	--	009	0	1	0.00	$0.00	Y
1	99417	PROLNG OP E/M EACH 15 MIN	28.38	$28.38	---	--	009	0	0	0.00	$0.00	Y
N	99418	PROLNG IP/OBS E/M EA 15 MIN	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
P	99418	PROLNG IP/OBS E/M EA 15 MIN	0.00	$0.00	---	--	019	0	0	0.00	$0.00	Y
P	99424	PRIN CARE MGMT PHYS 1ST 30	7.13	$71.30	$77.79	--	052	0	0	0.00	$0.00	Y
N	99424	PRIN CARE MGMT PHYS 1ST 30	71.31	$71.31	---	--	009	0	0	0.00	$0.00	Y
N	99425	PRIN CARE MGMT PHYS EA ADDL	51.53	$51.53	---	--	009	0	0	0.00	$0.00	Y
P	99425	PRIN CARE MGMT PHYS EA ADDL	5.15	$51.50	$56.19	--	052	0	0	0.00	$0.00	Y
P	99426	PRIN CARE MGMT STAFF 1ST 30	5.44	$54.40	$59.35	--	052	0	0	0.00	$0.00	Y
N	99426	PRIN CARE MGMT STAFF 1ST 30	54.41	$54.41	---	--	009	0	0	0.00	$0.00	Y
N	99427	PRIN CARE MGMT STAFF EA ADDL	41.93	$41.93	---	--	009	0	0	0.00	$0.00	Y
P	99427	PRIN CARE MGMT STAFF EA ADDL	4.19	$41.90	$45.71	--	052	0	0	0.00	$0.00	Y
N	99429	UNLISTED PREVENTIVE MED.	0.00	$0.00	---	--	001	0	1	0.00	$0.00	Y
N	99437	CHRNC CARE MGMT PHYS EA ADDL	52.49	$52.49	---	--	009	0	0	0.00	$0.00	Y
P	99437	CHRNC CARE MGMT PHYS EA ADDL	5.24	$52.40	$57.17	--	052	0	0	0.00	$0.00	Y
N	99439	CHRNC CARE MGMT SVC EA ADDL	32.58	$32.58	---	--	009	0	1	0.00	$0.00	Y
N	99451	NTRPROF PH1/NTRNET/EHR 5/>	31.45	$31.45	---	--	009	0	0	0.00	$0.00	N
N	99453	REM MNTR PHYSIOL PARAM SETUP	17.77	$17.77	---	--	009	0	0	0.00	$0.00	Y
N	99454	REM MNTR PHYSIOL PARAM DEV	58.92	$58.92	---	--	009	0	0	0.00	$0.00	Y
N	99457	REM PHYSIOL MNTR 1ST 20 MIN	44.84	$44.84	---	--	009	0	0	0.00	$0.00	Y
N	99458	REM PHYSIOL MNTR EA ADDL 20	35.59	$35.59	---	--	009	0	0	0.00	$0.00	Y
N	99460	INIT NB EM PER DAY HOSP	4.72	$47.20	$51.50	--	001	0	0	0.00	$0.00	Y
N	99461	INIT NB EM PER DAY NON-FAC	7.28	$72.80	$79.42	--	001	0	0	0.00	$0.00	Y
N	99462	SBSQ NB EM PER DAY HOSP	2.52	$25.20	$27.49	--	001	0	0	0.00	$0.00	Y
N	99463	SAME DAY NB DISCHARGE	113.75	$93.28	---	--	007	0	0	0.00	$0.00	Y
N	99464	ATTENDANCE AT DELIVERY	5.92	$59.20	$64.59	$73.53	001	1	0	0.00	$0.00	Y
N	99465	NB RESUSCITATION	12.20	$122.00	$133.10	--	001	0	0	0.00	$0.00	Y
N	99466	PED CRIT CARE TRANSPORT	236.54	$193.96	---	--	007	0	0	0.00	$0.00	Y
N	99467	PED CRIT CARE TRANSPORT ADDL	118.04	$96.79	---	--	007	0	0	0.00	$0.00	Y
N	99468	NEONATE CRIT CARE INITIAL	364.64	$299.00	---	--	007	0	0	0.00	$0.00	Y
N	99469	NEONATE CRIT CARE SUBSQ	175.02	$143.52	---	--	007	0	0	0.00	$0.00	Y
N	99471	PED CRITICAL CARE INITIAL	364.64	$299.00	---	--	007	0	0	0.00	$0.00	Y
N	99472	PED CRITICAL CARE SUBSQ	175.02	$143.52	---	--	007	0	0	0.00	$0.00	Y
N	99475	PED CRIT CARE AGE 2-5 INIT	364.64	$299.00	---	--	007	0	0	0.00	$0.00	Y
N	99476	PED CRIT CARE AGE 2-5 SUBSQ	175.02	$143.52	---	--	007	0	0	0.00	$0.00	Y
N	99477	INIT DAY HOSP NEONATE CARE	323.76	$265.48	---	$336.71	007	1	0	0.00	$0.00	Y
N	99478	IC LBW INF < 1500 GM SUBSQ	148.18	$121.51	---	--	007	0	0	0.00	$0.00	Y
N	99479	IC LBW INF 1500-2500 G SUBSQ	127.33	$104.41	---	--	007	0	0	0.00	$0.00	Y
N	99480	IC INF PBW 2501-5000 G SUBSQ	120.28	$98.63	---	--	007	0	0	0.00	$0.00	Y
N	99483	ASSMT & CARE PLN PT COG IMP	300.80	$246.66	---	--	007	0	0	0.00	$0.00	Y
N	99485	SUPRV INTERFACILTY TRANSPORT	76.31	$62.57	---	--	007	0	0	0.00	$0.00	Y
N	99486	SUPRV INTERFAC TRNSPORT ADDL	66.40	$54.44	---	--	007	0	0	0.00	$0.00	Y
N	99490	CHRNC CARE MGMT SVC 1ST 20	45.11	$45.11	---	--	009	0	0	0.00	$0.00	Y
V	99490	CHRNC CARE MGMT SVC 1ST 20	45.11	$45.11	---	--	009	0	0	0.00	$0.00	Y
N	99491	CHRNC CARE MGMT SVC 30 MIN	71.19	$71.19	---	--	009	0	0	0.00	$0.00	Y
N	99492	1ST PSYC COLLAB CARE MGMT	141.26	$141.26	---	--	009	0	0	0.00	$0.00	Y
N	99493	SBSQ PSYC COLLAB CARE MGMT	112.14	$112.14	---	--	009	0	0	0.00	$0.00	Y
N	99494	1ST/SBSQ PSYC COLLAB CARE	57.88	$57.88	---	--	009	0	0	0.00	$0.00	Y
N	99497	ADVNCD CARE PLAN 30 MIN	69.59	$69.59	---	--	009	0	0	0.00	$0.00	Y
V	99497	ADVNCD CARE PLAN 30 MIN	69.59	$69.59	---	--	009	0	0	0.00	$0.00	Y
V	99498	ADVNCD CARE PLAN ADDL 30 MIN	62.64	$62.64	---	--	009	0	0	0.00	$0.00	Y
N	99498	ADVNCD CARE PLAN ADDL 30 MIN	62.64	$62.64	---	--	009	0	0	0.00	$0.00	Y
N	99499	UNLISTED E & M SERVICE	0.00	$0.00	---	--	007	1	1	0.00	$0.00	Y
N	99501	HOME VISIT POSTNATAL	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	99502	HOME VISIT NB CARE	0.00	$0.00	---	--	007	0	0	0.00	$0.00	Y
N	99600	UNLISTED HOME VISIT SVC/PX	0.00	$0.00	---	--	007	0	0	0.00	$0.00	N