Section: File Summary
Hospital Name	Prices Posted And Effective	File Disclaimer	Payer Disclaimer	HC11200004	Gross Charges	Discounted Cash Price	Inpatient De-identified Negotiated Charge	Inpatient Payer Specific Charge	Outpatient De-identified Negotiated Charge	Outpatient Payer Specific Charge
Long Beach Memorial Medical Center	8/1/2023 12:00:00 AM	The information contained in this file is intended for informational purposes only and does not represent any obligation or agreement.	In the absence of payment rates by plan type (HMO vs PPO), unless otherwise noted, please assume all plans are contracted under the same payer specific negotiated charge.	HC11200011	Gross Charges	This section presents information regarding discounted cash pricing for those patients who decide to pay without insurance coverage.	This section presents the de-identified minimum and maximum charge for items, services, and service packages that occur in the inpatient setting.	This section presents the payer specific negotiated charge for items, services, and service packages that occur in the inpatient setting.	This section presents the de-identified minimum and maximum charge for items, services, and service packages that occur in the outpatient setting.	This section presents the payer specific negotiated charge for items, services, and service packages that occur in the outpatient setting.

Section: Gross Charges
Itemcode	Description	CDM Revenue Code	CDM Hcpcs	Item Price	Item Discount Cash Price	Fee Price	Fee Discount Cash Price
HC11200004	OBSERVATION PER HOUR - ICU	762	G0378	619	N/A	N/A	N/A
HC11200031	OBSERVATION PER HOUR - MED/SURG	762	G0378	253	N/A	N/A	N/A
HC11200043	OBSERVATION PER HOUR - TELEMETRY	762	G0378	405	N/A	N/A	N/A
HC11200096	OBSERVATION PER HOUR - PEDS ICU	762	G0378	710	N/A	N/A	N/A
HC11200131	OBSERVATION PER HOUR -PACU	762	G0378	350	N/A	N/A	N/A
HC11200144	TRANSPORT EXTERNAL NICU RN ACCOMP(STATISTICAL)	222		N/A	N/A	N/A	N/A
HC11200169	TRANSPORT EXTERNAL PEDIATRIC RN ACCOMP (STATISTICAL)	222		N/A	N/A	N/A	N/A
HC11200177	DESENSITIZATION RAPID EA HR	924	95180	1,027	N/A	N/A	N/A
HC11500014	EST PT LVL2-PROB FOCUS	510	99212	210	N/A	N/A	N/A
HC11500048	EST PT LVL5-COMPREHENSIVE	510	99215	349	N/A	N/A	N/A
HC11500089	NEW PT LVL4-DETAILED	510	99204	462	N/A	N/A	N/A
HC11500477	LACTATION E&M LIMITD NEW L:II	761	99202	228	N/A	N/A	N/A
HC11500501	LACTATION E&M COMPRHNS EST'D L:V	761	99215	394	N/A	N/A	N/A
HC11500543	LACTATION E&M EXT'D NEW L:IV	761	99204	321	N/A	N/A	N/A
HC11500659	WC NEW E&M ASSESS MINOR LVL 2	761	99202	276	N/A	N/A	N/A
HC11500675	WC NEW E&M ASSESS EXTENDED L:4	761	99204	544	N/A	N/A	N/A
HC11500709	WC ESTB E&M  MINOR LVL 2	761	99212	276	N/A	N/A	N/A
HC11500733	WC ESTB E&M  COMPREHENSIVE L:5	761	99215	544	N/A	N/A	N/A
HC11500782	AM/PACU EVAL MOD/HI-IV	761	99214	622	N/A	N/A	N/A
HC11500824	PEDS ESTAB PT ASSESS LTD(10')	761	99212	262	N/A	N/A	N/A
HC11500857	PEDS ESTAB PT ASSESS COMP(40')	761	99215	619	N/A	N/A	N/A
HC11500881	INFANT EXAM 20 MIN	761	99212	224	N/A	N/A	N/A
HC11500907	WM EXAM EST' PT EVAL  BRIEF LVL1	761	99211	154	N/A	N/A	N/A
HC11500949	WM EXAM NEW PT EVAL  MINOR LVL 2	761	99202	226	N/A	N/A	N/A
HC11500972	WM EXAM NEW PT EVAL  COMPLEX L 5	761	99205	483	N/A	N/A	N/A
HC11501020	COLLECTION SPECIMEN SARS-COV-2	300	C9803	198	N/A	N/A	N/A
HC11501053	HOSPITAL OUTPATIENT VISIT W/PROC	761	G0463	750	N/A	N/A	N/A
HC12200028	IV INF HYDRATION INITIAL HR	260	96360	886	N/A	N/A	N/A
HC12200051	IV INF THER SEQ/NEW RX 1ST HR	260	96367	574	N/A	N/A	N/A
HC12200077	IVP SINGLE/EA NEW RX ADD'L INJ	260	96375	458	N/A	N/A	N/A
HC12200085	IVP SINGLE/REPEAT RX ADD'L INJ	260	96376	266	N/A	N/A	N/A
HC12200101	IVAD IRRIGATION	940	96523	403	N/A	N/A	N/A
HC12200135	BLOOD DRAW IMP'T VENOUS DEVICE	300	36591	649	N/A	N/A	N/A
HC12200176	INF CNTR-NEW PT EVAL HI/MOD	510	99204	467	N/A	N/A	N/A
HC12200200	INF CNTR-ESTB'D PT EVAL MOD/HI	510	99214	465	N/A	N/A	N/A
HC12200234	INF CNTR-ESTBL'D PT EVAL-CMPLX	510	99215	609	N/A	N/A	N/A
HC12200267	SC INFUSION THERAPY INITIAL UP TO 1HR	260	96369	1,614	N/A	N/A	N/A
HC12200283	SC INFUSION THERAPY; ADD'L SET UP NEW SITE	260	96371	441	N/A	N/A	N/A
HC12200291	APPLY ON-BODY INJECTOR FOR TIMED SQ INJ	260	96377	316	N/A	N/A	N/A
HC12200325	IV INFUSE/SC MONOCLONAL CASIRIVIMAB/IMDEVIMAB (REGENERON)	771	M0243	1,904	N/A	N/A	N/A
HC12200382	IV INFUSE MONOCLONAL TOCILIZUMAB >2YEARS INITIAL	771	M0249	1,460	N/A	N/A	N/A
HC12200416	INJECTIONS MONOCLONAL TIXAGEN/CILGAV	771	M0220	575	N/A	N/A	N/A
HC12400016	CHEMO ADMIN IV ADD'L HR	335	96415	933	N/A	N/A	N/A
HC12400040	CHEMO ADMIN IVP SNGL/ADD'L INJ	335	96411	1,028	N/A	N/A	N/A
HC12400073	CHEMO HORMON ANTINEOPL SQ/IM	331	96402	853	N/A	N/A	N/A
HC12400107	INTRAPERITONEAL CHEMO THERAPY	335	96446	1,774	N/A	N/A	N/A
HC12400123	CHEMO ADMIN PLEURAL CAV W/THORACENTESIS	331	96440	2,536	N/A	N/A	N/A
HC12400156	CHEMO ADMIN INTRA ARTERIAL INF EA ADDL HR+	335	96423	388	N/A	N/A	N/A
HC12600029	ADMIN VACCINE INFLUENZA	771	G0008	184	N/A	N/A	N/A
HC12600060	ADMIN VACCINE COVID-19 30MCG/0.3ML INITIAL DOSE {PFIZER-BIONTECH}	771	0001A	131	N/A	N/A	N/A
HC12600094	ADMIN VACCINE COVID-19 100MCG/O.5 2ND DOSE {MODERNA}	771	0012A	128	N/A	N/A	N/A
HC12600128	ADMIN VACCINE COVID-19 100MCG/0.5 3RD DOSE {MODERNA}	771	0013A	139	N/A	N/A	N/A
HC12600151	ADMIN VACCINE COVID-19 50MCG/0.25 LO DOSE BOOSTER {MODERNA}	771	0064A	139	N/A	N/A	N/A
HC12600177	ADMIN VACCINE COVID-19 10MCG TRS-SUCR PEDS DOSE 2ND {PFIZER}	771	0072A	139	N/A	N/A	N/A
HC12600201	ADMIN VACCINE COVID-19 5MCG/0.5ML INITIAL DOSE {NOVAVAX}	771	0041A	125	N/A	N/A	N/A
HC12600235	ADMIN VACCINE COVID-19 30MCG TRS-SUCR 2ND DOSE {PFIZER}	771	0052A	125	N/A	N/A	N/A
HC12600268	ADMIN VACCINE COVID-19 10MCG TRS-SUCR PEDS DOSE 3RD {PFIZER}	771	0073A	125	N/A	N/A	N/A
HC12600300	ADMIN VACCINE COVID-19 25MCG/0.25ML IM PEDS DOSE INITIAL {MODERNA}	771	0111A	115	N/A	N/A	N/A
HC12600334	ADMIN VACCINE COVID-19 50 MCG/0.5 ML1ST {MODERNA}	771	0091A	139	N/A	N/A	N/A
HC12600391	ADMIN VACCINE COVID-19 BIVALENT 30MCG/0.3ML BOOSTER {PFIZER-BIONTECH}	771	0124A	115	N/A	N/A	N/A
HC12800009	PHLEBOTOMY THERAPEUTIC	940	99195	1,179	N/A	N/A	N/A
HC12800017	THER APHER W/EXTRACORP IMMUNO/ADSORP/FILTRATION	361	36516	13,653	N/A	N/A	N/A
HC12800041	THERAPEUTIC APHERESIS PLASMA	361	36514	10,036	N/A	N/A	N/A
HC12800074	THERAPEUTIC APHERESIS WBC'S	361	36511	7,696	N/A	N/A	N/A
HC13300009	LACTATION CONSULT IP 30 MIN (ST)	940		N/A	N/A	N/A	N/A
HC13500038	GENETIC CNSL RISK REDCTN 45MIN	942	99403	365	N/A	N/A	N/A
HC13500061	GENETIC COUNSELING EA 30MIN/P	940	96040	362	N/A	N/A	N/A
HC14500060	PREGNANCY DIAB MGT 1HR	942	99213	335	N/A	N/A	N/A
HC14500086	PREGNANCY DIAB MGT 2HR	942	99214	382	N/A	N/A	N/A
HC14500094	DIABETIC SELF MGMT TRN GRP 30M	942	G0109	202	N/A	N/A	N/A
HC14500110	DM PHONE CONSULT OP 15MIN (ST)	942		N/A	N/A	N/A	N/A
HC21000005	ABRASION; EA ADDL LESION 4OR<	361	15787	791	N/A	N/A	N/A
HC21000161	ASPIRATION OF ABCESS/CYST-ADDL	361	10160	2,401	N/A	N/A	N/A
HC21000195	BX BONE OPEN; SUPERFICIAL	361	20240	12,922	N/A	N/A	N/A
HC21000229	DEBRID/REMVL OPEN FX SKIN/SBQ	361	11010	3,477	N/A	N/A	N/A
HC21000252	DEBRIDE OF NAILS: 1-5	361	11720	689	N/A	N/A	N/A
HC21000286	DEBRIDE P-THICK BURN 5-10% BSA	361	16025	2,004	N/A	N/A	N/A
HC21000302	DEBRIDE SKIN EXT UP TO 10% BSA	361	11000	2,687	N/A	N/A	N/A
HC21000351	DBRD SKIN MUSL/BONE TO 20SQCM	361	11044	8,143	N/A	N/A	N/A
HC21000385	I&D HEMATOMA OR FLUID COLL	361	10140	7,231	N/A	N/A	N/A
HC21000450	GRAFTING SNGL/MULT UP TO 2CM	361	15050	5,182	N/A	N/A	N/A
HC21000484	I&D POLINIDAL CYST: SIMPLE	361	10080	1,874	N/A	N/A	N/A
HC21000518	PAIRING BENIGN LESION: 1	361	11055	609	N/A	N/A	N/A
HC21000542	PREP SITE TRUNK/EXT<100SQCM	361	15002	4,032	N/A	N/A	N/A
HC21000567	PREP SITE/SCR F/N/HF/G<100SQCM	361	15004	3,499	N/A	N/A	N/A
HC21000591	DEBRIDE OPN WND 1ST 20SQCM OR<	361	97597	2,018	N/A	N/A	N/A
HC21000625	WOUND VAC W/ DME <50 SQ CM PER SESSION	361	97605	1,134	N/A	N/A	N/A
HC21000666	REMOV IMPACTD EAR WAX(INSTRUMENT) BI           (NO MOD50)	361	69210	766	N/A	N/A	N/A
HC21000690	APPLY MULTILAY COMPRS BK BIL	361	29581	2,352	N/A	N/A	N/A
HC21000724	DBRD SKN MUSL/BON EA ADD20CM/<	361	11047	6,819	N/A	N/A	N/A
HC21000757	LAC REPAIR 7.6-12 5CM(MEDIUM)	361	12004	1,393	N/A	N/A	N/A
HC21000773	APPY SKIN SUB T A L 1ST 25SQ~HC	361	15271	3,747	N/A	N/A	N/A
HC21000781	APPY SKIN SUB T A L EA +25SQ~HC	361	15272	2,437	N/A	N/A	N/A
HC21000807	APPY SKIN SUB T A L EA+ 100SQ~HC	361	15274	3,159	N/A	N/A	N/A
HC21000831	APPY SKIN SUB HED/HND/FT 1ST100SQ~HC	361	15277	5,362	N/A	N/A	N/A
HC21000922	APPLY MULTILAY COMPRS UPREX LT	361	29584	1,158	N/A	N/A	N/A
HC21000955	APPY SKIN SUB T A L EA +25SQ~LC	361	C5272	3,080	N/A	N/A	N/A
HC21000989	APPY SKIN SUB HEAD/HND/FT 1ST25SQ~LC	361	C5275	4,602	N/A	N/A	N/A
HC21001011	APPY SKIN SUB HED/HND/FT EA+100SQ~LC	361	C5278	4,219	N/A	N/A	N/A
HC21001037	REMOV IMPACTD EAR WAX(INSTRUMENT) RT	361	69210	382	N/A	N/A	N/A
HC21001045	REMOV IMPACTD EAR WAX IRRIG/LAVG BI	361	69209	545	N/A	N/A	N/A
HC21001060	REMOV IMPACTD EAR WAX IRRIG/LAVG RT	361	69209	299	N/A	N/A	N/A
HC22000012	OST NEW PT EVAL LVL2-(20MIN)	761	99202	227	N/A	N/A	N/A
HC22000046	OST NEW PT EVAL LVL5-(60MIN)	761	99205	793	N/A	N/A	N/A
HC22000079	OST EST PT EVAL LVL 3-(15MIN)	761	99213	397	N/A	N/A	N/A
HC23000003	ANALYSIS IMPLANTED PUMP W/PROG	361	62368	2,159	N/A	N/A	N/A
HC23000045	ASP/INJ JOINT SM W/O UTZ GUIDE-LT	361	20600	1,547	N/A	N/A	N/A
HC23000078	ASP/INJ JOINT MED W/O UTZ GUIDE-LT	361	20605	2,021	N/A	N/A	N/A
HC23000094	ASP/INJ JOINT LRG W/O UTZ GUIDE-BILAT	361	20610	4,946	N/A	N/A	N/A
HC23000250	DESTRUCT OTHER PERIPH SNGL BI	361	64640	11,981	N/A	N/A	N/A
HC23000292	DESTRUCT CELIAC PLEXUS	361	64680	6,553	N/A	N/A	N/A
HC23000326	IMPLNT/REV/REPOS TUN EPI CATH	361	62350	17,091	N/A	N/A	N/A
HC23000375	INJ ANES/STEROID NERVE AXILLARY LT	361	64417	2,122	N/A	N/A	N/A
HC23000425	INJ ANES/STEROID NERVE SCIATIC BIL	361	64445	5,609	N/A	N/A	N/A
HC23000458	INJ ANES/STEROID NERVE SUPRASCAP BI	361	64418	4,168	N/A	N/A	N/A
HC23000474	INJ ANES/STEROID NERVE SUPRASCAP RT	361	64418	2,222	N/A	N/A	N/A
HC23000482	INJ ANES/STEROID NERVE VAGUS	361	64408	2,527	N/A	N/A	N/A
HC23000557	INJ CERVICAL PLEXUS BLOCK	361	64999	2,427	N/A	N/A	N/A
HC23000664	INJ ANES/STEROID NERVE FEMORAL RT	361	64447	2,309	N/A	N/A	N/A
HC23000698	INJ FORAMN EPI C/T INTL W/S&I-R	361	64479	7,902	N/A	N/A	N/A
HC23000722	INJ FORAMN EPI C/T ADD+ W/S&I-R	361	64480	4,923	N/A	N/A	N/A
HC23000755	INJ FORAMN EPI LMBR INTLW/S&I-R	361	64483	8,001	N/A	N/A	N/A
HC23000789	INJ FORAMN EPI LMBR ADDLWS&I+R	361	64484	5,058	N/A	N/A	N/A
HC23000821	INJ ANES/STEROID NERVE INTERCOSTAL SINGL	361	64420	4,498	N/A	N/A	N/A
HC23000839	INJ ANES/STEROID INTERCOSTAL ADDL EA	361	64421	6,292	N/A	N/A	N/A
HC23000912	INJ ANES/STEROID NERVE/BRNCH PERIPH LT	361	64450	2,742	N/A	N/A	N/A
HC23000946	INJ ANES/STEROID NERVE PUDENDAL BIL	361	64430	7,380	N/A	N/A	N/A
HC23000979	INJ DX/THER CERVICAL/THORACIC W/O IMAG	361	62320	6,203	N/A	N/A	N/A
HC23001001	INJ SUPERIOR HYPOGASTRIC PLEXS	361	64517	8,308	N/A	N/A	N/A
HC23001035	INJ ANES/STEROID NERVE TRIGEML BRNCH EA	361	64400	1,541	N/A	N/A	N/A
HC23001068	INJ W/CATH PLCMT EPI CERV/THOR W/O IMAG	361	62324	5,856	N/A	N/A	N/A
HC23001092	INJ/INF NEUROLYTIC CERV/THOR	361	62281	6,363	N/A	N/A	N/A
HC23001118	PERC IMPLANT'N NEUROSTIM ELEC	361	63650	17,138	N/A	N/A	N/A
HC23001142	DESTR C/T FAC JOINT +LVL W/IMG-B	361	64634	10,649	N/A	N/A	N/A
HC23001175	INJ S-I JOINT ANESTH W/IMAG LT	361	G0260	5,110	N/A	N/A	N/A
HC23001233	DESTR C/T FAC JOINT SNGL W/IMG-R	361	64633	7,219	N/A	N/A	N/A
HC23001266	DESTR L/S FAC JOINT SINGL W/IMG-L	361	64635	7,769	N/A	N/A	N/A
HC23001290	DESTR L/S FAC JOINT ADDL W/IMG-R	361	64636	6,322	N/A	N/A	N/A
HC23001340	INJ CER/THOR F/IMAGE SNG LVLLT	361	64490	7,597	N/A	N/A	N/A
HC23001365	INJ CER/THOR F/IMAGE 2ND LVLRT	361	64491	3,626	N/A	N/A	N/A
HC23001399	INJ CER/THR F/IMAGE 3RD+&LVLRT RT	361	64492	2,161	N/A	N/A	N/A
HC23001423	INJ  L/S F W/IMAGE 1ST LVL RT	361	64493	8,093	N/A	N/A	N/A
HC23001456	INJ  L/S F W/IMAGE 2ND LVL RT	361	64494	3,692	N/A	N/A	N/A
HC23001480	INJ  L/S F /IMAGE 3RD+& LVL RT	361	64495	3,594	N/A	N/A	N/A
HC23001514	INJ ANES/STEROID NERVE TRIGEML BRNCH EA RT	361	64400	1,541	N/A	N/A	N/A
HC23001555	INJ ANES/STEROID NERVE OCCIPITL GREAT RT	361	64405	1,814	N/A	N/A	N/A
HC23001571	INJ ANES/STEROID NERVE OCCIPITL GREAT BI	361	64405	3,656	N/A	N/A	N/A
HC23001589	INJ CERVICAL PLEXUS BLOCK RT	361	64999	2,427	N/A	N/A	N/A
HC23001605	INJ CERVICAL PLEXUS BLOCK BIL	361	64999	4,776	N/A	N/A	N/A
HC23001639	INJ ANES/STEROID BRACHIAL PLEXUS BI	361	64415	5,544	N/A	N/A	N/A
HC23001662	INJ ANES/STEROID INTERCOSTAL ADDL EA BI	361	64421	9,998	N/A	N/A	N/A
HC23001696	INJ ANES/STEROID ILIOINGNL/ILIOHYPOGAS BI	361	64425	4,376	N/A	N/A	N/A
HC23001720	N BLOCK INJ PLANTAR DIGIT (MOTONS) LT	361	64455	1,915	N/A	N/A	N/A
HC23001753	ASP/INJ JOINT SM W/UTZ GUIDE-LT	361	20604	4,060	N/A	N/A	N/A
HC23001779	ASP/INJ JOINT MED W/UTZ GUIDE-BILAT	361	20606	8,728	N/A	N/A	N/A
HC23001787	ASP/INJ JOINT MED W/UTZ GUIDE-LT	361	20606	4,735	N/A	N/A	N/A
HC23001803	ASP/INJ JOINT LRG W/UTZ GUIDE-BILAT	361	20611	8,990	N/A	N/A	N/A
HC23001837	INJ DX/THER CERVICAL/THORACIC W/IMAG	361	62321	8,861	N/A	N/A	N/A
HC23001860	INJ W/CATH PLCMT EPI LUMBAR W/IMAG	361	62327	6,669	N/A	N/A	N/A
HC23001894	INJ ANES/STEROID NERVE SI JOINT INNRV W/IMAGE LT	361	64451	2,544	N/A	N/A	N/A
HC23001928	INJ ANES/STEROID NERVE GENICULAR IMAGE GUIDE BI	361	64454	4,453	N/A	N/A	N/A
HC23001951	DESTR NERVE GENICULAR W/NEUROLYT AGNT W/IMAGE	361	64624	5,113	N/A	N/A	N/A
HC23001985	DESTR NERVE GENICULAR W/NEUROLYT AGNT W/IMAGE RT	361	64624	5,113	N/A	N/A	N/A
HC23002009	ABLATE RF NERVE SACROILIAC JT INNRV W/IMAGE BIL	361	64625	10,396	N/A	N/A	N/A
HC24000010	HBO TX EA 1/2 HR BASIC/M	940	G0277	1,613	N/A	N/A	N/A
HC24000093	HBO TX EA 1/2 HR COMPLEX/M	940	G0277	2,229	N/A	N/A	N/A
HC24000127	HBO EA SUBSEQUNT 15MIN CMPLX/C	413		729	N/A	N/A	N/A
HC25000001	ED LEVEL I-BRIEF	450	99281	667	N/A	N/A	N/A
HC25000035	ED LEVEL IV - EXTENDED	450	99284	3,558	N/A	N/A	N/A
HC25000068	CRITICAL CARE EA ADDL 30 MIN	450	99292	2,899	N/A	N/A	N/A
HC25000084	ASPIRATION OF BLADDER TROCAR	450	51101	2,083	N/A	N/A	N/A
HC25000118	REMOV IMPACTD EAR WAX(INSTRUMENT) BI           (NO MOD50)	450	69210	474	N/A	N/A	N/A
HC25000159	FB REMOVAL EAR	450	69200	499	N/A	N/A	N/A
HC25000183	FB REMOVAL SQ COMPLEX	450	10121	4,765	N/A	N/A	N/A
HC25000217	REPAIR NAIL BED	450	11760	1,640	N/A	N/A	N/A
HC25000241	BURNS LOCAL TREATMENT MED 18%	450	16025	878	N/A	N/A	N/A
HC25000274	LAC REPAIR TO 2.5 CM(SMALL)	450		370	N/A	N/A	N/A
HC25000290	LAC REPAIR 12.6-20CM	450		618	N/A	N/A	N/A
HC25000308	LAC REPAIR 2.6-7 5CM	450		468	N/A	N/A	N/A
HC25000324	THORACOTOMY	450		4,144	N/A	N/A	N/A
HC25000365	FB REMOVAL EYE	450		1,113	N/A	N/A	N/A
HC25000407	NASAL EPISTAXIS	450		772	N/A	N/A	N/A
HC25000431	MANIPULATION MAJOR JOINT	450		1,185	N/A	N/A	N/A
HC25000464	FRACTURE TX  LONG BONE	450		1,153	N/A	N/A	N/A
HC25000506	REMOVAL/BIVALVE CAST ARM OR LEG	450	29705	737	N/A	N/A	N/A
HC25000522	SPLINT LONG ARM	450	29105	878	N/A	N/A	N/A
HC25000530	SPLINT LONG LEG	450	29505	941	N/A	N/A	N/A
HC25000555	SPLINT SHORT LEG	450	29515	766	N/A	N/A	N/A
HC25000597	EMERGENCY DELIVERY VAGINAL	450	59409	5,016	N/A	N/A	N/A
HC25000654	LUMBAR PUNCTURE DX [NOT W/ CT OR FLUORO]	450	62270	1,958	N/A	N/A	N/A
HC25000779	AVULSION OF NAIL  EA ADDL'	450	11732	465	N/A	N/A	N/A
HC25000852	ASP/INJ SMALL JOINT-RT	450	20600	852	N/A	N/A	N/A
HC25000886	ASP/INJ MED JOINT-RT	450	20605	952	N/A	N/A	N/A
HC25000910	ASP/INJ LARGE JOINT-RT	450	20610	1,248	N/A	N/A	N/A
HC25000936	CHANGE GT TUBE W/O IMAGE/ENDO	450	43762	1,940	N/A	N/A	N/A
HC25000969	INHALATION TREATMENT INITIAL	412	94640	592	N/A	N/A	N/A
HC25001017	CARDIOVERSION EXTERNAL	450	92960	3,081	N/A	N/A	N/A
HC25001058	ASP BLADDER W/INSERT SUPRAPUB	450	51102	4,694	N/A	N/A	N/A
HC25001082	INSERT CT(OPEN) W/DRAIN SYSTEM LT	450	32551	2,379	N/A	N/A	N/A
HC25001116	INSERT PICC >5 YR AGE W/O IMAGING	450	36569	5,611	N/A	N/A	N/A
HC25001140	INSRT BLADDER CATH-TEMP-COMPLX	450	51703	907	N/A	N/A	N/A
HC25001165	PLCMNT CENTRAL VEN CATH>5 YR	450	36556	6,088	N/A	N/A	N/A
HC25001173	THORACENTESIS ASP W/O IMG GUID-BIL	450	32554	3,813	N/A	N/A	N/A
HC25001199	THORACENTESIS ASP W/O IMG GUID-RT	450	32554	2,119	N/A	N/A	N/A
HC25001223	THORACENTESIS W/TUBE W/O IMAG RT	450	32556	2,159	N/A	N/A	N/A
HC25001322	BURNS 1ST DEGREE INITIAL TX	450	16000	1,069	N/A	N/A	N/A
HC25001355	DEBRID OPN WOUND EA ADD 20CM/<	450	97598	878	N/A	N/A	N/A
HC25001389	INJ(S);TRIGGER POINT 1-2MUSCLES	450	20552	1,065	N/A	N/A	N/A
HC25001413	TRAUMA ACTVTN I CMPREN	682	G0390	40,926	N/A	N/A	N/A
HC25001439	TRAUMA ACTVTN III LMTD	682	G0390	16,708	N/A	N/A	N/A
HC25001496	REMOV IMPACTD EAR WAX(INSTRUMENT) LT	450	69210	267	N/A	N/A	N/A
HC25001512	PARACENTESIS ABD W/ IMAGING	450	49083	2,226	N/A	N/A	N/A
HC25001546	REMOV IMPACTD EAR WAX IRRIG/LAVG RT	450	69209	298	N/A	N/A	N/A
HC25001579	MOD CS DIFF PHYS/QHP <5 YR INIT'L 15MIN	372	99155	371	N/A	N/A	N/A
HC25002684	TRAUMA ACT' II W/O CC SERVICE	682		19,676	N/A	N/A	N/A
HC25002718	TRAUMA ACT' II W/O P-H ALERT	450		11,597	N/A	N/A	N/A
HC25002742	INSERT PICC <5 YR AGE W/ IMAGING	450	36572	3,914	N/A	N/A	N/A
HC25002817	I&D ABSCESS; COMPLICATED/MULT	450	10061	1,572	N/A	N/A	N/A
HC25002833	I&D POLINIDAL CYST; COMPLICATED	450	10081	2,549	N/A	N/A	N/A
HC25002866	DEBRIDE/REMOVL OPEN FX SKIN/SBQ	450	11010	2,370	N/A	N/A	N/A
HC25002890	DEBRIDE SKIN MUSCLE; FIRST 20SQCM OR LESS	450	11043	1,529	N/A	N/A	N/A
HC25002924	LAC REPAIR SIMPLE S/N/AX/GEN/T/EXT 2.5CM OR LESS	450	12001	707	N/A	N/A	N/A
HC25002957	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT 12.6-20.0CM	450	12005	1,054	N/A	N/A	N/A
HC25002981	LAC REPAIR SIMPLE F/E/E/N/L/M TO 2.5 CM	450	12011	746	N/A	N/A	N/A
HC25003013	LAC REPAIR SIMPLE F/E/E/N/L/M 7.6-12.5 CM	450	12015	968	N/A	N/A	N/A
HC25003039	LAC REPAIR SIMPLE F/E/E/N/L/M 20.1-30.0 CM	450	12017	1,387	N/A	N/A	N/A
HC25003062	CLOSURE SUPERFCL WOUND DEHISC W/PACKING	450	12021	1,747	N/A	N/A	N/A
HC25003096	LAC REPAIR INTMD S/A/T/EXT 7.6-12.5CM	450	12034	1,667	N/A	N/A	N/A
HC25003120	LAC REPAIR INTMD S/A/T/EXT >30.0CM	450	12037	4,400	N/A	N/A	N/A
HC25003153	LAC REPAIR INTMD N/H/F/GEN 7.6-12.5	450	12044	1,705	N/A	N/A	N/A
HC25003187	LAC REPAIR INTMD N/H/F/GEN >30.0CM	450	12047	3,519	N/A	N/A	N/A
HC25003211	LAC REPAIR INTMD F/E/E/N/L/MM 5.1-7.5CM	450	12053	1,760	N/A	N/A	N/A
HC25003237	LAC REPAIR INTMD F/E/E/N/L/MM 12.6-20CM	450	12055	1,998	N/A	N/A	N/A
HC25003245	LAC REPAIR INTMD F/E/E/N/L/MM 20.1-30.0CM	450	12056	2,220	N/A	N/A	N/A
HC25003260	LAC REPAIR CMPLX TRUNK 1.1-2.5 CM	450	13100	1,731	N/A	N/A	N/A
HC25003294	LAC REPAIR CMPLX S/A/L 2.6-7.5 CM	450	13121	1,941	N/A	N/A	N/A
HC25003328	LAC REPAIR CMPLX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM	450	13132	1,778	N/A	N/A	N/A
HC25003351	REMOVE FB MUSCLE/TENDON SHEATH SIMPLE	450	20520	2,771	N/A	N/A	N/A
HC25003385	INJ(S);SGL TNDN SHEATH/LIGMNT/APONEUR RT	450	20550	772	N/A	N/A	N/A
HC25003419	CLOSED TX NOSE FX W/O STABILIZATION	450	21315	3,097	N/A	N/A	N/A
HC25003435	CLOSED TX TMJ DISLOCATION 1ST/SBSQ	450	21480	690	N/A	N/A	N/A
HC25003443	CLOSED TX CLAVICLE FX-BIL	450	23500	991	N/A	N/A	N/A
HC25003468	CLOSED TX CLAVICLE FX RT	450	23500	825	N/A	N/A	N/A
HC25003492	CLOSED TX CLAVICLE FX W/MANIP RT	450	23505	1,713	N/A	N/A	N/A
HC25003526	CLOSED TX STERNOCLVCLE DISLOC W/MAN RT	450	23525	906	N/A	N/A	N/A
HC25003559	CLOSED TX HUMRL FX W/MAN W/WO SKLTL TRAC RT	450	23605	1,966	N/A	N/A	N/A
HC25003583	CLOSED TX SHOULDR DSLC W/MAN W/O ANES RT	450	23650	1,011	N/A	N/A	N/A
HC25003617	REMOVE FB UPPER ARM/ELBOW SQ RT	450	24200	2,066	N/A	N/A	N/A
HC25003641	REMOVE FB UPPER ARM/ELBOW DEEP RT	450	24201	4,009	N/A	N/A	N/A
HC25003666	CLOSED TX ELBOW DISLOC W/O ANES RT	450	24600	936	N/A	N/A	N/A
HC25003690	CLOSED TX ELBOW DISLOCATION RT	450	24640	748	N/A	N/A	N/A
HC25003724	REMOVE FB FOREARM DEEP LT	450	25248	3,758	N/A	N/A	N/A
HC25003757	CLOSED TX RADIAL SHAFT FX W/MANIP LT	450	25505	3,684	N/A	N/A	N/A
HC25003781	CLOSED TX ULNA SHAFT FX W/MANIP RT	450	25535	1,099	N/A	N/A	N/A
HC25003815	CLOSED TX RAD&ULN SHAFT FX W/MAN LT	450	25565	3,739	N/A	N/A	N/A
HC25003849	CLOSED TX RAD/EPHYSL SEP&ULN FX NO M RT	450	25600	913	N/A	N/A	N/A
HC25003864	CLOSED TX RAD/EPHYSL SEP&ULN FX W/MAN-BIL	450	25605	7,010	N/A	N/A	N/A
HC25003898	CLOSED TX CARPAL SCAPHOID FX W/MAN-BIL	450	25624	6,526	N/A	N/A	N/A
HC25003922	CLOSED TX CARPAL BONE FX W/M EA BONE LT	450	25635	3,797	N/A	N/A	N/A
HC25003955	CLOSED TX WRIST DSLOC 1/> BONES W/MAN LT	450	25660	1,074	N/A	N/A	N/A
HC25003989	CLOSED TX DISTL RADIOULNAR DISLOC W/M LT	450	25675	1,074	N/A	N/A	N/A
HC25004011	DRAIN ABSCESS FINGER SIMPLE	450	26010	950	N/A	N/A	N/A
HC25004045	CLOSED TX THUMB DISLOC W/MANIP LT	450	26641	763	N/A	N/A	N/A
HC25004060	CLOSED TX THUMB DISLOC W/MANIP BIL	450	26641	1,331	N/A	N/A	N/A
HC25004078	CLOSED TX THUMB FX DISLOC W/MAN(BENNETT)LT	450	26645	3,614	N/A	N/A	N/A
HC25004094	CLOSED TX THUMB FX DISLOC W/MAN(BENNETT)BIL	450	26645	6,607	N/A	N/A	N/A
HC25004128	CLOSED TX FINGER/THUMB SHAFT FX NO MANIP EA	450	26720	913	N/A	N/A	N/A
HC25004151	CLOSED TX FINGER/THUMB DISTAL FX NO MANIP EA	450	26750	896	N/A	N/A	N/A
HC25004185	CLOSED TX HIP DISLOC TRAUMIC LT	450	27250	913	N/A	N/A	N/A
HC25004219	CLOSED TX HIP DISLOC POST ARTHROPLASTY LT	450	27265	1,105	N/A	N/A	N/A
HC25004243	I&D ABSCESS/BURSA/HEMATOMA THIGH/KNEE DEEP LT	450	27301	4,738	N/A	N/A	N/A
HC25004268	I&D ABSCESS/BURSA/HEMATOMA THIGH/KNEE DEEP BIL	450	27301	8,529	N/A	N/A	N/A
HC25004276	REMOVE FB DEEP THIGH/KNEE AREA LT	450	27372	4,607	N/A	N/A	N/A
HC25004292	REMOVE FB DEEP THIGH/KNEE AREA BIL	450	27372	8,291	N/A	N/A	N/A
HC25004326	CLOSED TX KNEE DISLOC; NO ANESTH BIL	450	27550	1,989	N/A	N/A	N/A
HC25004359	CLOSED TX PATELLAR DISLOC; NO ANESTH BIL	450	27560	1,717	N/A	N/A	N/A
HC25004383	I&D ABSCESS/HEMATOMA LEG/ANKLE DEEP BIL	450	27603	7,838	N/A	N/A	N/A
HC25004417	CLOSED TX TIBIAL SHAFT FX W/MANIP W/W-O FIBFX/TRAC BIL	450	27752	7,442	N/A	N/A	N/A
HC25004441	CLOSED TX MEDIAL MALLEO(ANKLE)FX W/MANIP W/W-O TRAC BIL	450	27762	7,371	N/A	N/A	N/A
HC25004474	CLOSED TX PROX FIBULA/SHAFT FX; W/MANIP BIL	450	27781	6,739	N/A	N/A	N/A
HC25004490	CLOSED TX BIMALLEOLA ANKLE FX; W/MANIP RT	450	27810	4,037	N/A	N/A	N/A
HC25004524	CLOSED TX PROX TIBIOFIBULAR JNT DISLOC; NO ANES RT	450	27830	913	N/A	N/A	N/A
HC25004557	CLOSED TX ANKLE DISLOC; NO ANES RT	450	27840	991	N/A	N/A	N/A
HC25004581	REMOVE FB FOOT; SUBC RT	450	28190	1,688	N/A	N/A	N/A
HC25004615	REMOVE FB FOOT; DEEP RT	450	28192	3,269	N/A	N/A	N/A
HC25004649	CLOSED TX METATARSAL FX; NO MANIPULTN EA	450	28470	913	N/A	N/A	N/A
HC25004672	CLOSED TX BIG TOE FX; NO MANIPULTN RT	450	28490	849	N/A	N/A	N/A
HC25004698	CLOSED TX BIG TOE FX; W/MANIPULTN LT	450	28495	892	N/A	N/A	N/A
HC25004722	CLOSED TX PHALANX(TOE) FX; NO MANIPULTN	450	28510	838	N/A	N/A	N/A
HC25004755	CLOSED TX SESAMOID FX RT	450	28530	849	N/A	N/A	N/A
HC25004789	CLOSED TX TARSAL DISLOC; NO ANES RT	450	28540	924	N/A	N/A	N/A
HC25004813	CLOSED TX TALOTARSAL JNT DISLOC; NO ANES RT	450	28570	937	N/A	N/A	N/A
HC25004847	CLOSED TX METATARSOPHALAN JNT DISLOC; NO ANES LT	450	28630	869	N/A	N/A	N/A
HC25004870	APPLY CAST; SHOULDER TO HAND (LONG ARM) RT	450	29065	1,012	N/A	N/A	N/A
HC25004896	APPLY CAST; ELBOW TO FINGER (SHORT ARM) LT	450	29075	913	N/A	N/A	N/A
HC25004904	APPLY CAST; ELBOW TO FINGER (SHORT ARM) RT	450	29075	913	N/A	N/A	N/A
HC25004920	APPLY CAST HAND & LWR FOREARM (GAUNTLET) LT	450	29085	484	N/A	N/A	N/A
HC25004953	STRAPPING; SHOULDER LT	450	29240	412	N/A	N/A	N/A
HC25004987	APPLY CAST LONG LEG LT	450	29345	1,036	N/A	N/A	N/A
HC25005018	APPLY CAST SHORT LEG LT	450	29405	937	N/A	N/A	N/A
HC25005042	ADDING WALKER HEEL PREV CAST LT	450	29440	546	N/A	N/A	N/A
HC25005075	STRAPPING; ANKLE AND/OR FOOT LT	450	29540	439	N/A	N/A	N/A
HC25005109	REMOVE/BIVALVING; GAUNTLET BOOT OR BODY CAST	450	29700	798	N/A	N/A	N/A
HC25005125	CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE ANY TX	450	30901	451	N/A	N/A	N/A
HC25005158	CHANGE TRACH TUBE PRIOR ESTAB FISTULA TRACT	450	31502	802	N/A	N/A	N/A
HC25005182	REPAIR LIP FULL THICK; VERMILION ONLY	450	40650	1,760	N/A	N/A	N/A
HC25005216	DRAIN ABSCESS/LESION MOUTH; SIMPLE	450	40800	1,923	N/A	N/A	N/A
HC25005240	LAC REPAIR MOUTH; >2.5 CM/COMPLEX	450	40831	1,542	N/A	N/A	N/A
HC25005273	I&D ABSCESS PERITONSILLAR RT	450	42700	850	N/A	N/A	N/A
HC25005307	REPOSIT NASO/ORO GASTRIC FEED TUBE THRU DUODENUM	450	43761	1,154	N/A	N/A	N/A
HC25005323	PROCTOSIGMOIDOSCOPY RIGID W/REMOVE FB	450	45307	1,455	N/A	N/A	N/A
HC25005356	ANOSCOPY W/REMOVE FB	450	46608	1,305	N/A	N/A	N/A
HC25005380	I&D ABSCESS VULVA/PERINEUM	450	56405	982	N/A	N/A	N/A
HC25005414	INJ ANES/STEROID NERVE TRIGEML BRNCH EA RT	450	64400	825	N/A	N/A	N/A
HC25005448	INJ ANES/STEROID NERVE/BRNCH PERIPH RT	450	64450	1,542	N/A	N/A	N/A
HC25005471	REMOVE FB EXTRNL EYE; CONJUNCT SUPERF RT	450	65205	441	N/A	N/A	N/A
HC25005505	REMOVE FB EXTRNL EYE; CONJUNCT EMBEDD RT	450	65210	937	N/A	N/A	N/A
HC25005521	REMOVE FB EXTRNL EYE; CORNEAL NO SLITLAMP LT	450	65220	924	N/A	N/A	N/A
HC25005539	REMOVE FB EXTRNL EYE; CORNEAL NO SLITLAMP RT	450	65220	924	N/A	N/A	N/A
HC25005554	REMOVE FB EXTRNL EYE; CORNEAL W/SLITLAMP LT	450	65222	497	N/A	N/A	N/A
HC25005588	DRAIN EXTERNAL EAR LESION SIMPLE LT	450	69000	1,319	N/A	N/A	N/A
HC25005612	DRAIN EXTERNAL EAR LESION COMPLEX RT	450	69005	2,420	N/A	N/A	N/A
HC25005646	PACING TRANSCUTANEOUS TEMPORARY	450	92953	1,404	N/A	N/A	N/A
HC25005679	ASP/INJ JOINT/BURSA MAJOR W/US-BIL	450	20611	1,793	N/A	N/A	N/A
HC25005703	AMPUTATE FINGER/THUMB SGL W/CLOSURE	450	26951	5,755	N/A	N/A	N/A
HC25005729	AMPUTATE FINGER/THUMB SGL W/CLOSURE RT	450	26951	3,950	N/A	N/A	N/A
HC25005737	CLOSED TX HIP FX W/MANIP BIL	450	27222	2,198	N/A	N/A	N/A
HC25005752	CLOSED TX HIP FX W/MANIP RT	450	27222	1,312	N/A	N/A	N/A
HC25005786	CLOSED TX FIBULA DISTAL FX W/MANIP RT	450	27788	1,116	N/A	N/A	N/A
HC25005810	CLOSED TX ANKLE FX W/MANIP RT	450	27818	1,213	N/A	N/A	N/A
HC25005844	REMOVE CATH CV TUNNELED W/O PORT/PUMP	450	36589	1,904	N/A	N/A	N/A
HC25005877	CHANGE CYSTOSTOMY TUBE; SIMPLE	450	51705	904	N/A	N/A	N/A
HC25005901	INJ ANES/STEROID NERVE OCCIPITL GREAT LT	450	64405	716	N/A	N/A	N/A
HC25005935	PARACENTESIS EYE W/REMOVAL AQUEOUS LT	450	65800	2,544	N/A	N/A	N/A
HC25005968	NEW PT LVL2-PROB FOCUS	510	99202	272	N/A	N/A	N/A
HC25005992	NEW PT LVL5-COMPREHENSIVE	510	99205	575	N/A	N/A	N/A
HC25006024	EST PT LVL3-EXPANDED	510	99213	314	N/A	N/A	N/A
HC25006057	CLOSED TX TARSOMETATARSAL JNT DISLOC; NO ANES RT	450	28600	851	N/A	N/A	N/A
HC25006081	CLOSED TX METATARSOPHALAN JNT DISLOC; NO ANES BIL	450	28630	1,275	N/A	N/A	N/A
HC25006115	AMNIOCENTESIS	450	59000	3,265	N/A	N/A	N/A
HC25006149	FETAL CONTRACTION STRESS TEST	450	59020	1,271	N/A	N/A	N/A
HC25006164	TRANSABDOMINAL AMNIOINFUSION	450	59070	2,144	N/A	N/A	N/A
HC25006198	DELIVERY OF PLACENTA	450	59414	3,727	N/A	N/A	N/A
HC25006222	REMOVE SUTURE&STAPLES NO ANESTHESIA REQ+	450	15854	121	N/A	N/A	N/A
HC25090028	P: INTUBATION+ ET TUBE			N/A	N/A	N/A	N/A
HC25090051	P: THORACENTESIS PUNC(W/O IMAGE)-R +1 TRAY			N/A	N/A	N/A	N/A
HC25090085	P: INSRT CTW/H20 SEAL R+PLRVC CTUBE			N/A	N/A	N/A	N/A
HC25090119	P: PLCMNT CVC<5 YR+TRPL LMN CATH			N/A	N/A	N/A	N/A
HC25090135	P: INSERT PICC <5 YR AGE + PICC LINE			N/A	N/A	N/A	N/A
HC25090143	P: INSERT PICC >5 YR AGE + PICC LINE			N/A	N/A	N/A	N/A
HC25090168	P: GSTRC INTB ASP THER'LVG+TBS NG&LVG			N/A	N/A	N/A	N/A
HC25090192	P: INCSN EXTRNL HEMORRHOID+TRAY			N/A	N/A	N/A	N/A
HC25090226	P: BLADDR IRRG SIMPL+ CATH FOLEY			N/A	N/A	N/A	N/A
HC25090259	P: INSRT BLADDR CTH-TEMP-COMPLX+TRAY			N/A	N/A	N/A	N/A
HC25090283	P: CARDIOVERSION EXTERNAL+ELECTRODE			N/A	N/A	N/A	N/A
HC25090317	P: IV PUSH SINGLE/INITIAL INJ			N/A	N/A	N/A	N/A
HC25090333	P: I&D HEMATOMA			N/A	N/A	N/A	N/A
HC25090341	P: I&D POSTOP WOUND			N/A	N/A	N/A	N/A
HC25090366	P: LAC REPAIR 2.6-7.5CM			N/A	N/A	N/A	N/A
HC25090390	P: LAC RPR 7.6-12.5CM(MED)			N/A	N/A	N/A	N/A
HC25090424	P: LAC REPAIR 2.6-7.5CM+STAPLER SKIN			N/A	N/A	N/A	N/A
HC25090457	P: LAC RPR7.6-12.5CM(MED)+STPLR SKN			N/A	N/A	N/A	N/A
HC25090481	P: LAC RPR7.6-12.5CM(MED)+DERMABOND			N/A	N/A	N/A	N/A
HC25090515	P: NASAL EPISTAXIS+PACKING/BALLOON			N/A	N/A	N/A	N/A
HC25090556	P: THORACENT PNCT-L+1THORA VENT KIT			N/A	N/A	N/A	N/A
HC25090572	P: SINGLE PULSE OX W/PROBE			N/A	N/A	N/A	N/A
HC25090606	P: INSERT PICC <5 YR AGE W/ IMAGING + PICC LINE			N/A	N/A	N/A	N/A
HC26000026	BREECH VERSION EXTERNAL MANIP	361	59412	5,574	N/A	N/A	N/A
HC26000059	DELIVERY VAGINAL TWINS	720	59409	17,533	N/A	N/A	N/A
HC26000091	FETAL NON-STRESS TEST	720	59025	1,557	N/A	N/A	N/A
HC26000125	TRANSABDOMINAL AMNIOINFUSION	361	59070	3,229	N/A	N/A	N/A
HC26000166	L&D EVAL LEVEL II - LIMITED	720	99212	988	N/A	N/A	N/A
HC26000182	L&D EVAL LEVEL IV - EXTENDED	720	99214	1,470	N/A	N/A	N/A
HC27000017	ANORECTAL WALL BX ANAL APPROAC	750	45100	10,463	N/A	N/A	N/A
HC27000041	ANOSCOPY W/BIOPSY	750	46606	4,576	N/A	N/A	N/A
HC27000074	ANOSCOPY W/FB REMOVAL	750	46608	3,950	N/A	N/A	N/A
HC27000108	ANOSCOPY W/SNARE MULTI REMVL	750	46612	6,392	N/A	N/A	N/A
HC27000173	COLONOSCOPY DX (INCL COLLECTION)	750	45378	4,190	N/A	N/A	N/A
HC27000215	COLONOSCOPY STOMA W/BLEED CONT	750	44391	4,218	N/A	N/A	N/A
HC27000231	COLONOSCOPY STOMA W/HOT BIOPSY	750	44392	3,979	N/A	N/A	N/A
HC27000249	COLONOSCOPY STOMA W/SNARE TECH	750	44394	4,093	N/A	N/A	N/A
HC27000272	COLONOSCOPY W/BIOPSY	750	45380	4,283	N/A	N/A	N/A
HC27000306	COLONOSCOPY W/FB(S) REMOVAL	750	45379	4,344	N/A	N/A	N/A
HC27000330	COLONOSCOPY W/SNARE TECH	750	45385	4,134	N/A	N/A	N/A
HC27000397	EGD W/BALLOON DILATION <30MM  ~FO	750	43249	4,736	N/A	N/A	N/A
HC27000421	EGD W/CONTOL BLEED ~FO	750	43255	4,865	N/A	N/A	N/A
HC27000454	EGD W/FOREIGN BODY(S) REMOVAL ~FO	750	43247	4,729	N/A	N/A	N/A
HC27000470	EGD W/INJ SUBMUCOSAL ~FO	750	43236	4,460	N/A	N/A	N/A
HC27000488	EGD W/PEG PLACEMENT ~FO	750	43246	4,928	N/A	N/A	N/A
HC27000512	EGD W/TRANSENDO TUBE/CATH PLC ~FO	750	43241	4,031	N/A	N/A	N/A
HC27000546	ENDO SM INTST POUCH(KOCK)DX INCL COLLECT	750	44385	4,992	N/A	N/A	N/A
HC27000579	ENTEROSCOPY TO ILEUM	750	44376	6,388	N/A	N/A	N/A
HC27000603	ENTEROSCOPY W/ABLATION	750	44369	7,124	N/A	N/A	N/A
HC27000637	ENTEROSCOPY W/CONVRT PEG>JEJUN	750	44373	6,231	N/A	N/A	N/A
HC27000660	ENTEROSCOPY W/REMOV BY SNARE	750	44364	5,888	N/A	N/A	N/A
HC27000694	ERCP DIAGNOSTIC DC'D PROC	750	43260	3,484	N/A	N/A	N/A
HC27000744	ERCP W/LITHOTRIPSY	750	43265	6,884	N/A	N/A	N/A
HC27000793	ERCP W/STONE(S) REMOVAL	750	43264	6,614	N/A	N/A	N/A
HC27000835	ESOPH MOTILITY/MANO' DISCONT'D	750	91010	1,520	N/A	N/A	N/A
HC27000868	ESOPHAG REFLUX W/NASAL ELEC>1H	750	91038	6,928	N/A	N/A	N/A
HC27000900	ESOPHAGEAL REFLUX W/NASAL ELEC	750	91037	4,285	N/A	N/A	N/A
HC27000959	GASTRIC INTUB ASP THER' LAVAGE	750	43753	1,439	N/A	N/A	N/A
HC27001007	HEMORRHOIDECTOMY/BANDING	750	46221	5,335	N/A	N/A	N/A
HC27001031	ILEOSCOPY THRU STOMA W/BIOPSY(S)	750	44382	6,309	N/A	N/A	N/A
HC27001056	INJ SCLEROTHERAPY HEMORRHOIDS	750	46500	5,006	N/A	N/A	N/A
HC27001072	SIGMOIDOSCOPY DX DISCONT PROC	750	45330	920	N/A	N/A	N/A
HC27001106	SIGMOIDOSCOPY FLEX DIAGNOSTIC	750	45330	3,441	N/A	N/A	N/A
HC27001148	SIGMOIDSCPY FLEX W/DILAT 1+/>STRICT	750	45340	4,256	N/A	N/A	N/A
HC27001171	SIGMOIDOSCOPY FLEX W/SNARE	750	45338	3,993	N/A	N/A	N/A
HC27001205	M:GI LAB MISC PROCEDURE	750		1,443	N/A	N/A	N/A
HC27001239	COLONOS' SCREEN HI RISK (Q48MO)	750	G0105	3,496	N/A	N/A	N/A
HC27001254	GASTRIC INTUB ASP DX;SNGL SPEC	750	43754	1,704	N/A	N/A	N/A
HC27001262	GASTRIC INTUB ASP DX;MULT SPEC	750	43755	2,077	N/A	N/A	N/A
HC27001296	ANORECTAL MANOMETRY DISCON'D	750	91122	1,220	N/A	N/A	N/A
HC27001346	ERCP W/ABLAT TUMR/POLYP/LESN GUIDEWIRE	750	43278	6,983	N/A	N/A	N/A
HC27001379	EGD W/RESECT SUBMUCOSAL ~FO	750	43254	4,562	N/A	N/A	N/A
HC27001403	EGD W/ABLAT TUMR/POLYP/LESN(DIL&GIDEWR)~FO	750	43270	5,150	N/A	N/A	N/A
HC27001437	EGD W/STENT (DIL&GUIDEWIRE)	750	43266	6,319	N/A	N/A	N/A
HC27001460	ESOPHSCPY W/BALLN DIL=30MM (W-FLUOR) ~FO	750	43214	4,743	N/A	N/A	N/A
HC27001494	ESOPHSCPY W/TUMR/LES REMOV W/SNARE  ~FO	750	43217	4,522	N/A	N/A	N/A
HC27001510	ESOPHSCPY W/FRN BDY(S)REMOVAL ~FO	750	43215	4,415	N/A	N/A	N/A
HC27001544	ESOPHSCPY W/OPTICAL ENDOMICRO ~FO	750	43206	5,395	N/A	N/A	N/A
HC27001577	ESOPHSCPY W/BIOPSY(S) ~FO	750	43202	4,053	N/A	N/A	N/A
HC27001601	ILEOSCOPY STOMA W/STENT(W/DILATE)	750	44384	7,071	N/A	N/A	N/A
HC27001635	COLONOSCOPY STOMA W/RESECT MUCOSL	750	44403	4,313	N/A	N/A	N/A
HC27001668	COLONOSCOPY STOMA W/EXAM US COLON	750	44406	3,914	N/A	N/A	N/A
HC27001692	SIGMOIDSCPY FL W/ABLAT LESN(S)GUIDEWIRE	750	45346	4,319	N/A	N/A	N/A
HC27001718	SIGMOIDOSCOPY FLEX  W/RESECT MUCOSL	750	45349	4,614	N/A	N/A	N/A
HC27001742	COLONOSCOPY FLEX W/PLACE STENT	750	45389	4,870	N/A	N/A	N/A
HC27001775	COLONOSCOPY FLEX  W/LIGATION BAND	750	45398	3,996	N/A	N/A	N/A
HC27001809	ESOPHSCPY W/EUS FNA/BX ~FO	750	43232	4,697	N/A	N/A	N/A
HC27001833	EGD W/EUS ESOPH->DUOD/SURG ALT STOMCH JEJUN ~FO	750	43259	5,444	N/A	N/A	N/A
HC27001866	COLONOSCOPY FLEX W/EUS	750	45391	4,208	N/A	N/A	N/A
HC27001890	EGD PARTIAL/COMPL EG FUNDOPLASTY	750	43210	14,039	N/A	N/A	N/A
HC27001916	CHANGE GT TUBE W/REV TRACT W/O IMAGE/ENDO INCL REMVL	750	43763	5,412	N/A	N/A	N/A
HC27001924	GI TRACT CAPSULE PATENCY STUDY	750	91299	627	N/A	N/A	N/A
HC27001940	BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F ADD'L 15MIN+	917	90913	150	N/A	N/A	N/A
HC27002377	COLONOS' SCREEN NOT HI RISK (Q120MO)	750	G0121	3,501	N/A	N/A	N/A
HC28000024	CR REHAB CARDIAC W/ ECG SESSION (II)	943	93798	585	N/A	N/A	N/A
HC28000057	CR EST PT EVAL LVL2-(10MIN)	510	99212	229	N/A	N/A	N/A
HC28000081	CR EST PT EVAL LVL5-(40 MIN)	510	99215	554	N/A	N/A	N/A
HC28000123	CR NEW PT EVAL LVL4- (45MIN)	510	99204	486	N/A	N/A	N/A
HC28000156	EXTERNAL COUNTERPULSATION/TX	480	G0166	1,801	N/A	N/A	N/A
HC28000222	CR REHAB PAD PERIPHERAL PER SESSION	943	93668	289	N/A	N/A	N/A
HC29000346	PLETHYSMOGRAPHY	920	94726	506	N/A	N/A	N/A
HC29000502	E&M PREVENTIVE NEW 18-39 Y/O	770	99385	445	N/A	N/A	N/A
HC29000536	EVAL COMP PREVNTV MED NEW 40-64	770		363	N/A	N/A	N/A
HC29000577	PREVENTATIVE MED COUNSELING 45MIN	770	99403	234	N/A	N/A	N/A
HC29000619	AWV ANNUAL WELLNESS PLAN; SUBSEQUENT	770	G0439	310	N/A	N/A	N/A
HC29000643	ADMIN/INTERP RISK ASSESS INSTR PT-FOCUS	770	96160	165	N/A	N/A	N/A
HC29000692	TEST CHALLENGE INGEST ADD 60MIN+	924	95079	312	N/A	N/A	N/A
HC31000003	PT-SELF/HOME MGMT/ADL 15MIN/M	420	97535	233	N/A	N/A	N/A
HC31000037	PT-APPLIC SPLINT SHORT LEG	420	29515	921	N/A	N/A	N/A
HC31000060	PT-AQUATIC GRP 30MIN/MCW	423	97150	115	N/A	N/A	N/A
HC31000094	PT-AQUATIC GRP ADDL 15 MIN/CW	423		105	N/A	N/A	N/A
HC31000136	PT- TM CONF INTERDISCPLN NO PT/FAM  WMD 30MIN	420	99367	271	N/A	N/A	N/A
HC31000169	PT-CONTRAST BATH 15MIN/MW	420	97034	143	N/A	N/A	N/A
HC31000201	PT-THER ACTIVITIES 15MIN/M	420	97530	241	N/A	N/A	N/A
HC31000227	PT-GAIT TRAINING 15MIN/M	420	97116	235	N/A	N/A	N/A
HC31000300	PT-INFRARED/CMW	420	97026	163	N/A	N/A	N/A
HC31000334	PT-EVAL MOD COMPLEXITY 30MF2F 45MIN	424	97162	689	N/A	N/A	N/A
HC31000367	PT-EVAL HIGH COMPLEXITY 45MF2F 90MIN	424	97163	1,213	N/A	N/A	N/A
HC31000391	PT-MASSAGE 15MIN/M	420	97124	204	N/A	N/A	N/A
HC31000425	PT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN/M	420	97760	265	N/A	N/A	N/A
HC31000458	PT-RE-EVAL EST POC 15MIN	424	97164	270	N/A	N/A	N/A
HC31000474	PT-RE-EVAL EST POC 45MIN	424	97164	652	N/A	N/A	N/A
HC31000482	PT-RE-EVAL EST POC 60MIN	424	97164	779	N/A	N/A	N/A
HC31000615	PT-THER EXER 15MIN/M	420	97110	236	N/A	N/A	N/A
HC31000656	PT-DEBRIDE OPN WND 1ST 20SQCM OR<	420	97597	1,325	N/A	N/A	N/A
HC31000748	PT-APPLY WHIRLPOOL MODALITY	420	97022	325	N/A	N/A	N/A
HC31000771	PT-WOUND NON-SEL DEB 15MIN/MW	420	97602	302	N/A	N/A	N/A
HC31000805	PT-WOUND NON-SEL DEB 60MIN/MW	420	97602	1,109	N/A	N/A	N/A
HC31000839	PT-WOUND VAC 45MIN<50 SQ CM/M	420	97605	587	N/A	N/A	N/A
HC31000854	PT-WOUND VAC 15MIN>50 SQ CM/M	420	97606	526	N/A	N/A	N/A
HC31000862	PT-WOUND VAC 30MIN>50 SQ CM/CM	420	97606	552	N/A	N/A	N/A
HC31000888	PT-WOUND VAC 60>50 SQ CM/M	420	97606	943	N/A	N/A	N/A
HC31000920	PT-ELEC STIM/TENS ATTD30MIN/CW	420		392	N/A	N/A	N/A
HC31000953	PT-IONTOPHORESIS ADDL 15MIN/CW	420		172	N/A	N/A	N/A
HC31000987	PT-THER EXER 30MIN/CW	420		430	N/A	N/A	N/A
HC31001019	PT-NEUROMUSC RE-ED ADD15MIN/CW	420		176	N/A	N/A	N/A
HC31001043	PT-MASSAGE 30MIN/CW	420		336	N/A	N/A	N/A
HC31001076	PT-MANUAL THERAPY ADD 15MIN/CW	420		168	N/A	N/A	N/A
HC31001092	PT-MANUAL THER S0FT TIS MOB/W	420		236	N/A	N/A	N/A
HC31001126	PT-ORTHOTIC FIT/TRNG ADD15M/CW	420		177	N/A	N/A	N/A
HC31001159	PT-FUNC ACTIVITY 30MIN/CW	420		392	N/A	N/A	N/A
HC31001183	PT-ADL ADD 15MIN/CW	420		196	N/A	N/A	N/A
HC31001217	PT-CASE CONF 15MIN(STAT)/M	420		N/A	N/A	N/A	N/A
HC31001316	PT-HUBBARD TANK 30MIN/CW	420		352	N/A	N/A	N/A
HC31001357	PT-DBRD OPN WND EA+20SQCM OR <	420	97598	1,160	N/A	N/A	N/A
HC31001373	PT-RE-EVAL EST POC 90MIN	424	97164	1,132	N/A	N/A	N/A
HC31001431	PT-TEST/MEASUREMENT 1ST30MIN/C	424		395	N/A	N/A	N/A
HC31001456	PT-PROC+MODALITY.COMBO 30MIN/C	420		375	N/A	N/A	N/A
HC31001480	PT-THER PROC GRP 45MIN/MC	423	97150	247	N/A	N/A	N/A
HC31001522	PT-PHYS PERFORM TEST INL'30M/W	420		351	N/A	N/A	N/A
HC31001555	PT-THER PROC GRP ADD 15MIN/CW	423		98	N/A	N/A	N/A
HC31001589	PT-CONTRAST BATH 30MIN/CW	420		343	N/A	N/A	N/A
HC31001613	PT-COMMTY WK/REINT ADD15MIN/CW	420		163	N/A	N/A	N/A
HC31001639	PT-WHEELCHAIR MGT ADD 15MIN/C	420		190	N/A	N/A	N/A
HC31001647	PT-WOUND NON-SEL DEB ADD15M/C	420		182	N/A	N/A	N/A
HC31001662	PT-WD SEL DEBRID>20CM 15MIN+/C	420		212	N/A	N/A	N/A
HC31001704	REPOSITIONING CANALITH/DAY	420	95992	420	N/A	N/A	N/A
HC31001753	PT-EVAL LOCOMOTOR /W	420	97799	740	N/A	N/A	N/A
HC31001787	PT-EVAL HIGH COMPLEXITY 45MIF2F 120MIN	424	97163	1,403	N/A	N/A	N/A
HC31001811	PT-THER PROC GRP 90MIN/MC	423	97150	416	N/A	N/A	N/A
HC31001845	PT-EVAL HIGH COMPLEXITY 45MIF2F 180MIN	424	97163	2,425	N/A	N/A	N/A
HC31001878	PT-AQUATIC THERAPY ADD15MIN/CW	420		218	N/A	N/A	N/A
HC31001894	PT-EVAL LOCOMOTOR TRAINING	420	97799	311	N/A	N/A	N/A
HC31001928	PT-WINDOWING CAST	420	29730	638	N/A	N/A	N/A
HC31001977	PT - STRAPPING; ELBOW OR WRIST	420	29260	550	N/A	N/A	N/A
HC31002009	PT - STRAPPING; KNEE	420	29530	671	N/A	N/A	N/A
HC31002058	PT-EVAL MOD COMPLEXITY 30MF2F 30MIN	424	97162	494	N/A	N/A	N/A
HC31002082	PT-EVAL HIGH COMPLEXITY 45MF2F 30MIN	424	97163	537	N/A	N/A	N/A
HC31002116	PT-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	420	96112	489	N/A	N/A	N/A
HC31002140	PT-APPLIC CAST SHORT LEG WALK BILAT	420	29425	2,176	N/A	N/A	N/A
HC31010010	PT-NEUROMUSC RE-ED 15MIN	420	97112	227	N/A	N/A	N/A
HC31010044	PT-THER ACTIVITIES 15MIN	420	97530	228	N/A	N/A	N/A
HC31010077	PT-EVAL HIGH COMPLEXITY 45M F2F [15MIN]	424	97163	235	N/A	N/A	N/A
HC31010101	PT-ELEC STIM/TENS ATTD 15MIN	420	97032	195	N/A	N/A	N/A
HC31010135	PT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN	420	97760	265	N/A	N/A	N/A
HC31010168	PT-COMPUT DYNAMIC POSTURE SOT 6 CNDTNS; &MCT&ADT	420	92549	1,284	N/A	N/A	N/A
HC31010184	PT-BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F ADD'L 15MIN+	420	90913	149	N/A	N/A	N/A
HC31010218	PT-AQUATIC THERAPY 15MIN	420	97113	234	N/A	N/A	N/A
HC31010275	PT-IONTOPHORESIS 15MIN	420	97033	205	N/A	N/A	N/A
HC31010309	PT-RE-EVAL EST POC  120MIN	424	97164	1,330	N/A	N/A	N/A
HC31010333	PT- TM CONF INTERDISCPLN NO PT/FAM  WMD 45MIN	420	99367	325	N/A	N/A	N/A
HC31010366	PT- TM CONF INTERDISCPLN NO PT/FAM  WQHCP 60MIN	420	99368	350	N/A	N/A	N/A
HC31090004	P: PT DEVEL' TESTING 75 MIN/C			N/A	N/A	N/A	N/A
HC31090038	P: PT-EVAL 60MIN/C			N/A	N/A	N/A	N/A
HC31090053	P: PT-EVAL 75MIN/C			N/A	N/A	N/A	N/A
HC31090061	P: PT DEVEL' TESTING 150 MIN/C			N/A	N/A	N/A	N/A
HC31090087	P: PT DEVEL' TESTING 180 MIN/C			N/A	N/A	N/A	N/A
HC31090111	P: PT-INITIAL EVAL 180MIN/C			N/A	N/A	N/A	N/A
HC31090145	PT-ONLINE ASSESS & MANAGMNT EST PT 5-10MIN	420	98970	105	N/A	N/A	N/A
HC32000002	OT-ADL 15MIN	430	97535	233	N/A	N/A	N/A
HC32000044	OT-COMMTY WK/REINTEGRAT 15M/M	430	97537	228	N/A	N/A	N/A
HC32000101	OT-ELEC STIM/TENS ATTD15MIN/MW	430	97032	198	N/A	N/A	N/A
HC32000135	OT-FUNCTIONAL ACTIVITY 15MIN	430	97530	242	N/A	N/A	N/A
HC32000150	OT-GAIT TRAINING 15MIN/M	430	97116	235	N/A	N/A	N/A
HC32000234	OT-INFRARED/CMW	430	97026	163	N/A	N/A	N/A
HC32000267	OT-EVAL MOD COMPLEXITY 30MF2F 45MIN	434	97166	678	N/A	N/A	N/A
HC32000291	OT-EVAL HIGH COMPLEXITY 45MF2F 90MIN	434	97167	1,213	N/A	N/A	N/A
HC32000325	OT-MASSAGE 15MIN/M	430	97124	204	N/A	N/A	N/A
HC32000358	OT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN/M	430	97760	265	N/A	N/A	N/A
HC32000382	OT-RE-EVAL EST POC 15MIN	434	97168	273	N/A	N/A	N/A
HC32000408	OT-RE-EVAL EST POC 45MIN	434	97168	684	N/A	N/A	N/A
HC32000432	OT-SWALLOWING EVAL 30MIN	434	92610	1,013	N/A	N/A	N/A
HC32000465	OT-SWALLOWING EVAL 75 MIN	434	92610	1,756	N/A	N/A	N/A
HC32000499	OT-SWALLOWING THERAPY  15 MIN	430	92526	436	N/A	N/A	N/A
HC32000523	OT-SWALLOWING THERAPY  60 MIN	430	92526	1,270	N/A	N/A	N/A
HC32000556	OT-THER PROC GRP  ADD 15MIN/CW	430	97150	96	N/A	N/A	N/A
HC32000598	OT-DEBRIDE OPN WND 1ST 20SQCM OR<	430	97597	1,325	N/A	N/A	N/A
HC32000671	OT-WHIRLPOOL-EXTREMITY/CMW	430	97022	325	N/A	N/A	N/A
HC32000697	OT-WORK HARDENING INIT 2HR/CMW	430	97545	695	N/A	N/A	N/A
HC32000713	OT-WOUND NON-SEL DEB 15MIN/MW	430	97602	302	N/A	N/A	N/A
HC32000747	OT-WOUND NON-SEL DEB 60MIN/MW	430	97602	1,109	N/A	N/A	N/A
HC32000770	OT-WOUND VAC 45MIN<50 SQ CM/M	430	97605	587	N/A	N/A	N/A
HC32000804	OT-WOUND VAC 30MIN>50 SQ CM/CM	430	97606	552	N/A	N/A	N/A
HC32000838	OT-INITIAL EVAL ADD 15MIN/CW	434		234	N/A	N/A	N/A
HC32000861	OT-ELEC STIM/TENS ATT ADD15/CW	430		197	N/A	N/A	N/A
HC32000887	OT-IONTOPHORESIS  ADDL 15/CW	430		182	N/A	N/A	N/A
HC32000895	OT-ULTRASOUND 30MIN/CW	430		336	N/A	N/A	N/A
HC32000911	OT-THER EXER 30MIN/CW	430		427	N/A	N/A	N/A
HC32000945	OT-NEUROMUSC RE-ED ADD15MIN/CW	430		203	N/A	N/A	N/A
HC32000978	OT-MANUAL THERAPY 30 MIN/CW	430		366	N/A	N/A	N/A
HC32001000	OT-MANUAL THER S0FT TIS MOB/W	430		263	N/A	N/A	N/A
HC32001034	OT-ORTHOTIC FIT/TRNG ADD15M/CW	430		197	N/A	N/A	N/A
HC32001067	OT-FUNC ACTIVITY 30MIN/CW	430		392	N/A	N/A	N/A
HC32001091	OT-DEV COGNITIV SKLL ADD15M/CW	430		215	N/A	N/A	N/A
HC32001117	OT-ADL ADD 15MIN/CW	430		175	N/A	N/A	N/A
HC32001182	OT-ELEC STIM/TENS/MCW	430	G0283	413	N/A	N/A	N/A
HC32001216	OT-SENSRY INTEGR TECH 30MIN/CW	430		372	N/A	N/A	N/A
HC32001240	OT-GAIT TRAINING ADD 15MIN/CW	430		196	N/A	N/A	N/A
HC32001281	OT-RE-EVAL EST POC 90MIN	434	97168	1,205	N/A	N/A	N/A
HC32001315	OT-THER PROC GRP 60MIN/MC	430	97150	380	N/A	N/A	N/A
HC32001349	OT-CONTRAST BATH 30MIN/CW	430		274	N/A	N/A	N/A
HC32001364	OT-THER PROC GRP 45MIN/M	430	97150	236	N/A	N/A	N/A
HC32001398	OT-CASE/TEAM CONF ADD15 MIN/C	430		109	N/A	N/A	N/A
HC32001430	OT-COMMTY WK/REINT ADD15MIN/CW	430		341	N/A	N/A	N/A
HC32001463	OT-WOUND VAC 15MIN>50 SQ CM+/C	430		202	N/A	N/A	N/A
HC32001505	OT-REMOVE/BIVAL CAST FULL LIMB	430	29705	896	N/A	N/A	N/A
HC32001570	OT-EVAL DRIVING REHAB/W	434	97799	1,781	N/A	N/A	N/A
HC32001612	OT-APPLICATION CAST SHORT ARM	430	29075	952	N/A	N/A	N/A
HC32001638	OT-APPLICATION CAST FINGER	430	29086	575	N/A	N/A	N/A
HC32001646	OT-APPLICATION SPLINT LONG ARM	430	29105	996	N/A	N/A	N/A
HC32001661	OT-APPLIC'SPLINT FINGER STATIC	430	29130	742	N/A	N/A	N/A
HC32001695	OT-APP SPLINT SHORTARM;DYNAMIC	430	29126	955	N/A	N/A	N/A
HC32001729	OT-DYSPHAG/SWAL TX ADD'L 15MIN/C	430	X4112	269	N/A	N/A	N/A
HC32001752	OT-ASSISTV TECH ASSESS' 30MN/C	430		325	N/A	N/A	N/A
HC32001794	OT-ENDOSCOPIC EVAL SWALLOW	434	92612	1,814	N/A	N/A	N/A
HC32001828	OT-SWALLOWING EVAL 15MIN	434	92610	601	N/A	N/A	N/A
HC32001877	OT - STRAPPING; SHOULDER	430	29240	557	N/A	N/A	N/A
HC32001893	OT - STRAPPING; HAND OR FINGER	430	29280	551	N/A	N/A	N/A
HC32003303	OT-EVAL MOD COMPLEXITY 30MF2F 30MIN	434	97166	503	N/A	N/A	N/A
HC32003337	OT-EVAL HIGH COMPLEXITY 45MF2F 30MIN	434	97167	537	N/A	N/A	N/A
HC32003360	OT-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	430	96113	210	N/A	N/A	N/A
HC32010035	OT-NEUROMUSC RE-ED 15MIN	430	97112	227	N/A	N/A	N/A
HC32010068	OT-SWALLOWING EVAL [15MIN]	434	92610	310	N/A	N/A	N/A
HC32010092	OT-EVAL HIGH COMPLEXITY 60MIN [15MIN]	434	97167	237	N/A	N/A	N/A
HC32010118	OT-EVAL SWALLOW CINE/FLUORO [15MIN]	434	92611	338	N/A	N/A	N/A
HC32010142	OT-WHEELCHAIR MGT 15MIN	430	97542	211	N/A	N/A	N/A
HC32010175	OT-COMMTY WK/REINTEGRAT 15MIN	430	97537	220	N/A	N/A	N/A
HC32010209	OT-DEV COGNITIVE SKILLS ADDL 15MIN	430	97130	212	N/A	N/A	N/A
HC32010258	OT-AQUATIC THERAPY 15MIN	430	97113	234	N/A	N/A	N/A
HC32010324	OT-ONLINE ASSESS & MANAGMNT EST PT 5-10MIN	430	98970	105	N/A	N/A	N/A
HC32010357	OT-EVAL SWALLOW CINE/FLUORO 120MIN	434	92611	2,594	N/A	N/A	N/A
HC32010373	OT-EVAL SWALLOW CINE/FLUORO 180MIN	434	92611	3,508	N/A	N/A	N/A
HC32010381	OT-RE-EVAL EST POC  120MIN	434	97168	1,378	N/A	N/A	N/A
HC32010407	OT- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 60MIN	430	99366	375	N/A	N/A	N/A
HC32010431	OT- TM CONF INTERDISCPLN NO PT/FAM  WQHCP 45MIN	430	99368	300	N/A	N/A	N/A
HC32010464	OT- TM CONF INTERDISPLNS 3MNM WPT PRES 60MIN	430	G0175	450	N/A	N/A	N/A
HC32090011	P: OT-EVAL 60MIN/C			N/A	N/A	N/A	N/A
HC32090045	P: OT-EVAL 120MIN/C			N/A	N/A	N/A	N/A
HC32090078	P: ORTH HFO FLEX GLV ELSTC FNGR CNTRL (45MINUOS)			N/A	N/A	N/A	N/A
HC32090094	P: ORTH HO METACARPAL FRACTURE (45MINUOS)			N/A	N/A	N/A	N/A
HC32090102	P: ORTH HFO W/O JOINTS PREFAB OTS (45MINUOS)			N/A	N/A	N/A	N/A
HC32090128	P: ORTH FO PIP/DIP W/O JOINT/SPRING (45MINUOS)			N/A	N/A	N/A	N/A
HC32090151	P: ORTH EWHO W/NONTORSION JOINT(S) (90MINUOS)			N/A	N/A	N/A	N/A
HC32090185	P: ORTHOTIC WHO W/O JOINTS SPICA (90MINUOS)			N/A	N/A	N/A	N/A
HC32090219	P: ORTH HFO METACARPAL FRACTURE (90MINUOS)			N/A	N/A	N/A	N/A
HC32090243	P: SPLINT NERVE RADIAL HAND-BASED (90MINUOS)			N/A	N/A	N/A	N/A
HC33000118	SP-ASSESS ASSIST TECH 15MIN/CM	444	97755	173	N/A	N/A	N/A
HC33000159	ST-ENDOSCOPIC EVAL SWALLOW	444	92612	1,814	N/A	N/A	N/A
HC33000175	ST-EVAL RX SP GEN DEV ADD30MIN	444	92608	688	N/A	N/A	N/A
HC33000209	SP-LARYNGEAL FUNCTION STUDIES	444	92520	621	N/A	N/A	N/A
HC33000233	ST-SPEECH THERAPY 60 MIN/MCW	440	92507	1,093	N/A	N/A	N/A
HC33000266	ST-SPEECH THERAPY 120MIN/MW	440	92507	1,636	N/A	N/A	N/A
HC33000290	ST-SPEECH THERAPY GRP 60MIN/MCW	443	92508	514	N/A	N/A	N/A
HC33000324	ST-SWALLOWING EVAL 45MIN	444	92610	1,294	N/A	N/A	N/A
HC33000357	ST-SWALLOWING EVAL 90MIN	444	92610	1,878	N/A	N/A	N/A
HC33000373	ST-SWALLOWING EVAL  180MIN	444	92610	2,462	N/A	N/A	N/A
HC33000407	ST-SWALLOWING THERAPY  45 MIN	440	92526	937	N/A	N/A	N/A
HC33000431	ST-SWALLOWING THERAPY 90 MIN	440	92526	1,588	N/A	N/A	N/A
HC33000464	ST-THER SP GEN DEV W/PROG	440	92609	1,271	N/A	N/A	N/A
HC33000498	STP-ELEC STIM/TENS/MCW	440	G0283	413	N/A	N/A	N/A
HC33000563	ST-EVAL SWALLOW CINE/FLUORO 30M	444	92611	989	N/A	N/A	N/A
HC33000605	ST-SCREENING/IPA 15MIN (ST)	440		N/A	N/A	N/A	N/A
HC33000688	ST-SPEECH THERAPY GRP 15MIN/MW	443	92508	163	N/A	N/A	N/A
HC33000696	ST-EVAL LANGUAGE CMPNT 60MIN	444	92521	820	N/A	N/A	N/A
HC33000712	ST-EVAL LANGUAGE CMPT 120MIN	444	92521	1,202	N/A	N/A	N/A
HC33000761	ST-EVAL NONSPEECH DEVICE RX:1ST HR	444	92605	1,135	N/A	N/A	N/A
HC33000795	ST-LANGUAGE SCREENING/IP	440	V5363	172	N/A	N/A	N/A
HC33000829	ST- TM CONF INTERDISPLNS 3MNM WPT PRES 30MIN	440	G0175	325	N/A	N/A	N/A
HC33000852	ST-EVAL SPEECH CMPNT 90MIN	444	92522	1,158	N/A	N/A	N/A
HC33000910	ST EVAL SPEECH FLUENCY 45MIN/M	444	92521	514	N/A	N/A	N/A
HC33000936	ST EVAL SPEECH FLUENCY 90MIN/M	444	92521	900	N/A	N/A	N/A
HC33000944	ST EVAL SPEECH FLUENCY 120MIN/M	444	92521	965	N/A	N/A	N/A
HC33000977	ST EVAL SOUND PRODUCTION 45MIN/M	444	92522	448	N/A	N/A	N/A
HC33001009	ST EVAL SOUND PRODUCTION 120MIN/M	444	92522	877	N/A	N/A	N/A
HC33001041	ST EVAL SOUND W/LANG COMP&EXPRESS 60MIN/M	444	92523	919	N/A	N/A	N/A
HC33001074	ST EVAL SOUND W/LANG COMP&EXPRESS 180MIN/M	444	92523	1,588	N/A	N/A	N/A
HC33001108	ST EVAL BEHAVRAL QUAL VOICE 60MIN/M	444	92524	648	N/A	N/A	N/A
HC33001140	ST EVAL SPEECH FLUENCY 180MIN/M	444	92521	1,158	N/A	N/A	N/A
HC33001173	LARYNGOSC W/STROBOSCOPY	361	31579	1,442	N/A	N/A	N/A
HC33001215	ST-TEST COGNITIVE PERFORMANCE STDRD PER HOUR	440	96125	649	N/A	N/A	N/A
HC33010034	ST-EVAL SWALLOW CINE/FLUORO [15MIN]	444	92611	338	N/A	N/A	N/A
HC33010067	ST EVAL SOUND PRODUCTION [15MIN]	444	92522	146	N/A	N/A	N/A
HC33010117	ST-DEV COGNITIVE SKILLS INITL 15MIN	440	97129	220	N/A	N/A	N/A
HC33010190	ST-ONLINE ASSESS & MANAGMNT EST PT 5-10MIN	440	98970	105	N/A	N/A	N/A
HC33010224	ST-EVAL SWALLOW CINE/FLUORO 120MIN	444	92611	2,594	N/A	N/A	N/A
HC33010257	ST- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 45MIN	440	99366	325	N/A	N/A	N/A
HC33010273	ST- TM CONF INTERDISCPLN NO PT/FAM  WMD 45MIN	440	99367	325	N/A	N/A	N/A
HC33010307	ST- TM CONF INTERDISCPLN NO PT/FAM  WQHCP 60MIN	440	99368	350	N/A	N/A	N/A
HC34000000	PURE TONE AUDIO AIR ONLY	471	92552	324	N/A	N/A	N/A
HC34000034	AUDIO THRESHOLD W/RECOG	471	92556	368	N/A	N/A	N/A
HC34000067	ACOUSTIC REFLEX TEST THRESHOLD	471	92568	282	N/A	N/A	N/A
HC34000109	AUD-INFANT HEARING SCREEN AEP BBS AUTO INITIAL OP	471	92650	716	N/A	N/A	N/A
HC34000133	OTOACOUSTIC EVOKED RESP LTD	471	92587	575	N/A	N/A	N/A
HC34000158	HEARING AID EXAM MONAURAL	471	92590	404	N/A	N/A	N/A
HC34000166	HEARING AID EXAM&SEL BILAT	471	92591	557	N/A	N/A	N/A
HC34000208	AUD-AUDITORY EVOKED AEP THRESHOLD EST MULT FREQ W/I&R	471	92652	740	N/A	N/A	N/A
HC34000232	SCREENING PURE TONE HEARING AIR	471	92551	151	N/A	N/A	N/A
HC34000265	ACOUSTIC IMMITANCE TESTING	471	92570	388	N/A	N/A	N/A
HC34000299	ELECTROACOUSTIC EVAL FOR HEARING AID; MONOAURAL	471	92594	156	N/A	N/A	N/A
HC34000323	COCHLEAR IMPLT DX ANALYS W/REPROGRAM <7 SUBSEQ	471	92602	389	N/A	N/A	N/A
HC34000356	EVAL AUD FUNC SX IMPLANT 1ST HR	471	92626	389	N/A	N/A	N/A
HC34000372	REHAB AUD PRELINGUAL HEAR LOSS	471	92630	156	N/A	N/A	N/A
HC34000380	REHAB AUD POSTLINGUAL HEAR LOSS	471	92633	156	N/A	N/A	N/A
HC35000017	REC- EVALUATION 15MIN	941	99212	213	N/A	N/A	N/A
HC35000041	REC- EVALUATION 60MIN	941	99215	802	N/A	N/A	N/A
HC35000165	REC-SELF/HOME MGMT/ADL 15MIN	941	97535	209	N/A	N/A	N/A
HC35000199	REC- TM CONF INTERDISCPLN NO PT/FAM  WMD 30MIN	941	99367	260	N/A	N/A	N/A
HC35000223	REC' THER' TX 1-30 MIN	941	97110	334	N/A	N/A	N/A
HC35000264	REC- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 45MIN	941	99366	325	N/A	N/A	N/A
HC35000298	REC- TM CONF INTERDISCPLN NO PT/FAM  WMD 60MIN	941	99367	370	N/A	N/A	N/A
HC35000314	REC TM CONF INTERDISCPLN NO PT/FAM  WQHCP 60MIN	941	99368	300	N/A	N/A	N/A
HC35500040	MT-FUNCTIONAL ACTIVITY 15 MIN	941	97530	196	N/A	N/A	N/A
HC35500156	MT-BEHAVIOR TX INDIV 1ST 30 MIN	941	96158	251	N/A	N/A	N/A
HC35500180	MT-BEHAVIOR TX GROUP ADDL 15 MIN	915	96165	42	N/A	N/A	N/A
HC35500214	MT-BEHAV TX FAM W/O PT 1ST 30MIN	916	96170	110	N/A	N/A	N/A
HC35500248	MT-DEV COGNITIVE SKILLS ADDL 15MIN	941	97130	169	N/A	N/A	N/A
HC36000024	AEROSOL-CONTINUOUS TX EA AD'HR	412	94645	737	N/A	N/A	N/A
HC36000040	AEROSOL-HHN TX SUBSQ SAME DAY	412	94640	665	N/A	N/A	N/A
HC36000057	AEROSOL-IPPB TREATMENT INIT	412	94640	722	N/A	N/A	N/A
HC36000073	AEROSOL-MDI TREATMENT INIT	412	94640	722	N/A	N/A	N/A
HC36000107	AEROSOL-TREATMENT INITIAL	412	94640	722	N/A	N/A	N/A
HC36000131	MANIP CHEST WALL INIT DEMO/EVAL	410	94667	896	N/A	N/A	N/A
HC36000164	MANIP CHEST (INFANT) SUBSEQ	410	94668	737	N/A	N/A	N/A
HC36000214	INHAL W/GAS TX SUBSQ SAME DAY	412	94640	665	N/A	N/A	N/A
HC36000248	SPUTUM INDUC TX SUBSQ SAME DAY	412	94640	665	N/A	N/A	N/A
HC36000263	VENT DAY INITIAL-ADULT	410	94002	8,082	N/A	N/A	N/A
HC36000271	VENT DAY INITIAL-INFANT	410	94002	8,082	N/A	N/A	N/A
HC36000297	VENT DAY INIT-OSCIL&/OR HI FRQ	410	94002	8,082	N/A	N/A	N/A
HC36000321	VENT DAY SUBSQ-JET VENT	410	94003	7,501	N/A	N/A	N/A
HC36000636	DRUG - DETAILED CODING - RESP	636		N/A	N/A	N/A	N/A
HC36000669	GAS DILUT/WASHOUT LUNG VOL	410	94727	1,060	N/A	N/A	N/A
HC36000693	RT-TEAM CONF W/MD >30MIN(NO PT)	410	99367	160	N/A	N/A	N/A
HC36000727	ARTERIAL PUNCTURE	300	36600	586	N/A	N/A	N/A
HC36000784	PULSE OX NOCTURNAL STUDY	410	94762	1,565	N/A	N/A	N/A
HC36000800	HGB QUANT TRANSCUTANEOUS	300	88738	63	N/A	N/A	N/A
HC36000834	BRONCH W/NDL ASP BX(S);INITIAL	361	31629	7,311	N/A	N/A	N/A
HC36000867	BRONCH DIAG W/BRUSHING	361	31623	6,561	N/A	N/A	N/A
HC36000891	BRONCH THERAPEUTIC INIT (PER DOS)	361	31645	5,272	N/A	N/A	N/A
HC36000925	BRONCH W/LUNG BX;SINGLE LOBE	361	31628	6,695	N/A	N/A	N/A
HC36000958	BRONCH THERAPEUTIC DC'D PROC	361	31645	2,370	N/A	N/A	N/A
HC36000982	HTN ASSESSMENT W/ NITRIC OXIDE	460	94799	975	N/A	N/A	N/A
HC36001014	NITRIC OXIDE  PER HOUR	636	J3490	688	N/A	N/A	N/A
HC36001063	SPIROMETRY W/PRE&POST BRONCHO	460	94060	1,871	N/A	N/A	N/A
HC36001097	OSCILLATE CHEST WALL MECH EA SESSION	410	94669	864	N/A	N/A	N/A
HC36001139	BRONCH W/EBUS SAMPLING 3/> NODES	361	31653	10,756	N/A	N/A	N/A
HC36001162	BRONCHOSCOPY FIDUCIAL PLMT SGL/MULTI	361	31626	6,985	N/A	N/A	N/A
HC36500007	SMOKING CESSATION 3-10 MIN	942	99406	90	N/A	N/A	N/A
HC36800019	BRONCH W/BRONCHIAL/ENDO BX(S)	361	31625	6,576	N/A	N/A	N/A
HC36800035	BRONCH DIAG W/LAVAGE	361	31624	6,616	N/A	N/A	N/A
HC36800043	BRONCHOSCOPY DIAGNOSTIC	361	31622	6,245	N/A	N/A	N/A
HC36800068	BRONCH W/LUNG BX; SINGLE LOBE	361	31628	6,695	N/A	N/A	N/A
HC36800092	BRONCH THERAPEUTIC INIT (PER DOS)	361	31645	5,271	N/A	N/A	N/A
HC36800126	TEST BRONCHIAL INHAL CHALLENGE W/HISTAMINE	460	95070	1,771	N/A	N/A	N/A
HC36800183	FLOW VOLUME LOOP	460	94375	850	N/A	N/A	N/A
HC36800225	HTN ASSESSMENT W/ NITRIC OXIDE	460	94799	983	N/A	N/A	N/A
HC36800266	O2 UPTAKE CO2 OUTPUT @REST IND	460	94690	1,249	N/A	N/A	N/A
HC36800290	PNEUMOGRAM 12-24HR REC INFANT	460	94772	2,336	N/A	N/A	N/A
HC36800324	TEST EXERC CARIOPULM INCL VENT CO2 O2 EKG	460	94621	4,456	N/A	N/A	N/A
HC36800365	PULSE OX NOCTURNAL STUDY DC'D	460	94762	652	N/A	N/A	N/A
HC36800415	VITAL CAPACITY	410	94150	624	N/A	N/A	N/A
HC36800449	BLOOD GAS LTD CORD	301	82803	556	N/A	N/A	N/A
HC36800480	BRONCH W/LUNG BX; EACH ADD'L+	361	31632	3,471	N/A	N/A	N/A
HC36800514	BRONCH THERAPEUTIC DC'D PROC	361	31645	2,370	N/A	N/A	N/A
HC36800548	RT THER INC RESP FUNC 15MIN/MW	410	G0238	343	N/A	N/A	N/A
HC36800571	RT RESP THER GRP 45 MIN/MW	410	G0239	349	N/A	N/A	N/A
HC36800597	CARBOXYHEMOGLOBIN QUANT	301	82375	274	N/A	113	N/A
HC36800621	POTASSIUM	301	84132	139	N/A	42	N/A
HC36800654	CALCIUM IONIZED	301	82330	261	N/A	91	N/A
HC36800688	METHGB QUANT TRANSCUTANEUS/DAY	300	88741	291	N/A	N/A	N/A
HC36800712	GAS DILUT/WASHOUT LUNG VOL	460	94727	1,060	N/A	N/A	N/A
HC36800753	SPIROMETRY INFANT-2Y/O	460	94011	749	N/A	N/A	N/A
HC36800787	CAPILLARY/HEEL/FINGER STICK	300	36416	60	N/A	N/A	N/A
HC36800811	BREATHING RESPONSE HYPOXIA CURVE	460	94450	684	N/A	N/A	N/A
HC36800845	TRANSENDOSCOPIC EBUS DURING BRONCH DX OR TX FOR PERIPH NODE(S)+	361	31654	3,000	N/A	N/A	N/A
HC36800878	BRONCHOSCOPY FIDUCIAL PLMT SGL/MULTI	361	31626	6,985	N/A	N/A	N/A
HC36800910	PULM REHAB PER SESSION (90MIN) W POX2	948	94626	868	N/A	N/A	N/A
HC37000031	MNT INITIAL ASSESS INDIV EA 15MIN   1ST REF	942	97802	245	N/A	N/A	N/A
HC37000064	NUTRIT TEAM CONF(ST)EA 15 MIN	942		N/A	N/A	N/A	N/A
HC37000098	NUTRITION EDUCATION 15MIN (ST)	942		N/A	N/A	N/A	N/A
HC37000205	OP VISIT/REVIEW 15 MIN (ST)	942		N/A	N/A	N/A	N/A
HC37000296	DAILY MNGMT BREAST MILK PROC/STORE/DIST	940	T2101	1,125	N/A	N/A	N/A
HC37000312	MNT THERAPY GROUP EA 30 MIN      2ND REF(DX)	942	G0271	100	N/A	N/A	N/A
HC37090024	P: MNT INITIAL ASSESS 60 MIN-OP			N/A	N/A	N/A	N/A
HC37090057	P: MNT RE-ASSESS 30 MIN-OP			N/A	N/A	N/A	N/A
HC37090081	P: MNT THERAPY GROUP 60 MIN-OP/M			N/A	N/A	N/A	N/A
HC37090115	P: MNT INITIAL ASSESS 60 MIN-IP (ST)			N/A	N/A	N/A	N/A
HC37090149	P: MNT RE-ASSESS 30 MIN-IP (ST)			N/A	N/A	N/A	N/A
HC37090164	P: MNT RE-ASSESS 60 MIN-IP (ST)			N/A	N/A	N/A	N/A
HC37090172	P: MNT RE-ASSESS 75MIN-IP(ST)			N/A	N/A	N/A	N/A
HC38000014	APPLICATION CAST FINGER	700	29086	540	N/A	N/A	N/A
HC38000048	APPLY CAST SHORT LEG	700	29405	1,070	N/A	N/A	N/A
HC38000071	APPLY CAST RIGID TOTAL LEG	700	29445	1,606	N/A	N/A	N/A
HC38000105	REMV/BIVALVE FULL CAST ARM/LEG	700	29705	933	N/A	N/A	N/A
HC38000139	APPLY SPLINT LONG ARM	700	29105	1,106	N/A	N/A	N/A
HC38000162	APPLY SPLINT SHORT LEG	700	29515	952	N/A	N/A	N/A
HC38000196	APPLY CMPRSSN BOOT/WRAP(UNNA)R	700	29580	914	N/A	N/A	N/A
HC38000212	APPLY CMPRSSN BOOT/WRAP(UNNA)BI	700	29580	1,714	N/A	N/A	N/A
HC38000253	APPLY BODY CAST;SHOLD/HIP/1THI	700	29044	1,327	N/A	N/A	N/A
HC38000287	APPLY CAST SPICA SHOULDER	700	29055	1,109	N/A	N/A	N/A
HC38000311	APPLY LONG LEG CAST/WALKER	700	29355	1,282	N/A	N/A	N/A
HC38000345	APPLY CAST PATELR TENDN BEARNG	700	29435	1,064	N/A	N/A	N/A
HC38000378	REM/BIVALV SPICA SHOULDER/HIP	700	29710	1,059	N/A	N/A	N/A
HC38000402	WEDGING CAST CLUBFOOT	700	29750	753	N/A	N/A	N/A
HC38000428	APPLY CAST RISSER JACKET BODY; ONLY	700	29010	1,434	N/A	N/A	N/A
HC38000436	APPLY CAST RISSER JACKET BODY; WITH HEAD	700	29015	1,540	N/A	N/A	N/A
HC38420014	COLLECT AUTOLOGUS BLD INL' 2 HR	390	86891	2,191	N/A	N/A	N/A
HC38420048	LVAD/RVAD SERVICE/HR	480	92970	333	N/A	N/A	N/A
HC38420071	PERFUSION CARDIOASSIST DC'D PROC	481	92970	2,171	N/A	N/A	N/A
HC38420105	ECMO DAILY MNGMT EA DAY VENO-VENO	489	33948	9,625	N/A	N/A	N/A
HC38420139	ECMO REPSN OPEN A&/V PERC W/FLUOR=5Y	489	33959	9,096	N/A	N/A	N/A
HC38420162	ECMO/ECLS INSERT PERIPH CANNULA OPEN BIRTH-AGE 5	489	33953	18,537	N/A	N/A	N/A
HC38420188	ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS	489	33955	32,556	N/A	N/A	N/A
HC38420196	ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER	489	33956	32,556	N/A	N/A	N/A
HC38420212	ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER	489	33962	9,096	N/A	N/A	N/A
HC38420246	ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS	489	33965	7,143	N/A	N/A	N/A
HC38420279	ECMO/ECLS REMOVAL PRPH CANNULA OPEN 6 YRS & OLDER	489	33984	11,111	N/A	N/A	N/A
HC38420303	ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS	489	33987	8,221	N/A	N/A	N/A
HC38420337	ASSEMBLY & OPER PUMP OXYGEN; EA HR	481	99190	4,235	N/A	N/A	N/A
HC39000005	PSYCH DX EVAL EXAM (NO MED SVCS)	911	90791	544	N/A	N/A	N/A
HC39000112	PSYCH FAMILY GROUP THERAPY	915	90849	303	N/A	N/A	N/A
HC39000153	PSY MED RECORD REVIEW	919	90885	239	N/A	N/A	N/A
HC39000187	PSY PREPARE REPORT 2 HOURS	919	90889	581	N/A	N/A	N/A
HC39000245	PSY TM CONFW/NONMD 30/+MIN(NO PT	900	99368	233	N/A	N/A	N/A
HC39000278	PSYCH FAMILY TX W/O PT 50 MIN	914	90846	571	N/A	N/A	N/A
HC39000310	PSYCH GRP TX(NOT MULTI FAMILY)90MIN	915	90853	362	N/A	N/A	N/A
HC39000617	PSYCH CASE CONF 60MIN	914	99367	323	N/A	N/A	N/A
HC39000740	SW TEACH/COUNSEL INDIVIDUAL -COMM	914	S9445	109	N/A	N/A	N/A
HC39000765	PSYCH TEACH/COUNSEL INDIVIDUAL -COMM	914	S9445	160	N/A	N/A	N/A
HC39000799	PSYCH GROUP TEACH/COUNS SESSION	915	S9446	129	N/A	N/A	N/A
HC39000922	PSYCH TX FOR CRISIS EA ADD 30MINS+/COMM	914	90840	389	N/A	N/A	N/A
HC39000955	PSY TX W/PATIENT 45MIN W/E&M+	914	90836	604	N/A	N/A	N/A
HC39000997	PSYCH PSYCHOANALYSIS	914	90845	309	N/A	N/A	N/A
HC39001029	TMS INITIAL MAP THRES DEL MGMT SESS	900	90867	1,012	N/A	N/A	N/A
HC39001052	PSYCH THERAPY W/BIOFEEDBACK 30 MIN	900	90875	345	N/A	N/A	N/A
HC39001078	PSYCH HYPNOTHERAPY	900	90880	450	N/A	N/A	N/A
HC39001102	PHP OT SKILLS PER SESSION 45 M/>	430	G0129	463	N/A	N/A	N/A
HC39001136	PSYCH GROUP THER (NOT FAM)45-50MIN	915	G0410	417	N/A	N/A	N/A
HC39001235	NEUROBEHAVIORAL STATUS EXAM CLIN ASSESS INTERP & REPORT;  EA ADDL HR+	918	96121	564	N/A	N/A	N/A
HC39001268	NEUROPSYCH TESTING EVAL INTRG INTERP CLIN DES TX FEEDBACK; 1ST HOUR	918	96132	609	N/A	N/A	N/A
HC39001292	PSYCH/NEUROPSYCH TEST ADMIN & SCORING  2 OR > TESTS;  EA ADDL 30MIN+	918	96137	232	N/A	N/A	N/A
HC39001326	BEHAVIOR ADAPT TX ADMN QHCP EA 15MIN	918	97155	139	N/A	N/A	N/A
HC39001359	BEHAVIOR ADAPT TX GROUP BY QHCP; EA 15MIN	918	97158	139	N/A	N/A	N/A
HC39001375	PSY-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	900	96113	210	N/A	N/A	N/A
HC39001383	PSY-ASSESS APHASIA W/REPORT PER HOUR	900	96105	447	N/A	N/A	N/A
HC39001409	PSY-ASSESS BEHAVIOR W/SCORE & DOCD/STAND INSTRUMENT	900	96127	229	N/A	N/A	N/A
HC39001532	PSY-BEHAVIOR TX INDIV 1ST 30 MIN	914	96158	258	N/A	N/A	N/A
HC39001565	PSY-BEHAVIOR TX GROUP ADDL 15 MIN	915	96165	42	N/A	N/A	N/A
HC39001599	PSY-BEHAV TX FAM W/O PT 1ST 30MIN	916	96170	110	N/A	N/A	N/A
HC41000019	SLEEP STUDY ATTENDED	920	95807	4,985	N/A	N/A	N/A
HC41000043	POLYSOMNOGRAPHY 4+ STG 6&> REDCD SVC	740	95810	3,365	N/A	N/A	N/A
HC41000076	POLYSMN CPAP/BIPAP6&>ATTD REDCD SVC	740	95811	4,025	N/A	N/A	N/A
HC41000092	POLYSMNGRPH 4+STG<6Y/O ATTD RDC SVC	740	95782	3,923	N/A	N/A	N/A
HC41000126	POLYSMN CPAP/BIPAP<6 ATTD REDCD SVC	740	95783	3,453	N/A	N/A	N/A
HC41000129	HOME SLEEP STUDY/T IV MIN' 3CH	920	G0400	1,015	N/A	N/A	N/A
HC41500026	CALORIC VESTIB BITHERM 4 IRRIG W/REC	471	92537	1,187	N/A	N/A	N/A
HC41500059	DBS CORTICAL MAP EA ADDL' HRS	740	95962	1,447	N/A	N/A	N/A
HC41500117	EEG CEREBRAL SILENCE	740	95824	3,387	N/A	N/A	N/A
HC41500141	EEG MONITORING 41-60MINUTES	740	95812	2,188	N/A	N/A	N/A
HC41500174	EEG SLEEP(ONLY)	740	95822	2,910	N/A	N/A	N/A
HC41500208	EMG 2 EXTREMITY	922	95861	2,091	N/A	N/A	N/A
HC41500232	EMG FACIAL BILAT	922	95868	1,941	N/A	N/A	N/A
HC41500281	INFANT HEARING SCREEN AEP BBS AUTO INITIAL IP	471	92650	1,385	N/A	N/A	N/A
HC41500356	NEUROMUSC REPEAT STIM EA NERVE	922	95937	1,210	N/A	N/A	N/A
HC41500380	NYSTAGMUS SPONT GAZE/FIX	471	92541	629	N/A	N/A	N/A
HC41500414	SOMATOSENSORY HEAD/TRUNK	922	95927	2,925	N/A	N/A	N/A
HC41500430	SOMATOSENSORY UPPER LIMBS	922	95925	3,264	N/A	N/A	N/A
HC41500448	USE OF VERTICAL ELECTRODES	471	92547	675	N/A	N/A	N/A
HC41500463	VISUAL EVOKED RESP CNS/FLASH	922	95930	2,409	N/A	N/A	N/A
HC41500497	EMG EA EXTRM /PRSPNL;CMPL 5MUS+	922	95886	948	N/A	N/A	N/A
HC41500521	CENTRAL MOTOR EVOK UP& LWR LIMBS	922	95939	5,578	N/A	N/A	N/A
HC41500554	VESTIBULAR COMPREHENSIVE EVAL	471	92540	1,820	N/A	N/A	N/A
HC41500588	STUDIES NERVE CONDUCTN 5-6 STUDIES	922	95909	1,967	N/A	N/A	N/A
HC41500612	STUDIES NERVE CONDUCTN11-12 STUDIES	922	95912	2,800	N/A	N/A	N/A
HC41500638	MONITOR NEURO INTRAOP CONT ATTEND 1:1 EA 15MIN+	920	95940	284	N/A	N/A	N/A
HC41500646	MONITOR NEURO INTRAOP CONT REMOTE >1 PT PER HR	920	95941	461	N/A	N/A	N/A
HC41500661	CALORIC VESTIB BITHERM 2 IRRIG W/REC	471	92538	738	N/A	N/A	N/A
HC41500711	EMG LARYNX	922	95865	1,271	N/A	N/A	N/A
HC41500745	EMG LMTD EXTRM 1 (NOT PARASP/CRANIAL/SPHINC)	922	95870	678	N/A	N/A	N/A
HC41500778	EEG W/O VID UNMONITOR 2-12 HR	740	95705	997	N/A	N/A	N/A
HC41500802	EEG W/O VID UNMONITOR EA 12-26HR	740	95708	2,231	N/A	N/A	N/A
HC41500836	EEG W/VIDEO UNMONITOR 2-12 HR	740	95711	2,069	N/A	N/A	N/A
HC41500869	EEG W/VIDEO UNMONITOR EA 12-26 HR	740	95714	3,111	N/A	N/A	N/A
HC41500885	EEG W/VIDEO MONITOR CONT EA 12-26HR	740	95716	7,928	N/A	N/A	N/A
HC41500919	VESTIBULR EVOKD MYOGN POTENTL-VEMP; CVEMP & OVEMP	471	92519	1,234	N/A	N/A	N/A
HC42000018	ECG EXT PT ACTV EVENT MONITOR ATTEND 24HRS-30DAYS;HOOK&RECORD	731	93270	1,362	N/A	N/A	N/A
HC42000042	BIOIMPEDENCE THORACIC	480	93701	787	N/A	N/A	N/A
HC42000075	CV STRESS TEST PHARMACOLOGIC	482	93017	2,793	N/A	N/A	N/A
HC42000109	ECG ROUTINE 12+ LEADS	730	93005	714	N/A	N/A	N/A
HC42000133	ECHO 2D CMPLT W/O SPEC&CLR DOP	483	93307	3,518	N/A	N/A	N/A
HC42000158	ECHO 2D DOP SPEC&CLR W/CON	483	C8929	5,890	N/A	N/A	N/A
HC42000182	ECHO DOPPLER COLOR FLOW	483	93325	1,877	N/A	N/A	N/A
HC42000216	ECHO FETAL DOPPLER F/U OR REP	483	76828	1,053	N/A	N/A	N/A
HC42000240	ECHO 2D STRESS TRDMLW/EKG W/CON	483	C8928	5,039	N/A	N/A	N/A
HC42000299	EVAL PCMKR TRANSTELEPH ^90D	480	93293	505	N/A	N/A	N/A
HC42000349	INTERROGATE REMOTE ^90 D; SGL/DUAL/MULTI/LEADLESS/DEFIB	480	93296	558	N/A	N/A	N/A
HC42000372	INTERROGATE SQ CARDIAC RHYTHM MONITOR	480	93291	471	N/A	N/A	N/A
HC42000398	PROGRAM/EVAL T-ICD SNGL LEAD	480	93282	485	N/A	N/A	N/A
HC42000406	PROGRAM/EVAL T-ICD DUAL LEAD	480	93283	575	N/A	N/A	N/A
HC42000422	PROGRAM/EVAL T-ICD PRE/POST PROC	480	93287	519	N/A	N/A	N/A
HC42000455	PROGRAM/EVAL PACEMKR DUAL LEAD	480	93280	514	N/A	N/A	N/A
HC42000489	RHYTHM STRIP 1-3 LEADS	730	93041	402	N/A	N/A	N/A
HC42000513	TEE CONGENITAL COMPLETE	483	93315	5,324	N/A	N/A	N/A
HC42000562	WCH NEW PT LVL3-EXPANDED	510	99203	347	N/A	N/A	N/A
HC42000596	WCH EST PT LVL1-BRIEF	510	99211	152	N/A	N/A	N/A
HC42000612	WCH EST PT LVL3-EXPANDED	510	99213	223	N/A	N/A	N/A
HC42000620	WCH EST PT LVL4-DETAILED	510	99214	266	N/A	N/A	N/A
HC42000646	ECG EXT PT ACTV EVENT MONITOR ATTEND 24HRS-30DAYS; TRANSMIT/ANYS	731	93271	3,198	N/A	N/A	N/A
HC42000711	ECHO CNGNTL LTD OR F/U W/WO CONTR	483	C8922	3,249	N/A	N/A	N/A
HC42000745	TEE COMPLETE W/WO CONTRAST	483	C8925	5,955	N/A	N/A	N/A
HC42000778	ECHO 2D RX STRESS;CONT EKG W/WO CONTR	483	C8930	5,925	N/A	N/A	N/A
HC42000802	INTERROGATION S-ICD	480	93261	411	N/A	N/A	N/A
HC42000836	MYOCARDIAL STRAIN QUANT ASSESS +	480	93356	1,282	N/A	N/A	N/A
HC42000893	ECG EXT HOLTER >48HRS-7DAYS; SCANNING ANYS W/REPORT	731	93243	1,346	N/A	N/A	N/A
HC42000919	ECG EXT HOLTER >7DAYS-15DAYS; SCANNING ANYS W/REPORT	731	93247	2,023	N/A	N/A	N/A
HC42090001	P: COMPLETE TEE			N/A	N/A	N/A	N/A
HC42090035	P: CONGENITAL TEE			N/A	N/A	N/A	N/A
HC42090068	P: STRESS NUCLEAR TREADMILL			N/A	N/A	N/A	N/A
HC42090092	P:STRESS ECHO PHARAMACOLOGIC			N/A	N/A	N/A	N/A
HC42090142	P: LTD/FU ECHOCARDIOGRAM			N/A	N/A	N/A	N/A
HC42090183	P: ECHO STRESS W/DOPP W/WO CONTRAST			N/A	N/A	N/A	N/A
HC43000041	BREAST BX CORE W/O GUIDE-LT	361	19100	2,965	N/A	N/A	N/A
HC43000058	BREAST BX CORE W/O GUIDE-RT	361	19100	2,965	N/A	N/A	N/A
HC43000108	DUCTOGRAM/GALACTOGRAM SINGLE	320	77053	1,425	N/A	N/A	N/A
HC43000157	MAMMO DUCTO/GALACTO INJ-LT	361	19030	2,411	N/A	N/A	N/A
HC43000371	US GUIDE FNA	402	76942	1,930	N/A	N/A	N/A
HC43000546	PUNCTURE ASP CYST BREAST-RT	361	19000	3,068	N/A	N/A	N/A
HC43000579	DUCTOGRAM MULTI DUCT(S) RT	320	77054	1,628	N/A	N/A	N/A
HC43000686	DUCTOGRAM SINGLE LT	320	77053	1,425	N/A	N/A	N/A
HC43000710	US GUIDE BREAST CORE BIOPSY LT	402	76942	1,812	N/A	N/A	N/A
HC43000728	US GUIDE BREAST CORE BIOPSY RT	402	76942	1,811	N/A	N/A	N/A
HC43000744	US GUIDE CYST ASPIRATION RT	402	76942	1,900	N/A	N/A	N/A
HC43000975	US BREAST; COMPLETE LT	402	76641	967	N/A	N/A	N/A
HC43001007	US BREAST; LIMITED LT	402	76642	724	N/A	N/A	N/A
HC43001031	TOMO BRST DX 3-D; UNILAT LT+	401	77061	111	N/A	N/A	N/A
HC43001064	TOMO BRST SCREEN 3-D BILAT+	403	77063	127	N/A	N/A	N/A
HC43001098	MAMMO SCREEN W/IMP W/CAD BIL	403	77067	1,277	N/A	N/A	N/A
HC43001122	MAMMO DX W/CAD BILAT	401	77066	1,319	N/A	N/A	N/A
HC43001148	MAMMO DX W/SPC VWS W/CAD BIL	401	77066	1,378	N/A	N/A	N/A
HC43001171	MAMMO DX UNILAT W/CAD LT	401	77065	1,104	N/A	N/A	N/A
HC43001205	MAMMO DX W/SPC VWS UNILT W/CAD RT	401	77065	1,214	N/A	N/A	N/A
HC43001239	ABLATION CRYO BREAST MALIG TUMOR(S) &IMAG UNILAT	361	0581T	13,000	N/A	N/A	N/A
HC43500024	DEXA BONE DENS-BODY $	320	77080	1,106	N/A	N/A	N/A
HC43500057	DEXA BONE DENS&VERTBRL FX ASSESS	320	77085	1,408	N/A	N/A	N/A
HC44000024	ABDOMEN 2 VIEWS	320	74019	872	N/A	N/A	N/A
HC44000040	XR ABDOMEN COMPLETE (2/> IMAGES) W/CXR	320	74022	1,251	N/A	N/A	N/A
HC44000073	ANKLE 2 VIEWS BILAT	320	73600	1,304	N/A	N/A	N/A
HC44000107	ANKLE ARTHROGRAM BILAT	322	73615	2,737	N/A	N/A	N/A
HC44000131	ANKLE COMP MIN 3 VWS BILAT	320	73610	1,880	N/A	N/A	N/A
HC44000198	XR COLON SINGLE CONTRAST INC SCOUT DELAYED	320	74270	1,809	N/A	N/A	N/A
HC44000222	BONE LENGTH STUDIES	320	77073	2,033	N/A	N/A	N/A
HC44000255	BONE SURVEY LTD	320	77074	1,506	N/A	N/A	N/A
HC44000305	CALCANEUS (HEEL) LT	320	73650	622	N/A	N/A	N/A
HC44000313	CALCANEUS (HEEL) RT	320	73650	622	N/A	N/A	N/A
HC44000339	CERVICAL SPINE 2 OR 3VWS	320	72040	988	N/A	N/A	N/A
HC44000362	CHEST 2 VIEWS	324	71046	838	N/A	N/A	N/A
HC44000404	CHEST 4/> VIEWS	324	71048	1,164	N/A	N/A	N/A
HC44000446	CHOLANGIOGRAM INTRAOP ADDL SET	320	74301	546	N/A	N/A	N/A
HC44000511	CLAVICLE LT	320	73000	673	N/A	N/A	N/A
HC44000545	CYSTOGRAM	320	74430	1,345	N/A	N/A	N/A
HC44000560	DISKOGRAPHY-CERVICAL/THORACIC	320	72285	5,772	N/A	N/A	N/A
HC44000578	DISKOGRAPHY-LUMBAR	320	72295	5,351	N/A	N/A	N/A
HC44000602	ELBOW 2 VWS LT	320	73070	702	N/A	N/A	N/A
HC44000636	ELBOW ARTHROGRAM LT	322	73085	1,606	N/A	N/A	N/A
HC44000669	ELBOW COMP MIN 3 VWS LT	320	73080	898	N/A	N/A	N/A
HC44000693	XR ESOPHAGUS W/SNGLE CONSTRST INC SCOUT&DELAYS	320	74220	1,251	N/A	N/A	N/A
HC44000727	EYE FOR FOREIGN BODY RT	320	70030	452	N/A	N/A	N/A
HC44000750	FB CHILD NOSE-RECTUM EXAM	320	76010	623	N/A	N/A	N/A
HC44000784	FEMUR 2/> VIEWS RT	320	73552	1,006	N/A	N/A	N/A
HC44000800	FINGER(S) MIN 2 VWS-RT	320	73140	616	N/A	N/A	N/A
HC44000834	FLUORO GUIDE SPINE INJ(NONFRMN	320	77003	1,894	N/A	N/A	N/A
HC44000883	FOOT 2 VIEWS BILAT	320	73620	1,441	N/A	N/A	N/A
HC44000917	FOOT COMP MIN 3 VWS BILAT	320	73630	1,818	N/A	N/A	N/A
HC44000941	FOREARM BILAT	320	73090	1,369	N/A	N/A	N/A
HC44000974	HAND 2 VIEWS BILAT	320	73120	1,342	N/A	N/A	N/A
HC44001006	HAND COMPLETE MIN 3 VWS BILAT	320	73130	1,787	N/A	N/A	N/A
HC44001022	HAND COMPLETE MIN 3 VWS RT	320	73130	897	N/A	N/A	N/A
HC44001055	HIP ARTHROGRAM RT	322	73525	1,863	N/A	N/A	N/A
HC44001196	HUMERUS RT	320	73060	762	N/A	N/A	N/A
HC44001220	INFANT LOW EXTREM MIN 2VWS LT	320	73592	793	N/A	N/A	N/A
HC44001253	INFANT UP EXTREM MIN 2VWS LT	320	73092	691	N/A	N/A	N/A
HC44001287	INTRALUMINAL DILATION O/STRICT	320	74360	1,671	N/A	N/A	N/A
HC44001311	IVP DRIP OR BOLUS W/TOMO	320	74415	2,107	N/A	N/A	N/A
HC44001337	IVP LIMITED	320	74400	1,741	N/A	N/A	N/A
HC44001345	IVP ROUTINE	320	74400	2,251	N/A	N/A	N/A
HC44001360	KNEE 1 VIEW BILAT	320	73560	1,373	N/A	N/A	N/A
HC44001394	KNEE 2 VIEWS BILAT	320	73560	1,476	N/A	N/A	N/A
HC44001428	KNEE 3 VIEWS BILAT	320	73562	1,885	N/A	N/A	N/A
HC44001451	KNEE 4 OR MORE VWS BILAT	320	73564	2,296	N/A	N/A	N/A
HC44001485	KNEE ARTHROGRAM BILAT	322	73580	3,637	N/A	N/A	N/A
HC44001519	KNEES BILATERAL AP STANDING	320	73565	753	N/A	N/A	N/A
HC44001535	LUMBAR SPINE 2 OR 3 VWS	320	72100	923	N/A	N/A	N/A
HC44001543	LUMBAR SPINE BEND ONLY;2/3 VWS	320	72120	1,093	N/A	N/A	N/A
HC44001568	LUMBAR SPINE SERIES MIN 4VWS	320	72110	1,416	N/A	N/A	N/A
HC44001592	MASTOIDS < 3 VIEWS PER SIDE	320	70120	682	N/A	N/A	N/A
HC44001626	MYELOGRAM LUMBOSACRAL	320	72265	3,260	N/A	N/A	N/A
HC44001659	NASAL BONES	320	70160	898	N/A	N/A	N/A
HC44001683	OPTIC FORAMINA	320	70190	452	N/A	N/A	N/A
HC44001717	PELVIS 1 OR 2 VWS	320	72170	795	N/A	N/A	N/A
HC44001741	XR PHARYNX/CERVICAL ESOPHAGUS W/CNSTRST INC SCOUT&DELAYS	320	74210	1,048	N/A	N/A	N/A
HC44001766	REMOV FB ESOPHAGEAL W/BALLOON	320	74235	1,451	N/A	N/A	N/A
HC44001790	RIBS UNILAT 2 VIEWS LT	320	71100	839	N/A	N/A	N/A
HC44001824	RIBS UNILAT MIN 3 VWS W/PA-RT	320	71101	1,028	N/A	N/A	N/A
HC44001857	SACRUM & COCCYX MIN 2VWS	320	72220	877	N/A	N/A	N/A
HC44001881	SCAPULA LT	320	73010	713	N/A	N/A	N/A
HC44001923	SHOULDER 1 VIEW BILATERAL	320	73020	1,351	N/A	N/A	N/A
HC44001956	SHOULDER ARTHROGRAM BILAT	322	73040	3,309	N/A	N/A	N/A
HC44001972	SHOULDER ARTHROGRAM RT	322	73040	1,835	N/A	N/A	N/A
HC44001980	SHOULDER COMP MIN 2VWS BILAT	320	73030	1,782	N/A	N/A	N/A
HC44002004	SHOULDER COMP MIN 2VWS RT	320	73030	933	N/A	N/A	N/A
HC44002038	SINUSES LTD <  3 VWS	320	70210	722	N/A	N/A	N/A
HC44002061	XR SMALL BOWEL W/SINGLE CONTRAST INC SCOUT SERIAL	320	74250	1,600	N/A	N/A	N/A
HC44002095	SPEECH STUDY - CINE/VIDEO	320	70371	1,096	N/A	N/A	N/A
HC44002137	STRESS VIEW  ANY JOINT	320	77071	550	N/A	N/A	N/A
HC44002178	TEETH/LESS THAN FULL MOUTH	320	70310	519	N/A	N/A	N/A
HC44002194	THORACIC SPINE 2 VIEWS	320	72070	753	N/A	N/A	N/A
HC44002202	THORACIC SPINE 3 VIEWS	320	72072	901	N/A	N/A	N/A
HC44002228	SPINE THORACOLUMBAR JUNCTN MIN 2 VWS	320	72080	892	N/A	N/A	N/A
HC44002251	TIBIA & FIBULA (LEG) 2 VWS RT	320	73590	862	N/A	N/A	N/A
HC44002293	TMJ ARTHROGRAM RT	322	70332	1,028	N/A	N/A	N/A
HC44002327	TMJ UNILATERAL RIGHT	320	70328	480	N/A	N/A	N/A
HC44002350	TOE (S) RT	320	73660	602	N/A	N/A	N/A
HC44002442	XR UGI W/DOUBLE CONTRAST INC SCOUT DELAYED	320	74246	1,590	N/A	N/A	N/A
HC44002491	URETHROCYSTOGRAM VOIDING	320	74455	1,607	N/A	N/A	N/A
HC44002517	WRIST 2 VIEWS BILAT	320	73100	1,328	N/A	N/A	N/A
HC44002541	WRIST ARTHROGRAM BILAT	322	73115	2,981	N/A	N/A	N/A
HC44002574	WRIST COMP MIN 3 VWS BILAT	320	73110	1,782	N/A	N/A	N/A
HC44002608	XR EXAM SURGICAL SPECIMEN	320	76098	1,086	N/A	N/A	N/A
HC44002665	FLUORSOCOPY ASSIST OR >1HR(ST)	320		N/A	N/A	N/A	N/A
HC44002699	UROGRAPHY ANTEGRADE LTD RT	320	74425	1,142	N/A	N/A	N/A
HC44002723	WRIST - TWO VIEWS	320	73100	702	N/A	N/A	N/A
HC44002749	WRIST - FOUR VIEWS	320	73110	876	N/A	N/A	N/A
HC44002772	KNEE 4 VIEWS	320	73564	1,146	N/A	N/A	N/A
HC44002806	ANKLE MIN 3 VIEWS	320	73610	941	N/A	N/A	N/A
HC44002830	MYELOGRAPHY INJ W/S&I; CERVICAL	361	62302	9,219	N/A	N/A	N/A
HC44002863	MYELOGRAPHY INJ W/S&I; =/>2SPINALREGIONS	361	62305	10,610	N/A	N/A	N/A
HC44002897	SPINE ENTIRE SKULL-SACRUM 4-5 VIEWS	320	72083	1,542	N/A	N/A	N/A
HC44002921	HIP (W/PELVIS WHN PRFRMD) 1 VIEW RT	320	73501	784	N/A	N/A	N/A
HC44002947	HIP (W/PELVIS WHN PRFRMD) 2-3VWS RT	320	73502	1,073	N/A	N/A	N/A
HC44002954	HIP (W/PELVIS WHN PRFRMD) 4/>VWS LT	320	73503	1,281	N/A	N/A	N/A
HC44002970	HIPS BILAT2VWS(W/PELVIS WHN PRFRMD)	320	73521	1,119	N/A	N/A	N/A
HC44003002	FEMUR 1 VIEW LT	320	73551	544	N/A	N/A	N/A
HC44003051	CHEST 3 VIEWS	324	71047	947	N/A	N/A	N/A
HC44003085	XR SMALL BOWEL F-THRU INC SERIAL+	320	74248	953	N/A	N/A	N/A
HC44089902	CDSM MEDCURRENT	329	G1002	0	N/A	N/A	N/A
HC44089951	CDSM AIM SPECIALTY HEALTH	329	G1007	0	N/A	N/A	N/A
HC44089985	CDSM STANSON	329	G1010	0	N/A	N/A	N/A
HC44089993	CDSM QUALIFIED NOS	329	G1011	0	N/A	N/A	N/A
HC44200012	US ABDOMEN LTD	402	76705	1,765	N/A	N/A	N/A
HC44200046	ART STDY BILAT U/L 1-2 LVL LTD	921	93922	1,726	N/A	N/A	N/A
HC44200103	US DUPLEX ABD/PEL FLOW COMP	921	93975	3,204	N/A	N/A	N/A
HC44200137	US DUPLEX AORTA IVC ILIAC UNI/LTD	921	93979	1,833	N/A	N/A	N/A
HC44200160	US DUPLEX ART UP EXT COMP BIL	921	93930	2,902	N/A	N/A	N/A
HC44200194	US DUPLEX CAROTID UNILAT LT	921	93882	1,997	N/A	N/A	N/A
HC44200228	US DUPLEX HEMODIALYSIS ACCESS	921	93990	1,672	N/A	N/A	N/A
HC44200244	US DUPLEX PENILE VESSEL F/U OR LTD	921	93981	1,750	N/A	N/A	N/A
HC44200285	US FETAL BIO PROFILE W/NST	402	76818	1,748	N/A	N/A	N/A
HC44200319	US GUIDE COMP REPR PSEUDOANEUR	402	76936	3,301	N/A	N/A	N/A
HC44200343	US HEAD/NECK SOFT TISSUE	402	76536	1,830	N/A	N/A	N/A
HC44200376	US INFANT HIPS LTD/STATIC	402	76886	1,467	N/A	N/A	N/A
HC44200400	US OB >1ST TRI ADD'L GEST+	402	76810	1,680	N/A	N/A	N/A
HC44200434	US OB FOLLOW UP(RE-EVAL)	402	76816	1,175	N/A	N/A	N/A
HC44200459	US OB LIMITED FETUS(S)	402	76815	1,254	N/A	N/A	N/A
HC44200483	US OB TRANSVAGINAL	402	76817	1,607	N/A	N/A	N/A
HC44200533	US PELVIC(NON OB)LTD OR F/U	402	76857	1,420	N/A	N/A	N/A
HC44200566	US SCROTUM	402	76870	1,930	N/A	N/A	N/A
HC44200590	TCD EMBOLI DETECT W/O IV MICROBUBBL	921	93892	2,990	N/A	N/A	N/A
HC44200624	US TRANSRECT PROSTATE VOL STDY	402	76873	1,949	N/A	N/A	N/A
HC44200665	AMNIOCENTESIS	361	59000	5,089	N/A	N/A	N/A
HC44200699	US AAA SCREENING	402	76706	1,015	N/A	N/A	N/A
HC44200707	US GUIDE PLCMNT NEEDLE LOC	402	76942	1,949	N/A	N/A	N/A
HC44200756	US GUIDE FNA RT	402	76942	1,949	N/A	N/A	N/A
HC44200780	US GUIDE PLCMNT NEEDLE LOC LT	402	76942	1,949	N/A	N/A	N/A
HC44200814	US EXTREMITY NON VASC CMPLT-LT	402	76881	1,625	N/A	N/A	N/A
HC44200848	ART STDY SNG U/L 1-2 LVL LTD-R	921	93922	1,193	N/A	N/A	N/A
HC44200871	ART STDY SNG U/L 3/> LVL CMP-L	921	93922	1,726	N/A	N/A	N/A
HC44200913	TCD ICA VASOREACTIVITY STUDY	921	93890	3,599	N/A	N/A	N/A
HC44200939	US HEAD/NECK SOFT TISSUE LTD	402	76536	788	N/A	N/A	N/A
HC44200947	US MAPPING VESSEL HEMODIALYSIS; COMPLT BILAT	402	93985	1,606	N/A	N/A	N/A
HC44200962	US ELASTOGRAPHY	402	76981	827	N/A	N/A	N/A
HC44200996	US OB EVAL PLUS FETAL ANATOMIC DETAIL 1ST GEST	402	76811	2,775	N/A	N/A	N/A
HC44201028	US GUIDED ENDOMYOCARDIAL BX	402	76932	1,442	N/A	N/A	N/A
HC44500023	ABLATION RENAL TUMOR(S) PERC; RF RT	361	50592	20,794	N/A	N/A	N/A
HC44500056	ANGIO ADRENAL RT	323	75731	7,695	N/A	N/A	N/A
HC44500221	ANGIO EXTREMITY UE OR LE LT	323	75710	8,831	N/A	N/A	N/A
HC44500270	ANGIO PULMONARY BILAT	323	75743	13,427	N/A	N/A	N/A
HC44500296	ANGIO PULMONARY RT	323	75741	7,596	N/A	N/A	N/A
HC44500379	ANGIO SPINAL SELECTIVE  LT	323	75705	10,116	N/A	N/A	N/A
HC44500437	ANGIO VISCERAL	323	75726	10,068	N/A	N/A	N/A
HC44500460	AORTOGRAM ABDOMINAL LTD	323	75625	5,392	N/A	N/A	N/A
HC44500544	PERC DILATATION INTRACRANIAL VASOSPASM EA ADD VES DIFF TERRITORY+	361	61642	38,673	N/A	N/A	N/A
HC44500619	CAROTID STENT W/EMBOL PROT RT	481	37215	35,023	N/A	N/A	N/A
HC44500676	CINERADIOGRAPHY W/ EXAM	320	76125	625	N/A	N/A	N/A
HC44500692	CORPORA CAVERNOSGRAPHY	320	74445	2,262	N/A	N/A	N/A
HC44500700	CTA ABD AORTA/ILIOFEM RUNOFF	352	75635	10,013	N/A	N/A	N/A
HC44500734	PERC DIL URETER/URETHRA S&I-RT	320	74485	2,570	N/A	N/A	N/A
HC44500791	ERCP BILIARY DUCT SYSTEM	320	74328	2,606	N/A	N/A	N/A
HC44500866	GUIDE PERC DRAIN W/CATH PLCMNT	350	75989	2,637	N/A	N/A	N/A
HC44500908	INJ PERC EXT PSEUDOANEUR BILAT	361	36002	3,910	N/A	N/A	N/A
HC44500932	INJ SCLEROTHERAPY MULT VEINS-LT	361	36471	2,487	N/A	N/A	N/A
HC44500965	INJ SCLEROTHERAPY SNGL VEIN-RT	361	36470	2,137	N/A	N/A	N/A
HC44501013	INTRALUMIN OBST VEN DEV S&I	323	75902	3,560	N/A	N/A	N/A
HC44501203	MECH REMOV PERICTH CEN VEN S&I	320	75901	3,765	N/A	N/A	N/A
HC44501229	PLACE TUBE NASO/ORO-GASTRIC BY MD W/FLUORO	361	43752	2,468	N/A	N/A	N/A
HC44501443	PHLEBCT VEIN/EXT 10-20 STAB-RT	361	37765	14,115	N/A	N/A	N/A
HC44501476	PORTOGRAM W/O HEMODYNAMIC EVAL	320	75887	5,742	N/A	N/A	N/A
HC44501732	REM & REPLAC EXT URET CATH(IMG S&I) BI	361	50387	16,453	N/A	N/A	N/A
HC44501765	REM & REPLAC URETERAL STENT BI	361	50382	23,045	N/A	N/A	N/A
HC44501799	REMOVE NEPHROSTOMY TUBE BIL	361	50389	8,729	N/A	N/A	N/A
HC44501823	REMOVE URETERAL STENT BIL	361	50384	21,125	N/A	N/A	N/A
HC44501849	REMOVE URETERAL STENT RT	361	50384	11,119	N/A	N/A	N/A
HC44501880	STENT PLAC INTRACRANIAL	361	61635	41,527	N/A	N/A	N/A
HC44501914	THROMBECTOMY MECH PRIM ART RT(NONCOR/CRNL)	361	37184	18,803	N/A	N/A	N/A
HC44501948	THROMBECTOMY ART 2ND LT(NONCOR/CRNL)	361	37186	12,936	N/A	N/A	N/A
HC44501997	THROMBECTOMY VENOUS RT	361	37187	17,006	N/A	N/A	N/A
HC44502029	THROMBOLYSIS CEREBRAL/IV  RT	361	37195	1,456	N/A	N/A	N/A
HC44502052	TRANSCATH EMBOLIZ PERC-NON CNS	361	61626	36,498	N/A	N/A	N/A
HC44502136	TRANSHEP DIL BILI W/O-W STENT	320	74363	3,256	N/A	N/A	N/A
HC44502193	VENOGRAM ADRENAL RT	320	75840	7,084	N/A	N/A	N/A
HC44502227	VENOGRAM EPIDURAL	320	75872	6,397	N/A	N/A	N/A
HC44502250	VENOGRAM HEPATIC W/HEMO EVAL	320	75889	7,510	N/A	N/A	N/A
HC44502284	VENOGRAM RENAL LT	320	75831	7,097	N/A	N/A	N/A
HC44502318	ENDOVENOUS ABLAT LASER WS&I; INITIAL VEIN	361	36478	14,930	N/A	N/A	N/A
HC44502524	PERC DILATATION INTRACRANIAL VASSOSPASM INITIAL VESSEL -LT	361	61640	22,557	N/A	N/A	N/A
HC44502607	REMOVAL PLEURAL CATH W/CUFF RT	361	32552	4,730	N/A	N/A	N/A
HC44502615	REMOVAL PLEURAL CATH W/CUFF LT	361	32552	4,730	N/A	N/A	N/A
HC44502631	INSERT PLEURAL CATH TUNNELD LT	361	32550	14,785	N/A	N/A	N/A
HC44502706	CAROTID STENT W/O EMBO PROT RT	481	37216	35,023	N/A	N/A	N/A
HC44502730	REVASC ILIAC W/TLA INITL VES-BI	323	37220	34,291	N/A	N/A	N/A
HC44502763	REVASC ILIAC W/TLA & STENT-BI	323	37221	47,204	N/A	N/A	N/A
HC44502797	REVASC ILIAC EA+VES W/TLA-BI	323	37222	29,764	N/A	N/A	N/A
HC44502821	REVAS ILIAC EA+VES W/TLA&STENT-B	323	37223	40,751	N/A	N/A	N/A
HC44502847	REVASC FEM POP W/TLA-LT	323	37224	18,925	N/A	N/A	N/A
HC44502854	REVASC FEM POP W/TLA-BI	323	37224	34,063	N/A	N/A	N/A
HC44502870	REVASC FEM POP W/TLA&ATHER-LT	323	37225	31,539	N/A	N/A	N/A
HC44502904	REVASC FEM POP W/TLA&STENT-LT	323	37226	29,816	N/A	N/A	N/A
HC44502938	REVAS FEMPOP TLA&STENT&ATHER-L	323	37227	43,770	N/A	N/A	N/A
HC44502961	REVAS TIB/PERO W/TLA 1ST VES-LT	323	37228	17,867	N/A	N/A	N/A
HC44502995	REVAS TIB/PERO W/TLA & ATHER-LT	323	37229	28,363	N/A	N/A	N/A
HC44503027	REVAS TIB/PERO W/TLA&STENT-LT	323	37230	28,265	N/A	N/A	N/A
HC44503050	REVAS TIB/PERO TLA&STNT&ATHR-L	323	37231	33,451	N/A	N/A	N/A
HC44503076	REVASC TIB/PERO EA+VES W/TLA-R	323	37232	15,589	N/A	N/A	N/A
HC44503100	REVASC TIB/PERO EA+VES W/TLA-R	323	37233	20,679	N/A	N/A	N/A
HC44503134	REVAS TIB/PER EA+V TLA&STENT-R	323	37234	22,443	N/A	N/A	N/A
HC44503167	REVAS TIB/PER EA+TLA&ATH&STN-R	323	37235	25,788	N/A	N/A	N/A
HC44503191	ATHER' TRLUML RENAL ART&S&I-RT	323	0234T	26,781	N/A	N/A	N/A
HC44503225	ATHER' TRLUML VISERCL EA & S&I	323	0235T	16,265	N/A	N/A	N/A
HC44503258	ATHER'TRLUML BRACH EAVES W/S&I-L	323	0237T	27,000	N/A	N/A	N/A
HC44503274	ATHER'TRLUML ILIAC EAVES W/S&I-R	323	0238T	31,543	N/A	N/A	N/A
HC44503431	VENOGRAM EXTREMITY UNILAT RT	323	75820	3,562	N/A	N/A	N/A
HC44503464	DECLOT IVAD BY THROMBOLYTIC LT	361	36593	2,845	N/A	N/A	N/A
HC44503498	PHLEBCT VEIN/EXT >20 STAB-LT	361	37766	18,164	N/A	N/A	N/A
HC44503548	SEL CATH&RENAL ANGIO1STW/S&I-L	361	36251	11,569	N/A	N/A	N/A
HC44503571	SEL CATH&RENAL ANGIO2NDW/S&I-L	361	36253	13,105	N/A	N/A	N/A
HC44503605	PLCMNT IVC FILTER /S&I/IMAGE	361	37191	23,988	N/A	N/A	N/A
HC44503621	REMOV IVC FILTER/S&I/IMG GUIDE	361	37193	11,771	N/A	N/A	N/A
HC44503639	LIGATION INFERIOR VENA CAVA	361	37619	19,242	N/A	N/A	N/A
HC44503670	VERT/THOR CAROTID STENT 1ST RT	361	0075T	45,391	N/A	N/A	N/A
HC44503704	DEST SUPERIOR HYPOGASTR PLEXUS	361	64681	5,502	N/A	N/A	N/A
HC44503738	THROMBOLYSIS VEN NONCOR+S&I1ST DAY	323	37212	15,029	N/A	N/A	N/A
HC44503761	TRANSCATH RETRIEVAL PERC FB W/S&I	323	37197	16,228	N/A	N/A	N/A
HC44503795	SEL CATH CC/INOM &ANGIO EXCC W/S&I RT	323	36222	14,407	N/A	N/A	N/A
HC44503829	SEL CATH  IC CAROTID &ANG IC W/SI LT	323	36224	23,620	N/A	N/A	N/A
HC44503845	SEL CATH SUBC/INOM &ANG VRT W/SI LT	323	36225	14,539	N/A	N/A	N/A
HC44503852	SEL CATH SUBC/INOM &ANG VRT W/SI RT	323	36225	14,539	N/A	N/A	N/A
HC44503878	SEL CATH VERTEBRAL &ANG VRT W/SI RT	323	36226	20,973	N/A	N/A	N/A
HC44503902	SEL CATH EA IC CRTD/VERT&ANG W/SI LT+	323	36228	9,835	N/A	N/A	N/A
HC44503936	PLCMNT GRAFT FEM-FEM-AAA REP+	360	34813	17,318	N/A	N/A	N/A
HC44504033	EMBOLIZE ARTERIAL(ANY MALFORMTN)W/S&I	361	37242	49,338	N/A	N/A	N/A
HC44504066	REVAS OTHR PERIPH1ST ART W/STNT W-S&I	361	37236	26,662	N/A	N/A	N/A
HC44504090	REVAS OTHR PERIPH +VEIN W/STNT W-S&I	361	37239	11,780	N/A	N/A	N/A
HC44504124	ABLAT PULM TUMOR(S) PERC UNILAT W/IMG GUID; CRYO	361	32994	22,385	N/A	N/A	N/A
HC44504140	SEL CATH CC/INOM &ANGIO IC W/S&I BI	323	36223	36,118	N/A	N/A	N/A
HC44504173	SEL CATH VERTEBRAL &ANG VRT W/SI BI	323	36226	39,599	N/A	N/A	N/A
HC44504207	XRAY TEVAR W/ LT SUBCLAV; INT'L ENDO& DIST EXTS CELIAC S&I	481	75956	8,909	N/A	N/A	N/A
HC44504231	XRAY TEVAR; PLCMT OF DISTAL EXTS PROTH(S) DELAYED S&I	481	75959	5,631	N/A	N/A	N/A
HC44504264	VERTEBROPLASTY1BODY/GUIDE; EA ADD'L VBODY	361	22512	12,431	N/A	N/A	N/A
HC44504298	VERTEBRAL AUGMNT 1BODY W/GUIDE;EA ADD'L L	361	22515	19,150	N/A	N/A	N/A
HC44504322	ABLATION LIVER TUMOR(S) PERC; CRYO	361	47383	24,147	N/A	N/A	N/A
HC44504348	PLCMT CATH BIL DRN PERC(CHOLANG S&I)INT/EXT	361	47534	17,339	N/A	N/A	N/A
HC44504371	PLCMT STNT BIL PERC EA&CATH(CHOLANG BLN DIL S&I)NEW ACC	361	47540	17,259	N/A	N/A	N/A
HC44504405	REMOVE CATH DRN BIL PERC(CHOLANG S&I)	361	47537	5,769	N/A	N/A	N/A
HC44504439	BX(S) BILTREE PERC SNGL/MULTI(IMG S&I)+	361	47543	6,058	N/A	N/A	N/A
HC44504462	IVUS VESSEL INIT'L NONCORON W/EXAM+	402	37252	5,933	N/A	N/A	N/A
HC44504496	ENDOVASC INFUS CRANIAL(NON-THROMB)ADD TRRT+	361	61651	7,813	N/A	N/A	N/A
HC44504520	PLCMT URET STENT PERC(NEPH/URET'GRM S&I)PRE-EXIST BI	361	50693	24,292	N/A	N/A	N/A
HC44504546	PLCMT URET STENT PERC(NEPH/URET'GRM S&I)PRE-EXIST RT	361	50693	13,496	N/A	N/A	N/A
HC44504553	PLCMT URET STENT PERC(NEPH/URET'GRM S&I)NEW ACCES BI	361	50694	33,312	N/A	N/A	N/A
HC44504579	PLCMT URET STENT PERC(NEPH/URET'GRM S&I)NEW ACCES RT	361	50694	17,531	N/A	N/A	N/A
HC44504603	PLCMT URET STENT PERC(NEPH/URET'GRM S&I) NEW ACCES SEP CATH RT	361	50695	20,055	N/A	N/A	N/A
HC44504637	THROMBECT MECH PERC&/THROMBOLYSIS INF CRANI RT	361	61645	32,225	N/A	N/A	N/A
HC44504660	DILAT BALLOON STRICTURE URETERAL  LT	361	50706	7,294	N/A	N/A	N/A
HC44504694	ENDOVENOUS ABLAT MECHANOCHEM WS&I; INITIAL VEIN	361	36473	10,722	N/A	N/A	N/A
HC44504728	ACCESS DIALYSIS CIRCUIT EVAL->VENA CAVA WS&I; PDS PTA	361	36902	12,391	N/A	N/A	N/A
HC44504744	THROMBECT &/THROMBOLYSIS DIALYSIS CIRC WS&I PHARM INJ	361	36904	19,241	N/A	N/A	N/A
HC44504751	THROMBECT &/THROMBOLYSIS DIALYSIS CIRC WS&I PHARM INJ;&PTA OF PDS	361	36905	25,339	N/A	N/A	N/A
HC44504777	PTA CDS VIA DIALYSIS CIRCUIT WS&I +	361	36907	8,071	N/A	N/A	N/A
HC44504801	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:INTL LEFT	361	37246	15,363	N/A	N/A	N/A
HC44504835	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:ADDL + LT	361	37247	10,314	N/A	N/A	N/A
HC44504868	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:INTL LEFT	361	37248	14,005	N/A	N/A	N/A
HC44504892	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:ADDL + LT	361	37249	8,490	N/A	N/A	N/A
HC44504926	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE &TUBE PLC; NEW ACCESS RNL COL-LT	361	50437	17,359	N/A	N/A	N/A
HC44504959	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE /&TUBE-LT	361	50436	10,565	N/A	N/A	N/A
HC44504975	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE /&TUBE-BIL	361	50436	15,882	N/A	N/A	N/A
HC44505006	PERC PULM ARTERY REVASC W/STENT INITL; ABNRML NTV UNILAT	361	33902	30,758	N/A	N/A	N/A
HC44700011	BUNDLE OF HIS RECORDING	481	93600	6,848	N/A	N/A	N/A
HC44700136	COMP EP EVAL W/O IND ARRHYTH	481	93619	21,359	N/A	N/A	N/A
HC44700169	COMP EP EVAL W/LT VENT PACE+	481	93622	11,928	N/A	N/A	N/A
HC44700193	EP EVAL ICD LEADS/GEN AT IMPLA	481	93641	7,666	N/A	N/A	N/A
HC44700227	ESOPHAG REC ATRIAL ELECTROGRAM	481	93615	4,510	N/A	N/A	N/A
HC44700243	IMPLANT CARDIAC RHYTHM MONITOR SQ & PROGRAMMING	481	33285	12,424	N/A	N/A	N/A
HC44700250	INDUCTION OF ARRHYTHMIA	481	93618	5,198	N/A	N/A	N/A
HC44700342	INSERT ARTERIAL LINE RT	481	36620	956	N/A	N/A	N/A
HC44700375	INSERT PACER VENT SNGL CHAMBER	481	33207	23,129	N/A	N/A	N/A
HC44700409	INSERT/EXTRAC/RET/REPOS D TV LEADS	481	33217	17,799	N/A	N/A	N/A
HC44700433	INSERT/REPLC SYSTM T-ICD DUAL W/LDS	481	33249	37,448	N/A	N/A	N/A
HC44700466	INSRT PACER ONLY;W/EXIST SNGL LEAD	481	33212	14,414	N/A	N/A	N/A
HC44700490	INSRT ICD W/EXISTNG SNGL LEAD	481	33240	25,173	N/A	N/A	N/A
HC44700516	INTRA-ATRIAL PACING	481	93610	7,322	N/A	N/A	N/A
HC44700524	INTRA-ATRIAL RECORDING	481	93602	6,831	N/A	N/A	N/A
HC44700540	INTRACARDIAC EP 3D MAPPING+	481	93613	11,565	N/A	N/A	N/A
HC44700573	INTRAVENTRICULAR PACING	481	93612	7,606	N/A	N/A	N/A
HC44700623	LIGATION /BANDING A/V FISTULA	481	37607	10,470	N/A	N/A	N/A
HC44700698	PERC BALLOON VALVPLSTY MITRAL	481	92987	33,556	N/A	N/A	N/A
HC44700789	PERC TRANSLUM COR THROMBECTMY+	481	92973	10,063	N/A	N/A	N/A
HC44700896	PROG STIM/PACING POST MEDS+	481	93623	8,413	N/A	N/A	N/A
HC44700987	REMVL PERM PACER PULSE GN ONLY	481	33233	10,380	N/A	N/A	N/A
HC44701001	REMOV ICD LEADS EXTRACTN TRANSVENOS	481	33244	11,140	N/A	N/A	N/A
HC44701035	REMOVE DUAL LEAD	481	33235	11,543	N/A	N/A	N/A
HC44701068	REPOS PREV PLCD LV SYSTEM ELEC	481	33226	13,829	N/A	N/A	N/A
HC44701092	RELOCATE SKIN POCKET PACEMAKER	481	33222	10,825	N/A	N/A	N/A
HC44701159	THROMBOLYSIS INTRACORONARY INF WANGIO	481	92975	3,666	N/A	N/A	N/A
HC44701183	UPGRADE PACER  SNGL-DUAL	481	33214	23,070	N/A	N/A	N/A
HC44701217	INSTILL FIBRIN CT INIT' DAY RT	361	32561	2,702	N/A	N/A	N/A
HC44701233	INSTILL FIBRIN CT INIT' DAY LT	361	32561	2,702	N/A	N/A	N/A
HC44701324	LEFT HEART CATH; LT VENT W/S&I	481	93452	21,730	N/A	N/A	N/A
HC44701357	PLCMT CORON CATH;BYPASS GRAFTS	481	93455	21,425	N/A	N/A	N/A
HC44701381	PLCMT CORON CATH;LT HRT CATH	481	93458	26,670	N/A	N/A	N/A
HC44701415	PLCMT CORON CATH;R&L HRT&GRFT	481	93461	34,656	N/A	N/A	N/A
HC44701449	INJ PRO HRT CATH &IMG; AORTOCORON GRAFTS+	481	93564	6,600	N/A	N/A	N/A
HC44701472	INJ PRO CATH; SUPRAVALVULAR AORTAGRPY+	481	93567	5,610	N/A	N/A	N/A
HC44701548	INCISE FEMEROL; DELIVERY EVS PROTH	360	34812	12,684	N/A	N/A	N/A
HC44701555	PHYSIOLOGIC EXERCISE STUDY+	481	93464	1,740	N/A	N/A	N/A
HC44701571	INSRT PACER ONLY;EXST MULTI LD	481	33221	17,390	N/A	N/A	N/A
HC44701605	REMV&REPL PACER MULTI LEAD SYS	481	33229	26,029	N/A	N/A	N/A
HC44701639	REMV&REPLC SYSTM ICD LEAD SINGL	481	33262	24,345	N/A	N/A	N/A
HC44701662	PERC CLOSURE OF VSD W/IMPLANT	481	93581	36,521	N/A	N/A	N/A
HC44701712	PERC COR ANGIOPLST; SNGL CA/BRCH-LM	481	92920	23,521	N/A	N/A	N/A
HC44701746	PERC COR ANGIOPLST; SNGL CA/BRCH-RC	481	92920	23,521	N/A	N/A	N/A
HC44701761	PERC COR ANGIOPLST; ADDL CA/BRCH-LM+	481	92921	14,940	N/A	N/A	N/A
HC44701779	PERC COR ANGIOPLST; ADDL CA/BRCH-LD+	481	92921	14,940	N/A	N/A	N/A
HC44701795	PERC COR ANGIOPLST; ADDL CA/BRCH-RC+	481	92921	14,940	N/A	N/A	N/A
HC44701829	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-LD	481	92924	29,300	N/A	N/A	N/A
HC44701852	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-RI	481	92924	29,300	N/A	N/A	N/A
HC44701886	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-LC+	481	92925	17,742	N/A	N/A	N/A
HC44701910	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-LM	481	92928	27,128	N/A	N/A	N/A
HC44701944	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-RC	481	92928	27,128	N/A	N/A	N/A
HC44701977	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-LD+	481	92929	16,924	N/A	N/A	N/A
HC44701993	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-RC+	481	92929	16,924	N/A	N/A	N/A
HC44702025	PERC COR ATHR+STENT/ANGIOP; SNGL-LD	481	92933	32,208	N/A	N/A	N/A
HC44702058	PERC COR ATHR+STENT/ANGIOP; SNGL-RI	481	92933	32,208	N/A	N/A	N/A
HC44702082	PERC COR ATHR+STENT/ANGIOP; ADDL-LC+	481	92934	18,933	N/A	N/A	N/A
HC44702116	PERC CABG REVAS ATHR/STENT/ANG; SNGL-LM	481	92937	27,918	N/A	N/A	N/A
HC44702140	PERC CABG REVAS ATHR/STENT/ANG; SNGL-RC	481	92937	27,918	N/A	N/A	N/A
HC44702173	PERC CABG REVAS ATHR/STENT/ANG; ADDL-LD+	481	92938	16,889	N/A	N/A	N/A
HC44702199	PERC CABG REVAS ATHR/STENT/ANG; ADDL-RC+	481	92938	16,889	N/A	N/A	N/A
HC44702223	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-LD	481	92941	31,917	N/A	N/A	N/A
HC44702256	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-RI	481	92941	31,917	N/A	N/A	N/A
HC44702280	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-LC	481	92943	32,524	N/A	N/A	N/A
HC44702314	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-LM+	481	92944	19,137	N/A	N/A	N/A
HC44702348	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-RC+	481	92944	19,137	N/A	N/A	N/A
HC44702371	PERC COR DES STENT(S)/ANGIOP; SNGL-LD	481	92928	27,160	N/A	N/A	N/A
HC44702397	PERC COR DES STENT(S)/ANGIOP; SNGL-RC	481	92928	27,160	N/A	N/A	N/A
HC44702405	PERC COR DES STENT(S)/ANGIOP; SNGL-RI	481	92928	27,160	N/A	N/A	N/A
HC44702421	PERC COR DES STENT(S)/ANGIOP; ADDL-LD+	481	92929	16,924	N/A	N/A	N/A
HC44702454	PERC COR DES STENT(S)/ANGIOP; ADDL-RI+	481	92929	16,924	N/A	N/A	N/A
HC44702488	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-LC	481	92933	32,208	N/A	N/A	N/A
HC44702512	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-LM+	481	92934	18,933	N/A	N/A	N/A
HC44702546	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-RC+	481	92934	18,933	N/A	N/A	N/A
HC44702579	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-LD	481	92937	27,918	N/A	N/A	N/A
HC44702595	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-RC	481	92937	27,918	N/A	N/A	N/A
HC44702603	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-RI	481	92937	27,918	N/A	N/A	N/A
HC44702629	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-LD+	481	92938	16,889	N/A	N/A	N/A
HC44702652	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-RI+	481	92938	16,889	N/A	N/A	N/A
HC44702686	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-LC	481	92941	31,917	N/A	N/A	N/A
HC44702710	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-LM	481	92943	32,524	N/A	N/A	N/A
HC44702744	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-RC	481	92943	32,524	N/A	N/A	N/A
HC44702777	PERC COR CHRON REVAS ATHR/DES/A;ADDL-LD+	481	92944	19,137	N/A	N/A	N/A
HC44702801	PERC COR CHRON REVAS ATHR/DES/A;ADDL-RI+	481	92944	19,137	N/A	N/A	N/A
HC44702827	COMP EP EVAL W/INDUC&ABLAT 3D MAP TX VT	481	93654	49,308	N/A	N/A	N/A
HC44702850	ABLAT ADD'L ATRIUM A FIB POST PVI+	481	93657	11,121	N/A	N/A	N/A
HC44702884	REPAIR VISC AORTA FEVAR; 3 PROSTH	360	34843	44,358	N/A	N/A	N/A
HC44702918	REPAIR VISC AORTA FEVAR(PROX&DIST);2 PROSTH	360	34846	51,205	N/A	N/A	N/A
HC44702942	INSERT PERC VAD INC S&I ARTERIAL ONLY; LEFT HEART	361	33990	13,736	N/A	N/A	N/A
HC44702975	INSERT/REPLC SYSTM ICD PERM&SUBQ LD	481	33270	30,082	N/A	N/A	N/A
HC44703007	TAVR/TAVI W/ PROSTH; PERC FEM ARTERY	481	33361	37,914	N/A	N/A	N/A
HC44703023	TAVR/TAVI W/ PROSTH; OPEN AXILLARLY ARTERY	481	33363	42,075	N/A	N/A	N/A
HC44703031	TAVR/TAVI W/ PROSTH; OPEN ILIAC ARTERY	481	33364	44,163	N/A	N/A	N/A
HC44703056	TAVR/TAVI W/ PROSTH; TRANSAPICAL EXP (LT THORAC)	481	33366	55,500	N/A	N/A	N/A
HC44703080	TAVR/TAVI; BYPASS OPEN CENTRAL A&V(AORTA RA PA)+	481	33369	24,946	N/A	N/A	N/A
HC44703114	TEVAR; INITIAL ENDO & DIST EXTS TO CELIAC	360	33881	49,674	N/A	N/A	N/A
HC44703148	TEVAR; PLCMT OF DISTAL EXTS PROTH(S) DELAYED	360	33886	32,427	N/A	N/A	N/A
HC44703171	OPEN REPAIR INFRARENAL AAA; FAILED ENDOGRAFT; AORTO-BI-ILIAC PRO	360	34831	55,081	N/A	N/A	N/A
HC44703205	OPEN BRACHIAL FOR ILIAC OR AORTIC ENDOGRAFT  UNI	360	34834	9,931	N/A	N/A	N/A
HC44703239	RIGHT HEART CATH; W/SENSOR PULM ARTERY W/S&I	481	33289	12,139	N/A	N/A	N/A
HC44703247	INSERT ELECTRODE DEFIBRILLATOR SUBQ	481	33271	17,930	N/A	N/A	N/A
HC44703262	REPOSIT ELECTRODE DEFIBRILLATOR SUBQ	481	33273	9,955	N/A	N/A	N/A
HC44703296	REMOVE TRANSCATH PACER LEADLESS RV INCL ALL IMAGING	481	33275	10,693	N/A	N/A	N/A
HC44703320	EV REPAIR INFRARENAL AORTA&/ILIAC GRFT AORT-UNIILIAC NONRUPT	360	34703	33,270	N/A	N/A	N/A
HC44703353	EV REPAIR INFRARENAL AORTA&/ILIAC GRAFT AORTO-BI-ILIAC ~RUPT	360	34706	50,044	N/A	N/A	N/A
HC44703387	PLACMNT EXTNSN PROTH ILIAC ART/PROX RENAL EV PER VESSEL TX+	360	34709	5,709	N/A	N/A	N/A
HC44703411	TRANSCATH DELIVERY ENHANCED FIXATION DEVICE	360	34712	21,259	N/A	N/A	N/A
HC44703445	OPEN AXILLARY/SUBCLAV ART EXPOSE DELIVER EV PROTH UNILATL+	360	34715	6,667	N/A	N/A	N/A
HC44703460	REPAIR AORTA ASCENDING ENDOVSC STENT GRAFT	361	37799	53,618	N/A	N/A	N/A
HC44703494	PERICARDIAL DRAIN 0-5YR W/ANOMOLY INCL FLUORO &/US	361	33018	4,774	N/A	N/A	N/A
HC44703528	REVASCULARIZATION LITHOTRIPSY INTRAVASC	361	C9764	21,471	N/A	N/A	N/A
HC44703551	REVASCULARIZATION LITHOTRIPSY INTRAVASC W/STENT & ATHERECT	361	C9767	32,635	N/A	N/A	N/A
HC44703585	TMVR MITRACLIP INITIAL PROTH	481	33418	38,646	N/A	N/A	N/A
HC44703619	TRANSCATH INTRACARD SHUNT(TIS) STENT ICF CONGENTL INCLUDE IMAGI; 1ST SHUNT (FONTANE)	361	33745	42,940	N/A	N/A	N/A
HC44703643	REMOVE VAD PERCUT VENOUS RIGHT	361	33997	6,105	N/A	N/A	N/A
HC44703718	PERC REPAIR TRNSCTH TRICUSPID VALVE 1ST PROSTHESIS	481	0569T	36,981	N/A	N/A	N/A
HC44703742	RT HRT CATH CONGEN DEFECTS INCLUDE IMAG;NRML NATIVE CONNECT	481	93593	24,511	N/A	N/A	N/A
HC44703775	RT & LT HRT CATH CONGEN DEFECT INCLUDE IMAGE;NRML NATIVE CONNECT	481	93596	26,115	N/A	N/A	N/A
HC44703809	EV REPAIR STENT PLACE COARCT AORTA ACROSS MAJOR SIDE BRANCHES	360	33894	55,244	N/A	N/A	N/A
HC44703866	PERC TRANSLUM CORONARY LITHOTRIPSY +	481	0715T	10,890	N/A	N/A	N/A
HC44703890	INJ PRO HRT CATH &IMAG; SELCT PULM VENOUS EA VEIN+	481	93574	7,844	N/A	N/A	N/A
HC44703924	TMVR/TMVI W/PROTH; VIA CORONARY SINUS	481	0345T	32,680	N/A	N/A	N/A
HC44790012	P: TEVAR; INITIAL ENDO & DIST EXTS TO CELIAC/S&I			N/A	N/A	N/A	N/A
HC44790020	P: TEVAR; PLCMT PROX EXT PROTH; INITIAL/S&I			N/A	N/A	N/A	N/A
HC44790046	P: TEVAR; PLCMT OF DISTAL EXTS PROTH(S) DELAYED/S&I			N/A	N/A	N/A	N/A
HC44900025	CT ABDOMEN W/O CONTRAST	352	74150	5,376	N/A	N/A	N/A
HC44900066	CT BONE DENSITY STDY AXIAL SKL	352	77078	1,651	N/A	N/A	N/A
HC44900090	CT CHEST/LUNG LOW DOSE SCREENING	352	71271	2,662	N/A	N/A	N/A
HC44900124	CT CHEST DX W/O CONTRAST	352	71250	5,381	N/A	N/A	N/A
HC44900157	CT C-SPINE W/O CONTRAST	352	72125	6,252	N/A	N/A	N/A
HC44900173	CT GUIDE STEREOTACTIC LOC	350	77011	10,342	N/A	N/A	N/A
HC44900181	CT GUIDANCE ABLATION PARENCHYMAL TISSUE	350	77013	4,620	N/A	N/A	N/A
HC44900215	CT HEAD W/CONTRAST	351	70460	5,537	N/A	N/A	N/A
HC44900249	CT LOW EXT W&W/O CONTRAST LT	352	73702	6,217	N/A	N/A	N/A
HC44900272	CT LOW EXT W/CONTRAST LT	352	73701	5,432	N/A	N/A	N/A
HC44900306	CT LOW EXT W/O CONTRAST LT	352	73700	4,962	N/A	N/A	N/A
HC44900330	CT L-SPINE W/ CONTRAST	352	72132	7,153	N/A	N/A	N/A
HC44900363	CT MAXILLO FACIAL W&W/O CONT	351	70488	5,368	N/A	N/A	N/A
HC44900397	M: CT MISC STUDY	350	76497	N/A	N/A	N/A	N/A
HC44900413	CT NECK SOFT TISSUE W/ CONT	351	70491	5,138	N/A	N/A	N/A
HC44900447	CT ORBIT/SELLA/EAR W/ CONTRAST	351	70481	5,713	N/A	N/A	N/A
HC44900470	CT PELVIS W/ CONTRAST	352	72193	6,188	N/A	N/A	N/A
HC44900504	CT T-SPINE W&W/O  CONTRAST	352	72130	8,363	N/A	N/A	N/A
HC44900538	CT UPPER EXT W&W/O CONT BILAT	352	73202	10,646	N/A	N/A	N/A
HC44900561	CT UPPER EXT W/CONTRAST BILAT	352	73201	9,735	N/A	N/A	N/A
HC44900595	CT UPPER EXT W/O CONTRAST BIL	352	73200	9,706	N/A	N/A	N/A
HC44900611	CT UPPER EXT W/O CONTRAST RT	352	73200	5,072	N/A	N/A	N/A
HC44900645	CTA CHEST	352	71275	7,504	N/A	N/A	N/A
HC44900678	CTA LOW EXT LT	352	73706	7,055	N/A	N/A	N/A
HC44900702	CTA PELVIS	352	72191	7,578	N/A	N/A	N/A
HC44900736	CTA UPPER EXT W/CONTRAST-RT	352	73206	7,298	N/A	N/A	N/A
HC44900835	CT COLONOGRAPHY DX VIRTUAL W/O CONTRAST	350	74261	3,962	N/A	N/A	N/A
HC44900868	CT BODY SCAN LTD ABD/CHEST/PEL	350		1,069	N/A	N/A	N/A
HC44900884	CT BODY SCAN NK/CH/ABD/PEL/HRT	350		1,639	N/A	N/A	N/A
HC44900892	CT BODY SCAN NK/CH/ABD/PEL	350		1,425	N/A	N/A	N/A
HC44900918	CT BODY SCAN HRT/LUNG/SC	350		783	N/A	N/A	N/A
HC44900942	CT HEART CONGEN EVAL /3D IMAGE	350	75573	4,976	N/A	N/A	N/A
HC44900983	CT ABDOMEN & PELVIS W/CONTRAST	352	74177	9,381	N/A	N/A	N/A
HC44901023	CTA ABDOMEN+PELVIS	352	74174	11,733	N/A	N/A	N/A
HC44901056	CT BREAST 3D RENDER UNILAT W/O CONTRAST	352	0633T	2,815	N/A	N/A	N/A
HC44901080	CT BREAST 3D RENDER BILAT W/O CONTRAST	352	0636T	4,314	N/A	N/A	N/A
HC44901106	CT BREAST 3D RENDER UNILAT W&W/O CONTRAST	352	0638T	4,912	N/A	N/A	N/A
HC45200003	CARDIAC BLOOD POOL 1ST PASS+	341	78496	1,988	N/A	N/A	N/A
HC45200037	NM ADRENAL IMAGING	341	78075	4,699	N/A	N/A	N/A
HC45200060	NM BONE MARROW WHOLE BODY	341	78104	3,320	N/A	N/A	N/A
HC45200094	NM BONE SCAN 3 PHASE	341	78315	4,450	N/A	N/A	N/A
HC45200136	NM BRAIN IMAG MIN'4 STATC W/VF	341	78606	4,096	N/A	N/A	N/A
HC45200169	NM BRAIN IMAGING 4< STATIC VWS	341	78600	2,656	N/A	N/A	N/A
HC45200201	NM CARDIAC BP IMAG GATED SNGLE	341	78472	3,624	N/A	N/A	N/A
HC45200235	NM CARDIAC SCAN	341	78466	2,653	N/A	N/A	N/A
HC45200250	NM CARDIAC SCAN W/EF 1ST PASS	341	78468	2,745	N/A	N/A	N/A
HC45200284	NM CSF LEAKAGE IMAGING	341	78650	3,685	N/A	N/A	N/A
HC45200318	NM GASTRIC MUCOSA IMAGING	341	78261	2,475	N/A	N/A	N/A
HC45200342	NM GASTROINTESTINAL BLOOD LOSS	341	78278	4,156	N/A	N/A	N/A
HC45200391	NM KIDNEY IMAGING MORPHOLOGY	341	78700	2,580	N/A	N/A	N/A
HC45200425	NM KIDNEY IMAG FLW/FUNC W/PHAR	341	78708	3,885	N/A	N/A	N/A
HC45200490	NM LIVER IMAGING W/VASC FLOW	341	78202	2,870	N/A	N/A	N/A
HC45200516	NM LIVER/SPLEEN W/VASC FLOW	341	78216	3,066	N/A	N/A	N/A
HC45200524	PULM PERFUSION IMAGING	341	78580	3,384	N/A	N/A	N/A
HC45200540	NM MECKEL'S/BOWEL IMAGING	341	78290	3,872	N/A	N/A	N/A
HC45200656	NM PERITON VEN SHUNT PATENCY	341	78291	2,795	N/A	N/A	N/A
HC45200722	NM RADIONUCLIDE VOIDING CYSTO	341	78740	2,943	N/A	N/A	N/A
HC45200755	NM SALIVARY GLAND W/SER IMAG	341	78231	2,549	N/A	N/A	N/A
HC45200813	NM TESTICULAR IMAGING W/FLOW	341	78761	2,819	N/A	N/A	N/A
HC45200904	THYROID METS IMAG W/ADD STUDIES	341	78016	3,738	N/A	N/A	N/A
HC45200961	NM TUMOR LOCALIZE PLNR SGL AREA 1 DAY	341	78800	2,757	N/A	N/A	N/A
HC45200979	NM TUMOR LOCALIZE PLNR 2+AREAS 1+DAYS//1AREA 2+ DAYS	341	78801	3,437	N/A	N/A	N/A
HC45200995	NM TUMOR LOCALIZE SPECT SNGL AREA 1 DAY	341	78803	5,297	N/A	N/A	N/A
HC45201027	NM VENOGRAM(THROMBOS)UNILAT RT	341	78457	2,269	N/A	N/A	N/A
HC45201068	NM TUMOR LOCALIZE PLNR WHOLE BODY 2+ DAYS	341	78804	7,769	N/A	N/A	N/A
HC45201209	MIBI SPECT SNG STUDY W/WM & EF	341	78451	6,273	N/A	N/A	N/A
HC45201233	MIBI PLANAR MULT STUDY W/WM&EF	341	78454	6,547	N/A	N/A	N/A
HC45201266	QUANT DIFF PULM PERF	341	78597	2,663	N/A	N/A	N/A
HC45201290	HEPATOBIL SYS IMAGW/RX(&QUANT)	341	78227	4,863	N/A	N/A	N/A
HC45201316	NM THYROID SCAN IMAGE ONLY [W/VASC FLOW IF PERF]	341	78013	2,638	N/A	N/A	N/A
HC45201340	NM PARATHYRD SCN W/SPECT & CT	341	78072	4,448	N/A	N/A	N/A
HC45201373	NM TUMOR LOCALIZE SPECT CT  SNGL AREA 1 DAY	341	78830	6,143	N/A	N/A	N/A
HC45201407	NM RADIOPHARM QUANTIFICATION MSRMNT SINGLE AREA+	341	78835	338	N/A	N/A	N/A
HC45400017	MR ABDOMEN W/ CONTRAST	610	74182	8,208	N/A	N/A	N/A
HC45400041	MR BONE MARROW BLOOD SUPPLY	610	77084	6,792	N/A	N/A	N/A
HC45400074	MR BRAIN W/O CONTRAST	611	70551	6,804	N/A	N/A	N/A
HC45400090	MR CHEST W/CONTRAST	610	71551	7,352	N/A	N/A	N/A
HC45400124	MR C-SPINE W/CONTRAST	612	72142	7,614	N/A	N/A	N/A
HC45400157	MR GUIDANCE ABLATION PARENCHYMAL TISSUE	610	77022	4,707	N/A	N/A	N/A
HC45400181	MR LOW EXT(NON JNT)W/O CONT RT	610	73718	6,295	N/A	N/A	N/A
HC45400215	MR LOW EXT(NON JNT)W/CONT RT	610	73719	7,243	N/A	N/A	N/A
HC45400249	MR LO EXT(NON JNT)W&W/O CON RT	610	73720	10,125	N/A	N/A	N/A
HC45400272	MR LOW EXT(JNT) W/O CONT RT	610	73721	6,186	N/A	N/A	N/A
HC45400298	MR LOW EXT(JNT)W/CONT LT	610	73722	7,243	N/A	N/A	N/A
HC45400306	MR LOW EXT(JNT)W/CONT RT	610	73722	7,243	N/A	N/A	N/A
HC45400322	MR LOW EXT(JNT)W&W/O CONT LT	610	73723	9,940	N/A	N/A	N/A
HC45400355	MR L-SPINE W/CONTRAST	612	72149	8,435	N/A	N/A	N/A
HC45400389	MR ORBIT/FACE&OR NECK W/CONTR	611	70542	7,685	N/A	N/A	N/A
HC45400413	MR PELVIS W/CONTRAST	610	72196	7,410	N/A	N/A	N/A
HC45400462	MR TMJ(S)	610	70336	6,390	N/A	N/A	N/A
HC45400496	MR T-SPINE W/O CONTRAST	612	72146	7,260	N/A	N/A	N/A
HC45400512	MR UP EXT(NON JNT) W/O CONT LT	610	73218	6,098	N/A	N/A	N/A
HC45400520	MR UP EXT(NON JNT) W/O CONT RT	610	73218	6,098	N/A	N/A	N/A
HC45400546	MR UP EXT(NON JNT)W/CONT LT	610	73219	7,244	N/A	N/A	N/A
HC45400579	MR UP EXT(NON JNT) W&W/O LT	610	73220	10,290	N/A	N/A	N/A
HC45400603	MR UP EXT(JNT) W/O CONT LT	610	73221	6,127	N/A	N/A	N/A
HC45400637	MR UP EXT (JNT) W/CONT LT	610	73222	7,455	N/A	N/A	N/A
HC45400660	MRA CHEST W/CONTRAST	610	C8909	6,501	N/A	N/A	N/A
HC45400694	MRA HEAD W/CONTRAST	611	70545	7,147	N/A	N/A	N/A
HC45400728	MRA NECK W/ CONTRAST	611	70548	7,952	N/A	N/A	N/A
HC45400744	MRA PELVIS W/ CONTRAST	610	C8918	5,778	N/A	N/A	N/A
HC45400827	MRI CARDIAC FOR MORPH W/CON	610	75561	9,175	N/A	N/A	N/A
HC45400884	MRI CARDIAC W/STRESS IMG W/CON	610	75563	11,426	N/A	N/A	N/A
HC45400918	MR UP EXT JNT W&W/O CONT BILAT	610	73223	20,900	N/A	N/A	N/A
HC45401015	MR BREAST W/O CONTRAST LTD LT	610	77046	2,480	N/A	N/A	N/A
HC45401049	MR BREAST W/O& W/ CONTRAST RT	610	C8905	6,536	N/A	N/A	N/A
HC45401072	MR BREAST W/O&W CONTRAST LTD LT	610	C8905	2,825	N/A	N/A	N/A
HC45401114	MR BREASTS W/O CONTRAST LTD (BILAT)	610	77047	3,836	N/A	N/A	N/A
HC45401171	MRA LOW EXT W/CONT RT	610	C8912	5,418	N/A	N/A	N/A
HC45401205	MRA LOW EXT W/O CONT RT	610	C8913	6,018	N/A	N/A	N/A
HC45401239	MRA LOW EXT W&W/O CONT RT	610	C8914	7,415	N/A	N/A	N/A
HC45401262	MRA ABDOMEN W&W/O CONTRAST	610	C8902	7,533	N/A	N/A	N/A
HC45401312	MR CARDIAC VELOCITY FLOW MAP +	610	75565	1,721	N/A	N/A	N/A
HC45401346	MRA SPINE W/O CONTRAST	612	C8932	6,869	N/A	N/A	N/A
HC45401395	MRA UPPER EXT W/O CONT RT	610	C8935	4,618	N/A	N/A	N/A
HC45401403	MRA UPPER EXT W/O&W/CONT RT	610	C8936	5,475	N/A	N/A	N/A
HC45401429	MRA UPPER EXT W/O CONT LT	610	C8935	4,618	N/A	N/A	N/A
HC45401544	MRI FETAL INCL PLACENTA PLVC IF PRF; SINGLE 1ST GESTATION	610	74712	4,916	N/A	N/A	N/A
HC45401577	MR BREAST W/O& W/ CONTR & CAD LT [COMM&MCAL]	610	77048	6,488	N/A	N/A	N/A
HC45401601	MRI GUIDED US STEREOTACT ABLAT INTRACRAN LESION	361	0398T	56,160	N/A	N/A	N/A
HC45600020	PET LIMITED AREA	404	78811	10,181	N/A	N/A	N/A
HC45600053	PET  W/CT LIMITED AREA	404	78814	11,926	N/A	N/A	N/A
HC45600079	PET W/CT WHOLE BODY	404	78816	16,042	N/A	N/A	N/A
HC45600087	PET MELANOMA  NON-COV INDCTNS	404	G0219	9,291	N/A	N/A	N/A
HC45600103	PET BREAST CA INTL/ SURG PLAN	404	G0252	8,203	N/A	N/A	N/A
HC46000048	INJ ARTHRO HIP W/ANESTH-RT	361	27095	2,045	N/A	N/A	N/A
HC46000097	INJ ARTHROGRAM ANKLE-LT	361	27648	1,106	N/A	N/A	N/A
HC46000139	INJ ARTHROGRAM ELBOW-RT	361	24220	1,720	N/A	N/A	N/A
HC46000170	INJ ARTHROGRAM WRIST-RT	361	25246	1,221	N/A	N/A	N/A
HC46000238	INJ CORPORA CAVERNOSOGRAM	361	54230	2,193	N/A	N/A	N/A
HC46000261	INJ DISKOGRAM LUMBAR EA LVL	361	62290	4,304	N/A	N/A	N/A
HC46000311	INJ FOR DACRYCYSTOGRAPHY	361	68850	1,123	N/A	N/A	N/A
HC46000394	INJ PROCEDURE MYELOGRAPHY  LUMBAR	361	62284	3,401	N/A	N/A	N/A
HC46000436	INJ VENOGRAM EXTREMITY- BILAT	361	36005	2,836	N/A	N/A	N/A
HC46000469	INJECTION HIP ARTHROGRAM BIL	361	27093	3,177	N/A	N/A	N/A
HC46000493	INTRO CATH FALLOPIAN TUBE	361	58345	8,305	N/A	N/A	N/A
HC46000550	INTRO CATHETER AORTA	321	36200	8,645	N/A	N/A	N/A
HC46000626	INTRO NDL/CATH EXT ART UE OR LE LT	361	36140	3,114	N/A	N/A	N/A
HC46000675	INTRO OF CATH SVC OR IVC	361	36010	3,628	N/A	N/A	N/A
HC46000709	SEL CATH AB/PEL/LOEXT1ST OR BI	321	36245	12,540	N/A	N/A	N/A
HC46000741	SEL CATH AB/PEL/LOEXT2ND OR LT	321	36246	7,853	N/A	N/A	N/A
HC46000782	SEL CATH AB/PEL/LOEX 2ND+ORD RT	321	36248	2,391	N/A	N/A	N/A
HC46000824	SEL CATH PULMONARY ART BILAT	321	36014	4,898	N/A	N/A	N/A
HC46000857	SEL CATH SEGMNT PULM ART BILAT	321	36015	5,528	N/A	N/A	N/A
HC46000881	SEL CATH THOR/BRAC 1ST ORD LT	321	36215	6,374	N/A	N/A	N/A
HC46000907	SEL CATH THOR/BRAC 2ND ORD LT	321	36216	7,285	N/A	N/A	N/A
HC46000915	SEL CATH THOR/BRAC 2ND ORD RT	321	36216	7,285	N/A	N/A	N/A
HC46000931	SEL CATH THOR/BRAC 3RD ORD RT	321	36217	8,961	N/A	N/A	N/A
HC46000964	SEL VENOUS CATH 1ST ORD BI	321	36011	5,211	N/A	N/A	N/A
HC46000998	SEL VENOUS CATH 2ND+ORDR LT	321	36012	3,677	N/A	N/A	N/A
HC46001020	INTRO NDL/INTRACATH VEIN BI	361	36000	834	N/A	N/A	N/A
HC46001053	SEL CATH AB/PEL/LOEXT1ST OR	321	36245	7,139	N/A	N/A	N/A
HC46001087	SEL CATH AB/PEL/LOEX2ND+ORDERT	321	36248	2,391	N/A	N/A	N/A
HC46001103	INJ ARTHROGRAM ELBOW-SC BIL	361	24220	3,096	N/A	N/A	N/A
HC46001111	INJ ARTHRO HIP W/ANESTH-SC BIL	361	27095	3,684	N/A	N/A	N/A
HC46001244	INJECTION SINUS TRACT; THERAPEUTIC	361	20500	4,427	N/A	N/A	N/A
HC46001277	INJ ANTEGRAD COMP(NEPH/URET'GRM S&I)NEW ACCESS BI	361	50430	10,691	N/A	N/A	N/A
HC46001301	INJ ANTEGRAD NEPH/URET'GRM S&I EXIST ACCESS BI	361	50431	6,999	N/A	N/A	N/A
HC46001335	INJ CONTRAST KNEE ARTHRO/CT/MRI	361	27369	2,067	N/A	N/A	N/A
HC46500054	ASP PERC SPINAL CORD CYST	361	62268	2,893	N/A	N/A	N/A
HC46500088	ASP/INJ RENAL CYST/PELVIS BI	361	50390	11,427	N/A	N/A	N/A
HC46500112	ASP/INJ THYROID CYST	361	60300	3,399	N/A	N/A	N/A
HC46500146	BX BONE TROCAR/NEEDLE; DEEP	361	20225	9,440	N/A	N/A	N/A
HC46500252	BIOPSY MUSCLE PERC NEEDLE	361	20206	6,093	N/A	N/A	N/A
HC46500302	BIOPSY NEEDLE RENAL-BILAT	361	50200	14,862	N/A	N/A	N/A
HC46500336	BIOPSY NEEDLE SALIVARY GLAND	361	42400	3,621	N/A	N/A	N/A
HC46500369	BX VERTEBRAL BODY; OPEN THORACIC	361	20250	13,295	N/A	N/A	N/A
HC46500401	BX DEEP PELV/HIP-SC LT	361	27041	6,495	N/A	N/A	N/A
HC46500468	BX LYMPH NODE(S)-SUPERFCL-LT	361	38505	5,857	N/A	N/A	N/A
HC46500526	BX PLEURA NDL-LT	361	32400	3,532	N/A	N/A	N/A
HC46500534	BX PLEURA NDL-RT	361	32400	3,532	N/A	N/A	N/A
HC46500559	BX SFT TISS PELV/HIP-BIL	361	27040	10,980	N/A	N/A	N/A
HC46500609	BX THYROID NEEDLE CORE	361	60100	4,361	N/A	N/A	N/A
HC46500674	CHANGE PERC GT TO GJ TUBE W/FLUORO	361	49446	9,419	N/A	N/A	N/A
HC46500716	CIRCUMCISION PROCEDURE	361	54150	5,274	N/A	N/A	N/A
HC46500757	CYSTOGRAM COMPLEX	361	51726	3,105	N/A	N/A	N/A
HC46500864	EXCHANGE EXISTING DRAIN CATH	361	49423	5,218	N/A	N/A	N/A
HC46500906	FNA ASP BX W/O GUIDE; FIRST LESION	361	10021	1,837	N/A	N/A	N/A
HC46500914	FNA ASP BX W/O GUIDE; EACH ADD'L LESION	361	10004	1,653	N/A	N/A	N/A
HC46500948	INS PICC LINE W/PORT<5YR	361	36570	14,384	N/A	N/A	N/A
HC46500971	INS TUN VEN ACS DEV W/PORT<5YR	361	36560	18,862	N/A	N/A	N/A
HC46501003	INS TUN VEN CATH W/O PORT<5	361	36557	14,441	N/A	N/A	N/A
HC46501037	INSERT CT(OPEN) W/DRAIN SYSTEM BIL	361	32551	8,877	N/A	N/A	N/A
HC46501060	INSERT PERITONEAL CATH TUNNELED FOR DIALYSIS; OPEN	361	49421	13,936	N/A	N/A	N/A
HC46501094	INSERT PICC <5 YR AGE W/O IMAGING	361	36568	8,405	N/A	N/A	N/A
HC46501128	INSRT BLADDER CATH-TEMP FOLEY	361	51702	814	N/A	N/A	N/A
HC46501169	LUMBAR PUNCTURE DX [NOT W/ CT OR FLUORO ]	361	62270	4,775	N/A	N/A	N/A
HC46501193	MANOMETRIC STDY VIA NEPHRO LT	361	50396	2,776	N/A	N/A	N/A
HC46501227	PARACENTESIS ABD W/O IMAGING GUIDE	361	49082	4,267	N/A	N/A	N/A
HC46501268	PERC PLACEMENT DU/J TUBE W/FLUORO	361	49441	11,083	N/A	N/A	N/A
HC46501292	INS NO TUN CV ACCESS CATH 5YRS+	361	36556	7,685	N/A	N/A	N/A
HC46501359	PUNCTURE CISTERN/LAT CERVICAL C1-C2 W/INJ	361	61055	6,996	N/A	N/A	N/A
HC46501383	REMVL INTRALUMIN OBST VEN DEV	361	36596	5,328	N/A	N/A	N/A
HC46501409	REPAIR CV ACCESS CATH	361	36575	5,126	N/A	N/A	N/A
HC46501433	REPLACE PERC G-J TUBE W/FLUORO	361	49452	6,739	N/A	N/A	N/A
HC46501466	REPLC TUNNELED CV ACS DEVICE W/O PORT/PUMP	361	36581	12,058	N/A	N/A	N/A
HC46501490	REPLC NON-TUN CV ACS CATH W/O PORT/PUMP	361	36580	8,341	N/A	N/A	N/A
HC46501524	REPOSITION CV CATH UNDER FLUORO	361	36597	5,345	N/A	N/A	N/A
HC46501565	THORACENTESIS ASP W/ IMG GUID-RT	361	32555	6,959	N/A	N/A	N/A
HC46501599	THORACENTESIS W/TUBE W/ IMAG RT	361	32557	7,352	N/A	N/A	N/A
HC46501623	UROFLOWMETRY COMPLEX	361	51741	1,189	N/A	N/A	N/A
HC46501631	UROFLOWMETRY SIMPLE	361	51736	889	N/A	N/A	N/A
HC46501714	BX/RMVL LYMPH NODE(S)-OPEN LT	361	38510	9,368	N/A	N/A	N/A
HC46501748	BX LYMPH NODE(S)SUPERFICIAL-SC	361	38505	5,857	N/A	N/A	N/A
HC46501771	ASP/INJ RENAL CYST/PELVIS	361	50390	6,021	N/A	N/A	N/A
HC46501813	BX LYMPH NODE(S)SUPERFICIAL*DS	361	38505	5,857	N/A	N/A	N/A
HC46501920	ADJUST GASTRIC BAND VIA PORT	361	43999	3,839	N/A	N/A	N/A
HC46501953	PERC CHOLECYSTOSTOMY WCATH/S&I	361	47490	12,074	N/A	N/A	N/A
HC46501979	BONE MARROW DX; ASPIRATION(S) ONLY RT	361	38220	4,545	N/A	N/A	N/A
HC46501987	BONE MARROW DX; BIOPSY(SIES) ONLY	361	38221	4,906	N/A	N/A	N/A
HC46502001	BONE MARROW DX; BIOPSY(SIES) ONLY RT	361	38221	4,906	N/A	N/A	N/A
HC46502050	BX SOFT TISS THIGH/KNEE;SUP RT	361	27323	3,430	N/A	N/A	N/A
HC46502092	PARACENTESIS ABD W/IMAGING GUIDE	361	49083	5,996	N/A	N/A	N/A
HC46502126	ABLATION RENAL TUMOR(S) PERC; CRYO LT	361	50593	32,840	N/A	N/A	N/A
HC46502159	PERC BX BREAST W/LOC DEV SG ADDL LESN+	361	19082	4,286	N/A	N/A	N/A
HC46502183	PERC BX BREAST W/LOC DEV MR 1ST LESN	361	19085	9,399	N/A	N/A	N/A
HC46502217	PERC PLC BRST LOC DEV MAMMO ADDL LESN+	361	19282	4,602	N/A	N/A	N/A
HC46502233	PERC PLC BRST LOC DEV SG ADDL LESN+	361	19284	3,813	N/A	N/A	N/A
HC46502266	PERC PLC BRST LOC DEV MR 1ST LESN	361	19287	7,641	N/A	N/A	N/A
HC46502290	PERC DRAIN CATH W/IMAG; VISCERAL	361	49405	7,988	N/A	N/A	N/A
HC46502324	TENOTOMY SHOULDER AREA  SNGL TENDON	361	23405	10,809	N/A	N/A	N/A
HC46502357	TENOTOMY THIGH SINGLE TENDON	361	27306	11,142	N/A	N/A	N/A
HC46502381	FASCIOTOMY  FOOT AND/OR TOE	361	28008	14,027	N/A	N/A	N/A
HC46502415	PLCMT NEPHROSTOMY CATHETER (NEPH/URET'GRM S&I) LT	361	50432	8,762	N/A	N/A	N/A
HC46502431	PLCMT CATH NEPHURET PERC(NEPH/URET'GRM S&I)NEW ACC BI	361	50433	18,105	N/A	N/A	N/A
HC46502464	CONVERT NEPH CATH -> NEPH'URET PERC(NEPH/URET'GRM S&I)EXST BI	361	50434	15,339	N/A	N/A	N/A
HC46502498	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM S&I) BI	361	50435	16,189	N/A	N/A	N/A
HC46502522	LARYNGOSCOPY DIAGNOSTIC	361	31575	1,283	N/A	N/A	N/A
HC46502555	INJECT URETEROGRAPH VIA URETEROS/CATH	361	50684	1,535	N/A	N/A	N/A
HC46502589	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S) LT	361	38222	6,853	N/A	N/A	N/A
HC46502613	INSERT MIDLINE CATH >3 YR AGE	361	36410	5,553	N/A	N/A	N/A
HC46502639	FNA ASP BX W/US; FIRST LESION	361	10005	3,618	N/A	N/A	N/A
HC46502647	FNA ASP BX W/US; EACH ADD'L LESION	361	10006	2,468	N/A	N/A	N/A
HC46502662	FNA ASP BX W/FLUORO; EACH ADD'L LESION	361	10008	2,638	N/A	N/A	N/A
HC46502696	FNA ASP BX W/MR; FIRST LESION	361	10011	5,137	N/A	N/A	N/A
HC46502720	BIOPSY TANGENTIAL SKIN; EACH SEP ADD'L LESION	361	11103	964	N/A	N/A	N/A
HC46502753	BIOPSY INCISIONAL SKIN; SINGLE INITIAL LESION	361	11106	1,859	N/A	N/A	N/A
HC46502803	INSERT PICC>5 YR AGE W/IMAGING	361	36573	9,516	N/A	N/A	N/A
HC46502837	LUMBAR PUNCTR DX WITH FLUORO/CT [NOT W/MRI OR US]	361	62328	5,097	N/A	N/A	N/A
HC46502852	NEUROENDOSCOPY PLACE CATH/DRAIN INTRACRANIAL	361	62160	6,855	N/A	N/A	N/A
HC46502860	PERC BX CORE LUNG/MEDIASTINUM W/ IMAG IF OCCURS	361	32408	7,790	N/A	N/A	N/A
HC46502886	REVASC LITHOTRIP TIBIA/PERONEAL ENDOVASC W/STENT	361	C9773	20,612	N/A	N/A	N/A
HC46502910	PERC AV FISTULA UE SEPRT ACCESS ART & VEIN VASC & IMAG	361	36837	21,901	N/A	N/A	N/A
HC46502944	PERC AV FISTULA UE SINGLE ACCESS BOTH ART & VEIN VASC & IMAG	361	36836	16,770	N/A	N/A	N/A
HC46502977	BX SOFT TISS UPPER ARM/ELBOW DEEP LT	361	24066	6,776	N/A	N/A	N/A
HC46503009	BX SOFT TISS LEG/ANKLE DEEP LT	361	27614	6,050	N/A	N/A	N/A
HC46503033	BX SOFT TISS THIGH/KNEE DEEP LT	361	27324	6,050	N/A	N/A	N/A
HC46503066	BX SOFT TISSUE BACK DEEP LT	361	21925	5,929	N/A	N/A	N/A
HC46503082	BX SOFT TISS FOREARM&/WRIST DEEP RT	361	25066	5,808	N/A	N/A	N/A
HC46503116	BX SOFT TISS SHOULDER DEEP RT	361	23066	5,687	N/A	N/A	N/A
HC46503140	BX SOFT TISS UPPER ARM/ELBOW SUP RT	361	24065	5,082	N/A	N/A	N/A
HC46503173	BX SOFT TISS LEG/ANKLE SUP RT	361	27613	4,961	N/A	N/A	N/A
HC46503207	BX SOFT TISS SHOULDER SUP RT	361	23065	4,840	N/A	N/A	N/A
HC46503231	BX SOFT TISS FOREARM&/WRIST SUP RT	361	25065	4,719	N/A	N/A	N/A
HC46503264	BX SOFT TISSUE BACK SUP RT	361	21920	4,598	N/A	N/A	N/A
HC46503280	BX SOFT TISSUE BACK SUP BIL	361	21920	6,897	N/A	N/A	N/A
HC46503298	BIOPSY MUSCLE DEEP RT	361	20205	5,566	N/A	N/A	N/A
HC46503314	BIOPSY MUSCLE DEEP BIL	361	20205	8,349	N/A	N/A	N/A
HC46503348	BIOPSY MUSCLE SUPERFICIAL BIL	361	20200	6,353	N/A	N/A	N/A
HC47200084	BRACHYTX INSERT HEYMAN CAPSULE	333	58346	5,260	N/A	N/A	N/A
HC47200118	CT RAD THER PLANNING	350	77014	3,735	N/A	N/A	N/A
HC47200142	HYPERTHERMIA EXTERNAL DEEP	333	77605	4,358	N/A	N/A	N/A
HC47200175	HYPERTHERMIA INTRACAVITARY	333	77620	3,033	N/A	N/A	N/A
HC47200209	INTRACAVITARY TREATMT SIMPLE	333	77761	2,233	N/A	N/A	N/A
HC47200217	INTRACAVITARY TREATMT INTERMED	333	77762	3,822	N/A	N/A	N/A
HC47200258	INTERSTITIAL RADIATION  COMPLEX	333	77778	6,884	N/A	N/A	N/A
HC47200316	PHYSICS CONSULT SPECIAL	333	77370	2,222	N/A	N/A	N/A
HC47200340	PLC BRACHY CATH W/PART MAST RT	361	19298	15,019	N/A	N/A	N/A
HC47200373	PLC MAMMOSITE AFTER DOS RT	361	19296	16,098	N/A	N/A	N/A
HC47200407	PLC MAMMOSITE ON DOS RT	361	19297	13,017	N/A	N/A	N/A
HC47200456	RAD TREATMENT DELVR  = 1MEV;SIMPLE	333	77402	1,705	N/A	N/A	N/A
HC47200555	M: MISC RADIATION THERAPY	333	77399	N/A	N/A	N/A	N/A
HC47200571	SPECIAL DOSIMETRY	333	77331	1,507	N/A	N/A	N/A
HC47200613	APPLY LOW DOSE RADIONUCLIDE SOURCE	333	77789	1,294	N/A	N/A	N/A
HC47200647	TREATMENT DEVICES SIMPLE	333	77332	1,521	N/A	N/A	N/A
HC47200670	TREATMENT SIMULATION SIMPLE	333	77280	2,468	N/A	N/A	N/A
HC47200704	RADIOTHERAPY PLAN 3D W/VOL HISTOGRAM	333	77295	15,782	N/A	N/A	N/A
HC47200746	M: UNLISTED THERAPEUTIC PROC	333	77499	N/A	N/A	N/A	N/A
HC47200779	RAD ONC E&M LEVEL III INTERMED	761	99213	523	N/A	N/A	N/A
HC47200795	RAD ONC E&M LEVEL V COMPREHNSV	761	99215	710	N/A	N/A	N/A
HC47200829	SRS LINR ACCL FX 1-5 SESSNS CMPLT	333	77373	24,572	N/A	N/A	N/A
HC47200852	CT GUIDANCE SRS LOCALIZATION	350	77011	9,897	N/A	N/A	N/A
HC47200894	STEREOTACTIC BODY RAD THER	333	77435	4,229	N/A	N/A	N/A
HC47200977	TREATMENT DEVICES MLC FOR IMRT	333	77338	5,018	N/A	N/A	N/A
HC47201017	MANAGE RAD TREATMENT INTRAOP	333	77469	2,049	N/A	N/A	N/A
HC47201041	TELETX ISODOSE W/DOSIMETRY;COMPLEX	333	77307	5,218	N/A	N/A	N/A
HC47201066	BRACHYTX ISODOSE W/DOSIMETRY;INTRM	333	77317	4,615	N/A	N/A	N/A
HC47201074	BRACHYTX ISODOSE W/DOSIMETRY;CMPLX	333	77318	6,843	N/A	N/A	N/A
HC47201090	IMRT TX DELIVERY  GUIDE&TRACK CMPLX	333	77386	10,284	N/A	N/A	N/A
HC47201124	HDR RADIONUCLIDE INTRSTTL/INTRVIT BRACH 2-12 CHANN	333	77771	12,105	N/A	N/A	N/A
HC47201157	HDR ELECTRONIC BRACHYTHERAPY INTERSTIT/INTRACAV	333	0395T	3,963	N/A	N/A	N/A
HC47201181	TELEHEALTH ORIGINATING SITE FACILITY FEE	780	Q3014	79	N/A	N/A	N/A
HC51000008	OB FECES GUAIAC1-3 NEOPLSM SCR	300	82270	35	N/A	N/A	N/A
HC51000032	DM HEMOGLOBIN GLYCOSYLATED(A1C	301	83036	102	N/A	N/A	N/A
HC51000057	DECLOT IVAD W/THROMBOLYTIC	361	36593	421	N/A	N/A	N/A
HC51000065	INSRT BLADDER CATH-NON INDWELL	361	51701	294	N/A	N/A	N/A
HC51000081	INSRT BLADDER CATH-TEMP-COMPLX	361	51703	460	N/A	N/A	N/A
HC51000115	URO-EMG	361	51784	417	N/A	N/A	N/A
HC51000149	IMMUNIZATION ADMIN ADD'L	771	90472	50	N/A	N/A	N/A
HC51000172	SPIROMETRY W/MEASUREMNTS& REC	460	94010	267	N/A	N/A	N/A
HC51000206	IM OR SQ INJECTION THERAPEUTIC	260	96372	124	N/A	N/A	N/A
HC51000230	IV INFUSION THERAPY EA ADDL HR	260	96366	116	N/A	N/A	N/A
HC51000263	IVP SINGLE/EA NEW RX ADD'L INJ	260	96375	129	N/A	N/A	N/A
HC51000289	HOSP OP CAST ROOM VISIT (FACILITY FEE)	510	99213	227	N/A	N/A	N/A
HC51000412	IV INF HYDRATION EA ADD'L HR	260	96361	94	N/A	N/A	N/A
HC51000446	REPAIR CENTRAL VEN CATH W/PORT	361	36576	1,030	N/A	N/A	N/A
HC51000479	DECLOT IVAD W/THROMBOLYTC(TECH/HOSP)	361	36593	421	N/A	N/A	N/A
HC51000503	GLUCOSE SERUM QUANT (POS)	301	82947	44	N/A	N/A	N/A
HC51000537	CHEMO NONHRMNL ANTINEOPL SQ/IM	331	96401	241	N/A	N/A	N/A
HC51000560	INSERT PICC >5 YR AGE W/O IMAGING	361	36569	1,294	N/A	N/A	N/A
HC51001170	CLOSED TX CLAVICLE FX	361	23500	486	N/A	N/A	N/A
HC51001204	CLOSED TX HUMERL SUPRA/TRANS CON FX	361	24530	1,021	N/A	N/A	N/A
HC51001238	CLOSED TX RADIAL HED/NEK FX NO MANP	361	24650	753	N/A	N/A	N/A
HC51001261	CLOSED TX RADIUS&ULNA SHAFT FX NO M	361	25560	751	N/A	N/A	N/A
HC51001295	CLOSED TX FINGER SHAFT FX EA NO MAN	361	26720	394	N/A	N/A	N/A
HC51001329	CLOSED TX OF FEMUR FX	361	27500	811	N/A	N/A	N/A
HC51001352	CLOSED TX KNEECAP FX	361	27520	889	N/A	N/A	N/A
HC51001378	CLOSED TX TIBIA FX	361	27750	931	N/A	N/A	N/A
HC51001386	CLOSED TX FIBULA FX	361	27780	655	N/A	N/A	N/A
HC51001402	CLOSED TX LAT MALLEO ANKL FX NO MAN	361	27786	875	N/A	N/A	N/A
HC51001436	CLOSED TX BIG TOE FX	361	28490	327	N/A	N/A	N/A
HC51001469	APPLY CAST LONG ARM	700	29065	456	N/A	N/A	N/A
HC51001493	APPLY LONG LEG CAST/WALKER	700	29355	538	N/A	N/A	N/A
HC51001527	APPLY CAST SHORT LEG	700	29405	468	N/A	N/A	N/A
HC51001550	APPLY SPLINT LONG ARM	700	29105	406	N/A	N/A	N/A
HC51001576	APPLY SPLINT LONG LEG	700	29505	437	N/A	N/A	N/A
HC51001584	APPLY SPLINT SHORT LEG	700	29515	361	N/A	N/A	N/A
HC51001600	HANDLING & SENDOUT TO REF' LAB	300	99000	24	N/A	N/A	N/A
HC51001634	X-RAY SPINE LUMBOSACRAL; 2 OR 3VWS	320	72100	398	N/A	N/A	N/A
HC51001675	X-RAY CLAVICLE	320	73000	220	N/A	N/A	N/A
HC51001709	X-RAY ELBOW 2 VW	320	73070	408	N/A	N/A	N/A
HC51001733	X-RAY WRIST 2 VW	320	73100	226	N/A	N/A	N/A
HC51001766	X-RAY EXAM OF FINGERS MIN 2 VWS	320	73140	200	N/A	N/A	N/A
HC51001824	X-RAY KNEE CMPLET 4+ VWS	320	73564	271	N/A	N/A	N/A
HC51001840	X-RAY ANKLE 2 VWS	320	73600	227	N/A	N/A	N/A
HC51001873	X-RAY TOES MIN 2 VWS	320	73660	175	N/A	N/A	N/A
HC51001907	CBC WITH AUTOMATED DIFF	305	85025	84	N/A	33	N/A
HC51001931	CBC W/O DIFF	305	85027	67	N/A	30	N/A
HC51001964	HCG QUAL URINE (POS)	307	81025	59	N/A	21	N/A
HC51001998	REMOVE DRUG DELIVERY IMPLANT	361	11982	327	N/A	N/A	N/A
HC51002087	REMOV IMPACTD EAR WAX(INSTRUMENT) RT	361	69210	161	N/A	N/A	N/A
HC51002103	MNT INITIAL ASSESSMENT INDIV EA 15MIN  1ST REF	942	97802	96	N/A	N/A	N/A
HC51002111	MNT REASSESSMENT EA INDIV 15MIN       1ST REF	942	97803	93	N/A	N/A	N/A
HC51002137	RD COUNSELING NUTRITION VISIT/C	942	S9470	172	N/A	N/A	N/A
HC51002160	CYSTOGRAM W/ URETH PRFL STDY	361	51727	953	N/A	N/A	N/A
HC51002194	UROFLOWMETRY COMPLEX	361	51741	265	N/A	N/A	N/A
HC51002228	X RAY CYSTOGRAM MIN 3 VWS	320	74430	577	N/A	N/A	N/A
HC51002251	X RAY UROGRAPHY ANTEGRADE R&I	320	74425	639	N/A	N/A	N/A
HC51002285	MEATOTOMY (INFANT)	361	53025	521	N/A	N/A	N/A
HC51002301	LYSIS & STRETCHING ADHESIONS PREPUTIAL	361	54450	316	N/A	N/A	N/A
HC51002319	LYSIS OF LABIAL ADHESIONS	361	56441	883	N/A	N/A	N/A
HC51002335	CIRCUMCISION INFANT >28D EXCISE NO DEVICE	361	54161	856	N/A	N/A	N/A
HC51002368	EXCISN/FULGURATN POLYP(S) URETHRAL	361	53260	1,589	N/A	N/A	N/A
HC51002392	EXCISE LESION 0.6-1CM HND-FT-SC-NCK-GN	361	11421	636	N/A	N/A	N/A
HC51002426	EXCISE LESION 3.1-4CM HND-FT-SC-NCK-GN	361	11424	1,037	N/A	N/A	N/A
HC51002475	PERC NEUROSTIMULATION TIBIAL  SINGLE TX	361	64566	558	N/A	N/A	N/A
HC51002517	US TRANSRECTAL	402	76872	349	N/A	N/A	N/A
HC51002541	US ABDOMEN	402	76700	366	N/A	N/A	N/A
HC51002566	REMOV IMPACTD EAR WAX IRRIG/LAVG LT	361	69209	204	N/A	N/A	N/A
HC51002590	FNA ASP BX W/O GUIDE; FIRST LESION	361	10021	625	N/A	N/A	N/A
HC51002624	PUNCTURE ASP CYST BREAST	361	19000	1,595	N/A	N/A	N/A
HC51002657	I&D ABSCESS RECTAL	361	46040	1,938	N/A	N/A	N/A
HC51002681	REPAIR FISTULA ANAL W/PLUG	361	46707	4,603	N/A	N/A	N/A
HC51002715	REMOVE NEPHROSTOMY TUBE	361	50389	1,142	N/A	N/A	N/A
HC51002749	ASPIRATION OF BLADDER BY NEEDLE	361	51100	1,125	N/A	N/A	N/A
HC51002764	ASP BLADDER W/INSERT SUPRAPUB	361	51102	2,425	N/A	N/A	N/A
HC51002798	INSTILL BLADDER CHEMO	361	51720	568	N/A	N/A	N/A
HC51002822	CYSTOURETHROSCOPY W/CATH URETERAL	361	52005	2,468	N/A	N/A	N/A
HC51002855	CYSTOURETHROSCOPY W/DIL STRIC URETH	361	52281	2,616	N/A	N/A	N/A
HC51002889	CYSTOSCOPY W/INSERT STENT URETER INDW	361	52332	3,203	N/A	N/A	N/A
HC51002913	CYSTOURETHRSCPY&/PYELOSCPY W/BX&/FULG	361	52354	4,179	N/A	N/A	N/A
HC51002947	DILAT STRICTR URETHRL FLFRM MALE INT'L	361	53620	1,392	N/A	N/A	N/A
HC51002962	DILATION URETHRAL FEMALE INITIAL	361	53660	353	N/A	N/A	N/A
HC51002970	DILATION URETHRAL FEMALE SUBSEQUENT	361	53661	235	N/A	N/A	N/A
HC51002996	DESTROY LESION(S) PENILE SIMPLE/CHEM	361	54050	441	N/A	N/A	N/A
HC51003051	INJECT RX CORPORA CAVERNOSA	361	54235	676	N/A	N/A	N/A
HC51003085	VASECTOMY BILAT/UNILAT(SEP PROCEDURE)	361	55250	3,514	N/A	N/A	N/A
HC51003119	DESTROY LESION(S) VULVA EXTENSIVE	361	56515	4,179	N/A	N/A	N/A
HC51003143	COLPOSCOPY VULVA	361	56820	406	N/A	N/A	N/A
HC51003176	DESTROY LESION(S) VAGINAL EXTENSIVE	361	57065	3,825	N/A	N/A	N/A
HC51003192	BX VAGINA EXTENSIVE INCL CYSTS	361	57105	3,122	N/A	N/A	N/A
HC51003200	IRRIG &/APPLY OINTMENT VAGINAL	361	57150	274	N/A	N/A	N/A
HC51003226	COLPOSCOPY VAGINA W/CERVIX IF PRESENT	361	57420	710	N/A	N/A	N/A
HC51003259	COLPOSCPY CERV&ADJ VAG W/CERV BX(S)&ECC	361	57454	808	N/A	N/A	N/A
HC51003283	COLPOSCPY CERV W/BX(S)LOOP ELECTRD	361	57460	3,526	N/A	N/A	N/A
HC51003317	CURETTAGE ENDOCERVICAL (ECC)	361	57505	1,873	N/A	N/A	N/A
HC51003341	CONIZATION CERVIX LOOP ELECTRD	361	57522	4,179	N/A	N/A	N/A
HC51003374	BX(S)/SAMPL ENDOMETRIAL W/COLPOSCPY+	361	58110	286	N/A	N/A	N/A
HC51003408	URINALYSIS AUTO W/O MICRO	307	81003	30	N/A	N/A	N/A
HC51003432	SMOKING CESSATION 3-10 MIN	942	99406	58	N/A	N/A	N/A
HC51003481	SCREENING ETOH MISUSE ANNUAL 5-15MIN	770	G0442	147	N/A	N/A	N/A
HC51003515	OBTAIN/PREP/CONVEY SCREEN PAP SMEAR	300	Q0091	43	N/A	N/A	N/A
HC51003648	ANOSCOPY W/BIOPSY	361	46606	1,844	N/A	N/A	N/A
HC51003671	INJ SCLEROTHERAPY HEMORRHOIDS	361	46500	1,411	N/A	N/A	N/A
HC51003804	EXCISE LESION 0.6-1CM TRNK/ARMS/LEGS	361	11401	545	N/A	N/A	N/A
HC51003838	I&D ABSCESS COMPLICATED MULT	361	10061	612	N/A	N/A	N/A
HC51003853	REPAIR CIRCUMCISION INCOMPLETE	361	54163	2,444	N/A	N/A	N/A
HC51003887	X-RAY FEMUR MIN 2 VIEWS	320	73552	223	N/A	N/A	N/A
HC51003911	CHANGE GT TUBE W/REV TRACT W/O IMAGE/ENDO INCL REMVL	750	43763	420	N/A	N/A	N/A
HC51004034	COLLCTN SPUTM AEROSL TECH  SEP PROC	410	89220	316	N/A	N/A	N/A
HC51004067	AEROSOL-CONTINUOUS TX EA AD'HR	412	94645	96	N/A	N/A	N/A
HC51004117	TRACH TUBE CHANGE	361	31502	487	N/A	N/A	N/A
HC51004158	REMOV IMPACTD EAR WAX(INSTRUMENT) BI           (NO MOD50)	361	69210	234	N/A	N/A	N/A
HC51010064	DESTROY MUSCLE(S) FACIAL NERVE LT	361	64612	676	N/A	N/A	N/A
HC51010072	DESTROY MUSCLE(S) FACIAL NERVE RT	361	64612	676	N/A	N/A	N/A
HC51010155	DESTRUCT OTHER PERIPH NERV/BRNCH LT	361	64640	1,033	N/A	N/A	N/A
HC51010189	ASP/INJ SMALL JNT-SC LT	361	20600	280	N/A	N/A	N/A
HC51010213	ASP/INJ MED JOINT-LT	361	20605	298	N/A	N/A	N/A
HC51010247	ASP/INJ LARGE JOINT-LT	361	20610	334	N/A	N/A	N/A
HC51010270	INJ(S);SINGLE TENDON/SHEATH RT	361	20550	368	N/A	N/A	N/A
HC51010304	INJ(S);TRIGGER POINT 1-2MUSCLS	361	20552	407	N/A	N/A	N/A
HC51010320	BACLOPHEN PUMP TRIAL PROCEDURE	361	62326	1,155	N/A	N/A	N/A
HC51010338	ANAL' IMPLANTED PUMP NO PROG/REFILL	361	62367	375	N/A	N/A	N/A
HC51010353	ANAL' IMPLNTD PUMP W/PROG MD SKILL	361	62370	422	N/A	N/A	N/A
HC51010387	EMG 1 EXTREMITY	922	95860	458	N/A	N/A	N/A
HC51010411	EMG 4 EXTREMITY	922	95864	1,147	N/A	N/A	N/A
HC51010445	NASOPHARYNGOSCOPY	471	92511	494	N/A	N/A	N/A
HC51010478	TEST ALLERGY PERQ&INTRAQ VENOM	924	95017	71	N/A	N/A	N/A
HC51010502	TEST ALLERGY INTRAQ AIRBORNE	924	95027	71	N/A	N/A	N/A
HC51010536	TEST ALLERGY PATCH PHOTO	924	95052	64	N/A	N/A	N/A
HC51010551	TEST CHALLENGE INGEST ADD 60MIN	924	95079	261	N/A	N/A	N/A
HC51010585	IMMUNOTHERAPY ONE INJECTION /COMM	924	95120	96	N/A	N/A	N/A
HC51010619	IMMNTX 2 STING INSECTS /COMM	924	95131	133	N/A	N/A	N/A
HC51010643	IMMNTX 5 STING INSECTS /COMM	924	95134	240	N/A	N/A	N/A
HC51010676	IMMUNTX PREP-PROV AG2STING BUG VNM	924	95146	157	N/A	N/A	N/A
HC51010700	IMMUNTX PREP-PROV AG5STING BUG VNM	924	95149	156	N/A	N/A	N/A
HC51010734	DESENSITIZATION RAPID EA HR	924	95180	422	N/A	N/A	N/A
HC51010775	LARYNGOSCOPY DIAGNOSTIC	361	31575	460	N/A	N/A	N/A
HC51010809	MICROSCOPY BINOCULAR EAR	471	92504	114	N/A	N/A	N/A
HC51010858	THORACENTESIS W/TUBE W/O IMAG	361	32556	1,431	N/A	N/A	N/A
HC51010882	PUNCTURE SPINAL TX DRAIN CSF [NOT W/FLUORO/CT]	361	62272	859	N/A	N/A	N/A
HC51010916	INTRAPERITONEAL CHEMO THERAPY	335	96446	719	N/A	N/A	N/A
HC51010957	REMOVAL DEVICE INTRAUTERINE IUD	361	58301	541	N/A	N/A	N/A
HC51020014	RN DEV PT REPORT; INTERMEDIATE	920	Z4303	159	N/A	N/A	N/A
HC51020030	RN TEAM CONF PRTCPNT PER 15MIN	920	Z4310	53	N/A	N/A	N/A
HC51020048	RN GROUP TEACH/COUNS SESSION	942	Z4314	80	N/A	N/A	N/A
HC51020063	RN COORDINATOR ACTIVITIES CASE	920	Z4300	327	N/A	N/A	N/A
HC51020253	NP COORDINATOR ACTIVITIES CASE	920	Z4300	327	N/A	N/A	N/A
HC51020287	NP EST PT LVL II; LIMITED	510	99212	135	N/A	N/A	N/A
HC51020311	NP EST PT LVL V; COMPLEX	510	99215	270	N/A	N/A	N/A
HC51020352	NP NEW PT LVL IV;EXTENDED	510	99204	216	N/A	N/A	N/A
HC51020386	ADMIN VACCINE PNEUMOCOCCAL	771	G0009	98	N/A	N/A	N/A
HC51020402	SC INFUSION THERAPY EA ADDL HOUR	260	96370	433	N/A	N/A	N/A
HC51020410	SC INFUSION THERAPY; ADD'L SET UP NEW SITE	260	96371	251	N/A	N/A	N/A
HC51030005	SW ASSESS/INTERVENTION EA 30MIN	920	Z4307	93	N/A	N/A	N/A
HC51030039	SW COORDINATOR ACTIVITIES CASE	920	Z4300	327	N/A	N/A	N/A
HC51040020	RD CONSULT TELEPHONE PER 15MIN	920	Z5406	51	N/A	N/A	N/A
HC51040137	MNT THERAPY GROUP EA 30 MIN     2ND REF(DX)	942	G0271	54	N/A	N/A	N/A
HC51050011	RT TEAM CONF PER CASE	920	Z4302	44	N/A	N/A	N/A
HC51060010	AHCP GROUP TEACH/COUNS SESSION	942	Z4314	80	N/A	N/A	N/A
HC51060044	AHCP ASSESS/INTERVEN PER 30MIN	914	Z4309	98	N/A	N/A	N/A
HC51060069	PT-TEST/MEASUREMENT ADD15MIN/C	424		101	N/A	N/A	N/A
HC51060093	OT-EVAL+REPORT EA ADD 15 MIN/C	434		97	N/A	N/A	N/A
HC51060127	ST-SPEECH EVALUATION/C	440		379	N/A	N/A	N/A
HC51060168	PT-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	420	96110	288	N/A	N/A	N/A
HC51060200	OT-DYSPHAGIA/SWALLOW TX/M	430	92526	253	N/A	N/A	N/A
HC51060465	PT CONSULT TELEPHONE PER 15MIN	420		49	N/A	N/A	N/A
HC51060515	ST EVAL SPEECH FLUENCY/M	444	92521	222	N/A	N/A	N/A
HC51060531	ST EVAL SOUND PROD W/LANG COMP&EXPRESS/C	444	92523	279	N/A	N/A	N/A
HC51060549	ST EVAL BEHAVRAL QUAL VOICE &RESONANCE/M	444	92524	189	N/A	N/A	N/A
HC51060564	DESTROY MUSCLE(S) NECK NO LARYNX LT	361	64616	742	N/A	N/A	N/A
HC51060598	DESTROY MUSCLE(S) LARYNX LT	361	64617	1,082	N/A	N/A	N/A
HC51060622	DESTROY MUSCLE(S) 1-4 EA ADD EXTREM	361	64643	973	N/A	N/A	N/A
HC51060655	DESTROY MUSCLE(S) TRUNK 1-5	361	64646	1,277	N/A	N/A	N/A
HC51060689	OT-SWALLOWING EVAL	434	92610	219	N/A	N/A	N/A
HC51060713	OT-EVAL LOW COMPLEXITY 20MF2F 30MIN	434	97165	301	N/A	N/A	N/A
HC51060739	ST-SPEECH THERAPY 60 MIN	440	92507	159	N/A	N/A	N/A
HC51060747	PT-THER EXER 30MIN/C	420		96	N/A	N/A	N/A
HC51060762	PT-PROC+MOD.COMBO ADD 15MIN/C	420		64	N/A	N/A	N/A
HC51060796	PT-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	420	96112	399	N/A	N/A	N/A
HC51060929	OT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN/M	430	97760	178	N/A	N/A	N/A
HC51060952	OT-ORTHOTIC FIT/TRNG 30MIN/C	430		265	N/A	N/A	N/A
HC51060986	INJ ANTEGRAD NEPH/URET'GRM S&I EXIST ACCESS LT	361	50431	1,136	N/A	N/A	N/A
HC51061018	REMOVE NEPHROSTOMY TUBE LT	361	50389	1,119	N/A	N/A	N/A
HC51061042	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM S&I)EXST LT	361	50434	2,840	N/A	N/A	N/A
HC51061067	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM S&I) BI	361	50435	3,976	N/A	N/A	N/A
HC51061091	X RAY PYELOGRAM RETROGRADE	320	74420	693	N/A	N/A	N/A
HC51061125	CLOSED TX CARPAL SCAPHOID FX W/O MAN	361	25622	675	N/A	N/A	N/A
HC51061158	ECG ROUTINE 15 LEADS	730	93005	140	N/A	N/A	N/A
HC51061182	ST-ENDOSCOP EVAL SWALLOW/LARYN	440	92616	378	N/A	N/A	N/A
HC51061232	COLLECTION SPECIMEN SARS-COV-2	300	C9803	83	N/A	N/A	N/A
HC51061398	ADMIN VACCINE COVID-19 100MCG/0.5 INITIAL DOSE {MODERNA}	771	0011A	98	N/A	N/A	N/A
HC51061422	IV INFUSE/SC MONOCLONAL CASIRIVIMAB/IMDEVIMAB (REGENERON)	771	M0243	919	N/A	N/A	N/A
HC51061455	ECG EXT HOLTER W/CONNECT>48HRS-7DAYS; RECORDING	731	93242	135	N/A	N/A	N/A
HC51061489	ECG EXT HOLTER >7DAYS-15DAYS; SCANNING ANYS W/REPORT	731	93247	260	N/A	N/A	N/A
HC51061513	REMOVE IMPLANT SUPERFICIAL	361	20670	1,774	N/A	N/A	N/A
HC51061547	CLOSED TREATMENT ULNAR SHAFT FRACTURE W/O MANIP	361	25530	394	N/A	N/A	N/A
HC51061596	ECHO CONGENITAL LTD OR F/U	483	93304	1,378	N/A	N/A	N/A
HC51061620	ECHO DOPPLER F/U OR LTD+	483	93321	460	N/A	N/A	N/A
HC51061646	RETICULOCYTE - AUTO	305	85045	48	N/A	42	N/A
HC51061653	ECHO 2D CMPLT W/O SPEC&CLR DOP	483	93307	649	N/A	N/A	N/A
HC51061679	MYOCARDIAL STRAIN QUANT ASSESS+	483	93356	216	N/A	N/A	N/A
HC51061703	ECHO FETAL CARDIO 2D F/U OR REPEAT	483	76826	676	N/A	N/A	N/A
HC51061737	IV INFUSION MONOCLONAL ABX BAMLANIVIMAB/ETESEVIMAB	771	M0245	919	N/A	N/A	N/A
HC51061760	X-RAY SPINE CERVICAL; COMP 6/> VWS	320	72052	460	N/A	N/A	N/A
HC51061794	X-RAY SPINE THORACIC; MIN 4 VIEWS	320	72074	406	N/A	N/A	N/A
HC51061828	X-RAY SPINE ENTIRE SKULL-SACRUM 2-3 VIEWS	320	72082	352	N/A	N/A	N/A
HC51061844	X-RAY SPINE ENTIRE SKULL-SACRUM 6/> VIEWS	320	72084	460	N/A	N/A	N/A
HC51061851	X-RAY SPINE LUMBOSACRAL; CMPLT W/BEND MIN 6 VWS	320	72114	487	N/A	N/A	N/A
HC51061877	X-RAY SCAPULA	320	73010	243	N/A	N/A	N/A
HC51061901	X-RAY KNEE 1 OR 2 VWS	320	73560	227	N/A	N/A	N/A
HC51061935	SPIROMETRY PT INITIATED 30DAY; EDUCATION TRANSMIT INTERPRETATION	460	94014	568	N/A	N/A	N/A
HC51061968	GROUP HEALTH EDUCATION	942	99078	27	N/A	N/A	N/A
HC51061992	REMOTE MONITOR PHYSIOL PARAM INTL SUPPLY DEVICE EA 30DAY	949	99454	135	N/A	N/A	N/A
HC51062024	SELF MANAGEMENT EDUC & TRAINING INDIV 30MIN (PRIVAT INSAUTHREQ)	942	98960	162	N/A	N/A	N/A
HC51062057	IV INFUSE/SC MONOCLONAL CASIRIVIMAB/IMDEVIMAB (REGENERON) REPEAT	771	M0240	789	N/A	N/A	N/A
HC51062107	I&D ABSCESS VULVA/PERINEUM	361	56405	541	N/A	N/A	N/A
HC51062131	AMINES VAGINAL FLUID QUAL	301	82120	27	N/A	N/A	N/A
HC51062164	KOH TISSUE EXAM	301	87220	24	N/A	N/A	N/A
HC51062198	TEACH/COUNSEL INDIVIDUAL FPACT	914	S9445	81	N/A	N/A	N/A
HC51062222	DIABETIC SELF MANGMT TRNG EA 30M	942	G0108	130	N/A	N/A	N/A
HC51062255	NP ANTEPARTUM INITIAL VISIT	920	Z1032	270	N/A	N/A	N/A
HC51062289	CPSP DEPRESSION SCREENING IND POS	900	G8431	49	N/A	N/A	N/A
HC51062305	CPSP NUTRITION INITIAL ASSESS AND DEV POC; 1ST 30MIN	940	Z6200	64	N/A	N/A	N/A
HC51062339	CPSP ANTEPRTM NUTRITION F/U ASSES TX   GROUP  EACH 15MIN	940	Z6206	22	N/A	N/A	N/A
HC51062362	CPSP PSYCHOSOCIAL INIR' ASSESS/DEV;EA SUBSQ 15MIN	940	Z6302	32	N/A	N/A	N/A
HC51062396	CPSP POSTPRTM PSYCHOSOCIAL ASSESS  TX POC; INDIV'; EA 15MIN	940	Z6308	32	N/A	N/A	N/A
HC51062420	CPSP INITIAL HEALTH ED ASSESS/DEV POC; EA SUBSQ' 15MIN	940	Z6404	32	N/A	N/A	N/A
HC51062453	CPSP PERINATAL ED  INDIV'; EA 15MIN	940	Z6410	32	N/A	N/A	N/A
HC51062487	CPSP COMPREHENSIVE INIT' ASSESS NUTRITON  PSYCH  HEALTH ED POC; 1ST 30MIN EACH  TOTAL 90MIN	940	Z6500	270	N/A	N/A	N/A
HC51062503	PRINCIPAL CARE MGMT HI RISK D; EA ADDL 30MIN  PER MO+	949	99427	216	N/A	N/A	N/A
HC51062511	ADMIN VACCINE HEPATITIS B	771	G0010	98	N/A	N/A	N/A
HC51062545	CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX TX	361	30903	270	N/A	N/A	N/A
HC51062578	REMOVAL FB FRM EAR	361	69200	243	N/A	N/A	N/A
HC51062602	EMG FACIAL UNILATL LT	922	95867	346	N/A	N/A	N/A
HC51062636	FITTING DIAPHRAGM/CERVICAL CAP W/INSTRUCT	361	57170	390	N/A	N/A	N/A
HC51062677	KETONE BODY(S) QUALITATIVE	301	82009	35	N/A	N/A	N/A
HC51062701	APPLY CYLINDER CAST(THI-ANKLE) BIL	700	29365	702	N/A	N/A	N/A
HC51062727	APPLY CAST SHORT LEG WALKING BIL	700	29425	675	N/A	N/A	N/A
HC51062735	APPLY CAST PATELR TENDN BEARNG BIL	700	29435	697	N/A	N/A	N/A
HC51062750	APPLY SPLINT LONG LEG BILATERAL	700	29505	468	N/A	N/A	N/A
HC51062784	CHRONIC CARE MGMT EA ADDL 20MIN  PER MO+	949	99439	208	N/A	N/A	N/A
HC51062818	CHRONIC CARE MGMT INITL 20MIN  PER MONTH	949	99490	260	N/A	N/A	N/A
HC51062842	PHONE CALL BY NONPHYSICIAN HC PROF 11-20MIN	949	98967	93	N/A	N/A	N/A
HC51062875	CARE MGMT BEHAVORAL HEALTH CONDITION 20 MIN	949	99484	86	N/A	N/A	N/A
HC51062909	ADVANCE CARE PLAN 1ST 30MIN W/PAT FAM OR SURROGATE	949	99497	156	N/A	N/A	N/A
HC51062933	REMOTE AUTO SYSTM INSULIN DOSE CALC; DATA COLLCT EA 30DAYS	949	0741T	177	N/A	N/A	N/A
HC51062958	REMOVE SUTURE/STAPLES NOT REQUIRING ANESTHESIA+	949	15853	57	N/A	N/A	N/A
HC51062982	DEBRIDE SKIN MUSCLE; FIRST 20SQCM	361	11043	1,560	N/A	N/A	N/A
HC51063014	DEBRIDE SKIN MUSCLE EA ADD 20SQCM/<	361	11046	756	N/A	N/A	N/A
HC51063048	PAIRING BENIGN HYPERKERATOTIC LESIONS: 2-4	361	11056	494	N/A	N/A	N/A
HC51063071	DEBRIDE OF NAILS: 1-5	361	11720	182	N/A	N/A	N/A
HC51063105	AVULSION OF NAIL  SIMPLE; EA ADDL'	361	11732	208	N/A	N/A	N/A
HC51063139	BIOPSY NAIL UNIT SEP PROC	361	11755	1,612	N/A	N/A	N/A
HC51063154	EXCISION WEDGE SKIN NAIL FOLD (INGROWN TOENAIL)	361	11765	988	N/A	N/A	N/A
HC51063162	TRIMMING NONDYSTROPHIC NAILS	361	G0127	208	N/A	N/A	N/A
HC51063188	EVAL/MANAG DIABETIC PT SENSORY NEUROPATHY FLLWUP	940	G0246	338	N/A	N/A	N/A
HC51063212	PUNCH BX SKIN; EA SEP/ADDL LESION	361	11105	312	N/A	N/A	N/A
HC51070019	PSY MED RECORD REVIEW	919	90885	185	N/A	N/A	N/A
HC51070068	NEUROPSYCH STATUS EXAM/HR	918	96116	526	N/A	N/A	N/A
HC51070282	PSY-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	900	96110	197	N/A	N/A	N/A
HC51070316	PSYCH GRP TX (NOT MULTI FAMILY)	915	90853	189	N/A	N/A	N/A
HC51070332	INTERACTIVE COMPLEXITY+	914	90785	182	N/A	N/A	N/A
HC51070340	PSY FAMILY CONFERENCE 60MIN	919	90887	279	N/A	N/A	N/A
HC51070365	PSY TX W/PATIENT 30MIN W/E&M+	914	90833	322	N/A	N/A	N/A
HC51070399	PSYCH TX W/PATIENT 60MIN	914	90837	352	N/A	N/A	N/A
HC51070423	PSYCH FAMILY TX W/O PT 50 MIN	914	90846	480	N/A	N/A	N/A
HC51070456	PSYCH NARCOSYNTHESIS	914	90865	331	N/A	N/A	N/A
HC51070522	PSY TM CONF W/MD 30/+MIN(?PT)	900	99367	213	N/A	N/A	N/A
HC51070555	PSYCH TESTING EVAL INTEGR INTERPRET CLIN DES TX; 1ST HOUR	918	96130	433	N/A	N/A	N/A
HC51070589	NEUROPSYCH TEST EVAL INTRG INTERP  CLIN DES FEEDBACK; EA ADDL HR+	918	96133	281	N/A	N/A	N/A
HC51070605	PSYCH/NEUROPSYCH TEST ADMIN & SCORING  2 OR > TESTS;  EA ADDL 30MIN+	918	96137	98	N/A	N/A	N/A
HC51070639	BEHAVIOR ADAPT TX FAMILY GUIDNC QHCP W GUARDIANS EA 15MIN	918	97156	88	N/A	N/A	N/A
HC51070662	PSY-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	900	96112	399	N/A	N/A	N/A
HC51070696	PSY-TEST COGNITIVE PERFORMANCE STDRD PER HOUR	918	96125	300	N/A	N/A	N/A
HC51070720	TEACH/COUNSEL GROUP SESSION FPACT	942	S9446	49	N/A	N/A	N/A
HC51070753	PSY-BEHAVIOR TX INDIV ADDL 15 MIN	914	96159	102	N/A	N/A	N/A
HC51070787	PSY-BEHAVIOR TX FAMW/PT 1ST 30MIN	916	96167	94	N/A	N/A	N/A
HC51070803	PSY-BEHAV TX FAM W/O PT 1ST 30MIN	916	96170	94	N/A	N/A	N/A
HC51070837	TEST EXERC BRONCHOSPSM INCL SPIR & POX W/O ECG	460	94619	324	N/A	N/A	N/A
HC62200019	CAUTERY CORD	272		224	N/A	N/A	N/A
HC62200068	ABLATION DEVICE	272	C1886	10,712	N/A	N/A	N/A
HC62200092	ADAPTER AIRWAY/RESPIRATORY        E	270		177	N/A	N/A	N/A
HC62200134	ADAPTER SUCTION-IRRIGATION	272		102	N/A	N/A	N/A
HC62200167	ADAPTOR/CONNECTOR IRRIG TUR	272		112	N/A	N/A	N/A
HC62200183	AIRWAY SPECIALIZED	270		45	N/A	N/A	N/A
HC62200209	ARTERIAL LINE	272		332	N/A	N/A	N/A
HC62200225	ASPIRATOR MECONIUM	272		98	N/A	N/A	N/A
HC62200258	BAG BILE	272		78	N/A	N/A	N/A
HC62200282	BAG DECANTER	272		50	N/A	N/A	N/A
HC62200324	BAG FEEDING	272		41	N/A	N/A	N/A
HC62200357	BAG URINARY DRAINAGE	272		78	N/A	N/A	N/A
HC62200381	BAND LIGATOR	272		1,400	N/A	N/A	N/A
HC62200407	BANDAGE ELASTIC(ACE AND COBAN)	270		29	N/A	N/A	N/A
HC62200415	BANDAGE ESMARK	272		34	N/A	N/A	N/A
HC62200431	BANDAGE LEG COMP	270		115	N/A	N/A	N/A
HC62200464	BASKET RETRIEVAL                  N	272		1,020	N/A	N/A	N/A
HC62200498	BIO GLUE W/APPLICATOR	278		2,800	N/A	N/A	N/A
HC62200530	BLADE INCISIONAL                  D	272		280	N/A	N/A	N/A
HC62200563	BLADE INDIANACTOME	272		448	N/A	N/A	N/A
HC62200597	BLADE OPHTHALM                    Q	272		336	N/A	N/A	N/A
HC62200621	BLANKET HYPER/HYPOTHERMIA         C	272		106	N/A	N/A	N/A
HC62200647	BOARD PATIENT COMMUNICATION	270		42	N/A	N/A	N/A
HC62200670	BONE MARROW TRAY	272		195	N/A	140	N/A
HC62200704	BOOT BUCKS TRACTION UNIT	272		311	N/A	N/A	N/A
HC62200738	BOTTLE EVAC ADULT/PEDS	272		135	N/A	N/A	N/A
HC62200761	BREAST PUMP	272		288	N/A	N/A	N/A
HC62200795	BRUSH BRONCHIAL	272		339	N/A	N/A	N/A
HC62200829	BRUSH MEDULLARY CANAL             E	272		190	N/A	N/A	N/A
HC62200852	BURR MIDAS REX/ANSPACH            F	272		359	N/A	N/A	N/A
HC62200886	BURR ORTHO                        F	272		420	N/A	N/A	N/A
HC62200936	CABLE INTRAUTERINE PRESSURE	270		400	N/A	N/A	N/A
HC62200969	CANNULA AORTIC ARCH               D	272		140	N/A	N/A	N/A
HC62200993	CANNULA CORONARY	272		778	N/A	N/A	N/A
HC62201025	CANNULA INNER DISPOSABLE	272		70	N/A	N/A	N/A
HC62201058	CANNULA OXYGEN	270		70	N/A	N/A	N/A
HC62201074	CANNULA TRACH INNER               B	272	A4623	106	N/A	N/A	N/A
HC62201082	CANNULA HOLDER/GRIP SKIN TENDER	272		39	N/A	N/A	N/A
HC62201108	CANNULA VENOUS                    F	272		224	N/A	N/A	N/A
HC62201140	CARTRIDGE (DIALYSIS)	272		1,341	N/A	N/A	N/A
HC62201173	CASTING SUPPLIES SYNTHETIC	272		225	N/A	N/A	N/A
HC62201207	CATH ADAPTOR	272		141	N/A	N/A	N/A
HC62201231	CATH BARTHOLIN GLAND	272		73	N/A	N/A	N/A
HC62201264	CATH BRONCH VENTILATION	272		176	N/A	N/A	N/A
HC62201280	CATH CENTRAL VENOUS MULT LUMEN    I	272	C1751	490	N/A	N/A	N/A
HC62201298	CATH CHOLANGIOGRAM	272	C1887	140	N/A	N/A	N/A
HC62201322	CATH DIAGNOSTIC                   M	272		806	N/A	N/A	N/A
HC62201355	CATH EPIDURAL	272		365	N/A	N/A	N/A
HC62201389	CATH EXCHANGE PTCA	272		659	N/A	N/A	N/A
HC62201413	CATH FOGARTY                      I	272	C1757	486	N/A	N/A	N/A
HC62201447	CATH GASTRO TUBE	272		1,176	N/A	N/A	N/A
HC62201470	CATH INFUS/THROMBOLYSS(CRAGG-MCNAMARA)L	272	C1887	700	N/A	N/A	N/A
HC62201504	CATH MALECOT	272		182	N/A	N/A	N/A
HC62201538	CATH RADIAL ARTERY	272		190	N/A	N/A	N/A
HC62201561	CATH SUCTION	272		38	N/A	N/A	N/A
HC62201595	TROCAR ENDO                       G	272		350	N/A	N/A	N/A
HC62201629	CATH URETERAL DUAL LUMEN          V	272	C1758	476	N/A	N/A	N/A
HC62201652	CATH VASCULAR	272		848	N/A	N/A	N/A
HC62201686	CAUTERY HEMO ERASER (EYE)	272		144	N/A	N/A	N/A
HC62201710	CEMENT INJECTOR	272		437	N/A	N/A	N/A
HC62201744	CHEST DRAINAGE (PLEUREVAC)	272		428	N/A	N/A	N/A
HC62201751	CHEST TUBE                        B	272		70	N/A	N/A	N/A
HC62201777	CIRCUIT VENT BIPAP	270		182	N/A	N/A	N/A
HC62201801	CIRCUM' DEVICE/CLAMP DISPOSABLE	272		107	N/A	N/A	N/A
HC62201843	CLIP FOGARTY SOFT JAW	272		113	N/A	N/A	N/A
HC62201884	CLIPPER BLADE	272		36	N/A	N/A	N/A
HC62201918	COAGULATION SUCTION	272		70	N/A	N/A	N/A
HC62201942	COLLAR CERVICAL SOFT	274	L0120	88	N/A	N/A	N/A
HC62201975	CONNECTOR SURGICAL	272		295	N/A	N/A	N/A
HC62201983	CONNECTOR Y/T	272		45	N/A	N/A	N/A
HC62202007	CO-SET CARDIAC OUTPUT	272		223	N/A	N/A	N/A
HC62202031	INJECTOR KIT DOUBLE	272		47	N/A	N/A	N/A
HC62202064	KIT DRAINAGE	272		532	N/A	N/A	N/A
HC62202098	NEEDLE CHIBA	272		50	N/A	N/A	N/A
HC62202122	CURRETTE VACCUUM SUCTION	272		379	N/A	N/A	N/A
HC62202155	DERMABOND                         E	272		210	N/A	N/A	N/A
HC62202189	DEVICE BLADDER MONITOR	272		331	N/A	N/A	N/A
HC62202205	DEVICE ERCP LOCKING	272		102	N/A	N/A	N/A
HC62202239	DEVICE COMPRESSION FEMORAL        C	272		106	N/A	N/A	N/A
HC62202262	DEVICE KYPHOPLASTY BONE FILLER	272		583	N/A	N/A	N/A
HC62202296	DRAIN	272	C1729	288	N/A	N/A	N/A
HC62202346	DRAIN JACKSON PRATT	272	C1729	42	N/A	N/A	N/A
HC62202387	DRAIN WOUND	272	C1729	50	N/A	N/A	N/A
HC62202411	DRESSING AQUAPHOR GUAZE	272		50	N/A	N/A	N/A
HC62202437	DRESSING BIOBRANE	272	A6251	326	N/A	N/A	N/A
HC62202478	DRESSING TEGADERM MOISTURE PERMEABLE	272		70	N/A	N/A	N/A
HC62202502	DRESSING MICRODON	272		87	N/A	N/A	N/A
HC62202544	HEMOSTATIC GEL/SURGICEL           G	272		203	N/A	N/A	N/A
HC62202601	DRESSING WOUND	272		46	N/A	N/A	N/A
HC62202635	EAR TUBES-DRAIN	272		69	N/A	N/A	N/A
HC62202668	ELECTRODE DISP	272		70	N/A	N/A	N/A
HC62202684	ELECTRODE FETAL SCALP HELIX	272		106	N/A	N/A	N/A
HC62202692	ELECTRODE LEEP LOOPS              N	272		280	N/A	N/A	N/A
HC62202718	ELECTRODE PACING/DEFIB TEMPORARY  H	272		420	N/A	N/A	N/A
HC62202742	ELECTRODE ROLLER BALL             G	272		350	N/A	N/A	N/A
HC62202775	CATH EP DIAG/MAPPING<20 ELECT     V	272	C1732	8,400	N/A	N/A	N/A
HC62202809	EMBOLIZATION PROTECTIVE SYSTEM    Q	278	C1884	7,000	N/A	N/A	N/A
HC62202833	ENDO BALLOON PERITONEAL SYSTEM	272		1,058	N/A	N/A	N/A
HC62202866	ENDO INSTRUMENT	272		2,744	N/A	N/A	N/A
HC62202882	ENDO LOOP	272		279	N/A	N/A	N/A
HC62202890	NEEDLE ENDOSCOPIC                 F	272		280	N/A	N/A	N/A
HC62202916	ENDO PUSHER	272		127	N/A	N/A	N/A
HC62202940	SCISSORS ENDOSCOPIC               L	272		700	N/A	N/A	N/A
HC62202973	ENDO STAPLER SKIN	272		739	N/A	N/A	N/A
HC62203005	CLIP ENDOSCOPIC                   L	272		700	N/A	N/A	N/A
HC62203039	ET BAG COLOSTOMY	272		392	N/A	N/A	N/A
HC62203062	ET BELT	272		80	N/A	N/A	N/A
HC62203104	ET POUCH                          B	272		70	N/A	N/A	N/A
HC62203120	ET POWDER STOMAHESIVE	272		64	N/A	N/A	N/A
HC62203153	ET SKIN CARE KIT	272		148	N/A	N/A	N/A
HC62203187	ET WAFER	272		69	N/A	N/A	N/A
HC62203252	EYE OCCLUDER	272		39	N/A	N/A	N/A
HC62203294	FIBER LASER                       K	272		1,678	N/A	N/A	N/A
HC62203328	FILTER BLOOD	272		69	N/A	N/A	N/A
HC62203377	FILTER RESPIRATORY	272		56	N/A	N/A	N/A
HC62203401	FORCEP BIOPSY                     F	272		386	N/A	N/A	N/A
HC62203435	FORCEPS GRASPING	272		1,694	N/A	N/A	N/A
HC62203476	SCALPEL SHEARS HARMONIC	272		1,680	N/A	N/A	N/A
HC62203518	HOLDER TUBE{ET NG&TRACH}	270		42	N/A	N/A	N/A
HC62203542	IMMOBILZER KNEE	274	L1830	46	N/A	N/A	N/A
HC62203625	IRRIGATOR OPHTHALMIC	272		83	N/A	N/A	N/A
HC62203658	KIT ACCESSORY & LAPAROSCOPIC	272		227	N/A	N/A	N/A
HC62203674	KIT ANEURYSM	272		1,291	N/A	N/A	N/A
HC62203682	KIT ANGIO TOUCH HAND CONTROL	272		728	N/A	N/A	N/A
HC62203708	KIT ARTERIAL LINE	272		66	N/A	N/A	N/A
HC62203732	KIT BREAST PUMP ELECTRIC	272		83	N/A	N/A	N/A
HC62203765	KIT CATH SUCTION	272		47	N/A	N/A	N/A
HC62203799	KIT COOK TRIPLE LUMEN CATH	272		854	N/A	N/A	N/A
HC62203823	CATH DIALYSIS SHORT-TERM          K	272	C1752	957	N/A	N/A	N/A
HC62203856	KIT EPIDURAL	272		117	N/A	N/A	N/A
HC62203872	KIT FECAL MANAGEMENT              O	270		1,120	N/A	N/A	N/A
HC62203880	KIT FEMALE CATH	272		36	N/A	N/A	N/A
HC62203906	KIT HEMOSEEL(SEAL)	278		2,730	N/A	N/A	N/A
HC62203930	KIT HYSTEROSALPINGOGRAM	272		316	N/A	N/A	N/A
HC62203963	INTRODUCER/SHEATH(FLEXOR TIBIAL)  G	272	C1894	350	N/A	N/A	N/A
HC62203997	KIT IV START W/TEGADERM	272		30	N/A	N/A	N/A
HC62204029	KIT LASER VEIN ABLATION	272	C1888	2,207	N/A	N/A	N/A
HC62204052	KIT MICROINTRODUCER	272		127	N/A	N/A	N/A
HC62204086	KIT NEEDLE GUIDE (PICC)	272	C1751	210	N/A	N/A	N/A
HC62204102	PACK OPEN HEART	272		210	N/A	N/A	N/A
HC62204136	KIT PERITONEAL DRAINAGE ACCESS	278	A4300	1,723	N/A	N/A	N/A
HC62204169	KIT POST OP CATARACT	272		204	N/A	N/A	N/A
HC62204193	KIT RADICAL PROSTATECTOMY	272		358	N/A	N/A	N/A
HC62204227	KIT ROTALINK	272	C1724	4,797	N/A	N/A	N/A
HC62204250	KIT TEST PYLORI HELICOBACTER	272		98	N/A	N/A	N/A
HC62204284	KIT TRACH	272	A4624	275	N/A	N/A	N/A
HC62204300	KIT PRESSURE MONITOR/TRANSDUCER   E	272		210	N/A	N/A	N/A
HC62204334	KIT TWIST DRILL DISP	272		1,549	N/A	N/A	N/A
HC62204367	KIT WOUND VAC	272		201	N/A	N/A	N/A
HC62204391	KIT/TRAY SUTURE REMOVAL	272		33	N/A	N/A	N/A
HC62204425	KNIFE MYRINGOTOMY	272		85	N/A	N/A	N/A
HC62204458	BEAD LC MICROSPHERE PER VIAL	278	C1889	6,461	N/A	N/A	N/A
HC62204482	APPLIER LIGA/HEMOCLIP ENDO        D	272		141	N/A	N/A	N/A
HC62204508	LINE PRESSURE MONITOR	272		120	N/A	N/A	N/A
HC62204516	LINE PRESSURE TRANSDUCER	272		120	N/A	N/A	N/A
HC62204540	LOOPS CYSTO	272		415	N/A	N/A	N/A
HC62204573	CATH CARDIAC	278		1,148	N/A	N/A	N/A
HC62204607	RECHARGER BATTERY NRST RPLCMNT	271	L8689	4,200	N/A	N/A	N/A
HC62204631	M: SYSTEM ENT STEALTH	278	C1889	1,988	N/A	N/A	N/A
HC62204664	MAGNET DEVICE	272		224	N/A	N/A	N/A
HC62204698	MASK OXYGEN	272		42	N/A	N/A	N/A
HC62204714	MATTRESS ALTERNATING PRESSURE	270		112	N/A	N/A	N/A
HC62204722	METERED DOSE INHALER	270		56	N/A	N/A	N/A
HC62204755	MODULE OB CUSTOM DISP PACK	272		176	N/A	N/A	N/A
HC62204797	PACKING NASAL                     C	272		106	N/A	N/A	N/A
HC62204821	NASAL TAMPON	272		171	N/A	N/A	N/A
HC62204854	NEEDLE ASPIRATION TRANS-BRONCH	272		554	N/A	N/A	N/A
HC62204888	NEEDLE BIOPSY BONE VERTEBROPLASTY K	272		630	N/A	N/A	N/A
HC62204912	NEEDLE GUIDE STEREOTACTIC BX	272		106	N/A	N/A	N/A
HC62204953	SPHINCTEROTOME NEEDLE KNIFE	272		700	N/A	N/A	N/A
HC62204979	NEEDLE SCALP VEIN	272		36	N/A	N/A	N/A
HC62205000	NEEDLE SPINAL                     C	272		106	N/A	N/A	N/A
HC62205034	NEEDLE TRANSSEPTAL	272		770	N/A	N/A	N/A
HC62205067	NURSER CLEFT PALATE	270		127	N/A	N/A	N/A
HC62205109	CABLE PACER DISP                  C	272		223	N/A	N/A	N/A
HC62205133	PACK ANGIO	272		630	N/A	N/A	N/A
HC62205166	PACK BASIC	272		293	N/A	N/A	N/A
HC62205182	PACK CAROTID	272		87	N/A	N/A	N/A
HC62205208	PACK CELL SAVER	272		1,075	N/A	N/A	N/A
HC62205224	PACK C-SECTION	272		109	N/A	N/A	N/A
HC62205257	PACK ENDOSCOPY	272		140	N/A	N/A	N/A
HC62205281	PACK GEN/GYN	272		126	N/A	N/A	N/A
HC62205315	PACK LAMINECTOMY	272		207	N/A	N/A	N/A
HC62205349	PACK LAPAROTOMY	272		148	N/A	N/A	N/A
HC62205372	PACK MAJOR	272		73	N/A	N/A	N/A
HC62205398	PACK NEURO	272		1,261	N/A	N/A	N/A
HC62205406	PACK ORTHO ACCESSARY	272		106	N/A	N/A	N/A
HC62205422	KIT PERFUSION                     C	272		3,500	N/A	N/A	N/A
HC62205455	PACK UROLOGY CYSTO MAJOR	272		140	N/A	N/A	N/A
HC62205489	PACK VASCULAR	272		853	N/A	N/A	N/A
HC62205513	PACKING NUGAUZE	272		34	N/A	N/A	N/A
HC62205547	PAD BREAST	272		34	N/A	N/A	N/A
HC62205570	PAD GROUNDING	272		70	N/A	N/A	N/A
HC62205604	PAD SPECIALTY/HYPER/OTHERMIA	272		190	N/A	N/A	N/A
HC62205638	PAIN PUMP W/ SYSTEM               Q	272		1,244	N/A	N/A	N/A
HC62205679	PICC LINE INTRODUCER	272	C1751	766	N/A	N/A	N/A
HC62205703	PINS CRW HEAD DISP	272		2,895	N/A	N/A	N/A
HC62205737	POST OP SHOE	270		59	N/A	N/A	N/A
HC62205760	PROBE BICAP WITH NEEDLE	272		1,260	N/A	N/A	N/A
HC62205794	PROBE ENDO EYE	272		347	N/A	N/A	N/A
HC62205828	PROBE LASER                       N	272		980	N/A	N/A	N/A
HC62205844	PROBE PERCUTANEOUS	272		3,325	N/A	N/A	N/A
HC62205885	PROBE STEREO GUIDE	272		746	N/A	N/A	N/A
HC62205919	PUSHER OCCLUSION COIL	272		550	N/A	N/A	N/A
HC62205943	RESPIRATORY  EXERCISER	270		78	N/A	N/A	N/A
HC62205976	DEVICE RETRIEVAL                  C	272	C1773	2,100	N/A	N/A	N/A
HC62206008	M: RT MISC SUPPLY	270		4,860	N/A	N/A	N/A
HC62206032	SCISSORS EYE(DISP)	272		495	N/A	N/A	N/A
HC62206057	SENSOR BISPECTRAL INDEX	270		257	N/A	N/A	N/A
HC62206065	SENSOR IN-LINE	272		400	N/A	N/A	N/A
HC62206081	SET AMPLATZ	272	C1769	1,680	N/A	N/A	N/A
HC62206115	SET ARTERIAL LINE	272		65	N/A	N/A	N/A
HC62206149	SET CAP/DIAPH H  FREQ OSCILL      I	272		112	N/A	N/A	N/A
HC62206172	SET CHEST DRAINAGE	272		176	N/A	N/A	N/A
HC62206206	SET FLUID TRANSFER	272		70	N/A	N/A	N/A
HC62206230	SET INFANT GAVAGE	272		120	N/A	N/A	N/A
HC62206255	SET IPPB	272		84	N/A	N/A	N/A
HC62206263	SET IRRIGATION CYSTO/URO	272		106	N/A	N/A	N/A
HC62206289	SET IV/PORT ERCP EXTENSION	272		57	N/A	N/A	N/A
HC62206313	SET LIVER BIOPSY	272		1,680	N/A	N/A	N/A
HC62206347	SET PERFUSION	272		350	N/A	N/A	N/A
HC62206388	SET THERM FOR CARDIAC OUTPUT	272		158	N/A	N/A	N/A
HC62206412	SET TUBING VGFI	272		402	N/A	N/A	N/A
HC62206446	MARKER SHADOWFORM/VISICOIL	272	A4648	537	N/A	N/A	N/A
HC62206479	SHEATHS ILLUMINATOR	272		1,282	N/A	N/A	N/A
HC62206495	SHELL BREAST	272		94	N/A	N/A	N/A
HC62206537	SIZER MAMMARY                     C	272		1,118	N/A	N/A	N/A
HC62206560	SLING ARM	270	A4565	106	N/A	N/A	N/A
HC62206602	SNARE                             E	272		210	N/A	N/A	N/A
HC62206636	SOLUTION CONCHA WATER	272		80	N/A	N/A	N/A
HC62206669	SPHINCTEROTOME                    H	272		1,120	N/A	N/A	N/A
HC62206701	BOOT WLKNG AIR W/WO JNTS PREFB    C	274	L4360	106	N/A	N/A	N/A
HC62206727	SPLINT CLAVICLE	270		50	N/A	N/A	N/A
HC62206750	SPLINT FULL LEG AIR PREFAB	270		154	N/A	N/A	N/A
HC62206792	STAPLE REMOVER	272		33	N/A	N/A	N/A
HC62206834	STIMULATOR NERVE LOCATOR	272		362	N/A	N/A	N/A
HC62206909	STRAPS LEG BAG	270		65	N/A	N/A	N/A
HC62206933	SUCTION IRRIGATOR	272		358	N/A	N/A	N/A
HC62206974	SUPPORTER ATHLETIC	270		144	N/A	N/A	N/A
HC62206990	SUTURE                            B	272		42	N/A	N/A	N/A
HC62207006	SUTURE CARDIOVASCULAR             G	272		179	N/A	N/A	N/A
HC62207022	SUTURE GENERAL MULTI PKG	272		288	N/A	N/A	N/A
HC62207055	SUTURE NEURO                      D	272		98	N/A	N/A	N/A
HC62207089	SUTURE WIRE	272		144	N/A	N/A	N/A
HC62207113	SYRINGE KYPHOPLASTY INFLATION	272		504	N/A	N/A	N/A
HC62207147	SYSTEM RAPID REFILL INJECTION	272		106	N/A	N/A	N/A
HC62207170	TAPE RADIOPAQUE	270		120	N/A	N/A	N/A
HC62207196	TIP SUCTION	272		56	N/A	N/A	N/A
HC62207204	TIP VITALVUE SUCTION/IRRIG	272		449	N/A	N/A	N/A
HC62207220	TOURNIQUET	270		162	N/A	N/A	N/A
HC62207253	TRAY AMNIOCENTESIS	272		260	N/A	N/A	N/A
HC62207303	TRAY CUTDOWN	272		997	N/A	N/A	N/A
HC62207337	TRAY FOLEY CATH	272		36	N/A	N/A	N/A
HC62207360	TRAY GENERAL PURPOSE DISP	272		154	N/A	N/A	N/A
HC62207394	TRAY INTUBATION	270		271	N/A	N/A	N/A
HC62207428	TRAY LUMBAR PUNCTURE	272		363	N/A	N/A	N/A
HC62207451	TRAY NASAL	272		1,065	N/A	N/A	N/A
HC62207485	TRAY PELVIC EXAM	272		176	N/A	N/A	N/A
HC62207519	TRAY SPINAL/EPIDURAL	272		56	N/A	N/A	N/A
HC62207543	CATH UMBILICAL DOUBLE LUMEN	272		134	N/A	N/A	N/A
HC62207576	VACUUM TREPHINE	272		481	N/A	N/A	N/A
HC62207600	TUBE CONNECTING	272		36	N/A	N/A	N/A
HC62207634	TUBE ET                           B	272		70	N/A	N/A	N/A
HC62207667	TUBE GAUZE	270		115	N/A	N/A	N/A
HC62207675	TUBE GAVAGE/FEEDING INFANTS	272		34	N/A	N/A	N/A
HC62207691	TUBE JEUJUNOSTOMY	272		675	N/A	N/A	N/A
HC62207725	TUBE NASO GASTRIC	272		36	N/A	N/A	N/A
HC62207758	TUBE SILASTIC	272		42	N/A	N/A	N/A
HC62207782	IVS TUBING  BLOOD/FLUID WARMER	272		176	N/A	N/A	N/A
HC62207816	IVS TUBING BLOOD PUMP	272		134	N/A	N/A	N/A
HC62207857	TUBING HYSTEROSCOPY               D	272		280	N/A	N/A	N/A
HC62207873	IVS TUBING	272		50	N/A	N/A	N/A
HC62207899	IVS TUBING HOT LINE	272		50	N/A	N/A	N/A
HC62207923	TUBING PCA	272		36	N/A	N/A	N/A
HC62207956	TUBING SCD	272		204	N/A	N/A	N/A
HC62207980	TUBING SUCTION	272		46	N/A	N/A	N/A
HC62208012	TUBING VACUUM DELIVERY	272		111	N/A	N/A	N/A
HC62208046	URINE STRAINER	270		41	N/A	N/A	N/A
HC62208079	VACUUM CURRETTE	272		38	N/A	N/A	N/A
HC62208103	VALVE BIOPSY	272		879	N/A	N/A	N/A
HC62208129	VALVE HEIMLICH CHEST DRAIN	272		126	N/A	N/A	N/A
HC62208152	VALVE SUCTION	272		57	N/A	N/A	N/A
HC62208186	VEIN STRIPPER	272		92	N/A	N/A	N/A
HC62208228	WOUND CARE LOTION/GEL/CRM/OINT	270		84	N/A	N/A	N/A
HC62208251	CATHETER ENTEROCLYSIS	272		778	N/A	N/A	N/A
HC62208301	INK/DYE                           B	250		54	N/A	N/A	N/A
HC62208475	PROSTATE BIOPSY NEEDLE	272		751	N/A	N/A	N/A
HC62208491	PAD EXTERNAL CLOSURE	272		225	N/A	N/A	N/A
HC62208533	BIT VERTEBROPLASTY	272		364	N/A	N/A	N/A
HC62208566	HAND ACCESS DEVICE                B	272		840	N/A	N/A	N/A
HC62208608	SYSTEM VEIN HARVESTING	272		3,189	N/A	N/A	N/A
HC62208640	ET PASTE STOMAHESIVE	272		129	N/A	N/A	N/A
HC62208673	GUIDEWIRE                         S	272	C1769	1,556	N/A	N/A	N/A
HC62208707	CATH GUIDE F S OR M SINUPLASTY	272	C1887	1,487	N/A	N/A	N/A
HC62208723	CATHETER IRRIGATION SINUPLASTY	272		438	N/A	N/A	N/A
HC62208731	CATH BALLOON SINUPLASTY           J	272	C1726	2,800	N/A	N/A	N/A
HC62208756	PADS BREAST HYDROGEL	270		34	N/A	N/A	N/A
HC62208806	CATH INTRAVASC ULTRASOUND	272	C1753	2,947	N/A	N/A	N/A
HC62208830	VALVE HEMOSTATIC	272		120	N/A	N/A	N/A
HC62208889	ADVANCER ROTALINK	272		914	N/A	N/A	N/A
HC62208913	CATH PTCA BALLOON NON-LASER CRYO  Z	272	C1725	7,000	N/A	N/A	N/A
HC62208947	SYSTEM CONTRAST SPIKE/BAG	272		159	N/A	N/A	N/A
HC62208962	CLIP WIRE ROTABLATOR	272		162	N/A	N/A	N/A
HC62208970	PADS DEFIBRILLATOR HANDS FREE	272		159	N/A	N/A	N/A
HC62208996	CATH DIAGNOSTIC RADIAL	272		224	N/A	N/A	N/A
HC62209028	CATH SEGURA BASKET                R	272		736	N/A	N/A	N/A
HC62209051	MATTRESS WAFFLE OVERLAY	270		92	N/A	N/A	N/A
HC62209127	M: MISC GENERAL SUPPLY	270		1,086	N/A	N/A	N/A
HC62209150	KIT TISSUE EXPANDER	272		2,055	N/A	N/A	N/A
HC62209192	CAP PIN PROTECTOR	272		95	N/A	N/A	N/A
HC62209234	TUBE T	272		67	N/A	N/A	N/A
HC62209267	KIT TUBING BREAST PUMP	272		98	N/A	N/A	N/A
HC62209291	BALLOON TAMPONADE GYN (BAKRI)	270	C1726	722	N/A	N/A	N/A
HC62209325	DEVICE RETRIEVAL SPIDER NET       E	272		280	N/A	N/A	N/A
HC62209366	POSITIONER FLUIDIZED SML Z-FLO	271		140	N/A	N/A	N/A
HC62209390	BRUSH BIOPSY TRACKING	272		140	N/A	N/A	N/A
HC62209424	COIL MARKER FIDUCIAL	272	A4648	420	N/A	N/A	N/A
HC62209457	GLIDESCOPE GVL 0-2	272		67	N/A	N/A	N/A
HC62209473	M:MISC GENERAL SURGERY SUPPLY	272		893	N/A	N/A	N/A
HC62209507	M:MISC NEURO SURGERY SUPPLY	272		1,507	N/A	N/A	N/A
HC62209531	M:MISC SUPPLY ORTHO	272		1,039	N/A	N/A	N/A
HC62209564	TRACTION BUCKS UNIT	270		311	N/A	N/A	N/A
HC62209598	TRACTION PELVIC UNIT	270		596	N/A	N/A	N/A
HC62209622	SLING KODEL	270		176	N/A	N/A	N/A
HC62209655	KIT ACCESSORY IDD THERAPY	272		302	N/A	N/A	N/A
HC62209671	CATHETER IMPEDANCE PH	272		382	N/A	N/A	N/A
HC62209689	OVERTUBE ESOPHAGEAL	272		543	N/A	N/A	N/A
HC62209705	DEVICE HEMOSTATIC CLIPPING	272		644	N/A	N/A	N/A
HC62209739	STENT REMOVER                     F	272	C1773	840	N/A	N/A	N/A
HC62209762	COMPARTM'L PRESS' MSRMT SUPPLY	272		379	N/A	N/A	N/A
HC62209796	KIT ACCESSORY PACEMAKER	272		150	N/A	N/A	N/A
HC62209861	CATHETER MICRO CTO (CORSAIR)      W	272		3,500	N/A	N/A	N/A
HC62210158	KIT PROVOC ASTHMA METHACHOLINE	272		127	N/A	N/A	N/A
HC62210174	HEADGEAR OPTILIFE	272		49	N/A	N/A	N/A
HC62210182	CATH EMBOLECTOMY ARTERIAL FOGARTY F	272	C1757	280	N/A	N/A	N/A
HC62210208	NEEDLE BIOPSY TRACKING	272		280	N/A	N/A	N/A
HC62210240	CANNULA ECMO	278	C1889	8,225	N/A	N/A	N/A
HC62210273	SPLINT WRIST/ HAND RESTING	274	L3807	316	N/A	N/A	N/A
HC62210307	TUBE REPOGLE 8 FRENCH	272		179	N/A	N/A	N/A
HC62210331	BALLOON SIZING SEPTAL DEFECT	272	C1725	966	N/A	N/A	N/A
HC62210364	DEVICE ELECTROSURG ABLAT ENDOVASC	272	C1888	8,750	N/A	N/A	N/A
HC62210398	GUIDE ROD                         H	272		434	N/A	N/A	N/A
HC62210414	KIT CASS KNEE NAVITRAKER	272		1,400	N/A	N/A	N/A
HC62210463	SUTURE ACCESSORY	272		414	N/A	N/A	N/A
HC62210521	ORTHOTIC WHFO RESTING ADAPTABL    B	274	L3807	70	N/A	N/A	N/A
HC62210554	ORTHOTIC LIMB UPPER /WRIST	274	L3999	70	N/A	N/A	N/A
HC62210588	TUBING ASPIRATION NEURO	272		1,296	N/A	N/A	N/A
HC62210612	CATH MICRO NEURO(HEADWAY/MAGIC)   N	272	C1887	2,450	N/A	N/A	N/A
HC62210646	CATH BALLOON NEURO(SCEPTER)       B	272	C2628	4,900	N/A	N/A	N/A
HC62210661	DEVICE CLOT SEPARATOR NEURO      AD	272	C1887	9,800	N/A	N/A	N/A
HC62210679	DEVICE RETRIEVAL NEURO FB         F	272	C1773	10,500	N/A	N/A	N/A
HC62210695	DEVICE CLOSURE NEUROVASCULAR	278	C1760	6,825	N/A	N/A	N/A
HC62210737	SYSTEM ENTERAL FEED PRESRELIEF	270		34	N/A	N/A	N/A
HC62210760	PROBE BILIARY DIRECT VISUAL	272		2,520	N/A	N/A	N/A
HC62210794	KIT INTRAOP PERFUSION (SPY)	272		4,183	N/A	N/A	N/A
HC62210828	POSITIONER FLUIDIZED UTILITY	271		106	N/A	N/A	N/A
HC62210851	TRANSDCR OPTCL DATARSO2WIRELSS	271		542	N/A	N/A	N/A
HC62210885	M: CLAMP SPINAL	272		5,117	N/A	N/A	N/A
HC62210893	CIRCUIT VENT                      B	270		69	N/A	N/A	N/A
HC62210919	KIT CARDIOPLEGIA CANNULA	272		386	N/A	N/A	N/A
HC62210943	SET CPS CIRCUIT PERFUSION	272		4,200	N/A	N/A	N/A
HC62210976	COIL FLOW MID-CAB SHUNTS	272		403	N/A	N/A	N/A
HC62211008	CANNULA AORTIC PEDS	272		344	N/A	N/A	N/A
HC62211032	CANNULA AORTIC FEMORAL (CPS) EXISTS	272		728	N/A	N/A	N/A
HC62211065	CATHETER ENDOCLAMP	272		10,553	N/A	N/A	N/A
HC62211099	RESERVOIR CELL SAVER              D	272		140	N/A	N/A	N/A
HC62211115	TUBING SUCTION CELL SAVER	272		98	N/A	N/A	N/A
HC62211149	OXYGENATOR PEDIATRIC              C	272		2,205	N/A	N/A	N/A
HC62211172	KIT PERFUSION - PEDS	272		1,943	N/A	N/A	N/A
HC62211206	KIT PERITONEAL LAVAGE	272		117	N/A	N/A	N/A
HC62211248	M: ROD MAXILLOFACIAL	278	L8699	N/A	N/A	N/A	N/A
HC62211271	AUTO TRANSFUSION SUPPLIES	270		1,353	N/A	N/A	N/A
HC62211321	NEEDLE CATH CENTESIS/CV	272	C1729	66	N/A	N/A	N/A
HC62211347	TUBE TRACH NO-CUFF                D	272	A7520	131	N/A	N/A	N/A
HC62211370	OXISENSOR ADULT OR PEDS	272		36	N/A	N/A	N/A
HC62211404	KIT VENTRICULOSTOMY ACCESS	272		1,102	N/A	N/A	N/A
HC62211438	TUBE TRACH CUFFED ADJUSTABLE      G	272	A7521	350	N/A	N/A	N/A
HC62211461	CATH GUID NEURO/PERIPH(DI058X115/NAVIEN)W	272	C1887	5,600	N/A	N/A	N/A
HC62211503	BLADE INCISIONAL                  M	272		910	N/A	N/A	N/A
HC62211537	SCREW EXTRACTOR BOLT	272		428	N/A	N/A	N/A
HC62211552	NEEDLE ACCESS SPINAL INSULATED	272		963	N/A	N/A	N/A
HC62211560	CATH BALLOON SINUPLASTY           G	272	C1726	1,750	N/A	N/A	N/A
HC62211586	CASSETTE WND IRRIG/SUCTN	272		192	N/A	N/A	N/A
HC62211610	DEVICE COMPRESSION RADIAL	272		79	N/A	N/A	N/A
HC62211644	CATH ANGIOGRAPHY                  B	272	C1887	70	N/A	N/A	N/A
HC62211685	KIT DRESSING WOUND NEG PRESSURE   E	272		420	N/A	N/A	N/A
HC62211719	DRESSING HYDROGEL WND FILLER LG	272		382	N/A	N/A	N/A
HC62211743	CATH GUIDING DEFLECTABLE          Z	272	C1887	6,650	N/A	N/A	N/A
HC62211768	CATH BALLOON PTA         S	272	C1725	4,200	N/A	N/A	N/A
HC62211776	CATH PTA ANGIOPLS BALLOON NON-LSR Q	272	C1725	2,800	N/A	N/A	N/A
HC62211800	CIRCUIT VENT O2 HIGH FLOW THERAPY	272		325	N/A	N/A	N/A
HC62211834	DEVICE THROMBECT MECH NEURO       D	272	C1757	25,375	N/A	N/A	N/A
HC62211867	CATH PTCA ANGIOPLASTY NON-LASER   M	272	C1725	1,750	N/A	N/A	N/A
HC62211891	TRAY URINEMETER ADD A FOLEY IC	272	A4354	46	N/A	N/A	N/A
HC62211925	CATH SHEATH GUIDING	272	C1887	210	N/A	N/A	N/A
HC62211958	KIT CRICOTHYROTOMY EMERGENCY      H	272	A7520	420	N/A	N/A	N/A
HC62211982	TIP PROBE SUCTION LAPARASCOPIC	272		514	N/A	N/A	N/A
HC62212014	GUIDEWIRE(E.G. HALO/SUPER STIFF)  G	272	C1769	456	N/A	N/A	N/A
HC62212048	BLADE BONE/ENDO SHAVER            C	272		210	N/A	N/A	N/A
HC62212071	HEMOSTATIC GEL/GELFOAM/PAD        D	272		92	N/A	N/A	N/A
HC62212139	TUBE FEEDING ENTERAL NG W/O STYLET	272		43	N/A	N/A	N/A
HC62212162	TUBE FEEDING NG >36IN-NO STYLET	272		97	N/A	N/A	N/A
HC62212196	CATH PTA ANGIOPLS BALLOON NON-LSR E	272	C1725	490	N/A	N/A	N/A
HC62212220	COLLAR CERV SEMI-RIDG OCC/MAND SUP	274	L0160	41	N/A	N/A	N/A
HC62212246	MARKER DEVICE BIOPSY	272	A4648	237	N/A	N/A	N/A
HC62212279	KIT INTRODUCER PERC MRI VISIBLE	272		809	N/A	N/A	N/A
HC62212303	GUIDEWIRE(E.G. BENTSON)           A	272	C1769	36	N/A	N/A	N/A
HC62212337	COLLAR CERVICAL MIAMI J PEDS      E	274	L0172	210	N/A	N/A	N/A
HC62212360	M: BLADE MICRODEBRIDER	272		N/A	N/A	N/A	N/A
HC62212394	INTRODUCER/SHEATH                 K	272	C1894	630	N/A	N/A	N/A
HC62212428	INTRODUCER/SHEATH                 O	272	C1894	910	N/A	N/A	N/A
HC62212444	INTRODUCER/SHEATH                 Q	272	C1894	1,050	N/A	N/A	N/A
HC62212451	INTRODUCER/SHEATH                 T	272	C1894	1,233	N/A	N/A	N/A
HC62212477	LARYNGOSCOPE HANDLE ONLY DISP	270		78	N/A	N/A	N/A
HC62212501	ELECTRODE UROLOGICAL/ELECTROSURGICL	272		1,512	N/A	N/A	N/A
HC62212535	FORCEP BIOPSY DISP                C	272		176	N/A	N/A	N/A
HC62212568	FORCEP BIOPSY DISP                I	272		596	N/A	N/A	N/A
HC62212592	CATH PTCA BALLOON NON-LASER       F	272	C1725	840	N/A	N/A	N/A
HC62212626	CATH PTCA BALLOON NON-LASER       I	272	C1725	1,120	N/A	N/A	N/A
HC62212642	CATH PTCA BALLOON NON-LASER       L	272	C1725	1,416	N/A	N/A	N/A
HC62212659	CATH MICRO CTO/REPRFNS(ENTEER/5MAX ACE)AJ	272	C1887	9,100	N/A	N/A	N/A
HC62212675	GUIDEWIRE(COONS/ROSEN)            B	272	C1769	106	N/A	N/A	N/A
HC62212709	GUIDEWIRE                         F	272	C1769	386	N/A	N/A	N/A
HC62212733	GUIDEWIRE                         M	272	C1769	876	N/A	N/A	N/A
HC62212766	GUIDEWIRE                         R	272	C1769	1,366	N/A	N/A	N/A
HC62212790	GUIDEWIRE(AVIGO/NEURVSCLR SFT TIP)V	272	C1769	1,855	N/A	N/A	N/A
HC62212824	GUIDEWIRE                         Z	272	C1769	2,450	N/A	N/A	N/A
HC62212857	TUBING IRRIGATION MICRODEBRIDER	272		106	N/A	N/A	N/A
HC62212873	BLADE SHAVER                      D	272		276	N/A	N/A	N/A
HC62212907	BLADE SHAVER                      H	272		560	N/A	N/A	N/A
HC62212931	BLADE SHAVER                      K	272		764	N/A	N/A	N/A
HC62212964	BLADE SHAVER                      N	272		976	N/A	N/A	N/A
HC62212998	BLADE SHAVER                      Q	272		1,190	N/A	N/A	N/A
HC62213020	BLADE SHAVER                      T	272		1,400	N/A	N/A	N/A
HC62213053	BLADE SHAVER                      W	272		1,610	N/A	N/A	N/A
HC62213079	BLADE SHAVER                      Z	272		1,830	N/A	N/A	N/A
HC62213103	BLADE INCISIONAL                  H	272		560	N/A	N/A	N/A
HC62213137	BLADE INCISIONAL                  K	272		770	N/A	N/A	N/A
HC62213160	BLADE INCISIONAL                  O	272		1,050	N/A	N/A	N/A
HC62213194	BURR                              D	272		275	N/A	N/A	N/A
HC62213228	BURR                              J	272		700	N/A	N/A	N/A
HC62213251	BURR                              M	272		670	N/A	N/A	N/A
HC62213277	BURR                              O	272		1,051	N/A	N/A	N/A
HC62213285	BURR                              P	272		1,120	N/A	N/A	N/A
HC62213301	BURR                              R	272		1,261	N/A	N/A	N/A
HC62213335	CATH ATHERECTOMY ROTATNL (STEALTH)	272	C1724	11,883	N/A	N/A	N/A
HC62213368	REAMER                            G	272		220	N/A	N/A	N/A
HC62213392	REAMER                            J	272		506	N/A	N/A	N/A
HC62213426	REAMER                            M	272		832	N/A	N/A	N/A
HC62213459	REAMER                            P	272		910	N/A	N/A	N/A
HC62213475	REAMER                            R	272		1,067	N/A	N/A	N/A
HC62213483	REAMER                            S	272		1,121	N/A	N/A	N/A
HC62213509	REAMER                            U	272		1,389	N/A	N/A	N/A
HC62213533	REAMER                            X	272		1,497	N/A	N/A	N/A
HC62213566	REAMER                            AA	272		1,670	N/A	N/A	N/A
HC62213590	REAMER                            AD	272		1,890	N/A	N/A	N/A
HC62213624	APPLICATOR/TIP SYRINGE ONLY       E	272		208	N/A	N/A	N/A
HC62213657	CATHETER PICC PEDS	272	C1751	350	N/A	N/A	N/A
HC62213699	FORCEP OPTHALMIC DISPOSABLE	272		546	N/A	N/A	N/A
HC62213715	NEEDLE MICROTIP/TIP PHACOEMULS	272		215	N/A	N/A	N/A
HC62213749	KIT VITREORETINAL PERFLUORON 5ML	272	C1784	1,583	N/A	N/A	N/A
HC62213772	DRESSING TUBE W/-W/O ELASTIC PER YD	272	A6457	38	N/A	N/A	N/A
HC62213806	SEAL ENDO ROBOTIC                 B	272		70	N/A	N/A	N/A
HC62213830	KIT DRESSING	272		43	N/A	N/A	N/A
HC62213863	PACK MINOR ACCESSORY	272		38	N/A	N/A	N/A
HC62213897	TIP SUCTION/IRRIG	272		37	N/A	N/A	N/A
HC62213913	SLEEVE VITRECTOMY	272		126	N/A	N/A	N/A
HC62213921	DRESSING DYNA-FLEX	272		39	N/A	N/A	N/A
HC62213947	BLADE INCISIONAL                  A	272		70	N/A	N/A	N/A
HC62213970	CATH PTCA BALLOON NON-LASER       B	272	C1725	280	N/A	N/A	N/A
HC62214002	FORCEP BIOPSY DISP                B	272		106	N/A	N/A	N/A
HC62214036	SPLINT FOOT DROP PREFAB	274	L4398	88	N/A	N/A	N/A
HC62214069	SET AUTOTRANSFUS(CONSTAVAC CBCII)AP	272		2,520	N/A	N/A	N/A
HC62214093	NEEDLE TARGETING(STREAMLINE)      Q	272		1,330	N/A	N/A	N/A
HC62214119	CATH URETERAL                     B	272	C1758	37	N/A	N/A	N/A
HC62214127	CATH URETERAL                     C	272	C1758	42	N/A	N/A	N/A
HC62214143	CATH URETERAL                     E	272	C1758	70	N/A	N/A	N/A
HC62214176	CATH URETERAL                     I	272	C1758	129	N/A	N/A	N/A
HC62214200	CATH URETERAL                     L	272	C1758	196	N/A	N/A	N/A
HC62214242	CATH URETERAL                     Q	272	C1758	336	N/A	N/A	N/A
HC62214275	CATH URETERAL                     T	272	C1758	420	N/A	N/A	N/A
HC62214309	CATH URETERAL                     X	272	C1758	532	N/A	N/A	N/A
HC62214333	CLAMP INSERT	272		49	N/A	N/A	N/A
HC62214358	TUBING AUTOTRANSFUSE              B	272		70	N/A	N/A	N/A
HC62214382	STAPLE CARTRG/RELOAD LIN CUT      N	272		386	N/A	N/A	N/A
HC62214416	DEVICE PASSING NEEDLE ARTHR	272		490	N/A	N/A	N/A
HC62214440	KIT ARTHROSCOPY DISPSBLS          R	272		1,576	N/A	N/A	N/A
HC62214473	CHARGER BATTERY NEUROSTIM         B	270		5,495	N/A	N/A	N/A
HC62214515	RETRACTOR DISPOSABLE              G	272		630	N/A	N/A	N/A
HC62214549	RETRACTOR DISPOSABLE              J	272		1,050	N/A	N/A	N/A
HC62214564	CLIP STIMULATION NERVE            E	272		980	N/A	N/A	N/A
HC62214598	PROBE CATH V-PACING TRANSLUM	272		405	N/A	N/A	N/A
HC62214622	ADAPTER SIDEARM ENDO	272		50	N/A	N/A	N/A
HC62214655	DEVICE SUTURE ENDO                C	272		140	N/A	N/A	N/A
HC62214689	TIP SUCTION OPTHALMIC	272		103	N/A	N/A	N/A
HC62214713	CATH PTCA BALLOON NON-LASER       N	272	C1725	2,100	N/A	N/A	N/A
HC62214747	CATH PTA ANGIOPLS BALLOON NON-LSR S	272	C1725	3,500	N/A	N/A	N/A
HC62214762	CATH PTCA BALLOON NON-LASER       U	272	C1725	4,550	N/A	N/A	N/A
HC62214770	CATH PTCA BALLOON NON-LASER       V	272	C1725	4,900	N/A	N/A	N/A
HC62214796	CATH PTA ANGIOPLS BALLOON NON-LSR Y	272	C1725	5,775	N/A	N/A	N/A
HC62214945	BLADE CUP                         N	272		980	N/A	N/A	N/A
HC62215165	BLADE SAW                         B	272		34	N/A	N/A	N/A
HC62215199	BLADE SAW                         E	272		75	N/A	N/A	N/A
HC62215223	BLADE SAW                         H	272		113	N/A	N/A	N/A
HC62215256	BLADE SAW                         K	272		168	N/A	N/A	N/A
HC62215272	BLADE SAW                         N	272		252	N/A	N/A	N/A
HC62215280	BLADE SAW                         O	272		280	N/A	N/A	N/A
HC62215306	BLADE SAW                         Q	272		332	N/A	N/A	N/A
HC62215330	BLADE SAW                         T	272		420	N/A	N/A	N/A
HC62215363	BLADE SAW                         W	272		504	N/A	N/A	N/A
HC62215397	BLADE SAW                         Z	272		588	N/A	N/A	N/A
HC62215421	ELECTRODE SURGICAL	272		106	N/A	N/A	N/A
HC62215454	KIT DECOMPRESSION SPINAL          D	272		4,200	N/A	N/A	N/A
HC62215488	KNIFE BAYONET                     G	272		1,156	N/A	N/A	N/A
HC62215504	PROBE SPINAL DISPOSABLE           D	272		630	N/A	N/A	N/A
HC62215538	ROD WORKING SPINAL	272		304	N/A	N/A	N/A
HC62215561	SUTURE                            F	272		154	N/A	N/A	N/A
HC62215595	SUTURE                            J	272		259	N/A	N/A	N/A
HC62215629	SUTURE                            M	272		348	N/A	N/A	N/A
HC62215652	SUTURE                            Q	272		463	N/A	N/A	N/A
HC62215686	SUTURE                            U	272		574	N/A	N/A	N/A
HC62215702	SUTURE                            W	272		630	N/A	N/A	N/A
HC62215736	SUTURE                            Z	272		736	N/A	N/A	N/A
HC62215769	ADAPTER INJECTION SPINAL	272		1,163	N/A	N/A	N/A
HC62215793	FORCEPS BIPOLAR DISPOSABLE        P	272		1,260	N/A	N/A	N/A
HC62215827	NEEDLE BIOPSY                     C	272		70	N/A	N/A	N/A
HC62215850	NEEDLE BIOPSY                     G	272		182	N/A	N/A	N/A
HC62215884	NEEDLE BIOPSY                     J	272		266	N/A	N/A	N/A
HC62215900	TRAY BONE MARROW                  D	272		56	N/A	N/A	N/A
HC62215918	TRAY BONE MARROW                  E	272		70	N/A	N/A	N/A
HC62215934	TRAY BONE MARROW                  G	272		98	N/A	N/A	N/A
HC62215967	TRAY BONE MARROW                  J	272		140	N/A	N/A	N/A
HC62215991	CATH BALLOON DIL NON VASCULAR     D	272	C1726	140	N/A	N/A	N/A
HC62216023	CATH BALLOON DIL NON VASCULAR     L	272	C1726	700	N/A	N/A	N/A
HC62216056	DEVICE SUTURING ENDOSCOPIC        D	272		280	N/A	N/A	N/A
HC62216080	DEVICE SUTURING ENDOSCOPIC        G	272		700	N/A	N/A	N/A
HC62216106	STENT REMOVER                     C	272		420	N/A	N/A	N/A
HC62216114	STENT REMOVER                     D	272		560	N/A	N/A	N/A
HC62216130	STENT REMOVER                     G	272		980	N/A	N/A	N/A
HC62216163	SPHINCTEROTOME CANNULATING        I	272		1,260	N/A	N/A	N/A
HC62216197	SPHINCTEROTOME                    E	272		700	N/A	N/A	N/A
HC62216221	SHEARS COAGULATING HARMONIC       O	272		1,190	N/A	N/A	N/A
HC62216254	STABILIZER HEART OCTOPUS          E	272		2,800	N/A	N/A	N/A
HC62216296	TEMPLATE ORTHO/ROD SPINAL         M	272		476	N/A	N/A	N/A
HC62216320	NEEDLE INTRODUCER                 E	272		350	N/A	N/A	N/A
HC62216346	NEEDLE INTRODUCER                 J	272		526	N/A	N/A	N/A
HC62216379	NEEDLE BONE MARROW                D	272		299	N/A	N/A	N/A
HC62216411	PIN/WIRE FIXATION TEMPORARY       D	272		57	N/A	N/A	N/A
HC62216445	PIN/WIRE FIXATION TEMPORARY       G	272		94	N/A	N/A	N/A
HC62216478	PIN/WIRE FIXATION TEMPORARY       J	272		141	N/A	N/A	N/A
HC62216502	KIT SPINAL ACCESS DISPOSBL        E	272		3,920	N/A	N/A	N/A
HC62216536	PIN/WIRE FIXATION TEMPORARY       P	272		308	N/A	N/A	N/A
HC62216551	PIN/WIRE FIXATION TEMPORARY       R	272		364	N/A	N/A	N/A
HC62216569	PIN/WIRE FIXATION TEMPORARY       S	272		385	N/A	N/A	N/A
HC62216585	PIN/WIRE FIXATION TEMPORARY       U	272		448	N/A	N/A	N/A
HC62216619	PIN/WIRE FIXATION TEMPORARY       X	272		529	N/A	N/A	N/A
HC62216643	PIN/WIRE FIXATION TEMPORARY       AA	272		616	N/A	N/A	N/A
HC62216676	PIN/WIRE FIXATION TEMPORARY       AD	272		490	N/A	N/A	N/A
HC62216700	PIN/WIRE FIXATION TEMPORARY       AG	272		1,122	N/A	N/A	N/A
HC62216734	PIN/WIRE FIXATION TEMPORARY      AJ	272		1,543	N/A	N/A	N/A
HC62216767	CATH EP DIAG/ABLAT 3D/VECT        E	272	C1732	1,750	N/A	N/A	N/A
HC62216775	TUBING IRRIGATION                 D	272		224	N/A	N/A	N/A
HC62216791	INFLATOR FOR BALLOON              U	272		658	N/A	N/A	N/A
HC62216825	POST ANCHOR SPINAL DISPOSABLE     G	272		448	N/A	N/A	N/A
HC62216858	ENDO STAPLER                      W	272		1,610	N/A	N/A	N/A
HC62216882	ENDO STAPLER                      Z	272		1,822	N/A	N/A	N/A
HC62216916	ENDO STAPLER                     AC	272		1,429	N/A	N/A	N/A
HC62216940	TAMP BONE KYPHOPLASTY             C	272		1,400	N/A	N/A	N/A
HC62216973	PIN/WIRE FIXATION TEMPORARY      AV	272		3,220	N/A	N/A	N/A
HC62216999	NEEDLE TARGETING                  H	278		420	N/A	N/A	N/A
HC62217021	PROBE SPINAL DISPOSABLE           F	272		770	N/A	N/A	N/A
HC62217054	WRENCH TIP SPINAL (DISP)	272		1,156	N/A	N/A	N/A
HC62217088	SHIM DEVICE ACCESS SPINAL         X	272		1,852	N/A	N/A	N/A
HC62217112	CATH ANGIOGRAPHY GUIDING          C	272	C1887	106	N/A	N/A	N/A
HC62217146	KIT ROTATOR LEAD PACER	272		70	N/A	N/A	N/A
HC62217179	ORTHOTIC KNEE ELASTIC W/JOINTS PRFB	274	L1812	50	N/A	N/A	N/A
HC62217195	ORTHOTIC WHFO 1+JOINT(S) PREFAB	274	L3931	173	N/A	N/A	N/A
HC62217229	TUBE ENDOBRONCHIAL	272		191	N/A	N/A	N/A
HC62217252	CURETTE ADENOID	272		661	N/A	N/A	N/A
HC62217286	PASSER SUTURE                     M	272		787	N/A	N/A	N/A
HC62217310	DEVICE CHECK NEURO SURG SPINAL	272		3,420	N/A	N/A	N/A
HC62217344	RFID CHANDELIER OPTHALMIC	272		368	N/A	N/A	N/A
HC62217377	STOPCOCK LUER LOCK ENDOSCOPE	272		397	N/A	N/A	N/A
HC62217393	PUSHER KNOT ENDO                  D	272		490	N/A	N/A	N/A
HC62217401	SEALER BIPOLAR AQUAMANTYS	272		1,893	N/A	N/A	N/A
HC62217427	DEVICE LIGATOR                    M	272		1,538	N/A	N/A	N/A
HC62217450	REAMER                            B	272		42	N/A	N/A	N/A
HC62217484	KIT CONCENTRATOR PLATELETS        R	272		1,750	N/A	N/A	N/A
HC62217518	DRESSING SACRUM<324CM SQ(MEPITEL)	272	A6208	39	N/A	N/A	N/A
HC62217542	KIT CONCENTRATOR PLATELETS        M	272		840	N/A	N/A	N/A
HC62217575	SEPARATOR PLASMA PLASMAFLO	272		137	N/A	N/A	N/A
HC62217591	AWL SPINAL SINGLE PATIENT USE     C	272		420	N/A	N/A	N/A
HC62217609	AWL SPINAL SINGLE PATIENT USE     D	272		490	N/A	N/A	N/A
HC62217625	AWL SPINAL SINGLE PATIENT USE     G	272		700	N/A	N/A	N/A
HC62217658	AWL SPINAL SINGLE PATIENT USE     J	272		910	N/A	N/A	N/A
HC62217682	AWL SPINAL SINGLE PATIENT USE     Q	272		1,400	N/A	N/A	N/A
HC62217716	AWL SPINAL SINGLE PATIENT USE     V	272		2,100	N/A	N/A	N/A
HC62217740	ELECTRODE NEUROMONITORING SPINAL	272		955	N/A	N/A	N/A
HC62217773	TEMPLATE ORTHO/ROD SPINAL         E	272		252	N/A	N/A	N/A
HC62217807	TEMPLATE STAPLE SPINAL            C	272		490	N/A	N/A	N/A
HC62217823	TEMPLATE STAPLE SPINAL            L	272		806	N/A	N/A	N/A
HC62217856	SHIM DEVICE ACCESS SPINAL         Q	272		840	N/A	N/A	N/A
HC62217880	SET PIN DISTRACTORS-COUNT 10      A	272		3,493	N/A	N/A	N/A
HC62217914	PASSER SUTURE ORTHOPAEDIC        AA	272		3,150	N/A	N/A	N/A
HC62217948	CATH EMBOLECTOMY FOGARTY          E	272	C1757	210	N/A	N/A	N/A
HC62217971	TUBE ET                           E	272		210	N/A	N/A	N/A
HC62218003	PROBE ABLATION                    J	272		560	N/A	N/A	N/A
HC62218029	BLADE OPHTHALM                    Z	272		589	N/A	N/A	N/A
HC62218052	SHIELD EYE                        L	272		196	N/A	N/A	N/A
HC62218086	TROCAR BALLOON	272		739	N/A	N/A	N/A
HC62218110	CAPSULE PH (IMPLANT)              C	272		948	N/A	N/A	N/A
HC62218144	ELECTRODE  LAP                    D	272		140	N/A	N/A	N/A
HC62218177	KIT REPAIR PORT ACCESS LAP-BAND   D	272		2,450	N/A	N/A	N/A
HC62218201	KIT FECAL MANAGEMENT              G	272		350	N/A	N/A	N/A
HC62218227	CATH DIAGNOSTIC                   S	272		2,100	N/A	N/A	N/A
HC62218235	CATH INTRODUCER PEEL-AWAY         F	272	C1892	140	N/A	N/A	N/A
HC62218250	CATH INTRODUCER PEEL-AWAY         H	272	C1892	210	N/A	N/A	N/A
HC62218284	CATH INTRODUCER PEEL-AWAY        AA	272	C1892	1,400	N/A	N/A	N/A
HC62218318	ENDO STAPLER                      C	272		210	N/A	N/A	N/A
HC62218342	ENDO STAPLER                      G	272		490	N/A	N/A	N/A
HC62218375	ENDO STAPLER                      J	272		698	N/A	N/A	N/A
HC62218409	ENDO STAPLER                      N	272		974	N/A	N/A	N/A
HC62218425	ENDO STAPLER                      P	272		1,117	N/A	N/A	N/A
HC62218433	ENDO STAPLER                      Q	272		1,190	N/A	N/A	N/A
HC62218458	ENDO STAPLER                      S	272		1,331	N/A	N/A	N/A
HC62218482	ENDO STAPLER                     AI	272		2,450	N/A	N/A	N/A
HC62218516	STAPLE CARTRG/RELOAD LIN CUT      H	272		176	N/A	N/A	N/A
HC62218540	KIT MONITORING NERVE(S) SPINAL    J	272		4,550	N/A	N/A	N/A
HC62218573	STAPLE CARTRG/ENDO RELOAD         G	272		140	N/A	N/A	N/A
HC62218607	PROBE SPINAL DISPOSABLE           H	272		987	N/A	N/A	N/A
HC62218631	DEVICE RETRIEVAL                  F	272	C1773	3,150	N/A	N/A	N/A
HC62218656	TUBE LEAD INSERT ELECTRODE ARRAY W/STYLET	272		526	N/A	N/A	N/A
HC62218680	DRILL/DRILL BITS SINGLE USE       C	272		142	N/A	N/A	N/A
HC62218714	DRILL/DRILL BITS SINGLE USE       F	272		210	N/A	N/A	N/A
HC62218748	DRILL/DRILL BITS SINGLE USE       I	272		322	N/A	N/A	N/A
HC62218771	DRILL/DRILL BITS SINGLE USE       L	272		497	N/A	N/A	N/A
HC62218805	DRILL/DRILL BITS SINGLE USE       O	272		703	N/A	N/A	N/A
HC62218839	DRILL/DRILL BITS SINGLE USE       R	272		910	N/A	N/A	N/A
HC62218854	DRILL/DRILL BITS SINGLE USE       T	272		1,066	N/A	N/A	N/A
HC62218862	DRILL/DRILL BITS SINGLE USE       U	272		1,113	N/A	N/A	N/A
HC62218888	DRILL/DRILL BITS SINGLE USE       W	272		1,262	N/A	N/A	N/A
HC62218912	DRILL/DRILL BITS SINGLE USE       Z	272		1,473	N/A	N/A	N/A
HC62218946	DRILL/DRILL BITS SINGLE USE      AC	272		1,681	N/A	N/A	N/A
HC62218979	DRILL/DRILL BITS SINGLE USE      AF	272		2,032	N/A	N/A	N/A
HC62219001	RETRACTOR MIS SPINAL              K	272		4,900	N/A	N/A	N/A
HC62219035	FIBRIN SEALANT                    J	278		840	N/A	N/A	N/A
HC62219050	DEVICE RETRIEVAL VASC             A	272	C1773	1,400	N/A	N/A	N/A
HC62219068	DEVICE INFLATION (CALIBER/PRESTO)	272		88	N/A	N/A	N/A
HC62219084	ORTHOTIC KNEE W/JNTS PRFB CUSTM   C	274	L1832	490	N/A	N/A	N/A
HC62219118	BINDER/ORTHOSIS LUMBAR/SACRAL PRFB	274	L0625	53	N/A	N/A	N/A
HC62219142	CANNULA CURVED DUAL ELECTROSURG	272		113	N/A	N/A	N/A
HC62219175	CATH CAVITY MAMMOSITE EVAL	272		522	N/A	N/A	N/A
HC62219209	CATH EP QUAD RPRSD                H	272	C1730	420	N/A	N/A	N/A
HC62219233	CATH THROMBECTOMY/EMBOLECTOMY     E	272	C1757	420	N/A	N/A	N/A
HC62219266	DEVICE LIGATOR                    G	272		700	N/A	N/A	N/A
HC62219282	DILATOR FASCIAL INCL URO	272		51	N/A	N/A	N/A
HC62219324	EMBOLIZATION PROTECTIVE SYSTEM    J	278	C1884	4,550	N/A	N/A	N/A
HC62219357	GUIDE TRANSPORTAL ACL	272		3,063	N/A	N/A	N/A
HC62219381	INTRO/SHEATH STEERABLE NON-PEEL   F	272	C1766	3,150	N/A	N/A	N/A
HC62219415	KIT CATH ARTERIAL	272		45	N/A	N/A	N/A
HC62219456	KIT STARTER B-CPAP INFANT	272		246	N/A	N/A	N/A
HC62219480	ORTHOTIC AF PREFAB W/FIT& ADJUST	274	L1930	129	N/A	N/A	N/A
HC62219506	ORTHOSIS ANKLE/FT PRFB CUSTMZD    C	274	L4396	140	N/A	N/A	N/A
HC62219530	PASSER SUTURE                     E	272		218	N/A	N/A	N/A
HC62219563	PULLER SUTURE INCL TENSURE	272		700	N/A	N/A	N/A
HC62219605	STYLET CARDIAC                    B	272		106	N/A	N/A	N/A
HC62219639	TUBE TRACH CUFFED                 N	272	A7521	980	N/A	N/A	N/A
HC62219662	KIT INSTRUMENTS ENDOBUTTON	272		1,194	N/A	N/A	N/A
HC62219696	KIT VITRECTOMY PROBE              B	272		280	N/A	N/A	N/A
HC62219712	KIT VITRECTOMY PROBE              I	272		1,260	N/A	N/A	N/A
HC62219720	KIT VITRECTOMY PROBE              K	272		1,750	N/A	N/A	N/A
HC62219746	KIT VITRECTOMY PROBE              N	272		2,800	N/A	N/A	N/A
HC62219779	PROBE FLOW PERFUSION	272		80	N/A	N/A	N/A
HC62219803	SIZER MAMMARY                     L	272		832	N/A	N/A	N/A
HC62219837	HAND ACCESS DEVICE                G	272		1,750	N/A	N/A	N/A
HC62219860	ORTHOTIC WHFO NEO/INFANT PREFAB   A	274	L3908	36	N/A	N/A	N/A
HC62219894	BLADE SAW                        AE	272		770	N/A	N/A	N/A
HC62219910	CANNULA ARTHRSCPC ROTATING/BUR    E	272		840	N/A	N/A	N/A
HC62219928	CONNECTOR LUERLOCK ICP	272		167	N/A	N/A	N/A
HC62219944	KNIFE BAYONET                     K	272		2,135	N/A	N/A	N/A
HC62219977	KIT INSTRUMENTS UROLIFT	272		1,226	N/A	N/A	N/A
HC62220009	DEVICE BIOPSY BREAST              M	272		840	N/A	N/A	N/A
HC62220033	DEVICE SUTURE ENDO                I	272		1,120	N/A	N/A	N/A
HC62220066	RETRACTOR DISPOSABLE              D	272		280	N/A	N/A	N/A
HC62220090	CATH BALLOON DIL NON VASCULAR     A	272	C1726	36	N/A	N/A	N/A
HC62220124	KIT MONITORING NERVE(S) SPINAL    M	272		5,950	N/A	N/A	N/A
HC62220140	OVERTUBE ENDOSCOPIC               D	272	A4270	1,750	N/A	N/A	N/A
HC62220173	CANNULA ARTHROSCOPIC              E	272		210	N/A	N/A	N/A
HC62220207	CATH THROMBECTOMY/EMBOLECTOMY     Q	272	C1757	1,400	N/A	N/A	N/A
HC62220231	CUP UTERINE KOH	272		864	N/A	N/A	N/A
HC62220264	KIT MONITORING NERVE(S) SPINAL    D	272		2,450	N/A	N/A	N/A
HC62220298	NEEDLE ENDOSCOPIC                 E	272		210	N/A	N/A	N/A
HC62220322	ORTHOTIC TLSO 4MOD SACRO-SCAP PRE	274	L0464	4,379	N/A	N/A	N/A
HC62220348	PUNCH ARTHROSCOPIC	272		420	N/A	N/A	N/A
HC62220371	ADAPTOR/SPLINT WALKER WRIST	274	A4570	92	N/A	N/A	N/A
HC62220405	FIT TALAR LOCKING TRIAL	272		1,820	N/A	N/A	N/A
HC62220439	PUSHER KNOT ENDO                  L	272		1,750	N/A	N/A	N/A
HC62220462	MOLD/FORM CEMENT TIBIAL KNEE	272		2,800	N/A	N/A	N/A
HC62220496	APPLICATOR/TIP SYRINGE ONLY       D	272		140	N/A	N/A	N/A
HC62220520	DEVICE LIGATOR                    E	272		560	N/A	N/A	N/A
HC62220546	CUTTER LAPAROSCOPIC               S	272		2,143	N/A	N/A	N/A
HC62220553	FILTER HARVESTER BONE/BONE MARROW	272		967	N/A	N/A	N/A
HC62220579	INTRO/SHEATH EP FIXED NON-PEEL    H	272	C1893	630	N/A	N/A	N/A
HC62220603	INTRO/SHEATH EP FIXED NON-PEEL    B	272	C1893	210	N/A	N/A	N/A
HC62220637	HEADGEAR CPAP BONNET	272		39	N/A	N/A	N/A
HC62220660	KIT ACCESSORY                     B	272		210	N/A	N/A	N/A
HC62220694	KIT ACCESSORY                     I	272		700	N/A	N/A	N/A
HC62220728	COUNTERSINK CANNULATED            E	272		346	N/A	N/A	N/A
HC62220744	COUNTERSINK CANNULATED            O	272		1,056	N/A	N/A	N/A
HC62220751	DEVICE INDEFLATOR	272		172	N/A	N/A	N/A
HC62220777	CANNULA ARTHROSCOPIC              H	272		420	N/A	N/A	N/A
HC62220801	SUCTION DEVICE ENDOSCOPIC BIOVAC	272		386	N/A	N/A	N/A
HC62220835	BAG/POUCH RETRIEVAL SPECMN ENDO   M	272		946	N/A	N/A	N/A
HC62220868	BLADE INCISIONAL                  C	272		210	N/A	N/A	N/A
HC62220892	BLANKET HYPER/HYPOTHERMIA         B	272		70	N/A	N/A	N/A
HC62220926	CABLE PACING DISP                 B	272		70	N/A	N/A	N/A
HC62220959	CATH CENTRAL VENOUS               D	272	C1751	140	N/A	N/A	N/A
HC62220975	CATH FOLEY                        A	272		36	N/A	N/A	N/A
HC62221007	CATH UMBILICAL                    C	272		106	N/A	N/A	N/A
HC62221031	ET POUCH                          C	272		106	N/A	N/A	N/A
HC62221064	KIT CELL SAVER                    E	272		210	N/A	N/A	N/A
HC62221098	KIT CRICOTHYROTOMY EMERGENCY      J	272		560	N/A	N/A	N/A
HC62221122	KIT PRESSURE MONITOR/TRANSDUCER   A	272		36	N/A	N/A	N/A
HC62221163	KIT SUPRA PUBIC CATH              D	272		140	N/A	N/A	N/A
HC62221189	KIT TEMP MNGMNT-HEAD WRP-VEST-BLNKT	272		1,139	N/A	N/A	N/A
HC62221213	KIT W/ TRACH PERCUTANEOUS         E	272	A7520	1,260	N/A	N/A	N/A
HC62221247	NEEDLE ENDOSCOPIC                 B	272		70	N/A	N/A	N/A
HC62221270	POSITIONER FLUIDIZED FULL BODY PEDS	272		214	N/A	N/A	N/A
HC62221304	RESERVOIR CELL SAVER              G	272		350	N/A	N/A	N/A
HC62221338	SET AUTOTRANSFUSE                 K	272		252	N/A	N/A	N/A
HC62221361	SPLINT FOOT DROP PREFAB	274	L4398	305	N/A	N/A	N/A
HC62221387	SUCTION COLLECTION DEVICE         B	272		70	N/A	N/A	N/A
HC62221395	TRAY INTUBATION RETROGRADE	272		490	N/A	N/A	N/A
HC62221411	TRAY THORAC/PARACENTESIS          F	272		140	N/A	N/A	N/A
HC62221445	TROCAR ENDO                       D	272		140	N/A	N/A	N/A
HC62221478	TROCAR ENDO                       I	272		487	N/A	N/A	N/A
HC62221502	TUBE INSUFFLATOR                  D	272		140	N/A	N/A	N/A
HC62221536	TUBE TRACH CUFFED                 D	272	A7521	567	N/A	N/A	N/A
HC62221569	TUBE TRACH NO-CUFF                E	272	A7520	210	N/A	N/A	N/A
HC62221585	VALVE HEMOSTATIC W/GUIDEWIRE	272	C1769	232	N/A	N/A	N/A
HC62221593	CANNULA CEMENT BONE               E	272		210	N/A	N/A	N/A
HC62221619	CANNULA REDUCER ENDOWRIST	272		92	N/A	N/A	N/A
HC62221643	NEEDLE WIRE LOCALIZATION          E	272	C1819	109	N/A	N/A	N/A
HC62221676	GUIDE DRILL TRANSTIBIAL FEMORAL   U	272		2,800	N/A	N/A	N/A
HC62221700	NEEDLE WIRE LOCALIZATION          A	272	C1819	36	N/A	N/A	N/A
HC62221734	SNARE                             B	272		70	N/A	N/A	N/A
HC62221767	CLIP ENDOSCOPIC                   E	272		210	N/A	N/A	N/A
HC62221791	TAP SURGICAL                      F	272		280	N/A	N/A	N/A
HC62221817	TAP SURGICAL                      K	272		630	N/A	N/A	N/A
HC62221841	TAP SURGICAL                      N	272		980	N/A	N/A	N/A
HC62221874	TAP SURGICAL                      Q	272		749	N/A	N/A	N/A
HC62221908	CATH INTRODUCER PEEL-AWAY         T	272	C1892	1,120	N/A	N/A	N/A
HC62221932	KIT TRACKING JOINT ORTHO ROBOTIC	272		792	N/A	N/A	N/A
HC62221965	PIN CHECKPOINT TIBL/FEMORAL ROBOTIC	272		252	N/A	N/A	N/A
HC62221999	BLADE TREPHINE                    B	272		140	N/A	N/A	N/A
HC62222021	TUBE INSUFFLATOR                  F	272		280	N/A	N/A	N/A
HC62222039	CATHETER VENOGRAM BALLOON	272		350	N/A	N/A	N/A
HC62222054	CATH DIAGNOSTIC                   H	272		420	N/A	N/A	N/A
HC62222088	DEVICE RETRIEVAL                  D	272	C1773	2,450	N/A	N/A	N/A
HC62222112	GUIDE PIN ORTHO                   I	272		512	N/A	N/A	N/A
HC62222153	GUIDEWIRE                         K	272	C1769	734	N/A	N/A	N/A
HC62222187	NEEDLE BX HIP TAPERED COBALT/FNA(SHARKCORE)	272		1,750	N/A	N/A	N/A
HC62222211	CATH GUIDING                      D	272	C1887	140	N/A	N/A	N/A
HC62222237	SLEEVE COMPRESSION                B	272		70	N/A	N/A	N/A
HC62222245	INTRODUCER/SHEATH(PINNACL 10CM/RO)    C	272	C1894	106	N/A	N/A	N/A
HC62222260	CATH EP DX <20 ELECTRODES         H	272	C1730	1,120	N/A	N/A	N/A
HC62222294	SUPPORT/BRACE KNEE                F	274	A4467	159	N/A	N/A	N/A
HC62222328	PROBE ABLATION                    R	272		1,750	N/A	N/A	N/A
HC62222351	KIT PROCEDURE HYSTEROSCOPIC	272		1,260	N/A	N/A	N/A
HC62222385	GUIDE DRILL                       P	272		1,260	N/A	N/A	N/A
HC62222419	GUIDE ROD                         G	272		350	N/A	N/A	N/A
HC62222443	TUBE INSERTN LEAD ELECTRODE SINGLE	272		3,220	N/A	N/A	N/A
HC62222468	WAND ARTHRO                       K	272		630	N/A	N/A	N/A
HC62222492	WAND ARTHRO                       O	272		1,120	N/A	N/A	N/A
HC62222526	CABLE PACING DISP                 A	272		36	N/A	N/A	N/A
HC62222559	CATH NEPHROSTOMY                  G	272	C1729	350	N/A	N/A	N/A
HC62222583	TUBING ASPIRATOR ULTRASONIC       O	272		1,131	N/A	N/A	N/A
HC62222617	ELECTRODE ROLLER BALL             I	272		490	N/A	N/A	N/A
HC62222641	PROBE FLOW VASCULAR               B	272		84	N/A	N/A	N/A
HC62222666	TUBING ASPIRATOR ULTRASONIC       S	272		2,100	N/A	N/A	N/A
HC62222690	BLADE SHAVER                      B	272		263	N/A	N/A	N/A
HC62222724	CANNULA PERFUSION                 D	272		140	N/A	N/A	N/A
HC62222757	CAUTERY PENCIL                    C	272		106	N/A	N/A	N/A
HC62222781	DEVICE CLOSURE VASCULAR           J	272	C1760	560	N/A	N/A	N/A
HC62222815	SCISSORS ENDOSCOPIC               D	272		140	N/A	N/A	N/A
HC62222849	INFLATOR FOR BALLOON              F	272		175	N/A	N/A	N/A
HC62222864	PAIN PUMP W/ SYSTEM               K	272		627	N/A	N/A	N/A
HC62222872	PAIN PUMP W/ SYSTEM               M	272		840	N/A	N/A	N/A
HC62222898	PROBE LASER                       G	272		350	N/A	N/A	N/A
HC62222922	PROBE LASER                       M	272		840	N/A	N/A	N/A
HC62222955	CANNULA ARTERIAL                  J	272		700	N/A	N/A	N/A
HC62222989	DISSECTOR BALLOON ENDOSCOPIC      D	272		1,400	N/A	N/A	N/A
HC62223011	ELECTRODE RESECTOSCOPE            K	272		980	N/A	N/A	N/A
HC62223045	APPLIER LIGA/HEMOCLIP ENDO        J	272		560	N/A	N/A	N/A
HC62223060	APPLIER LIGA/HEMOCLIP ENDO        P	272		980	N/A	N/A	N/A
HC62223078	SLEEVE HOLDING ORTHO	272		420	N/A	N/A	N/A
HC62223094	TUBING PERFUSION PACK PUMP	272		241	N/A	N/A	N/A
HC62223128	DEVICE COUPLER ANASTAMOSIS	272		948	N/A	N/A	N/A
HC62223151	NEEDLE ENDOSCOPIC                 C	272		105	N/A	N/A	N/A
HC62223185	DEVICE PEP OSCILLATING	272	E0484	157	N/A	N/A	N/A
HC62223219	CATH INTRODUCER PEEL-AWAY         N	272		490	N/A	N/A	N/A
HC62223243	PROBE DOPPLER NEURO	272		1,452	N/A	N/A	N/A
HC62223276	SYSTEM LEAD EXTRACTION	272		2,672	N/A	N/A	N/A
HC62223292	TEMPLATE BRACHYTHERAPY            I	272		490	N/A	N/A	N/A
HC62223326	KIT ACCESSORY                     K	272		980	N/A	N/A	N/A
HC62223359	DEVICE SUTURE ENDO                R	278		4,469	N/A	N/A	N/A
HC62223383	CATH MICRO NEURO(ENVOY/REBAR)     L	272	C1887	1,750	N/A	N/A	N/A
HC62223417	CATH PTA ANGIOPLS BALLOON NON-LSR N	272	C1725	1,750	N/A	N/A	N/A
HC62223441	CATH EP DX <20 ELECTRODES RPRSD   D	272	C1730	140	N/A	N/A	N/A
HC62223474	COVER ORTHOTIC  'CTLS' UPRIGHT	274	L1120	150	N/A	N/A	N/A
HC62223490	ORTHOTIC ANKLE FOOT TIBIAL FX RT	274	L2112	1,797	N/A	N/A	N/A
HC62223524	SOCK FRACTURE ORTHOTIC	274	L3995	116	N/A	N/A	N/A
HC62223557	DRILL/DRILL BITS SINGLE USE      AG	272		2,275	N/A	N/A	N/A
HC62223581	SEALER VESSEL LAPAROSCOPIC	272		2,275	N/A	N/A	N/A
HC62223615	SNARE                             Q	272		1,402	N/A	N/A	N/A
HC62223649	STAPLE CARTRG/ENDO RELOAD         J	272		560	N/A	N/A	N/A
HC62223672	SYSTEM DETACHMENT COIL/PLUG (MVP)	272		3,500	N/A	N/A	N/A
HC62223698	NEEDLE BONE MARROW                Q	272		1,400	N/A	N/A	N/A
HC62223706	SENSOR CARDIAC OUTPUT	272		532	N/A	N/A	N/A
HC62223722	CATH NEPHROSTOMY                  H	272	C1729	420	N/A	N/A	N/A
HC62223755	SYSTEM DELIVERY LEAD              I	272	C1887	2,100	N/A	N/A	N/A
HC62223789	INK INDIA SINGLE-DOSE             C	272		106	N/A	N/A	N/A
HC62223813	PACKING NASAL                     E	272		210	N/A	N/A	N/A
HC62223847	SET DRILL BIT W/PIN(S)            M	272		840	N/A	N/A	N/A
HC62223870	CATH EP DX 20+ ELECTRODES RPRSD   O	272	C1731	1,120	N/A	N/A	N/A
HC62223896	CANNULA VENOUS                    D	272		140	N/A	N/A	N/A
HC62223904	CATH DIAGNOSTIC                   F	272		280	N/A	N/A	N/A
HC62223920	NEEDLE SPINAL                     B	272		70	N/A	N/A	N/A
HC62223953	TAP SURGICAL                      T	272		2,450	N/A	N/A	N/A
HC62223987	MANIPULATOR UTERINE               D	272		140	N/A	N/A	N/A
HC62224019	SCISSORS ENDOSCOPIC               H	272		420	N/A	N/A	N/A
HC62224043	SET DILATORS	272		280	N/A	N/A	N/A
HC62224076	ATTACHMENT DISTAL COLONOSCOPE	272		89	N/A	N/A	N/A
HC62224100	CUTTER LINEAR ENDO                G	272		350	N/A	N/A	N/A
HC62224126	CUTTER LINEAR ENDO                P	272		1,260	N/A	N/A	N/A
HC62224159	HANDPIECE IRRIGATOR SUCTION	272		140	N/A	N/A	N/A
HC62224183	SNARE                             F	272		280	N/A	N/A	N/A
HC62224217	GUIDE DRILLL                      M	272		840	N/A	N/A	N/A
HC62224241	SYSTEM DELIVERY SEPTAL DEFECT     U	272		2,800	N/A	N/A	N/A
HC62224274	NEEDLE ENDOSCOPIC                 G	272		350	N/A	N/A	N/A
HC62224308	KIT ARTHROSCOPY DISPSBLS          O	272		1,120	N/A	N/A	N/A
HC62224324	APPLIER CLIP ENDO                 Q	272		1,064	N/A	N/A	N/A
HC62224332	TUNNELER SURGICAL                 Q	272		1,560	N/A	N/A	N/A
HC62224357	CANNULA INTRAOCULAR               E	272		182	N/A	N/A	N/A
HC62224381	COLLAR CERVICAL MIAMI J           F	274	L0172	280	N/A	N/A	N/A
HC62224415	DERMABOND                         H	272		420	N/A	N/A	N/A
HC62224449	INJECTOR GUN CEMENT	272		1,790	N/A	N/A	N/A
HC62224472	NEEDLE BIOPSY NASHOLD             Q	272		1,330	N/A	N/A	N/A
HC62224506	PROBE LITHOTRIPTOR KIDNEY         T	272		2,450	N/A	N/A	N/A
HC62224522	SYSTEM MIXING BONE CEMENT VACUUM	272		840	N/A	N/A	N/A
HC62224530	TIP MIX LUERLOCK CORTOSS (CEMENT)	272		980	N/A	N/A	N/A
HC62224555	WAND ARTHRO                       F	272		280	N/A	N/A	N/A
HC62224589	DILATOR SET VASCULAR	272		700	N/A	N/A	N/A
HC62224613	SEALER VESSEL ROBOTIC	272		2,100	N/A	N/A	N/A
HC62224647	CATH DUODENOSCP DIGTL ACCESS/DELVRY	272		8,575	N/A	N/A	N/A
HC62224670	CATH SENSING PRESSUR INTRNL VESICAL	272		239	N/A	N/A	N/A
HC62224712	ELECTRODE NEEDLE UROLOGICAL HF	272		1,750	N/A	N/A	N/A
HC62224746	WRAP COMPRESSION BACK/SPINE	271		168	N/A	N/A	N/A
HC62224761	CATH THROMBECTOMY                AC	272	C1757	6,300	N/A	N/A	N/A
HC62224795	HANDPIECE VESSEL SEALER DEVICE    F	272		2,100	N/A	N/A	N/A
HC62224829	CATH GUIDNG(PX400/SILICONE/STRYKER BLLN)R	272	C1887	3,850	N/A	N/A	N/A
HC62224852	NEEDLE PROBE VASCULAR SMART	272		420	N/A	N/A	N/A
HC62224886	WRAP COLD BAG GEL CERVICAL	272		84	N/A	N/A	N/A
HC62224910	CATH ANGIOGRAPHY                  J	272	C1887	560	N/A	N/A	N/A
HC62224944	GUIDE DRILL                       I	272		504	N/A	N/A	N/A
HC62224969	PROBE LITHOTRIPTOR                M	272		840	N/A	N/A	N/A
HC62224993	MOLDS/FORMS CEMENT FEM&TIB KNEE	272		9,625	N/A	N/A	N/A
HC62225024	SET REMOVAL NUCLEUS SPINAL	272		2,618	N/A	N/A	N/A
HC62225057	INTRO/SHEATH EP FIXED NON-PEEL    Q	272	C1893	2,100	N/A	N/A	N/A
HC62225081	SEAL ENDO ROBOTIC                 A	272		68	N/A	N/A	N/A
HC62225115	CUSHION WHEEL CHAIR	272		84	N/A	N/A	N/A
HC62225149	TUBE INSUFFLATOR                  J	272		560	N/A	N/A	N/A
HC62225164	ORTHOTIC WHFO D-RING              A	274	L3908	36	N/A	N/A	N/A
HC62225172	ORTHOTIC WHFO D-RING              B	274	L3908	70	N/A	N/A	N/A
HC62225198	SYSTEM DELIVERY STENT BILIARY	272		280	N/A	N/A	N/A
HC62225222	KIT DRESSING WOUND NEG PRESSURE   J	272		840	N/A	N/A	N/A
HC62225255	GUIDE BX NEEDLE PROSTATE	272		70	N/A	N/A	N/A
HC62225289	SIZER MAMMARY                     G	272		589	N/A	N/A	N/A
HC62225313	GUIDE ROD                         M	272		837	N/A	N/A	N/A
HC62225347	CANNULA ARTHROSCOPIC              Q	272		1,400	N/A	N/A	N/A
HC62225362	KIT REPAIR BROVIAC/CV/HICKMAN     C	272		456	N/A	N/A	N/A
HC62225370	KIT REPAIR BROVIAC/CV/HICKMAN     E	272		612	N/A	N/A	N/A
HC62225396	OVERTUBE LIGATNG HEMOSTATC ENDO	272		350	N/A	N/A	N/A
HC62225420	ANCHOR CLIP ENDOSCOPIC	272		1,400	N/A	N/A	N/A
HC62225453	FIBER OPTIC ERCP	272		980	N/A	N/A	N/A
HC62225487	KIT PROCESSING MARROW BONE	272		3,500	N/A	N/A	N/A
HC62225511	NEEDLE BIOPSY EUS                 O	272		1,120	N/A	N/A	N/A
HC62225545	EXTENDER CATH DIALYSIS PERITONEAL	272		526	N/A	N/A	N/A
HC62225578	KIT INSERTION IABP	272		560	N/A	N/A	N/A
HC62225602	PUNCH AORTIC                      C	272		106	N/A	N/A	N/A
HC62225651	SET TUBING CATH COOL-TIP	272		367	N/A	N/A	N/A
HC62225685	CATH TRANSLUM ANGIO LASER         T	272	C1885	9,100	N/A	N/A	N/A
HC62225719	DRESSNG ENDOFRM TEMPLT 4X5 COLLAGEN	272		140	N/A	N/A	N/A
HC62225743	CATH GUIDING                      M	272	C1887	840	N/A	N/A	N/A
HC62225776	SYSTEM DRESSING WOUND NEG PRES    R	272		1,750	N/A	N/A	N/A
HC62225800	DEVICE SUTURING ENDOSCPC OVERSTITCH O	272		3,360	N/A	N/A	N/A
HC62225834	GUIDE DRILL                       J	272		560	N/A	N/A	N/A
HC62225867	GUIDE DRILL                       N	272		980	N/A	N/A	N/A
HC62225891	GUIDE DRILL                       W	272		3,500	N/A	N/A	N/A
HC62225925	COLLAR GYN BRACHYTHERAPY	272		246	N/A	N/A	N/A
HC62225958	TAP SURGICAL                      H	272		420	N/A	N/A	N/A
HC62225982	BLADE SHAVER                      C	272		208	N/A	N/A	N/A
HC62226014	COUNTERSINK                       Q	272		1,409	N/A	N/A	N/A
HC62226030	M: MODEL CUSTOM CRANIOMAXILLOFACIAL	272		8,177	N/A	N/A	N/A
HC62226048	SET NEEDLE INTRAOSEOUS      C	272		106	N/A	N/A	N/A
HC62226063	TAP SURGICAL                     H	272		420	N/A	N/A	N/A
HC62226105	DRILL/DRILL BITS SINGLE USE      AJ	272		2,596	N/A	N/A	N/A
HC62226139	KIT ACCESSORY                     P	272		1,680	N/A	N/A	N/A
HC62226162	CARTRIDGE MECHNCL WOUND NEG PRESSURE	272		420	N/A	N/A	N/A
HC62226196	STRAP WOUND CARE	272		36	N/A	N/A	N/A
HC62226220	CUTTER LEAD	272		176	N/A	N/A	N/A
HC62226246	INTRODUCER/SHEATH                 E	272	C1894	210	N/A	N/A	N/A
HC62226253	KIT ACCESSORY                     G	272		560	N/A	N/A	N/A
HC62226279	NEEDLE BIOPSY BONE                M	272		840	N/A	N/A	N/A
HC62226303	NEEDLE SPINAL                     G	272		350	N/A	N/A	N/A
HC62226337	PROBE SPINAL DISPOSABLE           A	272		350	N/A	N/A	N/A
HC62226378	PUSHER KNOT ENDO                  I	272		1,312	N/A	N/A	N/A
HC62226402	RETRACTOR MIS SPINAL              T	272		9,450	N/A	N/A	N/A
HC62226436	STABILIZER LEAD PACING	272		140	N/A	N/A	N/A
HC62226469	TOOL INSERTION TRANSVALVULAR	272		70	N/A	N/A	N/A
HC62226485	WAND LARYNGEAL	272		2,240	N/A	N/A	N/A
HC62226519	COLLAR CERV OCC/MAND SUP MULTI POST	274	L0180	490	N/A	N/A	N/A
HC62226543	DRESSING FOAM W/BRDR&ANTIMIC>48SQ IN	272	A6214	140	N/A	N/A	N/A
HC62226576	KIT DELIVERY GRAFT	272		2,450	N/A	N/A	N/A
HC62226600	RETRACTOR MIS SPINAL              A	272		700	N/A	N/A	N/A
HC62226634	TAP SURGICAL                      I	272		490	N/A	N/A	N/A
HC62226667	TEMPLATE ORTHO/ROD SPINAL         V	272		840	N/A	N/A	N/A
HC62226683	CABLE PACING DISP                 D	272		140	N/A	N/A	N/A
HC62226691	EXTENDER TAB SPINAL	272		1,400	N/A	N/A	N/A
HC62226717	GUIDEWIRE                         A	272	C1769	58	N/A	N/A	N/A
HC62226758	WOUND FILLER DRY COLLAGEN           S	272		1,766	N/A	N/A	N/A
HC62226782	GUIDE DRILL                       W	272		6,300	N/A	N/A	N/A
HC62226816	TROCAR ENDO                       O	272		1,120	N/A	N/A	N/A
HC62226840	CATH INFUS/THROMBOLYSS(CRAGG-MCNAMARA)H	272	C1887	420	N/A	N/A	N/A
HC62226873	DILATOR URETERAL	272		456	N/A	N/A	N/A
HC62226899	GUIDEWIRE                         I	272	C1769	596	N/A	N/A	N/A
HC62226907	HANDPIECE VESSEL SEALER DEVICE    B	272		1,400	N/A	N/A	N/A
HC62226923	CANNULA ARTERIAL                  B	272		280	N/A	N/A	N/A
HC62226956	CANNULA ARTERIAL                  C	272		280	N/A	N/A	N/A
HC62226980	CATH NEPHROSTOMY                  N	272	C1729	840	N/A	N/A	N/A
HC62227012	DILATOR BALLOON ENDO PULM	272	C1726	1,050	N/A	N/A	N/A
HC62227046	KNIFE URETHROTOME	272		980	N/A	N/A	N/A
HC62227079	SUMP INTRACARDIAC PEDS	272		42	N/A	N/A	N/A
HC62227103	CATH GUIDING (GUIDEZILLA II)      P	272	C1887	1,260	N/A	N/A	N/A
HC62227129	INTRODUCER/SHEATH                 V	272	C1894	2,047	N/A	N/A	N/A
HC62227152	DRILL/DRILL BITS SINGLE USE      AO	272		4,200	N/A	N/A	N/A
HC62227186	REAMER                           AG	272		2,310	N/A	N/A	N/A
HC62227210	CATH IV MIDLINE                   E	278	C1751	210	N/A	N/A	N/A
HC62227244	CATH IV MIDLINE                   I	278	C1751	490	N/A	N/A	N/A
HC62227277	FIBER LASER                       G	272		1,361	N/A	N/A	N/A
HC62227301	FASTENERS TIF(SEROSAFUSE CARTRIDGE)	272		1,487	N/A	N/A	N/A
HC62227327	WAND BREAST BIOPSY                N	272		1,050	N/A	N/A	N/A
HC62227350	TIP SUCTION/IRRIG                 D	272		140	N/A	N/A	N/A
HC62227384	NEEDLE DELIVERY BIOCARTILAGE	272		210	N/A	N/A	N/A
HC62227418	DRESSING ANTIMIC MICRO-CURRENT    B	272		70	N/A	N/A	N/A
HC62227442	DRESSING ANTIMIC MICRO-CURRENT    E	272		210	N/A	N/A	N/A
HC62227475	BALLOON LATEX EUS	272		70	N/A	N/A	N/A
HC62227509	KIT COLON W-BTTNS BX CAP VALVE ENDO	272		980	N/A	N/A	N/A
HC62227525	FORCEPS BIPOLAR DISPOSABLE        L	272		980	N/A	N/A	N/A
HC62227533	SPHINCTEROTOME                    C	272		420	N/A	N/A	N/A
HC62227558	GUIDE PIN ORTHO                   L	272		833	N/A	N/A	N/A
HC62227582	REAMER                           AH	272		2,170	N/A	N/A	N/A
HC62227624	NOTCHER TUNNEL                    R	272		1,750	N/A	N/A	N/A
HC62227657	CATH INTRACARDIAC ECHO/UTZ RPRSD  F	272	C1759	4,900	N/A	N/A	N/A
HC62227681	ELECTRODE MONOPOLAR BALL	272		1,750	N/A	N/A	N/A
HC62227715	TUBING HYSTEROSCOPY               F	272		420	N/A	N/A	N/A
HC62227731	TUBING SINUS	272		140	N/A	N/A	N/A
HC62227749	BLADE ROBOTIC (SNAP-FIT)	272		210	N/A	N/A	N/A
HC62227764	TIP DISSECTOR MICRO	272		210	N/A	N/A	N/A
HC62227798	PROTECTOR OVERFLOW BACTERIA (DHS)	272		280	N/A	N/A	N/A
HC62227822	POSITIONER FLUIDIZED SMALL	272		56	N/A	N/A	N/A
HC62227855	CANNULA ARTHROSCOPIC              P	272		1,260	N/A	N/A	N/A
HC62227889	KIT REPAIR BROVIAC/CV/HICKMAN     I	272		876	N/A	N/A	N/A
HC62227913	SHEATH ARTHROSCOPIC               E	272		280	N/A	N/A	N/A
HC62227947	KIT DRESSING WOUND NEG PRESSURE C	272		280	N/A	N/A	N/A
HC62227962	SYSTEM LAVAGE CLEANING WOUND	272		210	N/A	N/A	N/A
HC62227996	APPLICATOR/TIP SYRINGE ONLY	272		210	N/A	N/A	N/A
HC62228028	AWL SINGLE PATIENT USE	272		140	N/A	N/A	N/A
HC62228051	KIT NASAL PAP ADULT	272	A7027	140	N/A	N/A	N/A
HC62228085	MOLD/FORM CEMENT STEM HIP	272		4,550	N/A	N/A	N/A
HC62228119	ORTH ELBOW ADJUST POSITION LOCK PREFAB CUSTOM	274	L3760	1,544	N/A	N/A	N/A
HC62228143	ORTH WHFO  RIGID W/O JOINTS CUSTOM	274	L3808	1,404	N/A	N/A	N/A
HC62228168	ORTH WHFO EXT POWERED ELECTRIC CUSTOM	274	L3904	12,415	N/A	N/A	N/A
HC62228192	ORTH HFO W/O JOINTS CUSTOM	274	L3913	837	N/A	N/A	N/A
HC62228226	ORTH HFO METACARPAL FRACTURE PREFAB CUSTOM	274	L3917	326	N/A	N/A	N/A
HC62228259	ORTH HFO W/NONTORSION JOINT(S) CUSTOM	274	L3921	991	N/A	N/A	N/A
HC62228283	ORTH FO PIP/DIP W/O JOINT/SPRING PREFAB OTS	274	L3927	109	N/A	N/A	N/A
HC62228317	STAPLER SINGLE USE ROBOTIC	272		1,819	N/A	N/A	N/A
HC62228341	PROBE TURBINATE                   N	272		980	N/A	N/A	N/A
HC62228366	KIT TRANSSEPTAL (WATCHMAN)	272		2,975	N/A	N/A	N/A
HC62228374	NEEDLE TRANSSEPTAL NRG (WATCHMAN)	272		1,733	N/A	N/A	N/A
HC62228390	SHEATH TRANSSEPTAL GUIDE KIT(WATCHMAN)	272	C1893	2,888	N/A	N/A	N/A
HC62228424	ORTH FINGER NONTORSION JOINT CUSTOM	274	L3935	682	N/A	N/A	N/A
HC62228457	KIT SUTURE WIRE LASSO	272		1,400	N/A	N/A	N/A
HC62228481	NEEDLE TARGETING                  E	272		210	N/A	N/A	N/A
HC62228515	BRONCHOSCOPE ASCOPE LRG DISP	272		1,100	N/A	N/A	N/A
HC62228549	ELECTRODE PACING/DEFIB TEMPORARY  K	272		630	N/A	N/A	N/A
HC62228564	ELECTRODE PACING/DEFIB(ONESTEP)	272		280	N/A	N/A	N/A
HC62228572	DEVICE EXCHANGE	272	C1725	2,275	N/A	N/A	N/A
HC62228598	DEVICE CLOSURE SKIN(ZIPLINE)	272		386	N/A	N/A	N/A
HC62228622	KIT ROTAPRO	272	C1724	4,699	N/A	N/A	N/A
HC62228655	GUIDEWIRE(BABYWIRE)               B	272		65	N/A	N/A	N/A
HC62228689	PROBE ABLATION  CRYO              A	272	C2618	4,361	N/A	N/A	N/A
HC62228713	SYSTEM EMBOLECTOMY(CAPERE?) G200036	624	C1757	1	N/A	N/A	N/A
HC62228747	BRUSH(ALWAYS-ON TIP TRACKED?)	272		1,985	N/A	N/A	N/A
HC62228770	NEEDLE 22G SPIN FLEX?(ALWAYS-ON TIP TRACKED?)	272		2,977	N/A	N/A	N/A
HC62228796	SYSTEM ENDOAVF WAVELINQ?	272		24,499	N/A	N/A	N/A
HC62228820	SCISSORS ENDOSCOPIC               Q	272		1,131	N/A	N/A	N/A
HC62228853	TEMPLATE BRACHYTHERAPY            Y	272		3,338	N/A	N/A	N/A
HC62228887	DEVICE SUTURE FLOWSTASIS RETENTION	272		700	N/A	N/A	N/A
HC62228911	SUPPORT BKA DRESSING	274	L1812	977	N/A	N/A	N/A
HC62228945	IMMOBILIZER SHOULDER FIG8 PREFAB	274	L3650	178	N/A	N/A	N/A
HC62228978	ORTHOSIS LUMBAR SACRAL SAGCOR RIGID ANT/POST FRAME/PANEL PREFB CUST	274	L0637	2,904	N/A	N/A	N/A
HC62228994	SYSTEM NOVOTTF-200T G210071	624	A4555	1	N/A	N/A	N/A
HC62229026	CATH ANGIO PERIPH CROSSING SET	272	C1887	1,212	N/A	N/A	N/A
HC62229059	KIT TPN/CVP DRESSING              B	272		54	N/A	N/A	N/A
HC62229083	DEVICE SURGICAL SUPPLY TRIALING	272	A4649	1	N/A	N/A	N/A
HC62229117	PIN DISTRACTOR                    E	272		176	N/A	N/A	N/A
HC62229141	KIT DRESSING WOUND NEG PRESSURE	272	A6550	65	N/A	N/A	N/A
HC62229174	BOOT WLKNG AIR W/WO JNTS PREFB    F	274	L4360	248	N/A	N/A	N/A
HC62229190	ORTHOTIC TLSO 4 RIGID XLG(DONJOY)	274	L0464	1,232	N/A	N/A	N/A
HC62290010	P:AMNIOCENTESIS			N/A	N/A	N/A	N/A
HC62290036	P:BOA			N/A	N/A	N/A	N/A
HC62290150	P:AMNIOCENTESIS THERAPEUTIC			N/A	N/A	N/A	N/A
HC62290200	P:VAGINAL DELIVERY W/EPI			N/A	N/A	N/A	N/A
HC62290333	P:VAGINAL DELIVERY TWINS W/EPI			N/A	N/A	N/A	N/A
HC62290382	P: KIT SINUS DILATION VENTERA			N/A	N/A	N/A	N/A
HC62290556	GUIDE PIN ORTHO                   N	272		1,057	N/A	N/A	N/A
HC62300017	SCISSORS CURVED ROBOTIC           I	272		490	N/A	N/A	N/A
HC62300025	CAUTERY LTD REUSE/'PERMANT' ROBOTIC	272		700	N/A	N/A	N/A
HC62300066	CAUTERY MONOPOLAR ROBOTIC	272		753	N/A	N/A	N/A
HC62300090	DISSECTOR ROBOTIC                 Z	272		1,016	N/A	N/A	N/A
HC62300124	GRASPER ROBOTIC                   C	272		420	N/A	N/A	N/A
HC62300157	SCISSORS CURVED ROBOTIC           N	272		980	N/A	N/A	N/A
HC62300181	TIP CAUTERY HOOK ROBOTIC          Q	272		700	N/A	N/A	N/A
HC62300215	CABLE EP                         E	272		176	N/A	N/A	N/A
HC62300249	GRASPER ANVIL ROBOTIC             F	272		280	N/A	N/A	N/A
HC62300264	SHEARS HARMONIC ROBOTIC	272		196	N/A	N/A	N/A
HC62300298	FORCEP ROBOTIC                    K	272		630	N/A	N/A	N/A
HC62300439	HOLDER BLADE ROBOTIC (SNAP-FIT)	272		280	N/A	N/A	N/A
HC62300462	STABILIZER ENDOWRIST ROBOTIC	272		7,700	N/A	N/A	N/A
HC62300504	DRIVER NEEDLE ROBOTIC             O	272		980	N/A	N/A	N/A
HC62800024	BALLOON DILATOR BILIARY/NEPHRO	272	C1726	1,092	N/A	N/A	N/A
HC62800057	BALLOON HYSTEROSALPINGOGRAM	272	C1726	350	N/A	N/A	N/A
HC62800073	CATH PTCA BALLOON NON-LASER       K	272	C1725	1,260	N/A	N/A	N/A
HC62800081	CATH PTA ANGIOPLS BALLOON NON-LSR L	272	C1725	1,260	N/A	N/A	N/A
HC62800107	CATH PTA ANGIOPLS BALLOON NON-LSR R	272	C1725	3,150	N/A	N/A	N/A
HC62800131	CATH ABLAT VASC NON CARDIAC	272	C1888	4,200	N/A	N/A	N/A
HC62800164	CATH ATHERECTOMY DIRECTIONAL      E	272	C1714	9,570	N/A	N/A	N/A
HC62800198	CATH BALLOON DIL NON VASCULAR     J	272	C1726	620	N/A	N/A	N/A
HC62800222	CATH BALLOON RETRIEVAL            F	272	C1773	526	N/A	N/A	N/A
HC62800255	CATH BRACHY TX SEED ADMIN         K	272	C1728	9,800	N/A	N/A	N/A
HC62800271	CATH DILATOR                      I	272	C1726	490	N/A	N/A	N/A
HC62800289	CATH THROMBECTOMY/EMBOLECTOMY     T	272	C1757	2,450	N/A	N/A	N/A
HC62800305	CATH EP DX <20 ELECTRODES         Y	272	C1730	5,600	N/A	N/A	N/A
HC62800339	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP W	272	C1733	3,500	N/A	N/A	N/A
HC62800362	CATH GUIDING                      K	272	C1887	630	N/A	N/A	N/A
HC62800396	CATH INTRA AORTIC BALLOON         C	278	C1889	2,800	N/A	N/A	N/A
HC62800420	CATH IVUS PV SMALL VESSEL	272	C1753	2,947	N/A	N/A	N/A
HC62800453	CATH QUINTON                      Q	278	C1751	1,400	N/A	N/A	N/A
HC62800495	CATH SWAN GANZ/THERMODILUTION     M	278		778	N/A	N/A	N/A
HC62800511	CATH THROMBECTOMY                AG	272	C1757	7,000	N/A	N/A	N/A
HC62800545	CATH OCCLUSION                    H	272	C2628	420	N/A	N/A	N/A
HC62800578	DEVICE CLOSURE VASCULAR           Q	272	C1760	891	N/A	N/A	N/A
HC62800602	GUIDEWIRE(X-PEDION HYDROPHILIC)   P	272	C1769	1,156	N/A	N/A	N/A
HC62800636	M: AICD DUAL CHAMBER	275	C1721	40,900	N/A	N/A	N/A
HC62800669	M: ALLOGRAFT	278		4,924	N/A	N/A	N/A
HC62800693	M: BONE/BONE PLATE	278	C1713	5,393	N/A	N/A	N/A
HC62800719	M: BONE MORPHOGENET PRTN INFUSE	278		N/A	N/A	N/A	N/A
HC62800743	M: PROSTHESIS BREAST IMPLANT	278	C1789	4,486	N/A	N/A	N/A
HC62800776	TUBE GASTROSTOMY LOWPRFL BTTN     H	278	A4649	412	N/A	N/A	N/A
HC62800800	RECORDER CARDIAC EVENT(MEDTRONIC LINQ)	278	C1764	17,523	N/A	N/A	N/A
HC62800834	CATH HEMO/PERI DIAL SHORT TRM     N	278	C1752	1,016	N/A	N/A	N/A
HC62800867	CATH HICKMAN/BROVIAC              L	278	C1751	708	N/A	N/A	N/A
HC62800891	CATHETER PLEURAL/KIT	278	C1729	1,680	N/A	N/A	N/A
HC62800917	M: CEMENT RESTRICTOR	278		413	N/A	N/A	N/A
HC62800925	M: CEMENT SPACER	278		1,396	N/A	N/A	N/A
HC62800941	M: DEVICE INVESTIGATIONAL	624	C1889	N/A	N/A	N/A	N/A
HC62800974	M: DISK ARTIFICIAL SPINE LUMBAR	278	C1889	N/A	N/A	N/A	N/A
HC62801006	M: ELECTRODE NEUROSTIM EACH	278	C1778	41,664	N/A	N/A	N/A
HC62801030	FILTER VENA CAVA (E.G.GUNTHER)    G	278	C1880	4,383	N/A	N/A	N/A
HC62801063	M: GENRTR DUAL NRSTM RE-CHRG&CHRGR	278	L8687	74,425	N/A	N/A	N/A
HC62801097	M: GRAFT CARDIO-VASCULAR	278	C1768	1,006	N/A	N/A	N/A
HC62801113	M: GRAFT PERI STRIP BIO VASC	278	C1768	N/A	N/A	N/A	N/A
HC62801121	M: GRAFT VASCULAR	278	C1768	24,960	N/A	N/A	N/A
HC62801147	M: SHELL ACETABULAR HIP	278	C1776	3,170	N/A	N/A	N/A
HC62801170	M: STEM FEMORAL HIP	278	C1776	6,579	N/A	N/A	N/A
HC62801204	M: INJ BULK AGENT (DURASPHERE/COAPTITE)	278	L8606	3,292	N/A	N/A	N/A
HC62801238	M: IOL ANTERIOR CHAMBER	276	V2630	N/A	N/A	N/A	N/A
HC62801261	M: JOINT SMALL(FINGER/TOE)	278	C1776	3,444	N/A	N/A	N/A
HC62801295	M: KNEE MISC COMPONENT	278	L8699	3,724	N/A	N/A	N/A
HC62801329	M: INSERT TIBIAL KNEE	278	C1776	3,588	N/A	N/A	N/A
HC62801345	M: LEAD ICD ENDO DUAL COIL	275	C1895	9,717	N/A	N/A	N/A
HC62801378	M: LEAD NEUROSTIM TEST KIT	278	C1897	886	N/A	N/A	N/A
HC62801410	M: LEAD/ELECTRODE NEUROSTIM EA	278	C1778	11,392	N/A	N/A	N/A
HC62801444	M: MESH HERNIA/CRANIOFACIAL/BONE	278	C1781	2,132	N/A	N/A	N/A
HC62801477	M: MISC ORTHO IMPLANT	278	L8699	4,758	N/A	N/A	N/A
HC62801501	M: NEUROSTIM RECEIVR RADIOFREQ	278	C1816	55,459	N/A	N/A	N/A
HC62801535	M: PACEMAKER LEADS	275	C1779	N/A	N/A	N/A	N/A
HC62801550	M: PCMKR DUAL NON-RATE RESP	275	C2619	N/A	N/A	N/A	N/A
HC62801584	M: PCMKR SNGL NON-RATE RESP	275	C2620	N/A	N/A	N/A	N/A
HC62801618	M: PENILE PROSTH (INFLAT)	278	C1813	21,159	N/A	N/A	N/A
HC62801642	M: PIN ACL	278		N/A	N/A	N/A	N/A
HC62801675	M: PINS NEUFELD/KNOWLES	278		N/A	N/A	N/A	N/A
HC62801709	M: PLATE LOCKING CARDIAC	278	C1713	3,629	N/A	N/A	N/A
HC62801733	PORT INDWELLING W/CATH            M	278	C1788	2,450	N/A	N/A	N/A
HC62801758	M: PUMP INFUSION PROGRAMABLE	278	C1772	36,559	N/A	N/A	N/A
HC62801766	M: RETIN DET SCLERAL EXOPLANT	278	C1889	N/A	N/A	N/A	N/A
HC62801782	RING FALLOPIAN	278		275	N/A	N/A	N/A
HC62801816	M: SCREW INTERFERENCE	278	C1713	973	N/A	N/A	N/A
HC62801840	M: SCREW ORTHO	278	C1713	459	N/A	N/A	N/A
HC62801873	M: SHOULDER GLENOID	278	C1776	4,538	N/A	N/A	N/A
HC62801907	M: SHUNT CONNECTOR	278		1,037	N/A	N/A	N/A
HC62801931	M: SHUNT VASCULAR	278	C1889	421	N/A	N/A	N/A
HC62801956	M: SLING VAGINAL	278	C1771	6,169	N/A	N/A	N/A
HC62801964	M: CAGE SPINAL	278	L8699	10,282	N/A	N/A	N/A
HC62801980	M: PLATE SPINAL	278	C1713	6,564	N/A	N/A	N/A
HC62802012	M: TRANSCONEC/CROSSBRAC SPINAL	278	C1889	2,557	N/A	N/A	N/A
HC62802046	STENT NON-COAT/NON-COV W-DEL     AD	278	C1876	6,300	N/A	N/A	N/A
HC62802079	STENT BILIARY PLASTIC             L	278	C2617	666	N/A	N/A	N/A
HC62802103	STENT ENDOPRSTH PVD(VIABAHN)      G	278	C1874	11,241	N/A	N/A	N/A
HC62802137	STENT PV BARE METAL W/O DEL SYS	278	C1877	5,285	N/A	N/A	N/A
HC62802160	M: STENT PALMAZ	278	C1874	N/A	N/A	N/A	N/A
HC62802186	STENT NON-COAT/NON-COV W-DEL     AG	278	C1876	7,700	N/A	N/A	N/A
HC62802210	M: STENT WALLSTENT	278	C1874	N/A	N/A	N/A	N/A
HC62802244	M:PROSTHESIS BREAST TISS EXPANDER	278	C1789	5,980	N/A	N/A	N/A
HC62802277	TUBE JEJUNOSTOMY STANDARD         J	278	A4649	560	N/A	N/A	N/A
HC62802301	M: VALVE HEART	278	C1889	113,748	N/A	N/A	N/A
HC62802335	M: WEDGE ORTHO	278		6,538	N/A	N/A	N/A
HC62802368	INTRO/SHEATH EP FIXED NON-PEEL    J	272	C1893	770	N/A	N/A	N/A
HC62802384	INTRO/SHEATH EP FIXED PEEL       AN	272	C1892	3,850	N/A	N/A	N/A
HC62802392	INTRO/SHEATH EP LASER             F	272	C2629	490	N/A	N/A	N/A
HC62802418	INTRODUCER BLADDER STIM	272	C1894	840	N/A	N/A	N/A
HC62802442	INTRODUCER EP STEERBL NON-PEEL	272	C1894	728	N/A	N/A	N/A
HC62802475	INTRODUCER DIALYSIS PEEL AWAY	272	C1894	774	N/A	N/A	N/A
HC62802509	INTRODUCER SUPRAPUB FOLEY CATH	272	C1894	1,349	N/A	N/A	N/A
HC62802541	KIT PICC LINE                     M	278	C1751	910	N/A	N/A	N/A
HC62802574	WIRE BENTSON	272	C1769	98	N/A	N/A	N/A
HC62802590	WIRE INTERVENTIONAL SPECIALTY	272	C1769	1,184	N/A	N/A	N/A
HC62802608	WIRE PACING TEMP                  T	272		420	N/A	N/A	N/A
HC62802624	TUBE GASTROSTOMY LOWPRFL BTTN     O	278	A4649	1,089	N/A	N/A	N/A
HC62802657	VALVE HANCOCK II MEDTRONIC	278	C1889	22,785	N/A	N/A	N/A
HC62802681	M: RING RETINAL	278	C1889	N/A	N/A	N/A	N/A
HC62802715	M: VALVE HEART-MECHANICAL	278	C1889	N/A	N/A	N/A	N/A
HC62802756	STENT ESOPHAGEAL;CVRD;DEL         C	278	C1874	8,400	N/A	N/A	N/A
HC62802780	BEAD DC MICROSPHERE PER VIAL	278		5,688	N/A	N/A	N/A
HC62802814	BALLOON HDR APPLICATOR	278	C1728	2,177	N/A	N/A	N/A
HC62802830	KIT STENT BILIARY PLASTIC	278	C2617	767	N/A	N/A	N/A
HC62802863	TUBE GASTROSTOMY STANDARD         E	278		266	N/A	N/A	N/A
HC62802897	SEALANT PULMONARY (PROGEL)	278	C2615	3,465	N/A	N/A	N/A
HC62802921	COIL NEUROVASC(TARGET 360 SOFT/ULTRA)AK	278	C1889	6,300	N/A	N/A	N/A
HC62802954	STENT NEUROVASCULAR               D	278	C1876	9,100	N/A	N/A	N/A
HC62802988	DEVICE FLOW DIVERSION PIPELINE	278	C1781	48,649	N/A	N/A	N/A
HC62803010	M: IOL IRIS SUPPORTED	276	V2631	N/A	N/A	N/A	N/A
HC62803036	M: CLAMP IMPLANT SPINAL	278		2,311	N/A	N/A	N/A
HC62803069	M: INTRATUBAL OCCLUSION DEVICE	278	A4264	N/A	N/A	N/A	N/A
HC62803093	M: RING HEART TRICUSPID	278	C1889	10,073	N/A	N/A	N/A
HC62803127	M: VALVE HEART MECH PULM	278	C1889	N/A	N/A	N/A	N/A
HC62803150	M: VALVE HEART TISSUE MITRAL	278	C1889	20,458	N/A	N/A	N/A
HC62803184	M: PROSTHESIS TESTIS IMPLANT	278	C1889	N/A	N/A	N/A	N/A
HC62803218	M: NAIL TIBIAL ANCHOR BONE-BONE	278	C1713	6,183	N/A	N/A	N/A
HC62803234	M: CUP/SHELL JNT DEVICE FEM HEAD HIP	278	C1776	2,820	N/A	N/A	N/A
HC62803242	M: JOINT DEVICE LINER FEM HEAD HIP	278	C1776	3,015	N/A	N/A	N/A
HC62803267	M: MESH TISS CONNECTV NON-HUMAN/SYN	278	C1763	3,243	N/A	N/A	N/A
HC62803291	SYSTEM PORT EVACUATING SUBDURAL	278	C1889	6,098	N/A	N/A	N/A
HC62803325	STENT ENDOPRSTH AAA               I	278	C1874	12,250	N/A	N/A	N/A
HC62803358	M: SURGIMEND COLLGN MTRX NEONTL/0.5CM2	278	C9360	29,189	N/A	N/A	N/A
HC62803382	M: INTEGRA DRSG BMWD PER SQ CM	636	Q4104	9,771	N/A	N/A	N/A
HC62803416	M: ALLODERM  PER SQ CM	636	Q4116	1,094	N/A	N/A	N/A
HC62803432	M: STRATTICE TM PER SQ CM	278	Q4130	25,075	N/A	N/A	N/A
HC62803440	M: MEMBRANE AMNIOTIC PER PROC	278	V2790	5,007	N/A	N/A	N/A
HC62803465	M: NAIL TROCHANTERIC ANCHR B-B	278	C1713	4,968	N/A	N/A	N/A
HC62803507	M: STEM KNEE	278	C1776	3,945	N/A	N/A	N/A
HC62803531	M: KIT WRIST FIXATION	278	C1889	4,095	N/A	N/A	N/A
HC62803564	M: SLEEVE FEMORAL PROXIMAL	278		696	N/A	N/A	N/A
HC62803598	M: SYSTM&DEVICE CNTRCPTV OCCL TUBAL	278	A4264	N/A	N/A	N/A	N/A
HC62803630	M: SHOULDER TOTAL	278	C1776	10,007	N/A	N/A	N/A
HC62803663	M: SHOULDER HEMI	278	C1776	N/A	N/A	N/A	N/A
HC62803689	CATH ABLAT TISS(E.G.HALO 60/90)   E	272	C1886	4,200	N/A	N/A	N/A
HC62803713	KIT CATH HEMO DIAL SHORT TERM     V	278	C1752	3,185	N/A	N/A	N/A
HC62803747	STENT NON-COAT/NON-COV W-DEL      V	278	C1876	3,150	N/A	N/A	N/A
HC62803770	STENT NON-COAT/NON-COV W-DEL     AH	278	C1876	8,400	N/A	N/A	N/A
HC62803804	COIL EMBOLIZATION FIBERED         M	278		1,655	N/A	N/A	N/A
HC62803838	STENT DES CORO COV W/DEL SYS      X	278	C1874	11,900	N/A	N/A	N/A
HC62803861	STENT CORO BARE METAL W/DEL       C	278	C1876	2,377	N/A	N/A	N/A
HC62803887	STENT CORO BARE METAL W/DEL       E	278	C1876	2,800	N/A	N/A	N/A
HC62803911	STENT CORO BARE METAL W/DEL       H	278	C1876	4,900	N/A	N/A	N/A
HC62803945	M: PORT SUBQ BAND GASTRIC	278	C1889	N/A	N/A	N/A	N/A
HC62803978	STENT URETERAL                    H	278	C2617	469	N/A	N/A	N/A
HC62804000	FILTER VENA CAVA (E.G.OPTEASE)    C	278	C1880	2,702	N/A	N/A	N/A
HC62804034	FILTER VENA CAVA  (E.G. ALN)      F	278	C1880	3,941	N/A	N/A	N/A
HC62804067	M: DEVICE REFLUX MANAGEMENT	278	C1889	19,250	N/A	N/A	N/A
HC62804083	M:PROTECTOR NERVE(NEURAWRAP)PER CM	278	C9353	7,710	N/A	N/A	N/A
HC62804091	M:FILLER BONE PUTTY(MOZAIK/OS)PER0.5CC	278	C9359	4,338	N/A	N/A	N/A
HC62804117	M: AGENT BULKING INJ (DEFLUX)	278	L8604	3,294	N/A	N/A	N/A
HC62804158	M: GRAFT VASCULAR SYNTHETIC	278	L8670	4,663	N/A	N/A	N/A
HC62804182	COIL EMBOLIZATION                 G	278		798	N/A	N/A	N/A
HC62804216	COIL EMBOLIZATION                 E	278	C1889	560	N/A	N/A	N/A
HC62804240	COIL EMBOLIZATION                 N	278		1,820	N/A	N/A	N/A
HC62804273	COIL EMBOLIZATION                 Q	278		2,240	N/A	N/A	N/A
HC62804299	COIL EMBOLIZATION                 S	278		2,520	N/A	N/A	N/A
HC62804307	COIL EMBOLIZATION                 T	278		2,660	N/A	N/A	N/A
HC62804331	COIL EMBOLIZ(BARR PLAT DETACH)    W	278		3,080	N/A	N/A	N/A
HC62804364	COIL EMBOLIZATION                 Z	278		3,500	N/A	N/A	N/A
HC62804398	COIL EMBOLIZATION                AC	278		3,920	N/A	N/A	N/A
HC62804422	STENT TRACHEOBRONC COV W/DEL SYS  F	278	C1874	7,700	N/A	N/A	N/A
HC62804455	M: SCREW SPINAL	278	C1713	1,471	N/A	N/A	N/A
HC62804489	M: SYSTEM VENTRICULAR RESERVOIR	278	A4301	1,283	N/A	N/A	N/A
HC62804513	M: CABLE ORTHO/SPINAL	278	C1889	1,477	N/A	N/A	N/A
HC62804539	M: IOL  NEW TECHNOLOGY	278	C1780	N/A	N/A	N/A	N/A
HC62804562	CATH PICC PEDS                    G	278	C1751	350	N/A	N/A	N/A
HC62804596	STENT CORO BARE METAL W/DEL       B	278	C1876	1,676	N/A	N/A	N/A
HC62804620	STENT DES CORO COV W/DEL SYS      I	278	C1874	4,200	N/A	N/A	N/A
HC62804653	FILTER VENA CAVA                  A	278	C1880	1,908	N/A	N/A	N/A
HC62804687	CATH EP DIAG/MAPPING<20 ELECT     L	272	C1732	4,200	N/A	N/A	N/A
HC62804711	M: REPL JOINT INTERPHALAN 2/+	278	L8659	N/A	N/A	N/A	N/A
HC62804737	M: NECK FEMORAL HIP	278	C1776	8,419	N/A	N/A	N/A
HC62804745	M: SADDLE/CRADLE SPINAL	278	C1889	N/A	N/A	N/A	N/A
HC62804760	M: IMPLANT JOINT METACARPOPHALANGL	278	L8630	N/A	N/A	N/A	N/A
HC62804794	M: IMPLANT HALLUX (GREAT TOE)	278	L8642	N/A	N/A	N/A	N/A
HC62804828	CLIP LEFT ATRIAL APPENDAGE-LAA    A	278	C1889	4,466	N/A	N/A	N/A
HC62804851	M: CONNECTOR ROD TO ROD	278	C1713	525	N/A	N/A	N/A
HC62804885	M: PLATE TACK	278	C1713	315	N/A	N/A	N/A
HC62804919	STENT BILIARY COVRD W/DELSYS      A	278	C1874	2,800	N/A	N/A	N/A
HC62804935	STENT BILIARY COVRD W/DELSYS      C	278	C1874	3,500	N/A	N/A	N/A
HC62804943	STENT BILIARY COVRD W/DELSYS      T	278	C1874	9,437	N/A	N/A	N/A
HC62804968	STENT BILIARY COVRD W/DELSYS      V	278	C1874	10,150	N/A	N/A	N/A
HC62804992	M: CRIMP CABLE	278		2,767	N/A	N/A	N/A
HC62805023	M: KIT BALLN AUGMENTATION VERTEBRAL	278		N/A	N/A	N/A	N/A
HC62805056	CATH PTCA BALLOON NON-LASER       R	272	C1725	3,500	N/A	N/A	N/A
HC62805080	CATH EP DIAG/ABLAT 3D/VECT        X	272	C1732	9,800	N/A	N/A	N/A
HC62805114	CATH PTCA BALLOON NON-LASER       X	272	C1725	5,600	N/A	N/A	N/A
HC62805148	M: BLOCKER SPINAL	278		N/A	N/A	N/A	N/A
HC62805163	M: SYS DELIV SCP KNEE W/ BONE SUBST	278	C1713	N/A	N/A	N/A	N/A
HC62805197	M: IMPLANT PECTORAL	278	C1889	N/A	N/A	N/A	N/A
HC62805221	HEMOSTAT VITAGEL SURGICAL	272		1,820	N/A	N/A	N/A
HC62805254	M: SLEEVE/COLLAR SPINAL	278		N/A	N/A	N/A	N/A
HC62805288	STENT NON-COAT/NON-COV W-DEL     AJ	278	C1876	9,100	N/A	N/A	N/A
HC62805312	CATH SWAN GANZ/THERMODILUTION     D	272		140	N/A	N/A	N/A
HC62805353	M:STIMULATOR SPINAL BONE SPF	278	E0749	N/A	N/A	N/A	N/A
HC62805379	M: LEAD PACEMAKER/ICD COMBO	275	C1899	14,000	N/A	N/A	N/A
HC62805403	M: LINER/CUP HUMERAL	278	C1776	3,566	N/A	N/A	N/A
HC62805437	M: SYSTEM REVISION KNEE	278	C1776	7,493	N/A	N/A	N/A
HC62805460	CATH INTRACARDIAC ECHO/UTZ        F	272	C1759	9,450	N/A	N/A	N/A
HC62805494	CATH EP DIAG/ABLAT 3D/VECT        T	272	C1732	7,000	N/A	N/A	N/A
HC62805528	CATH GUIDING CARDIAC              S	272	C1887	2,100	N/A	N/A	N/A
HC62805551	CATH EP/ABLATION COOL-TIP         S	272	C2630	11,200	N/A	N/A	N/A
HC62805577	CATH EP/ABLATION COOL-TIP         I	272	C2630	5,600	N/A	N/A	N/A
HC62805585	CATH EP/ABLATION COOL-TIP         Q	272	C2630	9,800	N/A	N/A	N/A
HC62805601	CATH THROMBECTOMY/EMBOLECTOMY     V	272	C1757	3,150	N/A	N/A	N/A
HC62805635	DEVICE ABLAT COOL-TIP NONVASC     I	272	C1886	5,600	N/A	N/A	N/A
HC62805668	INTRO/SHEATH EP LASER             P	272	C2629	2,100	N/A	N/A	N/A
HC62805692	CATH GUIDING NEURO(DI058X125)    V	272	C1887	5,250	N/A	N/A	N/A
HC62805726	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AE	272	C1733	6,300	N/A	N/A	N/A
HC62805759	FIBRIN SEALANT                    O	278		1,592	N/A	N/A	N/A
HC62805775	HEMOSTATIC GEL/GELFOAM/PAD        E	272		204	N/A	N/A	N/A
HC62805783	HEMOSTATIC GEL/GELFOAM/PAD        F	272		307	N/A	N/A	N/A
HC62805809	HEMOSTATIC GEL/GELFOAM/PAD        J	272		428	N/A	N/A	N/A
HC62805833	HEMOSTATIC GEL/GELFOAM/PAD        M	272		1,153	N/A	N/A	N/A
HC62805866	M: MATRISTEM MULTILAYER MATRIX PER SQ CM (LC)	278	C1763	3,587	N/A	N/A	N/A
HC62805890	CATH EP DX <20 ELECTRODES         C	272	C1730	420	N/A	N/A	N/A
HC62805924	CATH EP DX <20 ELECTRODES         K	272	C1730	1,680	N/A	N/A	N/A
HC62805957	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP S	272	C1733	2,100	N/A	N/A	N/A
HC62805981	FIBRIN SEALANT                    G	278		420	N/A	N/A	N/A
HC62806005	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AT	272	C1733	18,200	N/A	N/A	N/A
HC62806039	CATH DIALYSIS SHORT-TERM          D	278	C1752	246	N/A	N/A	N/A
HC62806062	CATH HEMO/PERI DIAL LONG TERM     L	278	C1750	699	N/A	N/A	N/A
HC62806096	CATH HICKMAN/BROVIAC              J	278	C1751	560	N/A	N/A	N/A
HC62806120	PORT INDWELLING W/CATH            G	278	C1788	1,726	N/A	N/A	N/A
HC62806153	CATH BALLOON DUCT LACRIMAL        T	272	C1726	2,450	N/A	N/A	N/A
HC62806187	CATH THROMBECTOMY                AH	272	C1757	7,700	N/A	N/A	N/A
HC62806203	M: ARTHROFLEX-Q4125	278	Q4125	14,087	N/A	N/A	N/A
HC62806237	CATH PTA W/BALLOON RX(DCB)        D	272	C2623	4,900	N/A	N/A	N/A
HC62806260	CATH PTA W/BALLOON RX(DCB)        F	272	C2623	5,600	N/A	N/A	N/A
HC62806294	CATH ATHERCTMY ROTATNL(DIAMNDBCK) B	272	C1724	11,900	N/A	N/A	N/A
HC62806328	TUBE GASTROSTOMY STNDRD BTTN OPT  G	278	A4649	389	N/A	N/A	N/A
HC62806351	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AA	272	C1733	5,250	N/A	N/A	N/A
HC62806385	M: DEVICE/PUMP CIRC EXTRACORPOREAL	278	C1889	N/A	N/A	N/A	N/A
HC62806401	M: MATRISTEM BURN MATRIX PER SQ CM	278	C1763	N/A	N/A	N/A	N/A
HC62806419	M: MATRISTEM MICROMATRIX PER 1MG	278	Q4118	7,033	N/A	N/A	N/A
HC62806435	PORT INDWELLING W/CATH            F	278	C1788	1,856	N/A	N/A	N/A
HC62806468	GOLD SEED MARKER FIDUCIAL EA(NASHLUND)H	278	A4648	490	N/A	N/A	N/A
HC62806492	PROBE ABLATION                   AT	272		14,255	N/A	N/A	N/A
HC62806526	STENT NON-COAT/NON-COV W-DEL     AA	278	C1876	4,900	N/A	N/A	N/A
HC62806559	CATH BALLOON NEURO(HYPERGLIDE/SCEPTER XC)H	272	C2628	6,668	N/A	N/A	N/A
HC62806583	COIL EMBOLIZ(AXIUM HELIX BARE)   AH	278		5,250	N/A	N/A	N/A
HC62806609	COIL EMBOLIZ(PRIME/NYLON HELIX)  AJ	278		5,950	N/A	N/A	N/A
HC62806617	COIL EMBOLIZATION(3D/SMART)      AK	278		6,300	N/A	N/A	N/A
HC62806633	DIVERTER FLOW NEUROVASC(PIPELINE SM)C	278	C1889	47,949	N/A	N/A	N/A
HC62806666	CATH PICC PEDS                    H	278	C1751	420	N/A	N/A	N/A
HC62806690	MARKER TISSUE 3D	278	A4648	3,500	N/A	N/A	N/A
HC62806724	CATH EP/ABLATION COOL-TIP         T	272	C2630	11,900	N/A	N/A	N/A
HC62806757	CATH THROMBECTOMY                AL	272	C1757	10,500	N/A	N/A	N/A
HC62806781	M: GRAFT DURA REPAIR	278		3,179	N/A	N/A	N/A
HC62806815	STENT ENDOPRSTH AAA               M	278	C1874	16,375	N/A	N/A	N/A
HC62806831	STENT ENDOPRSTH AAA               W	278	C1874	34,039	N/A	N/A	N/A
HC62806864	STENT ENDOPRSTH AAA               F	278	C1874	10,850	N/A	N/A	N/A
HC62806898	STENT ENDOPRSTH PVD(VIABAHN)      J	278	C1874	13,471	N/A	N/A	N/A
HC62806922	STENT ENDOPRSTH TAA               W	278	C1874	34,999	N/A	N/A	N/A
HC62806955	WAND ASPIRATION/IRRIG NEUROVASC	278	C1889	19,442	N/A	N/A	N/A
HC62806989	CATH BI-CAVAL PERFUSION	272		8,225	N/A	N/A	N/A
HC62807011	PROBE ABLATION CRYO               C	272	C2618	8,432	N/A	N/A	N/A
HC62807037	CATH ATHERECTOMY ROTATIONAL      AE	272	C1724	6,300	N/A	N/A	N/A
HC62807060	COIL NEUROVASCULAR               AP	278	C1889	8,400	N/A	N/A	N/A
HC62807094	PROBE ABLATION CRYO               H	272	C2618	11,900	N/A	N/A	N/A
HC62807128	CATH THROMBECTOMY                AD	272	C1757	6,650	N/A	N/A	N/A
HC62807151	STENT NON-COAT/NON-COV W-DEL     AB	278	C1876	5,250	N/A	N/A	N/A
HC62807185	DIVERTER FLOW NEUROVASC(PIPELINE FLX 35)F	278	C1889	54,179	N/A	N/A	N/A
HC62807219	COIL NEUROVASCULAR               AD	278		4,550	N/A	N/A	N/A
HC62807235	STENT NON-COAT/NON-COV W-DEL     AF	278	C1876	25,532	N/A	N/A	N/A
HC62807243	STENT ENDOPRSTH TAA              AD	278	C1874	60,711	N/A	N/A	N/A
HC62807268	STENT COV W/DEL SYS PVD           M	278	C1874	16,800	N/A	N/A	N/A
HC62807292	PARTICLES EMBOLIZ (EMBOSPHERE 400)J	278		560	N/A	N/A	N/A
HC62807326	STENT COVRD W/DEL SYS(AXIOS)     AE	278	C1874	15,400	N/A	N/A	N/A
HC62807359	CLIP ENDOSCOPIC                   Q	278		1,400	N/A	N/A	N/A
HC62807383	M: NEOX1K/RT /CLARIX 1K CORD PER SQ CM	636	Q4148	10,287	N/A	N/A	N/A
HC62807417	STENT ENDOPRSTH TAA              AF	278	C1874	67,846	N/A	N/A	N/A
HC62807441	STENT NON-COAT/NON-COV W-DEL      U	278	C1876	3,639	N/A	N/A	N/A
HC62807458	STENT NON-COAT/NON-COV W-DEL     AC	278	C1876	5,600	N/A	N/A	N/A
HC62807474	M: OASIS TRI-LAYER WND MATRIX PER SQ CM	636	Q4124	N/A	N/A	N/A	N/A
HC62807508	M: BODY DISTRACTOR MAXILLARY	278	C1713	N/A	N/A	N/A	N/A
HC62807532	M: SCREW MACHINE DISTRACTOR MAXILLARY	278	C1713	N/A	N/A	N/A	N/A
HC62807565	M: FOOTPLATE A/B/C STYLE DISTRACTOR	278	C1713	N/A	N/A	N/A	N/A
HC62807599	KIT CATH HEMO/PERI DIALYS LG TRM  S	278	C1750	2,069	N/A	N/A	N/A
HC62807623	M: INSERT HIP	278	C1776	2,229	N/A	N/A	N/A
HC62807656	M: PROSTHESIS LARYNGEAL	278	L8500	700	N/A	N/A	N/A
HC62807672	M: STEM ANKLE TIBIAL	278	C1713	2,529	N/A	N/A	N/A
HC62807706	CATH HEMO/PERI DIAL LONG TERM     E	278	C1750	210	N/A	N/A	N/A
HC62807730	M: DISC INVERVERTEBRAL ARTIFICIAL	278	C1713	17,189	N/A	N/A	N/A
HC62807763	M: RING ACETABULAR HIP	278		428	N/A	N/A	N/A
HC62807797	M: PLUG PORT NEUROSTIMULATOR	278	C1889	532	N/A	N/A	N/A
HC62807821	STAPLE REINFORCEMENT(SEAMGUARD)???? C	272		655	N/A	N/A	N/A
HC62807854	STENT EXTENDER ENDOGRAFT AAA      Q	278	C1874	7,000	N/A	N/A	N/A
HC62807870	M: PACEMAKER LEADLESS SNGL CHMBR MICRA VR	275	C1786	38,768	N/A	N/A	N/A
HC62807888	M: MATRIX VIAFLOW WOUND FLOWABLE 2ML	278	C9399	7,171	N/A	N/A	N/A
HC62807904	M: CONNECTOR JOINT NAIL TO NAIL	278	C1713	910	N/A	N/A	N/A
HC62807938	SEALANT TISSUE HYDROGEL ET	278		5,166	N/A	N/A	N/A
HC62807961	STENT ENDOPRSTH LEG ILIAC         A	278	C1874	7,000	N/A	N/A	N/A
HC62807995	STENT URETERAL                    L	278	C2617	690	N/A	N/A	N/A
HC62808027	M: CAGE ACETABULAR	278	C1776	14,060	N/A	N/A	N/A
HC62808050	STENT ENDOPRSTH AAA               Y	278	C1874	41,999	N/A	N/A	N/A
HC62808076	STENT ENDOPRSTH TAA              AA	278	C1874	69,194	N/A	N/A	N/A
HC62808084	STENT EXTENDER ENDOGRAFT AAA      X	278	C1874	12,264	N/A	N/A	N/A
HC62808100	STENT EXTENDER ENDOGRAFT AAA      V	278	C1874	10,500	N/A	N/A	N/A
HC62808134	G130136 KIT STENTS ENDOPRSTH ASC AORTA	624	C1874	52,499	N/A	N/A	N/A
HC62808167	DEVICE REPAIR SUTURE MENISCAL	278	C1713	1,683	N/A	N/A	N/A
HC62808191	STENT NEUROVASC NEUROFORM ATLAS  H020002	278	C1876	25,375	N/A	N/A	N/A
HC62808225	M: CENTRALIZER KNEE	278	C1776	210	N/A	N/A	N/A
HC62808258	M:  EPICORD PER SQ CM	636	Q4187	N/A	N/A	N/A	N/A
HC62808282	M:  PURAPLY XT PER SQ CM	636	Q4197	N/A	N/A	N/A	N/A
HC62808308	M: ADAPTER SHOULDER	278	C1776	945	N/A	N/A	N/A
HC62808332	G170044 LEAD VITARIA	624	C1778	1	N/A	N/A	N/A
HC62808365	DEVICE CLOSURE LAA (WATCHMAN)	278	C1760	59,499	N/A	N/A	N/A
HC62808399	STENT DES CORO COV W/DEL SYS      E	278	C1874	2,800	N/A	N/A	N/A
HC62808423	RECORDER CARDIAC EVENT(ABBOTT/BOSTON SCI)	278	C1764	15,750	N/A	N/A	N/A
HC62808456	IMPLANT/INSERT DEVICE DEPENDENT NONE	278	C1890	0	N/A	N/A	N/A
HC62808480	M:INTEGRA MATRIX PER SQ CM	636	Q4108	26,091	N/A	N/A	N/A
HC62808506	M:CYTAL WOUND (MATRISTEM BURN) PER SQ CM	636	Q4166	N/A	N/A	N/A	N/A
HC62808530	GENERATOR PULSE NEUROSTIM(INSPIRE?)	278	C1767	63,261	N/A	N/A	N/A
HC62808563	SYSTEM SHUNT INTERATRIAL G180020	624	C1889	1	N/A	N/A	N/A
HC62808597	CATH LITHOTRIPSY CORONARY TRANSLUM INTRAVASC	272	C1761	32,703	N/A	N/A	N/A
HC62808621	CATH/TUBE BRACHY CLICK FIT	278	C1728	339	N/A	N/A	N/A
HC62808654	DEVICE ENDOSCOPE UGI IMAGING ILLUM DISP	278	C1748	23,547	N/A	N/A	N/A
HC62808696	DEVICE SURGICAL IMPLANT TRIALING	278	A4649	1	N/A	N/A	N/A
HC62808712	STENT COAT/COVRD W/O DEL SYS       V	278	C1875	24,769	N/A	N/A	N/A
HC62808720	KIT THROMBECTOMY/EMBOLECTOMY        Y	272	C1757	34,283	N/A	N/A	N/A
HC62808746	CATH INDIGO THROMB SEPARATOR L190CM[PENUMBRA]	272	C1757	2,504	N/A	N/A	N/A
HC62808779	CATH INDIGO THROMB 3.4&5FR[PENUMBRA]	272	C1757	4,071	N/A	N/A	N/A
HC62808803	CATH INDIGO THROMB 6FR L135CM[PENUMBRA]	272	C1757	7,893	N/A	N/A	N/A
HC62808837	KIT CATH INDIGO 7 LIGHT XTORQ PLUS[PENUMBRA]	272	C1757	19,635	N/A	N/A	N/A
HC62808860	BONE GRAFT INFUSE? IDE G160139	624	C1889	1	N/A	N/A	N/A
HC62808894	DEVICE FUSION SI JOINT(IFUSE SI-BONE?)I	278	C1713	10,500	N/A	N/A	N/A
HC62808910	DEVICE FUSION SI JOINT(IFUSE SI-BONE?)K	278	C1713	11,377	N/A	N/A	N/A
HC62808928	BONE GRAFT FILLER VOID 5ML(CERAMENT?BONESUPPORT?)	278	C1713	7,280	N/A	N/A	N/A
HC62808944	BONE GRAFT FILLER VOID 18ML(CERAMENT?BONESUPPORT?)	278	C1713	26,179	N/A	N/A	N/A
HC62808977	CATH PTA W/BALLOON RX(DCB)        K	272	C2623	7,735	N/A	N/A	N/A
HC62809033	FILTER VENA CAVA                  N	278	C1880	7,451	N/A	N/A	N/A
HC62890108	P: PACER CR 3 CHAMBERS C2621 W/ 3 LEADS C1898 &/ C1900			N/A	N/A	N/A	N/A
HC62890140	P: PACER CRT-P C2621 W/ 1 LEAD C1898			N/A	N/A	N/A	N/A
HC62890173	P: AICD SINGLE CHAMBER C1722 W/LEAD C1898			N/A	N/A	N/A	N/A
HC62890207	P: AICD C1882 W/C1777/C1892/C1893/C1895/C1896/C1898/C1900			N/A	N/A	N/A	N/A
HC62890223	P: AICD DUAL C1721W/C1777&/ C1895&/ C1898(3)			N/A	N/A	N/A	N/A
HC62899999	MULTIPLE ITEMS DOC AND CHRGE (UNBILLABLE EAP)	279		N/A	N/A	N/A	N/A
HC65000250_00002324030	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_00003089321	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_00003089431	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_00004080085	NONCDM CHARGE RECORD PHARMACY	250		99	N/A	N/A	N/A
HC65000250_00005417758	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00005434462	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00006011228	NONCDM CHARGE RECORD PHARMACY	250		111	N/A	N/A	N/A
HC65000250_00006022131	NONCDM CHARGE RECORD PHARMACY	250		112	N/A	N/A	N/A
HC65000250_00006027731	NONCDM CHARGE RECORD PHARMACY	250		111	N/A	N/A	N/A
HC65000250_00009003101	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00009032301	NONCDM CHARGE RECORD PHARMACY	250		182	N/A	N/A	N/A
HC65000250_00009035301	NONCDM CHARGE RECORD PHARMACY	250		272	N/A	N/A	N/A
HC65000250_00009043601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00009076004	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_00023024004	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_00023050601	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00023585318	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_00023916330	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_00024135301	NONCDM CHARGE RECORD PHARMACY	250	Z7610	21	N/A	N/A	N/A
HC65000250_00024515006	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_00025145134	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_00025146160	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_00025152534	NONCDM CHARGE RECORD PHARMACY	250		91	N/A	N/A	N/A
HC65000250_00032120601	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00032122401	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_00045020504	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00046110181	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65000250_00046110511	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_00049345019	NONCDM CHARGE RECORD PHARMACY	250	Z7610	26	N/A	N/A	N/A
HC65000250_00054001020	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00054001120	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00054004544	NONCDM CHARGE RECORD PHARMACY	250	Z7610	234	N/A	N/A	N/A
HC65000250_00054007928	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00054008826	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00054023525	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00054026424	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00054033425	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_00054039063	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00054040013	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00054042623	NONCDM CHARGE RECORD PHARMACY	250	Z7610	40	N/A	N/A	N/A
HC65000250_00054051750	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00054311763	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00054327099	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00054350049	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00054355563	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00054356710	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00054449625	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00054814622	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_00054830125	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00054852725	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00056016970	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00065008515	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65000250_00065035905	NONCDM CHARGE RECORD PHARMACY	250		362	N/A	N/A	N/A
HC65000250_00065041130	NONCDM CHARGE RECORD PHARMACY	250		97	N/A	N/A	N/A
HC65000250_00065079515	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_00065401105	NONCDM CHARGE RECORD PHARMACY	250		63	N/A	N/A	N/A
HC65000250_00067203991	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00069306030	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00069582043	NONCDM CHARGE RECORD PHARMACY	250		70	N/A	N/A	N/A
HC65000250_00071015823	NONCDM CHARGE RECORD PHARMACY	250		107	N/A	N/A	N/A
HC65000250_00071041813	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00071101441	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65000250_00074333330	NONCDM CHARGE RECORD PHARMACY	250		50	N/A	N/A	N/A
HC65000250_00074455211	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00074518290	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00074706811	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00074706990	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00074929690	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00078035752	NONCDM CHARGE RECORD PHARMACY	250		76	N/A	N/A	N/A
HC65000250_00078036034	NONCDM CHARGE RECORD PHARMACY	250		69	N/A	N/A	N/A
HC65000250_00078050215	NONCDM CHARGE RECORD PHARMACY	250		149	N/A	N/A	N/A
HC65000250_00078065920	NONCDM CHARGE RECORD PHARMACY	250		67	N/A	N/A	N/A
HC65000250_00081079888	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_00087040501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00088117112	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093005101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093005301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093013501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093031101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093031901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093032101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00093078701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093081105	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093117701	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00093172001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00093206406	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093220301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093220405	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093227434	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00093310905	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00093314501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093314705	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093342601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093415573	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093416176	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00093524565	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00093557156	NONCDM CHARGE RECORD PHARMACY	250		43	N/A	N/A	N/A
HC65000250_00093681573	NONCDM CHARGE RECORD PHARMACY	250		51	N/A	N/A	N/A
HC65000250_00093720198	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00093720298	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00093727398	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00093729601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093738756	NONCDM CHARGE RECORD PHARMACY	250	Z7610	142	N/A	N/A	N/A
HC65000250_00093786565	NONCDM CHARGE RECORD PHARMACY	250		79	N/A	N/A	N/A
HC65000250_00093816201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00093834301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093834498	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093873901	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00093914701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093970205	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00115136529	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00115180001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00115423301	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_00115552210	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00121043130	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00121050400	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00121054410	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00121057716	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00121059530	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00121064616	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00121067016	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4	N/A	N/A	N/A
HC65000250_00121067616	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00121072104	NONCDM CHARGE RECORD PHARMACY	250	Z7610	15	N/A	N/A	N/A
HC65000250_00121074740	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_00121079916	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00121086802	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65000250_00121090494	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00121091700	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00121094216	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00121094500	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00121094540	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_00121096605	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00121097440	NONCDM CHARGE RECORD PHARMACY	250		66	N/A	N/A	N/A
HC65000250_00121100800	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00121119000	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_00121148800	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00121157610	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00121173000	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00121174400	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00121176130	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_00121178100	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00121188450	NONCDM CHARGE RECORD PHARMACY	250	Z7610	32	N/A	N/A	N/A
HC65000250_00121457706	NONCDM CHARGE RECORD PHARMACY	250	Z7610	16	N/A	N/A	N/A
HC65000250_00121477640	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00131247760	NONCDM CHARGE RECORD PHARMACY	250		75	N/A	N/A	N/A
HC65000250_00131541072	NONCDM CHARGE RECORD PHARMACY	250		70	N/A	N/A	N/A
HC65000250_00132008112	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00132020220	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00135020001	NONCDM CHARGE RECORD PHARMACY	250		100	N/A	N/A	N/A
HC65000250_00143176901	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00143312610	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00143968125	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_00143988901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00143988915	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00143992801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00149003916	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00149032642	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00168000580	NONCDM CHARGE RECORD PHARMACY	250	Z7610	60	N/A	N/A	N/A
HC65000250_00168000715	NONCDM CHARGE RECORD PHARMACY	250		91	N/A	N/A	N/A
HC65000250_00168014630	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_00168020160	NONCDM CHARGE RECORD PHARMACY	250		234	N/A	N/A	N/A
HC65000250_00168035730	NONCDM CHARGE RECORD PHARMACY	250		98	N/A	N/A	N/A
HC65000250_00172208360	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00172409660	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00172541160	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00172572880	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00173071215	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65000250_00185001001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00185012201	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00185079901	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_00186077739	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_00224185213	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00225080047	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00228202710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00228203110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00228212810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00228253810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00228254010	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00228259711	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00228277811	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00228299611	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00245003642	NONCDM CHARGE RECORD PHARMACY	250	Z7610	13	N/A	N/A	N/A
HC65000250_00245010811	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00245014701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00245021111	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00245021211	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00245531601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00245531911	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00254101019	NONCDM CHARGE RECORD PHARMACY	250		97	N/A	N/A	N/A
HC65000250_00254200801	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_00281032608	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00283061026	NONCDM CHARGE RECORD PHARMACY	250		66	N/A	N/A	N/A
HC65000250_00283067902	NONCDM CHARGE RECORD PHARMACY	250		191	N/A	N/A	N/A
HC65000250_00299391742	NONCDM CHARGE RECORD PHARMACY	250	Z7610	25	N/A	N/A	N/A
HC65000250_00310110530	NONCDM CHARGE RECORD PHARMACY	250		168	N/A	N/A	N/A
HC65000250_00310135030	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00338051909	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_00338104902	NONCDM CHARGE RECORD PHARMACY	250		132	N/A	N/A	N/A
HC65000250_00378001805	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378020801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378022201	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00378087299	NONCDM CHARGE RECORD PHARMACY	250		290	N/A	N/A	N/A
HC65000250_00378180077	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00378180777	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00378181377	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00378181977	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00378190201	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00378305001	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00378312501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00378335299	NONCDM CHARGE RECORD PHARMACY	250		121	N/A	N/A	N/A
HC65000250_00378363201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378415101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378581377	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00378623201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378647044	NONCDM CHARGE RECORD PHARMACY	250		119	N/A	N/A	N/A
HC65000250_00378647099	NONCDM CHARGE RECORD PHARMACY	250		119	N/A	N/A	N/A
HC65000250_00378698288	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_00378773493	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_00378907193	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_00378911293	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00378912198	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_00378967130	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00386000802	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00386000803	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00395009016	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00395060501	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00395266216	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00406012562	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00406051262	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00406052362	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00406324301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00406577162	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00406838062	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_00406901276	NONCDM CHARGE RECORD PHARMACY	250		106	N/A	N/A	N/A
HC65000250_00406912576	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_00406996101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00409329906	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00409427601	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00409471302	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00409471365	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_00409488720	NONCDM CHARGE RECORD PHARMACY	250	J3490	4	N/A	N/A	N/A
HC65000250_00409488812	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00409662514	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00409739172	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00409955805	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00414200040	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00456045901	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00456120130	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0	N/A	N/A	N/A
HC65000250_00456140263	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65000250_00456140590	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_00456202001	NONCDM CHARGE RECORD PHARMACY	250		88	N/A	N/A	N/A
HC65000250_00456430001	NONCDM CHARGE RECORD PHARMACY	250		593	N/A	N/A	N/A
HC65000250_00469260230	NONCDM CHARGE RECORD PHARMACY	250		92	N/A	N/A	N/A
HC65000250_00472032126	NONCDM CHARGE RECORD PHARMACY	250	Z7610	35	N/A	N/A	N/A
HC65000250_00472037915	NONCDM CHARGE RECORD PHARMACY	250		66	N/A	N/A	N/A
HC65000250_00472120006	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00487020101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00487590199	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00487900760	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00487950125	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00487980101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00487990401	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00501320001	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_00517760425	NONCDM CHARGE RECORD PHARMACY	250		79	N/A	N/A	N/A
HC65000250_00527105001	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00527131301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00527136701	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00527163201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527221537	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00527296237	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00527328143	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527328246	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527328643	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527328946	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527411837	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00527600480	NONCDM CHARGE RECORD PHARMACY	250		136	N/A	N/A	N/A
HC65000250_00536100901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536104710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536104815	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536105429	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536118297	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536120215	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00536121794	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00536123441	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536126659	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536128806	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_00536130375	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00536132601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536132710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536199553	NONCDM CHARGE RECORD PHARMACY	250	Z7610	19	N/A	N/A	N/A
HC65000250_00536252525	NONCDM CHARGE RECORD PHARMACY	250	Z7610	24	N/A	N/A	N/A
HC65000250_00536404610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536440601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536509008	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536589588	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00536741551	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00555006602	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00555015902	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00555048401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00555087202	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00555088202	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00555088602	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00555901658	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00574006924	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00574007030	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00574010777	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00574024001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574030216	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574030416	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574052004	NONCDM CHARGE RECORD PHARMACY	250		87	N/A	N/A	N/A
HC65000250_00574052074	NONCDM CHARGE RECORD PHARMACY	250		87	N/A	N/A	N/A
HC65000250_00574200202	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_00574402439	NONCDM CHARGE RECORD PHARMACY	250		97	N/A	N/A	N/A
HC65000250_00574704012	NONCDM CHARGE RECORD PHARMACY	250		174	N/A	N/A	N/A
HC65000250_00574705050	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00575620030	NONCDM CHARGE RECORD PHARMACY	250		141	N/A	N/A	N/A
HC65000250_00591034301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00591044401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00591060501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00591207072	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_00591256230	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00591322001	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00591354160	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00591530701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00591533501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00591555401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00591565801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00597005801	NONCDM CHARGE RECORD PHARMACY	250		59	N/A	N/A	N/A
HC65000250_00597015230	NONCDM CHARGE RECORD PHARMACY	250		124	N/A	N/A	N/A
HC65000250_00597015337	NONCDM CHARGE RECORD PHARMACY	250		124	N/A	N/A	N/A
HC65000250_00597019090	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_00597036082	NONCDM CHARGE RECORD PHARMACY	250		53	N/A	N/A	N/A
HC65000250_00603038046	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00603107505	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00603139364	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_00603156705	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00603211532	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00603243921	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00603544821	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00603548421	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00713013512	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65000250_00713050301	NONCDM CHARGE RECORD PHARMACY	250		75	N/A	N/A	N/A
HC65000250_00713052612	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_00713088230	NONCDM CHARGE RECORD PHARMACY	250		109	N/A	N/A	N/A
HC65000250_00781107901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00781163501	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00781194339	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65000250_00781216460	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00781286810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00781569092	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00781627043	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_00781751587	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_00799000102	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_00832003801	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832051101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00832051201	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00832059011	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832121101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00832121301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832121500	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832121601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832121800	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00832151011	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00832154011	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00832532411	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832712301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00869016638	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00869083143	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904026252	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904052360	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904052380	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904053961	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904078814	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_00904131546	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904188261	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904205661	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904250091	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904272561	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904357161	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904386575	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904434270	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904504661	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904506860	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904530660	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904530780	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904544561	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904546052	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904546072	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904548652	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904550261	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904552461	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904561161	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904567761	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904578561	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904579061	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904579146	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904585361	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904585561	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904589261	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904592261	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904598426	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_00904601946	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904608261	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904608561	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904622161	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00904625549	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904629061	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904629304	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904630161	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904630521	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00904632261	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904632951	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904635361	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904635961	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904636445	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_00904637061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904637461	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904637861	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904640161	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904640761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904642661	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904643861	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904644161	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904645061	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904645561	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904646961	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904647561	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904647861	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904650161	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00904650506	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904651106	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65000250_00904651961	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904655061	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904655761	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00904657006	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_00904657561	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904659204	NONCDM CHARGE RECORD PHARMACY	250		73	N/A	N/A	N/A
HC65000250_00904661761	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904662061	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904663661	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00904663861	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904663961	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904664161	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904666761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904668208	NONCDM CHARGE RECORD PHARMACY	250	Z7610	34	N/A	N/A	N/A
HC65000250_00904670461	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904670782	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_00904671146	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904671761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904671839	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904672080	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904673080	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904674604	NONCDM CHARGE RECORD PHARMACY	250	Z7610	63	N/A	N/A	N/A
HC65000250_00904674880	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904675920	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904677861	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904678480	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904679104	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65000250_00904679761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904680061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904680940	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904681907	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00904682461	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904683006	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904683620	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904686161	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904686961	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904690706	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904692661	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904693181	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00904694961	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904695361	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904695661	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904698072	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00904698761	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904699104	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904699361	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904699880	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904700061	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904700635	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_00904700761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904702367	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904704261	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00904704461	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904704661	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904705761	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904708361	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904708661	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904709461	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904710304	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_00904710861	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904711161	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904712004	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_00904712561	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904714461	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_00904715661	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904716861	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_00904718761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904719106	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904720061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904721461	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904723860	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904724568	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_00904725761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904759080	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904772512	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904880467	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00955105290	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65000250_00990798108	NONCDM CHARGE RECORD PHARMACY	250		97	N/A	N/A	N/A
HC65000250_00998061505	NONCDM CHARGE RECORD PHARMACY	250	Z7610	490	N/A	N/A	N/A
HC65000250_01000670020	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01000670022	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01000670038	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01000673027	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01001955304	NONCDM CHARGE RECORD PHARMACY	250		137	N/A	N/A	N/A
HC65000250_01013517362	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01013562101	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01013565250	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01022302013	NONCDM CHARGE RECORD PHARMACY	250		773	N/A	N/A	N/A
HC65000250_01035609004	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_01037010103	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01070201301	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01070220101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093914233	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_01093915633	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_01093920444	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_01093933733	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093934044	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_01093938533	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093941433	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_01093956433	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_01093957833	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65000250_01093973944	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65000250_01093979233	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01093980944	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_01093986044	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01093990033	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01150900367	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_01152313142	NONCDM CHARGE RECORD PHARMACY	250		122	N/A	N/A	N/A
HC65000250_01153416501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01170105033	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_01184595505	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01216510003	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01254723813	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01310701401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01310704501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01351710716	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01366800801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01366801005	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01366810390	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01366810501	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01366821730	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_01392510701	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_01650002324	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01657120106	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01657133016	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_01657166401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01657167301	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_01657167516	NONCDM CHARGE RECORD PHARMACY	250	Z7610	9	N/A	N/A	N/A
HC65000250_01657169901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671400401	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_01671401401	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01671403502	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671404112	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671404401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671405901	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_01671406701	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65000250_01671407106	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671407801	NONCDM CHARGE RECORD PHARMACY	250		73	N/A	N/A	N/A
HC65000250_01671408310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671409701	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01671411001	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01671411702	NONCDM CHARGE RECORD PHARMACY	250		66	N/A	N/A	N/A
HC65000250_01671415701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01671416601	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01671417502	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671418502	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_01671420030	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01671423401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671426701	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_01671429801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671433201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671439102	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_01671439501	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_01671444401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01671444801	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01671445401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671447801	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01671448202	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671448301	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65000250_01671449601	NONCDM CHARGE RECORD PHARMACY	250		142	N/A	N/A	N/A
HC65000250_01671460102	NONCDM CHARGE RECORD PHARMACY	250	Z7610	15	N/A	N/A	N/A
HC65000250_01671461205	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671461304	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671462101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671463201	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01671465601	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671465701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671465901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671466201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671466302	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671468202	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671468303	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671468403	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671469301	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_01671469601	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_01671470101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671471701	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65000250_01671472102	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671474302	NONCDM CHARGE RECORD PHARMACY	250	Z7610	30	N/A	N/A	N/A
HC65000250_01671476601	NONCDM CHARGE RECORD PHARMACY	250		172	N/A	N/A	N/A
HC65000250_01671477101	NONCDM CHARGE RECORD PHARMACY	250		89	N/A	N/A	N/A
HC65000250_01671478202	NONCDM CHARGE RECORD PHARMACY	250		674	N/A	N/A	N/A
HC65000250_01671478301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01671478601	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_01671479701	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_01671481301	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01671481601	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01671482001	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_01671482901	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_01671483101	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01671483501	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01671484001	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_01671484401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671485201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01671486001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	85	N/A	N/A	N/A
HC65000250_01671488301	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01671489601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01671494801	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01671496401	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_01671498801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672902215	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672903510	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01672909001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672914201	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_01672918201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672918317	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672921615	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672927810	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01672932015	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672941401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01672944015	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01672944915	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01672945115	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01672945215	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672945415	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01686468001	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_01723861015	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65000250_01747806012	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_01747807031	NONCDM CHARGE RECORD PHARMACY	250		53	N/A	N/A	N/A
HC65000250_01747820102	NONCDM CHARGE RECORD PHARMACY	250		171	N/A	N/A	N/A
HC65000250_01747820605	NONCDM CHARGE RECORD PHARMACY	250		257	N/A	N/A	N/A
HC65000250_01747821502	NONCDM CHARGE RECORD PHARMACY	250		246	N/A	N/A	N/A
HC65000250_01747822312	NONCDM CHARGE RECORD PHARMACY	250		497	N/A	N/A	N/A
HC65000250_01747823835	NONCDM CHARGE RECORD PHARMACY	250	Z7610	90	N/A	N/A	N/A
HC65000250_01747829010	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65000250_01747840401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01747871130	NONCDM CHARGE RECORD PHARMACY	250		663	N/A	N/A	N/A
HC65000250_01747871410	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_01747871710	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_01747876206	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_01751806004	NONCDM CHARGE RECORD PHARMACY	250		90	N/A	N/A	N/A
HC65000250_01785604071	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_01785609624	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_02045187121	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_02055502101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02055503600	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02055504000	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315501105	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_02315510210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315510601	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02315519401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_02315528801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02315551230	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_02315553102	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02315560601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315562102	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_02315572401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_02315574703	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_02420829005	NONCDM CHARGE RECORD PHARMACY	250	Z7610	76	N/A	N/A	N/A
HC65000250_02420839915	NONCDM CHARGE RECORD PHARMACY	250		237	N/A	N/A	N/A
HC65000250_02420848510	NONCDM CHARGE RECORD PHARMACY	250		221	N/A	N/A	N/A
HC65000250_02420855555	NONCDM CHARGE RECORD PHARMACY	250		149	N/A	N/A	N/A
HC65000250_02420858060	NONCDM CHARGE RECORD PHARMACY	250		232	N/A	N/A	N/A
HC65000250_02420873501	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65000250_02420891055	NONCDM CHARGE RECORD PHARMACY	250	Z7610	99	N/A	N/A	N/A
HC65000250_02433812213	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6	N/A	N/A	N/A
HC65000250_02433813402	NONCDM CHARGE RECORD PHARMACY	250		43	N/A	N/A	N/A
HC65000250_02435770115	NONCDM CHARGE RECORD PHARMACY	250		104	N/A	N/A	N/A
HC65000250_02465826060	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_02502167376	NONCDM CHARGE RECORD PHARMACY	250		38	N/A	N/A	N/A
HC65000250_02502181230	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_02660801210	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_02724104910	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_02724113909	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_02724119990	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_02780806502	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_02780808602	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_02780815703	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02903300301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02903302801	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_02930012713	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_02930013601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02930015501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02930039810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172213801	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_03172214201	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_03172215290	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03172253712	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03172258630	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_03172262390	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_03172263231	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_03172270110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172270430	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_03172272150	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03172272690	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172277701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172293612	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03172294901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03334204807	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03334205507	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03334205607	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03334206310	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03334208909	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03334210207	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03334211607	NONCDM CHARGE RECORD PHARMACY	250	Z7610	7	N/A	N/A	N/A
HC65000250_03557342880	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03700002404	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03700003202	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_03700047709	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03700074108	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03786400033	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03877900689	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03877907448	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03932802415	NONCDM CHARGE RECORD PHARMACY	250		195	N/A	N/A	N/A
HC65000250_03982203105	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_03982212015	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_03982299002	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04009310609	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04110081102	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04110081128	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04110082073	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65000250_04116700609	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04167936513	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04219232901	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04219233901	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04219260845	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04219280201	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_04229118790	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04229141360	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04229146801	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_04229156760	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_04229178030	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_04229200120	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4	N/A	N/A	N/A
HC65000250_04229205403	NONCDM CHARGE RECORD PHARMACY	250		60	N/A	N/A	N/A
HC65000250_04249430124	NONCDM CHARGE RECORD PHARMACY	250		134	N/A	N/A	N/A
HC65000250_04257114126	NONCDM CHARGE RECORD PHARMACY	250		220	N/A	N/A	N/A
HC65000250_04257122730	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_04270210305	NONCDM CHARGE RECORD PHARMACY	250		260	N/A	N/A	N/A
HC65000250_04279401812	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04279401902	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_04279911901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04279960501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04280610201	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_04280626695	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_04280634101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04280650209	NONCDM CHARGE RECORD PHARMACY	250		115	N/A	N/A	N/A
HC65000250_04280655212	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04280671401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04285800110	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04285811830	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04285850203	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04306387160	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04329255606	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04338616006	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04338616106	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04338640503	NONCDM CHARGE RECORD PHARMACY	250		787	N/A	N/A	N/A
HC65000250_04354727010	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04354727603	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354728111	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354733510	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354733710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354735110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354735310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354735610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354739710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354740211	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354740610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354754425	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_04359821050	NONCDM CHARGE RECORD PHARMACY	250		81	N/A	N/A	N/A
HC65000250_04359823018	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04359843611	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04359844774	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_04359872101	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_04467710020	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65000250_04580200403	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_04580204811	NONCDM CHARGE RECORD PHARMACY	250		136	N/A	N/A	N/A
HC65000250_04580205003	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_04580205535	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_04580205536	NONCDM CHARGE RECORD PHARMACY	250	Z7610	67	N/A	N/A	N/A
HC65000250_04580205911	NONCDM CHARGE RECORD PHARMACY	250		134	N/A	N/A	N/A
HC65000250_04580206003	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_04580206335	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_04580206435	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_04580209851	NONCDM CHARGE RECORD PHARMACY	250		87	N/A	N/A	N/A
HC65000250_04580214370	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04580218816	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_04580235758	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04580241059	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_04580243401	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_04580246564	NONCDM CHARGE RECORD PHARMACY	250	Z7610	144	N/A	N/A	N/A
HC65000250_04580265078	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04580273032	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_04580273233	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04580275930	NONCDM CHARGE RECORD PHARMACY	250		63	N/A	N/A	N/A
HC65000250_04580286802	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_04580288014	NONCDM CHARGE RECORD PHARMACY	250		136	N/A	N/A	N/A
HC65000250_04596334202	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_04612224905	NONCDM CHARGE RECORD PHARMACY	250	Z7610	13	N/A	N/A	N/A
HC65000250_04612255705	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_04628700660	NONCDM CHARGE RECORD PHARMACY	250		134	N/A	N/A	N/A
HC65000250_04628750001	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_04658111020	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04658111060	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04687600025	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_04733532286	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04733590488	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04778130701	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_04778135503	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_04778142347	NONCDM CHARGE RECORD PHARMACY	250		106	N/A	N/A	N/A
HC65000250_04778142747	NONCDM CHARGE RECORD PHARMACY	250		130	N/A	N/A	N/A
HC65000250_04778147013	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65000250_04778164990	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04778166290	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04843310101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04843311001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04858200155	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_04858280220	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_04923064551	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_04934803729	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_04934814707	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04934817934	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04934819727	NONCDM CHARGE RECORD PHARMACY	250	Z7610	14	N/A	N/A	N/A
HC65000250_04934830239	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04934835625	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_04934857308	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_04934863634	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04934875707	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04934885472	NONCDM CHARGE RECORD PHARMACY	250	Z7610	13	N/A	N/A	N/A
HC65000250_04934892710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04941105030	NONCDM CHARGE RECORD PHARMACY	250		140	N/A	N/A	N/A
HC65000250_04945276802	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04948334001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04948348110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04948368703	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04970222813	NONCDM CHARGE RECORD PHARMACY	250		430	N/A	N/A	N/A
HC65000250_04988412205	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04988428901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04988432055	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04988446565	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_04988498401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05011132703	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05011132803	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05011133402	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05011148301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05011164701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05011178751	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0	N/A	N/A	N/A
HC65000250_05011191501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05011191801	NONCDM CHARGE RECORD PHARMACY	250	Z7610	13	N/A	N/A	N/A
HC65000250_05019014263	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05022842360	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05022846501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026806730	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026808815	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65000250_05026809515	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026811015	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026812711	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05026812715	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05026814013	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_05026815215	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026817913	NONCDM CHARGE RECORD PHARMACY	250		38	N/A	N/A	N/A
HC65000250_05026821715	NONCDM CHARGE RECORD PHARMACY	250	Z7610	13	N/A	N/A	N/A
HC65000250_05026826915	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026828615	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_05026829715	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_05026830315	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026831415	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05026833915	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_05026835115	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05026836215	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026840015	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_05026841215	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_05026844715	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05026847013	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_05026850515	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026852415	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026853415	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026856315	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05026857415	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05026858315	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026859415	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026859515	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026859815	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_05026860315	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026862415	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_05026863015	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026863315	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026864615	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05026866615	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026867113	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05026868415	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026868715	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026870215	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026872815	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026874015	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026875615	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026876515	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05026878712	NONCDM CHARGE RECORD PHARMACY	250		556	N/A	N/A	N/A
HC65000250_05026881615	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026885515	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026886315	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026886715	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05028942001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05038304248	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05038306312	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05038308712	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05038323210	NONCDM CHARGE RECORD PHARMACY	250		227	N/A	N/A	N/A
HC65000250_05038328616	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65000250_05038333913	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_05038366730	NONCDM CHARGE RECORD PHARMACY	250		225	N/A	N/A	N/A
HC65000250_05038377111	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4	N/A	N/A	N/A
HC65000250_05038377504	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05038377517	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05038377931	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05038380416	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05038391750	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05038396608	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_05045814130	NONCDM CHARGE RECORD PHARMACY	250		120	N/A	N/A	N/A
HC65000250_05045857910	NONCDM CHARGE RECORD PHARMACY	250		110	N/A	N/A	N/A
HC65000250_05045858010	NONCDM CHARGE RECORD PHARMACY	250		110	N/A	N/A	N/A
HC65000250_05045858030	NONCDM CHARGE RECORD PHARMACY	250		111	N/A	N/A	N/A
HC65000250_05045859601	NONCDM CHARGE RECORD PHARMACY	250		83	N/A	N/A	N/A
HC65000250_05045882002	NONCDM CHARGE RECORD PHARMACY	250		50	N/A	N/A	N/A
HC65000250_05047457066	NONCDM CHARGE RECORD PHARMACY	250		132	N/A	N/A	N/A
HC65000250_05058045711	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05058053408	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05074211301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05074218130	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05074223301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05074226001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05074250524	NONCDM CHARGE RECORD PHARMACY	250		117	N/A	N/A	N/A
HC65000250_05074261601	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05107902420	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_05107907420	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107909303	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_05107911820	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_05107914220	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107917020	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05107920520	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05107927303	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_05107929920	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107934820	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_05107938620	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_05107939120	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05107941820	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107943720	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05107944220	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05107944520	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107945820	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107952720	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107958205	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_05107963020	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_05107964420	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107969020	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05107973420	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05107975320	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05107976708	NONCDM CHARGE RECORD PHARMACY	250	Z7610	16	N/A	N/A	N/A
HC65000250_05107978920	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107981120	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107982120	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107988820	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05107992320	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05107992820	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05107993220	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107994320	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05107996620	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107997920	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05107999120	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05122400750	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05122410750	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05129362801	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05129382001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05152504708	NONCDM CHARGE RECORD PHARMACY	250	Z7610	68	N/A	N/A	N/A
HC65000250_05155200556	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_05155200699	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05155202109	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65000250_05155213451	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05166072411	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05167212752	NONCDM CHARGE RECORD PHARMACY	250	Z7610	144	N/A	N/A	N/A
HC65000250_05167212891	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65000250_05167220021	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_05167220036	NONCDM CHARGE RECORD PHARMACY	250	Z7610	26	N/A	N/A	N/A
HC65000250_05167220102	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_05167220751	NONCDM CHARGE RECORD PHARMACY	250	Z7610	21	N/A	N/A	N/A
HC65000250_05167221142	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05167240011	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05167240291	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05167241334	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05175450015	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05180101130	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05180101330	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05186245304	NONCDM CHARGE RECORD PHARMACY	250		86	N/A	N/A	N/A
HC65000250_05186285601	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05199134906	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_05199187733	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_05224410010	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_05237602102	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_05238012724	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65000250_05253618003	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_05256508515	NONCDM CHARGE RECORD PHARMACY	250		257	N/A	N/A	N/A
HC65000250_05265240011	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_05281718110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05281732510	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05281781508	NONCDM CHARGE RECORD PHARMACY	250		276	N/A	N/A	N/A
HC65000250_05332901311	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_05332993913	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_05332994675	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05348912002	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05348914401	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05348964801	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65000250_05374651105	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05374654401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05374657201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05374664201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05409218981	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_05416219016	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05448214801	NONCDM CHARGE RECORD PHARMACY	250	Z7610	17	N/A	N/A	N/A
HC65000250_05483800650	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05483820980	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05483852340	NONCDM CHARGE RECORD PHARMACY	250	Z7610	11	N/A	N/A	N/A
HC65000250_05493250181	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05511118015	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511123105	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511126281	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_05511132001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511134301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511146701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05511159490	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05511173001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511179630	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05515016102	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05551307330	NONCDM CHARGE RECORD PHARMACY	250		175	N/A	N/A	N/A
HC65000250_05618412105	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_05633100616	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_05723701890	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05723703101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05723704230	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05723704960	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05723707710	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05723712201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05723717201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05723722301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05766411788	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05766447451	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05766476113	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05784113013	NONCDM CHARGE RECORD PHARMACY	250		82	N/A	N/A	N/A
HC65000250_05789610201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789611314	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789620110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789630401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789645101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789645501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789655501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789678016	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789686406	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789690110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789698101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05846801301	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_05860277321	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05865731216	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_05865750508	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05865752804	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05865767501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05891401460	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05891421460	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05898001205	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_05901141010	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_05901141520	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65000250_05901142020	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65000250_05901642019	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05921224955	NONCDM CHARGE RECORD PHARMACY	250		97	N/A	N/A	N/A
HC65000250_05965102655	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_05965111860	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_05965129960	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05967656630	NONCDM CHARGE RECORD PHARMACY	250		416	N/A	N/A	N/A
HC65000250_05974611306	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05974630632	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05974638306	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05976200161	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_05976200741	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05976202601	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_05976205312	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05976207072	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_05976210611	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05976212061	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05976213081	NONCDM CHARGE RECORD PHARMACY	250		420	N/A	N/A	N/A
HC65000250_05976217102	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_05976231201	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_05976233281	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05976237211	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05976250071	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05976250081	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05976250082	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05976250501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06025800601	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06043203732	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06043209216	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_06043212916	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06043226415	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06043253716	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06043260416	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06043262116	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06050501420	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06050502471	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050504025	NONCDM CHARGE RECORD PHARMACY	250		101	N/A	N/A	N/A
HC65000250_06050508291	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06050525789	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06050525799	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050526561	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050531100	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06050531707	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06050532750	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06050545029	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050547133	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_06050562022	NONCDM CHARGE RECORD PHARMACY	250		43	N/A	N/A	N/A
HC65000250_06050562261	NONCDM CHARGE RECORD PHARMACY	250		296	N/A	N/A	N/A
HC65000250_06050570812	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_06050570842	NONCDM CHARGE RECORD PHARMACY	250		126	N/A	N/A	N/A
HC65000250_06068711221	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06068712765	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_06068715201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068716301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068717801	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068717901	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65000250_06068718821	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_06068721001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068721701	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068723001	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068724967	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_06068725601	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068728201	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06068728621	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65000250_06068730225	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_06068731725	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06068732865	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_06068734501	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068735501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068736801	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068737001	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068738001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068738621	NONCDM CHARGE RECORD PHARMACY	250		64	N/A	N/A	N/A
HC65000250_06068739001	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06068739583	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068740925	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068742321	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_06068742501	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06068742865	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06068743301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068743901	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068744867	NONCDM CHARGE RECORD PHARMACY	250	Z7610	54	N/A	N/A	N/A
HC65000250_06068745701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068746401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068747301	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068747601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068748401	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068748801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068749301	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06068749701	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068750525	NONCDM CHARGE RECORD PHARMACY	250		173	N/A	N/A	N/A
HC65000250_06068751901	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068752721	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_06068753601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	18	N/A	N/A	N/A
HC65000250_06068753821	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_06068755001	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068755632	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_06068756201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068757001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068757686	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_06068758121	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068758501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068758601	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06068759301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068759801	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068761221	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068762921	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06068763601	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068764201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068765121	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_06068765621	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068765711	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068767657	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_06075818805	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_06075880205	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_06126932560	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06131401601	NONCDM CHARGE RECORD PHARMACY	250		227	N/A	N/A	N/A
HC65000250_06131414310	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_06131420415	NONCDM CHARGE RECORD PHARMACY	250	Z7610	524	N/A	N/A	N/A
HC65000250_06131422705	NONCDM CHARGE RECORD PHARMACY	250		63	N/A	N/A	N/A
HC65000250_06131435502	NONCDM CHARGE RECORD PHARMACY	250		103	N/A	N/A	N/A
HC65000250_06131463006	NONCDM CHARGE RECORD PHARMACY	250		123	N/A	N/A	N/A
HC65000250_06131466505	NONCDM CHARGE RECORD PHARMACY	250	Z7610	418	N/A	N/A	N/A
HC65000250_06144212601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06157013155	NONCDM CHARGE RECORD PHARMACY	250		81	N/A	N/A	N/A
HC65000250_06174801206	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_06174802416	NONCDM CHARGE RECORD PHARMACY	250	Z7610	13	N/A	N/A	N/A
HC65000250_06195804011	NONCDM CHARGE RECORD PHARMACY	250	Z7610	272	N/A	N/A	N/A
HC65000250_06195810031	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65000250_06203756005	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06203783001	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06213519222	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06217511937	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06217526037	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06217526237	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06233200131	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06233203231	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06233206130	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_06233212090	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06233224671	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06233236506	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06237263015	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_06254230104	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06255915710	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06255923001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06255972101	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_06255982101	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06258426501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06258469321	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_06258473401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06258499401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06275614586	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06275625802	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06275651888	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06275671186	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06285658252	NONCDM CHARGE RECORD PHARMACY	250	Z7610	86	N/A	N/A	N/A
HC65000250_06330401760	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06330446050	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06330469201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06332306403	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_06332308950	NONCDM CHARGE RECORD PHARMACY	250	Z7610	79	N/A	N/A	N/A
HC65000250_06332317015	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_06332340703	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_06332349227	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06332349237	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_06332369210	NONCDM CHARGE RECORD PHARMACY	250		79	N/A	N/A	N/A
HC65000250_06332373820	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06340230410	NONCDM CHARGE RECORD PHARMACY	250		292	N/A	N/A	N/A
HC65000250_06340251001	NONCDM CHARGE RECORD PHARMACY	250		444	N/A	N/A	N/A
HC65000250_06345940430	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0	N/A	N/A	N/A
HC65000250_06371301972	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_06371301974	NONCDM CHARGE RECORD PHARMACY	250		178	N/A	N/A	N/A
HC65000250_06373612002	NONCDM CHARGE RECORD PHARMACY	250		55	N/A	N/A	N/A
HC65000250_06373901610	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373907710	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06373909810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373915710	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_06373916070	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06373921202	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373923610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373925340	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06373932710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373935810	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373940310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373941510	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06373943402	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373947910	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373948310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373952610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373954833	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_06373956410	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06373957010	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373957310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373967310	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373968610	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373969810	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06373978710	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06373988810	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06373990410	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373996940	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373998410	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06382400815	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06382405632	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06382405634	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06382471316	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06386828225	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_06438071206	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06438075906	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06438083406	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06476408060	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65000250_06476454311	NONCDM CHARGE RECORD PHARMACY	250		90	N/A	N/A	N/A
HC65000250_06476472030	NONCDM CHARGE RECORD PHARMACY	250		95	N/A	N/A	N/A
HC65000250_06476491830	NONCDM CHARGE RECORD PHARMACY	250		72	N/A	N/A	N/A
HC65000250_06489666401	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_06498014612	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06498033901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06498051305	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_06516205827	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06516208774	NONCDM CHARGE RECORD PHARMACY	250		149	N/A	N/A	N/A
HC65000250_06516218810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516219010	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516235109	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516244110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516246450	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516246610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516257210	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06516259606	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06516262710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516263709	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516268110	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06516269179	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06516273509	NONCDM CHARGE RECORD PHARMACY	250	Z7610	18	N/A	N/A	N/A
HC65000250_06516275310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516283703	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06562801610	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_06562807005	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_06564930103	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_06564931112	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06586200801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586201901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586204824	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06586206399	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586207101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06586207601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586211701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586214905	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586218730	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586219399	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586220290	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586221150	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06586221901	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06586222660	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06586235730	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586237501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06586244830	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06586247501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586251230	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586252201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586253401	NONCDM CHARGE RECORD PHARMACY	250	Z7610	17	N/A	N/A	N/A
HC65000250_06586253750	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06586257030	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_06586259601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	27	N/A	N/A	N/A
HC65000250_06586262201	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06586266230	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06586267201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06586270780	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06586275360	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_06586283030	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06586290901	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06586293630	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06655300101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06655300801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06668900450	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_06668900802	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65000250_06668902350	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_06668903799	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06668905699	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06668910810	NONCDM CHARGE RECORD PHARMACY	250		387	N/A	N/A	N/A
HC65000250_06668920308	NONCDM CHARGE RECORD PHARMACY	250		195	N/A	N/A	N/A
HC65000250_06668940316	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06668977508	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06668979050	NONCDM CHARGE RECORD PHARMACY	250		67	N/A	N/A	N/A
HC65000250_06686910490	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_06699383102	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65000250_06745718120	NONCDM CHARGE RECORD PHARMACY	250	J3490	19	N/A	N/A	N/A
HC65000250_06754611114	NONCDM CHARGE RECORD PHARMACY	250		942	N/A	N/A	N/A
HC65000250_06761830050	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787711601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787712420	NONCDM CHARGE RECORD PHARMACY	250		38	N/A	N/A	N/A
HC65000250_06787712485	NONCDM CHARGE RECORD PHARMACY	250	Z7610	143	N/A	N/A	N/A
HC65000250_06787719790	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787719905	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787722310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787728660	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06787732005	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787748330	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06787754360	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06787754888	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787757305	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787774601	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65000250_06800147748	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808404101	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06808407001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_06808409301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808409701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808409801	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808410701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808410901	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06808412801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808417521	NONCDM CHARGE RECORD PHARMACY	250		64	N/A	N/A	N/A
HC65000250_06808420201	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808420501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808421521	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_06808422001	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808424301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808425221	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_06808425501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808428001	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06808428401	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06808429521	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06808431301	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808431901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808432821	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_06808434401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808435401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808436601	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06808439665	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06808444401	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808444701	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_06808447901	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06808449101	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808451201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808454921	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_06808459201	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808460321	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_06808460621	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06808461701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808462121	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_06808465401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06808468301	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06808469801	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808471001	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06808472801	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06808473501	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_06808473701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808474825	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06808476521	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808478201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808480801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808484301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808484701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808485601	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808486801	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808488201	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_06808491231	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06808496525	NONCDM CHARGE RECORD PHARMACY	250		276	N/A	N/A	N/A
HC65000250_06809400762	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_06809403062	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_06809406162	NONCDM CHARGE RECORD PHARMACY	250	Z7610	12	N/A	N/A	N/A
HC65000250_06809419359	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06809425062	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_06809450359	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06809460061	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06809476462	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65000250_06817600011	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06818015001	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_06818028101	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06818037603	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818044101	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06818046901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06818056601	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06818065701	NONCDM CHARGE RECORD PHARMACY	250		38	N/A	N/A	N/A
HC65000250_06818065907	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_06818067801	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_06818084071	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_06818096301	NONCDM CHARGE RECORD PHARMACY	250	Z7610	234	N/A	N/A	N/A
HC65000250_06818096509	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06818096701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818096909	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06818097301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818098003	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838200514	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06838203516	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06838209201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838209405	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838212216	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_06838214406	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06838222705	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06838225601	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06838244405	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_06838247178	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06838247278	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06838252501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06838277277	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65000250_06838277316	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06838280601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838285701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846212701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846213001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846213701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846215713	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06846218117	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65000250_06846219913	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06846222901	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06846225301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846226001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846227501	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06846229301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846231417	NONCDM CHARGE RECORD PHARMACY	250		136	N/A	N/A	N/A
HC65000250_06846233290	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846235705	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846242169	NONCDM CHARGE RECORD PHARMACY	250		241	N/A	N/A	N/A
HC65000250_06846243790	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846257330	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_06846267860	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846280701	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06858500575	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06885001202	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06909712303	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06909716887	NONCDM CHARGE RECORD PHARMACY	250		122	N/A	N/A	N/A
HC65000250_06909741002	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06909764202	NONCDM CHARGE RECORD PHARMACY	250		100	N/A	N/A	N/A
HC65000250_06909783402	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06909784607	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06923810541	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06923811005	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06923811261	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06923812736	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06923815031	NONCDM CHARGE RECORD PHARMACY	250		79	N/A	N/A	N/A
HC65000250_06923815325	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_06923815343	NONCDM CHARGE RECORD PHARMACY	250		190	N/A	N/A	N/A
HC65000250_06923815401	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06923817468	NONCDM CHARGE RECORD PHARMACY	250		419	N/A	N/A	N/A
HC65000250_06929256401	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06931513701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06931530802	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_06931590510	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06933915019	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06936722001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06945213117	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06945215673	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06945222384	NONCDM CHARGE RECORD PHARMACY	250		115	N/A	N/A	N/A
HC65000250_06954337410	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06958411110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06961800858	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_06961803301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06961806610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06978418010	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06978463025	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1,184	N/A	N/A	N/A
HC65000250_06991856030	NONCDM CHARGE RECORD PHARMACY	250		101	N/A	N/A	N/A
HC65000250_07001006501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07001049201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07001075405	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07001077001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07006913101	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_07006923101	NONCDM CHARGE RECORD PHARMACY	250		64	N/A	N/A	N/A
HC65000250_07015610501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07040823932	NONCDM CHARGE RECORD PHARMACY	250		635	N/A	N/A	N/A
HC65000250_07048217060	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_07067700531	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_07067700581	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07067700681	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07067701452	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07071011373	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07074812906	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_07075217110	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_07075672111	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_07095402110	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_07095413620	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_07095421210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07095445510	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07124712601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07135101312	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_07139975045	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_07174011230	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_07214003147	NONCDM CHARGE RECORD PHARMACY	250	Z7610	72	N/A	N/A	N/A
HC65000250_07214045231	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_07220501290	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07220504411	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_07230511230	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_07257800201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07278909401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07288803505	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07288805201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_07330245601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	126	N/A	N/A	N/A
HC65000250_07375009105	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_07431201380	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07431229176	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07583401060	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07583415901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07583420501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07583425701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07620410001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07620460001	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_07628221490	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07628257190	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07632963005	NONCDM CHARGE RECORD PHARMACY	250		165	N/A	N/A	N/A
HC65000250_07638512350	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07638888025	NONCDM CHARGE RECORD PHARMACY	250		100	N/A	N/A	N/A
HC65000250_07733330810	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07733371510	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07733383110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07733393710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07733395110	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07811201104	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_07820612101	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_07985495010	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068100400	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068104100	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068107100	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068109900	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068113500	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068115900	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08103300240	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_08137003600	NONCDM CHARGE RECORD PHARMACY	250	Z7610	41	N/A	N/A	N/A
HC65000250_08142102004	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08208910234	NONCDM CHARGE RECORD PHARMACY	250		693	N/A	N/A	N/A
HC65000250_08290236850	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08290306547	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_08380007906	NONCDM CHARGE RECORD PHARMACY	250		50	N/A	N/A	N/A
HC65000250_08770140754	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_09999903368	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_54629056001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000255	MEDICATION-RADIOLOGY	255		N/A	N/A	N/A	N/A
HC65000259	MEDICATION-INVESTIGATIONAL	259		N/A	N/A	N/A	N/A
HC65000259_07777700131	NONCDM CHARGE RECORD PHARMACY	259	J9271	0	N/A	N/A	N/A
HC65000272	SUPPLY GENERAL- PHARMACY (NO NDC)	272		21	N/A	N/A	N/A
HC65000344	MEDICATION-THERAPEUTIC	344		N/A	N/A	N/A	N/A
HC65000636	DRUG - DETAILED CODING	636		N/A	N/A	N/A	N/A
HC65000636_00002759701	NONCDM CHARGE RECORD PHARMACY	636	J2358	28	N/A	N/A	N/A
HC65000636_00002771559	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000636_00003029305	NONCDM CHARGE RECORD PHARMACY	636	J3301	15	N/A	N/A	N/A
HC65000636_00003049420	NONCDM CHARGE RECORD PHARMACY	636	J3301	16	N/A	N/A	N/A
HC65000636_00003232822	NONCDM CHARGE RECORD PHARMACY	636	J9228	1,005	N/A	N/A	N/A
HC65000636_00003373413	NONCDM CHARGE RECORD PHARMACY	636	J9299	174	N/A	N/A	N/A
HC65000636_00003377412	NONCDM CHARGE RECORD PHARMACY	636	J9299	186	N/A	N/A	N/A
HC65000636_00006302602	NONCDM CHARGE RECORD PHARMACY	636	J9271	328	N/A	N/A	N/A
HC65000636_00006412102	NONCDM CHARGE RECORD PHARMACY	636	90649	1,643	N/A	N/A	N/A
HC65000636_00006483703	NONCDM CHARGE RECORD PHARMACY	636	90732	725	N/A	N/A	N/A
HC65000636_00006494300	NONCDM CHARGE RECORD PHARMACY	636	90732	761	N/A	N/A	N/A
HC65000636_00006542312	NONCDM CHARGE RECORD PHARMACY	636	C9399	778	N/A	N/A	N/A
HC65000636_00008451001	NONCDM CHARGE RECORD PHARMACY	636	J9203	2,777	N/A	N/A	N/A
HC65000636_00009001305	NONCDM CHARGE RECORD PHARMACY	636	J1720	57	N/A	N/A	N/A
HC65000636_00009001820	NONCDM CHARGE RECORD PHARMACY	636	J2930	51	N/A	N/A	N/A
HC65000636_00009004722	NONCDM CHARGE RECORD PHARMACY	636	J2930	61	N/A	N/A	N/A
HC65000636_00009008510	NONCDM CHARGE RECORD PHARMACY	636	J1071	0	N/A	N/A	N/A
HC65000636_00009028301	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,049	N/A	N/A	N/A
HC65000636_00009034702	NONCDM CHARGE RECORD PHARMACY	636	J1071	1	N/A	N/A	N/A
HC65000636_00009043601	NONCDM CHARGE RECORD PHARMACY	636	J7999	520	N/A	N/A	N/A
HC65000636_00009075801	NONCDM CHARGE RECORD PHARMACY	636	J2920	38	N/A	N/A	N/A
HC65000636_00009085608	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,315	N/A	N/A	N/A
HC65000636_00009307301	NONCDM CHARGE RECORD PHARMACY	636	J1030	2	N/A	N/A	N/A
HC65000636_00009316906	NONCDM CHARGE RECORD PHARMACY	636	J0270	19	N/A	N/A	N/A
HC65000636_00009514004	NONCDM CHARGE RECORD PHARMACY	636	J2020	139	N/A	N/A	N/A
HC65000636_00013111415	NONCDM CHARGE RECORD PHARMACY	636	J3490	196	N/A	N/A	N/A
HC65000636_00019095309	NONCDM CHARGE RECORD PHARMACY	636	Q9966	2	N/A	N/A	N/A
HC65000636_00024279210	NONCDM CHARGE RECORD PHARMACY	636	J2916	41	N/A	N/A	N/A
HC65000636_00024586001	NONCDM CHARGE RECORD PHARMACY	636	J9027	1,106	N/A	N/A	N/A
HC65000636_00026394825	NONCDM CHARGE RECORD PHARMACY	636	J7208	16	N/A	N/A	N/A
HC65000636_00049001383	NONCDM CHARGE RECORD PHARMACY	636	J0295	50	N/A	N/A	N/A
HC65000636_00049052022	NONCDM CHARGE RECORD PHARMACY	636	J2540	9	N/A	N/A	N/A
HC65000636_00049053028	NONCDM CHARGE RECORD PHARMACY	636	J2540	10	N/A	N/A	N/A
HC65000636_00049319028	NONCDM CHARGE RECORD PHARMACY	636	J3465	74	N/A	N/A	N/A
HC65000636_00053768033	NONCDM CHARGE RECORD PHARMACY	636	P9047	585	N/A	N/A	N/A
HC65000636_00054001820	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_00054016325	NONCDM CHARGE RECORD PHARMACY	636	Z7610	4	N/A	N/A	N/A
HC65000636_00054317763	NONCDM CHARGE RECORD PHARMACY	636	J8540	1	N/A	N/A	N/A
HC65000636_00054372263	NONCDM CHARGE RECORD PHARMACY	636	J7512	4	N/A	N/A	N/A
HC65000636_00054418225	NONCDM CHARGE RECORD PHARMACY	636	J8540	0	N/A	N/A	N/A
HC65000636_00054418425	NONCDM CHARGE RECORD PHARMACY	636	J8540	1	N/A	N/A	N/A
HC65000636_00054472825	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_00054817425	NONCDM CHARGE RECORD PHARMACY	636	J8540	1	N/A	N/A	N/A
HC65000636_00054817925	NONCDM CHARGE RECORD PHARMACY	636	J8540	1	N/A	N/A	N/A
HC65000636_00054872425	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_00065009265	NONCDM CHARGE RECORD PHARMACY	636	J3490	313	N/A	N/A	N/A
HC65000636_00068059901	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,161	N/A	N/A	N/A
HC65000636_00069023420	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_00069024810	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_00069024901	NONCDM CHARGE RECORD PHARMACY	636	Q5119	466	N/A	N/A	N/A
HC65000636_00069030501	NONCDM CHARGE RECORD PHARMACY	636	Q5116	520	N/A	N/A	N/A
HC65000636_00069032401	NONCDM CHARGE RECORD PHARMACY	636	Q5122	2,126	N/A	N/A	N/A
HC65000636_00069108530	NONCDM CHARGE RECORD PHARMACY	636	C9399	0	N/A	N/A	N/A
HC65000636_00069130710	NONCDM CHARGE RECORD PHARMACY	636	Q5106	72	N/A	N/A	N/A
HC65000636_00069131110	NONCDM CHARGE RECORD PHARMACY	636	Q5106	72	N/A	N/A	N/A
HC65000636_00069303220	NONCDM CHARGE RECORD PHARMACY	636	J9000	32	N/A	N/A	N/A
HC65000636_00069547102	NONCDM CHARGE RECORD PHARMACY	636	Q2009	86	N/A	N/A	N/A
HC65000636_00069600121	NONCDM CHARGE RECORD PHARMACY	636	J3490	91	N/A	N/A	N/A
HC65000636_00074228203	NONCDM CHARGE RECORD PHARMACY	636	J1950	0	N/A	N/A	N/A
HC65000636_00074364203	NONCDM CHARGE RECORD PHARMACY	636	J9217	11,910	N/A	N/A	N/A
HC65000636_00074379902	NONCDM CHARGE RECORD PHARMACY	636	J0135	9,099	N/A	N/A	N/A
HC65000636_00074437805	NONCDM CHARGE RECORD PHARMACY	636	J3490	377	N/A	N/A	N/A
HC65000636_00074438220	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,930	N/A	N/A	N/A
HC65000636_00075062160	NONCDM CHARGE RECORD PHARMACY	636	J1650	35	N/A	N/A	N/A
HC65000636_00078024615	NONCDM CHARGE RECORD PHARMACY	636	J7515	15	N/A	N/A	N/A
HC65000636_00078024815	NONCDM CHARGE RECORD PHARMACY	636	J7502	61	N/A	N/A	N/A
HC65000636_00078043561	NONCDM CHARGE RECORD PHARMACY	636	J3489	0	N/A	N/A	N/A
HC65000636_00078081881	NONCDM CHARGE RECORD PHARMACY	636	J2353	1,386	N/A	N/A	N/A
HC65000636_00085300403	NONCDM CHARGE RECORD PHARMACY	636	J8700	0	N/A	N/A	N/A
HC65000636_00088221905	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000636_00093901865	NONCDM CHARGE RECORD PHARMACY	636	J7515	7	N/A	N/A	N/A
HC65000636_00143908401	NONCDM CHARGE RECORD PHARMACY	636	J9000	45	N/A	N/A	N/A
HC65000636_00143921010	NONCDM CHARGE RECORD PHARMACY	636	J2400	59	N/A	N/A	N/A
HC65000636_00143923305	NONCDM CHARGE RECORD PHARMACY	636	J0515	146	N/A	N/A	N/A
HC65000636_00143924701	NONCDM CHARGE RECORD PHARMACY	636	J1190	1,672	N/A	N/A	N/A
HC65000636_00143926110	NONCDM CHARGE RECORD PHARMACY	636	J0690	28	N/A	N/A	N/A
HC65000636_00143928001	NONCDM CHARGE RECORD PHARMACY	636	J9280	1,027	N/A	N/A	N/A
HC65000636_00143929910	NONCDM CHARGE RECORD PHARMACY	636	J1570	445	N/A	N/A	N/A
HC65000636_00143937510	NONCDM CHARGE RECORD PHARMACY	636	J3105	9	N/A	N/A	N/A
HC65000636_00143938401	NONCDM CHARGE RECORD PHARMACY	636	J1453	3	N/A	N/A	N/A
HC65000636_00143950301	NONCDM CHARGE RECORD PHARMACY	636	J1120	282	N/A	N/A	N/A
HC65000636_00143951910	NONCDM CHARGE RECORD PHARMACY	636	J9260	12	N/A	N/A	N/A
HC65000636_00143953101	NONCDM CHARGE RECORD PHARMACY	636	J9208	239	N/A	N/A	N/A
HC65000636_00143955110	NONCDM CHARGE RECORD PHARMACY	636	J9150	382	N/A	N/A	N/A
HC65000636_00143955501	NONCDM CHARGE RECORD PHARMACY	636	J0640	65	N/A	N/A	N/A
HC65000636_00143957010	NONCDM CHARGE RECORD PHARMACY	636	J2916	41	N/A	N/A	N/A
HC65000636_00143958301	NONCDM CHARGE RECORD PHARMACY	636	J9206	26	N/A	N/A	N/A
HC65000636_00143959525	NONCDM CHARGE RECORD PHARMACY	636	J2001	3	N/A	N/A	N/A
HC65000636_00143962201	NONCDM CHARGE RECORD PHARMACY	636	J3490	6	N/A	N/A	N/A
HC65000636_00143965901	NONCDM CHARGE RECORD PHARMACY	636	J1071	1	N/A	N/A	N/A
HC65000636_00143968910	NONCDM CHARGE RECORD PHARMACY	636	J3490	320	N/A	N/A	N/A
HC65000636_00143971010	NONCDM CHARGE RECORD PHARMACY	636	J2260	24	N/A	N/A	N/A
HC65000636_00143972124	NONCDM CHARGE RECORD PHARMACY	636	J1956	20	N/A	N/A	N/A
HC65000636_00143974410	NONCDM CHARGE RECORD PHARMACY	636	J1626	6	N/A	N/A	N/A
HC65000636_00143985101	NONCDM CHARGE RECORD PHARMACY	636	J2920	22	N/A	N/A	N/A
HC65000636_00143985825	NONCDM CHARGE RECORD PHARMACY	636	J0696	4	N/A	N/A	N/A
HC65000636_00143987101	NONCDM CHARGE RECORD PHARMACY	636	J3490	768	N/A	N/A	N/A
HC65000636_00143987525	NONCDM CHARGE RECORD PHARMACY	636	J0282	3	N/A	N/A	N/A
HC65000636_00169701301	NONCDM CHARGE RECORD PHARMACY	636	J7181	10	N/A	N/A	N/A
HC65000636_00169720501	NONCDM CHARGE RECORD PHARMACY	636	J7189	16	N/A	N/A	N/A
HC65000636_00173088101	NONCDM CHARGE RECORD PHARMACY	636	J2182	103	N/A	N/A	N/A
HC65000636_00206885910	NONCDM CHARGE RECORD PHARMACY	636	J3490	69	N/A	N/A	N/A
HC65000636_00264194020	NONCDM CHARGE RECORD PHARMACY	636		1	N/A	N/A	N/A
HC65000636_00264315311	NONCDM CHARGE RECORD PHARMACY	636	J0696	28	N/A	N/A	N/A
HC65000636_00264405080	NONCDM CHARGE RECORD PHARMACY	636	J0131	1	N/A	N/A	N/A
HC65000636_00264570510	NONCDM CHARGE RECORD PHARMACY	636	J1644	3	N/A	N/A	N/A
HC65000636_00264785000	NONCDM CHARGE RECORD PHARMACY	636		911	N/A	N/A	N/A
HC65000636_00264959820	NONCDM CHARGE RECORD PHARMACY	636	J2001	0	N/A	N/A	N/A
HC65000636_00270014960	NONCDM CHARGE RECORD PHARMACY	636	Q9958	2	N/A	N/A	N/A
HC65000636_00270055615	NONCDM CHARGE RECORD PHARMACY	636	J2805	503	N/A	N/A	N/A
HC65000636_00270141125	NONCDM CHARGE RECORD PHARMACY	636	Q9966	29	N/A	N/A	N/A
HC65000636_00310072010	NONCDM CHARGE RECORD PHARMACY	636	J9395	603	N/A	N/A	N/A
HC65000636_00310183030	NONCDM CHARGE RECORD PHARMACY	636	J0157	580	N/A	N/A	N/A
HC65000636_00338001304	NONCDM CHARGE RECORD PHARMACY	636		596	N/A	N/A	N/A
HC65000636_00338007225	NONCDM CHARGE RECORD PHARMACY	636	J1885	6	N/A	N/A	N/A
HC65000636_00338042418	NONCDM CHARGE RECORD PHARMACY	636	J1644	30	N/A	N/A	N/A
HC65000636_00338051141	NONCDM CHARGE RECORD PHARMACY	636	J1580	3	N/A	N/A	N/A
HC65000636_00338070548	NONCDM CHARGE RECORD PHARMACY	636	J3480	3	N/A	N/A	N/A
HC65000636_00338100703	NONCDM CHARGE RECORD PHARMACY	636	J1265	7	N/A	N/A	N/A
HC65000636_00338102541	NONCDM CHARGE RECORD PHARMACY	636	J2540	14	N/A	N/A	N/A
HC65000636_00338170940	NONCDM CHARGE RECORD PHARMACY	636	J3475	21	N/A	N/A	N/A
HC65000636_00338358301	NONCDM CHARGE RECORD PHARMACY	636	J3370	71	N/A	N/A	N/A
HC65000636_00338399301	NONCDM CHARGE RECORD PHARMACY	636	J9208	119	N/A	N/A	N/A
HC65000636_00338955324	NONCDM CHARGE RECORD PHARMACY	636	J3490	29	N/A	N/A	N/A
HC65000636_00407141220	NONCDM CHARGE RECORD PHARMACY	636	Q9965	15	N/A	N/A	N/A
HC65000636_00407141351	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407141363	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407141365	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407141386	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407141451	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407141486	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407141493	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407222301	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_00407222304	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407222317	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_00407222319	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407222364	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_00409021201	NONCDM CHARGE RECORD PHARMACY	636	J2260	29	N/A	N/A	N/A
HC65000636_00409032320	NONCDM CHARGE RECORD PHARMACY	636	J9040	161	N/A	N/A	N/A
HC65000636_00409082901	NONCDM CHARGE RECORD PHARMACY	636	J3490	187	N/A	N/A	N/A
HC65000636_00409104130	NONCDM CHARGE RECORD PHARMACY	636	J0670	12	N/A	N/A	N/A
HC65000636_00409113403	NONCDM CHARGE RECORD PHARMACY	636	J2270	1	N/A	N/A	N/A
HC65000636_00409117630	NONCDM CHARGE RECORD PHARMACY	636	J2175	40	N/A	N/A	N/A
HC65000636_00409120703	NONCDM CHARGE RECORD PHARMACY	636	J1580	8	N/A	N/A	N/A
HC65000636_00409121901	NONCDM CHARGE RECORD PHARMACY	636	J2310	193	N/A	N/A	N/A
HC65000636_00409128331	NONCDM CHARGE RECORD PHARMACY	636	J1170	17	N/A	N/A	N/A
HC65000636_00409131632	NONCDM CHARGE RECORD PHARMACY	636	J1644	4	N/A	N/A	N/A
HC65000636_00409132305	NONCDM CHARGE RECORD PHARMACY	636	J2001	2	N/A	N/A	N/A
HC65000636_00409139122	NONCDM CHARGE RECORD PHARMACY	636	J2185	13	N/A	N/A	N/A
HC65000636_00409146301	NONCDM CHARGE RECORD PHARMACY	636	J2300	24	N/A	N/A	N/A
HC65000636_00409166010	NONCDM CHARGE RECORD PHARMACY	636	J3490	551	N/A	N/A	N/A
HC65000636_00409166020	NONCDM CHARGE RECORD PHARMACY	636	J3490	172	N/A	N/A	N/A
HC65000636_00409166050	NONCDM CHARGE RECORD PHARMACY	636	J3490	287	N/A	N/A	N/A
HC65000636_00409189023	NONCDM CHARGE RECORD PHARMACY	636	J2270	26	N/A	N/A	N/A
HC65000636_00409189301	NONCDM CHARGE RECORD PHARMACY	636	J2270	12	N/A	N/A	N/A
HC65000636_00409206605	NONCDM CHARGE RECORD PHARMACY	636	J2001	2	N/A	N/A	N/A
HC65000636_00409226754	NONCDM CHARGE RECORD PHARMACY	636	J3490	5	N/A	N/A	N/A
HC65000636_00409230801	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_00409233725	NONCDM CHARGE RECORD PHARMACY	636	J0895	45	N/A	N/A	N/A
HC65000636_00409234401	NONCDM CHARGE RECORD PHARMACY	636	J1250	39	N/A	N/A	N/A
HC65000636_00409234732	NONCDM CHARGE RECORD PHARMACY	636	J1250	41	N/A	N/A	N/A
HC65000636_00409259605	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_00409272001	NONCDM CHARGE RECORD PHARMACY	636	J1644	12	N/A	N/A	N/A
HC65000636_00409272101	NONCDM CHARGE RECORD PHARMACY	636	J1644	3	N/A	N/A	N/A
HC65000636_00409336510	NONCDM CHARGE RECORD PHARMACY	636	J1170	3	N/A	N/A	N/A
HC65000636_00409339004	NONCDM CHARGE RECORD PHARMACY	636	J2543	35	N/A	N/A	N/A
HC65000636_00409379301	NONCDM CHARGE RECORD PHARMACY	636	J1885	19	N/A	N/A	N/A
HC65000636_00409381412	NONCDM CHARGE RECORD PHARMACY	636	J2274	7	N/A	N/A	N/A
HC65000636_00409409001	NONCDM CHARGE RECORD PHARMACY	636		766	N/A	N/A	N/A
HC65000636_00409427601	NONCDM CHARGE RECORD PHARMACY	636	J2001	0	N/A	N/A	N/A
HC65000636_00409427702	NONCDM CHARGE RECORD PHARMACY	636	J2001	0	N/A	N/A	N/A
HC65000636_00409428202	NONCDM CHARGE RECORD PHARMACY	636	J2001	2	N/A	N/A	N/A
HC65000636_00409468812	NONCDM CHARGE RECORD PHARMACY	636	J1450	30	N/A	N/A	N/A
HC65000636_00409469933	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_00409471332	NONCDM CHARGE RECORD PHARMACY	636	J2001	5	N/A	N/A	N/A
HC65000636_00409477601	NONCDM CHARGE RECORD PHARMACY	636	J2001	4	N/A	N/A	N/A
HC65000636_00409490334	NONCDM CHARGE RECORD PHARMACY	636	J2001	3	N/A	N/A	N/A
HC65000636_00409493301	NONCDM CHARGE RECORD PHARMACY	636	J0171	5	N/A	N/A	N/A
HC65000636_00409508411	NONCDM CHARGE RECORD PHARMACY	636	J0713	29	N/A	N/A	N/A
HC65000636_00409592201	NONCDM CHARGE RECORD PHARMACY	636	J0280	52	N/A	N/A	N/A
HC65000636_00409610204	NONCDM CHARGE RECORD PHARMACY	636	J1940	9	N/A	N/A	N/A
HC65000636_00409610225	NONCDM CHARGE RECORD PHARMACY	636	J1940	22	N/A	N/A	N/A
HC65000636_00409610226	NONCDM CHARGE RECORD PHARMACY	636	J1940	9	N/A	N/A	N/A
HC65000636_00409647644	NONCDM CHARGE RECORD PHARMACY	636	J1364	547	N/A	N/A	N/A
HC65000636_00409650901	NONCDM CHARGE RECORD PHARMACY	636	J3370	50	N/A	N/A	N/A
HC65000636_00409653301	NONCDM CHARGE RECORD PHARMACY	636	J3370	4	N/A	N/A	N/A
HC65000636_00409656201	NONCDM CHARGE RECORD PHARMACY	636	J1071	1	N/A	N/A	N/A
HC65000636_00409665305	NONCDM CHARGE RECORD PHARMACY	636	J3480	2	N/A	N/A	N/A
HC65000636_00409672923	NONCDM CHARGE RECORD PHARMACY	636	J3475	6	N/A	N/A	N/A
HC65000636_00409677802	NONCDM CHARGE RECORD PHARMACY	636	J2060	6	N/A	N/A	N/A
HC65000636_00409707726	NONCDM CHARGE RECORD PHARMACY	636	J3480	3	N/A	N/A	N/A
HC65000636_00409724161	NONCDM CHARGE RECORD PHARMACY	636	J0171	1	N/A	N/A	N/A
HC65000636_00409733410	NONCDM CHARGE RECORD PHARMACY	636	J0696	3	N/A	N/A	N/A
HC65000636_00409733604	NONCDM CHARGE RECORD PHARMACY	636	J0696	5	N/A	N/A	N/A
HC65000636_00409733801	NONCDM CHARGE RECORD PHARMACY	636	J0696	3	N/A	N/A	N/A
HC65000636_00409779362	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_00409796905	NONCDM CHARGE RECORD PHARMACY	636	J3490	364	N/A	N/A	N/A
HC65000636_00409909335	NONCDM CHARGE RECORD PHARMACY	636	J3010	4	N/A	N/A	N/A
HC65000636_00409909422	NONCDM CHARGE RECORD PHARMACY	636	J3010	4	N/A	N/A	N/A
HC65000636_00409909461	NONCDM CHARGE RECORD PHARMACY	636	J3010	5	N/A	N/A	N/A
HC65000636_00409915801	NONCDM CHARGE RECORD PHARMACY	636	J3430	31	N/A	N/A	N/A
HC65000636_00456040010	NONCDM CHARGE RECORD PHARMACY	636	J0712	35	N/A	N/A	N/A
HC65000636_00469042099	NONCDM CHARGE RECORD PHARMACY	636	J1833	8	N/A	N/A	N/A
HC65000636_00469321110	NONCDM CHARGE RECORD PHARMACY	636	J2248	12	N/A	N/A	N/A
HC65000636_00517003125	NONCDM CHARGE RECORD PHARMACY	636	J3420	45	N/A	N/A	N/A
HC65000636_00517040125	NONCDM CHARGE RECORD PHARMACY	636	J0461	1	N/A	N/A	N/A
HC65000636_00517072001	NONCDM CHARGE RECORD PHARMACY	636	J0702	31	N/A	N/A	N/A
HC65000636_00517090125	NONCDM CHARGE RECORD PHARMACY	636	J0360	51	N/A	N/A	N/A
HC65000636_00517100425	NONCDM CHARGE RECORD PHARMACY	636	J0461	2	N/A	N/A	N/A
HC65000636_00517176701	NONCDM CHARGE RECORD PHARMACY	636	J1726	0	N/A	N/A	N/A
HC65000636_00517234010	NONCDM CHARGE RECORD PHARMACY	636	J1756	4	N/A	N/A	N/A
HC65000636_00517420125	NONCDM CHARGE RECORD PHARMACY	636	J3410	138	N/A	N/A	N/A
HC65000636_00517656025	NONCDM CHARGE RECORD PHARMACY	636		521	N/A	N/A	N/A
HC65000636_00517930225	NONCDM CHARGE RECORD PHARMACY	636		520	N/A	N/A	N/A
HC65000636_00548540025	NONCDM CHARGE RECORD PHARMACY	636	J1050	2	N/A	N/A	N/A
HC65000636_00548560300	NONCDM CHARGE RECORD PHARMACY	636	J1650	11	N/A	N/A	N/A
HC65000636_00548560800	NONCDM CHARGE RECORD PHARMACY	636	J1650	7	N/A	N/A	N/A
HC65000636_00574082001	NONCDM CHARGE RECORD PHARMACY	636	J1071	1	N/A	N/A	N/A
HC65000636_00574085010	NONCDM CHARGE RECORD PHARMACY	636	J1110	854	N/A	N/A	N/A
HC65000636_00591438579	NONCDM CHARGE RECORD PHARMACY	636	J1453	12	N/A	N/A	N/A
HC65000636_00597019705	NONCDM CHARGE RECORD PHARMACY	636	C9399	24,894	N/A	N/A	N/A
HC65000636_00597026010	NONCDM CHARGE RECORD PHARMACY	636	J1610	1,115	N/A	N/A	N/A
HC65000636_00641012125	NONCDM CHARGE RECORD PHARMACY	636	J1170	3	N/A	N/A	N/A
HC65000636_00641039112	NONCDM CHARGE RECORD PHARMACY	636	J1644	13	N/A	N/A	N/A
HC65000636_00641047725	NONCDM CHARGE RECORD PHARMACY	636	J2560	254	N/A	N/A	N/A
HC65000636_00641139835	NONCDM CHARGE RECORD PHARMACY	636	J3230	215	N/A	N/A	N/A
HC65000636_00641600125	NONCDM CHARGE RECORD PHARMACY	636	J2060	8	N/A	N/A	N/A
HC65000636_00641600810	NONCDM CHARGE RECORD PHARMACY	636	J3490	21	N/A	N/A	N/A
HC65000636_00641601510	NONCDM CHARGE RECORD PHARMACY	636	J3490	55	N/A	N/A	N/A
HC65000636_00641602010	NONCDM CHARGE RECORD PHARMACY	636	J2274	58	N/A	N/A	N/A
HC65000636_00641602901	NONCDM CHARGE RECORD PHARMACY	636	J3010	7	N/A	N/A	N/A
HC65000636_00641603901	NONCDM CHARGE RECORD PHARMACY	636	J2274	68	N/A	N/A	N/A
HC65000636_00641604825	NONCDM CHARGE RECORD PHARMACY	636	J2060	3	N/A	N/A	N/A
HC65000636_00641605725	NONCDM CHARGE RECORD PHARMACY	636	J2250	2	N/A	N/A	N/A
HC65000636_00641606010	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_00641607825	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_00641611610	NONCDM CHARGE RECORD PHARMACY	636	J0295	27	N/A	N/A	N/A
HC65000636_00641612725	NONCDM CHARGE RECORD PHARMACY	636	J2270	14	N/A	N/A	N/A
HC65000636_00641614525	NONCDM CHARGE RECORD PHARMACY	636	J1100	2	N/A	N/A	N/A
HC65000636_00641615125	NONCDM CHARGE RECORD PHARMACY	636	J1170	29	N/A	N/A	N/A
HC65000636_00641616610	NONCDM CHARGE RECORD PHARMACY	636	J0278	9	N/A	N/A	N/A
HC65000636_00641617610	NONCDM CHARGE RECORD PHARMACY	636	J2354	11	N/A	N/A	N/A
HC65000636_00641618425	NONCDM CHARGE RECORD PHARMACY	636	J1160	23	N/A	N/A	N/A
HC65000636_00641619410	NONCDM CHARGE RECORD PHARMACY	636	J2704	2	N/A	N/A	N/A
HC65000636_00641620410	NONCDM CHARGE RECORD PHARMACY	636	J1644	8	N/A	N/A	N/A
HC65000636_00641623125	NONCDM CHARGE RECORD PHARMACY	636	J0360	53	N/A	N/A	N/A
HC65000636_00641921710	NONCDM CHARGE RECORD PHARMACY	636	J3490	14	N/A	N/A	N/A
HC65000636_00703011303	NONCDM CHARGE RECORD PHARMACY	636	J1170	5	N/A	N/A	N/A
HC65000636_00703204503	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,880	N/A	N/A	N/A
HC65000636_00703330104	NONCDM CHARGE RECORD PHARMACY	636	J2354	15	N/A	N/A	N/A
HC65000636_00703333301	NONCDM CHARGE RECORD PHARMACY	636	J2354	11	N/A	N/A	N/A
HC65000636_00703367101	NONCDM CHARGE RECORD PHARMACY	636	J9260	67	N/A	N/A	N/A
HC65000636_00703367501	NONCDM CHARGE RECORD PHARMACY	636	J9260	12	N/A	N/A	N/A
HC65000636_00703398501	NONCDM CHARGE RECORD PHARMACY	636	J9263	3	N/A	N/A	N/A
HC65000636_00703424601	NONCDM CHARGE RECORD PHARMACY	636	J9045	43	N/A	N/A	N/A
HC65000636_00703450204	NONCDM CHARGE RECORD PHARMACY	636	J2765	20	N/A	N/A	N/A
HC65000636_00703505103	NONCDM CHARGE RECORD PHARMACY	636	J2597	102	N/A	N/A	N/A
HC65000636_00703514001	NONCDM CHARGE RECORD PHARMACY	636	J0640	65	N/A	N/A	N/A
HC65000636_00703574711	NONCDM CHARGE RECORD PHARMACY	636	J9060	25	N/A	N/A	N/A
HC65000636_00703851023	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_00703854023	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_00703903203	NONCDM CHARGE RECORD PHARMACY	636	J0278	15	N/A	N/A	N/A
HC65000636_00781305995	NONCDM CHARGE RECORD PHARMACY	636	J1160	18	N/A	N/A	N/A
HC65000636_00781311095	NONCDM CHARGE RECORD PHARMACY	636	J2543	12	N/A	N/A	N/A
HC65000636_00781315095	NONCDM CHARGE RECORD PHARMACY	636	J3490	90	N/A	N/A	N/A
HC65000636_00781315895	NONCDM CHARGE RECORD PHARMACY	636	J0583	13	N/A	N/A	N/A
HC65000636_00781320885	NONCDM CHARGE RECORD PHARMACY	636	J0696	2	N/A	N/A	N/A
HC65000636_00781321046	NONCDM CHARGE RECORD PHARMACY	636	J0696	6	N/A	N/A	N/A
HC65000636_00781323295	NONCDM CHARGE RECORD PHARMACY	636	C9113	31	N/A	N/A	N/A
HC65000636_00781324664	NONCDM CHARGE RECORD PHARMACY	636	J1650	14	N/A	N/A	N/A
HC65000636_00781326268	NONCDM CHARGE RECORD PHARMACY	636	J1650	15	N/A	N/A	N/A
HC65000636_00781328809	NONCDM CHARGE RECORD PHARMACY	636	J3490	51	N/A	N/A	N/A
HC65000636_00781329868	NONCDM CHARGE RECORD PHARMACY	636	J1650	15	N/A	N/A	N/A
HC65000636_00781331570	NONCDM CHARGE RECORD PHARMACY	636	J9263	2	N/A	N/A	N/A
HC65000636_00781340495	NONCDM CHARGE RECORD PHARMACY	636	J0290	18	N/A	N/A	N/A
HC65000636_00781340895	NONCDM CHARGE RECORD PHARMACY	636	J0290	11	N/A	N/A	N/A
HC65000636_00781341195	NONCDM CHARGE RECORD PHARMACY	636	J0330	12	N/A	N/A	N/A
HC65000636_00781343395	NONCDM CHARGE RECORD PHARMACY	636	J2020	94	N/A	N/A	N/A
HC65000636_00781345095	NONCDM CHARGE RECORD PHARMACY	636	J0690	14	N/A	N/A	N/A
HC65000636_00781345895	NONCDM CHARGE RECORD PHARMACY	636	J2370	0	N/A	N/A	N/A
HC65000636_00781400332	NONCDM CHARGE RECORD PHARMACY	636	J1950	778	N/A	N/A	N/A
HC65000636_00781921395	NONCDM CHARGE RECORD PHARMACY	636	J2543	26	N/A	N/A	N/A
HC65000636_00781922291	NONCDM CHARGE RECORD PHARMACY	636	J3490	87	N/A	N/A	N/A
HC65000636_00781940795	NONCDM CHARGE RECORD PHARMACY	636	J0290	23	N/A	N/A	N/A
HC65000636_00904662361	NONCDM CHARGE RECORD PHARMACY	636	J7507	9	N/A	N/A	N/A
HC65000636_00904709761	NONCDM CHARGE RECORD PHARMACY	636	J7507	9	N/A	N/A	N/A
HC65000636_00944049505	NONCDM CHARGE RECORD PHARMACY	636	P9045	375	N/A	N/A	N/A
HC65000636_00944270005	NONCDM CHARGE RECORD PHARMACY	636	J1569	505	N/A	N/A	N/A
HC65000636_00944303402	NONCDM CHARGE RECORD PHARMACY	636	J7195	11	N/A	N/A	N/A
HC65000636_00944304611	NONCDM CHARGE RECORD PHARMACY	636	J7192	12	N/A	N/A	N/A
HC65000636_00944305302	NONCDM CHARGE RECORD PHARMACY	636	J7192	0	N/A	N/A	N/A
HC65000636_00955100410	NONCDM CHARGE RECORD PHARMACY	636	J1650	14	N/A	N/A	N/A
HC65000636_00955174601	NONCDM CHARGE RECORD PHARMACY	636	J9027	942	N/A	N/A	N/A
HC65000636_00990707714	NONCDM CHARGE RECORD PHARMACY	636	J3480	4	N/A	N/A	N/A
HC65000636_00990771503	NONCDM CHARGE RECORD PHARMACY	636	J2150	12	N/A	N/A	N/A
HC65000636_01001907587	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,275	N/A	N/A	N/A
HC65000636_01001992602	NONCDM CHARGE RECORD PHARMACY	636	J9208	217	N/A	N/A	N/A
HC65000636_01001995301	NONCDM CHARGE RECORD PHARMACY	636	J9209	32	N/A	N/A	N/A
HC65000636_01001995601	NONCDM CHARGE RECORD PHARMACY	636	J9070	476	N/A	N/A	N/A
HC65000636_01001995701	NONCDM CHARGE RECORD PHARMACY	636	J9070	476	N/A	N/A	N/A
HC65000636_01012262010	NONCDM CHARGE RECORD PHARMACY	636	C9460	106	N/A	N/A	N/A
HC65000636_01051130012	NONCDM CHARGE RECORD PHARMACY	636	A9589	7,410	N/A	N/A	N/A
HC65000636_01353331801	NONCDM CHARGE RECORD PHARMACY	636	90375	2,179	N/A	N/A	N/A
HC65000636_01353360250	NONCDM CHARGE RECORD PHARMACY	636	J3490	198	N/A	N/A	N/A
HC65000636_01353363603	NONCDM CHARGE RECORD PHARMACY	636	90371	575	N/A	N/A	N/A
HC65000636_01353380020	NONCDM CHARGE RECORD PHARMACY	636	J1561	415	N/A	N/A	N/A
HC65000636_01353380040	NONCDM CHARGE RECORD PHARMACY	636	J1561	430	N/A	N/A	N/A
HC65000636_01353380071	NONCDM CHARGE RECORD PHARMACY	636	J1561	415	N/A	N/A	N/A
HC65000636_01478910910	NONCDM CHARGE RECORD PHARMACY	636	J3480	35	N/A	N/A	N/A
HC65000636_01478990110	NONCDM CHARGE RECORD PHARMACY	636	J2690	780	N/A	N/A	N/A
HC65000636_01505405306	NONCDM CHARGE RECORD PHARMACY	636	J0586	49	N/A	N/A	N/A
HC65000636_01671401610	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_01671403710	NONCDM CHARGE RECORD PHARMACY	636	J3490	184	N/A	N/A	N/A
HC65000636_01671405610	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_01671424801	NONCDM CHARGE RECORD PHARMACY	636	J1453	8	N/A	N/A	N/A
HC65000636_01671434501	NONCDM CHARGE RECORD PHARMACY	636	J7517	111	N/A	N/A	N/A
HC65000636_01671447225	NONCDM CHARGE RECORD PHARMACY	636	J1040	105	N/A	N/A	N/A
HC65000636_01671485901	NONCDM CHARGE RECORD PHARMACY	636	J9070	441	N/A	N/A	N/A
HC65000636_01671493001	NONCDM CHARGE RECORD PHARMACY	636	J9201	65	N/A	N/A	N/A
HC65000636_01672904301	NONCDM CHARGE RECORD PHARMACY	636	J7507	6	N/A	N/A	N/A
HC65000636_01672911431	NONCDM CHARGE RECORD PHARMACY	636	J9181	6	N/A	N/A	N/A
HC65000636_01672915131	NONCDM CHARGE RECORD PHARMACY	636	J9351	23	N/A	N/A	N/A
HC65000636_01672923993	NONCDM CHARGE RECORD PHARMACY	636	J3490	71	N/A	N/A	N/A
HC65000636_01672925938	NONCDM CHARGE RECORD PHARMACY	636	J1327	150	N/A	N/A	N/A
HC65000636_01672927638	NONCDM CHARGE RECORD PHARMACY	636	J9190	36	N/A	N/A	N/A
HC65000636_01672927735	NONCDM CHARGE RECORD PHARMACY	636	J9260	11	N/A	N/A	N/A
HC65000636_01672929512	NONCDM CHARGE RECORD PHARMACY	636	J9045	23	N/A	N/A	N/A
HC65000636_01672933205	NONCDM CHARGE RECORD PHARMACY	636	J9263	2	N/A	N/A	N/A
HC65000636_01672943445	NONCDM CHARGE RECORD PHARMACY	636	J0878	1	N/A	N/A	N/A
HC65000636_01672949345	NONCDM CHARGE RECORD PHARMACY	636	J0330	7	N/A	N/A	N/A
HC65000636_01672950143	NONCDM CHARGE RECORD PHARMACY	636	J1940	9	N/A	N/A	N/A
HC65000636_01672951243	NONCDM CHARGE RECORD PHARMACY	636	J0461	0	N/A	N/A	N/A
HC65000636_01723842406	NONCDM CHARGE RECORD PHARMACY	636	J3490	515	N/A	N/A	N/A
HC65000636_01747803005	NONCDM CHARGE RECORD PHARMACY	636	J3010	5	N/A	N/A	N/A
HC65000636_01747804532	NONCDM CHARGE RECORD PHARMACY	636	J3490	494	N/A	N/A	N/A
HC65000636_01747808292	NONCDM CHARGE RECORD PHARMACY	636	J3490	3	N/A	N/A	N/A
HC65000636_01747838020	NONCDM CHARGE RECORD PHARMACY	636	J1230	57	N/A	N/A	N/A
HC65000636_01747842020	NONCDM CHARGE RECORD PHARMACY	636	J3490	11	N/A	N/A	N/A
HC65000636_01747842040	NONCDM CHARGE RECORD PHARMACY	636	J3490	45	N/A	N/A	N/A
HC65000636_01747854202	NONCDM CHARGE RECORD PHARMACY	636	J0153	7	N/A	N/A	N/A
HC65000636_01747893101	NONCDM CHARGE RECORD PHARMACY	636	J0636	5	N/A	N/A	N/A
HC65000636_01747893705	NONCDM CHARGE RECORD PHARMACY	636	J3490	19	N/A	N/A	N/A
HC65000636_01747893726	NONCDM CHARGE RECORD PHARMACY	636	J3490	71	N/A	N/A	N/A
HC65000636_01865711704	NONCDM CHARGE RECORD PHARMACY	636	J3473	3	N/A	N/A	N/A
HC65000636_02315516641	NONCDM CHARGE RECORD PHARMACY	636	J3490	71	N/A	N/A	N/A
HC65000636_02315529441	NONCDM CHARGE RECORD PHARMACY	636	J0780	55	N/A	N/A	N/A
HC65000636_02315531331	NONCDM CHARGE RECORD PHARMACY	636	J1120	258	N/A	N/A	N/A
HC65000636_02315547344	NONCDM CHARGE RECORD PHARMACY	636	J1940	4	N/A	N/A	N/A
HC65000636_02315554742	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_02315560141	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_02420101020	NONCDM CHARGE RECORD PHARMACY	636	J2515	393	N/A	N/A	N/A
HC65000636_02502110110	NONCDM CHARGE RECORD PHARMACY	636	J0690	5	N/A	N/A	N/A
HC65000636_02502110720	NONCDM CHARGE RECORD PHARMACY	636	J0696	3	N/A	N/A	N/A
HC65000636_02502111020	NONCDM CHARGE RECORD PHARMACY	636	J0694	32	N/A	N/A	N/A
HC65000636_02502111487	NONCDM CHARGE RECORD PHARMACY	636	J0744	41	N/A	N/A	N/A
HC65000636_02502111506	NONCDM CHARGE RECORD PHARMACY	636	J3490	19	N/A	N/A	N/A
HC65000636_02502112720	NONCDM CHARGE RECORD PHARMACY	636	J0713	17	N/A	N/A	N/A
HC65000636_02502113281	NONCDM CHARGE RECORD PHARMACY	636	J1956	45	N/A	N/A	N/A
HC65000636_02502113610	NONCDM CHARGE RECORD PHARMACY	636	J0290	16	N/A	N/A	N/A
HC65000636_02502114330	NONCDM CHARGE RECORD PHARMACY	636	J0295	33	N/A	N/A	N/A
HC65000636_02502116430	NONCDM CHARGE RECORD PHARMACY	636	J2543	26	N/A	N/A	N/A
HC65000636_02502117520	NONCDM CHARGE RECORD PHARMACY	636	J2543	27	N/A	N/A	N/A
HC65000636_02502117750	NONCDM CHARGE RECORD PHARMACY	636	J2543	40	N/A	N/A	N/A
HC65000636_02502117916	NONCDM CHARGE RECORD PHARMACY	636	J0878	5	N/A	N/A	N/A
HC65000636_02502118467	NONCDM CHARGE RECORD PHARMACY	636	J1450	15	N/A	N/A	N/A
HC65000636_02502118510	NONCDM CHARGE RECORD PHARMACY	636	J1570	390	N/A	N/A	N/A
HC65000636_02502120401	NONCDM CHARGE RECORD PHARMACY	636	J9390	141	N/A	N/A	N/A
HC65000636_02502123550	NONCDM CHARGE RECORD PHARMACY	636	J9201	65	N/A	N/A	N/A
HC65000636_02502130520	NONCDM CHARGE RECORD PHARMACY	636	J1205	251	N/A	N/A	N/A
HC65000636_02502131002	NONCDM CHARGE RECORD PHARMACY	636	J3490	704	N/A	N/A	N/A
HC65000636_02502131104	NONCDM CHARGE RECORD PHARMACY	636	J1940	9	N/A	N/A	N/A
HC65000636_02502131598	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_02502140030	NONCDM CHARGE RECORD PHARMACY	636	J1644	1	N/A	N/A	N/A
HC65000636_02502140301	NONCDM CHARGE RECORD PHARMACY	636	J1644	3	N/A	N/A	N/A
HC65000636_02502140910	NONCDM CHARGE RECORD PHARMACY	636	J1327	157	N/A	N/A	N/A
HC65000636_02502145201	NONCDM CHARGE RECORD PHARMACY	636	J2354	11	N/A	N/A	N/A
HC65000636_02502150002	NONCDM CHARGE RECORD PHARMACY	636	J3411	39	N/A	N/A	N/A
HC65000636_02502160820	NONCDM CHARGE RECORD PHARMACY	636	J2704	2	N/A	N/A	N/A
HC65000636_02502161281	NONCDM CHARGE RECORD PHARMACY	636	J3475	27	N/A	N/A	N/A
HC65000636_02502167187	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_02502167710	NONCDM CHARGE RECORD PHARMACY	636	J0330	4	N/A	N/A	N/A
HC65000636_02502178305	NONCDM CHARGE RECORD PHARMACY	636	J2469	65	N/A	N/A	N/A
HC65000636_02502181230	NONCDM CHARGE RECORD PHARMACY	636	J0132	16	N/A	N/A	N/A
HC65000636_02502181530	NONCDM CHARGE RECORD PHARMACY	636	J0640	65	N/A	N/A	N/A
HC65000636_02502182682	NONCDM CHARGE RECORD PHARMACY	636	J3489	292	N/A	N/A	N/A
HC65000636_02502182761	NONCDM CHARGE RECORD PHARMACY	636	J1740	542	N/A	N/A	N/A
HC65000636_02502183082	NONCDM CHARGE RECORD PHARMACY	636	J3489	455	N/A	N/A	N/A
HC65000636_02568202501	NONCDM CHARGE RECORD PHARMACY	636	J1303	1,387	N/A	N/A	N/A
HC65000636_03600001225	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_03600028425	NONCDM CHARGE RECORD PHARMACY	636	J1940	4	N/A	N/A	N/A
HC65000636_03600032010	NONCDM CHARGE RECORD PHARMACY	636	J2590	40	N/A	N/A	N/A
HC65000636_03600032602	NONCDM CHARGE RECORD PHARMACY	636	J2469	4	N/A	N/A	N/A
HC65000636_03982201511	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,502	N/A	N/A	N/A
HC65000636_03982201901	NONCDM CHARGE RECORD PHARMACY	636	J1120	205	N/A	N/A	N/A
HC65000636_03982204126	NONCDM CHARGE RECORD PHARMACY	636	J3260	33	N/A	N/A	N/A
HC65000636_03982210771	NONCDM CHARGE RECORD PHARMACY	636	J3465	26	N/A	N/A	N/A
HC65000636_04202311602	NONCDM CHARGE RECORD PHARMACY	636	J2590	9	N/A	N/A	N/A
HC65000636_04202312306	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,689	N/A	N/A	N/A
HC65000636_04202315925	NONCDM CHARGE RECORD PHARMACY	636	J0171	10	N/A	N/A	N/A
HC65000636_04202316801	NONCDM CHARGE RECORD PHARMACY	636	J0171	5	N/A	N/A	N/A
HC65000636_04202322910	NONCDM CHARGE RECORD PHARMACY	636	J2248	10	N/A	N/A	N/A
HC65000636_04204339021	NONCDM CHARGE RECORD PHARMACY	636	Q0166	7	N/A	N/A	N/A
HC65000636_04249441625	NONCDM CHARGE RECORD PHARMACY	636	J2560	260	N/A	N/A	N/A
HC65000636_04265802101	NONCDM CHARGE RECORD PHARMACY	636	J9150	204	N/A	N/A	N/A
HC65000636_04285850103	NONCDM CHARGE RECORD PHARMACY	636	J0571	1	N/A	N/A	N/A
HC65000636_04306601801	NONCDM CHARGE RECORD PHARMACY	636	J9263	1	N/A	N/A	N/A
HC65000636_04306636020	NONCDM CHARGE RECORD PHARMACY	636	J0282	29	N/A	N/A	N/A
HC65000636_04359812811	NONCDM CHARGE RECORD PHARMACY	636	J2930	33	N/A	N/A	N/A
HC65000636_04359830562	NONCDM CHARGE RECORD PHARMACY	636	J9025	13	N/A	N/A	N/A
HC65000636_04359847611	NONCDM CHARGE RECORD PHARMACY	636	J0878	1	N/A	N/A	N/A
HC65000636_04359863510	NONCDM CHARGE RECORD PHARMACY	636	J1953	2	N/A	N/A	N/A
HC65000636_04359872525	NONCDM CHARGE RECORD PHARMACY	636	J3490	126	N/A	N/A	N/A
HC65000636_04359883936	NONCDM CHARGE RECORD PHARMACY	636	J2800	46	N/A	N/A	N/A
HC65000636_04359893109	NONCDM CHARGE RECORD PHARMACY	636	J2597	61	N/A	N/A	N/A
HC65000636_04382510201	NONCDM CHARGE RECORD PHARMACY	636	J0131	3	N/A	N/A	N/A
HC65000636_04420625110	NONCDM CHARGE RECORD PHARMACY	636	P9047	582	N/A	N/A	N/A
HC65000636_04420631025	NONCDM CHARGE RECORD PHARMACY	636	P9045	583	N/A	N/A	N/A
HC65000636_04420643605	NONCDM CHARGE RECORD PHARMACY	636	J1459	490	N/A	N/A	N/A
HC65000636_04420643940	NONCDM CHARGE RECORD PHARMACY	636	J1459	487	N/A	N/A	N/A
HC65000636_04456710310	NONCDM CHARGE RECORD PHARMACY	636	J0290	18	N/A	N/A	N/A
HC65000636_04456723610	NONCDM CHARGE RECORD PHARMACY	636	J0713	21	N/A	N/A	N/A
HC65000636_04456724110	NONCDM CHARGE RECORD PHARMACY	636	J0692	19	N/A	N/A	N/A
HC65000636_04456731110	NONCDM CHARGE RECORD PHARMACY	636	J2540	3	N/A	N/A	N/A
HC65000636_04456742024	NONCDM CHARGE RECORD PHARMACY	636	J3475	11	N/A	N/A	N/A
HC65000636_04456742124	NONCDM CHARGE RECORD PHARMACY	636	J3475	3	N/A	N/A	N/A
HC65000636_04456743624	NONCDM CHARGE RECORD PHARMACY	636	J1956	45	N/A	N/A	N/A
HC65000636_04456762024	NONCDM CHARGE RECORD PHARMACY	636	J0610	30	N/A	N/A	N/A
HC65000636_04456770125	NONCDM CHARGE RECORD PHARMACY	636	J0696	4	N/A	N/A	N/A
HC65000636_04456780210	NONCDM CHARGE RECORD PHARMACY	636	J2543	22	N/A	N/A	N/A
HC65000636_04596360755	NONCDM CHARGE RECORD PHARMACY	636	J9390	136	N/A	N/A	N/A
HC65000636_04596376552	NONCDM CHARGE RECORD PHARMACY	636	J9171	22	N/A	N/A	N/A
HC65000636_04733536141	NONCDM CHARGE RECORD PHARMACY	636	J0894	40	N/A	N/A	N/A
HC65000636_04733589180	NONCDM CHARGE RECORD PHARMACY	636	Z7610	262	N/A	N/A	N/A
HC65000636_04778158656	NONCDM CHARGE RECORD PHARMACY	636	J3490	37	N/A	N/A	N/A
HC65000636_04810204720	NONCDM CHARGE RECORD PHARMACY	636	J8540	0	N/A	N/A	N/A
HC65000636_04928154503	NONCDM CHARGE RECORD PHARMACY	636	90648	112	N/A	N/A	N/A
HC65000636_04940110101	NONCDM CHARGE RECORD PHARMACY	636	J0490	306	N/A	N/A	N/A
HC65000636_04970224015	NONCDM CHARGE RECORD PHARMACY	636	J0741	0	N/A	N/A	N/A
HC65000636_05024204413	NONCDM CHARGE RECORD PHARMACY	636	J2997	572	N/A	N/A	N/A
HC65000636_05024205306	NONCDM CHARGE RECORD PHARMACY	636	J9312	521	N/A	N/A	N/A
HC65000636_05024206001	NONCDM CHARGE RECORD PHARMACY	636	J9035	518	N/A	N/A	N/A
HC65000636_05024207001	NONCDM CHARGE RECORD PHARMACY	636	J9301	471	N/A	N/A	N/A
HC65000636_05024208801	NONCDM CHARGE RECORD PHARMACY	636	J9354	211	N/A	N/A	N/A
HC65000636_05024213501	NONCDM CHARGE RECORD PHARMACY	636	J3262	38	N/A	N/A	N/A
HC65000636_05024213801	NONCDM CHARGE RECORD PHARMACY	636	J3262	0	N/A	N/A	N/A
HC65000636_05024221401	NONCDM CHARGE RECORD PHARMACY	636	J2357	225	N/A	N/A	N/A
HC65000636_05024226001	NONCDM CHARGE RECORD PHARMACY	636	J9316	459	N/A	N/A	N/A
HC65000636_05024291801	NONCDM CHARGE RECORD PHARMACY	636	J9022	528	N/A	N/A	N/A
HC65000636_05026876112	NONCDM CHARGE RECORD PHARMACY	636	J8700	39	N/A	N/A	N/A
HC65000636_05041932005	NONCDM CHARGE RECORD PHARMACY	636	A9581	92	N/A	N/A	N/A
HC65000636_05041932537	NONCDM CHARGE RECORD PHARMACY	636	A9585	5	N/A	N/A	N/A
HC65000636_05047497075	NONCDM CHARGE RECORD PHARMACY	636	J3490	441	N/A	N/A	N/A
HC65000636_05063321011	NONCDM CHARGE RECORD PHARMACY	636	C9293	2,269	N/A	N/A	N/A
HC65000636_05107950820	NONCDM CHARGE RECORD PHARMACY	636	J7518	26	N/A	N/A	N/A
HC65000636_05107981820	NONCDM CHARGE RECORD PHARMACY	636	J7507	7	N/A	N/A	N/A
HC65000636_05114405001	NONCDM CHARGE RECORD PHARMACY	636	J9042	1,117	N/A	N/A	N/A
HC65000636_05171510004	NONCDM CHARGE RECORD PHARMACY	636	C9089	5	N/A	N/A	N/A
HC65000636_05175410004	NONCDM CHARGE RECORD PHARMACY	636	J3475	4	N/A	N/A	N/A
HC65000636_05175450601	NONCDM CHARGE RECORD PHARMACY	636	J0702	26	N/A	N/A	N/A
HC65000636_05199114417	NONCDM CHARGE RECORD PHARMACY	636	J2210	112	N/A	N/A	N/A
HC65000636_05253662510	NONCDM CHARGE RECORD PHARMACY	636	J1071	0	N/A	N/A	N/A
HC65000636_05428810515	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,293	N/A	N/A	N/A
HC65000636_05428813610	NONCDM CHARGE RECORD PHARMACY	636	J2560	121	N/A	N/A	N/A
HC65000636_05464356470	NONCDM CHARGE RECORD PHARMACY	636		596	N/A	N/A	N/A
HC65000636_05511155610	NONCDM CHARGE RECORD PHARMACY	636	J0894	78	N/A	N/A	N/A
HC65000636_05511167802	NONCDM CHARGE RECORD PHARMACY	636	J1652	31	N/A	N/A	N/A
HC65000636_05511168507	NONCDM CHARGE RECORD PHARMACY	636	J3489	124	N/A	N/A	N/A
HC65000636_05513513201	NONCDM CHARGE RECORD PHARMACY	636	J9317	181	N/A	N/A	N/A
HC65000636_05515011620	NONCDM CHARGE RECORD PHARMACY	636	J0295	18	N/A	N/A	N/A
HC65000636_05515012030	NONCDM CHARGE RECORD PHARMACY	636	J2543	26	N/A	N/A	N/A
HC65000636_05515015410	NONCDM CHARGE RECORD PHARMACY	636	J0133	1	N/A	N/A	N/A
HC65000636_05515015411	NONCDM CHARGE RECORD PHARMACY	636	J0133	1	N/A	N/A	N/A
HC65000636_05515015872	NONCDM CHARGE RECORD PHARMACY	636	J2001	9	N/A	N/A	N/A
HC65000636_05515016205	NONCDM CHARGE RECORD PHARMACY	636	J2001	3	N/A	N/A	N/A
HC65000636_05515016613	NONCDM CHARGE RECORD PHARMACY	636	J3490	127	N/A	N/A	N/A
HC65000636_05515017410	NONCDM CHARGE RECORD PHARMACY	636	J0456	37	N/A	N/A	N/A
HC65000636_05515018310	NONCDM CHARGE RECORD PHARMACY	636	J3490	271	N/A	N/A	N/A
HC65000636_05515019830	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_05515020210	NONCDM CHARGE RECORD PHARMACY	636	C9113	32	N/A	N/A	N/A
HC65000636_05515020902	NONCDM CHARGE RECORD PHARMACY	636	J3490	146	N/A	N/A	N/A
HC65000636_05515021910	NONCDM CHARGE RECORD PHARMACY	636	J1327	286	N/A	N/A	N/A
HC65000636_05515024110	NONCDM CHARGE RECORD PHARMACY	636	J0883	25	N/A	N/A	N/A
HC65000636_05515025220	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_05515025520	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_05515028610	NONCDM CHARGE RECORD PHARMACY	636	J3490	71	N/A	N/A	N/A
HC65000636_05515030425	NONCDM CHARGE RECORD PHARMACY	636	J1100	1	N/A	N/A	N/A
HC65000636_05515031825	NONCDM CHARGE RECORD PHARMACY	636	J3230	376	N/A	N/A	N/A
HC65000636_05515033701	NONCDM CHARGE RECORD PHARMACY	636	J9041	122	N/A	N/A	N/A
HC65000636_05515047801	NONCDM CHARGE RECORD PHARMACY	636	J1950	348	N/A	N/A	N/A
HC65000636_05539050002	NONCDM CHARGE RECORD PHARMACY	636	J3490	9	N/A	N/A	N/A
HC65000636_05551313201	NONCDM CHARGE RECORD PHARMACY	636	Q5117	587	N/A	N/A	N/A
HC65000636_05551319001	NONCDM CHARGE RECORD PHARMACY	636	J2506	3,320	N/A	N/A	N/A
HC65000636_05551320701	NONCDM CHARGE RECORD PHARMACY	636	Q5107	453	N/A	N/A	N/A
HC65000636_05551322301	NONCDM CHARGE RECORD PHARMACY	636	J2796	340	N/A	N/A	N/A
HC65000636_05551353010	NONCDM CHARGE RECORD PHARMACY	636	J1442	7	N/A	N/A	N/A
HC65000636_05551373001	NONCDM CHARGE RECORD PHARMACY	636	J0897	136	N/A	N/A	N/A
HC65000636_05551395601	NONCDM CHARGE RECORD PHARMACY	636	J9303	963	N/A	N/A	N/A
HC65000636_05789403001	NONCDM CHARGE RECORD PHARMACY	636	J1745	719	N/A	N/A	N/A
HC65000636_05789416001	NONCDM CHARGE RECORD PHARMACY	636	J1745	289	N/A	N/A	N/A
HC65000636_05789450220	NONCDM CHARGE RECORD PHARMACY	636	J9145	393	N/A	N/A	N/A
HC65000636_05816081052	NONCDM CHARGE RECORD PHARMACY	636	90700	161	N/A	N/A	N/A
HC65000636_05816081811	NONCDM CHARGE RECORD PHARMACY	636	90648	72	N/A	N/A	N/A
HC65000636_05816082052	NONCDM CHARGE RECORD PHARMACY	636	90744	164	N/A	N/A	N/A
HC65000636_05816084211	NONCDM CHARGE RECORD PHARMACY	636	90715	274	N/A	N/A	N/A
HC65000636_05816095509	NONCDM CHARGE RECORD PHARMACY	636	90734	926	N/A	N/A	N/A
HC65000636_05816097620	NONCDM CHARGE RECORD PHARMACY	636	90620	1,201	N/A	N/A	N/A
HC65000636_05840601004	NONCDM CHARGE RECORD PHARMACY	636	J1438	5,208	N/A	N/A	N/A
HC65000636_05891408052	NONCDM CHARGE RECORD PHARMACY	636	J0500	447	N/A	N/A	N/A
HC65000636_05914807280	NONCDM CHARGE RECORD PHARMACY	636	J0400	0	N/A	N/A	N/A
HC65000636_05926710254	NONCDM CHARGE RECORD PHARMACY	636	91305	0	N/A	N/A	N/A
HC65000636_05933877501	NONCDM CHARGE RECORD PHARMACY	636	Q0138	15	N/A	N/A	N/A
HC65000636_05967631001	NONCDM CHARGE RECORD PHARMACY	636	J0885	174	N/A	N/A	N/A
HC65000636_05974617206	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_05974617509	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_06021920561	NONCDM CHARGE RECORD PHARMACY	636	J8540	1	N/A	N/A	N/A
HC65000636_06050507595	NONCDM CHARGE RECORD PHARMACY	636	J0694	46	N/A	N/A	N/A
HC65000636_06050561305	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_06050561444	NONCDM CHARGE RECORD PHARMACY	636	J0692	21	N/A	N/A	N/A
HC65000636_06050561464	NONCDM CHARGE RECORD PHARMACY	636	J0692	25	N/A	N/A	N/A
HC65000636_06050561484	NONCDM CHARGE RECORD PHARMACY	636	J0696	4	N/A	N/A	N/A
HC65000636_06050561594	NONCDM CHARGE RECORD PHARMACY	636	J2543	22	N/A	N/A	N/A
HC65000636_06050562366	NONCDM CHARGE RECORD PHARMACY	636	J0895	84	N/A	N/A	N/A
HC65000636_06068727121	NONCDM CHARGE RECORD PHARMACY	636	Q0144	23	N/A	N/A	N/A
HC65000636_06068749401	NONCDM CHARGE RECORD PHARMACY	636	J7517	4	N/A	N/A	N/A
HC65000636_06079370110	NONCDM CHARGE RECORD PHARMACY	636	J0558	92	N/A	N/A	N/A
HC65000636_06126941020	NONCDM CHARGE RECORD PHARMACY	636	J9181	101	N/A	N/A	N/A
HC65000636_06131432610	NONCDM CHARGE RECORD PHARMACY	636	Q5101	6	N/A	N/A	N/A
HC65000636_06170330906	NONCDM CHARGE RECORD PHARMACY	636	J9370	36	N/A	N/A	N/A
HC65000636_06170330926	NONCDM CHARGE RECORD PHARMACY	636	J9370	37	N/A	N/A	N/A
HC65000636_06170332418	NONCDM CHARGE RECORD PHARMACY	636	J2430	83	N/A	N/A	N/A
HC65000636_06170333218	NONCDM CHARGE RECORD PHARMACY	636	J9040	182	N/A	N/A	N/A
HC65000636_06170333950	NONCDM CHARGE RECORD PHARMACY	636	J9045	32	N/A	N/A	N/A
HC65000636_06170334209	NONCDM CHARGE RECORD PHARMACY	636	J9267	2	N/A	N/A	N/A
HC65000636_06170334222	NONCDM CHARGE RECORD PHARMACY	636	J9267	2	N/A	N/A	N/A
HC65000636_06170334318	NONCDM CHARGE RECORD PHARMACY	636	J9293	111	N/A	N/A	N/A
HC65000636_06170336322	NONCDM CHARGE RECORD PHARMACY	636	J9263	3	N/A	N/A	N/A
HC65000636_06175500801	NONCDM CHARGE RECORD PHARMACY	636	J9119	175	N/A	N/A	N/A
HC65000636_06195829012	NONCDM CHARGE RECORD PHARMACY	636	C9399	45	N/A	N/A	N/A
HC65000636_06199002113	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_06199004111	NONCDM CHARGE RECORD PHARMACY	636	J1110	547	N/A	N/A	N/A
HC65000636_06232744444	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,478	N/A	N/A	N/A
HC65000636_06275601540	NONCDM CHARGE RECORD PHARMACY	636	J1071	0	N/A	N/A	N/A
HC65000636_06275612944	NONCDM CHARGE RECORD PHARMACY	636	C9113	42	N/A	N/A	N/A
HC65000636_06285638901	NONCDM CHARGE RECORD PHARMACY	636	J9179	817	N/A	N/A	N/A
HC65000636_06332301002	NONCDM CHARGE RECORD PHARMACY	636	J1580	22	N/A	N/A	N/A
HC65000636_06332301210	NONCDM CHARGE RECORD PHARMACY	636	J2590	5	N/A	N/A	N/A
HC65000636_06332301302	NONCDM CHARGE RECORD PHARMACY	636	J3411	38	N/A	N/A	N/A
HC65000636_06332304401	NONCDM CHARGE RECORD PHARMACY	636	J3420	45	N/A	N/A	N/A
HC65000636_06332306403	NONCDM CHARGE RECORD PHARMACY	636	J3475	6	N/A	N/A	N/A
HC65000636_06332306411	NONCDM CHARGE RECORD PHARMACY	636	J3475	1	N/A	N/A	N/A
HC65000636_06332310365	NONCDM CHARGE RECORD PHARMACY	636	J9060	23	N/A	N/A	N/A
HC65000636_06332310615	NONCDM CHARGE RECORD PHARMACY	636	J3475	1	N/A	N/A	N/A
HC65000636_06332311720	NONCDM CHARGE RECORD PHARMACY	636	J9190	19	N/A	N/A	N/A
HC65000636_06332312553	NONCDM CHARGE RECORD PHARMACY	636	J9201	64	N/A	N/A	N/A
HC65000636_06332313013	NONCDM CHARGE RECORD PHARMACY	636	J3490	145	N/A	N/A	N/A
HC65000636_06332313720	NONCDM CHARGE RECORD PHARMACY	636	J9040	238	N/A	N/A	N/A
HC65000636_06332314210	NONCDM CHARGE RECORD PHARMACY	636	J9208	377	N/A	N/A	N/A
HC65000636_06332316101	NONCDM CHARGE RECORD PHARMACY	636	J1885	23	N/A	N/A	N/A
HC65000636_06332316212	NONCDM CHARGE RECORD PHARMACY	636	J1885	3	N/A	N/A	N/A
HC65000636_06332316530	NONCDM CHARGE RECORD PHARMACY	636	J1100	2	N/A	N/A	N/A
HC65000636_06332317302	NONCDM CHARGE RECORD PHARMACY	636	J1580	17	N/A	N/A	N/A
HC65000636_06332320110	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_06332322110	NONCDM CHARGE RECORD PHARMACY	636	J3370	40	N/A	N/A	N/A
HC65000636_06332322930	NONCDM CHARGE RECORD PHARMACY	636	J2720	10	N/A	N/A	N/A
HC65000636_06332323610	NONCDM CHARGE RECORD PHARMACY	636	J0690	25	N/A	N/A	N/A
HC65000636_06332323710	NONCDM CHARGE RECORD PHARMACY	636	J0690	5	N/A	N/A	N/A
HC65000636_06332326037	NONCDM CHARGE RECORD PHARMACY	636	J0670	16	N/A	N/A	N/A
HC65000636_06332326530	NONCDM CHARGE RECORD PHARMACY	636	J2920	20	N/A	N/A	N/A
HC65000636_06332326950	NONCDM CHARGE RECORD PHARMACY	636	J2704	2	N/A	N/A	N/A
HC65000636_06332326965	NONCDM CHARGE RECORD PHARMACY	636	J2704	2	N/A	N/A	N/A
HC65000636_06332327602	NONCDM CHARGE RECORD PHARMACY	636	J1644	43	N/A	N/A	N/A
HC65000636_06332328004	NONCDM CHARGE RECORD PHARMACY	636	J1940	8	N/A	N/A	N/A
HC65000636_06332328564	NONCDM CHARGE RECORD PHARMACY	636	J2795	2	N/A	N/A	N/A
HC65000636_06332328567	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_06332328635	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_06332329337	NONCDM CHARGE RECORD PHARMACY	636	J0670	12	N/A	N/A	N/A
HC65000636_06332330351	NONCDM CHARGE RECORD PHARMACY	636	J3260	36	N/A	N/A	N/A
HC65000636_06332330630	NONCDM CHARGE RECORD PHARMACY	636	J3260	7	N/A	N/A	N/A
HC65000636_06332331801	NONCDM CHARGE RECORD PHARMACY	636	J1626	12	N/A	N/A	N/A
HC65000636_06332332520	NONCDM CHARGE RECORD PHARMACY	636	J0133	1	N/A	N/A	N/A
HC65000636_06332334125	NONCDM CHARGE RECORD PHARMACY	636	J0694	30	N/A	N/A	N/A
HC65000636_06332335550	NONCDM CHARGE RECORD PHARMACY	636	J3490	47	N/A	N/A	N/A
HC65000636_06332337420	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_06332337905	NONCDM CHARGE RECORD PHARMACY	636	J2354	16	N/A	N/A	N/A
HC65000636_06332340005	NONCDM CHARGE RECORD PHARMACY	636	J1953	1	N/A	N/A	N/A
HC65000636_06332340121	NONCDM CHARGE RECORD PHARMACY	636	J3490	178	N/A	N/A	N/A
HC65000636_06332340230	NONCDM CHARGE RECORD PHARMACY	636	J3490	355	N/A	N/A	N/A
HC65000636_06332340310	NONCDM CHARGE RECORD PHARMACY	636	Q2009	15	N/A	N/A	N/A
HC65000636_06332340703	NONCDM CHARGE RECORD PHARMACY	636	J0706	31	N/A	N/A	N/A
HC65000636_06332341125	NONCDM CHARGE RECORD PHARMACY	636	J2250	3	N/A	N/A	N/A
HC65000636_06332341710	NONCDM CHARGE RECORD PHARMACY	636	J3490	221	N/A	N/A	N/A
HC65000636_06332345101	NONCDM CHARGE RECORD PHARMACY	636	J2270	15	N/A	N/A	N/A
HC65000636_06332345501	NONCDM CHARGE RECORD PHARMACY	636	J2270	33	N/A	N/A	N/A
HC65000636_06332347827	NONCDM CHARGE RECORD PHARMACY	636	J2400	78	N/A	N/A	N/A
HC65000636_06332348527	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_06332348617	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_06332348627	NONCDM CHARGE RECORD PHARMACY	636	J2001	0	N/A	N/A	N/A
HC65000636_06332349157	NONCDM CHARGE RECORD PHARMACY	636	J2001	0	N/A	N/A	N/A
HC65000636_06332349237	NONCDM CHARGE RECORD PHARMACY	636	J2001	2	N/A	N/A	N/A
HC65000636_06332349507	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_06332350721	NONCDM CHARGE RECORD PHARMACY	636	J2185	8	N/A	N/A	N/A
HC65000636_06332351977	NONCDM CHARGE RECORD PHARMACY	636	J1644	29	N/A	N/A	N/A
HC65000636_06332353190	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332353393	NONCDM CHARGE RECORD PHARMACY	636	J1650	7	N/A	N/A	N/A
HC65000636_06332353598	NONCDM CHARGE RECORD PHARMACY	636	J1650	7	N/A	N/A	N/A
HC65000636_06332354011	NONCDM CHARGE RECORD PHARMACY	636	J1644	5	N/A	N/A	N/A
HC65000636_06332354036	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_06332355965	NONCDM CHARGE RECORD PHARMACY	636	J1650	7	N/A	N/A	N/A
HC65000636_06332356465	NONCDM CHARGE RECORD PHARMACY	636	J1650	7	N/A	N/A	N/A
HC65000636_06332356887	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332359303	NONCDM CHARGE RECORD PHARMACY	636	J1610	1,101	N/A	N/A	N/A
HC65000636_06332359613	NONCDM CHARGE RECORD PHARMACY	636	J1610	990	N/A	N/A	N/A
HC65000636_06332359930	NONCDM CHARGE RECORD PHARMACY	636	J0895	60	N/A	N/A	N/A
HC65000636_06332360594	NONCDM CHARGE RECORD PHARMACY	636	J1650	7	N/A	N/A	N/A
HC65000636_06332360990	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332361603	NONCDM CHARGE RECORD PHARMACY	636	J0282	2	N/A	N/A	N/A
HC65000636_06332361720	NONCDM CHARGE RECORD PHARMACY	636	J2260	217	N/A	N/A	N/A
HC65000636_06332364907	NONCDM CHARGE RECORD PHARMACY	636	J3490	686	N/A	N/A	N/A
HC65000636_06332365102	NONCDM CHARGE RECORD PHARMACY	636	J0153	14	N/A	N/A	N/A
HC65000636_06332365820	NONCDM CHARGE RECORD PHARMACY	636	J1205	320	N/A	N/A	N/A
HC65000636_06332365903	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,438	N/A	N/A	N/A
HC65000636_06332367120	NONCDM CHARGE RECORD PHARMACY	636	J3490	209	N/A	N/A	N/A
HC65000636_06332371100	NONCDM CHARGE RECORD PHARMACY	636	J0640	59	N/A	N/A	N/A
HC65000636_06332372405	NONCDM CHARGE RECORD PHARMACY	636	J3490	803	N/A	N/A	N/A
HC65000636_06332373510	NONCDM CHARGE RECORD PHARMACY	636	J2430	229	N/A	N/A	N/A
HC65000636_06332376210	NONCDM CHARGE RECORD PHARMACY	636	J9351	38	N/A	N/A	N/A
HC65000636_06332377810	NONCDM CHARGE RECORD PHARMACY	636	J2800	37	N/A	N/A	N/A
HC65000636_06332380601	NONCDM CHARGE RECORD PHARMACY	636	J3010	10	N/A	N/A	N/A
HC65000636_06332380605	NONCDM CHARGE RECORD PHARMACY	636	J3010	6	N/A	N/A	N/A
HC65000636_06332385225	NONCDM CHARGE RECORD PHARMACY	636	J1170	21	N/A	N/A	N/A
HC65000636_06332388514	NONCDM CHARGE RECORD PHARMACY	636	J3490	340	N/A	N/A	N/A
HC65000636_06332396510	NONCDM CHARGE RECORD PHARMACY	636	J3480	2	N/A	N/A	N/A
HC65000636_06332396730	NONCDM CHARGE RECORD PHARMACY	636	J3480	1	N/A	N/A	N/A
HC65000636_06345910310	NONCDM CHARGE RECORD PHARMACY	636	Q5115	550	N/A	N/A	N/A
HC65000636_06345939008	NONCDM CHARGE RECORD PHARMACY	636	J9033	193	N/A	N/A	N/A
HC65000636_06373951810	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_06373993128	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_06383338602	NONCDM CHARGE RECORD PHARMACY	636	J7168	20	N/A	N/A	N/A
HC65000636_06383361602	NONCDM CHARGE RECORD PHARMACY	636	J7187	9	N/A	N/A	N/A
HC65000636_06425322235	NONCDM CHARGE RECORD PHARMACY	636	J1642	1	N/A	N/A	N/A
HC65000636_06425333335	NONCDM CHARGE RECORD PHARMACY	636	J1642	0	N/A	N/A	N/A
HC65000636_06467901201	NONCDM CHARGE RECORD PHARMACY	636	J2543	29	N/A	N/A	N/A
HC65000636_06476430020	NONCDM CHARGE RECORD PHARMACY	636	J3380	131	N/A	N/A	N/A
HC65000636_06521901410	NONCDM CHARGE RECORD PHARMACY	636	J0290	14	N/A	N/A	N/A
HC65000636_06521919030	NONCDM CHARGE RECORD PHARMACY	636	J3465	48	N/A	N/A	N/A
HC65000636_06521938305	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_06521943315	NONCDM CHARGE RECORD PHARMACY	636	C9113	32	N/A	N/A	N/A
HC65000636_06525026609	NONCDM CHARGE RECORD PHARMACY	636	C9290	9	N/A	N/A	N/A
HC65000636_06564955103	NONCDM CHARGE RECORD PHARMACY	636	J2212	9	N/A	N/A	N/A
HC65000636_06622031522	NONCDM CHARGE RECORD PHARMACY	636	J3095	47	N/A	N/A	N/A
HC65000636_06630201401	NONCDM CHARGE RECORD PHARMACY	636	C9399	63,795	N/A	N/A	N/A
HC65000636_06665823001	NONCDM CHARGE RECORD PHARMACY	636	90378	9,757	N/A	N/A	N/A
HC65000636_06673394823	NONCDM CHARGE RECORD PHARMACY	636	J9055	460	N/A	N/A	N/A
HC65000636_06679415502	NONCDM CHARGE RECORD PHARMACY	636	J0475	1,536	N/A	N/A	N/A
HC65000636_06679420741	NONCDM CHARGE RECORD PHARMACY	636	J0295	34	N/A	N/A	N/A
HC65000636_06679423042	NONCDM CHARGE RECORD PHARMACY	636	J3490	73	N/A	N/A	N/A
HC65000636_06745712410	NONCDM CHARGE RECORD PHARMACY	636	J1200	4	N/A	N/A	N/A
HC65000636_06745715318	NONCDM CHARGE RECORD PHARMACY	636	J0282	3	N/A	N/A	N/A
HC65000636_06745719803	NONCDM CHARGE RECORD PHARMACY	636	J3490	457	N/A	N/A	N/A
HC65000636_06745720725	NONCDM CHARGE RECORD PHARMACY	636	J1190	679	N/A	N/A	N/A
HC65000636_06745722702	NONCDM CHARGE RECORD PHARMACY	636	J0834	573	N/A	N/A	N/A
HC65000636_06745729101	NONCDM CHARGE RECORD PHARMACY	636	J0360	39	N/A	N/A	N/A
HC65000636_06745729910	NONCDM CHARGE RECORD PHARMACY	636	J2310	151	N/A	N/A	N/A
HC65000636_06745734105	NONCDM CHARGE RECORD PHARMACY	636	J3370	50	N/A	N/A	N/A
HC65000636_06745735210	NONCDM CHARGE RECORD PHARMACY	636	J0290	11	N/A	N/A	N/A
HC65000636_06745738681	NONCDM CHARGE RECORD PHARMACY	636	J3490	471	N/A	N/A	N/A
HC65000636_06745741805	NONCDM CHARGE RECORD PHARMACY	636	J1100	1	N/A	N/A	N/A
HC65000636_06745742312	NONCDM CHARGE RECORD PHARMACY	636	J1100	1	N/A	N/A	N/A
HC65000636_06745743710	NONCDM CHARGE RECORD PHARMACY	636	J3490	111	N/A	N/A	N/A
HC65000636_06745747322	NONCDM CHARGE RECORD PHARMACY	636	J3260	12	N/A	N/A	N/A
HC65000636_06745752433	NONCDM CHARGE RECORD PHARMACY	636	J1740	531	N/A	N/A	N/A
HC65000636_06745753035	NONCDM CHARGE RECORD PHARMACY	636	J0640	17	N/A	N/A	N/A
HC65000636_06745755400	NONCDM CHARGE RECORD PHARMACY	636	J3475	5	N/A	N/A	N/A
HC65000636_06745758210	NONCDM CHARGE RECORD PHARMACY	636	J1652	48	N/A	N/A	N/A
HC65000636_06745761910	NONCDM CHARGE RECORD PHARMACY	636	J3489	305	N/A	N/A	N/A
HC65000636_06745763110	NONCDM CHARGE RECORD PHARMACY	636	J1327	51	N/A	N/A	N/A
HC65000636_06745783306	NONCDM CHARGE RECORD PHARMACY	636	Q5108	1,990	N/A	N/A	N/A
HC65000636_06745784744	NONCDM CHARGE RECORD PHARMACY	636	Q5114	569	N/A	N/A	N/A
HC65000636_06745785502	NONCDM CHARGE RECORD PHARMACY	636	J0153	6	N/A	N/A	N/A
HC65000636_06745786301	NONCDM CHARGE RECORD PHARMACY	636	J1626	7	N/A	N/A	N/A
HC65000636_06745799115	NONCDM CHARGE RECORD PHARMACY	636	Q5114	570	N/A	N/A	N/A
HC65000636_06785015000	NONCDM CHARGE RECORD PHARMACY	636	C9113	23	N/A	N/A	N/A
HC65000636_06785015025	NONCDM CHARGE RECORD PHARMACY	636	C9113	25	N/A	N/A	N/A
HC65000636_06787723022	NONCDM CHARGE RECORD PHARMACY	636	J7517	110	N/A	N/A	N/A
HC65000636_06791903001	NONCDM CHARGE RECORD PHARMACY	636	J0695	62	N/A	N/A	N/A
HC65000636_06800146441	NONCDM CHARGE RECORD PHARMACY	636	J1650	7	N/A	N/A	N/A
HC65000636_06808444901	NONCDM CHARGE RECORD PHARMACY	636	J7507	13	N/A	N/A	N/A
HC65000636_06808490721	NONCDM CHARGE RECORD PHARMACY	636	J7518	24	N/A	N/A	N/A
HC65000636_06838286010	NONCDM CHARGE RECORD PHARMACY	636	J0515	153	N/A	N/A	N/A
HC65000636_06840311006	NONCDM CHARGE RECORD PHARMACY	636	J3490	62,073	N/A	N/A	N/A
HC65000636_06851652141	NONCDM CHARGE RECORD PHARMACY	636	P9045	299	N/A	N/A	N/A
HC65000636_06851652161	NONCDM CHARGE RECORD PHARMACY	636	P9047	301	N/A	N/A	N/A
HC65000636_06868201227	NONCDM CHARGE RECORD PHARMACY	636	C9399	26,236	N/A	N/A	N/A
HC65000636_06872790003	NONCDM CHARGE RECORD PHARMACY	636	J9021	152	N/A	N/A	N/A
HC65000636_06898264301	NONCDM CHARGE RECORD PHARMACY	636	P9047	363	N/A	N/A	N/A
HC65000636_06909785067	NONCDM CHARGE RECORD PHARMACY	636	J0878	1	N/A	N/A	N/A
HC65000636_06933913632	NONCDM CHARGE RECORD PHARMACY	636	J3360	80	N/A	N/A	N/A
HC65000636_06937431410	NONCDM CHARGE RECORD PHARMACY	636	J2250	2	N/A	N/A	N/A
HC65000636_06937494750	NONCDM CHARGE RECORD PHARMACY	636	J2001	104	N/A	N/A	N/A
HC65000636_06968011225	NONCDM CHARGE RECORD PHARMACY	636	J3420	29	N/A	N/A	N/A
HC65000636_06991889910	NONCDM CHARGE RECORD PHARMACY	636	J2597	127	N/A	N/A	N/A
HC65000636_07006902125	NONCDM CHARGE RECORD PHARMACY	636	J1100	3	N/A	N/A	N/A
HC65000636_07006915110	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,190	N/A	N/A	N/A
HC65000636_07006980610	NONCDM CHARGE RECORD PHARMACY	636	J2710	5	N/A	N/A	N/A
HC65000636_07011410101	NONCDM CHARGE RECORD PHARMACY	636	Q5111	2,261	N/A	N/A	N/A
HC65000636_07012110031	NONCDM CHARGE RECORD PHARMACY	636	J1327	174	N/A	N/A	N/A
HC65000636_07012110495	NONCDM CHARGE RECORD PHARMACY	636	J3301	14	N/A	N/A	N/A
HC65000636_07012115735	NONCDM CHARGE RECORD PHARMACY	636	J1030	64	N/A	N/A	N/A
HC65000636_07012115775	NONCDM CHARGE RECORD PHARMACY	636	J2370	3	N/A	N/A	N/A
HC65000636_07012116807	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,073	N/A	N/A	N/A
HC65000636_07025756255	NONCDM CHARGE RECORD PHARMACY	636	J0476	214	N/A	N/A	N/A
HC65000636_07043602082	NONCDM CHARGE RECORD PHARMACY	636	J3370	22	N/A	N/A	N/A
HC65000636_07043602382	NONCDM CHARGE RECORD PHARMACY	636	J3370	63	N/A	N/A	N/A
HC65000636_07043602680	NONCDM CHARGE RECORD PHARMACY	636	J1327	229	N/A	N/A	N/A
HC65000636_07051526010	NONCDM CHARGE RECORD PHARMACY	636	J1160	482	N/A	N/A	N/A
HC65000636_07059404801	NONCDM CHARGE RECORD PHARMACY	636	J3370	59	N/A	N/A	N/A
HC65000636_07059408602	NONCDM CHARGE RECORD PHARMACY	636	J0290	14	N/A	N/A	N/A
HC65000636_07071013596	NONCDM CHARGE RECORD PHARMACY	636	C9254	2	N/A	N/A	N/A
HC65000636_07071017261	NONCDM CHARGE RECORD PHARMACY	636	J9261	64	N/A	N/A	N/A
HC65000636_07072095036	NONCDM CHARGE RECORD PHARMACY	636	J9202	5,012	N/A	N/A	N/A
HC65000636_07086010410	NONCDM CHARGE RECORD PHARMACY	636	J3370	45	N/A	N/A	N/A
HC65000636_07086012566	NONCDM CHARGE RECORD PHARMACY	636	J0456	23	N/A	N/A	N/A
HC65000636_07086020050	NONCDM CHARGE RECORD PHARMACY	636	J9267	3	N/A	N/A	N/A
HC65000636_07086021805	NONCDM CHARGE RECORD PHARMACY	636	J9070	450	N/A	N/A	N/A
HC65000636_07086030110	NONCDM CHARGE RECORD PHARMACY	636	J3490	76	N/A	N/A	N/A
HC65000636_07086030204	NONCDM CHARGE RECORD PHARMACY	636	J1940	5	N/A	N/A	N/A
HC65000636_07086040504	NONCDM CHARGE RECORD PHARMACY	636	J3490	19	N/A	N/A	N/A
HC65000636_07086045401	NONCDM CHARGE RECORD PHARMACY	636	J2597	85	N/A	N/A	N/A
HC65000636_07086060002	NONCDM CHARGE RECORD PHARMACY	636	J2250	3	N/A	N/A	N/A
HC65000636_07086060110	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_07086070103	NONCDM CHARGE RECORD PHARMACY	636	J1885	6	N/A	N/A	N/A
HC65000636_07086080101	NONCDM CHARGE RECORD PHARMACY	636	J3105	12	N/A	N/A	N/A
HC65000636_07126680201	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,917	N/A	N/A	N/A
HC65000636_07128620406	NONCDM CHARGE RECORD PHARMACY	636	J2270	6	N/A	N/A	N/A
HC65000636_07128801715	NONCDM CHARGE RECORD PHARMACY	636	J0878	0	N/A	N/A	N/A
HC65000636_07128811450	NONCDM CHARGE RECORD PHARMACY	636	J9201	60	N/A	N/A	N/A
HC65000636_07128816750	NONCDM CHARGE RECORD PHARMACY	636	J9305	86	N/A	N/A	N/A
HC65000636_07128820021	NONCDM CHARGE RECORD PHARMACY	636	J2260	10	N/A	N/A	N/A
HC65000636_07128840003	NONCDM CHARGE RECORD PHARMACY	636	J1644	31	N/A	N/A	N/A
HC65000636_07128840231	NONCDM CHARGE RECORD PHARMACY	636	J1644	1	N/A	N/A	N/A
HC65000636_07128841083	NONCDM CHARGE RECORD PHARMACY	636	J1650	10	N/A	N/A	N/A
HC65000636_07128871206	NONCDM CHARGE RECORD PHARMACY	636	J3490	265	N/A	N/A	N/A
HC65000636_07133610001	NONCDM CHARGE RECORD PHARMACY	636	J0222	622	N/A	N/A	N/A
HC65000636_07183910801	NONCDM CHARGE RECORD PHARMACY	636	J0878	1	N/A	N/A	N/A
HC65000636_07186320206	NONCDM CHARGE RECORD PHARMACY	636	J3490	27	N/A	N/A	N/A
HC65000636_07219604311	NONCDM CHARGE RECORD PHARMACY	636	J7999	291	N/A	N/A	N/A
HC65000636_07220503101	NONCDM CHARGE RECORD PHARMACY	636	J0894	39	N/A	N/A	N/A
HC65000636_07226610301	NONCDM CHARGE RECORD PHARMACY	636	J3490	4	N/A	N/A	N/A
HC65000636_07226613101	NONCDM CHARGE RECORD PHARMACY	636	J3465	19	N/A	N/A	N/A
HC65000636_07248510125	NONCDM CHARGE RECORD PHARMACY	636	J1200	30	N/A	N/A	N/A
HC65000636_07248510610	NONCDM CHARGE RECORD PHARMACY	636	J1953	1	N/A	N/A	N/A
HC65000636_07257201610	NONCDM CHARGE RECORD PHARMACY	636	J0290	5	N/A	N/A	N/A
HC65000636_07257205001	NONCDM CHARGE RECORD PHARMACY	636	J0131	0	N/A	N/A	N/A
HC65000636_07257207424	NONCDM CHARGE RECORD PHARMACY	636	J3490	18	N/A	N/A	N/A
HC65000636_07257212025	NONCDM CHARGE RECORD PHARMACY	636	J1100	2	N/A	N/A	N/A
HC65000636_07257214002	NONCDM CHARGE RECORD PHARMACY	636	J3360	50	N/A	N/A	N/A
HC65000636_07257217125	NONCDM CHARGE RECORD PHARMACY	636	J3010	5	N/A	N/A	N/A
HC65000636_07257225525	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_07257237025	NONCDM CHARGE RECORD PHARMACY	636	J2001	2	N/A	N/A	N/A
HC65000636_07257238025	NONCDM CHARGE RECORD PHARMACY	636	J2060	4	N/A	N/A	N/A
HC65000636_07257241510	NONCDM CHARGE RECORD PHARMACY	636	J2185	5	N/A	N/A	N/A
HC65000636_07257242701	NONCDM CHARGE RECORD PHARMACY	636	J2248	3	N/A	N/A	N/A
HC65000636_07257252025	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_07257257310	NONCDM CHARGE RECORD PHARMACY	636	J2543	10	N/A	N/A	N/A
HC65000636_07257260120	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_07257280102	NONCDM CHARGE RECORD PHARMACY	636	J3370	11	N/A	N/A	N/A
HC65000636_07261164225	NONCDM CHARGE RECORD PHARMACY	636	J3490	21	N/A	N/A	N/A
HC65000636_07261171925	NONCDM CHARGE RECORD PHARMACY	636	J1885	7	N/A	N/A	N/A
HC65000636_07261172225	NONCDM CHARGE RECORD PHARMACY	636	J1885	6	N/A	N/A	N/A
HC65000636_07261176110	NONCDM CHARGE RECORD PHARMACY	636	J3370	19	N/A	N/A	N/A
HC65000636_07269495401	NONCDM CHARGE RECORD PHARMACY	636	J9266	88,055	N/A	N/A	N/A
HC65000636_07452702203	NONCDM CHARGE RECORD PHARMACY	636	J9353	274	N/A	N/A	N/A
HC65000636_07601400410	NONCDM CHARGE RECORD PHARMACY	636	J2370	3	N/A	N/A	N/A
HC65000636_07604500411	NONCDM CHARGE RECORD PHARMACY	636	J2270	19	N/A	N/A	N/A
HC65000636_07604500610	NONCDM CHARGE RECORD PHARMACY	636	J2270	19	N/A	N/A	N/A
HC65000636_07604501011	NONCDM CHARGE RECORD PHARMACY	636	J1170	26	N/A	N/A	N/A
HC65000636_07607510101	NONCDM CHARGE RECORD PHARMACY	636	J9047	305	N/A	N/A	N/A
HC65000636_07612579025	NONCDM CHARGE RECORD PHARMACY	636	P9045	312	N/A	N/A	N/A
HC65000636_07632912401	NONCDM CHARGE RECORD PHARMACY	636	J3430	161	N/A	N/A	N/A
HC65000636_07632933401	NONCDM CHARGE RECORD PHARMACY	636	J0461	1	N/A	N/A	N/A
HC65000636_07632933995	NONCDM CHARGE RECORD PHARMACY	636	J2690	552	N/A	N/A	N/A
HC65000636_07647850120	NONCDM CHARGE RECORD PHARMACY	636	J2515	393	N/A	N/A	N/A
HC65000636_07820616201	NONCDM CHARGE RECORD PHARMACY	636	Q5104	490	N/A	N/A	N/A
HC65000636_07995211001	NONCDM CHARGE RECORD PHARMACY	636	C9084	1,527	N/A	N/A	N/A
HC65000636_08128461110	NONCDM CHARGE RECORD PHARMACY	636	J3490	47	N/A	N/A	N/A
HC65000636_08290306424	NONCDM CHARGE RECORD PHARMACY	636	J1642	0	N/A	N/A	N/A
HC65000636_09999904236	NONCDM CHARGE RECORD PHARMACY	636	J0698	11	N/A	N/A	N/A
HC65000636_70092109236	NONCDM CHARGE RECORD PHARMACY	636	J3010	9	N/A	N/A	N/A
HC65000636_70092155207	NONCDM CHARGE RECORD PHARMACY	636	J2590	39	N/A	N/A	N/A
HC65000637_00002751101	NONCDM CHARGE RECORD PHARMACY	636	J1815	9	N/A	N/A	N/A
HC65000637_00002771559	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00002821501	NONCDM CHARGE RECORD PHARMACY	636	J1815	5	N/A	N/A	N/A
HC65000637_00002822259	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00002840001	NONCDM CHARGE RECORD PHARMACY	636	J3110	0	N/A	N/A	N/A
HC65000637_00002880559	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00024592500	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00088222033	NONCDM CHARGE RECORD PHARMACY	636	J1815	9	N/A	N/A	N/A
HC65000637_00169183411	NONCDM CHARGE RECORD PHARMACY	636	J1815	4	N/A	N/A	N/A
HC65000637_00169210125	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00169255013	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00169368512	NONCDM CHARGE RECORD PHARMACY	636	J1815	10	N/A	N/A	N/A
HC65000637_00169643810	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00781325089	NONCDM CHARGE RECORD PHARMACY	636	J1595	0	N/A	N/A	N/A
HC65000637_04950225080	NONCDM CHARGE RECORD PHARMACY	636	J1815	9	N/A	N/A	N/A
HC65000637_06854632512	NONCDM CHARGE RECORD PHARMACY	636	J1595	0	N/A	N/A	N/A
HC65000888	PHARMACY CONVERSION			N/A	N/A	N/A	N/A
HC65001258_00264151031	NONCDM CHARGE RECORD PHARMACY	636	J7060	14	N/A	N/A	N/A
HC65001258_00264180031	NONCDM CHARGE RECORD PHARMACY	258	J7050	14	N/A	N/A	N/A
HC65001258_00264751000	NONCDM CHARGE RECORD PHARMACY	636	J7060	13	N/A	N/A	N/A
HC65001258_00264762500	NONCDM CHARGE RECORD PHARMACY	636	J7070	26	N/A	N/A	N/A
HC65001258_00264780000	NONCDM CHARGE RECORD PHARMACY	636	J7030	13	N/A	N/A	N/A
HC65001258_00264780020	NONCDM CHARGE RECORD PHARMACY	258	J7050	16	N/A	N/A	N/A
HC65001258_00264780510	NONCDM CHARGE RECORD PHARMACY	636	J7050	10	N/A	N/A	N/A
HC65001258_00338001704	NONCDM CHARGE RECORD PHARMACY	636	J7060	16	N/A	N/A	N/A
HC65001258_00338001731	NONCDM CHARGE RECORD PHARMACY	258	J7060	14	N/A	N/A	N/A
HC65001258_00338001748	NONCDM CHARGE RECORD PHARMACY	258	J7060	16	N/A	N/A	N/A
HC65001258_00338004903	NONCDM CHARGE RECORD PHARMACY	258	J7040	24	N/A	N/A	N/A
HC65001258_00338004911	NONCDM CHARGE RECORD PHARMACY	636	J7050	17	N/A	N/A	N/A
HC65001258_00338004938	NONCDM CHARGE RECORD PHARMACY	258	J7050	13	N/A	N/A	N/A
HC65001258_00338005403	NONCDM CHARGE RECORD PHARMACY	258	J7050	19	N/A	N/A	N/A
HC65001258_00338008503	NONCDM CHARGE RECORD PHARMACY	258	J7042	29	N/A	N/A	N/A
HC65001258_00338008904	NONCDM CHARGE RECORD PHARMACY	258	J7042	16	N/A	N/A	N/A
HC65001258_00338011702	NONCDM CHARGE RECORD PHARMACY	258	J7120	31	N/A	N/A	N/A
HC65001258_00338011704	NONCDM CHARGE RECORD PHARMACY	258	J7120	32	N/A	N/A	N/A
HC65001258_00338055318	NONCDM CHARGE RECORD PHARMACY	258	J7050	35	N/A	N/A	N/A
HC65001258_00338069504	NONCDM CHARGE RECORD PHARMACY	636	J7030	68	N/A	N/A	N/A
HC65001258_00338080704	NONCDM CHARGE RECORD PHARMACY	636	J7042	26	N/A	N/A	N/A
HC65001258_00409488810	NONCDM CHARGE RECORD PHARMACY	636	J7030	18	N/A	N/A	N/A
HC65001258_00409710167	NONCDM CHARGE RECORD PHARMACY	258	J7050	18	N/A	N/A	N/A
HC65001258_00409792202	NONCDM CHARGE RECORD PHARMACY	636	J7060	34	N/A	N/A	N/A
HC65001258_00409792209	NONCDM CHARGE RECORD PHARMACY	636	J7060	16	N/A	N/A	N/A
HC65001258_00409792609	NONCDM CHARGE RECORD PHARMACY	636	J7042	16	N/A	N/A	N/A
HC65001258_00409795309	NONCDM CHARGE RECORD PHARMACY	258	J7120	32	N/A	N/A	N/A
HC65001258_00409798309	NONCDM CHARGE RECORD PHARMACY	258	J7030	29	N/A	N/A	N/A
HC65001258_00409798413	NONCDM CHARGE RECORD PHARMACY	258	J7050	16	N/A	N/A	N/A
HC65001258_00990710709	NONCDM CHARGE RECORD PHARMACY	258	J7042	23	N/A	N/A	N/A
HC65001258_00990711509	NONCDM CHARGE RECORD PHARMACY	258	J7030	45	N/A	N/A	N/A
HC65001258_00990790209	NONCDM CHARGE RECORD PHARMACY	258	J7042	23	N/A	N/A	N/A
HC65001258_00990790409	NONCDM CHARGE RECORD PHARMACY	636	J7042	23	N/A	N/A	N/A
HC65001258_00990792203	NONCDM CHARGE RECORD PHARMACY	258	J7060	33	N/A	N/A	N/A
HC65001258_00990792261	NONCDM CHARGE RECORD PHARMACY	258	J7060	21	N/A	N/A	N/A
HC65001258_00990792323	NONCDM CHARGE RECORD PHARMACY	258	J7060	11	N/A	N/A	N/A
HC65001258_00990792403	NONCDM CHARGE RECORD PHARMACY	636	J7042	36	N/A	N/A	N/A
HC65001258_00990792609	NONCDM CHARGE RECORD PHARMACY	258	J7042	16	N/A	N/A	N/A
HC65001258_00990794103	NONCDM CHARGE RECORD PHARMACY	636	J7042	36	N/A	N/A	N/A
HC65001258_00990795303	NONCDM CHARGE RECORD PHARMACY	636	J7120	71	N/A	N/A	N/A
HC65001258_00990795309	NONCDM CHARGE RECORD PHARMACY	258	J7120	32	N/A	N/A	N/A
HC65001258_00990798303	NONCDM CHARGE RECORD PHARMACY	258	J7040	29	N/A	N/A	N/A
HC65001258_00990798411	NONCDM CHARGE RECORD PHARMACY	636	J7050	34	N/A	N/A	N/A
HC65001258_00990798423	NONCDM CHARGE RECORD PHARMACY	258	J7030	15	N/A	N/A	N/A
HC65001258_00990798509	NONCDM CHARGE RECORD PHARMACY	258	J7030	30	N/A	N/A	N/A
HC65001258_01727170102	NONCDM CHARGE RECORD PHARMACY	636	J7050	44	N/A	N/A	N/A
HC65001258_02457110806	NONCDM CHARGE RECORD PHARMACY	636	A4706	231	N/A	N/A	N/A
HC65001258_06332353075	NONCDM CHARGE RECORD PHARMACY	636	J7040	12	N/A	N/A	N/A
HC65001258_06332362361	NONCDM CHARGE RECORD PHARMACY	258	J7050	19	N/A	N/A	N/A
HC65001258_06332362404	NONCDM CHARGE RECORD PHARMACY	636	J7060	271	N/A	N/A	N/A
HC65001258_06332362474	NONCDM CHARGE RECORD PHARMACY	636	J7060	19	N/A	N/A	N/A
HC65001258_07629700101	NONCDM CHARGE RECORD PHARMACY	258	J7040	35	N/A	N/A	N/A
HC65001258_08290306544	NONCDM CHARGE RECORD PHARMACY	258	J7030	3	N/A	N/A	N/A
HC65001278	DRUG/IMPLANT - LARC	636		N/A	N/A	N/A	N/A
HC65001278_05041942301	NONCDM CHARGE RECORD PHARMACY	636	J7298	6,367	N/A	N/A	N/A
HC65001636	DRUG - NON-COVERED MEDICARE	636		N/A	N/A	N/A	N/A
HC65001636_00548570100	NONCDM CHARGE RECORD PHARMACY	636	J1050	2	N/A	N/A	N/A
HC65002250_00264210100	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65002250_00338000404	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65002250_00338004802	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65002250_00338013727	NONCDM CHARGE RECORD PHARMACY	250		117	N/A	N/A	N/A
HC65002250_00409713909	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65002250_00409799009	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002250_00436093616	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65002250_00990613822	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65002250_00990614322	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65002250_00990713909	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002250_00990797207	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65002250_00990799009	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65002258_00264752000	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65002258_00264762200	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65002258_00264770700	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65002258_00338002304	NONCDM CHARGE RECORD PHARMACY	250		50	N/A	N/A	N/A
HC65002258_00338113004	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65002258_00409793009	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002258_00990767003	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65002258_00990793003	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65002258_06332382474	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65002636	DRUG - DETAILED MCARE J3490  MCAL Z7610	636		N/A	N/A	N/A	N/A
HC65002636_00002418230	NONCDM CHARGE RECORD PHARMACY	636	J3490	928	N/A	N/A	N/A
HC65002636_00046087221	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,684	N/A	N/A	N/A
HC65002636_00065401303	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,132	N/A	N/A	N/A
HC65002636_00078040134	NONCDM CHARGE RECORD PHARMACY	636	J3490	609	N/A	N/A	N/A
HC65002636_00078079975	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1,619	N/A	N/A	N/A
HC65002636_00078093926	NONCDM CHARGE RECORD PHARMACY	636	J3490	349	N/A	N/A	N/A
HC65002636_00085222301	NONCDM CHARGE RECORD PHARMACY	636	Z7610	2,024	N/A	N/A	N/A
HC65002636_00085720607	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1,370	N/A	N/A	N/A
HC65002636_00093762998	NONCDM CHARGE RECORD PHARMACY	636	J3490	8	N/A	N/A	N/A
HC65002636_00168041630	NONCDM CHARGE RECORD PHARMACY	636	Z7610	880	N/A	N/A	N/A
HC65002636_00173069604	NONCDM CHARGE RECORD PHARMACY	636	J3490	986	N/A	N/A	N/A
HC65002636_00173071622	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,422	N/A	N/A	N/A
HC65002636_00173071920	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,749	N/A	N/A	N/A
HC65002636_00187065820	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,995	N/A	N/A	N/A
HC65002636_00378087399	NONCDM CHARGE RECORD PHARMACY	636	J3490	406	N/A	N/A	N/A
HC65002636_00469032014	NONCDM CHARGE RECORD PHARMACY	636	J3490	0	N/A	N/A	N/A
HC65002636_00527196174	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,433	N/A	N/A	N/A
HC65002636_00574402235	NONCDM CHARGE RECORD PHARMACY	636	J3490	642	N/A	N/A	N/A
HC65002636_00597002402	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,871	N/A	N/A	N/A
HC65002636_00597010061	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,169	N/A	N/A	N/A
HC65002636_00781618667	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,318	N/A	N/A	N/A
HC65002636_01012251001	NONCDM CHARGE RECORD PHARMACY	636	J3490	4,257	N/A	N/A	N/A
HC65002636_01048101128	NONCDM CHARGE RECORD PHARMACY	636	J3490	95	N/A	N/A	N/A
HC65002636_01063140701	NONCDM CHARGE RECORD PHARMACY	636	J3490	455	N/A	N/A	N/A
HC65002636_01671405502	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,161	N/A	N/A	N/A
HC65002636_01671487801	NONCDM CHARGE RECORD PHARMACY	636	J3490	391	N/A	N/A	N/A
HC65002636_01671488502	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,677	N/A	N/A	N/A
HC65002636_01747820910	NONCDM CHARGE RECORD PHARMACY	636	J3490	208	N/A	N/A	N/A
HC65002636_02192202905	NONCDM CHARGE RECORD PHARMACY	636	J3490	975	N/A	N/A	N/A
HC65002636_02420841005	NONCDM CHARGE RECORD PHARMACY	636	J3490	836	N/A	N/A	N/A
HC65002636_02420848610	NONCDM CHARGE RECORD PHARMACY	636	J3490	325	N/A	N/A	N/A
HC65002636_02420863110	NONCDM CHARGE RECORD PHARMACY	636	J3490	545	N/A	N/A	N/A
HC65002636_02420872002	NONCDM CHARGE RECORD PHARMACY	636	J3490	350	N/A	N/A	N/A
HC65002636_02433826008	NONCDM CHARGE RECORD PHARMACY	636	J3490	374	N/A	N/A	N/A
HC65002636_02576773545	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,546	N/A	N/A	N/A
HC65002636_03172286903	NONCDM CHARGE RECORD PHARMACY	636	J3490	487	N/A	N/A	N/A
HC65002636_04202313101	NONCDM CHARGE RECORD PHARMACY	636	J0770	182	N/A	N/A	N/A
HC65002636_04257114726	NONCDM CHARGE RECORD PHARMACY	636	J3490	319	N/A	N/A	N/A
HC65002636_04580211222	NONCDM CHARGE RECORD PHARMACY	636	J3490	58	N/A	N/A	N/A
HC65002636_04580221001	NONCDM CHARGE RECORD PHARMACY	636	J3490	922	N/A	N/A	N/A
HC65002636_04733523683	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,625	N/A	N/A	N/A
HC65002636_04778173002	NONCDM CHARGE RECORD PHARMACY	636	J3490	65	N/A	N/A	N/A
HC65002636_05024210040	NONCDM CHARGE RECORD PHARMACY	636	J3490	787	N/A	N/A	N/A
HC65002636_05048401030	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,756	N/A	N/A	N/A
HC65002636_05167212641	NONCDM CHARGE RECORD PHARMACY	636	J3490	114	N/A	N/A	N/A
HC65002636_05167213120	NONCDM CHARGE RECORD PHARMACY	636	J3490	112	N/A	N/A	N/A
HC65002636_05186245504	NONCDM CHARGE RECORD PHARMACY	636	J3490	226	N/A	N/A	N/A
HC65002636_05201508001	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,427	N/A	N/A	N/A
HC65002636_05515023410	NONCDM CHARGE RECORD PHARMACY	636	J3490	13	N/A	N/A	N/A
HC65002636_05914802150	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,321	N/A	N/A	N/A
HC65002636_05976200491	NONCDM CHARGE RECORD PHARMACY	636	J7509	5	N/A	N/A	N/A
HC65002636_06050508150	NONCDM CHARGE RECORD PHARMACY	636	J3490	800	N/A	N/A	N/A
HC65002636_06050547040	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,937	N/A	N/A	N/A
HC65002636_06068752321	NONCDM CHARGE RECORD PHARMACY	636	Z7610	307	N/A	N/A	N/A
HC65002636_06075811910	NONCDM CHARGE RECORD PHARMACY	636	J3490	572	N/A	N/A	N/A
HC65002636_06079321505	NONCDM CHARGE RECORD PHARMACY	636	J3490	581	N/A	N/A	N/A
HC65002636_06131412605	NONCDM CHARGE RECORD PHARMACY	636	J3490	180	N/A	N/A	N/A
HC65002636_06131463136	NONCDM CHARGE RECORD PHARMACY	636	J3490	85	N/A	N/A	N/A
HC65002636_06131464725	NONCDM CHARGE RECORD PHARMACY	636	J3490	156	N/A	N/A	N/A
HC65002636_06248400202	NONCDM CHARGE RECORD PHARMACY	636	J3490	157	N/A	N/A	N/A
HC65002636_06332336711	NONCDM CHARGE RECORD PHARMACY	636	J3490	14	N/A	N/A	N/A
HC65002636_06371301985	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,752	N/A	N/A	N/A
HC65002636_06498030130	NONCDM CHARGE RECORD PHARMACY	636	Z7610	129	N/A	N/A	N/A
HC65002636_06498032430	NONCDM CHARGE RECORD PHARMACY	636	J3490	134	N/A	N/A	N/A
HC65002636_06516283596	NONCDM CHARGE RECORD PHARMACY	636	J3490	390	N/A	N/A	N/A
HC65002636_06564920175	NONCDM CHARGE RECORD PHARMACY	636	J3490	801	N/A	N/A	N/A
HC65002636_06699307996	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,157	N/A	N/A	N/A
HC65002636_06787747379	NONCDM CHARGE RECORD PHARMACY	636	J3490	78	N/A	N/A	N/A
HC65002636_06791902010	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,182	N/A	N/A	N/A
HC65002636_06846218022	NONCDM CHARGE RECORD PHARMACY	636	J3490	57	N/A	N/A	N/A
HC65002636_06846256435	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,161	N/A	N/A	N/A
HC65002636_06846274617	NONCDM CHARGE RECORD PHARMACY	636	J3490	195	N/A	N/A	N/A
HC65002636_06868220175	NONCDM CHARGE RECORD PHARMACY	636	J3490	649	N/A	N/A	N/A
HC65002636_06880361210	NONCDM CHARGE RECORD PHARMACY	636	J3490	468	N/A	N/A	N/A
HC65002636_06934410233	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,950	N/A	N/A	N/A
HC65002636_07006942101	NONCDM CHARGE RECORD PHARMACY	636	J3490	59	N/A	N/A	N/A
HC65002636_07051571101	NONCDM CHARGE RECORD PHARMACY	636	Z7610	29	N/A	N/A	N/A
HC65002636_07059402602	NONCDM CHARGE RECORD PHARMACY	636	J3490	108	N/A	N/A	N/A
HC65002636_07059404902	NONCDM CHARGE RECORD PHARMACY	636	J3490	13	N/A	N/A	N/A
HC65002636_07226615801	NONCDM CHARGE RECORD PHARMACY	636	J3490	256	N/A	N/A	N/A
HC65002636_07647800205	NONCDM CHARGE RECORD PHARMACY	636	J3490	9	N/A	N/A	N/A
HC65002636_07820612701	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,024	N/A	N/A	N/A
HC65002636_08065183905	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,221	N/A	N/A	N/A
HC65003250	MED - GENERAL ALT COMMCRL J3490	250		N/A	N/A	N/A	N/A
HC65004250_00009043601	NONCDM CHARGE RECORD PHARMACY	250		112	N/A	N/A	N/A
HC65004250_00143923410	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65004250_00143925010	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65004250_00143950610	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65004250_00143958625	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65004250_00143968025	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65004250_00143978410	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65004250_00143978710	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65004250_00264553532	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65004250_00338002302	NONCDM CHARGE RECORD PHARMACY	250	J3490	32	N/A	N/A	N/A
HC65004250_00338010820	NONCDM CHARGE RECORD PHARMACY	250		227	N/A	N/A	N/A
HC65004250_00338051914	NONCDM CHARGE RECORD PHARMACY	250		113	N/A	N/A	N/A
HC65004250_00338104702	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65004250_00338519741	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65004250_00409110901	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65004250_00409114405	NONCDM CHARGE RECORD PHARMACY	250		191	N/A	N/A	N/A
HC65004250_00409148202	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65004250_00409163201	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65004250_00409196607	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65004250_00409317701	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_00409317803	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65004250_00409318211	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65004250_00409329451	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65004250_00409337504	NONCDM CHARGE RECORD PHARMACY	250		351	N/A	N/A	N/A
HC65004250_00409409001	NONCDM CHARGE RECORD PHARMACY	250		307	N/A	N/A	N/A
HC65004250_00409427602	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65004250_00409488720	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_00409488810	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65004250_00409488850	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65004250_00409553414	NONCDM CHARGE RECORD PHARMACY	250		80	N/A	N/A	N/A
HC65004250_00409662535	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65004250_00409664802	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65004250_00409729501	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65004250_00409729973	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65004250_00409751716	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65004250_00409806201	NONCDM CHARGE RECORD PHARMACY	250		111	N/A	N/A	N/A
HC65004250_00409955810	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65004250_00517037505	NONCDM CHARGE RECORD PHARMACY	250		1,225	N/A	N/A	N/A
HC65004250_00517301025	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65004250_00641600810	NONCDM CHARGE RECORD PHARMACY	250	J3490	19	N/A	N/A	N/A
HC65004250_00641614725	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_00703950303	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65004250_00781304095	NONCDM CHARGE RECORD PHARMACY	250		200	N/A	N/A	N/A
HC65004250_00781375595	NONCDM CHARGE RECORD PHARMACY	250		96	N/A	N/A	N/A
HC65004250_00990793002	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_00990793619	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65004250_01747850801	NONCDM CHARGE RECORD PHARMACY	250	J3490	8	N/A	N/A	N/A
HC65004250_02502131202	NONCDM CHARGE RECORD PHARMACY	250		189	N/A	N/A	N/A
HC65004250_02502165905	NONCDM CHARGE RECORD PHARMACY	250	J3490	42	N/A	N/A	N/A
HC65004250_02502167410	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65004250_03600014810	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65004250_03982242002	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65004250_04202310405	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65004250_04306600710	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65004250_04733593144	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65004250_04923020650	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65004250_04923020923	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_04923020950	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65004250_04928175221	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65004250_05175450014	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65004250_05175460004	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65004250_05464356502	NONCDM CHARGE RECORD PHARMACY	250		162	N/A	N/A	N/A
HC65004250_05515022220	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65004250_05515023510	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65004250_05515034225	NONCDM CHARGE RECORD PHARMACY	250		130	N/A	N/A	N/A
HC65004250_06332308605	NONCDM CHARGE RECORD PHARMACY	250		103	N/A	N/A	N/A
HC65004250_06332308863	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65004250_06332309561	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65004250_06332318410	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65004250_06332318600	NONCDM CHARGE RECORD PHARMACY	250	J3490	4	N/A	N/A	N/A
HC65004250_06332338510	NONCDM CHARGE RECORD PHARMACY	250		136	N/A	N/A	N/A
HC65004250_06332342605	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65004250_06332348157	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65004250_06332348257	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65004250_06332348737	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65004250_06332348837	NONCDM CHARGE RECORD PHARMACY	250		88	N/A	N/A	N/A
HC65004250_06332349405	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65004250_06332373912	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_06332382000	NONCDM CHARGE RECORD PHARMACY	250		140	N/A	N/A	N/A
HC65004250_06332388116	NONCDM CHARGE RECORD PHARMACY	250		126	N/A	N/A	N/A
HC65004250_06332388406	NONCDM CHARGE RECORD PHARMACY	250		108	N/A	N/A	N/A
HC65004250_06332394004	NONCDM CHARGE RECORD PHARMACY	250		76	N/A	N/A	N/A
HC65004250_06380710030	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_06425302091	NONCDM CHARGE RECORD PHARMACY	250		63	N/A	N/A	N/A
HC65004250_06521905229	NONCDM CHARGE RECORD PHARMACY	250		130	N/A	N/A	N/A
HC65004250_06679422841	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65004250_06745718120	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65004250_06745743322	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_06745743810	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65004250_06745747520	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65004250_06937421450	NONCDM CHARGE RECORD PHARMACY	250		86	N/A	N/A	N/A
HC65004250_06937451101	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65004250_07006901225	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65004250_07006927125	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65004250_07012115767	NONCDM CHARGE RECORD PHARMACY	250		138	N/A	N/A	N/A
HC65004250_07145600101	NONCDM CHARGE RECORD PHARMACY	250		195	N/A	N/A	N/A
HC65004250_07226614610	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65004250_07257216010	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65004250_07257265110	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65004250_07261174010	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_07632933041	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65004250_08290306545	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65004250_08290306553	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65025011_00409434673	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65025012	MEDICATION - MCAL S0020	250		N/A	N/A	N/A	N/A
HC65025012_00409115901	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65025012_00409116001	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65025012_00409116210	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65025012_00409116502	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65025012_00409156010	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65025012_00409158210	NONCDM CHARGE RECORD PHARMACY	250	S0020	0	N/A	N/A	N/A
HC65025012_00409158229	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65025012_00409174910	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65025012_00409176110	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65025012_00409904217	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65025012_05515017030	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65025012_06332346157	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65025012_06332346237	NONCDM CHARGE RECORD PHARMACY	250		43	N/A	N/A	N/A
HC65025012_06332346417	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65025012_06332346437	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65025012_06332346617	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65025012_06332346837	NONCDM CHARGE RECORD PHARMACY	250		38	N/A	N/A	N/A
HC65025013	MEDICATION - MCAL S0032	250		N/A	N/A	N/A	N/A
HC65025013_02502114010	NONCDM CHARGE RECORD PHARMACY	250		146	N/A	N/A	N/A
HC65025013_05515012215	NONCDM CHARGE RECORD PHARMACY	250		76	N/A	N/A	N/A
HC65025013_05515012499	NONCDM CHARGE RECORD PHARMACY	250	S0032	134	N/A	N/A	N/A
HC65025013_07086011726	NONCDM CHARGE RECORD PHARMACY	250		141	N/A	N/A	N/A
HC65025015	MEDICATION - MCAL S0080	250		N/A	N/A	N/A	N/A
HC65200250	MED - WOUND TOPICAL PRODUCT (NO NDC)	636		656	N/A	N/A	N/A
HC65200250_09999903891	NONCDM CHARGE RECORD PHARMACY	636	Q4196	444	N/A	N/A	N/A
HC65200250_09999904463	NONCDM CHARGE RECORD PHARMACY	636	Q4196	625	N/A	N/A	N/A
HC65200636_09978000199	NONCDM CHARGE RECORD PHARMACY	636	Q4101	272	N/A	N/A	N/A
HC65500754_00562780501	NONCDM CHARGE RECORD PHARMACY	636	J2790	708	N/A	N/A	N/A
HC65500754_07025733051	NONCDM CHARGE RECORD PHARMACY	636	J2790	708	N/A	N/A	N/A
HC65600343	NM MEDICATION-DIAGNOSTIC	343		577	N/A	N/A	N/A
HC65600343_01199412711	NONCDM CHARGE RECORD PHARMACY	250	A9558	269	N/A	N/A	N/A
HC65600343_01715602630	NONCDM CHARGE RECORD PHARMACY	250	A9502	100	N/A	N/A	N/A
HC65600343_04002851130	NONCDM CHARGE RECORD PHARMACY	250	A9552	374	N/A	N/A	N/A
HC65600343_04556700601	NONCDM CHARGE RECORD PHARMACY	255	A9538	195	N/A	N/A	N/A
HC65600343_04556704752	NONCDM CHARGE RECORD PHARMACY	250	A9510	185	N/A	N/A	N/A
HC65600343_06517428830	NONCDM CHARGE RECORD PHARMACY	250	A9539	384	N/A	N/A	N/A
HC65600343_06585745005	NONCDM CHARGE RECORD PHARMACY	255	A9520	511	N/A	N/A	N/A
HC65600343_06948800140	NONCDM CHARGE RECORD PHARMACY	255	A9587	237	N/A	N/A	N/A
HC65600343_06994505040	NONCDM CHARGE RECORD PHARMACY	255	A9572	16,751	N/A	N/A	N/A
HC65600343_06994509620	NONCDM CHARGE RECORD PHARMACY	250	A9562	1,166	N/A	N/A	N/A
HC65600344	NM MEDICATION-THERAPEUTIC	344		103	N/A	N/A	N/A
HC65601344	NM MEDICATION-THERAPEUTIC (340B)	344		1,422	N/A	N/A	N/A
HC65800021	CESIUM-131 NONSTRND PER SOURCE	278	C2643	406	N/A	N/A	N/A
HC65800054	BRACHY SEED HDR IRIDIUM 192	278	C1717	878	N/A	N/A	N/A
HC65800088	BRACHYTX NONSTRAND NOS PER SRC	278	C2699	195	N/A	N/A	N/A
HC65800104	IODINE-125 STRANDED PER SOURCE	278	C2638	328	N/A	N/A	N/A
HC65890006	P: PALLADIUM 103 20 SEEDS			N/A	N/A	N/A	N/A
HC73000002	DIALYSIS CAPD W/SNGL EVAL(IP)	803	90945	2,624	N/A	N/A	N/A
HC73000127	HEMODIALYSIS W/SNGL EVAL(IP)	801	90935	2,777	N/A	N/A	N/A
HC73000184	DIALYSIS URGENT/NON-ROUTINE ESRD (OP)	820	G0257	6,774	N/A	N/A	N/A
HC73000226	PERITONITIS TREATMENT	361	49084	4,697	N/A	N/A	N/A
HC73000259	DIALYSIS CCPD CANCEL-MED NEC	804	90945	1,303	N/A	N/A	N/A
HC74200007	OR TIME INITIAL HR LEVEL 1 (MCAL 1ST HOUR)	360		10,685	N/A	N/A	N/A
HC74200023	OR TIME INITIAL HR LEVEL 3 (MCAL 1ST HOUR)	360		15,433	N/A	N/A	N/A
HC74200056	OR TIME INITIAL HR LEVEL 6 (MCAL 1ST HOUR)	360		22,441	N/A	N/A	N/A
HC74200080	OR TIME ADD'L 15MIN LVL 3 (MCAL 1ST SUBSQNT 0.5 HR)	360		3,860	N/A	N/A	N/A
HC74200114	OR TIME ADD'L 15MIN LVL 6 (MCAL 1ST SUBSQNT 0.5 HR)	360		5,611	N/A	N/A	N/A
HC74200148	OR TIME INIT'L HR CASE CX LEVEL 3 (MCAL 1ST HOUR)	360		7,480	N/A	N/A	N/A
HC74200171	OR TIME INIT'L HR CASE CX LEVEL 6 (MCAL 1ST HOUR)	360		10,196	N/A	N/A	N/A
HC74200205	BEDSIDE/OTHER SURG INITIAL HR 3 (MCAL 1ST HOUR)	369		7,738	N/A	N/A	N/A
HC74200221	BEDSIDE/OTHER SURG INITIAL HR 5 (MCAL 1ST HOUR)	369		10,073	N/A	N/A	N/A
HC74200239	BEDSIDE/OTHER SURG INITIAL HR 6 (MCAL 1ST HOUR)	369		10,820	N/A	N/A	N/A
HC74200254	BEDSIDE/OTHER SURG ADD'L 15MIN 2 (MCAL 1ST SUBSQNT 0.5 HR)	369		1,676	N/A	N/A	N/A
HC74200288	BEDSIDE/OTHER SURG ADD'L 15MIN 5 (MCAL 1ST SUBSQNT 0.5 HR)	369		2,505	N/A	N/A	N/A
HC74200312	BEDSIDE/OTHER SURGICAL CANCEL LVL 2	369		3,322	N/A	N/A	N/A
HC74200346	BEDSIDE/OTHER SURGICAL CANCEL LVL 5	369		4,964	N/A	N/A	N/A
HC74200379	OR TIME ADD'L 15MIN CASE CX 2 (MCAL 1ST SUBSQNT 0.5 HR)	360		1,599	N/A	N/A	N/A
HC74200403	OR TIME ADD'L 15MIN CASE CX 5 (MCAL 1ST SUBSQNT 0.5 HR)	360		2,302	N/A	N/A	N/A
HC74200429	OR TIME ADD'L 15MIN LVL 1  (MCAL 2ND SUBSQNT 0.5 HR)	360		2,673	N/A	N/A	N/A
HC74200437	OR TIME ADD'L 15MIN LVL 2  (MCAL 2ND SUBSQNT 0.5 HR)	360		3,243	N/A	N/A	N/A
HC74200452	OR TIME ADD'L 15MIN LVL 4  (MCAL 2ND SUBSQNT 0.5 HR)	360		4,480	N/A	N/A	N/A
HC74200486	BEDSIDE/OTHER SURG ADD'L 15MIN 1 (MCAL 2ND SUBSQNT 0.5 HR)	369		1,292	N/A	N/A	N/A
HC74200510	BEDSIDE/OTHER SURG ADD'L 15MIN 4 (MCAL 2ND SUBSQNT 0.5 HR)	369		2,319	N/A	N/A	N/A
HC74200544	OR ROOM FIRST HOUR (MCAL ONLY)	360		N/A	N/A	N/A	N/A
HC74200577	OR ROOM FIRST HOUR MCAL	369		N/A	N/A	N/A	N/A
HC74200601	OR TIME ADD'L 15MIN CASE CX 3 (MCAL 2ND SUBSQNT 0.5 HR)	360		1,861	N/A	N/A	N/A
HC74200635	OR TIME ADD'L 15MIN CASE CX 6 (MCAL 2ND SUBSQNT 0.5 HR)	360		2,548	N/A	N/A	N/A
HC77400059	CS DIFF MD ADD'L 15 MIN	372	99157	368	N/A	N/A	N/A
HC77400083	BEDSIDE/OTHER ANESTH' ADD'L 15MIN	379		381	N/A	N/A	N/A
HC77400117	ANESTHESIA MAC EACH ADD 15 MIN	370		337	N/A	N/A	N/A
HC77400141	ANESTHESIA INIT'L HR CASE CX	370		2,200	N/A	N/A	N/A
HC77400174	ANESTHESIA SPINAL EA ADD 15MIN	370		271	N/A	N/A	N/A
HC77400208	ANESTHESIA LOCAL INITIAL HR	370		913	N/A	N/A	N/A
HC77400232	MOD CS SAME PHYS/QHP 5/>YR INIT'L 15MIN	372	99152	389	N/A	N/A	N/A
HC77400257	MOD CS DIFF PHYS/QHP 5/>YR INIT'L 15MIN	372	99156	428	N/A	N/A	N/A
HC77400281	BEDSIDE/OTHER ANESTH' ADD'L 15MIN CASE CX	379		191	N/A	N/A	N/A
HC78600046	PACU II 15MIN (SUBSEQUENT)	710		411	N/A	N/A	N/A
HC79200010	MUSCLE TEST  TWO LIMBS	922	95861	1,661	N/A	N/A	N/A
HC79200044	SURGERY MINOR 1ST 30 MIN	361		3,291	N/A	N/A	N/A
HC81100018	PROTEIN URINE	301	84156	164	N/A	63	N/A
HC81100042	POTASSIUM URINE	301	84133	159	N/A	47	N/A
HC81100067	OSMOLALITY URINE	301	83935	253	N/A	80	N/A
HC81100075	HDL CHOLESTEROL	301	83718	182	N/A	63	N/A
HC81100091	ACETAMINOPHEN/TYLENOL; 1-2	301	80143	400	N/A	92	N/A
HC81100125	GLUCOSE FLUID/URINE	301	82945	203	N/A	37	N/A
HC81100158	VANCOMYCIN INIT	301	80202	616	N/A	124	N/A
HC81100182	IRON	301	83540	182	N/A	33	N/A
HC81100216	GLUCOSE TOLERANCE 3 SPECIMENS	301	82951	325	N/A	66	N/A
HC81100257	UREA NITROGEN CLEARANCE	301	84545	188	N/A	88	N/A
HC81100273	COMP METABOLIC PANEL	301	80053	695	N/A	65	N/A
HC81100281	RENAL FUNCTION PANEL	301	80069	475	N/A	50	N/A
HC81100307	PHENYTOIN TOTAL	301	80185	618	N/A	75	N/A
HC81100331	VOL MEASURE TIMED COLLECTION	307	81050	79	N/A	27	N/A
HC81100364	ALBUMIN; SERUM/PLASMA/WHOLE BLOOD	301	82040	154	N/A	37	N/A
HC81100398	ALK PHOSPHATASE	301	84075	174	N/A	42	N/A
HC81100422	AMYLASE	301	82150	249	N/A	50	N/A
HC81100455	LACTIC ACID	301	83605	327	N/A	106	N/A
HC81100489	CALCIUM TOTAL	301	82310	163	N/A	42	N/A
HC81100505	DIGOXIN; TOTAL	301	80162	574	N/A	75	N/A
HC81100539	CPK	301	82550	294	N/A	33	N/A
HC81100562	CREATININE CLEARANCE	301	82575	335	N/A	74	N/A
HC81100596	GENTAMICIN INIT	301	80170	729	N/A	106	N/A
HC81100620	SGOT(AST)	301	84450	160	N/A	32	N/A
HC81100653	LIPASE	301	83690	312	N/A	60	N/A
HC81100687	PHOSPHORUS	301	84100	164	N/A	38	N/A
HC81100703	PROTEIN TOTAL	301	84155	157	N/A	39	N/A
HC81100737	SODIUM	301	84295	154	N/A	28	N/A
HC81100760	CPK - MB	301	82553	448	N/A	109	N/A
HC81100794	URINALYSIS AUTO W/ MICROSCOPY	307	81001	232	N/A	24	N/A
HC81100828	FETAL LUNG MATURITY L/S	301	83661	468	N/A	205	N/A
HC81100851	OB FECES GUAIAC1-3 NEOPLSM SCR	301	82270	114	N/A	37	N/A
HC81100893	AMIKACIN INIT	301	80150	483	N/A	106	N/A
HC81100919	ETHOSUXIMIDE	301	80168	440	N/A	87	N/A
HC81100927	LIDOCAINE	301	80176	445	N/A	81	N/A
HC81100943	PRIMIDONE	301	80188	355	N/A	135	N/A
HC81100976	METHOTREXATE	301	80204	536	N/A	117	N/A
HC81101008	UA QUAL/SEMIQUAN	307	81005	134	N/A	40	N/A
HC81101032	AMINO ACIDS SNGL QUAN EA	301	82131	308	N/A	184	N/A
HC81101065	CALCIUM IONIZED	301	82330	278	N/A	91	N/A
HC81101099	CHLORIDE OTHER SOURCE	301	82438	180	N/A	38	N/A
HC81101115	BLOOD GAS W/MEASURED O2 SAT	301	82805	746	N/A	89	N/A
HC81101123	GLUCOSE POST DOSE	301	82950	174	N/A	31	N/A
HC81101149	APT TEST (FETAL HGB)	301	83033	145	N/A	50	N/A
HC81101172	HEMOGLOBIN PLASMA	301	83051	163	N/A	72	N/A
HC81101206	PARATHYROID HORMONE	301	83970	524	N/A	209	N/A
HC81101230	TRANSFERRIN	301	84466	272	N/A	104	N/A
HC81101263	SWEAT COLLECT IONTOPHORESIS	301	89230	1,096	N/A	119	N/A
HC81101297	C4 COMPLEMENT	302	86160	310	N/A	94	N/A
HC81101321	BLOOD GAS O2 SAT ONLY	301	82810	239	N/A	97	N/A
HC81101354	LIPID PANEL SUBSEQUENT	301	80061	438	N/A	67	N/A
HC81101388	HGB O2 AFFINITY	301	82820	242	N/A	95	N/A
HC81101412	HAPTOGLOBIN/NEPHELOMTRY	301	83010	397	N/A	138	N/A
HC81101446	BASIC METABOLIC PANEL/ION'D CA	301	80047	461	N/A	39	N/A
HC81101479	LIPOPROTEIN A	301	83695	174	N/A	28	N/A
HC81101503	PROTEIN TOTAL  REFRCT	301	84160	167	N/A	57	N/A
HC81101552	C-PEPTIDE	301	84681	297	N/A	93	N/A
HC81101578	UA DIPSTICK (DIRECT ACCESS)	301	81003	117	N/A	25	N/A
HC81101586	GLUCOSE BY DEVICE (POS)	301	82962	101	N/A	22	N/A
HC81101602	OB FECES GUAIC 1-3 NON NEOPLSM	301	82272	98	N/A	37	N/A
HC81101669	P:POC CHEMISTRY & HH (PCCHHE)			N/A	N/A	N/A	N/A
HC81101701	CHOLESTEROL (DA)	301	82465	115	N/A	16	N/A
HC81101750	ACTH STIMULATION PANEL	301	80400	1,035	N/A	340	N/A
HC81101784	POTASSIUM (POS)	301	84132	148	N/A	42	N/A
HC81101818	PROCALCITONIN	301	84145	369	N/A	74	N/A
HC81101834	HEPATITIS C VIRUS (DA)	302	86803	218	N/A	40	N/A
HC81101842	OB FECES GUAIAC1-3 NEO SCR(DA)	301	82270	58	N/A	15	N/A
HC81101867	LIPID PANEL (DA)	301	80061	324	N/A	35	N/A
HC81101917	GENERAL HEALTH PANEL     (CHAMPUS)	300	80050	1,270	N/A	205	N/A
HC81101941	DRUG TEST PRESUMPTIVE CHEM ANALYZERS/ DOS	301	80307	597	N/A	62	N/A
HC81101974	DRUG TST DEFNTV15-21RX CLSS W/METBLTS/DAY	301	G0482	1,076	N/A	298	N/A
HC81190035	P: BASIC METAB PAN/ION'D CA &HCT(POS)			N/A	N/A	N/A	N/A
HC81190068	P: POS CG4 CARTRIDGE			N/A	N/A	N/A	N/A
HC81500027	PLATELET COUNT- AUTO	305	85049	183	N/A	37	N/A
HC81500043	SED RATE NON-AUTO	305	85651	144	N/A	46	N/A
HC81500076	PROTHROMBIN TIME	305	85610	178	N/A	18	N/A
HC81500100	D-DIMER QT ULTRA-SENS OR STD	305	85379	375	N/A	99	N/A
HC81500134	FIBRINOGEN	305	85384	302	N/A	57	N/A
HC81500167	WBC MANUAL DIFF	305	85007	165	N/A	30	N/A
HC81500191	THIN SMEAR  BLOOD PARASITES	300	87207	256	N/A	64	N/A
HC81500225	CELL COUNT CORD BLOOD	305	85027	179	N/A	30	N/A
HC81500241	FACTOR 8 INHIB/TITR	305	85335	402	N/A	224	N/A
HC81500274	WBC AUTO DIFF	305	85004	95	N/A	29	N/A
HC81500308	HEMOGLOBIN	305	85018	114	N/A	10	N/A
HC81500332	BONE MARROW SMEAR INTERP	305	85097	870	N/A	770	N/A
HC81500365	FACTOR VII STABLE	305	85230	462	N/A	141	N/A
HC81500399	FACTOR VIII VW MULTI	305	85247	421	N/A	285	N/A
HC81500423	FACTOR XII	305	85280	491	N/A	141	N/A
HC81500449	ANTITHROMBIN III AG	305	85301	278	N/A	118	N/A
HC81500456	INHIB PROTEIN C AG	305	85302	289	N/A	118	N/A
HC81500472	INHIB PROTEIN S TOTAL	305	85305	316	N/A	223	N/A
HC81500506	COAG TIME OTHER METHODS	305	85348	180	N/A	38	N/A
HC81500530	KLEIHAUER-BETKE	305	85460	371	N/A	126	N/A
HC81500563	LEUKOCYTE ALK PHOS W/ COUNT	305	85540	235	N/A	86	N/A
HC81500597	PT SUBS PLASMA FRACTIONS EA	305	85611	238	N/A	72	N/A
HC81500621	APTT SUBS PLASMA FRACTIONS EA	305	85732	290	N/A	85	N/A
HC81500670	FACTOR IX ASSAY	305	85250	511	N/A	141	N/A
HC81500688	FACTOR VIII ASSAY	305	85240	462	N/A	141	N/A
HC81500704	FIBRIN SPLIT PRODUCTS	305	85362	305	N/A	83	N/A
HC81500738	FACTOR XIII SCREEN	305	85291	211	N/A	57	N/A
HC81500761	SED RATE AUTOMATED	305	85652	113	N/A	27	N/A
HC81500795	HEMOGLOBIN -HPLC	301	83021	377	N/A	136	N/A
HC81500829	HEMOGLOBIN ELECT QUANT F S	301	83021	269	N/A	92	N/A
HC81500860	HEMATOCRIT (POS)	305	85014	110	N/A	10	N/A
HC81500894	RETICULATED PLATELET ASSAY	305	85055	350	N/A	110	N/A
HC81500910	INHIB CLOT PROTEIN S FREE (FUNC)	305	85306	499	N/A	200	N/A
HC81500944	URINALYSIS NON-AUTO W/O MICRO	307	81002	143	N/A	N/A	N/A
HC81500977	HEMOGLOBIN GLYCATED (A1C)	301	83036	219	N/A	45	N/A
HC81700023	FTA ABSORPTION	302	86780	226	N/A	70	N/A
HC81700056	BETA-2 MICROGLOBULIN	301	82232	254	N/A	67	N/A
HC81700080	VITAMIN B12	301	82607	293	N/A	101	N/A
HC81700114	IMMUNOGLOBULIN IGE	301	82785	378	N/A	102	N/A
HC81700130	LH (LUTEINIZING HORMONE)	301	83002	313	N/A	94	N/A
HC81700163	PROTEIN ELECT FRACT AND QT	301	84165	339	N/A	97	N/A
HC81700197	T4 FREE	301	84439	226	N/A	58	N/A
HC81700221	T3 TOTAL	301	84480	273	N/A	72	N/A
HC81700254	HCG QUAL	301	84703	302	N/A	47	N/A
HC81700288	COMPLEMENT TOT HEMOLYTIC CH50	302	86162	330	N/A	144	N/A
HC81700312	CA 27-29	302	86300	322	N/A	69	N/A
HC81700338	CA 125	302	86304	305	N/A	106	N/A
HC81700346	HETEROPHILE AB TITER	302	86309	130	N/A	67	N/A
HC81700361	CD3 ABSOLUTE COUNT	302	86359	483	N/A	140	N/A
HC81700395	RPR/VDRL QUAL	302	86592	137	N/A	22	N/A
HC81700429	HIV-1 & HIV-2 AB SNGL ASSAY	302	86703	240	N/A	70	N/A
HC81700452	HEPATITIS B SURFACE AB	302	86706	226	N/A	82	N/A
HC81700486	RUBEOLA AB IGG	302	86765	256	N/A	83	N/A
HC81700510	HEPATITIS C AB	302	86803	237	N/A	87	N/A
HC81700536	HEPATITIS B SURFACE AG	306	87340	299	N/A	65	N/A
HC81700544	C TRACHOMATIS BY DNA PROBE	306	87490	367	N/A	75	N/A
HC81700569	FLOW CYT MKR TC ADD+ KAPPA	311	88185	318	N/A	104	N/A
HC81700593	IMMUNOGLOBULIN IGA	301	82784	303	N/A	72	N/A
HC81700627	HCG QUAL URINE	301	81025	262	N/A	43	N/A
HC81700650	ANA TITER	302	86039	208	N/A	86	N/A
HC81700684	ANTI SMOOTH MUSC/RNP AB	302	86235	243	N/A	94	N/A
HC81700718	SMITH ANTIBODY EIA	302	86235	247	N/A	94	N/A
HC81700742	CRYPTOCUCCUS AG - SERUM	302	86256	226	N/A	66	N/A
HC81700767	IMMUNOFIX ELECTPH URINE	302	86325	291	N/A	114	N/A
HC81700791	HEPATITIS C QT BY DNA OR RNA	302	87522	749	N/A	144	N/A
HC81700825	CALLA/ACUTE LYMPH LEUK AG MKR+	311	88185	318	N/A	565	N/A
HC81700866	FLOW CYTO MKR TC ADD + CALLA	311	88185	318	N/A	104	N/A
HC81700890	FLW CYT MKR CD14 TC ADD+	311	88185	318	N/A	104	N/A
HC81700924	FLW CYT MKR CD20 TC ADD+	311	88185	318	N/A	104	N/A
HC81700957	FLW CYT MKR CD30 (KI-1)TC ADD+	311	88185	318	N/A	104	N/A
HC81700973	FLW CYT MKR CD34 (HPCA-1)ADD+	311	88185	318	N/A	104	N/A
HC81700981	FLOW CYT MKR TC CD45	311	88184	617	N/A	342	N/A
HC81701005	FLW CYT MKR CD56 TC ADD+	311	88185	318	N/A	104	N/A
HC81701039	FLW CYT MKR IGA TC ADD+	311	88185	318	N/A	104	N/A
HC81701062	FLW CYT MKR CD11B TC ADD+	311	88185	318	N/A	104	N/A
HC81701096	FLW CYT MKR  CDI TC ADD+	311	88185	318	N/A	104	N/A
HC81701120	PARTICLE AGGLUT TITER EACH AB	302	86406	236	N/A	120	N/A
HC81701179	HIV 1 AB	302	86701	226	N/A	100	N/A
HC81701195	TSH SUBSEQUENT	301	84443	384	N/A	78	N/A
HC81701211	CORTISOL  PREDOSE	301	82533	349	N/A	83	N/A
HC81701278	HCV RNA OR DNA AMP PROBE TECH	302	87521	643	N/A	251	N/A
HC81701393	MUMPS AB IGG	302	86735	181	N/A	60	N/A
HC81701450	B CELL TOTAL COUNT	302	86355	391	N/A	191	N/A
HC81701484	SCLERODERMA SCL-70 AB  IGG	302	86235	247	N/A	94	N/A
HC81701518	CLOTEST FOR H. PYLORI	301	83009	754	N/A	119	N/A
HC81701542	N-GONORRHEA BY DNA AMP PROBE	306	87591	475	N/A	101	N/A
HC81701617	SYPHILIS TOTAL IGG&IGM	302	86592	138	N/A	53	N/A
HC81701633	KAPPA FREE LIGHT CHAINS QT	301	83883	212	N/A	56	N/A
HC81701666	FLOW CYT TC; 1ST MARKER	311	88184	617	N/A	342	N/A
HC81701716	CRYOFIBRINOGEN	301	82585	123	N/A	47	N/A
HC81701740	EBV AB TO NUCLEAR AG  IGG	302	86664	213	N/A	88	N/A
HC81701773	FACTOR 2 MUTATION BY PCR	301	81240	584	N/A	249	N/A
HC81701807	HERPES I/II AB IGG	302	86694	215	N/A	58	N/A
HC81701831	HSV TYPE 2 AB  IGG	302	86696	259	N/A	80	N/A
HC81701856	IGG SUBCLASS 2; EACH	301	82787	298	N/A	33	N/A
HC81701880	CA 15-3	302	86300	322	N/A	69	N/A
HC81701914	TISSUE TRANSGLUTAMINASE IGA	302	86364	277	N/A	51	N/A
HC81701948	DEAMIDATED GLIADIN PEP IGA	302	86258	272	N/A	51	N/A
HC81701971	HEPATITIS C AB SCREENING	302	86803	223	N/A	75	N/A
HC81702003	TREPONEMA PALLIDUM AB  IGG	302	86780	177	N/A	70	N/A
HC81702037	FLW CYT MKR CD103 TC ADD+	311	88185	318	N/A	104	N/A
HC81702052	FLW CYT MKR CD138 TC ADD+	311	88185	318	N/A	104	N/A
HC81702060	FLW CYT MKR CD16 TC ADD+	311	88185	318	N/A	104	N/A
HC81702086	FLW CYT MKR CD235A TC ADD+	311	88185	318	N/A	104	N/A
HC81702110	FLW CYT MKR CD41 TC ADD+	311	88185	318	N/A	104	N/A
HC81702144	FLW CYT MKR CD64 TC ADD+	311	88185	318	N/A	104	N/A
HC81702177	FLW CYT MKR TCRAB TC ADD+	311	88185	318	N/A	104	N/A
HC81702201	HIV 2 ANTIBODY	302	86702	222	N/A	150	N/A
HC82200015	ELASTIC STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82200031	IRON STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82200049	ACID FAST STN/GR I W/INT&RPT+	312	88312	547	N/A	144	N/A
HC82200064	MUCIN MUCICARMINE STN/GRP II+	312	88313	474	N/A	107	N/A
HC82200098	PTAH STAIN/GRP II+	312	88313	474	N/A	71	N/A
HC82200122	RETICULUM STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82200155	STEINER STN/GR I W/I&R+	312	88312	547	N/A	144	N/A
HC82200189	IHC/IP PER SPEC INITIAL AB STAIN HMB-45	312	88342	593	N/A	193	N/A
HC82200213	IHC/IP PER SPEC INITIAL AB STAIN LCA/CD45	312	88342	593	N/A	193	N/A
HC82200247	IHC/IP PER SPEC INITIAL AB STAIN AFP	312	88342	593	N/A	193	N/A
HC82200262	IHC/IP PER SPEC INITIAL AB STAIN GFAP	312	88342	593	N/A	193	N/A
HC82200296	IHC/IP PER SPEC INITIAL AB STAIN LEU-22/CD 43	312	88342	593	N/A	193	N/A
HC82200320	BONE MARROW DX; ASP(S) ONLY	361	38220	4,591	N/A	1,651	N/A
HC82200353	TISSUE FROZEN SECTION	312	88331	576	N/A	302	N/A
HC82200387	TISSUE EXAM G&M LEVEL 2	312	88302	401	N/A	96	N/A
HC82200411	TISSUE EXAM G&M LEVEL 5	312	88307	1,128	N/A	296	N/A
HC82200445	SPECIAL STN GRP I W/I&R   * OP	312	88312	547	N/A	40	N/A
HC82200460	ANATOMIC CONSULT:COMP.REVIEW	312	88325	632	N/A	280	N/A
HC82200502	TISSUE FROZEN SECTION ADDIT'L	312	88332	276	N/A	151	N/A
HC82200536	MORPH STDY ISH PER SPEC INTL SNGL PROBE	312	88365	853	N/A	165	N/A
HC82200569	SPECIAL STAIN GRP I W/INT&RPT+	312	88312	547	N/A	144	N/A
HC82200601	TISSUE EXAM LVL 5 (PQRI)	312	88307	1,128	N/A	396	N/A
HC82200635	TISSUE FRZN SECTION REDUCED	312	88331	463	N/A	241	N/A
HC82200668	TISSUE EXAM LEVEL 4 SKIN	312	88305	780	N/A	125	N/A
HC82200684	TISSUE EXAM LEVEL 5 ADD'L	312	88307	1,128	N/A	309	N/A
HC82200692	CONSULT PATH SURGICAL GROSS	312	88329	397	N/A	102	N/A
HC82200726	INTRAOP CNSLT CYT PRP-DIST ADL	311	88334	394	N/A	93	N/A
HC82200759	INTRAOP CNSLT CYT PREP INT'L	311	88333	962	N/A	500	N/A
HC82200817	BONE MARROW DX; BX(S) ONLY RT	361	38221	4,954	N/A	1,651	N/A
HC82200858	AUTOPSY GROSS & MICRO W/O CNS	310	88020	N/A	N/A	N/A	N/A
HC82200882	AUTOPSY G&M INFANT W/BRAIN	310	88028	N/A	N/A	N/A	N/A
HC82200916	AUTOPSY FORENSIC	310	88040	N/A	N/A	N/A	N/A
HC82200932	TISSUE EX G&M  LVL 3  DIST SVC	312	88304	505	N/A	120	N/A
HC82200940	TISSUE EX G&M LVL 4  DIST SVC	312	88305	780	N/A	218	N/A
HC82200965	TISSUE EX G&M LVL 6 DIST SVC	312	88309	1,332	N/A	544	N/A
HC82200999	GROCOTT SILVER STN/GR I W/I&R+	312	88312	547	N/A	144	N/A
HC82201021	ZIEHL NEELSON STN/GR I W/I&R+	312	88312	547	N/A	85	N/A
HC82201054	AMYLOID ST BENNHOLDS/GRP II+	312	88313	474	N/A	107	N/A
HC82201088	F-M MELANIN STN BLEACH/GRPII+	312	88313	474	N/A	107	N/A
HC82201112	HALLS BILE STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82201146	LUXOL FAST BLUE STAIN GRP II+	312	88313	474	N/A	107	N/A
HC82201161	MAY GRUNWALD GIEMS STN GRP II+	312	88313	474	N/A	107	N/A
HC82201195	MYELIN STAIN GRP II+	312	88313	474	N/A	107	N/A
HC82201229	PERLS PRUSSIAN BLU STN GRP II+	312	88313	474	N/A	71	N/A
HC82201252	TOLUID BLU MAST CL STN/GRP II+	312	88313	474	N/A	107	N/A
HC82201286	HISTCHM ST ALK PTASE FRZ TIS	312	88319	962	N/A	500	N/A
HC82201310	HISTCHM ST ATPSE PH9.4 FR TS	312	88319	962	N/A	500	N/A
HC82201344	HISTCHM ST NADH-TR FROZ TISS	312	88319	962	N/A	500	N/A
HC82201369	HISTCHM ST ACRIDINE OR FR TS	312	88314	388	N/A	108	N/A
HC82201393	HISTCHM ST MAD  FROZ TIS BLK	312	88314	388	N/A	108	N/A
HC82201427	HISTCHM ST NNSPC ESTERS FR TS	312	88314	388	N/A	108	N/A
HC82201450	PAS W/DIGESTON FROZ TIS BLK	312	88313	470	N/A	108	N/A
HC82201484	PEROXIDASE STAIN  GRP III	312	88319	962	N/A	500	N/A
HC82201518	ALPHA NAPBUT STAIN  GRP III	312	88319	962	N/A	500	N/A
HC82201542	IHC/IP PER SPEC INITIAL AB STAIN DYSTROPH(ROD DOMAIN)	312	88342	593	N/A	193	N/A
HC82201567	IHC/IP PER SPEC INITIAL AB STAIN BRST2	312	88342	593	N/A	193	N/A
HC82201575	IHC/IP PER SPEC INITIAL AB STAIN CALCITONIN	312	88342	593	N/A	193	N/A
HC82201591	IHC/IP PER SPEC INITIAL AB STAIN DESMIN	312	88342	593	N/A	193	N/A
HC82201625	IHC/IP PER SPEC INITIAL AB STAIN GLUCAGON	312	88342	593	N/A	193	N/A
HC82201658	IHC/IP PER SPEC INITIAL AB STAIN KAPPA	312	88342	593	N/A	193	N/A
HC82201682	IHC/IP PER SPEC INITIAL AB STAIN L26/CD 20	312	88342	593	N/A	193	N/A
HC82201716	IHC/IP PER SPEC INITIAL AB STAIN LN2	312	88342	593	N/A	193	N/A
HC82201740	IHC/IP PER SPEC INITIAL AB STAIN MYGLOBIN	312	88342	593	N/A	193	N/A
HC82201765	IHC/IP PER SPEC INITIAL AB STAIN NSE	312	88342	593	N/A	193	N/A
HC82201773	IHC/IP PER SPEC INITIAL AB STAIN PROGEST RECEPT	312	88342	593	N/A	193	N/A
HC82201799	IHC/IP PER SPEC INITIAL AB STAIN SOMATOSATIN	312	88342	593	N/A	193	N/A
HC82201823	IHC/IP PER SPEC INITIAL AB STAIN UCHL1	312	88342	593	N/A	193	N/A
HC82201856	IHC/IP PER SPEC INITIAL AB STAIN CD3	312	88342	593	N/A	193	N/A
HC82201880	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-20	312	88342	593	N/A	193	N/A
HC82201914	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 13-A	312	88342	593	N/A	193	N/A
HC82201955	IHC/IP PER SPEC INITIAL AB STAIN KI-67	312	88342	593	N/A	193	N/A
HC82201997	IHC/IP PER SPEC INITIAL AB STAIN P-53	312	88342	593	N/A	193	N/A
HC82202011	IHC/IP PER SPEC INITIAL AB STAIN PROLACTIN	312	88342	593	N/A	193	N/A
HC82202052	IHC/IP PER SPEC INITIAL AB STAIN HER-2-NEU	312	88342	593	N/A	193	N/A
HC82202169	ELECTRON MICROSCOPY	312	88348	3,586	N/A	908	N/A
HC82202193	NERVE TEASING	312	88362	1,715	N/A	424	N/A
HC82202227	RADIOLOGIC EXAM-SURG SPEC (ST)	312	76098	N/A	N/A	N/A	N/A
HC82202250	TISSUE EXAM G&M LEVEL 4-REDUCE	312	88305	780	N/A	218	N/A
HC82202284	TISSUE FROZEN SECTION DIST SVC	312	88331	576	N/A	302	N/A
HC82202300	ELECTRON MICROSCOPY REDUCE SVC	312	88348	2,673	N/A	405	N/A
HC82202326	MD CALLBACK 1/2 HR (STAT)	310		N/A	N/A	N/A	N/A
HC82202367	BM CELL BLOCK & INTERP	312	88305	780	N/A	218	N/A
HC82202391	MORPH STDY TMR IHC CAT KI67 PER SPEC EA ADDL AB	312	88361	1,055	N/A	386	N/A
HC82202425	MORPH STDY TMR IHC CAT NOS PER SPEC EA ADDL AB	312	88361	1,055	N/A	386	N/A
HC82202458	MORPH STDY ISH CAT QNT/SPEC INTL SNGL PROBE CEP17	310	88367	1,732	N/A	568	N/A
HC82202482	MORPH STUDY MAN ISH QNT CEP 7	310	88368	1,330	N/A	607	N/A
HC82202524	FNA ASP BX W/O GUIDE; FIRST LESION	361	10021	1,837	N/A	375	N/A
HC82202540	TISSUE GROSS EXAM ONLY LVL1*OP	312	88300	265	N/A	30	N/A
HC82202557	TISSUE EXAM G&M LEVEL 2 *OP	312	88302	401	N/A	50	N/A
HC82202573	TISSUE EXAM G&M LEVEL 4 *OP	312	88305	780	N/A	95	N/A
HC82202607	SPECIAL STAIN GROUP I+	312	88312	547	N/A	40	N/A
HC82202649	MISC PATHOLOGY-SOF(CLIENT BILL	302	89240	146	N/A	14	N/A
HC82202698	LEVEL/RECUTS (CLIENT)	312	88399	102	N/A	6	N/A
HC82202722	BM CELL BLOCK & INTER-2ND SITE	312	88305	780	N/A	218	N/A
HC82202755	TISSUE EXAM G&M LVL 4(TC ONLY)	312	88305	780	N/A	120	N/A
HC82202789	ADDL UNSTAINED SLIDE/PROC BLK	310	88399	102	N/A	3	N/A
HC82202805	PROCESS  EMBED & 2 H&E'S	310	88399	73	N/A	10	N/A
HC82202912	IMMUNOCYTOCHEMICAL STAIN	310	88399	191	N/A	26	N/A
HC82202946	H&E FROM BLOCK	310	88399	190	N/A	4	N/A
HC82202979	IHC/IP PER SPEC INITIAL AB STAIN CALRETIN	312	88342	593	N/A	193	N/A
HC82203001	IHC/IP PER SPEC INITIAL AB STAIN CD4	312	88342	593	N/A	193	N/A
HC82203035	IHC/IP PER SPEC INITIAL AB STAIN CD8	312	88342	593	N/A	193	N/A
HC82203068	IHC/IP PER SPEC INITIAL AB STAIN CD23	312	88342	593	N/A	193	N/A
HC82203084	IHC/IP PER SPEC INITIAL AB STAIN CD56	312	88342	593	N/A	193	N/A
HC82203118	IHC/IP PER SPEC INITIAL AB STAIN CDX-2	312	88342	593	N/A	193	N/A
HC82203142	IHC/IP PER SPEC INITIAL AB STAIN CK-19	312	88342	593	N/A	193	N/A
HC82203175	IHC/IP PER SPEC INITIAL AB STAIN EMA (MC5)(LIVER)	312	88342	593	N/A	193	N/A
HC82203209	IHC/IP PER SPEC INITIAL AB STAIN INHIBIN	312	88342	593	N/A	193	N/A
HC82203233	IHC/IP PER SPEC INITIAL AB STAIN KERATIN HMWK	312	88342	593	N/A	193	N/A
HC82203266	IHC/IP PER SPEC INITIAL AB STAIN MYOGENIN	312	88342	593	N/A	193	N/A
HC82203282	IHC/IP PER SPEC INITIAL AB STAIN P63	312	88342	593	N/A	193	N/A
HC82203290	IHC/IP PER SPEC INITIAL AB STAIN PGP 9.5	312	88342	593	N/A	193	N/A
HC82203316	IHC/IP PER SPEC INITIAL AB STAIN TTF-1	312	88342	593	N/A	193	N/A
HC82203340	IHC/IP PER SPEC EA ADD AB STAIN+ S100	312	88341	516	N/A	183	N/A
HC82203373	IHC/IP PER SPEC EA ADD AB STAIN+ PSA	312	88341	516	N/A	183	N/A
HC82203407	IHC/IP PER SPEC EA ADD AB STAIN+ VIMENTIN	312	88341	516	N/A	183	N/A
HC82203431	IHC/IP PER SPEC EA ADD AB STAIN+ GFAP	312	88341	516	N/A	183	N/A
HC82203464	IHC/IP PER SPEC EA ADD AB STAIN+ LEU-22	312	88341	516	N/A	183	N/A
HC82203480	IHC/IP PER SPEC EA ADD AB STAIN+ SYNAPTOP	312	88341	516	N/A	183	N/A
HC82203498	IHC/IP PER SPEC EA ADD AB STAIN+ CYTOCHM	312	88341	516	N/A	183	N/A
HC82203514	IHC/IP PER SPEC EA ADD AB STAIN+ BCL-6	312	88341	516	N/A	183	N/A
HC82203548	IHC/IP PER SPEC EA ADD AB STAIN+ CD-21	312	88341	516	N/A	183	N/A
HC82203571	IHC/IP PER SPEC EA ADD AB STAIN+ CD-138	312	88341	516	N/A	183	N/A
HC82203605	IHC/IP PER SPEC EA ADD AB STAIN+ CK-5/6	312	88341	516	N/A	183	N/A
HC82203639	IHC/IP PER SPEC EA ADD AB STAIN+ EMA (MC5)(LIVER)	312	88341	516	N/A	183	N/A
HC82203662	IHC/IP PER SPEC EA ADD AB STAIN+ INHIBIN	312	88341	516	N/A	183	N/A
HC82203696	IHC/IP PER SPEC EA ADD AB STAIN+ KERATIN HMWK	312	88341	516	N/A	183	N/A
HC82203712	IHC/IP PER SPEC EA ADD AB STAIN+ MYOGENIN	312	88341	516	N/A	183	N/A
HC82203746	IHC/IP PER SPEC EA ADD AB STAIN+ TH	312	88341	516	N/A	183	N/A
HC82203779	IHC/IP PER SPEC EA ADD AB STAIN+ DYSTROPH (N-TERM)	312	88341	516	N/A	183	N/A
HC82203803	IHC/IP PER SPEC EA ADD AB STAIN+ MONOCLNL BREAST	312	88341	516	N/A	183	N/A
HC82203837	IHC/IP PER SPEC EA ADD AB STAIN+ DESMIN	312	88341	516	N/A	183	N/A
HC82203860	IHC/IP PER SPEC EA ADD AB STAIN+ GLUCAGON	312	88341	516	N/A	183	N/A
HC82203894	IHC/IP PER SPEC EA ADD AB STAIN+ KAPPA	312	88341	516	N/A	183	N/A
HC82203910	IHC/IP PER SPEC EA ADD AB STAIN+ KP-1	312	88341	516	N/A	183	N/A
HC82203944	IHC/IP PER SPEC EA ADD AB STAIN+ LN 1	312	88341	516	N/A	183	N/A
HC82203977	IHC/IP PER SPEC EA ADD AB STAIN+ MUSCLE	312	88341	516	N/A	183	N/A
HC82204009	IHC/IP PER SPEC EA ADD AB STAIN+ NSE	312	88341	516	N/A	183	N/A
HC82204033	IHC/IP PER SPEC EA ADD AB STAIN+ SOMATOSTN	312	88341	516	N/A	183	N/A
HC82204066	IHC/IP PER SPEC EA ADD AB STAIN+ UCHL 1	312	88341	516	N/A	183	N/A
HC82204108	IHC/IP PER SPEC EA ADD AB STAIN+ CD-68	312	88341	516	N/A	183	N/A
HC82204124	IHC/IP PER SPEC EA ADD AB STAIN+ CYTOKERATIN-20	312	88341	516	N/A	183	N/A
HC82204132	IHC/IP PER SPEC EA ADD AB STAIN+ CYTOKERATIN-7	312	88341	516	N/A	183	N/A
HC82204157	IHC/IP PER SPEC EA ADD AB STAIN+ FACTOR 13-A	312	88341	516	N/A	183	N/A
HC82204199	IHC/IP PER SPEC EA ADD AB STAIN+ KI-67	312	88341	516	N/A	183	N/A
HC82204223	IHC/IP PER SPEC EA ADD AB STAIN+ MYELOPEROXIDASE	312	88341	516	N/A	183	N/A
HC82204256	IHC/IP PER SPEC EA ADD AB STAIN+ PROLACTIN	312	88341	516	N/A	183	N/A
HC82204280	IHC/IP PER SPEC EA ADD AB STAIN+ UCHL-1	312	88341	516	N/A	183	N/A
HC82204314	IHC/IP PER SPEC EA ADD AB STAIN+ CALRETININ	312	88341	516	N/A	183	N/A
HC82204330	IHC/IP PER SPEC EA ADD AB STAIN+ CD5	312	88341	516	N/A	183	N/A
HC82204348	IHC/IP PER SPEC EA ADD AB STAIN+ CD7	312	88341	516	N/A	183	N/A
HC82204363	IHC/IP PER SPEC EA ADD AB STAIN+ CD10	312	88341	516	N/A	183	N/A
HC82204397	IHC/IP PER SPEC EA ADD AB STAIN+ CMV	312	88341	516	N/A	183	N/A
HC82204421	IHC/IP PER SPEC EA ADD AB STAIN+ P16	312	88341	516	N/A	183	N/A
HC82204454	IHC/IP PER SPEC EA ADD AB STAIN+ CD-79A	312	88341	516	N/A	183	N/A
HC82204488	BONE MARROW DX; BX(S) & ASP(S) RT	361	38222	6,853	N/A	2,782	N/A
HC82204512	BONE MARROW DX; ASP(S) ONLY BILAT	361	38220	6,248	N/A	2,477	N/A
HC82204546	IHC/IP PER SPEC EA ADD AB STAIN+ SOX10	312	88341	516	N/A	183	N/A
HC82204561	IHC/IP PER SPEC EA ADD AB STAIN+ PAX8	312	88341	516	N/A	183	N/A
HC82204595	IHC/IP PER SPEC INITIAL AB STAIN C-MYC	312	88342	593	N/A	193	N/A
HC82204629	IHC/IP PER SPEC EA ADD AB STAIN+ H PYLORI	312	88341	516	N/A	183	N/A
HC82204652	IHC/IP PER SPEC INITIAL AB STAIN HSV-2	312	88342	593	N/A	193	N/A
HC82204686	IHC/IP PER SPEC EA ADD AB STAIN+ MSH-2	312	88341	516	N/A	183	N/A
HC82204710	HANDLING AND/OR CONVEYANCE TO REF LAB(AP)	310	99001	129	N/A	25	N/A
HC82290032	P:BONE MARROW ASP/BX BILATERAL			N/A	N/A	N/A	N/A
HC82290057	P:BONE MARROW ASP/BX RIGHT			N/A	N/A	N/A	N/A
HC82290065	P: BONE MARROW ASPIRATION BILAT			N/A	N/A	N/A	N/A
HC82290081	P: BONE MARROW ASPIRATION RIGHT			N/A	N/A	N/A	N/A
HC83000018	RBC'S EA UNIT	390	P9021	789	N/A	401	N/A
HC83000042	RBC'S LEUKOREDUCE EA UNIT	390	P9016	952	N/A	416	N/A
HC83000075	CRYOPRECIPITATE EA UNIT	390	P9012	313	N/A	109	N/A
HC83000109	X-MATCH I-SPIN TECH EA UNIT	302	86920	426	N/A	175	N/A
HC83000141	BLOOD TYPE SEROLOGIC; ABO	300	86900	171	N/A	131	N/A
HC83000166	COMBS  DIRECT(EA)	302	86880	182	N/A	70	N/A
HC83000174	RBC ANTIBODY ELUTION	302	86860	416	N/A	112	N/A
HC83000190	X-MATCH INCUB TECH EA UNIT	302	86921	387	N/A	175	N/A
HC83000265	ROSETTE TEST FETAL HGB	305	85461	201	N/A	84	N/A
HC83000299	AUTOL/DD BLD/COMPON PROC/STOR	300	86890	1,253	N/A	175	N/A
HC83000331	THAWING BLOOD EA UNIT	300	86931	366	N/A	342	N/A
HC83000364	POOLING PLAT OR OTHER BLD PROD	300	86965	292	N/A	175	N/A
HC83000398	SERUM PRETREATMNT W/INHIB EA	302	86977	245	N/A	175	N/A
HC83000422	INJECTION IM (RHOGAM)	940	96372	330	N/A	45	N/A
HC83000463	RBC LEUKOREDUC/CMV NEG EA	390	P9051	607	N/A	377	N/A
HC83000497	PLATELETS IRRAD EA UNIT	390	P9032	598	N/A	390	N/A
HC83000521	PLATELET HLA LR APHER/PHER	390	P9052	2,843	N/A	945	N/A
HC83000554	PLATELETPHER LR IRRAD EA UNIT	390	P9037	2,743	N/A	1,355	N/A
HC83000588	BLOOD LR FROZ/DEGLY/WASH'D	390	P9054	1,047	N/A	365	N/A
HC83000612	RBC'S LR/CMV-NEG/IRRAD/UNIT	390	P9058	1,155	N/A	290	N/A
HC83000711	ALBUMIN 5% 250ML	636	P9041	500	N/A	400	N/A
HC83000745	THERAPEUTIC APHERESIS RBC'S	361	36512	9,968	N/A	1,600	N/A
HC83000786	THER APHER W/EXTRACORP IMMUNO/ADSORP/FILTRATION	361	36516	13,742	N/A	3,500	N/A
HC83000810	ALIQUOT RED CELLS	390	P9011	594	N/A	245	N/A
HC83000844	CRYOPRECIPITATE POOLED 5 UNITS	390	P9012	622	N/A	500	N/A
HC83000935	RBC'S LUK RED EA UNIT DIREC~BB	390	P9016	949	N/A	627	N/A
HC83000984	RBC'S EA UNIT -SB	390	P9021	789	N/A	279	N/A
HC83001016	CRYOPRECIPITATE EA UNIT -SB	390	P9012	313	N/A	94	N/A
HC83001032	RBC'S WASHED EA UNIT -SB	390	P9022	1,120	N/A	398	N/A
HC83001040	RBC'S EA UNIT (AUTOLOGOUS)-SB	390	P9021	789	N/A	400	N/A
HC83001065	BB PATH; INVEST TRANFUSION REACTION	310	86078	543	N/A	175	N/A
HC83001131	ALIQUOT PLASMA	390	P9011	559	N/A	234	N/A
HC83001172	CRYOPRECIPITATE EA UNIT	390	P9012	313	N/A	130	N/A
HC83001206	PLATELET LR PHER EA UNIT	390	P9035	2,088	N/A	650	N/A
HC83001230	BB PATH; DIFFICULT CROSSMATCH IRREG AB	310	86077	305	N/A	45	N/A
HC83001263	PLASMA CONVALESCENT (COVID-AB)	390	P9060	0	N/A	N/A	N/A
HC83001289	ALIQUOT PLASMA CONVALESCENT	390	P9011	559	N/A	N/A	N/A
HC83090001	P: CRYO UNIT & THAWING PROCEDURE			N/A	N/A	N/A	N/A
HC83090027	P: FFP UNIT AND THAWING			N/A	N/A	N/A	N/A
HC83090050	P: FFP  RBC LR/CMV- & POOL&THAW			N/A	N/A	N/A	N/A
HC83090100	P: PLASMA ALIQUOT CONVALESCENT & SPLITTING PROCEDURE	830		N/A	N/A	N/A	N/A
HC83500058	UROVYSION FISH BLADDER CA-US	311	88299	N/A	N/A	N/A	N/A
HC83500090	BONE MARROW SMEAR INTERP-IM	305	85097	N/A	N/A	N/A	N/A
HC83500140	SEX ID BARR BODIES-GZ	311	88130	N/A	N/A	N/A	N/A
HC83500199	CHROMO ANALYSIS  TISSUE -GZ	310	88233	350	N/A	350	N/A
HC83500215	CHROMO  TISSUE CULT-HP	310	88237	N/A	N/A	N/A	N/A
HC83500256	CHROMO  TISSUE BLOOD-US	310	88237	175	N/A	175	N/A
HC83500280	CHROMO SOLID TUMOR-GZ	310	88239	N/A	N/A	N/A	N/A
HC83500314	CHROMO TISSUE COUNT-GZ	310	88261	N/A	N/A	N/A	N/A
HC83500348	15-20 CELLS  2 KARYO BAND-GZ	310	88262	100	N/A	100	N/A
HC83500371	CHROMO CT 15-20 W/BANDING-IM	310	88262	N/A	N/A	N/A	N/A
HC83500405	CHROM ANAL TISSUE COUNT-GZ	310	88262	100	N/A	100	N/A
HC83500421	CHROMO AMNIOTIC FLD CT 17-GZ	310	88267	399	N/A	398	N/A
HC83500454	MOLECUL CYTO DNA PROBE FISH-IM	310	88271	N/A	N/A	N/A	N/A
HC83500488	INTERPHASE FISH HYBRI 25-99-HP	310	88274	N/A	N/A	N/A	N/A
HC83500512	INTERPHASE FISH HYBRI 25-99-GZ	310	88274	N/A	N/A	N/A	N/A
HC83500546	INTERPHS FISH HYBRI 100-300-US	310	88275	65	N/A	65	N/A
HC83500587	CHROM ANAL ADDL CELL CT-GZ	310	88285	N/A	N/A	N/A	N/A
HC83500611	CHROM ANAL ADDL CELL CT-US	310	88285	N/A	N/A	N/A	N/A
HC83500678	TISSUE EXAM G&M LEVEL 4-SU	312	88305	268	N/A	268	N/A
HC83500686	TISSUE EXAM G&M LEVEL 4-CS	312	88305	157	N/A	222	N/A
HC83500702	TISSUE EXAM G&M LEVEL 4-US	312	88305	N/A	N/A	N/A	N/A
HC83500744	TISSUE EXAM LVL 6 DIST SVC-US	312	88309	N/A	N/A	N/A	N/A
HC83500777	SPECIAL STAIN GRP I W/ I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83500801	ACID FAST STN/GRP I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83500835	ALCIAN BLUE STN/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83500868	BRWN BRN GRM ST/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83500884	DIETERL MOD STN/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83500892	DIETERL MOD STN/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83500918	GENTA STAIN/GROUP I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83500942	GIEMSA STN/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83500975	GRAMS STAIN-AP/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83501007	GROCOT SILVR ST/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83501031	PAS STAIN/GRP I W/ INT&RPT+-IM	312	88312	N/A	N/A	N/A	N/A
HC83501064	SILVR METHNM ST/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83501098	STEINER STN/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83501114	STEINER STN/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501148	WADES MOD FT ST/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501171	WARTHN-STARRY ST/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501205	ZIEHL NEELSON STN/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501239	SPECIAL STAIN GROUP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501262	ALCIAN BLUE NO DIGES/GRPII+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501296	ALCIAN BLUE W/DIGES/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501312	AMYLOID (CONGO RED)/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501346	AMYLOID (VIOLET)/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501379	AMYLOID STN BENHOLD/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501403	BONE MAR IRON STN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501437	ELASTIC STAIN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501460	F-M ARGENTAFFIN STN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501494	F-M MELAN STN BLEACH/GRPII+-US	312	88313	N/A	N/A	N/A	N/A
HC83501510	GIEMSA STN MAST CEL/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501528	GIEMSA STN MAST CEL/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501544	GRIMELIUS ARGYRO STN GRPII+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501577	HALLS BILE STAIN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501601	IRON STAIN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501635	IRON STAIN/B.M. SMEARS+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501668	JONES SILVER STAIN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501692	KOSSA CALCIUM STAIN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501726	LUXOL FAST BLUE STN GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501742	LUXOL FAST BLUE STN GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501775	MASSON TRICHROM STN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501809	MAY GRUN GIEMSA STN GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501833	MELANIN BLEACHING/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501866	METHYL GREEN PY STN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501890	MUCIN MUCICARM STN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501924	OIL RED O STAIN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501940	PAS STAIN W/DIGEST GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501973	PAS STAIN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83502005	PTAH STAIN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83502039	RETICULUM STAIN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83502062	SPECIAL STAIN GROUP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83502112	PAS W/DIGESTON -U2	312	88314	N/A	N/A	N/A	N/A
HC83502153	HISTOCHEMISTRY DETERMINATIV-HP	312	88319	N/A	N/A	N/A	N/A
HC83502229	ANATOMIC CONSULT; SLIDE REV-US	312	88321	N/A	N/A	N/A	N/A
HC83502245	ANATOMIC CONSULT; SLIDE REV-DR	312	88321	N/A	N/A	N/A	N/A
HC83502278	ANATOMIC CONSULT; REV/PREP-IM	312	88323	N/A	N/A	N/A	N/A
HC83502328	ANATOMIC CONSULT; COMP. REV-IM	310	88325	N/A	N/A	N/A	N/A
HC83502369	IHC/IP PER SPEC INITIAL AB STAIN -US	312	88342	180	N/A	180	N/A
HC83502401	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH C-TERMINS -US	312	88342	N/A	N/A	N/A	N/A
HC83502435	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH ROD DOMAN -IM	312	88342	N/A	N/A	N/A	N/A
HC83502468	IHC/IP PER SPEC INITIAL AB STAIN IHC/IP STAIN ACTH -US	312	88342	N/A	N/A	N/A	N/A
HC83502484	IHC/IP PER SPEC INITIAL AB STAIN AFP -US	312	88342	N/A	N/A	N/A	N/A
HC83502492	IHC/IP PER SPEC INITIAL AB STAIN BRST2 -IM	312	88342	N/A	N/A	N/A	N/A
HC83502518	IHC/IP PER SPEC INITIAL AB STAIN CALCITONIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83502542	IHC/IP PER SPEC INITIAL AB STAIN CD-34 -US	312	88342	N/A	N/A	N/A	N/A
HC83502575	IHC/IP PER SPEC INITIAL AB STAIN CHROMOGRNIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83502609	IHC/IP PER SPEC INITIAL AB STAIN DESMIN -US	312	88342	N/A	N/A	N/A	N/A
HC83502633	IHC/IP PER SPEC INITIAL AB STAIN ESTROGN RECPT -IM	312	88342	N/A	N/A	N/A	N/A
HC83502666	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 8 -US	312	88342	N/A	N/A	N/A	N/A
HC83502690	IHC/IP PER SPEC INITIAL AB STAIN GF -IM	312	88342	N/A	N/A	N/A	N/A
HC83502716	IHC/IP PER SPEC INITIAL AB STAIN GLUCAGON -IM	312	88342	N/A	N/A	N/A	N/A
HC83502740	IHC/IP PER SPEC INITIAL AB STAIN HCG -US	312	88342	N/A	N/A	N/A	N/A
HC83502773	IHC/IP PER SPEC INITIAL AB STAIN HMB-45 -IM	312	88342	N/A	N/A	N/A	N/A
HC83502807	IHC/IP PER SPEC INITIAL AB STAIN INSULIN -US	312	88342	N/A	N/A	N/A	N/A
HC83502856	IHC/IP PER SPEC INITIAL AB STAIN KI-1 -IM	312	88342	N/A	N/A	N/A	N/A
HC83502880	IHC/IP PER SPEC INITIAL AB STAIN KP1 -US	312	88342	N/A	N/A	N/A	N/A
HC83502914	IHC/IP PER SPEC INITIAL AB STAIN LAMBDA -IM	312	88342	N/A	N/A	N/A	N/A
HC83502930	IHC/IP PER SPEC INITIAL AB STAIN LCA -IM	312	88342	N/A	N/A	N/A	N/A
HC83502963	IHC/IP PER SPEC INITIAL AB STAIN LEU-22 -US	312	88342	N/A	N/A	N/A	N/A
HC83502997	IHC/IP PER SPEC INITIAL AB STAIN LN2 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503045	IHC/IP PER SPEC INITIAL AB STAIN MUSCLE -US	312	88342	N/A	N/A	N/A	N/A
HC83503078	IHC/IP PER SPEC INITIAL AB STAIN NEUROFILAMENT -IM	312	88342	N/A	N/A	N/A	N/A
HC83503102	IHC/IP PER SPEC INITIAL AB STAIN NSE -US	312	88342	N/A	N/A	N/A	N/A
HC83503136	IHC/IP PER SPEC INITIAL AB STAIN PSA -IM	312	88342	N/A	N/A	N/A	N/A
HC83503151	IHC/IP PER SPEC INITIAL AB STAIN S100 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503169	IHC/IP PER SPEC INITIAL AB STAIN S100 -US	312	88342	N/A	N/A	N/A	N/A
HC83503185	IHC/IP PER SPEC INITIAL AB STAIN SMOOTH MUSC -US	312	88342	N/A	N/A	N/A	N/A
HC83503219	IHC/IP PER SPEC INITIAL AB STAIN T4 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503243	IHC/IP PER SPEC INITIAL AB STAIN THYROGLOBULIN -US	312	88342	N/A	N/A	N/A	N/A
HC83503292	IHC/IP PER SPEC INITIAL AB STAIN SYNAPTOPH PER SPEC INITIAL AB STAIN  -IM	312	88342	N/A	N/A	N/A	N/A
HC83503326	IHC/IP PER SPEC INITIAL AB STAIN ACTH PIT PNL -US	312	88342	N/A	N/A	N/A	N/A
HC83503359	IHC/IP PER SPEC INITIAL AB STAIN ANTI-CD3/HRP -IM	312	88342	N/A	N/A	N/A	N/A
HC83503375	IHC/IP PER SPEC INITIAL AB STAIN CD-68 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503383	IHC/IP PER SPEC INITIAL AB STAIN CD-68 -US	312	88342	N/A	N/A	N/A	N/A
HC83503409	IHC/IP PER SPEC INITIAL AB STAIN CYCLIN D1 -US	312	88342	N/A	N/A	N/A	N/A
HC83503433	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-7 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503466	IHC/IP PER SPEC INITIAL AB STAIN EWINGS SARCOMA -US	312	88342	N/A	N/A	N/A	N/A
HC83503490	IHC/IP PER SPEC INITIAL AB STAIN GH STAIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83503524	IHC/IP PER SPEC INITIAL AB STAIN KERATIN 903 -US	312	88342	N/A	N/A	N/A	N/A
HC83503573	IHC/IP PER SPEC INITIAL AB STAIN LEU MI (CD15) -IM	312	88342	N/A	N/A	N/A	N/A
HC83503623	IHC/IP PER SPEC INITIAL AB STAIN MYELOPEROXIDASE -US	312	88342	N/A	N/A	N/A	N/A
HC83503649	IHC/IP PER SPEC INITIAL AB STAIN P-53 -US	312	88342	N/A	N/A	N/A	N/A
HC83503672	IHC/IP PER SPEC INITIAL AB STAIN PROLACTIN -IM	312	88342	40	N/A	40	N/A
HC83503706	IHC/IP PER SPEC INITIAL AB STAIN SEND OUT -US	312	88342	50	N/A	50	N/A
HC83503730	IHC/IP PER SPEC INITIAL AB STAIN TERM DEOZY -IM	312	88342	89	N/A	89	N/A
HC83503789	IHC/IP PER SPEC INITIAL AB STAIN HER-2-NEU -US	312	88342	154	N/A	154	N/A
HC83503813	IF STUDY DIRECT 1ST STAIN-CS	312	88346	55	N/A	55	N/A
HC83503854	ELECTRON MICROSCOPY PROF-CS	312	88348	303	N/A	303	N/A
HC83503870	MORPHOMETRIC STDY NERVE-AT	312	88356	N/A	N/A	N/A	N/A
HC83503920	TISSUE IN-SITU HYBRI INTER-US	312	88365	250	N/A	250	N/A
HC83503979	ANATMIC CONSULT; REV/PREP-ON	312	88323	N/A	N/A	N/A	N/A
HC83504019	CHROM ANAL 45 CELLS-GZ	310	88263	360	N/A	359	N/A
HC83504043	TISSUE EXAM G&M LEVEL 4PROF-CS	312	88305	116	N/A	115	N/A
HC83504084	MORPHOMETRIC STUDY TUMOR-PI	312	88358	50	N/A	50	N/A
HC83504126	M: MISC LAB PATHOLOGY REF LAB-CS	310		N/A	N/A	N/A	N/A
HC83504167	M: MISC LAB PATHOLOGY REF LAB-GZ	310		N/A	N/A	N/A	N/A
HC83504175	M: MISC LAB PATHOLOGY REF LAB-HP	310		N/A	N/A	N/A	N/A
HC83504191	M: MISC LAB PATHOLOGY REF LAB-JH	310		N/A	N/A	N/A	N/A
HC83504233	M: MISC LAB PATHOLOGY REF LAB-MG	310		N/A	N/A	N/A	N/A
HC83504274	M: MISC LAB PATHOLOGY REF LAB-U2	310		68	N/A	N/A	N/A
HC83504324	ANATOMIC CONSULT; SLIDE REV-MA	312	88321	259	N/A	259	N/A
HC83504365	ANATOMIC CONSULT; COMP. REV-JO	310	88325	N/A	N/A	N/A	N/A
HC83504399	IRON ASSAY TISSUE-AU	301	83540	155	N/A	155	N/A
HC83504415	MOLECUL CYTO DNA PROBE FISH-GC	310	88271	N/A	N/A	N/A	N/A
HC83504423	CHROM ANAL ADD SPEC BAND-GC	310	88283	N/A	N/A	N/A	N/A
HC83504449	ANATOMIC CONSULT; COMP. REV-CS	310	88325	1,283	N/A	1,283	N/A
HC83504472	M: MISC LAB PATHOLOGY REF LAB-GC	310		N/A	N/A	N/A	N/A
HC83504589	FLOW CYT MKR TC 1ST-U2	311	88184	N/A	N/A	N/A	N/A
HC83504621	M: MISC LAB PATHOLOGY REF LAB-NY	310		N/A	N/A	N/A	N/A
HC83504654	M: MISC LAB PATHOLOGY REF LAB-SJ	310		N/A	N/A	N/A	N/A
HC83504696	FLOW CYT MKR TC ADD+-HP	311	88185	N/A	N/A	N/A	N/A
HC83504779	IHC/IP PER SPEC INITIAL AB STAIN (PNL X 4)-HP	312	88342	88	N/A	88	N/A
HC83504795	MORPH STDY CAT ISH QNT HER2-NG	310	88367	231	N/A	231	N/A
HC83504829	MORPH STDY MAN ISH QNT HER2-NG	310	88368	201	N/A	201	N/A
HC83504852	IHC MSH2 QNT-NG	310	88360	45	N/A	59	N/A
HC83504928	MORPH STUDY MAN ISH HER2-NG	310	88368	169	N/A	169	N/A
HC83505123	M: MISC LAB PATHOLOGY REF LAB-GH	310		N/A	N/A	N/A	N/A
HC83505156	HUMAN PAPILLOMAVIRUS HI/LO- PI	302	87624	48	N/A	48	N/A
HC83505263	IF  EACH ADD'L SINGLE AB STAIN-CS	312	88350	51	N/A	N/A	N/A
HC83505289	M: MISC LAB PATHOLOGY REF LAB-FM	310		N/A	N/A	N/A	N/A
HC83505297	M: MISC LAB PATHOLOGY REF LAB-AI	310		N/A	N/A	N/A	N/A
HC83505313	M: MISC LAB PATHOLOGY REF LAB-NG	310		322	N/A	N/A	N/A
HC83505354	M: MISC LAB PATHOLOGY REF LAB-BR	310		N/A	N/A	N/A	N/A
HC83505412	FLOW CYT MKR TC 1ST (PNL) -NG	311	88184	76	N/A	N/A	N/A
HC83505446	M: MISC LAB PATHOLOGY REF LAB-SF	310		N/A	N/A	N/A	N/A
HC83505479	SPECIAL STAIN GROUP II -NG	312	88313	50	N/A	N/A	N/A
HC83505503	ANATOMIC CONSULT; SLIDE REV-CS	312	88321	140	N/A	N/A	N/A
HC83505529	IP/IHC PER SPEC INITIAL AB STAIN -CS	312	88342	317	N/A	N/A	N/A
HC83505537	ANATOMIC CONSULT; COMPLEX REV-UX	312	88321	272	N/A	N/A	N/A
HC83505552	M: MISC LAB PATHOLOGY REF LAB-JN	310		N/A	N/A	N/A	N/A
HC83505586	M: MISC LAB PATHOLOGY REF LAB-OU	310		N/A	N/A	N/A	N/A
HC83505610	IHC/IP PER SPEC EA ADD AB STAIN+ -CA	312	88341	148	N/A	N/A	N/A
HC83505644	KRAS MUT ANALSYS VARIANTS EXONS 2-NG	310	81275	500	N/A	N/A	N/A
HC83505677	NRAS MUT ANALYSIS EXON 4-NG	310	81403	340	N/A	N/A	N/A
HC83505701	IHC/IP PER SPEC EA ADD AB STAIN+ PMS2-NG	310	88341	45	N/A	N/A	N/A
HC83505735	EXAM GROSS&MICRO INTERM LVL IV(PANEL)-U2	314	88305	80	N/A	N/A	N/A
HC83505750	HISTCHM ST FROZ TIS BLK EA ADD(PANEL)+-U2	314	88314	44	N/A	N/A	N/A
HC83505784	M: MISC LAB PATHOLOGY REF LAB-FN	310		N/A	N/A	N/A	N/A
HC83505818	M: PATH REF LAB-BC	310		N/A	N/A	N/A	N/A
HC83505842	IHC/IP PER SPEC EA ADD AB STAIN+ - AP	312	88341	40	N/A	N/A	N/A
HC83505875	MORPH STDY CAT FISH EA MULTI PROBE HER2-NG	312	88374	270	N/A	N/A	N/A
HC83505909	SPECIAL STAIN GROUP I -AP	312	88312	25	N/A	N/A	N/A
HC83505933	TISSUE IN-SITU HYBRI EA ADDL -AP	312	88364	135	N/A	N/A	N/A
HC83505958	M: MISC LAB PATHOLOGY REF LAB-PA	310		61	N/A	N/A	N/A
HC83505982	MORPH STDY TMR IHC-AP	312	88361	150	N/A	N/A	N/A
HC83506014	FLOW CYT MKR CD4/CD8 BAL EA ADD+ (PNL)-NG	311	88185	13	N/A	N/A	N/A
HC83506048	MORPH STDY CAT FISH EA MULTI PROBE - NG	312	88374	270	N/A	N/A	N/A
HC83506071	M: MISC LAB PATHOLOGY REF LAB-HE	310		N/A	N/A	N/A	N/A
HC83590117	P:IMMUNOHISTOCHEM X 4-HP			N/A	N/A	N/A	N/A
HC83590331	P: FLOW CYTOM MKR PERIPH BLD 1ST+23 ADD-NG			N/A	N/A	N/A	N/A
HC83590356	M: MISC LAB PATHOLOGY REF LAB-SK	310		N/A	N/A	N/A	N/A
HC83590364	P: MUSCLE BIOPSY PANEL-U2			N/A	N/A	N/A	N/A
HC83590398	BRAF MUTATION ANALYSIS-AP	310	81210	175	N/A	N/A	N/A
HC83590422	KRAS MUT ANALYSIS EXON 4-AP	310	81276	193	N/A	N/A	N/A
HC84200013	CULTURE ANAEROBIC	306	87075	564	N/A	73	N/A
HC84200047	GRAM STAIN	306	87205	207	N/A	48	N/A
HC84200070	STREP A ANTIGN SCRN(DIRECT OBS)	306	87880	228	N/A	42	N/A
HC84200104	CULTURE THROAT	306	87070	488	N/A	43	N/A
HC84200120	CULTURE CSF	306	87070	488	N/A	95	N/A
HC84200138	PINWORM PREP	306	87172	143	N/A	40	N/A
HC84200153	KIRBY BAUER SENSITIVITY	306	87184	290	N/A	51	N/A
HC84200187	CULTURE SCREEN	306	87070	488	N/A	34	N/A
HC84200211	CULTURE MRSA & VRE	306	87081	315	N/A	42	N/A
HC84200245	WBC IN FECES	300	89055	148	N/A	59	N/A
HC84200278	AEROBIC ID EA ISOLATE	306	87077	305	N/A	41	N/A
HC84200302	CULTURE FUNGUS BLOOD	306	87103	524	N/A	91	N/A
HC84200336	ENZYME DET BETA LACTAMASE	306	87185	126	N/A	19	N/A
HC84200351	PARTICLE AGGLUTINATION EA AB	306	86403	228	N/A	110	N/A
HC84200385	CULTURE STOOL ADDL PATH	306	87046	354	N/A	30	N/A
HC84200419	CRYPTOCOCCUS NEOFORMANS AG	306	87327	291	N/A	58	N/A
HC84200468	OB FECAL IMM  ASSAY 1-3 CA SCR	301	G0328	144	N/A	81	N/A
HC84200492	ENTAMOEBA HISTO AG(DISPAR)	306	87336	187	N/A	33	N/A
HC84200526	E. COLI SHIGA-LIKE TOXIN ASSAY	306	87427	211	N/A	43	N/A
HC84200559	SHIGELLA TOXIN BY IMM	306	87899	174	N/A	43	N/A
HC84200575	M: CULTURE MISC	306	87070	488	N/A	57	N/A
HC84200609	STREP PNEUMONIAE URINE AG	306	87449	344	N/A	95	N/A
HC84200633	CULTURE RESPIRATORY	306	87070	488	N/A	95	N/A
HC84200666	CULTURE FUNGUS HAIR/SKIN/NAIL	306	87101	324	N/A	97	N/A
HC84200690	CULTURE CHLAMYDIA  ANY SOURCE	306	87110	530	N/A	157	N/A
HC84200724	AFB ID BY PROBE	306	87149	428	N/A	67	N/A
HC84200757	OVA/PARASITE-CONC PREP W/SMEAR	306	87177	233	N/A	45	N/A
HC84200773	AFB STAIN DIRECT	306	87206	247	N/A	53	N/A
HC84200799	ADDITIONAL VIRUS TEST	306	87253	356	N/A	71	N/A
HC84200815	ADENOVIRUS FA ANTIGEN	306	87260	276	N/A	103	N/A
HC84200849	HSV 2 FA ANTIGEN	306	87273	278	N/A	50	N/A
HC84200872	INFLUENZA A FA ANTIGEN	306	87276	343	N/A	103	N/A
HC84200906	VARICELLA ZOSTER FA ANTIGEN	306	87290	299	N/A	50	N/A
HC84200930	HELICOBACTER PYLORI	306	87339	276	N/A	74	N/A
HC84200963	ROTAVIRUS ASSAY EIA/ANTIGEN	306	87425	361	N/A	81	N/A
HC84200989	FAT STAIN FECES QUAL	300	89125	165	N/A	29	N/A
HC84200997	MEAT FIBERS  FECES	300	89160	129	N/A	45	N/A
HC84201011	SEMEN ANALYSIS POST	300	89321	281	N/A	61	N/A
HC84201045	BETA STREP SCREEN(QUAL)	306	87430	286	N/A	41	N/A
HC84201078	ENTAMOEBA HISTOL AG	306	87337	187	N/A	28	N/A
HC84201110	C DIFFICILE AG EIA	306	87449	263	N/A	71	N/A
HC84201144	CULTURE THROAT-SCREENING	306	87081	315	N/A	48	N/A
HC84201177	GRAM STAIN (MHL)	306	87205	207	N/A	48	N/A
HC84201201	CHARCOT-LEYDEN CRYSTALS	306	89060	370	N/A	32	N/A
HC84201227	INFLUENZA B BY PCR	306	87798	609	N/A	201	N/A
HC84201318	B. PERTUSSIS BY PCR (RVP PNL)	306	87798	620	N/A	150	N/A
HC84201342	INFLUENZA A OR B EIA EACH (POS)	306	87400	320	N/A	19	N/A
HC84201375	CULTURE BLOOD TRANS REACT-MHL	306	87040	660	N/A	75	N/A
HC84201409	IADNA-DNA/RNA PROBE TQ 12-25 GI PCR	306	87507	4,537	N/A	1,500	N/A
HC84201433	CULT DNA/RNA AMP PCR YEAST ISO	306	87150	528	N/A	220	N/A
HC84201466	DNA/RNA HERPES SIMPLEX I PCR(PNL)	306	87529	481	N/A	75	N/A
HC84201482	DNA/RNA HERPES VIRUS-6 PCR(PNL)	306	87532	481	N/A	75	N/A
HC84201490	DNA/RNA S PNEUMONIAE GROUP B PCR(PNL)	306	87653	540	N/A	150	N/A
HC84201516	DNA/RNA INFLUENZAE H PCR(PNL)	306	87798	524	N/A	150	N/A
HC84201540	DNA/RNA S AGALACTIAE PCR(PNL)	306	87798	524	N/A	150	N/A
HC84201573	DNA/RNA VARICELLA ZOSTER PCR(PNL)	306	87798	524	N/A	150	N/A
HC84201607	C TRACHOMATIS BY DNA AMP PROBE	306	87491	579	N/A	155	N/A
HC84201631	DNA/RNA MENINGITIS/ENCEPHALITIS PCR	306	87483	4,307	N/A	418	N/A
HC84201664	DNA/RNA KLEBSIELLA AEROGENES (PNL)	306	87798	483	N/A	150	N/A
HC84201680	DNA/RNA KLEBSIELLA PNEUMONIAE GROUP (PNL)	306	87798	483	N/A	150	N/A
HC84201698	DNA/RNA MORAXELLA CATARRHALIS (PNL)	306	87798	483	N/A	150	N/A
HC84201714	DNA/RNA PSEUDOMONAS AERUGINOSA (PNL)	306	87798	483	N/A	150	N/A
HC84201748	DNA/RNA STREPTOCOCCUS AGALACTIAE (PNL)	306	87798	483	N/A	150	N/A
HC84201771	DNA/RNA CHLAMYDIA PNEUMONIAE (PNL)	306	87486	303	N/A	125	N/A
HC84201805	RESP VIRUS 6-11 TARGETS (PNL)	306	87632	1,378	N/A	327	N/A
HC84201839	RESP BACTERIA/VIRAL 22 TRGT SARS-COV-2 QUAL RT-PCR(PNL RP2.1)	306	0202U	3,102	N/A	500	N/A
HC84201862	S AUREUS BY PCR	300	87640	569	N/A	N/A	N/A
HC84290014	P:CULTURE OTHER AEROB& ANAEROB			N/A	N/A	N/A	N/A
HC84290030	P:BACTERIAL ANTIGENS (PNL)			N/A	N/A	N/A	N/A
HC84290089	P: RESPIRATORY PANEL BY PCR			N/A	N/A	N/A	N/A
HC84600006	CYTOLOGY FLD/BRSH/WASH-DIST SV	311	88104	312	N/A	146	N/A
HC84600048	CYTOLOGY CONCENTRATE TECHNIQUE	311	88108	437	N/A	184	N/A
HC84600071	PAP SMEAR PATH INTERP+	311	88141	191	N/A	50	N/A
HC84600105	PAP SLIDES MANUAL SCREEN	311	88150	145	N/A	50	N/A
HC84600139	PAP BETHESDA MANUAL SCREEN	311	88164	148	N/A	53	N/A
HC84600154	CYTOLOGY SMEAR NON GYN S&I	311	88160	368	N/A	119	N/A
HC84600188	CYTP DX EVAL FNA 1ST EVAL EA SITE	311	88172	463	N/A	181	N/A
HC84600212	CYTO PREP NON GYN S&I-DIST SVC	311	88161	378	N/A	150	N/A
HC84600246	M: MISC CYTOLOGY PROCEDURE	311		N/A	N/A	N/A	N/A
HC84600279	M: MISC CYTOGENIC STUDY	311		N/A	N/A	N/A	N/A
HC84600303	CYTO CONC TECHNIQUE DIST SRV	311	88108	436	N/A	164	N/A
HC84600337	MORPH STDY IHC/PROG RCPTR PER SPEC EA AB	312	88360	777	N/A	239	N/A
HC84600485	COPPER STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC84600493	COLLOIDAL IRON STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC84600535	CYTOLOGY CONC TECHNIQUE *OP	311	88108	437	N/A	100	N/A
HC84600568	EXM/SELEC ARCHVL TISS MOL ANAL	312	88363	311	N/A	175	N/A
HC85100477	CBC WITH AUTOMATED DIFF	305	85025	76	N/A	N/A	N/A
HC85100501	RETICULOCYTE - AUTO	305	85045	45	N/A	N/A	N/A
HC88600010	CAPILLARY/HEEL/FINGER STICK	300	36416	58	N/A	18	N/A
HC88600051	VENIPUNCTURE BY PHYSICIAN OR QHC <3YRS	410	36406	67	N/A	18	N/A
HC88600077	VENIPUNCTURE ROUTINE	300	36415	58	N/A	18	N/A
HC88600093	HANDLING AND/OR CONVEYANCE TO REF LAB(TRIAGE)	309	99001	85	N/A	28	N/A
HC88600119	MONARCH SPECIAL PROCESSING	300	84999	N/A	N/A	N/A	N/A
HC88600226	SPECIAL COURIER       85	300	99001	108	N/A	85	N/A
HC88600267	SPECIAL COURIER       30	300	99001	38	N/A	30	N/A
HC88600291	VENIPUNCTURE ROUTINE AFP PROGRAM	300	36415	8	N/A	6	N/A
HC89000004	BLOOD TYPE SERO; ABO FRANCSLLA AGLTNS-AU	302	86900	95	N/A	95	N/A
HC89000038	HLA TYPING-U2	302	86813	225	N/A	225	N/A
HC89000061	TOXOPLASMA AB IGG(PNL)-AU	302	86777	11	N/A	10	N/A
HC89000087	REDUCING SUBSTANCES-U2	301	81002	N/A	N/A	N/A	N/A
HC89000111	ADENOVIRUS AB (PNL)-FT	302	86603	70	N/A	70	N/A
HC89000145	TESTOSTERONE FREE-QD	301	84402	25	N/A	25	N/A
HC89000178	HERPES 1 IGM AB (PNL)-FT	302	86695	70	N/A	70	N/A
HC89000202	INFLUENZA B SEROLOGY-QD	302	86710	34	N/A	34	N/A
HC89000236	INFLUENZA A SEROLOGY-QD	302	86710	23	N/A	23	N/A
HC89000269	HERPES SIMPLEX I AB-QD	302	86695	22	N/A	22	N/A
HC89000285	ANAEROBIC ID PRESUM(PNL)-FT	306	87185	39	N/A	38	N/A
HC89000327	ESTROGENS URINE-SL	301	82672	N/A	N/A	N/A	N/A
HC89000350	CALCIUM IONIZED-QD	301	82330	130	N/A	129	N/A
HC89000384	DHEA SULFATE-QD	301	82627	12	N/A	11	N/A
HC89000418	ALPHA-2 MACROGLOBULIN-QD	301	83883	N/A	N/A	N/A	N/A
HC89000442	IMMUNE COMPLEXES RAJI CELL-QD	302	86332	29	N/A	29	N/A
HC89000475	TULAREMIA AB-QD	302	86668	15	N/A	15	N/A
HC89000491	LEGIONELLA AG DFA-U2	306	87278	16	N/A	16	N/A
HC89000509	F-ACTIN (SM) AB  IGG  RFLX-AU	302	86256	8	N/A	8	N/A
HC89000525	COXSACKIE A AB-SL	302	86658	28	N/A	28	N/A
HC89000558	DENGUE FEVER AB-SL	302	86790	73	N/A	73	N/A
HC89000582	GLUCAGON-QD	301	82943	N/A	N/A	N/A	N/A
HC89000616	ALKALINE PHOS ISOENZYMES-QD	301	84080	41	N/A	41	N/A
HC89000640	17-OH CORTICOSTEROIDS-QD	301	83491	N/A	N/A	N/A	N/A
HC89000681	DIGITOXIN-QD	301	80299	60	N/A	60	N/A
HC89000707	HISTOPLASMA AB-QD	302	86698	17	N/A	17	N/A
HC89000715	CHLORPROPAMIDE-AU	301	80299	84	N/A	84	N/A
HC89000749	HEMOGLOBIN PLASMA-QD	301	83051	14	N/A	14	N/A
HC89000772	CIMETIDINE/TAGAMET-AU	301	80299	100	N/A	100	N/A
HC89000806	OXALATE URINE-QD	301	83945	14	N/A	13	N/A
HC89000848	ANGIOTENSIN CONVERT ENZYME-QD	301	82164	144	N/A	144	N/A
HC89000871	ENCAINIDE-AU	301	80299	422	N/A	422	N/A
HC89000905	ALDOSTERONE URINE-QD	301	82088	38	N/A	38	N/A
HC89000939	OLIGOCLONAL BANDS (CSF)-SL	301	83916	22	N/A	22	N/A
HC89000970	CULTURE BORD PERTUSSIS(PNL)-U2	306	87070	35	N/A	35	N/A
HC89001002	CYANIDE-QD	301	82600	N/A	N/A	N/A	N/A
HC89001036	ZINC-QD	301	84630	11	N/A	11	N/A
HC89001069	CARBOXYHEMOGLOBIN-QD	301	82375	8	N/A	8	N/A
HC89001093	HYDROXYPROLINE TOTAL-QD	301	83505	N/A	N/A	N/A	N/A
HC89001127	VISCOSITY-QD	305	85810	12	N/A	12	N/A
HC89001150	C-1 ESTERASE INHIBITOR-QD	302	83520	49	N/A	49	N/A
HC89001176	CYSTINE URINE QUAL-QD	301	82615	N/A	N/A	N/A	N/A
HC89001218	CALCITONIN-QD	301	82308	21	N/A	21	N/A
HC89001242	COPPER URINE-QD	301	82525	N/A	N/A	N/A	N/A
HC89001275	IODINE-QD	301	80299	60	N/A	60	N/A
HC89001325	ANTI-DNASE B-QD	302	86215	15	N/A	15	N/A
HC89001366	DARVON-QD	301	80299	60	N/A	60	N/A
HC89001408	CITRIC ACID-QD	301	82507	10	N/A	10	N/A
HC89001432	METHOCARBAMOL-AU	301	80299	98	N/A	98	N/A
HC89001440	CULTURE CHLAMYDIA-U2	306	87110	N/A	N/A	N/A	N/A
HC89001473	ECHOVIRUS AB-QD	302	86658	15	N/A	15	N/A
HC89001507	LEPTOSPIRA AB-QD	302	86720	16	N/A	16	N/A
HC89001531	CULTURE VIRUS-U2	306	87252	N/A	N/A	N/A	N/A
HC89001564	CULTURE LEGIONNELLA-U2	306	87081	N/A	N/A	N/A	N/A
HC89001598	ROTAVIRUS AG-QD	306	87425	15	N/A	15	N/A
HC89001622	VITAMIN B1 THIAMINE-QD	301	84425	25	N/A	24	N/A
HC89001655	ACID PHOS PROSTATIC-QD	301	84066	N/A	N/A	N/A	N/A
HC89001739	SPERM AB (PNL)-AU	300	89325	33	N/A	32	N/A
HC89001762	THIOTHIXENE-QD	301	80299	60	N/A	60	N/A
HC89001796	INSULIN AB-QD	302	86337	13	N/A	13	N/A
HC89001846	FOLATE RBC-QD	301	82747	7	N/A	7	N/A
HC89001879	HOMOVANILLIC ACID-QD	301	83150	N/A	N/A	N/A	N/A
HC89001903	METHEMOBLOBIN-QD	301	83050	N/A	N/A	N/A	N/A
HC89001937	PARIETAL FA AB SCRN-QD	302	86255	22	N/A	22	N/A
HC89001952	ALUMINUM-QD	301	82108	N/A	N/A	N/A	N/A
HC89001994	TACROLIMUS-U2	301	80197	40	N/A	N/A	N/A
HC89002026	METANEPHRINE-QD	301	83835	17	N/A	17	N/A
HC89002059	ARSENIC-QD	301	82175	63	N/A	62	N/A
HC89002091	HTLV-I AB-SL	302	86687	N/A	N/A	N/A	N/A
HC89002125	CANDIDA AB-QD	302	86628	13	N/A	13	N/A
HC89002158	HTLV-II AB-SL	302	86688	N/A	N/A	N/A	N/A
HC89002182	LEAD-QD	301	83655	38	N/A	38	N/A
HC89002190	GLOMERULAR BASEMENT MEMB AB-QD	301	83520	49	N/A	49	N/A
HC89002216	FACTOR X-U2	305	85260	N/A	N/A	N/A	N/A
HC89002240	BETA-2 MICROGLOBULIN-QD	301	82232	N/A	N/A	N/A	N/A
HC89002273	CITRIC ACID URINE-QD	301	82507	N/A	N/A	N/A	N/A
HC89002307	HEPATITIS DELTA AB-QD	302	86692	21	N/A	21	N/A
HC89002331	FACTOR VIII ASSAY-U2	305	85240	N/A	N/A	N/A	N/A
HC89002364	INTRINSIC FACTOR AB-QD	302	86340	22	N/A	22	N/A
HC89002380	CPK ISO-QD	301	82552	51	N/A	50	N/A
HC89002398	PLATELET AGG EA AGENT-U2	305	85576	N/A	N/A	N/A	N/A
HC89002463	HEPATISIS C RNA BY PCR-SL	306	87522	N/A	N/A	N/A	N/A
HC89002497	HSV PCR QUANT-SL	306	87530	N/A	N/A	N/A	N/A
HC89002521	AMINO ACIDS QUANT URINE-QD	301	82139	N/A	N/A	N/A	N/A
HC89002554	LEGIONELLA AG URINE-QD	306	87449	22	N/A	22	N/A
HC89002588	TOPIRAMATE-QD	301	80201	38	N/A	37	N/A
HC89002612	ANA TITER-QD	302	86039	12	N/A	12	N/A
HC89002653	CHLORIDE URINE 24HR-QD	301	82436	N/A	N/A	N/A	N/A
HC89002679	RUBELLA IGM AB-QD	302	86762	17	N/A	17	N/A
HC89002760	ALLERGEN(PNL 2)-AU	302	86003	5	N/A	5	N/A
HC89002810	YO FA AB SCRN-QD	302	86255	16	N/A	16	N/A
HC89002844	MERCURY URINE-QD	301	83825	N/A	N/A	N/A	N/A
HC89002877	AMIKACIN INITIAL-QD	301	80150	N/A	N/A	N/A	N/A
HC89002901	ANA FLUID-QD	302	86038	321	N/A	320	N/A
HC89002935	LIPID ASSOC SIALIC ACID-QD	301	84275	N/A	N/A	N/A	N/A
HC89002950	SMOOTH MUSCLE FA AB SCRN-QD	302	86255	27	N/A	27	N/A
HC89002984	5-HIAA 24HR URINE-QD	301	83497	8	N/A	7	N/A
HC89003016	LDH ISOENZYMES-QD	301	83625	10	N/A	10	N/A
HC89003040	HALOPERIDOL-QD	301	80173	N/A	N/A	N/A	N/A
HC89003073	17 KETOSTEROIDS-QD	301	83586	N/A	N/A	N/A	N/A
HC89003107	THYROGLOBULIN AB-QD	302	86800	19	N/A	19	N/A
HC89003131	C4 COMPLEMENT-QD	302	86160	16	N/A	16	N/A
HC89003156	CAROTENE-QD	301	82380	N/A	N/A	N/A	N/A
HC89003164	CERULOPLASMIN-QD	301	82390	19	N/A	19	N/A
HC89003180	GASTRIN-QD	301	82941	12	N/A	12	N/A
HC89003214	IMMUNO ELECT URINE-QD	302	86325	21	N/A	21	N/A
HC89003248	RUBELLA AB-QD	302	86762	13	N/A	13	N/A
HC89003271	CORTISOL FREE URINE-QD	301	82530	292	N/A	292	N/A
HC89003305	TRANSFERRIN-QD	301	84466	9	N/A	9	N/A
HC89003339	MERCURY-QD	301	83825	15	N/A	14	N/A
HC89003354	ENCEPHALITIS CALIF AB-QD	302	86651	24	N/A	24	N/A
HC89003362	ENCEPHALITIS EASTERN AB-QD	302	86652	26	N/A	26	N/A
HC89003388	ENCEPHALITIS WESTERN AB-QD	302	86654	26	N/A	26	N/A
HC89003412	FACTOR VIII VW AG-U2	305	85246	N/A	N/A	N/A	N/A
HC89003446	EBV AB TO EARLY AG-QD	302	86663	21	N/A	21	N/A
HC89003479	TOXOPLASMA AB-QD	302	86777	16	N/A	16	N/A
HC89003511	MUMPS IGM-AU	301	86735	13	N/A	9	N/A
HC89003545	ARYLSULFATASE A URINE-AU	301	84311	332	N/A	331	N/A
HC89003578	DIPHENHYDRAMINE URINE-AU	301	80299	90	N/A	90	N/A
HC89003594	HYDROXYZINE URINE-AU	301	80299	113	N/A	113	N/A
HC89003636	TISSUE CULTURE-HP	311	88237	N/A	N/A	N/A	N/A
HC89003669	ADENOSINE DEAMINASE-AU	301	84311	31	N/A	31	N/A
HC89003701	PHENMETRAZINE URINE-AU	301	80299	125	N/A	125	N/A
HC89003743	HERPES TYPE I IGM-QD	302	86695	N/A	N/A	N/A	N/A
HC89003776	TRICHLOROACETIC URINE(PNL)-AU	301	83918	91	N/A	91	N/A
HC89003800	NBS TYROSINE SCREEN-GE	301	84510	11	N/A	11	N/A
HC89003826	NBS TSH-GE	301	84443	18	N/A	16	N/A
HC89003859	HERPES SIMPLEX II AB-QD	302	86696	23	N/A	23	N/A
HC89003909	CULTURE BORDETELLA-U2	306	87081	35	N/A	35	N/A
HC89003933	CHROMO ANALYSIS TISSUE-GC	310	88233	N/A	N/A	N/A	N/A
HC89003966	5 CELLS  1 KARYO BANDING-GC	311	88261	N/A	N/A	N/A	N/A
HC89003990	KARYOTYPING ADD EA-GC	311	88280	192	N/A	192	N/A
HC89004022	HEPARIN ANTI-XA -AU	305	85520	85	N/A	110	N/A
HC89004048	AMYLASE ISOENZYMES -AU	301	82150	8	N/A	17	N/A
HC89004055	CLOMIPRAMINE; 1-2-AU	301	80335	16	N/A	16	N/A
HC89004071	TOPIRAMATE-AU	301	80201	26	N/A	16	N/A
HC89004105	ENTAMOEBA HISTOLYTICA AB - AU	302	86753	16	N/A	16	N/A
HC89004139	ACTIVATED PROT C RESISTANCE-AU	305	85307	21	N/A	21	N/A
HC89004162	ANTI-GLIADIN  IGA SPEC(PNL)-PR	302	83520	23	N/A	22	N/A
HC89004196	ANTI-ENDOMY IGA AB IFA1ST STAIN(PNL)-PR	310	88346	106	N/A	106	N/A
HC89004279	BETA-2 MICROGLOBULIN SR/PLS-AU	301	82232	8	N/A	8	N/A
HC89004295	M: MISC LAB GENERAL REF LAB-SU	300		835	N/A	N/A	N/A
HC89004345	CRYPTOSPORIDIUM ANTIGEN-AU	306	87328	16	N/A	16	N/A
HC89004360	BETA 2 GLYCOPROTEIN  IGM- AU	302	86146	10	N/A	20	N/A
HC89004394	ADENOVIRUS AB  IGG-AU	302	86603	11	N/A	11	N/A
HC89004428	CHLORAMPHENICOL CSF-MA	301	82415	124	N/A	124	N/A
HC89004451	ENCEPHALITIS EASTRN AB(PNL)-AU	302	86652	19	N/A	18	N/A
HC89004485	THROMBIN TIME-AU	305	85670	15	N/A	15	N/A
HC89004519	ANTI-HUMAN TIS TRNSIGA(PNL2-PR	302	83520	62	N/A	61	N/A
HC89004584	COPPER  LIVER TISSUE-MA	301	82525	71	N/A	71	N/A
HC89004600	ASCA IGG (PNL)-PR	302	83520	32	N/A	32	N/A
HC89004634	ANTI-CBIR1 (PNL)-PR	302	83520	32	N/A	32	N/A
HC89004667	STREPTOCOCCUS PNEUM AG-FT	302	86403	75	N/A	75	N/A
HC89004691	ANTI-RNP AB (PNL2)-RD	302	86235	24	N/A	24	N/A
HC89004725	ANTI-CHROMATIN AB (PNL2)-RD	302	86235	24	N/A	24	N/A
HC89004758	NBS BIOTINIDASE-GE	301	82261	18	N/A	16	N/A
HC89004782	CULTURE FUNGUS OTHER SRC-FT	306	87102	N/A	N/A	N/A	N/A
HC89004808	MTB COMPLEX DNA  PCR-FT	306	87556	269	N/A	268	N/A
HC89004816	KAPPA LIGHT CHAINS-QD	301	83883	90	N/A	90	N/A
HC89004832	STREPTOLYSIN O AB (ASO)-AU	302	86060	10	N/A	10	N/A
HC89004865	DRVVT RUSS VIPER VENOM 1:1MIX RFX-AU	305	85613	13	N/A	11	N/A
HC89004899	PLAT NEUT RFX - AU	305	85597	39	N/A	39	N/A
HC89004923	M: MISC LAB GENERAL REF LAB-AA	300		N/A	N/A	N/A	N/A
HC89004956	PARVOVIRUS B19 BY PCR -AU	306	87798	75	N/A	75	N/A
HC89004980	STREPTOCOCCUS GROUP B AG -AU	302	86403	20	N/A	19	N/A
HC89005003	S PNEUMONIA AG -AU	302	86403	20	N/A	19	N/A
HC89005011	N MENINGITIOIS GROUP C/W -AU	302	86403	20	N/A	19	N/A
HC89005037	GROUP B/E COLI K1 AG -AU	302	86403	20	N/A	19	N/A
HC89005060	TRIGLYCERIDES-VAP(IN GRP)-AU	301	84478	9	N/A	8	N/A
HC89005094	PARVOVIRUS B19 DNA QUAL PCR-FT	306	87798	100	N/A	268	N/A
HC89005128	B BURGDORFERI IGG WB -FT	302	86617	89	N/A	88	N/A
HC89005151	HSV 2 IGG INDEX&INTERP -FT	302	86696	63	N/A	63	N/A
HC89005185	HSV 2 IGM  IFA  -FT	302	86696	45	N/A	44	N/A
HC89005219	INFCT AGNT ADENO DNA(RFX QT-FT	306	87798	270	N/A	268	N/A
HC89005235	HERPESVIRUS 6 QUAL(RFX QNT)-FT	306	87532	269	N/A	268	N/A
HC89005268	HSV 1 QUANT PCR- FT	306	87530	158	N/A	157	N/A
HC89005292	BORDETELLA PERTUS PT IGA-FT	302	86615	41	N/A	41	N/A
HC89005334	HEPARIN-INDUCED PLATELET AB-EC	302	86022	210	N/A	210	N/A
HC89005367	SEX HORMONE BINDING GLOB2ND-AU	301	84270	12	N/A	12	N/A
HC89005391	B-TYPE NATRIURETIC PEPTIDE-UCI	301	83880	100	N/A	100	N/A
HC89005425	CULTURE MYCOPLASMA-FT	306	87109	99	N/A	99	N/A
HC89005441	CULTURE - CHLAMYDIA STAIN-FT	306	87140	30	N/A	30	N/A
HC89005474	BARTONELLA DNA QNT BY PCR-AU	306	87471	194	N/A	245	N/A
HC89005508	MAGNESIUM URINE 24 HR-AU	301	83735	10	N/A	144	N/A
HC89005532	ECHOVIRUS 7 AB-FT	302	86658	26	N/A	25	N/A
HC89005565	ECHOVIRUS 30 AB-FT	302	86658	26	N/A	25	N/A
HC89005599	COXSACKIE B3 AB-FT	302	86658	22	N/A	21	N/A
HC89005623	COXSACKIE B6 AB-FT	302	86658	22	N/A	21	N/A
HC89005649	INFLUENZA B ANTIBODY-FT	302	86710	63	N/A	63	N/A
HC89005656	C PNEUMONIAE IGG ANTIBODY-FT	302	86631	90	N/A	90	N/A
HC89005672	C PNEUMONIAE IGM ANTIBODY-FT	302	86632	90	N/A	90	N/A
HC89005706	H. INFLUENZA TYPE B ANTIGEN-FT	302	86403	84	N/A	83	N/A
HC89005730	N. MENINGITIDIS GRP A/Y-FT	302	86403	84	N/A	83	N/A
HC89005763	INTERPHASE FISH HYBRI 10-30-GC	310	88273	N/A	N/A	N/A	N/A
HC89005805	CYCLOSPORINE-QD	301	80158	N/A	N/A	N/A	N/A
HC89005839	PHENOBARBITAL-U2	301	80184	30	N/A	30	N/A
HC89005854	VIRUS TEST ADDITIONAL-U2	306	87253	N/A	N/A	N/A	N/A
HC89005862	VIRAL ID(SHELL VIAL)-U2	306	87254	N/A	N/A	N/A	N/A
HC89005920	DRUG SCREEN NONFORENSIC SRM^DOS-AU	301	80307	39	N/A	88	N/A
HC89006167	FLUPHENAZINE; 1-3-AU	301	80342	18	N/A	18	N/A
HC89006217	DS OPIATES SGL METHD^DOS-AU	301	80307	N/A	N/A	N/A	N/A
HC89006274	AMIKACIN PEAK OR TROUGH-U2	301	80150	35	N/A	35	N/A
HC89006332	BENZODIAZEPINES; 1-12-AU	301	80346	31	N/A	44	N/A
HC89006415	LIBRIUM; 1-12-AU	301	80346	21	N/A	21	N/A
HC89006456	CYCLOSPORIN A-U2	301	80158	N/A	N/A	N/A	N/A
HC89006472	CYCLOSPORINE-AU	301	80158	22	N/A	16	N/A
HC89006522	IMIPRAMINE; 1-2-AU	301	80335	6	N/A	18	N/A
HC89006555	PHENOBARBITAL LEVEL-AU	301	80184	11	N/A	8	N/A
HC89006589	NAPA-U2	301	80190	25	N/A	25	N/A
HC89006621	TOBRAMYCIN INITIAL-U2	301	80200	38	N/A	38	N/A
HC89006654	BROMIDES-AU	301	80299	32	N/A	31	N/A
HC89006688	DIPHENHYDRAMINE SERUM/PLASMA-AU	301	80375	90	N/A	90	N/A
HC89006704	EPHEDRINE-AU	301	80299	N/A	N/A	N/A	N/A
HC89006738	GABAPENTIN (SERUM)-AU	301	80171	19	N/A	16	N/A
HC89006761	LAMOTRIGINE-AU	301	80175	10	N/A	15	N/A
HC89006803	METHOTREXATE-QN	301	80204	N/A	N/A	N/A	N/A
HC89006837	NAPROXEN-AU	301	80299	106	N/A	106	N/A
HC89006860	PROPOXYPHENE-AU	301	80299	N/A	N/A	N/A	N/A
HC89006894	SULFONAMIDES - AU	301	80299	N/A	N/A	N/A	N/A
HC89006928	TRAZODONE; 1-2-AU	301	80338	20	N/A	20	N/A
HC89006936	TRIMIPRAMINE-AU	301	80375	113	N/A	113	N/A
HC89006951	VERAPAMIL-MA	301	80299	N/A	N/A	N/A	N/A
HC89006985	ACETYLCHOLINESTERASE-AU	301	82013	16	N/A	16	N/A
HC89007017	ACTH-AU	301	82024	18	N/A	18	N/A
HC89007082	ALBUMIN URINE -AU	301	82042	4	N/A	4	N/A
HC89007116	A-1 ANTITRYPSIN FECES-AU	301	82103	45	N/A	28	N/A
HC89007140	AFP-GE	301	82105	11	N/A	11	N/A
HC89007165	ALUMINIUM-AU	301	82108	15	N/A	16	N/A
HC89007173	AMINO ACID SINGLE QUANT-AU	301	82131	60	N/A	60	N/A
HC89007199	CYSTINE QUANT URINE-AU	301	82131	60	N/A	60	N/A
HC89007223	AMINO ACIDS QUANT URINE-CA	301	82139	158	N/A	158	N/A
HC89007256	AMYLASE-QD	301	82150	73	N/A	72	N/A
HC89007280	APOLIPOPROTEIN A1-QN	302	82172	N/A	N/A	N/A	N/A
HC89007314	BARBITURATES QUANTITATIVE EA SPEC-U2	301	80345	42	N/A	42	N/A
HC89007348	BILE ACIDS TOTAL-AU	301	82239	13	N/A	14	N/A
HC89007389	STONE/CALCULI ANALYS MICRO-AU	301	82365	13	N/A	27	N/A
HC89007405	CARNITINE FREE & TOTAL-AU	301	82379	31	N/A	32	N/A
HC89007439	CHLORAMPHENICOL-AU	301	82415	73	N/A	73	N/A
HC89007462	PSEUDOCHOLINESTERASE-AU	301	82480	10	N/A	10	N/A
HC89007637	DIURETIC SCREEN  URINE - AU	301	80377	126	N/A	126	N/A
HC89007660	N-TELOPEPTIDE CROSSLINK UR-AU	301	82523	22	N/A	29	N/A
HC89007694	CORTISOL FREE-QN	301	82530	125	N/A	125	N/A
HC89007744	CREATINE-QD	301	82540	N/A	N/A	N/A	N/A
HC89007769	CPK ISO-AU	301	82552	9	N/A	9	N/A
HC89007777	CPK ISO-QN	301	82552	24	N/A	23	N/A
HC89007793	CRYOGLOBULIN(QUAL/SEMI QT)-AU	301	82595	8	N/A	8	N/A
HC89007827	DHEA-AU	301	82626	22	N/A	30	N/A
HC89007850	DEOXYCORTISOL 11-AU	301	82634	32	N/A	30	N/A
HC89007884	COMPOUND S SPECIFIC-ES	301	82634	N/A	N/A	N/A	N/A
HC89007926	DIHYDROXYVITAMIN D 1-25-AU	301	82652	18	N/A	24	N/A
HC89007959	ESTRADIOL-ES	301	82670	68	N/A	68	N/A
HC89007975	ESTROGENS TOTAL-ES	301	82672	49	N/A	49	N/A
HC89007983	ESTRIOL-AU	301	82677	15	N/A	15	N/A
HC89008007	ESTRONE-AU	301	82679	38	N/A	20	N/A
HC89008031	FATTY ACIDS FREE-AU	301	82725	16	N/A	16	N/A
HC89008064	FLUORIDE-AU	301	82735	108	N/A	108	N/A
HC89008114	IMMUNOGLB IGA EA-AU	301	82784	6	N/A	6	N/A
HC89008148	IMMUNOGLOBULIN IGD-AU	301	82784	22	N/A	17	N/A
HC89008171	GASTRIN-AU	301	82941	15	N/A	14	N/A
HC89008213	GLUTAMINE FLUID-SL	301	82127	N/A	N/A	N/A	N/A
HC89008239	FRUCTOSAMINE-AU	301	82985	8	N/A	11	N/A
HC89008262	HUMAN GROWTH HORMONE-AU	301	83003	14	N/A	15	N/A
HC89008296	HEAVY METAL QN EA;BERYLLIUM-AU	301	83018	N/A	N/A	N/A	N/A
HC89008320	HGB ELECTROPHERESIS-AU	301	83020	16	N/A	16	N/A
HC89008353	HEMOGLOBIN GLYCATED (A1C)-ES	301	83036	19	N/A	19	N/A
HC89008387	HEMOSIDERIN QUAL URINE-AU	301	83070	9	N/A	9	N/A
HC89008411	HOMOVANILLIC ACID-AU	301	83150	17	N/A	17	N/A
HC89008437	17-OH CORTICOSTEROIDS-QN	301	83491	29	N/A	28	N/A
HC89008460	5-HIAA URINE-CA	301	83497	84	N/A	42	N/A
HC89008494	17-D HYDROXYPROGESTERONE-QN	301	83498	45	N/A	N/A	N/A
HC89008528	GLIADIN IGA AND IGG ABS-AU	301	83516	21	N/A	21	N/A
HC89008569	ENDORPHIN-QN	301	83519	N/A	N/A	N/A	N/A
HC89008593	IGF BINDING PROTEIN-3-ES	301	83519	42	N/A	41	N/A
HC89008627	MYASTHENIA GRAVIS EVAL-SL	301	83519	171	N/A	171	N/A
HC89008643	PANCREATIC POLYPEPTIDE-AU	301	83519	87	N/A	93	N/A
HC89008650	TRYPSIN-AU	301	83519	28	N/A	16	N/A
HC89008676	TSH HIGH SENSITIVITY-ES	301	83519	N/A	N/A	N/A	N/A
HC89008700	ADENOVIRUS AG-FT	301	83520	N/A	N/A	N/A	N/A
HC89008734	PEPSINOGEN-AU	301	83520	N/A	N/A	N/A	N/A
HC89008767	INSULIN TOTAL-ES	301	83525	25	N/A	25	N/A
HC89008791	17 KETOSTEROIDS-AU	301	83586	21	N/A	21	N/A
HC89008825	LD-AU	301	83625	11	N/A	10	N/A
HC89008841	LEAD URINE-AU	301	83655	10	N/A	8	N/A
HC89008866	L/S RATIO-MA	301	83661	N/A	N/A	N/A	N/A
HC89008882	LIPOPROTEIN ELECTROPHORESIS-AU	301	83700	46	N/A	52	N/A
HC89008916	VLDL CHOLESTEROL-QD	301	83719	N/A	N/A	N/A	N/A
HC89008957	NUCLEIC ACID PCR QUANT-HP	301	83789	N/A	N/A	N/A	N/A
HC89008999	METANEPHRINE-AU	301	83835	22	N/A	23	N/A
HC89009039	METHSUXIMIDE; 1-3-AU	301	80339	16	N/A	16	N/A
HC89009062	ALPHA-2 MACROGLOBULIN-AU	301	83883	19	N/A	19	N/A
HC89009336	OLIGOCLONAL BANDS (CSF)-AT	301	83916	N/A	N/A	N/A	N/A
HC89009351	ORGANIC ACIDS TOTAL QUANT-AU	301	83918	124	N/A	225	N/A
HC89009385	ORGANIC ACIDS TOT QUANT UR-AU	301	83918	100	N/A	120	N/A
HC89009419	ORGANIC ACIDS TOT QUANT UR-MA	301	83918	N/A	N/A	N/A	N/A
HC89009443	OXALATE URINE-AU	301	83945	21	N/A	14	N/A
HC89009476	PARATHYROID HORMONE INTACT-QN	301	83970	N/A	N/A	N/A	N/A
HC89009518	PARATHYROID HORMONE TERM-ES	301	83970	N/A	N/A	N/A	N/A
HC89009559	ACID PHOS -TOTAL-AU	301	84060	10	N/A	9	N/A
HC89009575	ALK PHOSPHATASE-AU	301	84075	N/A	N/A	N/A	N/A
HC89009609	PHOSPHATIDYL GLYCEROL-FE	301	84081	59	N/A	59	N/A
HC89009633	PHOSPHORUS URINE-AU	301	84105	16	N/A	16	N/A
HC89009666	PORPHYRINS FRACT URINE-AU	301	84120	29	N/A	23	N/A
HC89009690	PROLACTIN-ES	301	84146	47	N/A	47	N/A
HC89009724	TOT PROT REFRACTOMETRIC-AU	301	84160	8	N/A	7	N/A
HC89009757	PROINSULIN-AU	301	84206	32	N/A	24	N/A
HC89009773	VITAMIN B6 PYRIDOXAL-AU	301	84207	9	N/A	10	N/A
HC89009781	PYRUVATE-AU	301	84210	28	N/A	23	N/A
HC89009807	RENIN-AU	301	84244	14	N/A	14	N/A
HC89009831	SELENIUM-AU	301	84255	13	N/A	16	N/A
HC89009864	SEX HORMONE BINDING GLOB-AU	301	84270	8	N/A	8	N/A
HC89009898	SOMATOMEDIN-ES	301	84305	59	N/A	59	N/A
HC89009922	HEXOSAMINIDASE A-MA	301	84311	N/A	N/A	N/A	N/A
HC89009955	TESTOSTERONE TOTAL-ES	301	84403	54	N/A	51	N/A
HC89009971	VITAMIN B1 THIAMINE-AU	301	84425	16	N/A	17	N/A
HC89009989	THIOCYANATE-AU	301	84430	74	N/A	26	N/A
HC89010003	THYROGLOBULIN-ES	301	84432	N/A	N/A	N/A	N/A
HC89010037	THYROXINE BIND GLOBULIN-ES	301	84442	28	N/A	28	N/A
HC89010060	TSH RECEPTOR AB-ES	301	83519	120	N/A	119	N/A
HC89010094	T3 FREE-AU	301	84481	N/A	N/A	N/A	N/A
HC89010136	TRYPSIN (FECES)-AU	301	84488	11	N/A	11	N/A
HC89010169	UROBILINOGEN 24H URINE-AU	301	84580	N/A	N/A	N/A	N/A
HC89010193	VMA URINE-AU	301	84585	16	N/A	16	N/A
HC89010219	VASOACTIVE INTEST PEPTIDE-AU	301	84586	29	N/A	29	N/A
HC89010243	VITAMIN A-AU	301	84590	9	N/A	10	N/A
HC89010276	XYLOSE ABSORPTION TEST-AU	301	84620	N/A	N/A	N/A	N/A
HC89010300	C-PEPTIDE-AU	301	84681	N/A	N/A	N/A	N/A
HC89010367	M: MISC LAB GENERAL REF LAB-AT	300		571	N/A	N/A	N/A
HC89010391	M: MISC LAB GENERAL REF LAB-CS	300		N/A	N/A	N/A	N/A
HC89010425	M: MISC LAB GENERAL REF LAB-ES	300		58	N/A	N/A	N/A
HC89010441	M: MISC LAB GENERAL REF LAB-GC	300		75	N/A	N/A	N/A
HC89010474	M: MISC LAB GENERAL REF LAB-HP	300		N/A	N/A	N/A	N/A
HC89010508	M: MISC LAB GENERAL REF LAB-OC	300		N/A	N/A	N/A	N/A
HC89010532	M: MISC LAB GENERAL REF LAB-QD	300		41	N/A	N/A	N/A
HC89010565	M: MISC LAB GENERAL REF LAB-SL	300		N/A	N/A	N/A	N/A
HC89010599	M: MISC LAB GENERAL REF LAB-UD	300		44	N/A	N/A	N/A
HC89010623	FACTOR VIII VW AG-AU	305	85246	24	N/A	26	N/A
HC89010649	ANTITHROMBIN III AG-AU	305	85301	21	N/A	24	N/A
HC89010656	INHIB PROTEIN C AG-AU	301	85302	N/A	N/A	N/A	N/A
HC89010672	INHIB PROTEIN S TOTAL-AU	301	85305	15	N/A	15	N/A
HC89010706	PLASMINOGEN ACTIVATOR INH-1-AU	305	85415	54	N/A	54	N/A
HC89010730	MURAMIDASE-AU	305	85549	17	N/A	14	N/A
HC89010763	PLATELET NEUT-AU	305	85597	42	N/A	42	N/A
HC89010797	PARTIAL THROMBOPLASTIN-AU	305	85730	11	N/A	11	N/A
HC89010821	FEBRILE AGGLUTININS-FT	302	86000	16	N/A	16	N/A
HC89010854	PROTEUS OX2 AGGLUT-AU	302	86000	N/A	N/A	N/A	N/A
HC89010870	PROTEUS OXK AGGLUT-AU	302	86000	N/A	N/A	N/A	N/A
HC89010904	ALLERGEN-INDIVIDUAL-AU	302	86003	6	N/A	5	N/A
HC89010938	ANTI-CARDIOLIPIN AB-UT	302	86147	N/A	N/A	N/A	N/A
HC89010961	C1 INHIBITOR-AU	302	86160	13	N/A	14	N/A
HC89010995	C5 COMPLEMENT-AU	302	86160	28	N/A	36	N/A
HC89011027	C-1 ESTERASE INHIBITOR FUNCTIONAL-AU	302	86161	20	N/A	27	N/A
HC89011050	NEISSERIA GONORRHOEAE AB-AU	302	86609	57	N/A	57	N/A
HC89011076	HISTOPLASMOSIS CF-AU	302	86171	N/A	N/A	N/A	N/A
HC89011100	MELIOIDOSIS AB-AU	302	86171	N/A	N/A	N/A	N/A
HC89011159	ANALYZER1000/LUPUS PNL-SL	302	86235	N/A	N/A	N/A	N/A
HC89011183	ANTI-CCP AB (PNL)-RD	302	86235	32	N/A	31	N/A
HC89011217	ANTI-RNP AB (PNL)-RD	302	86235	13	N/A	13	N/A
HC89011241	ANTI-SCL-70 AB (PNL)-RD	302	86235	13	N/A	13	N/A
HC89011274	ANTI-SSA AB-AU	302	86235	16	N/A	16	N/A
HC89011290	CYTOPLASMIC NEUTRO AB-AU	302	86235	N/A	N/A	N/A	N/A
HC89011308	JO 1 AB-AU	302	86235	20	N/A	24	N/A
HC89011324	NEUTROPHIL CYTOPLAS IFA AB-AU	302	86235	16	N/A	16	N/A
HC89011357	RNP REFLEX (PNL)-AU	302	86235	16	N/A	16	N/A
HC89011381	SMITH (ENA) AD IGG-AU	302	86235	16	N/A	16	N/A
HC89011415	SSA ENA AB-QD	302	86235	13	N/A	13	N/A
HC89011449	ANTI SMOOTH MUSCLE AB-AU	302	86255	16	N/A	16	N/A
HC89011472	ENDOMYSIAL AB IGA TITER-AU	302	86256	17	N/A	40	N/A
HC89011498	ANTI-ANDREN CORTEX AB TITER-AU	302	86256	N/A	N/A	N/A	N/A
HC89011506	ANTI-CENTROM AB TITER(PNL)-RD	302	86256	13	N/A	13	N/A
HC89011522	ANTI-STRIAT MUSCLE AB IGG SCREEN-AU	302	86255	12	N/A	17	N/A
HC89011563	TYPHUS FEVER AB-AU	302	86256	N/A	N/A	N/A	N/A
HC89011597	HETEROPHILE AB SCREEN-AU	302	86308	9	N/A	9	N/A
HC89011621	CHROMOGRANIN A-AU	302	86316	35	N/A	46	N/A
HC89011654	GLOMERULAR BASEMENT MEMB AB-AU	302	86317	47	N/A	47	N/A
HC89011688	DIPHTHERIA AB-AU	302	86317	16	N/A	11	N/A
HC89011712	TETANUS/ELISA-FT	302	86317	N/A	N/A	N/A	N/A
HC89011738	IMMUNO ELECT-AU	302	86320	N/A	N/A	N/A	N/A
HC89011761	SCL-70-AU	302	86325	N/A	N/A	N/A	N/A
HC89011795	TEICHOIC ACID AB (ID)-FT	302	86329	84	N/A	84	N/A
HC89011829	CIQ BINDING ASSAY-AU	302	86332	18	N/A	18	N/A
HC89011852	IMMUNOFIX ELECTROPHORESIS-AU	302	86334	15	N/A	45	N/A
HC89011886	INSULIN AB-AU	302	86337	35	N/A	39	N/A
HC89011910	LYMPHOCYTE MITOGENS-SL	302	86353	N/A	N/A	N/A	N/A
HC89011936	LYMPH ABS CD4/CD8 CNT(PNL)-AU	302	86360	21	N/A	22	N/A
HC89011969	ANTI MICROSOMAL THYROID-AU	302	86376	14	N/A	9	N/A
HC89011993	POLIO VIRUS-AU	302	86382	N/A	N/A	N/A	N/A
HC89012025	SPOROTRICHOSIS AB-FT	302	86403	75	N/A	75	N/A
HC89012058	RHEUMATOID FACTOR-RD	302	86431	44	N/A	44	N/A
HC89012082	ADENOVIRUS AB-AU	302	86603	21	N/A	21	N/A
HC89012116	BARTONELLA AB-AU	302	86611	11	N/A	11	N/A
HC89012132	BLASTOMYCES AB-SL	302	86612	N/A	N/A	N/A	N/A
HC89012140	LYME DISEASE AB CONFIRM-AU	302	86617	16	N/A	16	N/A
HC89012165	BRUCELLA AB-FT	302	86622	N/A	N/A	N/A	N/A
HC89012199	CHLAMYDIA AB (PNL)-AU	302	86631	8	N/A	9	N/A
HC89012223	Q FEVER AB-AU	302	86638	15	N/A	36	N/A
HC89012256	CRYPTOCOCCUS AB-FT	302	86641	76	N/A	76	N/A
HC89012280	CMV AB IGM(PNL)-FT	302	86645	70	N/A	70	N/A
HC89012314	ENCEPHALITIS CALIF AB-FT	302	86651	N/A	N/A	N/A	N/A
HC89012330	ENCEPHALITIS EASTERN AB-FT	302	86652	N/A	N/A	N/A	N/A
HC89012348	ENCEPHALITIS ST LOUIS AB-FT	302	86653	N/A	N/A	N/A	N/A
HC89012363	ENCEPHALITIS WESTERN AB-FT	302	86654	N/A	N/A	N/A	N/A
HC89012397	COXSACKIE A AB (PNL)-AU	302	86658	23	N/A	16	N/A
HC89012421	COXSACKIE B AB (PNL)-AU	302	86658	16	N/A	19	N/A
HC89012454	EBV AB TO EARLY AG (PNL)-AU	302	86663	8	N/A	6	N/A
HC89012488	EBV AB TO NUCLEAR AG-AU	302	86664	N/A	N/A	N/A	N/A
HC89012512	HELICOBACTER PYLOR AB (PNL)-AU	302	86677	9	N/A	9	N/A
HC89012546	CYSTICERCOSIS AB-FT	302	86682	109	N/A	109	N/A
HC89012561	SCHISTOSOMA AB-AU	302	86682	90	N/A	63	N/A
HC89012595	HEMOPHILUS INFLUENZA AB-FT	302	86684	125	N/A	124	N/A
HC89012629	HERPES I&II SIMPLE AB (PNL)-AU	302	86694	15	N/A	12	N/A
HC89012652	HERPES SIMPLEX I GLYCO AB-AU	302	86695	14	N/A	12	N/A
HC89012686	HISTOPLASMA AB (PNL)-AU	302	86698	11	N/A	9	N/A
HC89012710	HIV 1&2 AB-AU	302	86703	16	N/A	16	N/A
HC89012744	LEGIONELLA AB-AU	302	86713	12	N/A	11	N/A
HC89012769	LEPTOSPIRA AB-AU	302	86720	29	N/A	29	N/A
HC89012793	MYCOPLASMA PNEUMONIAE AB-AU	302	86738	7	N/A	7	N/A
HC89012827	RSV AB-FT	302	86756	N/A	N/A	N/A	N/A
HC89012850	TYPHUS FEVER ANTIBODY-AU	302	86757	15	N/A	16	N/A
HC89012884	TETANUS AB-AU	302	86317	13	N/A	11	N/A
HC89012918	TOXOPLASMA AB IGM-AU	302	86778	10	N/A	11	N/A
HC89012942	VARICELLA AB (PNL)-AU	302	86787	8	N/A	8	N/A
HC89012967	VARICELLA ZOSTER (PNL)-AU	302	86787	8	N/A	16	N/A
HC89012975	VARICELLA-ZOSTER IGM-AU	302	86787	8	N/A	8	N/A
HC89012991	DENGUE FEVER AB-AU	302	86790	19	N/A	19	N/A
HC89013023	HEPATITIS C AB CONFIRM(DS)-U2	302	86803	N/A	N/A	N/A	N/A
HC89013056	HLA DR MULT AG-AU	302	86817	N/A	N/A	N/A	N/A
HC89013080	ANAEROBIC BACTERIAL ID-FT	306	87076	93	N/A	92	N/A
HC89013114	CULTURE MYCOPLASMA-AU	306	87109	39	N/A	39	N/A
HC89013148	SCHLICTER TEST-AU	306	87197	N/A	N/A	N/A	N/A
HC89013163	VIRAL ISOLATE CONFIRM-U2	306	87250	150	N/A	150	N/A
HC89013171	GIARDIA AG-AU	306	87329	16	N/A	16	N/A
HC89013197	HEPATITIS B SURFACE AG (DS)-U2	306	87340	N/A	N/A	N/A	N/A
HC89013221	CHLAMYDIA DNA PROBE (PNL)-AU	306	87490	N/A	N/A	N/A	N/A
HC89013254	CYTOMEGALOVIRUS DNA QNT PCR-AU	306	87497	60	N/A	55	N/A
HC89013288	HEPATISIS C RNA BY PCR-AU	306	87522	82	N/A	95	N/A
HC89013312	HIV-1 RNA QUANT BY PCR-AU	306	87536	75	N/A	75	N/A
HC89013346	GC DNA PROBE-AU	306	87590	11	N/A	11	N/A
HC89013379	HPV HI RISK(16 18 31 33 35 39 45 51 52 56 58 59 68)-AU	306	87624	47	N/A	47	N/A
HC89013395	AMPLIFIED PROBE TECH-AU	306	87801	16	N/A	16	N/A
HC89013429	COGENTIN/BENZTROPINE-SL	301	80299	N/A	N/A	N/A	N/A
HC89013452	VERAPAMIL-AU	301	80299	73	N/A	73	N/A
HC89013486	ANDROSTENEDIONE-ES	301	82157	65	N/A	58	N/A
HC89013510	BETA-2 MICROGLOBULIN URINE-AU	301	82232	14	N/A	12	N/A
HC89013544	CALCITONIN-ES	301	82308	54	N/A	54	N/A
HC89013585	CITRATE-AU	301	82507	13	N/A	14	N/A
HC89013601	CORTISOL-ES	301	82533	43	N/A	39	N/A
HC89013619	DHEA-ES	301	82626	79	N/A	N/A	N/A
HC89013635	IMMUNOGLOBULIN IGE(PNL)-AU	301	82785	N/A	N/A	N/A	N/A
HC89013668	NEURONAL CELL AB-AU	301	83520	75	N/A	75	N/A
HC89013692	MYELIN BASIC PROTEIN CSF-QD	301	83873	15	N/A	14	N/A
HC89013825	OLIGOCLONAL BANDS (CSF)-QD	301	83916	277	N/A	277	N/A
HC89013858	ORGANIC ACID SNGL QUANT UR-AU	301	83921	182	N/A	182	N/A
HC89013890	TOTAL PROTEIN(PNL)-AU	301	84155	5	N/A	N/A	N/A
HC89013916	PROTEIN ELECT FRACT&QT(PNL)-AU	301	84165	5	N/A	8	N/A
HC89013924	RI ANTIBODY-AT	301	84181	340	N/A	N/A	N/A
HC89013940	ACETYLCHOLINE RECEPTOR AB-AU	301	83519	15	N/A	36	N/A
HC89013973	THS 3RD GENERATION-AU	301	84443	16	N/A	16	N/A
HC89014005	POTASSIUM STOOL-AU	301	84999	14	N/A	13	N/A
HC89014039	ALLERGEN(PNL)-AU	302	86003	5	N/A	5	N/A
HC89014062	ANA TITER (PNL)-RD	302	86039	13	N/A	13	N/A
HC89014104	C7 COMPLEMENT-QN	302	86160	N/A	N/A	N/A	N/A
HC89014146	FLUORESCNT AB NON INF SREEN-U9	302	86255	N/A	N/A	N/A	N/A
HC89014161	LYSOSOMAL SCREEN-CA	302	86255	368	N/A	368	N/A
HC89014195	FLUORESCNT AB TITER EA AB-FT	302	86256	N/A	N/A	N/A	N/A
HC89014229	IMMUNO ELEC GEL DIF EA(PNL)-AU	302	86331	6	N/A	6	N/A
HC89014252	RHEUMATOID FACT IGM (PNL)-RD	302	86431	32	N/A	31	N/A
HC89014286	COXSACKIE A AB-QD	302	86658	17	N/A	17	N/A
HC89014310	TULAREMIA AB-AU	302	86668	20	N/A	59	N/A
HC89014344	HTLV-II AB-AU	302	86688	N/A	N/A	N/A	N/A
HC89014377	INFLUENZA A SEROLOGY-AU	302	86710	11	N/A	8	N/A
HC89014401	CHAGAS AB (PNL)-AU	302	86753	19	N/A	19	N/A
HC89014450	MEASLES (RUBEOLA)(PNL) IGG-AU	302	86765	9	N/A	8	N/A
HC89014484	VARICELLA AB (PNL)-FT	302	86787	70	N/A	70	N/A
HC89014518	HLA DR AG-AU	302	86816	N/A	N/A	N/A	N/A
HC89014542	UREA PLASMA/MYCOPLASMA-AU	306	87109	36	N/A	16	N/A
HC89014575	AFB MIC OTHER-AU	306	87186	N/A	N/A	N/A	N/A
HC89014591	AFB MIC PRIMARY(PNL)-AU	306	87190	62	N/A	62	N/A
HC89014609	AFB MIC SECONDARY(PNL)-AU	306	87188	N/A	N/A	N/A	N/A
HC89014625	CULTURE VIRUS - AU	306	87252	27	N/A	27	N/A
HC89014658	CRYPTOCOCCUS NEOFORMANS AG-AU	306	87327	21	N/A	20	N/A
HC89014690	HEPATITIS B DNA BY PCR-QD	306	87517	25	N/A	25	N/A
HC89014724	HSV PCR QUANT-QD	306	87529	13	N/A	13	N/A
HC89014757	B PARAPERTUSSIS PCR-AU	306	87798	45	N/A	47	N/A
HC89014781	STREPTOCOCCUS PNEUMONIAE AG-AU	306	83789	54	N/A	54	N/A
HC89014815	HEPATITIS C GENOTYPE PCR-QD	306	87902	27	N/A	27	N/A
HC89014823	LIMULUS LYSSATE ASSAY-AU	306	87999	90	N/A	90	N/A
HC89014849	FLOW CYT MKR TC 1ST-HP	311	88184	N/A	N/A	N/A	N/A
HC89014872	CHROM ANAL BLOOD TISSU CULT-GZ	311	88230	228	N/A	185	N/A
HC89014906	CHROM ANAL AF TISSUE CULT-GZ	311	88235	78	N/A	78	N/A
HC89014930	CHROM ANAL CRD BD TISS/CULT-GZ	311	88239	N/A	N/A	N/A	N/A
HC89014963	15-20 CELLS  2 KARYO BAND-GZ	311	88262	223	N/A	200	N/A
HC89014997	CHROM ANAL AF COUNTING-GZ	311	88267	250	N/A	250	N/A
HC89015028	KARYOTYPING ADD EA-GZ	311	88280	N/A	N/A	N/A	N/A
HC89015044	CHROM ANAL ADDL HI RESOLUT-GZ	311	88289	N/A	N/A	N/A	N/A
HC89015077	NORTRIPTYLINE(PNL); 3-5-AU	301	80336	12	N/A	12	N/A
HC89015101	APT TEST (FETAL HGB)-U2	301	83033	N/A	N/A	N/A	N/A
HC89015135	B CELL TOTAL COUNT-U2	302	86355	N/A	N/A	N/A	N/A
HC89015168	ALDOLASE-AU	301	82085	5	N/A	5	N/A
HC89015218	FLOW CYT MKR TC ADD+-HP	311	88185	N/A	N/A	N/A	N/A
HC89015242	INDERAL - AU	301	80299	19	N/A	19	N/A
HC89015267	PENTOBARBITAL-U2	301	80345	42	N/A	42	N/A
HC89015309	ALCOHOL; 1-2 (URINE)-QD	301	80320	17	N/A	17	N/A
HC89015333	VITAMIN D 25 OH-QD	301	82306	195	N/A	195	N/A
HC89015366	N-TELOPEPTIDE CROSSLINK-QD	301	82523	26	N/A	26	N/A
HC89015390	FOLIC ACID-QD	301	82746	13	N/A	13	N/A
HC89015424	FSH-QD	301	83001	6	N/A	6	N/A
HC89015457	LACTIC ACID-QD	301	83605	14	N/A	14	N/A
HC89015473	NUCLEOTIDASE-5-QD	301	83915	17	N/A	17	N/A
HC89015481	ALK PHOSPHATASE-QD	301	84075	18	N/A	18	N/A
HC89015507	VITAMIN B6 PYRIDOXAL-QD	301	84207	23	N/A	23	N/A
HC89015531	SELENIUM-QD	301	84255	11	N/A	11	N/A
HC89015564	VITAMIN E-QD	301	84446	12	N/A	12	N/A
HC89015598	UREA NITROGEN URINE-QD	301	84540	22	N/A	22	N/A
HC89015622	FACTOR VIII VW AG-QD	305	85246	20	N/A	20	N/A
HC89015655	INHIB PROTEIN C ACTIVITY-QD	301	85303	27	N/A	27	N/A
HC89015671	FIBRINOGEN-QD	305	85384	13	N/A	13	N/A
HC89015689	LEUKOCYTE ALKALINE PHOS-QD	305	85540	26	N/A	26	N/A
HC89015705	ANTI-DNA ANTIBODIES (SS)-QD	302	86226	27	N/A	27	N/A
HC89015739	IMMUNOFIXATION ELECT(URINE)-QD	302	86334	30	N/A	30	N/A
HC89015762	RPR/VDRL QUAL-QD	302	86592	16	N/A	16	N/A
HC89015796	HEPATITIS B CORE AB-QD	302	86704	22	N/A	22	N/A
HC89015820	HEPATITIS A AB IGM-QD	302	86709	21	N/A	21	N/A
HC89015853	SALMONELLA AB-QD	302	86768	16	N/A	16	N/A
HC89015887	DENGUE FEVER AB-QD	302	86790	18	N/A	18	N/A
HC89015903	ANAEROBIC SUSCEPTIBILITY-QD	306	87186	27	N/A	27	N/A
HC89015937	B. PARAPERTUSSIS/PERT DFA-QD	306	87265	29	N/A	29	N/A
HC89015960	HIV 1 AB-QD	302	86701	11	N/A	11	N/A
HC89015994	CARCINOEMBRYONIC ANTIGEN (CEA)-QD	301	82378	6	N/A	6	N/A
HC89016026	PREALBUMIN-QD	301	84134	13	N/A	13	N/A
HC89016059	CANDIDA AB - AU	302	86628	13	N/A	13	N/A
HC89016083	CARNITINE FREE & TOTAL-MA	301	82379	32	N/A	32	N/A
HC89016109	AMINO ACIDS QUANT-MA	301	82139	137	N/A	137	N/A
HC89016117	ORGANIC ACIDS TOT QUAL-MA	301	83919	55	N/A	55	N/A
HC89016133	AFP-QD	301	82105	22	N/A	22	N/A
HC89016166	CORTISOL-QD	301	82533	9	N/A	9	N/A
HC89016190	BILE ACID FRACTIONATED-QD	301	83789	2	N/A	2	N/A
HC89016224	FLOW CYT MKR TC ADD+-QD	311	88185	2	N/A	2	N/A
HC89016257	HEPATITIS B SURFACE AB-QD	302	86706	18	N/A	18	N/A
HC89016281	LIPOPROTEIN ELECTROPHORESIS-QD	301	83700	125	N/A	125	N/A
HC89016307	PARASITE IDENTIFICATION(O&P)QD	306	87177	2	N/A	2	N/A
HC89016315	REVERSE T3-QD	301	84482	2	N/A	2	N/A
HC89016331	RICKETTSIA AB PANEL-QD	302	86757	120	N/A	120	N/A
HC89016364	CULTURE TYPE AGGLUTIN EA-QD	306	87147	12	N/A	12	N/A
HC89016406	NEPHELOMETRY EA ANALYT UR-AU	302	83883	33	N/A	33	N/A
HC89016448	FLOW CYT MKR TC ADD+-AU	311	88185	18	N/A	17	N/A
HC89016547	TESTOSTERONE FREE FEM/CHILD-AU	301	84402	43	N/A	43	N/A
HC89016570	REDUCING SUBS FECAL-AU	301	84376	14	N/A	16	N/A
HC89016612	HIV-1 GENOTYPING-QD	306	87901	N/A	N/A	N/A	N/A
HC89016646	IMMUNO ELECT URINE-AU	302	86335	37	N/A	41	N/A
HC89016687	ACID FAST PARASITES-AU	306	87206	16	N/A	16	N/A
HC89016729	NBS 17 OH PROGESTERONE-GE	301	83498	N/A	N/A	N/A	N/A
HC89016760	NBS MS/MS AMINO ACID W/PKU-GE	301	83789	21	N/A	20	N/A
HC89016802	ANTI MICROSOMAL LIVR-KIDNEY-QD	302	86376	N/A	N/A	N/A	N/A
HC89016836	ACETYLCHOLINE RECEPTOR MOD-QD	301	83519	N/A	N/A	N/A	N/A
HC89016869	CRYOGLOBULIN IGA  QUANT-AU	301	82784	8	N/A	8	N/A
HC89016885	CRYOGLOBULIN IGG  QUANT-AU	301	82784	8	N/A	8	N/A
HC89016927	ANATOMIC CONSULT; CMPLX REV-CE	312	88321	275	N/A	275	N/A
HC89016950	HIV PHENOTYP P'SENS GT(PNL)-VI	306	87903	705	N/A	705	N/A
HC89016984	HIV PHENOTYPE 1ST 1-10(PNL)-VI	306	87903	755	N/A	755	N/A
HC89017016	CHOLESTEROL ARUP-AU	301	82465	13	N/A	12	N/A
HC89017040	HEPARIN AB DETECTION-AU	300	86022	30	N/A	50	N/A
HC89017073	AMNIOTIC BILIRUBIN SCAN-AU	301	82143	44	N/A	16	N/A
HC89017099	THROMBIN TIME 1:1 MIX-AU	305	85670	17	N/A	17	N/A
HC89017107	REPTILASE TIME-AU	305	85635	28	N/A	28	N/A
HC89017123	CYCLOSPORINE-U4	301	80158	75	N/A	75	N/A
HC89017156	IA F-ACTIN ANTIBODY  IGG-AU	301	86015	6	N/A	16	N/A
HC89017180	HEMOLYSIN SCREEN-AU	302	86941	N/A	N/A	N/A	N/A
HC89017214	LEPTIN ELISA-AU	301	82397	60	N/A	45	N/A
HC89017248	RUBELLA AB IGG - AU	302	86317	9	N/A	16	N/A
HC89017271	C4 COMPLEMENT-AU	302	86160	6	N/A	6	N/A
HC89017297	HIV-1 P24 AG - FT	306	87390	180	N/A	180	N/A
HC89017305	METHYL MALONIC ACID-QD	301	83921	55	N/A	54	N/A
HC89017321	ANTI-RIBOSOMAL AB-QD	302	83520	86	N/A	86	N/A
HC89017354	LYME AB  IGM BY WB -AU	302	86617	15	N/A	21	N/A
HC89017388	CHLORIDE CSF-AU	301	82438	16	N/A	16	N/A
HC89017412	PARASITE IDENTIFICATION(O&P)AU	306	87177	31	N/A	31	N/A
HC89017446	PTT HEPARIN NEUTRALZ RFX - AU	305	85525	39	N/A	39	N/A
HC89017479	FUNGUS SUSCEPTIBILITY-FT	306	87186	249	N/A	248	N/A
HC89017503	ANTI-CARDIOLIPIN IGG/GM(PNL-AU	302	86147	8	N/A	8	N/A
HC89017529	HSV 1 AG(PNL)-AU	306	87274	25	N/A	25	N/A
HC89017552	CMV AB IGM(PNL)-AU	302	86645	8	N/A	11	N/A
HC89017586	CMV AB IGG (PNL)-AU	302	86644	8	N/A	11	N/A
HC89017610	LEAD(PNL)-AU	301	83655	7	N/A	3	N/A
HC89017644	COPPER(PNL)-AU	301	82525	3	N/A	3	N/A
HC89017677	GLOMERULAR BSMT MEM EL(PNL)-AU	301	83516	30	N/A	30	N/A
HC89017727	IMMUNOGLOBULIN G(PNL)-AU	301	82784	9	N/A	9	N/A
HC89017743	ANTI-DNA AB (DS)(PNL)-AU	302	86225	16	N/A	16	N/A
HC89017776	CULTURE CMV(PNL)-AU	306	87252	33	N/A	33	N/A
HC89017800	ASPERGILLUS AB(PNL)-AU	302	86606	19	N/A	19	N/A
HC89017909	TUMOR IMMUNOHISTOCHEM/MANL-NG	310	88360	133	N/A	133	N/A
HC89017958	M: MISC LAB GENERAL REF LAB-AG	300		1,051	N/A	N/A	N/A
HC89017982	M: MISC LAB GENERAL REF LAB-LB	300		N/A	N/A	N/A	N/A
HC89018014	M: MISC LAB GENERAL REF LAB-GX	300		N/A	N/A	N/A	N/A
HC89018048	M: MISC LAB GENERAL REF LAB-SA	300		N/A	N/A	N/A	N/A
HC89018055	TISSUE TRANSGLUTAMNS AB IGG-AU	301	86364	15	N/A	30	N/A
HC89018071	CALCIUM FOR PTH(PNL)-QD	301	82310	170	N/A	170	N/A
HC89018105	ANTI-NEUTROPHIL CYTOPLSM IGG TITR-AU	302	86256	40	N/A	40	N/A
HC89018139	17-KETOSTEROID FRACTIONAT'N-QD	301	83593	98	N/A	98	N/A
HC89018162	11-DEHYROTHROMBOXANE B2 UR-ES	301	84431	93	N/A	93	N/A
HC89018196	FLOW CYT MKR TC ADD+-ES	311	88185	53	N/A	53	N/A
HC89018220	FACTOR VIII VW AG-EC	305	85246	81	N/A	81	N/A
HC89018246	PLATELET NEUT-EC	305	85597	112	N/A	112	N/A
HC89018253	IMMUNOGLOB IGA AR-AU	301	82784	7	N/A	6	N/A
HC89018279	SEROTONIN RELEASE ASSAY- QN	302	86022	260	N/A	260	N/A
HC89018303	FACTOR IX BETHESDA TITER(PNL) -EC	305	85335	130	N/A	130	N/A
HC89018337	FACTOR X ASSAY -EC	305	85260	163	N/A	163	N/A
HC89018360	FACTOR XIII ASSAY -EC	305	85290	163	N/A	163	N/A
HC89018394	LAMBDA FREE LIGHT CHAINS QT-AU	301	83521	15	N/A	25	N/A
HC89018444	PNH RBC GLYCOPHORIN-AU	302	86356	38	N/A	98	N/A
HC89018477	C-REACTIVE PROTEIN(PNL)-PR	302	86140	8	N/A	7	N/A
HC89018535	MICRODISSECTION; MANUAL-AU	310	88381	5	N/A	5	N/A
HC89018626	CHROM ANAL TISS CULT  BLD-AU	310	88230	149	N/A	199	N/A
HC89018667	CHROM COUNT 6-12 CELLS  AF-AU	311	88269	207	N/A	272	N/A
HC89018709	INTERPHS FISH HYBRI 100-300-AU	310	88275	181	N/A	130	N/A
HC89018956	HEINZ BODIES DIRECT-AU	305	85441	42	N/A	55	N/A
HC89018980	BORDETELLA PERTUS FHA IGG-AU	302	86615	12	N/A	18	N/A
HC89019012	ASPERGILLUS ANTIGEN-MV	302	87305	95	N/A	95	N/A
HC89019202	HPV TYPES 16&18(45) ONLY-AU	306	87625	67	N/A	43	N/A
HC89019251	PARECHOVIRUS RNA  RT-PCR-FT	306	87798	269	N/A	268	N/A
HC89019285	NEUTROPHIL OXIDATIVE BURST-AU	302	86352	160	N/A	200	N/A
HC89019400	HLA AB DETECT 1ST MARKERS-AU	311	88184	96	N/A	96	N/A
HC89019442	FUNGITELL ASSAY-BD	306	87449	168	N/A	128	N/A
HC89019475	CONCENTRATION;MICROSPORIDIA-AU	306	87015	12	N/A	7	N/A
HC89019533	FUNGITELL (1 3)BETA D-GLUC-AU	306	87449	70	N/A	165	N/A
HC89019558	GLIAD PEPTD AB IGA(PNL1155/6360)-PR	301	83520	28	N/A	28	N/A
HC89019566	GLIAD PEPTD AB IGG(PNL1155/6360)-PR	301	83520	28	N/A	28	N/A
HC89019582	ANTI-EMA IGA AB IFA 1ST STAIN(PNL1155/6360)-PR	312	88346	120	N/A	120	N/A
HC89019731	HU AUTOANTIBODY TEST-AT	301	83516	405	N/A	405	N/A
HC89019764	ENZYME ACT-RBC(P TPMT ENZYME)-PR	301	82657	88	N/A	88	N/A
HC89019798	QUANT HPLC-6-MMPN RBC(P THIOPUR)-PR	301	82542	108	N/A	108	N/A
HC89019889	HLA AB DETECTION-AU	301	86828	270	N/A	330	N/A
HC89019913	HEMOCHROMATOSIS MUTATION-AU	301	81256	89	N/A	100	N/A
HC89019947	PROTHROMBIN(F2) G20210A MUT-AU	301	81240	75	N/A	75	N/A
HC89019954	FACTOR V LEIDEN PCR-AU	301	81241	72	N/A	72	N/A
HC89019988	FHL2 PRF1 GENE MUTATION-CN	309	81479	3,984	N/A	2,346	N/A
HC89020010	FRAGILE X SCREEN REFLEX-AU	300	81243	95	N/A	130	N/A
HC89020051	HLA-DQB1(PNL 6260/6360)-PR	301	81382	260	N/A	260	N/A
HC89020085	ASCA ELISA IGG SPECIF(PNL)-PR	301	83520	20	N/A	20	N/A
HC89020119	ANTI-CBIR1 ELISA(PNL)-PR	301	83520	20	N/A	20	N/A
HC89020143	VEGF ELISA(PNL)-PR	301	83520	28	N/A	16	N/A
HC89020176	SAA CHEMILUMINESCENT (PNL)-PR	301	82397	28	N/A	16	N/A
HC89020192	PANCA INDIRECT IGG 1ST STAIN(PN)-PR	310	88346	120	N/A	72	N/A
HC89020226	ECM1 SNP (RS3737240)(PNL)-PR	301	81479	14	N/A	47	N/A
HC89020259	MAJOR BREAKPOINT (BCR/ABL1)-AU	309	81206	75	N/A	75	N/A
HC89020283	MALTASE (DISACCHARIDASE)-AU	301	82657	38	N/A	55	N/A
HC89020317	HLA-A GENOTYPE-AU	309	81380	325	N/A	325	N/A
HC89020341	CONNEXIN 26 (GJB2) SEQUENCING-AU	300	81252	520	N/A	520	N/A
HC89020374	MOLECULAR PATH PROC LVL 4-AU	301	81403	164	N/A	164	N/A
HC89020390	C.TRACHOMATIS DNA AMP PROBE-PI	302	87491	39	N/A	39	N/A
HC89020408	N.GONORRHEA DNA AMP PROBE-PI	302	87591	39	N/A	39	N/A
HC89020424	T3 UPTAKE-AU	301	84479	7	N/A	7	N/A
HC89020465	IMMUNOGLB IGG EA -AU	301	82784	6	N/A	6	N/A
HC89020499	T-CELL RECEPTOR EXCISION CIRCLES-GE	301	81479	1	N/A	0	N/A
HC89020762	M: MISC LAB GENERAL REF LAB-UC	300		300	N/A	N/A	N/A
HC89020846	HGB CHROMAT-SICKLE-AU	302	83021	9	N/A	9	N/A
HC89020879	SIN NOMBRE VIRUS IGM-AU	302	86790	52	N/A	52	N/A
HC89020895	17-D OH PROGES NEONATE STT -ES	301	83498	101	N/A	N/A	N/A
HC89020903	ALBUMIN; OTHER SRC: CSF -AU	301	82042	6	N/A	6	N/A
HC89020929	ANSER IFX MEAS OF SER INFLIXIMAB-PR	300	80230	225	N/A	2,500	N/A
HC89020952	ARSENIC  FRACTIONATED-AU	301	82175	87	N/A	126	N/A
HC89020986	ECHOVIRUS AB TYPE 9-AU	302	86658	25	N/A	18	N/A
HC89021018	CANDIDA SPECIES DNA-AU	306	87480	22	N/A	21	N/A
HC89021042	METANEPHRINES  PLASMA(FREE)-AU	301	83835	20	N/A	50	N/A
HC89021075	PEANUT COMP ANTGNC EPI ARA H1(PNL)-AU	302	86003	50	N/A	50	N/A
HC89021109	PEANUT COMP ANTGNC EPI ARA H4(PNL)-AU	302	86003	50	N/A	50	N/A
HC89021125	SOLUBLE IL-2R -CN	302	83520	309	N/A	309	N/A
HC89021158	FACTOR VIII INHIBITOR TEST(PNL) -EC	305	85240	122	N/A	122	N/A
HC89021182	PCA3 PROSTATE CA BIOMARKER-AU	310	81313	305	N/A	305	N/A
HC89021224	LCM AB  IGM-AU	302	86727	18	N/A	18	N/A
HC89021257	ENCEPHALITIS CALIF AB IGM-AU	302	86651	45	N/A	44	N/A
HC89021281	ENCEPHALITIS WESTERN AB IGM-AU	302	86654	45	N/A	44	N/A
HC89021315	HEAVY METAL QN EA;IODINE SERUM-AU	301	83018	165	N/A	N/A	N/A
HC89021331	BORDETELLA PERTUSSIS CULTURE-AU	306	87081	39	N/A	N/A	N/A
HC89021364	A TERREUS-VC	306	87798	131	N/A	N/A	N/A
HC89021406	M: MISC LAB GENERAL REF LAB-CT	300		N/A	N/A	N/A	N/A
HC89021430	PROGESTERONE QNT-HPLC MS/MS-AU	301	84144	23	N/A	23	N/A
HC89021463	SUSCEPTIBILITY ANTIMICROB MIC -AU	306	87186	90	N/A	89	N/A
HC89021505	DRUG SCREEN NONFORENSIC URN^DOS-AU	301	80307	39	N/A	N/A	N/A
HC89021539	M: MISC LAB GENERAL REF LAB -KI	300		165	N/A	N/A	N/A
HC89021554	THIOPURINE METABOL(CAT#3200)-PR	301	82542	216	N/A	N/A	N/A
HC89021562	CYTOMEGALOVIRUS DNA QUAL PCR-AU	306	87496	70	N/A	N/A	N/A
HC89021596	DRUG SCRN  TOF PRESUMP-AU	301	80307	78	N/A	N/A	N/A
HC89021620	FETAL LUNG MATURITY L/S RATIO-AU	301	83661	117	N/A	N/A	N/A
HC89021653	AMPHETAMINES;1 OR 2 MEC(CONF PNL)-AU	301	80324	48	N/A	N/A	N/A
HC89021687	CANNABINOIDS  NATURAL MEC(PNL)-AU	301	80349	50	N/A	N/A	N/A
HC89021711	OPIATES  1 OR MORE MEC(PNL)-AU	301	80361	33	N/A	N/A	N/A
HC89021745	AMPHETAMINES(MDA MDEA MDMA)MEC(CONF PNL)-AU	301	80359	48	N/A	N/A	N/A
HC89021760	OPIATES CNFRM/QNT 1/> URINE -AU	301	80361	10	N/A	N/A	N/A
HC89021778	CELIAC DX DUAL ANTIGEN SCREEN-AU	301	83516	39	N/A	N/A	N/A
HC89021885	ZIKA VIRUS BY PCR  BLOOD-AU	306	87798	150	N/A	N/A	N/A
HC89021968	ANTIDEPRSSNTS TRICYCL =6/> QUANT UR -AU	301	80337	37	N/A	N/A	N/A
HC89022008	PROGESTERONE MASS SPECTROMETRY-ES	301	84144	54	N/A	N/A	N/A
HC89022032	AMPHETAMINES;1 OR 2 SERUM QNT(PNL)-AU	301	80324	30	N/A	N/A	N/A
HC89022065	BUPRENORPHINE&METABLTS SERUM QNTS(PNL)-AU	301	80348	59	N/A	N/A	N/A
HC89022099	METHADONE&METABOLITE SERUM QNT(PNL)-AU	301	80358	61	N/A	N/A	N/A
HC89022123	OXYCODONE SERUM QNT(PNL) -AU	301	80365	28	N/A	N/A	N/A
HC89022149	ANGIOTENSIN CONVERT ENZYME CSF -AU	301	82164	20	N/A	N/A	N/A
HC89022172	HSV1&HSV2 SUBTYPES BY PCR -AU	306	87529	85	N/A	N/A	N/A
HC89022206	M: MISC LAB GENERAL REF LAB-CC	300		35	N/A	N/A	N/A
HC89022248	M: MISC LAB GENERAL REF LAB-GG	300		800	N/A	N/A	N/A
HC89022271	M: MISC LAB GENERAL REF LAB-MC	300		N/A	N/A	N/A	N/A
HC89022305	M: MISC LAB GENERAL REF LAB-OU	300		N/A	N/A	N/A	N/A
HC89022339	FLOW CYTOMETRY 1ST MRKR{W-INT/87}-CC	311	88184	123	N/A	N/A	N/A
HC89022354	FLOW CYTOMETRY 1ST MRKR{W-INT/89}-CC	311	88184	188	N/A	N/A	N/A
HC89022388	FLOW CYT LEUK/LYMPH 1ST MRKR{W-INT/88}-AU	311	88184	99	N/A	N/A	N/A
HC89022412	ANTI-STRIAT MUSCLE AB IGG TITER -AU	302	86256	45	N/A	N/A	N/A
HC89022446	CULTURE VIRUS RESPIRATORY-AU	306	87252	73	N/A	N/A	N/A
HC89022479	CULTURE ID DEFIN/ADDL HSV(PNL)+-AU	306	87253	13	N/A	N/A	N/A
HC89022503	CULTURE ID W/IMMUNOFLUOR' VZV(PNL)-AU	306	87254	31	N/A	N/A	N/A
HC89022545	M: MISC LAB GENERAL REF LAB -MN	300		N/A	N/A	N/A	N/A
HC89022560	ANDROSTENEDIONE-QN	301	82157	54	N/A	N/A	N/A
HC89022578	CORTICOSTERONE-QN	301	82528	51	N/A	N/A	N/A
HC89022594	CHROMATOGRAPHY/SPECTROMETRY QL/QN-QN	301	82542	185	N/A	N/A	N/A
HC89022628	11 DEOXYCORTISOL-QN	301	82634	60	N/A	N/A	N/A
HC89022651	PROGESTERONE-QN	301	84144	27	N/A	N/A	N/A
HC89022685	HLA CLASS I TYPING LOW RES COMPLETE-U9	310	81372	350	N/A	N/A	N/A
HC89022719	HLA CLASS II TYPING HIGH RES EACH LOCUS-U9	310	81382	300	N/A	N/A	N/A
HC89022743	HLA CLASS II TYPING INTERMED RES 1 LOCUS-U9	309	81376	130	N/A	N/A	N/A
HC89022776	ANSER VDZ MEAS OF SER VEDOLIZUMAB-PR	300	80280	225	N/A	N/A	N/A
HC89022792	TARGETED GENOME PNL SEQ 51/>GENES-AU	310	81455	1,900	N/A	N/A	N/A
HC89022818	SPECIFIC GRAVITY FLUID -U2	301	84315	14	N/A	N/A	N/A
HC89022842	M: MISC LAB GENERAL REF LAB-BD	300		N/A	N/A	N/A	N/A
HC89022875	M: MISC LAB GENERAL REF LAB-EG	300		N/A	N/A	N/A	N/A
HC89022909	BILIRUBIN SERUM(PANEL)-AU	301	82247	44	N/A	N/A	N/A
HC89022933	LIPASE  BODY FLUID-AU	301	83690	10	N/A	N/A	N/A
HC89022966	NET ABSORBANCE  OXYHEMOGLOBIN  CSF(PANEL)-AU	301	84311	32	N/A	N/A	N/A
HC89022990	POTASSIUM  BODY FLUID-AU	301	84999	11	N/A	N/A	N/A
HC89023014	ACTH-QN	301	82024	112	N/A	N/A	N/A
HC89023048	M: MISC LAB GENERAL REF LAB-ED	300		N/A	N/A	N/A	N/A
HC89023071	ANAL' GENE NUDT15 COMMON VARIANT-AU	310	81306	124	N/A	N/A	N/A
HC89023105	M: MISC LAB GENERAL REF LAB-QI	300		226	N/A	N/A	N/A
HC89023139	KAPPA FREE LIGHT CHAINS QT URINE-AU	301	83521	37	N/A	N/A	N/A
HC89023162	ENZYME ACTIVITY LYSOSOME-JU	301	82657	800	N/A	N/A	N/A
HC89023196	ESTRADIOL-QN	301	82670	60	N/A	N/A	N/A
HC89023212	LAMELLAR BODY DENSITY FETAL LUNG-U2	301	83664	45	N/A	N/A	N/A
HC89023220	FIBRINOLYSIS COAG ADAMTS-13-AU	305	85397	114	N/A	N/A	N/A
HC89023246	KAPPA FREE LIGHT CHAINS QT URINE(IFE)-AU	301	83520	14	N/A	N/A	N/A
HC89023279	HIV-1 DNA/RNA QUANT BY NAAT-AU	306	87536	94	N/A	N/A	N/A
HC89023303	M: MISC LAB GENERAL REF LAB-HG	300		N/A	N/A	N/A	N/A
HC89023337	M: MISC LAB GENERAL REF LAB-UH	300		N/A	N/A	N/A	N/A
HC89023378	ANTIBODY SARS-COV-2 COVID-19 QUAL CIA-AU	302	86769	28	N/A	N/A	N/A
HC89023402	RESP DNA/RNA SARS-COV-2/COVID-19 AMP PROBE-ET	302	U0003	55	N/A	N/A	N/A
HC89023428	ASPERGILLUS AB BY ID-AU	302	86606	11	N/A	N/A	N/A
HC89023436	B. PERTUSSIS & PARAPERTUSSIS PCR-AU	306	87798	70	N/A	N/A	N/A
HC89023451	HSV TYPE 1 &/OR 2AB IGM PNL)-AU	302	86694	10	N/A	N/A	N/A
HC89023485	M: MISC LAB GENERAL REF LAB -WI	300		N/A	N/A	N/A	N/A
HC89023519	HEPATITIS B DNA/RNA QUANT BY NAAT-AU	306	87517	99	N/A	N/A	N/A
HC89023550	INFCT AGNT ADENO DNA QUAL-FT	306	87798	270	N/A	N/A	N/A
HC89023584	TRICHOMONAS VAGINALIS TMA-AU	306	87661	55	N/A	N/A	N/A
HC89023618	ANTIBODY SARS-COV-2 COVID-19 QUANT CIA (SPIKE)-AU	302	86769	34	N/A	N/A	N/A
HC89023642	T CELL ABSOLUTE CD4 COUNT-AU	302	86361	40	N/A	N/A	N/A
HC89023667	NK CELL TOTAL COUNT-AU	302	86357	20	N/A	N/A	N/A
HC89023691	LDH TOTAL BODY FLUID-AU	301	83615	8	N/A	N/A	N/A
HC89023725	HIV-1 DNA PCR QUAL-QN	306	87535	226	N/A	N/A	N/A
HC89023758	INHIBIN B-AU	301	83520	70	N/A	N/A	N/A
HC89023782	CYTOGENO NEO SNP MICROARRAY ONCOLOGY-AU	300	81277	1,535	N/A	N/A	N/A
HC89023816	OPIOID &OPIATE ANALOG 5 OR > -AU	301	80364	25	N/A	N/A	N/A
HC89023840	ANALY CFTR GENE FULL SEQUENCE-AU	310	81223	663	N/A	N/A	N/A
HC89023873	ANSER VDZ MEAS OF ABS TO VEDOLIZUM-PR	300	82542	525	N/A	N/A	N/A
HC89023915	M: MISC LAB GENERAL REF LAB-OA	300		N/A	N/A	N/A	N/A
HC89023949	MONONUC CELL ANTIGEN(II)CD59-DEF RBC-AU	302	86356	29	N/A	N/A	N/A
HC89023972	MONONUC CELL ANTIGEN PNH PHENOTYPE RBC-AU	302	86356	29	N/A	N/A	N/A
HC89024004	ANTIBODY ANTI-C1Q IGG-AU	301	83516	110	N/A	N/A	N/A
HC89024038	MPL MUT ANALYSIS-AU	310	81338	337	N/A	N/A	N/A
HC89090005	P:NEWBORN SCREENING PROGRAM PANEL -GE			N/A	N/A	N/A	N/A
HC89090021	P:HISTOPLASMA AB BY CF - AU			N/A	N/A	N/A	N/A
HC89090039	P:CPK ISO - AU			N/A	N/A	N/A	N/A
HC89090054	P:LDH ISOENZYMES-AU			N/A	N/A	N/A	N/A
HC89090088	P:CHROMOSOME ANALYSS CRD BL-GZ			N/A	N/A	N/A	N/A
HC89090112	P:ANA 12 PLUS POSITIVE-RD			N/A	N/A	N/A	N/A
HC89090146	P:FETAL LUNG PROFILE-FE			N/A	N/A	N/A	N/A
HC89090195	P:CULTURE BORD PERTUSSIS -U2			N/A	N/A	N/A	N/A
HC89090229	P:ALLERGEN SO CALIF PANEL-AU			N/A	N/A	N/A	N/A
HC89090245	P:ALLERGEN GRASS PANEL-AU			N/A	N/A	N/A	N/A
HC89090252	P:ALLERGEN WEEDS PANEL-AU			N/A	N/A	N/A	N/A
HC89090278	P:ALLERGEN MOLD PANEL-AU			N/A	N/A	N/A	N/A
HC89090328	P:ENCEPHALITIS-ARBOVIRS ABS-AU			N/A	N/A	N/A	N/A
HC89090369	P:ANA 12-RD			N/A	N/A	N/A	N/A
HC89090419	P:CULTURE - CHLAMYDIA-FT			N/A	N/A	N/A	N/A
HC89090443	P:11-DEHYROTHROMBOXANE B2 UR P			N/A	N/A	N/A	N/A
HC89090476	P:MYCOPLASMA PNEUMONIAE AB-AU			N/A	N/A	N/A	N/A
HC89090500	P:IMMUNOCOMPROMISED VIRAL PNL-FT			N/A	N/A	N/A	N/A
HC89090542	P:VAP CHOLESTEROL TEST-AH			N/A	N/A	N/A	N/A
HC89090575	P:HEAVY METALS-AU			N/A	N/A	N/A	N/A
HC89090609	P:PARVOVIRUS B19 AB PANEL-AU			N/A	N/A	N/A	N/A
HC89090633	P:LYMPH PAN-3 CD4&CD8-AU			N/A	N/A	N/A	N/A
HC89090666	P:HYPERSENSITIVITY PNEUMO I -AU			N/A	N/A	N/A	N/A
HC89090690	P:H. PYLORI PANEL -AU			N/A	N/A	N/A	N/A
HC89090732	P:MULTIPLE SCLEROSIS PROFILE-AU			N/A	N/A	N/A	N/A
HC89090757	P:FUNGAL ANTIBODIES BY CF SERUM-AU			N/A	N/A	N/A	N/A
HC89090781	P:CULTURE CHLAMYDIA PNUEM-AU			N/A	N/A	N/A	N/A
HC89090815	P:COCCIDIOIDOMYCOSIS AB CSF -AU			N/A	N/A	N/A	N/A
HC89090914	P:NEWBORN SCREENING(PKU) PANEL			N/A	N/A	N/A	N/A
HC89090948	P: HIV PHENOSENSE GT-VI			N/A	N/A	N/A	N/A
HC89090997	P: CHROMOSOME ANALYS BM-AU			N/A	N/A	N/A	N/A
HC89091029	P: CHROMOSOME FISH INTERPHAS-AU			N/A	N/A	N/A	N/A
HC89091078	P: CELIAC SEROLOGY(CAT #1155)-PR			N/A	N/A	N/A	N/A
HC89091128	P: TPMT ENZYME(CAT#3320)-PR			N/A	N/A	N/A	N/A
HC89091151	P:RESP REGION13 ALLERGN(28)-AU			N/A	N/A	N/A	N/A
HC89091193	P:CEL GENETICS (CAT #6260-2013) -PR			N/A	N/A	N/A	N/A
HC89091243	P: BCR/ABL T(9:22)RT/PCR 2013-AU			N/A	N/A	N/A	N/A
HC89091284	P: DIBUCAINE NO +PSEUDOCHOLIN-AU			N/A	N/A	N/A	N/A
HC89091326	P: FACTOR VIII BETHESDA -ES			N/A	N/A	N/A	N/A
HC89091359	FAM ADENOM POLYPOSIS SEQ-AU	310	81201	1,000	N/A	1,000	N/A
HC89091375	HLA-B*5701-ABACAVIR SENS EA-AU	310	81381	100	N/A	160	N/A
HC89091383	P: IMIPRAMINE & DESIPRAMINE 1 OR 2-AU			N/A	N/A	N/A	N/A
HC89091409	CHIKUNGUNYA AB IGG -AU	302	86790	44	N/A	N/A	N/A
HC89091441	P: RX OF ABUSE MECONM POS RFLX CONFIRM AMPHETAMINES ONLY -AU			N/A	N/A	N/A	N/A
HC89091482	P: RX OF ABUSE MEC POS RFLX CONFIRM OPIATES-OXYCODONE -AU			N/A	N/A	N/A	N/A
HC89091516	HLA TYPING MULTI ANTIGEN A/B/C-U9	302	86813	N/A	N/A	N/A	N/A
HC89091607	P: HLA CLASS I TYPING(A/B/C LOCUS)-U9			N/A	N/A	N/A	N/A
HC89091649	P: HIV 1 DRUG RESISST NEXT GEN SEQUENCE-AU			N/A	N/A	N/A	N/A
HC89091672	P: ANSER IFX SUBSEQUENT MEASUREMENT-PR			N/A	N/A	N/A	N/A
HC89091698	P: ANSER VDZ SUBSEQUENT MEASUREMENT-PR			N/A	N/A	N/A	N/A
HC89500193	RBC PRETREAT W/DRUG/CHEM-AA	302	86970	45	N/A	80	N/A
HC89500417	RBC ANTIBODY ID EA TECH-SB	302	86870	85	N/A	71	N/A
HC89500441	RBC ANTIBODY ELUTION-SB	302	86860	100	N/A	81	N/A
HC89500490	BLOOD TYPE SEROLOGIC; ABO-SB	300	86900	20	N/A	16	N/A
HC89500532	CALL BACK FEE HRLY-SB	309	99027	380	N/A	380	N/A
HC89500573	RBC AG OTHER THAN ABO/RH-SB	300	86905	33	N/A	29	N/A
HC89500599	BLOOD TYPING AG SCREEN(PT)-SB	300	86904	62	N/A	50	N/A
HC89500607	SERUM PRETREATMNT W INHIB-SB	300	86977	65	N/A	45	N/A
HC89500698	FREEZING BLOOD EA UNIT-SB	300	86930	294	N/A	294	N/A
HC89500722	FREEZING BLOOD EA UNIT AUTO-SB	300	86930	155	N/A	155	N/A
HC89500862	IRRADIATION EA UNIT-HC	300	86945	35	N/A	35	N/A
HC89500961	ANTIGLOBULIN DIRECT TEST COOMBS; EACH ANTISERUM-SB	302	86880	15	N/A	N/A	N/A
HC89500995	RBC PRETX AB DETECT  ID  COMPAT; INCUB EZYM  EACH-SB	302	86971	75	N/A	N/A	N/A
HC89501027	RARE DONOR SEARCH-SB	302	86999	178	N/A	N/A	N/A
HC89501043	RBC DNA GENOTYPE 16 GROUPS 51 AG-SB	301	0246U	500	N/A	N/A	N/A
HC89590012	P:ABO RH BLOOD GROUP- SB			N/A	N/A	N/A	N/A
HC91000123	R&B ONCOLOGY	127		7,264	N/A	N/A	N/A
HC91000208	R&B TRAUMA ICU	208		17,586	N/A	N/A	N/A
HC91000404	R&B ICU - INTENSIVE PPE ISOLATION	209		16,096	N/A	N/A	N/A
HC91200134	R&B NEWBORN CARE	170		4,027	N/A	N/A	N/A
HC91200137	R&B NICU-NURSERY LEVEL III	173		21,683	N/A	N/A	N/A
HC91200242	R&B HIGH RISK PERINATAL	206		10,338	N/A	N/A	N/A
HC91400095	R&B PEDS STEPDOWN/DOU	206		12,677	N/A	N/A	N/A
HC91400496	R&B ICU PEDS - INTENSIVE PPE ISOLATION	209		17,928	N/A	N/A	N/A
Q4155	NONCDM CHARGE RECORD MEDICAL SUPPLIES	278	C1781	13,125	N/A	N/A	N/A
HC65001258_00338001738	NONCDM CHARGE RECORD PHARMACY	258	J7060	15	N/A	N/A	N/A
HC65001258_00338004304	NONCDM CHARGE RECORD PHARMACY	636	J7030	27	N/A	N/A	N/A
HC65001258_00338004904	NONCDM CHARGE RECORD PHARMACY	258	J7030	30	N/A	N/A	N/A
HC65001258_00338012504	NONCDM CHARGE RECORD PHARMACY	258	J7070	32	N/A	N/A	N/A
HC65001258_00338066304	NONCDM CHARGE RECORD PHARMACY	636	J7042	29	N/A	N/A	N/A
HC65001258_00409792909	NONCDM CHARGE RECORD PHARMACY	636	J7070	32	N/A	N/A	N/A
HC65001258_00409798302	NONCDM CHARGE RECORD PHARMACY	258	J7050	32	N/A	N/A	N/A
HC65001258_00409798325	NONCDM CHARGE RECORD PHARMACY	636	J7050	34	N/A	N/A	N/A
HC65001258_00990790509	NONCDM CHARGE RECORD PHARMACY	636	J7070	45	N/A	N/A	N/A
HC65001258_00990792209	NONCDM CHARGE RECORD PHARMACY	258	J7060	16	N/A	N/A	N/A
HC65001258_00990792306	NONCDM CHARGE RECORD PHARMACY	258	J7060	34	N/A	N/A	N/A
HC65001258_00990798309	NONCDM CHARGE RECORD PHARMACY	258	J7030	26	N/A	N/A	N/A
HC65001258_00990798413	NONCDM CHARGE RECORD PHARMACY	258	J7050	15	N/A	N/A	N/A
HC65001258_06332362450	NONCDM CHARGE RECORD PHARMACY	258	J7060	13	N/A	N/A	N/A
HC65001258_06332362610	NONCDM CHARGE RECORD PHARMACY	258	J7030	32	N/A	N/A	N/A
HC65001636_06699337179	NONCDM CHARGE RECORD PHARMACY	636	J1050	3	N/A	N/A	N/A
HC65002250_00264230400	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65002250_00338001304	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65002250_00436094616	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65002250_00990613922	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65002250_00990711807	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65002258_00338022104	NONCDM CHARGE RECORD PHARMACY	250		94	N/A	N/A	N/A
HC65002258_00409724803	NONCDM CHARGE RECORD PHARMACY	250		97	N/A	N/A	N/A
HC65002636_00054855025	NONCDM CHARGE RECORD PHARMACY	636	J8610	20	N/A	N/A	N/A
HC65002636_00074057611	NONCDM CHARGE RECORD PHARMACY	636	J3490	141	N/A	N/A	N/A
HC65002636_00078065615	NONCDM CHARGE RECORD PHARMACY	636	Z7610	0	N/A	N/A	N/A
HC65002636_00115147446	NONCDM CHARGE RECORD PHARMACY	636	Z7610	637	N/A	N/A	N/A
HC65002636_00172731320	NONCDM CHARGE RECORD PHARMACY	636	J7502	31	N/A	N/A	N/A
HC65002636_00173069704	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,607	N/A	N/A	N/A
HC65002636_00469052014	NONCDM CHARGE RECORD PHARMACY	636	J3490	617	N/A	N/A	N/A
HC65002636_00527197174	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,441	N/A	N/A	N/A
HC65002636_00574403125	NONCDM CHARGE RECORD PHARMACY	636	J3490	247	N/A	N/A	N/A
HC65002636_01671415601	NONCDM CHARGE RECORD PHARMACY	636	J3490	198	N/A	N/A	N/A
HC65002636_01671487802	NONCDM CHARGE RECORD PHARMACY	636	J3490	596	N/A	N/A	N/A
HC65002636_02420879535	NONCDM CHARGE RECORD PHARMACY	636	J3490	84	N/A	N/A	N/A
HC65002636_02433826012	NONCDM CHARGE RECORD PHARMACY	636	J3490	561	N/A	N/A	N/A
HC65002636_02859512049	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,216	N/A	N/A	N/A
HC65002636_04580290094	NONCDM CHARGE RECORD PHARMACY	636	J3490	292	N/A	N/A	N/A
HC65002636_04733577991	NONCDM CHARGE RECORD PHARMACY	636	J3490	141	N/A	N/A	N/A
HC65002636_04878311208	NONCDM CHARGE RECORD PHARMACY	636	J3490	134	N/A	N/A	N/A
HC65002636_05556628001	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,970	N/A	N/A	N/A
HC65002636_05965121430	NONCDM CHARGE RECORD PHARMACY	636	J3490	118	N/A	N/A	N/A
HC65002636_06131454701	NONCDM CHARGE RECORD PHARMACY	636	J3490	68	N/A	N/A	N/A
HC65002636_06131463705	NONCDM CHARGE RECORD PHARMACY	636	J3490	288	N/A	N/A	N/A
HC65002636_06516267684	NONCDM CHARGE RECORD PHARMACY	636	J3490	130	N/A	N/A	N/A
HC65002636_06516289129	NONCDM CHARGE RECORD PHARMACY	636	J3490	780	N/A	N/A	N/A
HC65002636_06586284003	NONCDM CHARGE RECORD PHARMACY	636	J3490	188	N/A	N/A	N/A
HC65002636_06846258476	NONCDM CHARGE RECORD PHARMACY	636	J8501	182	N/A	N/A	N/A
HC65002636_06846274635	NONCDM CHARGE RECORD PHARMACY	636	J3490	520	N/A	N/A	N/A
HC65002636_06868265220	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,972	N/A	N/A	N/A
HC65002636_07248520290	NONCDM CHARGE RECORD PHARMACY	636	J3490	8	N/A	N/A	N/A
HC65002636_07820612601	NONCDM CHARGE RECORD PHARMACY	636	Z7610	2,123	N/A	N/A	N/A
HC65004250_00143950810	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_00143963710	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65004250_00338051909	NONCDM CHARGE RECORD PHARMACY	250		249	N/A	N/A	N/A
HC65004250_00338051958	NONCDM CHARGE RECORD PHARMACY	250		98	N/A	N/A	N/A
HC65004250_00338104902	NONCDM CHARGE RECORD PHARMACY	250		136	N/A	N/A	N/A
HC65004250_00409163401	NONCDM CHARGE RECORD PHARMACY	250		216	N/A	N/A	N/A
HC65004250_00409205105	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65004250_00409317801	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65004250_00409488750	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65004250_00409488812	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_00409781124	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65004250_00409818301	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65004250_00409955849	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65004250_00703951403	NONCDM CHARGE RECORD PHARMACY	250		116	N/A	N/A	N/A
HC65004250_00781322092	NONCDM CHARGE RECORD PHARMACY	250		43	N/A	N/A	N/A
HC65004250_00781382796	NONCDM CHARGE RECORD PHARMACY	250		51	N/A	N/A	N/A
HC65004250_03600016210	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65004250_03982242006	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65004250_04928175222	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65004250_05175450015	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65004250_06332308615	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65004250_06332308950	NONCDM CHARGE RECORD PHARMACY	250		66	N/A	N/A	N/A
HC65004250_06332317005	NONCDM CHARGE RECORD PHARMACY	250		101	N/A	N/A	N/A
HC65004250_06332348217	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65004250_06332348327	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65004250_06332348817	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65004250_06380710001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65004250_06380710051	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65004250_06745785204	NONCDM CHARGE RECORD PHARMACY	250		129	N/A	N/A	N/A
HC65004250_06937431625	NONCDM CHARGE RECORD PHARMACY	250		145	N/A	N/A	N/A
HC65004250_07248510825	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65004250_07257248110	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65004250_07257274020	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65025011_00517912025	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65025012_00143933310	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65025012_00409115902	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65025012_00409174929	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65025012_00409361301	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65025012_06332346637	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65025012_06332347217	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65025013_00781312495	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65025016	MEDICATION - MCAL S0140	250		N/A	N/A	N/A	N/A
HC65200250_05531000301	NONCDM CHARGE RECORD PHARMACY	636	Q4186	976	N/A	N/A	N/A
HC65200250_09999903892	NONCDM CHARGE RECORD PHARMACY	636	Q4196	336	N/A	N/A	N/A
HC65600343_01199409036	NONCDM CHARGE RECORD PHARMACY	250	A9512	2	N/A	N/A	N/A
HC65600343_01715602101	NONCDM CHARGE RECORD PHARMACY	250	A9570	5,688	N/A	N/A	N/A
HC65600343_01715623501	NONCDM CHARGE RECORD PHARMACY	250	A9582	12,113	N/A	N/A	N/A
HC65600343_06994506401	NONCDM CHARGE RECORD PHARMACY	255	A9592	2,931	N/A	N/A	N/A
HC65600343_06994560220	NONCDM CHARGE RECORD PHARMACY	255	A9516	110	N/A	N/A	N/A
HC65890014	P:PALLADIUM103 NONSTRND20SEEDS			N/A	N/A	N/A	N/A
HC73000044	DIALYSIS CCPD W/SNGL EVAL(IP)	804	90945	2,737	N/A	N/A	N/A
HC73000168	HEMOPERFUSION	880	90997	2,523	N/A	N/A	N/A
HC74200031	OR TIME INITIAL HR LEVEL 4 (MCAL 1ST HOUR)	360		17,919	N/A	N/A	N/A
HC74200064	OR TIME ADD'L 15MIN LVL 1 (MCAL 1ST SUBSQNT 0.5 HR)	360		2,673	N/A	N/A	N/A
HC74200098	OR TIME ADD'L 15MIN LVL 4 (MCAL 1ST SUBSQNT 0.5 HR)	360		4,480	N/A	N/A	N/A
HC74200262	BEDSIDE/OTHER SURG ADD'L 15MIN 3 (MCAL 1ST SUBSQNT 0.5 HR)	369		2,000	N/A	N/A	N/A
HC74200296	BEDSIDE/OTHER SURG ADD'L 15MIN 6 (MCAL 1ST SUBSQNT 0.5 HR)	369		2,692	N/A	N/A	N/A
HC74200460	OR TIME ADD'L 15MIN LVL 5  (MCAL 2ND SUBSQNT 0.5 HR)	360		4,936	N/A	N/A	N/A
HC74200494	BEDSIDE/OTHER SURG ADD'L 15MIN 2 (MCAL 2ND SUBSQNT 0.5 HR)	369		1,676	N/A	N/A	N/A
HC77400067	ANESTHESIA INITIAL HR	370		3,119	N/A	N/A	N/A
HC77400091	BEDSIDE/OTHER ANESTH' INITIAL HR	379		1,518	N/A	N/A	N/A
HC77400125	ANESTHESIA REGIONAL INITIAL HOUR	370		1,075	N/A	N/A	N/A
HC77400265	BEDSIDE/OTHER ANESTH' INIT'L HR CASE CX	379		765	N/A	N/A	N/A
HC78600004	PACU I 1ST HOUR (INITIAL)	710		2,670	N/A	N/A	N/A
HC78600053	PACU II 1ST HOUR (INITIAL)	710		1,642	N/A	N/A	N/A
HC81100109	LDL CHOLESTEROL DIRECT	301	83721	207	N/A	49	N/A
HC81100133	PROTEIN FLUID	301	84157	184	N/A	57	N/A
HC81100315	PHENOBARBITOL	301	80184	596	N/A	113	N/A
HC81100349	ACETONE	301	82010	208	N/A	52	N/A
HC81100372	HEPATIC FUNCTION PANEL	301	80076	479	N/A	36	N/A
HC81100513	CHLORIDE SERUM	301	82435	141	N/A	38	N/A
HC81100547	CREATININE	301	82565	156	N/A	26	N/A
HC81100570	GGT	301	82977	187	N/A	42	N/A
HC81100711	QUINIDINE	301	80194	334	N/A	89	N/A
HC81100745	TRIGLYCERIDES	301	84478	182	N/A	48	N/A
HC81100778	PROCAINAMIDE W/NAPA	301	80192	372	N/A	80	N/A
HC81100950	PROCAINAMIDE	301	80190	411	N/A	80	N/A
HC81100984	NORPACE/DISOPYRAM	301	80299	454	N/A	117	N/A
HC81101156	HEMOGLOBIN GLYCATED (A1C)	301	83036	235	N/A	45	N/A
HC81101180	HOMOCYSTINE	301	83090	335	N/A	91	N/A
HC81101214	PHOSPHATIDYL GLYCEROL	301	84081	373	N/A	163	N/A
HC81101362	CARBOXYHEMOGLOBIN	301	82375	286	N/A	113	N/A
HC81101396	FOAM STABILITY	301	83662	263	N/A	95	N/A
HC81101420	PREALBUMIN	302	84134	293	N/A	85	N/A
HC81101628	PROTEIN TOTAL  FLUID	301	84160	170	N/A	57	N/A
HC81101685	DHEA SULFATE	301	82627	284	N/A	83	N/A
HC81101875	PREGNANCY  HCG-UR (DA)	301	84703	220	N/A	25	N/A
HC81101925	DRUG TEST PRESUMP DIRECT OBSERV/ DOS	301	80305	236	N/A	13	N/A
HC81500050	CRYSTALS FLUID	300	89060	296	N/A	64	N/A
HC81500084	PTT (APTT)	305	85730	272	N/A	34	N/A
HC81500118	ACTIVATED COAG TIME	305	85347	195	N/A	43	N/A
HC81500258	G6-PD SCREEN	301	82960	178	N/A	62	N/A
HC81500282	BUFFY COAT	305	85009	179	N/A	113	N/A
HC81500316	MANUAL CELL COUNT RED/LEUK/PLT	305	85032	174	N/A	82	N/A
HC81500480	ACTIVATED PROT C RESISTANCE	305	85307	388	N/A	135	N/A
HC81500514	D-DIMER ULTRA SENSITIVE	305	85380	328	N/A	94	N/A
HC81500712	HEMOGLOBIN ELECTROPHERESIS	301	83020	268	N/A	82	N/A
HC81500746	LAMELLAR BODY DENSITY	301	83664	293	N/A	82	N/A
HC81500928	URINALYSIS AUTO W/ MICROSCOPY	307	81001	222	N/A	24	N/A
HC81500951	FACTOR V LEIDEN BY PCR	301	81241	583	N/A	N/A	N/A
HC81700007	MONOSPOT TEST	302	86308	183	N/A	80	N/A
HC81700148	PROGESTERONE	301	84144	387	N/A	106	N/A
HC81700171	TESTOSTERONE TOTAL	301	84403	442	N/A	131	N/A
HC81700205	TSH	301	84443	395	N/A	78	N/A
HC81700379	CD4 AND CD8 COUNT WITH RATIO	302	86360	521	N/A	209	N/A
HC81700403	RPR/VDRL QUANT	302	86593	159	N/A	53	N/A
HC81700577	FERRITIN	301	82728	323	N/A	69	N/A
HC81700601	IMMUNOGLOBULIN IGG	301	82784	303	N/A	72	N/A
HC81700635	ALBUMIN; URINE QUANT	301	82043	168	N/A	45	N/A
HC81700775	THYROID PEROXIDASE AB BY EIA	302	86376	208	N/A	54	N/A
HC81700809	HIV-1 RNA  QUANT	302	87536	1,327	N/A	375	N/A
HC81700833	FLOW CYT MKR TC ADD+ CD23	311	88185	318	N/A	104	N/A
HC81701013	FLW CYT MKR CD7 TC ADD+	311	88185	318	N/A	104	N/A
HC81701047	FLW CYT MKR IGG TC ADD+	311	88185	318	N/A	104	N/A
HC81701377	PSA SCREENING	301	G0103	214	N/A	93	N/A
HC81701401	FLOW CYT MKR TC ADD+	311	88185	318	N/A	104	N/A
HC81701641	LAMBDA FREE LIGHT CHAINS QT	301	83883	212	N/A	56	N/A
HC81701690	S AUREUS BY PCR	300	87640	574	N/A	148	N/A
HC81701724	EBV AB TO VIRAL CAPSID AG  IGG	302	86665	278	N/A	100	N/A
HC81701864	IGG SUBCLASS 3; EACH	301	82787	298	N/A	33	N/A
HC81701898	HIV TYPE 1 OR 2ANTIBODY(RAPID)	302	86703	238	N/A	57	N/A
HC81701922	TISSUE TRANSGLUTAMINASE IGG	302	86364	277	N/A	51	N/A
HC81702094	FLW CYT MKR CD25 TC ADD+	311	88185	318	N/A	104	N/A
HC81702128	FLW CYT MKR CD57 TC ADD+	311	88185	318	N/A	104	N/A
HC82200072	OIL RED O STAIN/GRP II+	312	88313	474	N/A	108	N/A
HC82200106	TRICHROME STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82200270	IHC/IP PER SPEC INITIAL AB STAIN HCG	312	88342	593	N/A	193	N/A
HC82200304	IHC/IP PER SPEC INITIAL AB STAIN KERATIN	312	88342	593	N/A	193	N/A
HC82200338	TISSUE EXAM G&M LEVEL 6	312	88309	1,332	N/A	526	N/A
HC82200486	BONE MARROW SMEAR INTERP	305	85097	870	N/A	770	N/A
HC82200510	TISSUE EXAM - LAB REPORT - OP	310	88399	455	N/A	325	N/A
HC82200544	MOLECULAR CYTO DNA PROBE	310	88271	1,062	N/A	95	N/A
HC82200734	INTRAOP CNSLT CYT PRP-DIST SRV	311	88333	962	N/A	500	N/A
HC82200791	BONE MARROW DX; ASP(S) ONLY RT	361	38220	4,591	N/A	1,651	N/A
HC82200973	DIETERLE MODF STN/GR I W/I&R+	312	88312	547	N/A	50	N/A
HC82201005	WADES MOD FITE STN/GR I W/I&R+	312	88312	547	N/A	144	N/A
HC82201039	ALCIAN BLUE NO DIGEST'N/GRPII+	312	88313	482	N/A	107	N/A
HC82201179	MELANIN BLEACHING/GRP II+	312	88313	474	N/A	107	N/A
HC82201203	PAS STAIN W/DIGESTION GRP II+	312	88313	474	N/A	107	N/A
HC82201237	SNOOKS RETICULIN STAIN GRP II+	312	88313	474	N/A	60	N/A
HC82201377	HISTCHM ST AZURE-II MB FR TS	312	88314	388	N/A	108	N/A
HC82201401	HISTCHM ST MYPHSPHFRC1 FRO TS	312	88314	388	N/A	108	N/A
HC82201435	HISTOCHM STN SDH  FRZ TIS BLK	312	88319	962	N/A	500	N/A
HC82201609	IHC/IP PER SPEC INITIAL AB STAIN ESTROGN RECEPT	312	88342	593	N/A	193	N/A
HC82201633	IHC/IP PER SPEC INITIAL AB STAIN HERPES POLY	312	88342	593	N/A	193	N/A
HC82201807	IHC/IP PER SPEC INITIAL AB STAIN T4/CD 4	312	88342	593	N/A	193	N/A
HC82201831	IHC/IP PER SPEC INITIAL AB STAIN ACTH	312	88342	593	N/A	193	N/A
HC82201864	IHC/IP PER SPEC INITIAL AB STAIN CD-68	312	88342	593	N/A	193	N/A
HC82202029	IHC/IP PER SPEC INITIAL AB STAIN SMMHC	312	88342	593	N/A	193	N/A
HC82202060	IHC/IP PER SPEC INITIAL AB STAIN UBIQUITIN STAIN	312	88342	593	N/A	193	N/A
HC82202177	MORPHOMETRIC STUDY SKEL MUSC	312	88355	1,011	N/A	575	N/A
HC82202375	MORPH STDY TMR IHC CAT ER PER SPEC EA ADDL AB	312	88361	1,055	N/A	386	N/A
HC82202409	MORPH STDY TMR IHC CAT HER2 PER SPEC EA ADDL AB	312	88361	1,055	N/A	386	N/A
HC82202581	TISSUE EXAM G&M LEVEL 5 *OP	312	88307	1,128	N/A	110	N/A
HC82202615	SPECIAL STAIN GROUP II+ *OP	312	88313	474	N/A	60	N/A
HC82202813	PREP SURG TISSUE NON-MICRO STUDIES+	312	88388	242	N/A	108	N/A
HC82202920	PROCESS  EMBED & 1 UNSTN SLIDE	310	88399	106	N/A	8	N/A
HC82202953	IHC/IP PER SPEC INITIAL AB STAIN BASAL CELL COCKTAIL	312	88342	593	N/A	193	N/A
HC82203092	IHC/IP PER SPEC INITIAL AB STAIN CD117	312	88342	593	N/A	193	N/A
HC82203126	IHC/IP PER SPEC INITIAL AB STAIN CEA MONOCLONAL	312	88342	593	N/A	193	N/A
HC82203159	IHC/IP PER SPEC INITIAL AB STAIN CMV	312	88342	593	N/A	193	N/A
HC82203324	IHC/IP PER SPEC INITIAL AB STAIN WT-1	312	88342	593	N/A	193	N/A
HC82203357	IHC/IP PER SPEC EA ADD AB STAIN+ HMB-45	312	88341	516	N/A	183	N/A
HC82203522	IHC/IP PER SPEC EA ADD AB STAIN+ CAM5-2	312	88341	516	N/A	183	N/A
HC82203555	IHC/IP PER SPEC EA ADD AB STAIN+ CD-23	312	88341	516	N/A	183	N/A
HC82203589	IHC/IP PER SPEC EA ADD AB STAIN+ CDX-28	312	88341	516	N/A	183	N/A
HC82203720	IHC/IP PER SPEC EA ADD AB STAIN+ P63	312	88341	516	N/A	183	N/A
HC82203753	IHC/IP PER SPEC EA ADD AB STAIN+ WT-1	312	88341	516	N/A	183	N/A
HC82203787	IHC/IP PER SPEC EA ADD AB STAIN+ DYSTROPH (ROD DOMAIN)	312	88341	516	N/A	183	N/A
HC82203928	IHC/IP PER SPEC EA ADD AB STAIN+ L26 AB	312	88341	516	N/A	183	N/A
HC82203951	IHC/IP PER SPEC EA ADD AB STAIN+ LN 2	312	88341	516	N/A	183	N/A
HC82203985	IHC/IP PER SPEC EA ADD AB STAIN+ MYOGLOBIN	312	88341	516	N/A	183	N/A
HC82204165	IHC/IP PER SPEC EA ADD AB STAIN+ GROWTH HORM	312	88341	516	N/A	183	N/A
HC82204207	IHC/IP PER SPEC EA ADD AB STAIN+ LEU M1 (CD15)	312	88341	516	N/A	183	N/A
HC82204371	IHC/IP PER SPEC EA ADD AB STAIN+ CD56	312	88341	516	N/A	183	N/A
HC82204405	IHC/IP PER SPEC EA ADD AB STAIN+ EGFR	312	88341	516	N/A	183	N/A
HC82204439	IHC/IP PER SPEC EA ADD AB STAIN+ TTF-1	312	88341	516	N/A	183	N/A
HC82204579	IHC/IP PER SPEC INITIAL AB STAIN GATA-3	312	88342	593	N/A	193	N/A
HC82204603	IHC/IP PER SPEC EA ADD AB STAIN+ C-MYC	312	88341	516	N/A	183	N/A
HC82204637	IHC/IP PER SPEC INITIAL AB STAIN HSV-1	312	88342	593	N/A	193	N/A
HC82290099	P: MISMATCH REPAIR-MLH1 MSH2 MSH6 PMS2			N/A	N/A	N/A	N/A
HC83000026	WHOLE BLOOD EA UNIT	390	P9010	877	N/A	510	N/A
HC83000216	FFP THAWING EA UNIT	300	86927	342	N/A	175	N/A
HC83000273	CMV IGM	302	86645	249	N/A	74	N/A
HC83000471	RBC LR/CMV NEG DIVIDED UNIT	390	P9051	621	N/A	292	N/A
HC83000505	PLATELETS LR IRRAD EA UNIT	390	P9033	581	N/A	375	N/A
HC83000539	PLATELET LR CMV NEG APHER/PHER	390	P9055	1,683	N/A	1,167	N/A
HC83000752	THERAPEUTIC APHERESIS PLATELET	361	36513	9,792	N/A	800	N/A
HC83000794	COOMBS INDIRECT QUAL EA	302	86885	267	N/A	175	N/A
HC83000828	ALIQUOT PLATELETS	390	P9011	594	N/A	380	N/A
HC83001081	M: MISC BLOOD BANK	300		N/A	N/A	N/A	N/A
HC83001149	RBC'S LEUKO RED IRRAD EACH UNIT	390	P9040	1,186	N/A	575	N/A
HC83090035	P: RBC ALIQUOT & SPLITTING PROCEDURE			N/A	N/A	N/A	N/A
HC83090068	P: PLATELET ALIQUOT & SPLITTING			N/A	N/A	N/A	N/A
HC83500223	CHROMO  TISSUE CULT-GZ	310	88237	N/A	N/A	N/A	N/A
HC83500264	CHROMO  TISSUE BLOOD-HP	310	88237	N/A	N/A	N/A	N/A
HC83500298	CHROMOSOME BRKG ANAL 50-102-GZ	310	88248	N/A	N/A	N/A	N/A
HC83500439	CHROMO ANAL AMNIO FLD 6-14-GZ	310	88269	N/A	N/A	N/A	N/A
HC83500462	MOLECUL CYTO DNA PROBE FISH-US	310	88271	65	N/A	65	N/A
HC83500496	INTERPHASE FISH HYBRI 25-99-IM	310	88274	N/A	N/A	N/A	N/A
HC83500710	TISSUE EXAM G&M LEVEL 4 PRO-US	312	88305	N/A	N/A	N/A	N/A
HC83500751	SPECIAL STAIN GRP I W/ I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83500926	GENTA STAIN/GROUP I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83500959	GIEMSA STN/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83500983	GRAMS STAIN-AP/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83501122	WADES MOD FT ST/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83501155	WARTHN-STARRY ST/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83501189	ZIEHL NEELSON STN/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83501320	AMYLOID (CONGO RED)/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501353	AMYLOID (VIOLET)/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501387	AMYLOID STN BENHOLD/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501551	GRIMELIUS ARGYRO STN GRPII+-US	312	88313	N/A	N/A	N/A	N/A
HC83501585	HALLS BILE STAIN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501759	MASSON TRICHROM STN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501783	MAY GRUN GIEMSA STN GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501817	MELANIN BLEACHING/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501957	PAS STAIN W/DIGEST GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501981	PERLS PRUSS BLU STN GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83502013	PTAH STAIN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83502286	ANATMIC CONSULT; REV/PREP-US	312	88323	N/A	N/A	N/A	N/A
HC83502344	IHC/IP PER SPEC INITIAL AB STAIN (PNL 6&7)-HP	312	88342	59	N/A	58	N/A
HC83502526	IHC/IP PER SPEC INITIAL AB STAIN CALCITONIN -US	312	88342	N/A	N/A	N/A	N/A
HC83502559	IHC/IP PER SPEC INITIAL AB STAIN CEA -IM	312	88342	N/A	N/A	N/A	N/A
HC83502724	IHC/IP PER SPEC INITIAL AB STAIN GLUCAGON -US	312	88342	N/A	N/A	N/A	N/A
HC83502757	IHC/IP PER SPEC INITIAL AB STAIN HERPES POLY -IM	312	88342	N/A	N/A	N/A	N/A
HC83502781	IHC/IP PER SPEC INITIAL AB STAIN HMB-45 -US	312	88342	N/A	N/A	N/A	N/A
HC83502948	IHC/IP PER SPEC INITIAL AB STAIN LCA -US	312	88342	N/A	N/A	N/A	N/A
HC83502971	IHC/IP PER SPEC INITIAL AB STAIN LN1 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503003	IHC/IP PER SPEC INITIAL AB STAIN LN2 -US	312	88342	N/A	N/A	N/A	N/A
HC83503193	IHC/IP PER SPEC INITIAL AB STAIN SOMATOSATIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83503227	IHC/IP PER SPEC INITIAL AB STAIN T4 -US	312	88342	N/A	N/A	N/A	N/A
HC89013676	INSULIN TOTAL-AU	301	83525	8	N/A	9	N/A
HC89013957	THYROGLOBULIN-UE	301	84432	N/A	N/A	N/A	N/A
HC89013981	TSH-ES	301	84443	45	N/A	42	N/A
HC89014179	FLUORESCNT AB NON INF SREEN-CA	302	86255	N/A	N/A	N/A	N/A
HC89014203	FLUORESCNT AB TITER EA AB-SL	302	86256	70	N/A	70	N/A
HC89014237	HYPERSENSITIVITY PNEUMO I (PNL)-AU	302	86331	6	N/A	6	N/A
HC89014385	INFLUENZA B SEROLOGY-AU	302	86710	11	N/A	8	N/A
HC89014419	PROTOZOA AB OTHER-AU	302	86753	11	N/A	12	N/A
HC89014468	TOXOPLASMA AB IGG-AU	302	86777	16	N/A	16	N/A
HC89014633	CULTURE RAPID CYTOMEGALOVIRUS-AU	306	87254	55	N/A	65	N/A
HC89014674	LEGIONELLA AG DFA-AU	306	87278	37	N/A	37	N/A
HC89014856	FLOW CYT MKR TC 1ST-IM	311	88184	N/A	N/A	N/A	N/A
HC89014880	SPECIMEN PREP BLOOD-GZ	311	88230	N/A	N/A	N/A	N/A
HC89015051	M: MISC CYTOGENIC STUDY REF LAB-GZ	311		N/A	N/A	N/A	N/A
HC89015085	CYCLIC CITRU PEPTIDE AB-AU	301	86200	14	N/A	14	N/A
HC89015119	LYMPH ABS CD4/CD8 CNT-U2	302	86360	N/A	N/A	N/A	N/A
HC89015283	PRIMIDONE-QD	301	80188	12	N/A	12	N/A
HC89015317	ALDOLASE-QD	301	82085	11	N/A	11	N/A
HC89015341	CALCIUM URINE-QD	301	82340	16	N/A	16	N/A
HC89015515	RENIN-QD	301	84244	8	N/A	8	N/A
HC89015549	SEX HORMONE BINDING GLOB-QD	301	84270	27	N/A	27	N/A
HC89015713	CA 19-9-QD	302	86301	10	N/A	10	N/A
HC89015747	LYMPH ABS CD4/CD8 CNT(PNL)-QD	302	86360	29	N/A	29	N/A
HC89015770	BARTONELLA AB-QD	302	86611	16	N/A	16	N/A
HC89015911	ACIDFAST BACILL STAIN (OTH)-QD	306	87206	32	N/A	32	N/A
HC89015945	HEPATITIS B SURFACE AG (DS)-QD	306	87340	30	N/A	30	N/A
HC89015978	HIV AB WESTERN BLOT-QD	302	86689	29	N/A	29	N/A
HC89016141	VIRAL ID (SHELL VIAL)-QD	306	87254	19	N/A	19	N/A
HC89016174	CRYOGLOBULIN(QUAL/SEMI QT)-QD	301	82595	4	N/A	4	N/A
HC89016349	HELICOBACTER PYLORI AG-QD	302	86677	29	N/A	29	N/A
HC89016372	ELECTRON MICROSCOPY-QD	310	88348	2	N/A	2	N/A
HC89016653	TRIGLYCERIDES-VAP(IN GRP)-AH	301	84478	6	N/A	6	N/A
HC89016695	HEPATITIS B SURFACE AB-QD	302	86706	52	N/A	52	N/A
HC89016737	WEST NILE VIRUS AB EA-LB	300	86788	20	N/A	20	N/A
HC89016893	HTVL I/II W/ABS RFX TO WB-AU	302	86790	12	N/A	12	N/A
HC89016935	ANATOMIC CONSULT; CMPLX REV-JH	312	88321	250	N/A	250	N/A
HC89016968	HIV GENOTYPE P'SENS GT(PNL)-VI	306	87901	195	N/A	195	N/A
HC89017131	IM ASSAY TISSUE TG AB-AU	301	83516	9	N/A	9	N/A
HC89017164	PROPAFENONE-AU	301	80299	16	N/A	16	N/A
HC89017339	FUNGUS AB OTHER-QD	302	86671	84	N/A	84	N/A
HC89017362	LYME AB  IGG BY WB-AU	302	86617	15	N/A	21	N/A
HC89017537	COCCIDIOIDES FUNGAL AB PAN (PNL)-AU	302	86635	9	N/A	9	N/A
HC89017560	RUBELLA IGM AB(PNL)-AU	302	86762	9	N/A	9	N/A
HC89017594	RUBELLA AB IGG(PNL)-AU	302	86317	9	N/A	9	N/A
HC89017750	ANTI MICROSOMAL THYROID(PNL-AU	302	86376	16	N/A	16	N/A
HC89017784	CULTURE CMV VIR SHELL(PNL)-AU	306	87254	33	N/A	33	N/A
HC89017818	ANTI-RO SS-A (PNL)-RD	302	86235	31	N/A	31	N/A
HC89018089	VON WILLEBRAND FACT 2N BIND-EC	305	85246	172	N/A	172	N/A
HC89018113	M: MISC LAB GENERAL REF LAB-GN	300		N/A	N/A	N/A	N/A
HC89018287	FACTOR VIII BETHESDA TITER(PNL) -EC	305	85335	102	N/A	102	N/A
HC89018311	FACTOR V ASSAY -EC	305	85220	163	N/A	163	N/A
HC89018345	FACTOR XI ASSAY -EC	305	85270	163	N/A	163	N/A
HC89018592	CHROM ANAL TISSUE CULT  BM-AU	310	88237	163	N/A	215	N/A
HC89018634	CHROM ANAL 15-20 CELLS  BLD-AU	310	88262	161	N/A	213	N/A
HC89018675	CHROM ADD KARYOTYPE  AF-AU	310	88280	42	N/A	41	N/A
HC89019236	VARICELLA ZOSTER QNT-FT	306	87799	275	N/A	314	N/A
HC89019269	FACTOR VIII VW FACTOR AG-OS	305	85246	90	N/A	90	N/A
HC89019293	TSH RECEPTOR AB (TRAB)-AU	301	83520	31	N/A	35	N/A
HC89019590	TOT SRM IGA NPHLMT(PNL1155/6360)-PR	301	82784	20	N/A	20	N/A
HC89019749	PLATELET AB IDENTIFY-AU	302	86022	160	N/A	160	N/A
HC89019996	B PERTUSSIS PCR - AU	306	87798	46	N/A	46	N/A
HC89020036	TPMT GENETICS (3300)-PR	301	81401	316	N/A	316	N/A
HC89020069	LACTO TYPE (LCT)(CAT #6100-2013) -PR	301	81400	237	N/A	237	N/A
HC89020200	DNASE INDIRECT IGG ADDL STAIN(PNL)-PR	310	88350	120	N/A	72	N/A
HC89020234	NKX2-3 SNP (RS10883365)(PL)-PR	301	81479	14	N/A	47	N/A
HC89020267	MINOR BREAKPOINT (BCR/ABL1)-AU	309	81207	75	N/A	75	N/A
HC89020432	ZINC  WHOLE BLOOD -AU	301	84630	74	N/A	74	N/A
HC89020473	IMMUNOGLB IGM EA -AU	301	82784	6	N/A	6	N/A
HC89020937	SPINAL MUSCULAR ATROPHY-QN	301	81401	695	N/A	695	N/A
HC89020960	ECHOVIRUS AB TYPE 6-AU	302	86658	25	N/A	18	N/A
HC89021133	NK FUNCTION ASSAY(PNL) -CN	302	86352	430	N/A	430	N/A
HC89021166	FACTOR IX INHIBITOR TEST(PNL) -EC	305	85250	150	N/A	150	N/A
HC89021190	ALLERGEN IGE-EA(IMMUNOCAP ISAC)-PD	302	86003	3	N/A	3	N/A
HC89021349	PAN-ASPERGILLUS-VC	306	87798	132	N/A	N/A	N/A
HC89021372	PROCALCITONIN-U2	301	84145	70	N/A	N/A	N/A
HC89021414	HIV 1 AB -AU	302	86701	38	N/A	41	N/A
HC89021604	DS BENZODIAZEPINES DETECT/PRESUMP-AU	301	80307	17	N/A	N/A	N/A
HC89021638	SUGARS; SNGL QT GLYCOMARK EA SPEC -AU	301	84378	62	N/A	N/A	N/A
HC89021919	DEOXYCORTICOSTERONE (DOC)-ES	301	82633	155	N/A	N/A	N/A
HC89021976	FACTOR XIII ASSAY -AU	305	85290	125	N/A	N/A	N/A
HC89022016	BETA 2 GLYCOPROTEIN  IGA- AU	302	86146	10	N/A	N/A	N/A
HC89022156	CAFFEINE SERUM/PLASMA - AU	301	80155	40	N/A	N/A	N/A
HC89022180	M: MISC LAB GENERAL REF LAB-BG	300		300	N/A	N/A	N/A
HC89022214	M: MISC LAB GENERAL REF LAB-DR	300		200	N/A	N/A	N/A
HC89022362	FLOW CYTOMETRY MARKERS ADD+-CC	311	88185	24	N/A	N/A	N/A
HC89022396	FLOW CYT LEUK/LYMPH 1ST MRKR{W-INT/89}-AU	311	88184	114	N/A	N/A	N/A
HC89022420	M: MISC LAB GENERAL REF LAB -CO	300		N/A	N/A	N/A	N/A
HC89022602	DHEA-QN	301	82626	72	N/A	N/A	N/A
HC89022636	PREGNENOLONE-QN	301	84140	117	N/A	N/A	N/A
HC89022826	ALCOHOL; 1-2 (URINE)-U2	301	80320	23	N/A	N/A	N/A
HC89022859	M: MISC LAB GENERAL REF LAB-MV	300		52	N/A	N/A	N/A
HC89022883	AMYLASE  BODY FLUID-AU	301	82150	11	N/A	N/A	N/A
HC89023022	DHEA SULFATE-QN	301	82627	24	N/A	N/A	N/A
HC89023055	M: MISC LAB GENERAL REF LAB -GR	300		N/A	N/A	N/A	N/A
HC89023089	M: MISC LAB GENERAL REF LAB -MI	300		N/A	N/A	N/A	N/A
HC89023253	IMMUNO ELECT URINE (IFE)-AU	301	86335	49	N/A	N/A	N/A
HC89023287	SARS-COV-2 RNA QUAL RT-PCR-QN	302	87635	100	N/A	N/A	N/A
HC89023469	YERSINIA AB IGG BY IMMUNOBLOT-AU	302	86793	41	N/A	N/A	N/A
HC89023493	ISLET AUTOANTIBODY ANTIGEN-2-AU	302	86341	65	N/A	N/A	N/A
HC89023675	T-CELL TOTAL COUNT-AU	302	86359	20	N/A	N/A	N/A
HC89023709	GLUCOSE BODY FLUID-AU	301	82945	7	N/A	N/A	N/A
HC89023733	FENTANYL &METABOLITE QUANT URINE-AU	301	80354	41	N/A	N/A	N/A
HC89023899	FACTOR II 20210G>A VARIANT -QN	301	81240	125	N/A	N/A	N/A
HC89023923	M: MISC LAB GENERAL REF LAB-MO	300		N/A	N/A	N/A	N/A
HC89023956	MONONUC CELL ANTGN FLAER&CD157-DEF MONOS-AU	302	86356	29	N/A	N/A	N/A
HC89090062	P: VAP CHOLESTEROL TEST-AU			N/A	N/A	N/A	N/A
HC89090096	P: CHROMO ANALYSIS BLOOD-GZ			N/A	N/A	N/A	N/A
HC89090286	P:ALLERGEN FOOD EXT/PNL AD-AU			N/A	N/A	N/A	N/A
HC89090336	P:CELIAC SEROLOGY(1105PNL2)-PR			N/A	N/A	N/A	N/A
HC89090559	P:TORCH ANTIBODIES  IGM-AU			N/A	N/A	N/A	N/A
HC89090583	P:HEAVY METALS 6-URINE-AU			N/A	N/A	N/A	N/A
HC89090617	P:ANTICARDIOLIPIN AB IGG/IGM-AU			N/A	N/A	N/A	N/A
HC89090765	P:HERPES BY DFA-AU			N/A	N/A	N/A	N/A
HC89090799	P:LYMPHOCYTE PANEL-5 TOT ENUM-AU			N/A	N/A	N/A	N/A
HC89090823	P: PAROX NOCT HEMATURIA  RBC-AU			N/A	N/A	N/A	N/A
HC89091169	P: B PERTUSSIS/PARAPERTUSSIS PCR-AU			N/A	N/A	N/A	N/A
HC89091201	P:CEL PLUS-GEN&SER (CAT #6360-2013)-PR			N/A	N/A	N/A	N/A
HC89091417	CHIKUNGUNYA AB IGM -AU	302	86790	44	N/A	N/A	N/A
HC89091458	P: OPIATES  URINE  QUANTITATIVE-AU			N/A	N/A	N/A	N/A
HC89091490	P: FUNGAL ANTIBODIES BY IMMUNODILUTION			N/A	N/A	N/A	N/A
HC89091706	P: PNH RBC & WBC-AU			N/A	N/A	N/A	N/A
HC89500300	CALL BACK FEE HRLY(2HR MIN)-AA	309	99027	280	N/A	504	N/A
HC89500425	RBC PRETREAT W/DRUG/CHEM-SB	302	86970	75	N/A	89	N/A
HC89500706	CMV IGM / UNIT-SB	302	86645	40	N/A	40	N/A
HC89500748	HLA TYPING A B OR C -SB	302	86813	265	N/A	265	N/A
HC91000163	R&B ISOLATION/PRECAUTIONARY	164		6,678	N/A	N/A	N/A
HC91000243	R&B TELEMETRY CARE	129		9,745	N/A	N/A	N/A
HC91500125	R&B HOSPICE	125		5,009	N/A	N/A	N/A
HC65000250_05107998520	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107999220	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05122401060	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05155202699	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05164585101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05167220801	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65000250_05167221152	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05167240051	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05180101430	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05186245404	NONCDM CHARGE RECORD PHARMACY	250		145	N/A	N/A	N/A
HC65000250_05199107301	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05256509015	NONCDM CHARGE RECORD PHARMACY	250		257	N/A	N/A	N/A
HC65000250_05265260011	NONCDM CHARGE RECORD PHARMACY	250		53	N/A	N/A	N/A
HC65000250_05348912005	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05348936901	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05409219112	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_05428812530	NONCDM CHARGE RECORD PHARMACY	250	Z7610	32	N/A	N/A	N/A
HC65000250_05473814001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511119690	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511123190	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511126381	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_05515016205	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_05551380060	NONCDM CHARGE RECORD PHARMACY	250		55	N/A	N/A	N/A
HC65000250_05723711490	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05723715490	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05723722090	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789610101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789610410	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789618105	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_05789663506	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789679101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789686501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05865752816	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05865767601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05914803713	NONCDM CHARGE RECORD PHARMACY	250	Z7610	289	N/A	N/A	N/A
HC65000250_05936560651	NONCDM CHARGE RECORD PHARMACY	250		84	N/A	N/A	N/A
HC65000250_05965103247	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05974630732	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_05974638406	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05976200501	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_05976213501	NONCDM CHARGE RECORD PHARMACY	250	Z7610	91	N/A	N/A	N/A
HC65000250_05976221983	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05976701601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0	N/A	N/A	N/A
HC65000250_06025816001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06043260616	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06050500336	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06050501651	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06050525808	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050526718	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050531110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06050570822	NONCDM CHARGE RECORD PHARMACY	250		64	N/A	N/A	N/A
HC65000250_06068710421	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65000250_06068719501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068721121	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068729201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068730301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068732501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068737321	NONCDM CHARGE RECORD PHARMACY	250		66	N/A	N/A	N/A
HC65000250_06068738401	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06068738701	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06068743601	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068744301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068749101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068749501	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068750201	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06068754401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068755501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068755801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068759501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068760201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068766101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068768101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06131420615	NONCDM CHARGE RECORD PHARMACY	250		550	N/A	N/A	N/A
HC65000250_06131423710	NONCDM CHARGE RECORD PHARMACY	250		146	N/A	N/A	N/A
HC65000250_06131439601	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65000250_06174801211	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_06178751304	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_06195806011	NONCDM CHARGE RECORD PHARMACY	250		116	N/A	N/A	N/A
HC65000250_06217527137	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06233200191	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06254230117	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_06255919016	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06258489701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06275614201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06275618388	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06330408913	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65000250_06330462501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06330471990	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06332369404	NONCDM CHARGE RECORD PHARMACY	250		83	N/A	N/A	N/A
HC65000250_06332378110	NONCDM CHARGE RECORD PHARMACY	250	J3490	19	N/A	N/A	N/A
HC65000250_06373905110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373908610	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373912710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373926910	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373932810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373936610	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06373948610	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06373954410	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373954973	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06373979610	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373990210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06382472482	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06438016002	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06438073706	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06476473030	NONCDM CHARGE RECORD PHARMACY	250		95	N/A	N/A	N/A
HC65000250_06489666201	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_06495034245	NONCDM CHARGE RECORD PHARMACY	250		50	N/A	N/A	N/A
HC65000250_06516224709	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516236110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516264978	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65000250_06516268210	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06562820605	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_06564930302	NONCDM CHARGE RECORD PHARMACY	250		310	N/A	N/A	N/A
HC65000250_06586200501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586207175	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06586210701	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06586211801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586235430	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06586237401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586253820	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06586257390	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06586260130	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06586276990	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06586284130	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06586292127	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06668900816	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06668903150	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_06668903850	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06699314130	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65000250_06738631401	NONCDM CHARGE RECORD PHARMACY	250		158	N/A	N/A	N/A
HC65000250_06787719805	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787722001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787725115	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_06787754898	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06787773101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06787774957	NONCDM CHARGE RECORD PHARMACY	250		454	N/A	N/A	N/A
HC65000250_06808410711	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_06808411101	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808424401	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06808425301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808432601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808434201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808434601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808445821	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06808448201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808449401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06808464301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808467521	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06808475025	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808477525	NONCDM CHARGE RECORD PHARMACY	250	Z7610	7	N/A	N/A	N/A
HC65000250_06808487001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808489501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808492825	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06809423161	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06809449461	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06809450361	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06818046701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818055409	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818096601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818096801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818097001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838209205	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838212116	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838212305	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838253601	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06838277305	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846215813	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06846219001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846230201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846233090	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846233390	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846271408	NONCDM CHARGE RECORD PHARMACY	250		98	N/A	N/A	N/A
HC65000250_06846285001	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_06868217030	NONCDM CHARGE RECORD PHARMACY	250		348	N/A	N/A	N/A
HC65000250_06909785605	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06923810561	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06923815836	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_06923818361	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06936728302	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06945215020	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06945220713	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06961806401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06968011530	NONCDM CHARGE RECORD PHARMACY	250		88	N/A	N/A	N/A
HC65000250_06978420096	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_07006918101	NONCDM CHARGE RECORD PHARMACY	250		482	N/A	N/A	N/A
HC65000250_07012113955	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65000250_07070026894	NONCDM CHARGE RECORD PHARMACY	250		522	N/A	N/A	N/A
HC65000250_07071011611	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07074813006	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_07095431610	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_07095445610	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07126925010	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07214063377	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_07220501390	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07220504930	NONCDM CHARGE RECORD PHARMACY	250		70	N/A	N/A	N/A
HC65000250_07430000070	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_07431202832	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07620480001	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_07628225701	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_07628266339	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_07733380050	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_07733383510	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07733393810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068108000	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_08068110400	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08290306544	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_08349020760	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000259_07777700050	NONCDM CHARGE RECORD PHARMACY	259	J9153	0	N/A	N/A	N/A
HC65000259_07777700155	NONCDM CHARGE RECORD PHARMACY	259	J9271	0	N/A	N/A	N/A
HC65000278	SUPPLY IMPLANT- PHARMACY (NO NDC)	278		N/A	N/A	N/A	N/A
HC65000636_00003029320	NONCDM CHARGE RECORD PHARMACY	636	J3301	15	N/A	N/A	N/A
HC65000636_00003218713	NONCDM CHARGE RECORD PHARMACY	636	J0129	195	N/A	N/A	N/A
HC65000636_00003256016	NONCDM CHARGE RECORD PHARMACY	636	J3490	179	N/A	N/A	N/A
HC65000636_00008092355	NONCDM CHARGE RECORD PHARMACY	636	C9113	33	N/A	N/A	N/A
HC65000636_00009000302	NONCDM CHARGE RECORD PHARMACY	636	J2930	67	N/A	N/A	N/A
HC65000636_00009069801	NONCDM CHARGE RECORD PHARMACY	636	J2930	29	N/A	N/A	N/A
HC65000636_00009077526	NONCDM CHARGE RECORD PHARMACY	636	J3490	18	N/A	N/A	N/A
HC65000636_00009090211	NONCDM CHARGE RECORD PHARMACY	636	J3490	6	N/A	N/A	N/A
HC65000636_00023114501	NONCDM CHARGE RECORD PHARMACY	636	J0585	32	N/A	N/A	N/A
HC65000636_00024515010	NONCDM CHARGE RECORD PHARMACY	636	J2783	2,645	N/A	N/A	N/A
HC65000636_00026378665	NONCDM CHARGE RECORD PHARMACY	636	J7192	12	N/A	N/A	N/A
HC65000636_00049392083	NONCDM CHARGE RECORD PHARMACY	636	J3486	178	N/A	N/A	N/A
HC65000636_00054001720	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_00054001920	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_00054817525	NONCDM CHARGE RECORD PHARMACY	636	J8540	1	N/A	N/A	N/A
HC65000636_00054818025	NONCDM CHARGE RECORD PHARMACY	636	J8540	0	N/A	N/A	N/A
HC65000636_00069030801	NONCDM CHARGE RECORD PHARMACY	636	Q5116	522	N/A	N/A	N/A
HC65000636_00069034201	NONCDM CHARGE RECORD PHARMACY	636	Q5118	398	N/A	N/A	N/A
HC65000636_00069130510	NONCDM CHARGE RECORD PHARMACY	636	Q5106	59	N/A	N/A	N/A
HC65000636_00069600125	NONCDM CHARGE RECORD PHARMACY	636	J3490	176	N/A	N/A	N/A
HC65000636_00074334603	NONCDM CHARGE RECORD PHARMACY	636	J9217	11,570	N/A	N/A	N/A
HC65000636_00074366303	NONCDM CHARGE RECORD PHARMACY	636	J1950	4,411	N/A	N/A	N/A
HC65000636_00078046791	NONCDM CHARGE RECORD PHARMACY	636	J0895	221	N/A	N/A	N/A
HC65000636_00078082581	NONCDM CHARGE RECORD PHARMACY	636	J2353	1,384	N/A	N/A	N/A
HC65000636_00143925225	NONCDM CHARGE RECORD PHARMACY	636	J1265	4	N/A	N/A	N/A
HC65000636_00143926225	NONCDM CHARGE RECORD PHARMACY	636	J0690	3	N/A	N/A	N/A
HC65000636_00143952510	NONCDM CHARGE RECORD PHARMACY	636	J3490	416	N/A	N/A	N/A
HC65000636_00143954701	NONCDM CHARGE RECORD PHARMACY	636	J9000	1	N/A	N/A	N/A
HC65000636_00143955301	NONCDM CHARGE RECORD PHARMACY	636	J0640	39	N/A	N/A	N/A
HC65000636_00143962301	NONCDM CHARGE RECORD PHARMACY	636	J3490	15	N/A	N/A	N/A
HC65000636_00143967325	NONCDM CHARGE RECORD PHARMACY	636	J1953	1	N/A	N/A	N/A
HC65000636_00143970101	NONCDM CHARGE RECORD PHARMACY	636	J9206	40	N/A	N/A	N/A
HC65000636_00143992490	NONCDM CHARGE RECORD PHARMACY	636	J0690	4	N/A	N/A	N/A
HC65000636_00169720101	NONCDM CHARGE RECORD PHARMACY	636	J7189	16	N/A	N/A	N/A
HC65000636_00264705510	NONCDM CHARGE RECORD PHARMACY	636	J2400	96	N/A	N/A	N/A
HC65000636_00264957710	NONCDM CHARGE RECORD PHARMACY	636	J1644	4	N/A	N/A	N/A
HC65000636_00310304000	NONCDM CHARGE RECORD PHARMACY	636	J0491	100	N/A	N/A	N/A
HC65000636_00338006301	NONCDM CHARGE RECORD PHARMACY	636	Q2050	2,155	N/A	N/A	N/A
HC65000636_00338035702	NONCDM CHARGE RECORD PHARMACY	636	J2150	62	N/A	N/A	N/A
HC65000636_00338107502	NONCDM CHARGE RECORD PHARMACY	636	J1250	118	N/A	N/A	N/A
HC65000636_00338350841	NONCDM CHARGE RECORD PHARMACY	636	J0689	15	N/A	N/A	N/A
HC65000636_00338361224	NONCDM CHARGE RECORD PHARMACY	636	J3490	49	N/A	N/A	N/A
HC65000636_00407141390	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407141482	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_00409018101	NONCDM CHARGE RECORD PHARMACY	636	J9201	58	N/A	N/A	N/A
HC65000636_00409021202	NONCDM CHARGE RECORD PHARMACY	636	J2260	26	N/A	N/A	N/A
HC65000636_00409036601	NONCDM CHARGE RECORD PHARMACY	636	J9171	19	N/A	N/A	N/A
HC65000636_00409120725	NONCDM CHARGE RECORD PHARMACY	636	J1580	6	N/A	N/A	N/A
HC65000636_00409127332	NONCDM CHARGE RECORD PHARMACY	636	J3360	88	N/A	N/A	N/A
HC65000636_00409128337	NONCDM CHARGE RECORD PHARMACY	636	J1170	16	N/A	N/A	N/A
HC65000636_00409188602	NONCDM CHARGE RECORD PHARMACY	636	J1953	1	N/A	N/A	N/A
HC65000636_00409189101	NONCDM CHARGE RECORD PHARMACY	636	J2270	13	N/A	N/A	N/A
HC65000636_00409255201	NONCDM CHARGE RECORD PHARMACY	636	J1170	13	N/A	N/A	N/A
HC65000636_00409263401	NONCDM CHARGE RECORD PHARMACY	636	J1170	9	N/A	N/A	N/A
HC65000636_00409381512	NONCDM CHARGE RECORD PHARMACY	636	J2274	25	N/A	N/A	N/A
HC65000636_00409409201	NONCDM CHARGE RECORD PHARMACY	636		545	N/A	N/A	N/A
HC65000636_00409427602	NONCDM CHARGE RECORD PHARMACY	636	J2001	11	N/A	N/A	N/A
HC65000636_00409471365	NONCDM CHARGE RECORD PHARMACY	636	J2001	3	N/A	N/A	N/A
HC65000636_00409477702	NONCDM CHARGE RECORD PHARMACY	636	J0744	16	N/A	N/A	N/A
HC65000636_00409491134	NONCDM CHARGE RECORD PHARMACY	636	J0461	1	N/A	N/A	N/A
HC65000636_00409647844	NONCDM CHARGE RECORD PHARMACY	636	J1364	122	N/A	N/A	N/A
HC65000636_00409650949	NONCDM CHARGE RECORD PHARMACY	636	J3370	13	N/A	N/A	N/A
HC65000636_00409733201	NONCDM CHARGE RECORD PHARMACY	636	J0696	2	N/A	N/A	N/A
HC65000636_00409733503	NONCDM CHARGE RECORD PHARMACY	636	J0696	2	N/A	N/A	N/A
HC65000636_00409909425	NONCDM CHARGE RECORD PHARMACY	636	J3010	5	N/A	N/A	N/A
HC65000636_00409910420	NONCDM CHARGE RECORD PHARMACY	636	J1265	2	N/A	N/A	N/A
HC65000636_00409915855	NONCDM CHARGE RECORD PHARMACY	636	J3430	31	N/A	N/A	N/A
HC65000636_00517065001	NONCDM CHARGE RECORD PHARMACY	636	J1439	11	N/A	N/A	N/A
HC65000636_00517073510	NONCDM CHARGE RECORD PHARMACY	636	J3490	240	N/A	N/A	N/A
HC65000636_00517095501	NONCDM CHARGE RECORD PHARMACY	636	J2358	24	N/A	N/A	N/A
HC65000636_00548560100	NONCDM CHARGE RECORD PHARMACY	636	J1650	9	N/A	N/A	N/A
HC65000636_00548560400	NONCDM CHARGE RECORD PHARMACY	636	J1650	10	N/A	N/A	N/A
HC65000636_00641036725	NONCDM CHARGE RECORD PHARMACY	636	J1100	1	N/A	N/A	N/A
HC65000636_00641040012	NONCDM CHARGE RECORD PHARMACY	636	J1644	3	N/A	N/A	N/A
HC65000636_00641049325	NONCDM CHARGE RECORD PHARMACY	636	J1165	5	N/A	N/A	N/A
HC65000636_00641602725	NONCDM CHARGE RECORD PHARMACY	636	J3010	8	N/A	N/A	N/A
HC65000636_00641602925	NONCDM CHARGE RECORD PHARMACY	636	J3010	3	N/A	N/A	N/A
HC65000636_00641604425	NONCDM CHARGE RECORD PHARMACY	636	J2060	4	N/A	N/A	N/A
HC65000636_00641611710	NONCDM CHARGE RECORD PHARMACY	636	J0295	31	N/A	N/A	N/A
HC65000636_00641613225	NONCDM CHARGE RECORD PHARMACY	636	J2310	84	N/A	N/A	N/A
HC65000636_00641614625	NONCDM CHARGE RECORD PHARMACY	636	J1100	1	N/A	N/A	N/A
HC65000636_00641623825	NONCDM CHARGE RECORD PHARMACY	636	J3490	163	N/A	N/A	N/A
HC65000636_00703005104	NONCDM CHARGE RECORD PHARMACY	636	J1040	93	N/A	N/A	N/A
HC65000636_00703398601	NONCDM CHARGE RECORD PHARMACY	636	J9263	3	N/A	N/A	N/A
HC65000636_00703424801	NONCDM CHARGE RECORD PHARMACY	636	J9045	44	N/A	N/A	N/A
HC65000636_00703468001	NONCDM CHARGE RECORD PHARMACY	636	J9293	141	N/A	N/A	N/A
HC65000636_00703861023	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_00703904003	NONCDM CHARGE RECORD PHARMACY	636	J0278	1	N/A	N/A	N/A
HC65000636_00781307912	NONCDM CHARGE RECORD PHARMACY	636	J9395	276	N/A	N/A	N/A
HC65000636_00781325394	NONCDM CHARGE RECORD PHARMACY	636	J9025	14	N/A	N/A	N/A
HC65000636_00781326869	NONCDM CHARGE RECORD PHARMACY	636	J1650	15	N/A	N/A	N/A
HC65000636_00781344095	NONCDM CHARGE RECORD PHARMACY	636	J0834	515	N/A	N/A	N/A
HC65000636_00781345196	NONCDM CHARGE RECORD PHARMACY	636	J0690	4	N/A	N/A	N/A
HC65000636_00904662461	NONCDM CHARGE RECORD PHARMACY	636	J7507	13	N/A	N/A	N/A
HC65000636_00942064104	NONCDM CHARGE RECORD PHARMACY	636	J3490	65	N/A	N/A	N/A
HC65000636_00944265603	NONCDM CHARGE RECORD PHARMACY	636	J1566	573	N/A	N/A	N/A
HC65000636_00955102001	NONCDM CHARGE RECORD PHARMACY	636	J9171	35	N/A	N/A	N/A
HC65000636_00990707426	NONCDM CHARGE RECORD PHARMACY	636	J3480	8	N/A	N/A	N/A
HC65000636_00990707726	NONCDM CHARGE RECORD PHARMACY	636	J3480	2	N/A	N/A	N/A
HC65000636_01045471110	NONCDM CHARGE RECORD PHARMACY	636	J0587	9	N/A	N/A	N/A
HC65000636_01199401104	NONCDM CHARGE RECORD PHARMACY	636	Q9957	1,890	N/A	N/A	N/A
HC65000636_01478922010	NONCDM CHARGE RECORD PHARMACY	636	J1953	1	N/A	N/A	N/A
HC65000636_01505400431	NONCDM CHARGE RECORD PHARMACY	636	J9205	390	N/A	N/A	N/A
HC65000636_01671400101	NONCDM CHARGE RECORD PHARMACY	636	J9000	45	N/A	N/A	N/A
HC65000636_01671446701	NONCDM CHARGE RECORD PHARMACY	636	J8520	39	N/A	N/A	N/A
HC65000636_01671481501	NONCDM CHARGE RECORD PHARMACY	636	J3489	163	N/A	N/A	N/A
HC65000636_01671488601	NONCDM CHARGE RECORD PHARMACY	636	J9040	185	N/A	N/A	N/A
HC65000636_01672924231	NONCDM CHARGE RECORD PHARMACY	636	J3489	72	N/A	N/A	N/A
HC65000636_01672926763	NONCDM CHARGE RECORD PHARMACY	636	J9171	8	N/A	N/A	N/A
HC65000636_01672927667	NONCDM CHARGE RECORD PHARMACY	636	J9190	75	N/A	N/A	N/A
HC65000636_01672953308	NONCDM CHARGE RECORD PHARMACY	636	J3420	22	N/A	N/A	N/A
HC65000636_01747801502	NONCDM CHARGE RECORD PHARMACY	636	J0500	263	N/A	N/A	N/A
HC65000636_01747854602	NONCDM CHARGE RECORD PHARMACY	636	J1626	12	N/A	N/A	N/A
HC65000636_01747893401	NONCDM CHARGE RECORD PHARMACY	636	J0360	58	N/A	N/A	N/A
HC65000636_01747893710	NONCDM CHARGE RECORD PHARMACY	636	J3490	59	N/A	N/A	N/A
HC65000636_02315547341	NONCDM CHARGE RECORD PHARMACY	636	J1940	14	N/A	N/A	N/A
HC65000636_02315549742	NONCDM CHARGE RECORD PHARMACY	636	J0780	30	N/A	N/A	N/A
HC65000636_02315554931	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_02502112120	NONCDM CHARGE RECORD PHARMACY	636	J0692	21	N/A	N/A	N/A
HC65000636_02502112850	NONCDM CHARGE RECORD PHARMACY	636	J0713	25	N/A	N/A	N/A
HC65000636_02502117967	NONCDM CHARGE RECORD PHARMACY	636	J0878	1	N/A	N/A	N/A
HC65000636_02502118482	NONCDM CHARGE RECORD PHARMACY	636	J1450	49	N/A	N/A	N/A
HC65000636_02502131110	NONCDM CHARGE RECORD PHARMACY	636	J1940	4	N/A	N/A	N/A
HC65000636_02502140001	NONCDM CHARGE RECORD PHARMACY	636	J1644	15	N/A	N/A	N/A
HC65000636_02502140102	NONCDM CHARGE RECORD PHARMACY	636	J1644	34	N/A	N/A	N/A
HC65000636_02502160851	NONCDM CHARGE RECORD PHARMACY	636	J2704	2	N/A	N/A	N/A
HC65000636_02502161282	NONCDM CHARGE RECORD PHARMACY	636	J3475	7	N/A	N/A	N/A
HC65000636_02502167620	NONCDM CHARGE RECORD PHARMACY	636	J2515	455	N/A	N/A	N/A
HC65000636_02568200101	NONCDM CHARGE RECORD PHARMACY	636	J1300	1,413	N/A	N/A	N/A
HC65000636_03600000824	NONCDM CHARGE RECORD PHARMACY	636	J0744	13	N/A	N/A	N/A
HC65000636_03982210001	NONCDM CHARGE RECORD PHARMACY	636	J3490	50	N/A	N/A	N/A
HC65000636_04202310501	NONCDM CHARGE RECORD PHARMACY	636	J3490	69	N/A	N/A	N/A
HC65000636_04236757087	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,167	N/A	N/A	N/A
HC65000636_04257124469	NONCDM CHARGE RECORD PHARMACY	636	J0706	28	N/A	N/A	N/A
HC65000636_04265802102	NONCDM CHARGE RECORD PHARMACY	636	J9150	358	N/A	N/A	N/A
HC65000636_04359830920	NONCDM CHARGE RECORD PHARMACY	636	J9027	858	N/A	N/A	N/A
HC65000636_04359852936	NONCDM CHARGE RECORD PHARMACY	636	J2710	8	N/A	N/A	N/A
HC65000636_04359866625	NONCDM CHARGE RECORD PHARMACY	636	J0330	12	N/A	N/A	N/A
HC65000636_04420643710	NONCDM CHARGE RECORD PHARMACY	636	J1459	430	N/A	N/A	N/A
HC65000636_04456710110	NONCDM CHARGE RECORD PHARMACY	636	J0290	19	N/A	N/A	N/A
HC65000636_04456750601	NONCDM CHARGE RECORD PHARMACY	636	J9267	2	N/A	N/A	N/A
HC65000636_04456762124	NONCDM CHARGE RECORD PHARMACY	636	J0610	103	N/A	N/A	N/A
HC65000636_04456770725	NONCDM CHARGE RECORD PHARMACY	636	J0690	4	N/A	N/A	N/A
HC65000636_04733599201	NONCDM CHARGE RECORD PHARMACY	636	J3475	20	N/A	N/A	N/A
HC65000636_04778158868	NONCDM CHARGE RECORD PHARMACY	636	J2250	2	N/A	N/A	N/A
HC65000636_04928121515	NONCDM CHARGE RECORD PHARMACY	636	90714	234	N/A	N/A	N/A
HC65000636_05024208527	NONCDM CHARGE RECORD PHARMACY	636	J2997	535	N/A	N/A	N/A
HC65000636_05024210301	NONCDM CHARGE RECORD PHARMACY	636	J9309	696	N/A	N/A	N/A
HC65000636_05041932511	NONCDM CHARGE RECORD PHARMACY	636	A9585	5	N/A	N/A	N/A
HC65000636_05045856401	NONCDM CHARGE RECORD PHARMACY	636	J2426	0	N/A	N/A	N/A
HC65000636_05175405001	NONCDM CHARGE RECORD PHARMACY	636	J0706	25	N/A	N/A	N/A
HC65000636_05175412203	NONCDM CHARGE RECORD PHARMACY	636	J2710	6	N/A	N/A	N/A
HC65000636_05175920210	NONCDM CHARGE RECORD PHARMACY	636	J3031	0	N/A	N/A	N/A
HC65000636_05487902201	NONCDM CHARGE RECORD PHARMACY	636	J8530	23	N/A	N/A	N/A
HC65000636_05511165237	NONCDM CHARGE RECORD PHARMACY	636	J0583	15	N/A	N/A	N/A
HC65000636_05511167810	NONCDM CHARGE RECORD PHARMACY	636	J3490	150	N/A	N/A	N/A
HC65000636_05515015974	NONCDM CHARGE RECORD PHARMACY	636	J2001	3	N/A	N/A	N/A
HC65000636_05515016330	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_05515022810	NONCDM CHARGE RECORD PHARMACY	636	J3243	14	N/A	N/A	N/A
HC65000636_05515024251	NONCDM CHARGE RECORD PHARMACY	636	J2020	105	N/A	N/A	N/A
HC65000636_05515036425	NONCDM CHARGE RECORD PHARMACY	636	J3420	22	N/A	N/A	N/A
HC65000636_05539000310	NONCDM CHARGE RECORD PHARMACY	636	J1800	40	N/A	N/A	N/A
HC65000636_05539050005	NONCDM CHARGE RECORD PHARMACY	636	J3490	14	N/A	N/A	N/A
HC65000636_05551367001	NONCDM CHARGE RECORD PHARMACY	636	Q5121	325	N/A	N/A	N/A
HC65000636_05551388002	NONCDM CHARGE RECORD PHARMACY	636	J3111	65	N/A	N/A	N/A
HC65000636_05556622000	NONCDM CHARGE RECORD PHARMACY	636	J2597	132	N/A	N/A	N/A
HC65000636_05816084252	NONCDM CHARGE RECORD PHARMACY	636	90715	274	N/A	N/A	N/A
HC65000636_05816095801	NONCDM CHARGE RECORD PHARMACY	636	90734	850	N/A	N/A	N/A
HC65000636_05967634001	NONCDM CHARGE RECORD PHARMACY	636	J0885	160	N/A	N/A	N/A
HC65000636_05974617306	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_05992360110	NONCDM CHARGE RECORD PHARMACY	636	J2430	125	N/A	N/A	N/A
HC65000636_06050561470	NONCDM CHARGE RECORD PHARMACY	636	J3490	6	N/A	N/A	N/A
HC65000636_06050561505	NONCDM CHARGE RECORD PHARMACY	636	J0696	5	N/A	N/A	N/A
HC65000636_06050562304	NONCDM CHARGE RECORD PHARMACY	636	J9264	94	N/A	N/A	N/A
HC65000636_06131431801	NONCDM CHARGE RECORD PHARMACY	636	Q5101	6	N/A	N/A	N/A
HC65000636_06131486601	NONCDM CHARGE RECORD PHARMACY	636	Q5120	0	N/A	N/A	N/A
HC65000636_06170330916	NONCDM CHARGE RECORD PHARMACY	636	J9370	25	N/A	N/A	N/A
HC65000636_06170334909	NONCDM CHARGE RECORD PHARMACY	636	J9206	54	N/A	N/A	N/A
HC65000636_06170340841	NONCDM CHARGE RECORD PHARMACY	636	J9260	12	N/A	N/A	N/A
HC65000636_06275651244	NONCDM CHARGE RECORD PHARMACY	636	J0456	39	N/A	N/A	N/A
HC65000636_06293545345	NONCDM CHARGE RECORD PHARMACY	636	J9217	2,936	N/A	N/A	N/A
HC65000636_06332301020	NONCDM CHARGE RECORD PHARMACY	636	J1580	13	N/A	N/A	N/A
HC65000636_06332306423	NONCDM CHARGE RECORD PHARMACY	636	J3475	4	N/A	N/A	N/A
HC65000636_06332310601	NONCDM CHARGE RECORD PHARMACY	636	J3475	6	N/A	N/A	N/A
HC65000636_06332310801	NONCDM CHARGE RECORD PHARMACY	636	J3475	26	N/A	N/A	N/A
HC65000636_06332316501	NONCDM CHARGE RECORD PHARMACY	636	J1100	4	N/A	N/A	N/A
HC65000636_06332317260	NONCDM CHARGE RECORD PHARMACY	636	J9045	57	N/A	N/A	N/A
HC65000636_06332326206	NONCDM CHARGE RECORD PHARMACY	636	J1644	5	N/A	N/A	N/A
HC65000636_06332326929	NONCDM CHARGE RECORD PHARMACY	636	J2704	2	N/A	N/A	N/A
HC65000636_06332328630	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_06332328811	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_06332329427	NONCDM CHARGE RECORD PHARMACY	636	J0670	27	N/A	N/A	N/A
HC65000636_06332334225	NONCDM CHARGE RECORD PHARMACY	636	J0694	46	N/A	N/A	N/A
HC65000636_06332336019	NONCDM CHARGE RECORD PHARMACY	636	J0610	66	N/A	N/A	N/A
HC65000636_06332337601	NONCDM CHARGE RECORD PHARMACY	636	J2354	16	N/A	N/A	N/A
HC65000636_06332341510	NONCDM CHARGE RECORD PHARMACY	636	J2710	18	N/A	N/A	N/A
HC65000636_06332341820	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,839	N/A	N/A	N/A
HC65000636_06332349226	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_06332349257	NONCDM CHARGE RECORD PHARMACY	636	J2001	5	N/A	N/A	N/A
HC65000636_06332350601	NONCDM CHARGE RECORD PHARMACY	636	J1100	4	N/A	N/A	N/A
HC65000636_06332353784	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332354013	NONCDM CHARGE RECORD PHARMACY	636	J1644	24	N/A	N/A	N/A
HC65000636_06332354067	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_06332359616	NONCDM CHARGE RECORD PHARMACY	636	J1610	1,053	N/A	N/A	N/A
HC65000636_06332360401	NONCDM CHARGE RECORD PHARMACY	636	J1800	56	N/A	N/A	N/A
HC65000636_06332360788	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332366401	NONCDM CHARGE RECORD PHARMACY	636	J1200	16	N/A	N/A	N/A
HC65000636_06332367305	NONCDM CHARGE RECORD PHARMACY	636	J2469	27	N/A	N/A	N/A
HC65000636_06332380620	NONCDM CHARGE RECORD PHARMACY	636	J3010	5	N/A	N/A	N/A
HC65000636_06332388330	NONCDM CHARGE RECORD PHARMACY	636	J9000	41	N/A	N/A	N/A
HC65000636_06332396010	NONCDM CHARGE RECORD PHARMACY	636	J3243	20	N/A	N/A	N/A
HC65000636_06373990128	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_06373995325	NONCDM CHARGE RECORD PHARMACY	636	J1644	4	N/A	N/A	N/A
HC65000636_06383338702	NONCDM CHARGE RECORD PHARMACY	636	J7168	20	N/A	N/A	N/A
HC65000636_06521925701	NONCDM CHARGE RECORD PHARMACY	636	J3490	130	N/A	N/A	N/A
HC65000636_06521938310	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_06673395823	NONCDM CHARGE RECORD PHARMACY	636	J9055	469	N/A	N/A	N/A
HC65000636_06679415702	NONCDM CHARGE RECORD PHARMACY	636	J0475	1,536	N/A	N/A	N/A
HC65000636_06745721720	NONCDM CHARGE RECORD PHARMACY	636	J1230	115	N/A	N/A	N/A
HC65000636_06745723901	NONCDM CHARGE RECORD PHARMACY	636	J2354	13	N/A	N/A	N/A
HC65000636_06745729202	NONCDM CHARGE RECORD PHARMACY	636	J2310	80	N/A	N/A	N/A
HC65000636_06745742010	NONCDM CHARGE RECORD PHARMACY	636	J1100	1	N/A	N/A	N/A
HC65000636_06745742612	NONCDM CHARGE RECORD PHARMACY	636	J1630	6	N/A	N/A	N/A
HC65000636_06745744022	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_06745765725	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,099	N/A	N/A	N/A
HC65000636_06745783902	NONCDM CHARGE RECORD PHARMACY	636	J3490	845	N/A	N/A	N/A
HC65000636_06787726601	NONCDM CHARGE RECORD PHARMACY	636	J7517	2	N/A	N/A	N/A
HC65000636_06800140775	NONCDM CHARGE RECORD PHARMACY	636	J3370	62	N/A	N/A	N/A
HC65000636_06851652142	NONCDM CHARGE RECORD PHARMACY	636	P9045	299	N/A	N/A	N/A
HC65000636_06851652162	NONCDM CHARGE RECORD PHARMACY	636	P9047	301	N/A	N/A	N/A
HC65000636_06872771201	NONCDM CHARGE RECORD PHARMACY	636	J9223	1,143	N/A	N/A	N/A
HC65000636_06937431625	NONCDM CHARGE RECORD PHARMACY	636	J3490	145	N/A	N/A	N/A
HC65000636_06937498810	NONCDM CHARGE RECORD PHARMACY	636	J3490	780	N/A	N/A	N/A
HC65000636_06980042031	NONCDM CHARGE RECORD PHARMACY	636	90371	461	N/A	N/A	N/A
HC65000636_07012111681	NONCDM CHARGE RECORD PHARMACY	636	J3301	15	N/A	N/A	N/A
HC65000636_07012115741	NONCDM CHARGE RECORD PHARMACY	636	J1040	124	N/A	N/A	N/A
HC65000636_07059404502	NONCDM CHARGE RECORD PHARMACY	636	J3370	19	N/A	N/A	N/A
HC65000636_07059405301	NONCDM CHARGE RECORD PHARMACY	636	J0878	1	N/A	N/A	N/A
HC65000636_07059408902	NONCDM CHARGE RECORD PHARMACY	636	J0692	21	N/A	N/A	N/A
HC65000636_07086020005	NONCDM CHARGE RECORD PHARMACY	636	J9267	3	N/A	N/A	N/A
HC65000636_07086020350	NONCDM CHARGE RECORD PHARMACY	636	J9305	107	N/A	N/A	N/A
HC65000636_07086021810	NONCDM CHARGE RECORD PHARMACY	636	J9070	458	N/A	N/A	N/A
HC65000636_07086077602	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_07101918301	NONCDM CHARGE RECORD PHARMACY	636	J3475	14	N/A	N/A	N/A
HC65000636_07128840202	NONCDM CHARGE RECORD PHARMACY	636	J1644	12	N/A	N/A	N/A
HC65000636_07128840311	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_07219660441	NONCDM CHARGE RECORD PHARMACY	636	J2590	22	N/A	N/A	N/A
HC65000636_07220503601	NONCDM CHARGE RECORD PHARMACY	636	J0894	49	N/A	N/A	N/A
HC65000636_07226610341	NONCDM CHARGE RECORD PHARMACY	636	J3490	3	N/A	N/A	N/A
HC65000636_07257206125	NONCDM CHARGE RECORD PHARMACY	636	J0696	2	N/A	N/A	N/A
HC65000636_07257207624	NONCDM CHARGE RECORD PHARMACY	636	J3490	15	N/A	N/A	N/A
HC65000636_07257212225	NONCDM CHARGE RECORD PHARMACY	636	J1100	1	N/A	N/A	N/A
HC65000636_07257243025	NONCDM CHARGE RECORD PHARMACY	636	J2250	2	N/A	N/A	N/A
HC65000636_07257255010	NONCDM CHARGE RECORD PHARMACY	636	C9113	18	N/A	N/A	N/A
HC65000636_07261178502	NONCDM CHARGE RECORD PHARMACY	636	J9330	335	N/A	N/A	N/A
HC65000636_07309042101	NONCDM CHARGE RECORD PHARMACY	636	J2860	826	N/A	N/A	N/A
HC65000636_07607510201	NONCDM CHARGE RECORD PHARMACY	636	J9047	305	N/A	N/A	N/A
HC65000636_07612579210	NONCDM CHARGE RECORD PHARMACY	636	P9047	314	N/A	N/A	N/A
HC65000636_07632933161	NONCDM CHARGE RECORD PHARMACY	636	J0171	6	N/A	N/A	N/A
HC65000636_08077727399	NONCDM CHARGE RECORD PHARMACY	636	91306	0	N/A	N/A	N/A
HC65000636_08290306414	NONCDM CHARGE RECORD PHARMACY	636	J1642	1	N/A	N/A	N/A
HC65000636_08290306515	NONCDM CHARGE RECORD PHARMACY	636	J1642	0	N/A	N/A	N/A
HC65000637_00002831501	NONCDM CHARGE RECORD PHARMACY	636	J1815	5	N/A	N/A	N/A
HC65000637_00002871517	NONCDM CHARGE RECORD PHARMACY	636	J1815	5	N/A	N/A	N/A
HC65000637_00169368712	NONCDM CHARGE RECORD PHARMACY	636	J1815	10	N/A	N/A	N/A
HC65000637_00169750111	NONCDM CHARGE RECORD PHARMACY	636	J1815	8	N/A	N/A	N/A
HC65000637_00955172805	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65001258_00264180032	NONCDM CHARGE RECORD PHARMACY	258	J7050	15	N/A	N/A	N/A
HC65001258_00264751010	NONCDM CHARGE RECORD PHARMACY	636	J7060	19	N/A	N/A	N/A
HC65001258_00264775000	NONCDM CHARGE RECORD PHARMACY	636	J7120	19	N/A	N/A	N/A
HC62226931	DEVICE EMULSION SUBMUCOSAL INJ AMPOULE	272		284	N/A	N/A	N/A
HC62226964	CANNULA PERFUSION                 O	272		1,120	N/A	N/A	N/A
HC62227137	PROBE ABLATION                   AS	272		8,001	N/A	N/A	N/A
HC62227160	BLADE INCISIONAL                  T	272		1,400	N/A	N/A	N/A
HC62227194	BLADE HOOK  ENDOSCOPIC	272		1,260	N/A	N/A	N/A
HC62227335	GUIDE PIN ORTHO                   H	272		411	N/A	N/A	N/A
HC62227368	CUTTER SEALER BIPOLAR ULTRASONIC	272		1,399	N/A	N/A	N/A
HC62227392	KIT CONCENTRATOR PLATELETS        O	272		1,120	N/A	N/A	N/A
HC62227566	PUNCH ARTHROSCOPIC                B	272		280	N/A	N/A	N/A
HC62227590	REAMER                           AK	272		2,900	N/A	N/A	N/A
HC62227772	SET TUBING HARVESTER GRAFT ENDO	272		1,750	N/A	N/A	N/A
HC62227806	CANNISTER COLLECTING TISSUE (DHS)	272		280	N/A	N/A	N/A
HC62227970	PASSER SUTURE	272		1,256	N/A	N/A	N/A
HC62228002	LOOP PLASMA	272		4,802	N/A	N/A	N/A
HC62228036	CATH INTRACARDIAC ECHO/UTZ        H	272	C1759	9,800	N/A	N/A	N/A
HC62228176	ORTH WHO W/NONTORSION JOINTS CUSTOM	274	L3905	3,063	N/A	N/A	N/A
HC62228200	ORTH WHO W/NONTORSION JOINT(S) PREFAB CUSTOM	274	L3915	1,642	N/A	N/A	N/A
HC62228234	ORTH HO METACARPAL FRACTURE PREFAB OTS	274	L3918	326	N/A	N/A	N/A
HC62228408	SHEATH STEERBL GUIDE SUREFLEX (WATCHMAN)	272	C1766	3,150	N/A	N/A	N/A
HC62228432	SHEATH GUIDING TORFLEX (WATCHMAN)	272	C1893	560	N/A	N/A	N/A
HC62228606	WOUND FILLER GEL(PLUROGEL)-1.75OZ	272	A6261	341	N/A	N/A	N/A
HC62228630	CARTRIDGE ENZYME DIGEST RELIZORB	272		137	N/A	N/A	N/A
HC62228663	GUIDEWIRE(BABYWIRE)               A	272		43	N/A	N/A	N/A
HC62228804	DEVICE CLOSURE VASCULAR?????????? M	272	C1760	862	N/A	N/A	N/A
HC62228838	CATH MEASUREMENT ENDOFLIP	272	C1726	1,382	N/A	N/A	N/A
HC62228861	DEVICE SUTURE CAPTURE (VALVE)	272		408	N/A	N/A	N/A
HC62229000	CATH THROMBECTOMY                AZ	272	C1757	17,500	N/A	N/A	N/A
HC62229034	GEL VISCOUS SOL PRE-FILLED SYSTEM (ORISE)	272		333	N/A	N/A	N/A
HC62229067	PATCH EKG AUSCULA LVDP VIVIO	272		1	N/A	N/A	N/A
HC62290101	P:EXT BREECH VERSION			N/A	N/A	N/A	N/A
HC62290184	P:VAGINAL DELIVERY			N/A	N/A	N/A	N/A
HC62300074	DISSECTOR ROBOTIC                 F	272		316	N/A	N/A	N/A
HC62300108	DRIVER NEEDLE ROBOTIC	272		806	N/A	N/A	N/A
HC62300132	GRASPER ROBOTIC                   E	272		700	N/A	N/A	N/A
HC62300272	FORCEP ROBOTIC                    H	272		420	N/A	N/A	N/A
HC62300306	FORCEP ROBOTIC                    M	272		840	N/A	N/A	N/A
HC62300447	FORCEP ROBOTIC                    F	272		280	N/A	N/A	N/A
HC62800115	BALLOON TAMPONADE UTERINE	272	C1726	2,128	N/A	N/A	N/A
HC62800149	CATH ANGIOGRAPHY W/BALLOON        O	272	C1887	1,120	N/A	N/A	N/A
HC62800313	CATH EP DX <20 ELECTRODES         N	272	C1730	2,520	N/A	N/A	N/A
HC62800347	CATH EP/ABLATION COOL-TIP         G	272	C2630	4,900	N/A	N/A	N/A
HC62800529	CATH TRANSLUM ANGIO LASER         U	272	C1885	9,800	N/A	N/A	N/A
HC62800552	CATH OCCLUSION                    Q	272	C2628	1,400	N/A	N/A	N/A
HC62800586	DEVICE THROMBECTOMY/EMBOLECTOMY   X	272	C1757	3,850	N/A	N/A	N/A
HC62800727	M: BONE MORPHOGENET PROTN OP1	278		N/A	N/A	N/A	N/A
HC62800750	M: BREAST MAMMOSITE	278	C1728	N/A	N/A	N/A	N/A
HC62800784	CABLE DALL MILES	278		1,248	N/A	N/A	N/A
HC62800958	COIL EMBOLIZATION                 J	278		1,311	N/A	N/A	N/A
HC62800982	M: EAR OSSICULAR PROSTHESIS	278	L8613	1,193	N/A	N/A	N/A
HC62801154	M: CUP ACETABULAR HIP	278	C1776	3,680	N/A	N/A	N/A
HC62801188	M: COMPONENT MISC/REVISION HIP	278	C1776	4,074	N/A	N/A	N/A
HC62801212	M: INTERSPINOUS DEVICE/ XSTOP	278	C1821	N/A	N/A	N/A	N/A
HC62801352	M: LEAD ICD ENDO SNGL COIL	275	C1777	10,238	N/A	N/A	N/A
HC62801394	M: LEAD PCMKR NON-TRANSVENOUS	275	C1898	1,320	N/A	N/A	N/A
HC62801428	M: MANDIBULAR COMPONENT	278	L8699	N/A	N/A	N/A	N/A
HC62801568	M: PACEMAKER DUAL CHMBR RATE RESPONSIVE	275	C1785	12,806	N/A	N/A	N/A
HC62801592	M: PACEMAKER SNGL CHMBR RATE RESPONSIVE	275	C1786	11,200	N/A	N/A	N/A
HC62801626	M: PENILE PROSTH (NON INFLAT)	278	C2622	N/A	N/A	N/A	N/A
HC62801790	M: RING HEART	278	C1889	N/A	N/A	N/A	N/A
HC62801824	M: SCREW MAXILLOFACIAL	278	C1713	221	N/A	N/A	N/A
HC62801998	M: ROD SPINAL	278	L8699	799	N/A	N/A	N/A
HC62802020	M:STAPLE FIXATION ANCHOR BONE-BONE	278	C1713	4,364	N/A	N/A	N/A
HC62802053	STENT ENDOPRSTH TIPS(VIATORR)     K	278	C1874	14,700	N/A	N/A	N/A
HC62802194	STENT NON-CORON TEMP NO DELIV SYS L	278	C2617	586	N/A	N/A	N/A
HC62802228	M: SYRINGE CONTIGEN	278	L8603	N/A	N/A	N/A	N/A
HC62802251	M: TISSUE FASCIA LATA HUMAN	278	C1762	3,654	N/A	N/A	N/A
HC62802426	INTRODUCER/SHEATH                 H	272	C1894	420	N/A	N/A	N/A
HC62802459	INTRODUCER GUIDE	272	C1894	159	N/A	N/A	N/A
HC62802632	BUTTON TEFLON/PLASTIC	278		126	N/A	N/A	N/A
HC62802665	NEEDLE TEMPLAT ENDOCURR	278	C1715	633	N/A	N/A	N/A
HC62802848	SET PEG 14-20 FR  CONMED          G	278	A4649	350	N/A	N/A	N/A
HC62802871	TUBE JEJUN STANDRD TRANSGAS       L	278	A4649	704	N/A	N/A	N/A
HC62802905	PARTICLES EMBOLIZATION            Q	278		1,400	N/A	N/A	N/A
HC62803044	M: COCHLEAR DEVICE/SYSTEM	278	L8614	N/A	N/A	N/A	N/A
HC62803077	M: LVAD/RVAD IMPLANT	278	C1889	89,421	N/A	N/A	N/A
HC62803101	M: VALVE HEART MECH AORTIC	278	C1889	93,775	N/A	N/A	N/A
HC62803275	M: SUTURE KNOTLS ANCHR SFT TISS-BONE	278	C1713	1,485	N/A	N/A	N/A
HC62803309	CATH VENTRICL EXT DRAIN/MONITR	278	A4300	2,147	N/A	N/A	N/A
HC62803473	M: COVER SCREW	278	C1776	N/A	N/A	N/A	N/A
HC62803515	CAP END SCREW	278		306	N/A	N/A	N/A
HC62803697	CATH ABLATION THERMO HALO        AD	272	C1886	5,950	N/A	N/A	N/A
HC62803721	CATHETER PACING BIPOLAR           E	272	C1779	200	N/A	N/A	N/A
HC62803754	STENT NON-COAT/NON-COV W-DEL      X	278	C1876	3,850	N/A	N/A	N/A
HC62803895	STENT CORO BARE METAL W/DEL       F	278	C1876	3,500	N/A	N/A	N/A
HC62803929	STENT CORO BARE METAL W/DEL       I	278	C1876	5,600	N/A	N/A	N/A
HC62803952	STENT URETERAL                    C	278	C2617	104	N/A	N/A	N/A
HC62804125	M: DERMAGRAFT PER SQ CM	636	Q4106	8,585	N/A	N/A	N/A
HC62804166	COIL EMBOLIZATION                 D	278	C1889	410	N/A	N/A	N/A
HC62804349	COIL EMBOLIZATION                 X	278		3,220	N/A	N/A	N/A
HC62804372	COIL EMBOLIZATION                AA	278		3,640	N/A	N/A	N/A
HC62804406	COIL EMBOLIZ(AXIUM PRIME 3D 3MM) AD	278		4,060	N/A	N/A	N/A
HC62804547	M: NAIL BLADE	278	C1713	3,730	N/A	N/A	N/A
HC62804570	M: PEG ORTHO	278		300	N/A	N/A	N/A
HC62804604	STENT CORO BARE METAL W/DEL       K	278	C1876	7,000	N/A	N/A	N/A
HC62804778	M: REPL JNT PHAL METACARP2/+METAL+CER	278	L8631	N/A	N/A	N/A	N/A
HC62804802	M: SPACER JNT INTERPHAL SILICN/= EA	278	L8658	N/A	N/A	N/A	N/A
HC62804976	TUBE GASTROSTOMY KIT              I	278	A4649	513	N/A	N/A	N/A
HC62805007	M: CAP END CAGE	278		4,712	N/A	N/A	N/A
HC62805171	M: MISC SURGICAL IMPLANT	278		7,434	N/A	N/A	N/A
HC62805205	M: BLOCK ORTHO	278		4,102	N/A	N/A	N/A
HC62805239	M: RAIL SPINAL	278	C1889	N/A	N/A	N/A	N/A
HC62805387	CATH ATHERECTOMY ROTATNL (PREDATOR)	272	C1724	10,483	N/A	N/A	N/A
HC62805411	M: MATRIX WOUND FLOWABLE 3 ML	278	Q4114	N/A	N/A	N/A	N/A
HC62805445	M: SYSTEM REVISION SHOULDER	278	C1776	9,614	N/A	N/A	N/A
HC62805619	DEVICE ABLAT COOL-TIP NONVASC     F	272	C1886	4,550	N/A	N/A	N/A
HC62805643	DEVICE ABLAT COOL-TIP NONVASC    AG	272	C1886	7,000	N/A	N/A	N/A
HC62805817	HEMOSTATIC GEL/GELFOAM/PAD        K	272		554	N/A	N/A	N/A
HC62805841	HEMOSTATIC GEL/GELFOAM/PAD        N	272		1,308	N/A	N/A	N/A
HC62806013	INTRO/SHEATH STEERABLE NON-PEEL   I	272	C1766	4,200	N/A	N/A	N/A
HC62806047	CATH DIALYSIS SHORT-TERM          E	278	C1752	316	N/A	N/A	N/A
HC62806070	CATH HICKMAN/BROVIAC              H	278	C1751	420	N/A	N/A	N/A
HC62806211	STENT DES CORO COV W/DEL SYS      S	278	C1874	8,225	N/A	N/A	N/A
HC62806245	SYSTEM PERFUSION VENOUS(ANGIOVAC)	278	C1889	45,499	N/A	N/A	N/A
HC62806278	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP X	272	C1733	3,850	N/A	N/A	N/A
HC62806443	PORT INDWELLING W/CATH            I	278	C1788	1,260	N/A	N/A	N/A
HC62806476	GOLD SEED MARKER FIDUCIAL EA(ALPHAOMEGA)M	278	A4648	840	N/A	N/A	N/A
HC62806641	DIVERTER FLOW NEUROVASC(PIPELINE LG)E	278	C1889	52,482	N/A	N/A	N/A
HC62806674	INTRO/SHEATH STEERABLE NON-PEEL   E	272	C1766	2,800	N/A	N/A	N/A
HC62806708	CATH EP DIAG/ABLAT 3D/VECT        N	272	C1732	4,900	N/A	N/A	N/A
HC62806849	STENT ENDOPRSTH TAA              AE	278	C1874	62,999	N/A	N/A	N/A
HC62806872	STENT ENDOPRSTH PVD(VIABAHN)      F	278	C1874	10,633	N/A	N/A	N/A
HC62806906	CATH SWAN GANZ/THERMODILUTION     L	278		666	N/A	N/A	N/A
HC62807045	COIL NEUROVASCULAR(TARGET SOFT)  AC	278		5,600	N/A	N/A	N/A
HC62807078	COIL NEUROVASC(TARGET XL 360 SOFT)AJ	278	C1889	9,100	N/A	N/A	N/A
HC62807102	PROBE LITHOTRIPTOR ELECTRHYDRLC  AE	278		6,300	N/A	N/A	N/A
HC62807276	DEVICE CONTRACEPTION IUD PARAGARD	278	J7300	799	N/A	N/A	N/A
HC62807300	STENT TRACHEOBRONC COV W/DEL SYS  C	278	C1874	6,300	N/A	N/A	N/A
HC62807482	M: ALLOWRAP DS/DRY PER SQ CM	636	Q4150	N/A	N/A	N/A	N/A
HC62807516	M: FOOTPLATE ANT DISTRACTOR MAXILLARY	278	C1713	N/A	N/A	N/A	N/A
HC62807540	M: ARM EXTENSION DISTRACTOR	278	C1713	N/A	N/A	N/A	N/A
HC62807680	M: STEM INTERPHALANGEAL	278	C1713	4,200	N/A	N/A	N/A
HC62807714	M: ANCHOR LEAD NEUROSTIM	278		7,740	N/A	N/A	N/A
HC62807748	M: GENRTR NRSTM HI FREQU RE-CHRG&CHRGR	278	C1822	94,060	N/A	N/A	N/A
HC62807912	STENT URETERAL                    E	278	C2617	210	N/A	N/A	N/A
HC62807946	FIBRIN SEALANT                    D	278		6,832	N/A	N/A	N/A
HC62808118	STENT ENDOPRSTH TAA IDE G040175	624	C1874	52,499	N/A	N/A	N/A
HC62808142	I:FECAL MICROBIOTA (FMP250)	278	G0455	1,829	N/A	N/A	N/A
HC62808316	M: HIP FEM MODULAR COMPONENT ADAPTER	278	C1776	3,500	N/A	N/A	N/A
HC62808340	KIT SPRAYER & POWDER HEMOSTATIC	278	C1052	10,769	N/A	N/A	N/A
HC62808373	M: BONE GRAFT MATRIX(FIBERGRAFT BG)	278	C1889	8,475	N/A	N/A	N/A
HC62808514	CLIP DELIVERY SYSTEM MITRACLIP	278	C1889	104,998	N/A	N/A	N/A
HC62808548	LEAD SENSING RESPIRATORY(INSPIRE?)	278	C1778	11,812	N/A	N/A	N/A
HC62808571	STENT FULLY COVERED VIABIL	278	C1874	8,400	N/A	N/A	N/A
HC62808753	CATH INDIGO THROMB SEPARATOR 6FR L175CM[PENUMBRA]	272	C1757	3,780	N/A	N/A	N/A
HC62808787	CATH INDIGO THROMB 6FRXL135CM[PENUMBRA]	272	C1757	6,268	N/A	N/A	N/A
HC62808951	DEVICE SUTURE ENDO X-TACK	278		2,226	N/A	N/A	N/A
HC62808985	CATH PTA W/BALLOON RX(DCB)        M	272	C2623	8,785	N/A	N/A	N/A
HC62890009	P:PERITONEAL CATH KIT/3COMPNTS			N/A	N/A	N/A	N/A
HC62890231	P: AICD SINGLE C1722 W/LEAD C1777 OR C1895(1)			N/A	N/A	N/A	N/A
HC65000250	MEDICATION-GENERAL  (MCAL Z7610)	250		39	N/A	N/A	N/A
HC65000250_00002327030	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_00005445174	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00006011254	NONCDM CHARGE RECORD PHARMACY	250		112	N/A	N/A	N/A
HC65000250_00006022761	NONCDM CHARGE RECORD PHARMACY	250		194	N/A	N/A	N/A
HC65000250_00023040330	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00023050650	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00025172003	NONCDM CHARGE RECORD PHARMACY	250		82	N/A	N/A	N/A
HC65000250_00032121201	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_00032122407	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65000250_00054001021	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00054001121	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00054005746	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_00054040022	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00054046823	NONCDM CHARGE RECORD PHARMACY	250		85	N/A	N/A	N/A
HC65000250_00054458111	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_00054829725	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00065053001	NONCDM CHARGE RECORD PHARMACY	250		112	N/A	N/A	N/A
HC65000250_00065079550	NONCDM CHARGE RECORD PHARMACY	250		120	N/A	N/A	N/A
HC65000250_00067001624	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00071101268	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_00071101541	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65000250_00074372790	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00078042315	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65000250_00078050883	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_00093026215	NONCDM CHARGE RECORD PHARMACY	250		237	N/A	N/A	N/A
HC65000250_00093031801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093172301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093206506	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093220310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093317431	NONCDM CHARGE RECORD PHARMACY	250		178	N/A	N/A	N/A
HC65000250_00093412774	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00093415579	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6	N/A	N/A	N/A
HC65000250_00093729056	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_00093738201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093970101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00096073204	NONCDM CHARGE RECORD PHARMACY	250		80	N/A	N/A	N/A
HC65000250_00115146860	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_00121052710	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00121057616	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00121059500	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_00121074700	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_00121074750	NONCDM CHARGE RECORD PHARMACY	250		51	N/A	N/A	N/A
HC65000250_00121082016	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00121096694	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00121097800	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_00121174410	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00121176230	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00121183605	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00132007912	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00132019012	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_00132030140	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00149003904	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_00149003942	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_00172392560	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00172524060	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00185505001	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00187410010	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00225052547	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_00228253910	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00228254050	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00228262011	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00245021311	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00245531701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00299391753	NONCDM CHARGE RECORD PHARMACY	250	Z7610	25	N/A	N/A	N/A
HC65000250_00310111030	NONCDM CHARGE RECORD PHARMACY	250		156	N/A	N/A	N/A
HC65000250_00310620530	NONCDM CHARGE RECORD PHARMACY	250		118	N/A	N/A	N/A
HC65000250_00378086001	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00378108693	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00378180377	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00378306577	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00378334999	NONCDM CHARGE RECORD PHARMACY	250		121	N/A	N/A	N/A
HC65000250_00378336099	NONCDM CHARGE RECORD PHARMACY	250		121	N/A	N/A	N/A
HC65000250_00378699789	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00378804321	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00395041396	NONCDM CHARGE RECORD PHARMACY	250	Z7610	23	N/A	N/A	N/A
HC65000250_00395103116	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00406012362	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00406831562	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00406839062	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_00406910076	NONCDM CHARGE RECORD PHARMACY	250		179	N/A	N/A	N/A
HC65000250_00409488750	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00409488820	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00456140530	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65000250_00456141030	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_00472173803	NONCDM CHARGE RECORD PHARMACY	250		96	N/A	N/A	N/A
HC65000250_00487020103	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00487900330	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00501340102	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00525113990	NONCDM CHARGE RECORD PHARMACY	250	Z7610	39	N/A	N/A	N/A
HC65000250_00527128201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527328346	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527328646	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536114397	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_00536118612	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536121195	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_00536130485	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00536132701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536134957	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_00536570028	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00536589688	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00536781710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00573445174	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574006930	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574052104	NONCDM CHARGE RECORD PHARMACY	250	Z7610	87	N/A	N/A	N/A
HC65000250_00574200302	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_00574402450	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65000250_00591046001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00591060601	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00591225879	NONCDM CHARGE RECORD PHARMACY	250		87	N/A	N/A	N/A
HC65000250_00597004037	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_00597014030	NONCDM CHARGE RECORD PHARMACY	250		105	N/A	N/A	N/A
HC65000250_00603154258	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_00603158658	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00713050312	NONCDM CHARGE RECORD PHARMACY	250		70	N/A	N/A	N/A
HC65000250_00713066431	NONCDM CHARGE RECORD PHARMACY	250		358	N/A	N/A	N/A
HC65000250_00781106101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00781286831	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00781602346	NONCDM CHARGE RECORD PHARMACY	250	Z7610	90	N/A	N/A	N/A
HC65000250_00781729685	NONCDM CHARGE RECORD PHARMACY	250		234	N/A	N/A	N/A
HC65000250_00832121200	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00832121400	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832712401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00869060243	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6	N/A	N/A	N/A
HC65000250_00904078816	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904145361	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904188361	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904404073	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904504260	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904505359	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904549261	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904552261	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904585461	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904586061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904589361	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904617261	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904623761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904626908	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_00904632361	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00904635161	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904635761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904641292	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904642761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904647661	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904648838	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_00904650261	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904655861	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904657061	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_00904658304	NONCDM CHARGE RECORD PHARMACY	250		50	N/A	N/A	N/A
HC65000250_00904666561	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904667104	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904673059	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904674172	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00904679480	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904679861	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904680806	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904684072	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_00904686190	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904687045	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904698520	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904698861	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904702404	NONCDM CHARGE RECORD PHARMACY	250		151	N/A	N/A	N/A
HC65000250_00904704304	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904704561	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904709561	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904710561	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904710961	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904716261	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904717961	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904718861	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00904759161	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904773445	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_01000673013	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01000673051	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01011902090	NONCDM CHARGE RECORD PHARMACY	250	Z7610	31	N/A	N/A	N/A
HC65000250_01035610110	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_01037083111	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_01070203645	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01093939644	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093945944	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_01093991144	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01152311591	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_01287000011	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01310703105	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01310708305	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01366813201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01366827101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01392550530	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_01657181320	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671400701	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01671407204	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671408110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671408401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671417201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671417503	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671418602	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_01671435501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671439301	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_01671443901	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_01671450302	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_01671461201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671466101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671466202	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671467102	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_01671469801	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01671471301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671471801	NONCDM CHARGE RECORD PHARMACY	250		96	N/A	N/A	N/A
HC65000250_01671479501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671480001	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01671484201	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65000250_01671484402	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671497302	NONCDM CHARGE RECORD PHARMACY	250		218	N/A	N/A	N/A
HC65000250_01671498901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672903101	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_01672918401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672927310	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01672927901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01672945715	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01686468002	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_01747822412	NONCDM CHARGE RECORD PHARMACY	250		508	N/A	N/A	N/A
HC65000250_01747828435	NONCDM CHARGE RECORD PHARMACY	250		203	N/A	N/A	N/A
HC65000250_01747876610	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01785600795	NONCDM CHARGE RECORD PHARMACY	250	Z7610	32	N/A	N/A	N/A
HC65000250_01785606001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_02159934562	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_02315502601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315510301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315566301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_02315572501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_02420883060	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_02433810603	NONCDM CHARGE RECORD PHARMACY	250	Z7610	36	N/A	N/A	N/A
HC65000250_02433812403	NONCDM CHARGE RECORD PHARMACY	250		60	N/A	N/A	N/A
HC65000250_02660800118	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_02660802125	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_02724106303	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65000250_02780819001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_02903300305	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02930012601	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_03172215390	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03172256560	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_03172272250	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03172273030	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03172282030	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03334205610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03334206410	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03334209009	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03700080301	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_03786490599	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04056512249	NONCDM CHARGE RECORD PHARMACY	250		556	N/A	N/A	N/A
HC65000250_04110081123	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_04219234001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04219261501	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_04229107615	NONCDM CHARGE RECORD PHARMACY	250	Z7610	14	N/A	N/A	N/A
HC65000250_04229180030	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04229203820	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04245742060	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_04279912001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04279980601	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_04285800301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04285830125	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04285886706	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_04354722610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354727503	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354727609	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354735410	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354737803	NONCDM CHARGE RECORD PHARMACY	250		134	N/A	N/A	N/A
HC65000250_04354740110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04359844828	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_04359896630	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_04580205935	NONCDM CHARGE RECORD PHARMACY	250		91	N/A	N/A	N/A
HC65000250_04580206070	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04580206336	NONCDM CHARGE RECORD PHARMACY	250		53	N/A	N/A	N/A
HC65000250_04580235803	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04580241954	NONCDM CHARGE RECORD PHARMACY	250		132	N/A	N/A	N/A
HC65000250_04580243411	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_04580295226	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04596343965	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_04733500788	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_04733537983	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65000250_04778157701	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_04778165490	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04778166590	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04934802827	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_04934804537	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04934815078	NONCDM CHARGE RECORD PHARMACY	250		51	N/A	N/A	N/A
HC65000250_04934879072	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_04934886137	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04988405501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04988425601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05011133301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05011139801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05011156001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05022817705	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05022842730	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026805415	NONCDM CHARGE RECORD PHARMACY	250	Z7610	17	N/A	N/A	N/A
HC65000250_05026814115	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_05026817715	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026832115	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05026834615	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026835213	NONCDM CHARGE RECORD PHARMACY	250	Z7610	8	N/A	N/A	N/A
HC65000250_05026847615	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05026852015	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026852515	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026859915	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_05026860415	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026868515	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_05026870015	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026878815	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_05026885115	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026885815	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05038307913	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_05038317104	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05038326161	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_05038377933	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05038381016	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_05045863965	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65000250_05047400148	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_05074223830	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_05074226101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05074251530	NONCDM CHARGE RECORD PHARMACY	250		264	N/A	N/A	N/A
HC65000250_05107913320	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107916403	NONCDM CHARGE RECORD PHARMACY	250	Z7610	55	N/A	N/A	N/A
HC65000250_05107918020	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_05107942520	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05107944020	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05107968420	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107972220	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_05107973520	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107988220	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_05107992120	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107992420	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC45400132	MR C-SPINE W/O CONTRAST	612	72141	6,627	N/A	N/A	N/A
HC45400165	MR LOW EXT(NON JNT)W/O CONT BIL	610	73718	12,214	N/A	N/A	N/A
HC45400330	MR LOW EXT(JNT)W&W/O CONT RT	610	73723	9,940	N/A	N/A	N/A
HC45400363	MR L-SPINE W/O CONTRAST	612	72148	7,551	N/A	N/A	N/A
HC45400553	MR UP EXT(NON JNT)W/CONT RT	610	73219	7,244	N/A	N/A	N/A
HC45400587	MR UP EXT(NON JNT) W&W/O RT	610	73220	10,290	N/A	N/A	N/A
HC45400751	MRA PELVIS W/O & W/ CONTRAST	610	C8920	7,248	N/A	N/A	N/A
HC45400835	MRI CARDIAC MORPH W/O CONT	610	75557	6,854	N/A	N/A	N/A
HC45400892	MR UPPER EXT JNT W&W/O CONT RT	610	73223	10,995	N/A	N/A	N/A
HC45401122	MR BREASTS W/O&W CONTRAST (BILAT)	610	C8908	8,378	N/A	N/A	N/A
HC45401189	MRA LOW EXT W/CONT LT	610	C8912	5,418	N/A	N/A	N/A
HC45401213	MRA LOW EXT W/O CONT  LT	610	C8913	5,999	N/A	N/A	N/A
HC45401437	MRA UPPER EXT W/O&W/CONT LT	610	C8936	5,475	N/A	N/A	N/A
HC45401551	MRI FETAL PLACENTAL PLVC IF PRF; EA ADDL+	610	74713	3,441	N/A	N/A	N/A
HC46000014	INJ AIR/CONTRAST PERITONEAL CAVITY	361	49400	5,091	N/A	N/A	N/A
HC46000063	INJ ARTHRO/CT/MRI SHOULDER-LT	361	23350	1,770	N/A	N/A	N/A
HC46000105	INJ ARTHROGRAM ANKLE-RT	361	27648	1,106	N/A	N/A	N/A
HC46000378	INJ FOR RETRO URETHROCYSTO	361	51610	2,037	N/A	N/A	N/A
HC46000402	INJ OF GT/COLON TUBE; PATENCY W/IMAG	361	49465	3,091	N/A	N/A	N/A
HC46000444	INJ VENOGRAM EXTREMITY-LT	361	36005	1,521	N/A	N/A	N/A
HC46000683	INJ PROC;TRACER  SENTINEL NODE	361	38792	2,551	N/A	N/A	N/A
HC46000717	SEL CATH AB/PEL/LOEXT1ST OR LT	321	36245	7,074	N/A	N/A	N/A
HC46000758	SEL CATH AB/PEL/LOEXT2ND OR RT	321	36246	7,853	N/A	N/A	N/A
HC46000949	SEL CATH THOR/BRAC+ 2ND/3RD LT	321	36218	1,847	N/A	N/A	N/A
HC46000972	SEL VENOUS CATH 1ST ORD LT	321	36011	3,077	N/A	N/A	N/A
HC46001251	INJ CHOLANGIO PERC/S&I;EXIST ACCESS	361	47531	6,413	N/A	N/A	N/A
HC46001285	INJ ANTEGRAD COMP(NEPH/URET'GRM S&I)NEW ACCESS LT	361	50430	6,110	N/A	N/A	N/A
HC46001319	INJ ANTEGRAD NEPH/URET'GRM S&I EXIST ACCESS LT	361	50431	3,991	N/A	N/A	N/A
HC46500211	BX BONE TROC/NEEDLE; SUPERFICIAL	361	20220	6,392	N/A	N/A	N/A
HC46500286	BIOPSY NEEDLE ABD/RETROMASS	361	49180	6,330	N/A	N/A	N/A
HC46500310	BIOPSY NEEDLE RENAL-LT	361	50200	7,747	N/A	N/A	N/A
HC46500567	BX SFT TISS PELV/HIP-LT	361	27040	6,399	N/A	N/A	N/A
HC46500617	CHANGE CYSTOSTOMY TUBE; SIMPLE	361	51705	2,321	N/A	N/A	N/A
HC46500955	INS PICC LINE W/PORT>5YR	361	36571	14,384	N/A	N/A	N/A
HC46500989	INS TUN CV ACCESS DEV W/PORT 5YRS+	361	36561	18,671	N/A	N/A	N/A
HC46501177	PUNCTURE SPINAL TX DRAIN CSF [NOT W/FLUORO/CT]	361	62272	4,780	N/A	N/A	N/A
HC46501201	MANOMETRIC STDY VIA NEPHRO RT	361	50396	2,776	N/A	N/A	N/A
HC46501235	PERITONEAL LAVAGE W-W/O IMAG GUIDE	361	49084	5,248	N/A	N/A	N/A
HC46501417	REPAIR CV ACCESS CATH W/PORT	361	36576	9,167	N/A	N/A	N/A
HC46501441	REPLACE PERC GT/CEC TUBE W/FLUORO	361	49450	6,567	N/A	N/A	N/A
HC46501474	REPLC TUNNELED CV ACS DEVICE W/PORT	361	36582	16,274	N/A	N/A	N/A
HC46501722	BX/RMVL LYMPH NODE(S)-OPEN RT	361	38510	9,368	N/A	N/A	N/A
HC46501755	BX LYMPH NODE(S) DEEP CERVICAL	361	38510	9,368	N/A	N/A	N/A
HC46502035	BX SOFT TISS THIGH/KNEE;SUP BI	361	27323	6,095	N/A	N/A	N/A
HC46502068	BIOPSY PLEURA NEEDLE	361	32400	3,532	N/A	N/A	N/A
HC46502100	DRAIN CYSTS OVA UNI/BIL ABD APPR	361	58805	12,338	N/A	N/A	N/A
HC46502241	PERC PLC BRST LOC DEV US 1ST LESN	361	19285	4,890	N/A	N/A	N/A
HC46502274	PERC PLC BRST LOC DEV MR ADDL LESN+	361	19288	5,603	N/A	N/A	N/A
HC46502308	PERC DRAIN CATH W/IMAG; PERITONEAL/RETROPERIT	361	49406	8,371	N/A	N/A	N/A
HC46502449	PLCMT CATH NEPHURET PERC(NEPH/URET'GRM S&I)NEW ACC LT	361	50433	10,348	N/A	N/A	N/A
HC46502472	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM S&I)EXST LT	361	50434	8,075	N/A	N/A	N/A
HC46502506	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM S&I) LT	361	50435	9,385	N/A	N/A	N/A
HC46502670	FNA ASP BX W/CT; FIRST LESION	361	10009	4,686	N/A	N/A	N/A
HC46502704	FNA ASP BX W/MR; EACH ADD'L LESION	361	10012	3,883	N/A	N/A	N/A
HC46502894	REVASC LITHOTRIP ARTHERECTOMY TIBIA/PERONEAL ENDOVASC	361	C9774	21,041	N/A	N/A	N/A
HC46502928	ABLATION PERC CRYO UPPER EXTREMITY NERVE INCLD IMAG	361	0440T	7,627	N/A	N/A	N/A
HC46502951	INSERTION DEVICE INTRAUTERINE IUD	361	58300	4,235	N/A	N/A	N/A
HC46503090	BX SOFT TISS FOREARM&/WRIST DEEP LT	361	25066	5,808	N/A	N/A	N/A
HC46503124	BX SOFT TISS SHOULDER DEEP LT	361	23066	5,687	N/A	N/A	N/A
HC46503157	BX SOFT TISS UPPER ARM/ELBOW SUP LT	361	24065	5,082	N/A	N/A	N/A
HC46503322	BIOPSY MUSCLE SUPERFICIAL RT	361	20200	4,235	N/A	N/A	N/A
HC46590147	P:CIRCUMCISION PROC/DISP SUPPLIES			N/A	N/A	N/A	N/A
HC47200290	M: MISC RAD TX PROC PLANNING	333	77299	N/A	N/A	N/A	N/A
HC47200324	PLC BRACHY CATH W/PART MAST BIL	361	19298	29,907	N/A	N/A	N/A
HC47200589	SPECIAL TELETHERAPY PORT PLAN	333	77321	3,411	N/A	N/A	N/A
HC47200621	THERAPEUTIC RAD PORT IMAGES	333	77417	1,074	N/A	N/A	N/A
HC47200654	TREATMENT DEVICES INTERMEDIATE	333	77333	2,347	N/A	N/A	N/A
HC47200803	RADIOPHARM' TX; IV ADMIN	333	79101	2,279	N/A	N/A	N/A
HC47200837	SRS ROBOTIC TX 1 SESSN  CMPLT(CRANIAL)	333	77372	34,488	N/A	N/A	N/A
HC47200860	PLACE DEVICE/MARKER OTHER SITES(NON-PROST)	333	C9728	7,425	N/A	N/A	N/A
HC47201108	GUIDANCE RADIAJ TX DLVR (TRACKING)	333	77387	2,903	N/A	N/A	N/A
HC47201132	HDR RADIONUCLIDE INTRSTTL/INTRVIT BRACH 12+ CHANN	333	77772	14,730	N/A	N/A	N/A
HC51000099	CYSTOGRAM COMPLEX	361	51726	764	N/A	N/A	N/A
HC51000123	VOIDING PRESSURE STUDIES+	361	51797	242	N/A	N/A	N/A
HC51000396	HOSPITAL OUTPATIENT CLINIC VISIT (FACILITY FEE)	510	99213	227	N/A	N/A	N/A
HC51000420	IVAD IRRIGATION	940	96523	126	N/A	N/A	N/A
HC51000453	REMOV IMPL VEN CATH DEVICE	361	36589	1,015	N/A	N/A	N/A
HC51001188	CLOSED TX HUMERUS NECK FX NO MANIP	361	23600	723	N/A	N/A	N/A
HC51001212	CLOSED TX HUMRL CON FX MED/LAT NO M	361	24576	1,069	N/A	N/A	N/A
HC51001246	CLOSED TX ULNAR FX	361	24670	794	N/A	N/A	N/A
HC51001410	CLOSED TX BIMALLEO ANKLE FX NO MAN	361	27808	1,081	N/A	N/A	N/A
HC51001444	CLOSED TX TOE FX	361	28510	300	N/A	N/A	N/A
HC51001618	ECG ROUTINE 12+ LEADS; TRACING ONLY	730	93005	126	N/A	N/A	N/A
HC51001642	X-RAY SPINE LUMBOSACRAL; MIN 4VWS	320	72110	373	N/A	N/A	N/A
HC51001683	X-RAY SHOULDER; COMPLETE MIN 2 VWS	320	73030	249	N/A	N/A	N/A
HC51001857	X-RAY ANKLE 3+ VWS	320	73610	241	N/A	N/A	N/A
HC51001881	X-RAY BONE AGE STUDIES	320	77072	215	N/A	N/A	N/A
HC51001915	WBC MANUAL DIFF	305	85007	35	N/A	N/A	N/A
HC51002145	INJ FOR CYSTOGRAM	361	51600	522	N/A	N/A	N/A
HC51002178	CYSTOMETROGRAM W/VOID PRSSR& URTH PRFL	361	51729	1,278	N/A	N/A	N/A
HC51002343	INJ RETROGRADE URETHROCYSTO	361	51610	537	N/A	N/A	N/A
HC51002376	US PELVIC(NON OB)LTD OR F/U	402	76857	241	N/A	N/A	N/A
HC51002574	REMOV IMPACTD EAR WAX IRRIG/LAVG RT	361	69209	204	N/A	N/A	N/A
HC51002608	IMPLANT PELLET(S) HORMONE SUBQ	361	11980	272	N/A	N/A	N/A
HC51002632	THORACENTESIS ASP W/O IMG GUID	361	32554	1,099	N/A	N/A	N/A
HC51002772	BLADDER IRRIGATION SIMPLE	361	51700	456	N/A	N/A	N/A
HC51002806	STUDY REFLEX BLADDER URINARY	361	51792	170	N/A	N/A	N/A
HC51002830	CYSTOURETHROSCOPY W/BX(S)	361	52204	2,586	N/A	N/A	N/A
HC51003036	BIOPSY PENIS(SEPARATE PROC)	361	54100	2,057	N/A	N/A	N/A
HC51003069	ASP/INJ HYDROCELE	361	55000	1,087	N/A	N/A	N/A
HC51003234	COLPOSCOPY VAG W/BX(S)VAGINA/CERVIX	361	57421	1,754	N/A	N/A	N/A
HC51003267	COLPOSCPY CERV&ADJ VAG W/CERV BX(S)	361	57455	726	N/A	N/A	N/A
HC51003440	SMOKING CESSATION > 10 MIN	942	99407	102	N/A	N/A	N/A
HC51003499	SCREENING MISUSE BEHAVIORAL ETOH	770	G0443	148	N/A	N/A	N/A
HC51003622	ANOSCOPY DX (INCL COLLECTION)	361	46600	450	N/A	N/A	N/A
HC51003861	FRENULOTOMY PENIS	361	54164	2,292	N/A	N/A	N/A
HC51003895	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S)	361	38222	2,109	N/A	N/A	N/A
HC51003929	BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F 1ST 15MIN	919	90912	152	N/A	N/A	N/A
HC51010163	DESTRUCT OTHER PERIPH NERV/BRNCH RT	361	64640	1,033	N/A	N/A	N/A
HC51010197	ASP/INJ SMALL JNT-SC RT	361	20600	280	N/A	N/A	N/A
HC51010361	REFILL MAINT IMPLNT PMP/RESV WANAL'	261	95990	482	N/A	N/A	N/A
HC51010395	EMG 2 EXTREMITY	922	95861	693	N/A	N/A	N/A
HC51010429	EMG THORACIC PARASPINAL(NO T1/T12)	922	95869	241	N/A	N/A	N/A
HC51010569	IMMUNTX NOT INCL EXTRACT 1 INJ	924	95115	71	N/A	N/A	N/A
HC51010593	IMMUNOTHERAPY 2/> INJECTIONS /COMM	924	95125	139	N/A	N/A	N/A
HC51010627	IMMNTX 3 STING INSECTS /COMM	924	95132	170	N/A	N/A	N/A
HC51010783	DEBRIDE MASTOIDECT CAVITY COMPLEX	361	69222	994	N/A	N/A	N/A
HC51010833	BONE MARROW DX; ASPIRATION(S) ONLY	361	38220	1,321	N/A	N/A	N/A
HC51010866	THORACENTESIS W/TUBE W/IMAGING	361	32557	1,529	N/A	N/A	N/A
HC51020238	RN-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	900	96110	226	N/A	N/A	N/A
HC51020261	NP TEAM CONFER PRTCPNT PER 15MIN	920	Z4310	53	N/A	N/A	N/A
HC51030013	SW TEAM CONF PRTCPNT PER 15MIN	920	Z4311	49	N/A	N/A	N/A
HC51040004	RD ASSESS/EDUCATE PER 30MIN	942	Z4308	93	N/A	N/A	N/A
HC51040038	RD COORDINATOR ACTIVITIES CASE	920	Z4300	327	N/A	N/A	N/A
HC51060077	PT-TEAM CASE CONFERENCE EA 15MIN/C	420		49	N/A	N/A	N/A
HC51060101	OT-TEAM CASE CONFERENCE EA 15MIN/C	430		52	N/A	N/A	N/A
HC51060135	ST-TEAM CASE CONF  EA 15MIN/C	440		49	N/A	N/A	N/A
HC51060572	DESTROY MUSCLE(S) NECK NO LARYNX RT	361	64616	742	N/A	N/A	N/A
HC51060606	DESTROY MUSCLE(S) LARYNX RT	361	64617	1,082	N/A	N/A	N/A
HC51060770	OT-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	430	96112	399	N/A	N/A	N/A
HC51060804	PT-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	420	96113	163	N/A	N/A	N/A
HC51061075	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM S&I) LT	361	50435	2,840	N/A	N/A	N/A
HC51061109	US RETROPERITONEAL COMPLETE	402	76770	605	N/A	N/A	N/A
HC51061133	CLOSED TX FINGER/THUMB SHAFT FX W/MANIP EA	361	26725	739	N/A	N/A	N/A
HC51061430	ECG EXT HOLTER UP TO 48HRS; SCANNING ANYS & REPORT	731	93226	251	N/A	N/A	N/A
HC51061463	ECG EXT HOLTER >48HRS-7DAYS; SCANNING ANYS W/REPORT	731	93243	179	N/A	N/A	N/A
HC51061497	ECG EXT PT ACTV EVENT MONITOR ATTEND 24HRS-30DAYS;HOOK&RECORD	731	93270	140	N/A	N/A	N/A
HC51061687	3D RENDER W/O INDENDNPT WORKSTN	320	76376	216	N/A	N/A	N/A
HC51061711	ECHO FETAL DOPPLER COMPLETE	483	76827	379	N/A	N/A	N/A
HC51061885	X-RAY SHOULDER; 1 VW	320	73020	216	N/A	N/A	N/A
HC51061919	X-RAY LOWER EXTREMITY  INFANT MIN 2 VWS	320	73592	227	N/A	N/A	N/A
HC51061943	SPIROMETRY PT INITIATED 30DAY; HOOKUP RECORD TREND RECALIBRATION	460	94015	541	N/A	N/A	N/A
HC51062115	GENETIC COUNSELING 30 MIN	940	96040	216	N/A	N/A	N/A
HC51062149	URINALYSIS AUTO W/ MICROSCOPY	307	81001	22	N/A	N/A	N/A
HC51062172	PLACENTAL ALPHA MICROGLOBULIN-1	301	84112	162	N/A	N/A	N/A
HC51062313	CPSP NUTRITION INIT' ASSESS AND DEV POC; EA ADD' 15MIN	940	Z6202	32	N/A	N/A	N/A
HC51062347	CPSP POSTPRTM NUTRITION ASSES TX POC INDVIDUAL;EA 15MIN	940	Z6208	32	N/A	N/A	N/A
HC51062370	CPSP ANTEPRTM PSYCHOSOCIAL F/U ASSESS/TX INDIV'; EA 15MIN	940	Z6304	32	N/A	N/A	N/A
HC51062552	CONTROL NASAL HEMORRHAGE POST W/PCKS+/OR CAUTRY INT'L	361	30905	297	N/A	N/A	N/A
HC51062586	TYMPANOMETRY IMPEDANCE	471	92567	130	N/A	N/A	N/A
HC51062768	APPLY SPLINT SHORT LEG BILATERAL	700	29515	442	N/A	N/A	N/A
HC51062792	COMPLEX CHRONIC CARE MGMT INITL 60MIN  PER MONTH	949	99487	442	N/A	N/A	N/A
HC51062826	COMPRE ASSESS&CARE PLAN CHRONIC CARE MGMT+	949	G0506	208	N/A	N/A	N/A
HC51062966	REMOVE SUTURE&STAPLES NOT REQUIRING ANESTHESIA+	949	15854	78	N/A	N/A	N/A
HC51062990	DEBRIDE SKIN MUSL/BONE; FIRST 20SQCM	361	11044	3,744	N/A	N/A	N/A
HC51063022	DEBRIDE SKIN MUSL/BONE EA ADD20SQCM/<	361	11047	1,248	N/A	N/A	N/A
HC51063196	FOOT CARE DIABETIC PT W/LOPS BY MD	940	G0247	468	N/A	N/A	N/A
HC51063220	KETONES  URINE DIPSTICK POC	307	81002	16	N/A	N/A	N/A
HC51070373	PSYCH TX W/PATIENT 45MIN	914	90834	324	N/A	N/A	N/A
HC51070407	PSY TX W/PATIENT 60MIN W/E&M+	914	90838	584	N/A	N/A	N/A
HC51070613	BEHAVIOR ID ASSESS ADMIN BY QHCP PT/GUARD EA 15MIN	918	97151	88	N/A	N/A	N/A
HC51070647	BEHAVIOR ADAPT MULT FAM TX GDN W/O PT; EA 15MIN	918	97157	88	N/A	N/A	N/A
HC51070670	PSY-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	900	96113	163	N/A	N/A	N/A
HC51070811	PSY-BEHAV TX FAM W/O PT ADD 15	916	96171	48	N/A	N/A	N/A
HC51099999	NO CHARGE OPSC	510		N/A	N/A	N/A	N/A
HC62200027	CAUTERY TIP                       D	272		140	N/A	N/A	N/A
HC62200233	ASPIRATOR ULTRASONIC SURG         E	272		2,760	N/A	N/A	N/A
HC62200266	BAG BLOOD COLLECTION APHERESIS	270		42	N/A	N/A	N/A
HC62200449	BANDS RADIAL OCCLUSIVE	272		210	N/A	N/A	N/A
HC62200472	BINDER ABDOMINAL BASIC            C	270		106	N/A	N/A	N/A
HC62200654	BODY ALIGNER	272		415	N/A	N/A	N/A
HC62200688	TAMP BONE KYPHOPLASTY             J	278	C1889	3,929	N/A	N/A	N/A
HC62200712	BOOT WAFFLE DISP	270		108	N/A	N/A	N/A
HC62200860	BURN PADS	272		269	N/A	N/A	N/A
HC62200894	BURR                              F	272		419	N/A	N/A	N/A
HC62200944	CABLE PACING DISP                 E	272		246	N/A	N/A	N/A
HC62201116	CAP PEG	272		41	N/A	N/A	N/A
HC62201157	CASTING MATERIAL FIBERGLASS	272		42	N/A	N/A	N/A
HC62201330	CATH DIALYSIS SHORT-TERM          J	278	C1752	666	N/A	N/A	N/A
HC62201363	CATH ERCP (PUSHING)               C	272		421	N/A	N/A	N/A
HC62201397	CATH FEM ART SET	272		183	N/A	N/A	N/A
HC62201546	CATH ROBINSON/STRAIGHT	272		42	N/A	N/A	N/A
HC62201579	CATH SUPRAPUBIC/CYSTOSCOPIC       H	272	C2627	420	N/A	N/A	N/A
HC62201603	CATH UMBILICAL SINGLE LUMEN       D	272		140	N/A	N/A	N/A
HC62201785	CIRCUIT VENT HI-FREQ	270		873	N/A	N/A	N/A
HC62201819	CLAMP MORGAN	272		80	N/A	N/A	N/A
HC62202015	COVER FOOT AV IMPULSE	272		543	N/A	N/A	N/A
HC62202049	INJECTOR KIT SINGLE	272		92	N/A	N/A	N/A
HC62202213	DEVICE EXPRESS CORE BX	272		265	N/A	N/A	N/A
HC62202247	DEVICE HOLD OCCL LEVERAGE	272		246	N/A	N/A	N/A
HC62202270	DISSECTOR CURVED SHORT	272		910	N/A	N/A	N/A
HC62202445	DRESSING BURN NET	272		36	N/A	N/A	N/A
HC62202486	BARRIER ADHESION PELVIC(INTERCEED)	278	C1765	1,351	N/A	N/A	N/A
HC62202528	DRESSING OXYCEL	272		335	N/A	N/A	N/A
HC62202726	ELECTRODE QUICK COMBO	272		125	N/A	N/A	N/A
HC62202759	ELECTRODE TUR LOOP	272		324	N/A	N/A	N/A
HC62202924	ENDO REDUCER	272		70	N/A	N/A	N/A
HC62202957	ENDO SCRUB SHEATH	272		232	N/A	N/A	N/A
HC62203138	ET SET COLO/ILEO	272		213	N/A	N/A	N/A
HC62203161	ET SKIN SPRAY	272		148	N/A	N/A	N/A
HC62203237	EVACUATOR BLADDER	272		80	N/A	N/A	N/A
HC62203419	FORCEP BIOPSY DISP                J	272		627	N/A	N/A	N/A
HC62203443	GAS INTRAOCULAR                   D	272		1,045	N/A	N/A	N/A
HC62203484	HEMOCONCENTATOR	272		280	N/A	N/A	N/A
HC62203716	KIT BIOPSY	272		70	N/A	N/A	N/A
HC62203740	KIT CATH CV	272		672	N/A	N/A	N/A
HC62203914	SEALANT (FLOSEAL) KIT 5CC	278		665	N/A	N/A	N/A
HC62203948	KIT INFLATION	272		316	N/A	N/A	N/A
HC62203971	INTRODUCER/SHEATH                 D	272	C1894	140	N/A	N/A	N/A
HC62204110	KIT ORAL SUCTION/CATH	272		78	N/A	N/A	N/A
HC62204144	KIT PHACO	272		102	N/A	N/A	N/A
HC62204177	KIT PRESSURE MONITOR/TRANSDUCER   C	272		106	N/A	N/A	N/A
HC62204318	KIT TRANSJUGULAR VENOUS ACCESS	278	C1751	2,800	N/A	N/A	N/A
HC62204342	KIT VERTEBROPLASTY DISP	272		8,022	N/A	N/A	N/A
HC62204375	KIT VACUUM EXTRACTION	272		106	N/A	N/A	N/A
HC62204557	LOOPS VASCULAR	272		34	N/A	N/A	N/A
HC62204581	M: GI LAB MISC SUPPLY	270		3,149	N/A	N/A	N/A
HC62204763	MORCELLATOR	272	C1782	2,235	N/A	N/A	N/A
HC62204805	PACKING/BALLOON NASAL             F	270		280	N/A	N/A	N/A
HC62204839	NEBULIZER (GENERIC)	272		130	N/A	N/A	N/A
HC62204987	NEEDLE SCLEROTHERAPY	272		102	N/A	N/A	N/A
HC62205018	NEEDLE STEREOTACTIC BX	272		1,855	N/A	N/A	N/A
HC62205042	NEEDLE WIRE LOCALIZATION          F	272	C1819	280	N/A	N/A	N/A
HC62205232	KIT CUSA	272		1,016	N/A	N/A	N/A
HC62205265	PACK EYE	272		218	N/A	N/A	N/A
HC62205430	PACK TOTAL JOINT	272		248	N/A	N/A	N/A
HC62205463	PACK UROLOGY CYSTO MINOR	272		126	N/A	N/A	N/A
HC62205646	PEN SKIN MARKER	272		42	N/A	N/A	N/A
HC62205687	PILLOW CERVICAL	270		130	N/A	N/A	N/A
HC62205711	PLUG SILICONE	272		192	N/A	N/A	N/A
HC62205851	PROBE PRASS STANDARD NIM	272		694	N/A	N/A	N/A
HC62205893	PUNCH AORTIC                      O	272		526	N/A	N/A	N/A
HC62205927	RESERVIOR JACKSON PRATT	272		241	N/A	N/A	N/A
HC62206099	SET ANCHOR GASTROINTESTINAL	272		206	N/A	N/A	N/A
HC62206123	SET TUBING	272		210	N/A	N/A	N/A
HC62206297	SET LACRIMAL INTUBATION	272		223	N/A	N/A	N/A
HC62206321	SET LUMBAR DRAIN	272		771	N/A	N/A	N/A
HC62206354	SET PROSTATE STABILIZATION	272		428	N/A	N/A	N/A
HC62206503	SHIELD EYE                        D	272		61	N/A	N/A	N/A
HC62206545	SKIN ADHESIVE TOP 0.5ML APPL	272		70	N/A	N/A	N/A
HC62206586	SNARE                             G	272		350	N/A	N/A	N/A
HC62206735	SPLINT FINGER (STATIC/RING)	270	L3927	56	N/A	N/A	N/A
HC62206768	SPLINT MULTI-PODUS BOOT	274	L4386	196	N/A	N/A	N/A
HC62206800	STAPLER SKIN                      D	272		140	N/A	N/A	N/A
HC62207030	SUTURE                            C	272		70	N/A	N/A	N/A
HC62207063	SUTURE                            D	272		99	N/A	N/A	N/A
HC62207238	TRACH PLUG	272		70	N/A	N/A	N/A
HC62207261	TRAY ANGIO	272		745	N/A	N/A	N/A
HC62207311	TRAY DIALYSIS	272		1,200	N/A	N/A	N/A
HC62207469	TRAY NASAL HEMORRHAGE	272		246	N/A	N/A	N/A
HC62207493	TRAY PERICARIOCENTESIS	272		638	N/A	N/A	N/A
HC62207527	TRAY THORAC/PARACENTESIS          U	272		560	N/A	N/A	N/A
HC62207709	TUBE LAVAGE	272		372	N/A	N/A	N/A
HC62207733	TUBE NASOPHARYNGEAL	272		36	N/A	N/A	N/A
HC62207931	IVS TUBING PLUMSET	272		42	N/A	N/A	N/A
HC62207964	TUBING SET ASPIRATING CYSTO	272		42	N/A	N/A	N/A
HC62208137	VALVE NON-REBREATHING TEE	272		95	N/A	N/A	N/A
HC62208160	VALVE TRACH SPEAKING              L	274	L8501	700	N/A	N/A	N/A
HC62208194	VESSEL DILATOR                    C	272		112	N/A	N/A	N/A
HC62208509	DISC COMPRESSION	270		50	N/A	N/A	N/A
HC62208541	CANNULA WATERS	272		475	N/A	N/A	N/A
HC62208582	VASCULAR PUNCH	272		423	N/A	N/A	N/A
HC62208772	M: SYSTEM FIXATION ABSORBABLE	278		4,030	N/A	N/A	N/A
HC62208814	CATH PACING TRANSESOPHAGEAL	272	C1756	2,404	N/A	N/A	N/A
HC62209002	SPLINT FOOT	270		596	N/A	N/A	N/A
HC62209036	LARYNGOSCOPE BLADE DISP INFANT	272		36	N/A	N/A	N/A
HC62209275	MASK/SHADES BILI' LIGHTS	270		36	N/A	N/A	N/A
HC62209309	DECOMPRESSION SYSTEM-IO-FLEX	272		8,750	N/A	N/A	N/A
HC62209333	MANIFOLD INCL 4 PORT NEPTUNE	272		56	N/A	N/A	N/A
HC62209481	SPLINT WRIST PREFAB	274	L3984	154	N/A	N/A	N/A
HC62209515	M:MISC PLASTIC SURGERY SUPPLY	272		N/A	N/A	N/A	N/A
HC62209549	M:MISC VASCULAR SURGERY SUPPLY	272		1,784	N/A	N/A	N/A
HC62209713	FORCEP HOT BIOPSY                 G	272		467	N/A	N/A	N/A
HC62209747	CIRCUIT VENT HBO ADAPTABLE	272		218	N/A	N/A	N/A
HC62210224	NG CLOG ZAPPER KIT	270		136	N/A	N/A	N/A
HC62210257	OXYGENATOR ECMO	272		4,610	N/A	N/A	N/A
HC62210281	ORTHOTIC WHFO NO JOINT CONTOUR    E	274	L3807	210	N/A	N/A	N/A
HC62210422	KIT INTRASPINAL TRIAL	272	C1755	462	N/A	N/A	N/A
HC62210471	GLOVE NEOPRENE W/THUMB SPLINT	271		28	N/A	N/A	N/A
HC62210539	ORTHOTIC WHFO NO JOINT RESTING    G	274	L3807	350	N/A	N/A	N/A
HC62210703	SET DECOMPRESSION COLON	272		596	N/A	N/A	N/A
HC62210745	RETAINER NOSTRIL	272		140	N/A	N/A	N/A
HC62210927	CANNULA ENDO ARTERIAL	272		1,806	N/A	N/A	N/A
HC62210950	M: PERFUSION MISC SUPPLY	272		2,197	N/A	N/A	N/A
HC62211123	HOLDER SUTURE OCOTOBASE	272		350	N/A	N/A	N/A
HC62211156	PACK SUCTION SUPPLEMENT	272		158	N/A	N/A	N/A
HC62211180	RETRACTOR HEART POSITIONER	272		2,501	N/A	N/A	N/A
HC62211354	DRESSING SACRUM 18X18CM (MEPILEX)	272		27	N/A	N/A	N/A
HC62211388	TRAY CIRCUMCISION DISPOSABLE	272		45	N/A	N/A	N/A
HC62211412	SYSTEM VENTRICULAR DRAINAGE	272		918	N/A	N/A	N/A
HC62211594	DRESSING HYDROCOLLD WND FILLER	272		39	N/A	N/A	N/A
HC62211628	PAD TEMP MNGMNT SYSTEM/BOX	272		1,162	N/A	N/A	N/A
HC62211818	CATH ANGIO MICRO(DIAG/MARTHN/EXCLSR)Q	272	C1887	2,975	N/A	N/A	N/A
HC62211842	CATH MICRO'P'VASC INJECT SOL/COIL P	272	C1887	3,500	N/A	N/A	N/A
HC62212022	CAP ENDO HALO	272		99	N/A	N/A	N/A
HC62212055	SET AUTOTRANSFUSE CONSTAVAC       A	272	C1729	56	N/A	N/A	N/A
HC62212105	TIP CAUTERY SINGLE USE ROBOTIC	272		316	N/A	N/A	N/A
HC62212253	TROCAR ENDO W-W/O SLEEVE	272		89	N/A	N/A	N/A
HC62212287	FORCEP BIOPSY URETEROSCOP DISP	272		4,220	N/A	N/A	N/A
HC62212311	GUIDEWIRE(ADVANTAGE/URO ANGLE/STRGHT)J	272	C1769	666	N/A	N/A	N/A
HC62212485	HANDPIECE VESSEL SEALER DEVICE    C	272		1,750	N/A	N/A	N/A
HC62212519	CATH MICRO NEURO(ARC132)         AA	272	C1887	7,000	N/A	N/A	N/A
HC62212683	GUIDEWIRE(GLIDEWIRE ANGL)         C	272	C1769	176	N/A	N/A	N/A
HC62212717	GUIDEWIRE(NITREX)                 I	272	C1769	595	N/A	N/A	N/A
HC62212741	GUIDEWIRE                         N	272	C1769	946	N/A	N/A	N/A
HC62212881	BLADE SHAVER ORTHO                E	272		314	N/A	N/A	N/A
HC62212915	BLADE SHAVER                      I	272		630	N/A	N/A	N/A
HC62212949	BLADE SHAVER                      L	272		840	N/A	N/A	N/A
HC62213087	BLADE KNIFE                       B	272		140	N/A	N/A	N/A
HC62213111	BLADE INCISIONAL                  I	272		630	N/A	N/A	N/A
HC62213145	BLADE OSTEOTOME/CUP               J	272		1,147	N/A	N/A	N/A
HC62213319	BURR                              S	272		1,393	N/A	N/A	N/A
HC62213343	STOCKINGS TED HOSE KNEE HI	272	A4500	36	N/A	N/A	N/A
HC62213517	REAMER                            V	272		1,330	N/A	N/A	N/A
HC62213541	REAMER                            Y	272		1,575	N/A	N/A	N/A
HC62213574	REAMER                            AB	272		1,750	N/A	N/A	N/A
HC62213723	GAS INTRAOCULAR                   A	272		297	N/A	N/A	N/A
HC62213756	KIT VITREORETINAL PERFLUORON 7ML	272	C1784	2,295	N/A	N/A	N/A
HC62213780	CANNULA ARTHROSCOPIC              C	272		106	N/A	N/A	N/A
HC62213954	BLADE SHAVER                      A	272		70	N/A	N/A	N/A
HC62213988	CATH PTCA BALLOON NON-LASER       C	272	C1725	420	N/A	N/A	N/A
HC62214150	CATH URETERAL                     F	272	C1758	84	N/A	N/A	N/A
HC62214184	CATH URETERAL                     J	272	C1758	139	N/A	N/A	N/A
HC62214366	SET AUTOTRANSFUSE                 S	272		476	N/A	N/A	N/A
HC62214390	STYLET TUNNELING DIALYSIS	272		673	N/A	N/A	N/A
HC62214424	KNIFE CANNULATED RETRACT	272		700	N/A	N/A	N/A
HC62214572	PROBE ELECTROSURG LAPARASCOPIC DISP	272		389	N/A	N/A	N/A
HC62214606	SYRINGE BONE MARROW ASPIRATION 10CC	272		747	N/A	N/A	N/A
HC62214630	CAP KIT LEAD PACEMAKER            A	272		70	N/A	N/A	N/A
HC62214804	CATH PTCA BALLOON NON-LASER       Y	272	C1725	6,300	N/A	N/A	N/A
HC62214952	BLADE CUP/OSTOETOME               O	272		1,016	N/A	N/A	N/A
HC62215314	BLADE SAW                         R	272		364	N/A	N/A	N/A
HC62215348	BLADE SAW                         U	272		448	N/A	N/A	N/A
HC62215371	BLADE SAW                         X	272		532	N/A	N/A	N/A
HC62215512	RETRACTOR TUBE SPINAL ENDOSCOPIC	272		1,009	N/A	N/A	N/A
HC62215546	SUTURE                            A	272		42	N/A	N/A	N/A
HC62215579	SUTURE                            H	272		210	N/A	N/A	N/A
HC62215710	SUTURE                            X	272		658	N/A	N/A	N/A
HC62215744	BLADE SHAVER                     AH	272		4,550	N/A	N/A	N/A
HC62215777	PIN/WIRE FIXATION TEMPORARY       M	272		399	N/A	N/A	N/A
HC62215942	TRAY BONE MARROW                  H	272		112	N/A	N/A	N/A
HC62215975	TRAY BONE MARROW                  AE	272		728	N/A	N/A	N/A
HC62216148	SPHINCTEROTOME CANNULATING        G	272		980	N/A	N/A	N/A
HC62216171	SPHINCTEROTOME CANNULATING        J	272		1,400	N/A	N/A	N/A
HC62216205	SPHINCTEROTOME                    F	272		840	N/A	N/A	N/A
HC62216353	NEEDLE INTRODUCER                 N	272		666	N/A	N/A	N/A
HC62216395	PIN/WIRE FIXATION TEMPORARY       B	272		29	N/A	N/A	N/A
HC62216429	PIN/WIRE FIXATION TEMPORARY       E	272		69	N/A	N/A	N/A
HC62216593	PIN/WIRE FIXATION TEMPORARY       V	272		478	N/A	N/A	N/A
HC62216627	PIN/WIRE FIXATION TEMPORARY       Y	272		559	N/A	N/A	N/A
HC62216809	BALLOON VERTEBRAL	278	C1725	4,550	N/A	N/A	N/A
HC62216833	POST ANCHOR SPINAL DISPOSABLE     O	272		672	N/A	N/A	N/A
HC62217005	KIT SPINAL ACCESS DISPOSBL        D	272		3,640	N/A	N/A	N/A
HC62217039	PROBE SPINAL DISPOSABLE           K	272		1,120	N/A	N/A	N/A
HC62217062	WIRE PACING TEMP                  C	272		49	N/A	N/A	N/A
HC62217203	VEST SYSTEM OSCIL FREQU HI CHEST	271	A7025	242	N/A	N/A	N/A
HC62217237	KIT TUBE TRACH CUFFED             O	272	A7521	1,256	N/A	N/A	N/A
HC62217260	PUNCH ATHROSCOPIC ROTARY	272		3,483	N/A	N/A	N/A
HC62217435	FORCEPS BIPOLAR DISPOSABLE        O	272		1,120	N/A	N/A	N/A
HC62217468	REAMER                            D	272		70	N/A	N/A	N/A
HC62217633	AWL SPINAL SINGLE PATIENT USE     H	272		770	N/A	N/A	N/A
HC62217666	AWL SPINAL SINGLE PATIENT USE     K	272		980	N/A	N/A	N/A
HC62217831	CLOSURE WND EXPANDER TISSUE       A	272		3,322	N/A	N/A	N/A
HC62217864	SET PIN DISTRACTORS-COUNT 2       A	272		700	N/A	N/A	N/A
HC62217898	SET PIN DISTRACTORS-COUNT 10      B	272		7,273	N/A	N/A	N/A
HC62218037	BLADE OPHTHALM                    D	272		56	N/A	N/A	N/A
HC62218060	BASKET RETRIEVAL                  K	272		630	N/A	N/A	N/A
HC62218094	TUBING IRRIGATION/SUCTION	272		93	N/A	N/A	N/A
HC62218268	CATH INTRODUCER PEEL-AWAY         I	272	C1892	246	N/A	N/A	N/A
HC62218292	CATH INTRODUCER PEEL-AWAY        AB	272	C1892	1,750	N/A	N/A	N/A
HC62218466	ENDO STAPLER                      T	272		1,397	N/A	N/A	N/A
HC62218490	ENDO STAPLER                     AJ	272		2,523	N/A	N/A	N/A
HC62218524	APPLICATOR W/MIXING TIP ORTHO	272		193	N/A	N/A	N/A
HC62218664	OBTURATOR BLADELESS ROBOTIC	272		88	N/A	N/A	N/A
HC62218698	DRILL/DRILL BITS SINGLE USE       D	272		240	N/A	N/A	N/A
HC62218722	DRILL/DRILL BITS SINGLE USE       G	272		280	N/A	N/A	N/A
HC62218896	DRILL/DRILL BITS SINGLE USE       X	272		1,354	N/A	N/A	N/A
HC62218920	DRILL/DRILL BITS SINGLE USE      AA	272		1,556	N/A	N/A	N/A
HC62219092	TUBE CALIBRATION GASTRIC BANDING	272		438	N/A	N/A	N/A
HC62219126	BOOT WLKNG AIR W/WO JNTS PREFB    D	274	L4360	140	N/A	N/A	N/A
HC62219290	DILATOR RENAL AMPLATZ	272	C1726	1,451	N/A	N/A	N/A
HC62219332	EMBOLIZATN PROTECT SYSTEM(EZ)     L	278	C1884	5,250	N/A	N/A	N/A
HC62219365	GUIDEWIRE                        AE	272	C1769	3,850	N/A	N/A	N/A
HC62219514	ORTHOSIS ANKLE/FT PRFB CUSTMZD    D	274	L4396	210	N/A	N/A	N/A
HC62219548	PROBE LITHOTRIPTOR ELECTRHYDRLC   Y	272		4,319	N/A	N/A	N/A
HC62219589	SHIM DEVICE ACCESS SPINAL        AE	272		2,800	N/A	N/A	N/A
HC62219753	KIT VITRECTOMY PROBE              Z	272		7,000	N/A	N/A	N/A
HC62219787	PUMP BLOOD CENTRIFUGAL	272		621	N/A	N/A	N/A
HC62219951	OBTURATOR ARTHRO                  E	272		420	N/A	N/A	N/A
HC62219985	BASKET RETRIEVAL                  M	272		806	N/A	N/A	N/A
HC62220157	CATH BALLOON MANOMETRY ANORECTAL	272		155	N/A	N/A	N/A
HC62220181	CATH THROMBECTOMY/EMBOLECTOMY     O	272	C1757	1,120	N/A	N/A	N/A
HC62220215	CATH THROMBECTOMY/EMBOLECTOMY     R	272	C1757	1,750	N/A	N/A	N/A
HC62220355	RETRACTOR DISPOSABLE              N	272		1,610	N/A	N/A	N/A
HC62220389	CATH ANGIOG GUIDING DUAL ACCESS(ENVOY)J	272	C1887	1,260	N/A	N/A	N/A
HC62220413	KIT ARTHROSCOPY DISPSBLS          J	272		526	N/A	N/A	N/A
HC62220587	NEEDLE DELIVERY CEMENT	272		177	N/A	N/A	N/A
HC62220611	MASK CPAP	272		84	N/A	N/A	N/A
HC62220785	OXYGENATOR ECMO PEDS	272		6,948	N/A	N/A	N/A
HC62220819	CUFF AORTIC ROOT EXPOSURE DEVICE	272		263	N/A	N/A	N/A
HC62220843	BINDER ABDOMINAL BASIC            A	270		36	N/A	N/A	N/A
HC62220983	CATH IV ANGIOGRAPHIC	272		56	N/A	N/A	N/A
HC62221015	CATH URETHRAL TRAY                B	272		70	N/A	N/A	N/A
HC62221049	EVACUATOR BLADDER W/ADAPTER	272		70	N/A	N/A	N/A
HC62221197	KIT W/ TRACH PERCUTANEOUS         C	272	A7520	980	N/A	N/A	N/A
HC62221221	KIT/TRAY BIOPSY                   B	272		70	N/A	N/A	N/A
HC62221254	NEEDLE ENDOSCOPIC                 D	272		140	N/A	N/A	N/A
HC62221429	TROCAR ENDO                       B	272		70	N/A	N/A	N/A
HC62221452	TROCAR ENDO                       E	272		210	N/A	N/A	N/A
HC62221627	CANNULA TRACH INNER               C	272	A4623	176	N/A	N/A	N/A
HC62221650	DILATOR SPINE	272		537	N/A	N/A	N/A
HC62221684	KIT ARTHROSCOPY DISPSBLS          T	272		2,380	N/A	N/A	N/A
HC62221825	TAP SURGICAL                      L	272		723	N/A	N/A	N/A
HC62221858	TAP SURGICAL                      O	272		1,120	N/A	N/A	N/A
HC62221882	TAP SURGICAL                      R	272		1,438	N/A	N/A	N/A
HC62222062	CATH CENTRAL VENOUS               H	272	C1751	420	N/A	N/A	N/A
HC62222096	OXYGENATOR PEDIATRIC              I	272		4,200	N/A	N/A	N/A
HC62222278	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP F	272	C1733	280	N/A	N/A	N/A
HC62222302	MANOMETER INSPIRATORY	272		41	N/A	N/A	N/A
HC62222476	WAND ARTHRO                       L	272		700	N/A	N/A	N/A
HC62222500	WAND ARTHRO                       P	272		1,260	N/A	N/A	N/A
HC62222534	CATH NEPHROSTOMY                  A	272	C1729	36	N/A	N/A	N/A
HC62222674	ADAPTER AIRWAY/RESP CPAP          B	272		84	N/A	N/A	N/A
HC62222708	CANNULA CORONARY SOFT-TIP	272		70	N/A	N/A	N/A
HC62222732	CAUTERY PENCIL                    A	272		36	N/A	N/A	N/A
HC62222906	PROBE LASER                       J	272		567	N/A	N/A	N/A
HC62222930	TUBING IRRIGATION                 B	272		112	N/A	N/A	N/A
HC62223102	CANNULA VENOUS                    C	272		106	N/A	N/A	N/A
HC62223136	FIBER LASER                       L	272		2,250	N/A	N/A	N/A
HC62223169	CONNECTOR ASSIST PUMP VENTRICULAR	272		963	N/A	N/A	N/A
HC62223300	TEMPLATE BRACHYTHERAPY            L	272		840	N/A	N/A	N/A
HC62223334	CATH PTA ANGIOPLS BALLOON NON-LSR K	272	C1725	1,120	N/A	N/A	N/A
HC62223367	CATH MICRO NEURO(FUBUKI)          H	272	C1887	980	N/A	N/A	N/A
HC62223508	ORTHOTIC HAND SPREADING PREFAB	274	L3923	85	N/A	N/A	N/A
HC62223532	CANNULA ENDOSCOPIC SPINAL	272		1,383	N/A	N/A	N/A
HC62223565	DRILL/DRILL BITS SINGLE USE      AK	272		2,917	N/A	N/A	N/A
HC62223730	KIT CONCENTRATOR PLATELETS        F	272		280	N/A	N/A	N/A
HC62223763	CLIP MAGAZINE RANEY SCALP	272		50	N/A	N/A	N/A
HC62223938	PATCH 3D REFERENCE EP	272		1,400	N/A	N/A	N/A
HC62223961	TAP SURGICAL                      U	272		2,800	N/A	N/A	N/A
HC62223995	TOOL ACCESSORY PCMKR	272		1,750	N/A	N/A	N/A
HC62224134	ELECTRODE SEALING (E.G. LIGASURE)	272		490	N/A	N/A	N/A
HC62224167	SET SHEATH DILATOR	272		5,554	N/A	N/A	N/A
HC62224191	CAUTERY TIP                       F	272		280	N/A	N/A	N/A
HC62224365	CANNULA SUCTION & COAGULATION	272		840	N/A	N/A	N/A
HC62224399	CUTTER DISC SPINAL	272		630	N/A	N/A	N/A
HC62224563	CABLE ELECTRODE MICRO TARGET/SCREEN	272		316	N/A	N/A	N/A
HC62224597	SHEATH STAPLER ROBOTIC	272		70	N/A	N/A	N/A
HC62224779	CATH THROMBECTOMY/EMBOLECTOMY     V	272	C1757	4,200	N/A	N/A	N/A
HC62224803	KIT REPAIR CATH DIALYSIS PERITONEAL	272		224	N/A	N/A	N/A
HC62224837	CATH GUIDE REPERFUS(DAC/FLOWGATE) S	272	C1887	4,200	N/A	N/A	N/A
HC62224977	PROBE LITHOTRIPTOR                R	272		1,750	N/A	N/A	N/A
HC62225008	SLEEVE TROCAR RPRSD               B	272		75	N/A	N/A	N/A
HC62225032	NEEDLE ASPIRAT(EUS SLIMLIN22/25GA)L	272		700	N/A	N/A	N/A
HC62225206	CATH OCCLUSION                    F	272	C2628	280	N/A	N/A	N/A
HC62225230	ROD EXTRACTION CONICAL	272		1,050	N/A	N/A	N/A
HC62225404	PUSHER KNOT ENDO                  G	272		700	N/A	N/A	N/A
HC62225438	GRASPER TWIN ENDOSCOPIC	272		2,100	N/A	N/A	N/A
HC62225628	CATH TRANSLUM ANGIO LASER         K	272	C1885	4,900	N/A	N/A	N/A
HC62225669	CATH EP DIAG/ABLAT 3D/VECT       AA	272	C1732	11,900	N/A	N/A	N/A
HC62225693	CATH TRANSLUM ANGIO LASER         Z	272	C1885	12,600	N/A	N/A	N/A
HC62225842	GUIDE DRILL                       L	272		700	N/A	N/A	N/A
HC62225875	GUIDE DRILL                       O	272		1,288	N/A	N/A	N/A
HC62225909	ADAPTOR EXT BRACHYTHERAPY	272		106	N/A	N/A	N/A
HC62226089	TIP SACRO SURG DISP	272		246	N/A	N/A	N/A
HC62226113	DRILL/DRILL BITS SINGLE USE      AL	272		3,186	N/A	N/A	N/A
HC62226287	NEEDLE BONE MARROW                O	272		1,120	N/A	N/A	N/A
HC62226311	PICK VEIN	272		70	N/A	N/A	N/A
HC62226352	PROGRAMMER NEUROSTIM PAT          H	271	C1787	4,266	N/A	N/A	N/A
HC62226493	CABLE LIGHT MIS SPINAL DISP	272		1,455	N/A	N/A	N/A
HC62226527	COVER/SLEEVE PROBE	272		386	N/A	N/A	N/A
HC62226550	ELECTRODE EEG/EMG DISP	272		490	N/A	N/A	N/A
HC62226725	GUIDEWIRE                         C	272	C1769	142	N/A	N/A	N/A
HC62226766	FORCEPS BIOPSY MICRO(MORAY)	272		1,925	N/A	N/A	N/A
HC11200011	ASSESS-DIRECT OBSERV ADMIT	762	G0379	724	N/A	N/A	N/A
HC11200037	OBSERVATION PER HOUR - NICU	762	G0378	573	N/A	N/A	N/A
HC11500022	EST PT LVL3-EXPANDED	510	99213	237	N/A	N/A	N/A
HC11500063	NEW PT LVL2-PROB FOCUS	510	99202	219	N/A	N/A	N/A
HC11500683	WC NEW E&M ASSESS COMPREHN L:5	761	99205	624	N/A	N/A	N/A
HC11500717	WC ESTB E&M  INTERMEDIATE LVL3	761	99213	442	N/A	N/A	N/A
HC11500766	AM/PACU EVAL BRIEF-I	761	99211	219	N/A	N/A	N/A
HC11500915	WM EXAM EST' PT EVAL  MINOR LVL 2	761	99212	203	N/A	N/A	N/A
HC11500956	WM EXAM NEW PT EVAL MOD LVL3	761	99203	341	N/A	N/A	N/A
HC11500980	CRC CONFIRM NO CHARGES - RELEASE	115		N/A	N/A	N/A	N/A
HC12200119	REFILL/MAINTENANCE PORT PUMP	940	96521	1,167	N/A	N/A	N/A
HC12200150	INF CNTR-NEW PT EVAL LOW/MOD	510	99202	289	N/A	N/A	N/A
HC12200333	IV INFUSION MONOCLONAL ABX BAMLANIVIMAB/ETESEVIMAB	771	M0245	1,700	N/A	N/A	N/A
HC12200390	IV INFUSE MONOCLONAL TOCILIZUMAB >2YEARS DOSE 2ND	771	M0250	1,460	N/A	N/A	N/A
HC12400131	CHEMO INJECT(S) SUBARACHNOID/INTRAVENT VIA RESEVOIR	331	96542	1,758	N/A	N/A	N/A
HC12600003	IMMUNIZATION ADMIN SINGLE	771	90471	201	N/A	N/A	N/A
HC12600037	ADMIN VACCINE PNEUMOCOCCAL	771	G0009	184	N/A	N/A	N/A
HC12600185	ADMIN VACCINE COVID-19 5X10 10VP/.5ML INITIAL DOSE {ASTRAZENECA}	771	0021A	125	N/A	N/A	N/A
HC12600219	ADMIN VACCINE COVID-19 5MCG/0.5ML 2ND {NOVAVAX}	771	0042A	125	N/A	N/A	N/A
HC12600243	ADMIN VACCINE COVID-19 30MCG TRS-SUCR 3RD DOSE {PFIZER}	771	0053A	125	N/A	N/A	N/A
HC12800058	THERAPEUTIC APHERESIS PLATELET	361	36513	9,745	N/A	N/A	N/A
HC12800082	TRANSFUSION BLOOD &/OR COMPNTS	391	36430	3,876	N/A	N/A	N/A
HC14500128	DM INPT CONSULT 30 MIN (STAT)	942		N/A	N/A	N/A	N/A
HC21000013	ABRASION; SNGL LESION	361	15786	828	N/A	N/A	N/A
HC21000179	AVULSION OF NAIL  SIMPLE:1	361	11730	1,021	N/A	N/A	N/A
HC21000336	DEBRID SKIN&SUBQ UP TO 20 SQCM	361	11042	3,902	N/A	N/A	N/A
HC21000369	DESTRUCT PREMALG LESION 1ST	361	17000	672	N/A	N/A	N/A
HC21000393	ESCHAROTOMY; FULL THICK BURN	361	16035	3,086	N/A	N/A	N/A
HC21000575	PREP SITE F/N/HF/G EA +100SQCM	361	15005	3,060	N/A	N/A	N/A
HC21000609	DEBRID OPN WOUND EA ADD 20CM/<	361	97598	1,269	N/A	N/A	N/A
HC21000633	WOUND VAC W/ DME >50 SQ CM PER SESSION	361	97606	1,409	N/A	N/A	N/A
HC21000815	APPY SKIN SUB HEAD/HND/FT 1ST25SQ~HC	361	15275	3,682	N/A	N/A	N/A
HC21000849	APPY SKIN SUB HED/HND/FT EA+100SQ~HC	361	15278	3,183	N/A	N/A	N/A
HC21001078	WOUND VAC TX W/ DISP ASST/INSTR <50SQ CM SESSION	940	97607	1,745	N/A	N/A	N/A
HC22000020	OST NEW PT EVAL LVL3-(30MIN)	761	99203	364	N/A	N/A	N/A
HC22000053	OST EST PT EVAL LVL1-(5MIN)	761	99211	210	N/A	N/A	N/A
HC23000102	ASP/INJ JOINT LRG W/O UTZ GUIDE-LT	361	20610	2,827	N/A	N/A	N/A
HC23000268	DESTRUCT OTHER PERIPH SNGL LT	361	64640	5,990	N/A	N/A	N/A
HC23000300	DESTRUCT INTERCOSTAL NERVE	361	64620	5,857	N/A	N/A	N/A
HC23000649	INJ ANES/STEROID NERVE FEMORAL BIL	361	64447	4,550	N/A	N/A	N/A
HC23000672	INJ FORAMN EPI C/T INTLW/S&I-BI	361	64479	12,545	N/A	N/A	N/A
HC23000920	INJ ANES/STEROID NERVE/BRNCH PERIPH RT	361	64450	2,742	N/A	N/A	N/A
HC23000953	INJ ANES/STEROID NERVE PUDENDAL LT	361	64430	3,885	N/A	N/A	N/A
HC23001126	REMOVE EPIDURAL/INTRATH CATH	361	62355	5,711	N/A	N/A	N/A
HC23001159	DESTR L/S FAC JOINT SNGL W/IMG-B	361	64635	13,031	N/A	N/A	N/A
HC23001183	INJ S-I JOINT ANESTH W/IMAG RT	361	G0260	5,110	N/A	N/A	N/A
HC23001373	INJ CER/THOR F/IMAGE 2ND LVLLT	361	64491	3,626	N/A	N/A	N/A
HC23001407	INJ CER/THR F/IMAGE 3RD+&LVLLT LT	361	64492	2,161	N/A	N/A	N/A
HC23001431	INJ  L/S F W/IMAGE 1ST LVL LT	361	64493	8,093	N/A	N/A	N/A
HC23001613	INJ ANES/STEROID BRACHIAL PLEXUS RT	361	64415	2,781	N/A	N/A	N/A
HC23001647	INJ ANES/STEROID INTERCOSTAL ADDL EA RT	361	64421	5,642	N/A	N/A	N/A
HC23001811	ASP/INJ JOINT LRG W/UTZ GUIDE-LT	361	20611	4,998	N/A	N/A	N/A
HC23001845	INJ SINGLE LUMBAR/SACRAL W/IMAG	361	62323	6,536	N/A	N/A	N/A
HC23001878	INJ ANES/STEROID NERVE SI JOINT INNRV W/IMAGE	361	64451	2,544	N/A	N/A	N/A
HC23002017	ABLATE RF NERVE SACROILIAC JT INNRV W/IMAGE LT	361	64625	6,836	N/A	N/A	N/A
HC24000028	HBO FIRST 15MIN BASIC/C	413		529	N/A	N/A	N/A
HC24000101	HBO TX EA 1/2 HR INTERMEDIAT/M	940	G0277	1,880	N/A	N/A	N/A
HC25000092	CPR	410	92950	1,909	N/A	N/A	N/A
HC25000134	EVACUATE SUBUNGUAL HEMATOMA	450	11740	763	N/A	N/A	N/A
HC25000167	FB REMOVAL NASAL	450	30300	758	N/A	N/A	N/A
HC25000332	ANOSCOPY W/PROCEDURE	450		455	N/A	N/A	N/A
HC25000373	I&D ABSCESS	450		798	N/A	N/A	N/A
HC25000563	WINDOW CAST	450	29730	569	N/A	N/A	N/A
HC25000605	GASTRIC INTUB ASP THER' LAVAGE	450	43753	1,045	N/A	N/A	N/A
HC25000746	ASPIRATION OF ABCESS/CYST	450	10160	1,466	N/A	N/A	N/A
HC25000944	I&D PERIANAL ABSCESS	450	46050	3,697	N/A	N/A	N/A
HC25000977	INHALATION TX SUBSQ SAME DAY	412	94640	576	N/A	N/A	N/A
HC25001025	PERICARDIOCENTESIS INCL IMAGING	450	33016	1,343	N/A	N/A	N/A
HC25001207	THORACENTESIS W/TUBE W/O IMAG BI	450	32556	3,777	N/A	N/A	N/A
HC25001264	MOD CS BY MD  ADD'L 15 MIN	450	99153	293	N/A	N/A	N/A
HC25001520	REMOV IMPACTD EAR WAX IRRIG/LAVG BI	450	69209	527	N/A	N/A	N/A
HC25001553	MOD CS SAME PHYS/QHP<5YR INIT'L 15MIN	372	99151	349	N/A	N/A	N/A
HC25002841	I&D HEMATOMA/SEROMA/FLUID COLLECTION	450	10140	3,300	N/A	N/A	N/A
HC25002874	DEBRIDE/REMOVL OPEN FX&/DISLOC SQ T/M/BONE	450	11012	4,607	N/A	N/A	N/A
HC25002908	DEBRIDE SKIN MUSL/BONE; FIRST 20SQCM OR LESS	450	11044	3,865	N/A	N/A	N/A
HC25003047	LAC REPAIR SIMPLE F/E/E/N/L/M >30.0 CM	450	12018	1,446	N/A	N/A	N/A
HC25003070	LAC REPAIR INTMD S/A/T/EXT 2.5 CM/<	450	12031	1,422	N/A	N/A	N/A
HC25003104	LAC REPAIR INTMD S/A/T/EXT 12.6-20CM	450	12035	1,678	N/A	N/A	N/A
HC25003278	LAC REPAIR CMPLX TRUNK 2.6-7.5 CM	450	13101	1,788	N/A	N/A	N/A
HC25003302	LAC REPAIR CMPLX S/A/L ADDL 5 CM/>	450	13122	621	N/A	N/A	N/A
HC25003476	CLOSED TX CLAVICLE FX W/MANIP-BIL	450	23505	3,336	N/A	N/A	N/A
HC25003500	CLOSED TX STERNOCLVCLE DISLOC W/MAN-BIL	450	23525	1,330	N/A	N/A	N/A
HC25003674	CLOSED TX ELBOW DISLOC W/O ANES-BIL	450	24600	1,667	N/A	N/A	N/A
HC25003708	CLOSED TX ELBOW DISLOCATION-BIL	450	24640	1,347	N/A	N/A	N/A
HC25003732	REMOVE FB FOREARM DEEP RT	450	25248	3,758	N/A	N/A	N/A
HC25003872	CLOSED TX RAD/EPHYSL SEP&ULN FX W/MAN LT	450	25605	4,088	N/A	N/A	N/A
HC25003906	CLOSED TX CARPAL SCAPHOID FX W/MAN LT	450	25624	3,776	N/A	N/A	N/A
HC25003930	CLOSED TX CARPAL BONE FX W/M EA BONE RT	450	25635	3,797	N/A	N/A	N/A
HC25004102	CLOSED TX FINGER JNT DISLOC W/MAN SINGLE	450	26670	918	N/A	N/A	N/A
HC25004136	CLOSED TX FINGER/THUMB SHAFT FX W/MANIP EA	450	26725	860	N/A	N/A	N/A
HC25004300	CLOSED TX KNEE DISLOC; NO ANESTH LT	450	27550	1,096	N/A	N/A	N/A
HC25004334	CLOSED TX PATELLAR DISLOC; NO ANESTH LT	450	27560	913	N/A	N/A	N/A
HC25004367	I&D ABSCESS/HEMATOMA LEG/ANKLE DEEP LT	450	27603	4,349	N/A	N/A	N/A
HC25004508	CLOSED TX BIMALLEOLA ANKLE FX; W/MANIP BIL	450	27810	7,085	N/A	N/A	N/A
HC25004532	CLOSED TX PROX TIBIOFIBULAR JNT DISLOC; NO ANES BIL	450	27830	1,674	N/A	N/A	N/A
HC25004565	CLOSED TX ANKLE DISLOC; NO ANES BIL	450	27840	1,760	N/A	N/A	N/A
HC25004706	CLOSED TX BIG TOE FX; W/MANIPULTN RT	450	28495	892	N/A	N/A	N/A
HC25004730	CLOSED TX PHALANX(TOE) FX; W/MANIPULTN EA	450	28515	904	N/A	N/A	N/A
HC25004763	CLOSED TX SESAMOID FX BILAT	450	28530	1,519	N/A	N/A	N/A
HC25004938	APPLY CAST HAND & LWR FOREARM (GAUNTLET) RT	450	29085	484	N/A	N/A	N/A
HC25004961	STRAPPING; SHOULDER RT	450	29240	412	N/A	N/A	N/A
HC25005133	CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX ANY TX	450	30903	451	N/A	N/A	N/A
HC25005166	LARYNGOSCOPY W/REMOVE FB	450	31511	512	N/A	N/A	N/A
HC25005190	REPAIR LIP FULL THICK; TO HALF VERTICAL HT	450	40652	1,964	N/A	N/A	N/A
HC25005331	SIGMOIDOSCOPY FLEX W/REMOVE FB	450	45332	1,340	N/A	N/A	N/A
HC25005364	US MEASUR POST-VOID RES&/BLDR CAP NO IMG	450	51798	276	N/A	N/A	N/A
HC25005398	I&D ABSCESS BARTHOLIN'S GLAND	450	56420	764	N/A	N/A	N/A
HC25005562	REMOVE FB EXTRNL EYE; CORNEAL W/SLITLAMP RT	450	65222	497	N/A	N/A	N/A
HC25005596	DRAIN EXTERNAL EAR LESION SIMPLE RT	450	69000	1,319	N/A	N/A	N/A
HC25005760	CLOSED TX FIBULA DISTAL FX W/MANIP BIL	450	27788	1,987	N/A	N/A	N/A
HC25005794	CLOSED TX ANKLE FX W/MANIP BIL	450	27818	2,200	N/A	N/A	N/A
HC25005976	NEW PT LVL3-EXPANDED	510	99203	371	N/A	N/A	N/A
HC25006008	EST PT LVL1-BRIEF	510	99211	183	N/A	N/A	N/A
HC25006032	EST PT LVL4-DETAILED	510	99214	381	N/A	N/A	N/A
HC25006172	INSERTION CERVICAL DILATOR	450	59200	1,271	N/A	N/A	N/A
HC25006206	POSTPARTUM CARE	450	59430	1,325	N/A	N/A	N/A
HC25090002	P: TRACHEOSTOMY+ ADULT TRACH TUBE			N/A	N/A	N/A	N/A
HC25090176	P: CHNG GT TB W/O IMG/ENDO+CTH FOLEY			N/A	N/A	N/A	N/A
HC25090200	P: PARACNTSS ABD W/O IMGNG+TRAY			N/A	N/A	N/A	N/A
HC25090374	P: LAC REPAIR 20.1-30CM(LG)			N/A	N/A	N/A	N/A
HC25090408	P: LAC REPAIR TO 2.5 CM(SM)			N/A	N/A	N/A	N/A
HC25090432	P: LAC RPR20.1-30CM(LG)+STAPLER SKIN			N/A	N/A	N/A	N/A
HC25090580	P: MULTIPLE PULSE OX W/PROBE			N/A	N/A	N/A	N/A
HC26000000	AMNIOCENTESIS	361	59000	5,040	N/A	N/A	N/A
HC26000034	DELIVERY OF PLACENTA	361	59414	6,312	N/A	N/A	N/A
HC26000190	L&D EVAL LEVEL V - COMPREHENSV	720	99215	2,033	N/A	N/A	N/A
HC27000025	ANOSCOPY DX (INCL COLLECTION)	750	46600	1,362	N/A	N/A	N/A
HC27000058	ANOSCOPY W/BLEED CONTROL	750	46614	3,519	N/A	N/A	N/A
HC27000280	COLONOSCOPY W/BLEED CONTROL	750	45382	4,352	N/A	N/A	N/A
HC27000314	COLONOSCOPY W/HOT BIOPSY	750	45384	3,908	N/A	N/A	N/A
HC27000520	EGD W/TRANS DRAIN/STENT CYST(EUS) ~FO	750	43240	5,823	N/A	N/A	N/A
HC27000553	ENDO SM INTEST POUCH (KOCK) W/BX(S)	750	44386	6,054	N/A	N/A	N/A
HC27000587	ENTEROSCOPY TO ILEUM W/BIOPSY	750	44377	6,391	N/A	N/A	N/A
HC27000751	ERCP W/PRES MEAS SPHINC(ODDI)	750	43263	6,580	N/A	N/A	N/A
HC27000801	ESOPH DILATION OVER GUIDE WIRE	750	43453	7,666	N/A	N/A	N/A
HC27000843	ESOPH RFLUX PH STDY-LNG DISCTD	750	91034	1,880	N/A	N/A	N/A
HC27001080	SIGMOIDOSCOPY FLEX BLEED CONT	750	45334	4,656	N/A	N/A	N/A
HC27001114	SIGMOIDOSCOPY FLEX INJ SUBMCSL	750	45335	3,763	N/A	N/A	N/A
HC27001320	ERCP W/STENT REMV&XCH BILI/PANC DUCT	750	43276	8,527	N/A	N/A	N/A
HC27001353	ERCP W/BALLN DIL BILI/PANC DUCT/AMP EA	750	43277	6,691	N/A	N/A	N/A
HC27001528	ESOPHSCPY W/INJ SCLERO VARICES ~FO	750	43204	4,085	N/A	N/A	N/A
HC27001551	ESOPHSCPY W/DIL OVER GUIDEWIRE ~FO	750	43226	4,688	N/A	N/A	N/A
HC27001585	ESOPHSCPY W/INJ SUBMUCOSAL ~FO	750	43201	5,227	N/A	N/A	N/A
HC27001726	SIGMOIDOSCOPY FLEX  W/LIGATION BAND	750	45350	4,296	N/A	N/A	N/A
HC27001759	COLONOSCOPY FLEX W/RESECTN MUCOSL	750	45390	4,312	N/A	N/A	N/A
HC27001783	M: UNLISTED PROCEDURE  COLON	750	45399	5,864	N/A	N/A	N/A
HC27001957	ESOPHAGUS BALLOON DISTENTION PROVOC STUDY	750	91040	5,629	N/A	N/A	N/A
HC28000008	CR REHAB PHASE III MONTHLYNTH	943	S9472	112	N/A	N/A	N/A
HC29000353	OB FECES GUAIAC1-3SCR(IN DEPT)	300	82270	74	N/A	N/A	N/A
HC29000510	E&M PREVENTIVE NEW 40-64 Y/O	770	99386	445	N/A	N/A	N/A
HC29000551	PREVENTATIVE MED COUNSELING 15MIN	770	99401	78	N/A	N/A	N/A
HC31000011	PT-APPLICATION CAST SHORT LEG	420	29405	1,139	N/A	N/A	N/A
HC31000045	PT-APPLICATION SPLINT LONG LEG	420	29505	1,155	N/A	N/A	N/A
HC31000078	PT-AQUATIC GRP 45MIN/M	423	97150	224	N/A	N/A	N/A
HC31000284	PT-HOT/COLD PACKS /CMW	420	97010	130	N/A	N/A	N/A
HC31000318	PT-EVAL LOW COMPLEXITY <20MF2F 15MIN	424	97161	293	N/A	N/A	N/A
HC31000342	PT-EVAL HIGH COMPLEXITY 45MF2F 60MIN	424	97163	874	N/A	N/A	N/A
HC31000623	PT-TRACTION/MECHANICAL/CMW	420	97012	200	N/A	N/A	N/A
HC31000722	PT-WHEELCHAIR MGT 15MIN/M	420	97542	214	N/A	N/A	N/A
HC31000904	PT-INITIAL EVAL ADDL 15MIN/CW	424		239	N/A	N/A	N/A
HC31000938	PT-ELEC STIM/TENS ATT ADD15/CW	420		196	N/A	N/A	N/A
HC31000961	PT-ULTRASOUND 30MIN/CW	420		319	N/A	N/A	N/A
HC31001100	PT-MANUAL THER JOINT MOB/W	420		229	N/A	N/A	N/A
HC31001134	PT-PROSTHETIC TRNG 30MIN/CW	420		331	N/A	N/A	N/A
HC31001167	PT-FUNC ACTIVITY ADDL 15MIN/CW	420		196	N/A	N/A	N/A
HC31001464	PT-PROC+MOD.COMBO ADD 15MIN/C	420		182	N/A	N/A	N/A
HC31001498	PT-THER PROC GRP 60MIN/MC	423	97150	399	N/A	N/A	N/A
HC31001670	PT-WOUND VAC 15MIN<50 SQ+/C	420		180	N/A	N/A	N/A
HC31001712	PT-REMOVE/BIVAL CAST SHRT LIMB	420	29700	823	N/A	N/A	N/A
HC31001902	LOCOMOTOR TRAINING	420	97799	304	N/A	N/A	N/A
HC31001936	TRANSITIONAL REHAB 1/2 DAY (QA)	931		1	N/A	N/A	N/A
HC31001985	PT - STRAPPING; HAND OR FINGER	420	29280	551	N/A	N/A	N/A
HC31002157	PT-APPLIC CAST LONG LEG BILAT	420	29345	2,152	N/A	N/A	N/A
HC31010028	PT-EVAL MOD COMPLEXITY 30M F2F [15MIN]	424	97162	234	N/A	N/A	N/A
HC31010051	PT-THER EXER 15MIN	420	97110	230	N/A	N/A	N/A
HC31010283	PT-ULTRASOUND 15MIN	420	97035	179	N/A	N/A	N/A
HC31010317	PT- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 45MIN	420	99366	325	N/A	N/A	N/A
HC31090095	P: PT-EVAL 120MIN/C			N/A	N/A	N/A	N/A
HC31090129	P: PT DEVEL' TESTING 45 MIN/C			N/A	N/A	N/A	N/A
HC32000218	OT-HOT/COLD PACKS /CMW	430	97010	130	N/A	N/A	N/A
HC32000242	OT-EVAL LOW COMPLEXITY <20MF2F 15MIN	434	97165	271	N/A	N/A	N/A
HC32000275	OT-EVAL HIGH COMPLEXITY 45MF2F 60MIN	434	97167	892	N/A	N/A	N/A
HC32000416	OT-RE-EVAL EST POC 60MIN	434	97168	910	N/A	N/A	N/A
HC32000440	OT-SWALLOWING EVAL 45MIN	434	92610	1,282	N/A	N/A	N/A
HC32000473	OT-SWALLOWING EVAL 90MIN	434	92610	1,898	N/A	N/A	N/A
HC32000721	OT-WOUND NON-SEL DEB 30MIN/CMW	430	97602	572	N/A	N/A	N/A
HC32000754	OT-WOUND VAC 15MIN<50 SQ CM/M	430	97605	287	N/A	N/A	N/A
HC32000929	OT-TREATMENT ADD 15 MIN/CW	430		218	N/A	N/A	N/A
HC32000952	OT-MASSAGE 30MIN/CW	430		336	N/A	N/A	N/A
HC32000986	OT-MANUAL THERAPY ADDL 15MIN/CW	430		188	N/A	N/A	N/A
HC32001125	OT-WHEELCHAIR MGT 30MIN/C	430		386	N/A	N/A	N/A
HC32001190	OT-CASE CONF 15MIN (STAT)	430		N/A	N/A	N/A	N/A
HC32001224	OT-SENSRY INTEGR TECH ADD15/CW	430		191	N/A	N/A	N/A
HC32001372	OT-THER PROC GRP 60MIN/M	430	97150	380	N/A	N/A	N/A
HC32001414	OT- TM CONF INTERDISPLNS 3MNM WPT PRES 30MIN	430	G0175	325	N/A	N/A	N/A
HC32001448	OT-WD SEL DEBRID<20CM 15MIN+/C	430		213	N/A	N/A	N/A
HC32001679	OT-APPLY SPLINT FINGER DYNAMIC	430	29131	811	N/A	N/A	N/A
HC32001703	OT-AQUATIC THERAPY 15MIN/M	430	97113	241	N/A	N/A	N/A
HC32001919	OT - RANGE OF MOTION MEASUREMENTS	430	95852	138	N/A	N/A	N/A
HC32003311	OT-EVAL MOD COMPLEXITY 30MF2F 60MIN	434	97166	821	N/A	N/A	N/A
HC32003345	OT-EVAL HIGH COMPLEXITY 45MF2F 45MIN	434	97167	734	N/A	N/A	N/A
HC32010126	OT-THER PROC GROUP [15MIN]	433	97150	88	N/A	N/A	N/A
HC32010159	OT-ORTHOTIC MGMT & TRNG INITIAL ENC 15MIN	430	97760	265	N/A	N/A	N/A
HC32010183	OT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN	430	97763	214	N/A	N/A	N/A
HC32010415	OT- TM CONF INTERDISCPLN NO PT/FAM  WMD 45MIN	430	99367	325	N/A	N/A	N/A
HC32010449	OT- TM CONF INTERDISCPLN NO PT/FAM  WQHCP 60MIN	430	99368	350	N/A	N/A	N/A
HC32090136	P: ORTH ELBOW ADJUST POSITION LOCK (90MINUOS)			N/A	N/A	N/A	N/A
HC32090169	P: ORTH WHFO  RIGID W/O JOINTS (90MINUOS)			N/A	N/A	N/A	N/A
HC33000183	ST-EVAL SWALLOW CINE/FLUORO 60MIN	444	92611	1,633	N/A	N/A	N/A
HC33000217	ST-SPEECH THERAPY 30 MIN/MCW	440	92507	643	N/A	N/A	N/A
HC33000241	ST-SPEECH THERAPY 75 MIN/MW	440	92507	1,162	N/A	N/A	N/A
HC33000381	ST-SWALLOWING THERAPY  15 MIN	440	92526	436	N/A	N/A	N/A
HC33000415	ST-SWALLOWING THERAPY  60 MIN	440	92526	1,122	N/A	N/A	N/A
HC33000449	ST- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 30MIN	440	99366	271	N/A	N/A	N/A
HC33000720	ST-EVAL LANGUAGE CMPT 180MIN	444	92521	1,457	N/A	N/A	N/A
HC33000779	ST-LARYNGEAL FUNCTION STUDIES	444	92520	621	N/A	N/A	N/A
HC33000985	ST EVAL SOUND PRODUCTION 60MIN/M	444	92522	561	N/A	N/A	N/A
HC33001017	ST EVAL SOUND PRODUCTION 180MIN/M	444	92522	1,098	N/A	N/A	N/A
HC33001058	ST EVAL SOUND W/LANG COMP&EXPRESS 90MIN/M	444	92523	1,226	N/A	N/A	N/A
HC33010018	ST-SWALLOWING THERAPY  [15MIN]	440	92526	308	N/A	N/A	N/A
HC33010042	ST-SPEECH THERAPY [15MIN]	440	92507	268	N/A	N/A	N/A
HC33010075	ST EVAL SPEECH FLUENCY [15MIN]	444	92521	183	N/A	N/A	N/A
HC33010281	ST- TM CONF INTERDISCPLN NO PT/FAM  WMD 60MIN	440	99367	375	N/A	N/A	N/A
HC33010315	ST- TM CONF INTERDISPLNS 3MNM WPT PRES 45MIN	440	G0175	550	N/A	N/A	N/A
HC34000018	PURE TONE AUDIO AIR&BONE	471	92553	498	N/A	N/A	N/A
HC34000216	AUD-AUDITORY EVOKED AEP NEURODIAGNOSTIC W/I&R	471	92653	630	N/A	N/A	N/A
HC34000240	EVOKED OTOACOUSTIC EMISSIONS SCREEN	471	92558	156	N/A	N/A	N/A
HC35000025	REC- EVALUATION 30MIN	941	99213	437	N/A	N/A	N/A
HC35000074	REC' THER' TX ADD'L 15 MIN	941	97530	233	N/A	N/A	N/A
HC35000173	REC-COMMTY WK/REINTEGRAT 15M	941	97537	222	N/A	N/A	N/A
HC35000322	REC- TM CONF INTERDISPLNS 3MNM WPT PRES 45MIN	941	G0175	550	N/A	N/A	N/A
HC35500065	MT-SENSORY INTEGRATION 15 MIN	941	97533	182	N/A	N/A	N/A
HC35500164	MT-BEHAVIOR TX INDIV ADDL 15 MIN	941	96159	124	N/A	N/A	N/A
HC36000081	AEROSOL-MDI TX SUBSQ SAME DAY	412	94640	665	N/A	N/A	N/A
HC36000115	AEROSOL-TX SUBSQ SAME DAY	412	94640	665	N/A	N/A	N/A
HC36000305	VENT DAY SUBSEQUENT-ADULT	410	94003	7,377	N/A	N/A	N/A
HC36000339	VENT DAY SUBSQ-OSCIL&/OR HI FR	410	94003	7,377	N/A	N/A	N/A
HC36000818	BRONCHOSCOPY THRU ESTAB TRACH	361	31615	4,742	N/A	N/A	N/A
HC36000842	BRONCH W/NDL ASP BX; EA ADD'L+	361	31633	3,436	N/A	N/A	N/A
HC36000875	BRONCH W/DESTRUCT TUMOR/STEN	361	31641	10,103	N/A	N/A	N/A
HC36001022	HGB QUANT TRANSCUTANEOUS DAILY	300	88738	280	N/A	N/A	N/A
HC36001071	ATTENDANCE AT DELIVERY	410	99464	635	N/A	N/A	N/A
HC36001113	BREATHING RESPONSE HYPOXIA CURVE	410	94450	684	N/A	N/A	N/A
HC36800076	BRONCH W/NDL ASP BX(S) INITIAL	361	31629	7,311	N/A	N/A	N/A
HC36800100	BRONCH THERAPEUTIC SUBSEQ (PER DOS)	361	31646	5,223	N/A	N/A	N/A
HC36800381	SPIROMETRY W/MEASUREMNTS& REC	460	94010	1,008	N/A	N/A	N/A
HC36800423	BLOOD GAS PH ONLY	301	82800	214	N/A	N/A	N/A
HC36800456	BLOOD GAS W/MEASURED O2 SAT	301	82805	676	N/A	N/A	N/A
HC36800605	CHLORIDE	301	82435	125	N/A	38	N/A
HC36800639	SODIUM	301	84295	144	N/A	28	N/A
HC36800662	PH FLUID	301	83986	150	N/A	N/A	N/A
HC36800829	BRONCH W/EBUS SAMPLING 1/2 NODES	361	31652	10,023	N/A	N/A	N/A
HC36800852	TEST EXERC BRONCHOSPASM INCL SPIR&POX W/O ECG	460	94619	2,049	N/A	N/A	N/A
HC36800886	PERC BX CORE LUNG/MEDIASTINUM W/ IMAG IF OCCURS	361	32408	7,454	N/A	N/A	N/A
HC37090008	P: MNT INITIAL ASSESS 30 MIN-OP			N/A	N/A	N/A	N/A
HC37090032	P: MNT INITIAL ASSESS 75 MIN-OP			N/A	N/A	N/A	N/A
HC38000022	APPLY CAST SHORT ARM	700	29075	948	N/A	N/A	N/A
HC38000055	APPLY CAST SHORT LEG WALKING	700	29425	1,200	N/A	N/A	N/A
HC38000089	APPLICATION CAST GAUNTLET	700	29085	671	N/A	N/A	N/A
HC38000238	APPLY BODY CAST;SHOULDER-HIPS	700	29035	1,126	N/A	N/A	N/A
HC38000261	APPLY BODY CAST; FULL ADULT	700	29046	1,823	N/A	N/A	N/A
HC38000295	APPLY SPICA  HIP ONE LEG	700	29305	1,333	N/A	N/A	N/A
HC38420022	COLLECT AUTO'BLOOD ADD'L UNIT	390	86891	1,203	N/A	N/A	N/A
HC38420055	PERFUSION CARDIOASSIST INL' 2HR	481	92970	6,949	N/A	N/A	N/A
HC38420220	ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS	489	33963	26,388	N/A	N/A	N/A
HC38420253	ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER	489	33966	9,158	N/A	N/A	N/A
HC39000161	PSY FAMILY CONFERENCE	919	90887	235	N/A	N/A	N/A
HC39000203	NEUROPSYCH STATUS EXAM/HR	918	96116	845	N/A	N/A	N/A
HC39000252	PSY TM CONF W/PT&/FAM 60MIN	900	99366	374	N/A	N/A	N/A
HC39000773	PSYCH TEAM CONF PRTCPNT PER 15MIN	914		39	N/A	N/A	N/A
HC39000807	SW TEACH/COUNSEL GROUP SESSION - COMM/CCS	915	S9446	115	N/A	N/A	N/A
HC39000930	INTERACTIVE COMPLEXITY+	914	90785	218	N/A	N/A	N/A
HC39001144	PSYCH GROUP INTERACTIVE 45-50M	915	G0411	403	N/A	N/A	N/A
HC39001243	PSYCH TESTING EVAL INTEGR INTERPRET CLIN DES TX; 1ST HOUR	918	96130	609	N/A	N/A	N/A
HC39001417	PSY-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	918	96110	232	N/A	N/A	N/A
HC39001540	PSY-BEHAVIOR TX INDIV ADDL 15 MIN	914	96159	127	N/A	N/A	N/A
HC41000100	POLYSMNGRPH 4+STGS <6 DISCONT	740	95782	1,752	N/A	N/A	N/A
HC41000127	HOME SLEEP STUDY/T II MIN' 7CH	920	G0398	1,470	N/A	N/A	N/A
HC41500000	AUDITORY EVOKED AEP BBS HEARING DETERM W/I&R	471	92651	2,617	N/A	N/A	N/A
HC41500182	ELECTROCORTICOGRAM IN SURGERY	740	95829	3,266	N/A	N/A	N/A
HC41500216	EMG 3 EXTREMITY	922	95863	2,606	N/A	N/A	N/A
HC41500240	EMG FACIAL UNILAT LT	922	95867	1,112	N/A	N/A	N/A
HC41500471	WADA TEST	740	95958	3,654	N/A	N/A	N/A
HC41500505	EMG NON-EXTREM (FACIAL) MUSC +	922	95887	838	N/A	N/A	N/A
HC41500679	EEG ANALYSIS DIGITAL	740	95957	722	N/A	N/A	N/A
HC41500729	EMG HEMIDIAPHRAGM	922	95866	1,296	N/A	N/A	N/A
HC41500752	ORBICULARIS OCULI (BLINK) REFLEX	922	95933	627	N/A	N/A	N/A
HC41500893	VESTIBULAR EVOKD MYOGN POTENTL-VEMP;CERVICAL (CVEMP)	471	92517	802	N/A	N/A	N/A
HC41500927	AUDITORY EVOKED AEP THRESHOLD EST MULT FREQ W/I&R	471	92652	1,915	N/A	N/A	N/A
HC42000026	AMB BP MONITOR 24HR+ RECORD ONLY	480	93786	949	N/A	N/A	N/A
HC42000166	ECHO DOPPLER COMPLETE	483	93320	2,112	N/A	N/A	N/A
HC42000190	ECHO FETAL CARDIOVASCULAR	483	76825	3,132	N/A	N/A	N/A
HC42000224	ECHO FETAL F/U OR REPEAT	483	76826	1,689	N/A	N/A	N/A
HC42000430	PROGRAM EVAL CARDIAC RHYTHM MON SQ	480	93285	431	N/A	N/A	N/A
HC42000463	PROGRAM/EVAL PACEMKR MULT LEAD	480	93281	568	N/A	N/A	N/A
HC42000653	CV STRESS TEST NUCLEAR (ST)	482		N/A	N/A	N/A	N/A
HC42000729	ECHO 2D CMPLT W/O SPC&DOP W/WO CONTR	483	C8923	3,743	N/A	N/A	N/A
HC42000752	TEE CONGENITAL COMPLT W/WO CONTR	483	C8926	4,942	N/A	N/A	N/A
HC42000927	CTA CORONARY FFR DATA PREP&TRANSMIT	480	0502T	814	N/A	N/A	N/A
HC42090019	P: COMPLETE CONGENITAL ECHO			N/A	N/A	N/A	N/A
HC42090043	P:STRESS ECHO TREAD/DOPLER/CLR			N/A	N/A	N/A	N/A
HC43000116	DUCTOGRAM/GALACTOGRAM MULTI	320	77054	1,628	N/A	N/A	N/A
HC43000165	MAMMO DUCTO/GALACTO INJ-RT	361	19030	2,411	N/A	N/A	N/A
HC43000819	INCISION BREAST LESION-RT	361	19020	5,303	N/A	N/A	N/A
HC43000983	US BREAST; COMPLETE RT	402	76641	967	N/A	N/A	N/A
HC43001155	MAMMO DX LTD/FOCUS EXM UNILT W/CAD LT	401	77065	895	N/A	N/A	N/A
HC43001189	MAMMO DX UNILAT W/CAD RT	401	77065	1,104	N/A	N/A	N/A
HC43001213	METABOLIC IMAGING RISK ASSESSMENT (MIRA)	409	76499	113	N/A	N/A	N/A
HC44000057	ABDOMEN SINGLE VIEW	320	74018	607	N/A	N/A	N/A
HC44000081	ANKLE 2 VIEWS LT	320	73600	728	N/A	N/A	N/A
HC44000115	ANKLE ARTHROGRAM LT	322	73615	1,474	N/A	N/A	N/A
HC44000347	CERVICAL SPINE COMP 6/> VWS	320	72052	1,507	N/A	N/A	N/A
HC44000388	CHEST 2 VWS W/APICAL LORDOTIC (3VIEWS)	324	71047	947	N/A	N/A	N/A
HC44000610	ELBOW 2 VWS RT	320	73070	702	N/A	N/A	N/A
HC44000644	ELBOW ARTHROGRAM RT	322	73085	1,606	N/A	N/A	N/A
HC44000677	ELBOW COMP MIN 3 VWS RT	320	73080	897	N/A	N/A	N/A
HC44000818	FISTULA/SINUS ABSCESS STUDY	320	76080	1,724	N/A	N/A	N/A
HC44000842	FLUORO CV ACCESS CATH REPLACE/RMVL	320	77001	1,841	N/A	N/A	N/A
HC44000891	FOOT 2 VIEWS LT	320	73620	723	N/A	N/A	N/A
HC44001030	HIP ARTHROGRAM BILAT	322	73525	3,409	N/A	N/A	N/A
HC44001170	HUMERUS BILAT	320	73060	1,340	N/A	N/A	N/A
HC44001204	HYSTEROSALPINGOGRAM	320	74740	1,674	N/A	N/A	N/A
HC44001378	KNEE 1 VIEW LT	320	73560	740	N/A	N/A	N/A
HC44001402	KNEE 2 VIEWS LT	320	73560	826	N/A	N/A	N/A
HC44001576	MANDIBLE < 4 VIEWS	320	70100	709	N/A	N/A	N/A
HC44001600	MASTOIDS MIN 3 VIEWS	320	70130	986	N/A	N/A	N/A
HC44001634	MYELOGRAM THORACIC	320	72255	3,197	N/A	N/A	N/A
HC44001774	RIBS BILAT 3 VIEWS	320	71110	1,071	N/A	N/A	N/A
HC44001808	RIBS UNILAT 2 VIEWS RT	320	71100	838	N/A	N/A	N/A
HC44001832	SACRO-ILIAC JNTS 3 OR MORE VWS	320	72202	901	N/A	N/A	N/A
HC44002012	SIALOGRAPHY	320	70390	1,088	N/A	N/A	N/A
HC44002046	SKULL COMPLETE MIN 4 VWS	320	70260	1,381	N/A	N/A	N/A
HC44002236	TIBIA & FIBULA (LEG) 2 VWS BIL	320	73590	1,594	N/A	N/A	N/A
HC44002277	TMJ ARTHROGRAM BILAT	322	70332	2,044	N/A	N/A	N/A
HC44002525	WRIST 2 VIEWS LT	320	73100	702	N/A	N/A	N/A
HC44002558	WRIST ARTHROGRAM LT	322	73115	1,608	N/A	N/A	N/A
HC44002582	WRIST COMP MIN 3 VWS LT	320	73110	876	N/A	N/A	N/A
HC44002756	FINGER(S)	320	73140	616	N/A	N/A	N/A
HC44002780	TIBIA AND FIBULA	320	73590	862	N/A	N/A	N/A
HC44002814	OS CALSIS	320	73650	622	N/A	N/A	N/A
HC44002988	HIPS BILAT3-4VWS(W/PELVIS WHN PRFRMD)	320	73522	1,153	N/A	N/A	N/A
HC44003010	FEMUR 1 VIEW RT	320	73551	544	N/A	N/A	N/A
HC44200020	US GUIDANCE ABLATION PARENCHYMAL TISSUE	402	76940	1,715	N/A	N/A	N/A
HC44200053	ART STDY BILAT U/L 3/> LVL CMP	921	93923	2,663	N/A	N/A	N/A
HC44200251	US DUPLEX VEIN EXT COMP BILAT	921	93970	3,058	N/A	N/A	N/A
HC44200293	US FETAL BIO PROF W/O NST(INTL)	402	76819	1,539	N/A	N/A	N/A
HC44200327	US GUIDE VASC ACCESS	402	76937	1,425	N/A	N/A	N/A
HC44200467	US OB NUCHAL MEAS  1ST GEST	402	76813	1,410	N/A	N/A	N/A
HC44200491	US OPHTH B-SCAN	402	76512	1,273	N/A	N/A	N/A
HC44200541	US RETROPERITONEAL COMPLETE	402	76770	2,160	N/A	N/A	N/A
HC44200764	US GUIDE PLCMNT LT	402	76942	1,949	N/A	N/A	N/A
HC44200798	US GUIDE PLCMNT NEEDLE LOC RT	402	76942	1,949	N/A	N/A	N/A
HC44200970	US ELASTOGRAPHY 1ST LESION	402	76982	761	N/A	N/A	N/A
HC44201002	US OB EVA PLUS FETAL ANATOMIC DETAIL EA ADL GEST+	402	76812	1,875	N/A	N/A	N/A
HC44500007	ABLATION RENAL TUMOR(S) PERC; RF	361	50592	20,794	N/A	N/A	N/A
HC44500312	ANGIO PULMONARY NON SELECT LT	323	75746	6,685	N/A	N/A	N/A
HC44500387	ANGIO SPINAL SELECTIVE  RT	323	75705	10,116	N/A	N/A	N/A
HC44500445	AORTOGRAM ABD W/ RUN OFF	323	75630	10,359	N/A	N/A	N/A
HC44500759	ENDO BILI W/DILAT W/ STENT	361	47556	8,705	N/A	N/A	N/A
HC44500809	ERCP BILIARY&PANCREATIC SYSTEM	320	74330	2,773	N/A	N/A	N/A
HC44501237	OCCL BALLOON TEMP HEAD/NECK	361	61623	24,604	N/A	N/A	N/A
HC44501450	PLACEMT OF CHOLEDOCHAL STENT	361	47801	11,403	N/A	N/A	N/A
HC44501864	REVISION-TIPS	323	37183	45,933	N/A	N/A	N/A
HC44501898	THROMBEC VC/ILIAC FEMPOP INCSN	361	34421	10,093	N/A	N/A	N/A
HC44501922	THROMBECT MECH PRIM ART ADD LT(NONCOR/CRNL)+	361	37185	13,804	N/A	N/A	N/A
HC44502177	VENOGRAM ADRENAL BILAT	320	75842	10,097	N/A	N/A	N/A
HC44502201	VENOGRAM CAVAL INFERIOR	323	75825	7,899	N/A	N/A	N/A
HC44502235	VENOGRAM EXTREMITY BILAT	323	75822	6,274	N/A	N/A	N/A
HC44502649	REPOSIT NASO/ORO GFT THRU DUOD	361	43761	5,174	N/A	N/A	N/A
HC44502714	REVASC ILIAC W/TLA INITL VES-RT	323	37220	19,046	N/A	N/A	N/A
HC44502888	REVASC FEM POP W/TLA&ATHER-BI	323	37225	56,770	N/A	N/A	N/A
HC44502912	REVASC FEM POP W/TLA&STENT-BI	323	37226	53,666	N/A	N/A	N/A
HC44503084	REVASC TIB/PERO EA+VES W/TLA-L	323	37232	15,589	N/A	N/A	N/A
HC44503118	REVASC TIB/PERO EA+VES W/TLA-L	323	37233	20,679	N/A	N/A	N/A
HC44503142	REVAS TIB/PER EA+V TLA&STENT-L	323	37234	22,443	N/A	N/A	N/A
HC44503282	ATHER'TRLUML ILIAC EAVES W/S&I-L	323	0238T	31,543	N/A	N/A	N/A
HC44503449	DECLOTTING VASC ACCES/CATH LT	361	36593	2,787	N/A	N/A	N/A
HC44503472	DECLOT IVAD BY THROMBOLYTIC RT	361	36593	2,845	N/A	N/A	N/A
HC44503688	VERT/THOR CAROTID STENT+LT	361	0076T	9,187	N/A	N/A	N/A
HC44503712	INJ SCLEROTHERAPY LYMPHOCELE	361	38999	4,012	N/A	N/A	N/A
HC44503886	SEL CATH EX CAROTID&ANG EC W/SI LT+	323	36227	10,184	N/A	N/A	N/A
HC44503910	SEL CATH EA IC CRTD/VERT&ANG W/SI RT+	323	36228	9,835	N/A	N/A	N/A
HC44504017	ANGIO IL/FEM DURING HRTCATH&/CORO W/S&I	323	G0278	3,980	N/A	N/A	N/A
HC44504157	SEL CATH  IC CAROTID &ANG IC W/SI BI	323	36224	42,509	N/A	N/A	N/A
HC44504181	SEL CATH EX CAROTID&ANG EC W/SI BI+	323	36227	18,325	N/A	N/A	N/A
HC44504215	XRAY TEVAR; INITIAL ENDO & DIST EXTS TO CELIAC S&I	481	75957	7,304	N/A	N/A	N/A
HC44504355	PLCMT STNT BIL PERC EA(CHOLANG BLN DIL S&I)EXIST ACC	361	47538	19,733	N/A	N/A	N/A
HC44504389	CONVRT CATH DRN BIL EXT->INT-EXT PERC(CHOLANG S&I)	361	47535	10,982	N/A	N/A	N/A
HC44504413	PLCMT ACC BILTREE->SB4ENDO PERC(CHOLANG S&I) NEW ACC	361	47541	11,336	N/A	N/A	N/A
HC44504587	PLCMT URET STENT PERC(NEPH/URET'GRM S&I) NEW ACCES SEP CATH BI	361	50695	30,558	N/A	N/A	N/A
HC44504611	THROMBECT MECH PERC&/THROMBOLYSIS INF CRANI BI	361	61645	58,843	N/A	N/A	N/A
HC44504785	PLACEMENT STENT(S)CDS VIA DIALYSIS CIRCUIT WS&I  PTA+	361	36908	10,396	N/A	N/A	N/A
HC44504819	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:INTL RIGHT	361	37246	15,363	N/A	N/A	N/A
HC44504843	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:ADDL + RT	361	37247	10,314	N/A	N/A	N/A
HC44504983	PERC PULM ARTERY REVASC W/STENT INITL ; NRML NTV UNILAT	361	33900	28,836	N/A	N/A	N/A
HC44505014	PERC PULM ARTERY REVASC W/STENT INITL; ABNRML NTV BILAT	361	33903	33,641	N/A	N/A	N/A
HC44700029	CARDIOVERSION INTERNAL	481	92961	4,159	N/A	N/A	N/A
HC44700359	INSERT LV LEAD AT INIT IMPLNT+	481	33225	20,398	N/A	N/A	N/A
HC44700383	INSERT PACER DUAL CHAMBER	481	33208	27,585	N/A	N/A	N/A
HC44700557	INTRAVASC DOPPLER INIT VESSEL+	481	93571	5,904	N/A	N/A	N/A
HC44700607	IVUS/OCT CORONARY VESS/GRAFT INIT	481	92978	9,219	N/A	N/A	N/A
HC44701019	REMOVE CARDIAC RHYTHM MONITOR SQ	481	33286	4,803	N/A	N/A	N/A
HC44701043	REPAIR LEAD TV SNGL PACER/ICD	481	33218	11,355	N/A	N/A	N/A
HC44701076	REPOSITION PACER/ICD LEAD RT HRT	481	33215	11,215	N/A	N/A	N/A
HC44701241	INSTILL FIBRIN CT SUB' DAY LT	361	32562	2,394	N/A	N/A	N/A
HC44701332	RT & LT HEART CATH;LT VENT S&I	481	93453	25,247	N/A	N/A	N/A
HC44701365	PLCMT CORON CATH;RT HRT CATH	481	93456	24,709	N/A	N/A	N/A
HC44701589	REMV&REPL PACER SINGL LEAD SYS	481	33227	21,642	N/A	N/A	N/A
HC44701613	INSRT ICD W/EXSTNG DUAL LEAD	481	33230	26,755	N/A	N/A	N/A
HC44701803	PERC COR ANGIOPLST; ADDL CA/BRCH-RI+	481	92921	14,940	N/A	N/A	N/A
HC44701837	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-LC	481	92924	29,300	N/A	N/A	N/A
HC44701860	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-LM+	481	92925	17,742	N/A	N/A	N/A
HC44702009	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-RI+	481	92929	16,924	N/A	N/A	N/A
HC44702033	PERC COR ATHR+STENT/ANGIOP; SNGL-LC	481	92933	32,208	N/A	N/A	N/A
HC44702066	PERC COR ATHR+STENT/ANGIOP; ADDL-LM+	481	92934	18,933	N/A	N/A	N/A
HC44702207	PERC CABG REVAS ATHR/STENT/ANG; ADDL-RI+	481	92938	16,889	N/A	N/A	N/A
HC44702231	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-LC	481	92941	31,917	N/A	N/A	N/A
HC44702264	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-LM	481	92943	32,524	N/A	N/A	N/A
HC44702439	PERC COR DES STENT(S)/ANGIOP; ADDL-LC+	481	92929	16,924	N/A	N/A	N/A
HC44702462	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-LM	481	92933	32,208	N/A	N/A	N/A
HC44702637	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-LC+	481	92938	16,889	N/A	N/A	N/A
HC44702660	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-LM	481	92941	31,917	N/A	N/A	N/A
HC44702694	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-RC	481	92941	31,917	N/A	N/A	N/A
HC44702835	COMP EP EVAL W/INDUC&ABLAT 3D MAP ECHO S&I PVI AFIB	481	93656	57,526	N/A	N/A	N/A
HC44702868	REPAIR VISC AORTA FEVAR;1 PROSTH	360	34841	42,037	N/A	N/A	N/A
HC44702892	REPAIR VISC AORTA FEVAR; 4+PROSTH	360	34844	45,902	N/A	N/A	N/A
HC44703064	TAVR/TAVI; BYPASS PERC PERIPH A&V(FEM)+	481	33367	19,973	N/A	N/A	N/A
HC44703098	PERC CLOSURE OF PDA TRANSCATH	481	93582	26,374	N/A	N/A	N/A
HC44703270	PPVI PERC TRANSCATH PV IMPLANT W/STENTING	481	33477	35,513	N/A	N/A	N/A
HC44703304	EV REPAIR INFRARENAL AORTA DEPLOY GRAFT A-A NON-RUPT	360	34701	28,517	N/A	N/A	N/A
HC44703478	PERC CLOSURE LAA (WATCHMAN)	360	33340	22,871	N/A	N/A	N/A
HC44703502	PERICARDIAL DRAIN W/CATH & CT GUIDANCE	361	33019	3,877	N/A	N/A	N/A
HC44703536	REVASCULARIZATION LITHOTRIPSY INTRAVASC W/STENT	361	C9765	25,765	N/A	N/A	N/A
HC44703726	PERC REPAIR TRNSCTH TRICUSPID VALVE ADDL PROSTHESIS+	481	0570T	8,218	N/A	N/A	N/A
HC44703759	RT HRT CATH CONGEN DEFECTS INCLUDE IMAG;ABNRML NATIVE CONNECT'	481	93594	24,886	N/A	N/A	N/A
HC44703783	RT & LT HRT CATH CONGEN DEFECT INCLUDE IMAGE; ABNRML NATIVE CONNECT	481	93597	27,120	N/A	N/A	N/A
HC44900009	CT ABDOMEN W&W/O CONTRAST	352	74170	7,283	N/A	N/A	N/A
HC44900033	CT ABDOMEN W/O CONTRAST LTD	352	74150	3,687	N/A	N/A	N/A
HC44900223	CT HEAD W/O CONTRAST	351	70450	5,146	N/A	N/A	N/A
HC44900256	CT LOW EXT W&W/O CONTRAST RT	352	73702	6,217	N/A	N/A	N/A
HC44900421	CT NECK SOFT TISSUE W/O CONT	351	70490	4,689	N/A	N/A	N/A
HC44900454	CT ORBIT/SELLA/EAR W/O CONTRAS	351	70480	5,126	N/A	N/A	N/A
HC44900488	CT PELVIS W/O CONTRAST	352	72192	5,618	N/A	N/A	N/A
HC44900629	CT WHOLE BODY SCREEN	350	76497	1,525	N/A	N/A	N/A
HC44900652	CTA HEAD	351	70496	6,427	N/A	N/A	N/A
HC44900686	CTA LOW EXT RT	352	73706	7,055	N/A	N/A	N/A
HC44900926	CT COLONOGRAPHY DX VIRTUAL W/ CONTRAST	350	74262	4,794	N/A	N/A	N/A
HC44900959	CCTA HEART EVAL W/3D IMAGE	350	75574	7,506	N/A	N/A	N/A
HC45200045	NM BONE MARROW LTD AREA	341	78102	2,311	N/A	N/A	N/A
HC45200078	NM BONE SCAN LTD AREA	341	78300	2,994	N/A	N/A	N/A
HC45200110	NM BONE SCAN WHOLE BODY	341	78306	4,203	N/A	N/A	N/A
HC45200268	NM CARDIAC SHUNT DETECTION	341	78428	2,845	N/A	N/A	N/A
HC45200292	NM ESOPHAGEAL MOTILITY	341	78258	2,461	N/A	N/A	N/A
HC45200326	NM GASTRIC REFLUX STUDY	341	78262	2,781	N/A	N/A	N/A
HC45200631	M: NM NUCLEAR MED MISC PROC	341	78999	N/A	N/A	N/A	N/A
HC45200664	NM PLASMA VOL MULTI SAMPLE	341	78111	2,333	N/A	N/A	N/A
HC45201001	NM VASCULAR BLOOD FLOW	341	78445	2,541	N/A	N/A	N/A
HC45201035	NM VENOGRAM(THROMBOSIS)BILAT	341	78458	3,685	N/A	N/A	N/A
HC45201324	NM THYROID SCAN & UPTAKE SNG/MULT MSRMT [W/VASC FLOW IF PERF]	341	78014	3,083	N/A	N/A	N/A
HC45201357	NM GASTRIC EMPTYING SMALL BOWEL	341	78265	3,301	N/A	N/A	N/A
HC45201381	NM TUMOR LOCALIZE SPECT 2+ AREAS 1 DAY//SNGL AREA 2+DAYS	341	78831	7,678	N/A	N/A	N/A
HC45400108	MR CHEST W/O CONTRAST	610	71550	6,454	N/A	N/A	N/A
HC83503417	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-20 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503441	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-7 -US	312	88342	N/A	N/A	N/A	N/A
HC83503474	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 13-A -IM	312	88342	N/A	N/A	N/A	N/A
HC83503656	IHC/IP PER SPEC INITIAL AB STAIN PLAP -IM	312	88342	40	N/A	40	N/A
HC83503680	IHC/IP PER SPEC INITIAL AB STAIN PROLACTIN -US	312	88342	50	N/A	50	N/A
HC83503714	IHC/IP PER SPEC INITIAL AB STAIN SMMHC -IM	312	88342	89	N/A	89	N/A
HC83503904	MORPHOM STDY TUMOR IHC-US	312	88361	N/A	N/A	N/A	N/A
HC83503946	HANDLING AND/OR SHIPPING	300	99001	85	N/A	25	N/A
HC83503995	CHROM ANAL AMNIO/CHORIONIC-GZ	310	88235	N/A	N/A	N/A	N/A
HC83504217	M: MISC LAB PATHOLOGY REF LAB-LR	310		N/A	N/A	N/A	N/A
HC83504258	M: MISC LAB PATHOLOGY REF LAB-PI	310		N/A	N/A	N/A	N/A
HC83504456	IHC/IP PER SPEC INITIAL AB STAIN -EM	312	88342	80	N/A	80	N/A
HC83504480	M: MISC LAB PATHOLOGY REF LAB-UM	310		N/A	N/A	N/A	N/A
HC83504597	FLOW CYT MKR TC ADD+-U2	311	88185	N/A	N/A	N/A	N/A
HC83504803	MORPH STDY CAT ISH QNT/SPEC INTL SNGL PROBE CEP17-NG	310	88367	231	N/A	231	N/A
HC83504837	IHC MLH1 QNT-NG	310	88360	45	N/A	59	N/A
HC83504860	IP/IHC PER SPEC INITIAL AB STAIN -NG	312	88342	45	N/A	40	N/A
HC83505339	CONSULTATION PATH; REF SLIDE REV-BR	310	88321	300	N/A	N/A	N/A
HC83505396	M: MISC LAB PATHOLOGY REF LAB-PP	310		84	N/A	N/A	N/A
HC83505560	M: MISC LAB PATHOLOGY REF LAB-MC	310		N/A	N/A	N/A	N/A
HC83505594	M: MISC LAB PATHOLOGY REF LAB-SH	310		N/A	N/A	N/A	N/A
HC83505768	SPECIAL STAIN GRP III ENZYMES(PANEL)-U2	314	88319	69	N/A	N/A	N/A
HC83505792	M: MISC LAB PATHOLOGY REF LAB-NF	310		N/A	N/A	N/A	N/A
HC83505826	EGFR GENE COM VARIANTS-NG	310	81235	360	N/A	N/A	N/A
HC83505966	M: MISC LAB PATHOLOGY REF LAB-VA	310		N/A	N/A	N/A	N/A
HC83505990	TISSUE IN-SITU HYBRID SGL PROBE EA ADDL-NG	312	88364	80	N/A	N/A	N/A
HC83506022	M: MISC LAB PATHOLOGY REF LAB-TL	310		575	N/A	N/A	N/A
HC83590406	EGFR GENE COM VARIANTS-AP	310	81235	325	N/A	N/A	N/A
HC83590430	M: MISC LAB PATHOLOGY REF LAB-CT	310		N/A	N/A	N/A	N/A
HC84200161	MIC SENSITIVITY	306	87186	431	N/A	46	N/A
HC84200195	CULTURE MRSA	306	87081	315	N/A	42	N/A
HC84200229	CULTURE NASAL	306	87070	488	N/A	95	N/A
HC84200369	CULTURE URINE QUANTITATIVE	306	87086	474	N/A	37	N/A
HC84200393	SPUTUM EVALUATION STAIN	306	87205	207	N/A	48	N/A
HC84200427	INFLUENZA ANTIGEN DIRECT OPT	306	87804	233	N/A	57	N/A
HC84200583	CRYPTCOCCUS AB QNT BLOOD	306	86256	236	N/A	66	N/A
HC84200617	LEGIONELLA AG URINE	306	87449	342	N/A	115	N/A
HC84200641	CULTURE WOUND	306	87070	486	N/A	100	N/A
HC84200823	PERTUSSIS FA ANTIGEN	306	87265	276	N/A	49	N/A
HC84200856	HSV 1 FA ANTIGEN	306	87274	278	N/A	50	N/A
HC84201029	CULTURE WHIRLPOOL	306	87070	488	N/A	43	N/A
HC84201052	PARTICLE AGGLUTIN EA AB(PNL)	306	86403	222	N/A	110	N/A
HC84201094	SWINE FLU; STATISTIC SCREEN	306		N/A	N/A	N/A	N/A
HC84201284	CULTURE CRE	306	87081	315	N/A	48	N/A
HC84201326	C. PNEUMONIAE BY PCR (RVP PNL)	306	87486	596	N/A	150	N/A
HC84201359	RESPIRATORY SYNCTAL VIRUS EIA (POS)	306	87420	384	N/A	76	N/A
HC84201524	DNA/RNA L MONOCYTOGENES PCR(PNL)	306	87798	524	N/A	150	N/A
HC84201557	DNA/RNA ENTEROVIRUS PCR(PNL)	306	87798	537	N/A	150	N/A
HC84201722	DNA/RNA SERRATIA MARCESCENS (PNL)	306	87798	483	N/A	150	N/A
HC84201755	DNA/RNA STREPTOCOCCUS PNEUMONIAE (PNL)	306	87798	483	N/A	150	N/A
HC84290048	P:PARASITE CRYPTO/GIARD			N/A	N/A	N/A	N/A
HC84290105	P:CULTURE DNA/RNA PCR PANEL			N/A	N/A	N/A	N/A
HC84600014	CYTOLOGY FLUID/BRUSH/WASH	311	88104	312	N/A	146	N/A
HC84600162	CYTOLOGY PREP NON GYN S&I	311	88161	378	N/A	150	N/A
HC84600196	FNA INTERPRETATION/REPORT	311	88173	595	N/A	300	N/A
HC84600220	CYTP DX EVAL FNA EA ADDL SAME SITE	311	88177	328	N/A	100	N/A
HC84600543	CYTOPATH SELECT CELL ENHANC*OP	311	88112	691	N/A	70	N/A
HC84600576	PAP THIN LAYER  MNL SCRN DX	311	88142	249	N/A	85	N/A
HC88600176	RESEARCH STUDY FEE(SOCSMG)*CLB	300	84999	N/A	N/A	N/A	N/A
HC88600234	SPECIAL COURIER       25	300	99001	32	N/A	25	N/A
HC89000095	JO 1 ENA AB-QD	302	86235	14	N/A	14	N/A
HC89000129	EBV NUCLEAR AG AB (PNL)-FT	302	86664	70	N/A	70	N/A
HC89000152	PSA FREE-QD	301	84154	14	N/A	13	N/A
HC89000293	ESTRIOL URINE-SL	301	82677	N/A	N/A	N/A	N/A
HC89000335	ARGININE VASOPRESSIN HORMON-QD	301	84588	N/A	N/A	N/A	N/A
HC89000368	T-3 REVERSE-QD	301	84482	19	N/A	19	N/A
HC89000533	COXSACKIE B AB (PNL)-SL	302	86658	101	N/A	101	N/A
HC89000566	ANTI-HISTONE AB-AU	301	83516	11	N/A	12	N/A
HC89000756	PYRUVATE-QD	301	84210	9	N/A	9	N/A
HC89000780	DYPHYLLINE-AU	301	80299	94	N/A	94	N/A
HC89000814	THYROGLOBULIN-QD	301	84432	N/A	N/A	N/A	N/A
HC89000988	VITAMIN C-QD	301	82180	N/A	N/A	N/A	N/A
HC89001010	FECAL FAT QUANT-QD	301	82710	N/A	N/A	N/A	N/A
HC89001044	TOXOPLASMA AB IGM(PNL)-AU	302	86778	10	N/A	11	N/A
HC89001184	INDERAL-QD	301	80299	60	N/A	60	N/A
HC89001226	C-PEPTIDE-QD	301	84681	37	N/A	36	N/A
HC89001259	THYROXINE BIND GLOBULIN-QD	301	84442	30	N/A	30	N/A
HC89001481	CRYPTOCOCCUS AG-QD	306	87449	18	N/A	18	N/A
HC89001515	PARAINFLUENZA AB-QD	302	86790	19	N/A	19	N/A
HC89001747	DIBUCAINE NUMBER-QD	301	82638	N/A	N/A	N/A	N/A
HC89001770	ETHOSUXIMIDE-QD	301	80168	N/A	N/A	N/A	N/A
HC89001812	APOLIPOPROTIN A-SL	301	82172	N/A	N/A	N/A	N/A
HC89001978	CHOLINESTERASE-QD	301	82480	N/A	N/A	N/A	N/A
HC89002000	DESIPRAMINE; 1-2-AU	301	80335	17	N/A	17	N/A
HC89002034	CYCLOSPORINE-U2	301	80158	45	N/A	45	N/A
HC89002224	FACTOR V LABILE-U2	305	85220	N/A	N/A	N/A	N/A
HC89002257	LYME DISEASE AB-QD	302	86618	18	N/A	18	N/A
HC89002471	HEPATITIS C GENOTYPE PCR-SL	306	87902	N/A	N/A	N/A	N/A
HC89002505	HEPARIN-INDUCED PLATELET AB-QD	302	86022	135	N/A	87	N/A
HC89002687	WEST NILE VIR AB IGG/IGM(SERM)ELISA-AU	302	86790	14	N/A	17	N/A
HC89002794	GABAPENTIN (SERUM)-QD	301	80171	60	N/A	60	N/A
HC89002828	DISOPYRAMIDE-QD	301	80299	60	N/A	60	N/A
HC89002968	MITOCHONDRIAL FA AB SCRN-QD	302	86255	27	N/A	27	N/A
HC89002992	VMA URINE-QD	301	84585	18	N/A	18	N/A
HC89003024	CHLORIDE CSF-QD	301	82438	N/A	N/A	N/A	N/A
HC89003198	HGB ELECTROPHERESIS-QD	301	83020	19	N/A	19	N/A
HC89003222	PROTEIN ELECT FRACT&QT-QD	301	84165	13	N/A	13	N/A
HC89003396	FACTOR XI-U2	305	85270	N/A	N/A	N/A	N/A
HC89003420	FACTOR VIII RELATED AG-U2	305	85244	N/A	N/A	N/A	N/A
HC89003453	EBV AB TO NUCLEAR AG-QD	302	86664	23	N/A	23	N/A
HC89003610	MEPERIDINE ANLG; 1-2 URINE-AU	301	80361	103	N/A	103	N/A
HC89003644	RSV AB-AU	302	86756	12	N/A	11	N/A
HC89003677	CHLAMYDIA AB-QD	302	86631	12	N/A	12	N/A
HC89003834	NBS HGB CHROMATOGRAPHY-GE	301	83021	18	N/A	16	N/A
HC89003867	PROCAINAMIDE W/NAPA-U2	301	80192	25	N/A	25	N/A
HC89003917	B.PARAPERTUSSIS/PERT DFA-U2	306	87265	13	N/A	13	N/A
HC89004089	FAT FECAL QUAL-AU	301	82705	14	N/A	8	N/A
HC89004113	ADRENAL AB - AU	302	86255	46	N/A	46	N/A
HC89004378	ADENOVIRUS AG-AU	301	87301	19	N/A	11	N/A
HC89004402	ADENOVIRUS AB  IGM-AU	302	86603	11	N/A	11	N/A
HC89004436	CHAGAS AB-AU	302	86753	16	N/A	16	N/A
HC89004618	PANCA IGG (PNL)-PR	302	83520	32	N/A	32	N/A
HC89004642	NSNAII IGG 1ST STAIN(PNL)-PR	310	88346	98	N/A	98	N/A
HC89004675	ANTI-RO SS-A (PNL2)-RD	302	86235	21	N/A	21	N/A
HC89004840	ESTRONE BY TMS-AU	301	82679	31	N/A	31	N/A
HC89004873	DRVVT RUSS VIPER VNM CONFIRM RFX-AU	305	85613	23	N/A	23	N/A
HC89005045	CALCIUM IONIZED-U2	301	82330	30	N/A	30	N/A
HC89005078	ULTRACENTRIFUG VAP(IN PNL)-AU	301	83701	53	N/A	58	N/A
HC89005243	HERPESVIRUS 6 AB IGG- FT	302	86790	81	N/A	81	N/A
HC89005276	HSV 2 QUANT PCR- FT	306	87530	158	N/A	157	N/A
HC89005300	BORDETELLA PERTUS FHA IGG-FT	302	86615	41	N/A	41	N/A
HC89005458	CHLAMYDIA PNEUMONIAE BY PCR-AU	306	87486	180	N/A	179	N/A
HC89005482	INFLUENZA A&B ABS  IGG/IGM-AU	302	86710	10	N/A	32	N/A
HC89005516	ASPERGILLUS ANTIGEN-FT	302	87305	217	N/A	217	N/A
HC89005680	PARVOVIRUS B19 DNA QNT PCR-FT	306	87799	179	N/A	268	N/A
HC89005714	S. PNEUMONIAE ANTIGEN-FT	302	86403	84	N/A	83	N/A
HC89005961	DRUGS OF ABUSE TEST-DTI 7A-AU	301	80307	27	N/A	25	N/A
HC89006175	HALOPERIDOL-AU	301	80173	29	N/A	16	N/A
HC89006233	ASSAY PHENCYCLIDINE (PCP)-AU	301	83992	41	N/A	N/A	N/A
HC89006498	DOXEPIN; 1-2 SRM/PLSM-AU	301	80335	27	N/A	26	N/A
HC89006530	LIDOCAINE-AU	301	80176	16	N/A	16	N/A
HC89006563	PHENYTOIN FREE(PNL)-AU	301	80186	33	N/A	13	N/A
HC89006712	ETHOTOIN-AU	301	80299	N/A	N/A	N/A	N/A
HC89006746	IBUPROFEN; 1-2-AU	301	80329	16	N/A	16	N/A
HC89006779	LEVODOPA-AU	301	80299	N/A	N/A	N/A	N/A
HC89006969	WARFARIN-AU	301	80299	62	N/A	62	N/A
HC89006993	ACETYLCHOLINESTERASE-QD	301	82013	N/A	N/A	N/A	N/A
HC89007207	AMINOLEVULINIC ACID-AU	301	82135	36	N/A	35	N/A
HC89007231	AMINO ACIDS QUANT-AU	301	82139	84	N/A	90	N/A
HC89007264	ANGIOTENSIN CONVERT ENZYME-AU	301	82164	8	N/A	10	N/A
HC89007413	CAROTENE-AU	301	82380	16	N/A	14	N/A
HC89007447	CHLORIDE FECAL-AU	301	82438	14	N/A	14	N/A
HC89007470	CHOLINESTERASE RBC-AU	301	82482	17	N/A	17	N/A
HC89007801	CYANIDE-AU	301	82600	85	N/A	33	N/A
HC89007835	DHEA SULFATE-AU	301	82627	8	N/A	8	N/A
HC89008015	ETHYLENE GLYCOL-AU	301	82693	36	N/A	28	N/A
HC89008049	FATTY ACIDS FREE-QN	301	82725	22	N/A	21	N/A
HC89008247	FSH-ES	301	83001	29	N/A	29	N/A
HC89008270	HUMAN GROWTH HORMONE-ES	301	83003	35	N/A	35	N/A
HC89008304	HEAVY METAL QN EA;BISMUTH-AU	301	83018	N/A	N/A	N/A	N/A
HC89008445	17-OH CORTICOSTEROIDS -AU	301	83491	45	N/A	45	N/A
HC89008478	17 OH PROGESTERONE-AU	301	83498	19	N/A	15	N/A
HC89008502	HYDROXYPROLINE TOTAL-AU	301	83505	16	N/A	16	N/A
HC89008684	TSH RECEPTOR AB-AU	301	83519	16	N/A	16	N/A
HC89008718	GM1 AUTO AB-AT	301	83520	268	N/A	255	N/A
HC89008890	LDL SUBCLASS-AU	301	83701	48	N/A	47	N/A
HC89008924	MANGANESE-AU	301	83785	16	N/A	15	N/A
HC89009369	ORGANIC ACIDS TOTAL QUANT-QD	301	83918	N/A	N/A	N/A	N/A
HC89009393	ORGANIC ACIDS TOT QUANT UR-CA	301	83918	N/A	N/A	N/A	N/A
HC89009427	METHYL MALONIC ACID (B12)-AU	301	83921	15	N/A	20	N/A
HC89009583	ALKALINE PHOS ISOENZYMES-AU	301	84080	13	N/A	16	N/A
HC89009617	PHOSPHATIDYL GLYCEROL-MA	301	84081	N/A	N/A	N/A	N/A
HC89009641	PORPHOBILINOGEN QUANT-AU	301	84110	33	N/A	31	N/A
HC89009815	RENIN-ES	301	84244	60	N/A	60	N/A
HC89009849	SEROTONIN-AU	301	84260	31	N/A	38	N/A
HC89010011	T4 FREE-ES	301	84439	34	N/A	34	N/A
HC89010045	THYROXINE BIND GLOBULIN-AU	301	84442	17	N/A	17	N/A
HC89010078	VITAMIN E-AU	301	84446	9	N/A	15	N/A
HC89010227	ARGININE VASOPRESSIN HORMON-AU	301	84588	30	N/A	24	N/A
HC89010250	VOLATILES-AU	301	84600	22	N/A	25	N/A
HC89010284	ZINC  SERUM -AU	301	84630	5	N/A	8	N/A
HC89010458	M: MISC LAB GENERAL REF LAB-GL	300		N/A	N/A	N/A	N/A
HC89010482	M: MISC LAB GENERAL REF LAB-LC	300		185	N/A	N/A	N/A
HC89010516	M: MISC LAB GENERAL REF LAB-PR	300		993	N/A	N/A	N/A
HC89010680	INHIB PROTEIN S FREE (FUNC)-AU	301	85306	16	N/A	16	N/A
HC89010714	PLASMINOGEN-AU	305	85420	22	N/A	21	N/A
HC89010888	PROTEUS OXK AGGLUT-QD	302	86000	N/A	N/A	N/A	N/A
HC89010912	PLATELET ANTIBODIES-AU	302	86022	100	N/A	56	N/A
HC89010946	ANTI-CARDIOLIPIN AB-RD	302	86147	13	N/A	13	N/A
HC89011084	LCM TITER BY CF-AU	302	86171	N/A	N/A	N/A	N/A
HC89011126	ANTI-DNA ANTIBODIES (DS)-AU	302	86225	16	N/A	16	N/A
HC89011167	ANTI JO 1-SL	302	86235	N/A	N/A	N/A	N/A
HC89011332	NEUTROPHIL GRANULOCYTE AB-FT	302	86235	N/A	N/A	N/A	N/A
HC89011365	SCL-70 REFLEX (PNL)-AU	302	86235	16	N/A	16	N/A
HC89011548	MYELIN AB SCRP-AT	302	86256	N/A	N/A	N/A	N/A
HC89011571	DIPHTHERIA AB TITER-AU	302	86280	22	N/A	22	N/A
HC89011746	IMMUNO ELECT CSF-AT	302	86325	19	N/A	19	N/A
HC89011779	IMMUNODIF(PNL)-AU	302	86329	N/A	N/A	N/A	N/A
HC89011803	LYSOZYME MURAMIDASE (GID)-AU	302	86331	16	N/A	16	N/A
HC89011944	ANTI MICROSOMAL THYROID-ES	302	86376	32	N/A	32	N/A
HC89011977	COXSACKIE NEUT B VIRUS-AU	302	86382	N/A	N/A	N/A	N/A
HC89012009	BACTERIAL AG SCREEN - CSF-FT	302	86403	167	N/A	167	N/A
HC89012173	BRUCELLA AB-AU	302	86622	12	N/A	8	N/A
HC89012207	CHLAMYDIA AB IGM (PNL)-AU	302	86632	8	N/A	9	N/A
HC89012371	ENCEPHALITIS WESTERN AB IGG-AU	302	86654	19	N/A	19	N/A
HC89012405	COXSACKIE A9 AB-AU	302	86658	23	N/A	24	N/A
HC89012439	ECHOVIRUS AB (PNL)- AU	302	86658	90	N/A	90	N/A
HC89012579	SCHISTOSOMA AB-FT	302	86682	114	N/A	114	N/A
HC89012603	HTLV-I AB-AU	302	86687	16	N/A	16	N/A
HC89012637	HERPES SIMPLEX I&II AB-AU	302	86694	13	N/A	12	N/A
HC89012777	LEPTOSPIRA AB-FT	302	86720	87	N/A	86	N/A
HC89012801	PARVOVIRUS B19 AB-AU	302	86747	15	N/A	17	N/A
HC89012835	RICKETTSIA AB PANEL-AU	302	86757	32	N/A	31	N/A
HC89013007	PARAINFLUENZA AB-FT	302	86790	N/A	N/A	N/A	N/A
HC89013031	HEPATITIS C AB CONFIRM-AU	302	86804	77	N/A	77	N/A
HC89013205	HEPATITIS BE AG-AU	306	87350	16	N/A	12	N/A
HC89013239	CHLAMYDIA DNA PROBE-AU	306	87490	11	N/A	11	N/A
HC89013262	HEPATITIS B DNA BY PCR-AU	306	87517	99	N/A	82	N/A
HC89013403	HIV-1 GENOTYPING-AU	306	87901	140	N/A	325	N/A
HC89013437	FLUOXETINE; 1-2-AU	301	80332	32	N/A	16	N/A
HC89013460	AFP-GZ	301	82105	N/A	N/A	N/A	N/A
HC89013643	FRUCTOSAMINE-QD	301	82985	5	N/A	5	N/A
HC89013577	COENZYME Q10(PNL)-AU	301	82542	65	N/A	63	N/A
HC89013841	ORGANIC ACID SNGL QUANT-CA	301	83921	N/A	N/A	N/A	N/A
HC89013882	ACID PHOS PROSTATIC-AU	301	84066	16	N/A	16	N/A
HC89014054	ANA-AU	302	86038	16	N/A	16	N/A
HC89014096	C6 COMPLEMENT-QN	302	86160	N/A	N/A	N/A	N/A
HC89014120	RIBOSOMAL P PROTEIN AB-AU	302	86235	N/A	N/A	N/A	N/A
HC89014278	CMV AB IGG (PNL)-FT	302	86644	70	N/A	70	N/A
HC89014302	ECHOVIRUS AB CSF-AU	302	86658	N/A	N/A	N/A	N/A
HC89014336	GIARDIA AB IFA-AU	302	86674	71	N/A	71	N/A
HC89014500	THYROGLOBULIN AB-ES	302	86800	32	N/A	32	N/A
HC89014534	HLA MIXED LYMPH CULTURE-U9	302	86821	N/A	N/A	N/A	N/A
HC89014567	AFB MIC AVIUM(PNL)-AU	306	87186	N/A	N/A	N/A	N/A
HC89014740	B PERTUSSIS PCR(PNL)-AU	306	87798	45	N/A	47	N/A
HC89014773	VAGINAL PATHOGEN DNA PROBE-AU	306	87800	66	N/A	65	N/A
HC89014955	CHROM ANAL BM COUNT-US	311	88262	N/A	N/A	N/A	N/A
HC89014989	CHROMO AMNIOTIC FLD CT 17-GZ	311	88267	N/A	N/A	N/A	N/A
HC89015010	KARYOTYPING ADD EA-GZ	311	88280	20	N/A	20	N/A
HC89015150	FEBRILE AGGLUTININS-AU	302	86000	37	N/A	95	N/A
HC89015200	FLOW CYT MKR TC ADD+-U2	311	88185	N/A	N/A	N/A	N/A
HC89015234	FLOW CYT MKR TC ADD+-US	311	88185	N/A	N/A	N/A	N/A
HC89015416	G6PD-QD	301	82955	7	N/A	7	N/A
HC89015440	HOMOCYSTINE-QD	301	83090	14	N/A	14	N/A
HC89015614	FACTOR VIII ASSAY-QD	305	85240	20	N/A	20	N/A
HC89015648	ANTITHROMBIN III AG-QD	305	85301	22	N/A	22	N/A
HC89015812	HEPATITIS A ANTIBODY -QD	302	86708	29	N/A	29	N/A
HC89015846	RUBEOLA AB IGG-QD	302	86765	17	N/A	17	N/A
HC89015879	VARICELLA-ZOSTER IGM-QD	302	86787	23	N/A	23	N/A
HC89016018	ESTRADIOL-QD	301	82670	12	N/A	12	N/A
HC89016042	PROGESTERONE-QD	301	84144	15	N/A	15	N/A
HC89016075	HSV 1-2 BY PCR-FT	306	87801	165	N/A	165	N/A
HC89016240	HLA-A AND B PHENOTYPE-QD	302	86813	23	N/A	23	N/A
HC89016273	HIV 1&2 AB-QD	302	86703	25	N/A	24	N/A
HC89016539	TESTOSTERONE FREE-MALE-AU	301	84402	6	N/A	6	N/A
HC89016562	PH FLUID FECAL-AU	301	83986	11	N/A	5	N/A
HC89016604	VIRUS ID(SHELL VIAL)-AU	306	87254	N/A	N/A	N/A	N/A
HC89016794	NORCARDIA AB-QD	302	86744	N/A	N/A	N/A	N/A
HC89016828	ACETYLCHOLINE RECEPTOR BLOC-QD	301	83519	N/A	N/A	N/A	N/A
HC89016851	LACTIC ACID-AU	301	83605	8	N/A	7	N/A
HC89017008	CATECHOLAMINES FRACT UR-AU	301	82384	25	N/A	32	N/A
HC89017032	GC/CHL DNA PROBE-AU	306	87800	22	N/A	22	N/A
HC89017065	CHLAMYDIA FA ANTIGEN-AU	302	87270	28	N/A	28	N/A
HC89017230	CERULOPLASMIN-AU	301	82390	7	N/A	7	N/A
HC89017263	C3 COMPLEMENT-AU	302	86160	6	N/A	6	N/A
HC89017438	HEXAGONL PHOSLPD NEUTLZ RFX-AU	305	85597	75	N/A	75	N/A
HC89017461	THROMBIN TIME RFX - AU	305	85670	15	N/A	15	N/A
HC89017495	MYCOPLASMA PNEUMONA AB(PNL)-AU	302	86738	7	N/A	7	N/A
HC89017636	CADMIUM(PNL)-AU	301	82300	33	N/A	33	N/A
HC89017669	CHOLINESTERASE RBC(PNL)-AU	301	82482	14	N/A	13	N/A
HC89017719	MYELIN BASIC PROTEIN(PNL)-AU	301	83873	30	N/A	29	N/A
HC89017974	M: MISC LAB GENERAL REF LAB-CL	300		N/A	N/A	N/A	N/A
HC89018006	M: MISC LAB GENERAL REF LAB-GH	300		N/A	N/A	N/A	N/A
HC89018188	FLOW CYT MKR TC 1ST-ES	311	88184	90	N/A	90	N/A
HC89018212	ALPHA-2 UR-AU	301	83883	19	N/A	19	N/A
HC89018386	KAPPA FREE LIGHT CHAINS QT-AU	301	83521	15	N/A	25	N/A
HC89018436	PNH RBC CD59-AU	302	86356	38	N/A	98	N/A
HC89018469	CHEMILUMINESCENT ASSAY(PNL)-PR	301	82397	25	N/A	25	N/A
HC89018840	CHROM ANAL TISSUE POC-AU	310	88233	239	N/A	302	N/A
HC89018972	BORDETELLA PERTUS FHA IGA-AU	302	86615	12	N/A	18	N/A
HC89019004	BORDETELLA PERTUS IMMUNOBLOT IGG-AU	302	86615	25	N/A	32	N/A
HC89019467	PROCALCITONIN (PCT) - AU	301	84145	180	N/A	180	N/A
HC89019525	HIV GENO DRUG SPECIFIC SUS-VI	306	87900	90	N/A	90	N/A
HC89019871	ENTAMOEBA ANTIGEN EIA -AU	302	87337	22	N/A	18	N/A
HC89019905	CYTOGENOMIC SNP MICROARRAY -AU	300	81229	995	N/A	1,245	N/A
HC89020101	ANTI-OMPC ELISA IGA SPC(PN)-PR	301	83520	20	N/A	20	N/A
HC89020135	ANTI-FLA-X ELISA (PNL)-PR	301	83520	20	N/A	16	N/A
HC89020168	VCAM CHEMILUMINESCENT (PNL)-PR	301	82397	28	N/A	16	N/A
HC89020309	SUCRASE (DISACCHARIDASE)-AU	301	82657	38	N/A	55	N/A
HC89020333	CYTOGENOMIC SNP MICROARRAY-FETAL-AU	300	81229	1,503	N/A	1,950	N/A
HC89020366	EGFR GENE COM VARIANTS-AU	301	81235	443	N/A	443	N/A
HC89020838	BLASTOMYCES AB IMM -AU	302	86612	14	N/A	13	N/A
HC89020861	SIN NOMBRE VIRUS IGG-AU	302	86790	50	N/A	50	N/A
HC89021034	TRICHOMONAS VAGINALIS DNA-AU	306	87660	21	N/A	21	N/A
HC89021067	PEANUT ALLERGEN F13 (PNL)-AU	302	86003	50	N/A	50	N/A
HC89021091	PEANUT COMP ANTGNC EPI ARA H3(PNL)-AU	302	86003	50	N/A	50	N/A
HC89021240	M: MISC LAB GENERAL REF LAB-IS	300		275	N/A	N/A	N/A
HC89021273	ENCEPHALITIS ST LOUIS AB IGM-AU	302	86653	45	N/A	44	N/A
HC89021307	M: MISC LAB GENERAL REF LAB-ML	300		N/A	N/A	N/A	N/A
HC89021497	DS COCAINE CONF-AU	301	80353	34	N/A	N/A	N/A
HC89021521	M: MISC LAB GENERAL REF LAB-CE	300		N/A	N/A	N/A	N/A
HC89021703	METHADONE MEC(PNL)-AU	301	80358	98	N/A	N/A	N/A
HC89021737	PHENCYCLIDINE (PCP) MEC(PNL)-AU	301	83992	131	N/A	N/A	N/A
HC89022057	BENZODIAZEPINES 1-12 SERUM QNTS(PNL)-AU	301	80346	35	N/A	N/A	N/A
HC89022081	COCAINE SERUM QNT(PNL)-AU	301	80353	49	N/A	N/A	N/A
HC89022115	OPIATES 1 OR MORE SERUM QNT(PNL) -AU	301	80361	28	N/A	N/A	N/A
HC89022263	M: MISC LAB GENERAL REF LAB-JN	300		N/A	N/A	N/A	N/A
HC89022297	M: MISC LAB GENERAL REF LAB-NW	300		N/A	N/A	N/A	N/A
HC89022321	M: MISC LAB GENERAL REF LAB-SH	300		184	N/A	N/A	N/A
HC89022495	CULTURE PRESUMP ID VARICELLA ZV(PNL)-AU	306	87252	42	N/A	N/A	N/A
HC89022537	M: MISC LAB GENERAL REF LAB -KR	300		2,005	N/A	N/A	N/A
HC89022701	HLA CLASS I TYPING HIGH RES EACH LOCUS-U9	310	81380	350	N/A	N/A	N/A
HC89022735	CALPROTECTIN FECAL-AU	301	83993	95	N/A	N/A	N/A
HC89022925	CREATININE  BODY FLUID-AU	301	82570	9	N/A	N/A	N/A
HC89022958	NET ABSORBANCE  BILIRUBIN CSF(PANEL)-AU	301	84311	32	N/A	N/A	N/A
HC89022982	UREA NITROGEN  BODY FLUID-AU	301	84520	9	N/A	N/A	N/A
HC89023121	ELECTRO FRAC AND QUANT URINE-AU	301	84166	19	N/A	N/A	N/A
HC89023154	ENZYME ACTIVITY NONRAD; DISACCHARIDASE-AU	301	82657	80	N/A	N/A	N/A
HC89023188	VORICONAZOLE ANTIFNGL-AU	301	80285	53	N/A	N/A	N/A
HC89023360	HEMOGLOBIN GLYCATED (A1C)-U2	301	83036	25	N/A	N/A	N/A
HC89023394	FACTOR INHIBITOR ADAMTS13-AU	305	85335	175	N/A	N/A	N/A
HC89023576	CANDIDA SPECIES TMA-AU	306	87481	55	N/A	N/A	N/A
HC89023600	GENOTYPE DNA/RNA HIV-AU	306	87906	140	N/A	N/A	N/A
HC89023634	GENOMIC SNP MICROARRAY POC-AU	300	81229	1,448	N/A	N/A	N/A
HC89023774	HLA B27-AU	302	86812	27	N/A	N/A	N/A
HC89023808	BENZODIAZEPINES 13 OR > -AU	301	80347	25	N/A	N/A	N/A
HC89023832	ANALY CFTR GENE DELET/DUP VARIANTS-AU	310	81222	637	N/A	N/A	N/A
HC89023998	MONONUC CELL ANTGN PNH PHENOTYPE MONOCYTE-AU	302	86356	29	N/A	N/A	N/A
HC89024020	CALR MUT ANALYSIS-AU	310	81219	200	N/A	N/A	N/A
HC89024061	Q FEVER AB COXIELLA BURNETII PHASE TITER II-AU	302	86638	33	N/A	N/A	N/A
HC89090187	P:B.PARAPERTUSSIS/PERT DFA-U2			N/A	N/A	N/A	N/A
HC89090211	P:HYPERSENS PNEUMO EXT-AU			N/A	N/A	N/A	N/A
HC89090435	P:ANNEXIN AB V IGM  IGG- ES			N/A	N/A	N/A	N/A
HC89090468	P:VONWILL'D FCTR 2N&FCTVIII-EC			N/A	N/A	N/A	N/A
HC89090492	P:VARICELLA ABS-IGG/IGM-AU			N/A	N/A	N/A	N/A
HC89090658	P:PHENYTOIN FREE & TOTAL-AU			N/A	N/A	N/A	N/A
HC89090682	P:HERPES PANEL 1&2  IGG/IGM -AU			N/A	N/A	N/A	N/A
HC89090724	P:EBV AB PANEL-AU			N/A	N/A	N/A	N/A
HC89090971	P: HLA ANTIBODY DETECTION-AU			N/A	N/A	N/A	N/A
HC89091011	P: CHROMOSOME ANALYS AF-AU			N/A	N/A	N/A	N/A
HC89091318	P: NK FUNCTION-CN			N/A	N/A	N/A	N/A
HC89091342	FAM ADENOM POLYPOSIS DEL/DUP-AU	310	81203	320	N/A	320	N/A
HC89091599	P: STEROID COMPREHENSIVE-QN			N/A	N/A	N/A	N/A
HC89091623	P: BILIRUBIN  CSF(2005248)-AU			N/A	N/A	N/A	N/A
HC89091664	P: ANSER IFX-PR			N/A	N/A	N/A	N/A
HC89500482	RBC ANTIBODY SCRN EA TECH-SB	302	86850	50	N/A	38	N/A
HC89500516	BLOOD TYPE SERO; PER AG/ANTIGEN DNR-SB	300	86902	80	N/A	61	N/A
HC89500565	RH PHENOTYPE (CCEE)-SB	300	86906	62	N/A	52	N/A
HC89500987	FFP THAWING; EA UNIT-SB	302	86927	12	N/A	N/A	N/A
HC89501019	M: MISC RL BLOOD BANK -AA	300		N/A	N/A	N/A	N/A
HC91200136	R&B NICU-NURSERY LEVEL II	172		17,636	N/A	N/A	N/A
HC91200241	R&B L&D PP OBSTETRICS CARE	122		9,044	N/A	N/A	N/A
HC91400094	R&B PEDIATRIC ACUTE	123		9,095	N/A	N/A	N/A
HC65001258_00264780210	NONCDM CHARGE RECORD PHARMACY	258	J7030	10	N/A	N/A	N/A
HC65001258_00338001703	NONCDM CHARGE RECORD PHARMACY	258	J7060	22	N/A	N/A	N/A
HC65001258_00338004948	NONCDM CHARGE RECORD PHARMACY	258	J7050	15	N/A	N/A	N/A
HC65001258_00338007704	NONCDM CHARGE RECORD PHARMACY	636	J7042	19	N/A	N/A	N/A
HC65001258_00338954302	NONCDM CHARGE RECORD PHARMACY	636	J7050	30	N/A	N/A	N/A
HC65001258_00409488850	NONCDM CHARGE RECORD PHARMACY	636	J7030	10	N/A	N/A	N/A
HC65001258_00409798509	NONCDM CHARGE RECORD PHARMACY	636	J7030	32	N/A	N/A	N/A
HC65001258_00990711109	NONCDM CHARGE RECORD PHARMACY	258	J7120	58	N/A	N/A	N/A
HC65001258_00990790109	NONCDM CHARGE RECORD PHARMACY	636	J7042	23	N/A	N/A	N/A
HC65001258_00990792337	NONCDM CHARGE RECORD PHARMACY	258	J7060	13	N/A	N/A	N/A
HC65001258_00990792603	NONCDM CHARGE RECORD PHARMACY	258	J7042	36	N/A	N/A	N/A
HC65001258_00990792909	NONCDM CHARGE RECORD PHARMACY	258	J7070	32	N/A	N/A	N/A
HC65001258_00990925739	NONCDM CHARGE RECORD PHARMACY	258	J7030	45	N/A	N/A	N/A
HC65001258_02457110506	NONCDM CHARGE RECORD PHARMACY	636	A4706	138	N/A	N/A	N/A
HC65001258_08290306547	NONCDM CHARGE RECORD PHARMACY	636	J7030	2	N/A	N/A	N/A
HC65001278_00052433001	NONCDM CHARGE RECORD PHARMACY	636	J7307	4,908	N/A	N/A	N/A
HC65001278_07820614501	NONCDM CHARGE RECORD PHARMACY	636	J7307	6,747	N/A	N/A	N/A
HC65002250_00338011404	NONCDM CHARGE RECORD PHARMACY	250		867	N/A	N/A	N/A
HC65002250_00409713809	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002250_00409782808	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65002250_00990797307	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65002258_00264196510	NONCDM CHARGE RECORD PHARMACY	250		110	N/A	N/A	N/A
HC65002258_00990793002	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65002258_00990796509	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002636_00078087601	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,122	N/A	N/A	N/A
HC65002636_00085136603	NONCDM CHARGE RECORD PHARMACY	636	Z7610	2,961	N/A	N/A	N/A
HC65002636_00085461005	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,370	N/A	N/A	N/A
HC65002636_00173071820	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,320	N/A	N/A	N/A
HC65002636_00186091612	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,670	N/A	N/A	N/A
HC65002636_00338032201	NONCDM CHARGE RECORD PHARMACY	636	J3490	559	N/A	N/A	N/A
HC65002636_00781232368	NONCDM CHARGE RECORD PHARMACY	636	J8501	452	N/A	N/A	N/A
HC65002636_00904655304	NONCDM CHARGE RECORD PHARMACY	636	J3490	40	N/A	N/A	N/A
HC65002636_02192202107	NONCDM CHARGE RECORD PHARMACY	636	J3490	195	N/A	N/A	N/A
HC65002636_02420829525	NONCDM CHARGE RECORD PHARMACY	636	J3490	249	N/A	N/A	N/A
HC65002636_04202310701	NONCDM CHARGE RECORD PHARMACY	636	J0770	182	N/A	N/A	N/A
HC65002636_04249434003	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1,032	N/A	N/A	N/A
HC65002636_04359832675	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,026	N/A	N/A	N/A
HC65002636_05038323310	NONCDM CHARGE RECORD PHARMACY	636	J3490	325	N/A	N/A	N/A
HC65002636_05107967005	NONCDM CHARGE RECORD PHARMACY	636	J8610	18	N/A	N/A	N/A
HC65002636_05167212982	NONCDM CHARGE RECORD PHARMACY	636	Z7610	247	N/A	N/A	N/A
HC65002636_06050508335	NONCDM CHARGE RECORD PHARMACY	636	J3490	141	N/A	N/A	N/A
HC65002636_06050561292	NONCDM CHARGE RECORD PHARMACY	636	Z7610	89	N/A	N/A	N/A
HC65002636_06332332110	NONCDM CHARGE RECORD PHARMACY	636	J3490	13	N/A	N/A	N/A
HC65002636_06340231230	NONCDM CHARGE RECORD PHARMACY	636	Z7610	435	N/A	N/A	N/A
HC65002636_06495036204	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,548	N/A	N/A	N/A
HC65002636_06787741984	NONCDM CHARGE RECORD PHARMACY	636	J3490	23	N/A	N/A	N/A
HC65002636_06787763633	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,658	N/A	N/A	N/A
HC65002636_06838244614	NONCDM CHARGE RECORD PHARMACY	636	Z7610	82	N/A	N/A	N/A
HC65002636_06931531228	NONCDM CHARGE RECORD PHARMACY	636	J3490	452	N/A	N/A	N/A
HC65002636_07006905101	NONCDM CHARGE RECORD PHARMACY	636	J3490	153	N/A	N/A	N/A
HC65002636_07012710010	NONCDM CHARGE RECORD PHARMACY	636	J3490	195	N/A	N/A	N/A
HC65002636_53276105004	NONCDM CHARGE RECORD PHARMACY	636	Z7610	520	N/A	N/A	N/A
HC65004250_00000412400	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65004250_00143978610	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65004250_00264446010	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65004250_00264752020	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65004250_00409015224	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65004250_00409114402	NONCDM CHARGE RECORD PHARMACY	250		209	N/A	N/A	N/A
HC65004250_00409141210	NONCDM CHARGE RECORD PHARMACY	250	J3490	6	N/A	N/A	N/A
HC65004250_00409329425	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65004250_00409329906	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65004250_00409662514	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65004250_00409663734	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65004250_00517078110	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65004250_00517671010	NONCDM CHARGE RECORD PHARMACY	250		149	N/A	N/A	N/A
HC65004250_00641614710	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65004250_00990793009	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_01747850305	NONCDM CHARGE RECORD PHARMACY	250		2,904	N/A	N/A	N/A
HC65004250_02502113182	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65004250_04354754425	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65004250_04923020620	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65004250_05515022110	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65004250_05515022610	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65004250_05515025220	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65004250_06332318510	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65004250_06332320500	NONCDM CHARGE RECORD PHARMACY	250		211	N/A	N/A	N/A
HC65004250_06332342405	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65004250_06332348927	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65004250_06332373820	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65004250_06332378220	NONCDM CHARGE RECORD PHARMACY	250		153	N/A	N/A	N/A
HC65004250_06521944510	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65004250_06745716202	NONCDM CHARGE RECORD PHARMACY	250		660	N/A	N/A	N/A
HC65004250_07006927105	NONCDM CHARGE RECORD PHARMACY	250		189	N/A	N/A	N/A
HC65004250_07012113955	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65004250_07086075102	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65004250_07632933021	NONCDM CHARGE RECORD PHARMACY	250		97	N/A	N/A	N/A
HC65004250_08290306544	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65004250_08290306547	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65025012_00409116501	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65025012_00409155930	NONCDM CHARGE RECORD PHARMACY	250	S0020	3	N/A	N/A	N/A
HC65025012_05515017230	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65025012_06332346231	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65025013_04456722210	NONCDM CHARGE RECORD PHARMACY	250		143	N/A	N/A	N/A
HC65025013_05515012316	NONCDM CHARGE RECORD PHARMACY	250		148	N/A	N/A	N/A
HC65025013_07086011626	NONCDM CHARGE RECORD PHARMACY	250		75	N/A	N/A	N/A
HC65200636	MED - WOUND TOPICAL PRODUCT (W/NDC)	636		N/A	N/A	N/A	N/A
HC65500754_00562780500	NONCDM CHARGE RECORD PHARMACY	636	J2790	708	N/A	N/A	N/A
HC65500754_00562780525	NONCDM CHARGE RECORD PHARMACY	636	J2790	708	N/A	N/A	N/A
HC65600343_04556704552	NONCDM CHARGE RECORD PHARMACY	250	A9537	178	N/A	N/A	N/A
HC65600343_06517427030	NONCDM CHARGE RECORD PHARMACY	250	A9540	524	N/A	N/A	N/A
HC65800013	PALLADIUM-103 NONSTRND PER SOURCE	278	C2641	358	N/A	N/A	N/A
HC65800047	BRACHY NONSTRNDED GOLD 198 SRC	278	C1716	618	N/A	N/A	N/A
HC73000218	DIALYSIS;CANCEL-HOSP ISSUE(QA)	803		N/A	N/A	N/A	N/A
HC73000242	DIALYSIS CAPD CANCEL-MED NEC	803	90945	1,264	N/A	N/A	N/A
HC73000275	DIALYSIS URGENT ESRD(OP)CANCEL	820	G0257	2,765	N/A	N/A	N/A
HC74200130	OR TIME INIT'L HR CASE CX LEVEL 2 (MCAL 1ST HOUR)	360		6,425	N/A	N/A	N/A
HC74200163	OR TIME INIT'L HR CASE CX LEVEL 5 (MCAL 1ST HOUR)	360		9,252	N/A	N/A	N/A
HC74200197	BEDSIDE/OTHER SURG INITIAL HR 2 (MCAL 1ST HOUR)	369		6,743	N/A	N/A	N/A
HC74200361	OR TIME ADD'L 15MIN CASE CX 1 (MCAL 1ST SUBSQNT 0.5 HR)	360		1,245	N/A	N/A	N/A
HC74200395	OR TIME ADD'L 15MIN CASE CX 4 (MCAL 1ST SUBSQNT 0.5 HR)	360		2,063	N/A	N/A	N/A
HC74200569	OR ROOM 2ND SUBSEQUENT HALF HR (MCAL ONLY)	360		N/A	N/A	N/A	N/A
HC74200593	OR TIME ADD'L 15MIN CASE CX 2 (MCAL 2ND SUBSQNT 0.5 HR)	360		1,599	N/A	N/A	N/A
HC74200627	OR TIME ADD'L 15MIN CASE CX 5 (MCAL 2ND SUBSQNT 0.5 HR)	360		2,302	N/A	N/A	N/A
HC77400166	ANESTHESIA EPIDURAL INITIAL HR	370		1,197	N/A	N/A	N/A
HC77400190	ANESTHESIA LOCAL EA ADD 15MIN	370		231	N/A	N/A	N/A
HC77400224	MOD CS SAME PHYS/QHP <5 YR INIT'L 15MIN	372	99151	409	N/A	N/A	N/A
HC81100000	PHOSPHORUS URINE	301	84105	184	N/A	42	N/A
HC81100034	URIC ACID URINE	301	84560	174	N/A	48	N/A
HC81100208	TIBC	301	83550	189	N/A	46	N/A
HC81100240	BILIRUBIN DIRECT/CONJUGATED	301	82248	157	N/A	25	N/A
HC81100414	AMMONIA	301	82140	409	N/A	104	N/A
HC81100448	BASIC METABOLIC PANEL/TOTAL CA	301	80048	573	N/A	39	N/A
HC81100471	UREA NITROGEN	301	84520	135	N/A	22	N/A
HC81100612	TOBRAMYCIN INIT	301	80200	684	N/A	124	N/A
HC81100646	LDH	301	83615	228	N/A	42	N/A
HC81100679	OSMOLALITY	301	83930	237	N/A	80	N/A
HC81100844	PH FLUID	301	83986	160	N/A	46	N/A
HC81100877	ACUTE HEPATITIS PANEL	301	80074	921	N/A	314	N/A
HC81101057	OCCULT BLOOD OTHER SOURCE	301	82271	118	N/A	37	N/A
HC81101081	CHLORIDE URINE	301	82436	158	N/A	47	N/A
HC81101255	C-REACTIVE PROTEIN HI SENS	302	86141	203	N/A	66	N/A
HC81101289	C3 COMPLEMENT	302	86160	310	N/A	94	N/A
HC81101313	BLOOD GASES LTD	301	82803	624	N/A	89	N/A
HC81101461	CORTISOL(SUBSEQ)	301	82533	349	N/A	83	N/A
HC81101495	URINALYSIS MICROSCOPIC ONLY	307	81015	146	N/A	40	N/A
HC81101545	INSULIN TOTAL	301	83525	204	N/A	71	N/A
HC81101776	LACTIC ACID (POS)	301	83605	327	N/A	16	N/A
HC81101800	CALCIUM IONIZED (POS)	301	82330	278	N/A	91	N/A
HC81101990	M: MISC CHEMISTRY PROC	301		N/A	N/A	N/A	N/A
HC81190050	P: POS EG7 CARTRIDGE			N/A	N/A	N/A	N/A
HC81500019	NASAL SMEAR FOR EOS	300	89190	198	N/A	59	N/A
HC81500159	CBC W/O DIFF	305	85027	201	N/A	30	N/A
HC81500183	PLATELET AGG EA AGENT	305	85576	387	N/A	109	N/A
HC81500217	LEUKEMIA CELLS  SPINAL FL	311	88108	434	N/A	184	N/A
HC81500357	FACTOR V LABILE	305	85220	478	N/A	141	N/A
HC81500381	FACTOR VIII VW	305	85245	558	N/A	202	N/A
HC81500415	FACTOR XI PTA	305	85270	473	N/A	141	N/A
HC81500589	OSMOTIC FRAG INCUBATED	305	85557	322	N/A	125	N/A
HC81500613	THROMBIN TIME	305	85670	203	N/A	63	N/A
HC81500811	HEMOGLOBIN ELECTRO-CONFIRM	301	83020	268	N/A	82	N/A
HC81500852	PLACENTAL ALPHA MICROGLOBULIN-1	301	84112	748	N/A	125	N/A
HC81500886	RETICULOCYTE MULTI PARAMETERS	305	85046	184	N/A	52	N/A
HC81700049	AFP	301	82105	297	N/A	96	N/A
HC81700072	CRYOGLOBULIN	301	82595	148	N/A	53	N/A
HC81700106	FOLIC ACID	301	82746	300	N/A	106	N/A
HC81700270	CARDIOLIPIN AB EA IG CLASS	302	86147	297	N/A	71	N/A
HC81700304	EXTRCTBL NUCLEAR AG AB TO ECH	302	86235	247	N/A	95	N/A
HC81700478	RUBELLA SCREEN	302	86317	171	N/A	95	N/A
HC81700502	THYROGLOBULIN AB	302	86800	220	N/A	81	N/A
HC81700676	ASO SCREEN	302	86063	118	N/A	43	N/A
HC81700700	SJORGEN SYNDROME AB SSB EIA	302	86235	247	N/A	94	N/A
HC81700734	CENTROMERE AB	302	86256	177	N/A	66	N/A
HC81700882	FLW CYT MKR CD11 TC ADD+	311	88185	318	N/A	104	N/A
HC81700916	FLW CYT MKR CD2 TC ADD +	311	88185	318	N/A	104	N/A
HC81700940	FLW CYT MKR CD3 (LEU-4)TC ADD+	311	88185	318	N/A	104	N/A
HC81701112	IMMUNOELECTROPHERESIS-SRM	302	86320	305	N/A	125	N/A
HC81701161	HTLV I & II	302	86687	183	N/A	62	N/A
HC81701500	PROTEIN ELECT OTHER FLUIDS	301	84166	400	N/A	97	N/A
HC81701534	C TRACHOMATIS BY DNA AMP PROBE	306	87491	520	N/A	147	N/A
HC81701609	RUBELLA AB IGG	302	86762	201	N/A	95	N/A
HC81701765	FACTOR V LEIDEN BY PCR	301	81241	611	N/A	249	N/A
HC81701799	T CELL ABSOLUTE CD4 COUNT	302	86361	359	N/A	111	N/A
HC81701823	HSV TYPE 1 AB  IGG	302	86695	185	N/A	55	N/A
HC81701963	HIV TYPE 1 ANTIGEN (RAPID)	300	87390	368	N/A	38	N/A
HC81701997	HIV-1 AG W/ HIV-1 & HIV-2 ABS  SINGLE RESULT	302	87389	420	N/A	75	N/A
HC81702029	FLW CYT MKR CD117 TC ADD+	311	88185	318	N/A	104	N/A
HC81702193	FLW CYT MKR HLA-DR TC ADD+	311	88185	318	N/A	104	N/A
HC82200007	AMYLOID (CONGO RED)/GRP II+	312	88313	474	N/A	107	N/A
HC82200171	IHC/IP PER SPEC INITIAL AB STAIN S100	312	88342	593	N/A	193	N/A
HC82200205	IHC/IP PER SPEC INITIAL AB STAIN PSA	312	88342	593	N/A	193	N/A
HC82200239	IHC/IP PER SPEC INITIAL AB STAIN VIMENTIN	312	88342	593	N/A	193	N/A
HC82200379	TISSUE GROSS EXAM ONLY LEVEL 1	312	88300	265	N/A	60	N/A
HC82200403	TISSUE EXAM G&M LEVEL 4	312	88305	780	N/A	218	N/A
HC82200437	IHC/IP PER SPEC INITIAL AB STAIN -OP	312	88342	593	N/A	83	N/A
HC82200627	TISSUE EXAM LEVEL 6 ADD'L	312	88309	1,332	N/A	409	N/A
HC82200650	TISSUE EXAM LEVEL 3 ADD'L	312	88304	505	N/A	101	N/A
HC82200874	AUTOPSY GROSS & MICRO W/CNS	310	88027	N/A	N/A	N/A	N/A
HC82200908	AUTOPSY LIMITED/REGIONL G&/ORM	310	88036	N/A	N/A	N/A	N/A
HC82201070	F-M ARGENTAFFIN STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82201104	GRIMELIUS ARGYROPHL STN GRPII+	312	88313	474	N/A	107	N/A
HC82201138	KOSSA CALCIUM STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82201278	HISTOCHM STAIN FROZ TIS BLK	312	88314	388	N/A	108	N/A
HC82201302	HISTCHM ST ATPSE PH4.6 FR TS	312	88319	962	N/A	500	N/A
HC82201336	HISTCHM ST MYPHSPHRYLS FR TS	312	88319	962	N/A	500	N/A
HC82201500	N-CHLORO EST STAIN  GRP III	312	88319	962	N/A	500	N/A
HC82201534	IHC/IP PER SPEC INITIAL AB STAIN DYSTROPH(N-TERMINUS)	312	88342	593	N/A	193	N/A
HC82201708	IHC/IP PER SPEC INITIAL AB STAIN LN1	312	88342	593	N/A	193	N/A
HC82201732	IHC/IP PER SPEC INITIAL AB STAIN MUSCLE	312	88342	593	N/A	193	N/A
HC82201906	IHC/IP PER SPEC INITIAL AB STAIN EWINGS SARCOMA	312	88342	593	N/A	193	N/A
HC82201930	IHC/IP PER SPEC INITIAL AB STAIN KERATIN 903	312	88342	593	N/A	193	N/A
HC82201989	IHC/IP PER SPEC INITIAL AB STAIN MYELOPEROXIDASE	312	88342	593	N/A	193	N/A
HC82202219	FNA ASP BX W/O GUIDE; EACH ADD'L LESION	361	10004	1,653	N/A	194	N/A
HC82202243	TISSUE GROSS EXAM LV1-DIST SVC	312	88300	265	N/A	60	N/A
HC82202276	CONSULT DURING SURG DIST SVC	312	88329	397	N/A	102	N/A
HC82202474	MORPH STUDY MAN ISH QNT CEP 3	310	88368	1,330	N/A	607	N/A
HC82202508	MORPH STUDY MAN ISH QNT HER2	310	88368	1,330	N/A	513	N/A
HC82202714	BM BIOPSY PROC & INT 2ND SITE	312	88305	780	N/A	218	N/A
HC82202748	TISSUE EXAM G&M LVL 3(TC ONLY)	312	88304	505	N/A	69	N/A
HC82202771	TISSUE EXAM G&M LVL 6(TC ONLY)	312	88309	1,332	N/A	227	N/A
HC82202995	IHC/IP PER SPEC INITIAL AB STAIN CD1A	312	88342	593	N/A	193	N/A
HC82203027	IHC/IP PER SPEC INITIAL AB STAIN CD7	312	88342	593	N/A	193	N/A
HC82203050	IHC/IP PER SPEC INITIAL AB STAIN CD21	312	88342	593	N/A	193	N/A
HC82203225	IHC/IP PER SPEC INITIAL AB STAIN KERATIN (AE1/AE1) LN	312	88342	593	N/A	193	N/A
HC82203258	IHC/IP PER SPEC INITIAL AB STAIN MUM-1	312	88342	593	N/A	193	N/A
HC82203423	IHC/IP PER SPEC EA ADD AB STAIN+ FCTR 8 AG	312	88341	516	N/A	183	N/A
HC82203456	IHC/IP PER SPEC EA ADD AB STAIN+ EPI MEMBR	312	88341	516	N/A	183	N/A
HC82203621	IHC/IP PER SPEC EA ADD AB STAIN+ E-CADHERIN	312	88341	516	N/A	183	N/A
HC82203654	IHC/IP PER SPEC EA ADD AB STAIN+ IGD	312	88341	516	N/A	183	N/A
HC82203688	IHC/IP PER SPEC EA ADD AB STAIN+ KERATIN (AE1/AE3) LN	312	88341	516	N/A	183	N/A
HC82203829	IHC/IP PER SPEC EA ADD AB STAIN+ HPCA-1	312	88341	516	N/A	183	N/A
HC82203852	IHC/IP PER SPEC EA ADD AB STAIN+ GASTRIN	312	88341	516	N/A	183	N/A
HC82203886	IHC/IP PER SPEC EA ADD AB STAIN+ INSULIN	312	88341	516	N/A	183	N/A
HC82204058	IHC/IP PER SPEC EA ADD AB STAIN+ THYROGLOBLN	312	88341	516	N/A	183	N/A
HC82204090	IHC/IP PER SPEC EA ADD AB STAIN+ ANTI-CD3/HRP	312	88341	516	N/A	183	N/A
HC82204272	IHC/IP PER SPEC EA ADD AB STAIN+ TERM DEOXZYTRANS	312	88341	516	N/A	183	N/A
HC82204306	IHC/IP PER SPEC EA ADD AB STAIN+ UBIQUITIN	312	88341	516	N/A	183	N/A
HC82204470	IP/IHC PER SPEC INITIAL AB STAIN PROSTATIC ACID PHOS	312	88342	593	N/A	193	N/A
HC82204504	BONE MARROW DX; BX(S) & ASP(S) BILAT	361	38222	11,106	N/A	4,173	N/A
HC82204538	IHC/IP PER SPEC INITIAL AB STAIN SOX10	312	88342	593	N/A	193	N/A
HC82204678	IHC/IP PER SPEC INITIAL AB STAIN MLH-1	312	88342	593	N/A	193	N/A
HC82204702	IHC/IP PER SPEC EA ADD AB STAIN+ PMS2	312	88341	516	N/A	183	N/A
HC82290024	P:ASPIRATION BONE MARROW			N/A	N/A	N/A	N/A
HC83000091	RBC ANTIGENS OTHER THAN ABO/RH	300	86905	366	N/A	342	N/A
HC83000133	RBC ANTIBODY ID EACH TECH	302	86870	532	N/A	42	N/A
HC83000356	IRRADIATION EA UNIT	300	86945	310	N/A	72	N/A
HC83000380	RBC PRETREAT W/ENZYMES	302	86971	366	N/A	342	N/A
HC83000414	HOLD CLOT (ST)	309	86999	N/A	N/A	N/A	N/A
HC83000570	RBC IRRADIATED EA UNIT	390	P9038	866	N/A	629	N/A
HC83000604	RBC/FRZ/DEGLYC/WSHD/LR/IRRAD	390	P9057	1,350	N/A	1,011	N/A
HC83000638	GRANULOCYT PHERESIS EA UNIT-OS	390	P9050	6,510	N/A	2,725	N/A
HC83000927	RBC'S LUK RED EA UNIT AUTOL~BB	390	P9016	949	N/A	627	N/A
HC83000976	HANDLING AND/OR CONVEYANCE TO REF LAB(BB)	300	99001	129	N/A	38	N/A
HC83001008	PLATELET LR PHER EA UNIT -SB	390	P9035	2,088	N/A	556	N/A
HC83001222	X-MATCH ELECTRONIC TECH EA UNIT	302	86923	452	N/A	175	N/A
HC83001255	PATHOGEN(S) TEST PLATELETS	310	P9100	94	N/A	42	N/A
HC83500074	RECEPTOR ASSAY  PROGESTERON-PI	301	84234	28	N/A	28	N/A
HC83500124	CHEMOSENSITIVITY ASSAY-WD	300	86999	880	N/A	880	N/A
HC83500181	CHROMO LYMPHOCYTE TISSUE-GZ	310	88230	N/A	N/A	N/A	N/A
HC83500330	KARYOTYPING COUNT BANDING-GZ	310	88262	N/A	N/A	N/A	N/A
HC83500363	CHROMO CT 15-20 W/BANDING-HP	310	88262	N/A	N/A	N/A	N/A
HC83500397	CHROM ANAL TISSUE COUNT-US	310	88262	175	N/A	175	N/A
HC83500561	KARYOTYPING ADD EA-IM	310	88280	49	N/A	49	N/A
HC83500603	CHROM ANAL ADDL CELL CT-IM	310	88285	N/A	N/A	N/A	N/A
HC83500827	ALCIAN BLUE STN/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83500850	BRWN BRN GRM ST/GR I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83501023	GROCOT SILVR ST/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501056	PAS STAIN/GRP I W/ INT&RPT+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501080	SILVR METHNM ST/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501221	SPECIAL STAIN GROUP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501254	ALCIAN BLUE NO DIGES/GRPII+-US	312	88313	N/A	N/A	N/A	N/A
HC83501288	ALCIAN BLUE W/DIGES/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501452	F-M ARGENTAFFIN STN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501486	F-M MELAN STN BLEACH/GRPII+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501650	IRON STAIN/B.M. SMEARS+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501684	JONES SILVER STAIN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501718	KOSSA CALCIUM STAIN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501858	METHYL GREEN PYSTN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501882	MUCIN MUCICARM STN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501916	MYELIN STAIN GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83502054	SPECIAL STAIN GROUP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83502104	PAS W/DIGESTON -US	312	88314	N/A	N/A	N/A	N/A
HC83502138	OIL RED O STAIN -US	312	88314	N/A	N/A	N/A	N/A
HC83502427	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH N-TERMINS -US	312	88342	N/A	N/A	N/A	N/A
HC83502450	IHC/IP PER SPEC INITIAL AB STAIN IHC/IP STAIN ACTH -IM	312	88342	N/A	N/A	N/A	N/A
HC83502625	IHC/IP PER SPEC INITIAL AB STAIN EPITH -US	312	88342	N/A	N/A	N/A	N/A
HC83502658	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 8 -IM	312	88342	N/A	N/A	N/A	N/A
HC83502682	IHC/IP PER SPEC INITIAL AB STAIN GASTRIN -US	312	88342	N/A	N/A	N/A	N/A
HC83502823	IHC/IP PER SPEC INITIAL AB STAIN KAPPA -US	312	88342	N/A	N/A	N/A	N/A
HC83502872	IHC/IP PER SPEC INITIAL AB STAIN KP1 -IM	312	88342	N/A	N/A	N/A	N/A
HC83502906	IHC/IP PER SPEC INITIAL AB STAIN L26 -US	312	88342	N/A	N/A	N/A	N/A
HC83503094	IHC/IP PER SPEC INITIAL AB STAIN NSE -IM	312	88342	N/A	N/A	N/A	N/A
HC83503128	IHC/IP PER SPEC INITIAL AB STAIN PROGEST RECPT -US	312	88342	N/A	N/A	N/A	N/A
HC83503318	IHC/IP PER SPEC INITIAL AB STAIN ACTH PIT PNL -IM	312	88342	N/A	N/A	N/A	N/A
HC83503342	IHC/IP PER SPEC INITIAL AB STAIN ANTI-BCL-2 -US	312	88342	N/A	N/A	N/A	N/A
HC83503516	IHC/IP PER SPEC INITIAL AB STAIN KERATIN 903 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503565	IHC/IP PER SPEC INITIAL AB STAIN KI-67 -US	312	88342	N/A	N/A	N/A	N/A
HC83503615	IHC/IP PER SPEC INITIAL AB STAIN MYELOPEROXIDASE -IM	312	88342	N/A	N/A	N/A	N/A
HC83503771	IHC/IP PER SPEC INITIAL AB STAIN HER-2-NEU -IM	312	88342	124	N/A	124	N/A
HC83503805	IHC/IP PER SPEC INITIAL AB STAIN UBIQUITIN STAIN -US	312	88342	50	N/A	50	N/A
HC83503847	ELECTRON MICROSCOPY-CS	312	88348	771	N/A	484	N/A
HC83504076	IF STUDY INDIRECT 1ST STAIN-CS	310	88346	352	N/A	243	N/A
HC83504118	M: MISC LAB PATHOLOGY REF LAB-AU	310		39	N/A	N/A	N/A
HC83504357	ANATOMIC CONSULT; COMP. REV-JH	310	88325	N/A	N/A	N/A	N/A
HC83504381	IHC/IP PER SPEC INITIAL AB STAIN ANTI-BCL-2 -BR	312	88342	100	N/A	89	N/A
HC83504647	M: MISC LAB PATHOLOGY REF LAB-SD	310		N/A	N/A	N/A	N/A
HC83504688	FLOW CYT MKR TC 1ST-HP	311	88184	N/A	N/A	N/A	N/A
HC83504761	M: MISC LAB PATHOLOGY REF LAB-UW	310		38	N/A	N/A	N/A
HC83505099	TISSUE IN-SITU HYBRI INITIAL -NG	312	88365	80	N/A	75	N/A
HC83505149	M: MISC LAB PATHOLOGY REF LAB-UP	310		N/A	N/A	N/A	N/A
HC83505255	IHC/IP PER SPEC EA ADD AB STAIN+ -NG	312	88341	45	N/A	N/A	N/A
HC83505461	SPECIAL STAIN GROUP I -NG	312	88312	57	N/A	N/A	N/A
HC83505495	SPECIAL STAIN GROUP II+-CS	312	88313	70	N/A	N/A	N/A
HC83505669	NRAS MUT ANALYSIS EXONS 2&3-NG	310	81311	580	N/A	N/A	N/A
HC83505693	IHC/IP PER SPEC EA ADD AB STAIN+ MSH-6-NG	310	88341	45	N/A	N/A	N/A
HC83505727	IHC/IP PER SPEC EA ADD AB STAIN+ MSH-2-NG	310	88341	45	N/A	N/A	N/A
HC83505867	M: MISC LAB PATHOLOGY REF LAB -HB	310		N/A	N/A	N/A	N/A
HC83505891	CHROM ANAL 20-25 CELLS BONE MARROW-NG	311	88264	200	N/A	N/A	N/A
HC83505925	TISSUE IN-SITU HYBRI INITIAL -AP	312	88365	135	N/A	N/A	N/A
HC83506063	MORPH STDY CAT FISH EA MULTI PROBE HER2-AP	312	88374	270	N/A	N/A	N/A
HC83590109	P:IMMUNOHISTOCHEM X 5-HP			N/A	N/A	N/A	N/A
HC83590240	P:IMMUNOHISTOCHEM X 7 - HP			N/A	N/A	N/A	N/A
HC84200062	URINE ISOLATE  PRESUMP ID  EA	306	87088	345	N/A	41	N/A
HC84200096	KOH PREP	306	87220	198	N/A	39	N/A
HC84200260	BACTERIAL ANTIGENS EIA	306	87449	256	N/A	81	N/A
HC84200294	YEAST ID EA ORG	306	87106	316	N/A	52	N/A
HC84200328	MIC ANTIBIOTIC GRADIENT STRIP	306	87181	146	N/A	21	N/A
HC84200484	LACTOFERRIN/LEUK  FECAL; QUAL	300	83630	267	N/A	100	N/A
HC84200518	HUMAN METAPNEUMOVIRUS (HMPV)	306	87299	287	N/A	56	N/A
HC84200542	SHIGELLA TOXIN BY IMMUNOASSAY	306	87899	174	N/A	43	N/A
HC84200716	CULTURE MYCOBACTERIAL ID	306	87118	401	N/A	64	N/A
HC84200740	PARASITE ID	306	87169	152	N/A	22	N/A
HC84200922	GIARDIA	306	87329	228	N/A	79	N/A
HC84200955	RESPIRATORY SYNCTAL VIRUS EIA	306	87420	384	N/A	76	N/A
HC84201136	CULTURE TYPE AGGL EA;ST SCREEN	306	87081	N/A	N/A	24	N/A
HC84201169	INFLUENZA A&B BY PCR (RVP PNL)	306	87502	1,322	N/A	362	N/A
HC84201193	C DIFFICILE TOXIN	306	87324	475	N/A	105	N/A
HC84201391	M TUBERCULOSIS DNA AMP PROBE	306	87556	562	N/A	144	N/A
HC84201425	CULT DNA/RNA AMP PCR GRAM POS ISO	306	87150	528	N/A	220	N/A
HC84201458	DNA/RNA CMV PCR(PNL)	306	87496	545	N/A	150	N/A
HC84201623	MULTI ORGANIZ DNA BY AMP PROBE	306	87801	1,082	N/A	200	N/A
HC84201656	DNA/RNA ENTEROBACTER CLOACAE CMPLX (PNL)	306	87798	483	N/A	150	N/A
HC84201821	SARS-COV-2 COVID-19 AMP QUAL PCR	306	87635	579	N/A	110	N/A
HC84201854	STREPTOCCUS GROUP B  PCR	306	87653	609	N/A	N/A	N/A
HC84290006	P:CULTURE STOOL W ADD' PATHOGN			N/A	N/A	N/A	N/A
HC84600063	PAP SMEAR SCREEN (MCR)	311	P3000	108	N/A	30	N/A
HC84600097	PAP THIN LAYER PREP MAN&RE SCN	311	G0143	342	N/A	64	N/A
HC84600121	PAP DEFIN HORMONAL EVAL+	311	88155	109	N/A	35	N/A
HC84600261	CELL BLOCK (TISSUE EX)DIST SVC	312	88305	780	N/A	218	N/A
HC84600295	CYTO FLUID/BRUSH/WASH DIST SRV	311	88104	312	N/A	146	N/A
HC84600329	MORPH STDY IHC/ESTROG RCPTR PER SPEC EA AB	312	88360	777	N/A	236	N/A
HC88600002	ARTERIAL PUNCTURE	300	36600	390	N/A	131	N/A
HC88600044	VENIPUNCTURE ROUTINE (BY UNIT)	300	36415	58	N/A	18	N/A
HC88600317	HANDLING & SHIPPING-BD	309	99001	76	N/A	60	N/A
HC89000020	GLIADIN IGA AND IGG ABS-QD	301	83516	42	N/A	41	N/A
HC89000053	FRUCTOSAMINE-SL	301	82985	N/A	N/A	N/A	N/A
HC89000194	ESTRIOL-SL	301	82677	N/A	N/A	N/A	N/A
HC89000228	HERPES IGM SCREEN-QD	302	86694	20	N/A	20	N/A
HC89000251	CONCENTRATION INF AGTS(PNL)-FT	306	87015	15	N/A	15	N/A
HC89000434	C1Q COMPLEMENT-QD	302	86160	17	N/A	17	N/A
HC89000467	TEICHOIC ACID AB (ID)-QD	302	86329	24	N/A	24	N/A
HC89000632	LEGIONNELLA SCREEN-QD	302	86713	21	N/A	21	N/A
HC89000665	COPPER-QD	301	82525	23	N/A	22	N/A
HC89000863	ACTH-QD	301	82024	89	N/A	89	N/A
HC89000897	ALDOSTERONE-QD	301	82088	N/A	N/A	N/A	N/A
HC89000921	CATECHOLAMINES TOTAL-QD	301	82383	108	N/A	108	N/A
HC89001085	FLUOROCYTOSINE-QD	301	80299	60	N/A	60	N/A
HC89001119	THIOCYANATE-QD	301	84430	N/A	N/A	N/A	N/A
HC89001143	TOXOPLASMA AB IGG(PNL)-AU	302	86777	11	N/A	11	N/A
HC89001341	METHAQUALONE DEF 1-7CLS-AU	301	80368	148	N/A	148	N/A
HC89001390	STRIATED MUSCLE FA AB SCRN-QD	302	86255	29	N/A	29	N/A
HC89001580	RETICULIN FA AB SCRN-QD	302	86255	23	N/A	23	N/A
HC89001614	MANGANESE-QD	301	83785	N/A	N/A	N/A	N/A
HC89001648	PHENSUXIMIDE-AU	301	80299	112	N/A	112	N/A
HC89001861	CODEINE URINE-QD	301	80299	60	N/A	60	N/A
HC89001895	NITROGEN TOTAL URINE-QD	301	84999	5	N/A	4	N/A
HC89001929	FLOW CYTO EA BLOOD(T-PNL)-U2	311	88184	N/A	N/A	N/A	N/A
HC89002075	PLATELET ASSOCIATED IGG-QD	302	86023	68	N/A	67	N/A
HC89002117	CHOLINESTERASE RBC-QD	301	82482	N/A	N/A	N/A	N/A
HC89002141	ERYTHROPOIETIN-QD	301	82668	25	N/A	24	N/A
HC89002323	FACTOR VII STABLE-U2	305	85230	N/A	N/A	N/A	N/A
HC89002356	PLATELET ANTIBODIES-QD	302	86022	140	N/A	140	N/A
HC89002570	ANTI-DNA ANTIBODIES (DS)-QD	302	86225	27	N/A	27	N/A
HC89002604	KLEIHAUER BETKE-U2	305	85460	N/A	N/A	N/A	N/A
HC89002646	PHOSPHATIDYL GLYCEROL-U2	301	84081	46	N/A	46	N/A
HC89002869	ANTI NEUT CYTOPLASMIC AB-QD	302	86021	66	N/A	65	N/A
HC89002893	COCCIDIOIDES AB CSF-QD	302	86635	22	N/A	22	N/A
HC89002927	ANTI-MAG-QD	301	83520	49	N/A	49	N/A
HC89003099	HEAVY METAL(S) QUALITATIVE-QD	301	83015	37	N/A	37	N/A
HC89003123	C3 COMPLEMENT-QD	302	86160	16	N/A	16	N/A
HC89003297	PROTEIN ELECT FRACT&QT CSF-QD	301	84166	13	N/A	13	N/A
HC89003321	HEPATITIS BE AB-QD	302	86707	18	N/A	18	N/A
HC89003503	GM1 AUTO AB-QD	301	83520	49	N/A	49	N/A
HC89003537	ACETAZOLAMIDE URINE-AU	301	80299	91	N/A	91	N/A
HC89003560	HEAVY METAL QN EA URINE;BERYLLIUM-AU	301	83018	125	N/A	125	N/A
HC89003735	CREATININE URINE (PNL)-AU	301	82570	8	N/A	7	N/A
HC89003768	FLUORIDE URINE (PNL)-AU	301	82735	71	N/A	71	N/A
HC89003792	NBS PHENYLALANINE SCREEN-GE	301	84030	12	N/A	12	N/A
HC89003982	15 CELLS  1 KARYO BAND-GC	311	88267	N/A	N/A	N/A	N/A
HC89004014	TISSUE CULTURE BM  BLOOD-IM	311	88237	N/A	N/A	N/A	N/A
HC89004188	ANTI-HUMAN TIS TRNS IGA(PNL-PR	302	83520	62	N/A	61	N/A
HC89004261	AMIKACIN - RANDOM-U2	301	80150	35	N/A	35	N/A
HC89004477	ENCEPHALITIS WESTRN AB(PNL)-AU	302	86654	19	N/A	18	N/A
HC89004501	ANTI-GLIADIN  IGG SPEC(PNL2-PR	302	83520	23	N/A	22	N/A
HC89004535	IGA SER NEPHELOMETRY(PNL2)-PR	302	82784	20	N/A	20	N/A
HC89004717	ANTI-SCL-70 AB (PNL2)-RD	302	86235	24	N/A	24	N/A
HC89004741	ANTI-CARDIOLIPIN AB (PNL2)-RD	302	86147	40	N/A	40	N/A
HC89004774	CULTURE FUNG'HAIR/SKIN/NAIL-FT	306	87101	N/A	N/A	N/A	N/A
HC89004949	HISTOPLASMA AB CF (PNL)-AU	302	86698	11	N/A	11	N/A
HC89004972	CRYPTOCOCCUS AB (SERUM)-FT	302	86641	76	N/A	76	N/A
HC89005144	HSV I IGG INDEX&INTERP -FT	302	86695	63	N/A	63	N/A
HC89005177	HSV I IGM  IFA - FT	302	86695	45	N/A	44	N/A
HC89005201	ADENOVIRUS AB (SERUM) -FT	302	86603	62	N/A	61	N/A
HC89005359	PARATHYROID HORMONE RELPEP-AU	301	83519	75	N/A	75	N/A
HC89005383	ENDOMYSIAL AB IGA SCRN-AU	301	86231	17	N/A	16	N/A
HC89005417	TROPONIN-UCI	301	84484	45	N/A	45	N/A
HC89005557	ECHOVIRUS 11 AB-FT	302	86658	26	N/A	25	N/A
HC89005581	COXSACKIE B2 AB-FT	302	86658	22	N/A	21	N/A
HC89005615	COXSACKIE B5 AB-FT	302	86658	22	N/A	21	N/A
HC89005797	LAMOTRIGINE-QD	301	80175	60	N/A	60	N/A
HC89005821	AMIODARONE-AU	301	80151	18	N/A	20	N/A
HC89006308	ALPRAZOLAM (BENZODZEPNS) 1-12-AU	301	80346	40	N/A	40	N/A
HC89006399	DIAZEPAM; 1-12-AU	301	80346	30	N/A	30	N/A
HC89006431	CLORAZEPATE; 1-12-AU	301	80346	N/A	N/A	N/A	N/A
HC89006613	TACROLIMUS-AU	301	80197	15	N/A	15	N/A
HC89006647	ANTIMICROB LEVEL-FT	301	80299	N/A	N/A	N/A	N/A
HC89006670	DIGITOXIN-AU	301	80299	23	N/A	23	N/A
HC89006852	OXCARBAZEPINE METABOLITE-QD	301	80183	60	N/A	60	N/A
HC89006886	SIROLIMUS(RAPAMUNE)-AU	301	80299	30	N/A	62	N/A
HC89007108	A-1 ANTITRYPSIN-AU	301	82103	9	N/A	8	N/A
HC89007132	AFP-AU	301	82105	16	N/A	16	N/A
HC89007306	VITAMIN C-AU	301	82180	18	N/A	26	N/A
HC89007330	PENTOBARBITAL-AU	301	80345	16	N/A	16	N/A
HC89007363	CADMIUM-AU	301	82300	15	N/A	15	N/A
HC89007652	DEOXYPYRIDINOLIN CROSSLINKS-AU	301	82523	42	N/A	42	N/A
HC89007686	PYRIDINIUM CROSSLINKS TOTAL-AU	301	82523	54	N/A	54	N/A
HC89007710	CORTISOL FREE URINE-QN	301	82530	N/A	N/A	N/A	N/A
HC89007900	DIHYDROTESTOSTERONE TANDUM SPECT-AU	301	82542	20	N/A	38	N/A
HC89007942	ERYTHROPOIETIN-AU	301	82668	10	N/A	10	N/A
HC89008130	IMMUNOGLB IGA D G M EA-SL	301	82784	N/A	N/A	N/A	N/A
HC89008163	GASTRIN-QN	301	82941	N/A	N/A	N/A	N/A
HC89008197	GLUCAGON-QN	301	82943	N/A	N/A	N/A	N/A
HC89008346	HEMOGLOBIN GLYCATED (A1C)-AU	301	83036	12	N/A	11	N/A
HC89008379	HEMOGLOBIN PLASMA-AU	301	83051	19	N/A	15	N/A
HC89008403	HISTAMINE  WHOLE BLOOD-AU	301	83088	27	N/A	26	N/A
HC89008551	CARNITINE URINE-CA	301	83519	110	N/A	110	N/A
HC89008585	IGF BINDING PROTEIN-3-AU	301	82397	18	N/A	21	N/A
HC89008619	LEPTIN-QN	301	83519	75	N/A	75	N/A
HC89008783	IRON LIVER TISSUE-MA	301	83540	70	N/A	69	N/A
HC89008817	LDH-AU	301	83615	11	N/A	10	N/A
HC89009013	METHEMALBUMIN-AU	301	83857	N/A	N/A	N/A	N/A
HC89009054	MYELIN BASIC PROTEIN CSF-QN	301	83873	N/A	N/A	N/A	N/A
HC89009328	NUCLEOTIDASE-5-AU	301	83915	12	N/A	15	N/A
HC89009468	PARATHYROID HORMONE INTACT-ES	301	83970	N/A	N/A	N/A	N/A
HC89009500	PARATHYROID HORMONE MID-QN	301	83970	N/A	N/A	N/A	N/A
HC89009542	PHENYLALANINE SCREEN-AU	301	84030	16	N/A	16	N/A
HC89009716	PSA FREE-AU	301	84154	6	N/A	6	N/A
HC89009740	PROTOPORPHYRINS RBC QUANT-AU	301	84202	60	N/A	57	N/A
HC89009914	HEXOSAMINIDASE A-AU	301	84311	N/A	N/A	N/A	N/A
HC89009948	TESTOSTERONE FREE-ES	301	84402	7	N/A	7	N/A
HC89010110	T-3 REVERSE-ES	301	84482	47	N/A	46	N/A
HC89010151	UROBILINOGEN FECES-AU	301	84577	N/A	N/A	N/A	N/A
HC89010185	VMA URINE-CA	301	84585	93	N/A	48	N/A
HC89010334	M: MISC LAB GENERAL REF LAB-AH	300		N/A	N/A	N/A	N/A
HC89010383	M: MISC LAB GENERAL REF LAB-BW	300		462	N/A	N/A	N/A
HC89010417	M: MISC LAB GENERAL REF LAB-EC	300		N/A	N/A	N/A	N/A
HC89010581	M: MISC LAB GENERAL REF LAB-U2	300		35	N/A	N/A	N/A
HC89010615	FACTOR VIII VW-AU	305	85245	26	N/A	33	N/A
HC89010789	DRVVT RUSS VIPER VENOM-AU	305	85613	14	N/A	9	N/A
HC89010813	VISCOSITY-AU	305	85810	11	N/A	11	N/A
HC89010847	PROTEUS OX19 AGGLUT-QD	302	86000	N/A	N/A	N/A	N/A
HC89010987	C2 COMPLEMENT-AU	302	86160	32	N/A	36	N/A
HC89011019	C4 COMPLEMENT (PNL)-RD	302	86160	13	N/A	13	N/A
HC89011043	ECHOVIRUS(PNL)-AU	302	86171	N/A	N/A	N/A	N/A
HC89011209	ANTI-LA (SS-B) (PNL2)-RD	302	86235	13	N/A	13	N/A
HC89011233	ANTI-RO SS-A (PNL)-RD	302	86235	32	N/A	31	N/A
HC89011266	SM ENA AB-QD	302	86235	12	N/A	12	N/A
HC89011431	SSB ENA AB-QD	302	86235	13	N/A	13	N/A
HC89011464	ANTI-PARIETAL AB-AU	302	83516	20	N/A	16	N/A
HC89011647	GLOMERULAR BASEMENT MEMB AB-QN	302	86317	N/A	N/A	N/A	N/A
HC89011670	CYSTICERCOSIS ELISA-FT	302	86317	N/A	N/A	N/A	N/A
HC89011704	PNEUMOCOCCAL AB(PNL)-AU	302	86317	3	N/A	13	N/A
HC89011845	IMMUNE COMPLEXES RAJI CELL-AU	302	86332	148	N/A	148	N/A
HC89011878	INSULIN AB-ES	302	86337	N/A	N/A	N/A	N/A
HC89011902	ISLET AB-AU	302	86341	20	N/A	24	N/A
HC89012074	VDRL TITER QUANT-AU	302	86593	16	N/A	16	N/A
HC89012108	ASPERGILLUS AB BY CF-AU	302	86606	11	N/A	12	N/A
HC89012272	CMV AB IGM-AU	302	86645	8	N/A	11	N/A
HC89012306	ENCEPHALITIS CALIF AB IGG-AU	302	86651	19	N/A	19	N/A
HC89012470	EBV AB TO NUCLEAR AG (PNL)-AU	302	86664	8	N/A	6	N/A
HC89012504	EBV AB-VIRAL CAPSID AG-AU	302	86665	16	N/A	16	N/A
HC89012538	CYSTICERCOSIS AB-AU	302	86682	19	N/A	19	N/A
HC89012678	HERPES SIMPLEX II GLYCO AB-AU	302	86696	14	N/A	12	N/A
HC89012702	HIV-2 AB-AU	302	86702	73	N/A	73	N/A
HC89012736	HEPATITIS A AB IGM-AU	302	86709	N/A	N/A	N/A	N/A
HC89012900	TORCH TOXOPLASM AB IGM(PNL)-AU	302	86778	10	N/A	11	N/A
HC89012934	TRICHINELLA AB-AU	302	86784	95	N/A	44	N/A
HC89013106	CULTURE STOOL-AU	306	87045	N/A	N/A	N/A	N/A
HC89013130	CULTURE AFB OTHER(PNL)-FT	306	87116	27	N/A	27	N/A
HC89013304	HIV-1 DNA PCR QUAL-AU	306	87535	114	N/A	244	N/A
HC89013338	GC DNA PROBE (PNL)-AU	306	87590	N/A	N/A	N/A	N/A
HC89013361	HPV LO RISK TYPES(6 11 42 43 44)-AU	306	87623	47	N/A	47	N/A
HC89013502	BETA-2 MICROGLOBULIN CSF-AU	301	82232	12	N/A	12	N/A
HC89013536	CALCITONIN-AU	301	82308	20	N/A	24	N/A
HC65000250_05107993620	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05107995920	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_05129381001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05140743501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05167212841	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_05167213862	NONCDM CHARGE RECORD PHARMACY	250		474	N/A	N/A	N/A
HC65000250_05167240556	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_05175405013	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_05180100630	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05199183801	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05199191390	NONCDM CHARGE RECORD PHARMACY	250	Z7610	11	N/A	N/A	N/A
HC65000250_05226810001	NONCDM CHARGE RECORD PHARMACY	250		122	N/A	N/A	N/A
HC65000250_05281733210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05319124401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05374654201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05374657101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05374664101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05483811680	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05483851080	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_05483855680	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_05511135360	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05511159390	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05723701830	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05723701930	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05764800201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05766437708	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05766450888	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789630310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789644101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789645401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05823274001	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_05860270204	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05898001110	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_05898040925	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05965125601	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05967656201	NONCDM CHARGE RECORD PHARMACY	250		211	N/A	N/A	N/A
HC65000250_05974601032	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_05976201171	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_05976204015	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05976205421	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05976237201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05976250005	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06043212616	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06043221208	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06043246551	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_06050502533	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06050508271	NONCDM CHARGE RECORD PHARMACY	250		234	N/A	N/A	N/A
HC65000250_06050525788	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06050532516	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_06050534383	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06050546433	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068714301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068716101	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06068724501	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068725301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068728101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068733665	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06068735101	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06068735701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068740701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068741801	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068746101	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06068747201	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06068750801	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068752601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068753001	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068756901	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06068757521	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06068758001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068763401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06068764001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06079341130	NONCDM CHARGE RECORD PHARMACY	250		81	N/A	N/A	N/A
HC65000250_06126973556	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06131414305	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65000250_06131465625	NONCDM CHARGE RECORD PHARMACY	250		67	N/A	N/A	N/A
HC65000250_06144212110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06157013150	NONCDM CHARGE RECORD PHARMACY	250		90	N/A	N/A	N/A
HC65000250_06195823011	NONCDM CHARGE RECORD PHARMACY	250		276	N/A	N/A	N/A
HC65000250_06203759990	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06210333304	NONCDM CHARGE RECORD PHARMACY	250	Z7610	35	N/A	N/A	N/A
HC65000250_06233211990	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06233224631	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06255982001	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06258415901	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65000250_06258426701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06275651818	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06275653886	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06285627230	NONCDM CHARGE RECORD PHARMACY	250	Z7610	11	N/A	N/A	N/A
HC65000250_06332309330	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06332325410	NONCDM CHARGE RECORD PHARMACY	250		99	N/A	N/A	N/A
HC65000250_06340291164	NONCDM CHARGE RECORD PHARMACY	250		122	N/A	N/A	N/A
HC65000250_06362920951	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_06373916010	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06373919861	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06373922810	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06373941110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373943401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373947810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373957210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373966510	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_06373997310	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06380710011	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06438079901	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_06438097106	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06476424060	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_06498027903	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06498050448	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06498052810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516246550	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516257110	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06516275110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516277810	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06559710330	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_06586201230	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586202760	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06586206299	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586219301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586220199	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586245960	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06586250301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06586266130	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06586267001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06586270701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06630246760	NONCDM CHARGE RECORD PHARMACY	250		75	N/A	N/A	N/A
HC65000250_06655300401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06668510121	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06668920304	NONCDM CHARGE RECORD PHARMACY	250		159	N/A	N/A	N/A
HC65000250_06668933950	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06761830010	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06761831060	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06787732001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_06787745590	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787750651	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06808404001	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06808405921	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_06808408201	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06808419901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808420401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808428201	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808429201	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808431001	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06808436009	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808437601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808441501	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06808454101	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_06808459101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808459801	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_06808470901	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808472301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808482321	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06808484501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808485301	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06809400162	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06809401561	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06809404362	NONCDM CHARGE RECORD PHARMACY	250	Z7610	58	N/A	N/A	N/A
HC65000250_06817600010	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06818012202	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06818065906	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_06818067711	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_06818098001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06830848047	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06838202210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838218001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838225501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06838235316	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06838285601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846212601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846223401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846225601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846226390	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846240601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846243730	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846247301	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06909712203	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06909716864	NONCDM CHARGE RECORD PHARMACY	250		122	N/A	N/A	N/A
HC65000250_06909731953	NONCDM CHARGE RECORD PHARMACY	250		60	N/A	N/A	N/A
HC65000250_06923811739	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06923814901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06931521201	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06931590401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06933914919	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06954326790	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06954338810	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06958468410	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07001006301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07001049101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07043601004	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_07067700511	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_07075620211	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07095401910	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07095413610	NONCDM CHARGE RECORD PHARMACY	250	Z7610	11	N/A	N/A	N/A
HC65000250_07139974015	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07169905030	NONCDM CHARGE RECORD PHARMACY	250	Z7610	418	N/A	N/A	N/A
HC65000250_07193003712	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_07278901804	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_07288803501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07583415801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07583417002	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65000250_07638512301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07638513401	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_07733311810	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_07811201103	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_07811273621	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_07985420080	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068116900	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08103300340	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_08770142902	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_09999903809	NONCDM CHARGE RECORD PHARMACY	250		487	N/A	N/A	N/A
HC65000250_70092161144	NONCDM CHARGE RECORD PHARMACY	250		72	N/A	N/A	N/A
HC65000635	DRUG - EPOGEN>10 000 UNITS	635		N/A	N/A	N/A	N/A
HC65000636_00002418230	NONCDM CHARGE RECORD PHARMACY	636	C9399	541	N/A	N/A	N/A
HC65000636_00002764001	NONCDM CHARGE RECORD PHARMACY	636	J9305	501	N/A	N/A	N/A
HC65000636_00006302500	NONCDM CHARGE RECORD PHARMACY	636	J0565	247	N/A	N/A	N/A
HC65000636_00006384371	NONCDM CHARGE RECORD PHARMACY	636	J1335	418	N/A	N/A	N/A
HC65000636_00009003932	NONCDM CHARGE RECORD PHARMACY	636	J2920	39	N/A	N/A	N/A
HC65000636_00009004727	NONCDM CHARGE RECORD PHARMACY	636	J2930	63	N/A	N/A	N/A
HC65000636_00009307323	NONCDM CHARGE RECORD PHARMACY	636	J1030	70	N/A	N/A	N/A
HC65000636_00009347503	NONCDM CHARGE RECORD PHARMACY	636	J1040	120	N/A	N/A	N/A
HC65000636_00009752904	NONCDM CHARGE RECORD PHARMACY	636	J9206	86	N/A	N/A	N/A
HC65000636_00046074905	NONCDM CHARGE RECORD PHARMACY	636	J1410	2,184	N/A	N/A	N/A
HC65000636_00049001483	NONCDM CHARGE RECORD PHARMACY	636	J0295	57	N/A	N/A	N/A
HC65000636_00049053022	NONCDM CHARGE RECORD PHARMACY	636	J2540	10	N/A	N/A	N/A
HC65000636_00054372250	NONCDM CHARGE RECORD PHARMACY	636	J7512	4	N/A	N/A	N/A
HC65000636_00054418125	NONCDM CHARGE RECORD PHARMACY	636	J8540	0	N/A	N/A	N/A
HC65000636_00068059701	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,161	N/A	N/A	N/A
HC65000636_00069005901	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_00069130904	NONCDM CHARGE RECORD PHARMACY	636	Q5106	70	N/A	N/A	N/A
HC65000636_00069303120	NONCDM CHARGE RECORD PHARMACY	636	J9000	61	N/A	N/A	N/A
HC65000636_00069315083	NONCDM CHARGE RECORD PHARMACY	636	J0456	39	N/A	N/A	N/A
HC65000636_00074433906	NONCDM CHARGE RECORD PHARMACY	636	J0135	0	N/A	N/A	N/A
HC65000636_00074438081	NONCDM CHARGE RECORD PHARMACY	636	J3490	179	N/A	N/A	N/A
HC65000636_00075062101	NONCDM CHARGE RECORD PHARMACY	636	J1650	16	N/A	N/A	N/A
HC65000636_00093733401	NONCDM CHARGE RECORD PHARMACY	636	J7517	4	N/A	N/A	N/A
HC65000636_00143900601	NONCDM CHARGE RECORD PHARMACY	636	J1120	214	N/A	N/A	N/A
HC65000636_00143931724	NONCDM CHARGE RECORD PHARMACY	636	J1956	5	N/A	N/A	N/A
HC65000636_00143938110	NONCDM CHARGE RECORD PHARMACY	636	J3490	158	N/A	N/A	N/A
HC65000636_00143939210	NONCDM CHARGE RECORD PHARMACY	636	J3490	797	N/A	N/A	N/A
HC65000636_00143956410	NONCDM CHARGE RECORD PHARMACY	636	J2760	2,940	N/A	N/A	N/A
HC65000636_00143957710	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_00143959425	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_00143972024	NONCDM CHARGE RECORD PHARMACY	636	J1956	4	N/A	N/A	N/A
HC65000636_00143972905	NONCDM CHARGE RECORD PHARMACY	636	J0515	195	N/A	N/A	N/A
HC65000636_00143985001	NONCDM CHARGE RECORD PHARMACY	636	J2930	37	N/A	N/A	N/A
HC65000636_00173089242	NONCDM CHARGE RECORD PHARMACY	636	J2182	213	N/A	N/A	N/A
HC65000636_00228315603	NONCDM CHARGE RECORD PHARMACY	636	J0571	8	N/A	N/A	N/A
HC65000636_00270044540	NONCDM CHARGE RECORD PHARMACY	636	Q9963	4	N/A	N/A	N/A
HC65000636_00270141111	NONCDM CHARGE RECORD PHARMACY	636	Q9966	42	N/A	N/A	N/A
HC65000636_00270516413	NONCDM CHARGE RECORD PHARMACY	636	A9577	38	N/A	N/A	N/A
HC65000636_00338050348	NONCDM CHARGE RECORD PHARMACY	636	J1580	25	N/A	N/A	N/A
HC65000636_00338070348	NONCDM CHARGE RECORD PHARMACY	636	J3480	1	N/A	N/A	N/A
HC65000636_00338100702	NONCDM CHARGE RECORD PHARMACY	636	J1265	9	N/A	N/A	N/A
HC65000636_00338955810	NONCDM CHARGE RECORD PHARMACY	636	J1327	55	N/A	N/A	N/A
HC65000636_00407141310	NONCDM CHARGE RECORD PHARMACY	636	Q9967	26	N/A	N/A	N/A
HC65000636_00407141498	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5	N/A	N/A	N/A
HC65000636_00407222303	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00409103630	NONCDM CHARGE RECORD PHARMACY	636	J0670	12	N/A	N/A	N/A
HC65000636_00409110301	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,792	N/A	N/A	N/A
HC65000636_00409117410	NONCDM CHARGE RECORD PHARMACY	636	J3490	517	N/A	N/A	N/A
HC65000636_00409131901	NONCDM CHARGE RECORD PHARMACY	636	J3370	62	N/A	N/A	N/A
HC65000636_00409139051	NONCDM CHARGE RECORD PHARMACY	636	J2185	20	N/A	N/A	N/A
HC65000636_00409141210	NONCDM CHARGE RECORD PHARMACY	636	J3490	44	N/A	N/A	N/A
HC65000636_00409226720	NONCDM CHARGE RECORD PHARMACY	636	J3490	4	N/A	N/A	N/A
HC65000636_00409230517	NONCDM CHARGE RECORD PHARMACY	636	J2250	3	N/A	N/A	N/A
HC65000636_00409336501	NONCDM CHARGE RECORD PHARMACY	636	J1170	9	N/A	N/A	N/A
HC65000636_00409338513	NONCDM CHARGE RECORD PHARMACY	636	J2543	26	N/A	N/A	N/A
HC65000636_00409350501	NONCDM CHARGE RECORD PHARMACY	636	J2185	2	N/A	N/A	N/A
HC65000636_00409427902	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_00409433201	NONCDM CHARGE RECORD PHARMACY	636	J3370	50	N/A	N/A	N/A
HC65000636_00409469930	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_00409508216	NONCDM CHARGE RECORD PHARMACY	636	J0713	14	N/A	N/A	N/A
HC65000636_00409592101	NONCDM CHARGE RECORD PHARMACY	636	J0280	130	N/A	N/A	N/A
HC65000636_00409610202	NONCDM CHARGE RECORD PHARMACY	636	J1940	27	N/A	N/A	N/A
HC65000636_00409665106	NONCDM CHARGE RECORD PHARMACY	636	J3480	4	N/A	N/A	N/A
HC65000636_00409672903	NONCDM CHARGE RECORD PHARMACY	636	J3475	1	N/A	N/A	N/A
HC65000636_00409762003	NONCDM CHARGE RECORD PHARMACY	636	J1644	35	N/A	N/A	N/A
HC65000636_00409781022	NONCDM CHARGE RECORD PHARMACY	636	J1265	6	N/A	N/A	N/A
HC65000636_00409909332	NONCDM CHARGE RECORD PHARMACY	636	J3010	4	N/A	N/A	N/A
HC65000636_00456270010	NONCDM CHARGE RECORD PHARMACY	636	J0714	583	N/A	N/A	N/A
HC65000636_00469305130	NONCDM CHARGE RECORD PHARMACY	636	J0289	362	N/A	N/A	N/A
HC65000636_00469650189	NONCDM CHARGE RECORD PHARMACY	636	J2785	399	N/A	N/A	N/A
HC65000636_00517182510	NONCDM CHARGE RECORD PHARMACY	636	J2800	72	N/A	N/A	N/A
HC65000636_00517400225	NONCDM CHARGE RECORD PHARMACY	636	J2440	292	N/A	N/A	N/A
HC65000636_00574082701	NONCDM CHARGE RECORD PHARMACY	636	J1071	0	N/A	N/A	N/A
HC65000636_00591213695	NONCDM CHARGE RECORD PHARMACY	636	J2704	2	N/A	N/A	N/A
HC65000636_00641234141	NONCDM CHARGE RECORD PHARMACY	636	J1170	14	N/A	N/A	N/A
HC65000636_00641600710	NONCDM CHARGE RECORD PHARMACY	636	J3490	66	N/A	N/A	N/A
HC65000636_00641601410	NONCDM CHARGE RECORD PHARMACY	636	J3490	111	N/A	N/A	N/A
HC65000636_00641605325	NONCDM CHARGE RECORD PHARMACY	636	J2175	17	N/A	N/A	N/A
HC65000636_00641606001	NONCDM CHARGE RECORD PHARMACY	636	J2250	2	N/A	N/A	N/A
HC65000636_00641607025	NONCDM CHARGE RECORD PHARMACY	636	J2270	6	N/A	N/A	N/A
HC65000636_00641617510	NONCDM CHARGE RECORD PHARMACY	636	J2354	10	N/A	N/A	N/A
HC65000636_00641617801	NONCDM CHARGE RECORD PHARMACY	636	J2354	8	N/A	N/A	N/A
HC65000636_00703321701	NONCDM CHARGE RECORD PHARMACY	636	J9267	3	N/A	N/A	N/A
HC65000636_00703332104	NONCDM CHARGE RECORD PHARMACY	636	J2354	11	N/A	N/A	N/A
HC65000636_00703507503	NONCDM CHARGE RECORD PHARMACY	636	J9130	53	N/A	N/A	N/A
HC65000636_00703523313	NONCDM CHARGE RECORD PHARMACY	636	J9150	436	N/A	N/A	N/A
HC65000636_00703712103	NONCDM CHARGE RECORD PHARMACY	636	J1631	155	N/A	N/A	N/A
HC65000636_00781311495	NONCDM CHARGE RECORD PHARMACY	636	J2543	16	N/A	N/A	N/A
HC65000636_00781315695	NONCDM CHARGE RECORD PHARMACY	636	J0131	2	N/A	N/A	N/A
HC65000636_00781320795	NONCDM CHARGE RECORD PHARMACY	636	J0696	7	N/A	N/A	N/A
HC65000636_00781331275	NONCDM CHARGE RECORD PHARMACY	636	J2469	32	N/A	N/A	N/A
HC65000636_00781340295	NONCDM CHARGE RECORD PHARMACY	636	J0290	17	N/A	N/A	N/A
HC65000636_00781615395	NONCDM CHARGE RECORD PHARMACY	636	J3490	6	N/A	N/A	N/A
HC65000636_00781922191	NONCDM CHARGE RECORD PHARMACY	636	J3490	76	N/A	N/A	N/A
HC65000636_00781940495	NONCDM CHARGE RECORD PHARMACY	636	J0290	22	N/A	N/A	N/A
HC65000636_00944270007	NONCDM CHARGE RECORD PHARMACY	636	J1569	493	N/A	N/A	N/A
HC65000636_00944304610	NONCDM CHARGE RECORD PHARMACY	636	J7192	12	N/A	N/A	N/A
HC65000636_00944305202	NONCDM CHARGE RECORD PHARMACY	636	J7192	6	N/A	N/A	N/A
HC65000636_01001992501	NONCDM CHARGE RECORD PHARMACY	636	J9208	239	N/A	N/A	N/A
HC65000636_01001993901	NONCDM CHARGE RECORD PHARMACY	636	J9070	240	N/A	N/A	N/A
HC65000636_01353363402	NONCDM CHARGE RECORD PHARMACY	636	90389	3,887	N/A	N/A	N/A
HC65000636_01353380012	NONCDM CHARGE RECORD PHARMACY	636	J1561	423	N/A	N/A	N/A
HC65000636_01671403610	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_01671404610	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_01671408825	NONCDM CHARGE RECORD PHARMACY	636	J1030	57	N/A	N/A	N/A
HC65000636_01672904201	NONCDM CHARGE RECORD PHARMACY	636	J7507	4	N/A	N/A	N/A
HC65000636_01672911408	NONCDM CHARGE RECORD PHARMACY	636	J9181	6	N/A	N/A	N/A
HC65000636_01672911638	NONCDM CHARGE RECORD PHARMACY	636	J9280	1,027	N/A	N/A	N/A
HC65000636_01672929805	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_01672943405	NONCDM CHARGE RECORD PHARMACY	636	J0878	1	N/A	N/A	N/A
HC65000636_01747808290	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_01747825310	NONCDM CHARGE RECORD PHARMACY	636	J3490	313	N/A	N/A	N/A
HC65000636_01785637221	NONCDM CHARGE RECORD PHARMACY	636	J7512	8	N/A	N/A	N/A
HC65000636_01951581852	NONCDM CHARGE RECORD PHARMACY	636	90686	113	N/A	N/A	N/A
HC65000636_02315529041	NONCDM CHARGE RECORD PHARMACY	636	J0278	15	N/A	N/A	N/A
HC65000636_02315578541	NONCDM CHARGE RECORD PHARMACY	636	J0278	6	N/A	N/A	N/A
HC65000636_02433815020	NONCDM CHARGE RECORD PHARMACY	636	J3316	0	N/A	N/A	N/A
HC65000636_02502110610	NONCDM CHARGE RECORD PHARMACY	636	J0696	4	N/A	N/A	N/A
HC65000636_02502114220	NONCDM CHARGE RECORD PHARMACY	636	J0295	35	N/A	N/A	N/A
HC65000636_02502115899	NONCDM CHARGE RECORD PHARMACY	636	J3370	29	N/A	N/A	N/A
HC65000636_02502123410	NONCDM CHARGE RECORD PHARMACY	636	J9201	78	N/A	N/A	N/A
HC65000636_02502124504	NONCDM CHARGE RECORD PHARMACY	636	J9171	7	N/A	N/A	N/A
HC65000636_02502130982	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,261	N/A	N/A	N/A
HC65000636_02502140851	NONCDM CHARGE RECORD PHARMACY	636	J1327	135	N/A	N/A	N/A
HC65000636_02502145101	NONCDM CHARGE RECORD PHARMACY	636	J2354	15	N/A	N/A	N/A
HC65000636_02502146001	NONCDM CHARGE RECORD PHARMACY	636	J3490	367	N/A	N/A	N/A
HC65000636_02502178005	NONCDM CHARGE RECORD PHARMACY	636	J1953	1	N/A	N/A	N/A
HC65000636_02502180601	NONCDM CHARGE RECORD PHARMACY	636	J1630	32	N/A	N/A	N/A
HC65000636_02502181430	NONCDM CHARGE RECORD PHARMACY	636	J0640	65	N/A	N/A	N/A
HC65000636_03600030810	NONCDM CHARGE RECORD PHARMACY	636	J2310	28	N/A	N/A	N/A
HC65000636_03600032402	NONCDM CHARGE RECORD PHARMACY	636	J3490	71	N/A	N/A	N/A
HC65000636_04202314625	NONCDM CHARGE RECORD PHARMACY	636	J3490	66	N/A	N/A	N/A
HC65000636_04202316425	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,953	N/A	N/A	N/A
HC65000636_04202321410	NONCDM CHARGE RECORD PHARMACY	636	J2370	3	N/A	N/A	N/A
HC65000636_04306601610	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,318	N/A	N/A	N/A
HC65000636_04306602710	NONCDM CHARGE RECORD PHARMACY	636	J2795	0	N/A	N/A	N/A
HC65000636_04359808525	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,359	N/A	N/A	N/A
HC65000636_04359891758	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,073	N/A	N/A	N/A
HC65000636_04359897558	NONCDM CHARGE RECORD PHARMACY	636	J3490	520	N/A	N/A	N/A
HC65000636_04456724010	NONCDM CHARGE RECORD PHARMACY	636	J0692	19	N/A	N/A	N/A
HC65000636_04456724625	NONCDM CHARGE RECORD PHARMACY	636	J0694	65	N/A	N/A	N/A
HC65000636_04456782010	NONCDM CHARGE RECORD PHARMACY	636	J1335	497	N/A	N/A	N/A
HC65000636_04596373355	NONCDM CHARGE RECORD PHARMACY	636	J9000	62	N/A	N/A	N/A
HC65000636_04733533040	NONCDM CHARGE RECORD PHARMACY	636	J1205	626	N/A	N/A	N/A
HC65000636_04928186010	NONCDM CHARGE RECORD PHARMACY	636	90713	247	N/A	N/A	N/A
HC65000636_04970221305	NONCDM CHARGE RECORD PHARMACY	636	J3490	9	N/A	N/A	N/A
HC65000636_05024204164	NONCDM CHARGE RECORD PHARMACY	636	J2997	496	N/A	N/A	N/A
HC65000636_05024215001	NONCDM CHARGE RECORD PHARMACY	636	J2350	349	N/A	N/A	N/A
HC65000636_05024224501	NONCDM CHARGE RECORD PHARMACY	636	J9316	459	N/A	N/A	N/A
HC65000636_05107937920	NONCDM CHARGE RECORD PHARMACY	636	J7517	3	N/A	N/A	N/A
HC65000636_05107981720	NONCDM CHARGE RECORD PHARMACY	636	J7507	7	N/A	N/A	N/A
HC65000636_05114402001	NONCDM CHARGE RECORD PHARMACY	636	J9177	194	N/A	N/A	N/A
HC65000636_05253662501	NONCDM CHARGE RECORD PHARMACY	636	J1071	1	N/A	N/A	N/A
HC65000636_05428810310	NONCDM CHARGE RECORD PHARMACY	636	J0171	7	N/A	N/A	N/A
HC65000636_05428812710	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,033	N/A	N/A	N/A
HC65000636_05511169407	NONCDM CHARGE RECORD PHARMACY	636	J2469	32	N/A	N/A	N/A
HC65000636_05515011420	NONCDM CHARGE RECORD PHARMACY	636	J0290	11	N/A	N/A	N/A
HC65000636_05515011930	NONCDM CHARGE RECORD PHARMACY	636	J2543	18	N/A	N/A	N/A
HC65000636_05515018003	NONCDM CHARGE RECORD PHARMACY	636	J0282	3	N/A	N/A	N/A
HC65000636_05515019410	NONCDM CHARGE RECORD PHARMACY	636	J3490	29	N/A	N/A	N/A
HC65000636_05515028220	NONCDM CHARGE RECORD PHARMACY	636	J1335	313	N/A	N/A	N/A
HC65000636_05515030201	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_05515030801	NONCDM CHARGE RECORD PHARMACY	636	J2358	18	N/A	N/A	N/A
HC65000636_05551316001	NONCDM CHARGE RECORD PHARMACY	636	J9039	800	N/A	N/A	N/A
HC65000636_05551320601	NONCDM CHARGE RECORD PHARMACY	636	Q5107	452	N/A	N/A	N/A
HC65000636_05551322201	NONCDM CHARGE RECORD PHARMACY	636	J2796	568	N/A	N/A	N/A
HC65000636_05789450205	NONCDM CHARGE RECORD PHARMACY	636	J9145	392	N/A	N/A	N/A
HC65000636_05797010001	NONCDM CHARGE RECORD PHARMACY	636	J0875	109	N/A	N/A	N/A
HC65000636_05846800701	NONCDM CHARGE RECORD PHARMACY	636	J1931	24	N/A	N/A	N/A
HC65000636_05914804580	NONCDM CHARGE RECORD PHARMACY	636	J0401	0	N/A	N/A	N/A
HC65000636_06050501340	NONCDM CHARGE RECORD PHARMACY	636	J7502	73	N/A	N/A	N/A
HC65000636_06050546323	NONCDM CHARGE RECORD PHARMACY	636	J7502	29	N/A	N/A	N/A
HC65000636_06050561434	NONCDM CHARGE RECORD PHARMACY	636	J0690	4	N/A	N/A	N/A
HC65000636_06068712201	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_06068748121	NONCDM CHARGE RECORD PHARMACY	636	J0571	9	N/A	N/A	N/A
HC65000636_06079370010	NONCDM CHARGE RECORD PHARMACY	636	J0561	116	N/A	N/A	N/A
HC65000636_06170332618	NONCDM CHARGE RECORD PHARMACY	636	J2430	78	N/A	N/A	N/A
HC65000636_06170333922	NONCDM CHARGE RECORD PHARMACY	636	J9045	48	N/A	N/A	N/A
HC65000636_06199001302	NONCDM CHARGE RECORD PHARMACY	636	J2543	14	N/A	N/A	N/A
HC65000636_06199002131	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_06332301230	NONCDM CHARGE RECORD PHARMACY	636	J2590	8	N/A	N/A	N/A
HC65000636_06332302425	NONCDM CHARGE RECORD PHARMACY	636	J2150	31	N/A	N/A	N/A
HC65000636_06332306402	NONCDM CHARGE RECORD PHARMACY	636	J3475	5	N/A	N/A	N/A
HC65000636_06332312020	NONCDM CHARGE RECORD PHARMACY	636	J9100	7	N/A	N/A	N/A
HC65000636_06332313011	NONCDM CHARGE RECORD PHARMACY	636	J3490	175	N/A	N/A	N/A
HC65000636_06332313610	NONCDM CHARGE RECORD PHARMACY	636	J9040	215	N/A	N/A	N/A
HC65000636_06332320805	NONCDM CHARGE RECORD PHARMACY	636	J2001	2	N/A	N/A	N/A
HC65000636_06332322915	NONCDM CHARGE RECORD PHARMACY	636	J2720	11	N/A	N/A	N/A
HC65000636_06332327050	NONCDM CHARGE RECORD PHARMACY	636	J2704	2	N/A	N/A	N/A
HC65000636_06332328002	NONCDM CHARGE RECORD PHARMACY	636	J1940	14	N/A	N/A	N/A
HC65000636_06332328561	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_06332330602	NONCDM CHARGE RECORD PHARMACY	636	J3260	21	N/A	N/A	N/A
HC65000636_06332331510	NONCDM CHARGE RECORD PHARMACY	636	J1570	632	N/A	N/A	N/A
HC65000636_06332332510	NONCDM CHARGE RECORD PHARMACY	636	J0133	1	N/A	N/A	N/A
HC65000636_06332340120	NONCDM CHARGE RECORD PHARMACY	636	J3490	205	N/A	N/A	N/A
HC65000636_06332340220	NONCDM CHARGE RECORD PHARMACY	636	J3490	417	N/A	N/A	N/A
HC65000636_06332347410	NONCDM CHARGE RECORD PHARMACY	636	J1630	37	N/A	N/A	N/A
HC65000636_06332348526	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_06332350831	NONCDM CHARGE RECORD PHARMACY	636	J2185	8	N/A	N/A	N/A
HC65000636_06332352374	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_06332353383	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332356210	NONCDM CHARGE RECORD PHARMACY	636	J0583	13	N/A	N/A	N/A
HC65000636_06332356698	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332358696	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332361710	NONCDM CHARGE RECORD PHARMACY	636	J2260	160	N/A	N/A	N/A
HC65000636_06332364250	NONCDM CHARGE RECORD PHARMACY	636	J3475	3	N/A	N/A	N/A
HC65000636_06332372910	NONCDM CHARGE RECORD PHARMACY	636	J2248	12	N/A	N/A	N/A
HC65000636_06332375101	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_06332396600	NONCDM CHARGE RECORD PHARMACY	636	J3489	390	N/A	N/A	N/A
HC65000636_06332398321	NONCDM CHARGE RECORD PHARMACY	636	J2543	35	N/A	N/A	N/A
HC65000636_06345934804	NONCDM CHARGE RECORD PHARMACY	636	J9034	161	N/A	N/A	N/A
HC65000636_06383382502	NONCDM CHARGE RECORD PHARMACY	636	J0597	438	N/A	N/A	N/A
HC65000636_06425333333	NONCDM CHARGE RECORD PHARMACY	636	J1642	0	N/A	N/A	N/A
HC65000636_06440600801	NONCDM CHARGE RECORD PHARMACY	636	J2323	0	N/A	N/A	N/A
HC65000636_06564955102	NONCDM CHARGE RECORD PHARMACY	636	J2212	9	N/A	N/A	N/A
HC65000636_06564955204	NONCDM CHARGE RECORD PHARMACY	636	J2212	15	N/A	N/A	N/A
HC65000636_06745711850	NONCDM CHARGE RECORD PHARMACY	636	J3490	35	N/A	N/A	N/A
HC65000636_06745715309	NONCDM CHARGE RECORD PHARMACY	636	J0282	4	N/A	N/A	N/A
HC65000636_06745719602	NONCDM CHARGE RECORD PHARMACY	636	J3411	33	N/A	N/A	N/A
HC65000636_06745734001	NONCDM CHARGE RECORD PHARMACY	636	J3370	42	N/A	N/A	N/A
HC65000636_06745734910	NONCDM CHARGE RECORD PHARMACY	636	J0295	15	N/A	N/A	N/A
HC65000636_06745738599	NONCDM CHARGE RECORD PHARMACY	636	J1644	3	N/A	N/A	N/A
HC65000636_06745751625	NONCDM CHARGE RECORD PHARMACY	636	J3490	168	N/A	N/A	N/A
HC65000636_06745752920	NONCDM CHARGE RECORD PHARMACY	636	J0640	63	N/A	N/A	N/A
HC65000636_06745755300	NONCDM CHARGE RECORD PHARMACY	636	J3475	20	N/A	N/A	N/A
HC65000636_06745785730	NONCDM CHARGE RECORD PHARMACY	636	J0153	14	N/A	N/A	N/A
HC65000636_06745794010	NONCDM CHARGE RECORD PHARMACY	636	J0131	1	N/A	N/A	N/A
HC65000636_06808445101	NONCDM CHARGE RECORD PHARMACY	636	J7507	16	N/A	N/A	N/A
HC65000636_06809410110	NONCDM CHARGE RECORD PHARMACY	636	J2760	2,729	N/A	N/A	N/A
HC65000636_06838291601	NONCDM CHARGE RECORD PHARMACY	636	J7509	3	N/A	N/A	N/A
HC65000636_06898262302	NONCDM CHARGE RECORD PHARMACY	636	P9045	450	N/A	N/A	N/A
HC65000636_06909780232	NONCDM CHARGE RECORD PHARMACY	636	J1071	1	N/A	N/A	N/A
HC65000636_06923817971	NONCDM CHARGE RECORD PHARMACY	636	J1726	0	N/A	N/A	N/A
HC65000636_07006907110	NONCDM CHARGE RECORD PHARMACY	636	J2310	117	N/A	N/A	N/A
HC65000636_07006980125	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_07025756002	NONCDM CHARGE RECORD PHARMACY	636	J0475	1,536	N/A	N/A	N/A
HC65000636_07043601982	NONCDM CHARGE RECORD PHARMACY	636	J0456	31	N/A	N/A	N/A
HC65000636_07071015301	NONCDM CHARGE RECORD PHARMACY	636	Q2050	2,201	N/A	N/A	N/A
HC65000636_07072072310	NONCDM CHARGE RECORD PHARMACY	636	J2278	61	N/A	N/A	N/A
HC65000636_07086010010	NONCDM CHARGE RECORD PHARMACY	636	J0456	32	N/A	N/A	N/A
HC65000636_07086030202	NONCDM CHARGE RECORD PHARMACY	636	J1940	11	N/A	N/A	N/A
HC65000636_07086040010	NONCDM CHARGE RECORD PHARMACY	636	J3490	39	N/A	N/A	N/A
HC65000636_07086045110	NONCDM CHARGE RECORD PHARMACY	636	J3490	639	N/A	N/A	N/A
HC65000636_07128800630	NONCDM CHARGE RECORD PHARMACY	636	J0295	33	N/A	N/A	N/A
HC65000636_07128811310	NONCDM CHARGE RECORD PHARMACY	636	J9201	60	N/A	N/A	N/A
HC65000636_07128880702	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_07183910401	NONCDM CHARGE RECORD PHARMACY	636	J1453	2	N/A	N/A	N/A
HC65000636_07183911825	NONCDM CHARGE RECORD PHARMACY	636	J1644	5	N/A	N/A	N/A
HC65000636_07226616042	NONCDM CHARGE RECORD PHARMACY	636	J3486	65	N/A	N/A	N/A
HC65000636_07248510501	NONCDM CHARGE RECORD PHARMACY	636	J3490	296	N/A	N/A	N/A
HC65000636_07248510710	NONCDM CHARGE RECORD PHARMACY	636	J3490	58	N/A	N/A	N/A
HC65000636_07257217025	NONCDM CHARGE RECORD PHARMACY	636	J3010	5	N/A	N/A	N/A
HC65000636_07257225025	NONCDM CHARGE RECORD PHARMACY	636	J1644	11	N/A	N/A	N/A
HC65000636_07257235001	NONCDM CHARGE RECORD PHARMACY	636	J3490	3	N/A	N/A	N/A
HC65000636_07257275010	NONCDM CHARGE RECORD PHARMACY	636	J0330	10	N/A	N/A	N/A
HC65000636_07257280501	NONCDM CHARGE RECORD PHARMACY	636	J3370	12	N/A	N/A	N/A
HC65000636_07601490310	NONCDM CHARGE RECORD PHARMACY	636	J2710	6	N/A	N/A	N/A
HC65000636_07604500511	NONCDM CHARGE RECORD PHARMACY	636	J2270	16	N/A	N/A	N/A
HC65000636_07604500911	NONCDM CHARGE RECORD PHARMACY	636	J1170	22	N/A	N/A	N/A
HC65000636_07632933901	NONCDM CHARGE RECORD PHARMACY	636	J2001	4	N/A	N/A	N/A
HC65000636_07632990600	NONCDM CHARGE RECORD PHARMACY	636	J0171	5	N/A	N/A	N/A
HC65000636_07820611801	NONCDM CHARGE RECORD PHARMACY	636	J0702	25	N/A	N/A	N/A
HC65000636_70092150935	NONCDM CHARGE RECORD PHARMACY	636	J3010	6	N/A	N/A	N/A
HC65000637_00002751017	NONCDM CHARGE RECORD PHARMACY	636	J1815	9	N/A	N/A	N/A
HC65000637_00024592605	NONCDM CHARGE RECORD PHARMACY	636	J1815	4	N/A	N/A	N/A
HC65000637_00169183311	NONCDM CHARGE RECORD PHARMACY	636	J1815	4	N/A	N/A	N/A
HC65000637_06745767502	NONCDM CHARGE RECORD PHARMACY	636	J0630	11,639	N/A	N/A	N/A
HC65000777_00024591502	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65001258	MED - IV SOLUTION W/J-CODE	636		N/A	N/A	N/A	N/A
HC65001258_00264780010	NONCDM CHARGE RECORD PHARMACY	258	J7040	17	N/A	N/A	N/A
HC62227038	ELECTRODE BIPOLAR ENDO	272		2,450	N/A	N/A	N/A
HC62227061	PROBE SINUS	272		350	N/A	N/A	N/A
HC62227095	TUBE TRACH CUFFED                 M	272	A7521	840	N/A	N/A	N/A
HC62227236	CATH IV MIDLINE                   H	278	C1751	420	N/A	N/A	N/A
HC62227269	FIBER LASER                       F	272		2,422	N/A	N/A	N/A
HC62227293	DEVICE TIF (ESOPHYX)	272		9,713	N/A	N/A	N/A
HC62227434	DRESSING ANTIMIC MICRO-CURRENT    D	272		140	N/A	N/A	N/A
HC62227467	OBTURATOR                         C	272		106	N/A	N/A	N/A
HC62227491	OVERTUBE ENDOSCOPIC               B	272	A4270	1,050	N/A	N/A	N/A
HC62227673	ELECTRODE LOOP CUTTING BIPOLAR	272		1,262	N/A	N/A	N/A
HC62227707	KIT CASS KNEE 2 POD IASSIST	272		5,040	N/A	N/A	N/A
HC62227871	KIT ARTHROSCOPY DISPSBLS          Y	272		2,800	N/A	N/A	N/A
HC62227905	PUNCH ARTHROSCOPIC                E	272		700	N/A	N/A	N/A
HC62227939	CARTRIDGE MECHNCL WOUND NEG PRESSURE D	272		700	N/A	N/A	N/A
HC62228077	MOLD/FORM CEMENT SPACER FEMORAL	272		5,600	N/A	N/A	N/A
HC62228101	SYSTEM DRESSING WOUND NEG PRES    P	272		1,050	N/A	N/A	N/A
HC62228135	ORTH EWHO W/NONTORSION JOINT(S) CUSTOM	274	L3764	2,993	N/A	N/A	N/A
HC62228309	SIZER MAMMARY                     O	272		1,184	N/A	N/A	N/A
HC62228333	PROBE TURBINATE                   L	272		700	N/A	N/A	N/A
HC62228507	BRONCHOSCOPE ASCOPE REG DISP	272		956	N/A	N/A	N/A
HC62228531	SPLINT NASAL(POSISEP)             I	272		489	N/A	N/A	N/A
HC62228705	IVS TUBING PUMP RAPID INFUSER	272		512	N/A	N/A	N/A
HC62228739	SENSORS TRACKER VPAD?	272		1,508	N/A	N/A	N/A
HC62228762	NEEDLE 19G HISTO(ALWAYS-ON TIP TRACKED?)	272		1,985	N/A	N/A	N/A
HC62228903	COLLAR CERV SEMI-RIDG OCC/MAND	274	L0160	406	N/A	N/A	N/A
HC62228937	ORTHOSIS BELOW KNEE ADDON S0FT	274	L2820	326	N/A	N/A	N/A
HC62228960	ORTHOSIS BOOT NON-PNEUMATIC	274	L4386	380	N/A	N/A	N/A
HC62229133	MULTI-CANCER EARLY DETECT TEST GRAIL IDE G210176	624		1	N/A	N/A	N/A
HC62229166	ORTHOTIC LSO RIGID ANT POST LAT PANEL SACROCOC PREFAB	274	L0650	551	N/A	N/A	N/A
HC62290374	P: SYSTEM SINUPLASTY SPIN F S /M			N/A	N/A	N/A	N/A
HC62290440	TUBING URO INFUSE PUMP	272		42	N/A	N/A	N/A
HC62300173	TIP CAUTERY HOOK ROBOTIC          L	272		526	N/A	N/A	N/A
HC62300207	CABLE EP                         A	272		36	N/A	N/A	N/A
HC62300231	HOOK VALVE ROBOTIC	272		420	N/A	N/A	N/A
HC62300496	SUCTION IRRIGATOR ROBOTIC	272		106	N/A	N/A	N/A
HC62800016	BALLOON BILIARY	272	C1726	770	N/A	N/A	N/A
HC62800040	BALLOON ESOPHAGEAL	272	C1726	910	N/A	N/A	N/A
HC62800214	CATH BALLOON PYLORIC              T	272	C1726	2,450	N/A	N/A	N/A
HC62800248	CATH BALLOON ULTRA THIN           H	272	C1726	420	N/A	N/A	N/A
HC62800412	CATH IVUS PV LARGE VESSEL	272	C1753	2,947	N/A	N/A	N/A
HC62800446	CATH PICC                         L	278	C1751	778	N/A	N/A	N/A
HC62800479	CATH SWAN GANZ/THERMODILUTION     P	278		1,226	N/A	N/A	N/A
HC62800628	M: ADAPTER/EXTEND PACING LEAD	275	C1883	3,261	N/A	N/A	N/A
HC62800651	M: AICD SINGLE CHAMBER	275	C1722	44,496	N/A	N/A	N/A
HC62800685	M: BAND GASTRIC	278	A4301	N/A	N/A	N/A	N/A
HC62800859	M: CATH HEMODIAL EXTERNAL LNG TRM	278	C1750	1,006	N/A	N/A	N/A
HC62800883	CATHETER PERITONEAL              AH	278	A4300	1,680	N/A	N/A	N/A
HC62801055	M: GENRTR DUAL NRSTM NON-RECHG	278	C1767	32,462	N/A	N/A	N/A
HC62801089	M: GI LAB MISC IMPLANT	278		185	N/A	N/A	N/A
HC62801253	M: IOL PRESBYOPIA CORRECTNG	276	V2788	N/A	N/A	N/A	N/A
HC62801287	M: COMPONENT FEMORAL KNEE	278	C1776	6,001	N/A	N/A	N/A
HC62801311	M: BASEPLATE TIBIAL KNEE	278	C1776	4,124	N/A	N/A	N/A
HC62801469	M: MESH TITANIUM	278	C1781	N/A	N/A	N/A	N/A
HC62801493	NEEDLE BRACHYTHERAPY TANDEM CLICK	278	C1715	375	N/A	N/A	N/A
HC62801527	M: PACEMAKER GENERATOR	275	C2621	13,788	N/A	N/A	N/A
HC62801691	M: PLATE NEURO	278	C1713	734	N/A	N/A	N/A
HC62801725	PORT INDWELLING W/CATH            K	278	C1788	1,750	N/A	N/A	N/A
HC62801899	M: STEM HUMERAL SHOULDER	278	C1776	10,173	N/A	N/A	N/A
HC62801923	M: SHUNT PERITONEAL	278	A4301	9,315	N/A	N/A	N/A
HC62802095	STENT COAT/COVRD W/O DEL SYS	278	C1875	8,680	N/A	N/A	N/A
HC62802129	STENT DES CORO COV W/DEL SYS      V	278	C1874	10,850	N/A	N/A	N/A
HC62802152	STENT CORO BARE METAL W/DEL       J	278	C1876	6,300	N/A	N/A	N/A
HC62802293	M: VALVE GLAUCOMA (OCULAR I:)	278	C1783	2,807	N/A	N/A	N/A
HC62802327	M: WASHER/NUT ORTHO/SPINAL	278		255	N/A	N/A	N/A
HC62802350	INTRODUCER/SHEATH                 I	272	C1894	490	N/A	N/A	N/A
HC62802533	KIT DILATORS RENAL	272	C1726	840	N/A	N/A	N/A
HC62802566	CATH EP DIAG/MAPPING<20 ELECT     R	272	C1732	6,300	N/A	N/A	N/A
HC62802749	M: SYSTEM KNEE TOTAL	278	C1776	4,056	N/A	N/A	N/A
HC62802772	M: IOL A-C ASTIGMATISM CORRCTNG	276	V2787	N/A	N/A	N/A	N/A
HC62802806	CAPSULE ENDOSCOPY (PILL CAM)	278	C1889	1,702	N/A	N/A	N/A
HC62802947	EMBOLIC LIQUID ONYX PER VIAL(LOW VIS)	278	C1889	10,798	N/A	N/A	N/A
HC62802970	STENT NEUROVASCULAR               O	278	C1876	19,600	N/A	N/A	N/A
HC62803002	M: GRAFT PORCINE	278	C1768	N/A	N/A	N/A	N/A
HC62803143	M: VALVE HEART TISSUE AORTIC	278	C1889	52,897	N/A	N/A	N/A
HC62803176	M: VALVE HEART TISSUE TRICUSPID	278	C1889	N/A	N/A	N/A	N/A
HC62803200	M: PARTICLES OCCUSION	278		N/A	N/A	N/A	N/A
HC62803374	M: APLIGRAF PER SQ CM	636	Q4101	N/A	N/A	N/A	N/A
HC62803408	M: INTEGRA WOUND MATRIX INJ 1CC	278	Q4114	17,101	N/A	N/A	N/A
HC62803580	M: SLEEVE SCREW RESORBABLE	278		N/A	N/A	N/A	N/A
HC62803622	M: SYSTEM HIP REPLACEMENT	278	C1776	5,996	N/A	N/A	N/A
HC62803655	M: BARRIER ADHESION SURGICAL	278		1,043	N/A	N/A	N/A
HC62803796	M: SCREW SOFT TISSUE ABSORBABLE	278	C1713	N/A	N/A	N/A	N/A
HC62803820	STENT DES CORO COV W/DEL SYS      N	278	C1874	5,950	N/A	N/A	N/A
HC62803853	STENT DES CORO COV W/DEL SYS      Q	278	C1874	7,000	N/A	N/A	N/A
HC62804026	FILTER VENA CAVA (E.G.ELITE)      E	278	C1880	3,640	N/A	N/A	N/A
HC62804059	KIT CATH VENTRICULAR	278	A4300	540	N/A	N/A	N/A
HC62804232	COIL EMBOLIZATION                 L	278		1,540	N/A	N/A	N/A
HC62804265	COIL EMBOLIZATION                 P	278		2,100	N/A	N/A	N/A
HC62804448	STENT TRACHEOBRONC COV W/DEL SYS  H	278	C1874	9,100	N/A	N/A	N/A
HC62804471	KIT KYPHOPLASTY BALLOON AUGMENTATN	278	C1726	4,025	N/A	N/A	N/A
HC62804505	M: BOLT LOCKING	278		2,551	N/A	N/A	N/A
HC62804646	STENT DES CORO COV W/DEL SYS      T	278	C1874	9,100	N/A	N/A	N/A
HC62804679	STAPLE REINFORCEMENT(SEAMGUARD)???? D	272		955	N/A	N/A	N/A
HC62804703	M: FILLER BONE SOLID/WEDGE	278		5,652	N/A	N/A	N/A
HC62804877	M: DEVICE INTERBODY FUSION SPINAL	278	C1889	10,747	N/A	N/A	N/A
HC62804901	STENT NON CORON W/DELIV SYS       E	278	C2625	560	N/A	N/A	N/A
HC62805072	CATH EP DIAG/ABLAT 3D/VECT        V	272	C1732	8,400	N/A	N/A	N/A
HC62805106	CATH EP DX 20+ ELECTRODES         O	272	C1731	6,720	N/A	N/A	N/A
HC62805130	M:IMPLANT UROLIFT TIE-BACK (EACH)	278	C1889	2,713	N/A	N/A	N/A
HC62805270	DEVICE EMBOLIZATION NEURO(PIPELINE)	278	C1889	46,549	N/A	N/A	N/A
HC62805304	STENT BILIARY PLASTIC             F	278	C2617	489	N/A	N/A	N/A
HC62805338	CATH SWAN GANZ/THERMODILUTION     G	272		350	N/A	N/A	N/A
HC62805486	TUBE GASTROSTOMY REPLACE PEG      C	272		105	N/A	N/A	N/A
HC62805510	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP T	272	C1733	2,450	N/A	N/A	N/A
HC62805544	CATH THROMBOLYSIS/RX DELIVERY    AN	272	C1757	11,900	N/A	N/A	N/A
HC62805718	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AD	272	C1733	5,950	N/A	N/A	N/A
HC62805742	FIBRIN SEALANT                    I	278		696	N/A	N/A	N/A
HC62805916	CATH EP DX <20 ELECTRODES         J	272	C1730	1,400	N/A	N/A	N/A
HC62805940	CATH EP DX <20 ELECTRODES         U	272	C1730	4,480	N/A	N/A	N/A
HC62805973	INTRO/SHEATH STEERABLE NON-PEEL   C	272	C1766	2,100	N/A	N/A	N/A
HC62806112	TUBE GASTROSTOMY STANDARD         C	278		106	N/A	N/A	N/A
HC62806146	M: MESHED BILAYER WOUND MATRIX CM2	636	C9363	18,497	N/A	N/A	N/A
HC62806179	CATH EP DX 20+ ELECTRODES         C	272	C1731	3,360	N/A	N/A	N/A
HC62806344	TUBE GASTROSTOMY LOWPRFL BTTN OPT G	278	A4649	350	N/A	N/A	N/A
HC62806377	M: SCAFFOLD COLLAGEN CARDIOVASCULAR	278	C1889	N/A	N/A	N/A	N/A
HC62806542	DEVICE CLOS VASC(ANGIOSEAL/MYNX/PROGLIDE)L	272	C1760	713	N/A	N/A	N/A
HC62806575	COIL EMBOLIZATION                AG	278		4,900	N/A	N/A	N/A
HC62806740	KIT LIQ EMBOL ANEURYSM(ONYX HD-500)H060003	278	C1889	26,232	N/A	N/A	N/A
HC62806773	POUCH/ENVELOPE PACEMAKER          G	278		3,486	N/A	N/A	N/A
HC62806807	STENT ENDOPRSTH AAA               L	278	C1874	15,832	N/A	N/A	N/A
HC62806948	KIT ANEURYSM ENCAPSULTNG NEUROVASC	278	C1889	3,717	N/A	N/A	N/A
HC62806971	STENT BILIARY COVRD W/DELSYS      K	278	C1874	6,300	N/A	N/A	N/A
HC62807003	STENT NON-COAT/NON-COV W-DEL      T	278	C1876	2,450	N/A	N/A	N/A
HC62807177	DIVERTER FLOW NEUROVASC(PIPELINE FLX 16)D	278	C1889	49,769	N/A	N/A	N/A
HC62807201	STENT NEUROVASC LVIS MICROVENTION H130005	278	C1876	25,199	N/A	N/A	N/A
HC62807375	M: EPIFIX INJECTABLE PER 1 MG	278	Q4145	N/A	N/A	N/A	N/A
HC62807409	STENT ENDOPRSTH AAA               P	278	C1874	21,000	N/A	N/A	N/A
HC62807581	M: SPLINT RIB INSERTED	278	C1713	N/A	N/A	N/A	N/A
HC62807615	M: CENTRALIZER HIP	278	C1776	191	N/A	N/A	N/A
HC62807649	M: IMPLANT TARSI SINUS	278	C1889	3,482	N/A	N/A	N/A
HC62807789	M: PIN CABLE	278		2,177	N/A	N/A	N/A
HC62807813	M: LINER SHOULDER	278	C1776	3,519	N/A	N/A	N/A
HC62807847	M: AMNIOTIC MEMBRANE SKIN SUB NOS	636	Q4100	6,907	N/A	N/A	N/A
HC62808019	SPACER HYDROGEL PROSTATE-RECTUM	278	C1889	9,975	N/A	N/A	N/A
HC62808043	SEALANT STENT ENDOPRSTH	278		840	N/A	N/A	N/A
HC62808217	DEVICE NEUROVASC PULSERIDER H160002	278	C1876	43,749	N/A	N/A	N/A
HC62808241	M:  AMNIOEXCEL	636	Q4137	N/A	N/A	N/A	N/A
HC62808274	M:  PURAPLY AM PER SQ CM	636	Q4196	N/A	N/A	N/A	N/A
HC62808415	CATH VENTRICULAR NEURO	278	A4301	1,356	N/A	N/A	N/A
HC62808449	MONITOR CARDIAC ECG	278	C1889	15,750	N/A	N/A	N/A
HC62808472	M:INTEGRA DERMAL REGEN TEMP/OMNIGRFT PER SQ CM	636	Q4105	N/A	N/A	N/A	N/A
HC62808613	NEEDLE BRACHYTHERAPY METAL CLICK	278	C1715	339	N/A	N/A	N/A
HC62808647	PESSARY RUBBER	278	A4561	233	N/A	N/A	N/A
HC62808688	G200313  CATH BALLOON NEURESCUE	624	C1889	1	N/A	N/A	N/A
HC62808852	KIT CATH INDIGO 12 THROMB 12FR HTORQ[PENUMBRA]	272	C1757	23,835	N/A	N/A	N/A
HC62808886	STENT THORACIC SG AC CONFORM(TAG?GORE?)	278	C1874	69,194	N/A	N/A	N/A
HC62890132	P: PACER CRT-P C2621 W/ 2 LEADS C1898			N/A	N/A	N/A	N/A
HC62890165	P: AICD DUAL CHAMBER C1721 W/2LEADS C1777 OR C1898			N/A	N/A	N/A	N/A
HC62890199	P: AICD C1722 W/C1777/C1892/C1895/C1896/C1898			N/A	N/A	N/A	N/A
HC65000250_00003089421	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_00004003909	NONCDM CHARGE RECORD PHARMACY	250	Z7610	664	N/A	N/A	N/A
HC65000250_00004082205	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_00009031508	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_00009034201	NONCDM CHARGE RECORD PHARMACY	250		272	N/A	N/A	N/A
HC65000250_00024135202	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_00024414260	NONCDM CHARGE RECORD PHARMACY	250		70	N/A	N/A	N/A
HC65000250_00046110081	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65000250_00046110481	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65000250_00049318030	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_00054008813	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_00054023524	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00054023763	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00054319446	NONCDM CHARGE RECORD PHARMACY	250		63	N/A	N/A	N/A
HC65000250_00054329450	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00054855324	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00065002315	NONCDM CHARGE RECORD PHARMACY	250		193	N/A	N/A	N/A
HC65000250_00065035902	NONCDM CHARGE RECORD PHARMACY	250		199	N/A	N/A	N/A
HC65000250_00069100201	NONCDM CHARGE RECORD PHARMACY	250		534	N/A	N/A	N/A
HC65000250_00069580061	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_00071015640	NONCDM CHARGE RECORD PHARMACY	250		112	N/A	N/A	N/A
HC65000250_00074518211	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00074662411	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00074706911	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00087040303	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00087086644	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093075210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093081101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093102406	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00093221005	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093301956	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00093312701	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00093551798	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00093611816	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00093811956	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_00093820401	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00115351101	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00115551110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00116200116	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00121064610	NONCDM CHARGE RECORD PHARMACY	250	Z7610	7	N/A	N/A	N/A
HC65000250_00121065700	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00121067585	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00121091400	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00121094000	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00121131400	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00121155000	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00121172430	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_00121197100	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00121477240	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_00131247735	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_00143117201	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00143211205	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00143950610	NONCDM CHARGE RECORD PHARMACY	250	J3490	40	N/A	N/A	N/A
HC65000250_00168000680	NONCDM CHARGE RECORD PHARMACY	250		75	N/A	N/A	N/A
HC65000250_00168008031	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_00173068224	NONCDM CHARGE RECORD PHARMACY	250		96	N/A	N/A	N/A
HC65000250_00178030103	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00185005501	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00225081047	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_00228202910	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00228212750	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00245001201	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00245010801	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00254102047	NONCDM CHARGE RECORD PHARMACY	250		263	N/A	N/A	N/A
HC65000250_00254302902	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_00338051958	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00378001801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378018201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00378181177	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00378181777	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00378190101	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00378563059	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00378609001	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00378911998	NONCDM CHARGE RECORD PHARMACY	250	Z7610	106	N/A	N/A	N/A
HC65000250_00378912498	NONCDM CHARGE RECORD PHARMACY	250		179	N/A	N/A	N/A
HC65000250_00406048501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00406052301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00406114601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00406996001	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_00409205105	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00409409001	NONCDM CHARGE RECORD PHARMACY	250		198	N/A	N/A	N/A
HC65000250_00409818301	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00414200007	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00469260130	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_00472016630	NONCDM CHARGE RECORD PHARMACY	250		136	N/A	N/A	N/A
HC65000250_00472033730	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65000250_00487950101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00487970101	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65000250_00487990130	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00527132601	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00527143501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00527193106	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00527512570	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_00536100715	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536123201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536125494	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_00536127211	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00536247085	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536384401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536430608	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00555021110	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00555060702	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00574017810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574029201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574705012	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00574985510	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00591024101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00591321630	NONCDM CHARGE RECORD PHARMACY	250		83	N/A	N/A	N/A
HC65000250_00591352530	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00591401201	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00597018461	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_00597036055	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65000250_00603497521	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00603548321	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00703291403	NONCDM CHARGE RECORD PHARMACY	250	J3490	23	N/A	N/A	N/A
HC65000250_00781155601	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00781185220	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00781208102	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00781801601	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00832003800	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00832046515	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_00832121701	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00832121901	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904043006	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00904052372	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904053061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904227260	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904264172	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904292461	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904530680	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904535431	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00904567661	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904578461	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904595961	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904600861	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904605361	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904629261	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904630061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904630361	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904636961	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904637361	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904644961	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904645361	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904646861	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904651006	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65000250_00904651761	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904653061	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904661561	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904661961	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904663561	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904670561	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00904670961	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00904675514	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904677361	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904678261	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904681861	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6	N/A	N/A	N/A
HC65000250_00904682104	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_00904682661	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904693061	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904693961	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6	N/A	N/A	N/A
HC65000250_00904699860	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904699980	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904704861	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904707661	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904708645	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904711906	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904712461	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904713061	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_00904720660	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904723661	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00990797408	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65000250_00998040815	NONCDM CHARGE RECORD PHARMACY	250		173	N/A	N/A	N/A
HC65000250_01013562001	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01013565201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01013573560	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_01070227703	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01093914833	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_01093919844	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_01093969133	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01093978844	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_01153419201	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0	N/A	N/A	N/A
HC65000250_01184512295	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01198017405	NONCDM CHARGE RECORD PHARMACY	250		1,043	N/A	N/A	N/A
HC65000250_01351775701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01366801001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01366810230	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01650008806	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01657120310	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_01657160096	NONCDM CHARGE RECORD PHARMACY	250	Z7610	20	N/A	N/A	N/A
HC65000250_01671404110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671404211	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671410105	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671411602	NONCDM CHARGE RECORD PHARMACY	250		66	N/A	N/A	N/A
HC65000250_01671414301	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_01671422701	NONCDM CHARGE RECORD PHARMACY	250	Z7610	51	N/A	N/A	N/A
HC65000250_01671425701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671429401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01671445301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671447701	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01671461601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	18	N/A	N/A	N/A
HC65000250_01671463102	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671468302	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671468402	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671469102	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01671473301	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_01671476501	NONCDM CHARGE RECORD PHARMACY	250		91	N/A	N/A	N/A
HC65000250_01671477001	NONCDM CHARGE RECORD PHARMACY	250		89	N/A	N/A	N/A
HC65000250_01671481901	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_01671482301	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01671487603	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_01671489501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671490001	NONCDM CHARGE RECORD PHARMACY	250		151	N/A	N/A	N/A
HC65000250_01672907901	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01672913700	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672917101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672932115	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672944010	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01672944815	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01747806412	NONCDM CHARGE RECORD PHARMACY	250		103	N/A	N/A	N/A
HC65000250_01747810212	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65000250_01747862312	NONCDM CHARGE RECORD PHARMACY	250		77	N/A	N/A	N/A
HC65000250_01747871310	NONCDM CHARGE RECORD PHARMACY	250		109	N/A	N/A	N/A
HC65000250_01747871610	NONCDM CHARGE RECORD PHARMACY	250	Z7610	460	N/A	N/A	N/A
HC65000250_02045117813	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_02055500400	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02055503300	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315524801	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_02315551200	NONCDM CHARGE RECORD PHARMACY	250	Z7610	8	N/A	N/A	N/A
HC65000250_02420831510	NONCDM CHARGE RECORD PHARMACY	250	Z7610	70	N/A	N/A	N/A
HC65000250_02420841110	NONCDM CHARGE RECORD PHARMACY	250		177	N/A	N/A	N/A
HC65000250_02435770106	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_02451005010	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_02502160203	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_02724116101	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_02780803301	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4	N/A	N/A	N/A
HC65000250_02780808601	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_02930013801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02930022701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03172263131	NONCDM CHARGE RECORD PHARMACY	250	Z7610	17	N/A	N/A	N/A
HC65000250_03172270090	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172270190	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172293847	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03334200409	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03334205410	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03334211507	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_03334244711	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_03700002304	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03932802008	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03932815705	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_04116311208	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04116775142	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_04203710478	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_04229141260	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04229146610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04229156090	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04257122130	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_04270210215	NONCDM CHARGE RECORD PHARMACY	250		585	N/A	N/A	N/A
HC65000250_04280631250	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04280641001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04329255538	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04338609019	NONCDM CHARGE RECORD PHARMACY	250		126	N/A	N/A	N/A
HC65000250_04338616101	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04354728810	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04354733650	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354734709	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354741109	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04359821025	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65000250_04580204635	NONCDM CHARGE RECORD PHARMACY	250		257	N/A	N/A	N/A
HC65000250_04580204935	NONCDM CHARGE RECORD PHARMACY	250	Z7610	53	N/A	N/A	N/A
HC65000250_04580206535	NONCDM CHARGE RECORD PHARMACY	250		53	N/A	N/A	N/A
HC65000250_04580214303	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_04580217453	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_04580262626	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04580273030	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04580273230	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04628700601	NONCDM CHARGE RECORD PHARMACY	250		128	N/A	N/A	N/A
HC65000250_04628702004	NONCDM CHARGE RECORD PHARMACY	250		50	N/A	N/A	N/A
HC65000250_04778133530	NONCDM CHARGE RECORD PHARMACY	250		105	N/A	N/A	N/A
HC65000250_04778138426	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_04778142647	NONCDM CHARGE RECORD PHARMACY	250		82	N/A	N/A	N/A
HC65000250_04843310801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04843323015	NONCDM CHARGE RECORD PHARMACY	250		190	N/A	N/A	N/A
HC65000250_04858200440	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65000250_04934818810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04934827472	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_04934833736	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_04945240502	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04948322110	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04988440191	NONCDM CHARGE RECORD PHARMACY	250		43	N/A	N/A	N/A
HC65000250_04988490761	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_05002443100	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_05011178710	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_05011178910	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_05011191701	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026809315	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_05026810915	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026826911	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026827013	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026839115	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05026841112	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_05026843115	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026854115	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05026857315	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026858215	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_05026863215	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026864015	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026873212	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65000250_05026875515	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026876415	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05026886615	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05028932501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05038304224	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_05038331284	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_05038362750	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05038374120	NONCDM CHARGE RECORD PHARMACY	250		296	N/A	N/A	N/A
HC65000250_05045814030	NONCDM CHARGE RECORD PHARMACY	250		122	N/A	N/A	N/A
HC65000250_05045857810	NONCDM CHARGE RECORD PHARMACY	250		110	N/A	N/A	N/A
HC65000250_05058045811	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05058073005	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_05074217501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107902320	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_05107907220	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107908620	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107928520	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107930630	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_05107945320	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05107949920	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107976608	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10	N/A	N/A	N/A
HC65000250_05107978220	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05107980120	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107993120	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC45400207	MR LOW EXT(NON JNT)W/CONT LT	610	73719	7,243	N/A	N/A	N/A
HC45400231	MR LO EXT(NON JNT)W&W/O CON LT	610	73720	10,125	N/A	N/A	N/A
HC45400264	MR LOW EXT(JNT) W/O CONT LT	610	73721	6,186	N/A	N/A	N/A
HC45400439	MR SPECTROSCOPY	610	76390	6,556	N/A	N/A	N/A
HC45400488	MR T-SPINE W/CONTRAST	612	72147	8,276	N/A	N/A	N/A
HC45400652	MRA CHEST W&W/O CONTRAST	610	C8911	8,283	N/A	N/A	N/A
HC45400686	MRA HEAD W&W/O CONTRAST	611	70546	10,061	N/A	N/A	N/A
HC45400710	MRA NECK W&W/O CONTRAST	611	70549	10,321	N/A	N/A	N/A
HC45401007	MR BREAST W/O CONTRAST LTD RT	610	77046	2,480	N/A	N/A	N/A
HC45401031	MR BREAST W/O CONTRAST LT	610	77046	5,505	N/A	N/A	N/A
HC45401064	MR BREAST W/O&W CONTRAST LTD RT	610	C8905	2,825	N/A	N/A	N/A
HC45401288	MRA ABDOMEN W/O CONT	610	C8901	5,548	N/A	N/A	N/A
HC45401338	MRA SPINE W/O & W/ CONTRAST	612	C8933	9,526	N/A	N/A	N/A
HC45600012	PET BRAIN METABOLIC EVAL	404	78608	12,145	N/A	N/A	N/A
HC45600046	PET WHOLE BODY TUMOR IMAGING	404	78813	12,325	N/A	N/A	N/A
HC46000162	INJ ARTHROGRAM WRIST-LT	361	25246	1,221	N/A	N/A	N/A
HC46000220	INJ CONTRAST-ASSESS PV SHUNT	361	49427	1,313	N/A	N/A	N/A
HC46000253	INJ DISKOGRAM CS/TS EA LVL	361	62291	2,845	N/A	N/A	N/A
HC46000485	INJECTION HIP ARTHROGRAM RT	361	27093	1,767	N/A	N/A	N/A
HC46000543	INTRO CATH RT HEART/PUL ART	321	36013	2,863	N/A	N/A	N/A
HC46000584	INTRO NDL/INTRACATH VEIN RT	361	36000	420	N/A	N/A	N/A
HC46000840	SEL CATH PULMONARY ART RT	321	36014	2,935	N/A	N/A	N/A
HC46000873	SEL CATH SEGMNT PULM ART RT	321	36015	2,790	N/A	N/A	N/A
HC46001046	INJ PERC EXT PSEUDOANEUR	361	36002	2,063	N/A	N/A	N/A
HC46001079	SEL CATH AB/PEL/LOEXT3RD OR	321	36247	9,291	N/A	N/A	N/A
HC46500047	ASP BLADDER W/INSERT SUPRAPUB	361	51102	11,327	N/A	N/A	N/A
HC46500070	ASP/INJ HYDROCELE	361	55000	2,987	N/A	N/A	N/A
HC46500104	ASP/INJ RENAL CYST/PELVIS RT	361	50390	6,021	N/A	N/A	N/A
HC46500351	BIOPSY TRANSCATHETER	361	37200	10,884	N/A	N/A	N/A
HC46500393	BX DEEP PELV/HIP-SC BIL	361	27041	11,685	N/A	N/A	N/A
HC46500450	BX LYMPH NODE(S)-SUPERFCL-BIL	361	38505	11,128	N/A	N/A	N/A
HC46500740	CT ASP&INJ BONE CYST-RT	361	20615	3,183	N/A	N/A	N/A
HC46500773	DEST CUTANEOUS VASCULAR LESION	361	17106	1,738	N/A	N/A	N/A
HC46501052	INSERT CT(OPEN) W/DRAIN SYSTEM RT	361	32551	4,526	N/A	N/A	N/A
HC46501086	INSERT PERITONEAL CATH TUNNELED W/PORT	361	49419	19,967	N/A	N/A	N/A
HC46501110	INSRT BLADDER CATH-NON INDWELL	361	51701	728	N/A	N/A	N/A
HC46501284	PLCMNT CENTRAL VEN CATH<5 YR	361	36555	7,246	N/A	N/A	N/A
HC46501342	PUNCTURE CISTERN/LAT CERVICAL C1-C2 W/O INJ	361	61050	6,491	N/A	N/A	N/A
HC46501375	REMOVE PERITONEAL CATH TUNNELED	361	49422	13,515	N/A	N/A	N/A
HC46501557	THORACENTESIS ASP W/ IMG GUID-LT	361	32555	6,959	N/A	N/A	N/A
HC46501581	THORACENTESIS W/TUBE W/ IMAG LT	361	32557	7,352	N/A	N/A	N/A
HC46501912	BX LYMPH NODE(S) DEEP CERV-*DS	361	38510	9,368	N/A	N/A	N/A
HC46501946	M: MISC PROCEDURE	361		1,244	N/A	N/A	N/A
HC46502142	PERC BX BREAST W/LOC DEV SG 1ST LESN	361	19081	7,838	N/A	N/A	N/A
HC46502175	PERC BX BREAST W/LOC DEV US ADDL LESN+	361	19084	4,747	N/A	N/A	N/A
HC46502209	PERC PLC BRST LOC DEV MAMMO 1ST LESN	361	19281	5,509	N/A	N/A	N/A
HC46502340	TENOTOMY ELBOW  LATERAL OR MEDIAL	361	24357	12,415	N/A	N/A	N/A
HC46502373	TENOTOMY ACHILLES TENDON *DS	361	27605	12,422	N/A	N/A	N/A
HC46502407	PLCMT NEPHROSTOMY CATHETER (NEPH/URET'GRM S&I) BI	361	50432	15,328	N/A	N/A	N/A
HC46502571	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S) RT	361	38222	6,853	N/A	N/A	N/A
HC46502605	INSERT MIDLINE CATH <3 YR AGE	361	36406	3,052	N/A	N/A	N/A
HC46502787	INSERT PICC <5 YR AGE W/IMAGING	361	36572	10,376	N/A	N/A	N/A
HC46502829	INSERT/DRILL SUBDUR/VENTRIC CATH	361	61107	8,477	N/A	N/A	N/A
HC46502993	BX SOFT TISS LEG/ANKLE DEEP RT	361	27614	6,050	N/A	N/A	N/A
HC46503025	BX SOFT TISS THIGH/KNEE DEEP RT	361	27324	6,050	N/A	N/A	N/A
HC46503058	BX SOFT TISSUE BACK DEEP RT	361	21925	5,929	N/A	N/A	N/A
HC46503199	BX SOFT TISS LEG/ANKLE SUP BIL	361	27613	7,442	N/A	N/A	N/A
HC46503223	BX SOFT TISS SHOULDER SUP BIL	361	23065	7,260	N/A	N/A	N/A
HC46503256	BX SOFT TISS FOREARM&/WRIST SUP BIL	361	25065	7,079	N/A	N/A	N/A
HC47200134	HYPERTHERMIA EXTERNAL SUPERFCL	333	77600	3,182	N/A	N/A	N/A
HC47200167	HYPERTHERMIA PROBE 6+ APPS	333	77615	6,927	N/A	N/A	N/A
HC47200399	PLC MAMMOSITE ON DOS LT	361	19297	13,017	N/A	N/A	N/A
HC47200423	RADIATION TX SUPRFCL OR/ORTH PER DAY	333	77401	1,213	N/A	N/A	N/A
HC47200530	RAD TREATMENT DELVR  = 1MEV;CMPLX	333	77412	2,827	N/A	N/A	N/A
HC47200696	TREATMENT SIMULATION COMPLEX	333	77290	4,559	N/A	N/A	N/A
HC47200738	M: UNLISTED BRACHY PROCEDURE	333	77799	N/A	N/A	N/A	N/A
HC47200761	RAD ONC E&M LEVEL II LIMITED	761	99212	280	N/A	N/A	N/A
HC47200910	PLCMNT INTERSTIT DEV ABD/PELV	361	49411	6,017	N/A	N/A	N/A
HC47201009	DELIV TX ELCTRN INTRAOP SNGL SESS	333	77425	4,713	N/A	N/A	N/A
HC47201033	TELETX ISODOSE W/ DOSIMETRY;SIMPLE	333	77306	3,010	N/A	N/A	N/A
HC47290002	P:IORT POST OP DAY 0			N/A	N/A	N/A	N/A
HC51000024	GLUCOSE BY REAGENT STRIP	301	82948	36	N/A	N/A	N/A
HC51000198	DEMO&/OR EVAL OF INH TX	410	94664	155	N/A	N/A	N/A
HC51000222	IV INFUSION THERAPY 1ST HOUR	260	96365	393	N/A	N/A	N/A
HC51000255	IV INF THER CONCURRENT/ ENCNTR	260	96368	104	N/A	N/A	N/A
HC51000495	HEMOGLOBIN (POS - EG:HEMACUE)	305	85018	26	N/A	N/A	N/A
HC51000529	CHEMO ADMIN IVP SNGL/ADD'L INJ	335	96411	519	N/A	N/A	N/A
HC51000552	INSERT PICC <5 YR AGE W/O IMAGING	361	36568	1,300	N/A	N/A	N/A
HC51001311	CLOSED TX PELVIC RING FX W/O MANIPULATION	361	27197	1,080	N/A	N/A	N/A
HC51001345	CLOSED TX MIDFOOT FX  EACH	361	28450	727	N/A	N/A	N/A
HC51001519	APPLY CAST PATELR TENDN BEARNG	700	29435	465	N/A	N/A	N/A
HC51001543	APPLIC CAST LEG CLUBFOOT	700	29450	322	N/A	N/A	N/A
HC51001725	X-RAY FOREARM 2 VW	320	73090	268	N/A	N/A	N/A
HC51001758	X-RAY HAND 3+ VW	320	73130	262	N/A	N/A	N/A
HC51001816	X-RAY KNEE 3 VWS	320	73562	268	N/A	N/A	N/A
HC51001956	DRAW BLOOD VEN PICC/PERIPH CATH	300	36592	154	N/A	N/A	N/A
HC51001980	INSERT DRUG DELIVERY IMPLANT	361	11981	288	N/A	N/A	N/A
HC51002079	REMOV IMPACTD EAR WAX(INSTRUMENT) LT	361	69210	161	N/A	N/A	N/A
HC51002244	INJECT URETEROGRAGH VIA URETEROS	361	50684	426	N/A	N/A	N/A
HC51002277	MEATOTOMY (NON-INFANT)	361	53020	574	N/A	N/A	N/A
HC51002442	CHANGE CYSTOSTOMY; COMPLICATED	361	51710	918	N/A	N/A	N/A
HC51002509	US SCROTUM W/DOPPLER	402	76870	349	N/A	N/A	N/A
HC51002533	US TRANSVAGINAL(NON OB)	402	76830	356	N/A	N/A	N/A
HC51002673	REPAIR FISTULA ANAL W/GLUE	361	46706	3,968	N/A	N/A	N/A
HC51002707	PARACENTESIS ABD W/IMAGING GUIDE	361	49083	1,323	N/A	N/A	N/A
HC51002731	CYSTOSTOMY(I&D BLADDER)W/W-OUT DRAIN	361	51040	2,536	N/A	N/A	N/A
HC51002871	CYSTOSCOPY W/REM STNT/FB/CALC COMPLIC	361	52315	2,939	N/A	N/A	N/A
HC51002905	CYSTOURETHRSCPY&/PYELOSCPY FLEX DX	361	52351	3,009	N/A	N/A	N/A
HC51002939	DILAT STRICTURE URETHRAL MALE SUBSQ	361	53601	275	N/A	N/A	N/A
HC51003135	BX VULVA EACH ADDITIONAL+	361	56606	302	N/A	N/A	N/A
HC51003168	DESTROY LESION(S) VAGINAL SIMPLE	361	57061	3,057	N/A	N/A	N/A
HC51003333	ABLATION LASER CERVIX	361	57513	3,246	N/A	N/A	N/A
HC51003366	BX(S)/SAMPL ENDOMETRIAL(SEP PROC)	361	58100	423	N/A	N/A	N/A
HC51003390	X-RAY PERC DIL URETER/URETHRA	320	74485	1,711	N/A	N/A	N/A
HC51003663	HEMORRHOIDECTOMY/BANDING	361	46221	1,411	N/A	N/A	N/A
HC51003796	EXCISE LESION <0.5CM TRNK/ARMS/LEGS	361	11400	358	N/A	N/A	N/A
HC51003820	I&D ABSCESS SIMPLE SNGL	361	10060	326	N/A	N/A	N/A
HC51004109	ARTERIAL PUNCTURE	300	36600	150	N/A	N/A	N/A
HC51004133	ANALYZ NRSTM NO REPROGRAMMING	920	95970	290	N/A	N/A	N/A
HC51010262	INJ(S);SINGLE TENDON/SHEATH BI	361	20550	590	N/A	N/A	N/A
HC51010296	INJ(S);SNGL TNDON ORIGN/INSER	361	20551	421	N/A	N/A	N/A
HC51010460	MEASURE NO2 EXHALED	460	95012	87	N/A	N/A	N/A
HC51010494	TEST ALLERGY INTRAQ RX/BIOLOGIC	924	95024	108	N/A	N/A	N/A
HC51010528	TEST ALLERGY PATCH	924	95044	600	N/A	N/A	N/A
HC51010668	IMMUNTX PREP-PROV AG1STING BUG VNM	924	95145	56	N/A	N/A	N/A
HC51010692	IMMUNTX PREP-PROV AG4STING BUG VNM	924	95148	156	N/A	N/A	N/A
HC51010726	IMMUNTX PREP-PROV 1/+AG BUG/ARTHPD	924	95170	150	N/A	N/A	N/A
HC51010940	INSERT DEVICE INTRAUTERINE IUD	361	58300	649	N/A	N/A	N/A
HC51020006	RN ASSESSMENT EA 30MIN	920	Z4301	89	N/A	N/A	N/A
HC51020345	NP NEW PT LVL III;INTERMED	510	99203	189	N/A	N/A	N/A
HC51020378	ADMIN VACCINE INFLUENZA	771	G0008	98	N/A	N/A	N/A
HC51050003	RT ASSESS/INTERVENTION EA 30MIN	942	Z4309	66	N/A	N/A	N/A
HC51060002	AHCP COORDINATE ACTIVITIES CASE	920	Z4300	327	N/A	N/A	N/A
HC51060036	AHCP CONSULT TELEPHONE PER 15MIN	920	Z5406	51	N/A	N/A	N/A
HC51060192	OT-EVAL MOD COMPLEXITY 30MF2F 45MIN	434	97166	332	N/A	N/A	N/A
HC51060341	OT CONSULT TELEPHONE PER 15MIN	920	Z5406	51	N/A	N/A	N/A
HC51060499	PT EVAL/TX/PROG RPT	424		121	N/A	N/A	N/A
HC51060671	ST-SWALLOWING EVAL	444	92610	219	N/A	N/A	N/A
HC51060705	PT-EVAL HIGH COMPLEXITY 45MF2F 60MIN	424	97163	413	N/A	N/A	N/A
HC51060978	INJ ANTEGRAD NEPH/URET'GRM S&I EXIST ACCESS BI	361	50431	1,705	N/A	N/A	N/A
HC51061000	REMOVE NEPHROSTOMY TUBE BIL	361	50389	1,763	N/A	N/A	N/A
HC51061034	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM S&I)EXST BI	361	50434	3,976	N/A	N/A	N/A
HC51061174	ST-ENDOSCOPIC EVAL SWALLOW	440	92612	350	N/A	N/A	N/A
HC51061208	TELEHEALTH ORIGINATING SITE FACILITY FEE	780	Q3014	61	N/A	N/A	N/A
HC51061380	ADMIN VACCINE COVID-19 30MCG/0.3ML 2ND DOSE {PFIZER-BIONTECH}	771	0002A	98	N/A	N/A	N/A
HC51061588	ECHO CONGENITAL COMPLETE	483	93303	1,704	N/A	N/A	N/A
HC51061612	ECHO DOPPLER COMPLETE+	483	93320	487	N/A	N/A	N/A
HC51061786	X-RAY SPINE THORACIC; 3 VIEWS	320	72072	379	N/A	N/A	N/A
HC51061810	X-RAY SPINE ENTIRE SKULL-SACRUM 1 VIEW	320	72081	276	N/A	N/A	N/A
HC51061984	REMOTE MONITOR PHYSIOLOGIC PARAM INITIAL SET UP	949	99453	270	N/A	N/A	N/A
HC51062016	NO SHOW OPSC	510		N/A	N/A	N/A	N/A
HC51062040	SELF MANAGEMENT EDUC & TRAINING 5-8PTS 30MIN (PRIVAT INSAUTHREQ)	942	98962	81	N/A	N/A	N/A
HC51062214	GRAM STAIN	306	87205	37	N/A	N/A	N/A
HC51062248	WET MOUNT BY PROVIDER FPACT	300	Q0111	27	N/A	N/A	N/A
HC51062271	NP POST PARTUM FOLLOW UP VISIT	920	Z1038	135	N/A	N/A	N/A
HC51062446	CPSP ANTEPRTM HEALTH ED F/U ASSES/TX GROUP; EA 15MIN	940	Z6408	32	N/A	N/A	N/A
HC51062479	CPSP POSTPRTM HEALTH ED ASSESS  TX POC INDIV'; EA 15MIN	940	Z6414	32	N/A	N/A	N/A
HC51062669	M: MISCL PROCEDURE	361		260	N/A	N/A	N/A
HC51062693	APPLY LONG LEG CAST/WALKER BILAT	700	29355	728	N/A	N/A	N/A
HC51062867	ASSESSMENT & CARE PLAN PT COG IMP 60 MIN	949	99483	169	N/A	N/A	N/A
HC51062891	TRANSITIONAL CARE MANAGE SERVICE HI DECSN 7 DAY DISCHRG	949	99496	265	N/A	N/A	N/A
HC51062925	REMOTE AUTO SYSTM INSULIN DOSE CALC; INTL SETUP	949	0740T	260	N/A	N/A	N/A
HC51063063	TRIM NONDYSTROPHIC NAILS	361	11719	156	N/A	N/A	N/A
HC51063097	AVULSION OF NAIL  SIMPLE; SINGLE	361	11730	624	N/A	N/A	N/A
HC51063121	EXCISION OF NAIL & MATRIX PERMANENT	361	11750	1,144	N/A	N/A	N/A
HC51070274	PSYCH ASSESS/INTERVEN EA30MIN/MCL	914	Z4309	98	N/A	N/A	N/A
HC51070308	PSYCH TX FOR CRISIS EA ADD 30MINS+	914	90840	108	N/A	N/A	N/A
HC51070514	PSY TM CONF W/PT&/FAM 60MIN	900	99366	309	N/A	N/A	N/A
HC51070548	NEUROBEHAVIORAL STATUS EXAM CLIN ASSESS INTERP & REPORT;  EA ADDL HR+	918	96121	287	N/A	N/A	N/A
HC51070571	NEUROPSYCH TESTING EVAL INTRG INTERP CLIN DES TX FEEDBACK; 1ST HOUR	918	96132	433	N/A	N/A	N/A
HC51070712	PSYCH TEAM CONF PRTCPNT PER 15MIN	900	Z4302	29	N/A	N/A	N/A
HC51070746	PSY-BEHAVIOR TX INDIV 1ST 30 MIN	914	96158	214	N/A	N/A	N/A
HC51070779	PSY-BEHAVIOR TX GROUP ADDL 15 MIN	915	96165	34	N/A	N/A	N/A
HC62200084	ACAPELLA W/MOUTHPIECE (RESP)	270		140	N/A	N/A	N/A
HC62200126	ADAPTER FEEDING TUBE	270		60	N/A	N/A	N/A
HC62200159	ADAPTOR CATH UROLOGICAL	272		42	N/A	N/A	N/A
HC62200340	BAG PRESSURE	272		42	N/A	N/A	N/A
HC62200373	BAG VENTRICULAR DRAIN	272		140	N/A	N/A	N/A
HC62200555	BLADE INCISIONAL                  G	272		490	N/A	N/A	N/A
HC62200589	BLADE NEURO                       H	272		392	N/A	N/A	N/A
HC62200613	BLADE TREPHINE                    F	272		420	N/A	N/A	N/A
HC62200753	BOWL CEMENT MIXING	272		374	N/A	N/A	N/A
HC62200787	BRIDGE CARDIAC OUTPUT	272		192	N/A	N/A	N/A
HC62200811	BRUSH ERCP                        M	272		834	N/A	N/A	N/A
HC62201017	CANNULA INTRAOCULAR               C	272		89	N/A	N/A	N/A
HC62201041	TUBING NASAL CPAP	270		46	N/A	N/A	N/A
HC62201223	CATH ARTERY PULMONARY	272		280	N/A	N/A	N/A
HC62201256	CATH BRINKLEY	272		169	N/A	N/A	N/A
HC62201439	CATH FOLEY TEMP SENSOR	272		126	N/A	N/A	N/A
HC62201462	CATH INTRA AORTIC BALLOON         D	272		3,500	N/A	N/A	N/A
HC62201496	CATH INTRODUCER PEEL-AWAY         L	272	C1892	350	N/A	N/A	N/A
HC62201645	CATH URINARY	272		140	N/A	N/A	N/A
HC62201678	CAUTERY EYE	272		144	N/A	N/A	N/A
HC62201702	CAUTERY PENCIL                    D	272		139	N/A	N/A	N/A
HC62201900	CLOSURE DRAINABLE POUCH	272		36	N/A	N/A	N/A
HC62201934	COLLAR CERVICAL PHILADELPHIA	274	L0160	140	N/A	N/A	N/A
HC62202114	NEEDLE THORAC/PARACENTESIS	272		79	N/A	N/A	N/A
HC62202148	DEFOGGER(FRED)	272		122	N/A	N/A	N/A
HC62202171	DETECTOR CO2 (RESP)	270		505	N/A	N/A	N/A
HC62202320	DRAIN BLAKE                        B	272	C1729	56	N/A	N/A	N/A
HC62202379	DRAIN SUCTION ROUND OR FLAT	272	C1729	106	N/A	N/A	N/A
HC62202403	DRESSING AQUACEL ROPE	272		92	N/A	N/A	N/A
HC62202585	DRESSING VIGILON	272		50	N/A	N/A	N/A
HC62202627	DRILL/DRILL BITS SINGLE USE       A	272		668	N/A	N/A	N/A
HC62202650	ELECTRODE  LAP                    E	272		210	N/A	N/A	N/A
HC62202825	BAG/POUCH RETRIEVAL SPECMN ENDO   G	272		526	N/A	N/A	N/A
HC62202858	APPLIER LIGA/HEMOCLIP ENDO        L	272		700	N/A	N/A	N/A
HC62203021	ENDOSCOPIC SYSTEM	272		2,315	N/A	N/A	N/A
HC62203054	ET BARRIER WOUND CARE	272		157	N/A	N/A	N/A
HC62203088	ET DRESS STOMAHESIVE	272		169	N/A	N/A	N/A
HC62203286	FEMORAL CANAL BRUSH	272		134	N/A	N/A	N/A
HC62203310	FILTER BACTERIA	272		78	N/A	N/A	N/A
HC62203369	FILTER PULMONARY	272		107	N/A	N/A	N/A
HC62203617	IRRIGATOR BLADDER	272		98	N/A	N/A	N/A
HC62203641	KIT ACCESSORY                     F	272		490	N/A	N/A	N/A
HC62203815	KIT CVP MANOMETER	272		190	N/A	N/A	N/A
HC62203849	KIT DISSECTOR HYDRO PUMP	272		1,773	N/A	N/A	N/A
HC62204011	KIT KYPHOPAK ADD'L FRACTURE	278	C1889	7,084	N/A	N/A	N/A
HC62204045	KIT MANIFOLD SPECIALTY	272		599	N/A	N/A	N/A
HC62204078	KIT MICROPUNCTURE(STANDARD)	272		140	N/A	N/A	N/A
HC62204219	KIT RESPIRATORY	270		260	N/A	N/A	N/A
HC62204243	CATH SUPRAPUBIC/CYSTOSCOPIC       F	272	C2627	280	N/A	N/A	N/A
HC62204276	KIT TPN/CVP DRESSING               C	272		106	N/A	N/A	N/A
HC62204441	KNIFE SURGICAL	272		36	N/A	N/A	N/A
HC62204474	LENS VITRECTOMY FLAT	272		120	N/A	N/A	N/A
HC62204656	M: SYSTEM NEURO STEALTH	278	C1889	14,024	N/A	N/A	N/A
HC62204680	MASK BIPAP	272		191	N/A	N/A	N/A
HC62204870	NEEDLE BIOPSY BONE                L	272		700	N/A	N/A	N/A
HC62204904	NEEDLE DOPPLER	272		386	N/A	N/A	N/A
HC62204946	NEEDLE INFUSAID	272		67	N/A	N/A	N/A
HC62205083	OFF PUMP SUCTION SYS-STABILZER	272		4,593	N/A	N/A	N/A
HC62205125	PACK ANGIO COMBO	272		596	N/A	N/A	N/A
HC62205158	PACK ARTHROSCOPY ACCESSORY	272		140	N/A	N/A	N/A
HC62205331	PACK LAPAROSCOPIC	272		158	N/A	N/A	N/A
HC62205364	PACK LITHOTOMY	272		70	N/A	N/A	N/A
HC62205539	PAD ACRYLON	272		211	N/A	N/A	N/A
HC62205562	PAD DEFIBRILLATION/ECG       D	272		112	N/A	N/A	N/A
HC62205596	PAD INCONTINENT/AIR THERAPY	272		136	N/A	N/A	N/A
HC62205752	PROBE ABLATION  CRYO              I	272	C2618	13,300	N/A	N/A	N/A
HC62205786	PROBE CAUTERY	272		764	N/A	N/A	N/A
HC62205810	PROBE HEMOSTASIS (BICAP)          K	272		1,534	N/A	N/A	N/A
HC62205992	RING INFLATABLE	270		136	N/A	N/A	N/A
HC62206024	SCALPEL	272		120	N/A	N/A	N/A
HC62206198	SET ENTERAL FEEDING W/BAG	272		115	N/A	N/A	N/A
HC62206222	SET GALACTOGRAM INFUSION	272		266	N/A	N/A	N/A
HC62206404	SET THROMBECTOMY PUMP	272		1,203	N/A	N/A	N/A
HC62206438	SET VACUUM CANNISTER W/O GEL	272		126	N/A	N/A	N/A
HC62206461	INTRODUCER/SHEATH                 J	272	C1894	560	N/A	N/A	N/A
HC62206628	SOLUTION BSS PLUS 500ML	272		434	N/A	N/A	N/A
HC62206651	SPECULUM VAGINAL (DISP)	272		92	N/A	N/A	N/A
HC62206693	ORTHTC ANKLE CONTROL STIRRUP	270		78	N/A	N/A	N/A
HC62206925	SUCTION COLLECTION DEVICE         A	272		36	N/A	N/A	N/A
HC62206966	SUPPORT LUMBAR-SACRAL	270		260	N/A	N/A	N/A
HC62207139	SYSTEM DALL MILES CABLE GRIP	272		1,815	N/A	N/A	N/A
HC62207162	TAPE HYPAFIX	272		168	N/A	N/A	N/A
HC62207352	TRAY GASTRIC LAVAGE	272		190	N/A	N/A	N/A
HC62207386	TRAY INCISION & DRAINAGE DISP	272		322	N/A	N/A	N/A
HC62207410	TRAY LACERATION DISPOSABLE	272		176	N/A	N/A	N/A
HC62207568	CATH URETHRAL TRAY                C	272		106	N/A	N/A	N/A
HC62207592	TUBE CANTOR	272		545	N/A	N/A	N/A
HC62207626	TUBE EMG REINFORCED NIM	272		1,037	N/A	N/A	N/A
HC62207808	TUBING ARTHROSCOPIC PUMP	272		207	N/A	N/A	N/A
HC62207840	TUBING HIGH PRESSURE	272		120	N/A	N/A	N/A
HC62208038	URINE METER	272		47	N/A	N/A	N/A
HC62208061	MANIPULATOR UTERINE               G	272		350	N/A	N/A	N/A
HC62208095	VALVE ANTI REFLUX	272		95	N/A	N/A	N/A
HC62208244	CLIP TISSUE MARKER	272	A4648	280	N/A	N/A	N/A
HC62208285	SET VAGINAL DILATORS	272		134	N/A	N/A	N/A
HC62208467	NEEDLE GUIDE ENDOCAVITY	272		179	N/A	N/A	N/A
HC62208632	DRIVER CATH CAPSULE EGD	272		584	N/A	N/A	N/A
HC62208665	FIBER LASER - GREEN LIGHT         T	272		4,460	N/A	N/A	N/A
HC62208699	DEVICE INFLATE SINUS BALLOON	272		261	N/A	N/A	N/A
HC62208905	BALLOON VALVULOPLASTY	272	C1725	2,861	N/A	N/A	N/A
HC62208939	SYSTEM CONTRAST SAVER	272		159	N/A	N/A	N/A
HC62209143	BLANKET TEMP MNGMNT SYSTEM/BOX	270		3,241	N/A	N/A	N/A
HC62209176	DEVICE ABLATION GYN KIT	272		3,989	N/A	N/A	N/A
HC62209226	DEVICE SUTURE CAPTURE (VAG)	272		535	N/A	N/A	N/A
HC62209382	BRUSH CYTOLOGY BRONCHIAL          G	272		339	N/A	N/A	N/A
HC62209416	CATH BASKET RETRIEVAL AIRWAY      Y	272		980	N/A	N/A	N/A
HC62209440	SENSOR SPHB  SPMET  SPO2	272		490	N/A	N/A	N/A
HC62209614	SLING CUFF AND COLLAR	270		158	N/A	N/A	N/A
HC62209648	CATH PASSER IDD THERAPY	272		344	N/A	N/A	N/A
HC62209812	DEVICE STABIL'ZN IAB STATLOCK	272		61	N/A	N/A	N/A
HC62210141	CANNULA SAMPLING CO2 W/W-O O2	272		55	N/A	N/A	N/A
HC62210323	BALLOON EXPANDER AAA STENT	272	C1725	1,558	N/A	N/A	N/A
HC62210356	COLLAR CERVICAL MIAMI J           D	274	L0172	140	N/A	N/A	N/A
HC62210380	EMBOLIC PROTECT SYSTEM; VASC      G	272	C1884	3,500	N/A	N/A	N/A
HC62210570	KIT ASPIRATION THROMBO NEURO	272		700	N/A	N/A	N/A
HC62210604	GUIDEWIRE(MIRAGE/X-CELERATOR)     X	272	C1769	2,100	N/A	N/A	N/A
HC62210638	CATH GUIDING REPERFUS(MARKSMAN)   T	272	C1887	4,550	N/A	N/A	N/A
HC62210810	CAPSULE DISSOLVABLE DX RFID	270		106	N/A	N/A	N/A
HC62210844	TRANSDCR OPTCL DATA  RSO2 P/A	271		420	N/A	N/A	N/A
HC62211024	CANNULA ARTERIAL STRAIGHT         N	272		1,026	N/A	N/A	N/A
HC62211057	CANNULA VENOUS STRAIGHT           K	272		620	N/A	N/A	N/A
HC62211081	CATHETER SINUS ENDO PLEDGE	272		7,263	N/A	N/A	N/A
HC62211230	CATH CHEST(ARGYLE)	272		57	N/A	N/A	N/A
HC62211263	SYSTEM EXCHANGE SEPTAL DEFECT	272		2,114	N/A	N/A	N/A
HC62211313	KIT VENT THORACIC (URESIL)	272		806	N/A	N/A	N/A
HC62211453	NEBULIZER W/ RESERVOIR	272		33	N/A	N/A	N/A
HC62211487	PACK CATARACT CUSTOM	272		1,198	N/A	N/A	N/A
HC62211529	INSERTER TIP SURGICAL             L	272		700	N/A	N/A	N/A
HC62211701	CATHETER ASPIRATION	272		143	N/A	N/A	N/A
HC62211735	CATH GUIDING DEFLECTABLE          T	272	C1887	2,450	N/A	N/A	N/A
HC62211917	DSG ABD ABTHERA OPEN	272		1,298	N/A	N/A	N/A
HC62211941	DRESSING SACRUM10X20CM(MEPILEX)	272	A6212	71	N/A	N/A	N/A
HC62211974	SPHINCTEROTOME CANNULATING        L	272		1,680	N/A	N/A	N/A
HC62212154	TUBE GASTROSTOMY STRD BUTTON/NONE A	272		36	N/A	N/A	N/A
HC62212188	CATH BALLOON SINUPLASTY SYSTEM    J	272	C1726	2,800	N/A	N/A	N/A
HC62212212	CATH PTCA BALLOON NON-LASER       E	272	C1725	694	N/A	N/A	N/A
HC62212386	INTRODUCER/SHEATH(PINNACL 25CM/VSI)B	272	C1894	70	N/A	N/A	N/A
HC62212410	INTRODUCER/SHEATH                 M	272	C1894	770	N/A	N/A	N/A
HC62212584	CATH PTCA BALLOON NON-LASER       D	272	C1725	560	N/A	N/A	N/A
HC62212618	CATH PTCA BALLOON NON-LASER       H	272	C1725	1,050	N/A	N/A	N/A
HC62212782	GUIDEWIRE(CHIKAI)                 U	272	C1769	1,716	N/A	N/A	N/A
HC62212816	GUIDEWIRE                         Y	272	C1769	2,345	N/A	N/A	N/A
HC62212840	STYLET CARDIAC                    G	272		420	N/A	N/A	N/A
HC62212980	BLADE SHAVER                      P	272		1,120	N/A	N/A	N/A
HC62213012	BLADE SHAVER                      S	272		1,325	N/A	N/A	N/A
HC62213046	BLADE SHAVER                      V	272		1,540	N/A	N/A	N/A
HC62213210	BURR                              I	272		630	N/A	N/A	N/A
HC62213244	BURR                              L	272		846	N/A	N/A	N/A
HC62213418	REAMER                            L	272		630	N/A	N/A	N/A
HC62213442	REAMER                            O	272		847	N/A	N/A	N/A
HC62213616	REAMER                            AF	272		2,030	N/A	N/A	N/A
HC62213640	CANNULA TROCAR	272		526	N/A	N/A	N/A
HC62213681	CANNULA ARTERIAL                  A	272		140	N/A	N/A	N/A
HC62213822	NEEDLE SURG OPTHALMIC	272		75	N/A	N/A	N/A
HC62213855	NEEDLE NERVE/REGION BLOCK	272		55	N/A	N/A	N/A
HC62213889	SET IRRIG TUBING LAPAROSCOPY	272		102	N/A	N/A	N/A
HC62214051	CLAMP ABLATION (ISOL SYNERGY)	272		9,800	N/A	N/A	N/A
HC62214085	NEEDLE TROCAR TARGET(STREAMLINE)  M	272		778	N/A	N/A	N/A
HC62214267	CATH URETERAL                     S	272	C1758	392	N/A	N/A	N/A
HC62214291	CATH URETERAL                     W	272	C1758	500	N/A	N/A	N/A
HC62214325	CATH URETERAL                     Z	272	C1758	588	N/A	N/A	N/A
HC62214465	CHARGER BATTERY NEUROSTIM         A	270		18,235	N/A	N/A	N/A
HC62214507	RETRACTOR DISPOSABLE              F	272		482	N/A	N/A	N/A
HC62214531	RETRACTOR DISPOSABLE              I	272		910	N/A	N/A	N/A
HC62214705	ADAPTER PTCA W/GUIDEWIRE	272	C1769	298	N/A	N/A	N/A
HC62214739	CATH PTCA BALLOON NON-LASER       P	272	C1725	2,800	N/A	N/A	N/A
HC62215215	BLADE SAW                         G	272		98	N/A	N/A	N/A
HC62215249	BLADE SAW                         J	272		140	N/A	N/A	N/A
HC62215413	DEVICE TROCHANTER GALILEO	272		316	N/A	N/A	N/A
HC62215447	KIT DECOMPRESSION SPINAL          C	272		2,100	N/A	N/A	N/A
HC62215470	KNIFE BAYONET                     A	272		526	N/A	N/A	N/A
HC62215611	SUTURE                            L	272		322	N/A	N/A	N/A
HC62215645	SUTURE                            P	272		434	N/A	N/A	N/A
HC62215678	SUTURE                            T	272		543	N/A	N/A	N/A
HC62215843	NEEDLE BIOPSY                     E	272		126	N/A	N/A	N/A
HC62215876	NEEDLE BIOPSY                     I	272		238	N/A	N/A	N/A
HC62216049	PROBE HEMOSTASIS (BICAP)          H	272		1,120	N/A	N/A	N/A
HC62216072	DEVICE SUTURE ENDO                F	272		560	N/A	N/A	N/A
HC62216247	SHEARS COAGULATING HARMONIC       Q	272		1,506	N/A	N/A	N/A
HC62216270	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP Y	272	C1733	4,200	N/A	N/A	N/A
HC62216312	NEEDLE BIOPSY BONE                I	272		490	N/A	N/A	N/A
HC62216460	PIN/WIRE FIXATION TEMPORARY       I	272		122	N/A	N/A	N/A
HC62216494	PIN/WIRE FIXATION TEMPORARY       L	272		193	N/A	N/A	N/A
HC62216528	PIN/WIRE FIXATION TEMPORARY       O	272		268	N/A	N/A	N/A
HC62216692	PIN/WIRE FIXATION TEMPORARY       AF	272		978	N/A	N/A	N/A
HC62216726	PIN/WIRE FIXATION TEMPORARY       AI	272		1,402	N/A	N/A	N/A
HC62216908	ENDO STAPLER                     AB	272		1,955	N/A	N/A	N/A
HC62216932	ENDO STAPLER                     AE	272		2,215	N/A	N/A	N/A
HC62216965	PUNCH AORTIC                      B	272		70	N/A	N/A	N/A
HC62217104	CATH ANGIOGRAPHY(LB HNB)          A	272	C1887	36	N/A	N/A	N/A
HC62217138	KIT PTCA SYRINGE (CUSTOM)	272		53	N/A	N/A	N/A
HC62217161	ORTHOTIC ANKLE RIGID PNEUM/GEL PRFB    A	274	L4350	36	N/A	N/A	N/A
HC62217302	STRIPPER TENDON	272		1,786	N/A	N/A	N/A
HC62217336	CANNULA BIOPSY BREAST	272		144	N/A	N/A	N/A
HC62217369	KIT DEVICE RETRIEVAL NEURO FB     S	272	C1773	25,199	N/A	N/A	N/A
HC62217534	RETRACTOR DISPOSABLE              B	272		140	N/A	N/A	N/A
HC62217567	MARKER SPHERE PASSIVE REFLECTIVE	272	A4648	67	N/A	N/A	N/A
HC62217732	PUNCH SPINAL	272		1,375	N/A	N/A	N/A
HC62217765	TEMPLATE ORTHO/ROD SPINAL         D	272		224	N/A	N/A	N/A
HC62217799	NEEDLE BONE MARROW                K	272		630	N/A	N/A	N/A
HC62217930	CATH DIAGNOSTIC                   I	272		525	N/A	N/A	N/A
HC62217963	TUBE ET                           D	272		140	N/A	N/A	N/A
HC62217997	GUIDE SHAFT DRIVER ORTHO	272		718	N/A	N/A	N/A
HC62218169	KIT REPAIR PORT ACCESS LAP-BAND   C	272		2,100	N/A	N/A	N/A
HC62218193	TRAY THORAC/PARACENTESIS          G	272		168	N/A	N/A	N/A
HC62218367	ENDO STAPLER                      I	272		630	N/A	N/A	N/A
HC62218391	ENDO STAPLER                      M	272		912	N/A	N/A	N/A
HC62218565	STAPLE CARTRG/ENDO RELOAD         F	272		280	N/A	N/A	N/A
HC62218599	STAPLE CARTRG/ENDO RELOAD         Q	272		1,401	N/A	N/A	N/A
HC62218623	DEVICE RETRIEVAL                  I	272	C1773	5,390	N/A	N/A	N/A
HC62218763	DRILL/DRILL BITS SINGLE USE       K	272		421	N/A	N/A	N/A
HC62218797	DRILL/DRILL BITS SINGLE USE       N	272		634	N/A	N/A	N/A
HC62218821	DRILL/DRILL BITS SINGLE USE       Q	272		847	N/A	N/A	N/A
HC62218995	RETRACTOR MIS SPINAL              I	272		4,200	N/A	N/A	N/A
HC62219027	RETRACTOR MIS SPINAL              Q	272		7,000	N/A	N/A	N/A
HC62219191	CATH DIALYSIS SHORT-TERM          C	278	C1752	176	N/A	N/A	N/A
HC62219225	CATH SIALOGRAPHY	272		93	N/A	N/A	N/A
HC62219258	DEVICE DELIVERY SUTURE INCL LARIAT	272		17,325	N/A	N/A	N/A
HC62219407	KIT ACCESSORY STIMULATOR NERVE	272		210	N/A	N/A	N/A
HC62219449	KIT SPINAL ACCESS DISPOSBL        F	272		4,200	N/A	N/A	N/A
HC62219472	NEEDLE ACCESS FISTULA DIALYSIS	272		333	N/A	N/A	N/A
HC62219621	TUBE TRACH CUFFED ADJUSTABLE      K	272	A7521	630	N/A	N/A	N/A
HC62219654	PRESSURIZER FEMORAL	272		53	N/A	N/A	N/A
HC62219688	DILATOR SPINE/NERVE NEUROVISION	272		2,195	N/A	N/A	N/A
HC62219852	TUBE ET NIM                       O	272		1,120	N/A	N/A	N/A
HC62219886	ADAPTER ARTHROSCPC	272		630	N/A	N/A	N/A
HC62220058	RETRACTOR DISPOSABLE              C	272		211	N/A	N/A	N/A
HC62220082	CATH THROMBECTOMY/EMBOLECTOMY     N	272	C1757	980	N/A	N/A	N/A
HC62220116	KIT MONITORING NERVE(S) SPINAL    G	272		3,500	N/A	N/A	N/A
HC62220256	KIT MONITORING NERVE(S) SPINAL    C	272		2,100	N/A	N/A	N/A
HC62220280	SYSTEM DELIVERY LEAD              M	272	C1887	3,500	N/A	N/A	N/A
HC62220314	ORTHOTIC KNEE W/JNTS PRFB CUSTM   O	274	L1832	1,750	N/A	N/A	N/A
HC62220488	APPLICATOR/TIP SYRINGE ONLY       B	272		70	N/A	N/A	N/A
HC62220512	APPLICATOR/TIP SYRINGE ONLY       I	272		490	N/A	N/A	N/A
HC62220686	KIT ACCESSORY                     D	272		350	N/A	N/A	N/A
HC62220710	NEEDLE BIOPSY/ASPIRATION          C	272		106	N/A	N/A	N/A
HC62220884	BLANKET HYPER/HYPOTHERMIA         A	272		36	N/A	N/A	N/A
HC62220918	BRUSH CYTOLOGY                    A	272		36	N/A	N/A	N/A
HC62220942	CATH CENTRAL VENOUS               C	272	C1751	106	N/A	N/A	N/A
HC62221080	KIT CELL SAVER                    O	272		1,120	N/A	N/A	N/A
HC62221114	KIT PRESSURE MONITOR INTRACOMPRTMNT	272		239	N/A	N/A	N/A
HC62221155	KIT SUPRA PUBIC CATH              B	272		70	N/A	N/A	N/A
HC62221320	RESERVOIR CELL SAVER              K	272		630	N/A	N/A	N/A
HC62221353	SLEEVE COMPRESSION                D	272		140	N/A	N/A	N/A
HC62221528	TUBE TRACH CUFFED                 C	272	A7521	106	N/A	N/A	N/A
HC62221551	TUBE TRACH NO CUFF                B	272	A7520	70	N/A	N/A	N/A
HC62221726	SET TUBING STABILZR ENDOWRST ROBOTIC	272		980	N/A	N/A	N/A
HC62221759	CLIP ENDOSCOPIC                   A	272		36	N/A	N/A	N/A
HC62221783	HEMOSTATIC GEL/GELFOAM/PAD        B	272		70	N/A	N/A	N/A
HC62221924	PLEDGET CARDIOVASCULAR (6/PK)	272		39	N/A	N/A	N/A
HC62221957	TUBING IRRIGATION  HF ROBOTIC        C	272		162	N/A	N/A	N/A
HC62221981	PIN CHECKPOINT HEX ROBOTIC	272		319	N/A	N/A	N/A
HC62222179	CANNULA PERFUSION W/FILTER        Q	272		1,460	N/A	N/A	N/A
HC62222203	SYRINGE BONE MARROW ASPIRATION 30CC	272		1,579	N/A	N/A	N/A
HC62222377	ASPIRATOR ULTRASONIC SURG         B	272		1,750	N/A	N/A	N/A
HC62222401	GUIDE ROD                         B	272		70	N/A	N/A	N/A
HC62222435	SNARE                             A	272		88	N/A	N/A	N/A
HC62222575	CATH BALLOON RENAL                O	272	C1726	1,124	N/A	N/A	N/A
HC62222609	ELECTRODE ROLLER BALL             H	272		420	N/A	N/A	N/A
HC62222633	INTRO/SHEATH EP FIXED NON-PEEL    S	272	C1893	2,800	N/A	N/A	N/A
HC62222807	DEVICE INFLAT ENCORE              B	272		126	N/A	N/A	N/A
HC62222831	FORCEPS BIPOLAR DISPOSABLE        D	272		140	N/A	N/A	N/A
HC62223003	DEVICE ELECTROSURGICAL CUT-CAUTERY N	272		1,040	N/A	N/A	N/A
HC62223037	APPLIER LIGA/HEMOCLIP ENDO        I	272		490	N/A	N/A	N/A
HC62223201	TUBE NASOJEJUNAL	272		155	N/A	N/A	N/A
HC62223235	KIT HEMORRHOID SLIDE ONE	272		1,830	N/A	N/A	N/A
HC62223268	CATH PTA ANGIOPLS BALLOON NON-LSR G	272	C1725	630	N/A	N/A	N/A
HC62223409	CATH PTA ANGIOPLS BALLOON NON-LSR I	272	C1725	907	N/A	N/A	N/A
HC62223433	CATH EP DX <20 ELECTRODES RPRSD   I	272	C1730	490	N/A	N/A	N/A
HC62223466	ORTHOTIC LMBR1-5SAG PNL ANT/POST CSTM	274	L0627	1,380	N/A	N/A	N/A
HC62223631	STAPLE CARTRG/ENDO RELOAD         I	272		490	N/A	N/A	N/A
HC62223664	SYSTEM DETACHMENT COIL	272		700	N/A	N/A	N/A
HC62223839	SET DRILL BIT W/PIN(S)            I	272		490	N/A	N/A	N/A
HC62223862	TEMPLATE ORTHO/ROD SPINAL         A	272		140	N/A	N/A	N/A
HC62224035	CATH EXCHANGER AIRWAY	272		210	N/A	N/A	N/A
HC62224068	HOLDER PIN	272		260	N/A	N/A	N/A
HC62224092	CANNULA ERCP                      E	272		176	N/A	N/A	N/A
HC62224233	PROBE ELECTROHEMOSTASIS	272		462	N/A	N/A	N/A
HC62224266	PROBE HEMOSTASIS (BICAP)          E	272		700	N/A	N/A	N/A
HC62224290	KIT ARTHROSCOPY DISPSBLS          K	272		630	N/A	N/A	N/A
HC62224464	KIT REPAIR LEAD PCMKR	272		350	N/A	N/A	N/A
HC62224498	PASSER SUTURE                     J	272		601	N/A	N/A	N/A
HC62224662	CATH SENSING PRESSUR INTRNL ABDOMEN	272		204	N/A	N/A	N/A
HC62224704	ELECTRODE ENDOSCOPIC BALL TIP	272		585	N/A	N/A	N/A
HC62224738	SYSTEM ILLUMINATION ENDOSCOPIC	272		1,893	N/A	N/A	N/A
HC62224878	SPLINT FINGER OUTRIGGER           B	272	L3925	78	N/A	N/A	N/A
HC62224902	CATH PTA ANGIOPLS BALLOON NON-LSR H	272	C1725	700	N/A	N/A	N/A
HC62224936	DEVICE CLOSURE VASCULAR           A	272	C1760	36	N/A	N/A	N/A
HC62225073	DILATOR SET URETHRAL PEDIATRIC	272		280	N/A	N/A	N/A
HC62225107	CATH PTA ANGIOPLS BALLOON NON-LSR A	272	C1725	1,394	N/A	N/A	N/A
HC62225131	NEEDLE BIOPSY EUS                 F	272		280	N/A	N/A	N/A
HC62225305	EXTRACTOR NAIL	272		2,096	N/A	N/A	N/A
HC62225339	CANNULA ARTHROSCOPIC              N	272		980	N/A	N/A	N/A
HC62225503	CASTING MATERIAL THERMOPLSTC EA ROLL	272		78	N/A	N/A	N/A
HC62225537	ELEVATOR KNEE FOAM W/COVER	272		112	N/A	N/A	N/A
HC62225560	DRESSNG ENDOFRM TEMPLT 2X2 COLLAGEN	272		42	N/A	N/A	N/A
HC62225735	ASPIRATOR ULTRASONIC SURG         C	272		2,254	N/A	N/A	N/A
HC62225768	KIT DRESSING WOUND NEG PRESSURE   N	272		1,420	N/A	N/A	N/A
HC62225792	TEMPLATE ORTHO/ROD SPINAL         S	272		672	N/A	N/A	N/A
HC62225974	TEMPLATE BRACHYTHERAPY            D	272		140	N/A	N/A	N/A
HC62226006	COUNTERSINK                       K	272		822	N/A	N/A	N/A
HC62226188	KIT DRESSING WOUND NEG PRESSURE   B	272	A6550	212	N/A	N/A	N/A
HC62226212	CAUTERY PENCIL                    F	272		280	N/A	N/A	N/A
HC62226394	RETRACTOR MIS SPINAL              B	272		1,400	N/A	N/A	N/A
HC62226428	SLEEVE SUTURE LEAD PACEMAKER	272		140	N/A	N/A	N/A
HC62226451	TIP DISSECTOR MICRO ULTRSONC (SONOPET)	272		2,800	N/A	N/A	N/A
HC62226592	PROBE SPINAL DISPOSABLE          AC	272		2,520	N/A	N/A	N/A
HC62226626	SLEEVE IMPACTOR	272		210	N/A	N/A	N/A
HC62226659	TAP SURGICAL                      X	272		3,850	N/A	N/A	N/A
HC62226832	CATH CENTRAL VENOUS               G	272		350	N/A	N/A	N/A
HC62226865	CIRCUIT VENT                      A	272		36	N/A	N/A	N/A
HC11200128	TRANSPORT EXTERNAL ADULT RN CCU ACCOMP(STATISTICAL)	222		N/A	N/A	N/A	N/A
HC11200143	OBSERVATION PER HOUR - ED	762	G0378	379	N/A	N/A	N/A
HC11500493	LACTATION E&M EXT'D EST'D L:IV	761	99214	336	N/A	N/A	N/A
HC11500535	LACTATION E&M INTRMD EST'L:III	761	99213	235	N/A	N/A	N/A
HC11500576	AM/PACU EVAL LO/MOD-III	761	99213	497	N/A	N/A	N/A
HC11500816	PEDS ESTAB PT ASSES BRIEF(5')	761	99211	175	N/A	N/A	N/A
HC11500840	PEDS ESTAB PT ASSESS EXT(25')	761	99214	394	N/A	N/A	N/A
HC11500873	WM EXAM EST' PT EVAL MOD/HI IV	761	99214	424	N/A	N/A	N/A
HC11501046	WC PROLONGED E&M SERVICE ADDL 15MIN+	761	99417	100	N/A	N/A	N/A
HC12200010	IV INFUSION THERAPY EA ADDL HR	260	96366	542	N/A	N/A	N/A
HC12200044	IV INF THER CONCURRENT/ ENCNTR	260	96368	373	N/A	N/A	N/A
HC12200226	INF CNTR-ESTBLD PT EVAL LOWMOD	510	99213	354	N/A	N/A	N/A
HC12200259	INITIATE PROLONG THERA INFUSION VIA PUMP	260	C8957	2,446	N/A	N/A	N/A
HC12400032	CHEMO ADMIN IVP SNGL/INIT'LINJ	335	96409	1,336	N/A	N/A	N/A
HC12400065	CHEMO ADMIN CNS W/SPINAL PUNCTURE	331	96450	2,006	N/A	N/A	N/A
HC12400099	ADMIN CHEMO INTRA ARTERIAL INJ	335	96420	1,507	N/A	N/A	N/A
HC12600086	ADMIN VACCINE COVID-19 100MCG/0.5 INITIAL DOSE {MODERNA}	771	0011A	128	N/A	N/A	N/A
HC12600110	ADMIN VACCINE COVID-19 30MCG/0.3ML BOOSTER DOSE {PFIZER-BIONTECH}	771	0004A	139	N/A	N/A	N/A
HC12600144	ADMIN VACCINE COVID-19 0.5ML AD26 BOOSTER DOSE {JANSSEN }	771	0034A	139	N/A	N/A	N/A
HC12600326	ADMIN VACCINE COVID-19 25MCG/0.25ML 3RD {MODERNA}	771	0113A	128	N/A	N/A	N/A
HC12600359	ADMIN VACCINE COVID-19 50 MCG/0.5 ML 3RD {MODERNA}	771	0093A	125	N/A	N/A	N/A
HC13500053	GENETIC COUNSEL 15MIN  CMRCL/C	940		207	N/A	N/A	N/A
HC14500052	PREGNANCY DIAB MGT 30MIN	942	99212	247	N/A	N/A	N/A
HC21000211	DEBRID SKIN EXT EA ADDL 10%BSA	361	11001	1,204	N/A	N/A	N/A
HC21000245	DEBRID/REMVL OPEN FX &BONE	361	11012	6,709	N/A	N/A	N/A
HC21000278	DEBRIDE P-THICK BURN SM<5%BSA	361	16020	1,557	N/A	N/A	N/A
HC21000476	I&D ABSCESS COMPLICATED MULT	361	10061	3,120	N/A	N/A	N/A
HC21000500	I&D POLINIDAL CYST: COMPLICATE	361	10081	4,463	N/A	N/A	N/A
HC21000534	PAIRING BENIGN LESIONS: >4	361	11057	1,287	N/A	N/A	N/A
HC21000716	DBRD SKN MUSCL EA ADD 20SQCM/<	361	11046	3,272	N/A	N/A	N/A
HC21000740	LAC REPAIR 2.6-7 5CM	361	12002	1,100	N/A	N/A	N/A
HC21000971	APPY SKIN SUB T A L EA+ 100SQ~LC	361	C5274	4,390	N/A	N/A	N/A
HC21001003	APPY SKIN SUB HED/HND/FT 1ST100SQ~LC	361	C5277	6,557	N/A	N/A	N/A
HC22000095	OST EST PT EVAL LVL5-(40 MIN)	761	99215	642	N/A	N/A	N/A
HC23000037	ASP/INJ JOINT SM W/O UTZ GUIDE-BILAT	361	20600	2,917	N/A	N/A	N/A
HC23000060	ASP/INJ JOINT MED W/O UTZ GUIDE-BILAT	361	20605	4,330	N/A	N/A	N/A
HC23000367	INJ ANES/STEROID NERVE AXILLARY BIL	361	64417	3,686	N/A	N/A	N/A
HC23000391	INJ ANES/STEROID BRACHIAL PLEXUS	361	64415	2,781	N/A	N/A	N/A
HC23000441	INJ ANES/STEROID NERVE SCIATIC RT	361	64445	3,055	N/A	N/A	N/A
HC23000748	INJ FORAMN EPI LMBR INTLW/S&I-L	361	64483	8,001	N/A	N/A	N/A
HC23000771	INJ FORAMN EPI LMBR ADDLWS&I+L	361	64484	5,058	N/A	N/A	N/A
HC23001027	INJ(S);SINGLE TENDON/SHEATH	361	20550	1,519	N/A	N/A	N/A
HC23001050	INJ(S);TRIGGER POINT 3/>MUSCLES	361	20553	2,205	N/A	N/A	N/A
HC23001084	INJ/INF NEUROLYTIC AGNT SUBARACH	361	62280	4,193	N/A	N/A	N/A
HC23001258	DESTR C/T FAC JOINT +LVL W/IMG-R	361	64634	5,609	N/A	N/A	N/A
HC23001282	DESTR L/S FAC JOINT ADDL W/IMG-L	361	64636	6,322	N/A	N/A	N/A
HC23001332	INJ CER/THOR F/IMAGE SNG LVLRT	361	64490	7,597	N/A	N/A	N/A
HC23001472	INJ  L/S F W/IMAGE 2ND LVL BIL	361	64494	7,582	N/A	N/A	N/A
HC23001506	INJ  L/S F /IMAGE 3RD+& LVL BI	361	64495	6,922	N/A	N/A	N/A
HC23001530	INJ ANES/STEROID NERVE TRIGEML BRNCH EA BI	361	64400	3,068	N/A	N/A	N/A
HC23001712	N BLOCK INJ PLANTAR DIGIT (MOTONS) BIL	361	64455	3,518	N/A	N/A	N/A
HC23001746	ASP/INJ JOINT SM W/UTZ GUIDE-BILAT	361	20604	5,282	N/A	N/A	N/A
HC23001910	INJ ANES/STEROID NERVE GENICULAR IMAGE GUIDE	361	64454	2,852	N/A	N/A	N/A
HC23001944	INJ ANES/STEROID NERVE GENICULAR IMAGE GUIDE RT	361	64454	2,852	N/A	N/A	N/A
HC23001977	DESTR NERVE GENICULAR W/NEUROLYT AGNT W/IMAGE LT	361	64624	5,113	N/A	N/A	N/A
HC24000143	HBO FIRST 15MIN INTERMEDIATE/C	413		579	N/A	N/A	N/A
HC25000027	ED LEVEL III - INTERMEDIATE	450	99283	2,203	N/A	N/A	N/A
HC25000050	ED LEVEL VI - CRITICAL	450	99291	6,615	N/A	N/A	N/A
HC25000233	BURNS LOCAL TREATMENT LG 36%	450	16030	1,080	N/A	N/A	N/A
HC25000266	I&D HEMATOMA	450		670	N/A	N/A	N/A
HC25000456	FRACTURE TX FINGER/TOE	450		883	N/A	N/A	N/A
HC25000480	FRACTURE TX  NASAL	450		464	N/A	N/A	N/A
HC25000845	ASP/INJ SMALL JOINT-LT	450	20600	852	N/A	N/A	N/A
HC25000878	ASP/INJ MED JOINT-LT	450	20605	952	N/A	N/A	N/A
HC25000902	ASP/INJ LARGE JOINT-LT	450	20610	1,248	N/A	N/A	N/A
HC25001074	INSERT CT(OPEN) W/DRAIN SYSTEM BIL	450	32551	5,465	N/A	N/A	N/A
HC25001108	INSERT PICC <5 YR AGE W/O IMAGING	450	36568	3,267	N/A	N/A	N/A
HC25001132	INSRT BLADDER CATH-TEMP FOLEY	450	51702	734	N/A	N/A	N/A
HC25001371	NO CHARGE (STATISTICAL)	450		N/A	N/A	N/A	N/A
HC25001405	ADMIN VACCINE HEPATITIS B	450	G0010	111	N/A	N/A	N/A
HC25002700	TRAUMA ACT' I W/O P-H ALERT	450		22,542	N/A	N/A	N/A
HC25002734	CHANGE GT TUBE W/REV TRACT W/O IMAGE ENDO INCL REMVL	450	43763	2,188	N/A	N/A	N/A
HC25002809	I&D ABSCESS; SIMPLE/SINGLE	450	10060	862	N/A	N/A	N/A
HC25002940	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT 7.6-12.5CM	450	12004	889	N/A	N/A	N/A
HC25002973	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT >30.0CM	450	12007	1,156	N/A	N/A	N/A
HC25003005	LAC REPAIR SIMPLE F/E/E/N/L/M 5.1-7.5 CM	450	12014	912	N/A	N/A	N/A
HC25003146	LAC REPAIR INTMD N/H/F/GEN 2.6-7.5	450	12042	1,622	N/A	N/A	N/A
HC25003179	LAC REPAIR INTMD N/H/F/GEN 20.1-30	450	12046	1,981	N/A	N/A	N/A
HC25003203	LAC REPAIR INTMD F/E/E/N/L/MM 2.6-5.0CM	450	12052	1,655	N/A	N/A	N/A
HC25003377	INJ(S);SGL TNDN SHEATH/LIGMNT/APONEUR LT	450	20550	772	N/A	N/A	N/A
HC25003401	ASP & INJ GANGLION CYST(S)	450	20612	766	N/A	N/A	N/A
HC25003575	CLOSED TX SHOULDR DSLC W/MAN W/O ANES LT	450	23650	1,011	N/A	N/A	N/A
HC25003609	REMOVE FB UPPER ARM/ELBOW SQ LT	450	24200	2,066	N/A	N/A	N/A
HC25003633	REMOVE FB UPPER ARM/ELBOW DEEP LT	450	24201	4,009	N/A	N/A	N/A
HC25003773	CLOSED TX ULNA SHAFT FX W/MANIP LT	450	25535	1,099	N/A	N/A	N/A
HC25003807	CLOSED TX RAD&ULN SHAFT FX W/MAN-BIL	450	25565	6,580	N/A	N/A	N/A
HC25003831	CLOSED TX RAD/EPHYSL SEP&ULN FX NO M LT	450	25600	913	N/A	N/A	N/A
HC25004003	CLOSED TX DISTL RADIOULNAR DISLOC W/M-BIL	450	25675	1,586	N/A	N/A	N/A
HC25004037	CLOSED TX METACARPAL FX W/MAN EA	450	26605	831	N/A	N/A	N/A
HC25004201	CLOSED TX HIP DISLOC TRAUMIC BIL	450	27250	1,611	N/A	N/A	N/A
HC25004235	CLOSED TX HIP DISLOC POST ARTHROPLASTY BIL	450	27265	1,989	N/A	N/A	N/A
HC25004409	CLOSED TX TIBIAL SHAFT FX W/MANIP W/W-O FIBFX/TRAC RT	450	27752	4,009	N/A	N/A	N/A
HC25004433	CLOSED TX MEDIAL MALLEO(ANKLE)FX W/MANIP W/W-O TRAC RT	450	27762	3,990	N/A	N/A	N/A
HC25004466	CLOSED TX PROX FIBULA/SHAFT FX; W/MANIP RT	450	27781	3,761	N/A	N/A	N/A
HC25004607	REMOVE FB FOOT; DEEP LT	450	28192	3,269	N/A	N/A	N/A
HC25004631	CLOSED TX TARSAL FX; W/MANIPLTN EA	450	28455	3,197	N/A	N/A	N/A
HC25004664	CLOSED TX BIG TOE FX; NO MANIPULTN LT	450	28490	849	N/A	N/A	N/A
HC25004839	CLOSED TX TARSOMETATARSAL JNT DISLOC; NO ANES LT	450	28600	937	N/A	N/A	N/A
HC25004862	APPLY CAST; SHOULDER TO HAND (LONG ARM) LT	450	29065	1,012	N/A	N/A	N/A
HC25005034	APPLY CAST SHORT LEG BILATERAL	450	29405	1,849	N/A	N/A	N/A
HC25005067	ADDING WALKER HEEL PREV CAST BILAT	450	29440	982	N/A	N/A	N/A
HC25005091	STRAPPING; ANKLE AND/OR FOOT BILAT	450	29540	651	N/A	N/A	N/A
HC25005232	LAC REPAIR MOUTH; 2.5 CM OR LESS	450	40830	880	N/A	N/A	N/A
HC25005265	I&D ABSCESS PERITONSILLAR LT	450	42700	850	N/A	N/A	N/A
HC25005299	REMOVE FB PHARYNX	450	42809	1,542	N/A	N/A	N/A
HC25005430	IINJ ANES/STEROID NERVE/BRNCH PERIPH LT	450	64450	1,542	N/A	N/A	N/A
HC25005463	REMOVE FB EXTRNL EYE; CONJUNCT SUPERF LT	450	65205	441	N/A	N/A	N/A
HC25005497	REMOVE FB EXTRNL EYE; CONJUNCT EMBEDD LT	450	65210	937	N/A	N/A	N/A
HC25005661	REMOV SKIN TAGS UP TO&INCL 15 LESIONS	450	11200	1,086	N/A	N/A	N/A
HC25005695	ASP/INJ JOINT/BURSA MAJOR W/US-RT	450	20611	1,194	N/A	N/A	N/A
HC25005869	I&D ABSCESS RECTAL	450	46040	2,829	N/A	N/A	N/A
HC25005893	INJ ANES/STEROID NERVE OCCIPITL GREAT BI	450	64405	1,056	N/A	N/A	N/A
HC25005927	PARACENTESIS EYE W/REMOVAL AQUEOUS BIL	450	65800	4,400	N/A	N/A	N/A
HC25006073	CLOSED TX METATARSOPHALAN JNT DISLOC; NO ANES RT	450	28630	791	N/A	N/A	N/A
HC25006107	CLOSED TX INTERPHALANGEAL JNT DISLOC; NO ANES BIL	450	28660	1,275	N/A	N/A	N/A
HC25006131	FETAL CONTRACT/NIPPLE STIM	450	59020	1,233	N/A	N/A	N/A
HC25090077	P: INSRT CTW/H20 SEAL L+PLRVC CTUBE			N/A	N/A	N/A	N/A
HC25090101	P: TRSFSN BLD&/CMPNTS+FLTR WRMR TUB			N/A	N/A	N/A	N/A
HC25090275	P: BLOOD PATCH(INJ EPIDURAL)+TRAY LP			N/A	N/A	N/A	N/A
HC25090309	P: IV INFUSION TX 1ST HR			N/A	N/A	N/A	N/A
HC25090473	P: LAC REPAIR 2.6-7.5CM+DERMABOND			N/A	N/A	N/A	N/A
HC25090507	P: NASAL EPISTAXIS+TAMPON			N/A	N/A	N/A	N/A
HC25090549	P: THORACNT PNCT-BI+2THORA VENT KITS			N/A	N/A	N/A	N/A
HC26000083	FETAL CONTRACTION STRESS TEST	720	59020	1,946	N/A	N/A	N/A
HC26000117	POSTPARTUM CARE	361	59430	2,058	N/A	N/A	N/A
HC26000158	L&D EVAL LEVEL I - BRIEF	720	99211	496	N/A	N/A	N/A
HC27000157	CHANGE GT TUBE W/O IMAGE/ENDO	750	43762	3,071	N/A	N/A	N/A
HC27000207	COLONOSCOPY STOMA W/BIOPSY	750	44389	3,986	N/A	N/A	N/A
HC27000413	EGD W/BIOPSY(S) ~FO	750	43239	4,085	N/A	N/A	N/A
HC27000447	EGD W/DILATION GASTRIC OUTLET ~FO	750	43245	4,790	N/A	N/A	N/A
HC27000629	ENTEROSCOPY W/BLEED CONTROL	750	44366	7,121	N/A	N/A	N/A
HC27000652	ENTEROSCOPY W/HOT BIOPSY	750	44365	5,565	N/A	N/A	N/A
HC27000686	ERCP DIAGNOSTIC (W/SPEC)	750	43260	6,361	N/A	N/A	N/A
HC27000892	ESOPH GASTROESOPH REFLUX PH STDY-LONG	750	91034	5,695	N/A	N/A	N/A
HC27000926	ESOPHSCPY DX- BRUSH/WASH ~FO	750	43200	3,666	N/A	N/A	N/A
HC27000991	GI TRACT CAPSULE ENDO IMAG ESOPH THRU ILEUM	750	91110	9,154	N/A	N/A	N/A
HC27001197	M: UNLISTED PROCEDURE  STOMACH	750	43999	N/A	N/A	N/A	N/A
HC27001221	SIGMOIDOSCOPY FLEX SCRN (Q48MO)	750	G0104	2,437	N/A	N/A	N/A
HC27001429	EGD W/DIL BALLN =30MM (FLUORO) ~FO	750	43233	4,445	N/A	N/A	N/A
HC27001452	ESOPHSCPY W/ABLAT TUMR/LESN(S(DILATE)~FO	750	43229	6,679	N/A	N/A	N/A
HC27001486	ESOPHSCPY W/CONTROL BLEED  ~FO	750	43227	4,416	N/A	N/A	N/A
HC27001627	COLONOSCOPY STOMA W/PLCMNT STENT	750	44402	4,354	N/A	N/A	N/A
HC27001650	COLONOSCOPY STOMA W/DILATN BALLOON	750	44405	3,924	N/A	N/A	N/A
HC27001684	COLONOSCOPY STOMA W/DECOMP&PLACE TUBE	750	44408	3,801	N/A	N/A	N/A
HC27001825	EGD W/EUS FNA/BX ESOPH->DUOD/SURG ALT STOMCH JEJUN~FO	750	43242	4,886	N/A	N/A	N/A
HC27001858	COLONOSCOPY FLEX W/EUS FNA/BX	750	45392	4,103	N/A	N/A	N/A
HC27001882	CHEMODENERVATION ANAL MUSCLE	750	46505	5,443	N/A	N/A	N/A
HC28000073	CR EST PT EVAL LVL4-(25MIN)	510	99214	443	N/A	N/A	N/A
HC28000115	CR NEW PT EVAL LVL3-(30MIN)	510	99203	370	N/A	N/A	N/A
HC29000601	AWV ANNUAL WELLNESS PLAN; INITIAL	770	G0438	380	N/A	N/A	N/A
HC29000635	COUNSEL ASSESS CA LUNG SCREEN LDCT	770	G0296	251	N/A	N/A	N/A
HC29000684	TEST CHALLENGE INGEST 1ST120MIN	924	95076	910	N/A	N/A	N/A
HC31000128	PT- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 30MIN	420	99366	271	N/A	N/A	N/A
HC31000151	PT-COMPUT DYNAMIC POSTURE SOT 6 CONDITIONS	420	92548	1,045	N/A	N/A	N/A
HC31000193	PT-ELEC STIM/TENS ATTD15MIN/MW	420	97032	198	N/A	N/A	N/A
HC31000417	PT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN/CMW	420	97763	224	N/A	N/A	N/A
HC31000441	PT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN/M	420	97761	209	N/A	N/A	N/A
HC31000797	PT-WOUND NON-SEL DEB 45MIN/MW	420	97602	854	N/A	N/A	N/A
HC31000821	PT-WOUND VAC 30MIN<50 SQ CM/CM	420	97605	522	N/A	N/A	N/A
HC31001001	PT-NEUROMUSC RE-ED 30MIN/CW	420		350	N/A	N/A	N/A
HC31001035	PT-GAIT TRAINING ADD 15MIN/CW	420		194	N/A	N/A	N/A
HC31001068	PT-MANUAL THERAPY 30 MIN/CW	420		336	N/A	N/A	N/A
HC31001209	PT CASE CONF & RPT ADD'L 15MIN	420		82	N/A	N/A	N/A
HC31001274	PT-STATUS REVIEW 15MIN(STAT)	420		N/A	N/A	N/A	N/A
HC31001340	PT-SCREENING/IPA 15MIN(ST)	420		N/A	N/A	N/A	N/A
HC31001571	PT-ELEC STIM/WOUND CARE/M	420	G0281	412	N/A	N/A	N/A
HC31001605	PT-COMMTY WK/REINTEGRAT 30M/CW	420		352	N/A	N/A	N/A
HC31001803	PT-APPLICATIN CAST LEG CLBFOOT	420	29450	1,010	N/A	N/A	N/A
HC31001837	PT-EVAL HIGH COMPLEXITY 45MIF2F 150MIN	424	97163	2,020	N/A	N/A	N/A
HC31001860	PT-AQUATIC THERAPY 30MIN/CW	420		437	N/A	N/A	N/A
HC31002033	PT - STRAPPING; SHOULDER	420	29240	557	N/A	N/A	N/A
HC31002074	PT-EVAL MOD COMPLEXITY 30MF2F 90MIN	424	97162	1,119	N/A	N/A	N/A
HC31002108	PT-EVAL LOW COMPLEXITY 20MF2F 45MIN	424	97161	608	N/A	N/A	N/A
HC31010093	PT-THER PROC GROUP [15MIN]	423	97150	88	N/A	N/A	N/A
HC31010127	PT-COMMTY WK/REINTEGRT 15MIN	420	97537	220	N/A	N/A	N/A
HC31010150	PT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN	420	97763	214	N/A	N/A	N/A
HC31010382	PT- TM CONF INTERDISPLNS 3MNM WPT PRES 60MIN	420	G0175	450	N/A	N/A	N/A
HC31090020	P: PT DEVEL' TESTING 90 MIN/C			N/A	N/A	N/A	N/A
HC32000036	OT- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 30MIN	430	99366	271	N/A	N/A	N/A
HC32000069	OT-CONTRAST BATH 15MIN/MW	430	97034	143	N/A	N/A	N/A
HC32000127	OT-EVAL SWALLOW CINE/FLUORO 90MIN	434	92611	2,153	N/A	N/A	N/A
HC32000317	OT-MANUAL THERAPY 15MIN/M	430	97140	231	N/A	N/A	N/A
HC32000341	OT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN/M	430	97763	224	N/A	N/A	N/A
HC32000374	OT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN/M	430	97761	209	N/A	N/A	N/A
HC32000549	OT-THER EXER 15MIN/M	430	97110	236	N/A	N/A	N/A
HC32000572	OT-ULTRASOUND 15MIN/MW	430	97035	187	N/A	N/A	N/A
HC32000820	OT-WOUND VAC 60>50 SQ CM/M	430	97606	943	N/A	N/A	N/A
HC32000853	OT-ELEC STIM/TENS ATTD30MIN/CW	430		352	N/A	N/A	N/A
HC32001026	OT-ORTHOTIC FIT/TRNG 30MIN/CW	430		393	N/A	N/A	N/A
HC32001059	OT-PROSTHETIC TRNG ADD15MIN/CW	430		184	N/A	N/A	N/A
HC32001083	OT-DEV COGNITIVE SKLL 30MIN/CW	430		377	N/A	N/A	N/A
HC32001273	OT-RE-EVAL EST POC 75MIN	434	97168	1,020	N/A	N/A	N/A
HC32001307	OT-THER PROC GRP 45MIN/MC	430	97150	228	N/A	N/A	N/A
HC32001331	OT- TM CONF INTERDISCPLN NO PT/FAM  WQHCP 30MIN	430	99368	261	N/A	N/A	N/A
HC32001539	OT-THER PROC GRP 120MIN/MC	433	97150	400	N/A	N/A	N/A
HC32001604	OT-APPLICATION CAST LONG ARM	430	29065	1,047	N/A	N/A	N/A
HC32001786	OT-DYSPHAGIA SCREENING/IP	430	V5364	170	N/A	N/A	N/A
HC32001810	OT-ENDOSCOP EVAL SWALLOW/LARYN	434	92616	1,496	N/A	N/A	N/A
HC32001844	OT-EVAL SWALLOW CINE/FLUORO 45MIN	434	92611	1,294	N/A	N/A	N/A
HC32010027	OT-SWALLOWING THERAPY  [15MIN]	430	92526	308	N/A	N/A	N/A
HC32010050	OT-THER EXER 15MIN	430	97110	229	N/A	N/A	N/A
HC32010084	OT-EVAL MOD COMPLEXITY 45MIN F2F [15MIN]	434	97166	236	N/A	N/A	N/A
HC32010241	OT-SENSORY INTEGRT TECH 15MIN	430	97533	205	N/A	N/A	N/A
HC32010316	OT-ULTRASOUND 15MIN	430	97035	179	N/A	N/A	N/A
HC32010340	OT-ONLINE ASSESS & MANAGMNT EST PT 21+MIN	430	98972	209	N/A	N/A	N/A
HC32090037	P: OT-EVAL 90MIN/C			N/A	N/A	N/A	N/A
HC32090060	P: OT-EVAL 180MIN/C			N/A	N/A	N/A	N/A
HC32090235	P: ORTH HFO W/NONTORSION JOINT(S) (90MINUOS)			N/A	N/A	N/A	N/A
HC33000001	SP-ASSESS APHASIA/REPT EA HR/M	440	96105	447	N/A	N/A	N/A
HC33000142	ST-ENDOSCOPIC EVAL LARYNGEAL	444	92614	1,428	N/A	N/A	N/A
HC33000282	ST-SPEECH THERAPY GRP 45MIN/MCW	443	92508	417	N/A	N/A	N/A
HC33000316	ST-SWALLOWING EVAL 30MIN	444	92610	1,022	N/A	N/A	N/A
HC33000340	ST-SWALLOWING EVAL 75MIN	444	92610	1,728	N/A	N/A	N/A
HC33000555	ST-SWALLOWING EVAL 15MIN	444	92610	596	N/A	N/A	N/A
HC33000597	ST-SPEECH THERAPY GRP 90MIN/MCW	443	92508	605	N/A	N/A	N/A
HC33000845	ST-EVAL SPEECH CMPNT 60MIN	444	92522	811	N/A	N/A	N/A
HC33000902	ST EVAL SPEECH FLUENCY 30MIN/M	444	92521	350	N/A	N/A	N/A
HC33001090	ST EVAL BEHAVRAL QUAL VOICE 45MIN/M	444	92524	522	N/A	N/A	N/A
HC33001132	ST EVAL BEHAVRAL QUAL VOICE 180MIN/M	444	92524	1,252	N/A	N/A	N/A
HC33001165	ST EVAL BEHAVRAL QUAL VOICE 90MIN/M	444	92524	873	N/A	N/A	N/A
HC33010174	ST-SPEECH THERAPY GROUP [15MIN]	443	92508	121	N/A	N/A	N/A
HC33010216	ST-ONLINE ASSESS & MANAGMNT EST PT 21+MIN	440	98972	209	N/A	N/A	N/A
HC33010240	ST-EVAL SWALLOW CINE/FLUORO 180MIN	444	92611	3,508	N/A	N/A	N/A
HC34000091	CONDITIONING PLAY AUDIO	471	92582	451	N/A	N/A	N/A
HC34000125	AUD-AUDITORY EVOKED AEP BBS HEARING DETERM W/I&R	471	92651	708	N/A	N/A	N/A
HC34000315	COCHLEAR IMPLT DX ANALYS W/PROGRAM <7	471	92601	389	N/A	N/A	N/A
HC34000349	COCHLEAR IMPLT DX ANALYS W/REPROGRAM >7 SUBSEQ	471	92604	389	N/A	N/A	N/A
HC35000215	REC- TM CONF INTERDISPLNS 3MNM WPT PRES 30MIN	941	G0175	325	N/A	N/A	N/A
HC35000256	REC-DEV COGNITIVE SKILLS ADDL 15MIN	941	97130	208	N/A	N/A	N/A
HC35000280	REC- TM CONF INTERDISCPLN NO PT/FAM  WMD 45MIN	941	99367	320	N/A	N/A	N/A
HC35500206	MT-BEHAVIOR TX FAMW/PT ADD 15MIN	916	96168	55	N/A	N/A	N/A
HC35500230	MT-DEV COGNITIVE SKILLS INITL 15MIN	941	97129	176	N/A	N/A	N/A
HC36000016	AEROSOL-CONTINUOUS TX FIRST HR	412	94644	823	N/A	N/A	N/A
HC36000206	INHALATION W/GAS TX INITIAL	412	94640	722	N/A	N/A	N/A
HC36000230	SPUTUM INDUCTION INIT TX	412	94640	722	N/A	N/A	N/A
HC36000685	DIFFUSING CAPACITY+	410	94729	1,123	N/A	N/A	N/A
HC36000719	CAPILLARY/HEEL/FINGER STICK	300	36416	60	N/A	18	N/A
HC36000743	IPV TREATMENT SUBSQ SAME DAY	412	94640	745	N/A	N/A	N/A
HC36000917	BRONCH W/BRONCHIAL/ENDO BX(S)	361	31625	6,576	N/A	N/A	N/A
HC36000941	BRONCH DIAGNOSTIC DC'D PROC	361	31622	2,352	N/A	N/A	N/A
HC36000974	RT INHALATION TREATMENT SUBSQ	410	94640	658	N/A	N/A	N/A
HC36001154	TRANSPORT EXTERNAL MILLER ASSIST RT ACCOMP(STATISTICAL)	410		N/A	N/A	N/A	N/A
HC36001188	BRONCH W/COMPTR-ASST IMAGE-GUIDE NAVIGATE+	361	31627	2,303	N/A	N/A	N/A
HC36800001	BRONCHOSCOPY THRU ESTAB TRACH	361	31615	4,742	N/A	N/A	N/A
HC36800217	HIGH ALTD SIM TEST W/O2TI-HAST	460	94453	1,992	N/A	N/A	N/A
HC36800258	O2 UPTAKE COMPLETE	460	94681	1,843	N/A	N/A	N/A
HC36800506	BRONCHOSCOPY W/FB REMOVAL	361	31635	6,706	N/A	N/A	N/A
HC36800530	RT THER MUSC STRENGTH 15MIN/MW	410	G0237	313	N/A	N/A	N/A
HC36800563	RT RESP THER GRP 30 MIN/MW	410	G0239	235	N/A	N/A	N/A
HC36800704	PLETHYSMOGRAPHY LUNG VOL	460	94726	1,263	N/A	N/A	N/A
HC36800738	DIFFUSING CAPACITY+	460	94729	1,129	N/A	N/A	N/A
HC36800779	PFT/LUNG VOL INFANT-2Y/O	460	94013	1,414	N/A	N/A	N/A
HC37000056	IP VISIT (STATISTIC) EA 15 MIN	942		N/A	N/A	N/A	N/A
HC37000080	MNT RE-ASSESS EA 15MIN-IP(ST)	942		N/A	N/A	N/A	N/A
HC37090107	P: MNT INITIAL ASSESS 45 MIN-IP (ST)			N/A	N/A	N/A	N/A
HC37090131	P: MNT INITIAL ASSESS 90 MIN-IP (ST)			N/A	N/A	N/A	N/A
HC38000121	APPLY SPLINT FINGER STATIC	700	29130	399	N/A	N/A	N/A
HC38000154	APPLY SPLINT SHORT ARM	700	29125	889	N/A	N/A	N/A
HC38000188	WINDOW CAST	700	29730	746	N/A	N/A	N/A
HC38000337	APPLY CYLINDER CAST(THI-ANKLE)	700	29365	1,012	N/A	N/A	N/A
HC38000360	APPLY STRAPPNG KNEE(ROBRTJONES	700	29530	671	N/A	N/A	N/A
HC38000394	WEDGING CAST EXCEPT CLUBFOOT	700	29740	734	N/A	N/A	N/A
HC38420121	ECMO REPSN PERIF A&/V PERC W/FLUOR=5Y	489	33957	7,143	N/A	N/A	N/A
HC38420154	ECMO/ECLS INSERT PERIPH CANNULA PERC BIRTH-AGE 5	489	33951	16,584	N/A	N/A	N/A
HC38420329	REMOVAL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS	489	33989	19,331	N/A	N/A	N/A
HC38420352	ASSEMBLY & OPER PUMP OXYGEN; 30MIN	481	99192	2,118	N/A	N/A	N/A
HC39000039	PSYCH TX W/PATIENT 45MIN	914	90834	610	N/A	N/A	N/A
HC39000302	PSY TEAM CONF W/PT&/FAM 30MIN	900	99366	273	N/A	N/A	N/A
HC39000609	PSYCH CASE CONF 30MIN	914	99367	231	N/A	N/A	N/A
HC39000732	SW ASSESS/INTERVEN PER 30MIN/MCL	914		113	N/A	N/A	N/A
HC39000989	PSYCH DIAG EVAL W/ MED SERVICE	900	90792	607	N/A	N/A	N/A
HC39001011	PSYCH NARCOSYNTHESIS	914	90865	381	N/A	N/A	N/A
HC39001045	TMS REDETERMINATION THRES DELV MGNT	900	90869	1,112	N/A	N/A	N/A
HC39001318	BEHAVIOR ID ASSESS ADMIN BY QHCP PT/GUARD EA 15MIN	918	97151	139	N/A	N/A	N/A
HC39001342	BEHAVIOR ADAPT MULT FAM TX GDN W/O PT; EA 15MIN	918	97157	139	N/A	N/A	N/A
HC41000001	SLEEP STUDY - MSLT/MWT	740	95805	5,510	N/A	N/A	N/A
HC41000035	POLYSOMNOGRAPHY 4+ STAGES 6&> ATTD	740	95810	7,425	N/A	N/A	N/A
HC41000068	POLYSMNGRPH 4+STG6&> ATTD DISCONT'	740	95810	1,857	N/A	N/A	N/A
HC41500042	CENTRAL MOTOR EVOKED UP LIMBS	922	95928	2,727	N/A	N/A	N/A
HC41500109	EEG AWAKE AND DROWSY	740	95816	2,460	N/A	N/A	N/A
HC41500133	EEG MONITORING 61-119MINUTES	740	95813	3,416	N/A	N/A	N/A
HC41500372	NYSTAGMUS OPTOKINETIC BIDIRECT	471	92544	609	N/A	N/A	N/A
HC41500406	SINUSOIDAL VERT ROTATION(VORT)	471	92546	1,604	N/A	N/A	N/A
HC41500570	STUDIES NERVE CONDUCTN 3-4 STUDIES	922	95908	1,665	N/A	N/A	N/A
HC41500604	STUDIES NERVE CONDUCTN 9-10 STUDIES	922	95911	2,616	N/A	N/A	N/A
HC41500794	EEG W/O VID MONITOR CONT 2-12HR	740	95707	3,349	N/A	N/A	N/A
HC41500828	EEG W/O VID MONITOR CONT EA 12-26HR	740	95710	3,993	N/A	N/A	N/A
HC41500851	EEG W/VIDEO MONITOR CONT 2-12 HR	740	95713	4,458	N/A	N/A	N/A
HC42000067	CV STRESS TEST TREADMILL	482	93017	2,625	N/A	N/A	N/A
HC42000091	ECHO CONGENITAL LTD OR F/U	483	93304	2,614	N/A	N/A	N/A
HC42000125	ECHO 2D CMPLT W/SPEC&CLR DOPLR	483	93306	6,000	N/A	N/A	N/A
HC42000331	ECG EXT HOLTER UP TO 48HRS; SCANNING ANYS & REPORT	731	93226	2,009	N/A	N/A	N/A
HC42000364	INTERROGATE  IMP' CVPHYS MONITOR 1 OR MORE DATA	480	93290	525	N/A	N/A	N/A
HC42000554	WCH NEW PT LVL2-PROB FOCUS	510	99202	202	N/A	N/A	N/A
HC42000588	WCH NEW PT LVL5-COMPREHEN	510	99205	507	N/A	N/A	N/A
HC42000794	PROGRAM/EVAL S-ICD SNGL LEAD	480	93260	411	N/A	N/A	N/A
HC42000828	ECG EXT TELEM MCT>24HRS-30DAYS TECH ATTEND TIME;CONNECT&TRANS	731	93229	3,296	N/A	N/A	N/A
HC42000885	ECG EXT HOLTER W/CONNECT>48HRS-7DAYS; RECORDING	731	93242	1,145	N/A	N/A	N/A
HC42090084	P: 30 DAY EVENT MONITOR			N/A	N/A	N/A	N/A
HC42090134	P: COMPLETE ECHOCARDIOGRAM			N/A	N/A	N/A	N/A
HC42090175	P: ECHO STRESS W/WO DOPP-PHARM  W/WO CON			N/A	N/A	N/A	N/A
HC43000561	DUCTOGRAM MULTI DUCT(S) LT	320	77054	1,628	N/A	N/A	N/A
HC43000629	PUNCTURE ASP CYST BREAST-LT	361	19000	3,068	N/A	N/A	N/A
HC43001056	TOMO BRST DX 3-D; BILAT+	401	77062	127	N/A	N/A	N/A
HC43001080	MAMMO SCREEN W/CAD BILAT	403	77067	1,170	N/A	N/A	N/A
HC43001114	MAMMO SCREENING W/CAD RIGHT	403	77067	760	N/A	N/A	N/A
HC43500016	DEXA BONE DENS-AXIAL SKELETAL	320	77080	1,115	N/A	N/A	N/A
HC43500040	DEXA BONE DENS-AXIAL/APPEND COMB	320	77080	1,210	N/A	N/A	N/A
HC44000016	3D RENDER W/O INDENDNPT WORKSTN	320	76376	1,852	N/A	N/A	N/A
HC44000214	BONE AGE STUDIES	320	77072	721	N/A	N/A	N/A
HC44000248	BONE SURVEY INFANT	320	77076	1,552	N/A	N/A	N/A
HC44000503	CLAVICLE BILATERAL	320	73000	1,204	N/A	N/A	N/A
HC44000537	CONSULT OUTSIDE FILM (ST)	320	76140	N/A	N/A	N/A	N/A
HC44000719	EYE FOR FOREIGN BODY LT	320	70030	452	N/A	N/A	N/A
HC44000743	FACIAL BONES LTD < THAN 3 VWS	320	70140	765	N/A	N/A	N/A
HC44000776	FEMUR 2/> VIEWS LT	320	73552	1,006	N/A	N/A	N/A
HC44000933	FOOT COMP MIN 3 VWS RT	320	73630	909	N/A	N/A	N/A
HC44000966	FOREARM RT	320	73090	745	N/A	N/A	N/A
HC44000990	HAND 2 VIEWS RT	320	73120	689	N/A	N/A	N/A
HC44001279	INTERNAL AUDITORY CANAL	320	70134	565	N/A	N/A	N/A
HC44001303	XR INTRO GI TUBE IMAGING S&I	320	74340	1,422	N/A	N/A	N/A
HC44001477	KNEE 4 OR MORE VWS RT	320	73564	1,146	N/A	N/A	N/A
HC44001501	KNEE ARTHROGRAM RT	322	73580	1,918	N/A	N/A	N/A
HC44001675	NECK  SOFT TISSUE (REDUCED SVC)	320	70360	410	N/A	N/A	N/A
HC44001709	ORTHOPANTOGRAM	320	70355	679	N/A	N/A	N/A
HC44001733	PERINEOGRAM	320	74775	1,136	N/A	N/A	N/A
HC44001873	SCAPULA BILATERAL	320	73010	1,257	N/A	N/A	N/A
HC44001915	SELLA TURCICA	320	70240	486	N/A	N/A	N/A
HC44001949	SHOULDER 1 VIEW RT	320	73020	710	N/A	N/A	N/A
HC44002129	STERNUM MIN 2 VIEWS	320	71120	740	N/A	N/A	N/A
HC44002160	TEETH SINGLE VIEW	320	70300	374	N/A	N/A	N/A
HC44002343	TOE (S) LT	320	73660	602	N/A	N/A	N/A
HC44002400	TRANSCERV CATH FALLOPIAN TUBES	320	74742	1,529	N/A	N/A	N/A
HC44002483	URETHROCYSTOGRAM RETROGRADE	320	74450	1,393	N/A	N/A	N/A
HC44002657	FLUOROSCOPY ASSIST OR <1HR(ST)	320		N/A	N/A	N/A	N/A
HC44002681	UROGRAPHY ANTEGRADE LTD LT	320	74425	1,142	N/A	N/A	N/A
HC44002715	UPPER EXTREMITY - INFANT	320	73092	691	N/A	N/A	N/A
HC44002855	MYELOGRAPHY INJ W/S&I; LUMBOSAC	361	62304	9,605	N/A	N/A	N/A
HC44002889	SPINE ENTIRE SKULL-SACRUM 2-3 VIEWS	320	72082	1,151	N/A	N/A	N/A
HC44002913	HIP (W/PELVIS WHN PRFRMD) 1 VIEW LT	320	73501	784	N/A	N/A	N/A
HC44089894	CDSM EVICORE	329	G1001	0	N/A	N/A	N/A
HC44089928	CDSM NATIONAL DECISION SUPPORT COMPANY (NDSC)	329	G1004	0	N/A	N/A	N/A
HC44200152	US DUPLEX ART LOW EXT UNILAT/LTD	921	93926	1,931	N/A	N/A	N/A
HC44200186	US DUPLEX CAROTID COMP BILAT	921	93880	3,015	N/A	N/A	N/A
HC44200210	US DUPLEX CAROTID LTD	921	93882	1,677	N/A	N/A	N/A
HC44200368	US INFANT HIPS(DYNAMIC)	402	76885	1,880	N/A	N/A	N/A
HC44200392	US OB >1ST TRI/1ST GEST	402	76805	2,309	N/A	N/A	N/A
HC44200426	US OB 1ST TRI ADD'L GEST +	402	76802	1,099	N/A	N/A	N/A
HC44200616	TRANSCRANIAL DOPPLER STUDY LTD	921	93888	2,037	N/A	N/A	N/A
HC44200640	US TRANSVAGINAL(NON OB)	402	76830	1,887	N/A	N/A	N/A
HC44200863	ART STDY SNG U/L 3/> LVL CMP-R	921	93922	1,726	N/A	N/A	N/A
HC44200897	US FETAL BPP W/O NST(EA ADD'L)+	402	76819	1,427	N/A	N/A	N/A
HC44500049	ANGIO ADRENAL LT	323	75731	7,695	N/A	N/A	N/A
HC44500213	ANGIO EXTREMITY BILAT	323	75716	14,130	N/A	N/A	N/A
HC44500262	ANGIO PELVIC	323	75736	8,251	N/A	N/A	N/A
HC44500486	ASP/DECOMP PERC DISKECTOMY	361	62287	16,880	N/A	N/A	N/A
HC44500601	CAROTID STENT W/EMBOL PROT LT	481	37215	35,023	N/A	N/A	N/A
HC44500668	CHOLANGIOGRAM W/STONE REMVL	361	47554	10,258	N/A	N/A	N/A
HC44500924	INJ PERC EXT PSEUDOANEUR RT	361	36002	2,171	N/A	N/A	N/A
HC44500957	INJ SCLEROTHERAPY SNGL VEIN-LT	361	36470	2,137	N/A	N/A	N/A
HC44501757	REM & REPLAC EXT URET CATH(IMG S&I) RT	361	50387	8,662	N/A	N/A	N/A
HC44501781	REM & REPLAC URETERAL STENT RT	361	50382	12,127	N/A	N/A	N/A
HC44501815	REMOVE NEPHROSTOMY TUBE RT	361	50389	4,701	N/A	N/A	N/A
HC44501989	THROMBECTOMY VENOUS LT	361	37187	17,006	N/A	N/A	N/A
HC44502011	THROMBECTOMY VEIN REPEAT RT	361	37188	13,828	N/A	N/A	N/A
HC44502045	TRANSCATH EMBOLIZ PERC-CNS	361	61624	37,161	N/A	N/A	N/A
HC44502276	VENOGRAM RENAL BILAT	320	75833	10,554	N/A	N/A	N/A
HC44502300	VENOGRAM SINUS/JUGULAR	320	75860	6,464	N/A	N/A	N/A
HC44502359	VENOUS SAMPLING THRU CATH	323	75893	6,579	N/A	N/A	N/A
HC44502789	REVASC ILIAC EA+VES W/TLA-LT	323	37222	16,447	N/A	N/A	N/A
HC44502813	REVAS ILIAC EA+VES W/TLA&STENT-L	323	37223	21,216	N/A	N/A	N/A
HC44502987	REVAS TIB/PERO W/TLA & ATHER-RT	323	37229	28,363	N/A	N/A	N/A
HC44503019	REVAS TIB/PERO W/TLA&STENT-RT	323	37230	28,265	N/A	N/A	N/A
HC44503043	REVAS TIB/PERO TLA&STNT&ATHR-R	323	37231	33,451	N/A	N/A	N/A
HC44503183	REVAS TIB/PER EA+TLA&ATH&STN-B	323	37235	48,981	N/A	N/A	N/A
HC44503217	ATHER' TRLUML RENAL ART&S&I-BI	323	0234T	49,471	N/A	N/A	N/A
HC44503241	ATHER'TRLUML BRACH EAVES W/S&I-R	323	0237T	27,000	N/A	N/A	N/A
HC44503563	SEL CATH&RENAL ANGIO1STW/S&I-B	361	36252	18,700	N/A	N/A	N/A
HC44503597	SEL CATH&RENAL ANGIO2NDW/S&I-B	361	36254	20,289	N/A	N/A	N/A
HC44503787	SEL CATH CC/INOM &ANGIO EXCC W/S&I LT	323	36222	14,407	N/A	N/A	N/A
HC44503811	SEL CATH CC/INOM &ANGIO IC W/S&I RT	323	36223	19,524	N/A	N/A	N/A
HC44504058	EMBOLIZE VES HEMORRG/LYMPH EXTRAVW/S&I	361	37244	55,999	N/A	N/A	N/A
HC44504082	REVAS OTHR PERIPH1ST VEIN W/STNT W-S&I	361	37238	22,771	N/A	N/A	N/A
HC44504116	PERC TRNSCTH RENAL SYMP DENRV W/IMG BI	361	0339T	19,858	N/A	N/A	N/A
HC44504256	VERTEBROPLASTY 1BODY/GUIDE;LUMBOSACRAL	361	22511	14,210	N/A	N/A	N/A
HC44504280	VERTEBRAL AUGMNT 1BODY W/GUIDE;LUMBAR	361	22514	27,637	N/A	N/A	N/A
HC44504314	PERC SACRAL AUGMT BILAT W/ GUIDANCE&BX	361	0201T	14,057	N/A	N/A	N/A
HC44504488	ENDOVASC INFUS CRANIAL(NON-THROMB)INIT'L TRRT	361	61650	18,974	N/A	N/A	N/A
HC44504512	PERC PLCMT TISS SOFT DEV ADDL LESN+	361	10036	2,649	N/A	N/A	N/A
HC44504686	ABLATION UTERINE FIBROID(S) TRANSCERV W US GUIDE; RF	361	0404T	11,865	N/A	N/A	N/A
HC44504710	ACCESS DIALYSIS CIRCUIT EVAL->VENA CAVA WS&I	361	36901	7,775	N/A	N/A	N/A
HC44504884	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:INTL BILAT	361	37248	25,200	N/A	N/A	N/A
HC44504918	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:ADDL + BILAT	361	37249	15,295	N/A	N/A	N/A
HC44504942	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE &TUBE PLC; NEW ACCESS RNL COL-BIL	361	50437	31,241	N/A	N/A	N/A
HC44700151	COMP EP EVAL W/LT ATRIAL PACE+	481	93621	13,899	N/A	N/A	N/A
HC44700185	EP EVAL ICD LEADS AT IMPLANT	481	93640	8,776	N/A	N/A	N/A
HC44700219	EP FOLLOW UP POST THERAPY	481	93624	11,599	N/A	N/A	N/A
HC44700458	INSERTION OF IABP PERCUTANEOUS	481	33967	9,850	N/A	N/A	N/A
HC44700482	INSRT/REPL TEMP DUAL PACER	481	33211	11,966	N/A	N/A	N/A
HC44700714	PERC CLOSURE OF ASD W/IMPLANT	481	93580	29,397	N/A	N/A	N/A
HC44700813	PLACEMENT COIL  SEPTUM	481	33647	28,374	N/A	N/A	N/A
HC44700912	PTA PULMONARY ARTERY EA ADDL+	481	92998	8,184	N/A	N/A	N/A
HC44701126	RT VENTRICULAR RECORDING	481	93603	6,295	N/A	N/A	N/A
HC44701175	TILT TABLE EVALUATION	480	93660	3,785	N/A	N/A	N/A
HC44701209	EXTRA PUMP TIME/.5 HR	480		1,997	N/A	N/A	N/A
HC44701431	INJ PRO HRT CATH &IMG; SELCT CORON CONGNTL HRT+	481	93563	7,099	N/A	N/A	N/A
HC44701464	INJ PRO HRT CATH &IMG; SELCT RT VENT / ATRIUM+	481	93566	5,448	N/A	N/A	N/A
HC44701688	FLUORO GUIDANCE UNLISTED PROCEDURE	481	76496	1,739	N/A	N/A	N/A
HC44701738	PERC COR ANGIOPLST; SNGL CA/BRCH-LC	481	92920	23,521	N/A	N/A	N/A
HC44701902	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-RI+	481	92925	17,742	N/A	N/A	N/A
HC44701936	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-LC	481	92928	27,128	N/A	N/A	N/A
HC44701969	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-LM+	481	92929	16,924	N/A	N/A	N/A
HC44702108	PERC COR ATHR+STENT/ANGIOP; ADDL-RI+	481	92934	18,933	N/A	N/A	N/A
HC44702132	PERC CABG REVAS ATHR/STENT/ANG; SNGL-LC	481	92937	27,918	N/A	N/A	N/A
HC44702165	PERC CABG REVAS ATHR/STENT/ANG; ADDL-LM+	481	92938	16,889	N/A	N/A	N/A
HC44702330	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-LC+	481	92944	19,137	N/A	N/A	N/A
HC44702363	PERC COR DES STENT(S)/ANGIOP; SNGL-LM	481	92928	27,160	N/A	N/A	N/A
HC44702538	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-LC+	481	92934	18,933	N/A	N/A	N/A
HC44702561	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-LM	481	92937	27,918	N/A	N/A	N/A
HC44702736	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-LC	481	92943	32,524	N/A	N/A	N/A
HC44702769	PERC COR CHRON REVAS ATHR/DES/A;ADDL-LM+	481	92944	19,137	N/A	N/A	N/A
HC44702793	PERC COR CHRON REVAS ATHR/DES/A;ADDL-RC+	481	92944	19,137	N/A	N/A	N/A
HC44702934	REPAIR VISC AORTA FEVAR(PROX&DIST);4 PROSTH	360	34848	54,166	N/A	N/A	N/A
HC44702967	REPOSIT PERC VAD DEVICE INC S&I; LEFT OR RIGHT HEART DEVICE	361	33993	6,309	N/A	N/A	N/A
HC44702991	REMV&REPLC SUBQ ICD GEN ONLY	481	33262	24,345	N/A	N/A	N/A
HC44703163	OPEN REPAIR INFRARENAL AAA; FAILED ENDOGRAFT; TUBE PRO	360	34830	54,615	N/A	N/A	N/A
HC44703197	OPEN ILIAC FOR ILIAC OR AORTIC ENDOGRAFT  UNI	360	34833	23,589	N/A	N/A	N/A
HC44703379	EV REPAIR ILIAC GRFT ILIO-ILIAC AORTIC BI DIST UNILAT ~RUPT	360	34708	37,491	N/A	N/A	N/A
HC44703403	PLACMNT DELAY DISTL/PRX EXTSN INFRARENL AA ILIAC:ADD'L VSSL+	360	34711	5,228	N/A	N/A	N/A
HC44703437	OPEN FEMORAL ART CONDUIT DELIVER EV PROTH / BYPASS UNILATL+	360	34714	6,353	N/A	N/A	N/A
HC44703577	EV REPAIR NON-AORTOILIAC DEPLOY GRAFT ILIAC CATH UNILAT NON-RUPT	360	34718	26,554	N/A	N/A	N/A
HC44703601	TRANSCATH ATRIAL SEPT(TAS)CONGENTL INCLED ALL IMAG(RASHKIND)	361	33741	34,352	N/A	N/A	N/A
HC44703635	INSERT VAD PERCUT INC S&I VENOUS ONLY RIGHT	361	33995	13,736	N/A	N/A	N/A
HC44703825	PTA NATIVE/RECURRENT COARCTATION AORTA	360	33897	25,111	N/A	N/A	N/A
HC44703882	INJ PRO HRT CATH &IMAG; SELCT PULM ARTRL ANGIO BILAT+	481	93573	7,113	N/A	N/A	N/A
HC44703916	TMVI W/ PROSTH; PERC SEPTAL PUCNCT	481	0483T	33,641	N/A	N/A	N/A
HC44900116	CT CHEST DX W/ CONTRAST	352	71260	5,862	N/A	N/A	N/A
HC44900140	CT C-SPINE W/ CONTRAST	352	72126	6,705	N/A	N/A	N/A
HC44900322	CT L-SPINE W&W/O  CONTRAST	352	72133	8,183	N/A	N/A	N/A
HC44900355	CT LTD OR LOCALIZED F/U STUDY	350	76380	2,677	N/A	N/A	N/A
HC44900389	CT MAXILLO FACIAL W/O CONTRAST	351	70486	4,268	N/A	N/A	N/A
HC44900520	CT T-SPINE W/O CONTRAST	352	72128	6,500	N/A	N/A	N/A
HC44900553	CT UPPER EXT W&W/O CONTRAST RT	352	73202	6,469	N/A	N/A	N/A
HC44900587	CT UPPER EXT W/CONTRAST RT	352	73201	5,507	N/A	N/A	N/A
HC44900827	CT COLONOGRAPHY SCREEN VIRTUAL W&WO CONTRAST	350	74263	2,056	N/A	N/A	N/A
HC44900850	CT BODY SCAN LTD ABD/CHEST	350		783	N/A	N/A	N/A
HC44901049	ABLATE BONE TUMOR(S) PERQ W/CT;CRYO	361	20983	21,100	N/A	N/A	N/A
HC44901072	CT BREAST 3D RENDER UNILAT W&W/O CONTRAST	352	0635T	3,505	N/A	N/A	N/A
HC45200151	NM BRAIN IMAG VASC FLOW ONLY	341	78610	2,847	N/A	N/A	N/A
HC45200193	NM CARDIAC BP 1ST PASS(EF)MULT	341	78483	4,282	N/A	N/A	N/A
HC45200227	NM CARDIAC BP SPECT REST WM/EF	341	78494	3,285	N/A	N/A	N/A
HC45200383	NM INTRAVASCULAR RAD TX	342	79445	2,630	N/A	N/A	N/A
HC45200417	NM KIDNEY IMAG FLOW/FUNCTION	341	78707	4,185	N/A	N/A	N/A
HC45200482	NM LIVER IMAGING STATIC ONLY	341	78201	2,691	N/A	N/A	N/A
HC45200805	NM SPLEEN SCAN IMAGING ONLY	341	78185	2,306	N/A	N/A	N/A
HC45200896	NM THYROID CA METS LTD AREA	341	78015	2,893	N/A	N/A	N/A
HC45201225	MIBI PLANAR SNG STUDY W/WM &EF	341	78453	5,483	N/A	N/A	N/A
HC45201258	PULM VENTILATION & PERF IMAG	341	78582	4,538	N/A	N/A	N/A
HC45201282	HEPATOBILIARY SYSTEM IMAGING	341	78226	3,933	N/A	N/A	N/A
HC45400009	MR ABDOMEN W&W/O CONTRAST	610	74183	11,386	N/A	N/A	N/A
HC45400033	MR ABDOMEN(MRCP)W/O CONTRAST	610	74181	7,134	N/A	N/A	N/A
HC45400066	MR BRAIN W/CONTRAST	611	70552	7,847	N/A	N/A	N/A
HC83503201	IHC/IP PER SPEC INITIAL AB STAIN SOMATOSATIN -US	312	88342	N/A	N/A	N/A	N/A
HC83503235	IHC/IP PER SPEC INITIAL AB STAIN THYROGLOBULIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83503284	IHC/IP PER SPEC INITIAL AB STAIN VIMENTIN -US	312	88342	N/A	N/A	N/A	N/A
HC83503425	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-20 -US	312	88342	N/A	N/A	N/A	N/A
HC83503458	IHC/IP PER SPEC INITIAL AB STAIN EWINGS SARCOMA -IM	312	88342	N/A	N/A	N/A	N/A
HC83503482	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 13-A -US	312	88342	N/A	N/A	N/A	N/A
HC83503698	IHC/IP PER SPEC INITIAL AB STAIN SEND OUT -IM	312	88342	N/A	N/A	N/A	N/A
HC83503722	IHC/IP PER SPEC INITIAL AB STAIN SMMHC -US	312	88342	50	N/A	50	N/A
HC83503961	HISTOCHEMISTRY DETERMINATIV-ON	312	88319	N/A	N/A	N/A	N/A
HC83504001	CHROMO SOLID TUMOR-HP	310	88239	N/A	N/A	N/A	N/A
HC83504035	CHROM ANAL ADD SPEC BAND-GZ	310	88283	135	N/A	135	N/A
HC83504225	M: MISC LAB PATHOLOGY REF LAB-MA	310		328	N/A	N/A	N/A
HC83504266	M: MISC LAB PATHOLOGY REF LAB-SU	310		243	N/A	N/A	N/A
HC83504308	M: MISC LAB PATHOLOGY REF LAB-WD	310		N/A	N/A	N/A	N/A
HC83504563	HANDLING SPEC COURIER-CS	300	99001	85	N/A	85	N/A
HC83504613	M: MISC LAB PATHOLOGY REF LAB-MY	310		213	N/A	N/A	N/A
HC83504845	IHC EGFR QNT-NG	310	88360	45	N/A	59	N/A
HC83504910	MORPH STDY CAT ISH/SPEC INTL SNGL PROBE HER2-NG	310	88367	241	N/A	240	N/A
HC83505347	IHC/IP PER SPEC EA ADD AB STAIN+ -BR	310	88341	N/A	N/A	N/A	N/A
HC83505404	M: MISC LAB PATHOLOGY REF LAB-SC	310		160	N/A	N/A	N/A
HC83505438	M: MISC LAB PATHOLOGY REF LAB-CE	310		N/A	N/A	N/A	N/A
HC83505578	M: MISC LAB PATHOLOGY REF LAB-NW	310		N/A	N/A	N/A	N/A
HC83505602	IP/IHC PER SPEC INITIAL AB STAIN -CA	312	88342	148	N/A	N/A	N/A
HC83505636	BRAF MUTATION ANALYSIS-NG	310	81210	170	N/A	N/A	N/A
HC83505800	ANATOMIC CONSULT; SLIDE REV-BC	312	88321	125	N/A	N/A	N/A
HC83505834	IHC/IP PER SPEC INITIAL AB STAIN - AP	312	88342	40	N/A	N/A	N/A
HC83506006	FLOW CYT MKR CD4/CD8 BAL 1ST (PNL)-NG	311	88184	91	N/A	N/A	N/A
HC83506030	M: MISC LAB PATHOLOGY REF LAB-HS	310		N/A	N/A	N/A	N/A
HC83590414	KRAS MUT ANALYSIS VARIANTS EXONS 2-AP	310	81275	193	N/A	N/A	N/A
HC84200005	CULTURE CATH TIP	306	87070	488	N/A	95	N/A
HC84200039	CULTURE FUNGUS OTHER SOURCE	306	87102	497	N/A	100	N/A
HC84200179	CLOSTRIDIUM DIFFICILE TOXIN	306	87230	360	N/A	100	N/A
HC84200203	CULTURE VRE	306	87081	315	N/A	48	N/A
HC84200237	CULTURE GC	306	87081	315	N/A	48	N/A
HC84200401	CULT QT AEROBIC OTHER SOURCE	306	87071	477	N/A	131	N/A
HC84200435	TRICHROME STAIN CMPLX OVA/PARA	300	87209	355	N/A	91	N/A
HC84200625	SPECIAL STAIN THICK	306	87015	180	N/A	39	N/A
HC84200658	CULTURE PERTUSSIS	306	87081	315	N/A	42	N/A
HC84200682	CULTURE MYCOPLASMA ANY SOURCE	306	87109	420	N/A	78	N/A
HC84200831	CHLAMYDIA FA ANTIGEN	306	87270	337	N/A	96	N/A
HC84200864	INFLUENZA B FA ANTIGEN	306	87275	343	N/A	103	N/A
HC84200898	RESPIRATORY SYNCTAL VIRUS AG	306	87280	269	N/A	50	N/A
HC84201060	CRYPTOSPORIDIUM	306	87328	228	N/A	45	N/A
HC84201102	CLOTEST FOR H. PYLORI	306	87077	376	N/A	41	N/A
HC84201334	M. PNEUMONIAE BY PCR (RVP PNL)	306	87581	586	N/A	150	N/A
HC84201367	CULTURE CARBAPENEM RESIST ENTER	306	87081	315	N/A	48	N/A
HC84201532	DNA/RNA N MENINGITIDIS PCR(PNL)	306	87798	524	N/A	150	N/A
HC84201565	DNA/RNA HUMAN PARECHOVIRUS PCR(PNL)	306	87798	537	N/A	150	N/A
HC84201599	DNA/RNA STREP A AMP PROBE(XPERT XPRESS)	306	87651	523	N/A	150	N/A
HC84201730	DNA/RNA STAPHYLOCOCCUS AUREUS (PNL)	306	87798	483	N/A	150	N/A
HC84201763	DNA/RNA STREPTOCOCCUS PYOGENES (PNL)	306	87798	483	N/A	150	N/A
HC84201797	DNA/RNA MYCOPLASMA PNEUMONIAE (PNL)	306	87581	293	N/A	75	N/A
HC84290121	P: PNEUMONIA PANEL BY PCR			N/A	N/A	N/A	N/A
HC84600022	CYTOLOGY FILTER ONLY	311	88106	254	N/A	143	N/A
HC84600204	CYTO SMEAR NON GYN S&I-DIS SVC	311	88160	368	N/A	109	N/A
HC84600238	FNA INTERPR/REPORT-DIST SVC	311	88173	595	N/A	300	N/A
HC84600550	FNA INTERPRETATION/REPORT *OP	311	88173	365	N/A	70	N/A
HC85100469	WBC MANUAL DIFF	305	85007	32	N/A	N/A	N/A
HC85100493	RETICULOCYTE MANUAL	305	85044	46	N/A	N/A	N/A
HC88600200	AP TRANSPORT CHARGE	309	99001	68	N/A	34	N/A
HC88600242	SPECIAL COURIER       40	300	99001	51	N/A	40	N/A
HC88600283	SPECIAL COURIER-MISC	300	99001	N/A	N/A	N/A	N/A
HC89000137	PSA TOTAL-QD	301	84153	52	N/A	52	N/A
HC89000160	HERPES 1&2 IGM AB (PNL)-FT	302	86694	70	N/A	70	N/A
HC89000343	A-1 ANTITRYPSIN PHENOTYPE-QD	301	82104	N/A	N/A	N/A	N/A
HC89000376	DHEA-QD	301	82626	13	N/A	12	N/A
HC89000400	UA QUAL/SEMI QUAN MELANIN-AU	301	81005	9	N/A	9	N/A
HC89000541	EPSTEIN BARR VIR DNA PCR-AU	306	87798	65	N/A	75	N/A
HC89000574	ANTI-DNASE B-AU	302	86215	7	N/A	11	N/A
HC89000608	IMMUNOGLOB G INDEX(PNL)-AU	301	82784	6	N/A	7	N/A
HC89000764	SEROTONIN-QD	301	84260	17	N/A	17	N/A
HC89000798	PORPHYRINS FRACT URINE-QD	301	84120	75	N/A	75	N/A
HC89000830	ANTI CENTROMERE-QD	302	86038	18	N/A	18	N/A
HC89001028	RAST-INDIVIDUAL-QD	302	86003	9	N/A	9	N/A
HC89001051	CYCLIC AMP-QD	301	82030	N/A	N/A	N/A	N/A
HC89001234	BILE ACIDS TOTAL-QD	301	82239	N/A	N/A	N/A	N/A
HC89001267	HISTAMINE-QD	301	83088	N/A	N/A	N/A	N/A
HC89001309	BLASTOMYCES AB-QD	302	86612	17	N/A	17	N/A
HC89001499	CRYPTOCOCCUS AB-QD	302	86641	18	N/A	18	N/A
HC89001523	POLIOVIRUS-QD	302	86658	13	N/A	13	N/A
HC89001556	CULTURE MYCOPLASMA-U2	306	87109	N/A	N/A	N/A	N/A
HC89001788	ANTI-DNA ANTIBODIES (SS)-SL	302	86226	N/A	N/A	N/A	N/A
HC89001820	FETAL FIBRONECTIN-U2	301	82731	N/A	N/A	N/A	N/A
HC89002018	VASOACTIVE INTEST PEPTIDE-QD	301	84586	25	N/A	24	N/A
HC89002042	METHOTREXATE-QD	301	80204	60	N/A	60	N/A
HC89002232	MEXILETINE-QD	301	80299	60	N/A	60	N/A
HC89002265	CHLAMYDIA AB IGM-QD	302	86632	19	N/A	19	N/A
HC89002299	SULFATIDE AB-SL	301	83520	N/A	N/A	N/A	N/A
HC89002489	HIV-1 RNA QUANT BY PCR-SL	306	87536	N/A	N/A	N/A	N/A
HC89002513	HEPATITIS B DNA BY PCR-SL	306	87517	N/A	N/A	N/A	N/A
HC89002547	MYOGLOBIN URINE-QD	301	83874	16	N/A	15	N/A
HC89002802	HU FA AB SCRN-QD	302	86255	16	N/A	16	N/A
HC89002836	ARSENIC URINE-QD	301	82175	63	N/A	62	N/A
HC89003008	CATECHOLAMINES TOTAL URINE-QD	301	82382	14	N/A	14	N/A
HC89003032	PROPAFENONE-QD	301	80299	60	N/A	60	N/A
HC89003065	QUINIDINE-U2	301	80194	N/A	N/A	N/A	N/A
HC89003206	IMMUNO ELECT-QD	302	86334	15	N/A	15	N/A
HC89003230	PROTEIN ELECT FRACT&QT UR-QD	301	84166	13	N/A	13	N/A
HC89003263	VDRL CSF-QD	302	86592	11	N/A	11	N/A
HC89003404	FACTOR XIII ASSAY-U2	305	85290	N/A	N/A	N/A	N/A
HC89003438	FACTOR VIII VW-U2	305	85245	N/A	N/A	N/A	N/A
HC89003461	EBV AB-VIRAL CAPSID AG-QD	302	86665	25	N/A	25	N/A
HC89003651	FLECAINIDE-QD	301	80181	60	N/A	60	N/A
HC89003685	CHLAMYDIA AB-QD	302	86631	N/A	N/A	N/A	N/A
HC89003891	LIDOCAINE-U2	301	80176	38	N/A	38	N/A
HC89003925	FLOW CYTOMETRY EA BLOOD-U2	311	88182	N/A	N/A	N/A	N/A
HC89003958	CHROM ANALYSIS BONE MARROW-GC	310	88237	517	N/A	517	N/A
HC89004097	OSTEOCALCIN-AU	301	83937	16	N/A	16	N/A
HC89004121	FIBRINOGEN ANTIGEN-AU	305	85385	39	N/A	39	N/A
HC89004154	PHOSPHOLIPIDS - AU	301	84311	25	N/A	20	N/A
HC89004410	HTLV I/II AB  WESTERN BLOT-AU	302	86689	79	N/A	78	N/A
HC89004444	ENCEPHALITIS CALIF AB (PNL)-AU	302	86651	19	N/A	18	N/A
HC89004659	NSNAII IGG DNASE 1ST STAIN(PNL)-PR	310	88346	98	N/A	98	N/A
HC89004683	ANTI-SM AB (PNL2)-RD	302	86235	24	N/A	24	N/A
HC89004857	ESTROGENS  FRACTIONATED TMS-AU	301	82671	25	N/A	20	N/A
HC89004881	PTT-D CORR RFX- AU	305	85732	11	N/A	11	N/A
HC89004915	M: MISC LAB GENERAL REF LAB-GE	300		N/A	N/A	N/A	N/A
HC89005052	CALCIUM IONIZED-AU	301	82330	9	N/A	9	N/A
HC89005086	INFECT AGNT-VARIC ZSTR PCR-FT	306	87798	224	N/A	268	N/A
HC89005110	B BURGDORFERI C6 PEP RFLX-FT	302	86618	93	N/A	93	N/A
HC89005284	BORDETELLA PERTUS PT IGG-FT	302	86615	41	N/A	41	N/A
HC89005318	BORDETELLA PERTUS FHA IGA-FT	302	86615	41	N/A	41	N/A
HC89005490	MYELOPEROXIDASE AB (MPO)-AU	301	83516	13	N/A	14	N/A
HC89005524	ECHOVIRUS 4 AB-FT	302	86658	26	N/A	25	N/A
HC89005698	STREPTOCOCCUS GRP B ANTIGEN-FT	302	86403	81	N/A	80	N/A
HC89005722	N. MENINGITIDIS GRP C/W135-FT	302	86403	84	N/A	83	N/A
HC89005755	MOLECUL CYTO DNA PROBE FISH-GC	310	88271	N/A	N/A	N/A	N/A
HC89006159	AMPHETAMINE 1-2-AU	301	80324	31	N/A	N/A	N/A
HC89006191	METHADONE &METABOLITE QUANT URINE-AU	301	80358	36	N/A	39	N/A
HC89006258	CANNABINOIDS  NATURAL(THC)-AU	301	80349	20	N/A	N/A	N/A
HC89006548	NORTRIPTYLINE; 1-2-AU	301	80335	17	N/A	14	N/A
HC89006571	PRIMIDONE-AU	301	80188	5	N/A	8	N/A
HC89006753	ISONIAZID-NM	301	80299	90	N/A	90	N/A
HC89006787	MAPROTILINE/LUDIOMIL-QN	301	80299	N/A	N/A	N/A	N/A
HC89006829	MEXILETINE-AU	301	80299	29	N/A	29	N/A
HC89006977	BETA HYDROXYBUTYRATE-AU	301	82010	N/A	N/A	N/A	N/A
HC89007009	ACTH-ES	301	82024	88	N/A	87	N/A
HC89007074	ALBUMIN SERUM/PLASMA NEPHELOMETRY-AU	301	82040	12	N/A	23	N/A
HC89007249	DELTA OD 450-U2	301	82143	16	N/A	16	N/A
HC89007272	APOLIPOPROTEIN A-1 AU	301	82172	11	N/A	15	N/A
HC89007454	CHOLINESTERASE-AU	301	82480	14	N/A	13	N/A
HC89007488	CHROMATOGRAPHY QUAL-AU	301	83789	120	N/A	120	N/A
HC89007819	VIT B12 BINDING CAPACITY-AU	301	82608	22	N/A	17	N/A
HC89007843	DHEA SULFATE-ES	301	82627	50	N/A	48	N/A
HC89007876	DEOXYCORTISOL 11-ES	301	82634	170	N/A	74	N/A
HC89008023	FECAL FAT QUANT-AU	301	82710	100	N/A	100	N/A
HC89008056	FLUORIDE URINE-AU	301	82735	N/A	N/A	N/A	N/A
HC89008106	GALACTOSE-1-PHOS URIDYL TR-AU	301	82775	75	N/A	74	N/A
HC89008288	HAPTOGLOBIN QUANT-AU	301	83010	16	N/A	16	N/A
HC89008312	HEAVY METAL QN EA;THALLIUM-AU	301	83018	N/A	N/A	N/A	N/A
HC89008486	17 OH PROGESTERONE-ES	301	83498	65	N/A	58	N/A
HC89008510	SERINE PROTEASE3 IGG IMMUNOASSAY-AU	301	83516	13	N/A	14	N/A
HC89008692	ADRENOGENITAL-QN	301	83520	N/A	N/A	N/A	N/A
HC89008726	GM1 AUTO AB-AU	301	83520	N/A	N/A	N/A	N/A
HC89008759	INSULIN TOTAL-QD	301	83525	N/A	N/A	N/A	N/A
HC89008908	VLDL CHOLESTEROL-AU	301	83719	16	N/A	16	N/A
HC89008940	BILE ACID FRACTIONATED-AU	301	83789	205	N/A	205	N/A
HC89008981	MERCURY BLOOD-AU	301	83825	10	N/A	11	N/A
HC89009401	ORGANIC ACIDS TOT QUANT UR-QD	301	83918	242	N/A	242	N/A
HC89009435	MEPERIDINE ANLG; 1-2 SRM/PLSM-AU	301	80361	83	N/A	83	N/A
HC89009625	PHOSPHATIDYL GLYCEROL-AU	301	84081	N/A	N/A	N/A	N/A
HC89009658	PORPHYRINS QUAL URINE-AU	301	84119	N/A	N/A	N/A	N/A
HC89009682	17-HYDROXYPREGNENOLONE-AU	301	84143	30	N/A	N/A	N/A
HC89009823	VITAMIN B-2-AU	301	84252	33	N/A	176	N/A
HC89009856	SEX HORMONE BINDING GLOB-ES	301	84270	48	N/A	48	N/A
HC89009880	SODIUM OTHER SOURCE-AU	301	84302	14	N/A	13	N/A
HC89010029	T4 FREE-AU	301	84439	30	N/A	30	N/A
HC89010052	THYROID STIM IMMUNOGLOB-AU	301	84445	39	N/A	45	N/A
HC89010086	TRANSFERRIN-AU	301	84466	16	N/A	16	N/A
HC89010268	VOLATILES-NM	301	84600	N/A	N/A	N/A	N/A
HC89010292	C PEPTIDE-ES	301	84681	50	N/A	50	N/A
HC89010490	M: MISC LAB GENERAL REF LAB-MA	300		190	N/A	N/A	N/A
HC89010524	M: MISC LAB GENERAL REF LAB-PS	300		N/A	N/A	N/A	N/A
HC89010557	M: MISC LAB GENERAL REF LAB-RD	300		N/A	N/A	N/A	N/A
HC89010698	EUGLOBULIN CLOT LYSIS-AU	305	85360	N/A	N/A	N/A	N/A
HC89010722	LEUKOCYTE ALKALINE PHOS-AU	305	85540	60	N/A	60	N/A
HC89010755	OSMOTIC FRAGILITY UNINCUBAT-AU	305	85555	73	N/A	75	N/A
HC89010920	PLATELET ASSOCIATED ABS-AU	302	86023	29	N/A	33	N/A
HC89010953	ANTI-CARDIOLIPIN AB-AU	302	86147	16	N/A	16	N/A
HC89011134	ANTI-DNA ANTIBODIES (DS)-RD	302	86225	13	N/A	13	N/A
HC89011175	ANTI JO 1-SL-AU	302	86235	N/A	N/A	N/A	N/A
HC89011340	RNP AB IGG-AU	302	86235	16	N/A	16	N/A
HC89011373	SCLERODERMA SCL-70 AB IGG-AU	302	86235	16	N/A	16	N/A
HC89011407	SSA REFLEX (PNL)-AU	302	86235	16	N/A	16	N/A
HC89011555	RIBOSOMAL P PROTEIN AB-AU	302	83516	17	N/A	14	N/A
HC89011589	ECHINOCOCCUS AB IHA-FT	302	86280	N/A	N/A	N/A	N/A
HC89011613	CANCER AG 15-3-AU	302	86300	10	N/A	10	N/A
HC89011787	TEICHOIC ACID AB (ID)-AU	302	86329	25	N/A	16	N/A
HC89011811	TEICHOIC ACID AB (GID)-AU	302	86331	N/A	N/A	N/A	N/A
HC89011985	ECHOVIRUS-AU	302	86382	N/A	N/A	N/A	N/A
HC89012017	CANDIDA AB-FT	302	86403	16	N/A	16	N/A
HC89012041	RHEUMATOID FACTOR-AU	302	86431	9	N/A	9	N/A
HC89012181	CANDIDA AB-FT	302	86628	16	N/A	16	N/A
HC89012215	COCCIDIOIDES AB SERUM -AU	302	86635	9	N/A	11	N/A
HC89012249	CRYPTOCOCCUS AB-AU	302	86641	75	N/A	74	N/A
HC89012389	COXSACKIE A AB (PNL)-FT	302	86658	22	N/A	22	N/A
HC89012413	COXSACKIE B AB-AU	302	86658	116	N/A	115	N/A
HC89012447	POLIOVIRUS AB (PNL)-AU	302	86658	39	N/A	99	N/A
HC89012611	HEPATITIS DELTA AB-AU	302	86692	14	N/A	8	N/A
HC89012645	HERPES SMPLX I GLYC AB(PNL)-AU	302	86695	6	N/A	6	N/A
HC89012819	PARVOVIRUS B19 AB (PNL)-AU	302	86747	14	N/A	17	N/A
HC89012843	ROCKY MT  SPOTTED FEVER AB-AU	302	86757	13	N/A	31	N/A
HC89012876	MEASLES (RUBEOLA) AB (CSF)-AU	302	86765	N/A	N/A	N/A	N/A
HC89013015	THYROGLOBULIN AB-AU	302	86800	8	N/A	9	N/A
HC89013049	HLA-A AND B PHENOTYPE-AU	302	86813	180	N/A	180	N/A
HC89013072	CULTURE CLOSTRIDUIM FECAL-AU	306	87075	N/A	N/A	N/A	N/A
HC89013247	CHLAMYDIA TRACHOMATIS AMP-AU	306	87491	15	N/A	27	N/A
HC89013270	HEPATITIS C PCR QUAL-AU	306	87521	66	N/A	66	N/A
HC89013445	NEURONTIN-AU	301	80299	N/A	N/A	N/A	N/A
HC89013478	ANDROSTENEDIONE-AU	301	82157	24	N/A	35	N/A
HC89013650	GLIADIN AB IGA-AU	301	86258	11	N/A	11	N/A
HC89013684	LIPASE-AU	301	83690	26	N/A	26	N/A
HC89013718	NEPHELOMETRY EA ANALYT(PNL)-AU	302	83883	N/A	N/A	N/A	N/A
HC89013965	T4/THYROXINE-ES	301	84436	20	N/A	20	N/A
HC89013999	T3 TOTAL-ES	301	84480	33	N/A	32	N/A
HC89014021	ALLERGEN-AU	302	86003	7	N/A	7	N/A
HC89014211	ANTI-SMOOTH MUSCLE TITER AB-AU	302	86256	34	N/A	40	N/A
HC89014245	IMMUNOFIX ELECTROPH UR(PNL)-AU	302	86334	N/A	N/A	N/A	N/A
HC89014443	MEASLES (RUBEOLA)(PNL) IGM-AU	302	86765	14	N/A	10	N/A
HC89014476	FLUORESCENT TREPONMAL ABCSF-AU	302	86780	11	N/A	11	N/A
HC89014641	VIRUS TEST ADDITIONAL-U2	306	87253	N/A	N/A	N/A	N/A
HC89014682	LEGIONELLA AG URINE-AU	306	87449	15	N/A	16	N/A
HC89014716	HSV BY PCR(CSF)-AU	306	87529	55	N/A	55	N/A
HC89014864	FLOW CYT MKR TC 1ST-US	311	88184	N/A	N/A	N/A	N/A
HC89014898	CHROM ANAL-TISSUE-TISSU CUL-GZ	310	88233	252	N/A	185	N/A
HC89014922	CHROM ANALYSIS BONE MARROW-GZ	311	88237	110	N/A	110	N/A
HC89015093	MYCOPHENOLIC ACID-AU	301	80180	24	N/A	20	N/A
HC89015127	NK CELL TOTAL COUNT-U2	302	86357	N/A	N/A	N/A	N/A
HC89015325	A-1 ANTITRYPSIN-QD	301	82103	18	N/A	18	N/A
HC89015358	N-TELOPEPTIDE CROSSLINK UR-QD	301	82523	29	N/A	29	N/A
HC89015382	ESTRIOL-QD	300	82677	10	N/A	10	N/A
HC89015523	VITAMIN B-2-QD	301	84252	14	N/A	14	N/A
HC89015556	THYROID STIM IMMUNOGLOB-QD	301	84445	26	N/A	26	N/A
HC89015580	T3 FREE-QD	301	84481	10	N/A	10	N/A
HC89015754	RHEUMATOID FACTOR-QD	302	86431	20	N/A	20	N/A
HC89015788	HELICOBACTER PYLORI AB-QD	302	86677	25	N/A	25	N/A
HC89015952	LEGIONELLA AG URINE-QD	306	87449	22	N/A	22	N/A
HC89015986	INHIBIN A-QD	302	86336	12	N/A	12	N/A
HC89016158	COMPLEMENT TOTAL HEMOLYTIC-QD	302	86162	16	N/A	16	N/A
HC89016182	CULTURE STOOL ADDL PATH-QD	306	87046	16	N/A	16	N/A
HC89016216	FIBRIN SPLIT PRODUCTS-QD	305	85362	4	N/A	4	N/A
HC89016356	CULTURE FUNGUS BLOOD-QD	306	87103	8	N/A	8	N/A
HC89016398	TOTAL PROTEIN UR-AU	301	84156	7	N/A	5	N/A
HC89016430	FLOW CYT MKR TC 1ST-AU	311	88184	18	N/A	17	N/A
HC89016711	NBS TANDEM MASS SPEC MS/MS-GE	301	83789	18	N/A	16	N/A
HC89016745	FACTOR VIII ASSAY-AU	305	85240	20	N/A	20	N/A
HC89016943	HIV GENE SEQ-VI	306	87901	495	N/A	495	N/A
HC89016976	HIV PHENOTYP EACH ADDL(PNL)-VI	306	87904	40	N/A	40	N/A
HC89017149	ALLERGEN SPECIFIC IGE  EACH-IB	302	86003	419	N/A	419	N/A
HC89017172	HISTOPLASMA AG-AU	306	87385	60	N/A	110	N/A
HC89017206	PTH RELATED PROTEIN-AU	301	83519	N/A	N/A	N/A	N/A
HC89017347	LYME AB IGG & IGM BY WB-AU	302	86617	42	N/A	42	N/A
HC89017370	GLIADIN AB IGG-AU	302	86258	11	N/A	11	N/A
HC89017404	H. PYLORI BREATH (& KIT)-AU	301	83013	77	N/A	77	N/A
HC89017578	HSV AB IGG(PNL)-AU	302	86694	13	N/A	12	N/A
HC89017602	ARSENIC URINE (PNL)-AU	301	82175	13	N/A	27	N/A
HC89017792	CULTURE CHLAMYDIA(PNL)-AU	306	87110	23	N/A	23	N/A
HC89017883	MICRODISSECTION  MANUAL-NG	310	88381	258	N/A	257	N/A
HC89017933	M: MISC LAB GENERAL REF LAB-WD	300		N/A	N/A	N/A	N/A
HC89018097	WEST NILE VIR AB IGM  CSF-AU	302	86788	18	N/A	17	N/A
HC89018121	CREATININE OTHER SRC (PNL)-QD	301	82570	98	N/A	98	N/A
HC89018154	ANNEXIN AB V IGG -EC	301	83516	93	N/A	93	N/A
HC89018295	FACTOR IX ASSAY -EC	305	85250	163	N/A	163	N/A
HC89018329	FACTOR VII ASSAY-EC	305	85230	145	N/A	145	N/A
HC89018352	FACTOR XII ASSAY -EC	305	85280	163	N/A	163	N/A
HC89018659	CHROM ANAL TISSUE CULT  AF-AU	310	88235	183	N/A	241	N/A
HC89018691	MOLECUL CYTO DNA PROBE FISH-AU	310	88271	85	N/A	69	N/A
HC89019277	FACTOR VIII INHIBITOR-OS	305	85335	90	N/A	90	N/A
HC89019301	PM/SCL-100 AB  IGG-AU	301	86235	73	N/A	72	N/A
HC89019434	FATTY ACID PROFILE  COMP -MA	301	82542	130	N/A	130	N/A
HC89019707	THYROGLOBULIN BY LC/MS/MS-AU	301	84432	60	N/A	69	N/A
HC89019756	OXYCODONE CONFIRM URINE -AU	301	80365	10	N/A	39	N/A
HC89019780	QUANT HPLC 6-TGN RBC(P THIOPUR)-PR	301	82542	108	N/A	108	N/A
HC89020044	HLA-DQA1(PNL 6260/6360)-PR	301	81382	260	N/A	260	N/A
HC89020077	ASCA ELISA IGA SPECIFIC(PNL) -PR	301	83520	20	N/A	20	N/A
HC89020242	STAT3 SNP (RS744166)(PNL)-PR	301	81479	14	N/A	47	N/A
HC89020275	LACTASE  (DISACCHARIDASE)-AU	301	82657	38	N/A	55	N/A
HC89020457	C-TELOPEPTIDE BETA-X-LINKED-AU	301	82523	40	N/A	84	N/A
HC89020481	BENZODIAZEPINES ;13 OR > URINE-AU	301	80347	43	N/A	39	N/A
HC89020515	ISONIAZID -AU	301	80299	102	N/A	101	N/A
HC89020945	PANCREATIC ELASTERASE FEC-AU	301	83520	70	N/A	75	N/A
HC89020978	ECHOVIRUS AB TYPE 7-AU	302	86658	25	N/A	18	N/A
HC89021000	ECHOVIRUS AB TYPE 30-AU	302	86658	25	N/A	18	N/A
HC89021174	FACTOR VIII ACTIVITY -EC	305	85240	163	N/A	163	N/A
HC89021216	MAG AUTOANTIBODY-AT	301	83520	285	N/A	273	N/A
HC89021398	M: MISC LAB GENERAL REF LAB-FL	300		120	N/A	N/A	N/A
HC89021422	HIV 2 AB -AU	302	86702	38	N/A	62	N/A
HC89021455	CONCENTRATION AGNT INF SPECIMEN -AU	306	87015	35	N/A	35	N/A
HC89021612	DRUGS OF ABUSE SCR STIM AMINES URINE-AU	301	80307	17	N/A	N/A	N/A
HC89021646	DRUGS OF ABUSE SCRN MEC W-RFLX CONF(PNL)-AU	301	80307	30	N/A	N/A	N/A
HC89021679	BENZODIAZEPINES; 1-12 MEC(PNL)-AU	301	80346	129	N/A	N/A	N/A
HC89021950	PNEUMOCYSTIS JIROVECII DFA-AU	306	87299	37	N/A	N/A	N/A
HC89021984	LEVETIRACETAM (KEPPRA) -AU	301	80177	33	N/A	N/A	N/A
HC89022024	DRUG SCRN 9 SERUM W-RFLX CONF(PNL)-AU	301	80307	51	N/A	N/A	N/A
HC89022198	M: MISC LAB GENERAL REF LAB-BP	300		65	N/A	N/A	N/A
HC89022222	M: MISC LAB GENERAL REF LAB-FG	300		N/A	N/A	N/A	N/A
HC89022404	FLOW CYT LEUK/LYMPH MRKRS ADD+-AU	311	88185	15	N/A	N/A	N/A
HC89022438	CULTURE VIRUS NON-RESPIRATORY-AU	306	87252	49	N/A	N/A	N/A
HC89022461	CULTURE PRESUMPTIVE ID HSV(PNL)-AU	306	87252	16	N/A	N/A	N/A
HC89022610	DEOXYCORTICOSTERONE (DOC)-QN	301	82633	215	N/A	N/A	N/A
HC89022644	17-HYDROXYPREGNENOLONE-QN	301	84143	65	N/A	N/A	N/A
HC89022677	M: MISC LAB GENERAL REF LAB-SS	300		N/A	N/A	N/A	N/A
HC89022867	M: MISC LAB GENERAL REF LAB-NM	300		139	N/A	N/A	N/A
HC89022891	BILIRUBIN  TOTAL BODY FLUID-AU	301	82247	9	N/A	N/A	N/A
HC89023063	ANAL' GENE TPMT COMMON VARIANT-AU	310	81335	76	N/A	N/A	N/A
HC89023097	ANTI-DNA ANTIBODIES SNGL STRND-QI	302	86226	130	N/A	N/A	N/A
HC89023261	TOTAL PROTEIN URINE (IFE)-AU	301	84156	10	N/A	N/A	N/A
HC89023295	SARS-COV-2 RNA QUAL RT-PCR-AU	302	87635	95	N/A	N/A	N/A
HC89023329	B-TYPE NATRIURETIC PEPTIDE-AU	301	83880	60	N/A	N/A	N/A
HC89023477	HSV TYPE 1 &/OR 2AB IGG PNL)-AU	302	86694	13	N/A	N/A	N/A
HC89023501	ISLET AB ZINC TRANSPORTER 8-AU	302	86341	205	N/A	N/A	N/A
HC89023543	ACYLCARNITINES QUANT-AU	301	82017	109	N/A	N/A	N/A
HC89023717	TOTAL PROTEIN BODY FLUID-AU	301	84157	8	N/A	N/A	N/A
HC89023741	ORTHOPOXVIRUS (MONKEYPOX) PCR-AU	306	87593	85	N/A	N/A	N/A
HC89023931	MONONUC CELL ANTIGEN(I)CD59-DEF RBC-AU	302	86356	29	N/A	N/A	N/A
HC89023964	MONONUC CELL ANTGN FLAER&CD157-DEF NEUTROPHIL-AU	302	86356	29	N/A	N/A	N/A
HC89090070	P:CHROMOSOME ANALYSIS POC-GZ			N/A	N/A	N/A	N/A
HC89090104	P:CHROMOSOME ANALYSIS AMNIO-GZ			N/A	N/A	N/A	N/A
HC89090138	P:CMV AB IGG IGM-AU			N/A	N/A	N/A	N/A
HC89090294	P:FLUORIDE URINE-AU			N/A	N/A	N/A	N/A
HC89090351	P:IBD SEROLOGY 7 (1007)-PR			N/A	N/A	N/A	N/A
HC89090393	P:LIBRIUM & NORDIAZEPAM			N/A	N/A	N/A	N/A
HC89090591	P:PNEUMOCOCCAL AB-AU			N/A	N/A	N/A	N/A
HC89090625	P:RUBELLA IGG/IGM-AU			N/A	N/A	N/A	N/A
HC89090807	P:PARAINFLUENZA ANTIBODIES-AU			N/A	N/A	N/A	N/A
HC89090898	P: MICROSPORIDIA-MOD TRICHRM-AU			N/A	N/A	N/A	N/A
HC89090930	P: CHROMO ANALYSIS POC-GZ			N/A	N/A	N/A	N/A
HC89091177	P: IBD SGI DX 2013 (CAT #1800) -PR			N/A	N/A	N/A	N/A
HC89091227	P: GM1 AUTO ANTIBODY-AT			N/A	N/A	N/A	N/A
HC89091276	ALBUMIN; OTHER SRC - AU	301	82042	6	N/A	6	N/A
HC89091474	P: RX OF ABUSE MEC POS RFLX CONFIRM AMPHTMINS-MDA MDEA MDMA -AU			N/A	N/A	N/A	N/A
HC89091508	P: DISACCHARIDASE TISSUE-AU			N/A	N/A	N/A	N/A
HC89500326	AUTO/DD BLD/COMP PROC/STOR-UCI	300	86890	773	N/A	773	N/A
HC89500433	SERUM PRETREATMNT/ABSORP-SB	302	86978	70	N/A	57	N/A
HC89500714	IRRADIATION EA UNIT-SB	300	86945	40	N/A	40	N/A
HC89500839	CMV IGM / UNIT-HC	302	86645	40	N/A	40	N/A
HC89500953	HEMOGLOBIN SICKLE TESTING-SB	305	85660	46	N/A	N/A	N/A
HC91000204	R&B INTENSIVE CARE	200		14,877	N/A	N/A	N/A
HC91000331	R&B STANDARD	121		5,844	N/A	N/A	N/A
HC91200133	R&B NURSERY LEVEL EOL	170		1,155	N/A	N/A	N/A
HC65001258_00338004902	NONCDM CHARGE RECORD PHARMACY	258	J7050	20	N/A	N/A	N/A
HC65001258_00338004910	NONCDM CHARGE RECORD PHARMACY	258	J7050	10	N/A	N/A	N/A
HC65001258_00338004931	NONCDM CHARGE RECORD PHARMACY	258	J7050	13	N/A	N/A	N/A
HC65001258_00338055118	NONCDM CHARGE RECORD PHARMACY	258	J7060	36	N/A	N/A	N/A
HC65001258_00338068304	NONCDM CHARGE RECORD PHARMACY	636	J7070	62	N/A	N/A	N/A
HC65001258_00338080304	NONCDM CHARGE RECORD PHARMACY	636	J7042	29	N/A	N/A	N/A
HC65001258_00409798303	NONCDM CHARGE RECORD PHARMACY	258	J7040	35	N/A	N/A	N/A
HC65001258_00409798361	NONCDM CHARGE RECORD PHARMACY	636	J7050	34	N/A	N/A	N/A
HC65001258_00990792225	NONCDM CHARGE RECORD PHARMACY	636	J7060	34	N/A	N/A	N/A
HC65001258_00990792313	NONCDM CHARGE RECORD PHARMACY	258	J7060	14	N/A	N/A	N/A
HC65001258_00990798361	NONCDM CHARGE RECORD PHARMACY	258	J7030	12	N/A	N/A	N/A
HC65001258_00990798420	NONCDM CHARGE RECORD PHARMACY	258	J7050	14	N/A	N/A	N/A
HC65001258_00990798437	NONCDM CHARGE RECORD PHARMACY	258	J7050	12	N/A	N/A	N/A
HC65001258_06332362461	NONCDM CHARGE RECORD PHARMACY	258	J7060	14	N/A	N/A	N/A
HC65001258_06521923825	NONCDM CHARGE RECORD PHARMACY	258	J7060	21	N/A	N/A	N/A
HC65001258_07629700131	NONCDM CHARGE RECORD PHARMACY	258	J7050	32	N/A	N/A	N/A
HC65002250_00264785000	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65002250_00338004747	NONCDM CHARGE RECORD PHARMACY	250		69	N/A	N/A	N/A
HC65002250_00990614309	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002250_00990713809	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002250_00990782808	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65002258_00338071906	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65002258_00409767009	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002258_00990712007	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65002636_00065064725	NONCDM CHARGE RECORD PHARMACY	636	Z7610	515	N/A	N/A	N/A
HC65002636_00074057622	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,630	N/A	N/A	N/A
HC65002636_00078068515	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,265	N/A	N/A	N/A
HC65002636_00173069504	NONCDM CHARGE RECORD PHARMACY	636	J3490	986	N/A	N/A	N/A
HC65002636_00173071522	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,422	N/A	N/A	N/A
HC65002636_00527213335	NONCDM CHARGE RECORD PHARMACY	636	J3490	160	N/A	N/A	N/A
HC65002636_00591231215	NONCDM CHARGE RECORD PHARMACY	636	J3490	976	N/A	N/A	N/A
HC65002636_00597010051	NONCDM CHARGE RECORD PHARMACY	636	J3490	487	N/A	N/A	N/A
HC65002636_01671450201	NONCDM CHARGE RECORD PHARMACY	636	J3490	361	N/A	N/A	N/A
HC65002636_01671488501	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,192	N/A	N/A	N/A
HC65002636_01672948601	NONCDM CHARGE RECORD PHARMACY	636	J8610	3	N/A	N/A	N/A
HC65002636_02502112720	NONCDM CHARGE RECORD PHARMACY	636	J0713	1	N/A	N/A	N/A
HC65002636_03172274920	NONCDM CHARGE RECORD PHARMACY	636	J3490	38	N/A	N/A	N/A
HC65002636_04733589272	NONCDM CHARGE RECORD PHARMACY	636	Z7610	457	N/A	N/A	N/A
HC65002636_04988416111	NONCDM CHARGE RECORD PHARMACY	636	J3490	487	N/A	N/A	N/A
HC65002636_05789415012	NONCDM CHARGE RECORD PHARMACY	636	J3490	590	N/A	N/A	N/A
HC65002636_05967660012	NONCDM CHARGE RECORD PHARMACY	636	J3490	0	N/A	N/A	N/A
HC65002636_06050505824	NONCDM CHARGE RECORD PHARMACY	636	J3490	270	N/A	N/A	N/A
HC65002636_06131454703	NONCDM CHARGE RECORD PHARMACY	636	J3490	86	N/A	N/A	N/A
HC65002636_06131463710	NONCDM CHARGE RECORD PHARMACY	636	J3490	575	N/A	N/A	N/A
HC65002636_06233250503	NONCDM CHARGE RECORD PHARMACY	636	J3490	257	N/A	N/A	N/A
HC65002636_06516291446	NONCDM CHARGE RECORD PHARMACY	636	J3490	46	N/A	N/A	N/A
HC65002636_06699307896	NONCDM CHARGE RECORD PHARMACY	636	J3490	864	N/A	N/A	N/A
HC65002636_06868204550	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,901	N/A	N/A	N/A
HC65002636_06868265520	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1,972	N/A	N/A	N/A
HC65002636_07347330370	NONCDM CHARGE RECORD PHARMACY	636	J3490	585	N/A	N/A	N/A
HC65002636_07820612602	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,411	N/A	N/A	N/A
HC65002636_08065183150	NONCDM CHARGE RECORD PHARMACY	636	J3490	704	N/A	N/A	N/A
HC65004250_00143950910	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65004250_00143966010	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65004250_00143968410	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65004250_00338081909	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65004250_00338105548	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65004250_00409212288	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65004250_00409317802	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65004250_00409318201	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65004250_00409488799	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65004250_00409488820	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_00409492834	NONCDM CHARGE RECORD PHARMACY	250		72	N/A	N/A	N/A
HC65004250_00409781137	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65004250_00409955805	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65004250_00409955850	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65004250_00781322095	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65004250_00990712007	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_03982211001	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65004250_04202310401	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65004250_04202311510	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65004250_05175420014	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65004250_05175450114	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65004250_05464356491	NONCDM CHARGE RECORD PHARMACY	250		70	N/A	N/A	N/A
HC65004250_06332309330	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65004250_06332317015	NONCDM CHARGE RECORD PHARMACY	250		121	N/A	N/A	N/A
HC65004250_06332348717	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65004250_06332348831	NONCDM CHARGE RECORD PHARMACY	250		74	N/A	N/A	N/A
HC65004250_06380710011	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65004250_06425302030	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_06425390036	NONCDM CHARGE RECORD PHARMACY	250		59	N/A	N/A	N/A
HC65004250_06745790210	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65004250_06937450425	NONCDM CHARGE RECORD PHARMACY	250		175	N/A	N/A	N/A
HC65004250_06978423120	NONCDM CHARGE RECORD PHARMACY	250	J3490	53	N/A	N/A	N/A
HC65004250_07257265010	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65004250_07257274710	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65025012_00143933410	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65025012_00409115910	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65025012_00409116202	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65025012_00409176102	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65025012_00409904201	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65025012_05515016910	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65025012_06332346817	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65025012_06332347237	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65025013_02502113910	NONCDM CHARGE RECORD PHARMACY	250		72	N/A	N/A	N/A
HC65200250_05531000308	NONCDM CHARGE RECORD PHARMACY	636	Q4186	537	N/A	N/A	N/A
HC65200250_09999904155	NONCDM CHARGE RECORD PHARMACY	636	Q4196	675	N/A	N/A	N/A
HC65600343_01715602305	NONCDM CHARGE RECORD PHARMACY	250	A9569	4,264	N/A	N/A	N/A
HC65600343_01715625108	NONCDM CHARGE RECORD PHARMACY	250	A9548	2,094	N/A	N/A	N/A
HC65600343_04556700301	NONCDM CHARGE RECORD PHARMACY	250	A9541	289	N/A	N/A	N/A
HC65600343_06994506820	NONCDM CHARGE RECORD PHARMACY	250	A9560	621	N/A	N/A	N/A
HC65600343_07472510064	NONCDM CHARGE RECORD PHARMACY	255	A9597	3,055	N/A	N/A	N/A
HC65601343	NM MEDICATION-DIAGNOSTIC (340B)	343		2,717	N/A	N/A	N/A
HC73000085	DIALYSIS CRRT W/SNGL EVAL(IP)	881	90945	3,705	N/A	N/A	N/A
HC73000176	HEMOPERFUSION DRY RUN	880		2,337	N/A	N/A	N/A
HC74200072	OR TIME ADD'L 15MIN LVL 2 (MCAL 1ST SUBSQNT 0.5 HR)	360		3,243	N/A	N/A	N/A
HC74200106	OR TIME ADD'L 15MIN LVL 5 (MCAL 1ST SUBSQNT 0.5 HR)	360		4,936	N/A	N/A	N/A
HC74200270	BEDSIDE/OTHER SURG ADD'L 15MIN 4 (MCAL 1ST SUBSQNT 0.5 HR)	369		2,319	N/A	N/A	N/A
HC74200304	BEDSIDE/OTHER SURGICAL CANCEL LVL 1	369		2,560	N/A	N/A	N/A
HC74200338	BEDSIDE/OTHER SURGICAL CANCEL LVL 4	369		4,593	N/A	N/A	N/A
HC74200478	OR TIME ADD'L 15MIN LVL 6  (MCAL 2ND SUBSQNT 0.5 HR)	360		5,611	N/A	N/A	N/A
HC74200502	BEDSIDE/OTHER SURG ADD'L 15MIN 3 (MCAL 2ND SUBSQNT 0.5 HR)	369		2,000	N/A	N/A	N/A
HC74200536	BEDSIDE/OTHER SURG ADD'L 15MIN 6 (MCAL 2ND SUBSQNT 0.5 HR)	369		2,692	N/A	N/A	N/A
HC77400109	ANESTHESIA MAC INITIAL HOUR	370		1,345	N/A	N/A	N/A
HC77400133	ANESTHESIA REGIONAL ADD 15 MIN	370		271	N/A	N/A	N/A
HC78600012	PACU I 15MIN (SUBSEQUENT)	710		669	N/A	N/A	N/A
HC79200002	MUSCLE TEST  ONE LIMB	922	95860	1,085	N/A	N/A	N/A
HC79200036	MUSCLE TEST  FOUR LIMBS	922	95864	2,510	N/A	N/A	N/A
HC81100117	GLUCOSE; QUANTITATIVE  BLOOD (EXCEPT REAGENT STRIP)	301	82947	154	N/A	22	N/A
HC81100141	URIC ACID FLUID	301	84560	174	N/A	48	N/A
HC81100174	B-TYPE NATRIURETIC PEPTIDE	301	83880	495	N/A	172	N/A
HC81100323	BILIRUBIN TOTAL	301	82247	144	N/A	46	N/A
HC81100356	THEOPHYLINE	301	80198	538	N/A	91	N/A
HC81100380	ALCOHOL; 1-2	301	80320	374	N/A	85	N/A
HC81100554	CREATININE OTHER	301	82570	165	N/A	50	N/A
HC81100588	GENTAMICIN SUBS	301	80170	699	N/A	106	N/A
HC81100752	URIC ACID	301	84550	153	N/A	28	N/A
HC81100786	FECAL FAT QUAL	301	82705	70	N/A	48	N/A
HC81100810	FAT STAIN URINE/FECES/SECRETNS	301	89125	161	N/A	22	N/A
HC81100968	CAFFEINE	301	80155	405	N/A	108	N/A
HC81100992	URINALYSIS NON-AUTO W/O MICRO	307	81002	151	N/A	22	N/A
HC81101024	ALDOLASE	301	82085	188	N/A	83	N/A
HC81101198	LEAD	301	83655	157	N/A	62	N/A
HC81101222	SODIUM FLUID	301	84302	166	N/A	47	N/A
HC81101404	FLORESCENCE POLARIZATION	301	83663	275	N/A	98	N/A
HC81101438	NT PRO BNP NATRIURETIC PEPTIDE	301	83880	490	N/A	93	N/A
HC81101636	GLUCOSE; QUANTITATIVE  BLOOD (EXCEPT REAGENT STRIP)	301	82947	154	N/A	22	N/A
HC81101693	BILIRUBIN TRANSCUTANEOUS(POCS)	301	88720	165	N/A	28	N/A
HC81101735	INFLUENZA B BY PCR	306	87798	609	N/A	201	N/A
HC81101891	BASIC METABOLIC PAN/ION'D CA (POS)	301	80047	432	N/A	39	N/A
HC81101933	DRUG TEST PRESUMP DIR OPT INSTRMNT ASS'T/ DOS	301	80306	285	N/A	17	N/A
HC81101966	DRUG TST DEFNTV 8-14RX CLSS W/METBLTS/DAY	301	G0481	901	N/A	235	N/A
HC81500092	BLEEDING TIME	305	85002	201	N/A	63	N/A
HC81500126	D-DIMER QUAL OR SEMI-QT	305	85378	294	N/A	106	N/A
HC81500290	HEMATOCRIT	305	85014	110	N/A	10	N/A
HC81500324	RETICULOCYTE MANUAL	305	85044	148	N/A	45	N/A
HC81500498	FACTOR INHIBITOR TEST	305	85335	528	N/A	224	N/A
HC81500522	HEINZ BODIES DIRECT	305	85441	130	N/A	58	N/A
HC81500555	HEPARIN ASSAY	305	85520	391	N/A	126	N/A
HC81500720	PROTAMINE SULFATE/PARACOAG	305	85366	282	N/A	77	N/A
HC81500753	HEPARIN NEUTRALIZATION	305	85525	244	N/A	93	N/A
HC81500787	BLOOD COUNT LEUKOCYTE(WBC)AUTO	305	85048	99	N/A	38	N/A
HC81500969	FACTOR 2 MUTATION BY PCR	301	81240	557	N/A	N/A	N/A
HC81700015	RHEUMATOID FACTOR QUAL	302	86430	150	N/A	43	N/A
HC81700189	T4/THYROXINE TOTAL	301	84436	180	N/A	34	N/A
HC81700213	T3 OR T4 UPTAKE	301	84479	179	N/A	30	N/A
HC81700247	HCG QUANT	301	84702	371	N/A	69	N/A
HC81700387	RPR/VDRL SPINAL FLUID/QUAL.	302	86592	137	N/A	53	N/A
HC81700411	HELICOBACTER PYLORI IGG AB	302	86677	247	N/A	131	N/A
HC81700445	HEPATITIS B CORE AB IGM	302	86705	236	N/A	85	N/A
HC81700585	PSA TOTAL	301	84153	276	N/A	93	N/A
HC81700619	IMMUNOGLOBULIN IGM.	301	82784	303	N/A	72	N/A
HC81700643	PSA COMPLEXED	301	84152	243	N/A	93	N/A
HC81700817	ABSOLUTE T4/CELL MRKR ADD+	311	88185	318	N/A	104	N/A
HC81700858	FLOW CYT MKR TC ADD + CD38	311	88185	318	N/A	104	N/A
HC81701021	FLW CYT MKR CD8 TC ADD+	311	88185	318	N/A	104	N/A
HC81701054	FLW CYT MKR IGM TC ADD+	311	88185	318	N/A	104	N/A
HC81701088	FLW CYT MKR VS. CD13 TC ADD+	311	88185	318	N/A	104	N/A
HC81701385	HEPATITIS B DNA ULTRA QNT PCR	306	87517	740	N/A	218	N/A
HC81701419	FLOW CYT MKR (TDT) TC ADD+	311	88185	318	N/A	104	N/A
HC81701476	MORPH STDY ISH MNL PER SPEC INTL SNGL PROBE	310	88368	1,344	N/A	407	N/A
HC81701708	MRSA BY PCR	300	87641	683	N/A	148	N/A
HC81701732	EBV AB TO VIRAL CAPSID AG  IGM	302	86665	278	N/A	100	N/A
HC81701906	ALLERGEN IGE CRUDE EXTRACT  EACH	302	86003	54	N/A	22	N/A
HC81701930	CYCLIC CITRULLINATED PEPTIDE	302	86200	181	N/A	71	N/A
HC81702102	FLW CYT MKR CD4 TC ADD+	311	88185	318	N/A	104	N/A
HC81702136	FLW CYT MKR CD61 TC ADD+	311	88185	318	N/A	104	N/A
HC81702169	FLW CYT MKR MPO TC ADD+	311	88185	318	N/A	104	N/A
HC82200080	PAS STAIN/GROUP I W/ INT&RPT+	312	88312	547	N/A	144	N/A
HC82200114	SILVER METHENMN ST/GR I W/I&R+	312	88312	547	N/A	121	N/A
HC82200148	AMYLOID (CRYST VIOLET)/GRP II+	312	88313	474	N/A	107	N/A
HC82200312	IHC/IP PER SPEC INITIAL AB STAIN SYNAPTOPH	312	88342	593	N/A	193	N/A
HC82200346	DECALCIFICATION+	312	88311	158	N/A	49	N/A
HC82200528	IHC/IP PER SPEC INITIAL AB STAIN	312	88342	593	N/A	193	N/A
HC82200551	INTERPHASE IN-SITU HYBRI 25-99	310	88274	1,572	N/A	252	N/A
HC82200585	TISSUE EXAM - OP	310		812	N/A	325	N/A
HC82200742	INTRAOP CNSLT CYTOPREP  ADL	311	88334	394	N/A	120	N/A
HC82200809	BONE MARROW DX; ASP(S) ONLY LT	361	38220	4,591	N/A	1,651	N/A
HC82200841	AUTOPSY MACERATED FETUS	310	88016	N/A	N/A	N/A	N/A
HC82200981	GRAMS STAIN-AP/GR I W/INT&RPT+	312	88312	547	N/A	144	N/A
HC82201013	WARTHIN-STARRY STN/GR I W/I&R+	312	88312	547	N/A	144	N/A
HC82201047	ALCIAN BLUE STN W/DIG/GRP II+	312	88313	474	N/A	107	N/A
HC82201211	PAS STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82201245	SUDA BLACK B STN/GRP II+	312	88313	474	N/A	107	N/A
HC82201419	HISTCHM ST MYPHSPHFRC2 FRO TS	312	88314	388	N/A	108	N/A
HC82201443	HISTOCHM STN OS-PPD FROZ TIS	312	88314	388	N/A	108	N/A
HC82201476	HISTOCHEM DETERMINATIVE GRIII	312	88319	962	N/A	500	N/A
HC82201617	IHC/IP PER SPEC INITIAL AB STAIN GASTRIN	312	88342	593	N/A	193	N/A
HC82201641	IHC/IP PER SPEC INITIAL AB STAIN INSULIN	312	88342	593	N/A	193	N/A
HC82201674	IHC/IP PER SPEC INITIAL AB STAIN KP1	312	88342	593	N/A	193	N/A
HC82201849	IHC/IP PER SPEC INITIAL AB STAIN ANTI-BCL-2	312	88342	593	N/A	193	N/A
HC82201872	IHC/IP PER SPEC INITIAL AB STAIN CYCLIN D1	312	88342	593	N/A	193	N/A
HC82202078	IF STUDY DIRECT 1ST STAIN	312	88346	562	N/A	93	N/A
HC82202185	MORPHOMETRIC STUDY NERVE	312	88356	856	N/A	458	N/A
HC82202383	MORPH STDY TMR IHC CAT PR PER SPEC EA ADDL AB	312	88361	1,055	N/A	386	N/A
HC82202417	MORPH STDY TMR IHC CAT EGFR PER SPEC EA ADDL AB	312	88361	1,055	N/A	429	N/A
HC82202441	MORPH STDY ISH CAT QNT/SPEC INTL SNGL PROBE HER2	310	88367	1,732	N/A	568	N/A
HC82202599	DECALCIFICATION+ *OP	312	88311	158	N/A	21	N/A
HC82202623	ANATOMIC CONSULT:SLIDE REVW*OP	312	88321	429	N/A	30	N/A
HC82202680	H & E BLOCK ADDITIONAL(CLIENT)	312	88399	102	N/A	10	N/A
HC82202938	PROCESS & EMBED ONLY	310	88399	106	N/A	6	N/A
HC82202961	IHC/IP PER SPEC INITIAL AB STAIN BCL-6	312	88342	593	N/A	193	N/A
HC82203134	IHC/IP PER SPEC INITIAL AB STAIN CK-5/6	312	88342	593	N/A	193	N/A
HC82203167	IHC/IP PER SPEC INITIAL AB STAIN E-CADHERIN	312	88342	593	N/A	193	N/A
HC82203191	IHC/IP PER SPEC INITIAL AB STAIN IGD	312	88342	593	N/A	193	N/A
HC82203332	IHC/IP PER SPEC INITIAL AB STAIN EGFR	312	88342	593	N/A	193	N/A
HC82203365	IHC/IP PER SPEC EA ADD AB STAIN+ CEA	312	88341	516	N/A	183	N/A
HC82203399	IHC/IP PER SPEC EA ADD AB STAIN+ CHROMOGRAN	312	88341	516	N/A	183	N/A
HC82203530	IHC/IP PER SPEC EA ADD AB STAIN+ CD-1A	312	88341	516	N/A	183	N/A
HC82203563	IHC/IP PER SPEC EA ADD AB STAIN+ CD-31	312	88341	516	N/A	183	N/A
HC82203597	IHC/IP PER SPEC EA ADD AB STAIN+ CEA MONOCLON	312	88341	516	N/A	183	N/A
HC82203761	IHC/IP PER SPEC EA ADD AB STAIN+ DYSTROPH (C-TERM)	312	88341	516	N/A	183	N/A
HC82203795	IHC/IP PER SPEC EA ADD AB STAIN+ ACTH	312	88341	516	N/A	183	N/A
HC82203969	IHC/IP PER SPEC EA ADD AB STAIN+ MT-1	312	88341	516	N/A	183	N/A
HC82203993	IHC/IP PER SPEC EA ADD AB STAIN+ NEURFLMNT	312	88341	516	N/A	183	N/A
HC82204025	IHC/IP PER SPEC EA ADD AB STAIN+ SMOOTH MUSC	312	88341	516	N/A	183	N/A
HC82204173	IHC/IP PER SPEC EA ADD AB STAIN+ KERATIN 903	312	88341	516	N/A	183	N/A
HC82204215	IHC/IP PER SPEC EA ADD AB STAIN+ MT-1	312	88341	516	N/A	183	N/A
HC82204249	IHC/IP PER SPEC EA ADD AB STAIN+ PLAP	312	88341	516	N/A	183	N/A
HC82204413	IHC/IP PER SPEC EA ADD AB STAIN+ MELAN-A	312	88341	516	N/A	183	N/A
HC82204447	IHC/IP PER SPEC INITIAL AB STAIN CD-79A	312	88342	593	N/A	193	N/A
HC82204611	IP/IHC PER SPEC INITIAL AB STAIN H PYLORI	312	88342	593	N/A	193	N/A
HC82204645	IHC/IP PER SPEC EA ADD AB STAIN+ HSV-1	312	88341	516	N/A	183	N/A
HC83000000	PLATELETS CONCENTRATE EA UNIT	390	P9019	454	N/A	130	N/A
HC83000034	RBC'S WASHED EA UNIT	390	P9022	1,120	N/A	635	N/A
HC83000067	PLATELET LR APHER/PHER EA UNIT	390	P9035	2,137	N/A	906	N/A
HC83000224	SPLITTING BLD/BLD PROD EA UNIT	302	86985	323	N/A	175	N/A
HC83000281	COMBS  INDIR TITER EA ANTISER	302	86886	369	N/A	175	N/A
HC83000323	FREEZING BLOOD EA UNIT	300	86930	397	N/A	342	N/A
HC83000513	PLATELET PHERESIS EA UNIT	390	P9034	2,160	N/A	806	N/A
HC83000547	PLATELET PHERESIS IRRD EA UNIT	390	P9036	2,154	N/A	886	N/A
HC83000802	COLD AGGLUTININS TITER	302	86157	155	N/A	54	N/A
HC83000836	THER APHERESIS PLASMA CX/ABORT	361	36514	3,606	N/A	1,600	N/A
HC83001123	CRYOPRECIPITATE 4 UNITS POOLED-SB	390	P9012	559	N/A	150	N/A
HC83001156	PLASMA FRZN COLL 8-24 HRS EA UNIT	390	P9059	388	N/A	255	N/A
HC83001198	RBC'S EA UNIT	390	P9021	789	N/A	305	N/A
HC83090043	P: BLOOD TYPE; ABO & RH(D)			N/A	N/A	N/A	N/A
HC83090092	P: PLASMA ALIQUOT & SPLITTING PROCEDURE	390		N/A	N/A	N/A	N/A
HC83500041	STONE ANALYSIS-LH	301	82360	N/A	N/A	N/A	N/A
HC83500272	CHROMO  TISSUE BLOOD-IM	310	88237	175	N/A	175	N/A
HC83500306	CHROMO TISSUE COUNT-HP	310	88261	N/A	N/A	N/A	N/A
HC83500470	MOLECUL CYTO DNA PROBE FISH-GZ	310	88271	490	N/A	490	N/A
HC83500504	INTERPHASE FISH HYBRI 25-99-US	310	88274	N/A	N/A	N/A	N/A
HC83500538	INTERPHS FISH HYBRI 100-300-IM	310	88275	N/A	N/A	N/A	N/A
HC83500736	TISSUE EXAM G&M LEVEL 5-US	312	88307	N/A	N/A	N/A	N/A
HC83500769	SPECIAL STAIN GRP I W/ I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83500793	ACID FAST STN/GRP I W/I&R+-IM	312	88312	N/A	N/A	N/A	N/A
HC83500934	GENTA STAIN/GROUP I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83500967	GIEMSA STN/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83500991	GRAMS STAIN-AP/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501163	WARTHN-STARRY ST/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83501197	ZIEHL NEELSON STN/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83501361	AMYLOID STN BENHOLD/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501395	BONE MAR IRON STN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501429	ELASTIC STAIN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501569	GRIMELIUS ARGYRO STN GRPII+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501593	HALLS BILE STAIN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501627	IRON STAIN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501791	MAY GRUN GIEMSA STN GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501825	MELANIN BLEACHING/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501999	PERLS PRUSS BLU STN GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83502021	RETICULUM STAIN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83502294	ANATOMIC CONSULT; COMP. REV-HP	310	88325	N/A	N/A	N/A	N/A
HC83502351	IHC/IP PER SPEC INITIAL AB STAIN -IM	312	88342	40	N/A	40	N/A
HC83502393	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH C-TERMINS -IM	312	88342	N/A	N/A	N/A	N/A
HC83502534	IHC/IP PER SPEC INITIAL AB STAIN CD-34 -IM	312	88342	N/A	N/A	N/A	N/A
HC83502567	IHC/IP PER SPEC INITIAL AB STAIN CEA -US	312	88342	N/A	N/A	N/A	N/A
HC83502591	IHC/IP PER SPEC INITIAL AB STAIN DESMIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83502765	IHC/IP PER SPEC INITIAL AB STAIN HERPES POLY -US	312	88342	N/A	N/A	N/A	N/A
HC83502799	IHC/IP PER SPEC INITIAL AB STAIN INSULIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83502989	IHC/IP PER SPEC INITIAL AB STAIN LN1 -US	312	88342	N/A	N/A	N/A	N/A
HC83503037	IHC/IP PER SPEC INITIAL AB STAIN MUSCLE -IM	312	88342	N/A	N/A	N/A	N/A
HC83503060	IHC/IP PER SPEC INITIAL AB STAIN MYGLOBIN -US	312	88342	N/A	N/A	N/A	N/A
HC65000250_05122402230	NONCDM CHARGE RECORD PHARMACY	250	Z7610	8	N/A	N/A	N/A
HC65000250_05129361101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05155204549	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05166014190	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05167212632	NONCDM CHARGE RECORD PHARMACY	250		191	N/A	N/A	N/A
HC65000250_05167221162	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05167240231	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_05186248601	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_05199134806	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_05256512207	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_05265290011	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_05281732310	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05348914101	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65000250_05348938601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05374636101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05448214407	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05483800530	NONCDM CHARGE RECORD PHARMACY	250	Z7610	11	N/A	N/A	N/A
HC65000250_05511125660	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05511128130	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_05511134201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05529960104	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_05618412041	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_05633100615	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_05723711901	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_05723717090	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05723722190	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789611114	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789618405	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_05789679901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789690101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789698016	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05865764501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05865770310	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05891417110	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_05965101890	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05965105290	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05974638506	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05976200731	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05976217101	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_05976223506	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_05976233043	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06021955229	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06025819309	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06043206575	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65000250_06050500800	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050501709	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06050526719	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050531130	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050570832	NONCDM CHARGE RECORD PHARMACY	250		80	N/A	N/A	N/A
HC65000250_06068710521	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068712401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068720601	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068721501	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_06068722901	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068731201	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06068732701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068738425	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06068738921	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_06068739483	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068743701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068744601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068745301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068749601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068750401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06068755511	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068755901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068759632	NONCDM CHARGE RECORD PHARMACY	250		88	N/A	N/A	N/A
HC65000250_06068760901	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068762301	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06068767611	NONCDM CHARGE RECORD PHARMACY	250	Z7610	13	N/A	N/A	N/A
HC65000250_06068768757	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_06075880110	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_06131424501	NONCDM CHARGE RECORD PHARMACY	250		331	N/A	N/A	N/A
HC65000250_06131462810	NONCDM CHARGE RECORD PHARMACY	250		67	N/A	N/A	N/A
HC65000250_06187411520	NONCDM CHARGE RECORD PHARMACY	250		276	N/A	N/A	N/A
HC65000250_06195807011	NONCDM CHARGE RECORD PHARMACY	250		399	N/A	N/A	N/A
HC65000250_06217589143	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06233202531	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_06233205531	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06255913807	NONCDM CHARGE RECORD PHARMACY	250		139	N/A	N/A	N/A
HC65000250_06255922530	NONCDM CHARGE RECORD PHARMACY	250		77	N/A	N/A	N/A
HC65000250_06255929101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06275614301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06275618488	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06330462601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06330496230	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65000250_06332308861	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0	N/A	N/A	N/A
HC65000250_06332369504	NONCDM CHARGE RECORD PHARMACY	250		66	N/A	N/A	N/A
HC65000250_06339520113	NONCDM CHARGE RECORD PHARMACY	250		53	N/A	N/A	N/A
HC65000250_06340230830	NONCDM CHARGE RECORD PHARMACY	250		270	N/A	N/A	N/A
HC65000250_06373906933	NONCDM CHARGE RECORD PHARMACY	250		55	N/A	N/A	N/A
HC65000250_06373908702	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373914310	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373935733	NONCDM CHARGE RECORD PHARMACY	250	Z7610	431	N/A	N/A	N/A
HC65000250_06373936710	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06373954510	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373956010	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06373956910	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06373979733	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_06373990310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373996310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06438018401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06438075806	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06489666301	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_06498010401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06516227210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516237210	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06516246410	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516267384	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06516268690	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06516271110	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06564930303	NONCDM CHARGE RECORD PHARMACY	250		312	N/A	N/A	N/A
HC65000250_06586200601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586211601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586214150	NONCDM CHARGE RECORD PHARMACY	250		75	N/A	N/A	N/A
HC65000250_06586218501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586235705	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586237405	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586241901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586255990	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586257490	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586260330	NONCDM CHARGE RECORD PHARMACY	250	Z7610	19	N/A	N/A	N/A
HC65000250_06586285901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586292730	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06668903650	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65000250_06668905599	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06668910710	NONCDM CHARGE RECORD PHARMACY	250		128	N/A	N/A	N/A
HC65000250_06699342285	NONCDM CHARGE RECORD PHARMACY	250		70	N/A	N/A	N/A
HC65000250_06738682019	NONCDM CHARGE RECORD PHARMACY	250		232	N/A	N/A	N/A
HC65000250_06754611112	NONCDM CHARGE RECORD PHARMACY	250		875	N/A	N/A	N/A
HC65000250_06787722210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787726030	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_06787773295	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_06800143594	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808410801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808411901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808415701	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808424801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808425401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808427101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808434301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808434701	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808449001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808451101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808464501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808467601	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808469701	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808475325	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_06808477601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808480521	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06808489509	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808496425	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_06809449462	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06809450362	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06809475059	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_06818046801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818055609	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818059001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06818096901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818097101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838212205	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838213210	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06838277177	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65000250_06838277306	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06838280505	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846216305	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846219005	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846222301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846233190	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846235701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846285101	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_06878410212	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06909786283	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06923810691	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06923811249	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06923816052	NONCDM CHARGE RECORD PHARMACY	250		130	N/A	N/A	N/A
HC65000250_06929256201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06931513401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06945215120	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06945220913	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_06968013060	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06978442012	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_06991830130	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_07006919101	NONCDM CHARGE RECORD PHARMACY	250		493	N/A	N/A	N/A
HC65000250_07015610401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07037700712	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07071011101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07071011656	NONCDM CHARGE RECORD PHARMACY	250		72	N/A	N/A	N/A
HC65000250_07074817530	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65000250_07095451810	NONCDM CHARGE RECORD PHARMACY	250		197	N/A	N/A	N/A
HC65000250_07132180320	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07220504211	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_07226619601	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_07257274020	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_07431200640	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07431219377	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07582613910	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07628234801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07632933041	NONCDM CHARGE RECORD PHARMACY	250	J3490	58	N/A	N/A	N/A
HC65000250_07733393410	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07733394010	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068109800	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068113100	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068115500	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_08290306546	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_08349030760	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_08679001930	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000259_09999903858	NONCDM CHARGE RECORD PHARMACY	259	J9039	0	N/A	N/A	N/A
HC65000343	MEDICATION-DIAGNOSTIC	343		N/A	N/A	N/A	N/A
HC65000636_00003232711	NONCDM CHARGE RECORD PHARMACY	636	J9228	1,018	N/A	N/A	N/A
HC65000636_00003257016	NONCDM CHARGE RECORD PHARMACY	636	J3490	369	N/A	N/A	N/A
HC65000636_00003377211	NONCDM CHARGE RECORD PHARMACY	636	J9299	186	N/A	N/A	N/A
HC65000636_00008092360	NONCDM CHARGE RECORD PHARMACY	636	C9113	21	N/A	N/A	N/A
HC65000636_00009001104	NONCDM CHARGE RECORD PHARMACY	636	J1720	87	N/A	N/A	N/A
HC65000636_00009001612	NONCDM CHARGE RECORD PHARMACY	636	J1720	89	N/A	N/A	N/A
HC65000636_00009072809	NONCDM CHARGE RECORD PHARMACY	636	J3490	8	N/A	N/A	N/A
HC65000636_00009082501	NONCDM CHARGE RECORD PHARMACY	636	J1720	49	N/A	N/A	N/A
HC65000636_00009090218	NONCDM CHARGE RECORD PHARMACY	636	J3490	9	N/A	N/A	N/A
HC65000636_00024582411	NONCDM CHARGE RECORD PHARMACY	636	J9043	1,357	N/A	N/A	N/A
HC65000636_00026394225	NONCDM CHARGE RECORD PHARMACY	636	J7208	16	N/A	N/A	N/A
HC65000636_00054001725	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_00054001925	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_00054317644	NONCDM CHARGE RECORD PHARMACY	636	J8540	4	N/A	N/A	N/A
HC65000636_00054817625	NONCDM CHARGE RECORD PHARMACY	636	J8540	1	N/A	N/A	N/A
HC65000636_00054818125	NONCDM CHARGE RECORD PHARMACY	636	J8540	1	N/A	N/A	N/A
HC65000636_00054874025	NONCDM CHARGE RECORD PHARMACY	636	J7512	1	N/A	N/A	N/A
HC65000636_00069080901	NONCDM CHARGE RECORD PHARMACY	636	Q5103	269	N/A	N/A	N/A
HC65000636_00069130610	NONCDM CHARGE RECORD PHARMACY	636	Q5106	72	N/A	N/A	N/A
HC65000636_00074364103	NONCDM CHARGE RECORD PHARMACY	636	J1950	9,967	N/A	N/A	N/A
HC65000636_00074377903	NONCDM CHARGE RECORD PHARMACY	636	J1950	608	N/A	N/A	N/A
HC65000636_00078068615	NONCDM CHARGE RECORD PHARMACY	636		1,871	N/A	N/A	N/A
HC65000636_00078088361	NONCDM CHARGE RECORD PHARMACY	636	J0791	348	N/A	N/A	N/A
HC65000636_00088221900	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000636_00143925425	NONCDM CHARGE RECORD PHARMACY	636	J1265	4	N/A	N/A	N/A
HC65000636_00143927310	NONCDM CHARGE RECORD PHARMACY	636	J1110	972	N/A	N/A	N/A
HC65000636_00143929810	NONCDM CHARGE RECORD PHARMACY	636	J2916	11	N/A	N/A	N/A
HC65000636_00143955001	NONCDM CHARGE RECORD PHARMACY	636	J9150	436	N/A	N/A	N/A
HC65000636_00143955401	NONCDM CHARGE RECORD PHARMACY	636	J0640	52	N/A	N/A	N/A
HC65000636_00143967401	NONCDM CHARGE RECORD PHARMACY	636	J0883	13	N/A	N/A	N/A
HC65000636_00143970910	NONCDM CHARGE RECORD PHARMACY	636	J2260	26	N/A	N/A	N/A
HC65000636_00143998303	NONCDM CHARGE RECORD PHARMACY	636	J0690	4	N/A	N/A	N/A
HC65000636_00169720201	NONCDM CHARGE RECORD PHARMACY	636	J7189	16	N/A	N/A	N/A
HC65000636_00173051700	NONCDM CHARGE RECORD PHARMACY	636	J1325	143	N/A	N/A	N/A
HC65000636_00264757810	NONCDM CHARGE RECORD PHARMACY	636	J2150	19	N/A	N/A	N/A
HC65000636_00264958720	NONCDM CHARGE RECORD PHARMACY	636	J1644	4	N/A	N/A	N/A
HC65000636_00270014957	NONCDM CHARGE RECORD PHARMACY	636	Q9958	1	N/A	N/A	N/A
HC65000636_00338006910	NONCDM CHARGE RECORD PHARMACY	636	J1885	9	N/A	N/A	N/A
HC65000636_00338041102	NONCDM CHARGE RECORD PHARMACY	636	J2001	0	N/A	N/A	N/A
HC65000636_00338355248	NONCDM CHARGE RECORD PHARMACY	636	J3370	85	N/A	N/A	N/A
HC65000636_00338381424	NONCDM CHARGE RECORD PHARMACY	636	J3490	62	N/A	N/A	N/A
HC65000636_00338954924	NONCDM CHARGE RECORD PHARMACY	636	J3490	46	N/A	N/A	N/A
HC65000636_00407141403	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407141484	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_00407141491	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_00409030201	NONCDM CHARGE RECORD PHARMACY	636	J9351	11	N/A	N/A	N/A
HC65000636_00409080601	NONCDM CHARGE RECORD PHARMACY	636	J0690	11	N/A	N/A	N/A
HC65000636_00409128305	NONCDM CHARGE RECORD PHARMACY	636	J1170	20	N/A	N/A	N/A
HC65000636_00409131230	NONCDM CHARGE RECORD PHARMACY	636	J1170	11	N/A	N/A	N/A
HC65000636_00409189001	NONCDM CHARGE RECORD PHARMACY	636	J2270	15	N/A	N/A	N/A
HC65000636_00409189123	NONCDM CHARGE RECORD PHARMACY	636	J2270	21	N/A	N/A	N/A
HC65000636_00409198530	NONCDM CHARGE RECORD PHARMACY	636	J2060	18	N/A	N/A	N/A
HC65000636_00409259603	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_00409263405	NONCDM CHARGE RECORD PHARMACY	636	J1170	6	N/A	N/A	N/A
HC65000636_00409272003	NONCDM CHARGE RECORD PHARMACY	636	J1644	1	N/A	N/A	N/A
HC65000636_00409426401	NONCDM CHARGE RECORD PHARMACY	636	J1170	18	N/A	N/A	N/A
HC65000636_00409427701	NONCDM CHARGE RECORD PHARMACY	636	J2001	0	N/A	N/A	N/A
HC65000636_00409477723	NONCDM CHARGE RECORD PHARMACY	636	J0744	16	N/A	N/A	N/A
HC65000636_00409492134	NONCDM CHARGE RECORD PHARMACY	636	J0171	3	N/A	N/A	N/A
HC65000636_00409648201	NONCDM CHARGE RECORD PHARMACY	636	J1364	534	N/A	N/A	N/A
HC65000636_00409651001	NONCDM CHARGE RECORD PHARMACY	636	J3370	64	N/A	N/A	N/A
HC65000636_00409653331	NONCDM CHARGE RECORD PHARMACY	636	J3370	12	N/A	N/A	N/A
HC65000636_00409733220	NONCDM CHARGE RECORD PHARMACY	636	J0696	2	N/A	N/A	N/A
HC65000636_00409733520	NONCDM CHARGE RECORD PHARMACY	636	J0696	2	N/A	N/A	N/A
HC65000636_00409733720	NONCDM CHARGE RECORD PHARMACY	636	J0696	5	N/A	N/A	N/A
HC65000636_00409915701	NONCDM CHARGE RECORD PHARMACY	636	J3430	29	N/A	N/A	N/A
HC65000636_00409963005	NONCDM CHARGE RECORD PHARMACY	636	J0461	4	N/A	N/A	N/A
HC65000636_00517074020	NONCDM CHARGE RECORD PHARMACY	636	J2210	189	N/A	N/A	N/A
HC65000636_00517100125	NONCDM CHARGE RECORD PHARMACY	636	J0461	1	N/A	N/A	N/A
HC65000636_00517102025	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,017	N/A	N/A	N/A
HC65000636_00548560200	NONCDM CHARGE RECORD PHARMACY	636	J1650	10	N/A	N/A	N/A
HC65000636_00548560500	NONCDM CHARGE RECORD PHARMACY	636	J1650	10	N/A	N/A	N/A
HC65000636_00574080530	NONCDM CHARGE RECORD PHARMACY	636	J0132	20	N/A	N/A	N/A
HC65000636_00641037625	NONCDM CHARGE RECORD PHARMACY	636	J1200	5	N/A	N/A	N/A
HC65000636_00641047625	NONCDM CHARGE RECORD PHARMACY	636	J2560	122	N/A	N/A	N/A
HC65000636_00641139735	NONCDM CHARGE RECORD PHARMACY	636	J3230	239	N/A	N/A	N/A
HC65000636_00641603001	NONCDM CHARGE RECORD PHARMACY	636	J3010	6	N/A	N/A	N/A
HC65000636_00641604610	NONCDM CHARGE RECORD PHARMACY	636	J2060	7	N/A	N/A	N/A
HC65000636_00641614225	NONCDM CHARGE RECORD PHARMACY	636	J2370	3	N/A	N/A	N/A
HC65000636_00641614910	NONCDM CHARGE RECORD PHARMACY	636	J2710	6	N/A	N/A	N/A
HC65000636_00641616410	NONCDM CHARGE RECORD PHARMACY	636	J0706	9	N/A	N/A	N/A
HC65000636_00641624410	NONCDM CHARGE RECORD PHARMACY	636	J3360	27	N/A	N/A	N/A
HC65000636_00703011301	NONCDM CHARGE RECORD PHARMACY	636	J1170	10	N/A	N/A	N/A
HC65000636_00703203303	NONCDM CHARGE RECORD PHARMACY	636	J3490	127	N/A	N/A	N/A
HC65000636_00703424891	NONCDM CHARGE RECORD PHARMACY	636	J9045	44	N/A	N/A	N/A
HC65000636_00703471401	NONCDM CHARGE RECORD PHARMACY	636	J9351	17	N/A	N/A	N/A
HC65000636_00781210301	NONCDM CHARGE RECORD PHARMACY	636	J7507	6	N/A	N/A	N/A
HC65000636_00781309895	NONCDM CHARGE RECORD PHARMACY	636	J2185	12	N/A	N/A	N/A
HC65000636_00781325666	NONCDM CHARGE RECORD PHARMACY	636	J1650	15	N/A	N/A	N/A
HC65000636_00781326995	NONCDM CHARGE RECORD PHARMACY	636	J3490	185	N/A	N/A	N/A
HC65000636_00781329009	NONCDM CHARGE RECORD PHARMACY	636	J3490	50	N/A	N/A	N/A
HC65000636_00781344395	NONCDM CHARGE RECORD PHARMACY	636	J1652	38	N/A	N/A	N/A
HC65000636_00781345295	NONCDM CHARGE RECORD PHARMACY	636	J0690	4	N/A	N/A	N/A
HC65000636_00781348192	NONCDM CHARGE RECORD PHARMACY	636	J3243	16	N/A	N/A	N/A
HC65000636_00944049302	NONCDM CHARGE RECORD PHARMACY	636	P9047	376	N/A	N/A	N/A
HC65000636_00944270004	NONCDM CHARGE RECORD PHARMACY	636	J1569	452	N/A	N/A	N/A
HC65000636_00990707526	NONCDM CHARGE RECORD PHARMACY	636	J3480	2	N/A	N/A	N/A
HC65000636_00990711807	NONCDM CHARGE RECORD PHARMACY	636		591	N/A	N/A	N/A
HC65000636_01001905561	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,017	N/A	N/A	N/A
HC65000636_01045471210	NONCDM CHARGE RECORD PHARMACY	636	J0587	43	N/A	N/A	N/A
HC65000636_01353313101	NONCDM CHARGE RECORD PHARMACY	636	90714	177	N/A	N/A	N/A
HC65000636_01353331805	NONCDM CHARGE RECORD PHARMACY	636	90375	2,179	N/A	N/A	N/A
HC65000636_01478990002	NONCDM CHARGE RECORD PHARMACY	636	J2690	1,950	N/A	N/A	N/A
HC65000636_01505405001	NONCDM CHARGE RECORD PHARMACY	636	J0586	22	N/A	N/A	N/A
HC65000636_01671400610	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_01671483401	NONCDM CHARGE RECORD PHARMACY	636	J2469	179	N/A	N/A	N/A
HC65000636_01671488910	NONCDM CHARGE RECORD PHARMACY	636	J1335	345	N/A	N/A	N/A
HC65000636_01672926764	NONCDM CHARGE RECORD PHARMACY	636	J9171	7	N/A	N/A	N/A
HC65000636_01672927730	NONCDM CHARGE RECORD PHARMACY	636	J9260	22	N/A	N/A	N/A
HC65000636_01672928838	NONCDM CHARGE RECORD PHARMACY	636	J9060	19	N/A	N/A	N/A
HC65000636_01672953363	NONCDM CHARGE RECORD PHARMACY	636	J3420	22	N/A	N/A	N/A
HC65000636_01747803002	NONCDM CHARGE RECORD PHARMACY	636	J3010	8	N/A	N/A	N/A
HC65000636_01747804101	NONCDM CHARGE RECORD PHARMACY	636	J2310	85	N/A	N/A	N/A
HC65000636_01747893415	NONCDM CHARGE RECORD PHARMACY	636	J0360	39	N/A	N/A	N/A
HC65000636_01747893725	NONCDM CHARGE RECORD PHARMACY	636	J3490	37	N/A	N/A	N/A
HC65000636_02315554741	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_02315560041	NONCDM CHARGE RECORD PHARMACY	636	J2250	2	N/A	N/A	N/A
HC65000636_02502112250	NONCDM CHARGE RECORD PHARMACY	636	J0692	16	N/A	N/A	N/A
HC65000636_02502112999	NONCDM CHARGE RECORD PHARMACY	636	J0713	14	N/A	N/A	N/A
HC65000636_02502113410	NONCDM CHARGE RECORD PHARMACY	636	J0290	13	N/A	N/A	N/A
HC65000636_02502118466	NONCDM CHARGE RECORD PHARMACY	636	J1450	26	N/A	N/A	N/A
HC65000636_02502118487	NONCDM CHARGE RECORD PHARMACY	636	J1450	60	N/A	N/A	N/A
HC65000636_02502120111	NONCDM CHARGE RECORD PHARMACY	636	J9209	26	N/A	N/A	N/A
HC65000636_02502140010	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_02502140201	NONCDM CHARGE RECORD PHARMACY	636	J1644	3	N/A	N/A	N/A
HC65000636_02502167182	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_02502167650	NONCDM CHARGE RECORD PHARMACY	636	J2515	292	N/A	N/A	N/A
HC65000636_02568200701	NONCDM CHARGE RECORD PHARMACY	636	J2840	547	N/A	N/A	N/A
HC65000636_03600000924	NONCDM CHARGE RECORD PHARMACY	636	J3490	21	N/A	N/A	N/A
HC65000636_03600028325	NONCDM CHARGE RECORD PHARMACY	636	J1940	9	N/A	N/A	N/A
HC65000636_03982210555	NONCDM CHARGE RECORD PHARMACY	636	J0285	284	N/A	N/A	N/A
HC65000636_04202310701	NONCDM CHARGE RECORD PHARMACY	636	J0770	182	N/A	N/A	N/A
HC65000636_04202311925	NONCDM CHARGE RECORD PHARMACY	636	J3250	289	N/A	N/A	N/A
HC65000636_04265801001	NONCDM CHARGE RECORD PHARMACY	636	J9065	227	N/A	N/A	N/A
HC65000636_04280640001	NONCDM CHARGE RECORD PHARMACY	636	J7509	1	N/A	N/A	N/A
HC65000636_04359854910	NONCDM CHARGE RECORD PHARMACY	636	J2704	2	N/A	N/A	N/A
HC65000636_04359869858	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,080	N/A	N/A	N/A
HC65000636_04359875710	NONCDM CHARGE RECORD PHARMACY	636	J1953	2	N/A	N/A	N/A
HC65000636_04420643820	NONCDM CHARGE RECORD PHARMACY	636	J1459	472	N/A	N/A	N/A
HC65000636_04456710210	NONCDM CHARGE RECORD PHARMACY	636	J0290	19	N/A	N/A	N/A
HC65000636_04456723525	NONCDM CHARGE RECORD PHARMACY	636	J0713	17	N/A	N/A	N/A
HC65000636_04456762224	NONCDM CHARGE RECORD PHARMACY	636	J0610	12	N/A	N/A	N/A
HC65000636_04456770810	NONCDM CHARGE RECORD PHARMACY	636	J0690	14	N/A	N/A	N/A
HC65000636_04778159891	NONCDM CHARGE RECORD PHARMACY	636	J3370	19	N/A	N/A	N/A
HC65000636_04928128610	NONCDM CHARGE RECORD PHARMACY	636	90700	207	N/A	N/A	N/A
HC65000636_05024208701	NONCDM CHARGE RECORD PHARMACY	636	J9354	219	N/A	N/A	N/A
HC65000636_05024213201	NONCDM CHARGE RECORD PHARMACY	636	J9355	661	N/A	N/A	N/A
HC65000636_05024213701	NONCDM CHARGE RECORD PHARMACY	636	J3262	33	N/A	N/A	N/A
HC65000636_05041932512	NONCDM CHARGE RECORD PHARMACY	636	A9585	5	N/A	N/A	N/A
HC65000636_05047463697	NONCDM CHARGE RECORD PHARMACY	636	J3490	650	N/A	N/A	N/A
HC65000636_05063312011	NONCDM CHARGE RECORD PHARMACY	636	J1162	26,864	N/A	N/A	N/A
HC65000636_05175442004	NONCDM CHARGE RECORD PHARMACY	636	J3490	100	N/A	N/A	N/A
HC65000636_05175920410	NONCDM CHARGE RECORD PHARMACY	636	J3031	0	N/A	N/A	N/A
HC65000636_05511165301	NONCDM CHARGE RECORD PHARMACY	636	J7520	89	N/A	N/A	N/A
HC65000636_05511168010	NONCDM CHARGE RECORD PHARMACY	636	J1652	24	N/A	N/A	N/A
HC65000636_05515016102	NONCDM CHARGE RECORD PHARMACY	636	J2001	7	N/A	N/A	N/A
HC65000636_05515016505	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_05515017305	NONCDM CHARGE RECORD PHARMACY	636	J3030	162	N/A	N/A	N/A
HC65000636_05515023210	NONCDM CHARGE RECORD PHARMACY	636	J3490	126	N/A	N/A	N/A
HC65000636_05515025110	NONCDM CHARGE RECORD PHARMACY	636	J2001	2	N/A	N/A	N/A
HC65000636_05515025410	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_05539010110	NONCDM CHARGE RECORD PHARMACY	636	J3105	26	N/A	N/A	N/A
HC65000636_05539056505	NONCDM CHARGE RECORD PHARMACY	636	J3490	14	N/A	N/A	N/A
HC65000636_05551395401	NONCDM CHARGE RECORD PHARMACY	636	J9303	918	N/A	N/A	N/A
HC65000636_05556684031	NONCDM CHARGE RECORD PHARMACY	636	J9155	41	N/A	N/A	N/A
HC65000636_05789406103	NONCDM CHARGE RECORD PHARMACY	636	J3357	582	N/A	N/A	N/A
HC65000636_05816088752	NONCDM CHARGE RECORD PHARMACY	636	90686	15	N/A	N/A	N/A
HC65000636_05816096412	NONCDM CHARGE RECORD PHARMACY	636	90675	2,422	N/A	N/A	N/A
HC65000636_05839463703	NONCDM CHARGE RECORD PHARMACY	636	J7195	8	N/A	N/A	N/A
HC65000636_05974617106	NONCDM CHARGE RECORD PHARMACY	636	J7512	1	N/A	N/A	N/A
HC65000636_05974617506	NONCDM CHARGE RECORD PHARMACY	636	J7512	0	N/A	N/A	N/A
HC65000636_06021910761	NONCDM CHARGE RECORD PHARMACY	636	J7500	4	N/A	N/A	N/A
HC65000636_06050561521	NONCDM CHARGE RECORD PHARMACY	636	J0696	5	N/A	N/A	N/A
HC65000636_06050562315	NONCDM CHARGE RECORD PHARMACY	636	J0690	9	N/A	N/A	N/A
HC65000636_06170330538	NONCDM CHARGE RECORD PHARMACY	636	J9100	41	N/A	N/A	N/A
HC65000636_06170330925	NONCDM CHARGE RECORD PHARMACY	636	J9370	35	N/A	N/A	N/A
HC65000636_06170332322	NONCDM CHARGE RECORD PHARMACY	636	J9040	302	N/A	N/A	N/A
HC65000636_06170336318	NONCDM CHARGE RECORD PHARMACY	636	J9263	3	N/A	N/A	N/A
HC65000636_06170342153	NONCDM CHARGE RECORD PHARMACY	636	J7999	596	N/A	N/A	N/A
HC65000636_06195829011	NONCDM CHARGE RECORD PHARMACY	636	C9399	39	N/A	N/A	N/A
HC65000636_06302004901	NONCDM CHARGE RECORD PHARMACY	636	J9041	297	N/A	N/A	N/A
HC65000636_06332301207	NONCDM CHARGE RECORD PHARMACY	636	J2590	23	N/A	N/A	N/A
HC65000636_06332310605	NONCDM CHARGE RECORD PHARMACY	636	J3475	26	N/A	N/A	N/A
HC65000636_06332311710	NONCDM CHARGE RECORD PHARMACY	636	J9190	19	N/A	N/A	N/A
HC65000636_06332316505	NONCDM CHARGE RECORD PHARMACY	636	J1100	2	N/A	N/A	N/A
HC65000636_06332317301	NONCDM CHARGE RECORD PHARMACY	636	J1580	12	N/A	N/A	N/A
HC65000636_06332320102	NONCDM CHARGE RECORD PHARMACY	636	J2001	4	N/A	N/A	N/A
HC65000636_06332326226	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_06332326937	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_06332326959	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_06332328821	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_06332329561	NONCDM CHARGE RECORD PHARMACY	636	J3370	48	N/A	N/A	N/A
HC65000636_06332336059	NONCDM CHARGE RECORD PHARMACY	636	J0610	33	N/A	N/A	N/A
HC65000636_06332337701	NONCDM CHARGE RECORD PHARMACY	636	J2354	16	N/A	N/A	N/A
HC65000636_06332339810	NONCDM CHARGE RECORD PHARMACY	636	J0456	48	N/A	N/A	N/A
HC65000636_06332341605	NONCDM CHARGE RECORD PHARMACY	636	J3490	81	N/A	N/A	N/A
HC65000636_06332343400	NONCDM CHARGE RECORD PHARMACY	636	J0131	2	N/A	N/A	N/A
HC65000636_06332345401	NONCDM CHARGE RECORD PHARMACY	636	J2270	17	N/A	N/A	N/A
HC65000636_06332349227	NONCDM CHARGE RECORD PHARMACY	636	J2001	8	N/A	N/A	N/A
HC65000636_06332349297	NONCDM CHARGE RECORD PHARMACY	636	J2001	4	N/A	N/A	N/A
HC65000636_06332350720	NONCDM CHARGE RECORD PHARMACY	636	J2185	15	N/A	N/A	N/A
HC65000636_06332354015	NONCDM CHARGE RECORD PHARMACY	636	J1644	5	N/A	N/A	N/A
HC65000636_06332354313	NONCDM CHARGE RECORD PHARMACY	636	J1644	7	N/A	N/A	N/A
HC65000636_06332360584	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332360798	NONCDM CHARGE RECORD PHARMACY	636	J1650	7	N/A	N/A	N/A
HC65000636_06332361455	NONCDM CHARGE RECORD PHARMACY	636	J0360	12	N/A	N/A	N/A
HC65000636_06332366501	NONCDM CHARGE RECORD PHARMACY	636	J3105	115	N/A	N/A	N/A
HC65000636_06332371050	NONCDM CHARGE RECORD PHARMACY	636	J0640	35	N/A	N/A	N/A
HC65000636_06332372303	NONCDM CHARGE RECORD PHARMACY	636	J3490	418	N/A	N/A	N/A
HC65000636_06332388510	NONCDM CHARGE RECORD PHARMACY	636	J3490	749	N/A	N/A	N/A
HC65000636_06332396505	NONCDM CHARGE RECORD PHARMACY	636	J3480	15	N/A	N/A	N/A
HC65000636_06380760055	NONCDM CHARGE RECORD PHARMACY	636	J1642	0	N/A	N/A	N/A
HC65000636_06383361502	NONCDM CHARGE RECORD PHARMACY	636	J7187	9	N/A	N/A	N/A
HC65000636_06521925945	NONCDM CHARGE RECORD PHARMACY	636	J2543	23	N/A	N/A	N/A
HC65000636_06521942950	NONCDM CHARGE RECORD PHARMACY	636	J0883	14	N/A	N/A	N/A
HC65000636_06525013309	NONCDM CHARGE RECORD PHARMACY	636	C9290	10	N/A	N/A	N/A
HC65000636_06675805002	NONCDM CHARGE RECORD PHARMACY	636	J9171	23	N/A	N/A	N/A
HC65000636_06679420641	NONCDM CHARGE RECORD PHARMACY	636	J0295	42	N/A	N/A	N/A
HC65000636_06679422041	NONCDM CHARGE RECORD PHARMACY	636	J0290	14	N/A	N/A	N/A
HC65000636_06745724501	NONCDM CHARGE RECORD PHARMACY	636	J2354	11	N/A	N/A	N/A
HC65000636_06745729750	NONCDM CHARGE RECORD PHARMACY	636	C9399	12,350	N/A	N/A	N/A
HC65000636_06745743010	NONCDM CHARGE RECORD PHARMACY	636	J2430	171	N/A	N/A	N/A
HC65000636_06745744610	NONCDM CHARGE RECORD PHARMACY	636	J2430	203	N/A	N/A	N/A
HC65000636_06745779005	NONCDM CHARGE RECORD PHARMACY	636	J1953	1	N/A	N/A	N/A
HC65000636_06745784330	NONCDM CHARGE RECORD PHARMACY	636	J2020	149	N/A	N/A	N/A
HC65000636_06745785350	NONCDM CHARGE RECORD PHARMACY	636	J1120	260	N/A	N/A	N/A
HC65000636_06787749301	NONCDM CHARGE RECORD PHARMACY	636	J7500	2	N/A	N/A	N/A
HC65000636_06800141636	NONCDM CHARGE RECORD PHARMACY	636	J0640	52	N/A	N/A	N/A
HC65000636_06808422901	NONCDM CHARGE RECORD PHARMACY	636	J7500	4	N/A	N/A	N/A
HC65000636_06851652165	NONCDM CHARGE RECORD PHARMACY	636	P9047	197	N/A	N/A	N/A
HC65000636_06872774502	NONCDM CHARGE RECORD PHARMACY	636	J9153	1,314	N/A	N/A	N/A
HC65000636_06954337110	NONCDM CHARGE RECORD PHARMACY	636	J2469	28	N/A	N/A	N/A
HC65000636_06985301021	NONCDM CHARGE RECORD PHARMACY	636	C9041	1,619	N/A	N/A	N/A
HC65000636_07000430069	NONCDM CHARGE RECORD PHARMACY	636	J1170	33	N/A	N/A	N/A
HC65000636_07012115731	NONCDM CHARGE RECORD PHARMACY	636	J1030	69	N/A	N/A	N/A
HC65000636_07012115745	NONCDM CHARGE RECORD PHARMACY	636	J1040	107	N/A	N/A	N/A
HC65000636_07012116515	NONCDM CHARGE RECORD PHARMACY	636	J3301	14	N/A	N/A	N/A
HC65000636_07059404602	NONCDM CHARGE RECORD PHARMACY	636	J3370	43	N/A	N/A	N/A
HC65000636_07059408402	NONCDM CHARGE RECORD PHARMACY	636	J0290	12	N/A	N/A	N/A
HC65000636_07070018622	NONCDM CHARGE RECORD PHARMACY	636	J9190	34	N/A	N/A	N/A
HC65000636_07086021803	NONCDM CHARGE RECORD PHARMACY	636	J9070	476	N/A	N/A	N/A
HC65000636_07086030105	NONCDM CHARGE RECORD PHARMACY	636	J3490	20	N/A	N/A	N/A
HC65000636_07086078210	NONCDM CHARGE RECORD PHARMACY	636	J1453	2	N/A	N/A	N/A
HC65000636_07122510501	NONCDM CHARGE RECORD PHARMACY	636	J1726	0	N/A	N/A	N/A
HC65000636_07128501081	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,017	N/A	N/A	N/A
HC65000636_07128840211	NONCDM CHARGE RECORD PHARMACY	636	J1644	4	N/A	N/A	N/A
HC65000636_07128841081	NONCDM CHARGE RECORD PHARMACY	636	J1650	10	N/A	N/A	N/A
HC65000636_07128850111	NONCDM CHARGE RECORD PHARMACY	636	J2710	9	N/A	N/A	N/A
HC65000636_07226610201	NONCDM CHARGE RECORD PHARMACY	636	J3490	7	N/A	N/A	N/A
HC65000636_07226611825	NONCDM CHARGE RECORD PHARMACY	636	J1885	6	N/A	N/A	N/A
HC65000636_07257210001	NONCDM CHARGE RECORD PHARMACY	636	J0878	0	N/A	N/A	N/A
HC65000636_07257212808	NONCDM CHARGE RECORD PHARMACY	636	J3490	181	N/A	N/A	N/A
HC65000636_07257247010	NONCDM CHARGE RECORD PHARMACY	636	J3490	241	N/A	N/A	N/A
HC65000636_07257257125	NONCDM CHARGE RECORD PHARMACY	636	J2370	1	N/A	N/A	N/A
HC65000636_07257259010	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_07269451501	NONCDM CHARGE RECORD PHARMACY	636	J3490	71,593	N/A	N/A	N/A
HC65000636_07359493101	NONCDM CHARGE RECORD PHARMACY	636	J1437	163	N/A	N/A	N/A
HC65000636_07601400310	NONCDM CHARGE RECORD PHARMACY	636	J2710	10	N/A	N/A	N/A
HC65000636_07631002425	NONCDM CHARGE RECORD PHARMACY	636	J1455	309	N/A	N/A	N/A
HC65000636_07632933391	NONCDM CHARGE RECORD PHARMACY	636	J0461	1	N/A	N/A	N/A
HC65000636_08290306423	NONCDM CHARGE RECORD PHARMACY	636	J1642	0	N/A	N/A	N/A
HC65000636_09999600025	NONCDM CHARGE RECORD PHARMACY	636		520	N/A	N/A	N/A
HC65000636_70092103505	NONCDM CHARGE RECORD PHARMACY	636	J3490	171	N/A	N/A	N/A
HC65000637_00002831517	NONCDM CHARGE RECORD PHARMACY	636	J1815	5	N/A	N/A	N/A
HC65000637_00002879959	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00024587102	NONCDM CHARGE RECORD PHARMACY	637	J1815	0	N/A	N/A	N/A
HC65000637_00169633910	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00378696112	NONCDM CHARGE RECORD PHARMACY	636	J1595	0	N/A	N/A	N/A
HC65000637_04202320501	NONCDM CHARGE RECORD PHARMACY	636	J0630	11,292	N/A	N/A	N/A
HC65001258_00264751020	NONCDM CHARGE RECORD PHARMACY	258	J7060	18	N/A	N/A	N/A
HC65001258_00264775100	NONCDM CHARGE RECORD PHARMACY	258	J7070	19	N/A	N/A	N/A
HC62226808	TAMP BONE KYPHOPLASTY             B	272		1,050	N/A	N/A	N/A
HC62226949	WOUND FILLER GEL COLLAGEN	272	A6011	280	N/A	N/A	N/A
HC62226972	CATH FOLLOWER URETH PHILLIPS      F	272		210	N/A	N/A	N/A
HC62227004	DEVICE INFLATN ACCESS ABD	272		2,315	N/A	N/A	N/A
HC62227178	COUNTERSINK CANNULATED            M	272		980	N/A	N/A	N/A
HC62227202	CATH IV MIDLINE                   D	278	C1751	140	N/A	N/A	N/A
HC62227376	KIT CONCENTRATOR PLATELETS        J	272		630	N/A	N/A	N/A
HC62227400	DRESSING ANTIMIC MICRO-CURRENT    A	272		36	N/A	N/A	N/A
HC62227574	REAMER                            F	272		220	N/A	N/A	N/A
HC62227608	TAP SURGICAL                      G	272		350	N/A	N/A	N/A
HC62227640	CATH EP DX <20 ELECTRODES RPRSD   M	272	C1730	910	N/A	N/A	N/A
HC62227780	RETRIEVER GRAFT	272		210	N/A	N/A	N/A
HC62227814	KIT REPAIR BROVIAC/CV/HICKMAN     H	272		806	N/A	N/A	N/A
HC62227848	HEADREST PUPILLOMETER	272		106	N/A	N/A	N/A
HC62228010	MARKER GRAFT RADIOPAQUE	272		36	N/A	N/A	N/A
HC62228044	GRASPER ENDO	272		210	N/A	N/A	N/A
HC62228218	ORTH WHO NONTORSION JOINT(S) PREFAB OTS	274	L3916	1,642	N/A	N/A	N/A
HC62228242	ORTH HO W/O JOINTS CUSTOM	274	L3919	837	N/A	N/A	N/A
HC62228275	ORTH FO PIP/DIP W/ JOINT/SPRING PREFAB OTS	274	L3925	204	N/A	N/A	N/A
HC62228416	ORTH WHFO W/NONTORSION JOINT(S) CUSTOM	274	L3806	1,403	N/A	N/A	N/A
HC62228440	DEVICE REVASC/THROMBCT(EMBOTRAP)	272	C1757	21,000	N/A	N/A	N/A
HC62228473	BASKET RETRIEVAL BILIARY (SPYGLASS)	272		1,777	N/A	N/A	N/A
HC62228614	WOUND FILLER GEL(PLUROGEL)-14.1OZ	272	A6261	2,287	N/A	N/A	N/A
HC62228648	APPLIER CLIP CLOSURE ANASTOMOSIS	272		3,497	N/A	N/A	N/A
HC62228671	PAD DEFIBRILLATION/ECG	272		61	N/A	N/A	N/A
HC62228846	TEMPLATE BRACHYTHERAPY            U	272		2,286	N/A	N/A	N/A
HC62228879	LARYNGOSCOPE RHINO SLIM FLEX	272		770	N/A	N/A	N/A
HC62229042	NEEDLE HUBER/PORT-A-CATH          A	272		34	N/A	N/A	N/A
HC62229075	CATHETER PRESSURE MIKRO-CATH (MILLAR)	272		1	N/A	N/A	N/A
HC62229109	GUIDE PIN ORTHO                   U	272		2,380	N/A	N/A	N/A
HC62290127	P:CERCLAGE REMOVAL LVL 2			N/A	N/A	N/A	N/A
HC62290192	P:VAGINAL DELIVERY TWINS			N/A	N/A	N/A	N/A
HC62290325	P:C-SECTION W/GENERAL QUINTS			N/A	N/A	N/A	N/A
HC62300116	FORCEP ROBOTIC                    L	272		729	N/A	N/A	N/A
HC62300140	GRASPER ROBOTIC                   F	272		872	N/A	N/A	N/A
HC62300314	FORCEP ROBOTIC                    N	272		980	N/A	N/A	N/A
HC62300454	DRIVER NEEDLE ROBOTIC             I	272		420	N/A	N/A	N/A
HC62800123	BALLOON UTERINE	272	C1726	2,128	N/A	N/A	N/A
HC62800156	CATH BALLOON PTA(COYOTE)          H	272	C1725	1,050	N/A	N/A	N/A
HC62800180	CATH ATHERECTOMY ROTATIONAL      AH	272	C1724	7,700	N/A	N/A	N/A
HC62800321	CATH EP DX 20+ ELECTRODES         J	272	C1731	5,320	N/A	N/A	N/A
HC62800354	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AG	272	C1733	7,000	N/A	N/A	N/A
HC62800388	CATH INFUSION                     Q	272	C1887	1,400	N/A	N/A	N/A
HC62800560	DEVICE CLOSURE FASCIA	272		437	N/A	N/A	N/A
HC62800594	GUIDEWIRE                         E	272	C1769	315	N/A	N/A	N/A
HC62800768	M: BURR HOLE COVER	278	C1713	680	N/A	N/A	N/A
HC62800792	CAPSULE PH (IMPLANT)              I	278	C1889	1,680	N/A	N/A	N/A
HC62800826	CATH HEMO/PERI DIAL LONG TERM     O	278	C1750	1,119	N/A	N/A	N/A
HC62800966	M: CORNEAL TRANSPLANT ACQ	278	V2785	12,046	N/A	N/A	N/A
HC62800990	M: ELBOW COMPONENT	278	C1776	10,039	N/A	N/A	N/A
HC62801022	M: NAIL FEMORAL ANCHOR BONE-BONE	278	C1713	5,736	N/A	N/A	N/A
HC62801162	M:HIP FEM HEAD JOINT DEVICE	278	C1776	1,985	N/A	N/A	N/A
HC62801196	M: I.M. ROD	278	L8699	N/A	N/A	N/A	N/A
HC62801220	M: INTRASPINAL CATHETER	278	C1755	3,646	N/A	N/A	N/A
HC62801402	M: LEAD PCMKR TRANSVENOUS	275	C1779	1,371	N/A	N/A	N/A
HC62801436	M: MAXILLOFACIAL	278	L8699	7,507	N/A	N/A	N/A
HC62801600	PEG REPLACEMENT	278		248	N/A	N/A	N/A
HC62801634	M: PIN ABSORABLE	278		N/A	N/A	N/A	N/A
HC62801667	M: PIN TRANSFIXAT'N ANCHOR BONE-BNE	278	C1713	1,017	N/A	N/A	N/A
HC62801808	M: ROD ORTHO	278	L8699	1,600	N/A	N/A	N/A
HC62801832	M: SCREW NEURO	278	C1713	734	N/A	N/A	N/A
HC62801865	TUBE JEJUN STD TRANSG/SET PEG     M	278	A4649	840	N/A	N/A	N/A
HC62802038	M: STENT ABD AORTIC ANEURYSM	278	C1874	46,004	N/A	N/A	N/A
HC62802061	STENT CORO COVRD W/DEL SYS	278	C1874	9,975	N/A	N/A	N/A
HC62802236	M: TISSUE DURA DERM	278	C1762	7,998	N/A	N/A	N/A
HC62802269	TUBE JEJUN LOWPRO TG BUTTON	278	A4649	1,146	N/A	N/A	N/A
HC62802434	INTRODUCER COAXIAL	272	C1894	190	N/A	N/A	N/A
HC62802467	INTRODUCER KYPHOPLASTY OSTEO	272	C1894	3,745	N/A	N/A	N/A
HC62802491	INTRODUCER/SHEATH                 N	272	C1894	839	N/A	N/A	N/A
HC62802640	NEEDLE HDR BREAST IMPLANT	278	C1715	53	N/A	N/A	N/A
HC62802673	M: RING ORTHO	278		262	N/A	N/A	N/A
HC62802707	M: VALVE HEART-HOMOGEN	278	C1889	N/A	N/A	N/A	N/A
HC62802889	M: VALVE CONDUIT PULMONARY H020003	278	C1889	24,823	N/A	N/A	N/A
HC62802913	COIL NEUROVASC(HELIX/ULTRA HELICAL)AA	278		4,900	N/A	N/A	N/A
HC62803085	M: RING HEART MITRAL	278	C1889	9,849	N/A	N/A	N/A
HC62803119	M: VALVE HEART MECH MITRAL	278	C1889	16,225	N/A	N/A	N/A
HC62803283	KIT MONITOR PRESSURE ICP	272	C1729	2,963	N/A	N/A	N/A
HC62803317	STENT ENDOPRSTH AAA               V	278	C1874	31,499	N/A	N/A	N/A
HC62803341	M: SURGIMEND COLLGN MTRX FETAL/0.5CM2	278	C9358	14,525	N/A	N/A	N/A
HC62803499	M: JOINT MAJOR(SHOULDER/ANKLE)	278	C1776	5,273	N/A	N/A	N/A
HC62803523	COUNTERSINK CANNULATED            F	272		481	N/A	N/A	N/A
HC62803556	M: SLEEVE FEMORAL CENTERING	278		10,482	N/A	N/A	N/A
HC62803739	STENT NON-COAT/NON-COV W-DEL      S	278	C1876	2,100	N/A	N/A	N/A
HC62803762	STENT NON-COAT/NON-COV W-DEL     AE	278	C1876	6,650	N/A	N/A	N/A
HC62803937	STENT DES CORO COV W/DEL SYS      L	278	C1874	5,250	N/A	N/A	N/A
HC62803960	STENT URETERAL                    G	278	C2617	511	N/A	N/A	N/A
HC62803994	FILTER VENA CAVA  (E.G.TRAPEASE)  B	278	C1880	2,555	N/A	N/A	N/A
HC62804133	M: STENT ENDOVASC AV DIALYSIS	278	C1874	N/A	N/A	N/A	N/A
HC62804174	COIL EMBOLIZATION                 F	278		700	N/A	N/A	N/A
HC62804208	COIL EMBOLIZATION                 I	278		1,120	N/A	N/A	N/A
HC62804356	COIL EMBOLIZATION                 Y	278		3,360	N/A	N/A	N/A
HC62804380	COIL EMBOLIZATION                AB	278		3,780	N/A	N/A	N/A
HC62804414	STENT TRACHEOBRONC COV W/DEL SYS  E	278	C1874	7,000	N/A	N/A	N/A
HC62804588	STENT CORO BARE METAL W/DEL       A	278	C1876	980	N/A	N/A	N/A
HC62804612	STENT DES CORO COV W/DEL SYS      D	278	C1874	2,450	N/A	N/A	N/A
HC62804786	M: IMPLANT JOINT METATARSAL	278	L8641	N/A	N/A	N/A	N/A
HC62804810	M: REPL JNT INTRPHAL FINGR2/+METL-CER	278	L8659	2,754	N/A	N/A	N/A
HC62804844	GUIDE PIN ORTHO                   F	272		147	N/A	N/A	N/A
HC62804984	M: OFFSET SPINAL	278		616	N/A	N/A	N/A
HC62805015	CATH EP DX <20 ELECTRODES         E	272	C1730	700	N/A	N/A	N/A
HC62805049	M: HEAD SCREW SPINAL	278		1,575	N/A	N/A	N/A
HC62805213	M: PLUG SCLERAL OPTHALMIC	278		N/A	N/A	N/A	N/A
HC62805247	M: SLEEVE RIB VEPTR	278		N/A	N/A	N/A	N/A
HC62805429	M: SYSTEM REVISION HIP	278	C1776	8,750	N/A	N/A	N/A
HC62805452	M: IMPLANT SINUS DRUG-ELUTING	278	C2625	3,278	N/A	N/A	N/A
HC62805627	DEVICE ABLAT COOL-TIP NONVASC     H	272	C1886	5,250	N/A	N/A	N/A
HC62805650	DEVICE ABLAT COOL-TIP NONVASC    AN	272	C1886	11,900	N/A	N/A	N/A
HC62805684	CATH EP DX 20+ ELECTRODES         L	272	C1731	5,880	N/A	N/A	N/A
HC62805825	HEMOSTATIC GEL/GELFOAM/PAD        L	272		700	N/A	N/A	N/A
HC62805858	INTRO/SHEATH EP LASER            AH	272	C2629	9,800	N/A	N/A	N/A
HC62805882	CATH EP DX <20 ELECTRODES         B	272	C1730	280	N/A	N/A	N/A
HC62806054	CATH DIALYSIS SHORT-TERM          F	278	C1752	386	N/A	N/A	N/A
HC62806088	CATH HICKMAN/BROVIAC              I	278	C1751	490	N/A	N/A	N/A
HC62806252	CATH PTA W/BALLOON RX(DCB)        E	272	C2623	5,250	N/A	N/A	N/A
HC62806286	KIT CATH GASTROSTOMY PEG          G	278	A4649	350	N/A	N/A	N/A
HC62806310	TUBE GASTROSTOMY STNDRD BTTN OPT  F	278		280	N/A	N/A	N/A
HC62806450	STENT NON-COAT/NON-COV W-DEL      I	278	C1876	490	N/A	N/A	N/A
HC62806484	CATH BRACHY TX SEED ADMIN         C	272	C1728	5,316	N/A	N/A	N/A
HC62806518	KIT CATH GASTROSTOMY PEG          L	278	A4649	700	N/A	N/A	N/A
HC62806658	CATH BALLOON RETRIEVAL            D	272	C1773	350	N/A	N/A	N/A
HC62806682	STENT URETERAL ENDOPYELOTOMY     AB	278	C2617	5,250	N/A	N/A	N/A
HC62806716	DEVICE REVSC/THROMBCT(CAPTUR/SOLITAIR/TREVO)E	272	C1757	26,739	N/A	N/A	N/A
HC62806880	STENT ENDOPRSTH PVD(VIABAHN)      H	278	C1874	12,110	N/A	N/A	N/A
HC62806914	STENT EXTENDER ENDOGRAFT AAA      J	278	C1874	4,550	N/A	N/A	N/A
HC62807086	KIT KYPHOPAK 1ST FRACTURE         C	278	C1889	9,632	N/A	N/A	N/A
HC62807110	CATH ABLATION CARDIAC	272	C1733	11,025	N/A	N/A	N/A
HC62807144	STENT NON-COAT/NON-COV W-DEL     AI	278	C1876	8,925	N/A	N/A	N/A
HC62807284	CATH PTA W/BALLOON RX(DCB)        H	272	C2623	6,300	N/A	N/A	N/A
HC62807318	STENT TRACHEOBRONC COV W/DEL SYS  L	278	C1874	11,900	N/A	N/A	N/A
HC62807342	CLIP ENDOSCOPIC                   S	278		2,100	N/A	N/A	N/A
HC62807524	M: FOOTPLATE POST DISTRACTOR MAXILLARY	278	C1713	N/A	N/A	N/A	N/A
HC62807557	M: CAP END DISTRACTOR	278		N/A	N/A	N/A	N/A
HC62807722	M: BODY VERTEBRAL REPLACEMENT	278	C1889	18,287	N/A	N/A	N/A
HC62807755	M: GRAFT REPAIR NERVE	278	C1889	7,876	N/A	N/A	N/A
HC62807920	SEALANT TISSUE HYDROGEL	278		2,695	N/A	N/A	N/A
HC62807953	STENT ENDOPRSTH AAA               C	278	C1874	8,400	N/A	N/A	N/A
HC62807987	STENT ENDOPRSTH TAA              AC	278	C1874	55,999	N/A	N/A	N/A
HC62808126	M: PRIMATRIX PER SQ CM	636	Q4110	9,603	N/A	N/A	N/A
HC62808159	STENT COV W/DEL SYS PVD           B	278	C1874	8,225	N/A	N/A	N/A
HC62808183	STENT DES CORO COV GRAFTMASTER H000001	278	C1874	8,400	N/A	N/A	N/A
HC62808357	STENT NON-COAT/NON-COV W-DEL      R	278	C1876	1,750	N/A	N/A	N/A
HC62808381	CATHETER PACING BIPOLAR           G	272	C1779	350	N/A	N/A	N/A
HC62808555	M: PARTICLES EMBOLIZ  SLURRY	278		N/A	N/A	N/A	N/A
HC62808589	SYSTEM STENT-GRAFT THORACIC RELAY BRANCH IDE G160237	624	C1874	69,999	N/A	N/A	N/A
HC62808761	CATH INDIGO THROMB SEPARATOR 8 L150CM[PENUMBRA]	272	C1757	6,580	N/A	N/A	N/A
HC62808795	CATH INDIGO THROMB L140CM[PENUMBRA]	272	C1757	6,790	N/A	N/A	N/A
HC62808829	CATH INDIGO 8 THROMB 8FR TORQ/XTORQ[PENUMBRA]	272	C1757	10,115	N/A	N/A	N/A
HC62808969	G210241 SYSTEM EMBOLIC HYDROGEL EMBRACE INSTYLLA?	624	C1889	1	N/A	N/A	N/A
HC62809025	ATRIAL FLOW REGULATOR(OCCLUTECH)G210281	624	C1817	1	N/A	N/A	N/A
HC62890090	P: AICD SINGLE CHAMBER C1722 W/LEAD C1777 OR C1895 OR C1898			N/A	N/A	N/A	N/A
HC65000250_00002323560	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_00002411230	NONCDM CHARGE RECORD PHARMACY	250		84	N/A	N/A	N/A
HC65000250_00006022128	NONCDM CHARGE RECORD PHARMACY	250		112	N/A	N/A	N/A
HC65000250_00006027728	NONCDM CHARGE RECORD PHARMACY	250		111	N/A	N/A	N/A
HC65000250_00007414220	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_00023040350	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00023455430	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00023615108	NONCDM CHARGE RECORD PHARMACY	250		194	N/A	N/A	N/A
HC65000250_00032121207	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_00039413012	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00054004421	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00054006447	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_00054042523	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_00054051744	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00054070920	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00054458127	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00054829925	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00054852625	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00065080050	NONCDM CHARGE RECORD PHARMACY	250		519	N/A	N/A	N/A
HC65000250_00067200091	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00071201223	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00074434190	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00078050115	NONCDM CHARGE RECORD PHARMACY	250		149	N/A	N/A	N/A
HC65000250_00078051005	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00078077720	NONCDM CHARGE RECORD PHARMACY	250		67	N/A	N/A	N/A
HC65000250_00093026230	NONCDM CHARGE RECORD PHARMACY	250		474	N/A	N/A	N/A
HC65000250_00093031805	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093032001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093217801	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00093220401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093414664	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_00093416173	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00093506201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093729501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093738598	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093762056	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093970201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00115101001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00115164501	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00121057708	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_00121059516	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00121075908	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00121086230	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_00121090340	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00121097400	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_00121097810	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00121115440	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00121177500	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00121187000	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00132020140	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00132070336	NONCDM CHARGE RECORD PHARMACY	250	Z7610	13	N/A	N/A	N/A
HC65000250_00149003908	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00149003978	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00168000480	NONCDM CHARGE RECORD PHARMACY	250	Z7610	46	N/A	N/A	N/A
HC65000250_00172392660	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00172524160	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_00172572870	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00223176001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00225055050	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_00228257111	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00228263111	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00228282011	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00245053660	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00245531901	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00245532630	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00310009530	NONCDM CHARGE RECORD PHARMACY	250		85	N/A	N/A	N/A
HC65000250_00310111039	NONCDM CHARGE RECORD PHARMACY	250		157	N/A	N/A	N/A
HC65000250_00310621030	NONCDM CHARGE RECORD PHARMACY	250		118	N/A	N/A	N/A
HC65000250_00378161001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378180577	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00378335099	NONCDM CHARGE RECORD PHARMACY	250		121	N/A	N/A	N/A
HC65000250_00378351501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378410591	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_00378728653	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_00378907093	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_00378910493	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00395266116	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00406012462	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00406851562	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00406911276	NONCDM CHARGE RECORD PHARMACY	250		106	N/A	N/A	N/A
HC65000250_00409488810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00409488850	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00409729973	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00456140563	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_00456141090	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65000250_00456320563	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_00487278401	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00487900360	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00527058601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527130101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00527328446	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527328846	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527411737	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00536116134	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00536120207	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00536121277	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_00536132706	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536136223	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536730001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00555003302	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00555015802	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574006716	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_00574006945	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574010770	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00574200815	NONCDM CHARGE RECORD PHARMACY	250		117	N/A	N/A	N/A
HC65000250_00574703412	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00591079601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00591247501	NONCDM CHARGE RECORD PHARMACY	250	Z7610	82	N/A	N/A	N/A
HC65000250_00597005216	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00597014090	NONCDM CHARGE RECORD PHARMACY	250		107	N/A	N/A	N/A
HC65000250_00597015330	NONCDM CHARGE RECORD PHARMACY	250		123	N/A	N/A	N/A
HC65000250_00603155416	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65000250_00603188016	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65000250_00603221321	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00713068215	NONCDM CHARGE RECORD PHARMACY	250		257	N/A	N/A	N/A
HC65000250_00781107701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00781603946	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00781730931	NONCDM CHARGE RECORD PHARMACY	250		88	N/A	N/A	N/A
HC65000250_00832121201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00832121401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832121600	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832712411	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00869066738	NONCDM CHARGE RECORD PHARMACY	250	Z7610	8	N/A	N/A	N/A
HC65000250_00904020261	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904188260	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904188372	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904504561	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904506260	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904528261	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00904549280	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904552361	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904561061	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904585560	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904589161	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904592161	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904623861	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904626945	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_00904635261	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904635861	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904636361	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904641861	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904643604	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_00904644061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904650061	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904650361	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00904657261	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904658561	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904666661	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904667106	NONCDM CHARGE RECORD PHARMACY	250	S0081	2	N/A	N/A	N/A
HC65000250_00904669161	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904673061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904674561	NONCDM CHARGE RECORD PHARMACY	250	Z7610	31	N/A	N/A	N/A
HC65000250_00904674780	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904679961	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904680861	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904686861	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904689361	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_00904692561	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904698640	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904699061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904699261	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904704206	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904704361	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00904704606	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904710661	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904711061	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904718361	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904718904	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_00904719361	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904759180	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904791461	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00955104818	NONCDM CHARGE RECORD PHARMACY	250	Z7610	39	N/A	N/A	N/A
HC65000250_01001955303	NONCDM CHARGE RECORD PHARMACY	250		138	N/A	N/A	N/A
HC65000250_01013511101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01048101118	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_01070216901	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01093940233	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_01093950233	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01093957144	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093995368	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01152313141	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_01152714351	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_01310703134	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01310715430	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01381167830	NONCDM CHARGE RECORD PHARMACY	250	Z7610	34	N/A	N/A	N/A
HC65000250_01625253901	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_01659048930	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_01671400901	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01671403501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671407701	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_01671408210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671408701	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0	N/A	N/A	N/A
HC65000250_01671417601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	0	N/A	N/A	N/A
HC65000250_01671419901	NONCDM CHARGE RECORD PHARMACY	250		51	N/A	N/A	N/A
HC65000250_01671439401	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_01671444301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01671444701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671451001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671461204	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671461301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671466301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671468201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671471503	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671472002	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671479601	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_01671480401	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01671481401	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_01671484301	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_01671484901	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_01671485301	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01671499001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672903410	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01672927801	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01672928001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01686424001	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01686468003	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_01723890030	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01747822612	NONCDM CHARGE RECORD PHARMACY	250		533	N/A	N/A	N/A
HC65000250_01747828810	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_01747840303	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01785603122	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_01785609623	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_02315510201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315510405	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315519201	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02315572301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02315573001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02318514505	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_02420891019	NONCDM CHARGE RECORD PHARMACY	250		64	N/A	N/A	N/A
HC65000250_02433812203	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_02433813213	NONCDM CHARGE RECORD PHARMACY	250		123	N/A	N/A	N/A
HC65000250_02724100106	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02724113436	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_02903302602	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_02930012613	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_02930013505	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172215490	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03172258530	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_03172258730	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03172273090	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03172283330	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_03334206510	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03334209809	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03736110277	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03848580855	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03877907438	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04110080604	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04110081127	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_04110081163	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04219280101	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04229118590	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04229204120	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04249430112	NONCDM CHARGE RECORD PHARMACY	250		127	N/A	N/A	N/A
HC65000250_04249440901	NONCDM CHARGE RECORD PHARMACY	250		258	N/A	N/A	N/A
HC65000250_04279921701	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_04280608701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04280626301	NONCDM CHARGE RECORD PHARMACY	250	Z7610	43	N/A	N/A	N/A
HC65000250_04285810301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04285830225	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04293770110	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04354727509	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354728110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354738609	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354740210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354740350	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04359865530	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04422930760	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04467710302	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_04580206170	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04580206405	NONCDM CHARGE RECORD PHARMACY	250	Z7610	127	N/A	N/A	N/A
HC65000250_04580243321	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04580243803	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_04580295243	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_04603600739	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04612239272	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04733532186	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04733571186	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04778129903	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6	N/A	N/A	N/A
HC65000250_04778165790	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04778172902	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_04934809529	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04934815472	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_04934881813	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04934887277	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_04934898023	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04988412201	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04988425701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04988431155	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_05011143401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05011156101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05022845801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026806215	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026808612	NONCDM CHARGE RECORD PHARMACY	250		235	N/A	N/A	N/A
HC65000250_05026815115	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026817815	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_05026819015	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026835015	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026836115	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026852215	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026852915	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05026860115	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_05026862115	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026862815	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_05026868615	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026870115	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026871715	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026885215	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026886015	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05038317290	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05038328604	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65000250_05038379516	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_05038385924	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05038396134	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05045864565	NONCDM CHARGE RECORD PHARMACY	250	Z7610	48	N/A	N/A	N/A
HC65000250_05047457009	NONCDM CHARGE RECORD PHARMACY	250		134	N/A	N/A	N/A
HC65000250_05058013404	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05074226201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05074261501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107916503	NONCDM CHARGE RECORD PHARMACY	250		214	N/A	N/A	N/A
HC65000250_05107920406	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_05107925520	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107943620	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05107944120	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107944420	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05107968520	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107972420	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107974720	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05107992220	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_05107992520	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_05107999820	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC45400371	MR ORBIT/FACE&OR NECK W&WO CON	611	70543	11,815	N/A	N/A	N/A
HC45400405	MR PELVIS W&W/O CONTRAST	610	72197	11,403	N/A	N/A	N/A
HC45400561	MR UP EXT(NON JNT) W&W/O BIL	610	73220	19,553	N/A	N/A	N/A
HC45400595	MR UP EXT(JNT) W/O CONT BIL	610	73221	11,414	N/A	N/A	N/A
HC45400629	MR UP EXT (JNT) W/CONT BIL	610	73222	14,167	N/A	N/A	N/A
HC45400843	MRI CARDIAC MORPH W/STRESS W/O	610	75559	9,029	N/A	N/A	N/A
HC45400900	MR UPPER EXT JNT W&W/O CONT LT	610	73223	10,995	N/A	N/A	N/A
HC45401197	MRA LOW EXT W/CONT BILAT	610	C8912	10,829	N/A	N/A	N/A
HC45401221	MRA LOW EXT W/O CONT BILAT	610	C8913	9,671	N/A	N/A	N/A
HC45401254	MRA LOW EXT W&W/O CONT BILAT	610	C8914	12,791	N/A	N/A	N/A
HC45401536	MR ABDOMEN(MRCP)W&W/O CONTRAST	610	74183	11,386	N/A	N/A	N/A
HC45401569	MR ELASTOGRAPHY	610	76391	2,819	N/A	N/A	N/A
HC45401593	MR BREASTS W/O&W CONTR & CAD (BILAT) [COMM&MCAL]	610	77049	10,129	N/A	N/A	N/A
HC46000030	INJ ARTHRO HIP W/ANESTH-LT	361	27095	2,045	N/A	N/A	N/A
HC46000071	INJ ARTHRO/CT/MRI SHOULDER-RT	361	23350	1,770	N/A	N/A	N/A
HC46000121	INJ ARTHROGRAM ELBOW-LT	361	24220	1,720	N/A	N/A	N/A
HC46000428	INJ PROC SPLENOPORTOGRAM	361	38200	1,794	N/A	N/A	N/A
HC46000451	INJ VENOGRAM EXTREMITY-RT	361	36005	1,521	N/A	N/A	N/A
HC46000725	SEL CATH AB/PEL/LOEXT1ST OR RT	321	36245	7,074	N/A	N/A	N/A
HC46000774	SEL CATH AB/PEL/LOEX 2ND+ORD LT	321	36248	2,391	N/A	N/A	N/A
HC46000816	SEL CATH AB/PEL/LOEXT3RD OR RT	321	36247	9,291	N/A	N/A	N/A
HC46000956	SEL CATH THOR/BRAC+ 2ND/3RD RT	321	36218	1,847	N/A	N/A	N/A
HC46000980	SEL VENOUS CATH 1ST ORD RT	321	36011	3,077	N/A	N/A	N/A
HC46001012	VENOUS CATH ORGAN BLD SIMPLE	361	36500	2,958	N/A	N/A	N/A
HC46001293	INJ ANTEGRAD COMP(NEPH/URET'GRM S&I)NEW ACCESS RT	361	50430	6,110	N/A	N/A	N/A
HC46001327	INJ ANTEGRAD NEPH/URET'GRM S&I EXIST ACCESS RT	361	50431	3,991	N/A	N/A	N/A
HC46500294	BIOPSY NEEDLE PANCREAS	361	48102	6,057	N/A	N/A	N/A
HC46500328	BIOPSY NEEDLE RENAL-RT	361	50200	7,747	N/A	N/A	N/A
HC46500575	BX SFT TISS PELV/HIP-RT	361	27040	6,399	N/A	N/A	N/A
HC46500625	CHANGE CYSTOSTOMY; COMPLICATED	361	51710	4,461	N/A	N/A	N/A
HC46500708	CHANGE URETEROSTOMY TUBE RT	361	50688	7,717	N/A	N/A	N/A
HC46500963	INS TUN VEN ACS DEV 2 SITES	361	36565	15,641	N/A	N/A	N/A
HC46500997	INS TUN VEN ACS DEV W/SQ PUMP	361	36563	17,121	N/A	N/A	N/A
HC46501029	INS VEN ACS DEV 2SITES W/PORT	361	36566	18,812	N/A	N/A	N/A
HC46501219	MECH REMOV PERICATH OBSTR MAT CV	361	36595	11,836	N/A	N/A	N/A
HC46501250	PERC PLACEMENT CEC TUBE W/FLUORO	361	49442	10,129	N/A	N/A	N/A
HC46501458	REPLC CATH ONLY CV ACESS W/PORT	361	36578	12,854	N/A	N/A	N/A
HC46501482	REPLC TUNNELED CV ACS DEV W/PUMP	361	36583	17,507	N/A	N/A	N/A
HC46501516	REPLC PICC LINE W/ SQ PORT	361	36585	14,395	N/A	N/A	N/A
HC46501730	BX NECK/THORAX SOFT TISSUE-SC	361	21550	8,045	N/A	N/A	N/A
HC46501763	BIOPSY NEEDLE RENAL	361	50200	7,747	N/A	N/A	N/A
HC46501797	INSERT CT(OPEN) W/DRAIN SYSTEM	361	32551	4,582	N/A	N/A	N/A
HC46502043	BX SOFT TISS THIGH/KNEE;SUP LT	361	27323	3,430	N/A	N/A	N/A
HC46502084	BX PROSTATE STEREO/TEMPLAT W/IMG	361	55706	8,086	N/A	N/A	N/A
HC46502118	ABLAT RENAL TUMOR(S) PERC CRYO	361	50593	32,840	N/A	N/A	N/A
HC46502282	PERC DRAIN CATH W/IMAG; SOFT TISSUE	361	10030	6,130	N/A	N/A	N/A
HC46502316	PERC DRAIN W/IMAG; PERIT/RETROPERIT TRANSVAG/RECTAL	361	49407	7,519	N/A	N/A	N/A
HC46502480	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM S&I)EXST RT	361	50434	8,075	N/A	N/A	N/A
HC46502514	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM S&I) RT	361	50435	9,385	N/A	N/A	N/A
HC46502548	TENOTOMY  PERC  TOE; MULTIPLE TENDONS	361	28011	10,573	N/A	N/A	N/A
HC46502688	FNA ASP BX W/CT; EACH ADD'L LESION	361	10010	3,426	N/A	N/A	N/A
HC46502712	BIOPSY TANGENTIAL SKIN; SINGLE INITIAL LESION	361	11102	1,416	N/A	N/A	N/A
HC46502746	BIOPSY PUNCH SKIN; EACH SEP ADD'L LESION	361	11105	1,144	N/A	N/A	N/A
HC46502936	ABLATION PERC CRYO LOWER EXTREMITY NERVE INCLDE IMAG	361	0441T	7,627	N/A	N/A	N/A
HC46502969	BX SOFT TISS UPPER ARM/ELBOW DEEP RT	361	24066	6,776	N/A	N/A	N/A
HC46503132	BX SOFT TISS SHOULDER DEEP BIL	361	23066	8,531	N/A	N/A	N/A
HC46503165	BX SOFT TISS UPPER ARM/ELBOW SUP BIL	361	24065	7,623	N/A	N/A	N/A
HC46503330	BIOPSY MUSCLE SUPERFICIAL LT	361	20200	4,235	N/A	N/A	N/A
HC47200001	BASIC DOSIMETRY CALCULATION	333	77300	1,789	N/A	N/A	N/A
HC47200100	ABLAT PULM TUMOR(S) PERC UNILAT  W/IMG GUID; RF	361	32998	16,389	N/A	N/A	N/A
HC47200308	PHYSICS CONSULT CONTINUOUS	333	77336	1,847	N/A	N/A	N/A
HC47200332	PLC BRACHY CATH W/PART MAST LT	361	19298	15,019	N/A	N/A	N/A
HC47200365	PLC MAMMOSITE AFTER DOS LT	361	19296	16,098	N/A	N/A	N/A
HC47200639	TRANSCATH PLCMNT RAD DEL DEVIC	333	92974	7,380	N/A	N/A	N/A
HC47200662	TREATMENT DEVICES COMPLEX	333	77334	3,619	N/A	N/A	N/A
HC47200845	SRS ROBOTIC FX EA 1-5 SESS CMPLT	333	77373	24,828	N/A	N/A	N/A
HC47200886	REMOVAL OF FIXATION DEVICE	361	20665	1,403	N/A	N/A	N/A
HC47201116	HDR RADIONUCLIDE INTRSTTL/INTRVIT BRACH 1 CHANNEL	333	77770	8,992	N/A	N/A	N/A
HC47201140	HDR ELECTRONIC BRACHYTHERAPY SKIN SURFACE	333	0394T	1,131	N/A	N/A	N/A
HC47201173	TRANSPERINEAL PLCMNT BIODEGRADABLE MATERIAL	361	55874	18,026	N/A	N/A	N/A
HC51000107	CYSTOMETROGRAM W/VOID PRESSURE	361	51728	1,136	N/A	N/A	N/A
HC51000131	IMMUNIZATION ADMIN SINGLE	771	90471	119	N/A	N/A	N/A
HC51000164	ECG ROUTINE 12+ LEADS	730	93005	126	N/A	N/A	N/A
HC51000438	REPAIR CENTRAL VEN CATH(TECH/HOSP)	361	36575	838	N/A	N/A	N/A
HC51000461	BLOOD DRAW IMP'T VENOUS DEVICE	300	36591	157	N/A	N/A	N/A
HC51001220	CLOSED TX ELBOW DISLOCATION	361	24640	595	N/A	N/A	N/A
HC51001253	CLOSED TX RADIAL SHAFT FX NO MANIP	361	25500	745	N/A	N/A	N/A
HC51001287	CLOSED TX METACARPAL FX NO MANIP	361	26600	699	N/A	N/A	N/A
HC51001428	CLOSED TX METATARSAL FX	361	28470	699	N/A	N/A	N/A
HC51001451	REFILL&MAINT'N IMPLANT PUMP	940	96522	385	N/A	N/A	N/A
HC51001485	APPLY CAST LONG LEG	700	29345	489	N/A	N/A	N/A
HC51001659	X-RAY SPINE LUMBOSCARAL; BEND ONLY 2 OR 3VWS	320	72120	391	N/A	N/A	N/A
HC51001691	X-RAY HUMERUS; MIN 2 VWS	320	73060	253	N/A	N/A	N/A
HC51001899	X-RAY BONE LENGTH STUDIES	320	77073	225	N/A	N/A	N/A
HC51001923	RETICULOCYTE MANUAL	305	85044	49	N/A	45	N/A
HC51002152	CYSTOGRAM SIMPLE	361	51725	431	N/A	N/A	N/A
HC51002186	UROFLOWMETRY SIMPLE	361	51736	229	N/A	N/A	N/A
HC51002210	URINALYSIS DIP STICK NONAUTO W/SCOPE	300	81000	17	N/A	N/A	N/A
HC51002350	EXCISION GLAND BULBOURETHRAL	361	53250	1,008	N/A	N/A	N/A
HC51002384	EXCISE LESION <0.5CM HND-FT-SC-NCK-GN	361	11420	341	N/A	N/A	N/A
HC51002418	EXCISE LESION 2.1-3CM HND-FT-SC-NCK-GN	361	11423	869	N/A	N/A	N/A
HC51002616	CAUTERIZE W/CHEM; GRAN TISSUE	361	17250	349	N/A	N/A	N/A
HC51002640	THORACENTESIS ASP W/ IMG GUID	361	32555	1,237	N/A	N/A	N/A
HC51002814	CYSTOURETHROSCOPY(SEPARATE PROC)	361	52000	2,250	N/A	N/A	N/A
HC51002848	CYSTOURETHROSCOPY W/DIL BLADDER	361	52265	2,651	N/A	N/A	N/A
HC51003044	INJ CORPORA CAVERNOSOGRAM	361	54230	652	N/A	N/A	N/A
HC51003077	DRAIN ABSCESS WALL SCROTAL	361	55100	2,115	N/A	N/A	N/A
HC51003101	DESTROY LESION(S) VULVA SIMPLE	361	56501	3,004	N/A	N/A	N/A
HC51003242	COLPOSCOPY CERVIX&ADJACENT VAGINA	361	57452	458	N/A	N/A	N/A
HC51003275	COLPOSCPY CERV&ADJ VAG W/ECC	361	57456	676	N/A	N/A	N/A
HC51003309	BX(S)CERVIX / EXCISE LESION(SEP PROC)	361	57500	1,478	N/A	N/A	N/A
HC51003507	SCREENING DEPRESSION ANNUAL 5-15MIN	770	G0444	64	N/A	N/A	N/A
HC51003630	ANOSCOPY W/DILATION	361	46604	1,845	N/A	N/A	N/A
HC51003903	FNA ASP BX W/O GUIDE; EACH ADD'L LESION	361	10004	439	N/A	N/A	N/A
HC51003937	BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F ADD'L 15MIN+	919	90913	58	N/A	N/A	N/A
HC51004059	AEROSOL-CONTINUOUS TX FIRST HR	412	94644	164	N/A	N/A	N/A
HC51010171	ASP/INJ SMALL JNT-SC BILAT	361	20600	490	N/A	N/A	N/A
HC51010205	ASP/INJ MED JOINT-BILAT	361	20605	520	N/A	N/A	N/A
HC51010239	ASP/INJ LARGE JOINT-BILAT	361	20610	535	N/A	N/A	N/A
HC51010379	REFILL MAINT IMPL PMP/RESV WANAL'MD	261	95991	579	N/A	N/A	N/A
HC51010403	EMG 3 EXTREMITY	922	95863	779	N/A	N/A	N/A
HC51010437	EMG LTD NOT PARASP/CRANIAL/SPHINC	922	95870	162	N/A	N/A	N/A
HC51010601	IMMNTX 1 STING INSECT /COMM	924	95130	89	N/A	N/A	N/A
HC51010635	IMMNTX 4 STING INSECTS /COMM	924	95133	206	N/A	N/A	N/A
HC51010841	BONE MARROW DX; BIOPSY(SIES) ONLY	361	38221	1,668	N/A	N/A	N/A
HC51010874	LUMBAR PUNCTURE DX [NOT W/ CT OR FLUORO ]	361	62270	803	N/A	N/A	N/A
HC51010908	CHEMO ADMIN PLEURAL CAV W/THORACENTESIS	331	96440	1,175	N/A	N/A	N/A
HC51020246	NP DEV PT REPORT; COMPREHENSIVE	920	Z4304	283	N/A	N/A	N/A
HC51020279	NP EST PT LVL I; BRIEF	510	99211	81	N/A	N/A	N/A
HC51020303	NP EST PT LVL IV;EXTENDED	510	99214	216	N/A	N/A	N/A
HC51040012	RD TEAM CONF PRTCPNT PER 15MIN	920	Z4312	49	N/A	N/A	N/A
HC51040129	MNT RE ASSESS INDIV EA 15MIN    2ND REF (DX)	942	G0270	88	N/A	N/A	N/A
HC51060119	ST-LANGUAGE EVALUATION/C	440		379	N/A	N/A	N/A
HC51060143	PT-EVAL MOD COMPLEXITY 30MF2F 45MIN	424	97162	341	N/A	N/A	N/A
HC51060580	DESTROY MUSCLE(S) LARYNX BI	361	64617	1,622	N/A	N/A	N/A
HC51060614	DESTROY MUSCLE(S) 1-4 1ST EXTREMITY	361	64642	1,277	N/A	N/A	N/A
HC51060648	DESTROY MUSCLE(S) 5/+ EA ADD EXTREM	361	64645	973	N/A	N/A	N/A
HC51060788	OT-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	430	96113	163	N/A	N/A	N/A
HC51060812	PSYCH/NEUROPSYCH TEST ADMIN SNGLE AUTO INSTRU VIA ELECTRONIC AUTO RESULT ON	918	96146	86	N/A	N/A	N/A
HC51060945	OT-ORTHOTIC/PROSTH MGMT/TRAIN SUBSQ 15MIN/M	430	97763	183	N/A	N/A	N/A
HC51061117	CLOSED TX RAD/EPHYSL SEP&ULN FX W/MAN	361	25605	2,700	N/A	N/A	N/A
HC51061141	OSTEOTOMY TIBIA	361	27705	11,502	N/A	N/A	N/A
HC51061471	ECG EXT HOLTER W/CONNECT >7DAYS-15DAYS; RECORDING	731	93246	179	N/A	N/A	N/A
HC51061505	ECG EXT PT ACTV EVENT MONITOR ATTEND 24HRS-30DAYS; TRANSMIT/ANYS	731	93271	254	N/A	N/A	N/A
HC51061539	ASP & INJ GANGLION CYST	361	20612	494	N/A	N/A	N/A
HC51061695	ECHO FETAL CARDIOVASCULAR 2D	483	76825	919	N/A	N/A	N/A
HC51061729	ECHO FETAL DOPPLER F/U OR REPEAT	483	76828	324	N/A	N/A	N/A
HC51061752	X-RAY SPINE CERVICAL; 2 OR 3VWS	320	72040	270	N/A	N/A	N/A
HC51061893	X-RAY UPPER EXTREMITY INFANT MIN 2 VWS	320	73092	260	N/A	N/A	N/A
HC51061927	X-RAY FOOT 2 VWS	320	73620	211	N/A	N/A	N/A
HC51061950	MONITOR AMB GLUCOSE ASSESS 72+ HRS	920	95249	216	N/A	N/A	N/A
HC51062156	GLUCOSE BY DEVICE	301	82962	22	N/A	N/A	N/A
HC51062180	PH FLUID	301	83986	22	N/A	N/A	N/A
HC51062354	CPSP PSYCHOSOCIAL INIT' ASSESS/DEVEL POC; 1ST 30MIN	940	Z6300	64	N/A	N/A	N/A
HC51062388	CPSP ANTEPRTM PSYCHOSOCIAL F/U ASSESS/TX GROUP; EA 15MIN	940	Z6306	22	N/A	N/A	N/A
HC51062412	CPSP INITIAL HEALTH ED ASSESS/DEV POC; 1ST 30MIN	940	Z6402	64	N/A	N/A	N/A
HC51062560	BRONCHOSCOPY VIA ESTAB TRACH	361	31615	649	N/A	N/A	N/A
HC51062594	EMG FACIAL BILATERAL	922	95868	379	N/A	N/A	N/A
HC51062628	TELEHEALTH TRANSMISSION PER MIN (MCAL ONLY)	510	T1014	1	N/A	N/A	N/A
HC51062800	COMPLEX CHRONIC CARE MGMT EA ADDL 30MIN  PER MO+	949	99489	220	N/A	N/A	N/A
HC51062834	PHONE CALL BY NONPHYSICIAN HC PROF 5-10MIN	949	98966	50	N/A	N/A	N/A
HC51063006	DEBRIDE SKIN SUBQ EA ADD 20SQCM/<	361	11045	596	N/A	N/A	N/A
HC51063030	PAIRING BENIGN HYPERKERATOTIC LESION: 1	361	11055	468	N/A	N/A	N/A
HC51063204	PUNCH BX SKIN; SINGLE INL' LESION	361	11104	702	N/A	N/A	N/A
HC51070001	PSYCH DX EVAL EXAM (NO MED SVCS)	911	90791	374	N/A	N/A	N/A
HC51070035	PSY PREPARE REPORT	919	90889	303	N/A	N/A	N/A
HC51070381	PSY TX W/PATIENT 45MIN W/E&M+	914	90836	497	N/A	N/A	N/A
HC51070415	PSYCH PSYCHOANALYSIS	914	90845	260	N/A	N/A	N/A
HC51070449	PSYCH FAMILY GROUP THERAPY	915	90849	255	N/A	N/A	N/A
HC51070654	BEHAVIOR ADAPT TX GROUP BY QHCP; EA 15MIN	918	97158	88	N/A	N/A	N/A
HC51070688	PSY-ASSESS APHASIA W/REPORT PER HOUR	900	96105	281	N/A	N/A	N/A
HC62200001	CATH IV BASIC	272		64	N/A	N/A	N/A
HC62200050	ABDUCTION PILLOW	270		92	N/A	N/A	N/A
HC62200241	SET AUTOTRANSFUSE                AK	272		980	N/A	N/A	N/A
HC62200274	BAG COLOSTOMY/ILEOSTOMY/LOOP	272		34	N/A	N/A	N/A
HC62200316	BAG ENEMA W/ W/O TUBING	272		70	N/A	N/A	N/A
HC62200456	BASKET RETRIEVAL                  O	272		1,050	N/A	N/A	N/A
HC62200480	BINDER BREAST	270		70	N/A	N/A	N/A
HC62200522	BLADE INCISIONAL                  E	272		350	N/A	N/A	N/A
HC62200696	BONE WAX	272		120	N/A	N/A	N/A
HC62200720	BOTTLE DRAIN DBL DUAL LUMEN	272		211	N/A	N/A	N/A
HC62200902	BUTTON GASTRIC EXTENSION	272		666	N/A	N/A	N/A
HC62200951	CANNISTER SUCTION	270		39	N/A	N/A	N/A
HC62200985	CANNULA ARTERIAL                  V	272		1,719	N/A	N/A	N/A
HC62201132	CARTRIDGE HIGH FREQ JET	272		1,013	N/A	N/A	N/A
HC62201165	CASTING MATERIAL PLASTER	272		154	N/A	N/A	N/A
HC62201199	CATH ABR TRIPLE LUMEN	272		463	N/A	N/A	N/A
HC62201371	CATH ESOPHAGEAL PH	272		322	N/A	N/A	N/A
HC62201405	CATH FLUSH	272		295	N/A	N/A	N/A
HC62201587	CATH THORACIC	272		191	N/A	N/A	N/A
HC62201611	CATH URETERAL                     P	272	C1758	308	N/A	N/A	N/A
HC62201793	CIRCUIT VENT                      D	270		196	N/A	N/A	N/A
HC62201835	CLIP COLOSTOMY BAG	272		34	N/A	N/A	N/A
HC62201876	CLIP RANEY	272		232	N/A	N/A	N/A
HC62202023	CRUTCHES	272		45	N/A	N/A	N/A
HC62202056	KIT BIOPSY GUN	272		218	N/A	N/A	N/A
HC62202080	NEEDLE BX SPECIALTY	272		260	N/A	N/A	N/A
HC62202254	DEVICE INFLAT ENCORE              D	272		252	N/A	N/A	N/A
HC62202288	DONUT PILLOW INFANT/PREMIE	272		92	N/A	N/A	N/A
HC62202494	DRESSING INTERDRY AG PKG	272		205	N/A	N/A	N/A
HC62202536	DRESSING RAYON	272		195	N/A	N/A	N/A
HC62202734	ELECTRODE RESECTOSCOPE            E	272		419	N/A	N/A	N/A
HC62202767	ELECTRODE VAPORTRODE/VAPRTOME	272		725	N/A	N/A	N/A
HC62202791	EMBOLIC PROTECT SYSTEM CAROTID	278	C1884	6,861	N/A	N/A	N/A
HC62202932	STAPLE CARTRG/ENDO RELOAD         H	272		420	N/A	N/A	N/A
HC62202965	ENDO STAPLER                      K	272		770	N/A	N/A	N/A
HC62202999	TROCAR ENDO                       F	272		280	N/A	N/A	N/A
HC62203179	ET TAPE HYPAFIX	272		135	N/A	N/A	N/A
HC62203245	EVACUATOR ELLIK	272		209	N/A	N/A	N/A
HC62203468	HANDPIECE VESSEL SEALER DEVICE    A	272		1,065	N/A	N/A	N/A
HC62203492	SEALANT (FLOSEAL) KIT 10CC	278		1,065	N/A	N/A	N/A
HC62203534	IMMOBILIZER SHOULDER	274	L3670	112	N/A	N/A	N/A
HC62203724	KIT BONE PREP	272		537	N/A	N/A	N/A
HC62203757	KIT CATH RADIAL ARTERY	272	C1769	316	N/A	N/A	N/A
HC62203781	KIT CHOLANGIOGRAM	272		403	N/A	N/A	N/A
HC62203922	KIT REPAIR BROVIAC/CV/HICKMAN     G	272		736	N/A	N/A	N/A
HC62203955	KIT INTRAUTERINE PRESSURE	272		139	N/A	N/A	N/A
HC62203989	KIT INTRODUCER NEPHR/BILI/GI	272	C1894	711	N/A	N/A	N/A
HC62204151	KIT PNEUMOTHORAX	272		592	N/A	N/A	N/A
HC62204185	KIT PTCA CUSTOM NAMIC	272		428	N/A	N/A	N/A
HC62204359	KIT W/ TRACH PERCUTANEOUS         F	272	A7520	1,599	N/A	N/A	N/A
HC62204383	KIT/TRAY BIOPSY                   G	272		350	N/A	N/A	N/A
HC62204417	KNIFE MICROSURGICAL	272		255	N/A	N/A	N/A
HC62204565	LUER LOCK W/INJ CAP	272		116	N/A	N/A	N/A
HC62204599	PROGRAMMER NEUROSTIM PAT          B	271	C1787	2,887	N/A	N/A	N/A
HC62204623	M: NRSTM TRNSMTR BLADDER BOWEL	272	L8684	28,106	N/A	N/A	N/A
HC62204813	SPLINT NASAL                      D	272		183	N/A	N/A	N/A
HC62204847	NEEDLE ASPIRATION                 H	272		434	N/A	N/A	N/A
HC62205026	NEEDLE SUTURE GRICE	272		187	N/A	N/A	N/A
HC62205059	NERVE LOCATOR DISP	272		172	N/A	N/A	N/A
HC62205240	PACK CYSTOSCOPY	272		87	N/A	N/A	N/A
HC62205273	PACK FACET INJECTION	272		125	N/A	N/A	N/A
HC62205307	PACK KNEE TOTAL	272		221	N/A	N/A	N/A
HC62205448	PACK UNIVERSAL	272		140	N/A	N/A	N/A
HC62205471	PACK VAGINAL DELIVERY	272		106	N/A	N/A	N/A
HC62205505	PACKING IODOFROM	272		126	N/A	N/A	N/A
HC62205695	PIN PASSING	272		459	N/A	N/A	N/A
HC62205729	TRAP POLYP	272		65	N/A	N/A	N/A
HC62205901	PUNCH SKIN BX	272		50	N/A	N/A	N/A
HC62205935	RESIN ACRYLIC	272		554	N/A	N/A	N/A
HC62205968	RETRACTOR STAYS ELASTIC	272		442	N/A	N/A	N/A
HC62206107	SET ANGIO PUMP W/BAG	272		423	N/A	N/A	N/A
HC62206131	SET BLOOD Y TYPE	272		53	N/A	N/A	N/A
HC62206164	SET CATH FIXATION	272		732	N/A	N/A	N/A
HC62206305	SET LITHOTRIPTOR	272		1,073	N/A	N/A	N/A
HC62206339	SET NEEDLE INTRAOSEOUS	272		337	N/A	N/A	N/A
HC62206370	SET SUSPENSION EYE(FRONTALIS)	272		271	N/A	N/A	N/A
HC62206552	SLEEVE COMPRESSION                E	272		210	N/A	N/A	N/A
HC62206594	SNARE DLP TOURNIKWIK	272		340	N/A	N/A	N/A
HC62206776	ORTHOTIC FX WRIST PREFAB	274	L3984	191	N/A	N/A	N/A
HC62206818	STAYS UROLOGY[LONESTAR]	272		134	N/A	N/A	N/A
HC62206883	STRAP CLAVICLE	270		192	N/A	N/A	N/A
HC62207048	SUTURE LAURUS                     O	272		406	N/A	N/A	N/A
HC62207071	SUTURE RETRIEVER	272		308	N/A	N/A	N/A
HC62207105	SYRINGE ANGIO	272		36	N/A	N/A	N/A
HC62207287	TRAY BONE MARROW                  Q	272		336	N/A	N/A	N/A
HC62207329	TRAY EYE CARE	272		134	N/A	N/A	N/A
HC62207501	TRAY PLASTIC SUTURE	272		728	N/A	N/A	N/A
HC62207535	TRAY TRACH CARE/CLEANING	272		92	N/A	N/A	N/A
HC62207717	TUBE MYRINGOTOMY	272		227	N/A	N/A	N/A
HC62207741	TUBE SALEM SUMP	272		36	N/A	N/A	N/A
HC62207774	TUBE URINARY EXTENSION	272		45	N/A	N/A	N/A
HC62207949	TUBING PRESSURE MONITOR	272		57	N/A	N/A	N/A
HC62207972	TUBING SILICON	272		235	N/A	N/A	N/A
HC62208004	TUBING UTERINE VAC	272		57	N/A	N/A	N/A
HC62208178	VALVULTOME	272		6,577	N/A	N/A	N/A
HC62208210	WAFFLE WHEEL CHAIR	270		56	N/A	N/A	N/A
HC62208558	CONNECTOR COBE	272		135	N/A	N/A	N/A
HC62208590	KIT HEART LASER CO2	272		9,835	N/A	N/A	N/A
HC62208798	CATH INTRACARDIAC ECHO/UTZ        C	272	C1759	4,200	N/A	N/A	N/A
HC62208822	END CAP	272		22	N/A	N/A	N/A
HC62208871	SET DRAINAGE ANCHOR	272		266	N/A	N/A	N/A
HC62209010	IVS TUBING/CASSETTE PUMP	272		56	N/A	N/A	N/A
HC62209044	DRESSING SORBAVIEW	272		36	N/A	N/A	N/A
HC62209101	CT ELECTRODE SPRSLIM 2.0 CM EA	272		4,791	N/A	N/A	N/A
HC62209317	PROBE PH	272		350	N/A	N/A	N/A
HC62209358	APPLIER PORT RAPIDPORT EZ	272		2,432	N/A	N/A	N/A
HC62209523	M:MISC SPINE SURGERY SUPPLY	272		2,150	N/A	N/A	N/A
HC62209556	SYSTEM SINUS ILLUMINATION	272		1,502	N/A	N/A	N/A
HC62209580	TRACTION KIRSCHNER WIRE UNIT	270		984	N/A	N/A	N/A
HC62209721	G-TUBE DECLOGGER	272		151	N/A	N/A	N/A
HC62209754	IVS TUBING HBO ADAPTABLE	272		106	N/A	N/A	N/A
HC62209788	KIT CATH LT HEART FLUSH DEVICE	272		151	N/A	N/A	N/A
HC62210265	PACK TUBING ECMO	272		1,139	N/A	N/A	N/A
HC62210299	CATH SUCTION ELBOW INLINE	272		106	N/A	N/A	N/A
HC62210513	GLOVE COMPRESSION OPEN FINGER	271	E1399	53	N/A	N/A	N/A
HC62210547	ORTHTC HAND FUNCTIONL POSITION    D	274	L3807	140	N/A	N/A	N/A
HC62210729	WRAP COMPRESSION KNEE/HIP	270		130	N/A	N/A	N/A
HC62210752	CATH ACCESS DUODENOSCOPE	272		2,660	N/A	N/A	N/A
HC62210786	DEVICE ELECTROSURGICAL CUT-CAUTERY H	272		431	N/A	N/A	N/A
HC62210935	PACK LVAD/RVAD	272		1,050	N/A	N/A	N/A
HC62210968	PUMP CENTRIFUGAL	272		428	N/A	N/A	N/A
HC62210992	CANNULA AORTIC EASY FLOW	272		658	N/A	N/A	N/A
HC62211164	SENSOR GAS CBP	272		480	N/A	N/A	N/A
HC62211198	STABILIZER HEART OCTOPUS          O	272		6,300	N/A	N/A	N/A
HC62211396	IVS-INTL PERIPH SUPPLIES/TUBINGS	272		41	N/A	N/A	N/A
HC62211420	SENSOR PRESSURE HEMODYN (FLOTRAC)	272		1,053	N/A	N/A	N/A
HC62211602	DRESSING HYDROGEL WND FILLER SM	272		50	N/A	N/A	N/A
HC62211636	CATH SUCTION INLINE CLOSED RESP	272		61	N/A	N/A	N/A
HC62211669	CATH DRAINAGE                     Y	272	C1729	4,200	N/A	N/A	N/A
HC62211826	PAD STOMA TRACHEOSTOMY	272		56	N/A	N/A	N/A
HC62211859	KIT/SYS CATH MICRO'P'VASC INJ/COIL DEL	272	C1887	1,400	N/A	N/A	N/A
HC62211883	TRAY FOLEY CATH STATLOCK	272	A4314	56	N/A	N/A	N/A
HC62212063	CATH ANGIOG PERIPH CTO CROSSING  AQ	272	C1887	14,000	N/A	N/A	N/A
HC62212113	PORT SINGLE-SITE ROBOTIC	272		526	N/A	N/A	N/A
HC62212295	CATH RETRIEV STONE BACKSTOP GEL  AI	272		1,314	N/A	N/A	N/A
HC62212329	COLLAR CERV RIGID TRACHEA OPEN LG	274	L0172	56	N/A	N/A	N/A
HC62212352	PAD COLLAR REPLACEMENT	274	L4210	73	N/A	N/A	N/A
HC62212493	KIT PUMP REFILL SYNCHROMED	272	A4220	70	N/A	N/A	N/A
HC62212527	INTRODUCER/SHEATH                 Y	272	C1894	3,457	N/A	N/A	N/A
HC62212550	FORCEP BIOPSY DISP                H	272		526	N/A	N/A	N/A
HC62212691	GUIDEWIRE                         D	272	C1769	245	N/A	N/A	N/A
HC62212725	GUIDEWIRE                         L	272	C1769	804	N/A	N/A	N/A
HC62212758	GUIDEWIRE                         O	272	C1769	1,086	N/A	N/A	N/A
HC62212923	BLADE SHAVER                      J	272		701	N/A	N/A	N/A
HC62212956	BLADE SHAVER                      M	272		910	N/A	N/A	N/A
HC62213129	BLADE INCISIONAL                  J	272		700	N/A	N/A	N/A
HC62213152	BLADE INCISIONAL                  N	272		980	N/A	N/A	N/A
HC62213186	BURR                              C	272		210	N/A	N/A	N/A
HC62213327	PACK LAP GASTRIC BY-PASS	272		10,895	N/A	N/A	N/A
HC62213350	KIT NEBULIZER AERONEB SOLO	272	E0574	150	N/A	N/A	N/A
HC62213384	REAMER                            I	272		400	N/A	N/A	N/A
HC62213558	REAMER                            Z	272		1,610	N/A	N/A	N/A
HC62213582	REAMER                            AC	272		1,566	N/A	N/A	N/A
HC62213764	BAG AUTOTRANSFUSION	272		42	N/A	N/A	N/A
HC62213798	CANNULA INFUSION/IRRIG OPHTH	272		87	N/A	N/A	N/A
HC62213962	BURR                              B	272		142	N/A	N/A	N/A
HC62213996	FORCEP BIOPSY DISP                A	272		53	N/A	N/A	N/A
HC62214028	DRESSING NONADHERENT OWENS	272		41	N/A	N/A	N/A
HC62214168	CATH URETERAL                     G	272	C1758	98	N/A	N/A	N/A
HC62214192	CATH URETERAL                     K	272	C1758	168	N/A	N/A	N/A
HC62214226	CATH URETERAL                     O	272	C1758	280	N/A	N/A	N/A
HC62214408	TROCAR ENDO                       A	272		50	N/A	N/A	N/A
HC62214432	NEEDLE INJ FENESTRATED	272		140	N/A	N/A	N/A
HC62214614	SYRINGE BONE MARROW ASPIRATION 20CC	272		1,327	N/A	N/A	N/A
HC62214648	CAP KIT LEAD PACEMAKER            B	272		122	N/A	N/A	N/A
HC62214671	STAPLE CARTRG/ENDO RELOAD         B	272		70	N/A	N/A	N/A
HC62214812	BASKET RETRIEVAL                  F	272		308	N/A	N/A	N/A
HC62215082	BLADE CUP                        AB	272		2,100	N/A	N/A	N/A
HC62215181	BLADE SAW                         D	272		56	N/A	N/A	N/A
HC62215322	BLADE SAW                         S	272		393	N/A	N/A	N/A
HC62215355	BLADE SAW                         V	272		475	N/A	N/A	N/A
HC62215389	BLADE SAW                         Y	272		560	N/A	N/A	N/A
HC62215553	SUTURE                            E	272		126	N/A	N/A	N/A
HC62215587	SUTURE                            I	272		238	N/A	N/A	N/A
HC62215751	TEMPLATE ORTHO/ROD SPINAL         H	272		336	N/A	N/A	N/A
HC62215785	FORCEPS BIPOLAR DISPOSABLE        M	272		852	N/A	N/A	N/A
HC62215819	NEEDLE BIOPSY                     B	272		42	N/A	N/A	N/A
HC62215959	TRAY BONE MARROW                  I	272		126	N/A	N/A	N/A
HC62215983	CATH ERCP (PUSHING)               A	272		140	N/A	N/A	N/A
HC62216015	CATH BALLOON DIL NON VASCULAR     H	272	C1726	420	N/A	N/A	N/A
HC62216189	SPHINCTEROTOME CANNULATING        K	272		1,540	N/A	N/A	N/A
HC62216213	SPHINCTEROTOME                    G	272		980	N/A	N/A	N/A
HC62216403	PIN/WIRE FIXATION TEMPORARY       C	272		100	N/A	N/A	N/A
HC62216437	PIN/WIRE FIXATION TEMPORARY       F	272		84	N/A	N/A	N/A
HC62216601	PIN/WIRE FIXATION TEMPORARY       W	272		504	N/A	N/A	N/A
HC62216635	PIN/WIRE FIXATION TEMPORARY       Z	272		578	N/A	N/A	N/A
HC62216668	PIN/WIRE FIXATION TEMPORARY       AC	272		654	N/A	N/A	N/A
HC62216817	NEEDLE INSUFFLATION	272		116	N/A	N/A	N/A
HC62216841	ENDO STAPLER                      V	272		1,540	N/A	N/A	N/A
HC62216874	ENDO STAPLER                      Y	272		1,740	N/A	N/A	N/A
HC62217047	WRENCH TORQUE SHAFT SPINAL (DISP)	272		630	N/A	N/A	N/A
HC62217070	TUNNELER SURGICAL                 B	272		185	N/A	N/A	N/A
HC62217245	BLADE MILL BONE	272		1,400	N/A	N/A	N/A
HC62217278	PASSER SUTURE                     B	272		78	N/A	N/A	N/A
HC62217443	FORCEPS BIPOLAR DISPOSABLE        Q	272		1,613	N/A	N/A	N/A
HC62217476	KIT MIXER THROMBIN AUTOLOGUS	272		140	N/A	N/A	N/A
HC62217500	DRESSING AQUACEL AG	272		126	N/A	N/A	N/A
HC62217641	AWL SPINAL SINGLE PATIENT USE     I	272		840	N/A	N/A	N/A
HC62217674	AWL SPINAL SINGLE PATIENT USE     N	272		1,190	N/A	N/A	N/A
HC62217708	AWL SPINAL SINGLE PATIENT USE     S	272		1,680	N/A	N/A	N/A
HC62217872	SET PIN DISTRACTORS-COUNT 2       B	272		1,456	N/A	N/A	N/A
HC62217906	CATH MICRO NEURO (AXS CATALYST)  AH	272	C1887	7,700	N/A	N/A	N/A
HC62218078	STAPLE CARTRG/ENDO RELOAD         D	272		140	N/A	N/A	N/A
HC62218102	FIBER LASER                       D	272		565	N/A	N/A	N/A
HC62218136	PROBE APC/ARGON PLASMA COAGULATOR	272		750	N/A	N/A	N/A
HC62218276	CATH INTRODUCER PEEL-AWAY         J	272	C1892	280	N/A	N/A	N/A
HC62218300	ENDO STAPLER                      B	272		140	N/A	N/A	N/A
HC62218334	ENDO STAPLER                      E	272		355	N/A	N/A	N/A
HC62218474	LEAD DELIVERY SYSTEM              J	272		2,800	N/A	N/A	N/A
HC62218508	ENDO STAPLER                     AQ	272		3,490	N/A	N/A	N/A
HC62218532	KIT MONITORING NERVE(S) SPINAL    I	272		4,200	N/A	N/A	N/A
HC62218706	DRILL/DRILL BITS SINGLE USE       E	272		203	N/A	N/A	N/A
HC62218730	DRILL/DRILL BITS SINGLE USE       H	272		281	N/A	N/A	N/A
HC62218904	DRILL/DRILL BITS SINGLE USE       Y	272		1,436	N/A	N/A	N/A
HC62218938	DRILL/DRILL BITS SINGLE USE      AB	272		1,617	N/A	N/A	N/A
HC62218961	DRILL/DRILL BITS SINGLE USE      AE	272		1,943	N/A	N/A	N/A
HC62219100	ADHESIVE SKIN CARDIAC/PCMKR	272		84	N/A	N/A	N/A
HC62219134	CANNULA ARTHRSCPC(STICK SWITCHING)H	272		456	N/A	N/A	N/A
HC62219167	CATH ATRIOSEPTISTOTOMY	272		2,415	N/A	N/A	N/A
HC62219340	GUIDE TIBIAL ORTHO	272		1,282	N/A	N/A	N/A
HC62219373	HOOK MARKING ORTHO	272		1,400	N/A	N/A	N/A
HC62219555	PROBE SPINAL DISPOSABLE           O	272		1,400	N/A	N/A	N/A
HC62219597	STAPLE CARTRG/ENDO RELOAD         E	272		216	N/A	N/A	N/A
HC62219761	INSTRUMENT KYPHO PAC BEVELED	272		574	N/A	N/A	N/A
HC62219795	KIT PERFUSION                     D	272		3,850	N/A	N/A	N/A
HC62219829	PROGRAMMER NEUROSTIM PAT          H	271	C1787	4,193	N/A	N/A	N/A
HC62219969	OBTURATOR ARTHRO                  G	272		560	N/A	N/A	N/A
HC62219993	FASTENERS/ANCHORS TUBE GI-SET OF 3	272		381	N/A	N/A	N/A
HC62220025	PROBE ABLATION RF BIPOLR ARTHROSCPC	272		585	N/A	N/A	N/A
HC62220199	CATH THROMBECTOMY/EMBOLECTOMY     P	272	C1757	1,260	N/A	N/A	N/A
HC62220223	CLIP STIMULATION NERVE            I	272		1,750	N/A	N/A	N/A
HC62220397	CATH INTRODUCER PEEL-AWAY         C	272	C1892	56	N/A	N/A	N/A
HC62220421	KNIFE ANNULOTOMY (MAXCESS)	272		2,832	N/A	N/A	N/A
HC62220454	SPRAY ADHESIVE OSTOMY	272		57	N/A	N/A	N/A
HC62220595	SHEARS COAGULATING HARMONIC       R	272		1,820	N/A	N/A	N/A
HC62220629	HEADGEAR CPAP AIRLIFE	272		56	N/A	N/A	N/A
HC62220652	KIT ACCESSORY                     A	272		140	N/A	N/A	N/A
HC62220793	TRAY DRAIN PNEUMOPERICARDIUM	272	C1729	448	N/A	N/A	N/A
HC62220827	BAG/POUCH RETRIEVAL SPECMN ENDO   C	272		247	N/A	N/A	N/A
HC62220850	BINDER ABDOMINAL BASIC            B	270		70	N/A	N/A	N/A
HC62221023	ET POUCH                          A	272		36	N/A	N/A	N/A
HC62221056	KIT CANISTER BIOPSY CARTILAGE	272		1,733	N/A	N/A	N/A
HC62221239	NEEDLE ENDOSCOPIC                 A	272		44	N/A	N/A	N/A
HC62221262	NEEDLE SPINAL                     A	272		36	N/A	N/A	N/A
HC62221296	RESERVOIR CELL SAVER              F	272		280	N/A	N/A	N/A
HC62221437	TROCAR ENDO                       C	272		106	N/A	N/A	N/A
HC62221460	TROCAR ENDO                       H	272		420	N/A	N/A	N/A
HC62221494	TUBE INSUFFLATOR                  B	272		70	N/A	N/A	N/A
HC62221668	DRESSING SURGICEL                 C	272		162	N/A	N/A	N/A
HC62221692	KIT SPINAL ACCESS DISPOSBL        M	272		6,440	N/A	N/A	N/A
HC62221866	TAP SURGICAL                      P	272		1,260	N/A	N/A	N/A
HC62221890	TAP SURGICAL                      S	272		2,100	N/A	N/A	N/A
HC62222070	CATH CENTRAL VENOUS               M	272	C1751	840	N/A	N/A	N/A
HC62222104	GUIDE PIN ORTHO                   K	272		630	N/A	N/A	N/A
HC62222146	CASSETTE PURGE LVAD/RVAD	272		700	N/A	N/A	N/A
HC62222286	CANNULA ARTHROSCOPIC              F	272		280	N/A	N/A	N/A
HC62222310	DEVICE BIOPSY BREAST              Q	272		1,400	N/A	N/A	N/A
HC62222344	OVERTUBE ENDOSCOPIC               A	272		700	N/A	N/A	N/A
HC62222518	WAND ARTHRO                       Q	272		1,400	N/A	N/A	N/A
HC62222542	CATH NEPHROSTOMY                  F	272	C1729	280	N/A	N/A	N/A
HC62222716	CANNULA PERFUSION ARTRL/VENOUS    B	272		70	N/A	N/A	N/A
HC62222740	CAUTERY PENCIL                    B	272		70	N/A	N/A	N/A
HC62222773	CHEST TUBE                        A	272		36	N/A	N/A	N/A
HC62222914	PROBE LASER                       L	272		700	N/A	N/A	N/A
HC62222948	MANIPULATOR UTERINE               E	272		210	N/A	N/A	N/A
HC62222971	DILATOR/BOUGIE ESOPHAGEAL	272		361	N/A	N/A	N/A
HC62223110	CATH EMBOLECTOMY FOGARTY          D	272	C1757	140	N/A	N/A	N/A
HC62223144	FIBER LASER                       M	272		6,735	N/A	N/A	N/A
HC62223177	DEVICE ILLUMINATION MAST	272		1,789	N/A	N/A	N/A
HC62223342	CATH PTA ANGIOPLS BALLOON NON-LSR B	272	C1725	280	N/A	N/A	N/A
HC62223375	CATH MICROCATHETER NEUROVASC      I	272	C1887	1,120	N/A	N/A	N/A
HC62223540	DILATOR SET URETHRAL	272		703	N/A	N/A	N/A
HC62223573	ELECTRODE HOOK LAPAROSCOPIC	272		159	N/A	N/A	N/A
HC62223607	SNARE                             O	272		1,120	N/A	N/A	N/A
HC62223748	SYSTEM DELIVERY LEAD              C	272	C1887	840	N/A	N/A	N/A
HC62223771	DISSECTOR BALLOON ENDOSCOPIC      F	272		2,100	N/A	N/A	N/A
HC62223805	PACKING NASAL                     B	272		70	N/A	N/A	N/A
HC62223979	CANNISTER SUCTION NEURO/SPINAL	272		1,260	N/A	N/A	N/A
HC62224001	TUBING SUCTN/IRRIG NEURO/SPINAL	272		420	N/A	N/A	N/A
HC62224175	SHEARS COAGULATING HARMONIC       K	272		630	N/A	N/A	N/A
HC62224209	ELECTRODE LOOP                    E	272		210	N/A	N/A	N/A
HC62224373	CIRCUIT VENT SHORT WIRE HEATED	272		420	N/A	N/A	N/A
HC62224407	CUTTER RPRSD	272		78	N/A	N/A	N/A
HC62224431	HOOK DISSECTING ENDO	272		490	N/A	N/A	N/A
HC62224571	DEVICE SUTURE ENDOSCOPIC          O	272		2,938	N/A	N/A	N/A
HC62224605	CATH EP DX <20 ELECTRODES RPRSD   M	272	C1730	840	N/A	N/A	N/A
HC62224639	REAMER                           AJ	272		2,520	N/A	N/A	N/A
HC62224811	CATH BLOCKER BRONCH/TRACH	272		420	N/A	N/A	N/A
HC62224845	KIT PLACEMENT SHUNT ELECTROMAGNETIC	272		2,310	N/A	N/A	N/A
HC62225016	SPLINT NERVE RADIAL HAND-BASED	274	L3923	368	N/A	N/A	N/A
HC62225040	NEEDLE ASPIRAT(EUS SLIMLIN 19GA)  Q	272		1,400	N/A	N/A	N/A
HC62225214	ET PORT DRAIN FISTULA	272		70	N/A	N/A	N/A
HC62225248	KIT CAUTERY LEEP (REDIKIT)	272		630	N/A	N/A	N/A
HC62225271	SENSOR OXIMETRY CEREBRAL SOMATIC	272		280	N/A	N/A	N/A
HC62225412	PUSHER KNOT ENDO                  H	272		937	N/A	N/A	N/A
HC62225446	DEVICE RESECTION MUCOSAL ENDO(EMR)	272		1,138	N/A	N/A	N/A
HC62225479	IMMOBILIZER SHOULDER PEDS	274	L3670	280	N/A	N/A	N/A
HC62225677	CATH EP DIAG/ABLAT 3D/VECT       AB	272	C1732	12,600	N/A	N/A	N/A
HC62225701	CANNISTER WOUND NEG PRESSURE	272		106	N/A	N/A	N/A
HC62225883	GUIDE DRILL                       R	272		1,750	N/A	N/A	N/A
HC62225917	BASKET RETRIEVAL                  H	272		456	N/A	N/A	N/A
HC62225941	TUBE INSERT TONGUE BRACHYTHERAPY	272		70	N/A	N/A	N/A
HC62226097	DRILL/DRILL BITS SINGLE USE      AI	272		3,150	N/A	N/A	N/A
HC62226121	DRILL/DRILL BITS SINGLE USE      AM	272		3,500	N/A	N/A	N/A
HC62226154	CATH INTRACARDIAC ECHO/UTZ RPRSD  B	272	C1759	2,450	N/A	N/A	N/A
HC62226295	NEEDLE INSERTION NEUROSTIM	272		560	N/A	N/A	N/A
HC62226329	PIN/WIRE FIXATION TEMPORARY      AM	272		2,240	N/A	N/A	N/A
HC62226360	PROTECTOR CORNEAL	272		700	N/A	N/A	N/A
HC62226535	DRESSING FOAM W/BRDR&ANTIMIC<OR=48SQ IN	272	A6213	92	N/A	N/A	N/A
HC62226568	INTRODUCER/SHEATH                 F	272	C1894	280	N/A	N/A	N/A
HC62226733	MOLD/FORM CEMENT	272		1,750	N/A	N/A	N/A
HC62226774	COUNTERSINK CANNULATED            G	272		630	N/A	N/A	N/A
HC11200023	OBSERVATION PER HOUR - ONCOLOGY	762	G0378	307	N/A	N/A	N/A
HC11200041	OBSERVATION PER HOUR - OB	762	G0378	391	N/A	N/A	N/A
HC11200095	OBSERVATION PER HOUR - PEDS DOU	762	G0378	512	N/A	N/A	N/A
HC11500030	EST PT LVL4-DETAILED	510	99214	284	N/A	N/A	N/A
HC11500071	NEW PT LVL3-EXPANDED	510	99203	386	N/A	N/A	N/A
HC11500469	LACTATION E&M BRIEF EST'D L:I	761	99211	201	N/A	N/A	N/A
HC11500725	WC ESTB E&M  EXTENDED LVL 4	761	99214	487	N/A	N/A	N/A
HC11500774	AM/PACU EVAL MINOR-II	761	99212	363	N/A	N/A	N/A
HC11500964	WM EXAM NEW PT EVAL  HIGH L 4	761	99204	443	N/A	N/A	N/A
HC11500998	TELEHEALTH ORIGINATING SITE FACILITY FEE	780	Q3014	78	N/A	N/A	N/A
HC12200127	REFILL&MAINT'N IMPLANT PUMP	940	96522	861	N/A	N/A	N/A
HC12200168	INF CNTR-NEW PT EVAL MODERATE	510	99203	358	N/A	N/A	N/A
HC12200192	INF CNTR-ESTBD PT EVAL MINOR	510	99212	303	N/A	N/A	N/A
HC12200341	IV INFUSE/SC MONOCLONAL CASIRIVIMAB/IMDEVIMAB (REGENERON) REPEAT	771	M0240	1,460	N/A	N/A	N/A
HC12200408	IV INFUSE MONOCLONAL ABX SOTROVIMAB	771	M0247	1,700	N/A	N/A	N/A
HC12400008	CHEMO ADMIN IV INITIAL HR	335	96413	1,961	N/A	N/A	N/A
HC12600011	IMMUNIZATION ADMIN ADD'L	771	90472	170	N/A	N/A	N/A
HC12600052	ADMIN VACCINE HEPATITIS B	771	G0010	184	N/A	N/A	N/A
HC12600227	ADMIN VACCINE COVID-19 30MCG TRS-SUCR INITIAL DOSE {PFIZER}	771	0051A	125	N/A	N/A	N/A
HC12600250	ADMIN VACCINE COVID-19 30MCG TRS-SUCR BOOSTER DOSE {PFIZER}	771	0054A	125	N/A	N/A	N/A
HC12600284	ADMIN VACCINE COVID-19 50MCG/0.5ML BOOSTER {MODERNA}	771	0094A	125	N/A	N/A	N/A
HC12800066	THERAPEUTIC APHERESIS RBC'S	361	36512	9,921	N/A	N/A	N/A
HC12800090	TRANSFUSION EXCHANGE BLOOD NOT NEWBORN	391	36455	3,675	N/A	N/A	N/A
HC13500020	GENETIC CNSL RISK REDCTN 30MIN	942	99402	278	N/A	N/A	N/A
HC14500136	DM HEMOGLOBIN GLYCOSYLATED(A1C	301	83036	171	N/A	N/A	N/A
HC21000153	ASPIRATION OF ABCESS/CYST	361	10160	2,846	N/A	N/A	N/A
HC21000187	AVULSION OF NAIL  EA ADDL'	361	11732	676	N/A	N/A	N/A
HC21000377	DESTRUCT PREMALG LESIONS 2-14	361	17003	308	N/A	N/A	N/A
HC21000401	EXCISION OF NAIL/MATRIX PERM	361	11750	2,457	N/A	N/A	N/A
HC21000617	WOUND NON-SEL DEBRID PER SESSN	361	97602	1,177	N/A	N/A	N/A
HC21000658	WOUND ULTRASOUND PER DAY	361	97610	830	N/A	N/A	N/A
HC21000682	APPLY MULTILAY COMPRS BK LT	361	29581	1,140	N/A	N/A	N/A
HC21000823	APPY SKIN SUB HEAD/HND/FT EA+25SQ~HC	361	15276	2,079	N/A	N/A	N/A
HC21000914	APPLY MULTILAY COMPRS UPREX B	361	29584	2,309	N/A	N/A	N/A
HC21000948	APPY SKIN SUB T A L 1ST 25SQ~LC	361	C5271	4,447	N/A	N/A	N/A
HC22000038	OST NEW PT EVAL LVL4- (45MIN)	761	99204	540	N/A	N/A	N/A
HC22000061	OST EST PT EVAL LVL2-(10MIN)	761	99212	252	N/A	N/A	N/A
HC23000276	DESTRUCT OTHER PERIPH SNGL RT	361	64640	5,990	N/A	N/A	N/A
HC23000318	EPIDUROLYSIS PROCEDURE	361	62264	6,772	N/A	N/A	N/A
HC23000656	INJ ANES/STEROID NERVE FEMORAL LT	361	64447	2,309	N/A	N/A	N/A
HC23000680	INJ FORAMN EPI C/T INTL W/S&I-L	361	64479	7,902	N/A	N/A	N/A
HC23000714	INJ FORAMN EPI C/T ADD+ W/S&I-L	361	64480	4,923	N/A	N/A	N/A
HC23000938	INJ PARAVERT SYMPATH NERVE	361	64520	5,714	N/A	N/A	N/A
HC23000961	INJ ANES/STEROID NERVE PUDENDAL RT	361	64430	3,885	N/A	N/A	N/A
HC23000995	INJ STELLATE GANGLION	361	64510	6,542	N/A	N/A	N/A
HC23001167	DESTR L/S FAC JOINT ADDL W/IMG-B	361	64636	12,019	N/A	N/A	N/A
HC23001225	DESTR C/T FAC JOINT SINGL W/IMG-L	361	64633	7,219	N/A	N/A	N/A
HC23001415	INJ CER/THR F/IMAGE 3RD+&LVLBI	361	64492	4,109	N/A	N/A	N/A
HC23001449	INJ  L/S F W/IMAGE 1ST LVL BIL	361	64493	16,181	N/A	N/A	N/A
HC23001621	INJ ANES/STEROID BRACHIAL PLEXUS LT	361	64415	2,781	N/A	N/A	N/A
HC23001654	INJ ANES/STEROID INTERCOSTAL ADDL EA LT	361	64421	5,642	N/A	N/A	N/A
HC23001688	INJ ANES/STEROID ILIOINGNL/ILIOHYPOGAS LT	361	64425	2,233	N/A	N/A	N/A
HC23001829	ASP/INJ JOINT LRG W/UTZ GUIDE-RT	361	20611	4,998	N/A	N/A	N/A
HC23001852	INJ W/CATH PLCMT EPI CERV/THOR W/IMAG	361	62325	6,977	N/A	N/A	N/A
HC23001886	INJ ANES/STEROID NERVE SI JOINT INNRV W/IMAGE BI	361	64451	4,183	N/A	N/A	N/A
HC24000036	HBO EA SUBSEQUNT 15MIN BASIC/C	413		526	N/A	N/A	N/A
HC24000119	HBO EA SUBSEQNT 15MIN INTERM/C	413		580	N/A	N/A	N/A
HC25000142	EXCISE NAIL FOLD INGROWN	450	11765	906	N/A	N/A	N/A
HC25000175	FB REMOVAL SQ SIMPLE	450	10120	2,521	N/A	N/A	N/A
HC25000209	INSERT/REPLAC TEMP PACER; SNGL	450	33210	6,786	N/A	N/A	N/A
HC25000357	EXPLORE WOUND	450		1,351	N/A	N/A	N/A
HC25000399	LAC REPAIR 30.0+CM	450		873	N/A	N/A	N/A
HC25000423	LARYNGOSCOPY FIBEROP W/FB REM	450		1,288	N/A	N/A	N/A
HC25000639	PARACENTESIS ABD W/O IMAGING	450	49082	1,810	N/A	N/A	N/A
HC25000761	AVULSION OF NAIL  SIMPLE:1	450	11730	812	N/A	N/A	N/A
HC25000985	INTUBATION	450	31500	1,500	N/A	N/A	N/A
HC25001041	THROMBOLYSIS CORONARY IV INFUSION	450	92977	1,624	N/A	N/A	N/A
HC25001215	THORACENTESIS W/TUBE W/O IMAG LT	450	32556	2,159	N/A	N/A	N/A
HC25001298	CS DIFF MD ADD'L 15 MIN	450	99157	293	N/A	N/A	N/A
HC25001348	DEBRIDE OPN WND 1ST 20SQCM OR<	450	97597	1,255	N/A	N/A	N/A
HC25001538	REMOV IMPACTD EAR WAX IRRIG/LAVG LT	450	69209	298	N/A	N/A	N/A
HC25001561	MOD CS SAME PHYS/QHP 5/>YR INIT'L 15MIN	372	99152	351	N/A	N/A	N/A
HC25002676	TRAUMA ACT' I W/O CC SERVICE	682		35,856	N/A	N/A	N/A
HC25002882	DEBRIDE SKIN SUBQ; FIRST 20SQCM OR LESS	450	11042	1,485	N/A	N/A	N/A
HC25002916	EXCISION OF NAIL/MATRIX PERM	450	11750	1,521	N/A	N/A	N/A
HC25003088	LAC REPAIR INTMD S/A/T/EXT 2.6-7.5CM	450	12032	1,512	N/A	N/A	N/A
HC25003112	LAC REPAIR INTMD S/A/T/EXT 20.1-30CM	450	12036	1,717	N/A	N/A	N/A
HC25003286	LAC REPAIR CMPLX S/A/L 1.1-2.5 CM	450	13120	1,760	N/A	N/A	N/A
HC25003310	LAC REPAIR CMPLX F/C/C/M/N/AX/G/H/F 1.1-2.5CM	450	13131	1,667	N/A	N/A	N/A
HC25003344	LAC REPAIR CMPLX E/N/E/L 2.6-7.5 CM	450	13152	1,889	N/A	N/A	N/A
HC25003484	CLOSED TX CLAVICLE FX W/MANIP LT	450	23505	1,713	N/A	N/A	N/A
HC25003518	CLOSED TX STRENOCLVCLE DISLOC W/MAN LT	450	23525	906	N/A	N/A	N/A
HC25003542	CLOSED TX HUMRL FX W/MAN W/WO SKLTL TRAC LT	450	23605	1,966	N/A	N/A	N/A
HC25003716	REMOVE FB FOREARM DEEP-BIL	450	25248	6,071	N/A	N/A	N/A
HC25003740	CLOSED TX RADIAL SHAFT FX W/MANIP-BIL	450	25505	6,317	N/A	N/A	N/A
HC25003914	CLOSED TX CARPAL SCAPHOID FX W/MAN RT	450	25624	3,776	N/A	N/A	N/A
HC25003948	CLOSED TX CARPAL BONE FX W/M EA BONE-BIL	450	25635	6,451	N/A	N/A	N/A
HC25003971	CLOSED TX WRIST DSLOC 1/> BONES W/MAN-BIL	450	25660	1,640	N/A	N/A	N/A
HC25004110	CLOSED TX KNUCLE DISLOC W/MANIP EA	450	26700	852	N/A	N/A	N/A
HC25004144	CLOSED TX ARTICULAR FX W/MANIP EA	450	26742	3,280	N/A	N/A	N/A
HC25004177	CLOSED TX FINGER JNT DISLOC	450	26770	891	N/A	N/A	N/A
HC25004318	CLOSED TX KNEE DISLOC; NO ANESTH RT	450	27550	1,096	N/A	N/A	N/A
HC25004342	CLOSED TX PATELLAR DISLOC; NO ANESTH RT	450	27560	913	N/A	N/A	N/A
HC25004375	I&D ABSCESS/HEMATOMA LEG/ANKLE DEEP RT	450	27603	4,349	N/A	N/A	N/A
HC25004540	CLOSED TX ANKLE DISLOC; NO ANES LT	450	27840	991	N/A	N/A	N/A
HC25004573	REMOVE FB FOOT; SUBC LT	450	28190	1,688	N/A	N/A	N/A
HC25004748	CLOSED TX SESAMOID FX LT	450	28530	849	N/A	N/A	N/A
HC25004771	CLOSED TX TARSAL DISLOC; NO ANES LT	450	28540	924	N/A	N/A	N/A
HC25004805	CLOSED TX TALOTARSAL JNT DISLOC; NO ANES LT	450	28570	937	N/A	N/A	N/A
HC25004946	APPLY CAST HAND & LWR FOREARM (GAUNTLET) BIL	450	29085	870	N/A	N/A	N/A
HC25004979	STRAPPING; SHOULDER BILATERAL	450	29240	739	N/A	N/A	N/A
HC25005000	APPLY CAST LONG LEG BILATERAL	450	29345	1,876	N/A	N/A	N/A
HC25005174	DRAIN ABSCESS LYMPH NODE/LYMPHADENITIS; SIMPLE	450	38300	2,488	N/A	N/A	N/A
HC25005208	REPAIR LIP FULL THICK; OVER 1/2 VERTICAL HT/COMPLEX	450	40654	3,768	N/A	N/A	N/A
HC25005372	DRAIN ABSCESS WALL SCROTAL	450	55100	2,981	N/A	N/A	N/A
HC25005406	INJ ANES/STEROID NERVE TRIGEML BRNCH EA LT	450	64400	825	N/A	N/A	N/A
HC25005570	REMOVE FB EXTRNL EYE; CORNL W/SLITLAMP BIL	450	65222	892	N/A	N/A	N/A
HC25005604	DRAIN EXTERNAL EAR LESION SIMPLE BIL	450	69000	2,420	N/A	N/A	N/A
HC25005638	DRAIN EXTERNAL EAR LESION COMPLEX BIL	450	69005	4,400	N/A	N/A	N/A
HC25005778	CLOSED TX FIBULA DISTAL FX W/MANIP LT	450	27788	1,116	N/A	N/A	N/A
HC25005802	CLOSED TX ANKLE FX W/MANIP LT	450	27818	1,213	N/A	N/A	N/A
HC25005836	ASPIRATION W/ CATHETER; NASOTRACHEAL	450	31720	286	N/A	N/A	N/A
HC25006016	EST PT LVL2-PROB FOCUS	510	99212	235	N/A	N/A	N/A
HC25006040	EST PT LVL5-COMPREHENSIVE	510	99215	444	N/A	N/A	N/A
HC25006214	REMOVE SUTURE/STAPLES NO ANESTHESIA REQ+	450	15853	91	N/A	N/A	N/A
HC25090010	P: TRACHEOSTOMY+PEDS CUFFED TUBE			N/A	N/A	N/A	N/A
HC25090044	P: THORACENTESIS PNCT(W/O IMAGE)-L +1 TRAY			N/A	N/A	N/A	N/A
HC25090184	P: I&D  PERIANAL ABSCESS			N/A	N/A	N/A	N/A
HC25090218	P: ASPRTN BLADDER TROCAR+CATH			N/A	N/A	N/A	N/A
HC25090242	P: INSRT BLADDR CATH-TEMP FOLEY+TRAY			N/A	N/A	N/A	N/A
HC25090382	P: LAC REPAIR 30.0+CM			N/A	N/A	N/A	N/A
HC25090416	P: LAC REPAIR 12.6-20CM+STAPLR SKIN			N/A	N/A	N/A	N/A
HC25090440	P: LAC REPAIR 30.0+CM+STAPLER SKIN			N/A	N/A	N/A	N/A
HC26000018	AMNIOCENTESIS FLUID REDUCTION	361	59001	6,095	N/A	N/A	N/A
HC26000042	DELIVERY VAGINAL	720	59409	10,153	N/A	N/A	N/A
HC27000033	ANOSCOPY W/ABLATION	750	46615	6,642	N/A	N/A	N/A
HC27000066	ANOSCOPY W/DILATION	750	46604	4,458	N/A	N/A	N/A
HC27000090	ANOSCOPY W/SNARE SINGLE REMVL	750	46611	4,306	N/A	N/A	N/A
HC27000298	COLONOSCOPY W/DILATION/BALLOON	750	45386	4,532	N/A	N/A	N/A
HC27000322	COLONOSCOPY W/INJ SUBMUCOSAL	750	45381	4,028	N/A	N/A	N/A
HC27000363	EGD DIAGNOSTIC DISCONTINUED PROC	750	43235	1,216	N/A	N/A	N/A
HC27000561	ENTEROSCPY (NOT ILEUM)INCL COLLECTN	750	44360	6,347	N/A	N/A	N/A
HC27000595	ENTEROSCOPY W/ PERC JEJUN TUBE	750	44372	6,634	N/A	N/A	N/A
HC27000819	ESOPH DILATION UNGUIDED	750	43450	6,536	N/A	N/A	N/A
HC27000850	ESOPH RFLUX W/PH ELECTR DISCTD	750	91035	1,904	N/A	N/A	N/A
HC27001098	SIGMOIDOSCOPY FL W/DECOMP&PLAC TUBE	750	45337	3,674	N/A	N/A	N/A
HC27001130	SIGMOIDOSCOPY FLEX W/BIOPSY	750	45331	3,696	N/A	N/A	N/A
HC27001163	SIGMOIDOSCOPY FLEX W/HOT BX	750	45333	3,805	N/A	N/A	N/A
HC27001338	ERCP W/STENT PLACE BILI/PANC DUCT EA	750	43274	7,863	N/A	N/A	N/A
HC27001361	ERCP W/STENT/FB REMOV BILI/PANC DUCT	750	43275	6,589	N/A	N/A	N/A
HC27001395	ESOPHSCPY W/RESECT MUCOSAL ~FO	750	43211	4,316	N/A	N/A	N/A
HC27001569	ESOPHSCPY W/BALLOON DILATION <30MM ~FO	750	43220	4,525	N/A	N/A	N/A
HC27001593	ILEOSCOPY THRU STOMA DILATN BALLOON	750	44381	6,317	N/A	N/A	N/A
HC27001767	COLONOSCOPY FLEX W/DECOMP&PLACE TUBE	750	45393	4,388	N/A	N/A	N/A
HC27001791	ESOPHSCPY DX- BRSH/WSH~FO DISCONT'D	750	43200	1,357	N/A	N/A	N/A
HC27001965	ESOPHAG REFLUX W/NASAL ELEC>1H DISCON'D	750	91038	1,903	N/A	N/A	N/A
HC28000016	CR REHAB CARDIAC IP SESSION PHASE I	943	93798	585	N/A	N/A	N/A
HC28000040	CR EST PT EVAL LVL1-(5MIN)	510	99211	184	N/A	N/A	N/A
HC29000460	SCREENING VISION	920	99172	100	N/A	N/A	N/A
HC29000528	EVAL COMP PREVNTV MED NEW 18-39	770		363	N/A	N/A	N/A
HC29000569	PREVENTATIVE MED COUNSELING 30MIN	770	99402	156	N/A	N/A	N/A
HC31000052	PT-AQUATIC THERAPY 15MIN/M	420	97113	242	N/A	N/A	N/A
HC31000086	PT-AQUATIC GRP 60MIN/M	423	97150	393	N/A	N/A	N/A
HC31000326	PT-EVAL LOW COMPLEXITY 20MF2F 30MIN	424	97161	477	N/A	N/A	N/A
HC31000359	PT-EVAL HIGH COMPLEXITY 45MF2F 75MIN	424	97163	1,079	N/A	N/A	N/A
HC31000383	PT-MANUAL THERAPY 15MIN/M	420	97140	231	N/A	N/A	N/A
HC31000631	PT-ULTRASOUND 15MIN/MW	420	97035	187	N/A	N/A	N/A
HC31000730	PT-APPLY WHIRLPOOL MODALITY	420	97022	325	N/A	N/A	N/A
HC31000763	PT-WORK HARDENING ADD 1HR/CMW+	420	97546	379	N/A	N/A	N/A
HC31000946	PT-IONTOPHORESIS 30MIN/CW	420		343	N/A	N/A	N/A
HC31000979	PT-ULTRASOUND  ADD 15MIN/CW	420		147	N/A	N/A	N/A
HC31001142	PT-PROSTHETIC TRNG ADD15MIN/CW	420		164	N/A	N/A	N/A
HC31001175	PT-ADL 30MIN/CW	420		384	N/A	N/A	N/A
HC31001472	PT-THER PROC GRP 30MIN/MWC	423	97150	197	N/A	N/A	N/A
HC31001514	PT-APPLY VASOPNEUMATIC DEV/MW	420	97016	165	N/A	N/A	N/A
HC31001548	PT-INDIV PROC W/COMPUT EQUIP/W	420		414	N/A	N/A	N/A
HC31001688	PT-WOUND VAC 15MIN>50 SQ+/C	420		194	N/A	N/A	N/A
HC31001720	PT-REMOVE/BIVAL CAST FULL LIMB	420	29705	896	N/A	N/A	N/A
HC31001779	PT-THER PROC GRP 15MIN/M	423	97150	94	N/A	N/A	N/A
HC31001944	TRANSITIONAL REHAB FULL DAY (QA)	932		1	N/A	N/A	N/A
HC31001993	PT - STRAPPING; HIP	420	29520	586	N/A	N/A	N/A
HC31010036	PT-GAIT TRAINING 15MIN	420	97116	228	N/A	N/A	N/A
HC31010069	PT-EVAL LOW COMPLEXITY 20MIN F2F [15MIN]	424	97161	228	N/A	N/A	N/A
HC31010291	PT-PHYS PERFORM TEST 15 MIN	424	97750	199	N/A	N/A	N/A
HC31010325	PT- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 60MIN	420	99366	375	N/A	N/A	N/A
HC31010358	PT- TM CONF INTERDISCPLN NO PT/FAM  WQHCP 45MIN	420	99368	300	N/A	N/A	N/A
HC31090103	P: PT-INITIAL EVAL 150MIN/C			N/A	N/A	N/A	N/A
HC31090137	P: PT DEVEL' TESTING 60 MIN/C			N/A	N/A	N/A	N/A
HC31090160	PT-ONLINE ASSESS & MANAGMNT EST PT 21+MIN	420	98972	209	N/A	N/A	N/A
HC32000259	OT-EVAL LOW COMPLEXITY 20MF2F 30MIN	434	97165	493	N/A	N/A	N/A
HC32000283	OT-EVAL HIGH COMPLEXITY 45MF2F 75MIN	434	97167	1,059	N/A	N/A	N/A
HC32000457	OT-SWALLOWING EVAL 60MIN	434	92610	1,647	N/A	N/A	N/A
HC32000481	OT-SWALLOWING EVAL  120MIN	434	92610	2,107	N/A	N/A	N/A
HC32000515	OT-SWALLOWING THERAPY  45 MIN	430	92526	983	N/A	N/A	N/A
HC32000739	OT-WOUND NON-SEL DEB 45MIN/MW	430	97602	854	N/A	N/A	N/A
HC32000762	OT-WOUND VAC 30MIN<50 SQ CM/CM	430	97605	506	N/A	N/A	N/A
HC32000796	OT-WOUND VAC 15MIN>50 SQ CM/M	430	97606	526	N/A	N/A	N/A
HC32000937	OT-NEUROMUSC RE-ED 30MIN/CW	430		405	N/A	N/A	N/A
HC32000960	OT-MASSAGE ADDL 15MIN/CW	430		177	N/A	N/A	N/A
HC32000994	OT-MANUAL THER MYOFASC REL/W	430		254	N/A	N/A	N/A
HC32001208	OT-STATUS REVIEW 15MIN(STAT)	430		N/A	N/A	N/A	N/A
HC32001232	OT-GAIT TRAINING 30MIN/CW	430		392	N/A	N/A	N/A
HC32001422	OT-COMMTY WK/REINTEGRAT 30M/CW	430		236	N/A	N/A	N/A
HC32001455	OT-WOUND VAC 15MIN<50 SQ CM+/C	430		190	N/A	N/A	N/A
HC32001497	OT-REMOVE/BIVAL CAST SHRT LIMB	430	29700	823	N/A	N/A	N/A
HC32001687	OT-WINDOWING CAST	430	29730	638	N/A	N/A	N/A
HC32001711	OT-EVAL HIGH COMPLEXITY 45MF2F 120MIN	434	97167	1,351	N/A	N/A	N/A
HC32001745	OT-EVAL HIGH COMPLEXITY 45MF2F 180MIN	434	97167	1,929	N/A	N/A	N/A
HC32003329	OT-EVAL MOD COMPLEXITY 30MF2F 90MIN	434	97166	1,121	N/A	N/A	N/A
HC32003352	OT-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	430	96112	489	N/A	N/A	N/A
HC32010167	OT-MANUAL THERAPY 15MIN	430	97140	221	N/A	N/A	N/A
HC32010191	OT-DEV COGNITIVE SKILLS INITL 15MIN	430	97129	220	N/A	N/A	N/A
HC32010423	OT- TM CONF INTERDISCPLN NO PT/FAM  WMD 60MIN	430	99367	375	N/A	N/A	N/A
HC32010456	OT- TM CONF INTERDISPLNS 3MNM WPT PRES 45MIN	430	G0175	550	N/A	N/A	N/A
HC32090003	P: OT-EVAL 45 MIN/C			N/A	N/A	N/A	N/A
HC32090144	P: ORTH EWHO RIGID W/O JOINTS (90MINUOS)			N/A	N/A	N/A	N/A
HC32090177	P: ORTH WHO W/NONTORSION JOINTS (90MINUOS)			N/A	N/A	N/A	N/A
HC32090201	P: ORTH WHO W/NONTORSION JOINT(S) (90MINUOS)			N/A	N/A	N/A	N/A
HC33000225	ST-SPEECH THERAPY 45 MIN/MW	440	92507	818	N/A	N/A	N/A
HC33000258	ST-SPEECH THERAPY 90 MIN/MW	440	92507	1,365	N/A	N/A	N/A
HC33000423	ST-SWALLOWING THERAPY 75 MIN	440	92526	1,258	N/A	N/A	N/A
HC33000456	ST-THER NON-SP GEN DEV W/PROG	440	92606	1,089	N/A	N/A	N/A
HC33000480	ST-CASE CONF  ADD 15MIN/C	440		108	N/A	N/A	N/A
HC33000746	ST-NASOPHARYNGOSCOPY	440	92511	1,708	N/A	N/A	N/A
HC33000787	ST-DYSPHAGIA SCREENING/IP	440	V5364	172	N/A	N/A	N/A
HC33000811	ST-EVAL NONSP'CH DEV RX:ADD30MIN	444	92618	699	N/A	N/A	N/A
HC33000993	ST EVAL SOUND PRODUCTION 90MIN/M	444	92522	789	N/A	N/A	N/A
HC33001025	ST EVAL SOUND W/LANG COMP&EXPRESS 30MIN/M	444	92523	574	N/A	N/A	N/A
HC33001066	ST EVAL SOUND W/LANG COMP&EXPRESS 120MIN/M	444	92523	1,346	N/A	N/A	N/A
HC33010059	ST EVAL SOUND W/LANG COMP&EXPRESS [15MIN]	444	92523	218	N/A	N/A	N/A
HC33010083	ST EVAL BEHAVRAL QUAL VOICE [15MIN]	444	92524	166	N/A	N/A	N/A
HC33010323	ST- TM CONF INTERDISPLNS 3MNM WPT PRES 60MIN	440	G0175	450	N/A	N/A	N/A
HC34000026	AUDIOMETRY THRESHOLD	471	92555	226	N/A	N/A	N/A
HC34000059	TYMPANOMETRY IMPEDANCE	471	92567	354	N/A	N/A	N/A
HC34000224	TYMPANOMETRY & REFLEX THRESH	471	92550	390	N/A	N/A	N/A
HC34000257	STENGER TEST PURE TONE	471	92565	104	N/A	N/A	N/A
HC34000281	STENGER TEST SPEECH	471	92577	905	N/A	N/A	N/A
HC35000157	REC-SENSRY INTEGRT TECH 15MIN	941	97533	198	N/A	N/A	N/A
HC35000181	REC- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 30MIN	941	99366	251	N/A	N/A	N/A
HC35500149	MT-BEHAVIOR ASSESS/RE-ASSESS	941	96156	251	N/A	N/A	N/A
HC35500172	MT-BEHAVIOR TX GROUP 1ST 30 MIN	941	96164	88	N/A	N/A	N/A
HC36000099	AEROSOL-PENTAMADINE	412	94642	762	N/A	N/A	N/A
HC36000123	CPAP/BIPAP DAILY MGMT	410	94660	5,810	N/A	N/A	N/A
HC36000156	MANIP CHEST WALL SUBSEQUENT	410	94668	737	N/A	N/A	N/A
HC36000313	VENT DAY SUBSEQUENT-INFANT	410	94003	7,377	N/A	N/A	N/A
HC36000354	TRANSPORT EXTERNAL LBM ASSIST RT ACCOMP(STATISTICAL)	410		N/A	N/A	N/A	N/A
HC36000651	PLETHYSMOGRAPHY LUNG VOL	410	94726	1,252	N/A	N/A	N/A
HC36000859	BRONCHOSCOPY W/FB REMOVAL	361	31635	6,705	N/A	N/A	N/A
HC36000883	BRONCH DIAG W/LAVAGE	361	31624	6,616	N/A	N/A	N/A
HC36001089	ASPIRATION W/ CATHETER; NASOTRACHEAL	410	31720	478	N/A	N/A	N/A
HC36001121	BRONCH W/EBUS SAMPLING 1/2 NODES	361	31652	10,023	N/A	N/A	N/A
HC36800084	BRONCH THERAPEUTIC DC'D PROC	361	31645	2,370	N/A	N/A	N/A
HC36800118	BRONCH W/DESTRUCT TUMOR/STEN	361	31641	10,103	N/A	N/A	N/A
HC36800175	EXHALED NITRIC OXIDE MEASRMNT	460	95012	803	N/A	N/A	N/A
HC36800399	SPIROMETRY W/PRE&POST BRONCHO	460	94060	1,871	N/A	N/A	N/A
HC36800431	BLOOD GAS LTD	301	82803	556	N/A	N/A	N/A
HC36800464	BLOOD GAS O2 SAT ONLY	301	82810	242	N/A	N/A	N/A
HC36800647	HEMOGLOBIN	305	85018	106	N/A	10	N/A
HC36800670	HGB QUANT TRANSCUTANEOUS	300	88738	63	N/A	N/A	N/A
HC36800860	TEST STRESS PULMON INCL HR POX O2 TIT	460	94618	1,140	N/A	N/A	N/A
HC36800894	BRONCH W/COMPTR-ASST IMAGE-GUIDE NAVIGATE+	361	31627	2,303	N/A	N/A	N/A
HC37000023	MNT THERAPY GROUP EA 30 MIN         1ST REF	942	97804	212	N/A	N/A	N/A
HC37090016	P: MNT INITIAL ASSESS 45 MIN-OP			N/A	N/A	N/A	N/A
HC37090040	P: MNT INITIAL ASSESS 90 MIN-OP			N/A	N/A	N/A	N/A
HC37090073	P: MNT RE-ASSESS 60 MIN-OP			N/A	N/A	N/A	N/A
HC38000063	APPLY CAST LONG LEG	700	29345	1,184	N/A	N/A	N/A
HC38000097	APPLY CMPRSSN BOOT/WRAP(UNNA)	700	29580	914	N/A	N/A	N/A
HC38000279	APPLY BODY CAST; FULL CHILD	700	29046	1,768	N/A	N/A	N/A
HC38000303	APPLY SPICA HIP1 1/2 OR 2 LEGS	700	29325	1,595	N/A	N/A	N/A
HC38420030	IABP SERV/SUPPORT PER HR	480	92970	132	N/A	N/A	N/A
HC38420063	PERFUSION CARDIO' EA ADDL .5HR	481	92970	1,237	N/A	N/A	N/A
HC38420097	ECMO INITIATION VENO-ARTERIAL	489	33947	13,491	N/A	N/A	N/A
HC38420238	ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER	489	33964	19,331	N/A	N/A	N/A
HC38420261	ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS	489	33969	10,622	N/A	N/A	N/A
HC38420295	ECMO/ECLS REMOVAL OF CENTRAL CANNULA 6 YRS & OLDER	489	33986	20,348	N/A	N/A	N/A
HC39000237	PSY TM CONF W/MD 30/+MIN(NO PT)	900	99367	258	N/A	N/A	N/A
HC39000260	PSYCH FAMILY TX W/PT 50MIN	914	90847	687	N/A	N/A	N/A
HC39000914	PSYCH TX FOR CRISIS 1ST 60MINS/COMM	914	90839	889	N/A	N/A	N/A
HC39000948	PSY TX W/PATIENT 30MIN W/E&M+	914	90833	384	N/A	N/A	N/A
HC39001227	AHCP CONSULT TELEPHONE PER 15MIN/C	914	Z5406	101	N/A	N/A	N/A
HC39001250	PSYCH TESTING EVAL INTEGR INTERPRET CLIN DES TX; EA ADDL HR+	918	96131	621	N/A	N/A	N/A
HC39001284	PSYCH/NEUROPSYCH TEST ADMIN & SCORING  2 OR > TESTS; 1ST 30 MIN	918	96136	269	N/A	N/A	N/A
HC39001524	PSY-BEHAVIOR ASSESS/RE-ASSESS	914	96156	258	N/A	N/A	N/A
HC39001557	PSY-BEHAVIOR TX GROUP 1ST 30 MIN	915	96164	88	N/A	N/A	N/A
HC39001581	PSY-BEHAVIOR TX FAMW/PT ADD 15MIN	916	96168	55	N/A	N/A	N/A
HC41000128	HOME SLEEP STUDY/T III MIN'4CH	920	G0399	1,191	N/A	N/A	N/A
HC41500018	AUDITORY EVOKED AEP BBS HEARING DETERM W/I&R	471	92651	1,463	N/A	N/A	N/A
HC41500224	EMG 4 EXTREMITY	922	95864	3,167	N/A	N/A	N/A
HC41500257	EMG FACIAL UNILAT RT	922	95867	1,112	N/A	N/A	N/A
HC41500307	INFANT HEARING SCREEN AEP BBS AUTO REPEAT OP	471	92650	993	N/A	N/A	N/A
HC41500489	EMG 1 EXTREM W/PARASPINAL LTD+	922	95885	937	N/A	N/A	N/A
HC41500513	SOMATOSENSORY UPPER& LWR LIMBS	922	95938	4,974	N/A	N/A	N/A
HC41500547	AUDITORY EVOKED AEP BBS HEARING DETERM W/I&R	471	92651	2,617	N/A	N/A	N/A
HC41500703	EEG PHARMACOLOGICAL/PHYSICAL ACTIVATION	740	95954	4,525	N/A	N/A	N/A
HC41500737	EMG THORACIC PARASPINAL(NO T1/T12)	922	95869	906	N/A	N/A	N/A
HC41500760	EEG SETUP W/VIDEO REC CONT MIN8 CHNNL	740	95700	1,198	N/A	N/A	N/A
HC41500935	AUDITORY EVOKED AEP NEURODIAGNOSTIC W/I&R	471	92653	1,915	N/A	N/A	N/A
HC42000034	AMB BP MONITOR 24HR+ ANALYSIS W/RPT; SCANNING	480	93788	950	N/A	N/A	N/A
HC42000208	ECHO FETAL DOPPLER COMPLETE	483	76827	1,265	N/A	N/A	N/A
HC42000232	ECHO 2D STRESS PHARMOCOLOGIC	483	93350	4,762	N/A	N/A	N/A
HC42000281	ERGONOVINE PROVOCATION TEST	482	93024	1,229	N/A	N/A	N/A
HC42000448	PROGRAM EVAL PACEMAKER SINGLE LEAD/LEADLESS	480	93279	412	N/A	N/A	N/A
HC42000471	PROGRAM EVAL PERI-OP PACEMAKER SGL/DUAL/MULTI/LEADLESS	480	93286	479	N/A	N/A	N/A
HC42000505	TEE COMPLETE	483	93312	5,656	N/A	N/A	N/A
HC42000737	ECHO 2D LMTD W/O SPEC&DOP W/WO CONTR	483	C8924	2,962	N/A	N/A	N/A
HC42000760	TEE MONITORING COMPLT W/WO CONTR	483	C8927	5,109	N/A	N/A	N/A
HC42090027	P: LTD/FU CONGENITAL ECHO			N/A	N/A	N/A	N/A
HC42090050	P:STRESS ECHO RX DOPLER/CLRFLW			N/A	N/A	N/A	N/A
HC43000140	MAMMO DUCTO/GALACTO INJ-BI	361	19030	4,600	N/A	N/A	N/A
HC43000322	PUNC CYST ASP BREAST ADD'L	361	19001	2,246	N/A	N/A	N/A
HC43000520	FILM DUPLICATION (STATISTIC)	270		N/A	N/A	N/A	N/A
HC43000827	INCISION BREAST LESION-LT	361	19020	5,303	N/A	N/A	N/A
HC43000991	US BREAST; COMPLETE BILATERAL	402	76641	1,783	N/A	N/A	N/A
HC43001023	US BREAST; LIMITED BILATERAL	402	76642	1,424	N/A	N/A	N/A
HC43001197	MAMMO DX W/SPC VWS UNILT W/CAD LT	401	77065	1,214	N/A	N/A	N/A
HC43001221	QT SCAN BREAST	409	76999	137	N/A	N/A	N/A
HC44000099	ANKLE 2 VIEWS RT	320	73600	728	N/A	N/A	N/A
HC44000123	ANKLE ARTHROGRAM RT	322	73615	1,474	N/A	N/A	N/A
HC44000156	ANKLE COMP MIN 3 VWS RT	320	73610	941	N/A	N/A	N/A
HC44000354	CERVICAL SPINE 4/5VWS	320	72050	1,420	N/A	N/A	N/A
HC44000396	CHEST 2 VWS W/OBLIQUES (4VIEWS)	324	71048	996	N/A	N/A	N/A
HC44000438	CHOLANGIOGRAM INTRAOPERATIVE	320	74300	1,649	N/A	N/A	N/A
HC44000628	ELBOW ARTHROGRAM BILAT	322	73085	3,025	N/A	N/A	N/A
HC44000651	ELBOW COMP MIN 3 VWS BILAT	320	73080	1,801	N/A	N/A	N/A
HC44000685	ENEMA THERAPEUTIC CONTRAST/AIR	320	74283	2,157	N/A	N/A	N/A
HC44000867	FLUOROSCOPY < 1HR	320	76000	1,745	N/A	N/A	N/A
HC44000909	FOOT 2 VIEWS RT	320	73620	723	N/A	N/A	N/A
HC44001188	HUMERUS LT	320	73060	762	N/A	N/A	N/A
HC44001212	INFANT LOW EXT MIN 2VWS BILAT	320	73592	1,483	N/A	N/A	N/A
HC44001246	INFANT UP EXTREM MIN 2VW BILAT	320	73092	1,406	N/A	N/A	N/A
HC44001386	KNEE 1 VIEW RT	320	73560	740	N/A	N/A	N/A
HC44001410	KNEE 2 VIEWS RT	320	73560	826	N/A	N/A	N/A
HC44001444	KNEE 3 VIEWS RT	320	73562	959	N/A	N/A	N/A
HC44001618	MYELOGRAM CERVICAL	320	72240	3,139	N/A	N/A	N/A
HC44001642	MYELOGRAM ENTIRE SPINE CANAL	320	72270	3,971	N/A	N/A	N/A
HC44001816	RIBS UNILAT MIN 3 VWS W/PA-LT	320	71101	1,028	N/A	N/A	N/A
HC44001840	SACROILIAC JOINTS < 3VWS	320	72200	683	N/A	N/A	N/A
HC44002020	SINUSES COMP MIN 3 VIEWS	320	70220	1,058	N/A	N/A	N/A
HC44002053	SKULL LTD <4 VIEWS	320	70250	855	N/A	N/A	N/A
HC44002087	SOFT PALATE CINE (OR VIDEO)	320	70370	774	N/A	N/A	N/A
HC44002244	TIBIA & FIBULA (LEG) 2 VWS LT	320	73590	862	N/A	N/A	N/A
HC44002285	TMJ ARTHROGRAM LT	322	70332	1,028	N/A	N/A	N/A
HC44002319	TMJ UNILATERAL LEFT	320	70328	480	N/A	N/A	N/A
HC44002566	WRIST ARTHROGRAM RT	322	73115	1,608	N/A	N/A	N/A
HC44002590	WRIST COMP MIN 3 VWS RT	320	73110	876	N/A	N/A	N/A
HC44002798	ANKLE 2 VIEWS	320	73600	728	N/A	N/A	N/A
HC44002822	SWALLOW FUNC W/CINE/VIDEO	320	74230	1,441	N/A	N/A	N/A
HC44002996	HIPS BILAT MIN5VWS(W/PELVS WHN PRFRMD)	320	73523	1,726	N/A	N/A	N/A
HC44003036	PERITONEOGRAM S&I	320	74190	1,640	N/A	N/A	N/A
HC44003077	XR ESOPHAGUS W/DOUBLE CONSTRST INC SCOUT&DELAYS	320	74221	1,536	N/A	N/A	N/A
HC44200038	US ART NONINVAS REST/STRES LEA	921	93924	2,392	N/A	N/A	N/A
HC44200095	US CHEST	402	76604	1,539	N/A	N/A	N/A
HC44200129	US DUPLEX AORTA IVC ILIAC COMP	921	93978	2,388	N/A	N/A	N/A
HC44200301	US GUIDANCE INTRAOPERATIVE	402	76998	2,724	N/A	N/A	N/A
HC44200335	US HEAD	402	76506	2,017	N/A	N/A	N/A
HC44200525	US PELVIC(NON OB)	402	76856	2,030	N/A	N/A	N/A
HC44200558	US RETROPERITONEAL LTD	402	76775	1,485	N/A	N/A	N/A
HC44200582	TCD EMBOLI DETECT W/ IV MICROBUBBLE	921	93893	3,191	N/A	N/A	N/A
HC44200772	US GUIDE PLCMNT RT	402	76942	1,949	N/A	N/A	N/A
HC44200806	US EXTREMITY NON VASC CMPLT-RT	402	76881	1,625	N/A	N/A	N/A
HC44200830	US EXTREMITY NON VASC LTD- LT	402	76882	840	N/A	N/A	N/A
HC44201010	US NERVE(S) & STRUX ENTIRE COMPREHSV W/IMG PER EXTREM	402	76883	1,400	N/A	N/A	N/A
HC44500015	ABLATION RENAL TUMOR(S) PERC; RF LT	361	50592	20,794	N/A	N/A	N/A
HC44500395	ANGIO THRU EXISTING CATH	323	75898	4,229	N/A	N/A	N/A
HC44500452	AORTOGRAM ABDOMINAL	323	75625	8,611	N/A	N/A	N/A
HC44500767	ENDO BILI W/DILAT W/O STENT	361	47555	7,875	N/A	N/A	N/A
HC44500817	ERCP PANCREATIC DUCT SYSTEM	320	74329	1,735	N/A	N/A	N/A
HC44500890	INJ CHEMONUCLEOLYSIS	361	62292	7,624	N/A	N/A	N/A
HC44501435	PHLEBCT VEIN/EXT 10-20 STAB-LT	361	37765	14,115	N/A	N/A	N/A
HC44501468	PORTOGRAM W/ HEMODYNAMIC EVAL	320	75885	7,162	N/A	N/A	N/A
HC44501583	PTA INTRACRANIAL	361	61630	41,355	N/A	N/A	N/A
HC44501906	THROMBECTOMY MECH PRIM ART LT(NONCOR/CRNL)	361	37184	18,803	N/A	N/A	N/A
HC44501930	THROMBECT MECH PRIM ART ADD RT(NONCOR/CRNL)+	361	37185	13,804	N/A	N/A	N/A
HC44502219	VENOGRAM CAVAL SUPERIOR	323	75827	7,359	N/A	N/A	N/A
HC44502243	VENOGRAM EXTREMITY UNILAT LT	323	75820	3,562	N/A	N/A	N/A
HC44502698	CAROTID STENT W/O EMBO PROT LT	481	37216	35,023	N/A	N/A	N/A
HC44502722	REVASC ILIAC W/TLA INITL VES-LT	323	37220	19,046	N/A	N/A	N/A
HC44502755	REVASC ILIAC W/TLA & STENT-LT	323	37221	25,754	N/A	N/A	N/A
HC44502896	REVASC FEM POP W/TLA&STENT-RT	323	37226	29,816	N/A	N/A	N/A
HC44502920	REVAS FEMPOP TLA&STENT&ATHER-R	323	37227	43,770	N/A	N/A	N/A
HC44502953	REVAS TIB/PERO W/TLA 1ST VES-RT	323	37228	17,867	N/A	N/A	N/A
HC44503126	REVASC TIB/PERO EA+VES W/TLA-B	323	37233	39,284	N/A	N/A	N/A
HC44503159	REVAS TIB/PER EA+V TLA&STENT-B	323	37234	42,636	N/A	N/A	N/A
HC44503456	DECLOTTING VASC ACCES/CATH RT	361	36593	2,787	N/A	N/A	N/A
HC44503480	PHLEBCT VEIN/EXT >20 STAB-RT	361	37766	18,164	N/A	N/A	N/A
HC44503530	ENDOVENOUS ABLAT RADIO FREQ WS&I; ADDL VEIN+	361	36476	9,620	N/A	N/A	N/A
HC44503696	VERT/THOR CAROTID STENT+RT	361	0076T	9,187	N/A	N/A	N/A
HC44503720	THROMBOLYSIS ART OTHER NONCOR/CRNL+S&I1ST DAY	323	37211	16,960	N/A	N/A	N/A
HC44503753	THROMBOLYSIS NONCOR END OF TX	323	37214	16,098	N/A	N/A	N/A
HC44503894	SEL CATH EX CAROTID&ANG EC W/SI RT+	323	36227	10,184	N/A	N/A	N/A
HC44503928	PLCMNT DEV ENDOVAS OCCLUD ART ILIAC+	360	34808	6,362	N/A	N/A	N/A
HC44504025	EMBOLIZE VENOUS (ANY MALFORMTN)W/S&I	361	37241	41,799	N/A	N/A	N/A
HC44504199	SEL CATH EA IC CRTD/VERT&ANG W/SI BI+	323	36228	17,699	N/A	N/A	N/A
HC44504223	XRAY TEVAR; PLCMT PROX EXT PROTH S&I	481	75958	5,631	N/A	N/A	N/A
HC44504397	EXCHNG CATH DRN BIL EXT->INT-EXT PERC(CHOLANG S&I)	361	47536	9,551	N/A	N/A	N/A
HC44504421	DILATE DUCT(S)BIL /AMPULLA PERC(IMG S&I);EA+	361	47542	6,282	N/A	N/A	N/A
HC44504454	SCLEROTX FLUID (CYST) PERC(IMAG S&I)	361	49185	5,587	N/A	N/A	N/A
HC44504595	PLCMT URET STENT PERC(NEPH/URET'GRM S&I) NEW ACCES SEP CATH LT	361	50695	20,055	N/A	N/A	N/A
HC44504629	THROMBECT MECH PERC&/THROMBOLYSIS INF CRANI LT	361	61645	32,225	N/A	N/A	N/A
HC44504652	EMBOLIZATION/OCCLUSION URETERAL  RT	361	50705	7,724	N/A	N/A	N/A
HC44504827	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:INTL BILAT	361	37246	29,187	N/A	N/A	N/A
HC44504850	TRANSLUMINAL BALO ANGIOP ARTERY W/S&I:ADDL + BILAT	361	37247	18,731	N/A	N/A	N/A
HC44505022	PERC PULM ARTERY REVASC W/STENT INITL; EA ADDL LESION+	361	33904	17,302	N/A	N/A	N/A
HC44700037	CATH ABLAT AV NODE HEART BLOCK	481	93650	20,408	N/A	N/A	N/A
HC44700367	INSERT PACER ATRIAL SNGL CHAMB	481	33206	21,634	N/A	N/A	N/A
HC44700391	INSERT SWAN-GANZ CATHETER	481	93503	3,450	N/A	N/A	N/A
HC44700425	INSERT/REPLAC TEMP PACER	481	33210	11,666	N/A	N/A	N/A
HC44700565	INTRAVASC DOPPLER ADDL VESSEL+	481	93572	3,545	N/A	N/A	N/A
HC44700615	IVUS/OCT CORONARY VES/GRFT EA ADL+	481	92979	5,388	N/A	N/A	N/A
HC44700680	PERC BALLOON VALVPLSTY AORTIC	481	92986	29,903	N/A	N/A	N/A
HC44701050	REPAIR LEADS TV DUAL PACER/ICD	481	33220	12,066	N/A	N/A	N/A
HC44701084	RELOCATE SKIN POCKET ICD	481	33223	11,279	N/A	N/A	N/A
HC44701340	PLCMT CORONARY CATH(ANGIO/S&I)	481	93454	19,960	N/A	N/A	N/A
HC44701373	PLCMT CORON CATH;GRAFTS&RT HRT	481	93457	26,831	N/A	N/A	N/A
HC44701407	PLCMT CORON CATH;R&L HRT CATH	481	93460	31,687	N/A	N/A	N/A
HC44701597	REMV&REPL PACER DUAL LEAD SYS	481	33228	23,978	N/A	N/A	N/A
HC44701621	INSRT ICD W/EXSTNG MULTI LEADS	481	33231	30,759	N/A	N/A	N/A
HC44701654	REMV&REPLC SYSTM ICD LEAD MULTI	481	33264	30,383	N/A	N/A	N/A
HC44701811	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-LM	481	92924	29,300	N/A	N/A	N/A
HC44701845	PERC COR ANGIOP/ATHRECT; SNGL CA/BR-RC	481	92924	29,300	N/A	N/A	N/A
HC44701878	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-LD+	481	92925	17,742	N/A	N/A	N/A
HC44702041	PERC COR ATHR+STENT/ANGIOP; SNGL-RC	481	92933	32,208	N/A	N/A	N/A
HC44702074	PERC COR ATHR+STENT/ANGIOP; ADDL-LD+	481	92934	18,933	N/A	N/A	N/A
HC44702249	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-RC	481	92941	31,917	N/A	N/A	N/A
HC44702272	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-LD	481	92943	32,524	N/A	N/A	N/A
HC44702306	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-RI	481	92943	32,524	N/A	N/A	N/A
HC44702447	PERC COR DES STENT(S)/ANGIOP; ADDL-RC+	481	92929	16,924	N/A	N/A	N/A
HC44702470	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-LD	481	92933	32,208	N/A	N/A	N/A
HC44702504	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-RI	481	92933	32,208	N/A	N/A	N/A
HC44702678	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-LD	481	92941	31,917	N/A	N/A	N/A
HC44702702	PERC COR AMI REVAS ATHR/DES/ANGP;SNGL-RI	481	92941	31,917	N/A	N/A	N/A
HC44702876	REPAIR VISC AORTA FEVAR; 2 PROSTH	360	34842	43,198	N/A	N/A	N/A
HC44702900	REPAIR VISC AORTA FEVAR(PROX&DIS);1 PROSTH	360	34845	50,800	N/A	N/A	N/A
HC44703072	TAVR/TAVI; BYPASS OPEN PERIPH A&V(F/I/A)+	481	33368	23,833	N/A	N/A	N/A
HC44703106	TEVAR W/ LT SUBCLAV; INITIAL ENDO& DIST EXTS CELIAC	360	33880	54,529	N/A	N/A	N/A
HC44703130	TEVAR; PLCMT PROX EXT PROTH; EACH ADD'L+	360	33884	15,344	N/A	N/A	N/A
HC44703288	INSERT/REPLACE TRANSCATH PACER LEADLESS RV	481	33274	14,612	N/A	N/A	N/A
HC44703312	EV REPAIR INFRARENAL AORTA DEPLOY GRAFT A-A ~RUPT	360	34702	38,741	N/A	N/A	N/A
HC44703346	EV REPAIR INFRARENAL AORTA&/ILIAC GRFT AORT-BI-ILIAC NONRUPT	360	34705	35,363	N/A	N/A	N/A
HC44703510	INTRAPRCDRL CORONARY FFR ANGIO W/3D MAP+	481	0523T	6,041	N/A	N/A	N/A
HC44703544	REVASCULARIZATION LITHOTRIPSY INTRAVASC & ATHERECT	361	C9766	26,624	N/A	N/A	N/A
HC44703767	LT HRT CATH CONGEN DEFECTS INCLUDE IMAG; NRML/ABNRML NATIVE CONNECT'	481	93595	25,614	N/A	N/A	N/A
HC44703791	CARDIAC OUTPUT MEASUREMENT  THERMO/OTHR W/ HRT CATH CONGEN DEFECT+	481	93598	503	N/A	N/A	N/A
HC44900017	CT ABDOMEN W/ CONTRAST	352	74160	6,162	N/A	N/A	N/A
HC44900041	ABLATE BONE TUMOR(S) PERQ W/CT;RF	361	20982	21,123	N/A	N/A	N/A
HC44900082	CT CHEST DX HI RESOLUTION W/O CNTRST	352	71250	5,496	N/A	N/A	N/A
HC44900231	CT LOW EXT W&W/O CONT BILAT	352	73702	10,550	N/A	N/A	N/A
HC44900264	CT LOW EXT W/CONTRAST BILAT	352	73701	10,126	N/A	N/A	N/A
HC44900298	CT LOW EXT W/O CONTRAST BILAT	352	73700	8,637	N/A	N/A	N/A
HC44900462	CT PELVIS W&W/O CONTRAST	352	72194	7,002	N/A	N/A	N/A
HC44900496	CT PELVIS W/O CONTRAST LTD	352	72192	3,784	N/A	N/A	N/A
HC44900660	CTA LOW EXT BILAT	352	73706	13,339	N/A	N/A	N/A
HC44900694	CTA NECK	351	70498	6,302	N/A	N/A	N/A
HC44900728	CTA UPPER EXT W/CONTRAST-LT	352	73206	7,298	N/A	N/A	N/A
HC44900934	CT HEART EVAL W/ 3D IMAGE	350	75572	4,108	N/A	N/A	N/A
HC44900975	CT ABDOMEN & PELVIS W/O CONTRAST	352	74176	7,997	N/A	N/A	N/A
HC44901007	CT ABD & PELVIS W/O CONST LTD	352	74176	4,775	N/A	N/A	N/A
HC45200086	NM BONE SCAN MULTI AREA	341	78305	3,492	N/A	N/A	N/A
HC45200128	NM BRAIN IMAG 4<VWS W/VASCFLOW	341	78601	3,667	N/A	N/A	N/A
HC45200300	NM GASTRIC EMPTYING	341	78264	4,046	N/A	N/A	N/A
HC45200334	NM GASTROINTEST PROTEIN LOSS	341	78282	2,162	N/A	N/A	N/A
HC45200649	NM PARATHYROID PLANAR IMAG+SUBTR	341	78070	3,045	N/A	N/A	N/A
HC45200714	RADIOPHARM' TX; IV ADMIN	342	79101	2,314	N/A	N/A	N/A
HC45200748	NM RED CELL VOL SNGL SAMPLE	341	78120	2,457	N/A	N/A	N/A
HC45201019	NM VENOGRAM(THROMBOS)UNILAT LT	341	78457	2,269	N/A	N/A	N/A
HC45201043	NM VENOUS THROMBOSIS PEPTIDE	341	78456	3,486	N/A	N/A	N/A
HC45201175	RADIOPHARM' TX; ORAL ADMIN	342	79005	3,086	N/A	N/A	N/A
HC45201365	NM GASTRIC EMPTY SML BWL&COLON>1DAY	341	78266	4,334	N/A	N/A	N/A
HC45201399	NM TUMOR LOCALIZE SPECT CT  2+ AREAS 1 DAY//SNGL AREA 2+DAYS	341	78832	8,907	N/A	N/A	N/A
HC45400140	MR IMAG GUIDE NEEDLE PLACEMENT	610	77021	4,634	N/A	N/A	N/A
HC45400173	MR LOW EXT(NON JNT)W/O CONT LT	610	73718	6,295	N/A	N/A	N/A
HC45400348	MR L-SPINE W&W/O CONTRAST	612	72158	12,337	N/A	N/A	N/A
HC83503391	IHC/IP PER SPEC INITIAL AB STAIN CYCLIN D1 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503581	IHC/IP PER SPEC INITIAL AB STAIN LEU MI (CD15) -US	312	88342	N/A	N/A	N/A	N/A
HC83503631	IHC/IP PER SPEC INITIAL AB STAIN P-53 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503664	IHC/IP PER SPEC INITIAL AB STAIN PLAP -US	312	88342	50	N/A	50	N/A
HC83503821	IF STUDY DIRECT PROF 1ST STAIN-CS	312	88346	207	N/A	207	N/A
HC83503862	MORPHOMETRIC STDY SKEL MUSC-AT	312	88355	N/A	N/A	N/A	N/A
HC83503912	MORPHOM STDY TUMOR IHC PROF-US	312	88361	N/A	N/A	N/A	N/A
HC83504159	M: MISC LAB PATHOLOGY REF LAB-EM	310		N/A	N/A	N/A	N/A
HC83504183	M: MISC LAB PATHOLOGY REF LAB-IM	310		N/A	N/A	N/A	N/A
HC83504407	CHROMO LYMPHOCYTE TISSUE-GC	310	88230	N/A	N/A	N/A	N/A
HC83504431	CHROM ANAL ADDL CELL CT-GC	310	88285	N/A	N/A	N/A	N/A
HC83504464	TISSUE IN-SITU HYBRI INTER-GC	312	88365	N/A	N/A	N/A	N/A
HC83504746	FLOW CYT MKR TC ADD+-US	311	88185	14	N/A	14	N/A
HC83504787	IHC/IP PER SPEC INITIAL AB STAIN (PNL X 5)-HP	312	88342	70	N/A	70	N/A
HC83504811	MORPH STDY MAN ISH QNTCEP17-NG	310	88368	201	N/A	201	N/A
HC83505248	IHC/IP PER SPEC EA ADD AB STAIN+ -PI	312	88341	28	N/A	28	N/A
HC83505271	M: MISC LAB PATHOLOGY REF LAB-AP	310		22	N/A	N/A	N/A
HC83505305	M: MISC LAB PATHOLOGY REF LAB-BT	310		N/A	N/A	N/A	N/A
HC83505511	IHC/IP PER SPEC EA ADD AB STAIN+ -CS	312	88341	40	N/A	N/A	N/A
HC83505545	M: MISC LAB PATHOLOGY REF LAB-CC	310		27	N/A	N/A	N/A
HC83505719	IHC/IP PER SPEC INITIAL AB STAIN MLH-1-NG	310	88342	45	N/A	N/A	N/A
HC83505743	SPECIAL STAIN GROUP II(PANEL)-U2	314	88313	50	N/A	N/A	N/A
HC83505776	M: MISC LAB PATHOLOGY REF LAB-CF	310		N/A	N/A	N/A	N/A
HC83505917	SPECIAL STAIN GROUP II -AP	312	88313	40	N/A	N/A	N/A
HC83505941	IHC/IP PER SPEC EA ADD AB STAIN+ -MA	312	88341	194	N/A	N/A	N/A
HC83505974	M: MISC LAB PATHOLOGY REF LAB-CM	310		88	N/A	N/A	N/A
HC83590349	P: MISMATCH REPAIR-MLH1 MSH2 MSH6 PMS2 -NG			N/A	N/A	N/A	N/A
HC83590380	P: FLOW CYT MKR CD4/CD8 BAL-NG			N/A	N/A	N/A	N/A
HC84200112	WET MOUNT	306	87210	255	N/A	39	N/A
HC84200146	CULTURE STOOL	306	87045	507	N/A	65	N/A
HC84200310	CULTURE TYPE AGGLUTINATION EA	306	87147	178	N/A	24	N/A
HC84200344	CRYPTOCOCCUS AG EA CSF	306	86406	266	N/A	152	N/A
HC84200377	TISSUE PROCESS GRINDING	306	87176	194	N/A	30	N/A
HC84200534	TRICHOMONAS RAPID TEST	306	87808	220	N/A	43	N/A
HC84200567	CONCENTRATION AFB/TB/MYCOBACTERIA	306	87015	181	N/A	67	N/A
HC84200591	CULTURE SPUTUM QUANT	306	87071	477	N/A	131	N/A
HC84200765	SMEAR CELL TYPE	306	87205	207	N/A	48	N/A
HC84200807	VIRAL ID (SHELL VIAL)	306	87254	373	N/A	99	N/A
HC84200971	TRICHROME STAIN	310	88313	465	N/A	107	N/A
HC84201003	SEMEN ANALYSIS COMPLETE	300	89320	454	N/A	99	N/A
HC84201037	H.PYLORI BREATH TST UREASE	301	83013	796	N/A	244	N/A
HC84201185	C DIFFICILE TOXIN GENE PCR	306	87493	597	N/A	151	N/A
HC84201219	INFLUENZA A BY PCR	306	87798	609	N/A	201	N/A
HC84201292	RESP VIRUS 12-25 TRGTS(RVP PNL)	306	87633	4,077	N/A	1,500	N/A
HC84201441	CULT DNA/RNA AMP PCR RESISTANT GENE	306	87150	528	N/A	220	N/A
HC84201474	DNA/RNA HERPES SIMPLEX II PCR(PNL)	306	87529	481	N/A	75	N/A
HC84201508	DNA/RNA E COLI K1 PCR(PNL)	306	87798	524	N/A	150	N/A
HC84201672	DNA/RNA KLEBSIELLA OXYTOCA (PNL)	306	87798	483	N/A	150	N/A
HC84201706	DNA/RNA PROTEUS SPP (PNL)	306	87798	483	N/A	150	N/A
HC84201870	MRSA BY PCR	300	87641	683	N/A	N/A	N/A
HC84290022	P:OVA/PARASITES W/TRICHR STAIN			N/A	N/A	N/A	N/A
HC84290055	P:INFLUENZA VIRUS H1N1/A/B PCR			N/A	N/A	N/A	N/A
HC84600113	PAP SLIDES MAN& RE-SCREEN	311	88153	154	N/A	50	N/A
HC84600147	PAP BETHESDA MAN & RE-SCREEN	311	88165	168	N/A	53	N/A
HC84600170	CYTOLOGY EXTENDED STUDY>5SLIDE	311	88162	365	N/A	126	N/A
HC84600345	CYTO SEL CELL ENHANCE DIST SRV	311	88112	691	N/A	266	N/A
HC84600527	CYTOLOGY FLUID/BRUSH/WASH *OP	311	88104	312	N/A	60	N/A
HC88600069	VENIPUNCTURE CUTDOWN <1	361	36420	585	N/A	131	N/A
HC88600101	NBS HANDLE COLLECTION CARD-GE	309	99001	1	N/A	1	N/A
HC89000046	EBV CAPSID AG AB (PNL)-FT	302	86665	70	N/A	70	N/A
HC89000079	PH FLUID-QD	301	83986	N/A	N/A	N/A	N/A
HC89000103	HERPES 2 IGM AB (PNL)-FT	302	86696	70	N/A	70	N/A
HC89000244	MUMPS AB-QD	302	86735	11	N/A	11	N/A
HC89000277	MEASLES (RUBEOLA)-SL	302	86765	N/A	N/A	N/A	N/A
HC89000301	ANAEROBIC SUSC(PNL)-FT	306	87186	39	N/A	38	N/A
HC89000483	Q FEVER AB-QD	302	86638	13	N/A	13	N/A
HC89000517	SPERM ANTIBODIES-AU	300	89325	48	N/A	48	N/A
HC89000699	BETA-GLUCURONIDASE  CSF-AU	301	84311	164	N/A	163	N/A
HC89000731	MYCOPLASMA PNEUMONIAE AB-QD	302	86738	27	N/A	27	N/A
HC89000913	CATECHOLAMINES FRACT-QD	301	82384	N/A	N/A	N/A	N/A
HC89000947	MYELIN BASIC PROTEIN CSF-SL	301	83873	N/A	N/A	N/A	N/A
HC89000996	AMINOLEVULINIC ACID-QD	301	82135	N/A	N/A	N/A	N/A
HC89001135	ASPERGILLUS AB-QD	302	86606	17	N/A	17	N/A
HC89001168	CHLORAMPHENICOL-QD	301	82415	N/A	N/A	N/A	N/A
HC89001200	LIPOPROTEIN-ASSOC PHS(PLAC)-AU	301	83698	125	N/A	125	N/A
HC89001416	TRICHINELLA AB-QD	302	86784	17	N/A	17	N/A
HC89001457	METHYPRYLON-AU	301	80299	95	N/A	95	N/A
HC89001630	ANTI-HISTONE AB-QD	302	86235	18	N/A	18	N/A
HC89001671	YERSINIA AB-QD	302	86793	14	N/A	14	N/A
HC89001754	CYSTICERCOSIS AB-SL	301	84182	N/A	N/A	N/A	N/A
HC89001911	TOCAINIDE-QD	301	80299	60	N/A	60	N/A
HC89001945	PORPHOBILINOGEN QUANT-QD	301	84110	N/A	N/A	N/A	N/A
HC89001986	AMYLASE ISOENZYME-QD	301	84999	5	N/A	4	N/A
HC89002166	ETHYLENE GLYCOL-QD	301	82693	14	N/A	14	N/A
HC89002208	FACTOR XII-U2	305	85280	N/A	N/A	N/A	N/A
HC89002372	IMMUNOGLOBULIN D-QD	301	82784	6	N/A	6	N/A
HC89002406	BETA-HCG QUANT-QD	301	84702	96	N/A	95	N/A
HC89002620	TRYPSIN-QD	301	84485	N/A	N/A	N/A	N/A
HC89002661	PARVOVIRUS AB-QD	302	86747	16	N/A	16	N/A
HC89002745	ACTIVATED PROT C RESISTANCE-QD	301	85307	N/A	N/A	N/A	N/A
HC89002919	RHEUMATOID FACTOR-SL	302	86431	8	N/A	8	N/A
HC89002943	CIMETIDINE/TAGAMET-QD	301	80299	60	N/A	60	N/A
HC89002976	IGG SUBCLASS-QD	301	82787	70	N/A	70	N/A
HC89003149	CA 15-3-QD	302	86300	10	N/A	10	N/A
HC89003172	CMV AB IGG-QD	302	86644	13	N/A	13	N/A
HC89003347	SCL 70 ENA AB-QD	302	86235	16	N/A	16	N/A
HC89003370	ENCEPHALITIS ST LOUIS AB-QD	302	86653	27	N/A	27	N/A
HC89003552	ARSENIC URINE-AU	301	82175	13	N/A	15	N/A
HC89003586	EPHEDRINE; 1-2 URINE-AU	301	80324	115	N/A	115	N/A
HC89003628	NITROGEN URINE-AU	301	84999	213	N/A	213	N/A
HC89003784	WEST NILE VIRUS AB  IGM-QD	302	86788	N/A	N/A	N/A	N/A
HC89003818	NBS TRANSFERASE-GE	301	82776	18	N/A	16	N/A
HC89003842	CMV AB IGM-QD	302	86645	13	N/A	13	N/A
HC89004030	NEUTROPHIL-ASSOC ANTIBODIES -AU	302	86021	71	N/A	69	N/A
HC89004063	CARNITINE  FREE-AU	301	83789	23	N/A	16	N/A
HC89004287	MEAT FIBERS  FECES-AU	300	89160	16	N/A	16	N/A
HC89004352	BETA 2 GLYCOPROTEIN  IGG- AU	302	86146	10	N/A	20	N/A
HC89004386	PROCAINAMIDE W/NAPA-AU	301	80192	16	N/A	16	N/A
HC89004527	ANTI-ENDOMY IGA AB IFA1ST STAIN(PNL2-PR	310	88346	106	N/A	106	N/A
HC89004592	ASCA IGA (PNL)-PR	302	83520	32	N/A	32	N/A
HC89004626	ANTI-OMPC IGA (PNL)-PR	302	83520	32	N/A	32	N/A
HC89004766	NBS IMMUNO TRYPSINOGEN(IRT)-GE	301	83516	18	N/A	16	N/A
HC89004790	CULTURE FUNGUS BLOOD-FT	306	87103	N/A	N/A	N/A	N/A
HC89004824	OXALATE SERUM-QD	301	83945	N/A	N/A	N/A	N/A
HC89004998	H INFULENZA AG -AU	302	86403	20	N/A	19	N/A
HC89005029	N MENINGITIOIS GROUP A/Y -AU	302	86403	20	N/A	19	N/A
HC89005193	INFCT AGNT ADENO DNA  PCR-FT	306	87799	275	N/A	314	N/A
HC89005227	HERPES VIRUS-6 DNA QUANT -FT	306	87533	314	N/A	314	N/A
HC89005250	HERPESVIRUS 6 AB IGM -FT	302	86790	81	N/A	81	N/A
HC89005409	MYOGLOBIN-UCI	301	83874	39	N/A	39	N/A
HC89005433	CULTURE CHLAMYDIA-FT	306	87110	100	N/A	100	N/A
HC89005466	EPSTEIN-BARR VIRUS QNT PCR-AU	306	87799	75	N/A	100	N/A
HC89005631	INFLUENZA A ANTIBODY-FT	302	86710	63	N/A	63	N/A
HC89005664	C PNEUMONIAE IGA ANTIBODY-FT	302	86631	90	N/A	90	N/A
HC89005847	SPECIMEN CONCENTRATION-U2	306	87015	9	N/A	9	N/A
HC89005870	FACTOR VIII VW MULTI-AU	305	85247	33	N/A	63	N/A
HC89006423	LORAZEPAM; 1-12-AU	301	80346	34	N/A	16	N/A
HC89006464	CYCLOSPORINE -CA	301	80158	N/A	N/A	N/A	N/A
HC89006506	ETHOSUXIMIDE-AU	301	80168	12	N/A	12	N/A
HC89006662	CLOZAPINE-AU	301	80159	24	N/A	18	N/A
HC89006696	DISOPYRAMIDE-AU	301	80299	20	N/A	20	N/A
HC89006720	FLECAINIDE-AU	301	80181	29	N/A	20	N/A
HC89006902	THIOTHIXENE-AU	301	80299	N/A	N/A	N/A	N/A
HC89006944	TRIMIPRAMINE-QN	301	80299	N/A	N/A	N/A	N/A
HC89007157	AFP AMNIOTIC FLUID-GZ	301	82106	N/A	N/A	N/A	N/A
HC89007181	AMINO ACID SINGLE QUANT-QD	301	82131	130	N/A	129	N/A
HC89007215	AMINO ACIDS QUANT-CA	301	82139	158	N/A	158	N/A
HC89007355	CHOLYGLYCINE BILE ACIDS-AU	301	82240	N/A	N/A	N/A	N/A
HC89007397	CARBOXYHEMOGLOBIN-AU	301	82375	39	N/A	39	N/A
HC89007421	CATECHOLAMINES FRACT-AU	301	82384	28	N/A	32	N/A
HC89007702	CORTISOL FREE URINE-AU	301	82530	18	N/A	17	N/A
HC89007751	CPK-AU	301	82550	9	N/A	9	N/A
HC89007785	CRYOFIBRINOGEN-AU	301	82585	9	N/A	8	N/A
HC89007967	ESTROGENS FRACTIONATED-AU	301	82671	20	N/A	20	N/A
HC89007991	ESTRONE-QN	301	82679	N/A	N/A	N/A	N/A
HC89008189	GLUCAGON-AU	301	82943	23	N/A	18	N/A
HC89008221	ALPHA-1 ACID GLYCOPROTEIN-AU	301	82985	63	N/A	62	N/A
HC89008254	LH(LUTEINIZ HORMONE)-ES	301	83002	33	N/A	32	N/A
HC89008395	HEXOSAMINIDASE-AU	301	83080	152	N/A	232	N/A
HC89008429	HVA URINE-CA	301	83150	93	N/A	48	N/A
HC89008452	5-HIAA URINE-AU	301	83497	20	N/A	17	N/A
HC89008635	MYASTHENIA GRAVIS EVAL-AT	301	83519	N/A	N/A	N/A	N/A
HC89008668	TRYPSIN-QD	301	83519	45	N/A	44	N/A
HC89008833	LDH ISOENZYMES(PNL)-AU	301	83625	16	N/A	16	N/A
HC89008874	LEUCINE AMINOPEPTIDASE-AU	301	83670	27	N/A	27	N/A
HC89009070	ASSAY NICOTINE-AU	301	80323	68	N/A	68	N/A
HC89009344	OLIGOCLONAL BANDS (CSF)-AU	301	83916	65	N/A	72	N/A
HC89009377	ORGANIC ACIDS TOTAL QUANT-MA	301	83918	N/A	N/A	N/A	N/A
HC89009526	PARATHYROID HORMONE TERM-QN	301	83970	55	N/A	54	N/A
HC89009567	ACID PHOS PROSTATIC-AU	301	84066	13	N/A	13	N/A
HC89009591	ALK PHOS ISO BONE SPECIFIC-AU	301	84080	30	N/A	69	N/A
HC89009765	PROINSULIN-QD	301	84206	N/A	N/A	N/A	N/A
HC89009799	QUININE-AU	301	84228	97	N/A	97	N/A
HC89009963	TESTOSTERONE TOTAL MALE-AU	301	84403	7	N/A	6	N/A
HC89009997	THYROGLOBULIN BY CIA-AU	301	84432	19	N/A	11	N/A
HC89010177	VANILLYLMANDELIC ACID URINE-AU	301	84585	15	N/A	17	N/A
HC89010201	VASOACTIVE INTEST PEPTIDE-QN	301	84586	57	N/A	56	N/A
HC89010235	ARGININE VASOPRESSIN HORMON-QN	301	84588	61	N/A	60	N/A
HC89010409	M: MISC LAB GENERAL REF LAB-DN	300		N/A	N/A	N/A	N/A
HC89010433	M: MISC LAB GENERAL REF LAB-FT	300		131	N/A	N/A	N/A
HC89010466	M: MISC LAB GENERAL REF LAB-GZ	300		2,103	N/A	N/A	N/A
HC89010631	ANTITHROMBIN III-AU	305	85300	23	N/A	26	N/A
HC89010664	INHIB PROTEIN C ACTIVITY-AU	301	85303	24	N/A	24	N/A
HC89010839	PROTEUS OX19 AGGLUT-AU	302	86000	N/A	N/A	N/A	N/A
HC89010862	PROTEUS OX2 AGGLUT-QD	302	86000	N/A	N/A	N/A	N/A
HC89010896	WEIL FELIX AGGLUT-AU	302	86000	N/A	N/A	N/A	N/A
HC89011035	COMPLEMENT TOTAL HEMOLYTIC-AU	302	86162	15	N/A	7	N/A
HC89011068	HISTOPLASMOSIS CF-FT	302	86171	N/A	N/A	N/A	N/A
HC89011092	LCM TITER BY CF-SL	302	86171	N/A	N/A	N/A	N/A
HC89011282	ANTI-SSB AB-AU	302	86235	16	N/A	16	N/A
HC89011316	NEUTROPHIL CYTOPLAS IFA AB-FT	302	86235	N/A	N/A	N/A	N/A
HC89011480	GLOMERULAR BSMT MEM IF-AU	302	86255	50	N/A	60	N/A
HC89011514	ANTI-RETICULIN AB TITER-AU	302	86255	84	N/A	52	N/A
HC89011696	HBV SURFACE AB QUANT-SL	302	86317	16	N/A	16	N/A
HC89011720	TOXOCARA CANIS/ELISA-FT	302	86317	110	N/A	110	N/A
HC89011753	PM 1 AB-AU	302	86325	N/A	N/A	N/A	N/A
HC89011894	INTRINSIC FACTOR AB-AU	302	86340	20	N/A	17	N/A
HC89011928	LYMPH T-CELL TOT CNT (PNL)-AU	302	86359	14	N/A	22	N/A
HC89011951	ANTI MICROSOMAL THYROI(PNL)-RD	302	86376	13	N/A	13	N/A
HC89012124	BLASTOMYCES AB-AU	302	86612	12	N/A	12	N/A
HC89012157	LYME DISEASE AB-AU	302	86618	8	N/A	9	N/A
HC89012322	ENCEPHALITIS EASTERN AB IGG-AU	302	86652	19	N/A	19	N/A
HC89012355	ENCEPHALITIS ST LOUIS AB IGG-AU	302	86653	19	N/A	19	N/A
HC89012520	HELICOBACTER PYLORI AB-AU	302	86677	8	N/A	8	N/A
HC89012553	ECHINOCOCCUS AB-AU	302	86682	15	N/A	20	N/A
HC89012587	TOXOCARA AB ELISA -AU	302	86682	90	N/A	24	N/A
HC89012728	HEPATITIS BE AB-AU	302	86707	17	N/A	14	N/A
HC89012751	LEISHMANIASIS AB -AU	302	86717	39	N/A	38	N/A
HC89012785	MUMPS AB-AU	302	86735	10	N/A	16	N/A
HC89012959	VARICELLA ZOSTER IGG-AU	302	86787	8	N/A	8	N/A
HC89012983	DENGUE FEVER AB-FT	302	86790	94	N/A	94	N/A
HC89013155	CLOSTRIDIUM DIFFICILE TOXIN-AU	306	87230	28	N/A	N/A	N/A
HC89013189	HELICOBACTER PYLORI AG-AU	306	87338	40	N/A	16	N/A
HC89013213	HEPATITIS DELTA AG-AU	306	87380	125	N/A	125	N/A
HC89013353	N-GONORRHEA DNA AMP PROBE-AU	306	87591	15	N/A	27	N/A
HC89013387	RESP VIRAL EACH ORG (PNL)-AU	306	87798	N/A	N/A	N/A	N/A
HC89013411	AMOXAPINE/HPLC-AU	301	80299	N/A	N/A	N/A	N/A
HC89013551	CALCIUM URINE-AU	301	82340	N/A	N/A	N/A	N/A
HC89013593	COPPER-AU	301	82525	6	N/A	14	N/A
HC89013627	IMMUNOGLOBULIN IGE-AU	301	82785	9	N/A	9	N/A
HC89013908	TOT PROT REFRACTOM(PNL)-AU	301	84160	4	N/A	4	N/A
HC89013932	WESTERN BLOT IMMUNE PROBE-AT	301	84182	N/A	N/A	N/A	N/A
HC89014112	ANTIBODY PM-1 AB-AU	302	86235	71	N/A	71	N/A
HC89014153	FLUORESCNT AB NON INF SREEN-AU	302	86255	N/A	N/A	N/A	N/A
HC89014187	FLUORESCNT AB TITER EA AB-AU	302	86256	N/A	N/A	N/A	N/A
HC89014328	FUNGUS AB OTHER-FT	302	86671	N/A	N/A	N/A	N/A
HC89014369	HEPATITIS B CORE AB-U2	302	86704	N/A	N/A	N/A	N/A
HC89014393	LCM AB-AU	302	86727	20	N/A	16	N/A
HC89014583	AFB MIC RAPID GROW-AU	306	87186	N/A	N/A	N/A	N/A
HC89014617	FUNGUS ID-FT	306	87220	53	N/A	53	N/A
HC89014807	HEPATITIS C GENOTYPE PCR-AU	306	87902	80	N/A	245	N/A
HC89014831	BUCCAL SMEAR-IG-GZ	311	88130	N/A	N/A	N/A	N/A
HC89015002	CHROMO ANAL AMNIO FLD 6-14-GZ	311	88269	N/A	N/A	N/A	N/A
HC89015036	CHROM ANAL ADDL CELL CT-GZ	311	88285	N/A	N/A	N/A	N/A
HC89015069	FAT STAIN URINE-AU	300	89125	N/A	N/A	N/A	N/A
HC89015226	FLOW CYT MKR TC ADD+-IM	311	88185	N/A	N/A	N/A	N/A
HC89015259	CODEINE URINE - U2	301	80299	71	N/A	70	N/A
HC89015291	BETA HYDROXYBUTYRATE-QD	301	82010	23	N/A	23	N/A
HC89015465	ASSAY NICOTINE-QD	300	80323	11	N/A	11	N/A
HC89015499	PROLACTIN-QD	301	84146	12	N/A	12	N/A
HC89015663	INHIB PROTEIN S FREE (FUNC)-QD	301	85306	30	N/A	30	N/A
HC89015697	ASO TITER-QD	302	86060	12	N/A	12	N/A
HC89015721	CA 125-QD	302	86304	9	N/A	9	N/A
HC89015861	VARICELLA ZOSTER IGG-QD	302	86787	23	N/A	23	N/A
HC89015895	HLA B27-QD	302	86812	10	N/A	10	N/A
HC89015929	CULTURE VIRUS-QD	306	87252	16	N/A	16	N/A
HC89016067	FLOW CYT MKR 1ST-QD	311	88184	N/A	N/A	N/A	N/A
HC89016091	ACYLCARNITINES QUANT-MA	301	82017	48	N/A	48	N/A
HC89016125	HEPATITIS C PCR QUAL-QD	306	87521	54	N/A	54	N/A
HC89016299	ALBUMIN; URINE QUANT-QD	301	82043	8	N/A	8	N/A
HC89016323	ANTI JO 1-SL-QD	302	86235	21	N/A	21	N/A
HC89016588	ENTEROVIRUS BY PCR-FT	306	87498	165	N/A	165	N/A
HC89016620	CULTURE - CHLAMYDIA STAIN-AU	306	87140	23	N/A	23	N/A
HC89016661	ULTRACENTRIFUG VAP(IN PNL)-AH	301	83701	33	N/A	33	N/A
HC89016844	VOLTAGE GATED CA CHANNEL AB-QD	301	83519	N/A	N/A	N/A	N/A
HC89016877	CRYOGLOBULIN IGM  QUANT-AU	301	82784	8	N/A	8	N/A
HC89016901	NORDIAZEPAM; 1-12-AU	301	80346	21	N/A	21	N/A
HC89017081	PHOSPHATIDYLSERINE ANTIBODY-AU	305	86148	59	N/A	59	N/A
HC89017115	REPTILASE TIME 1:1 MIX-AU	305	85635	30	N/A	29	N/A
HC89017289	CMV AB IGG(PNL-2)-AU	302	86644	8	N/A	11	N/A
HC89017313	NEISSERIA GONORRHOEAE AB-QD	302	86609	43	N/A	43	N/A
HC89017487	HERPESVIRUS 6 (HHV-6)AB IGG-AU	302	86790	100	N/A	18	N/A
HC89017511	HSV 2 AG(PNL)-AU	306	87273	25	N/A	25	N/A
HC89017545	BLASTOMYCES AB(PNL)-AU	302	86612	14	N/A	9	N/A
HC89017701	OLIGOCLONAL BANDS (PNL)-AU	301	83916	28	N/A	28	N/A
HC89017735	APOLIPOPROTEIN A1(PNL)-AU	301	82172	15	N/A	15	N/A
HC89017768	PARAINFLUENZA AB(PNL)-AU	302	86790	13	N/A	13	N/A
HC89018022	M: MISC LAB GENERAL REF LAB-GF	300		769	N/A	N/A	N/A
HC89018063	TISSUE TRANSGLUTAMNS AB IGA-AU	301	86364	6	N/A	6	N/A
HC89018238	FACTOR VIII INHIBITOR-EC	305	85335	40	N/A	40	N/A
HC89018261	HIV-2 AB CONFIRM IMMUNOBLOT-AU	301	86689	103	N/A	103	N/A
HC89018451	IMMUNOASSAY ANA QUANT (PNL)-PR	301	83520	24	N/A	23	N/A
HC89018485	IMMUNOFLUOR' STUDY EA AB1ST STAIN(PNL)-PR	310	88346	51	N/A	51	N/A
HC89018600	CHROM ANAL 20-25 CELLS  BM-AU	310	88264	163	N/A	211	N/A
HC89018998	BORDETELLA PERTUS IMMUNOBLOT IGA-AU	302	86615	31	N/A	32	N/A
HC89019038	HYDROXYPROLINE TOTAL URINE -AU	301	83505	51	N/A	51	N/A
HC89019244	WEST NILE VIRUS IGG AB-AU	302	86789	17	N/A	17	N/A
HC89019541	ANTIBODY IGG MUMPS VIRUS -AU	302	86735	9	N/A	9	N/A
HC89019574	ANTI-HU-TTG IGA (PNL1155/6360)-PR	301	83520	36	N/A	36	N/A
HC89019939	MTHFR MUTATION DETECTION-AU	301	81291	60	N/A	60	N/A
HC89019970	17 HYDROXYPREGNENOLONE -ES	301	84143	65	N/A	58	N/A
HC89020002	B PARAPERTUSSIS PCR - AU	306	87798	46	N/A	46	N/A
HC89020150	ICAM CHEMILUMINESCENT (PNL)-PR	301	82397	28	N/A	16	N/A
HC89020184	C-REACTIVE PROTEIN(PNL2)-PR	301	86140	22	N/A	24	N/A
HC89020218	ATG16L1 SNP (RS2241880)(PL)-PR	301	81479	14	N/A	47	N/A
HC89020382	KRAS GENE ANALYSIS-AU	301	81275	164	N/A	164	N/A
HC89020416	THEOPHYLLINE-U2	301	80198	36	N/A	36	N/A
HC89020887	WEST NILE VIRUS ELISA(PNL) -AU	302	86789	17	N/A	17	N/A
HC89020911	M: MISC LAB GENERAL REF LAB-CN	300		274	N/A	N/A	N/A
HC89021083	PEANUT COMP ANTGNC EPI ARA H2(PNL)-AU	302	86003	50	N/A	50	N/A
HC89021117	PEANUT COMP ANTGNC EPI ARA H5(PNL)-AU	302	86003	50	N/A	50	N/A
HC89021141	NK CELLS TOTAL COUNT(PNL) -CN	302	86357	129	N/A	128	N/A
HC89021299	M: MISC LAB GENERAL REF LAB-BA	300		N/A	N/A	N/A	N/A
HC89021323	EOSINOPHIL SPUTUM-AU	305	89190	8	N/A	N/A	N/A
HC89021356	A FUMIGATUS-VC	306	87798	132	N/A	N/A	N/A
HC89021547	M: MISC LAB GENERAL REF LAB-UX	300		N/A	N/A	N/A	N/A
HC89021570	PREGNENOLONE  SERUM/PLASMA-AU	301	84140	29	N/A	N/A	N/A
HC89021752	OXYCODONE MEC(PNL)-AU	301	80365	33	N/A	N/A	N/A
HC89021877	ZIKA VIRUS IGM AB CAPTURE-AU	302	86790	85	N/A	N/A	N/A
HC89022107	METHAMPHETAMINES(MDA MDEA MDMA)SERUM QNTS(PNL)-AU	301	80359	33	N/A	N/A	N/A
HC89022131	PHENCYCLIDINE (PCP)SERUM QNT(PNL)-AU	301	83992	77	N/A	N/A	N/A
HC89022164	ANTIBODY ACETYLCHOLINE RCPTR MODULTNG -AU	301	83516	35	N/A	N/A	N/A
HC89022313	M: MISC LAB GENERAL REF LAB-PG	300		364	N/A	N/A	N/A
HC89022347	FLOW CYTOMETRY 1ST MRKR{W-INT/88}-CC	311	88184	148	N/A	N/A	N/A
HC89022370	FLOW CYT LEUK/LYMPH 1ST MRKR{W-INT/87}-AU	311	88184	79	N/A	N/A	N/A
HC89022552	M: MISC LAB GENERAL REF LAB -NJ	300		123	N/A	N/A	N/A
HC89022586	CORTISOL-QN	301	82533	21	N/A	N/A	N/A
HC89022768	M: MISC LAB GENERAL REF LAB -GI	300		2,549	N/A	N/A	N/A
HC89022800	CHOLESTEROL FLUID SPECTROPHTMTRY-AU	301	84311	10	N/A	N/A	N/A
HC89022834	M: MISC LAB GENERAL REF LAB-VC	300		N/A	N/A	N/A	N/A
HC89022974	TRIGLYCERIDES  BODY FLUID-AU	301	84478	9	N/A	N/A	N/A
HC89023006	CARCINOEMBRYONIC ANTIGEN (CEA) BODY FLUID-AU	301	82378	17	N/A	N/A	N/A
HC89023030	RENIN-QN	301	84244	35	N/A	N/A	N/A
HC89023170	M: MISC LAB GENERAL REF LAB-JU	300		N/A	N/A	N/A	N/A
HC89023204	ALDOSTERONE-QN	301	82088	82	N/A	N/A	N/A
HC89023238	LAMBDA FREE LIGHT CHAINS QT URINE(IFE)-AU	301	83520	14	N/A	N/A	N/A
HC89023410	TARGETED GENOME PNL SEQ 5-50 GENES PANCREASEQ-SS	309	81445	750	N/A	N/A	N/A
HC89023444	HISTAMINE  URINE-AU	302	83088	25	N/A	N/A	N/A
HC89023626	M: MISC LAB GENERAL REF LAB-UT	300		N/A	N/A	N/A	N/A
HC89023659	B CELL TOTAL COUNT-AU	302	86355	20	N/A	N/A	N/A
HC89023683	T CELL ABSOLUTE CD4/CD8 CNT-AU	302	86360	27	N/A	N/A	N/A
HC89023824	GABAPENTIN NON-BLOOD-AU	301	80355	25	N/A	N/A	N/A
HC89023857	ANSER IFX MEASUOF ABS TO INFLIXIMAB-PR	300	82542	525	N/A	N/A	N/A
HC89023907	FACTOR V LEIDEN -QN	301	81241	92	N/A	N/A	N/A
HC89090013	P:SPERM AB-AU			N/A	N/A	N/A	N/A
HC89090047	P:CHROMOSOME ANALYSIS TISSU-GZ			N/A	N/A	N/A	N/A
HC89090237	P:ALLERGEN FOOD PANEL ADULT-AU			N/A	N/A	N/A	N/A
HC89090260	P:ALLERGEN FOOD PANEL PED 9-AU			N/A	N/A	N/A	N/A
HC89090484	P: COXSACKIE A AB PANEL-FT			N/A	N/A	N/A	N/A
HC89090518	P:CULTURE AFB+STAIN-FT			N/A	N/A	N/A	N/A
HC89090567	P:TORCH ANTIBODIES  IGG-AU			N/A	N/A	N/A	N/A
HC89090708	P:GLOMERULAR BSMT MEM PANEL-AU			N/A	N/A	N/A	N/A
HC89090740	P:APOLIPOPROTEIN B/A RATIO-AU			N/A	N/A	N/A	N/A
HC89090773	P:COENZYME Q10-AU			N/A	N/A	N/A	N/A
HC89091045	P: CHROMOSOME ANALYS POC-AU			N/A	N/A	N/A	N/A
HC89091136	P: THIOPUR METABOL(CAT#3200)-PR			N/A	N/A	N/A	N/A
HC89091367	ANTI-MULLERIAN HORMONE-AU	302	83520	63	N/A	98	N/A
HC89091391	STRONGYLOIDES AB IGG -AU	302	86682	20	N/A	N/A	N/A
HC89091425	SEROTONIN RELEASE ASSAY -AU	301	86022	135	N/A	N/A	N/A
HC89091656	P: CYSTIC FIBROSIS BY NGS DEL/DUP-AU			N/A	N/A	N/A	N/A
HC89091680	P: ANSER VDZ-PR			N/A	N/A	N/A	N/A
HC89500128	BLOOD TYPING AG SCREEN(PT)-AA	300	86904	60	N/A	98	N/A
HC89500557	COOMBS DIRECT(EA)-SB	302	86886	17	N/A	15	N/A
HC89500581	COOMBS INDIR TITER EA -SB	302	86886	90	N/A	63	N/A
HC89500680	PLATELET ANTIBODY ID -SB	302	86022	195	N/A	150	N/A
HC89501035	HISTORICAL ANTIGEN FEE-SB	302	86999	46	N/A	N/A	N/A
HC91000044	R&B STEP DOWN/DOU INTERMD ICU	206		10,887	N/A	N/A	N/A
HC91200404	R&B IICU - INTENSIVE PPE ISOLATION	209		16,096	N/A	N/A	N/A
HC91400096	R&B PEDIATRIC INTENSIVE CARE	203		17,037	N/A	N/A	N/A
HC91600029	R&B REHABILITATION	128		5,510	N/A	N/A	N/A
HC65001258_00338001741	NONCDM CHARGE RECORD PHARMACY	636	J7060	16	N/A	N/A	N/A
HC65001258_00338008504	NONCDM CHARGE RECORD PHARMACY	258	J7042	16	N/A	N/A	N/A
HC65001258_00338011703	NONCDM CHARGE RECORD PHARMACY	258	J7120	30	N/A	N/A	N/A
HC65001258_00409790209	NONCDM CHARGE RECORD PHARMACY	636	J7042	6	N/A	N/A	N/A
HC65001258_00409792409	NONCDM CHARGE RECORD PHARMACY	636	J7042	16	N/A	N/A	N/A
HC65001258_00409794109	NONCDM CHARGE RECORD PHARMACY	636	J7042	16	N/A	N/A	N/A
HC65001258_00990711609	NONCDM CHARGE RECORD PHARMACY	258	J7030	58	N/A	N/A	N/A
HC65001258_00990790309	NONCDM CHARGE RECORD PHARMACY	636	J7042	23	N/A	N/A	N/A
HC65001258_00990792202	NONCDM CHARGE RECORD PHARMACY	258	J7060	31	N/A	N/A	N/A
HC65001258_00990792903	NONCDM CHARGE RECORD PHARMACY	636	J7070	36	N/A	N/A	N/A
HC65001258_00990794109	NONCDM CHARGE RECORD PHARMACY	258	J7042	16	N/A	N/A	N/A
HC65001258_00990798302	NONCDM CHARGE RECORD PHARMACY	258	J7030	32	N/A	N/A	N/A
HC65001258_02457111306	NONCDM CHARGE RECORD PHARMACY	636	A4706	227	N/A	N/A	N/A
HC65001258_06332362374	NONCDM CHARGE RECORD PHARMACY	258	J7050	8	N/A	N/A	N/A
HC65001278_05936551281	NONCDM CHARGE RECORD PHARMACY	636	J7300	5,856	N/A	N/A	N/A
HC65001636_00009737611	NONCDM CHARGE RECORD PHARMACY	636	J1050	2	N/A	N/A	N/A
HC65002250	MED - IRRIGATION SOLUTION	250		14	N/A	N/A	N/A
HC65002250_00409713936	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002250_00436067216	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65002250_00990613803	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65002258_00264752020	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65002258_00264934155	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65002258_06332382476	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65002636_00003052811	NONCDM CHARGE RECORD PHARMACY	636	J3490	0	N/A	N/A	N/A
HC65002636_00085432402	NONCDM CHARGE RECORD PHARMACY	636	J3490	0	N/A	N/A	N/A
HC65002636_00093112589	NONCDM CHARGE RECORD PHARMACY	636	J3490	0	N/A	N/A	N/A
HC65002636_00168009930	NONCDM CHARGE RECORD PHARMACY	636	J3490	162	N/A	N/A	N/A
HC65002636_00310461612	NONCDM CHARGE RECORD PHARMACY	636		0	N/A	N/A	N/A
HC65002636_00378427093	NONCDM CHARGE RECORD PHARMACY	636	J3490	250	N/A	N/A	N/A
HC65002636_00472024260	NONCDM CHARGE RECORD PHARMACY	636	Z7610	643	N/A	N/A	N/A
HC65002636_01012251003	NONCDM CHARGE RECORD PHARMACY	636	J3490	12,331	N/A	N/A	N/A
HC65002636_01198018005	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,043	N/A	N/A	N/A
HC65002636_02420846325	NONCDM CHARGE RECORD PHARMACY	636	J3490	117	N/A	N/A	N/A
HC65002636_02420863562	NONCDM CHARGE RECORD PHARMACY	636	J3490	545	N/A	N/A	N/A
HC65002636_02433823012	NONCDM CHARGE RECORD PHARMACY	636	J3490	292	N/A	N/A	N/A
HC65002636_04279401008	NONCDM CHARGE RECORD PHARMACY	636	Z7610	368	N/A	N/A	N/A
HC65002636_04580213970	NONCDM CHARGE RECORD PHARMACY	636	J3490	828	N/A	N/A	N/A
HC65002636_04733523583	NONCDM CHARGE RECORD PHARMACY	636	J8610	5	N/A	N/A	N/A
HC65002636_05167212981	NONCDM CHARGE RECORD PHARMACY	636	J3490	147	N/A	N/A	N/A
HC65002636_05167213702	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,161	N/A	N/A	N/A
HC65002636_05256500814	NONCDM CHARGE RECORD PHARMACY	636	Z7610	68	N/A	N/A	N/A
HC65002636_06075811905	NONCDM CHARGE RECORD PHARMACY	636	J3490	375	N/A	N/A	N/A
HC65002636_06131404475	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,035	N/A	N/A	N/A
HC65002636_06428110006	NONCDM CHARGE RECORD PHARMACY	636	J7674	5	N/A	N/A	N/A
HC65002636_06498032005	NONCDM CHARGE RECORD PHARMACY	636	Z7610	419	N/A	N/A	N/A
HC65002636_06516280314	NONCDM CHARGE RECORD PHARMACY	636	J8700	11	N/A	N/A	N/A
HC65002636_06818096256	NONCDM CHARGE RECORD PHARMACY	636	J3490	75	N/A	N/A	N/A
HC65002636_06846253435	NONCDM CHARGE RECORD PHARMACY	636	Z7610	765	N/A	N/A	N/A
HC65002636_06846258576	NONCDM CHARGE RECORD PHARMACY	636	J8501	164	N/A	N/A	N/A
HC65002636_07059402304	NONCDM CHARGE RECORD PHARMACY	636	J0770	182	N/A	N/A	N/A
HC65002636_07086010310	NONCDM CHARGE RECORD PHARMACY	636	J3490	12	N/A	N/A	N/A
HC65004250_00143923210	NONCDM CHARGE RECORD PHARMACY	250		103	N/A	N/A	N/A
HC65004250_00143931010	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65004250_00264752000	NONCDM CHARGE RECORD PHARMACY	250	J3490	1	N/A	N/A	N/A
HC65004250_00338002304	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65004250_00338051913	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65004250_00409120901	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65004250_00409163110	NONCDM CHARGE RECORD PHARMACY	250		50	N/A	N/A	N/A
HC65004250_00409177805	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65004250_00409401101	NONCDM CHARGE RECORD PHARMACY	250		128	N/A	N/A	N/A
HC65004250_00409488710	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65004250_00409669501	NONCDM CHARGE RECORD PHARMACY	250		38	N/A	N/A	N/A
HC65004250_00409739172	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65004250_00641602225	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_00703291403	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65004250_00703952601	NONCDM CHARGE RECORD PHARMACY	250		259	N/A	N/A	N/A
HC65004250_02315516041	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65004250_02502131604	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65004250_03600003310	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65004250_04923020692	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65004250_04923020992	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65004250_05515023620	NONCDM CHARGE RECORD PHARMACY	250		119	N/A	N/A	N/A
HC65004250_06026770550	NONCDM CHARGE RECORD PHARMACY	250		695	N/A	N/A	N/A
HC65004250_06332308861	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65004250_06332338620	NONCDM CHARGE RECORD PHARMACY	250		219	N/A	N/A	N/A
HC65004250_06332342610	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65004250_06332348227	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65004250_06332382074	NONCDM CHARGE RECORD PHARMACY	250		160	N/A	N/A	N/A
HC65004250_06332392430	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65004250_06745722805	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65004250_06745745720	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65004250_07070016725	NONCDM CHARGE RECORD PHARMACY	250		84	N/A	N/A	N/A
HC65004250_07226612225	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_07257205210	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65004250_08290306546	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65025011	MEDICATION - MCAL S0017	250		N/A	N/A	N/A	N/A
HC65025011_07257201525	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65025012_00409156029	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65025012_00409174630	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65025012_06332346357	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65025012_06332346557	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65025013_06785003210	NONCDM CHARGE RECORD PHARMACY	250		81	N/A	N/A	N/A
HC65025014	MEDICATION - MCAL S0077	250		N/A	N/A	N/A	N/A
HC65025017	MEDICATION - MCAL S0164	250		N/A	N/A	N/A	N/A
HC65500754_00562780505	NONCDM CHARGE RECORD PHARMACY	636	J2790	708	N/A	N/A	N/A
HC65600278	SUPPLY IMPLANT-THERAPEUTIC (NO NDC)	278		96,000	N/A	N/A	N/A
HC65600343_01199412106	NONCDM CHARGE RECORD PHARMACY	250	A9556	170	N/A	N/A	N/A
HC65600343_06517466030	NONCDM CHARGE RECORD PHARMACY	250	A9503	126	N/A	N/A	N/A
HC65600343_06993200130	NONCDM CHARGE RECORD PHARMACY	255	A9588	1,424	N/A	N/A	N/A
HC65800062	BRACHY SEED IRIDIUM-192\NON HI	278	C1719	202	N/A	N/A	N/A
HC65800112	PALLADIUM-103 STRANDED PER SOURCE	278	C2640	390	N/A	N/A	N/A
HC65890022	P:IODINE 125 NONSTRND 20SEEDS			N/A	N/A	N/A	N/A
HC73000267	DIALYSIS CVVH (CONT VENOVENOUS) QD	809	90947	3,810	N/A	N/A	N/A
HC74200015	OR TIME INITIAL HR LEVEL 2 (MCAL 1ST HOUR)	360		12,973	N/A	N/A	N/A
HC74200049	OR TIME INITIAL HR LEVEL 5 (MCAL 1ST HOUR)	360		19,740	N/A	N/A	N/A
HC74200189	BEDSIDE/OTHER SURG INITIAL HR 1 (MCAL 1ST HOUR)	369		5,288	N/A	N/A	N/A
HC74200213	BEDSIDE/OTHER SURG INITIAL HR 4 (MCAL 1ST HOUR)	369		9,323	N/A	N/A	N/A
HC74200247	BEDSIDE/OTHER SURG ADD'L 15MIN 1 (MCAL 1ST SUBSQNT 0.5 HR)	369		1,292	N/A	N/A	N/A
HC74200411	OR TIME ADD'L 15MIN CASE CX 6 (MCAL 1ST SUBSQNT 0.5 HR)	360		2,548	N/A	N/A	N/A
HC74200445	OR TIME ADD'L 15MIN LVL 3  (MCAL 2ND SUBSQNT 0.5 HR)	360		3,860	N/A	N/A	N/A
HC74200619	OR TIME ADD'L 15MIN CASE CX 4 MCAL (2ND SUBSQNT 0.5 HR)	360		2,063	N/A	N/A	N/A
HC77400026	MOD CS BY MD  ADD'L 15 MIN	372	99153	337	N/A	N/A	N/A
HC77400075	ANESTHESIA ADD'L 15MIN	370		784	N/A	N/A	N/A
HC77400216	MOD CS GI ENDO SVCS>5YRS INIT'L 15MIN	372	G0500	373	N/A	N/A	N/A
HC77400240	MOD CS DIFF PHYS/QHP <5 YR INIT'L 15MIN	372	99155	445	N/A	N/A	N/A
HC77400273	ANESTHESIA ADD'L 15MIN CASE CX	370		551	N/A	N/A	N/A
HC81100059	SODIUM URINE	301	84300	167	N/A	47	N/A
HC81100083	LIPID PANEL	301	80061	454	N/A	67	N/A
HC81100265	VALPROIC ACID; TOTAL	301	80164	689	N/A	96	N/A
HC81100299	CARBAMAZEPINE  TOTAL	301	80161	409	N/A	98	N/A
HC81100463	BICARBONATE/CO2	301	82374	124	N/A	37	N/A
HC81100497	CALCIUM URINE QUANT TIMED SPEC	301	82340	165	N/A	50	N/A
HC81100521	CHOLESTEROL	301	82465	135	N/A	42	N/A
HC81100661	MAGNESIUM	301	83735	208	N/A	57	N/A
HC81100695	POTASSIUM	301	84132	148	N/A	42	N/A
HC81100729	SALICYLATES; 1-2	301	80179	314	N/A	57	N/A
HC81100901	AMIKACIN  SUBS	301	80150	483	N/A	106	N/A
HC81100935	PHENYTOIN FREE	301	80186	706	N/A	106	N/A
HC81101107	FETAL FIBRONECTIN	301	82731	1,154	N/A	327	N/A
HC81101131	G6PD	301	82955	175	N/A	72	N/A
HC81101164	METHEMOBLOBIN QT	301	83050	381	N/A	91	N/A
HC81101305	GLUCOSE BY REAGENT STRIP	301	82948	112	N/A	22	N/A
HC81101347	PARATHYROID HORMONE SUBSEQUENT	301	83970	524	N/A	209	N/A
HC81101370	BLOOD GAS PH ONLY	301	82800	228	N/A	46	N/A
HC81101511	ALBUMIN ISCHEMIA MODIFIED	301	82045	409	N/A	151	N/A
HC81101560	BICARBONATE	301	82374	122	N/A	36	N/A
HC81101594	LDL CHOLEST DIRECT	301	83721	204	N/A	49	N/A
HC81101826	SEX HORMONE BINDING GLOB	301	84270	277	N/A	90	N/A
HC81101859	HEMOGLOBIN GLYCATED  A1C(DA)	301	83036	155	N/A	30	N/A
HC81500001	CELL COUNT FLUID W/ DIFF	300	89051	380	N/A	48	N/A
HC81500035	RETICULOCYTE - AUTO	305	85045	146	N/A	42	N/A
HC81500068	CBC WITH AUTOMATED DIFF	305	85025	282	N/A	33	N/A
HC81500209	THICK SMEAR  BLOOD PARASITES	300	87015	180	N/A	39	N/A
HC81500233	BLOOD COUNT/WBC (EOS)	305	85032	181	N/A	46	N/A
HC81500266	HEMOSIDERIN QUAL	301	83070	128	N/A	53	N/A
HC81500431	ANTITHROMBIN III	305	85300	432	N/A	128	N/A
HC81500464	INHIB PROTEIN C ACTIVITY	305	85303	438	N/A	149	N/A
HC81500639	BLOOD SMEAR SCAN	305	85008	83	N/A	18	N/A
HC81500696	FACTOR XIII ASSAY	305	85290	342	N/A	195	N/A
HC81500878	PROTHROMBIN TIME (POS)	305	85610	161	N/A	18	N/A
HC81500902	HEPARIN PROTAMINE TOLERANCE	305	85530	178	N/A	95	N/A
HC81500936	URINALYSIS AUTO W/O MICRO	307	81003	134	N/A	22	N/A
HC81700098	ESTRADIOL	301	82670	378	N/A	87	N/A
HC81700122	FSH	301	83001	341	N/A	94	N/A
HC81700155	PROLACTIN	301	84146	352	N/A	99	N/A
HC81700320	CA 19-9	302	86301	298	N/A	76	N/A
HC81700353	IMMUNOFIXATION ELECTROPHORESIS	302	86334	305	N/A	152	N/A
HC81700528	HLA B27	302	86812	300	N/A	140	N/A
HC81700551	N-GONORRHEA BY DNA PROBE	306	87590	345	N/A	102	N/A
HC81700726	ANTI-DNA (DS)	302	86256	177	N/A	66	N/A
HC81700759	MYOCARDIAL AB	301	86256	177	N/A	66	N/A
HC81700783	HEPATITIS B SURFACE AG CONFIRM	302	87341	259	N/A	67	N/A
HC81700932	FLW CYT MKR CD24 TC ADD+	311	88185	318	N/A	104	N/A
HC81700965	FLW CYT MKR CD33 TC ADD+	311	88185	318	N/A	104	N/A
HC81700999	FLW CYT MKR CD5 TC ADD+	311	88185	318	N/A	104	N/A
HC81701187	ALPHA1 ANTITRYPSIN	301	82103	290	N/A	15	N/A
HC81701237	HPV HI RISK(16 18 31 33 35 39 45 51 52 56 58 59 68)	306	87624	475	N/A	162	N/A
HC81701559	MULTI ORGANIZ DNA BY AMP PROBE	306	87801	1,082	N/A	295	N/A
HC81701625	ENTEROVIRUS RNA RT PCR	306	87498	568	N/A	215	N/A
HC81701658	VITAMIN D  25-HYDROXY	301	82306	421	N/A	130	N/A
HC81701815	HERPES I/II AB IGM	302	86694	215	N/A	58	N/A
HC81701849	IGG SUBCLASS 1; EACH	301	82787	298	N/A	33	N/A
HC81701872	IGG SUBCLASS 4; EACH	301	82787	298	N/A	33	N/A
HC81702045	FLW CYT MKR CD11C TC ADD+	311	88185	318	N/A	104	N/A
HC81702078	FLW CYT MKR CD22 TC ADD+	311	88185	316	N/A	104	N/A
HC82200023	GIEMSA STAIN/GRP I W/INT&RPT+	312	88312	547	N/A	144	N/A
HC82200056	BROWN BREEN GRM STN/GR I W/I&R+	312	88312	547	N/A	50	N/A
HC82200221	IHC/IP PER SPEC INITIAL AB STAIN CHROMOGRNIN	312	88342	593	N/A	193	N/A
HC82200254	IHC/IP PER SPEC INITIAL AB STAIN FACTOR 8	312	88342	593	N/A	193	N/A
HC82200288	IHC/IP PER SPEC INITIAL AB STAIN EPITH	312	88342	593	N/A	193	N/A
HC82200429	ANATOMIC CONSULT:SLIDE REVIEW	312	88321	429	N/A	242	N/A
HC82200452	ANATOMIC CONSULT:REVIEW/PREP	312	88323	555	N/A	272	N/A
HC82200494	IRON STAIN/B.M. SMEARS+	312	88313	474	N/A	97	N/A
HC82200676	TISSUE EXAM LEVEL 4 SPECIAL	312	88305	780	N/A	218	N/A
HC82200718	TISSUE EXAM G&M SLIDE PREP-MHL	312	88305	780	N/A	218	N/A
HC82200924	TISSUE EX G&M LVL 2  DIST SVC	312	88302	401	N/A	96	N/A
HC82200957	TISSUE EX G&M LVL 5  DIST SVC	312	88307	1,128	N/A	296	N/A
HC82201120	JONES SILVER STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82201153	MASSON TRICHROME STAIN/GRP II+	312	88313	474	N/A	107	N/A
HC82201187	METHYL GREEN PYRON STN/GRP II+	312	88313	474	N/A	107	N/A
HC82201328	HISTCHM ST GOM TRICHRM FR TS	312	88313	470	N/A	108	N/A
HC82201351	HISTCHM ST ACID PTASE FRO TS	312	88314	388	N/A	108	N/A
HC82201385	HISTCHM ST CYTCHRM OXDS FR TS	312	88319	962	N/A	500	N/A
HC82201559	IHC/IP PER SPEC INITIAL AB STAIN IHC/IP STAIN ACTH	312	88342	593	N/A	193	N/A
HC82201583	IHC/IP PER SPEC INITIAL AB STAIN CD-34	312	88342	593	N/A	193	N/A
HC82201757	IHC/IP PER SPEC INITIAL AB STAIN NEUROFILAMENT	312	88342	593	N/A	193	N/A
HC82201781	IHC/IP PER SPEC INITIAL AB STAIN SMOOTH MUSC	312	88342	593	N/A	193	N/A
HC82201815	IHC/IP PER SPEC INITIAL AB STAIN THYROGLOBULIN	312	88342	593	N/A	193	N/A
HC82201963	IHC/IP PER SPEC INITIAL AB STAIN LEU MI (CD15)	312	88342	593	N/A	193	N/A
HC82202003	IHC/IP PER SPEC INITIAL AB STAIN PLAP	312	88342	593	N/A	193	N/A
HC82202037	IHC/IP PER SPEC INITIAL AB STAIN TERM DEOZY	312	88342	593	N/A	193	N/A
HC82202268	DECALCIFICATION DIST SVC	312	88311	158	N/A	49	N/A
HC82202292	TISSUE FROZ SECT AD'L DIST SVC	312	88332	276	N/A	151	N/A
HC82202334	M: MISC SURGICAL PATH PROC	310	88399	N/A	N/A	N/A	N/A
HC82202532	BONE MARROW DX; BX(S) ONLY	361	38221	4,954	N/A	1,651	N/A
HC82202565	TISSUE EXAM G&M LEVEL 3 *OP	312	88304	505	N/A	58	N/A
HC82202763	TISSUE EXAM G&M LVL 5(TC ONLY)	312	88307	1,128	N/A	169	N/A
HC82202797	ADDITIONAL UNSTAINED SLIDES	310	88399	108	N/A	3	N/A
HC82202862	PROSTATE NEEDLE BX ANY METHD	312	G0416	3,636	N/A	2,280	N/A
HC82203043	IHC/IP PER SPEC INITIAL AB STAIN CD10	312	88342	593	N/A	193	N/A
HC82203076	IHC/IP PER SPEC INITIAL AB STAIN CD31	312	88342	593	N/A	193	N/A
HC82203100	IHC/IP PER SPEC INITIAL AB STAIN CD138	312	88342	593	N/A	193	N/A
HC82203274	IHC/IP PER SPEC INITIAL AB STAIN P16	312	88342	593	N/A	193	N/A
HC82203308	IHC/IP PER SPEC INITIAL AB STAIN TH	312	88342	593	N/A	193	N/A
HC82203472	IHC/IP PER SPEC EA ADD AB STAIN+ KERATIN	312	88341	516	N/A	183	N/A
HC82203506	IP/IHC AB BC COCKTAIL PER SPEC; EA MULTIPLEX	312	88344	704	N/A	193	N/A
HC82203670	IHC/IP PER SPEC EA ADD AB STAIN+ INI-1	312	88341	516	N/A	183	N/A
HC82203704	IHC/IP PER SPEC EA ADD AB STAIN+ MUM-1	312	88341	516	N/A	183	N/A
HC82203738	IHC/IP PER SPEC EA ADD AB STAIN+ PGP 9.5	312	88341	516	N/A	183	N/A
HC82203878	IHC/IP PER SPEC EA ADD AB STAIN+ HERPES POLYV	312	88341	516	N/A	183	N/A
HC82203902	IHC/IP PER SPEC EA ADD AB STAIN+ KI-1	312	88341	516	N/A	183	N/A
HC82203936	IHC/IP PER SPEC EA ADD AB STAIN+ LAMBDA	312	88341	516	N/A	183	N/A
HC82204116	IHC/IP PER SPEC EA ADD AB STAIN+ CYCLIN D1	312	88341	516	N/A	183	N/A
HC82204140	IHC/IP PER SPEC EA ADD AB STAIN+ EWINGS SARCOMA	312	88341	516	N/A	183	N/A
HC82204322	IHC/IP PER SPEC EA ADD AB STAIN+ CD4	312	88341	516	N/A	183	N/A
HC82204355	IHC/IP PER SPEC EA ADD AB STAIN+ CD8	312	88341	516	N/A	183	N/A
HC82204389	IHC/IP PER SPEC EA ADD AB STAIN+ CD117	312	88341	516	N/A	183	N/A
HC82204520	BONE MARROW DX; BX(S) ONLY BILAT	361	38221	7,939	N/A	2,477	N/A
HC82204553	IHC/IP PER SPEC INITIAL AB STAIN PAX8	312	88342	593	N/A	193	N/A
HC82204587	IHC/IP PER SPEC EA ADD AB STAIN+ GATA-3	312	88341	516	N/A	183	N/A
HC82290016	P:BONE MARROW ASP/BX PROCEDURE			N/A	N/A	N/A	N/A
HC82290040	P:BONE MARROW ASP/BX LEFT			N/A	N/A	N/A	N/A
HC82290073	P: BONE MARROW ASPIRATION LEFT			N/A	N/A	N/A	N/A
HC83000158	BLOOD TYPE SEROLOGIC; RH(D)	300	86901	170	N/A	40	N/A
HC83000182	X-MATCH AHG TECH EA UNIT	302	86922	422	N/A	175	N/A
HC83000406	SERUM PRETREATMNT/ABSORPTION	302	86978	244	N/A	101	N/A
HC83000430	THERAPEUTIC PHLEBOTOMY	940	99195	1,181	N/A	132	N/A
HC83000489	PLATELETS LEUKO RED EA UNIT	390	P9031	450	N/A	250	N/A
HC83000620	PLASMA CRYO REDUCED EA UNIT-OS	390	P9044	411	N/A	105	N/A
HC83000737	THERAPEUTIC APHERESIS WBC'S	361	36511	7,885	N/A	1,600	N/A
HC83000760	THERAPEUTIC APHERESIS PLASMA	361	36514	10,060	N/A	1,600	N/A
HC83001024	CRYOPRECIP 5 UNITS POOLED -SB	390	P9012	639	N/A	428	N/A
HC83001057	CMV AB NEGATIVE BLOOD	302	86318	157	N/A	40	N/A
HC83001271	PLASMA CONVALESCENT (COVID-AB) -SB	390	P9060	719	N/A	N/A	N/A
HC83090019	P: PLASMA CRYO REDUCED UNIT & THAWING			N/A	N/A	N/A	N/A
HC83500157	PAP SMEAR PATH INTERP+ -PI	311	88141	30	N/A	30	N/A
HC83500207	CHROMO  TISSUE CULT-GZ	310	88237	N/A	N/A	N/A	N/A
HC83500249	CHROM ANAL BM TISSUE CULT-GZ	310	88237	N/A	N/A	N/A	N/A
HC83500389	CHROMO CT 15-20 W/BANDING-US	310	88262	180	N/A	180	N/A
HC83500413	15 CELLS  1 KARYO  BAND -GZ	310	88267	N/A	N/A	N/A	N/A
HC83500447	MOLECUL CYTO DNA PROBE FISH-HP	310	88271	N/A	N/A	N/A	N/A
HC83500629	CHROM ANAL ADDL HI RESOLUTION -GZ	310	88289	149	N/A	149	N/A
HC83500694	TISSUE EXAM G&M LEVEL 4-HP	312	88305	N/A	N/A	N/A	N/A
HC83500876	BRWN BRN GRM ST/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83500900	DIETERL MOD STN/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501072	SILVR METHNM ST/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83501106	STEINER STN/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83501130	WADES MOD FT ST/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83501270	ALCIAN BLUE W/DIGES/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501304	AMYLOID (CONGO RED)/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501338	AMYLOID (VIOLET)/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501502	F-M MELAN STN BLEACH/GRPII+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501536	GIEMSA STN MAST CEL/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501700	KOSSA CALCIUM STAIN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501734	LUXOL FAST BLUE STN GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501767	MASSON TRICHROM STN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501908	MYELIN STAIN GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501932	OIL RED O STAIN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501965	PAS STAIN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83502211	ANATOMIC CONSULT; SLIDE REV-IM	312	88321	N/A	N/A	N/A	N/A
HC83502252	ANATOMIC CONSULT; SLIDE REV-JH	312	88321	225	N/A	225	N/A
HC83502476	IHC/IP PER SPEC INITIAL AB STAIN AFP -IM	312	88342	N/A	N/A	N/A	N/A
HC83502500	IHC/IP PER SPEC INITIAL AB STAIN BRST2 -US	312	88342	N/A	N/A	N/A	N/A
HC83502674	IHC/IP PER SPEC INITIAL AB STAIN GASTRIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83502708	IHC/IP PER SPEC INITIAL AB STAIN GF -US	312	88342	N/A	N/A	N/A	N/A
HC83502732	IHC/IP PER SPEC INITIAL AB STAIN HCG -IM	312	88342	N/A	N/A	N/A	N/A
HC83502898	IHC/IP PER SPEC INITIAL AB STAIN L26 -IM	312	88342	N/A	N/A	N/A	N/A
HC83502922	IHC/IP PER SPEC INITIAL AB STAIN LAMBDA -US	312	88342	N/A	N/A	N/A	N/A
HC83502955	IHC/IP PER SPEC INITIAL AB STAIN LEU-22 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503144	IHC/IP PER SPEC INITIAL AB STAIN PSA -US	312	88342	N/A	N/A	N/A	N/A
HC83503177	IHC/IP PER SPEC INITIAL AB STAIN SMOOTH MUSC -IM	312	88342	N/A	N/A	N/A	N/A
HC83503367	IHC/IP PER SPEC INITIAL AB STAIN ANTI-CD3/HRP -US	312	88342	N/A	N/A	N/A	N/A
HC65000250_05155201069	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05167220022	NONCDM CHARGE RECORD PHARMACY	250		43	N/A	N/A	N/A
HC65000250_05167220356	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_05167221028	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05175460014	NONCDM CHARGE RECORD PHARMACY	250	Z7610	21	N/A	N/A	N/A
HC65000250_05180101230	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05186207901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05238001262	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05253618303	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65000250_05332909014	NONCDM CHARGE RECORD PHARMACY	250		117	N/A	N/A	N/A
HC65000250_05332998004	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05374657301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05374666901	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05409254701	NONCDM CHARGE RECORD PHARMACY	250		105	N/A	N/A	N/A
HC65000250_05483855550	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_05511117915	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511122990	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511172901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05515012499	NONCDM CHARGE RECORD PHARMACY	250	S0032	145	N/A	N/A	N/A
HC65000250_05723704001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05723705060	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05766450658	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05784113001	NONCDM CHARGE RECORD PHARMACY	250		72	N/A	N/A	N/A
HC65000250_05789610110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789645208	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789646208	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789675201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05865731016	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05865750916	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05901141020	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_05901144020	NONCDM CHARGE RECORD PHARMACY	250		99	N/A	N/A	N/A
HC65000250_05921224256	NONCDM CHARGE RECORD PHARMACY	250		95	N/A	N/A	N/A
HC65000250_05967657001	NONCDM CHARGE RECORD PHARMACY	250		77	N/A	N/A	N/A
HC65000250_05974611506	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05974636290	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05976205401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05976210051	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05976212071	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05976250072	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05976250141	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06043246400	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06043253760	NONCDM CHARGE RECORD PHARMACY	250		76	N/A	N/A	N/A
HC65000250_06043260816	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06050513201	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06050525798	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050525809	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050562021	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_06050570802	NONCDM CHARGE RECORD PHARMACY	250		106	N/A	N/A	N/A
HC65000250_06068717357	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068718457	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068726621	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_06068728265	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10	N/A	N/A	N/A
HC65000250_06068729925	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_06068735601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068736901	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068737501	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_06068742401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068743001	NONCDM CHARGE RECORD PHARMACY	250		38	N/A	N/A	N/A
HC65000250_06068747501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068748701	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068749221	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_06068752801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068753701	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068754921	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068757901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068758201	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068759101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068764211	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068765701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06131401910	NONCDM CHARGE RECORD PHARMACY	250		162	N/A	N/A	N/A
HC65000250_06131420315	NONCDM CHARGE RECORD PHARMACY	250		513	N/A	N/A	N/A
HC65000250_06131422605	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_06157007301	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_06174801201	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_06174801830	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06217511837	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06217526137	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06233234230	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_06254140410	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_06258426601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06258473301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06258498401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06275679788	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_06299115862	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_06330424159	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65000250_06332346817	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_06332369030	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06371301973	NONCDM CHARGE RECORD PHARMACY	250		159	N/A	N/A	N/A
HC65000250_06373900333	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_06373921310	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373925110	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373929410	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_06373947802	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373948010	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373952510	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_06373967710	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06373977710	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_06382400850	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06382471016	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06382473216	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06476411901	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65000250_06476454411	NONCDM CHARGE RECORD PHARMACY	250		90	N/A	N/A	N/A
HC65000250_06476475030	NONCDM CHARGE RECORD PHARMACY	250		95	N/A	N/A	N/A
HC65000250_06516206205	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_06516218910	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516257310	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06516263609	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516299708	NONCDM CHARGE RECORD PHARMACY	250		59	N/A	N/A	N/A
HC65000250_06562806301	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_06562820810	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_06586206201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586206401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586207360	NONCDM CHARGE RECORD PHARMACY	250	Z7610	16	N/A	N/A	N/A
HC65000250_06586220299	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586221960	NONCDM CHARGE RECORD PHARMACY	250		91	N/A	N/A	N/A
HC65000250_06586251290	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586253650	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06586268730	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_06586275250	NONCDM CHARGE RECORD PHARMACY	250		43	N/A	N/A	N/A
HC65000250_06586278201	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06668510022	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06668900550	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_06668902050	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_06668971116	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06682504720	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06787712405	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65000250_06787714601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787719890	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06787750330	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06787754588	NONCDM CHARGE RECORD PHARMACY	250	Z7610	16	N/A	N/A	N/A
HC65000250_06787757301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808407521	NONCDM CHARGE RECORD PHARMACY	250		179	N/A	N/A	N/A
HC65000250_06808409401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808409901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808421401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808422901	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808430021	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06808431801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808432701	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808440001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808444601	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_06808445921	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_06808460501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808461801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808472921	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_06808474001	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808485101	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06808485901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808487501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06809404361	NONCDM CHARGE RECORD PHARMACY	250		59	N/A	N/A	N/A
HC65000250_06809410961	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06809423162	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06818028001	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06818044001	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_06818072304	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_06818096501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818096609	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06838202201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838205001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838209401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838225605	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06838244614	NONCDM CHARGE RECORD PHARMACY	250	Z7610	225	N/A	N/A	N/A
HC65000250_06838252001	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_06846212801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846213801	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06846226190	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_06846229201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06846230450	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06846247101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06846263945	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06846279917	NONCDM CHARGE RECORD PHARMACY	250		82	N/A	N/A	N/A
HC65000250_06909745805	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06909784053	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06923815323	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_06923815345	NONCDM CHARGE RECORD PHARMACY	250		88	N/A	N/A	N/A
HC65000250_06933913819	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06936720301	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06945211420	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10	N/A	N/A	N/A
HC65000250_06958461150	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06961801501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06961806602	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07001075401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07006901225	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_07067700541	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_07067701381	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07095404110	NONCDM CHARGE RECORD PHARMACY	250		82	N/A	N/A	N/A
HC65000250_07095415110	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_07095444420	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_07193003512	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07214003868	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_07220501190	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07288803960	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07356211201	NONCDM CHARGE RECORD PHARMACY	250		49	N/A	N/A	N/A
HC65000250_07583422101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07620420001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07620490001	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_07643935310	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07733351610	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07733381210	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07985407941	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_08019656775	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_08068105700	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08137003640	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4	N/A	N/A	N/A
HC65000250_08290236712	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_70092113544	NONCDM CHARGE RECORD PHARMACY	250		77	N/A	N/A	N/A
HC65000256	MEDICATION-EXPERIMENTAL/RESEARCH	256		N/A	N/A	N/A	N/A
HC65000259_07777700054	NONCDM CHARGE RECORD PHARMACY	259	J0248	0	N/A	N/A	N/A
HC65000636_00002762301	NONCDM CHARGE RECORD PHARMACY	636	J9305	510	N/A	N/A	N/A
HC65000636_00002821517	NONCDM CHARGE RECORD PHARMACY	636		804	N/A	N/A	N/A
HC65000636_00003037113	NONCDM CHARGE RECORD PHARMACY	636	J0485	25	N/A	N/A	N/A
HC65000636_00006468100	NONCDM CHARGE RECORD PHARMACY	636	90707	554	N/A	N/A	N/A
HC65000636_00006498100	NONCDM CHARGE RECORD PHARMACY	636	90744	162	N/A	N/A	N/A
HC65000636_00009008601	NONCDM CHARGE RECORD PHARMACY	636	J1071	1	N/A	N/A	N/A
HC65000636_00009041702	NONCDM CHARGE RECORD PHARMACY	636	J1071	0	N/A	N/A	N/A
HC65000636_00009752903	NONCDM CHARGE RECORD PHARMACY	636	J9206	52	N/A	N/A	N/A
HC65000636_00019086207	NONCDM CHARGE RECORD PHARMACY	636	Q9958	1	N/A	N/A	N/A
HC65000636_00023608210	NONCDM CHARGE RECORD PHARMACY	636	J1750	102	N/A	N/A	N/A
HC65000636_00049052083	NONCDM CHARGE RECORD PHARMACY	636	J2540	9	N/A	N/A	N/A
HC65000636_00049319001	NONCDM CHARGE RECORD PHARMACY	636	J3465	22	N/A	N/A	N/A
HC65000636_00052031510	NONCDM CHARGE RECORD PHARMACY	636	J0725	0	N/A	N/A	N/A
HC65000636_00054418325	NONCDM CHARGE RECORD PHARMACY	636	J8540	1	N/A	N/A	N/A
HC65000636_00054474125	NONCDM CHARGE RECORD PHARMACY	636	Z7610	1	N/A	N/A	N/A
HC65000636_00069023801	NONCDM CHARGE RECORD PHARMACY	636	Q5119	466	N/A	N/A	N/A
HC65000636_00069029310	NONCDM CHARGE RECORD PHARMACY	636	Q5110	5	N/A	N/A	N/A
HC65000636_00069031501	NONCDM CHARGE RECORD PHARMACY	636	Q5118	398	N/A	N/A	N/A
HC65000636_00069307030	NONCDM CHARGE RECORD PHARMACY	636	Z7610	19	N/A	N/A	N/A
HC65000636_00069547402	NONCDM CHARGE RECORD PHARMACY	636	J3490	66	N/A	N/A	N/A
HC65000636_00074012402	NONCDM CHARGE RECORD PHARMACY	636	J0135	0	N/A	N/A	N/A
HC65000636_00074969403	NONCDM CHARGE RECORD PHARMACY	636	J1950	738	N/A	N/A	N/A
HC65000636_00078024015	NONCDM CHARGE RECORD PHARMACY	636	J7515	26	N/A	N/A	N/A
HC65000636_00078038566	NONCDM CHARGE RECORD PHARMACY	636	J7518	33	N/A	N/A	N/A
HC65000636_00143908601	NONCDM CHARGE RECORD PHARMACY	636	J9000	43	N/A	N/A	N/A
HC65000636_00143924510	NONCDM CHARGE RECORD PHARMACY	636	J9130	26	N/A	N/A	N/A
HC65000636_00143939110	NONCDM CHARGE RECORD PHARMACY	636	J3490	598	N/A	N/A	N/A
HC65000636_00143951001	NONCDM CHARGE RECORD PHARMACY	636	J9181	6	N/A	N/A	N/A
HC65000636_00143953001	NONCDM CHARGE RECORD PHARMACY	636	J9208	192	N/A	N/A	N/A
HC65000636_00143959310	NONCDM CHARGE RECORD PHARMACY	636	J3490	167	N/A	N/A	N/A
HC65000636_00143962125	NONCDM CHARGE RECORD PHARMACY	636	J3420	45	N/A	N/A	N/A
HC65000636_00143963310	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,241	N/A	N/A	N/A
HC65000636_00143985725	NONCDM CHARGE RECORD PHARMACY	636	J0696	4	N/A	N/A	N/A
HC65000636_00143987210	NONCDM CHARGE RECORD PHARMACY	636	J1800	52	N/A	N/A	N/A
HC65000636_00264310511	NONCDM CHARGE RECORD PHARMACY	636	J0690	21	N/A	N/A	N/A
HC65000636_00264410090	NONCDM CHARGE RECORD PHARMACY	636	J0131	1	N/A	N/A	N/A
HC65000636_00270141215	NONCDM CHARGE RECORD PHARMACY	636	Q9967	37	N/A	N/A	N/A
HC65000636_00310173030	NONCDM CHARGE RECORD PHARMACY	636	J0517	970	N/A	N/A	N/A
HC65000636_00310450012	NONCDM CHARGE RECORD PHARMACY	636	J9173	488	N/A	N/A	N/A
HC65000636_00338070948	NONCDM CHARGE RECORD PHARMACY	636	J3480	6	N/A	N/A	N/A
HC65000636_00338100902	NONCDM CHARGE RECORD PHARMACY	636	J1265	6	N/A	N/A	N/A
HC65000636_00338130501	NONCDM CHARGE RECORD PHARMACY	636	J9209	32	N/A	N/A	N/A
HC65000636_00407141361	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407141366	NONCDM CHARGE RECORD PHARMACY	636	Q9967	5	N/A	N/A	N/A
HC65000636_00407222316	NONCDM CHARGE RECORD PHARMACY	636	Q9967	9	N/A	N/A	N/A
HC65000636_00407222321	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00409018301	NONCDM CHARGE RECORD PHARMACY	636	J9201	57	N/A	N/A	N/A
HC65000636_00409113502	NONCDM CHARGE RECORD PHARMACY	636	J2270	2	N/A	N/A	N/A
HC65000636_00409117930	NONCDM CHARGE RECORD PHARMACY	636	J2175	41	N/A	N/A	N/A
HC65000636_00409121501	NONCDM CHARGE RECORD PHARMACY	636	J2310	114	N/A	N/A	N/A
HC65000636_00409141204	NONCDM CHARGE RECORD PHARMACY	636	J3490	46	N/A	N/A	N/A
HC65000636_00409163010	NONCDM CHARGE RECORD PHARMACY	636	J0461	0	N/A	N/A	N/A
HC65000636_00409166035	NONCDM CHARGE RECORD PHARMACY	636	J3490	530	N/A	N/A	N/A
HC65000636_00409230850	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_00409234402	NONCDM CHARGE RECORD PHARMACY	636	J1250	36	N/A	N/A	N/A
HC65000636_00409341401	NONCDM CHARGE RECORD PHARMACY	636	J2765	6	N/A	N/A	N/A
HC65000636_00409379501	NONCDM CHARGE RECORD PHARMACY	636	J1885	17	N/A	N/A	N/A
HC65000636_00409403101	NONCDM CHARGE RECORD PHARMACY	636	J2150	14	N/A	N/A	N/A
HC65000636_00409469924	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_00409471302	NONCDM CHARGE RECORD PHARMACY	636	J2001	2	N/A	N/A	N/A
HC65000636_00409475503	NONCDM CHARGE RECORD PHARMACY	636	J2405	2	N/A	N/A	N/A
HC65000636_00409610210	NONCDM CHARGE RECORD PHARMACY	636	J1940	8	N/A	N/A	N/A
HC65000636_00409610227	NONCDM CHARGE RECORD PHARMACY	636	J1940	6	N/A	N/A	N/A
HC65000636_00409672924	NONCDM CHARGE RECORD PHARMACY	636	J3475	24	N/A	N/A	N/A
HC65000636_00409724101	NONCDM CHARGE RECORD PHARMACY	636	J0171	5	N/A	N/A	N/A
HC65000636_00409909311	NONCDM CHARGE RECORD PHARMACY	636	J3010	2	N/A	N/A	N/A
HC65000636_00409909338	NONCDM CHARGE RECORD PHARMACY	636	J3010	4	N/A	N/A	N/A
HC65000636_00409909431	NONCDM CHARGE RECORD PHARMACY	636	J3010	4	N/A	N/A	N/A
HC65000636_00469325010	NONCDM CHARGE RECORD PHARMACY	636	J2248	12	N/A	N/A	N/A
HC65000636_00517037405	NONCDM CHARGE RECORD PHARMACY	636	Q9968	33	N/A	N/A	N/A
HC65000636_00517071001	NONCDM CHARGE RECORD PHARMACY	636	J1451	113	N/A	N/A	N/A
HC65000636_00517560125	NONCDM CHARGE RECORD PHARMACY	636	J3410	74	N/A	N/A	N/A
HC65000636_00548540000	NONCDM CHARGE RECORD PHARMACY	636	J1050	0	N/A	N/A	N/A
HC65000636_00597005345	NONCDM CHARGE RECORD PHARMACY	636	J1610	1,115	N/A	N/A	N/A
HC65000636_00603533521	NONCDM CHARGE RECORD PHARMACY	636	J7512	1	N/A	N/A	N/A
HC65000636_00641601310	NONCDM CHARGE RECORD PHARMACY	636	J3490	21	N/A	N/A	N/A
HC65000636_00641601910	NONCDM CHARGE RECORD PHARMACY	636	J2274	50	N/A	N/A	N/A
HC65000636_00641602825	NONCDM CHARGE RECORD PHARMACY	636	J3010	7	N/A	N/A	N/A
HC65000636_00641606125	NONCDM CHARGE RECORD PHARMACY	636	J2250	2	N/A	N/A	N/A
HC65000636_00641608025	NONCDM CHARGE RECORD PHARMACY	636	J2405	1	N/A	N/A	N/A
HC65000636_00641612525	NONCDM CHARGE RECORD PHARMACY	636	J2270	16	N/A	N/A	N/A
HC65000636_00641619010	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_00641622825	NONCDM CHARGE RECORD PHARMACY	636	J3411	40	N/A	N/A	N/A
HC65000636_00703334301	NONCDM CHARGE RECORD PHARMACY	636	J2354	8	N/A	N/A	N/A
HC65000636_00703367801	NONCDM CHARGE RECORD PHARMACY	636	J9260	11	N/A	N/A	N/A
HC65000636_00703424401	NONCDM CHARGE RECORD PHARMACY	636	J9045	45	N/A	N/A	N/A
HC65000636_00703574811	NONCDM CHARGE RECORD PHARMACY	636	J9060	25	N/A	N/A	N/A
HC65000636_00703853023	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_00703868023	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_00781315972	NONCDM CHARGE RECORD PHARMACY	636	J2358	14	N/A	N/A	N/A
HC65000636_00781320895	NONCDM CHARGE RECORD PHARMACY	636	J0696	5	N/A	N/A	N/A
HC65000636_00781323863	NONCDM CHARGE RECORD PHARMACY	636	J1650	14	N/A	N/A	N/A
HC65000636_00781340795	NONCDM CHARGE RECORD PHARMACY	636	J0290	18	N/A	N/A	N/A
HC65000636_00781342292	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_00781940295	NONCDM CHARGE RECORD PHARMACY	636	J0290	19	N/A	N/A	N/A
HC65000636_00781940895	NONCDM CHARGE RECORD PHARMACY	636	J0290	22	N/A	N/A	N/A
HC65000636_00904691461	NONCDM CHARGE RECORD PHARMACY	636	J7509	12	N/A	N/A	N/A
HC65000636_00944305102	NONCDM CHARGE RECORD PHARMACY	636	J7192	0	N/A	N/A	N/A
HC65000636_00955100310	NONCDM CHARGE RECORD PHARMACY	636	J1650	14	N/A	N/A	N/A
HC65000636_00955102104	NONCDM CHARGE RECORD PHARMACY	636	J9171	35	N/A	N/A	N/A
HC65000636_01001995501	NONCDM CHARGE RECORD PHARMACY	636	J9070	476	N/A	N/A	N/A
HC65000636_01001999101	NONCDM CHARGE RECORD PHARMACY	636	J9041	111	N/A	N/A	N/A
HC65000636_01353380024	NONCDM CHARGE RECORD PHARMACY	636	J1561	426	N/A	N/A	N/A
HC65000636_01478901505	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,941	N/A	N/A	N/A
HC65000636_01671406610	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_01671430910	NONCDM CHARGE RECORD PHARMACY	636	J3370	1	N/A	N/A	N/A
HC65000636_01671446801	NONCDM CHARGE RECORD PHARMACY	636	J8521	100	N/A	N/A	N/A
HC65000636_01672911505	NONCDM CHARGE RECORD PHARMACY	636	J9280	1,581	N/A	N/A	N/A
HC65000636_01672922405	NONCDM CHARGE RECORD PHARMACY	636	J0894	32	N/A	N/A	N/A
HC65000636_01672924838	NONCDM CHARGE RECORD PHARMACY	636	J9280	1,027	N/A	N/A	N/A
HC65000636_01672946408	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_01672950243	NONCDM CHARGE RECORD PHARMACY	636	J1940	4	N/A	N/A	N/A
HC65000636_01747841510	NONCDM CHARGE RECORD PHARMACY	636	J3490	307	N/A	N/A	N/A
HC65000636_01747851002	NONCDM CHARGE RECORD PHARMACY	636	J3490	509	N/A	N/A	N/A
HC65000636_01747870102	NONCDM CHARGE RECORD PHARMACY	636	J3490	741	N/A	N/A	N/A
HC65000636_02315524041	NONCDM CHARGE RECORD PHARMACY	636	J2765	12	N/A	N/A	N/A
HC65000636_02315529442	NONCDM CHARGE RECORD PHARMACY	636	J0780	57	N/A	N/A	N/A
HC65000636_02315547342	NONCDM CHARGE RECORD PHARMACY	636	J1940	9	N/A	N/A	N/A
HC65000636_02502110299	NONCDM CHARGE RECORD PHARMACY	636	J0690	4	N/A	N/A	N/A
HC65000636_02502110910	NONCDM CHARGE RECORD PHARMACY	636	J0694	32	N/A	N/A	N/A
HC65000636_02502111504	NONCDM CHARGE RECORD PHARMACY	636	J3490	13	N/A	N/A	N/A
HC65000636_02502116648	NONCDM CHARGE RECORD PHARMACY	636	J2543	24	N/A	N/A	N/A
HC65000636_02502117915	NONCDM CHARGE RECORD PHARMACY	636	J0878	1	N/A	N/A	N/A
HC65000636_02502130884	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,099	N/A	N/A	N/A
HC65000636_02502131102	NONCDM CHARGE RECORD PHARMACY	636	J1940	14	N/A	N/A	N/A
HC65000636_02502131501	NONCDM CHARGE RECORD PHARMACY	636	J2370	1	N/A	N/A	N/A
HC65000636_02502145301	NONCDM CHARGE RECORD PHARMACY	636	J2354	11	N/A	N/A	N/A
HC65000636_02502160103	NONCDM CHARGE RECORD PHARMACY	636	J0706	17	N/A	N/A	N/A
HC65000636_02502161110	NONCDM CHARGE RECORD PHARMACY	636	J2710	3	N/A	N/A	N/A
HC65000636_02502181630	NONCDM CHARGE RECORD PHARMACY	636	J0640	62	N/A	N/A	N/A
HC65000636_02502182850	NONCDM CHARGE RECORD PHARMACY	636	J0640	65	N/A	N/A	N/A
HC65000636_03877903885	NONCDM CHARGE RECORD PHARMACY	636	J0475	79	N/A	N/A	N/A
HC65000636_03982204121	NONCDM CHARGE RECORD PHARMACY	636	J3260	35	N/A	N/A	N/A
HC65000636_04202320101	NONCDM CHARGE RECORD PHARMACY	636	J3490	725	N/A	N/A	N/A
HC65000636_04202323010	NONCDM CHARGE RECORD PHARMACY	636	J2248	10	N/A	N/A	N/A
HC65000636_04249441525	NONCDM CHARGE RECORD PHARMACY	636	J2560	170	N/A	N/A	N/A
HC65000636_04306655712	NONCDM CHARGE RECORD PHARMACY	636	J3490	520	N/A	N/A	N/A
HC65000636_04359828335	NONCDM CHARGE RECORD PHARMACY	636	Q2050	2,519	N/A	N/A	N/A
HC65000636_04359840516	NONCDM CHARGE RECORD PHARMACY	636	J3430	28	N/A	N/A	N/A
HC65000636_04420625105	NONCDM CHARGE RECORD PHARMACY	636	P9047	577	N/A	N/A	N/A
HC65000636_04420631050	NONCDM CHARGE RECORD PHARMACY	636	P9045	583	N/A	N/A	N/A
HC65000636_04456741024	NONCDM CHARGE RECORD PHARMACY	636	J3475	11	N/A	N/A	N/A
HC65000636_04456743524	NONCDM CHARGE RECORD PHARMACY	636	J1956	47	N/A	N/A	N/A
HC65000636_04456761110	NONCDM CHARGE RECORD PHARMACY	636	J2250	2	N/A	N/A	N/A
HC65000636_04733515440	NONCDM CHARGE RECORD PHARMACY	636	J9201	182	N/A	N/A	N/A
HC65000636_04733589072	NONCDM CHARGE RECORD PHARMACY	636	J8700	25	N/A	N/A	N/A
HC65000636_04778158629	NONCDM CHARGE RECORD PHARMACY	636	J3490	8	N/A	N/A	N/A
HC65000636_05024204062	NONCDM CHARGE RECORD PHARMACY	636	J2357	62	N/A	N/A	N/A
HC65000636_05024205121	NONCDM CHARGE RECORD PHARMACY	636	J9312	579	N/A	N/A	N/A
HC65000636_05024206101	NONCDM CHARGE RECORD PHARMACY	636	J9035	518	N/A	N/A	N/A
HC65000636_05024291701	NONCDM CHARGE RECORD PHARMACY	636	J9022	504	N/A	N/A	N/A
HC65000636_05038392493	NONCDM CHARGE RECORD PHARMACY	636	J0571	3	N/A	N/A	N/A
HC65000636_05114400301	NONCDM CHARGE RECORD PHARMACY	636	J9273	961	N/A	N/A	N/A
HC65000636_05122401210	NONCDM CHARGE RECORD PHARMACY	636	J2760	2,729	N/A	N/A	N/A
HC65000636_05175405021	NONCDM CHARGE RECORD PHARMACY	636	J0706	20	N/A	N/A	N/A
HC65000636_05428811105	NONCDM CHARGE RECORD PHARMACY	636	J1980	214	N/A	N/A	N/A
HC65000636_05448214701	NONCDM CHARGE RECORD PHARMACY	636	J1955	139	N/A	N/A	N/A
HC65000636_05511152501	NONCDM CHARGE RECORD PHARMACY	636	J7507	2	N/A	N/A	N/A
HC65000636_05515012150	NONCDM CHARGE RECORD PHARMACY	636	J2543	21	N/A	N/A	N/A
HC65000636_05515015520	NONCDM CHARGE RECORD PHARMACY	636	J0133	1	N/A	N/A	N/A
HC65000636_05515020120	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_05515021899	NONCDM CHARGE RECORD PHARMACY	636	J1327	206	N/A	N/A	N/A
HC65000636_05515030724	NONCDM CHARGE RECORD PHARMACY	636	J0131	1	N/A	N/A	N/A
HC65000636_05515032425	NONCDM CHARGE RECORD PHARMACY	636	J1940	4	N/A	N/A	N/A
HC65000636_05515038201	NONCDM CHARGE RECORD PHARMACY	636	J9305	84	N/A	N/A	N/A
HC65000636_05551322101	NONCDM CHARGE RECORD PHARMACY	636	J2796	563	N/A	N/A	N/A
HC65000636_05551347810	NONCDM CHARGE RECORD PHARMACY	636	J0885	108	N/A	N/A	N/A
HC65000636_05551371001	NONCDM CHARGE RECORD PHARMACY	636	J0897	153	N/A	N/A	N/A
HC65000636_05816081152	NONCDM CHARGE RECORD PHARMACY	636	90723	561	N/A	N/A	N/A
HC65000636_05816082552	NONCDM CHARGE RECORD PHARMACY	636	90632	228	N/A	N/A	N/A
HC65000636_05926710003	NONCDM CHARGE RECORD PHARMACY	636	91300	0	N/A	N/A	N/A
HC65000636_05963026610	NONCDM CHARGE RECORD PHARMACY	636	J0699	12	N/A	N/A	N/A
HC65000636_06050561425	NONCDM CHARGE RECORD PHARMACY	636	J0690	2	N/A	N/A	N/A
HC65000636_06050561454	NONCDM CHARGE RECORD PHARMACY	636	J0692	16	N/A	N/A	N/A
HC65000636_06050561474	NONCDM CHARGE RECORD PHARMACY	636	J0692	30	N/A	N/A	N/A
HC65000636_06079360010	NONCDM CHARGE RECORD PHARMACY	636	J0558	82	N/A	N/A	N/A
HC65000636_06079370210	NONCDM CHARGE RECORD PHARMACY	636	J0561	71	N/A	N/A	N/A
HC65000636_06131432601	NONCDM CHARGE RECORD PHARMACY	636	Q5101	6	N/A	N/A	N/A
HC65000636_06170333956	NONCDM CHARGE RECORD PHARMACY	636	J9045	31	N/A	N/A	N/A
HC65000636_06170334250	NONCDM CHARGE RECORD PHARMACY	636	J9267	1	N/A	N/A	N/A
HC65000636_06199006112	NONCDM CHARGE RECORD PHARMACY	636	J3490	55	N/A	N/A	N/A
HC65000636_06275601740	NONCDM CHARGE RECORD PHARMACY	636	J1071	0	N/A	N/A	N/A
HC65000636_06275652940	NONCDM CHARGE RECORD PHARMACY	636	J2597	107	N/A	N/A	N/A
HC65000636_06332304710	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_06332306410	NONCDM CHARGE RECORD PHARMACY	636	J3475	1	N/A	N/A	N/A
HC65000636_06332310351	NONCDM CHARGE RECORD PHARMACY	636	J9060	22	N/A	N/A	N/A
HC65000636_06332313212	NONCDM CHARGE RECORD PHARMACY	636	J9293	322	N/A	N/A	N/A
HC65000636_06332314010	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,016	N/A	N/A	N/A
HC65000636_06332316201	NONCDM CHARGE RECORD PHARMACY	636	J1885	15	N/A	N/A	N/A
HC65000636_06332322935	NONCDM CHARGE RECORD PHARMACY	636	J2720	8	N/A	N/A	N/A
HC65000636_06332323861	NONCDM CHARGE RECORD PHARMACY	636	J0690	11	N/A	N/A	N/A
HC65000636_06332328420	NONCDM CHARGE RECORD PHARMACY	636	J3370	52	N/A	N/A	N/A
HC65000636_06332328565	NONCDM CHARGE RECORD PHARMACY	636	J2795	2	N/A	N/A	N/A
HC65000636_06332328631	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_06332332293	NONCDM CHARGE RECORD PHARMACY	636	J0743	41	N/A	N/A	N/A
HC65000636_06332332620	NONCDM CHARGE RECORD PHARMACY	636	J0692	21	N/A	N/A	N/A
HC65000636_06332335120	NONCDM CHARGE RECORD PHARMACY	636	J3490	994	N/A	N/A	N/A
HC65000636_06332340302	NONCDM CHARGE RECORD PHARMACY	636	J3490	22	N/A	N/A	N/A
HC65000636_06332341112	NONCDM CHARGE RECORD PHARMACY	636	J2250	2	N/A	N/A	N/A
HC65000636_06332348557	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_06332348657	NONCDM CHARGE RECORD PHARMACY	636	J2001	0	N/A	N/A	N/A
HC65000636_06332353198	NONCDM CHARGE RECORD PHARMACY	636	J1650	7	N/A	N/A	N/A
HC65000636_06332353587	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332353903	NONCDM CHARGE RECORD PHARMACY	636	J1650	15	N/A	N/A	N/A
HC65000636_06332358499	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332359403	NONCDM CHARGE RECORD PHARMACY	636	J1610	1,053	N/A	N/A	N/A
HC65000636_06332359710	NONCDM CHARGE RECORD PHARMACY	636	J0895	84	N/A	N/A	N/A
HC65000636_06332364916	NONCDM CHARGE RECORD PHARMACY	636	J3490	722	N/A	N/A	N/A
HC65000636_06332365827	NONCDM CHARGE RECORD PHARMACY	636	J1205	316	N/A	N/A	N/A
HC65000636_06332376350	NONCDM CHARGE RECORD PHARMACY	636	J9267	3	N/A	N/A	N/A
HC65000636_06332380602	NONCDM CHARGE RECORD PHARMACY	636	J3010	8	N/A	N/A	N/A
HC65000636_06332380650	NONCDM CHARGE RECORD PHARMACY	636	J3010	6	N/A	N/A	N/A
HC65000636_06345910450	NONCDM CHARGE RECORD PHARMACY	636	Q5115	475	N/A	N/A	N/A
HC65000636_06345939120	NONCDM CHARGE RECORD PHARMACY	636	J9033	193	N/A	N/A	N/A
HC65000636_06373992025	NONCDM CHARGE RECORD PHARMACY	636	J1644	16	N/A	N/A	N/A
HC65000636_06438072606	NONCDM CHARGE RECORD PHARMACY	636	J7517	3	N/A	N/A	N/A
HC65000636_06467975902	NONCDM CHARGE RECORD PHARMACY	636	J1940	9	N/A	N/A	N/A
HC65000636_06521901810	NONCDM CHARGE RECORD PHARMACY	636	J0290	1	N/A	N/A	N/A
HC65000636_06628811001	NONCDM CHARGE RECORD PHARMACY	636	J0690	4	N/A	N/A	N/A
HC65000636_06668930708	NONCDM CHARGE RECORD PHARMACY	636	J7517	82	N/A	N/A	N/A
HC65000636_06745716302	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,016	N/A	N/A	N/A
HC65000636_06745719805	NONCDM CHARGE RECORD PHARMACY	636	J3490	837	N/A	N/A	N/A
HC65000636_06745722005	NONCDM CHARGE RECORD PHARMACY	636	Q9968	138	N/A	N/A	N/A
HC65000636_06745737499	NONCDM CHARGE RECORD PHARMACY	636	J1644	4	N/A	N/A	N/A
HC65000636_06745739054	NONCDM CHARGE RECORD PHARMACY	636	J3489	71	N/A	N/A	N/A
HC65000636_06745742254	NONCDM CHARGE RECORD PHARMACY	636	J1100	1	N/A	N/A	N/A
HC65000636_06745756320	NONCDM CHARGE RECORD PHARMACY	636	J0475	1,206	N/A	N/A	N/A
HC65000636_06745762910	NONCDM CHARGE RECORD PHARMACY	636	J1327	52	N/A	N/A	N/A
HC65000636_06768419012	NONCDM CHARGE RECORD PHARMACY	636	J3490	7,956	N/A	N/A	N/A
HC65000636_06787147906	NONCDM CHARGE RECORD PHARMACY	636	J1430	2,862	N/A	N/A	N/A
HC65000636_06838291010	NONCDM CHARGE RECORD PHARMACY	636	J3490	156	N/A	N/A	N/A
HC65000636_06851652140	NONCDM CHARGE RECORD PHARMACY	636	P9045	301	N/A	N/A	N/A
HC65000636_06851652145	NONCDM CHARGE RECORD PHARMACY	636	P9045	329	N/A	N/A	N/A
HC65000636_06923815943	NONCDM CHARGE RECORD PHARMACY	636	J7520	114	N/A	N/A	N/A
HC65000636_06933913634	NONCDM CHARGE RECORD PHARMACY	636	J3360	77	N/A	N/A	N/A
HC65000636_06937452005	NONCDM CHARGE RECORD PHARMACY	636	J2001	8	N/A	N/A	N/A
HC65000636_07010042402	NONCDM CHARGE RECORD PHARMACY	636	J3490	618	N/A	N/A	N/A
HC65000636_07012110492	NONCDM CHARGE RECORD PHARMACY	636	J3301	13	N/A	N/A	N/A
HC65000636_07043602182	NONCDM CHARGE RECORD PHARMACY	636	J3370	22	N/A	N/A	N/A
HC65000636_07043602780	NONCDM CHARGE RECORD PHARMACY	636	J1327	130	N/A	N/A	N/A
HC65000636_07084216010	NONCDM CHARGE RECORD PHARMACY	636	J2265	14	N/A	N/A	N/A
HC65000636_07086010520	NONCDM CHARGE RECORD PHARMACY	636	J3370	11	N/A	N/A	N/A
HC65000636_07086020017	NONCDM CHARGE RECORD PHARMACY	636	J9267	3	N/A	N/A	N/A
HC65000636_07086040610	NONCDM CHARGE RECORD PHARMACY	636	J3490	31	N/A	N/A	N/A
HC65000636_07086045410	NONCDM CHARGE RECORD PHARMACY	636	J2597	101	N/A	N/A	N/A
HC65000636_07086070002	NONCDM CHARGE RECORD PHARMACY	636	J1885	12	N/A	N/A	N/A
HC65000636_07128811530	NONCDM CHARGE RECORD PHARMACY	636	J9025	6	N/A	N/A	N/A
HC65000636_07128820305	NONCDM CHARGE RECORD PHARMACY	636	J1940	5	N/A	N/A	N/A
HC65000636_07183911725	NONCDM CHARGE RECORD PHARMACY	636	J1644	28	N/A	N/A	N/A
HC65000636_07207802610	NONCDM CHARGE RECORD PHARMACY	636	J1327	43	N/A	N/A	N/A
HC65000636_07220500792	NONCDM CHARGE RECORD PHARMACY	636	J8521	3	N/A	N/A	N/A
HC65000636_07248510701	NONCDM CHARGE RECORD PHARMACY	636	J3490	18	N/A	N/A	N/A
HC65000636_07257201710	NONCDM CHARGE RECORD PHARMACY	636	J0290	4	N/A	N/A	N/A
HC65000636_07257206225	NONCDM CHARGE RECORD PHARMACY	636	J0696	2	N/A	N/A	N/A
HC65000636_07257237225	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_07257241610	NONCDM CHARGE RECORD PHARMACY	636	J2185	7	N/A	N/A	N/A
HC65000636_07261171601	NONCDM CHARGE RECORD PHARMACY	636	J1190	2,124	N/A	N/A	N/A
HC65000636_07261174910	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_07604500906	NONCDM CHARGE RECORD PHARMACY	636	J1170	29	N/A	N/A	N/A
HC65000636_07604510910	NONCDM CHARGE RECORD PHARMACY	636	J1100	4	N/A	N/A	N/A
HC65000636_07607510301	NONCDM CHARGE RECORD PHARMACY	636	J9047	305	N/A	N/A	N/A
HC65000636_07647850150	NONCDM CHARGE RECORD PHARMACY	636	J2515	288	N/A	N/A	N/A
HC65000636_07867000367	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,213	N/A	N/A	N/A
HC65000636_08128441105	NONCDM CHARGE RECORD PHARMACY	636	J1110	507	N/A	N/A	N/A
HC65000637_00002771459	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00002821517	NONCDM CHARGE RECORD PHARMACY	636	J1815	5	N/A	N/A	N/A
HC65000637_00169183711	NONCDM CHARGE RECORD PHARMACY	636	J1815	4	N/A	N/A	N/A
HC65000637_00169266015	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65001250	MED - GENERAL W/O J-CODE	250		N/A	N/A	N/A	N/A
HC65001258_00264151032	NONCDM CHARGE RECORD PHARMACY	258	J7060	14	N/A	N/A	N/A
HC65001258_00264180036	NONCDM CHARGE RECORD PHARMACY	258	J7050	14	N/A	N/A	N/A
HC65001258_00338001702	NONCDM CHARGE RECORD PHARMACY	258	J7060	24	N/A	N/A	N/A
HC65001258_00338001718	NONCDM CHARGE RECORD PHARMACY	636	J7060	16	N/A	N/A	N/A
HC62226915	KIT ABALATION (MAZE)	272		61,249	N/A	N/A	N/A
HC62227087	TUBE TRACH CUFFED                 L	272	A7521	700	N/A	N/A	N/A
HC62227111	CONTROL DOSE C02 MANUAL PAT(AEROFORM)	272		1,100	N/A	N/A	N/A
HC62227145	KIT EXTRACT RESURFAC HIP	272		2,800	N/A	N/A	N/A
HC62227285	FIBER LASER                       H	272		1,150	N/A	N/A	N/A
HC62227319	ELECTRODE BIPOLAR ENDO            D	272		1,750	N/A	N/A	N/A
HC62227343	BAG/POUCH RETRIEVAL SPECMN ENDO   B	272		140	N/A	N/A	N/A
HC62227517	KIT COLON W-SEAL  HYDRA  ORCA VALVE	272		386	N/A	N/A	N/A
HC62227541	SHIELD COLLAGEN CORNEAL	272		736	N/A	N/A	N/A
HC62227723	TUBING HYSTEROSCOPY               H	272		560	N/A	N/A	N/A
HC62227756	COVER TIP ACCESSORY ROBOTIC	272		70	N/A	N/A	N/A
HC62227921	SHEATH ARTHROSCOPIC               H	272		700	N/A	N/A	N/A
HC62227954	SYSTEM DRESSING WOUND NEG PRES S	272		2,135	N/A	N/A	N/A
HC62227988	EMBOLIZATION PROTECTIVE SYSTEM (TCAR) X	272	C1884	12,075	N/A	N/A	N/A
HC62228127	ORTH EWHO RIGID W/O JOINTS CUSTOM	274	L3763	2,604	N/A	N/A	N/A
HC62228150	ORTH WHFO DYNAMIC FLEX HINGE CABLE DRIVEN CUSTOM	274	L3901	6,202	N/A	N/A	N/A
HC62228184	ORTH HFO FLEX GLOVE W/ELSTC FNGR CNTRL PREFAB OTS	274	L3912	403	N/A	N/A	N/A
HC62228358	SET SHEATH DILATOR (TRUSEAL WATCHMAN)	272	C1766	4,900	N/A	N/A	N/A
HC62228382	WIRE PIGTAIL PROTRACK (WATCHMAN)	272	C1769	683	N/A	N/A	N/A
HC62228556	ELECTRODE PACING/DEFIB TEMPORARY  L	272		700	N/A	N/A	N/A
HC62228580	STAPLER INTERNAL EEA	272		4,119	N/A	N/A	N/A
HC62228754	FORCEPS(ALWAYS-ON TIP TRACKED?)	272		1,985	N/A	N/A	N/A
HC62228788	KIT SPIN PERC?(ALWAYS-ON TIP TRACKED?)	272		2,504	N/A	N/A	N/A
HC62228812	SET NEURO MRI GUIDED ABLATE (INSIGHTEC?)	272		10,500	N/A	N/A	N/A
HC62228952	ORTHOTIC ANKLE RIGID PNEUM/GEL PRFB    B	274	L4350	67	N/A	N/A	N/A
HC62228986	STYLET PROBE NAVIGATION	272		1,982	N/A	N/A	N/A
HC62229018	INTRODUCER/SHEATH                  AF	272	C1894	5,250	N/A	N/A	N/A
HC62229182	ORTHOSIS LSO RIGID ANT/POST FRM/PNL PREFB CUST(DJ)	274	L0637	538	N/A	N/A	N/A
HC62290028	P:AMNIOINFUSION			N/A	N/A	N/A	N/A
HC62300009	RETRACTOR ATRIAL SHORT ROBOTIC	272		1,033	N/A	N/A	N/A
HC62300058	APPLIER CLIP ROBOTIC              B	272		60	N/A	N/A	N/A
HC62300082	DISSECTOR ROBOTIC                 I	272		420	N/A	N/A	N/A
HC62300223	CATH INTRACARDIAC ECHO/UTZ RPRSD  C	272	C1759	3,150	N/A	N/A	N/A
HC62300256	STAPLER ROBOTIC (ENDOWRIST)	272		497	N/A	N/A	N/A
HC62300280	FORCEP ROBOTIC                    J	272		560	N/A	N/A	N/A
HC62800032	BALLOON ERCP	272	C1726	910	N/A	N/A	N/A
HC62800065	CATH PTA ANGIOPLS BALLOON NON-LSR M	272	C1725	1,393	N/A	N/A	N/A
HC62800099	CATH PTCA BALLOON NON-LASER       Q	272	C1725	3,150	N/A	N/A	N/A
HC62800263	CATH CORONARY SINUS	272	C1887	3,724	N/A	N/A	N/A
HC62800297	CATH EP DIAG/ABLAT 3D/VECT        W	272	C1732	9,100	N/A	N/A	N/A
HC62800461	CATH SINGLE LUMEN	278		350	N/A	N/A	N/A
HC62800503	CATH THROMBECTOMY/EMBOLECTOMY     U	272	C1757	2,800	N/A	N/A	N/A
HC62800537	CATH TRIPLE LUMEN	278		350	N/A	N/A	N/A
HC62800677	M: ANKLE COMPONENT	278	L8699	11,960	N/A	N/A	N/A
HC62800701	M: BONE GRAFT/PUTTY/GEL	278		5,495	N/A	N/A	N/A
HC62800735	M:BONE PLUG	278		416	N/A	N/A	N/A
HC62800909	M: CEMENT BONE	278		787	N/A	N/A	N/A
HC62800933	M: CLIP ANEURYSM	278		1,586	N/A	N/A	N/A
HC62801105	M: GRAFT PATCH	278	C1768	1,911	N/A	N/A	N/A
HC62801139	M: LINER ACETABULAR HIP	278	C1776	2,453	N/A	N/A	N/A
HC62801303	M: KNEE PATELLA	278	L8699	1,420	N/A	N/A	N/A
HC62801337	M: LEAD CORONARY VENOUS	275	C1900	5,746	N/A	N/A	N/A
HC62801360	M: LEAD ICD NON-SNGL/DUAL	275	C1896	N/A	N/A	N/A	N/A
HC62801519	M: OCULAR	278	L8610	895	N/A	N/A	N/A
HC62801543	PARTICLES EMBOLIZ (EMBOSPHERE)    M	278		980	N/A	N/A	N/A
HC62801576	M: PCMKR OTHER THAN SNGL/DUAL	275	C2621	19,978	N/A	N/A	N/A
HC62801741	M: PUMP INFUSION NON PROGRAMBL	278	C2626	N/A	N/A	N/A	N/A
HC62801774	OIL SILICON TAMPONADE RETINAL	278	C1814	1,050	N/A	N/A	N/A
HC62801949	M: JOINT SILASTIC	278	C1763	N/A	N/A	N/A	N/A
HC62801972	M: NUT SPINAL	278		350	N/A	N/A	N/A
HC62802004	M: SPACER/STABILIZER SPINAL	278	C1776	9,815	N/A	N/A	N/A
HC62802145	M: STENT NON CORON W/DELIV SYS	278	C2625	1,314	N/A	N/A	N/A
HC62802178	STENT PANCREATIC                  M	278	C2617	342	N/A	N/A	N/A
HC62802202	M: STENT URINARY DIVERSN W/DEL SYS	278	C2625	3,433	N/A	N/A	N/A
HC62802343	M: WIRE TITANIUM/STAIN STEEL	278	C1713	217	N/A	N/A	N/A
HC62802376	INTRO/SHEATH EP FIXED PEEL       AK	272	C1892	1,505	N/A	N/A	N/A
HC62802400	INTRODUCER/SHEATH                 F	272	C1894	280	N/A	N/A	N/A
HC62802582	WIRE INTERVENTIONAL	272	C1769	386	N/A	N/A	N/A
HC62802616	WIRE TEFLON BENTSON	272	C1769	92	N/A	N/A	N/A
HC62802798	SYSTEM SEAL HEART STRING	278	C1889	1,638	N/A	N/A	N/A
HC62802822	PROGRAMMER IDD TX (CONTROL)	271		2,783	N/A	N/A	N/A
HC62802855	STENT COLONIC/DUOD NOCOV&DEL	278	C1876	8,700	N/A	N/A	N/A
HC62802996	RECORDER CARDC EVNT(BIOTRONIK BIOMNTR 2AF)	278	C1764	17,150	N/A	N/A	N/A
HC62803028	M: STENT INLAY LUBRICIOUS	278	C2625	N/A	N/A	N/A	N/A
HC62803051	M: HOOK IMPLANT SPINAL	278	C1889	1,536	N/A	N/A	N/A
HC62803226	M: BUTTON CONT LP ANCHOR SOFT TISS-B	278	C1713	755	N/A	N/A	N/A
HC62803259	M: MENISC REPAIR ANCHOR SOFT TISS-B	278	C1713	1,629	N/A	N/A	N/A
HC62803424	M: FLEX HD ALLOPATCH PER SQ CM	636	Q4128	14,287	N/A	N/A	N/A
HC62803457	M: NAIL ORTHO	278	C1713	7,327	N/A	N/A	N/A
HC62803648	KIT CATH HEMO/PERI DIALYS LG TRM  N	278	C1750	962	N/A	N/A	N/A
HC62803671	CATH ABLAT TISS COOL-TIP(HALO 360)I	272	C1886	8,313	N/A	N/A	N/A
HC62803705	COIL EMBOLIZATION MICROCOIL       C	278	C1889	327	N/A	N/A	N/A
HC62803846	STENT DES CORO COV W/DEL SYS      O	278	C1874	6,300	N/A	N/A	N/A
HC62803879	STENT CORO BARE METAL W/DEL       D	278	C1876	2,581	N/A	N/A	N/A
HC62803903	STENT CORO BARE METAL W/DEL       G	278	C1876	4,200	N/A	N/A	N/A
HC62804075	M:GUIDE NERVE(NEURAGEN)PER CM	278	C9352	N/A	N/A	N/A	N/A
HC62804109	M:FILLER BONE STRIP(MOZAIK)EA0.5CC	278	C9362	3,500	N/A	N/A	N/A
HC62804281	COIL EMBOLIZ(CONCERTO HELIX NYLON)R	278		2,380	N/A	N/A	N/A
HC62804315	COIL EMBOLIZATION                 U	278		2,800	N/A	N/A	N/A
HC62804497	COIL EMBOLIZATION                 B	278		140	N/A	N/A	N/A
HC62804521	M: CAP ORTHO/SPINAL	278		210	N/A	N/A	N/A
HC62804554	M: OASIS WOUND PER SQ CM	636	Q4102	N/A	N/A	N/A	N/A
HC62804695	SYSTEM DRAIN PLEURAL/PERIT (ASPIRA)	278	C1729	9,800	N/A	N/A	N/A
HC62804729	M: PLUG ORTHO/SPINAL	278		211	N/A	N/A	N/A
HC62804752	M: FIXATOR STERNAL CABLE/ZIP	278	C1889	2,169	N/A	N/A	N/A
HC62804927	STENT BILIARY COVRD W/DELSYS      B	278	C1874	3,150	N/A	N/A	N/A
HC62804950	STENT BILIARY COVRD W/DELSYS      U	278	C1874	9,800	N/A	N/A	N/A
HC62805122	M: CRIMP SPINAL	278		N/A	N/A	N/A	N/A
HC62805155	SET NEEDLE TARGETING W/WIRE       X	278		1,750	N/A	N/A	N/A
HC62805189	M: SLING MALE	278	C1889	N/A	N/A	N/A	N/A
HC62805320	CATH SWAN GANZ/THERMODILUTION     E	272		176	N/A	N/A	N/A
HC62805361	M: CABLE ORTHO	278		3,333	N/A	N/A	N/A
HC62805395	M: DART CHONDRAL	278	C1713	N/A	N/A	N/A	N/A
HC62805569	CATH DIALYSIS SHORT-TERM          G	278	C1752	456	N/A	N/A	N/A
HC62805593	CATH ANGIO/GUID NEURO/PERIPH(DAC44)R	272	C1887	3,850	N/A	N/A	N/A
HC62805767	FIBRIN SEALANT                    S	278		3,283	N/A	N/A	N/A
HC62805791	HEMOSTATIC GEL/GELFOAM/PAD         H	272		404	N/A	N/A	N/A
HC62805965	CATH PTCA ANGIOPLASTY NON-LASER   O	272	C1725	2,450	N/A	N/A	N/A
HC62805999	FIBRIN SEALANT                    H	278		517	N/A	N/A	N/A
HC62806021	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AS	272	C1733	16,800	N/A	N/A	N/A
HC62806161	CATH EP DX <20 ELECTRODES         L	272	C1730	1,960	N/A	N/A	N/A
HC62806195	FILTER VENA CAVA (E.G.CELECT)     I	278	C1880	5,338	N/A	N/A	N/A
HC62806229	CATH THROMBECTOMY/REPERFUS(3MAX) AD	272	C1757	5,950	N/A	N/A	N/A
HC62806393	CATH EP DX <20 ELECTRODES         I	272	C1730	1,260	N/A	N/A	N/A
HC62806427	PORT INDWELLING W/CATH            E	278	C1788	718	N/A	N/A	N/A
HC62806591	COIL EMBOLIZ(HELIX BARE SUPER SFT)AI	278		5,600	N/A	N/A	N/A
HC62806625	COIL EMBOLIZ(3D PRIME BARE SUPER SFT)AN	278	C1889	7,350	N/A	N/A	N/A
HC62806799	STENT ENDOPRSTH AAA               K	278	C1874	14,000	N/A	N/A	N/A
HC62806823	STENT ENDOPRSTH AAA               S	278	C1874	25,199	N/A	N/A	N/A
HC62806856	HEMOSTATIC GEL/GELFOAM/PAD        Y	272		2,808	N/A	N/A	N/A
HC62806997	CATH SWAN GANZ/THERMODILUTION     R	278		1,750	N/A	N/A	N/A
HC62807029	STENT NON CORON W/DELIV SYS       B	278	C2625	281	N/A	N/A	N/A
HC62807052	COIL NEUROVASC(TARGET 360 NANO)  AM	278	C1889	7,000	N/A	N/A	N/A
HC62807227	PARTICLES EMBOLIZ (CONTOUR)       G	278	C1889	350	N/A	N/A	N/A
HC62807250	TUBE GASTROSTOMY LOWPRFL BTTN OPT L	278	A4649	700	N/A	N/A	N/A
HC62807433	POLYMER FILLER RING GRAFT/STENT	278		2,625	N/A	N/A	N/A
HC62807466	GOLD SEED MARKER FIDUCIAL DELVRY SYS(DSF2201)	278	A4648	1,750	N/A	N/A	N/A
HC62807490	M: CLAMP CRANIAL IMPLANTABLE	278	C1713	N/A	N/A	N/A	N/A
HC62807631	M: COLLAR STEM HIP	278	C1776	6,412	N/A	N/A	N/A
HC62807664	M: STAPLE BONE	278	C1713	5,288	N/A	N/A	N/A
HC62807698	CAP KIT LEAD PACEMAKER            I	278		490	N/A	N/A	N/A
HC62807839	PLUG PORT LEAD GENERATOR PULSE	278		140	N/A	N/A	N/A
HC62807862	STENT EXTENDER ENDOGRAFT TAA      O	278	C1874	19,250	N/A	N/A	N/A
HC62807896	M: STEM ELBOW	278	C1776	9,964	N/A	N/A	N/A
HC62808068	STENT ENDOPRSTH AAA              AA	278	C1874	47,123	N/A	N/A	N/A
HC62808092	STENT EXTENDER ENDOGRAFT AAA     AD	278	C1874	21,916	N/A	N/A	N/A
HC62808266	M:  PURAPLY PER SQ CM	636	Q4195	N/A	N/A	N/A	N/A
HC62808290	STENT TRANSCAROTID COV W/DEL SYS	278	C1874	9,092	N/A	N/A	N/A
HC62808324	G170044 GENERATOR VITARIA IDE	624	C1767	1	N/A	N/A	N/A
HC62808464	M: PACEMAKER LEADLESS SNGL CHMBR MICRA AV	275	C1786	46,374	N/A	N/A	N/A
HC62808498	M:MEMODERM DERMASPAN  TRANZGRAFT OR INTEGUPLY PER SQ	636	Q4126	N/A	N/A	N/A	N/A
HC62808522	PARTICLES EMBOLIZ (EMBOCUBES)	278		36	N/A	N/A	N/A
HC62808704	STENT COAT/COVRD W/O DEL SYS       U	278	C1875	21,538	N/A	N/A	N/A
HC62808738	KIT THROMBECTOMY/EMBOLECTOMY        Z	272	C1757	34,983	N/A	N/A	N/A
HC62808902	DEVICE FUSION SI JOINT(IFUSE SI-BONE?)J	278	C1713	11,017	N/A	N/A	N/A
HC62808936	BONE GRAFT FILLER VOID 10ML(CERAMENT?BONESUPPORT?)	278	C1713	14,560	N/A	N/A	N/A
HC62890181	P: AICD C1721 W/C1777/C1892/C1895/C1896/C1898			N/A	N/A	N/A	N/A
HC62890215	P: PACER DUAL RR C1785 W/ 2 LEADS C1779&/C1898&/C1899&/C1900			N/A	N/A	N/A	N/A
HC62890249	P: PACER DUAL RRSPNSV C1785 W/ 2 LEADS C1779&/C1895&/C1896			N/A	N/A	N/A	N/A
HC65000250_00004080285	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65000250_00005417990	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00006003220	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_00009039605	NONCDM CHARGE RECORD PHARMACY	250		88	N/A	N/A	N/A
HC65000250_00009513601	NONCDM CHARGE RECORD PHARMACY	250		361	N/A	N/A	N/A
HC65000250_00024542131	NONCDM CHARGE RECORD PHARMACY	250		131	N/A	N/A	N/A
HC65000250_00025152034	NONCDM CHARGE RECORD PHARMACY	250	Z7610	55	N/A	N/A	N/A
HC65000250_00032120370	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00049317030	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10	N/A	N/A	N/A
HC65000250_00054000725	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00054001025	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00054023749	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00054031950	NONCDM CHARGE RECORD PHARMACY	250	Z7610	495	N/A	N/A	N/A
HC65000250_00054039168	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00054350547	NONCDM CHARGE RECORD PHARMACY	250		73	N/A	N/A	N/A
HC65000250_00054372763	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00065030355	NONCDM CHARGE RECORD PHARMACY	250		319	N/A	N/A	N/A
HC65000250_00065039602	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_00065074114	NONCDM CHARGE RECORD PHARMACY	250		64	N/A	N/A	N/A
HC65000250_00071000740	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00071036940	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00071101341	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65000250_00074712611	NONCDM CHARGE RECORD PHARMACY	250	Z7610	38	N/A	N/A	N/A
HC65000250_00078035834	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_00088210224	NONCDM CHARGE RECORD PHARMACY	250	Z7610	27	N/A	N/A	N/A
HC65000250_00093005405	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093083201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093171801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093202631	NONCDM CHARGE RECORD PHARMACY	250	Z7610	15	N/A	N/A	N/A
HC65000250_00093312301	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00093314701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093342201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093681673	NONCDM CHARGE RECORD PHARMACY	250		59	N/A	N/A	N/A
HC65000250_00093727298	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00093834401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093874001	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00115703301	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00121048900	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_00121053005	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_00121067516	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00121067816	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_00121074730	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_00121094250	NONCDM CHARGE RECORD PHARMACY	250	Z7610	31	N/A	N/A	N/A
HC65000250_00121094794	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_00121168016	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00121173030	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00121176030	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_00121479940	NONCDM CHARGE RECORD PHARMACY	250	Z7610	37	N/A	N/A	N/A
HC65000250_00131247860	NONCDM CHARGE RECORD PHARMACY	250		113	N/A	N/A	N/A
HC65000250_00132007924	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00143988701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00143988980	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_00168016360	NONCDM CHARGE RECORD PHARMACY	250	Z7610	376	N/A	N/A	N/A
HC65000250_00168035755	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_00185003451	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_00185061501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00186077660	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_00228212710	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00228212910	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00228253950	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00245014401	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_00245021201	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00281032630	NONCDM CHARGE RECORD PHARMACY	250		222	N/A	N/A	N/A
HC65000250_00299391702	NONCDM CHARGE RECORD PHARMACY	250	Z7610	39	N/A	N/A	N/A
HC65000250_00378003210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378020810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378087199	NONCDM CHARGE RECORD PHARMACY	250		172	N/A	N/A	N/A
HC65000250_00378182377	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00378240501	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00378306677	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00378641001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10	N/A	N/A	N/A
HC65000250_00378698188	NONCDM CHARGE RECORD PHARMACY	250		59	N/A	N/A	N/A
HC65000250_00378967193	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00386000804	NONCDM CHARGE RECORD PHARMACY	250		38	N/A	N/A	N/A
HC65000250_00395042096	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_00406055262	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00406575562	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00406833062	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00409330803	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_00409469801	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_00409488710	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00440629130	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00456140230	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65000250_00472033720	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_00472040015	NONCDM CHARGE RECORD PHARMACY	250		667	N/A	N/A	N/A
HC65000250_00486112501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00487980160	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00496088206	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65000250_00517750425	NONCDM CHARGE RECORD PHARMACY	250		54	N/A	N/A	N/A
HC65000250_00527296137	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00527328146	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536101001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536105405	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536127180	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00536129701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536131628	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00536408501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536478701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536589488	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00555087302	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00555097302	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00574030316	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574052008	NONCDM CHARGE RECORD PHARMACY	250		123	N/A	N/A	N/A
HC65000250_00574061816	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00591024001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00591040401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00591058201	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00591387044	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00591532101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00591555601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00603020922	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00603116158	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00641602225	NONCDM CHARGE RECORD PHARMACY	250	J3490	6	N/A	N/A	N/A
HC65000250_00713028031	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00713050324	NONCDM CHARGE RECORD PHARMACY	250		75	N/A	N/A	N/A
HC65000250_00781207401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00781282210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00781531801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00832051200	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832121100	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00832152011	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00832532511	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904053060	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904053980	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904110309	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_00904292061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904385461	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904404360	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904544861	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904546080	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904578961	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904582360	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904605261	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904608461	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904618761	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904630261	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904632206	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904632946	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904637761	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904640180	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904646161	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904647061	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904647761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904652261	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904655161	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904656461	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904663761	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904664061	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904671741	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904672040	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904678061	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904678744	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00904679489	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904682561	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904683061	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00904685261	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904695061	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904696661	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904700161	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904700861	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904708404	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904709361	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904709661	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_00904712661	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00904714504	NONCDM CHARGE RECORD PHARMACY	250	Z7610	63	N/A	N/A	N/A
HC65000250_00904716461	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904724468	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904759060	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00998063006	NONCDM CHARGE RECORD PHARMACY	250		735	N/A	N/A	N/A
HC65000250_01000670028	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01000673021	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01013568962	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01031028313	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_01036179301	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_01093916733	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_01093933233	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093935444	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093979444	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093987244	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_01191705014	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01249612083	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_01287000012	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01366808630	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_01366810401	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01366820230	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_01657166450	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01657168303	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671404701	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_01671407104	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671414201	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01671415901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671417501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671429302	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671429903	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671435801	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01671447802	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_01671449401	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01671463302	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_01671465801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671466102	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671469101	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_01671469401	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01671469803	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01671476901	NONCDM CHARGE RECORD PHARMACY	250		112	N/A	N/A	N/A
HC65000250_01671478201	NONCDM CHARGE RECORD PHARMACY	250		425	N/A	N/A	N/A
HC65000250_01671478401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01671483001	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_01671483801	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01671489802	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671495001	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01671498601	NONCDM CHARGE RECORD PHARMACY	250	Z7610	22	N/A	N/A	N/A
HC65000250_01672917001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672918301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672918929	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_01672945015	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01672945315	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01747820115	NONCDM CHARGE RECORD PHARMACY	250	Z7610	152	N/A	N/A	N/A
HC65000250_01747821505	NONCDM CHARGE RECORD PHARMACY	250		334	N/A	N/A	N/A
HC65000250_01747871510	NONCDM CHARGE RECORD PHARMACY	250		96	N/A	N/A	N/A
HC65000250_01747876106	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_01747876830	NONCDM CHARGE RECORD PHARMACY	250		121	N/A	N/A	N/A
HC65000250_02055502500	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02055503601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02192200909	NONCDM CHARGE RECORD PHARMACY	250		129	N/A	N/A	N/A
HC65000250_02315551901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315560701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02420853920	NONCDM CHARGE RECORD PHARMACY	250		744	N/A	N/A	N/A
HC65000250_02420873006	NONCDM CHARGE RECORD PHARMACY	250		170	N/A	N/A	N/A
HC65000250_02468911901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02502167377	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65000250_02660800156	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_02780808201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02780815701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02903300101	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_02930041101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172215130	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03172270130	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172270730	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03172272320	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_03334205407	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03334205510	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03334206207	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_03700003201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_03700047710	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_03982212012	NONCDM CHARGE RECORD PHARMACY	250		72	N/A	N/A	N/A
HC65000250_04009310107	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04202310401	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_04219233001	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_04219260816	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04229150701	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04229162230	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04229180815	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04279400908	NONCDM CHARGE RECORD PHARMACY	250		195	N/A	N/A	N/A
HC65000250_04279401912	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04280654909	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04280671405	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04338616012	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04338633001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04354726810	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04354733810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354735210	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354735411	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04359821055	NONCDM CHARGE RECORD PHARMACY	250		79	N/A	N/A	N/A
HC65000250_04359844670	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_04580205435	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_04580205635	NONCDM CHARGE RECORD PHARMACY	250		257	N/A	N/A	N/A
HC65000250_04580206001	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_04580214762	NONCDM CHARGE RECORD PHARMACY	250	Z7610	5	N/A	N/A	N/A
HC65000250_04580227603	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04580239504	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_04580273033	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04580275830	NONCDM CHARGE RECORD PHARMACY	250		63	N/A	N/A	N/A
HC65000250_04580286866	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_04628750030	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04658121006	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04778142447	NONCDM CHARGE RECORD PHARMACY	250		45	N/A	N/A	N/A
HC65000250_04778142847	NONCDM CHARGE RECORD PHARMACY	250		179	N/A	N/A	N/A
HC65000250_04778164390	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04858200330	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65000250_04898500170	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04934803040	NONCDM CHARGE RECORD PHARMACY	250		125	N/A	N/A	N/A
HC65000250_04934854301	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_04934874027	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_04948334150	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04970220548	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_04993810230	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_05011132801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05011133401	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_05011191601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05019014123	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05022835190	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026811115	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05026813115	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05026828713	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05026831215	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_05026833715	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_05026843015	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026844815	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05026850415	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026857515	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026858515	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026859715	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026865212	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_05026867612	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_05026875915	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05026876615	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05026881112	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_05038304205	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05038306307	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05038308707	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05038377116	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05038377916	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_05045857930	NONCDM CHARGE RECORD PHARMACY	250		111	N/A	N/A	N/A
HC65000250_05045858090	NONCDM CHARGE RECORD PHARMACY	250		111	N/A	N/A	N/A
HC65000250_05074211808	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_05074219001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05074225130	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05107908320	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05107910320	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107914120	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05107937420	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107941720	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_05107954420	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05107963220	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_05107979020	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107981320	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_05107988620	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_05107995820	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_05107997820	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05107998620	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05152504709	NONCDM CHARGE RECORD PHARMACY	250	Z7610	76	N/A	N/A	N/A
HC45400504	MR UP EXT(NON JNT) W/O CONT BIL	610	73218	12,665	N/A	N/A	N/A
HC45400538	MR UP EXT(NON JNT)W/CONT BIL	610	73219	13,760	N/A	N/A	N/A
HC45400702	MRA HEAD W/O CONTRAST	611	70544	6,375	N/A	N/A	N/A
HC45400736	MRA NECK W/O CONTRAST	611	70547	6,375	N/A	N/A	N/A
HC45400769	MRA PELVIS W/O CONTRAST	610	C8919	5,376	N/A	N/A	N/A
HC45401056	MR BREAST W/O& W/ CONTRAST LT	610	C8905	6,536	N/A	N/A	N/A
HC45401106	MR BREASTS W/O CONTRAST (BILAT)	610	77047	6,758	N/A	N/A	N/A
HC45401130	MR BREASTS W/O&W CONTRST LTD (BILAT)	610	C8908	4,297	N/A	N/A	N/A
HC45401387	MRA UPPER EXT W/CONT RT	610	C8934	5,010	N/A	N/A	N/A
HC45401411	MRA UPPER EXT W/CONT LT	610	C8934	5,010	N/A	N/A	N/A
HC45600061	PET W/CT SKULL BASE-MID THIGH	404	78815	15,256	N/A	N/A	N/A
HC45600095	PET ANY SITE  NOS	404	G0235	10,224	N/A	N/A	N/A
HC46000246	INJ SINUS TRACT; DIAGNOSTIC (SINOGRAM)	361	20501	3,614	N/A	N/A	N/A
HC46000287	INJ FOR CYSTOGRAM	361	51600	2,235	N/A	N/A	N/A
HC46000386	INJ FOR SIALOGRAPHY	361	42550	1,416	N/A	N/A	N/A
HC46000576	INTRO NDL/INTRACATH VEIN LT	361	36000	420	N/A	N/A	N/A
HC46000634	INTRO NDL/CATH EXT ART UE OR LE RT	361	36140	3,114	N/A	N/A	N/A
HC46000691	PERC PORTAL VEIN CATH	323	36481	2,896	N/A	N/A	N/A
HC46000899	SEL CATH THOR/BRAC 1ST ORD RT	321	36215	6,374	N/A	N/A	N/A
HC46000923	SEL CATH THOR/BRAC 3RD ORD LT	321	36217	8,961	N/A	N/A	N/A
HC46001095	INJ ARTHRO/CT/MRI SHOULDER-BIL	361	23350	3,104	N/A	N/A	N/A
HC46001137	INJ ARTHROGRAM ANKLE-SC BIL	361	27648	2,204	N/A	N/A	N/A
HC46001269	INJ CHOLANGIO PERC/S&I;NEW ACCESS	361	47532	9,128	N/A	N/A	N/A
HC46500096	ASP/INJ RENAL CYST/PELVIS LT	361	50390	6,021	N/A	N/A	N/A
HC46500120	BONE MARROW DX; ASPIRATION(S) ONLY	361	38220	4,545	N/A	N/A	N/A
HC46500245	BIOPSY LIVER(NEEDLE/PERCUTAN)	361	47000	8,058	N/A	N/A	N/A
HC46500476	BX LYMPH NODE(S)-SUPERFCL-RT	361	38505	5,857	N/A	N/A	N/A
HC46500542	BX PROSTATE NDL/PUNCH SGL/MULT	361	55700	7,640	N/A	N/A	N/A
HC46500898	FIX G/COLON TUBE W/ DEVICE W/FLUORO	361	49460	4,075	N/A	N/A	N/A
HC46500930	INJ W/FLUOR  EVAL CV ACCESS DEVICE	361	36598	2,028	N/A	N/A	N/A
HC46501102	INSERT PICC >5 YR AGE W/O IMAGING	361	36569	7,446	N/A	N/A	N/A
HC46501136	INSRT BLADDER CATH-TEMP-COMPLX	361	51703	1,028	N/A	N/A	N/A
HC46501185	MANOMETRIC STDY VIA NEPHRO BI	361	50396	5,285	N/A	N/A	N/A
HC46501367	REMOV TUNNELED CV ACS CATH W/O PORT/PUMP	361	36589	7,852	N/A	N/A	N/A
HC46501391	REMVL TUN CV ACS DEVICE W/ SQ PORT	361	36590	9,501	N/A	N/A	N/A
HC46501425	REPLACE PERC DU/J TUBE W/FLUORO	361	49451	6,751	N/A	N/A	N/A
HC46501615	URO-EMG	361	51784	1,421	N/A	N/A	N/A
HC46501706	BX/RMVL LYMPH NODE(S)-OPEN BI	361	38510	17,803	N/A	N/A	N/A
HC46501961	BONE MARROW DX; ASPIRATION(S) ONLY LT	361	38220	4,545	N/A	N/A	N/A
HC46501995	BONE MARROW DX; BIOPSY(SIES) ONLY LT	361	38221	4,906	N/A	N/A	N/A
HC46502191	PERC BX BREAST W/LOC DEV MR ADDL LESN+	361	19086	7,056	N/A	N/A	N/A
HC46502225	PERC PLC BRST LOC DEV SG 1ST LESN	361	19283	5,747	N/A	N/A	N/A
HC46502258	PERC PLC BRST LOC DEV US ADDL LESN+	361	19286	3,890	N/A	N/A	N/A
HC46502399	DIVSN PLANTR FASCIA&MUSCLE(STEINDLER STRIP)	361	28250	12,905	N/A	N/A	N/A
HC46502423	PLCMT NEPHROSTOMY CATHETER (NEPH/URET'GRM S&I) RT	361	50432	8,762	N/A	N/A	N/A
HC46502456	PLCMT CATH NEPHURET PERC(NEPH/URET'GRM S&I)NEW ACC RT	361	50433	10,348	N/A	N/A	N/A
HC46502621	INJECT URETEROGRAPH VIA ILEAL CONDUIT	361	50690	2,246	N/A	N/A	N/A
HC46502654	FNA ASP BX W/FLUORO; FIRST LESION	361	10007	4,008	N/A	N/A	N/A
HC46502845	PUNCTURE SPINAL TX CSF WITH FLUORO/CT[NOT W/MRI OR US]	361	62329	5,777	N/A	N/A	N/A
HC46502878	REVASC LITHOTRIP TIBIA/PERONEAL ENDOVASC	361	C9772	19,753	N/A	N/A	N/A
HC46502902	REVASC LITHOTRIP ARTHERECTOMY TIBIA/PERONEAL ENDOVASC W/STENT	361	C9775	21,901	N/A	N/A	N/A
HC46503041	BX SOFT TISS THIGH/KNEE DEEP BIL	361	27324	9,075	N/A	N/A	N/A
HC46503074	BX SOFT TISSUE BACK DEEP BIL	361	21925	8,894	N/A	N/A	N/A
HC46503108	BX SOFT TISS FOREARM&/WRIST DEEP BIL	361	25066	8,712	N/A	N/A	N/A
HC46503249	BX SOFT TISS FOREARM&/WRIST SUP LT	361	25065	4,719	N/A	N/A	N/A
HC46503272	BX SOFT TISSUE BACK SUP LT	361	21920	4,598	N/A	N/A	N/A
HC46503306	BIOPSY MUSCLE DEEP LT	361	20205	5,566	N/A	N/A	N/A
HC47200183	IMRT TX PLAN	333	77301	18,388	N/A	N/A	N/A
HC47200225	INTRACAVITARY TREATMT COMPLEX	333	77763	4,461	N/A	N/A	N/A
HC47200498	RAD TREATMENT DELVR  = 1MEV;INTRMED	333	77407	2,137	N/A	N/A	N/A
HC47200563	RADIOELEMENT INFUSION	333	77750	1,184	N/A	N/A	N/A
HC47200597	SPECIAL RAD TX;IRRAD ENDO CONE	333	77470	6,021	N/A	N/A	N/A
HC47200753	RAD ONC E&M LEVEL I BRIEF	761	99211	214	N/A	N/A	N/A
HC47200787	RAD ONC E&M LEVEL IV EXTENDED	761	99214	563	N/A	N/A	N/A
HC47200811	SRS LINR ACCL TX 1 SESSN CMPLT(CRANIAL)	333	77372	34,488	N/A	N/A	N/A
HC47201058	BRACHYTX ISODOSE W/DOSIMETRY; SIMPL	333	77316	3,497	N/A	N/A	N/A
HC47201082	IMRT TX DELIVERY GUIDE&TRACK SIMPLE	333	77385	7,651	N/A	N/A	N/A
HC51000040	REPAIR CENTRAL VENOUS CATH	361	36575	1,018	N/A	N/A	N/A
HC51000073	INSRT BLADDER CATH-TEMP FOLEY	361	51702	346	N/A	N/A	N/A
HC51000248	IV INF THER SEQ/NEW RX 1ST HR	260	96367	189	N/A	N/A	N/A
HC51000271	IVP SINGLE/REPEAT RX ADD'L INJ	260	96376	73	N/A	N/A	N/A
HC51000404	IV INF HYDRATION INITIAL HR	260	96360	310	N/A	N/A	N/A
HC51000545	CHEMO HORMON ANTINEOPL SQ/IM	331	96402	178	N/A	N/A	N/A
HC51000578	CHANGE GT TUBE W/O IMAGE/ENDO	750	43762	332	N/A	N/A	N/A
HC51001196	CLOSED TX HUMERUS SHAFT FX NO MANIP	361	24500	908	N/A	N/A	N/A
HC51001360	CLOSED TX KNEE FX(S)	361	27538	2,284	N/A	N/A	N/A
HC51001394	CLOSED TX ANKLE FX	361	27760	890	N/A	N/A	N/A
HC51001568	APPLY SPLINT SHORT ARM	700	29125	336	N/A	N/A	N/A
HC51001592	VENIPUNCTURE ROUTINE	300	36415	18	N/A	N/A	N/A
HC51001626	X-RAY SPINE CERVICAL; 4 OR 5VWS	320	72050	422	N/A	N/A	N/A
HC51001774	X-RAY PELVIS 1 OR 2 VWS	320	72170	223	N/A	N/A	N/A
HC51001832	X-RAY TIBULA + FIBULA  2 VWS	320	73590	228	N/A	N/A	N/A
HC51001865	X-RAY FOOT 3+ VWS	320	73630	236	N/A	N/A	N/A
HC51002061	REMOVE/INSERT DRUG DELIVERY IMPLANT	361	11983	525	N/A	N/A	N/A
HC51002095	TB TEST (PPD) PROCEDURE	300	86580	92	N/A	N/A	N/A
HC51002129	MNT THERAPY 2>/GROUP EA 30 MIN      1ST REF	942	97804	56	N/A	N/A	N/A
HC51002293	CIRCUMCISION W/DEVICE RING/BLOCK	361	54150	599	N/A	N/A	N/A
HC51002327	CIRCUMCISION INFANT<28D EXCISE NO DEVICE	361	54160	720	N/A	N/A	N/A
HC51002525	US GUIDE PLCMNT NEEDLE /BX	402	76942	407	N/A	N/A	N/A
HC51002558	REMOV IMPACTD EAR WAX IRRIG/LAVG BI	361	69209	235	N/A	N/A	N/A
HC51002582	ANALYZ COMPLX NRSTM SPNL CD/PERIPH W/PROG	920	95972	410	N/A	N/A	N/A
HC51002723	MANOMETRIC STDY VIA NEPHRO	361	50396	914	N/A	N/A	N/A
HC51002756	ASPIRATION OF BLADDER TROCAR	361	51101	1,813	N/A	N/A	N/A
HC51002780	INJECT ENDOSCOPIC MATERIAL IMPLANT	361	51715	3,314	N/A	N/A	N/A
HC51002954	DILAT STRICTR URETHRL FLFRM MALE SUBSQ	361	53621	588	N/A	N/A	N/A
HC51002988	INSERT STENT URETHRAL PROSTATIC TEMP	361	53855	2,410	N/A	N/A	N/A
HC51003184	BX VAGINA SIMPLE	361	57100	1,326	N/A	N/A	N/A
HC51003218	FIT&INSERT PESSARY/INTRAVAG SPPRT DEV	361	57160	369	N/A	N/A	N/A
HC51003382	X-RAY ORPORA CAVERNOSGRAPHY	320	74445	595	N/A	N/A	N/A
HC51003424	ANORECTAL MANOMETRY	750	91122	757	N/A	N/A	N/A
HC51003457	CA SCREEN-EXAM PELVIC/BREAST	770	G0101	158	N/A	N/A	N/A
HC51003812	REMOV SKIN TAGS UP TO&INCL 15 LESIONS	361	11200	238	N/A	N/A	N/A
HC51003846	I&D HEMATOMA OR FLUID COLL	361	10140	706	N/A	N/A	N/A
HC51003879	X-RAY FEMUR 1 VIEW	320	73551	211	N/A	N/A	N/A
HC51010056	DESTROY MUSCLE(S) FACIAL NERVE BI	361	64612	1,080	N/A	N/A	N/A
HC51010148	DESTRUCT OTHER PERIPH NERV/BRNCH BI	361	64640	2,018	N/A	N/A	N/A
HC51010312	INJ(S);TRIGGER POINT 3/>MUSCLS	361	20553	439	N/A	N/A	N/A
HC51010346	ANALYSIS IMPLANTED PUMP W/PROG	361	62368	483	N/A	N/A	N/A
HC51010510	TEST ALLERGY INTRAQ DELAYED RXN	924	95028	81	N/A	N/A	N/A
HC51010544	TEST CHALLENGE INGEST 1ST120MIN	924	95076	600	N/A	N/A	N/A
HC51010577	IMMUNTX NOT INCL EXTRCT 2/+ INJ	924	95117	76	N/A	N/A	N/A
HC51010718	IMMUNTX PREP-PROV 1/+ANTIGNS	924	95165	150	N/A	N/A	N/A
HC51010767	ENDOSCOPY NASAL DX UNI/BILAT	361	31231	379	N/A	N/A	N/A
HC51010791	EAR WICK (UNLISTED PROCEDURE)	361	69399	229	N/A	N/A	N/A
HC51020022	RN DEV PT REPORT;COMPREHENSIVE	920	Z4304	283	N/A	N/A	N/A
HC51020055	RN CONSULT TELEPHONE PER 15MIN	920	Z5406	51	N/A	N/A	N/A
HC51020394	SC INFUSION THERAPY INITIAL UP TO 1HR	260	96369	577	N/A	N/A	N/A
HC51020428	NP DEV PT REPORT; INTERMEDIATE	920	Z4303	159	N/A	N/A	N/A
HC51030021	SW CONSULT TELEPHONE PER 15MIN	920	Z5406	51	N/A	N/A	N/A
HC51060028	AHCP TEAM CONF PRTCPNT EA 15MIN	920	Z4302	47	N/A	N/A	N/A
HC51060051	PT-TEST&MEASUREMENT 1ST30MIN/C	424		208	N/A	N/A	N/A
HC51060085	OT-EVAL+REPORT INITIAL 30 MIN/C	434		216	N/A	N/A	N/A
HC51060473	OT CONSULT TELEPHONE PER 15MIN	430		52	N/A	N/A	N/A
HC51060523	ST EVAL SOUND PRODUCTION/M	444	92522	174	N/A	N/A	N/A
HC51060556	DESTROY MUSCLE(S) NECK NO LARYNX BI	361	64616	1,411	N/A	N/A	N/A
HC51060721	OT-EVAL HIGH COMPLEXITY 45MF2F 60MIN	434	97167	413	N/A	N/A	N/A
HC51060754	PT-THER EXER 15MIN/M	420	97110	73	N/A	N/A	N/A
HC51061026	REMOVE NEPHROSTOMY TUBE RT	361	50389	1,119	N/A	N/A	N/A
HC51061059	CONVERT NEPH CATH->NEPH'URET PERC(NEPH/URET'GRM S&I)EXST RT	361	50434	2,840	N/A	N/A	N/A
HC51061083	EXCHANGE TUBE NEPHRO(NEPH/URET'GRM S&I) RT	361	50435	2,840	N/A	N/A	N/A
HC51061372	ADMIN VACCINE COVID-19 30MCG/0.3ML INITIAL DOSE {PFIZER-BIONTECH}	771	0001A	98	N/A	N/A	N/A
HC51061406	ADMIN VACCINE COVID-19 100MCG/O.5 2ND DOSE {MODERNA}	771	0012A	98	N/A	N/A	N/A
HC51061448	ECG EXT TELEM MCT>24HRS-30DAYS TECH ATTEND TIME;CONNECT&TRANS	731	93229	379	N/A	N/A	N/A
HC51061638	ECHO DOPPLER COLOR FLOW+	483	93325	433	N/A	N/A	N/A
HC51061661	ECHO 2D LMTD W/O SPEC&CLR /DOP	483	93308	514	N/A	N/A	N/A
HC51061836	X-RAY SPINE ENTIRE SKULL-SACRUM 4-5 VIEWS	320	72083	384	N/A	N/A	N/A
HC51061869	X-RAY PELVIS COMPLETE MIN 3 VWS	320	72190	254	N/A	N/A	N/A
HC51062032	SELF MANAGEMENT EDUC & TRAINING 2-4PTS 30MIN (PRIVAT INSAUTHREQ)	942	98961	108	N/A	N/A	N/A
HC51062099	REMOVE CONTRACEPTIVE CAPSULE	361	11976	1,179	N/A	N/A	N/A
HC51062123	SMEAR WET MOUNT INFECT AGENT	306	87210	27	N/A	N/A	N/A
HC51062263	NP ANTEPARTUM FOLLOW UP VISIT	920	Z1034	135	N/A	N/A	N/A
HC51062297	CPSP DEPRESSION SCREENING IND NEG	900	G8510	27	N/A	N/A	N/A
HC51062321	CPSP ANTEPRTM NUTRITION F/U ASSESS TX  INDIVIDUAL; EA 15MIN	940	Z6204	32	N/A	N/A	N/A
HC51062495	PRINCIPAL CARE MGMT HI RISK D; 1ST 30 MIN  PER MONTH	949	99426	379	N/A	N/A	N/A
HC51062537	CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE TX	361	30901	243	N/A	N/A	N/A
HC51062719	APPLY CAST SHORT LEG BILATERAL	700	29405	681	N/A	N/A	N/A
HC51062743	APPLIC CAST LEG CLUBFOOT BILAT	700	29450	520	N/A	N/A	N/A
HC51062776	CLOSED TX CARPAL BONE FX W/MNPLTN EA BONE	361	25635	2,600	N/A	N/A	N/A
HC51062917	ADVANCE CARE PLAN DISCUSS DIRECTIVES EA ADD 30MIN+	949	99498	52	N/A	N/A	N/A
HC51062941	TRANSCUT AURICULAR NEUROSTIM SETUP PT EDUC EQUIP	949	0783T	338	N/A	N/A	N/A
HC51062974	DEBRIDE SKIN SUBQ; FIRST 20SQCM	361	11042	1,040	N/A	N/A	N/A
HC51063113	EVACUATION SUBUNGUAL HEMATOMA	361	11740	364	N/A	N/A	N/A
HC51063147	REPAIR NAIL BED	361	11760	1,456	N/A	N/A	N/A
HC51063170	EVAL/MANAG DIABETIC PT SENSORY NEUROPATHY INITIAL	940	G0245	364	N/A	N/A	N/A
HC51070324	PSYCH GRP TX(NOT MULTI FAMILY)90MIN	915	90853	224	N/A	N/A	N/A
HC51070357	PSYCH TX W/PATIENT 30MIN	914	90832	297	N/A	N/A	N/A
HC51070563	PSYCH TESTING EVAL INTEGR INTERPRET CLIN DES TX; EA ADDL HR+	918	96131	309	N/A	N/A	N/A
HC51070597	PSYCH/NEUROPSYCH TEST ADMIN & SCORING  2 OR > TESTS; 1ST 30 MIN	918	96136	215	N/A	N/A	N/A
HC51070621	BEHAVIOR ADAPT TX ADMN QHCP EA 15MIN	918	97155	88	N/A	N/A	N/A
HC51070761	PSY-BEHAVIOR TX GROUP 1ST 30 MIN	915	96164	76	N/A	N/A	N/A
HC51070795	PSY-BEHAVIOR TX FAMW/PT ADD 15MIN	916	96168	46	N/A	N/A	N/A
HC51070829	TEST STRESS PULMON INCL HR POX O2 TIT (6MIN WALK)	460	94618	379	N/A	N/A	N/A
HC62200175	AEROCHAMBER	270		42	N/A	N/A	N/A
HC62200217	WAND ARTHRO                       M	272		840	N/A	N/A	N/A
HC62200399	BANDAGE COMPRESSION	270		112	N/A	N/A	N/A
HC62200423	BANDAGE KLING	270		34	N/A	N/A	N/A
HC62200605	BLADE SHAVER                      F	272		420	N/A	N/A	N/A
HC62200639	NEEDLE BONE MARROW ADD'L	272		109	N/A	N/A	N/A
HC62200662	BONE MARROW SUPPLY FEE	272		111	N/A	163	N/A
HC62200803	BRUSH CYTOLOGY                    G	272		350	N/A	N/A	N/A
HC62200845	BURR                              G	272		497	N/A	N/A	N/A
HC62200878	BURR                              E	272		380	N/A	N/A	N/A
HC62201066	CANNULA RETROPLEGIA	272		386	N/A	N/A	N/A
HC62201090	CANNULA VEIN IRRIGATION	272		505	N/A	N/A	N/A
HC62201272	CATH CENTRAL VENOUS               F	272	C1751	280	N/A	N/A	N/A
HC62201314	CATH DIAGNOSTIC                   D	272		140	N/A	N/A	N/A
HC62201348	CATH DRAINAGE                     F	272	C1729	280	N/A	N/A	N/A
HC62201488	CATH INTRODUCER	272		229	N/A	N/A	N/A
HC62201512	CATH NEPHROSTOMY                  I	272	C1729	490	N/A	N/A	N/A
HC62201553	CATH SILICONE	272		154	N/A	N/A	N/A
HC62201694	CAUTERY HOOK ASSEMBLY            AO	272		1,226	N/A	N/A	N/A
HC62201728	CEMENT VERTEBROPLASTY	272		437	N/A	N/A	N/A
HC62201769	CIRCUIT AEROSOL/IPPB	270		106	N/A	N/A	N/A
HC62201959	CONCHA COLUMN STANDARD	272		235	N/A	N/A	N/A
HC62201991	COOKS TRIPLE LUMEN	272		350	N/A	N/A	N/A
HC62202163	DERMACARRIER	272		98	N/A	N/A	N/A
HC62202197	DEVICE CIRCULATORY ENHANCER	270		361	N/A	N/A	N/A
HC62202221	DEVICE COMPRESSION FEMORAL        D	272		140	N/A	N/A	N/A
HC62202395	DRESSING ALLEVYN	272		177	N/A	N/A	N/A
HC62202429	DRESSING BAND UNIV. FACIAL	272		351	N/A	N/A	N/A
HC62202460	DRESSING FOAM (HYDROFERA)	272		64	N/A	N/A	N/A
HC62202676	ELECTRODE EEG (DISP)	272		70	N/A	N/A	N/A
HC62202700	ELECTRODE PACER TEMPORARY	272		1,050	N/A	N/A	N/A
HC62202874	CUTTER LINEAR ENDO                O	272		1,133	N/A	N/A	N/A
HC62202908	BAG/POUCH RETRIEVAL SPECMN ENDO   D	272		316	N/A	N/A	N/A
HC62203070	ET CLAMP OSOTOMY/ HOLLISTER	272		34	N/A	N/A	N/A
HC62203112	ET POUCH/BAG UROSTOMY	272		260	N/A	N/A	N/A
HC62203146	ET SET IRRIGATION	272		36	N/A	N/A	N/A
HC62203336	FILTER IV	272		56	N/A	N/A	N/A
HC62203393	FLOWMETER	270		157	N/A	N/A	N/A
HC62203427	FORCEP JEWELER BIPOLAR            F	272		280	N/A	N/A	N/A
HC62203666	KIT ARTHROSCOPY DISPSBLS          M	272		806	N/A	N/A	N/A
HC62203690	KIT ANGIOGRAPHY	272		192	N/A	N/A	N/A
HC62203864	KIT EXTRACTION CUP	272		84	N/A	N/A	N/A
HC62203898	KIT HEMOFILTRATION	272		770	N/A	N/A	N/A
HC62204060	KIT MICROPUNCTURE(SPECIALTY)	272		420	N/A	N/A	N/A
HC62204094	KIT NEEDLE US VACUUM ASSIST	272		911	N/A	N/A	N/A
HC62204128	KIT PERCUTANEOUS CATH	272		980	N/A	N/A	N/A
HC62204268	KIT TIPS	272		1,750	N/A	N/A	N/A
HC62204292	KIT TRACH COLLAR	272		70	N/A	N/A	N/A
HC62204326	KIT TRIPLE LUMEN/IV CATH	272		854	N/A	N/A	N/A
HC62204490	LIGHT FLEXIBLE DISP	272		84	N/A	N/A	N/A
HC62204532	LITE PIPE	272		297	N/A	N/A	N/A
HC62204706	MASK TRACH	272		64	N/A	N/A	N/A
HC62204748	M: MISC ORTHOTICS	274		1,517	N/A	N/A	N/A
HC62204771	MORGAN LENS	272		81	N/A	N/A	N/A
HC62204938	NEEDLE HUBER/PORT-A-CATH          B	272		57	N/A	N/A	N/A
HC62204961	NEEDLE RETROBULBAR	272		363	N/A	N/A	N/A
HC62204995	NEEDLE SPECIALTY	272		345	N/A	N/A	N/A
HC62205141	PACK ARTHROSCOPY	272		87	N/A	N/A	N/A
HC62205174	PACK CARDIAC ACCESSORY	272		1,254	N/A	N/A	N/A
HC62205216	PACK CRANIOTOMY	272		183	N/A	N/A	N/A
HC62205380	PACK MINOR	272		59	N/A	N/A	N/A
HC62205414	PACK ORTHO MAJOR	272		962	N/A	N/A	N/A
HC62205588	HEMOSTATIC GEL/GELFOAM/PAD         G	272		356	N/A	N/A	N/A
HC62205612	PAD/PROTECTOR HEEL ELBOW	272		56	N/A	N/A	N/A
HC62205653	PERFORATOR	272		602	N/A	N/A	N/A
HC62205802	PROBE GALACTOGRAM	272		316	N/A	N/A	N/A
HC62205836	PROBE LITHOTRIPTOR                N	272		980	N/A	N/A	N/A
HC62205877	PROBE RECTAL/ESOPHAGEAL	272		210	N/A	N/A	N/A
HC62206040	SCREWS LONG HEAD 4 (SRS)	272		490	N/A	N/A	N/A
HC62206073	SENSOR LOW LEVEL	272		224	N/A	N/A	N/A
HC62206248	SET INTRODUCER MICROPUNC	272		115	N/A	N/A	N/A
HC62206271	SET IV TAXOL	272		93	N/A	N/A	N/A
HC62206453	SHEATH ABLATION	272		704	N/A	N/A	N/A
HC62206487	SHEEPSKIN	270		130	N/A	N/A	N/A
HC62206529	SHUNT CAROTID	272		335	N/A	N/A	N/A
HC62206677	SPHINCTEROTOME W/WIRE             M	272		1,820	N/A	N/A	N/A
HC62206719	ORTHOTIC WHFO D-RING              C	274	L3908	106	N/A	N/A	N/A
HC62206743	SPLINT LEG	274	L1830	154	N/A	N/A	N/A
HC62206982	SUPPORTER COTTON	272		50	N/A	N/A	N/A
HC62207014	SUTURE EYE                        D	272		98	N/A	N/A	N/A
HC62207188	TENT RESPIRATORY/AEROSOL	270		162	N/A	N/A	N/A
HC62207212	DEVICE TORQUE                     D	272		140	N/A	N/A	N/A
HC62207246	KIT PRESSURE MONITOR/TRANSDUCER   B	272		70	N/A	N/A	N/A
HC62207402	TRAY IRRIGATION	272		36	N/A	N/A	N/A
HC62207444	TRAY MYELOGRAM DISP	272		200	N/A	N/A	N/A
HC62207477	TRAY PARACERVICAL	272		246	N/A	N/A	N/A
HC62207618	TUBE DRAINAGE CONNECTING	272		70	N/A	N/A	N/A
HC62207659	TUBE GASTROSTOMY                  L	278	A4649	700	N/A	N/A	N/A
HC62207683	TUBE INSUFFLATOR                  E	272		210	N/A	N/A	N/A
HC62207865	TUBING IRRIGATION                 H	272		336	N/A	N/A	N/A
HC62207907	TUBING MICRODEBRIDER	272		209	N/A	N/A	N/A
HC62208087	VACUUM SUCTION (NEWBORN)	272		168	N/A	N/A	N/A
HC62208111	VALVE CHEST DRAIN	272		112	N/A	N/A	N/A
HC62208145	VALVE PEEP	272		206	N/A	N/A	N/A
HC62208459	ACAPELLA DEVICE	270		271	N/A	N/A	N/A
HC62208483	PACK KYPHOPLASTY	272		93	N/A	N/A	N/A
HC62208525	STAPLER POWERED	272		778	N/A	N/A	N/A
HC62208715	CATH BALLOON SINUPLASTY           I	272	C1726	2,450	N/A	N/A	N/A
HC62208749	ENDO LOOP MONO LINA GOLD	272		1,226	N/A	N/A	N/A
HC62208954	NEEDLE PERCUTANEOUS	272		192	N/A	N/A	N/A
HC62208988	ROTABLATOR LUBRICANT	272		344	N/A	N/A	N/A
HC62209200	BONE TUNNELING SYSTEM	272		686	N/A	N/A	N/A
HC62209259	SYSTEM ANASTOMOSIS DEVICE	272		2,604	N/A	N/A	N/A
HC62209283	INFLATOR FOR BALLOON              K	272		297	N/A	N/A	N/A
HC62209432	KIT LOCATABLE GUIDE (LARGE)	272		3,483	N/A	N/A	N/A
HC62209465	GLIDESCOPE GVL 3-4	272		51	N/A	N/A	N/A
HC62209499	CONTACT LENS REMOVER	270		38	N/A	N/A	N/A
HC62209663	CATH ACCESS PORT IDD THERAPY	272		88	N/A	N/A	N/A
HC62209697	DEVICE CAPSULE ENDOSCP DELIVER	272		526	N/A	N/A	N/A
HC62210166	CIRCUIT VENT KIT W/CHAMBER O2 ADAPT	272		136	N/A	N/A	N/A
HC62210190	FORCEP BIOPSY DISP/TRACKING       E	272		386	N/A	N/A	N/A
HC62210232	FILTER CONT VENOVENOUS HEMO'EA	272		1,394	N/A	N/A	N/A
HC62210372	DRESSING PROFORE BANDAGE SYS	272		45	N/A	N/A	N/A
HC62210406	INSUFFLATOR LAPAROSCOPIC	272		41	N/A	N/A	N/A
HC62210430	KIT PUMP REFILL                   C	272		526	N/A	N/A	N/A
HC62210620	CATH ANGIO(BNCHMRK/ECHELN/EXCELSR/DAC57/HEADWY)Q	272	C1887	3,500	N/A	N/A	N/A
HC62210653	DEVICE EMBOLIC PROTECT NEURO	272	C1884	6,983	N/A	N/A	N/A
HC62210687	SYSTEM MICRODELIVERY FOR STENT	272		19,744	N/A	N/A	N/A
HC62210869	SPINAL HOOK DEVICE	272		280	N/A	N/A	N/A
HC62210901	KIT PRESSURE MONITORING W/SWAN	272		141	N/A	N/A	N/A
HC62211073	CATHETER ENDOVENT PULMONARY	272		4,970	N/A	N/A	N/A
HC62211107	PACK CELL SAVER TUBING	272		227	N/A	N/A	N/A
HC62211131	KIT BLOWER/MISTER CLEARVIEW	272		788	N/A	N/A	N/A
HC62211289	NG CLOG ZAPPER KIT	272		75	N/A	N/A	N/A
HC62211339	TUBE TRACH CUFFED                 E	272	A7521	208	N/A	N/A	N/A
HC62211362	DRESSING SACRUM 23X23CM (MEPILEX)	272		38	N/A	N/A	N/A
HC62211545	CATH IRRIG/DRAIN SINUSPLASTY	272		542	N/A	N/A	N/A
HC62211578	SET TUBING DUAL WND IRRIG/SUCTN	272		262	N/A	N/A	N/A
HC62211750	KIT CATH IV PERIPH LONGTERM	272		168	N/A	N/A	N/A
HC62211784	GUIDEWIRE(X-PEDION ANGIO)         Q	272	C1769	1,226	N/A	N/A	N/A
HC62211966	GUIDEWIRE BILIARY CURVED TIP      H	272	C1769	526	N/A	N/A	N/A
HC62212006	CATH BALLOON SIZING HALO ESOPH    Q	272	C1726	1,400	N/A	N/A	N/A
HC62212030	CANNULA PERFUSN VENOUS FEMORAL    M	272		873	N/A	N/A	N/A
HC62212204	CATH ANGIOGRAPHY W/BALLOON        E	272	C1887	210	N/A	N/A	N/A
HC62212238	COLLAR CERV CALIF TRACH	274	L0172	37	N/A	N/A	N/A
HC62212261	CATH ANGIOG GUIDING(SLIP/GLIDE)   E	272	C1887	216	N/A	N/A	N/A
HC62212436	INTRODUCER/SHEATH                 P	272	C1894	980	N/A	N/A	N/A
HC62212469	LARYNGOSCOPE BLADE W-HANDLE DISP	272		55	N/A	N/A	N/A
HC62212634	CATH PTCA BALLOON NON-LASER       J	272	C1725	1,190	N/A	N/A	N/A
HC62212667	CATHETER MICRO CTO(VIANCE)       AG	272	C1887	7,000	N/A	N/A	N/A
HC62212832	GUIDEWIRE                        AA	272	C1769	2,555	N/A	N/A	N/A
HC62212865	BLADE BONE SHAVER                 B	272		140	N/A	N/A	N/A
HC62212899	BLADE SHAVER                      G	272		402	N/A	N/A	N/A
HC62213038	BLADE SHAVER                      U	272		1,470	N/A	N/A	N/A
HC62213061	BLADE SHAVER                      X	272		1,680	N/A	N/A	N/A
HC62213095	BLADE INCISIONAL ORTHO            E	272		350	N/A	N/A	N/A
HC62213269	BURR                              N	272		980	N/A	N/A	N/A
HC62213293	BURR                              Q	272		1,487	N/A	N/A	N/A
HC62213467	REAMER                            Q	272		980	N/A	N/A	N/A
HC62213491	REAMER                            T	272		1,193	N/A	N/A	N/A
HC62213525	REAMER                            W	272		1,422	N/A	N/A	N/A
HC62213665	WOUND FILLER DRY FORM PER GM	272	A6262	168	N/A	N/A	N/A
HC62213707	PACK CATARACT CUSTOM W/O BSS	272		187	N/A	N/A	N/A
HC62213731	PACK VITRECTOMY W/O BSS	272		181	N/A	N/A	N/A
HC62213871	PROBE MYOCARDIAL TEMP	272		56	N/A	N/A	N/A
HC62213905	KIT REPAIR BAG PLEURAL DRAINAGE	272		43	N/A	N/A	N/A
HC62213939	CANNULA PERFUSION                 F	272		280	N/A	N/A	N/A
HC62214101	CATH URETERAL                     A	272	C1758	34	N/A	N/A	N/A
HC62214135	CATH URETERAL                     D	272	C1758	215	N/A	N/A	N/A
HC62214317	CATH URETERAL                     Y	272	C1758	560	N/A	N/A	N/A
HC62214341	PROBE PEDICLE	272		1,195	N/A	N/A	N/A
HC62214374	SHEARS COAGULATING HARMONIC       N	272		1,050	N/A	N/A	N/A
HC62214523	RETRACTOR DISPOSABLE              H	272		717	N/A	N/A	N/A
HC62214556	RETRACTOR DISPOSABLE              K	272		1,190	N/A	N/A	N/A
HC62214580	KIT SPINAL ACCESS DISPOSBL(MAXCESS)	272		4,480	N/A	N/A	N/A
HC62214754	CATH PTCA BALLOON NON-LASER       T	272	C1725	4,200	N/A	N/A	N/A
HC62214788	CATH PTCA BALLOON NON-LASER       W	272	C1725	5,250	N/A	N/A	N/A
HC62215264	BLADE SAW                         M	272		698	N/A	N/A	N/A
HC62215298	BLADE SAW                         P	272		324	N/A	N/A	N/A
HC62215462	KIT HARVESTING BONE GRAFT         W	272		3,500	N/A	N/A	N/A
HC62215496	PROBE SPINAL DISPOSABLE          AA	272		2,301	N/A	N/A	N/A
HC62215520	RETRIEVER STENT BILI SOEHENDRA	272		438	N/A	N/A	N/A
HC62215660	SUTURE                            R	272		490	N/A	N/A	N/A
HC62215694	SUTURE                            V	272		602	N/A	N/A	N/A
HC62215728	SUTURE                            Y	272		685	N/A	N/A	N/A
HC62215892	NEEDLE BIOPSY                     K	272		294	N/A	N/A	N/A
HC62215926	TRAY BONE MARROW                  F	272		84	N/A	N/A	N/A
HC62216098	DEVICE SUTURE ENDO                H	272		840	N/A	N/A	N/A
HC62216122	STENT REMOVER                     E	272		700	N/A	N/A	N/A
HC62216155	SPHINCTEROTOME CANNULATING        H	272		1,120	N/A	N/A	N/A
HC62216304	NEEDLE BIOPSY BONE                F	272		280	N/A	N/A	N/A
HC62216338	NEEDLE INTRODUCER                 I	272		490	N/A	N/A	N/A
HC62216361	NEEDLE INTRODUCER                 O	272		700	N/A	N/A	N/A
HC62216510	PIN/WIRE FIXATION TEMPORARY       N	272		247	N/A	N/A	N/A
HC62216544	PIN/WIRE FIXATION TEMPORARY       Q	272		335	N/A	N/A	N/A
HC62216577	PIN/WIRE FIXATION TEMPORARY       T	272		425	N/A	N/A	N/A
HC62216759	PIN/WIRE FIXATION TEMPORARY      AL	272		1,797	N/A	N/A	N/A
HC62216783	INSERTER TIP SURGICAL             H	272		1,107	N/A	N/A	N/A
HC62216957	KIT MONITORING NERVE(S) SPINAL    F	272		3,150	N/A	N/A	N/A
HC62216981	NEEDLE TARGETING                  G	278		350	N/A	N/A	N/A
HC62217013	KIT SPINAL ACCESS DISPOSBL       AB	272		10,360	N/A	N/A	N/A
HC62217153	SLITTER CATH ADJUST	272		57	N/A	N/A	N/A
HC62217187	PAD BOOT	274		271	N/A	N/A	N/A
HC62217211	NEEDLES 5/PACK ENDOSCOPIC         W	272		683	N/A	N/A	N/A
HC62217385	DEVICE FIXATION TACKER(LAP)	272		2,343	N/A	N/A	N/A
HC62217419	DEVICE LIGATOR                    K	272		1,260	N/A	N/A	N/A
HC62217583	DRAIN ADAPTOR                     D	272		64	N/A	N/A	N/A
HC62217617	AWL SPINAL SINGLE PATIENT USE     E	272		560	N/A	N/A	N/A
HC62217781	NEEDLE BONE MARROW                G	272		490	N/A	N/A	N/A
HC62217815	TEMPLATE STAPLE SPINAL            G	272		630	N/A	N/A	N/A
HC62217849	CLOSURE WND EXPANDER TISSUE       B	272		3,672	N/A	N/A	N/A
HC62217989	INSERTER TIP SURGICAL             G	272		350	N/A	N/A	N/A
HC62218011	TUBING SET OPHTH INJECT/EXTRACT	272		207	N/A	N/A	N/A
HC62218045	BLADE OPHTHALM                    B	272		29	N/A	N/A	N/A
HC62218219	CATH DIAGNOSTIC                   R	272		1,802	N/A	N/A	N/A
HC62218243	CATH INTRODUCER PEEL-AWAY         G	272	C1892	176	N/A	N/A	N/A
HC62218417	ENDO STAPLER                      O	272		1,023	N/A	N/A	N/A
HC62218441	ENDO STAPLER                      R	272		1,260	N/A	N/A	N/A
HC62218615	ELECTRODE HOOK ARTHROSCOPIC	272		79	N/A	N/A	N/A
HC62218649	TRACKER INSTRUMENT FUSION ENT	272		560	N/A	N/A	N/A
HC62218672	DRILL/DRILL BITS SINGLE USE       B	272		92	N/A	N/A	N/A
HC62218813	DRILL/DRILL BITS SINGLE USE       P	272		776	N/A	N/A	N/A
HC62218847	DRILL/DRILL BITS SINGLE USE       S	272		988	N/A	N/A	N/A
HC62218870	DRILL/DRILL BITS SINGLE USE       V	272		1,283	N/A	N/A	N/A
HC62219043	PORT INSTRMNT MULTI LAPAROSCPC	272		1,914	N/A	N/A	N/A
HC62219076	CAP ENDOSEAL	272		56	N/A	N/A	N/A
HC62219241	CUTTER SUTURE INCL SURECUT        Q	272		1,400	N/A	N/A	N/A
HC62219274	DEVICE RETRIEVAL                  H	272	C1773	3,850	N/A	N/A	N/A
HC62219316	EMBOLIZATN PROTECT SYSTEM(SPIDER) H	278	C1884	3,850	N/A	N/A	N/A
HC62219464	SYSTEM DELIVERY LEAD              J	272	C1887	2,450	N/A	N/A	N/A
HC62219498	ORTHOSIS ANKLE GAUNTLET PRFB	274	L1902	71	N/A	N/A	N/A
HC62219522	PASSER SURGICAL INCL PERITONEAL   I	272		498	N/A	N/A	N/A
HC62219704	KIT VITRECTOMY PROBE              C	272		420	N/A	N/A	N/A
HC62219738	KIT VITRECTOMY PROBE              M	272		2,450	N/A	N/A	N/A
HC62219902	CANNULA ARTHRSCPC ROTATING        K	272		1,977	N/A	N/A	N/A
HC62219936	DISSECTOR ULTRASONIC CORDLESS	272		2,100	N/A	N/A	N/A
HC62220108	ACCESS PORTL TRANSJUG INTRAHEP HSKL	272		2,205	N/A	N/A	N/A
HC62220132	OVERTUBE ENDOSCOPIC               C	272	A4270	1,400	N/A	N/A	N/A
HC62220165	BLADE SAW                        AA	272		616	N/A	N/A	N/A
HC62220306	ORTHOTIC KNEE ELSTC W/JNT PRFB CSTM	274	L1810	71	N/A	N/A	N/A
HC62220330	PIN DISTRACTOR	272		78	N/A	N/A	N/A
HC62220363	SHIM DEVICE ACCESS SPINAL        AK	272		7,000	N/A	N/A	N/A
HC62220538	DERMABOND                         F	272		280	N/A	N/A	N/A
HC62220561	INTRO/SHEATH EP FIXED NON-PEEL    E	272	C1893	420	N/A	N/A	N/A
HC62220736	COUNTERSINK CANNULATED            L	272		910	N/A	N/A	N/A
HC62220769	SUPPORT/BRACE LIMB	274	A4467	46	N/A	N/A	N/A
HC62220934	CATH CENTRAL VENOUS               A	272	C1751	36	N/A	N/A	N/A
HC62220967	CATH CENTRAL VENOUS               E	272	C1751	210	N/A	N/A	N/A
HC62220991	CATH UMBILICAL                    A	272		36	N/A	N/A	N/A
HC62221148	KIT PRESSURE MONITOR/TRANSDUCER   F	272		280	N/A	N/A	N/A
HC62221171	KIT SUPRA PUBIC CATH              G	272		350	N/A	N/A	N/A
HC62221205	KIT W/ TRACH PERCUTANEOUS         D	272	A7520	1,120	N/A	N/A	N/A
HC62221379	STAPLER SKIN                      F	272		280	N/A	N/A	N/A
HC62221403	TRAY THORAC/PARACENTESIS          B	272		84	N/A	N/A	N/A
HC62221577	MANIPULATOR UTERINE               C	272		106	N/A	N/A	N/A
HC62221601	CANNULA CEMENT BONE               Q	272		1,400	N/A	N/A	N/A
HC62221635	CATH GUIDING EXTENSION(GUIDEZILLA)Q	272	C1887	1,400	N/A	N/A	N/A
HC62221775	CLIP ENDOSCOPIC                   I	272		490	N/A	N/A	N/A
HC62221809	TAP SURGICAL                      J	272		560	N/A	N/A	N/A
HC62221833	TAP SURGICAL                      M	272		905	N/A	N/A	N/A
HC62221973	PIN CHECKPOINT KNEE ROBOTIC	272		344	N/A	N/A	N/A
HC62222013	GRASPER ALLIGATOR ENDO            L	272		700	N/A	N/A	N/A
HC62222047	VESSEL DILATOR                    B	272		56	N/A	N/A	N/A
HC62222229	CATH GUIDING                      F	272	C1887	280	N/A	N/A	N/A
HC62222252	CATH EP DX <20 ELECTRODES         G	272	C1730	980	N/A	N/A	N/A
HC62222427	INSERTER FUNNEL IMPLANT BREAST	272		364	N/A	N/A	N/A
HC62222450	WAND ARTHRO                       D	272		140	N/A	N/A	N/A
HC62222484	WAND ARTHRO                       N	272		980	N/A	N/A	N/A
HC62222625	ELECTRODE ROLLER BALL             L	272		700	N/A	N/A	N/A
HC62222658	SCALPEL HARMONIC ELECTRODE HOOK	272		507	N/A	N/A	N/A
HC62222682	BLADE OPHTHALM                    F	272		84	N/A	N/A	N/A
HC62222856	PAD GROUNDING                     A	272		36	N/A	N/A	N/A
HC62222880	PAIN PUMP W/ SYSTEM               S	272		2,100	N/A	N/A	N/A
HC62223052	APPLIER LIGA/HEMOCLIP ENDO        N	272		840	N/A	N/A	N/A
HC62223086	TUBING ASPIRATOR (SONASTAR)       S	272		2,100	N/A	N/A	N/A
HC62223250	WIRE PACING TEMP                  F	272		154	N/A	N/A	N/A
HC62223284	TUBE BRACHY TX SEED ADMIN         A	272		70	N/A	N/A	N/A
HC62223318	KIT ACCESSORY                     J	272		840	N/A	N/A	N/A
HC62223458	INTRODUCER/SHEATH                 W	272	C1894	2,452	N/A	N/A	N/A
HC62223482	ORTHOTIC KNEE W/JNTS PRFB CUSTM   A	274	L1832	140	N/A	N/A	N/A
HC62223516	ORTHOSIS HUMERAL FRACTURE	274	L3980	1,260	N/A	N/A	N/A
HC62223680	FUNNEL GRAFT BONE BIOCARTLG	272		98	N/A	N/A	N/A
HC62223714	SYSTEM MIX/DELIVR GRAFT BIOCARTLG	272		662	N/A	N/A	N/A
HC62223888	PORT ENDOSCOPIC	272		162	N/A	N/A	N/A
HC62223912	INTRODUCER/SHEATH(NEURON MAX)     U	272	C1894	1,750	N/A	N/A	N/A
HC62223946	SYSTEM COLLECTION/TRANSFER FAT	272		2,292	N/A	N/A	N/A
HC62224084	CANNULA AORTIC ARCH               B	272		70	N/A	N/A	N/A
HC62224118	CUTTER LINEAR ENDO                M	272		840	N/A	N/A	N/A
HC62224142	GUIDE PIN ORTHO                   B	272		70	N/A	N/A	N/A
HC62224282	DEVICE FIXATION SOFT TISSUE	272		1,786	N/A	N/A	N/A
HC62224316	RASP SPINAL DISPSBL	272		1,120	N/A	N/A	N/A
HC62224340	APPLIER LIGA/HEMOCLIP ENDO        F	272		280	N/A	N/A	N/A
HC62224514	SPLINT ELBOW/KNEE                 F	272		280	N/A	N/A	N/A
HC62224548	KIT HEYMAN CATH URETHRA OBSTRUCT	272		784	N/A	N/A	N/A
HC62224720	ORTHOTIC WHO W/O JOINTS SPICA	274	L3906	120	N/A	N/A	N/A
HC62224753	CATH EP DX <20 ELECTRODES   RPRSD H	272	C1730	420	N/A	N/A	N/A
HC62224787	GUIDE PIN ORTHO                   D	272		413	N/A	N/A	N/A
HC62224928	CATH BALLOON DIL NON VASCULAR     S	272	C1726	2,100	N/A	N/A	N/A
HC62224951	PROBE LITHOTRIPTOR                F	272		280	N/A	N/A	N/A
HC62224985	RETRIEVER SUTURE                  D	272		140	N/A	N/A	N/A
HC62225156	RESERVOIR CSF VENTRICULAR	272		442	N/A	N/A	N/A
HC62225180	STRAP FLEXION FINGER	274	L3908	42	N/A	N/A	N/A
HC62225354	CATH ERCP (PUSHING)               B	272		350	N/A	N/A	N/A
HC62225388	KIT REPAIR BROVIAC/CV/HICKMAN     F	272		666	N/A	N/A	N/A
HC62225552	INJECTOR GRAFT/STENT	272		4,290	N/A	N/A	N/A
HC62225594	DRESSING COLLAGEN W/ AG	272		294	N/A	N/A	N/A
HC62225644	CATH EP/ABLATION COOL-TIP         L	272	C2630	6,650	N/A	N/A	N/A
HC62225784	SYSTEM DRESSING WOUND NEG PRES    T	272		2,500	N/A	N/A	N/A
HC62225818	GUIDE DRILL                       H	272		420	N/A	N/A	N/A
HC62225859	GUIDE DRILL                       M	272		840	N/A	N/A	N/A
HC62226022	COUNTERSINK                       R	272		1,750	N/A	N/A	N/A
HC62226055	SPIKE BONE ORTHO	272		280	N/A	N/A	N/A
HC62226238	DRILL/DRILL BITS SINGLE USE      AR	272		4,833	N/A	N/A	N/A
HC62226261	KIT DILATOR SPINAL	272		3,719	N/A	N/A	N/A
HC62226444	STYLET CARDIAC                    C	272		176	N/A	N/A	N/A
HC62226477	TUBE BRACHY TX SEED ADMIN         G	272		280	N/A	N/A	N/A
HC62226501	CHARGER BATTERY NEUROSTIM         B	271	L8689	5,229	N/A	N/A	N/A
HC62226642	TAP SURGICAL                      V	272		3,150	N/A	N/A	N/A
HC62226675	INTRODUCER/SHEATH                 X	272	C1894	2,800	N/A	N/A	N/A
HC62226709	GUIDE DRILL                       E	272		210	N/A	N/A	N/A
HC62226881	GUIDEWIRE                         G	272	C1769	451	N/A	N/A	N/A
HC11200000	OBSERVATION PER HOUR	762	G0378	252	N/A	N/A	N/A
HC11200151	TRANSPORT EXTERNAL PICU RN ACCOMP(STATISTICAL)	222		N/A	N/A	N/A	N/A
HC11500006	EST PT LVL1-BRIEF	510	99211	172	N/A	N/A	N/A
HC11500550	LACTATION E&M COMPRHNS NEW:V	761	99205	365	N/A	N/A	N/A
HC11500667	WC NEW E&M ASSESS INTRMED LVL3	761	99203	446	N/A	N/A	N/A
HC11500691	WC ESTB E&M  BRIEF LVL1	761	99211	202	N/A	N/A	N/A
HC11500865	WM EXAM EST' PT EVAL LO/MODIII	761	99213	295	N/A	N/A	N/A
HC11500899	HOSPITAL OUTPATIENT CLINIC VISIT (FACILITY FEE)	510	99213	248	N/A	N/A	N/A
HC11500923	WM EXAM EST' PT EVAL  COMPLEX L 5	761	99215	461	N/A	N/A	N/A
HC12200069	IV PUSH SINGLE/INIT'L INJ	260	96374	622	N/A	N/A	N/A
HC12200093	IM OR SQ INJECTION THERAPEUTIC	260	96372	266	N/A	N/A	N/A
HC12200275	SC INFUSION THERAPY EA ADDL HOUR	260	96370	881	N/A	N/A	N/A
HC12200309	EXTENDED RECOVERY PER HOUR	710		234	N/A	N/A	N/A
HC12400081	CHEMO NONHRMNL ANTINEOPL SQ/IM	331	96401	965	N/A	N/A	N/A
HC12400115	INITIATE PROLONG CHEMO INFUSION PORTBL PUMP &F/U VISIT	335	G0498	2,175	N/A	N/A	N/A
HC12400149	CHEMO ADMIN INTRA ARTERIAL INFUSION UP TO 1 HR	335	96422	1,343	N/A	N/A	N/A
HC12600136	ADMIN VACCINE COVID-19 0.5ML AD26 INITIAL DOSE {JANSSEN }	771	0031A	139	N/A	N/A	N/A
HC12600169	ADMIN VACCINE COVID-19 10MCG TRS-SUCR PEDS DOSE INITIAL {PFIZER}	771	0071A	139	N/A	N/A	N/A
HC12600193	ADMIN VACCINE COVID-19 5X10 10VP/.5ML 2ND DOSE {ASTRAZENECA}	771	0022A	125	N/A	N/A	N/A
HC12600409	ADMIN VACCINE COVID-19 BIVALENT 50MCG/0.5ML BOOSTER {MODERNA}	771	0134A	115	N/A	N/A	N/A
HC12800025	THER APHERESIS PLASMA CX/DC'D	361	36514	3,589	N/A	N/A	N/A
HC14500078	SS-NUTRIT-POST PARTUM EA 15MIN	942	99212	202	N/A	N/A	N/A
HC14500102	DIABETIC SELF MGMT TRNG EA 30M	942	G0108	297	N/A	N/A	N/A
HC21000260	DEBRIDE OF NAILS: 6 OR >	361	11721	800	N/A	N/A	N/A
HC21000294	DEBRIDE P-THICK BURN LG>10%BSA	361	16030	2,252	N/A	N/A	N/A
HC21000344	DBRD SKIN MUSCL UP TO 20 SQCM	361	11043	4,651	N/A	N/A	N/A
HC21000526	PAIRING BENIGN LESIONS: 2-4	361	11056	906	N/A	N/A	N/A
HC21000559	PREP TRUNK/EXT EA ADDL 100SQCM	361	15003	3,334	N/A	N/A	N/A
HC21000583	TRIM NONDYSTROPHIC NAILS	361	11719	573	N/A	N/A	N/A
HC21000765	COMPARTM'L PRESSURE MEASURM'NT	361	20950	2,250	N/A	N/A	N/A
HC21000799	APPY SKIN SUB T A L 1ST 100SQ~HC	361	15273	5,656	N/A	N/A	N/A
HC21001029	REMOV IMPACTD EAR WAX(INSTRUMENT) LT	361	69210	382	N/A	N/A	N/A
HC21001052	REMOV IMPACTD EAR WAX IRRIG/LAVG LT	361	69209	299	N/A	N/A	N/A
HC21001086	WOUND VAC TX W/ DISP ASST/INSTR >50SQ CM SESSION	940	97608	1,975	N/A	N/A	N/A
HC23000052	ASP/INJ JOINT SM W/O UTZ GUIDE-RT	361	20600	1,517	N/A	N/A	N/A
HC23000086	ASP/INJ JOINT MED W/O UTZ GUIDE-RT	361	20605	2,024	N/A	N/A	N/A
HC23000110	ASP/INJ JOINT LRG W/O UTZ GUIDE-RT	361	20610	2,827	N/A	N/A	N/A
HC23000433	INJ ANES/STEROID NERVE SCIATIC LT	361	64445	3,055	N/A	N/A	N/A
HC23000466	INJ ANES/STEROID NERVE SUPRASCAP LT	361	64418	2,222	N/A	N/A	N/A
HC23000516	INJ CELIAC PLEXUS	361	64530	6,340	N/A	N/A	N/A
HC23000797	INJ ANES/STEROID ILIOINGNL/ILIOHYPOGAS NERVE	361	64425	2,233	N/A	N/A	N/A
HC23000904	INJ ANES/STEROID NERVE/BRNCH PERIPH BIL	361	64450	4,939	N/A	N/A	N/A
HC23001076	INJ W/CATH PLCMT EPI LUMBAR W/O IMAG	361	62326	6,199	N/A	N/A	N/A
HC23001100	INJ/INF NEUROLYTIC LUMB/SACRAL	361	62282	4,846	N/A	N/A	N/A
HC23001134	DESTR C/T FAC JOINT SNGL W/IMG-B	361	64633	13,720	N/A	N/A	N/A
HC23001308	INJ S-I JOINT ANESTH W/IMAG BI	361	G0260	9,376	N/A	N/A	N/A
HC23001357	INJ CER/THOR F/IMAGE SNG LVLBI	361	64490	14,519	N/A	N/A	N/A
HC23001381	INJ CER/THOR F/IMAGE 2ND LVLBI	361	64491	6,709	N/A	N/A	N/A
HC23001563	INJ ANES/STEROID NERVE OCCIPITL GREAT LT	361	64405	1,814	N/A	N/A	N/A
HC23001597	INJ CERVICAL PLEXUS BLOCK LT	361	64999	2,427	N/A	N/A	N/A
HC23001761	ASP/INJ JOINT SM W/UTZ GUIDE-RT	361	20604	4,060	N/A	N/A	N/A
HC23001795	ASP/INJ JOINT MED W/UTZ GUIDE-RT	361	20606	4,735	N/A	N/A	N/A
HC23001969	DESTR NERVE GENICULAR W/NEUROLYT AGNT W/IMAGE BI	361	64624	7,667	N/A	N/A	N/A
HC23001993	ABLATE RF NERVE SACROILIAC JT INNRV W/IMAGE	361	64625	6,836	N/A	N/A	N/A
HC23002025	ABLATE RF NERVE SACROILIAC JT INNRV W/IMAGE RT	361	64625	6,836	N/A	N/A	N/A
HC25000043	ED LEVEL V - COMPREHENSIVE	450	99285	4,849	N/A	N/A	N/A
HC25000076	LEFT W/O BEING SEEN BY MD (QA)	450		N/A	N/A	N/A	N/A
HC25000100	CRICOTHYROIDOSTOMY	450	31605	1,665	N/A	N/A	N/A
HC25000282	LAC REPAIR 20.1-30CM(LARGE)	450		711	N/A	N/A	N/A
HC25000316	LAC REPAIR 7.6-12 5CM(MEDIUM)	450		552	N/A	N/A	N/A
HC25000514	SPLINT FINGER STATIC	450	29130	679	N/A	N/A	N/A
HC25000548	SPLINT SHORT ARM	450	29125	730	N/A	N/A	N/A
HC25000571	BLADDER IRRIGATION SIMPLE	450	51700	937	N/A	N/A	N/A
HC25000894	ASP/INJ LARGE JOINT-BILAT	450	20610	2,320	N/A	N/A	N/A
HC25000928	ANOSCOPY DIAGNOSTIC	450	46600	691	N/A	N/A	N/A
HC25000951	INCISION EXTERNAL HEMORRHOID	450	46083	1,882	N/A	N/A	N/A
HC25001124	INSRT BLADDER CATH-NON INDWELL	450	51701	648	N/A	N/A	N/A
HC25001157	PLCMNT CENTRAL VEN CATH<5 YR	450	36555	5,789	N/A	N/A	N/A
HC25001181	THORACENTESIS ASP W/O IMG GUID-LT	450	32554	2,119	N/A	N/A	N/A
HC25001421	TRAUMA ACTVTN II INTRM	682	G0390	24,283	N/A	N/A	N/A
HC25001504	REMOV IMPACTD EAR WAX(INSTRUMENT) RT	450	69210	267	N/A	N/A	N/A
HC25002759	INSERT PICC >5 YR AGE W/ IMAGING	450	36573	6,059	N/A	N/A	N/A
HC25002825	I&D POLINIDAL CYST; SIMPLE	450	10080	1,667	N/A	N/A	N/A
HC25002858	DEBRIDE ECZEM/INFCT SKIN UP TO 10% BSA	450	11000	1,663	N/A	N/A	N/A
HC25002999	LAC REPAIR SIMPLE F/E/E/N/L/M 2.6-5.0 CM	450	12013	768	N/A	N/A	N/A
HC25003021	LAC REPAIR SIMPLE F/E/E/N/L/M 12.6-20.0 CM	450	12016	1,123	N/A	N/A	N/A
HC25003054	CLOSURE SUPERFCL WOUND DEHISC SIMPLE	450	12020	1,534	N/A	N/A	N/A
HC25003229	LAC REPAIR INTMD F/E/E/N/L/MM 7.6-12.5CM	450	12054	1,889	N/A	N/A	N/A
HC25003252	LAC REPAIR INTMD F/E/E/N/L/MM  >30.0CM	450	12057	2,538	N/A	N/A	N/A
HC25003427	CLOSED TX NOSE FX W/ STABILIZATION	450	21320	3,396	N/A	N/A	N/A
HC25003450	CLOSED TX CLAVICLE FX LT	450	23500	825	N/A	N/A	N/A
HC25003625	REMOVE FB UPPER ARM/ELBOW DEEP-BIL	450	24201	6,804	N/A	N/A	N/A
HC25003658	CLOSED TX ELBOW DISLOC W/O ANES LT	450	24600	936	N/A	N/A	N/A
HC25003682	CLOSED TX ELBOW DISLOCATION LT	450	24640	748	N/A	N/A	N/A
HC25003823	CLOSED TX RAD&ULN SHAFT FX W/MAN RT	450	25565	3,739	N/A	N/A	N/A
HC25003856	CLOSED TX RAD/EPHYSL SEP&ULN FX NO M-BIL	450	25600	1,377	N/A	N/A	N/A
HC25003880	CLOSED TX RAD/EPHYSL SEP&ULN FX W/MAN RT	450	25605	4,088	N/A	N/A	N/A
HC25004052	CLOSED TX THUMB DISLOC W/MANIP RT	450	26641	763	N/A	N/A	N/A
HC25004086	CLOSED TX THUMB FX DISLOC W/MAN(BENNETT)RT	450	26645	3,614	N/A	N/A	N/A
HC25004250	I&D ABSCESS/BURSA/HEMATOMA THIGH/KNEE DEEP RT	450	27301	4,738	N/A	N/A	N/A
HC25004284	REMOVE FB DEEP THIGH/KNEE AREA RT	450	27372	4,607	N/A	N/A	N/A
HC25004458	CLOSED TX PROX FIBULA/SHAFT FX; W/MANIP LT	450	27781	3,761	N/A	N/A	N/A
HC25004482	CLOSED TX BIMALLEOLA ANKLE FX; W/MANIP LT	450	27810	4,037	N/A	N/A	N/A
HC25004516	CLOSED TX PROX TIBIOFIBULAR JNT DISLOC; NO ANES LT	450	27830	913	N/A	N/A	N/A
HC25004656	CLOSED TX METATARSAL FX; W/MANIPULTN EA	450	28475	861	N/A	N/A	N/A
HC25004680	CLOSED TX BIG TOE FX; NO MANIPULTN BIL	450	28490	1,526	N/A	N/A	N/A
HC25004714	CLOSED TX BIG TOE FX; W/MANIPULTN BIL	450	28495	1,676	N/A	N/A	N/A
HC25004888	APPLY CAST; SHOULDER TO HAND (LONG ARM) BILAT	450	29065	1,806	N/A	N/A	N/A
HC25004912	APPLY CAST; ELBOW TO FINGER (SHORT ARM) BILAT	450	29075	1,717	N/A	N/A	N/A
HC25005083	STRAPPING; ANKLE AND/OR FOOT RT	450	29540	439	N/A	N/A	N/A
HC25005117	WEDGING CAST EXCEPT CLUBFOOT	450	29740	818	N/A	N/A	N/A
HC25005141	CONTROL NASAL HEMORRHAGE POSTERIOR W/PACKS+/OR CAUTRY INT'L	450	30905	563	N/A	N/A	N/A
HC25005281	I&D ABSCESS PERITONSILLAR BILAT	450	42700	1,156	N/A	N/A	N/A
HC25005315	I&D ABSCESS SUBMUCSL RECTUM	450	45005	2,670	N/A	N/A	N/A
HC25005349	HEMORRHOIDECTOMY/BANDING	450	46221	2,263	N/A	N/A	N/A
HC25005513	REMOVE FB EXTRNL EYE; CONJUNCT EMBEDD BIL	450	65210	1,870	N/A	N/A	N/A
HC25005547	REMOVE FB EXTRNL EYE; CORNEAL NO SLITLAMP BIL	450	65220	1,760	N/A	N/A	N/A
HC25005711	AMPUTATE FINGER/THUMB SGL W/CLOSURE LT	450	26951	3,950	N/A	N/A	N/A
HC25005745	CLOSED TX HIP FX W/MANIP LT	450	27222	1,312	N/A	N/A	N/A
HC25005919	INJ ANES/STEROID NERVE OCCIPITL GREAT RT	450	64405	716	N/A	N/A	N/A
HC25005943	PARACENTESIS EYE W/REMOVAL AQUEOUS RT	450	65800	2,544	N/A	N/A	N/A
HC25005984	NEW PT LVL4-DETAILED	510	99204	444	N/A	N/A	N/A
HC25006123	AMNIOCENTESIS FLUID REDUCTION	450	59001	2,577	N/A	N/A	N/A
HC25006156	FETAL NON-STRESS TEST	450	59025	943	N/A	N/A	N/A
HC25006180	BREECH VERSION EXTERNAL MANIP	450	59412	3,673	N/A	N/A	N/A
HC25090127	P: PLCMNT CVC>5 YR+TRPL LMN CATH			N/A	N/A	N/A	N/A
HC25090150	P: INSRT NDL INTRAOSSS INF+SET NDL			N/A	N/A	N/A	N/A
HC25090325	P: I&D ABSCESS			N/A	N/A	N/A	N/A
HC25090358	P: LAC REPAIR 12.6-20CM			N/A	N/A	N/A	N/A
HC25090531	P: I&D ABSCESS			N/A	N/A	N/A	N/A
HC25090564	P: THORACENT PNCT-R+1THORA VENT KIT			N/A	N/A	N/A	N/A
HC25090598	P: INSERT PICC >5 YR AGE W/ IMAGING + PICC LINE			N/A	N/A	N/A	N/A
HC26000141	FETAL MONITORING (STATISTICAL)	720		N/A	N/A	N/A	N/A
HC26000174	L&D EVAL LEVEL III - INTERMED	720	99213	1,322	N/A	N/A	N/A
HC27000009	ANORECTAL MANOMETRY	750	91122	4,704	N/A	N/A	N/A
HC27000223	COLONOSCOPY STOMA W/FRN BDY(S)REMOV	750	44390	3,798	N/A	N/A	N/A
HC27000256	COLONOSCOPY THRU STOMA INCL COLLECTN	750	44388	3,768	N/A	N/A	N/A
HC27000462	EGD W/TUMR/LES REMOV HOT BX~FO	750	43250	4,179	N/A	N/A	N/A
HC27000496	EGD W/SCLEROTHERAPY ~FO	750	43243	4,562	N/A	N/A	N/A
HC27000538	EGD W/TUMR/LES REMOV W/SNARE~FO	750	43251	4,108	N/A	N/A	N/A
HC27000678	ENTEROSCOPY(ILEUM) W/BLEED CON	750	44378	6,626	N/A	N/A	N/A
HC27000728	ERCP W/BIOPSY	750	43261	6,430	N/A	N/A	N/A
HC27000777	ERCP W/SPHINCTER/PAPILLOTOMY	750	43262	6,580	N/A	N/A	N/A
HC27000983	GI TRACT CAPSULE ENDO IMAG ESOPHAGUS ONLY	750	91111	7,829	N/A	N/A	N/A
HC27001023	ILEOSCOPY THRU STOMA INCL COLLECTN	750	44380	5,990	N/A	N/A	N/A
HC27001064	REPOSIT GASTRO FEED TUBE(PEG)	750	43761	5,586	N/A	N/A	N/A
HC27001247	ESOPH MOTILTY STDY/STIM/PERF2D	750	91013	2,799	N/A	N/A	N/A
HC27001288	ENDO PANCREATOSCOPY DUCT(S) +	750	43273	6,032	N/A	N/A	N/A
HC27001478	ESOPHSCPY W/STENT (DIL PRE-POST) ~FO	750	43212	6,661	N/A	N/A	N/A
HC27001502	ESOPHSCPY W/BAND VARICES ~FO	750	43205	4,898	N/A	N/A	N/A
HC27001536	ESOPHSCPY W/LES(S) REMOV HOT BX ~FO	750	43216	5,656	N/A	N/A	N/A
HC27001676	COLONOSCOPY STOMA W/EUS FNA/BX COLON	750	44407	3,990	N/A	N/A	N/A
HC27001700	SIGMOIDOSCOPY FLEX  W/PLACE STENT	750	45347	4,446	N/A	N/A	N/A
HC27001734	COLONOSCOPY FLEX ABLAT TUMR/POLYP/LESN GUIDEWIRE	750	45388	4,573	N/A	N/A	N/A
HC27001908	INSTILL FECAL MICROBIOTA (FMT)	750	G0455	4,021	N/A	N/A	N/A
HC27001932	BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F 1ST 15MIN	917	90912	219	N/A	N/A	N/A
HC28000131	CR NEW PT EVAL LVL5-(60MIN)	510	99205	657	N/A	N/A	N/A
HC29000296	TB TEST (PPD) PROCEDURE	300	86580	134	N/A	N/A	N/A
HC29000650	ADMIN/INTERP RISK ASSESS INSTR CAREGIVER FCS	770	96161	165	N/A	N/A	N/A
HC29000700	EXAM CERVICAL OR VAGINAL SCREENING	770	G0101	364	N/A	N/A	N/A
HC31000029	PT-APPLIC CAST SHORT LEG WALK	420	29425	1,207	N/A	N/A	N/A
HC31000185	PT-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	420	96110	431	N/A	N/A	N/A
HC31000219	PT-PHYS PERFORM TEST 15 MIN/M	424	97750	199	N/A	N/A	N/A
HC31000292	PT-HUBBARD TANK 15MIN/M	420	97036	231	N/A	N/A	N/A
HC31000466	PT-RE-EVAL EST POC 30MIN	424	97164	456	N/A	N/A	N/A
HC31000607	PT- TM CONF INTERDISCPLN NO PT/FAM  WQHCP 30MIN	420	99368	261	N/A	N/A	N/A
HC31000847	PT-WOUND VAC 60MIN<50 SQ CM/M	420	97605	766	N/A	N/A	N/A
HC31000870	PT-WOUND VAC 45MIN>50 SQ CM/M	420	97606	706	N/A	N/A	N/A
HC31000912	PT-RE-EVAL ADDL 15MIN/CW	420		218	N/A	N/A	N/A
HC31001050	PT-MASSAGE  ADD 15MIN/CW	420		168	N/A	N/A	N/A
HC31001084	PT-MANUAL THER MYOFASC REL/W	420		236	N/A	N/A	N/A
HC31001118	PT-ORTHOTIC FIT/TRNG 30MIN/CW	420		352	N/A	N/A	N/A
HC31001324	PT-HUBBARD TANK ADD15MIN/CW	420		175	N/A	N/A	N/A
HC31001365	PT-RE-EVAL EST POC 75MIN	424	97164	936	N/A	N/A	N/A
HC31001449	PT-TEST/MEASUREMENT ADD15MIN/C	424		203	N/A	N/A	N/A
HC31001621	PT-WHEELCHAIR MGT 30MIN/C	420		378	N/A	N/A	N/A
HC31001654	PT-WD SEL DEBRID<20CM 15MIN+/C	420		212	N/A	N/A	N/A
HC31001852	CAST ROOM USE	700		383	N/A	N/A	N/A
HC31001886	PT-WHEELCHAIR ASSESS 15 MIN/M	424	97750	199	N/A	N/A	N/A
HC31001910	LOCOMOTOR TRAINING/W	420	97799	740	N/A	N/A	N/A
HC31002090	PT-EVAL HIGH COMPLEXITY 45MF2F 45MIN	424	97163	734	N/A	N/A	N/A
HC31002132	PT-DEVEL TEST ADMIN ASSESS COG INSTR;  EA ADD 30MIN+	420	96113	210	N/A	N/A	N/A
HC31010002	PT-SELF/HOME MGMT/ADL 15MIN	420	97535	228	N/A	N/A	N/A
HC31010176	PT-BIOFEEDBACK PERINEAL MSCLS W/EMG&/MNMTRY F2F 1ST 15MIN	420	90912	218	N/A	N/A	N/A
HC31010234	PT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN	420	97761	209	N/A	N/A	N/A
HC31090046	P: PT DEVEL' TESTING 120 MIN/C			N/A	N/A	N/A	N/A
HC31090079	P: PT-EVAL 90MIN/C			N/A	N/A	N/A	N/A
HC32000119	OT-EVAL SWALLOW CINE/FLUORO 60MIN	434	92611	1,633	N/A	N/A	N/A
HC32000143	OT-PHYS PERFORM TEST 15 MIN/MW	430	97750	199	N/A	N/A	N/A
HC32000226	OT-HUBBARD TANK 15MIN/M	430	97036	231	N/A	N/A	N/A
HC32000366	OT-PARAFFIN BATH /CMW	430	97018	156	N/A	N/A	N/A
HC32000390	OT-RE-EVAL EST POC 30MIN	434	97168	474	N/A	N/A	N/A
HC32000424	OT-SENSRY INTEGRT TECH 15MIN	430	97533	200	N/A	N/A	N/A
HC32000663	OT-WHEELCHAIR MGT 15MIN	430	97542	213	N/A	N/A	N/A
HC32000705	OT-WORK HARDENING ADD 1HR/CMW+	430	97546	379	N/A	N/A	N/A
HC32000879	OT-IONTOPHORESIS 30MIN/CW	430		352	N/A	N/A	N/A
HC32000903	OT-ULTRASOUND  ADD 15MIN/CW	430		175	N/A	N/A	N/A
HC32001075	OT-FUNC ACTIVITY ADDL 15MIN/CW	430		196	N/A	N/A	N/A
HC32001109	OT-ADL 30MIN/CW	430		346	N/A	N/A	N/A
HC32001133	OT-WHEELCHAIR MGT ADD15MIN/C	430		192	N/A	N/A	N/A
HC32001323	OT- TM CONF INTERDISCPLN NO PT/FAM  WMD 30MIN	430	99367	271	N/A	N/A	N/A
HC32001356	OT-THER PROC GRP 30MIN/CMW	430	97150	190	N/A	N/A	N/A
HC32001380	OT-TRTMNT(ANY) INIT'L 30MIN	430		393	N/A	N/A	N/A
HC32001620	OT-APPLICATION CAST GAUNTLET	430	29085	844	N/A	N/A	N/A
HC32001653	OT-APPLICATION SPLINT SHORTARM	430	29125	918	N/A	N/A	N/A
HC32001836	OT-EVAL SWALLOW CINE/FLUORO 30MIN	434	92611	989	N/A	N/A	N/A
HC32001885	OT - STRAPPING; ELBOW OR WRIST	430	29260	550	N/A	N/A	N/A
HC32003295	OT-EVAL LOW COMPLEXITY 20MF2F 45MIN	434	97165	606	N/A	N/A	N/A
HC32010076	OT-EVAL LOW COMPLEXITY 30MIN F2F [15MIN]	434	97165	230	N/A	N/A	N/A
HC32010100	OT-RE-EVAL EST POC[15MIN]	434	97168	221	N/A	N/A	N/A
HC32010134	OT-ELEC STIM/TENS ATTD 15MIN	430	97032	195	N/A	N/A	N/A
HC32010365	OT-EVAL SWALLOW CINE/FLUORO 150MIN	434	92611	3,050	N/A	N/A	N/A
HC32010399	OT- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 45MIN	430	99366	325	N/A	N/A	N/A
HC32090086	P: ORTH WHO NONTORSION JOINT(S) (45MINUOS)			N/A	N/A	N/A	N/A
HC32090110	P: ORTH FO PIP/DIP W/ JOINT/SPRING (45MINUOS)			N/A	N/A	N/A	N/A
HC33000134	ST-ENDOSCOP EVAL SWALLOW/LARYN	444	92616	1,496	N/A	N/A	N/A
HC33000167	ST-EVAL RX SP GEN DEVC; 1ST HR	444	92607	1,609	N/A	N/A	N/A
HC33000191	ST-EVAL SWALLOW CINE/FLUORO 90MIN	444	92611	2,153	N/A	N/A	N/A
HC33000332	ST-SWALLOWING EVAL 60MIN	444	92610	1,641	N/A	N/A	N/A
HC33000365	ST-SWALLOWING EVAL  120MIN	444	92610	2,031	N/A	N/A	N/A
HC33000399	ST-SWALLOWING THERAPY  30 MIN	440	92526	659	N/A	N/A	N/A
HC33000670	ST- TM CONF INTERDISCPLN NO PT/FAM  WQHCP 30MIN	440	99368	253	N/A	N/A	N/A
HC33000704	ST-EVAL LANGUAGE CMPNT 90MIN	444	92521	1,093	N/A	N/A	N/A
HC33000928	ST EVAL SPEECH FLUENCY 60MIN/M	444	92521	659	N/A	N/A	N/A
HC33000969	ST EVAL SOUND PRODUCTION 30MIN/M	444	92522	293	N/A	N/A	N/A
HC33001157	ST EVAL SOUND W/LANG COMP&EXPRESS 45MIN/M	444	92523	757	N/A	N/A	N/A
HC33001207	ST-DEV COGNITIVE SKILL 30MIN/CW	440		352	N/A	N/A	N/A
HC33010026	ST-SWALLOWING EVAL [15MIN]	444	92610	310	N/A	N/A	N/A
HC33010232	ST-EVAL SWALLOW CINE/FLUORO 150MIN	444	92611	3,050	N/A	N/A	N/A
HC33010265	ST- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 60MIN	440	99366	375	N/A	N/A	N/A
HC33010299	ST- TM CONF INTERDISCPLN NO PT/FAM  WQHCP 45MIN	440	99368	300	N/A	N/A	N/A
HC34000141	OTOACOUSTIC EVOKED EMM COMP	471	92588	808	N/A	N/A	N/A
HC34000190	AUD-INFANT HEARING SCREEN AEP BBS AUTO INITIAL IP	471	92650	829	N/A	N/A	N/A
HC34000364	EVAL AUD FUNC SX IMPLANT ADD 15MIN	471	92627	389	N/A	N/A	N/A
HC34000398	UNLISTED ENT PROCEDURE/SERVICE	471	92700	208	N/A	N/A	N/A
HC35000033	REC- EVALUATION 45MIN	941	99214	632	N/A	N/A	N/A
HC35000272	REC- TM CONF INTERDISCPLN F2F PT/FAM WQHCP 60MIN	941	99366	375	N/A	N/A	N/A
HC35000306	REC TM CONF INTERDISCPLN NO PT/FAM  WQHCP 45MIN	941	99368	275	N/A	N/A	N/A
HC35000330	REC- TM CONF INTERDISPLNS 3MNM WPT PRES 60MIN	941	G0175	450	N/A	N/A	N/A
HC36000008	ADMIN SURFACTANT THRU TUBE	410	94610	559	N/A	N/A	N/A
HC36000032	AEROSOL-HHN TREATMENT INIT	412	94640	722	N/A	N/A	N/A
HC36000065	AEROSOL-IPPB TX SUBSQ SAME DAY	412	94640	665	N/A	N/A	N/A
HC36000255	TRACH TUBE CHANGE	361	31502	2,638	N/A	N/A	N/A
HC36000289	VENT DAY INIT-JET VENT	410	94002	8,123	N/A	N/A	N/A
HC36000735	IPV TREATMENT INITIAL	412	94640	798	N/A	N/A	N/A
HC36000792	METHGB QUANT TRANSCUTANEUS/DAY	300	88741	291	N/A	N/A	N/A
HC36000826	BRONCH DIAGNOSTIC	361	31622	6,234	N/A	N/A	N/A
HC36000966	RT INHALATION TREATMENT	410	94640	722	N/A	N/A	N/A
HC36001006	VENIPUNCTURE ROUTINE	300	36415	60	N/A	N/A	N/A
HC36001055	SPIROMETRY W/MEASUREMNTS& REC	460	94010	1,008	N/A	N/A	N/A
HC36800027	BRONCH DIAG W/BRUSHING	361	31623	6,561	N/A	N/A	N/A
HC36800050	BRONCH DIAGNOSTIC DC'D PROC	361	31622	2,352	N/A	N/A	N/A
HC36800274	PHYSIOLOGIC DATA COLLECTION	920	99091	84	N/A	N/A	N/A
HC36800357	PULSE OX NOCTURNAL STUDY	460	94762	1,563	N/A	N/A	N/A
HC36800555	RT RESP THER GRP 15 MIN/MW	410	G0239	126	N/A	N/A	N/A
HC36800589	RT RESP THER GRP 60 MIN/MW	410	G0239	460	N/A	N/A	N/A
HC36800613	METHEMOGLOBIN QUANT	300	83050	115	N/A	N/A	N/A
HC36800761	SPIROMETRY INF PRE&POST RX ADM	460	94012	1,282	N/A	N/A	N/A
HC36800795	ARTERIAL PUNCTURE	300	36600	586	N/A	N/A	N/A
HC36800837	BRONCH W/EBUS SAMPLING 3/> NODES	361	31653	10,604	N/A	N/A	N/A
HC37000106	NUTRITION SCREENING 15MIN (ST)	942		N/A	N/A	N/A	N/A
HC37000304	MNT RE ASSESS INDIV EA 15MIN   2ND REF (DX)	942	G0270	130	N/A	N/A	N/A
HC37090156	P: MNT RE-ASSESS 45 MIN-IP (ST)			N/A	N/A	N/A	N/A
HC38000006	APPLIC CAST LEG CLUBFOOT	700	29450	827	N/A	N/A	N/A
HC38000030	APPLY CAST LONG ARM	700	29065	1,059	N/A	N/A	N/A
HC38000170	USE OF CAST ROOM	700	99213	370	N/A	N/A	N/A
HC38000204	APPLY CMPRSSN BOOT/WRAP(UNNA)L	700	29580	914	N/A	N/A	N/A
HC38000246	APPLY BODY CAST;SHOLD-HIP-HEAD	700	29040	1,215	N/A	N/A	N/A
HC38000386	REPAIR SPICA BODY CAST	700	29720	1,069	N/A	N/A	N/A
HC38000410	APPLY TRACTN MECHANCL 1+ AREAS	700	97012	194	N/A	N/A	N/A
HC38420006	REMOVAL IABP DEVICE; PERC	481	33968	2,365	N/A	N/A	N/A
HC38420170	ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN	489	33954	18,537	N/A	N/A	N/A
HC38420204	ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER	489	33958	7,143	N/A	N/A	N/A
HC39000013	PSYCH TX W/PATIENT 30MIN	914	90832	452	N/A	N/A	N/A
HC39000120	PSYCH GRP TX(NOT MULTI FAMILY)60MIN/COMM	915	90853	284	N/A	N/A	N/A
HC39000179	PSY PREPARE REPORT 1 HOUR	919	90889	367	N/A	N/A	N/A
HC39000724	PSY PREPARE REPORT	919	90889	367	N/A	N/A	N/A
HC39000757	PSYCH ASSESS/INTERVEN EA30MIN/MCL	914		150	N/A	N/A	N/A
HC39000781	SW TEAM CONF PRTCPNT PER 15MIN	914		57	N/A	N/A	N/A
HC39001060	PSYCH THERAPY W/BIOFEEDBACK 45 MIN	900	90876	419	N/A	N/A	N/A
HC39001128	PSYCH EDUCATION TRNG SESS 45M/>	915	G0177	591	N/A	N/A	N/A
HC39001367	PSY-DEVEL TEST ADMIN ASSESS COG INSTR; 1ST HR	900	96112	489	N/A	N/A	N/A
HC39001391	PSY-TEST COGNITIVE PERFORMANCE STDRD PER HOUR	900	96125	674	N/A	N/A	N/A
HC41000050	POLYSOMNOGRAPHY CPAP/BIPAP 6&> ATTD	740	95811	7,478	N/A	N/A	N/A
HC41000084	POLYSMNGRPH 4+STGS <6 Y/O ATTD	740	95782	7,609	N/A	N/A	N/A
HC41000118	POLYSMNGRPH CPAP/BIPAP <6Y/O ATTD	740	95783	7,871	N/A	N/A	N/A
HC41500125	EEG INTRAOP NON-INTRACRANIAL	740	95955	1,478	N/A	N/A	N/A
HC41500166	EEG ROUTINE(AWAKE&ASLEEP)	740	95819	3,062	N/A	N/A	N/A
HC41500190	EMG 1 EXTREMITY	922	95860	1,423	N/A	N/A	N/A
HC41500422	SOMATOSENSORY LOWER LIMBS	922	95926	3,115	N/A	N/A	N/A
HC41500455	VASOMOTOR ADRENERGIC INNERV	920	95922	1,171	N/A	N/A	N/A
HC41500620	STUDIES NERVE CONDUCTN 13/> STUDIES	922	95913	3,177	N/A	N/A	N/A
HC41500653	MONITOR NEURO INTRAOP CONT REMOTE PER PT 15MIN+	920	G0453	244	N/A	N/A	N/A
HC41500844	EEG W/VIDEO MONITOR INTERMT 2-12 HR	740	95712	4,567	N/A	N/A	N/A
HC41500877	EEG W/VIDEO MONITOR INTERMT EA 12-26HR	740	95715	5,032	N/A	N/A	N/A
HC41500901	VESTIBULR EVOKD MYOGN POTENTL-VEMP;OCULAR (OVEMP)	471	92518	802	N/A	N/A	N/A
HC42000117	ECG ROUTINE 15 LEADS	730	93005	750	N/A	N/A	N/A
HC42000141	ECHO 2D LMTD W/O SPEC&CLR /DOP	483	93308	2,278	N/A	N/A	N/A
HC42000174	ECHO DOPPLER F/U OR LTD*	483	93321	1,494	N/A	N/A	N/A
HC42000380	INTERROGATE  PACEMAKER SGL/DUAL/MULTI/LEADLESS	480	93288	588	N/A	N/A	N/A
HC42000414	PROGRAM/EVAL T-ICD MULTI LEAD	480	93284	663	N/A	N/A	N/A
HC42000604	WCH EST PT LVL2-PROB FOCUS	510	99212	195	N/A	N/A	N/A
HC42000638	WCH EST PT LVL5-COMPREHEN	510	99215	312	N/A	N/A	N/A
HC42000703	ECHO CONGENITAL CMPLT W/ORWO FOL CONTR	483	C8921	4,483	N/A	N/A	N/A
HC42000877	INTERROGATE CV PHYS MONITOR REMOTE 30 DAYS	480	G2066	183	N/A	N/A	N/A
HC42000901	ECG EXT HOLTER W/CONNECT >7DAYS-15DAYS; RECORDING	731	93246	1,378	N/A	N/A	N/A
HC42000935	CTA CORO FFR ANLYSIS FLUID DYNAMICS&HYPEREMIA MAX SIM W/DATA MODEL	480	0503T	4,486	N/A	N/A	N/A
HC43000009	ABLATION CRYO BREAST FIBROADENOMA EA W/US	361	19105	8,898	N/A	N/A	N/A
HC43000066	BREAST BX CORE W/O GUIDE-BI	361	19100	4,989	N/A	N/A	N/A
HC43000694	DUCTOGRAM SINGLE RT	320	77053	1,425	N/A	N/A	N/A
HC43000736	US GUIDE CYST ASPIRATION LT	402	76942	1,900	N/A	N/A	N/A
HC43001106	MAMMO SCREENING W/CAD LEFT	403	77067	760	N/A	N/A	N/A
HC43001130	MAMMO DX LTD/FOCUS EXM W/CAD BIL	401	77066	970	N/A	N/A	N/A
HC43001163	MAMMO DX LTD/FOCUS EXM UNILT W/CAD RT	401	77065	895	N/A	N/A	N/A
HC44000008	3D RENDER W/ INDEPNDNT WORKSTN	320	76377	2,696	N/A	N/A	N/A
HC44000032	ABDOMEN W/DECUB &/OR ERECT (3/>VIEWS)	320	74021	1,057	N/A	N/A	N/A
HC44000065	AC JOINTS BILAT	320	73050	909	N/A	N/A	N/A
HC44000297	CALCANEUS (HEEL) BILAT	320	73650	1,159	N/A	N/A	N/A
HC44000321	CERVICAL SPINE 1 VIEW	320	72020	722	N/A	N/A	N/A
HC44000552	DACRYOCYSTOGRAPHY	320	70170	834	N/A	N/A	N/A
HC44000594	ELBOW 2 VWS BILAT	320	73070	1,385	N/A	N/A	N/A
HC44000768	FEMUR 2/> VIEWS BILAT	320	73552	1,951	N/A	N/A	N/A
HC44000792	FINGER(S) MIN 2 VWS-LT	320	73140	616	N/A	N/A	N/A
HC44000826	FLUORO GUIDE NDL PLCMT	320	77002	1,945	N/A	N/A	N/A
HC44000982	HAND 2 VIEWS LT	320	73120	689	N/A	N/A	N/A
HC44001014	HAND COMPLETE MIN 3 VWS LT	320	73130	897	N/A	N/A	N/A
HC44001048	HIP ARTHROGRAM LT	322	73525	1,863	N/A	N/A	N/A
HC44001329	IVP INFUSION DRIP OR BOLUS	320	74410	1,755	N/A	N/A	N/A
HC44001352	JNT SURVEY SNGL VW 2 OR>JNTS	320	77077	1,136	N/A	N/A	N/A
HC44001527	LUMBAR SPINE 1 VIEW	320	72020	722	N/A	N/A	N/A
HC44001550	LUMBAR SPINE W/BEND MIN 6 VWS	320	72114	1,622	N/A	N/A	N/A
HC44001584	MANDIBLE COMPLETE MIN 4 VWS	320	70110	1,145	N/A	N/A	N/A
HC44001725	PELVIS COMP MIN 3 VWS	320	72190	1,004	N/A	N/A	N/A
HC44001758	PYELOGRAM RETROGRADE	320	74420	2,034	N/A	N/A	N/A
HC44001782	RIBS BILAT MIN 4VWS W/PA CHEST	320	71111	1,233	N/A	N/A	N/A
HC44001931	SHOULDER 1 VIEW LT	320	73020	710	N/A	N/A	N/A
HC44001964	SHOULDER ARTHROGRAM LT	322	73040	1,835	N/A	N/A	N/A
HC44001998	SHOULDER COMP MIN 2VWS LT	320	73030	933	N/A	N/A	N/A
HC44002186	THORACIC SPINE 1VIEW	320	72020	722	N/A	N/A	N/A
HC44002210	THORACIC SPINE MIN 4 VIEWS	320	72074	1,068	N/A	N/A	N/A
HC44002467	UGI W/O KUB	320	74240	1,491	N/A	N/A	N/A
HC44002509	UROGRAPHY ANTEGRADE	320	74425	1,872	N/A	N/A	N/A
HC44002533	WRIST 2 VIEWS RT	320	73100	702	N/A	N/A	N/A
HC44002707	ELBOW - COMPLETE	320	73080	898	N/A	N/A	N/A
HC44002731	WRIST MIN 3 VIEWS	320	73110	876	N/A	N/A	N/A
HC44002764	KNEE 1 OR 2 VIEWS	320	73560	732	N/A	N/A	N/A
HC44002939	HIP (W/PELVIS WHN PRFRMD) 2-3VWS LT	320	73502	1,073	N/A	N/A	N/A
HC44002962	HIP (W/PELVIS WHN PRFRMD) 4/>VWS RT	320	73503	1,281	N/A	N/A	N/A
HC44089969	CDSM CRANBERRY PEAK	329	G1008	0	N/A	N/A	N/A
HC44200004	US ABDOMEN	402	76700	2,460	N/A	N/A	N/A
HC44200202	US DUPLEX CAROTID UNILAT RT	921	93882	1,997	N/A	N/A	N/A
HC44200236	US DUPLEX PENILE VESSEL COMP	921	93980	2,253	N/A	N/A	N/A
HC44200269	US DUPLEX VEIN EXT UNILAT/LTD	921	93971	2,159	N/A	N/A	N/A
HC44200418	US OB 1ST TRI/1ST GEST	402	76801	1,967	N/A	N/A	N/A
HC44200442	US OB FOLLOW UP EA ADD'L FETUS+	402	76816	1,182	N/A	N/A	N/A
HC44200475	US OB NUCHAL MEAS EA ADL GEST+	402	76814	1,247	N/A	N/A	N/A
HC44200673	US GUIDANCE AMNIOCENTESIS	402	76946	1,398	N/A	N/A	N/A
HC44200749	US GUIDE FNA LT	402	76942	1,949	N/A	N/A	N/A
HC44200921	US CHEST LTD	402	76604	820	N/A	N/A	N/A
HC44200954	US MAPPING VESSEL HEMODIALYSIS; COMPLT UNILAT	402	93986	1,296	N/A	N/A	N/A
HC44200988	US ELASTOGRAPHY ADDTL LESION	402	76983	496	N/A	N/A	N/A
HC44500239	ANGIO EXTREMITY UE OR LE RT	323	75710	8,831	N/A	N/A	N/A
HC44500288	ANGIO PULMONARY LT	323	75741	7,596	N/A	N/A	N/A
HC44500320	ANGIO PULMONARY NON SELECT RT	323	75746	6,685	N/A	N/A	N/A
HC44500650	PERC DRAINAGE TUBE/CATH	320	75984	2,172	N/A	N/A	N/A
HC44500684	CINERADIOGRAPHY(SEPARATE PROC)	320	76120	906	N/A	N/A	N/A
HC44500726	PERC DIL URETER/URETHRA S&I-LT	320	74485	2,570	N/A	N/A	N/A
HC44501005	INSERTION-TIPS	323	37182	53,277	N/A	N/A	N/A
HC44501211	MISC VASCULAR SURGICAL PROC	361	37799	7,591	N/A	N/A	N/A
HC44501807	REMOVE NEPHROSTOMY TUBE LT	361	50389	4,701	N/A	N/A	N/A
HC44501831	REMOVE URETERAL STENT LT	361	50384	11,119	N/A	N/A	N/A
HC44501872	SPLENOPORTOGRAM	323	75810	6,438	N/A	N/A	N/A
HC44502037	THROMBOLYSIS CEREBRAL/IV LT	361	37195	1,456	N/A	N/A	N/A
HC44502060	TRANSCATH EMBOLIZATION S&I	320	75894	11,077	N/A	N/A	N/A
HC44502185	VENOGRAM ADRENAL LT	320	75840	7,084	N/A	N/A	N/A
HC44502532	PERC DILATATION INTRACRANIAL VASSOSPASM INITIAL VESSEL -RT	361	61640	22,557	N/A	N/A	N/A
HC44502623	INSERT PLEURAL CATH TUNNELD RT	361	32550	14,785	N/A	N/A	N/A
HC44502839	REVASC FEM POP W/TLA-RT	323	37224	18,925	N/A	N/A	N/A
HC44502862	REVASC FEM POP W/TLA&ATHER-RT	323	37225	31,539	N/A	N/A	N/A
HC44503035	REVAS TIB/PERO W/TLA&STENT-BI	323	37230	51,258	N/A	N/A	N/A
HC44503068	REVAS TIB/PERO TLA&STNT&ATHR-B	323	37231	63,564	N/A	N/A	N/A
HC44503092	REVASC TIB/PERO EA+VES W/TLA-B	323	37232	29,034	N/A	N/A	N/A
HC44503233	ATHER' TRLUML ABD AORTA W/S&I	323	0236T	26,480	N/A	N/A	N/A
HC44503266	ATHER'TRLUML BRACH EAVES W/S&I-B	323	0237T	49,982	N/A	N/A	N/A
HC44503290	ATHER'TRLUML ILIAC EAVES W/S&I-B	323	0238T	57,454	N/A	N/A	N/A
HC44503613	REPOS IVC FILTER/S&I/IMG GUIDE	361	37192	11,556	N/A	N/A	N/A
HC44503662	VERT/THOR CAROTID STENT 1ST LT	361	0075T	45,391	N/A	N/A	N/A
HC44503837	SEL CATH  IC CAROTID &ANG IC W/SI RT	323	36224	23,620	N/A	N/A	N/A
HC44503860	SEL CATH VERTEBRAL &ANG VRT W/SI LT	323	36226	20,973	N/A	N/A	N/A
HC44504108	PERC TRNSCTH RENAL SYMP DENRV W/IMG UNILAT	361	0338T	13,618	N/A	N/A	N/A
HC44504132	SEL CATH CC/INOM &ANGIO EXCC W/S&I BI	323	36222	24,796	N/A	N/A	N/A
HC44504165	SEL CATH SUBC/INOM &ANG VRT W/SI BI	323	36225	26,164	N/A	N/A	N/A
HC44504306	PERC SACRAL AUGMT UNILAT W/ GUIDANCE&BX	361	0200T	14,057	N/A	N/A	N/A
HC44504330	PLCMT CATH BIL DRN PERC(CHOLANG S&I)EXTRNL	361	47533	15,619	N/A	N/A	N/A
HC44504363	PLCMT STNT BIL PERC EA(CHOLANG BLN DIL S&I)NEW ACC	361	47539	14,778	N/A	N/A	N/A
HC44504538	PLCMT URET STENT PERC(NEPH/URET'GRM S&I)PRE-EXIST LT	361	50693	13,496	N/A	N/A	N/A
HC44504561	PLCMT URET STENT PERC(NEPH/URET'GRM S&I)NEW ACCES LT	361	50694	17,531	N/A	N/A	N/A
HC44504736	ACCESS DIALYSIS CIRCUIT EVAL->VENA CAVA WS&I: PDS PTA STENT(S)	361	36903	18,261	N/A	N/A	N/A
HC44504769	THROMBECT &/THROMBOLYSIS DIALYSIS CIRC WS&I PHARM INJ; &PTA STENT(S)OF PDS	361	36906	29,805	N/A	N/A	N/A
HC44504793	EMBOLIZATION DIALYSIS CIRCUIT VEIN(S)WS&I+	361	36909	9,871	N/A	N/A	N/A
HC44504934	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE &TUBE PLC; NEW ACCESS RNL COL-RT	361	50437	17,359	N/A	N/A	N/A
HC44504967	PERC DILAT EXIST TRACT UROLOGIC PX W/IMAGE /&TUBE-RT	361	50436	10,565	N/A	N/A	N/A
HC44504991	PERC PULM ARTERY REVASC W/STENT INITL; NRML NTV BILAT	361	33901	31,719	N/A	N/A	N/A
HC44700235	ESOPHAGEAL RECORDING W/PACING	481	93616	4,929	N/A	N/A	N/A
HC44700334	INSERT ARTERIAL LINE LT	481	36620	956	N/A	N/A	N/A
HC44700508	INSRT/RPLC DUAL ICD GENERATOR	481	33240	25,173	N/A	N/A	N/A
HC44700532	INTRACARDIAC ECHO +	481	93662	7,525	N/A	N/A	N/A
HC44700904	PTA PULMONARY ARTERY SNGL	481	92997	19,776	N/A	N/A	N/A
HC44700995	REMOVAL ICD GENERATOR ONLY	481	33241	9,154	N/A	N/A	N/A
HC44701027	REMOVE SINGLE LEAD	481	33234	9,411	N/A	N/A	N/A
HC44701191	UPGRADE W/ ADD LV LEAD	481	33224	25,169	N/A	N/A	N/A
HC44701225	INSTILL FIBRIN CT SUB' DAY RT	361	32562	2,394	N/A	N/A	N/A
HC44701316	PERC IMPLANT NEURO ELEC; PERIP	481	64555	23,442	N/A	N/A	N/A
HC44701480	INJ PRO HRT CATH &IMAG; NONSELCT PULM ARTRL ANGIO+	481	93568	5,821	N/A	N/A	N/A
HC44701563	ADMIN RX;MULT MSRMNTS PRE/PST+	481	93463	1,078	N/A	N/A	N/A
HC44701753	PERC COR ANGIOPLST; SNGL CA/BRCH-RI	481	92920	23,521	N/A	N/A	N/A
HC44701787	PERC COR ANGIOPLST; ADDL CA/BRCH-LC+	481	92921	14,940	N/A	N/A	N/A
HC44701951	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-RI	481	92928	27,128	N/A	N/A	N/A
HC44701985	PERC COR STENT(S)/ANGIOP; ADDL CA/BR-LC+	481	92929	16,906	N/A	N/A	N/A
HC44702017	PERC COR ATHR+STENT/ANGIOP; SNGL-LM	481	92933	32,208	N/A	N/A	N/A
HC44702157	PERC CABG REVAS ATHR/STENT/ANG; SNGL-RI	481	92937	16,574	N/A	N/A	N/A
HC44702181	PERC CABG REVAS ATHR/STENT/ANG; ADDL-LC+	481	92938	16,889	N/A	N/A	N/A
HC44702215	PERC COR AMI REVAS ATHR/STNT/ANG;SNGL-LM	481	92941	31,917	N/A	N/A	N/A
HC44702389	PERC COR DES STENT(S)/ANGIOP; SNGL-LC	481	92928	27,160	N/A	N/A	N/A
HC44702413	PERC COR DES STENT(S)/ANGIOP; ADDL-LM+	481	92929	16,924	N/A	N/A	N/A
HC44702587	PERC CABG REVAS ATHR/DES/ANGIOP; SNGL-LC	481	92937	27,918	N/A	N/A	N/A
HC44702611	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-LM+	481	92938	16,889	N/A	N/A	N/A
HC44702645	PERC CABG REVAS ATHR/DES/ANGPL; ADDL-RC+	481	92938	16,889	N/A	N/A	N/A
HC44702785	PERC COR CHRON REVAS ATHR/DES/A;ADDL-LC+	481	92944	19,137	N/A	N/A	N/A
HC44702819	COMP EP EVAL W/INDUC&ABLAT 3D MAP TX SVT	481	93653	41,090	N/A	N/A	N/A
HC44702843	ABLAT NON1 DEG INCL RPT DX INDUC ARRHM+	481	93655	11,055	N/A	N/A	N/A
HC44702983	EVAL EP ICD/LEAD SUBQ	481	93644	6,523	N/A	N/A	N/A
HC44703015	TAVR/TAVI W/ PROSTH; OPEN FEM ARTERY	481	33362	46,495	N/A	N/A	N/A
HC44703049	TAVR/TAVI W/ PROSTH; TRANSAORTIC EXP (STERNO)	481	33365	49,070	N/A	N/A	N/A
HC44703221	PERC LT ATRIAL APPEND CLOSURE (LARIAT)	360	33999	39,640	N/A	N/A	N/A
HC44703254	REMOVE ELECTRODE DEFIBRILLATOR SUBQ	481	33272	7,669	N/A	N/A	N/A
HC44703429	PERCUT ACCESS & CLOSE FEMORAL ARTERY DELIVERY GRAFT+	360	34713	2,953	N/A	N/A	N/A
HC44703452	OPEN AXILL/SUBCLV ART CONDUIT DELIVER PROTH /BYPASS UNILAT+	360	34716	9,353	N/A	N/A	N/A
HC44703486	PERICARDIAL DRAIN 6+YR W/O ANOMOLY INCL FLUORO &/US	361	33017	4,186	N/A	N/A	N/A
HC44703627	TRANSCATH INTRACARD SHUNT(TIS) STENT CONGENTL INCLUDE IMAGE; EA ADDL+	361	33746	20,162	N/A	N/A	N/A
HC44703700	PERC TRANSCATH INTRATRIAL SEPTAL SHUNT	481	C9758	38,447	N/A	N/A	N/A
HC44703734	INSERT PERC VAD INC S&I TRANSSEPTL PUNC; LEFT HEART	489	33991	17,989	N/A	N/A	N/A
HC44790004	P: TEVAR W/ LT SUB; INT'L ENDO& DIST EXTS CELIAC/S&I			N/A	N/A	N/A	N/A
HC44790038	P: TEVAR; PLCMT PROX EXT PROTH; EACH ADD'L+/S&I			N/A	N/A	N/A	N/A
HC44900165	CT GUIDE NEEDLE PLACEMENT	350	77012	4,889	N/A	N/A	N/A
HC44900207	CT HEAD W&W/O CONTRAST	351	70470	5,987	N/A	N/A	N/A
HC44900371	CT MAXILLO FACIAL W/ CONTRAST	351	70487	4,902	N/A	N/A	N/A
HC44900405	CT NECK SOFT TISSUE W&W/O CONT	351	70492	5,968	N/A	N/A	N/A
HC44900439	CT ORBIT/SELLA/EAR W&W/O CONT	351	70482	6,197	N/A	N/A	N/A
HC44900579	CT UPPER EXT W/CONTRAST LT	352	73201	5,507	N/A	N/A	N/A
HC44900603	CT UPPER EXT W/O CONTRAST LT	352	73200	5,072	N/A	N/A	N/A
HC44900637	CTA ABDOMEN	352	74175	7,762	N/A	N/A	N/A
HC44900876	CT BODY SCAN ABD/CHEST/PEL/HRT	350		1,354	N/A	N/A	N/A
HC44900900	CT PRIVATE CONSULT W/RAD	350		71	N/A	N/A	N/A
HC44901098	CT BREAST 3D RENDER BILAT W/CONTRAST	352	0637T	4,583	N/A	N/A	N/A
HC45200029	CSF FLOW W/ VENTRICULOGRAPHY	341	78635	3,825	N/A	N/A	N/A
HC45200052	NM BONE MARROW MULTI AREA	341	78103	3,078	N/A	N/A	N/A
HC45200219	NM CARDIAC BP IMAG GATED MULTI	341	78473	4,367	N/A	N/A	N/A
HC45200243	NM CARDIAC SCAN SPECT	341	78469	3,422	N/A	N/A	N/A
HC45200276	NM CISTERNOGRAM	341	78630	4,206	N/A	N/A	N/A
HC45200433	NM KIDNEY FLW/FUNC MULTI STUDY	341	78709	4,377	N/A	N/A	N/A
HC45200508	NM LIVER/SPLEEN IMAGING STATIC	341	78215	3,267	N/A	N/A	N/A
HC45200532	NM LYMPH GLAND/NODES IMAGING	341	78195	4,391	N/A	N/A	N/A
HC45200912	NM THYROID METS UPTAKE (+)	341	78020	1,476	N/A	N/A	N/A
HC45200987	NM TUMOR LOCALIZE PLNR WHOLE BODY 1 DAY	341	78802	5,040	N/A	N/A	N/A
HC45201274	QUANT DIFF PULM PERF& VENT	341	78598	4,320	N/A	N/A	N/A
HC45201308	NM THYROID UPTAKE (PROBE) ONLY SNGL/MULT QNT MSRMT	341	78012	2,025	N/A	N/A	N/A
HC45201332	NM PARATHYRD SCN W/SPECT W-W/O SUBTR	341	78071	4,196	N/A	N/A	N/A
HC45400058	MR BRAIN W&W/O CONTRAST	611	70553	11,376	N/A	N/A	N/A
HC45400082	MR CHEST W&W/O CONTRAST	610	71552	12,154	N/A	N/A	N/A
HC45400116	MR C-SPINE W&W/O CONTRAST	612	72156	11,580	N/A	N/A	N/A
HC45400280	MR LOW EXT(JNT)W/CONT BIL	610	73722	13,762	N/A	N/A	N/A
HC45400314	MR LOW EXT(JNT)W&W/O CONT BIL	610	73723	17,216	N/A	N/A	N/A
HC83503276	IHC/IP PER SPEC INITIAL AB STAIN VIMENTIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83503300	IHC/IP PER SPEC INITIAL AB STAIN SYNAPTOPH PER SPEC INITIAL AB STAIN  -US	312	88342	N/A	N/A	N/A	N/A
HC83503334	IHC/IP PER SPEC INITIAL AB STAIN ANTI-BCL-2 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503508	IHC/IP PER SPEC INITIAL AB STAIN GH STAIN -US	312	88342	N/A	N/A	N/A	N/A
HC83503557	IHC/IP PER SPEC INITIAL AB STAIN KI-67 -IM	312	88342	N/A	N/A	N/A	N/A
HC83503748	IHC/IP PER SPEC INITIAL AB STAIN TERM DEOZY -US	312	88342	50	N/A	50	N/A
HC83503797	IHC/IP PER SPEC INITIAL AB STAIN UBIQUITIN STAIN -IM	312	88342	40	N/A	40	N/A
HC83504027	KARYOTYPING ADD EA-GZ	310	88280	68	N/A	68	N/A
HC83504050	TISSUE EXAM G&M LEVEL 5-CS	312	88307	365	N/A	365	N/A
HC83504092	TISSUE IN-SITU HYBRI INTER-IM	312	88365	621	N/A	621	N/A
HC83504290	M: MISC LAB PATHOLOGY REF LAB-VU	310		N/A	N/A	N/A	N/A
HC83504340	ANATOMIC CONSULT; COMP. REV-DR	310	88325	N/A	N/A	N/A	N/A
HC83504373	ANATOMIC CONSULT; COMP. REV-BR	310	88325	N/A	N/A	N/A	N/A
HC83504639	M: MISC LAB PATHOLOGY REF LAB-PU	310		N/A	N/A	N/A	N/A
HC83504670	M: MISC LAB PATHOLOGY REF LAB-UF	310		N/A	N/A	N/A	N/A
HC83505081	M: MISC LAB PATHOLOGY REF LAB OTHER (ADD RL#)	310		N/A	N/A	N/A	N/A
HC83505131	M: MISC LAB PATHOLOGY REF LAB-RT	310		N/A	N/A	N/A	N/A
HC83505420	FLOW CYT MKR TC EACH ADD+ -NG	311	88185	13	N/A	N/A	N/A
HC83505453	M: MISC LAB PATHOLOGY REF LAB-UC	310		164	N/A	N/A	N/A
HC83505487	STAIN IMMUNOHISTOCHEMICAL QUANT -NG	312	88360	45	N/A	N/A	N/A
HC83505628	M: MISC LAB PATHOLOGY REF LAB-CA	310		N/A	N/A	N/A	N/A
HC83505651	KRAS MUT ANALYSIS EXON 4-NG	310	81276	369	N/A	N/A	N/A
HC83505685	PD-L1 IHC QNT-NG	310	88360	150	N/A	N/A	N/A
HC83505859	M: MISC LAB PATHOLOGY REF LAB -NC	310		N/A	N/A	N/A	N/A
HC83505883	CHROM TISSUE CULT BONE MARROW-NG	311	88237	150	N/A	N/A	N/A
HC83506055	M: MISC LAB PATHOLOGY REF LAB-JL	310		N/A	N/A	N/A	N/A
HC83590091	P:IMMUNOHISTOCHEM X 6-HP			N/A	N/A	N/A	N/A
HC83590133	P:RENAL BIOPSY-CS			N/A	N/A	N/A	N/A
HC84200021	CULTURE BLOOD	306	87040	660	N/A	75	N/A
HC84200054	CULTURE DECUBITUS	306	87070	488	N/A	95	N/A
HC84200088	CULTURE  BACTERIAL-OTHR SOURCE	306	87070	489	N/A	57	N/A
HC84200252	SPECIAL STAIN	306	87207	267	N/A	64	N/A
HC84200286	ANAEROBIC ID EA ISOLATE	306	87076	349	N/A	41	N/A
HC84200476	OB FECAL IMM ASSAY QUAL 1-3 DX	301	82274	218	N/A	81	N/A
HC84200500	CULTURE GROUP B STREPTOCOCCUS	306	87081	315	N/A	48	N/A
HC84200674	MOLD ID EA ORG	306	87107	262	N/A	52	N/A
HC84200708	CULTURE ACID FAST	306	87116	537	N/A	101	N/A
HC84200732	ARTHROPOD ID	306	87168	146	N/A	22	N/A
HC84200880	PARAINFLUENZA EA TYPE	306	87279	275	N/A	103	N/A
HC84200914	C DIFFICILE AG  EIA	306	87324	468	N/A	128	N/A
HC84200948	INFLUENZA A OR B EIA EACH	306	87400	320	N/A	41	N/A
HC84201128	CULTURE MRSA; STATISTIC SCREEN	306	87081	N/A	N/A	34	N/A
HC84201151	INFLUENZA H1N1 BY PCR	306	87503	413	N/A	88	N/A
HC84201383	CULTURE CIPROFLOXACIN RESIST SCRN	306	87081	315	N/A	48	N/A
HC84201417	CULT DNA/RNA AMP PCR GRAM NEG ISO	306	87150	528	N/A	191	N/A
HC84201581	DNA/RNA C NEOFORMANS/GATTII PCR(PNL)	306	87798	524	N/A	150	N/A
HC84201615	N-GONORRHEA BY DNA AMP PROBE	306	87591	475	N/A	75	N/A
HC84201649	DNA/RNA ACINETOBACTER CALCOACETICUS-BAUMANNII CMPLX(PNL)	306	87798	483	N/A	150	N/A
HC84201789	DNA/RNA LEGIONELLA PNEUMOPHILA (PNL)	306	87541	324	N/A	75	N/A
HC84201813	RESP VIRUS 3-5 TARGETS	306	87631	706	N/A	215	N/A
HC84201847	SARS-COV-2/FLU/RSV RNA QUAL PCR	306	0241U	1,005	N/A	220	N/A
HC84600055	CYTOPATH SELECT CELL ENHANCE	311	88112	690	N/A	266	N/A
HC84600089	PAP THIN LAYER PREP MANL SCRN	311	88142	249	N/A	85	N/A
HC84600253	CELL BLOCK (TISSUE EXAM LVL 4)	312	88305	780	N/A	218	N/A
HC84600287	MORPH STDY IHC QT MANUAL PER SPEC EA AB	312	88360	777	N/A	236	N/A
HC84600311	MORPH STDY IHC/HER-2/NEU PER SPEC EA AB	312	88360	777	N/A	236	N/A
HC85100485	CBC W/O DIFF	305	85027	61	N/A	N/A	N/A
HC85100519	MANUAL CELL COUNT RED/LEUK/PLT	305	85032	47	N/A	23	N/A
HC88600028	NEWBORN SCREEN DRAW FEE (GE)	300	36416	6	N/A	6	N/A
HC88600275	SPECIAL COURIER      110	300	99001	139	N/A	110	N/A
HC88600309	VENIPUNCTURE ROUTINE SPECIAL CLIENT	300	36415	32	N/A	25	N/A
HC89000012	ENDOMYSIAL FA AB SCRN-QD	302	86255	24	N/A	24	N/A
HC89000186	CULTURE AFB DIR STAIN(PNL)-FT	306	87206	13	N/A	13	N/A
HC89000210	ADENOVIRUS AB-QD	302	86603	16	N/A	16	N/A
HC89000392	HUMAN GROWTH HORMONE-QD	301	83003	10	N/A	10	N/A
HC89000426	C1 INHIBITOR-QD	302	83883	N/A	N/A	N/A	N/A
HC89000459	HISTONE REACTIVE ANA-SL	301	83520	23	N/A	23	N/A
HC89000590	SOMATOMEDIN-QD	301	84305	27	N/A	26	N/A
HC89000624	COCCIDIOIDES AB-QD	302	86635	11	N/A	11	N/A
HC89000657	PROTOZOA AB OTHER-QD	302	86753	20	N/A	20	N/A
HC89000855	COMPOUND S-QD	301	82634	N/A	N/A	N/A	N/A
HC89000889	PARATHYROID HORMONE TERM-QD	301	83970	181	N/A	181	N/A
HC89001077	AMINO ACID SCREEN-QD	301	82128	68	N/A	67	N/A
HC89001101	METHEMALBUMIN-QD	301	83857	N/A	N/A	N/A	N/A
HC89001291	DIHYDROXYVITAMIN D 1-25-QD	301	82652	35	N/A	35	N/A
HC89001333	LOXAPINE & METABOLITE-AU	301	80299	222	N/A	222	N/A
HC89001382	ACETYLCHOLINE RECEPTOR AB-QD	301	84238	61	N/A	60	N/A
HC89001549	CULTURE LEPTOSPIRA-U2	306	87077	N/A	N/A	N/A	N/A
HC89001572	MYOCARDIAL FA AB SCRN-QD	302	86255	24	N/A	24	N/A
HC89001606	CULTURE HERPES-U2	306	87252	N/A	N/A	N/A	N/A
HC89001853	AMIODARONE-QD	301	80151	60	N/A	60	N/A
HC89001887	SULFONAMIDES-QD	301	80299	60	N/A	60	N/A
HC89002067	FLUORIDE-QD	301	82735	N/A	N/A	N/A	N/A
HC89002109	FLOW CYTO EA BLOOD(T&B PNL)-U2	311	88184	N/A	N/A	N/A	N/A
HC89002133	EPIDERMAL FA AB SCRN-QD	302	86255	23	N/A	23	N/A
HC89002281	C2 COMPLEMENT-QD	302	86160	16	N/A	16	N/A
HC89002315	EUGLOBULIN CLOT LYSIS-QD	305	85360	N/A	N/A	N/A	N/A
HC89002349	FACTOR IX ASSAY-U2	305	85250	N/A	N/A	N/A	N/A
HC89002539	LEAD URINE-QD	301	83655	38	N/A	38	N/A
HC89002562	PARATHYROID HORMONE INTACT-QD	301	83970	N/A	N/A	N/A	N/A
HC89002596	CAFFEINE-U2	300	80155	26	N/A	26	N/A
HC89002851	PLASMINOGEN ACTIVITY-QD	305	85421	N/A	N/A	N/A	N/A
HC89002885	AMIKACIN SUBSEQUENT-QD	301	80150	71	N/A	70	N/A
HC89003057	FACTOR INHIBITOR TEST-U2	301	85335	N/A	N/A	N/A	N/A
HC89003081	PRIMIDONE-U2	301	80188	35	N/A	35	N/A
HC89003115	ANTI MICROSOMAL THYROID-QD	302	86376	26	N/A	26	N/A
HC89003255	TESTOSTERONE TOTAL-QD	301	84403	7	N/A	7	N/A
HC89003289	IMMUNO ELECT CSF-QD	302	86335	19	N/A	19	N/A
HC89003313	HEPATITIS BE AG-QD	306	87350	18	N/A	18	N/A
HC89003487	TOXOPLASMA AB IGM-QD	302	86778	20	N/A	20	N/A
HC89003529	ENTEROVIRUS BY PCR/BLOOD-AU	306	87498	110	N/A	110	N/A
HC89003719	PHENYLPROPANOLAMINE URINE-AU	301	80299	97	N/A	97	N/A
HC89003750	HERPES TYPE I IGM-QD	302	86695	N/A	N/A	N/A	N/A
HC89003941	CHROMO ANALYSIS AMINIO FLD-GC	311	88235	N/A	N/A	N/A	N/A
HC89003974	15-20 CELLS  2 KARYO BAND-GC	311	88262	N/A	N/A	N/A	N/A
HC89004006	CHROM ANAL ADDL CELL CT-GC	311	88285	N/A	N/A	N/A	N/A
HC89004147	HEXA P'LIPID NEUTRALIZATION-AU	305	85597	75	N/A	75	N/A
HC89004170	ANTI-GLIADIN  IGG SPEC(PNL)-PR	302	83520	23	N/A	22	N/A
HC89004204	IGA SER NEPHELOMETRY(PNL)-PR	302	82784	20	N/A	20	N/A
HC89004469	ENCEPHALITIS STLOUIS AB(PNL-AU	302	86653	19	N/A	18	N/A
HC89004493	ANTI-GLIADIN  IGA SPEC(PNL2-PR	302	83520	23	N/A	22	N/A
HC89004709	ANTI-LA (SS-B) (PNL)-RD	302	86235	24	N/A	24	N/A
HC89004733	ANTI MICROSOMAL THYROI(PNL2-RD	302	86376	25	N/A	25	N/A
HC89004907	M: MISC LAB GENERAL REF LAB-CA	300		98	N/A	N/A	N/A
HC89004931	M: MISC LAB GENERAL REF LAB-LA	300		N/A	N/A	N/A	N/A
HC89004964	ASPERGILLUS ANTIGEN-AU	302	87305	50	N/A	84	N/A
HC89005102	VORICONAZOLE ANTIFNGL-FT	301	80299	178	N/A	178	N/A
HC89005136	B BURGDORFERI IGM WB -FT	302	86617	89	N/A	88	N/A
HC89005169	HSV I/2 IGM INDEX&INTERP- FT	302	86694	63	N/A	63	N/A
HC89005342	FIBRINOGEN ANTIGEN-EC	305	85385	130	N/A	130	N/A
HC89005375	IMMUNOGLOB IGA-AU	301	82784	16	N/A	16	N/A
HC89005540	ECHOVIRUS 9 AB-FT	302	86658	26	N/A	25	N/A
HC89005573	COXSACKIE B1 AB-FT	302	86658	22	N/A	21	N/A
HC89005607	COXSACKIE B4 AB-FT	302	86658	22	N/A	21	N/A
HC89005748	CHROM LYMPHOCYTE TISSUE-GC	310	88230	N/A	N/A	N/A	N/A
HC89005789	WEST NILE VIRUS AB EA-QD	302	86789	24	N/A	24	N/A
HC89005813	TACROLIMUS-QD	301	80197	35	N/A	35	N/A
HC89006290	AMITRIPTYLINE (ANTIDEPR)1 OR 2-AU	301	80335	24	N/A	12	N/A
HC89006381	CLONAZEPAM; 1-12-AU	301	80346	29	N/A	29	N/A
HC89006597	QUINIDINE-AU	301	80194	15	N/A	15	N/A
HC89006639	TOBRAMYCIN SUBSEQUENT-U2	301	80200	N/A	N/A	N/A	N/A
HC89006811	METHOTREXATE-AU	301	80204	16	N/A	16	N/A
HC89006845	OXCARBAZEPINE METABOLITE-AU	301	80183	20	N/A	25	N/A
HC89006878	PROTRIPTYLINE; 1-2-AU	301	80335	18	N/A	18	N/A
HC89007025	ADRENOCORTICOTROPIC HRMN-AU	301	82024	6	N/A	6	N/A
HC89007090	ALDOSTERONE-AU	301	82088	15	N/A	17	N/A
HC89007124	A-1 ANTITRYPSIN/PHENOTYPE-AU	301	82104	16	N/A	8	N/A
HC89007298	ARSENIC  BLOOD-AU	301	82175	11	N/A	15	N/A
HC89007322	BUTALBITAL/FLORINAL-AU	301	80345	16	N/A	16	N/A
HC89007645	TRIMIPRAMINE & METAB QUANT-AU	301	80335	N/A	N/A	N/A	N/A
HC89007678	NTX SERUM-AU	301	82523	95	N/A	123	N/A
HC89007868	DEOXYCORTISOL 11-QD	301	82634	N/A	N/A	N/A	N/A
HC89007892	DIBUCAINE NO +PSEUDOCHOLIN-AU	301	82638	12	N/A	11	N/A
HC89007934	BETA GLUCURONIDASE CSF-AU	301	82657	N/A	N/A	N/A	N/A
HC89008098	FOLATE RBC-AU	301	82747	8	N/A	15	N/A
HC89008122	IMMUNOGLB IGA D G M EA-QD	301	82784	6	N/A	6	N/A
HC89008155	IGG SUBCLASS-AU	301	82787	40	N/A	58	N/A
HC89008338	HGB CHROMATOGRAPHY-AU	301	83021	15	N/A	15	N/A
HC89008361	METHEMOBLOBIN-AU	301	83050	39	N/A	39	N/A
HC89008544	CARNITINE-CA	301	83519	42	N/A	41	N/A
HC89008577	GLUTAMIC ACID AB-AU	301	86341	35	N/A	42	N/A
HC89008601	LEGIONELLA AG URINE-AU	301	83519	16	N/A	16	N/A
HC89008742	TRYPTASE-AU	301	83520	41	N/A	123	N/A
HC89008775	IRON TOTAL URINE-AU	301	83540	175	N/A	168	N/A
HC89008809	17-KETOSTEROID FRACTIONAT'N-AU	301	83593	288	N/A	287	N/A
HC89008965	MEPROBAMATE; 1-2-AU	301	80369	18	N/A	18	N/A
HC89009005	METHADONE &METABOLITE QUANT SERUM-AU	301	80358	73	N/A	73	N/A
HC89009047	MYELIN BASIC PROTEIN CSF-AU	301	83873	29	N/A	20	N/A
HC89009450	PARATHYROID HORMONE INTACT-AU	301	83970	18	N/A	17	N/A
HC89009492	PARATHYROID HORMONE MID-QD	301	83970	N/A	N/A	N/A	N/A
HC89009674	PORPHYRINS FECAL FRACT-AU	301	84126	126	N/A	126	N/A
HC89009708	PSA TOTAL-AU	301	84153	6	N/A	6	N/A
HC89009732	PROTEIN ELECT FRACT&QT(PNL)-AU	301	84165	4	N/A	4	N/A
HC89009872	LIPID ASSOC SIALIC ACID-AU	301	84275	19	N/A	19	N/A
HC89009906	SOMATOMEDIN-AU	301	84305	9	N/A	12	N/A
HC89009930	TESTOSTERONE FREE-AU	301	84402	14	N/A	14	N/A
HC89010102	T-3 REVERSE-AU	301	84482	14	N/A	14	N/A
HC89010144	URIC ACID FLUID-AU	301	84560	16	N/A	16	N/A
HC89010318	BETA-HCG QUANT-AU	301	84702	14	N/A	13	N/A
HC89010375	M: MISC LAB GENERAL REF LAB-AU	300		42	N/A	N/A	N/A
HC89010540	M: MISC LAB GENERAL REF LAB-QN	300		148	N/A	N/A	N/A
HC89010573	M: MISC LAB GENERAL REF LAB-US	300		N/A	N/A	N/A	N/A
HC89010607	M: MISC LAB GENERAL REF LAB OTHER (ADD RL#)	300		438	N/A	N/A	N/A
HC89010748	MURAMIDASE-MA	305	85549	N/A	N/A	N/A	N/A
HC89010771	PROTHROMBIN -AU	305	85610	10	N/A	10	N/A
HC89010805	PTT 1:1 MIX-AU	305	85732	N/A	N/A	N/A	N/A
HC89010979	C1Q COMPLEMENT-QN	302	86160	22	N/A	21	N/A
HC89011001	C3 COMPLEMENT (PNL)-RD	302	86160	13	N/A	13	N/A
HC89011191	ANTI-CHROMATIN AB (PNL)-RD	302	86235	13	N/A	13	N/A
HC89011225	RNP ENA AB-QD	302	86235	13	N/A	13	N/A
HC89011258	ANTI-SM AB (PNL)-RD	302	86235	13	N/A	13	N/A
HC89011399	SMITH REFLEX (PNL)-AU	302	86235	16	N/A	16	N/A
HC89011423	SSB REFLEX (PNL)-AU	302	86235	16	N/A	16	N/A
HC89011456	ANTI-NEUTROPHIL CYTOPLSMC SCRN IGG-AU	302	86036	12	N/A	15	N/A
HC89011605	HETEROPHILE AB TITER-AU	302	86309	N/A	N/A	N/A	N/A
HC89011639	NEURON SPECIFIC ENOLASE-AU	302	86316	32	N/A	36	N/A
HC89011662	CATSCRATCH FEVER-AU	302	86317	N/A	N/A	N/A	N/A
HC89011837	IMMUNE COMPLEX C1Q BIND-AU	302	86332	147	N/A	153	N/A
HC89011860	IMMUNOFIX ELECTROPHOR(PNL)-AU	302	86334	10	N/A	10	N/A
HC89012033	STREPTOZYME AB-AU	302	86403	9	N/A	9	N/A
HC89012066	VDRL CSF-AU	302	86592	6	N/A	6	N/A
HC89012090	ADENOVIRUS AB-SL	302	86603	N/A	N/A	N/A	N/A
HC89012231	Q FEVER AB-FT	302	86638	N/A	N/A	N/A	N/A
HC89012264	CMV AB IGG-AU	302	86644	8	N/A	11	N/A
HC89012298	DIPHTHERIA/ELISA AB-FT	302	86648	N/A	N/A	N/A	N/A
HC89012462	EBV AB TO EARLY AG-AU	302	86663	10	N/A	10	N/A
HC89012496	EBV AB-VIRAL CAPSID AG(PNL)-AU	302	86665	8	N/A	11	N/A
HC89012660	HERPES SIMPL II GLYCO (PNL)-AU	302	86696	6	N/A	6	N/A
HC89012694	HISTOPLASMA AB-AU	302	86698	11	N/A	11	N/A
HC89012868	RUBELLA IGM AB-AU	302	86762	9	N/A	9	N/A
HC89012892	TORCH TOXOPLASM AB IGG(PNL)-AU	302	86777	10	N/A	10	N/A
HC89012926	TREPONEMA PALLIDUM AB-AU	302	86780	13	N/A	16	N/A
HC89013064	ANAEROBIC ID PRESUMPTIVE-FT	306	87075	N/A	N/A	N/A	N/A
HC89013098	CULTURE LEGIONELLA-AU	306	87081	39	N/A	40	N/A
HC89013122	CULTURE CHLAMYDIA-AU	306	87110	73	N/A	73	N/A
HC89013296	HSV BY PCR-AU	306	87529	55	N/A	55	N/A
HC89013320	HIV-1 ULTRA RNA QUANT PCR-AU	306	87536	100	N/A	100	N/A
HC89013494	LIPOPROTEIN A-QD	301	83695	20	N/A	19	N/A
HC89013528	VITAMIN D 25 OH-AU	301	82306	10	N/A	10	N/A
HC89013700	MYOGLOBIN URINE-AU	301	83874	12	N/A	13	N/A
HC89013833	ORGANIC ACID SNGL QUANT-AU	301	83921	N/A	N/A	N/A	N/A
HC89013866	CHLORPROMAZINE; 1-3-AU	301	80342	65	N/A	59	N/A
HC89014013	KLEIHAUER BETKE-AU	305	85460	124	N/A	123	N/A
HC89014047	ANA-RD	302	86038	32	N/A	31	N/A
HC89014070	ANA TITER REFLEX (PNL)-AU	302	86039	14	N/A	14	N/A
HC89014260	COCCIDIOIDES AB CSF(PNL) -AU	302	86635	11	N/A	11	N/A
HC89014294	COXSACKIE B AB-QD	302	86658	17	N/A	17	N/A
HC89014492	YERSINIA AB IGA BY IMMUNOBLOT-ARUP	302	86793	42	N/A	38	N/A
HC89014526	HLA DR MULT AG-U9	302	86817	338	N/A	338	N/A
HC89014559	ANAEROBIC SUSCEPTIBILITY-FT	306	87186	N/A	N/A	N/A	N/A
HC89014708	HEPATITIS C RNA BY PCR-QD	306	87522	25	N/A	25	N/A
HC89014732	HIV-1 RNA QUANT BY PCR-QD	306	87536	25	N/A	25	N/A
HC89014765	ENTEROVIRUS BY PCR -AU	306	87498	110	N/A	110	N/A
HC89014914	CHROM ANAL-POC TISSUE CULT-GZ	311	88235	N/A	N/A	N/A	N/A
HC89014948	CHROMOSOME BRKG ANAL 50-102-GZ	311	88248	N/A	N/A	N/A	N/A
HC89014971	BM: CHROMOSOME ANALYSIS-GZ	311	88262	N/A	N/A	N/A	N/A
HC89015143	LYMPH T-CELL TOT CNT (PNL)-AU	302	86359	N/A	N/A	N/A	N/A
HC89015192	FLOW CYT MKR TC 1ST-U2	311	88184	N/A	N/A	N/A	N/A
HC89015374	ESTROGEN TOTAL-QD	301	82672	17	N/A	17	N/A
HC89015408	IMMUNOGLOBULIN IGE-QD	301	82785	21	N/A	21	N/A
HC89015432	LH(LUTEINIZ HORMONE)-QD	301	83002	23	N/A	23	N/A
HC89015572	T3 TOTAL-QD	301	84480	11	N/A	11	N/A
HC89015606	URIC ACID FLUID-QD	301	84560	18	N/A	18	N/A
HC89015630	ANTITHROMBIN III-QD	305	85300	19	N/A	19	N/A
HC89015804	HEPATITIS B CORE AB IGM-QD	302	86705	26	N/A	26	N/A
HC89015838	ROCKY MT  SPOTTED FEVER AB-QD	302	86757	29	N/A	29	N/A
HC89016000	VITAMIN B12-QD	301	82607	14	N/A	14	N/A
HC89016034	PREGNENOLONE-QD	301	84140	15	N/A	15	N/A
HC89016208	BRUCELLA AB-QD	302	86622	20	N/A	20	N/A
HC89016232	GIARDIA AB IFA-QD	302	86674	2	N/A	2	N/A
HC89016265	HEPATITIS C AB CONFIRM(DS)-QD	302	86803	8	N/A	8	N/A
HC89016422	PYRUVATE KINASE-AU	301	84220	39	N/A	39	N/A
HC89016521	PHENYTOIN TOTAL(PNL)-AU	301	80185	N/A	N/A	13	N/A
HC89016554	FAT FECAL QUAL-U2	301	82705	N/A	N/A	N/A	N/A
HC89016778	NBS 17 OH PROGESTERONE-GE	301	83498	18	N/A	16	N/A
HC89016810	IMMUNO ELECT OTHER FLUIDS-QD	302	86335	N/A	N/A	N/A	N/A
HC89016992	LIPOPROTEIN A-AU	301	83695	7	N/A	20	N/A
HC89017024	MITOCHONDRIAL M2 AB IGG-AU	302	86381	7	N/A	7	N/A
HC89017057	AEROBIC BACTERIAL ID-FT	306	87077	58	N/A	57	N/A
HC89017198	ASCA AB  IGG/IGA - AU	302	86671	N/A	N/A	N/A	N/A
HC89017222	METHOTREXATE-U2	301	80204	55	N/A	55	N/A
HC89017255	AMINO ACIDS QUANT URINE-AU	301	82139	109	N/A	109	N/A
HC89017396	TRANSGLUT'AB IGA REFLEX IFA-AU	302	86364	6	N/A	16	N/A
HC89017420	TRICHROME STAIN CMPLX(O&P)-AU	306	87209	31	N/A	31	N/A
HC89017453	REPTILASE TIME RFX- AU	305	85635	28	N/A	28	N/A
HC89017628	MERCURY URINE (PNL)-AU	301	83825	11	N/A	3	N/A
HC89017651	ZINC  SERUM (PNL) -AU	301	84630	3	N/A	3	N/A
HC89017925	M: MISC LAB GENERAL REF LAB-HC	300		N/A	N/A	N/A	N/A
HC89017966	M: MISC LAB GENERAL REF LAB-CD	300		N/A	N/A	N/A	N/A
HC89017990	M: MISC LAB GENERAL REF LAB-RT	300		N/A	N/A	N/A	N/A
HC89018147	ANNEXIN AB V IGM -EC	301	83516	93	N/A	93	N/A
HC89018170	CREATININE URINE (PNL)-ES	301	82570	52	N/A	52	N/A
HC89018204	FACTOR VIII ASSAY -EC	305	85240	125	N/A	125	N/A
HC89018378	TESTOSTERONE TOTL FEM/CHILD-AU	301	84403	17	N/A	12	N/A
HC89018402	QUANTIFERON-TB GOLD-AU	302	86480	40	N/A	50	N/A
HC89018832	CHROM ANAL 15-20 CELLS  POC-AU	310	88262	212	N/A	268	N/A
HC89018964	HEINZ BODIES INDUCED-AU	305	85445	77	N/A	89	N/A
HC89019418	HLA AB DETECT MARKERS ADD+-AU	311	88185	20	N/A	20	N/A
HC89019459	FUNGITELL ASSAY  DILUTION-BD	306	87449	114	N/A	84	N/A
HC89019483	SPECIAL STAIN;MICROSPORIDIA-AU	306	87207	10	N/A	6	N/A
HC89019772	QUANT HPLC-6-MTG(P TPMT ENZYME)-PR	301	82542	88	N/A	88	N/A
HC89019863	AH50-ALTERNATE PATHWAY-SL	302	86162	92	N/A	91	N/A
HC89019897	FRAGILE X (FMR1) DIAGNOSTIC-AU	301	81244	460	N/A	325	N/A
HC89020093	ANCA ELISA IGG SPECIF(PNL)-PR	301	83520	20	N/A	20	N/A
HC89020127	ANTI-A4-FLE2 ELISA(PNL)-PR	301	83520	20	N/A	16	N/A
HC89020291	PALATINASE (DISACCHARIDASE)-AU	301	82657	38	N/A	56	N/A
HC89020325	HLA-B GENOTYPE-AU	309	81380	325	N/A	325	N/A
HC89020358	HEAT SHOCK PROTEIN 70-AU	301	83516	128	N/A	195	N/A
HC89020507	CYSTATIN C  SERUM-AU	301	82610	60	N/A	60	N/A
HC89020820	HELICOBACTER PYLORI IGM - AU	302	86677	8	N/A	8	N/A
HC89020853	NEISSERIA GONORRHOEAE CF-AU	302	86171	57	N/A	57	N/A
HC89020994	ECHOVIRUS AB TYPE 11-AU	302	86658	25	N/A	18	N/A
HC89021026	GARDNERELLA VAGINALIS DNA-AU	306	87510	21	N/A	21	N/A
HC89021059	ASPERGILLUS AB (PNL2)-AU	302	86606	6	N/A	6	N/A
HC89021232	HSV 6 (HHV6)(A&B)  QNT PCR-AU	306	87533	150	N/A	N/A	N/A
HC89021265	ENCEPHALITIS EASTERN AB IGM-AU	302	86652	45	N/A	44	N/A
HC89021448	MAGNESIUM RBC - AU	301	83735	54	N/A	N/A	N/A
HC89021489	DS BARBITURATES CONFIRM-AU	301	80345	59	N/A	N/A	N/A
HC89021513	AFB MTB DNA  PCR-AU	306	87556	195	N/A	N/A	N/A
HC89021661	BARBITURATES MEC(PNL)-AU	301	80345	136	N/A	N/A	N/A
HC89021695	COCAINE MEC(PNL)-AU	301	80353	99	N/A	N/A	N/A
HC89021729	BUPRENORPHINE MEC(PNL)-AU	301	80348	79	N/A	N/A	N/A
HC89022040	BARBITURATES SERUM QNTS(PNL)-AU	301	80345	76	N/A	N/A	N/A
HC89022073	CANNABINOIDS NATURAL SERUM QNT(PNL)-AU	301	80349	54	N/A	N/A	N/A
HC89022255	M: MISC LAB GENERAL REF LAB-IC	300		392	N/A	N/A	N/A
HC89022289	M: MISC LAB GENERAL REF LAB-NP	300		N/A	N/A	N/A	N/A
HC89022453	CULTURE VIRUS ID DEFIN/ADDL+-AU	306	87253	45	N/A	N/A	N/A
HC89022487	DFA W/REFLEX CULT VARICELLA ZV-AU	306	87290	77	N/A	N/A	N/A
HC89022511	OROTIC ACID QUANT URINE -AU	301	83921	100	N/A	N/A	N/A
HC89022669	TESTOSTERONE TOTAL-QN	301	84403	36	N/A	N/A	N/A
HC89022693	HLA CLASS II TYPING LOW RES HLA-DRB1/3/4/5&-DQB1-U9	310	81375	220	N/A	N/A	N/A
HC89022727	NBS TESTS PANEL NEWBORN METABLC SCRNING-GE	301	S3620	210	N/A	N/A	N/A
HC89022917	CHLORIDE  BODY FLUID-AU	301	82438	10	N/A	N/A	N/A
HC89022941	SODIUM  BODY FLUID-AU	301	84302	10	N/A	N/A	N/A
HC89023113	M: MISC LAB GENERAL REF LAB-GD	300		N/A	N/A	N/A	N/A
HC89023147	LAMBDA FREE LIGHT CHAINS QT URINE-AU	301	83521	37	N/A	N/A	N/A
HC89023311	INTERLEUKIN 6-AU	301	83529	65	N/A	N/A	N/A
HC89023352	DIGITOXIN QUANTITATIVE-AU	301	80375	89	N/A	N/A	N/A
HC89023386	ANTIBODY SARS-COV-2 COVID-19 ELISA-AU	302	86769	40	N/A	N/A	N/A
HC89023535	PARATHYROID HORMONE RELPEP-AU	301	82542	45	N/A	N/A	N/A
HC89023568	BACTERIAL VAGINOSIS TMA-AU	306	81513	55	N/A	N/A	N/A
HC89023592	PHENOTYPE INFECT AGENT DRUG-AU	306	87900	140	N/A	N/A	N/A
HC89023766	INHIBIN A-AU	302	86336	27	N/A	N/A	N/A
HC89023790	AMPHETAMINES 5 OR > -AU	301	80326	25	N/A	N/A	N/A
HC89023980	MONONUC CELL ANTGN PNH PHENOTYPE NEUTROPHIL-AU	302	86356	29	N/A	N/A	N/A
HC89024012	JAK2 V617F QUAL-AU	310	81270	125	N/A	N/A	N/A
HC89024053	Q FEVER AB COXIELLA BURNETII PHASE TITER I-AU	302	86638	33	N/A	N/A	N/A
HC89090120	P:ANA 12 PLUS - RD			N/A	N/A	N/A	N/A
HC89090161	P:IMMUNOGLOB G CSF INDEX-AU			N/A	N/A	N/A	N/A
HC89090203	P:TOXOPLASMA IGG&IGM -AU			N/A	N/A	N/A	N/A
HC89090377	P:ANA 12 POSITIVE-RD			N/A	N/A	N/A	N/A
HC89090427	P:17-KETOSTEROID FRAC/CR OTHR-			N/A	N/A	N/A	N/A
HC89090450	P:PARO NOCT HGBUR RBC - ES			N/A	N/A	N/A	N/A
HC89090641	P:INSECTICIDE EXPOSURE PANEL-AU			N/A	N/A	N/A	N/A
HC89090674	P:HERPES 1&2 GLYCO IGG-AU			N/A	N/A	N/A	N/A
HC89090922	P: CHROMO ANALYSIS BM-GZ			N/A	N/A	N/A	N/A
HC89090955	P: HIV PHENOTYPE-COMPREHENSV-VI			N/A	N/A	N/A	N/A
HC89091003	P: CHROMOSOME ANALYS PB-AU			N/A	N/A	N/A	N/A
HC89091250	P: CHLAMYDIA AB (PNL)-AU	302		N/A	N/A	N/A	N/A
HC89091300	P:ALLERGEN PEANUT COMPONNTS-AU			N/A	N/A	N/A	N/A
HC89091334	P:  FACTOR IX BETHESDA TITER -ES			N/A	N/A	N/A	N/A
HC89091524	M: MISC LAB GENERAL REF LAB-U9	300		85	N/A	N/A	N/A
HC89091615	P: HLA CLASS II TYPING(D LOCUS)-U9			N/A	N/A	N/A	N/A
HC89500458	SAMPLE TRANSPORT-SB	300	99001	75	N/A	75	N/A
HC89500508	BLOOD TYPE SEROLOGIC; RH(D)-SB	300	86901	20	N/A	16	N/A
HC89500946	RBC AG PROFILE-MOLECULAR LEVEL 4-SB	301	81403	575	N/A	N/A	N/A
HC89500979	ANTIGLOBULIN INDIRECT TEST COOMBS; QUAL EA REAGENT RC-SB	302	86885	20	N/A	N/A	N/A
HC89501001	M: MISC RL BLOOD BANK -SB	300		N/A	N/A	N/A	N/A
HC91200131	R&B STANDARD-WOMEN	121		5,844	N/A	N/A	N/A
HC91200135	R&B NEWBORN CARE-BOARDER	171		6,091	N/A	N/A	N/A
HC91200138	R&B NICU-NURSERY LEVEL IV	174		24,903	N/A	N/A	N/A
HC65001258_00264780200	NONCDM CHARGE RECORD PHARMACY	258	J7030	18	N/A	N/A	N/A
HC65001258_00338004918	NONCDM CHARGE RECORD PHARMACY	258	J7050	14	N/A	N/A	N/A
HC65001258_00338004941	NONCDM CHARGE RECORD PHARMACY	258	J7050	12	N/A	N/A	N/A
HC65001258_00338006230	NONCDM CHARGE RECORD PHARMACY	636	J7060	139	N/A	N/A	N/A
HC65001258_00338070434	NONCDM CHARGE RECORD PHARMACY	636	J7030	45	N/A	N/A	N/A
HC65001258_00338081104	NONCDM CHARGE RECORD PHARMACY	636	J7120	66	N/A	N/A	N/A
HC65001258_00409488820	NONCDM CHARGE RECORD PHARMACY	636	J7030	17	N/A	N/A	N/A
HC65001258_00409798437	NONCDM CHARGE RECORD PHARMACY	636	J7050	12	N/A	N/A	N/A
HC65001258_00990710909	NONCDM CHARGE RECORD PHARMACY	258	J7042	26	N/A	N/A	N/A
HC65001258_00990792336	NONCDM CHARGE RECORD PHARMACY	258	J7060	14	N/A	N/A	N/A
HC65001258_00990792409	NONCDM CHARGE RECORD PHARMACY	258	J7042	16	N/A	N/A	N/A
HC65001258_00990798436	NONCDM CHARGE RECORD PHARMACY	258	J7050	7	N/A	N/A	N/A
HC65001258_00990799309	NONCDM CHARGE RECORD PHARMACY	636	J7042	23	N/A	N/A	N/A
HC65001258_01727170105	NONCDM CHARGE RECORD PHARMACY	636	J7050	49	N/A	N/A	N/A
HC65001258_07629700102	NONCDM CHARGE RECORD PHARMACY	636	J7040	36	N/A	N/A	N/A
HC65001258_08290306546	NONCDM CHARGE RECORD PHARMACY	636	J7030	3	N/A	N/A	N/A
HC65001278_00023585801	NONCDM CHARGE RECORD PHARMACY	636	J7297	5,403	N/A	N/A	N/A
HC65002250_00338004804	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65002250_00409613803	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65002250_00990713936	NONCDM CHARGE RECORD PHARMACY	250		31	N/A	N/A	N/A
HC65002250_00990797208	NONCDM CHARGE RECORD PHARMACY	250		35	N/A	N/A	N/A
HC65002258	MED - IV SOLUTION W/O J-CODE	258		N/A	N/A	N/A	N/A
HC65002258_00409793519	NONCDM CHARGE RECORD PHARMACY	250		75	N/A	N/A	N/A
HC65002258_00990767009	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65002258_00990793009	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65002636_00078084101	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,411	N/A	N/A	N/A
HC65002636_00085132801	NONCDM CHARGE RECORD PHARMACY	636	J3490	303	N/A	N/A	N/A
HC65002636_00173071722	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,110	N/A	N/A	N/A
HC65002636_00173088714	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,878	N/A	N/A	N/A
HC65002636_00597008717	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,874	N/A	N/A	N/A
HC65002636_00713065540	NONCDM CHARGE RECORD PHARMACY	636	J3490	419	N/A	N/A	N/A
HC65002636_00781713593	NONCDM CHARGE RECORD PHARMACY	636	J3490	291	N/A	N/A	N/A
HC65002636_01671489701	NONCDM CHARGE RECORD PHARMACY	636	J3490	629	N/A	N/A	N/A
HC65002636_01747860510	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,362	N/A	N/A	N/A
HC65002636_02315574841	NONCDM CHARGE RECORD PHARMACY	636	J3490	462	N/A	N/A	N/A
HC65002636_04202310301	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,629	N/A	N/A	N/A
HC65002636_04229204303	NONCDM CHARGE RECORD PHARMACY	636	J3490	217	N/A	N/A	N/A
HC65002636_05026852715	NONCDM CHARGE RECORD PHARMACY	636	J8610	7	N/A	N/A	N/A
HC65002636_05107955068	NONCDM CHARGE RECORD PHARMACY	636	J3490	760	N/A	N/A	N/A
HC65002636_05976203332	NONCDM CHARGE RECORD PHARMACY	636	J3490	61	N/A	N/A	N/A
HC65002636_06050508236	NONCDM CHARGE RECORD PHARMACY	636	J3490	487	N/A	N/A	N/A
HC65002636_06050547050	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,285	N/A	N/A	N/A
HC65002636_06195825011	NONCDM CHARGE RECORD PHARMACY	636	J3490	752	N/A	N/A	N/A
HC65002636_06332311310	NONCDM CHARGE RECORD PHARMACY	636	J3490	652	N/A	N/A	N/A
HC65002636_06332339306	NONCDM CHARGE RECORD PHARMACY	636	J0770	182	N/A	N/A	N/A
HC65002636_06699396245	NONCDM CHARGE RECORD PHARMACY	636	Z7610	896	N/A	N/A	N/A
HC65002636_06787763602	NONCDM CHARGE RECORD PHARMACY	636	J3490	2,299	N/A	N/A	N/A
HC65002636_06923815943	NONCDM CHARGE RECORD PHARMACY	636	Z7610	114	N/A	N/A	N/A
HC65002636_06968012035	NONCDM CHARGE RECORD PHARMACY	636	J3490	181	N/A	N/A	N/A
HC65002636_07006942103	NONCDM CHARGE RECORD PHARMACY	636	J3490	47	N/A	N/A	N/A
HC65002636_07820612702	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,418	N/A	N/A	N/A
HC65002636_53276101009	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,805	N/A	N/A	N/A
HC65004250	MEDICATION-GENERAL IVS   (MCAL J3490)	250		N/A	N/A	N/A	N/A
HC65004250_00143968125	NONCDM CHARGE RECORD PHARMACY	250		60	N/A	N/A	N/A
HC65004250_00143978510	NONCDM CHARGE RECORD PHARMACY	250		122	N/A	N/A	N/A
HC65004250_00143987325	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65004250_00338954124	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65004250_00409114102	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65004250_00409318101	NONCDM CHARGE RECORD PHARMACY	250		53	N/A	N/A	N/A
HC65004250_00409318301	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65004250_00409329905	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_00409490234	NONCDM CHARGE RECORD PHARMACY	250		69	N/A	N/A	N/A
HC65004250_00409662502	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65004250_00409663714	NONCDM CHARGE RECORD PHARMACY	250		81	N/A	N/A	N/A
HC65004250_00517037510	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65004250_00517481025	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65004250_00990793003	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65004250_01671462025	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65004250_04202311310	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65004250_04306699710	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65004250_04733593244	NONCDM CHARGE RECORD PHARMACY	250		200	N/A	N/A	N/A
HC65004250_05175460014	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65004250_05464390071	NONCDM CHARGE RECORD PHARMACY	250		73	N/A	N/A	N/A
HC65004250_05515022505	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65004250_06332318500	NONCDM CHARGE RECORD PHARMACY	250	J3490	500	N/A	N/A	N/A
HC65004250_06332318610	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65004250_06332348921	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65004250_06332366005	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65004250_06332378110	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65004250_06425311123	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_06521905429	NONCDM CHARGE RECORD PHARMACY	250		134	N/A	N/A	N/A
HC65004250_06745700110	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65004250_06978423020	NONCDM CHARGE RECORD PHARMACY	250		42	N/A	N/A	N/A
HC65004250_07006901325	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65004250_07006936210	NONCDM CHARGE RECORD PHARMACY	250		88	N/A	N/A	N/A
HC65004250_07632933011	NONCDM CHARGE RECORD PHARMACY	250		63	N/A	N/A	N/A
HC65004250_07632933521	NONCDM CHARGE RECORD PHARMACY	250		98	N/A	N/A	N/A
HC65025012_00409116201	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65025012_00409116301	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65025012_00409155910	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65025012_05515016830	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65025012_05515017110	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65025012_06332346217	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65025013_04456722110	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65025013_05515012315	NONCDM CHARGE RECORD PHARMACY	250		148	N/A	N/A	N/A
HC65200250_09999904464	NONCDM CHARGE RECORD PHARMACY	636	Q4196	648	N/A	N/A	N/A
HC65500754	DRUG - BLOOD PRODUCT	636		N/A	N/A	N/A	N/A
HC65600343_04554814110	NONCDM CHARGE RECORD PHARMACY	250	A9500	111	N/A	N/A	N/A
HC65600343_04556704551	NONCDM CHARGE RECORD PHARMACY	250	A9537	103	N/A	N/A	N/A
HC65600343_04881510011	NONCDM CHARGE RECORD PHARMACY	255	A9509	1,041	N/A	N/A	N/A
HC65600344_06517488025	NONCDM CHARGE RECORD PHARMACY	255	A9517	96	N/A	N/A	N/A
HC65800005	IODINE-125 NONSTRND PER SOURCE	278	C2639	216	N/A	N/A	N/A
HC65800039	M: SEED(S) GOLD BRACHYTHERAPY	278	C1716	618	N/A	N/A	N/A
HC73000200	HEMODIALYSIS CANCEL-MED NEC	800	90935	1,270	N/A	N/A	N/A
HC73000234	DIALYSIS CRRT CANCEL-MED NEC	881	90945	1,816	N/A	N/A	N/A
HC74200122	OR TIME INIT'L HR CASE CX LEVEL 1 (MCAL 1ST HOUR)	360		5,004	N/A	N/A	N/A
HC74200155	OR TIME INIT'L HR CASE CX LEVEL 4 (MCAL 1ST HOUR)	360		8,293	N/A	N/A	N/A
HC74200320	BEDSIDE/OTHER SURGICAL CANCEL LVL 3	369		3,961	N/A	N/A	N/A
HC74200353	BEDSIDE/OTHER SURGICAL CANCEL LVL 6	369		5,331	N/A	N/A	N/A
HC74200387	OR TIME ADD'L 15MIN CASE CX 3 (MCAL 1ST SUBSQNT 0.5 HR)	360		1,861	N/A	N/A	N/A
HC74200528	BEDSIDE/OTHER SURG ADD'L 15MIN 5 (MCAL 2ND SUBSQNT 0.5 HR)	369		2,505	N/A	N/A	N/A
HC74200551	OR ROOM 1ST SUBSEQUENT HALF HR (MCAL ONLY)	360		N/A	N/A	N/A	N/A
HC74200585	OR TIME ADD'L 15MIN CASE CX 1 (MCAL 2ND SUBSQNT 0.5 HR)	360		1,245	N/A	N/A	N/A
HC77400158	ANESTHESIA EPIDURAL EA ADD 15MIN	370		300	N/A	N/A	N/A
HC77400182	ANESTHESIA SPINAL INITIAL HR	370		1,079	N/A	N/A	N/A
HC79200028	MUSCLE TEST  THREE LIMBS	922	95863	1,950	N/A	N/A	N/A
HC79200051	SURGERY MINOR ADD'L 15 MIN	361		1,681	N/A	N/A	N/A
HC81100026	UREA NITROGEN URINE	301	84540	187	N/A	58	N/A
HC81100166	VANCOMYCIN SUBS	301	80202	604	N/A	124	N/A
HC81100190	LITHIUM	301	80178	356	N/A	47	N/A
HC81100224	GLUCOSE TOLERANCE EA ADDL SPEC	301	82952	118	N/A	22	N/A
HC81100406	TROPONIN	301	84484	342	N/A	94	N/A
HC81100430	ELECTROLYTE PANEL	301	80051	342	N/A	36	N/A
HC81100604	TOBRAMYCIN SUBS	301	80200	658	N/A	193	N/A
HC81100638	SGPT(ALT)	301	84460	163	N/A	27	N/A
HC81100802	URINALYSIS AUTO W/O MICRO	307	81003	140	N/A	22	N/A
HC81100836	SPECIFIC GRAVITY FLUID	301	84315	83	N/A	53	N/A
HC81100869	MYOGLOBIN	301	83874	315	N/A	80	N/A
HC81101016	ACETYLCHOLINESTERASE	301	82013	159	N/A	77	N/A
HC81101040	AMNIOTIC FLUID SCAN	301	82143	271	N/A	113	N/A
HC81101073	CERULOPLASMIN	301	82390	205	N/A	88	N/A
HC81101248	C-REACTIVE PROTEIN	302	86140	161	N/A	41	N/A
HC81101271	PROTEIN OTHER SOURCE	301	84157	180	N/A	57	N/A
HC81101453	CORTISOL(INITIAL)	301	82533	349	N/A	83	N/A
HC81101487	ALBUMIN; OTHER SOURCE	301	82042	213	N/A	38	N/A
HC81101727	INFLUENZA A BY PCR	306	87798	609	N/A	151	N/A
HC81101768	BLOOD GASES LTD  (POS)	301	82803	624	N/A	89	N/A
HC81101792	SODIUM  (POS)	301	84295	154	N/A	28	N/A
HC81101958	DRUG TST DEFNTV 1-7RX CLSS W/METBLTS/DAY	301	G0480	749	N/A	172	N/A
HC81101982	DRUG TST DEFNTV 22/>RX CLSS W/METBLTS/DAY	301	G0483	1,254	N/A	370	N/A
HC81190043	CREATININE (POS)	301	82565	152	N/A	26	N/A
HC81500142	CELL COUNT FLUID W/O DIFF	300	89050	314	N/A	45	N/A
HC81500175	PLATELET AGG EPINEPHRINE	305	85576	379	N/A	109	N/A
HC81500340	FACTOR II PT SPECIFIC	305	85210	427	N/A	141	N/A
HC81500373	FACTOR VIII RELATED AG	305	85244	533	N/A	127	N/A
HC81500407	FACTOR X	305	85260	472	N/A	141	N/A
HC81500548	HEMOLYSIN ACID	305	85475	207	N/A	64	N/A
HC81500571	OSMOTIC FRAGILITY UNINCUBATED	305	85555	190	N/A	125	N/A
HC81500605	SICKLE CELL SCREEN	305	85660	169	N/A	42	N/A
HC81500779	MUCIN CLOT BODY FLUID	301	83872	195	N/A	37	N/A
HC81500803	HEMATOCRIT SPUN	305	85013	132	N/A	31	N/A
HC81500837	PLATELET AGG PLAVIX RESISTANCE	305	85576	333	N/A	109	N/A
HC81700031	RHEUMATOID FACTOR QUANT	302	86431	150	N/A	45	N/A
HC81700064	CARCINOEMBRYONIC ANTIGEN (CEA)	301	82378	416	N/A	96	N/A
HC81700239	T3 FREE	301	84481	326	N/A	86	N/A
HC81700262	ANTI-NUCLEAR AB EIA	302	86038	207	N/A	87	N/A
HC81700296	DNA DOUBLE STRAND AB IGG EIA	302	86225	182	N/A	46	N/A
HC81700437	HEPATITIS B CORE AB  TOT	302	86704	234	N/A	85	N/A
HC81700460	HEPATITIS A ANTIBODY	302	86708	239	N/A	97	N/A
HC81700494	VARICELLA AB	302	86787	226	N/A	80	N/A
HC81700668	ASO TITER	302	86060	135	N/A	30	N/A
HC81700692	SJORGEN SYNDROME AB SSA EIA	302	86235	247	N/A	95	N/A
HC81700874	FLOW CYTO CELL MKR TC ADD+	311	88185	318	N/A	104	N/A
HC81700908	FLW CYT MKR CD19 TC ADD+	311	88185	318	N/A	104	N/A
HC81701070	FLW CYT MKR LAMBDA TC ADD+	311	88185	318	N/A	104	N/A
HC81701104	TDT TEST IFA 1ST STAIN	310	88346	580	N/A	248	N/A
HC81701138	HEP A ANTIBODY IGM	302	86709	230	N/A	91	N/A
HC81701468	NK CELL TOTAL COUNT	302	86357	414	N/A	191	N/A
HC81701492	IMMUNOFIX ELECT OTHER FLUIDS	302	86335	361	N/A	156	N/A
HC81701526	STREPTOCCUS GROUP B  PCR	306	87653	615	N/A	147	N/A
HC81701757	EBV AB TO EARLY (D) AG  IGG	302	86663	205	N/A	75	N/A
HC81701781	GENOTYPE DNA/RNA HEPATITIS C	306	87902	3,929	N/A	775	N/A
HC81701955	DEAMIDATED GLIADIN PEP IGG	302	86258	272	N/A	51	N/A
HC81701989	FLW CYT MKR CD10/CA TC ADD+	311	88185	318	N/A	104	N/A
HC81702011	ALLERGEN IGE SPECFC RECOMB QNT/SEMI QNT EA	302	86008	166	N/A	20	N/A
HC81702151	FLW CYT MKR CD79A TC ADD+	311	88185	318	N/A	104	N/A
HC81702185	FLW CYT MKR TCRGD TC ADD+	311	88185	318	N/A	104	N/A
HC81702219	TREPONEMA PALLIDUM AB QUALITATIVE	302	86780	177	N/A	70	N/A
HC82200130	ALCIAN BLUE STAIN/ GR I W/I&R+	312	88312	547	N/A	140	N/A
HC82200163	GENTA STAIN/GROUP I W/INT&RPT+	312	88312	547	N/A	144	N/A
HC82200197	IHC/IP PER SPEC INITIAL AB STAIN CEA	312	88342	593	N/A	193	N/A
HC82200361	CONSULT DURING SURGERY	312	88329	397	N/A	102	N/A
HC82200395	TISSUE EXAM G&M LEVEL 3	312	88304	505	N/A	120	N/A
HC82200577	SPECIAL STAIN GROUP II+	312	88313	474	N/A	107	N/A
HC82200619	TISSUE EXAM LVL 6 (PQRI)	312	88309	1,332	N/A	526	N/A
HC82200643	TISSUE EXAM LEVEL 2 ADD'L	312	88302	401	N/A	78	N/A
HC82200825	BONE MARROW DX; BX(S) ONLY LT	361	38221	4,954	N/A	1,651	N/A
HC82200866	AUTOPSY GROSS & MICRO W/BRAIN	310	88025	N/A	N/A	N/A	N/A
HC82200890	AUTOPSY G&M STILL/NB W/BRAIN	310	88029	N/A	N/A	N/A	N/A
HC82201062	BONE MAR IRON STN/GRP II+	312	88313	474	N/A	107	N/A
HC82201096	GIEMSA STAIN MAST CELL/GRP II+	312	88313	474	N/A	107	N/A
HC82201260	VERHOFF ELASTI TIS STN/GRP II+	312	88313	474	N/A	107	N/A
HC82201294	HISTCHM ST ATPSE PH4.3 FR TS	312	88319	962	N/A	500	N/A
HC82201468	OIL RED O STAIN FROZ TIS BLK	312	88314	388	N/A	98	N/A
HC82201492	ACID PTASE STAIN  GRP III	312	88319	962	N/A	500	N/A
HC82201526	IHC/IP PER SPEC INITIAL AB STAIN DYSTROPH(C-TERMINUS)	312	88342	593	N/A	193	N/A
HC82201666	IHC/IP PER SPEC INITIAL AB STAIN KI-1	312	88342	593	N/A	193	N/A
HC82201690	IHC/IP PER SPEC INITIAL AB STAIN LAMBDA	312	88342	593	N/A	193	N/A
HC82201724	IHC/IP PER SPEC INITIAL AB STAIN MT1	312	88342	593	N/A	193	N/A
HC82201898	IHC/IP PER SPEC INITIAL AB STAIN CYTO KERATIN-7	312	88342	593	N/A	193	N/A
HC82201922	IHC/IP PER SPEC INITIAL AB STAIN GROWTH HORMONE STN	312	88342	593	N/A	193	N/A
HC82202201	CRYSTALS FLUID	300	89060	290	N/A	64	N/A
HC82202235	AUTOPSY GROSS INFANT W/BRAIN	310	88014	N/A	N/A	N/A	N/A
HC82202433	MORPH STDY TMR IHC CAT PER SPEC EA ADDL AB	312	88361	1,055	N/A	429	N/A
HC82202466	MORPH STUDY MAN ISH QNT 9P21	310	88368	1,330	N/A	607	N/A
HC82202490	MORPH STUDY MAN ISH QNT CEP17	310	88368	1,330	N/A	607	N/A
HC82202672	H & E BLOCK (CLIENT)	312	88399	102	N/A	10	N/A
HC82202706	BM BIOPSY PROCESSING & INTERP	312	88305	780	N/A	218	N/A
HC82202730	TISSUE EXAM G&M LVL 2(TC ONLY)	312	88302	401	N/A	69	N/A
HC82202987	IHC/IP PER SPEC INITIAL AB STAIN CAM5-2	312	88342	593	N/A	193	N/A
HC82203019	IHC/IP PER SPEC INITIAL AB STAIN CD5	312	88342	593	N/A	193	N/A
HC82203183	IHC/IP PER SPEC INITIAL AB STAIN HEPPAR	312	88342	593	N/A	193	N/A
HC82203217	IHC/IP PER SPEC INITIAL AB STAIN INI-1	312	88342	593	N/A	193	N/A
HC82203241	IHC/IP PER SPEC INITIAL AB STAIN MELAN-A	312	88342	593	N/A	193	N/A
HC82203381	IHC/IP PER SPEC EA ADD AB STAIN+ LCA AP	312	88341	516	N/A	183	N/A
HC82203415	IHC/IP PER SPEC EA ADD AB STAIN+ AFP	312	88341	516	N/A	183	N/A
HC82203449	IHC/IP PER SPEC EA ADD AB STAIN+ HCG	312	88341	516	N/A	183	N/A
HC82203613	IHC/IP PER SPEC EA ADD AB STAIN+ CK-19	312	88341	516	N/A	183	N/A
HC82203647	IHC/IP PER SPEC EA ADD AB STAIN+ HEPPAR	312	88341	516	N/A	183	N/A
HC82203811	IHC/IP PER SPEC EA ADD AB STAIN+ CALCITON	312	88341	516	N/A	183	N/A
HC82203845	IHC/IP PER SPEC EA ADD AB STAIN+ ESTR RCPT	312	88341	516	N/A	183	N/A
HC82204017	IHC/IP PER SPEC EA ADD AB STAIN+ PROGEST REC	312	88341	516	N/A	183	N/A
HC82204041	IHC/IP PER SPEC EA ADD AB STAIN+ T4	312	88341	516	N/A	183	N/A
HC82204082	IHC/IP PER SPEC EA ADD AB STAIN+ ANTI-BCL-2	312	88341	516	N/A	183	N/A
HC82204231	IHC/IP PER SPEC EA ADD AB STAIN+ P-53	312	88341	516	N/A	183	N/A
HC82204264	IHC/IP PER SPEC EA ADD AB STAIN+ SMMHC	312	88341	516	N/A	183	N/A
HC82204298	IHC/IP PER SPEC EA ADD AB STAIN+ HER-2-NEU	312	88341	516	N/A	183	N/A
HC82204462	IHC/IP PER SPEC EA ADD AB STAIN+ PROS ACID PHOS	312	88341	516	N/A	183	N/A
HC82204496	BONE MARROW DX; BX(S) & ASP(S) LT	361	38222	6,853	N/A	2,782	N/A
HC82204660	IHC/IP PER SPEC EA ADD AB STAIN+ HSV-2	312	88341	516	N/A	183	N/A
HC82204694	IHC/IP PER SPEC EA ADD AB STAIN+ MSH-6	312	88341	516	N/A	183	N/A
HC83000059	RBC'S DEGLYCEROLIZED EA UNIT	390	P9039	1,485	N/A	834	N/A
HC83000083	FRESH FROZEN PLASMA EA UNIT	390	P9017	409	N/A	107	N/A
HC83000125	RBC ANTIBODY SCREEN	300	86850	282	N/A	58	N/A
HC83000315	RH PHENOTYPE	300	86906	165	N/A	64	N/A
HC83000349	FREEZING & THAW BLD EA UNIT	300	86932	354	N/A	185	N/A
HC83000372	RBC PRETREAT W/DRUG/CHEM	302	86970	163	N/A	8	N/A
HC83000562	PLATELETPHER LR/CMV-/IRRAD/U	390	P9053	2,439	N/A	1,828	N/A
HC83000596	WHOLE BLOOD LEUKO RED/IRRAD EA UNIT	390	P9056	894	N/A	644	N/A
HC83000919	BLOOD TYPE SERO; PER AG/ANTIGEN DONOR	302	86902	366	N/A	342	N/A
HC83000943	RBC'S LUK RED'IRR EAUNIT DD~BB	390	P9056	894	N/A	768	N/A
HC83000992	RBC'S LEUKO REDUCED EA UNIT-SB	390	P9016	953	N/A	286	N/A
HC83001180	RBC'S LEUKO REDUCED EA UNIT	390	P9016	945	N/A	335	N/A
HC83001214	RBC DEGLYCEROLIZED EA UNIT	390	P9039	1,485	N/A	147	N/A
HC83001248	PLATELET PHERESIS PATHOGEN REDUCED EA UNIT	390	P9073	1,963	N/A	700	N/A
HC83500033	STONE ANALYSIS-AU	301	82360	27	N/A	27	N/A
HC83500066	RECEPTOR ASSAY  ESTROGEN-PI	301	84233	28	N/A	28	N/A
HC83500116	CHEMOSENSITIVITY ASSAY-ON	300	86999	N/A	N/A	N/A	N/A
HC83500322	BM: CHROMOSOME ANALYSIS-GZ	310	88262	200	N/A	200	N/A
HC83500355	15-20 CELLS 2 KARYO BAND-IM	310	88262	N/A	N/A	N/A	N/A
HC83500520	INTERPHS FISH HYBRI 100-300-HP	310	88275	N/A	N/A	N/A	N/A
HC83500553	KARYOTYPING ADD EA-HP	310	88280	N/A	N/A	N/A	N/A
HC83500595	CHROM ANAL ADDL CELL CT-HP	310	88285	N/A	N/A	N/A	N/A
HC83500785	SPECIAL STAIN GRP I W/ I&R+-MA	312	88312	152	N/A	151	N/A
HC83500819	ACID FAST STN/GRP I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83500843	ALCIAN BLUE STN/GR I W/I&R+-U2	312	88312	N/A	N/A	N/A	N/A
HC83501015	GROCOT SILVR ST/GR I W/I&R+-US	312	88312	N/A	N/A	N/A	N/A
HC83501049	PAS STAIN/GRP I W/ INT&RPT+-US	312	88312	N/A	N/A	N/A	N/A
HC83501213	SPECIAL STAIN GROUP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501247	ALCIAN BLUE NO DIGES/GRPII+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501411	BONE MAR IRON STN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501445	ELASTIC STAIN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501478	F-M ARGENTAFFIN STN/GRP II+-U2	312	88313	N/A	N/A	N/A	N/A
HC83501619	IRON STAIN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501643	IRON STAIN/B.M. SMEARS+-US	312	88313	N/A	N/A	N/A	N/A
HC83501676	JONES SILVER STAIN/GRP II+-US	312	88313	N/A	N/A	N/A	N/A
HC83501841	METHYL GREEN PY STN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83501874	MUCIN MUCICARM STN/GRP II+-IM	312	88313	N/A	N/A	N/A	N/A
HC83502047	SPECIAL STAIN GROUP II+-SU	312	88313	N/A	N/A	N/A	N/A
HC83502096	PAS W/DIGESTON -IM	312	88314	N/A	N/A	N/A	N/A
HC83502120	OIL RED O STAIN -IM	312	88314	N/A	N/A	N/A	N/A
HC83502385	IHC/IP PER SPEC INITIAL AB STAIN -MA	312	88342	194	N/A	104	N/A
HC83502419	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH N-TERMINS -IM	312	88342	N/A	N/A	N/A	N/A
HC83502443	IHC/IP PER SPEC INITIAL AB STAIN DYSTRPH ROD DOMAN -US	312	88342	N/A	N/A	N/A	N/A
HC83502583	IHC/IP PER SPEC INITIAL AB STAIN CHROMOGRNIN -US	312	88342	N/A	N/A	N/A	N/A
HC83502617	IHC/IP PER SPEC INITIAL AB STAIN EPITH -IM	312	88342	N/A	N/A	N/A	N/A
HC83502641	IHC/IP PER SPEC INITIAL AB STAIN ESTROGN RECPT -US	312	88342	N/A	N/A	N/A	N/A
HC83502815	IHC/IP PER SPEC INITIAL AB STAIN KAPPA -IM	312	88342	N/A	N/A	N/A	N/A
HC83502864	IHC/IP PER SPEC INITIAL AB STAIN KI-1 -US	312	88342	N/A	N/A	N/A	N/A
HC83503052	IHC/IP PER SPEC INITIAL AB STAIN MYGLOBIN -IM	312	88342	N/A	N/A	N/A	N/A
HC83503086	IHC/IP PER SPEC INITIAL AB STAIN NEUROFILAMENT -US	312	88342	N/A	N/A	N/A	N/A
HC83503110	IHC/IP PER SPEC INITIAL AB STAIN PROGEST RECPT -IM	312	88342	N/A	N/A	N/A	N/A
HC65000250_05129369601	NONCDM CHARGE RECORD PHARMACY	250		59	N/A	N/A	N/A
HC65000250_05129382101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05167212581	NONCDM CHARGE RECORD PHARMACY	250		405	N/A	N/A	N/A
HC65000250_05167212821	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_05167213861	NONCDM CHARGE RECORD PHARMACY	250		237	N/A	N/A	N/A
HC65000250_05167240481	NONCDM CHARGE RECORD PHARMACY	250		110	N/A	N/A	N/A
HC65000250_05167252971	NONCDM CHARGE RECORD PHARMACY	250		63	N/A	N/A	N/A
HC65000250_05199183716	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05199190701	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_05224430010	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_05281721010	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05281733200	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05295925100	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05374617360	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05374651401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05374654501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05483801150	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05483850280	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05511132101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05511135260	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05511153201	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05633100614	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_05723701760	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05723701899	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05723723301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05766416752	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789630301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789642601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05789692101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05823207193	NONCDM CHARGE RECORD PHARMACY	250		29	N/A	N/A	N/A
HC65000250_05846801322	NONCDM CHARGE RECORD PHARMACY	250	Z7610	116	N/A	N/A	N/A
HC65000250_05891417014	NONCDM CHARGE RECORD PHARMACY	250		27	N/A	N/A	N/A
HC65000250_05891450156	NONCDM CHARGE RECORD PHARMACY	250		239	N/A	N/A	N/A
HC65000250_05898040912	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05965118030	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05967627801	NONCDM CHARGE RECORD PHARMACY	250		278	N/A	N/A	N/A
HC65000250_05976200751	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05976204011	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05976231401	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_05976237191	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05976250001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06043206500	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06043212608	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06043215016	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06050502532	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06050508261	NONCDM CHARGE RECORD PHARMACY	250		234	N/A	N/A	N/A
HC65000250_06050532506	NONCDM CHARGE RECORD PHARMACY	250		76	N/A	N/A	N/A
HC65000250_06050532753	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06050546423	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06068711301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068712901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068715721	NONCDM CHARGE RECORD PHARMACY	250		61	N/A	N/A	N/A
HC65000250_06068722401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068724201	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068724977	NONCDM CHARGE RECORD PHARMACY	250	Z7610	28	N/A	N/A	N/A
HC65000250_06068733301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068734601	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068739101	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06068740101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068741094	NONCDM CHARGE RECORD PHARMACY	250		357	N/A	N/A	N/A
HC65000250_06068745001	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06068745801	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06068746801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068750601	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06068752521	NONCDM CHARGE RECORD PHARMACY	250		168	N/A	N/A	N/A
HC65000250_06068756801	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06068757137	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06068762201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06068763101	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06068763801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06075880105	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_06075890810	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_06126973041	NONCDM CHARGE RECORD PHARMACY	250	Z7610	39	N/A	N/A	N/A
HC65000250_06131465605	NONCDM CHARGE RECORD PHARMACY	250		85	N/A	N/A	N/A
HC65000250_06144211201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06195814011	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65000250_06203759790	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06210333300	NONCDM CHARGE RECORD PHARMACY	250	Z7610	12	N/A	N/A	N/A
HC65000250_06233203731	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06233210790	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_06233219030	NONCDM CHARGE RECORD PHARMACY	250		33	N/A	N/A	N/A
HC65000250_06255923501	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06255973101	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06255982201	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06275645788	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06275652069	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_06332308605	NONCDM CHARGE RECORD PHARMACY	250	J3490	34	N/A	N/A	N/A
HC65000250_06332309301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06332318730	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06340230430	NONCDM CHARGE RECORD PHARMACY	250		294	N/A	N/A	N/A
HC65000250_06340291130	NONCDM CHARGE RECORD PHARMACY	250		122	N/A	N/A	N/A
HC65000250_06348168706	NONCDM CHARGE RECORD PHARMACY	250		147	N/A	N/A	N/A
HC65000250_06373915910	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06373916510	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06373941010	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06373943202	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373956710	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06373957110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373964510	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06373994310	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06373997210	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06373999764	NONCDM CHARGE RECORD PHARMACY	250		204	N/A	N/A	N/A
HC65000250_06438079701	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_06438097025	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06498017750	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_06498050312	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_06498051405	NONCDM CHARGE RECORD PHARMACY	250		63	N/A	N/A	N/A
HC65000250_06516246310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516246510	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06516247505	NONCDM CHARGE RECORD PHARMACY	250	Z7610	12	N/A	N/A	N/A
HC65000250_06516269890	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06516275003	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06516275710	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06586201001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586202106	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06586214990	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586219201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586220190	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586239010	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06586245860	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06586249647	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06586265401	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06586266330	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06586294760	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06655300201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06668906099	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_06668920204	NONCDM CHARGE RECORD PHARMACY	250		120	N/A	N/A	N/A
HC65000250_06668930516	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_06745743322	NONCDM CHARGE RECORD PHARMACY	250	J3490	6	N/A	N/A	N/A
HC65000250_06761811128	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06761831030	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_06787729860	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06787739230	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808402701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808404501	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808413521	NONCDM CHARGE RECORD PHARMACY	250		36	N/A	N/A	N/A
HC65000250_06808418901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808420301	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06808426901	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_06808428101	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808428801	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808435501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06808437301	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06808453601	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808457201	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808459701	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06808469201	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06808470825	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808471301	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_06808478261	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06808481309	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06808484401	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06808498832	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06809400862	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_06809460062	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_06813420116	NONCDM CHARGE RECORD PHARMACY	250		53	N/A	N/A	N/A
HC65000250_06817600015	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06818058901	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06818065806	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_06818067511	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_06818097901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06818098101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838214601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838222714	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06838280501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06838280605	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846210230	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_06846220030	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06846223301	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06846225501	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06846238160	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_06846243630	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06907614601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06909714260	NONCDM CHARGE RECORD PHARMACY	250	Z7610	6	N/A	N/A	N/A
HC65000250_06909731602	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_06923811053	NONCDM CHARGE RECORD PHARMACY	250	Z7610	41	N/A	N/A	N/A
HC65000250_06923811543	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06923813051	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_06931513301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06931521101	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_06931530805	NONCDM CHARGE RECORD PHARMACY	250		90	N/A	N/A	N/A
HC65000250_06954325910	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_06954338090	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_06991810101	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_06996800609	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07001006510	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07031246129	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07040864434	NONCDM CHARGE RECORD PHARMACY	250		103	N/A	N/A	N/A
HC65000250_07067700211	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_07075620111	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07088213260	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07139901101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07139984605	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07250820407	NONCDM CHARGE RECORD PHARMACY	250		78	N/A	N/A	N/A
HC65000250_07257808901	NONCDM CHARGE RECORD PHARMACY	250		79	N/A	N/A	N/A
HC65000250_07278913160	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_07582611810	NONCDM CHARGE RECORD PHARMACY	250		40	N/A	N/A	N/A
HC65000250_07583412401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07583417001	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_07638511401	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07638512401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_07733398310	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_07811210189	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068114101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08068116801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_08103300250	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_08489800001	NONCDM CHARGE RECORD PHARMACY	250		18	N/A	N/A	N/A
HC65000250_08770142581	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_09999903394	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65000634	DRUG - EPOGEN<10 000 UNITS	634		N/A	N/A	N/A	N/A
HC65000636_00000366800	NONCDM CHARGE RECORD PHARMACY	636	J3010	45	N/A	N/A	N/A
HC65000636_00003375614	NONCDM CHARGE RECORD PHARMACY	636	J9299	190	N/A	N/A	N/A
HC65000636_00005197105	NONCDM CHARGE RECORD PHARMACY	636	90670	1,434	N/A	N/A	N/A
HC65000636_00006302604	NONCDM CHARGE RECORD PHARMACY	636	J9271	28	N/A	N/A	N/A
HC65000636_00009001306	NONCDM CHARGE RECORD PHARMACY	636	J1720	78	N/A	N/A	N/A
HC65000636_00009003928	NONCDM CHARGE RECORD PHARMACY	636	J2920	39	N/A	N/A	N/A
HC65000636_00009004726	NONCDM CHARGE RECORD PHARMACY	636	J2930	63	N/A	N/A	N/A
HC65000636_00009307303	NONCDM CHARGE RECORD PHARMACY	636	J1030	70	N/A	N/A	N/A
HC65000636_00009347501	NONCDM CHARGE RECORD PHARMACY	636	J1040	123	N/A	N/A	N/A
HC65000636_00037900105	NONCDM CHARGE RECORD PHARMACY	636	J3490	118	N/A	N/A	N/A
HC65000636_00049001481	NONCDM CHARGE RECORD PHARMACY	636	J0295	34	N/A	N/A	N/A
HC65000636_00054016625	NONCDM CHARGE RECORD PHARMACY	636	J7517	4	N/A	N/A	N/A
HC65000636_00054372144	NONCDM CHARGE RECORD PHARMACY	636	J7512	6	N/A	N/A	N/A
HC65000636_00054418025	NONCDM CHARGE RECORD PHARMACY	636	J8540	0	N/A	N/A	N/A
HC65000636_00054873925	NONCDM CHARGE RECORD PHARMACY	636	J7512	1	N/A	N/A	N/A
HC65000636_00065054301	NONCDM CHARGE RECORD PHARMACY	636	J3300	24	N/A	N/A	N/A
HC65000636_00069005801	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_00069130810	NONCDM CHARGE RECORD PHARMACY	636	Q5106	72	N/A	N/A	N/A
HC65000636_00069303020	NONCDM CHARGE RECORD PHARMACY	636	J9000	54	N/A	N/A	N/A
HC65000636_00074433902	NONCDM CHARGE RECORD PHARMACY	636	J0135	0	N/A	N/A	N/A
HC65000636_00074438010	NONCDM CHARGE RECORD PHARMACY	636	J3490	106	N/A	N/A	N/A
HC65000636_00085432001	NONCDM CHARGE RECORD PHARMACY	636	J0702	24	N/A	N/A	N/A
HC65000636_00093574065	NONCDM CHARGE RECORD PHARMACY	636	J7515	7	N/A	N/A	N/A
HC65000636_00131181067	NONCDM CHARGE RECORD PHARMACY	636	C9254	3	N/A	N/A	N/A
HC65000636_00143928410	NONCDM CHARGE RECORD PHARMACY	636	C9113	42	N/A	N/A	N/A
HC65000636_00143930010	NONCDM CHARGE RECORD PHARMACY	636	C9113	18	N/A	N/A	N/A
HC65000636_00143937601	NONCDM CHARGE RECORD PHARMACY	636	J9181	3	N/A	N/A	N/A
HC65000636_00143955901	NONCDM CHARGE RECORD PHARMACY	636	J0883	26	N/A	N/A	N/A
HC65000636_00143957510	NONCDM CHARGE RECORD PHARMACY	636	J2001	0	N/A	N/A	N/A
HC65000636_00143971910	NONCDM CHARGE RECORD PHARMACY	636	J2260	25	N/A	N/A	N/A
HC65000636_00143972224	NONCDM CHARGE RECORD PHARMACY	636	J1956	37	N/A	N/A	N/A
HC65000636_00143974610	NONCDM CHARGE RECORD PHARMACY	636	J3105	26	N/A	N/A	N/A
HC65000636_00172731320	NONCDM CHARGE RECORD PHARMACY	636	J7502	31	N/A	N/A	N/A
HC65000636_00173089201	NONCDM CHARGE RECORD PHARMACY	636	J2182	0	N/A	N/A	N/A
HC65000636_00206886102	NONCDM CHARGE RECORD PHARMACY	636	J2543	48	N/A	N/A	N/A
HC65000636_00264987210	NONCDM CHARGE RECORD PHARMACY	636	J1644	26	N/A	N/A	N/A
HC65000636_00270044535	NONCDM CHARGE RECORD PHARMACY	636	Q9963	5	N/A	N/A	N/A
HC65000636_00270131430	NONCDM CHARGE RECORD PHARMACY	636	Q9966	5	N/A	N/A	N/A
HC65000636_00338043103	NONCDM CHARGE RECORD PHARMACY	636	J1644	29	N/A	N/A	N/A
HC65000636_00338070341	NONCDM CHARGE RECORD PHARMACY	636	J3480	3	N/A	N/A	N/A
HC65000636_00338604537	NONCDM CHARGE RECORD PHARMACY	636	J3490	74	N/A	N/A	N/A
HC65000636_00338955712	NONCDM CHARGE RECORD PHARMACY	636	J3490	520	N/A	N/A	N/A
HC65000636_00407141230	NONCDM CHARGE RECORD PHARMACY	636	Q9965	5	N/A	N/A	N/A
HC65000636_00407141489	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_00407141494	NONCDM CHARGE RECORD PHARMACY	636	Q9967	6	N/A	N/A	N/A
HC65000636_00407222302	NONCDM CHARGE RECORD PHARMACY	636	Q9967	7	N/A	N/A	N/A
HC65000636_00409083001	NONCDM CHARGE RECORD PHARMACY	636	J3490	413	N/A	N/A	N/A
HC65000636_00409106720	NONCDM CHARGE RECORD PHARMACY	636	J0670	17	N/A	N/A	N/A
HC65000636_00409131702	NONCDM CHARGE RECORD PHARMACY	636	J1165	4	N/A	N/A	N/A
HC65000636_00409136201	NONCDM CHARGE RECORD PHARMACY	636	J2175	50	N/A	N/A	N/A
HC65000636_00409193202	NONCDM CHARGE RECORD PHARMACY	636	J0153	11	N/A	N/A	N/A
HC65000636_00409216877	NONCDM CHARGE RECORD PHARMACY	636	J3475	1	N/A	N/A	N/A
HC65000636_00409230505	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_00409272002	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_00409272301	NONCDM CHARGE RECORD PHARMACY	636	J1644	3	N/A	N/A	N/A
HC65000636_00409338302	NONCDM CHARGE RECORD PHARMACY	636	J2543	23	N/A	N/A	N/A
HC65000636_00409427801	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_00409428301	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_00409501701	NONCDM CHARGE RECORD PHARMACY	636	J3370	62	N/A	N/A	N/A
HC65000636_00409582001	NONCDM CHARGE RECORD PHARMACY	636	J1265	4	N/A	N/A	N/A
HC65000636_00409593301	NONCDM CHARGE RECORD PHARMACY	636	J0878	1	N/A	N/A	N/A
HC65000636_00409653321	NONCDM CHARGE RECORD PHARMACY	636	J3370	35	N/A	N/A	N/A
HC65000636_00409663501	NONCDM CHARGE RECORD PHARMACY	636	J3480	10	N/A	N/A	N/A
HC65000636_00409672723	NONCDM CHARGE RECORD PHARMACY	636	J3475	23	N/A	N/A	N/A
HC65000636_00409733701	NONCDM CHARGE RECORD PHARMACY	636	J0696	4	N/A	N/A	N/A
HC65000636_00409733820	NONCDM CHARGE RECORD PHARMACY	636	J0696	3	N/A	N/A	N/A
HC65000636_00409780922	NONCDM CHARGE RECORD PHARMACY	636	J1265	8	N/A	N/A	N/A
HC65000636_00456060010	NONCDM CHARGE RECORD PHARMACY	636	J0712	24	N/A	N/A	N/A
HC65000636_00469301601	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,474	N/A	N/A	N/A
HC65000636_00517101025	NONCDM CHARGE RECORD PHARMACY	636	J0461	1	N/A	N/A	N/A
HC65000636_00517179101	NONCDM CHARGE RECORD PHARMACY	636	J1726	0	N/A	N/A	N/A
HC65000636_00517234025	NONCDM CHARGE RECORD PHARMACY	636	J1756	4	N/A	N/A	N/A
HC65000636_00548590000	NONCDM CHARGE RECORD PHARMACY	636	J0834	590	N/A	N/A	N/A
HC65000636_00574082010	NONCDM CHARGE RECORD PHARMACY	636	J1071	0	N/A	N/A	N/A
HC65000636_00574086610	NONCDM CHARGE RECORD PHARMACY	636	J7516	254	N/A	N/A	N/A
HC65000636_00641141035	NONCDM CHARGE RECORD PHARMACY	636	J1160	18	N/A	N/A	N/A
HC65000636_00641600610	NONCDM CHARGE RECORD PHARMACY	636	J0461	0	N/A	N/A	N/A
HC65000636_00641605225	NONCDM CHARGE RECORD PHARMACY	636	J2175	17	N/A	N/A	N/A
HC65000636_00641605910	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_00641616110	NONCDM CHARGE RECORD PHARMACY	636	J3490	15	N/A	N/A	N/A
HC65000636_00641617410	NONCDM CHARGE RECORD PHARMACY	636	J2354	14	N/A	N/A	N/A
HC65000636_00641617701	NONCDM CHARGE RECORD PHARMACY	636	J2354	11	N/A	N/A	N/A
HC65000636_00703150102	NONCDM CHARGE RECORD PHARMACY	636	J0270	28	N/A	N/A	N/A
HC65000636_00703205603	NONCDM CHARGE RECORD PHARMACY	636	J3490	105	N/A	N/A	N/A
HC65000636_00703331104	NONCDM CHARGE RECORD PHARMACY	636	J2354	11	N/A	N/A	N/A
HC65000636_00703505401	NONCDM CHARGE RECORD PHARMACY	636	J2597	124	N/A	N/A	N/A
HC65000636_00703514501	NONCDM CHARGE RECORD PHARMACY	636	J0640	16	N/A	N/A	N/A
HC65000636_00781311395	NONCDM CHARGE RECORD PHARMACY	636	J2543	14	N/A	N/A	N/A
HC65000636_00781315401	NONCDM CHARGE RECORD PHARMACY	636	Q0138	11	N/A	N/A	N/A
HC65000636_00781328909	NONCDM CHARGE RECORD PHARMACY	636	J3490	62	N/A	N/A	N/A
HC65000636_00781329969	NONCDM CHARGE RECORD PHARMACY	636	J1650	14	N/A	N/A	N/A
HC65000636_00781331780	NONCDM CHARGE RECORD PHARMACY	636	J9263	2	N/A	N/A	N/A
HC65000636_00781346670	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_00781502201	NONCDM CHARGE RECORD PHARMACY	636	J7509	7	N/A	N/A	N/A
HC65000636_00781921495	NONCDM CHARGE RECORD PHARMACY	636	J2543	23	N/A	N/A	N/A
HC65000636_00944270006	NONCDM CHARGE RECORD PHARMACY	636	J1569	488	N/A	N/A	N/A
HC65000636_00944304510	NONCDM CHARGE RECORD PHARMACY	636	J7192	0	N/A	N/A	N/A
HC65000636_00990799009	NONCDM CHARGE RECORD PHARMACY	636		691	N/A	N/A	N/A
HC65000636_01001967210	NONCDM CHARGE RECORD PHARMACY	636	J3490	975	N/A	N/A	N/A
HC65000636_01001993801	NONCDM CHARGE RECORD PHARMACY	636	J9070	240	N/A	N/A	N/A
HC65000636_01353331803	NONCDM CHARGE RECORD PHARMACY	636	90375	2,179	N/A	N/A	N/A
HC65000636_01353360612	NONCDM CHARGE RECORD PHARMACY	636	J3490	3,094	N/A	N/A	N/A
HC65000636_01353370501	NONCDM CHARGE RECORD PHARMACY	636	J0256	34	N/A	N/A	N/A
HC65000636_01671402610	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_01671403725	NONCDM CHARGE RECORD PHARMACY	636	J3490	100	N/A	N/A	N/A
HC65000636_01671498102	NONCDM CHARGE RECORD PHARMACY	636	J1050	0	N/A	N/A	N/A
HC65000636_01672910811	NONCDM CHARGE RECORD PHARMACY	636	J9280	1,027	N/A	N/A	N/A
HC65000636_01672928811	NONCDM CHARGE RECORD PHARMACY	636	J9060	22	N/A	N/A	N/A
HC65000636_01672929533	NONCDM CHARGE RECORD PHARMACY	636	J9045	38	N/A	N/A	N/A
HC65000636_01672936468	NONCDM CHARGE RECORD PHARMACY	636	J3243	16	N/A	N/A	N/A
HC65000636_01747804001	NONCDM CHARGE RECORD PHARMACY	636	J2060	12	N/A	N/A	N/A
HC65000636_01747808130	NONCDM CHARGE RECORD PHARMACY	636	J3490	55	N/A	N/A	N/A
HC65000636_01747810730	NONCDM CHARGE RECORD PHARMACY	636	J1956	55	N/A	N/A	N/A
HC65000636_01747895302	NONCDM CHARGE RECORD PHARMACY	636	J0153	3	N/A	N/A	N/A
HC65000636_01951580852	NONCDM CHARGE RECORD PHARMACY	636	90686	119	N/A	N/A	N/A
HC65000636_02315560142	NONCDM CHARGE RECORD PHARMACY	636	J2250	1	N/A	N/A	N/A
HC65000636_02420110024	NONCDM CHARGE RECORD PHARMACY	636	J0131	2	N/A	N/A	N/A
HC65000636_02502113282	NONCDM CHARGE RECORD PHARMACY	636	J1956	37	N/A	N/A	N/A
HC65000636_02502113720	NONCDM CHARGE RECORD PHARMACY	636	J0290	12	N/A	N/A	N/A
HC65000636_02502115799	NONCDM CHARGE RECORD PHARMACY	636	J3370	28	N/A	N/A	N/A
HC65000636_02502118984	NONCDM CHARGE RECORD PHARMACY	636	J1455	304	N/A	N/A	N/A
HC65000636_02502123320	NONCDM CHARGE RECORD PHARMACY	636	J9263	2	N/A	N/A	N/A
HC65000636_02502124501	NONCDM CHARGE RECORD PHARMACY	636	J9171	8	N/A	N/A	N/A
HC65000636_02502140304	NONCDM CHARGE RECORD PHARMACY	636	J1644	1	N/A	N/A	N/A
HC65000636_02502141450	NONCDM CHARGE RECORD PHARMACY	636	J0883	23	N/A	N/A	N/A
HC65000636_02502175110	NONCDM CHARGE RECORD PHARMACY	636	C9113	23	N/A	N/A	N/A
HC65000636_02502179120	NONCDM CHARGE RECORD PHARMACY	636	C9254	2	N/A	N/A	N/A
HC65000636_02502181310	NONCDM CHARGE RECORD PHARMACY	636	J0640	65	N/A	N/A	N/A
HC65000636_03600028225	NONCDM CHARGE RECORD PHARMACY	636	J1940	14	N/A	N/A	N/A
HC65000636_03600030660	NONCDM CHARGE RECORD PHARMACY	636	J0131	1	N/A	N/A	N/A
HC65000636_03600032202	NONCDM CHARGE RECORD PHARMACY	636	J3490	2	N/A	N/A	N/A
HC65000636_04202311625	NONCDM CHARGE RECORD PHARMACY	636	J2590	23	N/A	N/A	N/A
HC65000636_04202313101	NONCDM CHARGE RECORD PHARMACY	636	J0770	182	N/A	N/A	N/A
HC65000636_04202316410	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,475	N/A	N/A	N/A
HC65000636_04306600810	NONCDM CHARGE RECORD PHARMACY	636	J3490	29	N/A	N/A	N/A
HC65000636_04306602310	NONCDM CHARGE RECORD PHARMACY	636	J2795	2	N/A	N/A	N/A
HC65000636_04359875510	NONCDM CHARGE RECORD PHARMACY	636	J1953	2	N/A	N/A	N/A
HC65000636_04359884858	NONCDM CHARGE RECORD PHARMACY	636	J3486	120	N/A	N/A	N/A
HC65000636_04359894811	NONCDM CHARGE RECORD PHARMACY	636	J1453	4	N/A	N/A	N/A
HC65000636_04456721110	NONCDM CHARGE RECORD PHARMACY	636	J0295	65	N/A	N/A	N/A
HC65000636_04456723706	NONCDM CHARGE RECORD PHARMACY	636	J0713	17	N/A	N/A	N/A
HC65000636_04456724525	NONCDM CHARGE RECORD PHARMACY	636	J0694	63	N/A	N/A	N/A
HC65000636_04456780310	NONCDM CHARGE RECORD PHARMACY	636	J2543	15	N/A	N/A	N/A
HC65000636_04596361455	NONCDM CHARGE RECORD PHARMACY	636	J9206	39	N/A	N/A	N/A
HC65000636_04928158905	NONCDM CHARGE RECORD PHARMACY	636	90734	871	N/A	N/A	N/A
HC65000636_04940110201	NONCDM CHARGE RECORD PHARMACY	636	J0490	201	N/A	N/A	N/A
HC65000636_05024213601	NONCDM CHARGE RECORD PHARMACY	636	J3262	31	N/A	N/A	N/A
HC65000636_05024214501	NONCDM CHARGE RECORD PHARMACY	636	J9306	88	N/A	N/A	N/A
HC65000636_05024221501	NONCDM CHARGE RECORD PHARMACY	636	J2357	211	N/A	N/A	N/A
HC65000636_05063201001	NONCDM CHARGE RECORD PHARMACY	636	90675	2,464	N/A	N/A	N/A
HC65000636_05074252005	NONCDM CHARGE RECORD PHARMACY	636	J9070	406	N/A	N/A	N/A
HC65000636_05107972120	NONCDM CHARGE RECORD PHARMACY	636	J7517	3	N/A	N/A	N/A
HC65000636_05199173520	NONCDM CHARGE RECORD PHARMACY	636	Q0166	23	N/A	N/A	N/A
HC65000636_05265220016	NONCDM CHARGE RECORD PHARMACY	636	J8610	114	N/A	N/A	N/A
HC65000636_05511168852	NONCDM CHARGE RECORD PHARMACY	636	J3489	383	N/A	N/A	N/A
HC65000636_05515011310	NONCDM CHARGE RECORD PHARMACY	636	J0290	16	N/A	N/A	N/A
HC65000636_05515011720	NONCDM CHARGE RECORD PHARMACY	636	J0295	21	N/A	N/A	N/A
HC65000636_05515017301	NONCDM CHARGE RECORD PHARMACY	636	J3030	151	N/A	N/A	N/A
HC65000636_05515017705	NONCDM CHARGE RECORD PHARMACY	636	J1953	1	N/A	N/A	N/A
HC65000636_05515018810	NONCDM CHARGE RECORD PHARMACY	636	J3490	100	N/A	N/A	N/A
HC65000636_05515025350	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_05515028209	NONCDM CHARGE RECORD PHARMACY	636	J1335	256	N/A	N/A	N/A
HC65000636_05515030025	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_05551314101	NONCDM CHARGE RECORD PHARMACY	636	Q5117	587	N/A	N/A	N/A
HC65000636_05551319201	NONCDM CHARGE RECORD PHARMACY	636	J2506	3,359	N/A	N/A	N/A
HC65000636_05789405427	NONCDM CHARGE RECORD PHARMACY	636	J3358	66	N/A	N/A	N/A
HC65000636_05789435001	NONCDM CHARGE RECORD PHARMACY	636	J1602	260	N/A	N/A	N/A
HC65000636_05789450301	NONCDM CHARGE RECORD PHARMACY	636	J9144	300	N/A	N/A	N/A
HC65000636_05839463503	NONCDM CHARGE RECORD PHARMACY	636	J7195	9	N/A	N/A	N/A
HC65000636_05846800302	NONCDM CHARGE RECORD PHARMACY	636	J3240	11,941	N/A	N/A	N/A
HC65000636_05914801971	NONCDM CHARGE RECORD PHARMACY	636	J0400	0	N/A	N/A	N/A
HC65000636_06050501330	NONCDM CHARGE RECORD PHARMACY	636	J7515	18	N/A	N/A	N/A
HC65000636_06050507954	NONCDM CHARGE RECORD PHARMACY	636	J1650	10	N/A	N/A	N/A
HC65000636_06057441141	NONCDM CHARGE RECORD PHARMACY	636	90378	10,583	N/A	N/A	N/A
HC65000636_06068743801	NONCDM CHARGE RECORD PHARMACY	636	J7517	4	N/A	N/A	N/A
HC65000636_06170331922	NONCDM CHARGE RECORD PHARMACY	636	J9100	6	N/A	N/A	N/A
HC65000636_06170332518	NONCDM CHARGE RECORD PHARMACY	636	J2430	106	N/A	N/A	N/A
HC65000636_06170333918	NONCDM CHARGE RECORD PHARMACY	636	J9045	74	N/A	N/A	N/A
HC65000636_06195821011	NONCDM CHARGE RECORD PHARMACY	636	Z7610	669	N/A	N/A	N/A
HC65000636_06199001202	NONCDM CHARGE RECORD PHARMACY	636	J2543	14	N/A	N/A	N/A
HC65000636_06199002122	NONCDM CHARGE RECORD PHARMACY	636	J2370	2	N/A	N/A	N/A
HC65000636_06332301211	NONCDM CHARGE RECORD PHARMACY	636	J2590	20	N/A	N/A	N/A
HC65000636_06332301309	NONCDM CHARGE RECORD PHARMACY	636	J3411	25	N/A	N/A	N/A
HC65000636_06332311805	NONCDM CHARGE RECORD PHARMACY	636	J1644	7	N/A	N/A	N/A
HC65000636_06332312820	NONCDM CHARGE RECORD PHARMACY	636	J9130	35	N/A	N/A	N/A
HC65000636_06332318001	NONCDM CHARGE RECORD PHARMACY	636	J3415	108	N/A	N/A	N/A
HC65000636_06332320202	NONCDM CHARGE RECORD PHARMACY	636	J2001	4	N/A	N/A	N/A
HC65000636_06332322905	NONCDM CHARGE RECORD PHARMACY	636	J2720	17	N/A	N/A	N/A
HC65000636_06332326957	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_06332326967	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_06332327810	NONCDM CHARGE RECORD PHARMACY	636	J9360	25	N/A	N/A	N/A
HC65000636_06332330355	NONCDM CHARGE RECORD PHARMACY	636	J3260	34	N/A	N/A	N/A
HC65000636_06332331461	NONCDM CHARGE RECORD PHARMACY	636	J3370	58	N/A	N/A	N/A
HC65000636_06332339306	NONCDM CHARGE RECORD PHARMACY	636	J0770	182	N/A	N/A	N/A
HC65000636_06332340101	NONCDM CHARGE RECORD PHARMACY	636	J3490	235	N/A	N/A	N/A
HC65000636_06332340126	NONCDM CHARGE RECORD PHARMACY	636	J3490	178	N/A	N/A	N/A
HC65000636_06332345201	NONCDM CHARGE RECORD PHARMACY	636	J2270	24	N/A	N/A	N/A
HC65000636_06332347401	NONCDM CHARGE RECORD PHARMACY	636	J1630	37	N/A	N/A	N/A
HC65000636_06332348457	NONCDM CHARGE RECORD PHARMACY	636	J2001	1	N/A	N/A	N/A
HC65000636_06332350830	NONCDM CHARGE RECORD PHARMACY	636	J2185	17	N/A	N/A	N/A
HC65000636_06332352277	NONCDM CHARGE RECORD PHARMACY	636	J1644	2	N/A	N/A	N/A
HC65000636_06332355993	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332356497	NONCDM CHARGE RECORD PHARMACY	636	J1650	13	N/A	N/A	N/A
HC65000636_06332361401	NONCDM CHARGE RECORD PHARMACY	636	J0360	49	N/A	N/A	N/A
HC65000636_06332361609	NONCDM CHARGE RECORD PHARMACY	636	J0282	2	N/A	N/A	N/A
HC65000636_06332364220	NONCDM CHARGE RECORD PHARMACY	636	J3475	3	N/A	N/A	N/A
HC65000636_06332371313	NONCDM CHARGE RECORD PHARMACY	636	J2020	86	N/A	N/A	N/A
HC65000636_06332372810	NONCDM CHARGE RECORD PHARMACY	636	J2248	12	N/A	N/A	N/A
HC65000636_06332373912	NONCDM CHARGE RECORD PHARMACY	636		525	N/A	N/A	N/A
HC65000636_06332396520	NONCDM CHARGE RECORD PHARMACY	636	J3480	1	N/A	N/A	N/A
HC65000636_06332398121	NONCDM CHARGE RECORD PHARMACY	636	J2543	30	N/A	N/A	N/A
HC65000636_06383361702	NONCDM CHARGE RECORD PHARMACY	636	J7187	9	N/A	N/A	N/A
HC65000636_06425333323	NONCDM CHARGE RECORD PHARMACY	636	J1642	0	N/A	N/A	N/A
HC65000636_06525013304	NONCDM CHARGE RECORD PHARMACY	636	C9290	10	N/A	N/A	N/A
HC65000636_06559740601	NONCDM CHARGE RECORD PHARMACY	636	J9358	158	N/A	N/A	N/A
HC65000636_06564955107	NONCDM CHARGE RECORD PHARMACY	636	J2212	8	N/A	N/A	N/A
HC65000636_06679421943	NONCDM CHARGE RECORD PHARMACY	636	J2020	48	N/A	N/A	N/A
HC65000636_06715710151	NONCDM CHARGE RECORD PHARMACY	636	J3490	286	N/A	N/A	N/A
HC65000636_06745715303	NONCDM CHARGE RECORD PHARMACY	636	J0282	5	N/A	N/A	N/A
HC65000636_06745731625	NONCDM CHARGE RECORD PHARMACY	636	J0894	51	N/A	N/A	N/A
HC65000636_06745734210	NONCDM CHARGE RECORD PHARMACY	636	J3370	63	N/A	N/A	N/A
HC65000636_06745748040	NONCDM CHARGE RECORD PHARMACY	636	J9260	13	N/A	N/A	N/A
HC65000636_06745752810	NONCDM CHARGE RECORD PHARMACY	636	J0640	65	N/A	N/A	N/A
HC65000636_06745754620	NONCDM CHARGE RECORD PHARMACY	636	J9027	823	N/A	N/A	N/A
HC65000636_06745785204	NONCDM CHARGE RECORD PHARMACY	636	J3490	227	N/A	N/A	N/A
HC65000636_06745785620	NONCDM CHARGE RECORD PHARMACY	636	J0153	14	N/A	N/A	N/A
HC65000636_06745788910	NONCDM CHARGE RECORD PHARMACY	636	J1453	3	N/A	N/A	N/A
HC65000636_06808414901	NONCDM CHARGE RECORD PHARMACY	636	J7509	11	N/A	N/A	N/A
HC65000636_06808445001	NONCDM CHARGE RECORD PHARMACY	636	J7507	12	N/A	N/A	N/A
HC65000636_06808492125	NONCDM CHARGE RECORD PHARMACY	636	J7502	82	N/A	N/A	N/A
HC65000636_06881713450	NONCDM CHARGE RECORD PHARMACY	636	J9264	94	N/A	N/A	N/A
HC65000636_06909752235	NONCDM CHARGE RECORD PHARMACY	636	J3490	4,225	N/A	N/A	N/A
HC65000636_06991890110	NONCDM CHARGE RECORD PHARMACY	636	J2597	111	N/A	N/A	N/A
HC65000636_07006906425	NONCDM CHARGE RECORD PHARMACY	636	J2795	1	N/A	N/A	N/A
HC65000636_07006930110	NONCDM CHARGE RECORD PHARMACY	636	J0330	12	N/A	N/A	N/A
HC65000636_07012116477	NONCDM CHARGE RECORD PHARMACY	636	J3243	14	N/A	N/A	N/A
HC65000636_07025756001	NONCDM CHARGE RECORD PHARMACY	636	J0475	1,345	N/A	N/A	N/A
HC65000636_07025756301	NONCDM CHARGE RECORD PHARMACY	636	J0475	1,044	N/A	N/A	N/A
HC65000636_07071014781	NONCDM CHARGE RECORD PHARMACY	636	J1451	97	N/A	N/A	N/A
HC65000636_07071017268	NONCDM CHARGE RECORD PHARMACY	636	J9261	859	N/A	N/A	N/A
HC65000636_07086030125	NONCDM CHARGE RECORD PHARMACY	636	J3490	65	N/A	N/A	N/A
HC65000636_07086030210	NONCDM CHARGE RECORD PHARMACY	636	J1940	3	N/A	N/A	N/A
HC65000636_07128501021	NONCDM CHARGE RECORD PHARMACY	636	J3490	1,012	N/A	N/A	N/A
HC65000636_07128800520	NONCDM CHARGE RECORD PHARMACY	636	J0295	33	N/A	N/A	N/A
HC65000636_07128810610	NONCDM CHARGE RECORD PHARMACY	636	J9040	199	N/A	N/A	N/A
HC65000636_07128841087	NONCDM CHARGE RECORD PHARMACY	636	J1650	10	N/A	N/A	N/A
HC65000636_07128871911	NONCDM CHARGE RECORD PHARMACY	636	J0330	6	N/A	N/A	N/A
HC65000636_07183758435	NONCDM CHARGE RECORD PHARMACY	636	J2820	323	N/A	N/A	N/A
HC65000636_07226616010	NONCDM CHARGE RECORD PHARMACY	636	J3486	108	N/A	N/A	N/A
HC65000636_07248510401	NONCDM CHARGE RECORD PHARMACY	636	J0706	14	N/A	N/A	N/A
HC65000636_07257215010	NONCDM CHARGE RECORD PHARMACY	636	J3490	131	N/A	N/A	N/A
HC65000636_07257217201	NONCDM CHARGE RECORD PHARMACY	636	J3010	6	N/A	N/A	N/A
HC65000636_07257226525	NONCDM CHARGE RECORD PHARMACY	636	J0360	14	N/A	N/A	N/A
HC65000636_07257257410	NONCDM CHARGE RECORD PHARMACY	636	J2543	10	N/A	N/A	N/A
HC65000636_07257261210	NONCDM CHARGE RECORD PHARMACY	636	J2704	1	N/A	N/A	N/A
HC65000636_07257280301	NONCDM CHARGE RECORD PHARMACY	636	J3370	11	N/A	N/A	N/A
HC65000636_07598713015	NONCDM CHARGE RECORD PHARMACY	636	J3241	1,942	N/A	N/A	N/A
HC65000636_07601400525	NONCDM CHARGE RECORD PHARMACY	636	J3490	123	N/A	N/A	N/A
HC65000636_07604500510	NONCDM CHARGE RECORD PHARMACY	636	J2270	19	N/A	N/A	N/A
HC65000636_07632933691	NONCDM CHARGE RECORD PHARMACY	636	J2310	107	N/A	N/A	N/A
HC65000636_07632982611	NONCDM CHARGE RECORD PHARMACY	636	J2060	5	N/A	N/A	N/A
HC65000636_09999904512	NONCDM CHARGE RECORD PHARMACY	636	J0698	10	N/A	N/A	N/A
HC65000636_70092117546	NONCDM CHARGE RECORD PHARMACY	636	J2001	46	N/A	N/A	N/A
HC65000637	DRUG - SELF-ADMINISTRABLE	636		N/A	N/A	N/A	N/A
HC65000637_00002882427	NONCDM CHARGE RECORD PHARMACY	636	J1815	6	N/A	N/A	N/A
HC65000637_00024592505	NONCDM CHARGE RECORD PHARMACY	636	J1815	0	N/A	N/A	N/A
HC65000637_00088250205	NONCDM CHARGE RECORD PHARMACY	637	J1815	0	N/A	N/A	N/A
HC65000637_04950239380	NONCDM CHARGE RECORD PHARMACY	636		3	N/A	N/A	N/A
HC65000777	MEDICATION-DEFAULT	250		N/A	N/A	N/A	N/A
HC65001258_00264780009	NONCDM CHARGE RECORD PHARMACY	258	J7030	4	N/A	N/A	N/A
HC62226857	CATH PTA ANGIOPLS BALLOON NON-LSR J	272	C1725	980	N/A	N/A	N/A
HC62226998	CATH PTA ANGIOPLS BALLOON NON-LSR C	272	C1725	350	N/A	N/A	N/A
HC62227020	DISSECTOR NEURO	272		140	N/A	N/A	N/A
HC62227053	PROBE OPTHALMIC	272		84	N/A	N/A	N/A
HC62227228	CATH IV MIDLINE                   F	278	C1751	280	N/A	N/A	N/A
HC62227251	CATH IV MIDLINE                   J	278	C1751	560	N/A	N/A	N/A
HC62227426	DRESSING ANTIMIC MICRO-CURRENT    C	272		106	N/A	N/A	N/A
HC62227459	GUIDE COMPONENT KNEE CUSTOM PATIENT	272		1,750	N/A	N/A	N/A
HC62227483	CAP ENDOSCOPIC HYBRID             D	272		140	N/A	N/A	N/A
HC62227632	CANNULA PERFUSION RETROGRADE	272		2,100	N/A	N/A	N/A
HC62227665	COUNTERSINK                       C	272		280	N/A	N/A	N/A
HC62227699	ILLUMINATOR STRIP RETRACTOR	272		700	N/A	N/A	N/A
HC62227830	POSITIONER FLUIDIZED LARGE	272		210	N/A	N/A	N/A
HC62227863	DRESSING CLOT QUICK	272	A6222	616	N/A	N/A	N/A
HC62227897	OBTURATOR ARTHRO                  K	272		1,120	N/A	N/A	N/A
HC62228069	MOLD/FORM CEMENT ADAPTER FEMORAL	272		910	N/A	N/A	N/A
HC62228093	PATCH WIRELESS MONITOR MATERNAL-FETAL	270		176	N/A	N/A	N/A
HC62228267	ORTH HFO W/O JOINTS PREFAB OTS	274	L3924	277	N/A	N/A	N/A
HC62228291	ORTH FO W/O JOINTS CUSTOM	274	L3933	658	N/A	N/A	N/A
HC62228325	STAPLE CARTRG/ENDO RELOAD         M	272		910	N/A	N/A	N/A
HC62228465	PASSER SUTURE                     N	272		980	N/A	N/A	N/A
HC62228499	BRONCHOSCOPE ASCOPE SLIM DISP	272		956	N/A	N/A	N/A
HC62228523	SYSTEM THROMBECTOMY(CAPERE?)	272	C1757	1	N/A	N/A	N/A
HC62228697	DEVICE SUTURE CAPIO	272		1,902	N/A	N/A	N/A
HC62228721	SLEEP REMOTE(INSPIRE?)	270	C1787	4,900	N/A	N/A	N/A
HC62228895	SYSTEM FLOWTRIEVER?	272	C1757	38,499	N/A	N/A	N/A
HC62228929	ORTHOSIS KNEE HINGE PREFAB	274	L1820	364	N/A	N/A	N/A
HC62229091	GUIDE PIN ORTHO                   S	272		1,702	N/A	N/A	N/A
HC62229125	BLADE TREPHINE                    S	272		1,648	N/A	N/A	N/A
HC62229158	ORTHOTIC TLSO 4 RIGID(DONJOY)	274	L0464	862	N/A	N/A	N/A
HC62290218	P:VAGINAL DELIVERY NO IV			N/A	N/A	N/A	N/A
HC62290341	P:BLOOD PATCH PROCEDURE			N/A	N/A	N/A	N/A
HC62290432	WOUND FILLER DRY COLLAGEN (VENTRIS MED)          AF	272		5,075	N/A	N/A	N/A
HC62300165	SCISSORS POTTS ROBOTIC	272		683	N/A	N/A	N/A
HC62300199	TIP CAUTERY HOOK ROBOTIC          F	272		316	N/A	N/A	N/A
HC62300488	DISSECTOR ROBOTIC                 S	272		770	N/A	N/A	N/A
HC62800008	M: ANCHOR BONE SOFT TISSUE	278	C1713	2,727	N/A	N/A	N/A
HC62800172	CATH ATHERECTOMY DIRECTIONAL      H	272	C1714	12,110	N/A	N/A	N/A
HC62800206	CATH BALLOON DILAT URO MAX        J	272	C1726	560	N/A	N/A	N/A
HC62800230	CATH BALLOON THERMACHOICE         U	272	C1726	2,800	N/A	N/A	N/A
HC62800370	CATH GUIDING                      R	272	C1887	1,726	N/A	N/A	N/A
HC62800404	CATH INTRACARDIAC ECHO/UTZ RPRSD  E	272	C1759	4,200	N/A	N/A	N/A
HC62800438	CATH NON VASC DIL RENAL	272	C1726	799	N/A	N/A	N/A
HC62800610	M: ADAPTER/EXTEND NEURSTM LEAD	278	C1883	10,277	N/A	N/A	N/A
HC62800644	M: AICD NON-SINGLE/NON-DUAL	275	C1882	55,799	N/A	N/A	N/A
HC62800818	CATH CVP/PICC GROSHONG	278	C1751	532	N/A	N/A	N/A
HC62800842	M: CATH HEMODIAL PORT/RSRV LNG TRM	278	C1750	N/A	N/A	N/A	N/A
HC62800875	M: CATH VENTRICULAR NEURO	278	A4301	2,240	N/A	N/A	N/A
HC62801014	M: EYE TUTOPLAST	278	C1762	N/A	N/A	N/A	N/A
HC62801048	M: FIXATOR	278	C1889	2,065	N/A	N/A	N/A
HC62801071	M: GENRTR SNGL NRSTM NON-RECHG	278	C1767	89,630	N/A	N/A	N/A
HC62801246	M: IOL POSTERIOR CHAMBER	276	V2632	541	N/A	N/A	N/A
HC62801279	KIT CVP (PASSPORT)	278	C1751	934	N/A	N/A	N/A
HC62801451	M: MESH COMPOSIX	278	C1781	3,272	N/A	N/A	N/A
HC62801485	M: MISC SPINAL IMPLANT	278	L8699	5,504	N/A	N/A	N/A
HC62801659	M:PIN/K-WIRE/STEINMAN ANCHOR BN-BN	278	C1713	245	N/A	N/A	N/A
HC62801683	M: PLATE MAXILLOFACIAL	278	C1713	1,544	N/A	N/A	N/A
HC62801717	M: PLATE ORTHO	278	C1713	2,623	N/A	N/A	N/A
HC62801857	M: SEPTAL DEFECT IMPLANT SYS	278	C1817	28,368	N/A	N/A	N/A
HC62801881	M: SHOULDER HUMERAL HEAD	278	C1776	3,870	N/A	N/A	N/A
HC62801915	M: SHUNT NEURO	278	C1729	14,520	N/A	N/A	N/A
HC62802087	STENT CAROTID	278	C1874	11,200	N/A	N/A	N/A
HC62802111	STENT PV SELF EXP CVRD/DEL SPX	278	C1874	11,690	N/A	N/A	N/A
HC62802285	M: URINARY SPHINCTER	278	C1815	16,864	N/A	N/A	N/A
HC62802319	M: VALVE PUDENZ FLUSH	278	C1889	N/A	N/A	N/A	N/A
HC62802483	INTRODUCER/SHEATH(FLEXOR CHECK-FLO)E	272	C1894	210	N/A	N/A	N/A
HC62802525	KIT CVP LINE	278	C1751	316	N/A	N/A	N/A
HC62802558	KIT QUINTON MAHURKAR CATH	278	C1751	1,559	N/A	N/A	N/A
HC62802699	M: ICP CATH/MONITOR KIT	278	C1889	N/A	N/A	N/A	N/A
HC62802731	GOLD SEED MARKER FIDUCIAL EA      A	278	A4648	491	N/A	N/A	N/A
HC62802764	ADAPT/EXT PACING LEAD SPX	272	C1883	1,260	N/A	N/A	N/A
HC62802939	COIL NEUROVASCULAR               AO	278	C1889	7,700	N/A	N/A	N/A
HC62802962	COIL NEUROVASCULAR               AR	278	C1889	9,800	N/A	N/A	N/A
HC62803135	M: VALVE HEART MECH TRICUSPID	278	C1889	N/A	N/A	N/A	N/A
HC62803168	M: VALVE HEART TISSUE PULM	278	C1889	N/A	N/A	N/A	N/A
HC62803192	DEVICE MECH' OCCLUDE(COIL/PLUG)	278	C1760	63	N/A	N/A	N/A
HC62803333	DEVICE CLOSURE VASCULAR PLUG      U	272	C1760	2,800	N/A	N/A	N/A
HC62803366	COIL CEREBRAL ANEURYSM            A	278		78	N/A	N/A	N/A
HC62803390	M: GRAFTJACKET PER SQ CM	636	Q4107	7,883	N/A	N/A	N/A
HC62803549	M: DISK ARTIFICIAL SPINE CERVICAL	278	C1889	20,226	N/A	N/A	N/A
HC62803572	M: SLEEVE ORTHO MODULAR	278	C1776	7,857	N/A	N/A	N/A
HC62803606	HEMOSTATIC GEL/GELFOAM/PAD        I	272		401	N/A	N/A	N/A
HC62803788	STENT NON-CORON TEMP NO DELIV SYS F	278	C2617	460	N/A	N/A	N/A
HC62803812	STENT DES CORO COV W/DEL SYS      M	278	C1874	5,600	N/A	N/A	N/A
HC62803986	STENT PANC/URETERAL               J	278	C2617	558	N/A	N/A	N/A
HC62804018	FILTER VENA CAVA(DENLI-ECLPS-MERIDN) D	278	C1880	3,193	N/A	N/A	N/A
HC62804042	FILTER VENA CAVA                  H	278	C1880	4,909	N/A	N/A	N/A
HC62804190	COIL EMBOLIZATION                 H	278		980	N/A	N/A	N/A
HC62804224	COIL EMBOLIZATION                 K	278		1,400	N/A	N/A	N/A
HC62804257	COIL EMBOLIZATION                 O	278		1,960	N/A	N/A	N/A
HC62804430	STENT TRACHEOBRONC COV W/DEL SYS  G	278	C1874	8,400	N/A	N/A	N/A
HC62804463	M: BAR PECTUS	278	L8699	4,794	N/A	N/A	N/A
HC62804638	STENT DES CORO COV W/DEL SYS      R	278	C1874	8,225	N/A	N/A	N/A
HC62804661	STAPLE REINFORCEMENT(SEAMGUARD)???? B	272		538	N/A	N/A	N/A
HC62804836	CLIP LEFT ATRIAL APPENDAGE-LAA    B	278	C1889	7,486	N/A	N/A	N/A
HC62804869	M: CONNECTOR/COUPLER SPINAL	278		1,993	N/A	N/A	N/A
HC62804893	STENT NON CORON W/DELIV SYS       D	278	C2625	489	N/A	N/A	N/A
HC62805031	CATH MAPPING PH ESOPHAGEAL	272	C1732	1,925	N/A	N/A	N/A
HC62805064	CATH EP DIAG/ABLAT 3D/VECT        Q	272	C1732	7,280	N/A	N/A	N/A
HC62805098	CATH EP DX 20+ ELECTRODES         E	272	C1731	3,920	N/A	N/A	N/A
HC62805262	M: STAPLE SPINAL	278		N/A	N/A	N/A	N/A
HC62805296	CATHETER PERITONEAL               F	278	A4300	445	N/A	N/A	N/A
HC62805478	CATH PTCA BALLOON NON-LASER      AD	272	C1725	9,800	N/A	N/A	N/A
HC62805502	CATH EP DIAG/ABLAT 3D/VECT        U	272	C1732	7,700	N/A	N/A	N/A
HC62805536	M: SYSTEM KNEE MPFL LIGAMENT RECON	278	C1713	N/A	N/A	N/A	N/A
HC62805676	M: PIN EXTERNAL FIXATION	278	C1713	405	N/A	N/A	N/A
HC62805700	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP U	272	C1733	2,800	N/A	N/A	N/A
HC62805734	CATH PICC PEDS                    C	278	C1751	106	N/A	N/A	N/A
HC62805874	CATH PICC PEDS                    B	278	C1751	70	N/A	N/A	N/A
HC62805908	CATH EP DX <20 ELECTRODES         D	272	C1730	560	N/A	N/A	N/A
HC62805932	CATH EP DX <20 ELECTRODES         Q	272	C1730	3,360	N/A	N/A	N/A
HC62806104	CATH SWAN GANZ/THERMODILUTION     I	272		490	N/A	N/A	N/A
HC62806138	PORT INDWELLING W/CATH            J	278	C1788	1,400	N/A	N/A	N/A
HC62806302	CATH ATHERCTMY ROTATNL(DIAMNDBCK) D	272	C1724	13,300	N/A	N/A	N/A
HC62806336	TUBE GASTROSTOMY STNDRD BTTN OPT  H	278	A4649	409	N/A	N/A	N/A
HC62806369	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP AF	272	C1733	6,650	N/A	N/A	N/A
HC62806500	PROBE TEMPERATURE ESOPHAGEAL	272	C1732	2,275	N/A	N/A	N/A
HC62806534	TUBE JEJUN STANDRD TRANSGAS       G	278	A4649	350	N/A	N/A	N/A
HC62806567	CATH BALLOON NEURO(HYPERFORM)     I	272	C2628	7,053	N/A	N/A	N/A
HC62806732	COIL EMBOLIZ(PRIME 3D ES)        AM	278	C1889	7,000	N/A	N/A	N/A
HC62806765	POUCH/ENVELOPE PACEMAKER          E	278		3,110	N/A	N/A	N/A
HC62806930	STENT ENDOPRSTH TAA              AB	278	C1874	52,499	N/A	N/A	N/A
HC62806963	SENSOR PULMONARY ARTERY PRESS IMPL WIRELESS SYS	278	C2624	80,324	N/A	N/A	N/A
HC62807136	CATH THROMBECTOMY                AI	272	C1757	9,800	N/A	N/A	N/A
HC62807169	COIL EMBOLIZ(PRIME/HYPERSOFT 3D) AL	278	C1889	6,650	N/A	N/A	N/A
HC62807193	STENT NEUROVASC WINGSPAN H050001	278	C1876	25,532	N/A	N/A	N/A
HC62807334	CLIP ENDOSCOPIC                   R	278		1,750	N/A	N/A	N/A
HC62807367	M: EPIFIX PER SQ CM	636	Q4186	N/A	N/A	N/A	N/A
HC62807391	M: CLARIXFLO PER 1MG	278	Q4155	6,904	N/A	N/A	N/A
HC62807573	M: PLATE W/DISTRACTOR RIDGE ALVEOLAR	278	C1713	N/A	N/A	N/A	N/A
HC62807607	M: CLIP JOINT SMALL	278	C1776	3,360	N/A	N/A	N/A
HC62807771	M: HIP FEM MODULAR COMPONENT	278	C1776	7,264	N/A	N/A	N/A
HC62807805	M: SPACER HUMERAL SHOULDER	278	C1776	651	N/A	N/A	N/A
HC62807979	STENT ENDOPRSTH LEG ILIAC         G	278	C1874	14,011	N/A	N/A	N/A
HC62808001	M: MATERIAL VOCAL CORD MEDIALIZATION SYNTHETIC             NONPS	278	C1878	N/A	N/A	N/A	N/A
HC62808035	SYSTEM REFLECTOR RADAR LOCALIZ(SCOUT)	278	A4648	1,562	N/A	N/A	N/A
HC62808175	G150087 KIT STENTS ENDOPRSTH DSC AORTA	624	C1874	1	N/A	N/A	N/A
HC62808209	STENT NEUROVASC CODMAN ENTRPRS H060001	278	C1876	26,414	N/A	N/A	N/A
HC62808233	M: BEARING TIBIAL	278	C1776	4,860	N/A	N/A	N/A
HC62808407	STENT DES CORO COV W/DEL SYS      G	278	C1874	3,500	N/A	N/A	N/A
HC62808431	STENT EXTENDER ENDOGRAFT AAA      Q	278	C1874	7,000	N/A	N/A	N/A
HC62808605	BONE GRAFT INFUSE? IDE G180160	624	C1889	1	N/A	N/A	N/A
HC62808639	OXYGENATOR ECMO CIRCUIT CARDIOHELP	278	C1889	46,199	N/A	N/A	N/A
HC62808662	G200149 SYSTEM EMBOLIC HYDROGEL EMBRACE (HES)	624	C1889	1	N/A	N/A	N/A
HC62808811	CATH INDIGO SEPARATOR TUBING 7-8FR[PENUMBRA]	272	C1757	9,415	N/A	N/A	N/A
HC62808845	KIT CATH INDIGO 12 THROMB 8FR XTORQ[PENUMBRA]	272	C1757	20,335	N/A	N/A	N/A
HC62808878	TUBE GJ GASTRO/JEJUN LOWPRO	278	A4649	1,488	N/A	N/A	N/A
HC62890116	P: PACER SNGL RATE C1786 RSPNSV W/LEAD C1779 OR C1898			N/A	N/A	N/A	N/A
HC62890157	P: AICD NOT S/D C1882 3LDSC1777/1898/1895/1900W/SHEATH C1894			N/A	N/A	N/A	N/A
HC65000250_00003089331	NONCDM CHARGE RECORD PHARMACY	250		56	N/A	N/A	N/A
HC65000250_00003633517	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00006027754	NONCDM CHARGE RECORD PHARMACY	250		111	N/A	N/A	N/A
HC65000250_00009026001	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_00009033303	NONCDM CHARGE RECORD PHARMACY	250	Z7610	16	N/A	N/A	N/A
HC65000250_00023599060	NONCDM CHARGE RECORD PHARMACY	250		67	N/A	N/A	N/A
HC65000250_00023916360	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_00024159601	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00045020904	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00046110281	NONCDM CHARGE RECORD PHARMACY	250		41	N/A	N/A	N/A
HC65000250_00054008013	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_00054022463	NONCDM CHARGE RECORD PHARMACY	250	Z7610	30	N/A	N/A	N/A
HC65000250_00054052625	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00054312041	NONCDM CHARGE RECORD PHARMACY	250		62	N/A	N/A	N/A
HC65000250_00054329446	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00054849619	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00054852825	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00056018875	NONCDM CHARGE RECORD PHARMACY	250	Z7610	14	N/A	N/A	N/A
HC65000250_00069097195	NONCDM CHARGE RECORD PHARMACY	250		69	N/A	N/A	N/A
HC65000250_00069314019	NONCDM CHARGE RECORD PHARMACY	250	Z7610	144	N/A	N/A	N/A
HC65000250_00074455290	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00074659490	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00074706890	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00078069620	NONCDM CHARGE RECORD PHARMACY	250		66	N/A	N/A	N/A
HC65000250_00087040203	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00087074002	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093031905	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093075201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00093081001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00093221001	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00093227534	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00093417773	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00093535286	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00093590786	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_00093744201	NONCDM CHARGE RECORD PHARMACY	250		26	N/A	N/A	N/A
HC65000250_00093811856	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00093818064	NONCDM CHARGE RECORD PHARMACY	250	Z7610	76	N/A	N/A	N/A
HC65000250_00115180201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00115441101	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00121063800	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_00121064908	NONCDM CHARGE RECORD PHARMACY	250		284	N/A	N/A	N/A
HC65000250_00121089818	NONCDM CHARGE RECORD PHARMACY	250		247	N/A	N/A	N/A
HC65000250_00121090594	NONCDM CHARGE RECORD PHARMACY	250		25	N/A	N/A	N/A
HC65000250_00121091840	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00121115400	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00121127600	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_00121154440	NONCDM CHARGE RECORD PHARMACY	250		60	N/A	N/A	N/A
HC65000250_00121189410	NONCDM CHARGE RECORD PHARMACY	250	Z7610	25	N/A	N/A	N/A
HC65000250_00121467500	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_00140000501	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_00143177101	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00143924920	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00168000415	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00168000615	NONCDM CHARGE RECORD PHARMACY	250		30	N/A	N/A	N/A
HC65000250_00168002031	NONCDM CHARGE RECORD PHARMACY	250		39	N/A	N/A	N/A
HC65000250_00172572860	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00173054700	NONCDM CHARGE RECORD PHARMACY	250		258	N/A	N/A	N/A
HC65000250_00173085702	NONCDM CHARGE RECORD PHARMACY	250		92	N/A	N/A	N/A
HC65000250_00225080547	NONCDM CHARGE RECORD PHARMACY	250		22	N/A	N/A	N/A
HC65000250_00228202750	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00228277911	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00228299650	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00245007011	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00245531915	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00254101196	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_00254302802	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_00338051913	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00363070008	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00378180977	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00378181577	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00378363401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00378561578	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00378606001	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_00378910293	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00378911693	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00378912398	NONCDM CHARGE RECORD PHARMACY	250		130	N/A	N/A	N/A
HC65000250_00406048462	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00406052262	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00406917576	NONCDM CHARGE RECORD PHARMACY	250		130	N/A	N/A	N/A
HC65000250_00409114102	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00409729501	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00409798108	NONCDM CHARGE RECORD PHARMACY	250		162	N/A	N/A	N/A
HC65000250_00409955810	NONCDM CHARGE RECORD PHARMACY	250		46	N/A	N/A	N/A
HC65000250_00456320560	NONCDM CHARGE RECORD PHARMACY	250		48	N/A	N/A	N/A
HC65000250_00469012599	NONCDM CHARGE RECORD PHARMACY	250		0	N/A	N/A	N/A
HC65000250_00472008216	NONCDM CHARGE RECORD PHARMACY	250	Z7610	24	N/A	N/A	N/A
HC65000250_00487930103	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00487960101	NONCDM CHARGE RECORD PHARMACY	250		52	N/A	N/A	N/A
HC65000250_00527131801	NONCDM CHARGE RECORD PHARMACY	250		28	N/A	N/A	N/A
HC65000250_00527139330	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00527185943	NONCDM CHARGE RECORD PHARMACY	250		392	N/A	N/A	N/A
HC65000250_00527411637	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00527512162	NONCDM CHARGE RECORD PHARMACY	250		71	N/A	N/A	N/A
HC65000250_00536100294	NONCDM CHARGE RECORD PHARMACY	250	Z7610	10	N/A	N/A	N/A
HC65000250_00536122858	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_00536124701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536245001	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00536322301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00555007102	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00555015904	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00555048402	NONCDM CHARGE RECORD PHARMACY	250	Z7610	8	N/A	N/A	N/A
HC65000250_00574010601	NONCDM CHARGE RECORD PHARMACY	250		20	N/A	N/A	N/A
HC65000250_00574011302	NONCDM CHARGE RECORD PHARMACY	250	Z7610	3	N/A	N/A	N/A
HC65000250_00574024101	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00574704512	NONCDM CHARGE RECORD PHARMACY	250		143	N/A	N/A	N/A
HC65000250_00574722612	NONCDM CHARGE RECORD PHARMACY	250		57	N/A	N/A	N/A
HC65000250_00591292754	NONCDM CHARGE RECORD PHARMACY	250		383	N/A	N/A	N/A
HC65000250_00591336901	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00597015237	NONCDM CHARGE RECORD PHARMACY	250		124	N/A	N/A	N/A
HC65000250_00597016061	NONCDM CHARGE RECORD PHARMACY	250		367	N/A	N/A	N/A
HC65000250_00597035556	NONCDM CHARGE RECORD PHARMACY	250		53	N/A	N/A	N/A
HC65000250_00603221221	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00603254421	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_00603548221	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00781148701	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00781169501	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00781751687	NONCDM CHARGE RECORD PHARMACY	250		19	N/A	N/A	N/A
HC65000250_00799000104	NONCDM CHARGE RECORD PHARMACY	250		34	N/A	N/A	N/A
HC65000250_00832031011	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00832121501	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832121700	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00832121801	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904020161	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904043004	NONCDM CHARGE RECORD PHARMACY	250		24	N/A	N/A	N/A
HC65000250_00904052361	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904208560	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904253321	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904513559	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904530661	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904530909	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904560961	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904561646	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904572514	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904593061	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00904600761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904629161	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904629461	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904636061	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904636461	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_00904637161	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904643961	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904644261	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904645204	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904650561	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904651661	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904659304	NONCDM CHARGE RECORD PHARMACY	250		77	N/A	N/A	N/A
HC65000250_00904661861	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904662735	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_00904668961	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904670506	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_00904670806	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_00904674724	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904675180	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904676130	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_00904681806	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904682076	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_00904691761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904692761	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904693806	NONCDM CHARGE RECORD PHARMACY	250		11	N/A	N/A	N/A
HC65000250_00904699161	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_00904699760	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904699960	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904704761	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_00904705861	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_00904711561	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904712161	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904719306	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904720546	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904722461	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_00904880567	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_00990793002	NONCDM CHARGE RECORD PHARMACY	250	J3490	1	N/A	N/A	N/A
HC65000250_00998020415	NONCDM CHARGE RECORD PHARMACY	250		600	N/A	N/A	N/A
HC65000250_01013554101	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_01013563801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01070225301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093914344	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093956833	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_01093957844	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01093974444	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01152372683	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_01153416503	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01184505651	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01351711201	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01366800901	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01650008619	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01657120210	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01657140110	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671401930	NONCDM CHARGE RECORD PHARMACY	250		60	N/A	N/A	N/A
HC65000250_01671403901	NONCDM CHARGE RECORD PHARMACY	250		43	N/A	N/A	N/A
HC65000250_01671404210	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671410102	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671411502	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_01671421301	NONCDM CHARGE RECORD PHARMACY	250		10	N/A	N/A	N/A
HC65000250_01671424401	NONCDM CHARGE RECORD PHARMACY	250		21	N/A	N/A	N/A
HC65000250_01671444601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671445201	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671445501	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_01671461206	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671461305	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671463101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671468301	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671468401	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671473201	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_01671475301	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_01671481302	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01671481701	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_01671482101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01671485202	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_01671487402	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01671488701	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_01672904615	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672913616	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672932110	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01672943315	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_01672944715	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01723890011	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_01747806235	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_01747810002	NONCDM CHARGE RECORD PHARMACY	250		77	N/A	N/A	N/A
HC65000250_01747829111	NONCDM CHARGE RECORD PHARMACY	250		148	N/A	N/A	N/A
HC65000250_01747862235	NONCDM CHARGE RECORD PHARMACY	250		68	N/A	N/A	N/A
HC65000250_01747871131	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_01785680405	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_02055500100	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315519101	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_02315519501	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_02315548601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02315576701	NONCDM CHARGE RECORD PHARMACY	250	Z7610	21	N/A	N/A	N/A
HC65000250_02420831334	NONCDM CHARGE RECORD PHARMACY	250		44	N/A	N/A	N/A
HC65000250_02420841105	NONCDM CHARGE RECORD PHARMACY	250		94	N/A	N/A	N/A
HC65000250_02433813610	NONCDM CHARGE RECORD PHARMACY	250		47	N/A	N/A	N/A
HC65000250_02438511878	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02724116001	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_02743720603	NONCDM CHARGE RECORD PHARMACY	250		75	N/A	N/A	N/A
HC65000250_02930012810	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02930013701	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_02930017116	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_03172258690	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_03172263031	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_03172270010	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172293747	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03172299801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03334211407	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_03334225866	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_03665226769	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03877904195	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_03877917798	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_03932805750	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04110081132	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_04110082076	NONCDM CHARGE RECORD PHARMACY	250	Z7610	32	N/A	N/A	N/A
HC65000250_04116706003	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04229137490	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04229146601	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04249434001	NONCDM CHARGE RECORD PHARMACY	250	Z7610	4,129	N/A	N/A	N/A
HC65000250_04257116030	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04265812204	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04280614301	NONCDM CHARGE RECORD PHARMACY	250		82	N/A	N/A	N/A
HC65000250_04280631205	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04280635925	NONCDM CHARGE RECORD PHARMACY	250		58	N/A	N/A	N/A
HC65000250_04319901401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_04329255881	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354728210	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_04354733610	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354740310	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04354741009	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04359816430	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04467710202	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04580201402	NONCDM CHARGE RECORD PHARMACY	250		14	N/A	N/A	N/A
HC65000250_04580204835	NONCDM CHARGE RECORD PHARMACY	250		91	N/A	N/A	N/A
HC65000250_04580206436	NONCDM CHARGE RECORD PHARMACY	250		51	N/A	N/A	N/A
HC65000250_04580214301	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_04580249071	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_04580265087	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04612226530	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_04612264513	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_04628700901	NONCDM CHARGE RECORD PHARMACY	250	Z7610	40	N/A	N/A	N/A
HC65000250_04778101401	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_04778130801	NONCDM CHARGE RECORD PHARMACY	250		15	N/A	N/A	N/A
HC65000250_04778135703	NONCDM CHARGE RECORD PHARMACY	250		32	N/A	N/A	N/A
HC65000250_04843310401	NONCDM CHARGE RECORD PHARMACY	250	Z7610	1	N/A	N/A	N/A
HC65000250_04843320230	NONCDM CHARGE RECORD PHARMACY	250		5	N/A	N/A	N/A
HC65000250_04934818520	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_04934819878	NONCDM CHARGE RECORD PHARMACY	250		17	N/A	N/A	N/A
HC65000250_04934830339	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04934895344	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04941105208	NONCDM CHARGE RECORD PHARMACY	250		1,003	N/A	N/A	N/A
HC65000250_04948308010	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_04988430702	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_04988432155	NONCDM CHARGE RECORD PHARMACY	250		8	N/A	N/A	N/A
HC65000250_04988472401	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05011164801	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05011178766	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_05026806915	NONCDM CHARGE RECORD PHARMACY	250		13	N/A	N/A	N/A
HC65000250_05026808915	NONCDM CHARGE RECORD PHARMACY	250		65	N/A	N/A	N/A
HC65000250_05026810515	NONCDM CHARGE RECORD PHARMACY	250		16	N/A	N/A	N/A
HC65000250_05026818915	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026826815	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026827011	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026837515	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026840215	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026853515	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026857012	NONCDM CHARGE RECORD PHARMACY	250		74	N/A	N/A	N/A
HC65000250_05026862515	NONCDM CHARGE RECORD PHARMACY	250		23	N/A	N/A	N/A
HC65000250_05026863115	NONCDM CHARGE RECORD PHARMACY	250		3	N/A	N/A	N/A
HC65000250_05026863915	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05026870915	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05026873015	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05026875415	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05026886515	NONCDM CHARGE RECORD PHARMACY	250	Z7610	2	N/A	N/A	N/A
HC65000250_05026886815	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05038331147	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05038334911	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05038370016	NONCDM CHARGE RECORD PHARMACY	250		7	N/A	N/A	N/A
HC65000250_05038393093	NONCDM CHARGE RECORD PHARMACY	250		9	N/A	N/A	N/A
HC65000250_05041977301	NONCDM CHARGE RECORD PHARMACY	250		37	N/A	N/A	N/A
HC65000250_05045857710	NONCDM CHARGE RECORD PHARMACY	250		55	N/A	N/A	N/A
HC65000250_05047487015	NONCDM CHARGE RECORD PHARMACY	250		118	N/A	N/A	N/A
HC65000250_05058045770	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05058060002	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05080416438	NONCDM CHARGE RECORD PHARMACY	250		6	N/A	N/A	N/A
HC65000250_05107905820	NONCDM CHARGE RECORD PHARMACY	250		12	N/A	N/A	N/A
HC65000250_05107920620	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05107928420	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107930020	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107944320	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107945120	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107948020	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC65000250_05107975920	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107977120	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107993020	NONCDM CHARGE RECORD PHARMACY	250		1	N/A	N/A	N/A
HC65000250_05107993520	NONCDM CHARGE RECORD PHARMACY	250		2	N/A	N/A	N/A
HC65000250_05122416299	NONCDM CHARGE RECORD PHARMACY	250		4	N/A	N/A	N/A
HC45400256	MR LOW EXT(JNT) W/O CONT BIL	610	73721	12,671	N/A	N/A	N/A
HC45400397	MR ORBIT/FACE&OR NECK W/O CONT	611	70540	6,506	N/A	N/A	N/A
HC45400421	MR PELVIS W/O CONTRAST	610	72195	6,661	N/A	N/A	N/A
HC45400470	MR T-SPINE W&W/O CONTRAST	612	72157	12,247	N/A	N/A	N/A
HC45400611	MR UP EXT(JNT) W/O CONT RT	610	73221	6,127	N/A	N/A	N/A
HC45400645	MR UP EXT (JNT) W/CONT RT	610	73222	7,455	N/A	N/A	N/A
HC45400678	MRA CHEST W/O CONTRAST	610	C8910	5,926	N/A	N/A	N/A
HC45400926	MR BREAST CAD+	610	C8937	969	N/A	N/A	N/A
HC45401023	MR BREAST W/O CONTRAST RT	610	77046	5,505	N/A	N/A	N/A
HC45401247	MRA LOW EXT W&W/O CONT LT	610	C8914	7,415	N/A	N/A	N/A
HC45401270	MRA ABDOMEN W/CONT	610	C8900	6,337	N/A	N/A	N/A
HC45401320	MRA SPINE W/ CONTRAST	612	C8931	8,603	N/A	N/A	N/A
HC45401585	MR BREAST W/O& W/ CONTR & CAD RT [COMM&MCAL]	610	77048	6,488	N/A	N/A	N/A
HC45600004	PET ASSESS MYOCARD VIABILITY	404	78459	10,013	N/A	N/A	N/A
HC45600038	PET SKULL BASE TO MID-THIGH	404	78812	11,916	N/A	N/A	N/A
HC46000147	INJ ARTHROGRAM TMJ	361	21116	821	N/A	N/A	N/A
HC46000212	INJ CONT-ASSESS CYST VIA CATH	361	49424	1,338	N/A	N/A	N/A
HC46000477	INJECTION HIP ARTHROGRAM LT	361	27093	1,767	N/A	N/A	N/A
HC46000501	INTRO CATH HYSTERO	361	58340	1,728	N/A	N/A	N/A
HC46000808	SEL CATH AB/PEL/LOEXT3RD OR LT	321	36247	9,291	N/A	N/A	N/A
HC46000832	SEL CATH PULMONARY ART LT	321	36014	2,935	N/A	N/A	N/A
HC46000865	SEL CATH SEGMNT PULM ART LT	321	36015	2,790	N/A	N/A	N/A
HC46001004	SEL VENOUS CATH 2ND+ORDR RT	321	36012	3,677	N/A	N/A	N/A
HC46001038	INTRO NDL/INTRACATH VEIN	361	36000	420	N/A	N/A	N/A
HC46001061	SEL CATH AB/PEL/LOEXT2ND OR	321	36246	7,853	N/A	N/A	N/A
HC46500005	ABLATION LIVER TUMOR(S) PERC; RF	361	47382	17,533	N/A	N/A	N/A
HC46500062	ASP&INJ BONE CYST	361	20615	3,183	N/A	N/A	N/A
HC46500344	BIOPSY TRANSCATHETER RAD S&I	361	75970	6,637	N/A	N/A	N/A
HC46500385	BLOOD PATCH (INJ EPIDURAL)	361	62273	6,268	N/A	N/A	N/A
HC46500419	BX DEEP PELV/HIP-SC RT	361	27041	6,495	N/A	N/A	N/A
HC46500690	CHANGE URETEROSTOMY TUBE LT	361	50688	7,717	N/A	N/A	N/A
HC46500732	CT ASP&INJ BONE CYST-LT	361	20615	3,183	N/A	N/A	N/A
HC46500765	DECLOTTING IVAD W/THROMBOLYTIC	361	36593	2,913	N/A	N/A	N/A
HC46501011	INS TUN CV ACS CATH W/O PORT 5YRS+	361	36558	14,297	N/A	N/A	N/A
HC46501045	INSERT CT(OPEN) W/DRAIN SYSTEM LT	361	32551	4,526	N/A	N/A	N/A
HC46501078	INSERT PERITONEAL CATH TUNNELED W/IMAGING	361	49418	16,972	N/A	N/A	N/A
HC46501276	PERC PLCMNT GT TUBE W/FLUORO	361	49440	10,627	N/A	N/A	N/A
HC46501334	PUNC SHUNT/RES FOR ASP/INJ	361	61070	4,935	N/A	N/A	N/A
HC46501508	REPLC PICC LINE W/O SQ PORT/PUMP &W/O IMAGING	361	37799	4,260	N/A	N/A	N/A
HC46501540	THORACENTESIS ASP W/ IMG GUID-BILAT	361	32555	13,220	N/A	N/A	N/A
HC46501573	THORACENTESIS W/TUBE W/ IMAG BI	361	32557	13,980	N/A	N/A	N/A
HC46501789	THORACENTESIS ASP W/O IMAG GUIDE	361	32554	5,418	N/A	N/A	N/A
HC46501821	BX NECK/THORAX SOFT TISSUE*DS	361	21550	8,045	N/A	N/A	N/A
HC46501938	PERC ASP INTERDISCAL DX	361	62267	3,374	N/A	N/A	N/A
HC46502134	ABLATION RENAL TUMOR(S) PERC; CRYO RT	361	50593	32,840	N/A	N/A	N/A
HC46502167	PERC BX BREAST W/LOC DEV US 1ST LESN	361	19083	7,331	N/A	N/A	N/A
HC46502332	TENOTOMY SHOULDER AREA  MULT TENDNS	361	23406	12,883	N/A	N/A	N/A
HC46502365	TENOTOMY THIGH MULTIPLE TENDONS	361	27307	15,524	N/A	N/A	N/A
HC46502530	TENOTOMY  PERC  TOE; SINGLE TENDON	361	28010	8,105	N/A	N/A	N/A
HC46502563	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S)	361	38222	6,853	N/A	N/A	N/A
HC46502597	BONE MARROW DX; BIOPSY(IES) & ASPIRATION(S) BILAT	361	38222	11,106	N/A	N/A	N/A
HC46502738	BIOPSY PUNCH SKIN; SINGLE INITIAL LESION	361	11104	1,663	N/A	N/A	N/A
HC46502761	BIOPSY INCISIONAL SKIN; EACH SEP ADD'L LESION	361	11107	1,361	N/A	N/A	N/A
HC46502811	REPLC PICC LINE W/O SQ PORT/PUMP W/IMAGING	361	36584	8,819	N/A	N/A	N/A
HC46502985	BX SOFT TISS UPPER ARM/ELBOW DEEP BIL	361	24066	10,164	N/A	N/A	N/A
HC46503017	BX SOFT TISS LEG/ANKLE DEEP BIL	361	27614	9,075	N/A	N/A	N/A
HC46503181	BX SOFT TISS LEG/ANKLE SUP LT	361	27613	4,961	N/A	N/A	N/A
HC46503215	BX SOFT TISS SHOULDER SUP LT	361	23065	4,840	N/A	N/A	N/A
HC47200092	BRACHYTX INSERT UTERINE TANDEM	333	57155	6,253	N/A	N/A	N/A
HC47200126	HANDLING/LOADING RAD SOURCE	333	77790	1,636	N/A	N/A	N/A
HC47200159	HYPERTHERMIA PROBE 1-5 APPS	333	77610	5,651	N/A	N/A	N/A
HC47200357	PLC MAMMOSITE AFTER DOS BIL	361	19296	29,242	N/A	N/A	N/A
HC47200381	PLC MAMMOSITE ON DOS BIL	361	19297	25,761	N/A	N/A	N/A
HC47200415	PLCMNT INTERSTIT DEV PROSTATE	361	55876	6,505	N/A	N/A	N/A
HC47200688	TREATMENT SIMULATION INTERMED	333	77285	3,254	N/A	N/A	N/A
HC47200720	US GUIDE RAD ELEMENT APP	402	76965	3,373	N/A	N/A	N/A
HC47200902	PLCMNT INTERSTIT DEV THORACIC	361	32553	5,146	N/A	N/A	N/A
HC47200993	DELIV TX XRAY INTRAOP SNGL SESSION	333	77424	4,681	N/A	N/A	N/A
HC47201025	MOTION RESPIRATORY MGNT SIMULATION+	333	77293	4,870	N/A	N/A	N/A
HC47201165	BRACHYTX INSERT VAG RAD AFTRLOAD DEVICE	333	57156	2,910	N/A	N/A	N/A
HC47201215	COLLECTION SPECIMEN SARS-COV-2	300	C9803	198	N/A	N/A	N/A
HC51000016	URINALYSIS NON-AUTO W/O MICRO	307	81002	29	N/A	N/A	N/A
HC51000156	BREATH HYDROGEN TEST	300	91065	276	N/A	N/A	N/A
HC51000180	SPIROMETRY W/PRE&POST BRONCHO	460	94060	505	N/A	N/A	N/A
HC51000214	IV PUSH SINGLE/INIT'L INJ	260	96374	278	N/A	N/A	N/A
HC51000487	STREP A ANTIGN SCRN(DIRECT OBS)	300	87880	96	N/A	N/A	N/A
HC51000511	CHEMO ADMIN IVP SNGL/INIT'LINJ	335	96409	534	N/A	N/A	N/A
HC51001279	CLOSED TX FX RAD/ULN DISTAL FX NO M	361	25600	815	N/A	N/A	N/A
HC51001303	CLOSED TX FINGER DISTAL FX EA NO M	361	26750	432	N/A	N/A	N/A
HC51001337	CLOSED TX OF THIGH FX	361	27501	811	N/A	N/A	N/A
HC51001477	APPLY CAST SHORT ARM	700	29075	337	N/A	N/A	N/A
HC51001501	APPLY CYLINDER CAST(THI-ANKLE)	700	29365	452	N/A	N/A	N/A
HC51001535	APPLY CAST SHORT LEG WALKING	700	29425	490	N/A	N/A	N/A
HC51001717	X-RAY ELBOW 3+ VW	320	73080	268	N/A	N/A	N/A
HC51001741	X-RAY HAND 2 VW	320	73120	223	N/A	N/A	N/A
HC51001949	ECG EXT HOLTER W/CONNECT UP TO 48HRS; RECORD	731	93225	251	N/A	N/A	N/A
HC51001972	US MEASUR POST-VD RES&/BLDR CAP NO IMG	361	51798	234	N/A	N/A	N/A
HC51002202	X RAY URETHROCYSTOGRAM VOIDING	320	74455	604	N/A	N/A	N/A
HC51002236	ASP/INJ RENAL CYST/PELVIS	361	50390	1,141	N/A	N/A	N/A
HC51002269	X RAY URETHROCYSTOGRAM RETROGRADE	361	74450	552	N/A	N/A	N/A
HC51002400	EXCISE LESION 1.1-2CM HND-FT-SC-NCK-GN	361	11422	742	N/A	N/A	N/A
HC51002434	CHANGE CYSTOSTOMY TUBE; SIMPLE	361	51705	509	N/A	N/A	N/A
HC51002483	X RAY FLUORO GUIDANCE	320	76000	444	N/A	N/A	N/A
HC51002665	REMOVE HEMORRHOID INT&EXT GROUPS 2+	361	46260	4,573	N/A	N/A	N/A
HC51002699	PARACENTESIS ABD W/O IMAGING GUIDE	361	49082	1,128	N/A	N/A	N/A
HC51002863	CYSTOSCOPY W/REMV STENT/FB/CALC SIMPL	361	52310	2,604	N/A	N/A	N/A
HC51002897	CYSTOURETHRSCPY W/TX URETER STRICT	361	52341	3,004	N/A	N/A	N/A
HC51002921	DILAT STRICTURE URETHRAL MALE INT'L	361	53600	582	N/A	N/A	N/A
HC51003093	BX PROSTATE NDL/PUNCH SGL/MULT	361	55700	2,881	N/A	N/A	N/A
HC51003127	BX VULVA	361	56605	526	N/A	N/A	N/A
HC51003150	COLPOSCOPY VULVA W/BX(S)	361	56821	574	N/A	N/A	N/A
HC51003291	COLPOSCPY CERV W/CONIZ LOOP ELECTRD	361	57461	3,825	N/A	N/A	N/A
HC51003325	CRYOCAUTERY CERVIX	361	57511	766	N/A	N/A	N/A
HC51003358	DILAT CANAL CERV INSTRMNT(SEP PROC)	361	57800	2,689	N/A	N/A	N/A
HC51003655	ANOSCOPY W/FB REMOVAL	361	46608	1,411	N/A	N/A	N/A
HC51003788	LYSIS ADHESIONS POST-CIRCUMCISION	361	54162	1,529	N/A	N/A	N/A
HC51004042	INHALATION TREATMENT INITIAL	412	94640	243	N/A	N/A	N/A
HC51004091	CAPILLARY/HEEL/FINGER STICK	300	36416	19	N/A	N/A	N/A
HC51004125	DIFFUSING CAPACITY+ /M	460	94729	238	N/A	N/A	N/A
HC51010221	ASP/INJ MED JOINT-RT	361	20605	298	N/A	N/A	N/A
HC51010254	ASP/INJ LARGE JOINT-RT	361	20610	334	N/A	N/A	N/A
HC51010288	INJ(S);SINGLE TENDON/SHEATH LT	361	20550	368	N/A	N/A	N/A
HC51010452	TESTS PERCUTANEOUS ALLERGY	924	95004	600	N/A	N/A	N/A
HC51010486	TEST ALLERGY PERQ&INTRAQ RX/BIOLOGIC	924	95018	81	N/A	N/A	N/A
HC51010650	IMMUNTX PREP-PROV AG SNGL DOSE VL	924	95144	81	N/A	N/A	N/A
HC51010684	IMMUNTX PREP-PROV AG3STING BUG VNM	924	95147	156	N/A	N/A	N/A
HC51010890	CHEMO ADMIN CNS W/SPINAL PUNCTURE	331	96450	833	N/A	N/A	N/A
HC51010932	CHEMO INJECT(S) SUBARACHNOID/INTRAVENT VIA RESEVOIR	331	96542	573	N/A	N/A	N/A
HC51010973	PUNC SHUNT/RES FOR ASP/INJ	361	61070	1,434	N/A	N/A	N/A
HC51020295	NP EST PT LVL III;INTERMED	510	99213	189	N/A	N/A	N/A
HC51020337	NP NEW PT LVL II; LIMITED	510	99202	135	N/A	N/A	N/A
HC51020360	NP NEW PT LVL V; COMPLEX	510	99205	270	N/A	N/A	N/A
HC51040145	3D RENDER W/ INDEPNDNT WORKSTN	320	76377	324	N/A	N/A	N/A
HC51050029	RT CONSULT TELEPHONE PER 15MIN	920	Z5406	51	N/A	N/A	N/A
HC51060184	OT-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	430	96110	254	N/A	N/A	N/A
HC51060333	PT CONSULT TELEPHONE PER 15MIN	920	Z5406	51	N/A	N/A	N/A
HC51060630	DESTROY MUSCLE(S) 5/+ 1ST EXTREMITY	361	64644	1,277	N/A	N/A	N/A
HC51060663	DESTROY MUSCLE(S) TRUNK RT 6/+	361	64647	973	N/A	N/A	N/A
HC51060697	PT-EVAL LOW COMPLEXITY 20MF2F 30MIN	424	97161	294	N/A	N/A	N/A
HC51060937	OT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN/M	430	97761	172	N/A	N/A	N/A
HC51060960	OT-ORTHOTIC FIT/TRNG ADD15M/C	430		129	N/A	N/A	N/A
HC51060994	INJ ANTEGRAD NEPH/URET'GRM S&I EXIST ACCESS RT	361	50431	1,136	N/A	N/A	N/A
HC51061166	ST-LARYNGOSC W/STROBOSCOPY	361	31579	719	N/A	N/A	N/A
HC51061190	ST-LARYNGEAL FUNCTION STUDIES	440	92520	332	N/A	N/A	N/A
HC51061521	CLOSED TREATMENT TIBIAL FRACTURE PROXIMAL W/O MANIP	361	27530	395	N/A	N/A	N/A
HC51061554	STRAPPING; HAND OR FINGER	700	29280	146	N/A	N/A	N/A
HC51061604	ECHO 2D CMPLT W/SPEC&CLR DOPLR	483	93306	1,568	N/A	N/A	N/A
HC51061745	X-RAY SPINE 1 VIEW ANY LEVEL	320	72020	238	N/A	N/A	N/A
HC51061778	X-RAY SPINE THORACIC; 2 VIEWS	320	72070	352	N/A	N/A	N/A
HC51061802	X-RAY SPINE THORACOLUMBAR JUNCTN MIN 2 VWS	320	72080	287	N/A	N/A	N/A
HC51061976	COLLECT INTERP PHYSIOLOGIC DATA PT TRANSMIT	949	99091	27	N/A	N/A	N/A
HC51062008	SELF MEASURE BP PT EDUCATION/TRAINING	949	99473	81	N/A	N/A	N/A
HC51062206	URINALYSIS MICROSCOPIC ONLY	307	81015	32	N/A	N/A	N/A
HC51062230	DIABETIC SELF MANGMT TRNG GRP 30M	942	G0109	37	N/A	N/A	N/A
HC51062404	CPSP CLIENT ORIENTATION/HEALTH ED; EA 15MIN	940	Z6400	32	N/A	N/A	N/A
HC51062438	CPSP ANTEPRTM HEALTH ED F/U ASSESS/TX INDIV'; EA 15MIN	940	Z6406	32	N/A	N/A	N/A
HC51062461	CPSP PERINATAL ED  GROUP; EA 15MIN	940	Z6412	32	N/A	N/A	N/A
HC51062610	EMG FACIAL UNILATL RT	922	95867	346	N/A	N/A	N/A
HC51062651	REMOVAL FB NASAL	361	30300	213	N/A	N/A	N/A
HC51062685	APPLY CAST LONG LEG BILATERAL	700	29345	707	N/A	N/A	N/A
HC51062859	PHONE CALL BY NONPHYSICIAN HC PROF 21-30MIN	949	98968	133	N/A	N/A	N/A
HC51062883	TRANSITIONAL CARE MANAGE SERVICE MOD DECSN 14 DAY DISCHRG	949	99495	260	N/A	N/A	N/A
HC51063055	PAIRING BENIGN HYPERKERATOTIC LESIONS: >4	361	11057	520	N/A	N/A	N/A
HC51063089	DEBRIDE OF NAILS: 6 OR >	361	11721	312	N/A	N/A	N/A
HC51070027	PSY FAMILY CONFERENCE	919	90887	152	N/A	N/A	N/A
HC51070134	PSY TM CONFW/NONMD 30/+MIN(NO PT)/M	900	99368	138	N/A	N/A	N/A
HC51070290	PSYCH TX FOR CRISIS 1ST 60MINS/COMM	914	90839	352	N/A	N/A	N/A
HC51070431	PSYCH FAMILY TX W/PT 50MIN	914	90847	576	N/A	N/A	N/A
HC51070464	PSYCH HYPNOTHERAPY	900	90880	379	N/A	N/A	N/A
HC51070530	PSY-TEAM CONF W/PT &3D 30MINOR>	914	G0175	208	N/A	N/A	N/A
HC51070704	PSY-ASSESS BEHAVIOR W/SCORE & DOCD/STAND INSTRUMENT	918	96127	118	N/A	N/A	N/A
HC51070738	PSY-BEHAVIOR ASSESS/RE-ASSESS	900	96156	214	N/A	N/A	N/A
HC62200076	ABLATION DEVICE(CARDIAC TISS)	272	C1886	20,300	N/A	N/A	N/A
HC62200100	ADAPTER CATH URETERAL/URINARY     C	272		98	N/A	N/A	N/A
HC62200142	ADAPTER/CONNECTOR IV	272		56	N/A	N/A	N/A
HC62200308	BAG/POUCH DRAINAGE	272		100	N/A	N/A	N/A
HC62200332	BAG NEONATAL HYPERIFLATION	270		256	N/A	N/A	N/A
HC62200365	BAG URINARY LEG	272		36	N/A	N/A	N/A
HC62200506	DEVICE BIOPSY	272		415	N/A	N/A	N/A
HC62200548	BLADE DERMATOME	272		210	N/A	N/A	N/A
HC62200571	BLADE BEAVER                      C	272		210	N/A	N/A	N/A
HC62200746	BOTTLE FEEDING	272		83	N/A	N/A	N/A
HC62200779	BREAST SHIELD	270		36	N/A	N/A	N/A
HC62200977	CANNULA AORTIC ROOT	272		109	N/A	N/A	N/A
HC62201009	CANNULA ERCP                      G	272		246	N/A	N/A	N/A
HC62201033	CANNULA NASAL	270		24	N/A	N/A	N/A
HC62201181	CATH EP/ABLAT NOT COOL-TIP/3D/V MAP V	272	C1733	3,150	N/A	N/A	N/A
HC62201215	CATH A-LINE INSYTE	272		101	N/A	N/A	N/A
HC62201249	CATH BONNANO	272		246	N/A	N/A	N/A
HC62201421	CATH FOLEY                        B	272		70	N/A	N/A	N/A
HC62201454	CATH HYDRAGLIDE PVC ATRIUM	272		736	N/A	N/A	N/A
HC62201637	CATH URETERAL                     M	272	C1758	225	N/A	N/A	N/A
HC62201660	CAUTERY BOVIE	272		101	N/A	N/A	N/A
HC62201850	CLIP GUN COMPLETE	272		351	N/A	N/A	N/A
HC62201892	CLIPPER HEAD SNG/USE FOR 3M	272		36	N/A	N/A	N/A
HC62201926	COLLAR CERVICAL HARD	270		238	N/A	N/A	N/A
HC62202072	NEEDLE BIOPSY/ASPIRATION          E	272		177	N/A	N/A	N/A
HC62202106	NEEDLE DEVICE	272		228	N/A	N/A	N/A
HC62202130	CURVED LIFT STRL	272		181	N/A	N/A	N/A
HC62202312	SET AUTOTRANSFUSE                 Q	272	C1729	420	N/A	N/A	N/A
HC62202361	DRAIN SILICONE	272	C1729	106	N/A	N/A	N/A
HC62202577	DRESSING VIASORB	272		83	N/A	N/A	N/A
HC62202619	KIT DRESSING WOUND NEG PRESSURE   D	272	A6550	482	N/A	N/A	N/A
HC62202643	EJECTOR SALIVA FLEXIBLE	272		81	N/A	N/A	N/A
HC62202783	ELECTRODES 4 CHANNEL NIM	272		457	N/A	N/A	N/A
HC62202817	EMG NEEDLE	270		85	N/A	N/A	N/A
HC62202841	CLIP ENDOSCOPIC                   H	272		423	N/A	N/A	N/A
HC62202981	ENDO STITCH/CATCH	272		770	N/A	N/A	N/A
HC62203013	ENDOCURIE RIBBON LONG	272		400	N/A	N/A	N/A
HC62203047	ET BARRIER DUODEEM	272		120	N/A	N/A	N/A
HC62203278	SYSTEM COMPRESSION (FEMOSTOP)	272		368	N/A	N/A	N/A
HC62203302	FIBRIN SEALANT                    P	278		2,140	N/A	N/A	N/A
HC62203526	HUMIDIFIERS	270		64	N/A	N/A	N/A
HC62203559	INSTRUMENT SINGLE PATIENT USE	272		70	N/A	N/A	N/A
HC62203633	SOLUTION DEBRIDEMENT WOUND	272		210	N/A	N/A	N/A
HC62203773	KIT CELL SAVER	272		490	N/A	N/A	N/A
HC62203807	KIT CRANIOPLASTIC RESIN	278	C1889	4,494	N/A	N/A	N/A
HC62203831	KIT DIALYSIS	272		337	N/A	N/A	N/A
HC62204003	KIT KYPHOPAK 1ST FRACTURE         E	278	C1889	11,726	N/A	N/A	N/A
HC62204037	KIT MANIFOLD	272		350	N/A	N/A	N/A
HC62204201	KIT REPAIR BROVIAC/CV/HICKMAN     D	272		526	N/A	N/A	N/A
HC62204235	KIT SHOULDER SUSPENSION	272		204	N/A	N/A	N/A
HC62204409	KNIFE COLD DISP	272		529	N/A	N/A	N/A
HC62204433	BLADE OPHTHALM                    J	272		140	N/A	N/A	N/A
HC62204466	SYSTEM DELIVERY LEAD              B	272	C1887	700	N/A	N/A	N/A
HC62204615	ANTENNA TRANSMIT EXT NEUROSTIM	271	L8683	270	N/A	N/A	N/A
HC62204649	M: SYSTEM NERVE RESPONSE	272	C1889	6,989	N/A	N/A	N/A
HC62204672	MALLET	272		137	N/A	N/A	N/A
HC62204862	NEEDLE BIOPSY                     F	272		154	N/A	N/A	N/A
HC62204896	NEEDLE BONE MARROW                H	272		526	N/A	71	N/A
HC62205075	OBTURATOR                         H	272		280	N/A	N/A	N/A
HC62205117	PACK ACL	272		330	N/A	N/A	N/A
HC62205299	PACK HIP TOTAL	272		270	N/A	N/A	N/A
HC62205323	PACK LAP CHOLE	272		164	N/A	N/A	N/A
HC62205356	PACK LEFT HEART	272		666	N/A	N/A	N/A
HC62205497	KIT VITRECTOMY PROBE              J	272		1,400	N/A	N/A	N/A
HC62205521	PACKING VAGINAL	272		112	N/A	N/A	N/A
HC62205554	PAD CPM	272		150	N/A	N/A	N/A
HC62205745	PRESSURE WIRE	272		2,275	N/A	N/A	N/A
HC62205778	PROBE FLOW VASCULAR UTZ           N	272		943	N/A	N/A	N/A
HC62205950	RESUSCITATOR	272		140	N/A	N/A	N/A
HC62205984	RETRIEVAL NET	272		319	N/A	N/A	N/A
HC62206016	SALINE LOCK	272		84	N/A	N/A	N/A
HC62206156	SET CARDIOPLEGIA	272		445	N/A	N/A	N/A
HC62206180	SET DIALYSIS PREWARM	272		766	N/A	N/A	N/A
HC62206214	SET FRAGMATONE	272		269	N/A	N/A	N/A
HC62206396	SET THORACENTESIS	272		557	N/A	N/A	N/A
HC62206420	SET URICATH	272		316	N/A	N/A	N/A
HC62206610	SOLUTION BSS	272		78	N/A	N/A	N/A
HC62206644	SOLUTION DIALYSIS	272		87	N/A	N/A	N/A
HC62206859	STOCKINGS TED HOSE THIGH HI	272	A4495	41	N/A	N/A	N/A
HC62206917	STYLET INTUBATION	272		39	N/A	N/A	N/A
HC62206941	SUCTION TRAP MICRODEBRIDER	272		414	N/A	N/A	N/A
HC62207097	SUTURE SPECIALTY                  S	272		518	N/A	N/A	N/A
HC62207121	SYSTEM CORE BIOPSY GUN	272		45	N/A	N/A	N/A
HC62207154	SYSTEM STEALTH ALL	272		8,690	N/A	N/A	N/A
HC62207345	TRAY FOLEY CATH W/URINEMETER	272		117	N/A	N/A	N/A
HC62207378	TRAY HYPERAL DRESSING(DISP)	272		172	N/A	N/A	N/A
HC62207550	TRAY UNIVERSAL PROCEDURE	272		134	N/A	N/A	N/A
HC62207584	TUBE ASPIRATING	272		73	N/A	N/A	N/A
HC62207766	TUBE TRACH NO CUFF                F	272	A7520	280	N/A	N/A	N/A
HC62207790	TUBING  PRESSURE	272		92	N/A	N/A	N/A
HC62207832	TUBING HEMODYNAMIC	272		134	N/A	N/A	N/A
HC62207998	TUBING SUCTION NEZHAT DORSEY	272		190	N/A	N/A	N/A
HC62208020	TUNNELER SURGICAL                 F	272		316	N/A	N/A	N/A
HC62208053	NEEDLE BIOPSY THYROID	272		151	N/A	N/A	N/A
HC62208236	DRAIN PLEURAL W/VAC BOTTLE	272		2,394	N/A	N/A	N/A
HC62208277	KIT PERICARDIOCENTESIS	272		630	N/A	N/A	N/A
HC62208616	VEST CHEST/AIRWAY CLEARANCE	270		277	N/A	N/A	N/A
HC62208657	ECP TIGHTS	270		64	N/A	N/A	N/A
HC62208681	CATH HANDLE SINUS GUIDE	272		193	N/A	N/A	N/A
HC62208848	INFUSION WIRE	272		280	N/A	N/A	N/A
HC62208897	CABLE THRESHOLD	272		378	N/A	N/A	N/A
HC62208921	DEVICE EXCHANGE CATH/WIRE	272		241	N/A	N/A	N/A
HC62209085	HOOK PHLEBECTOMY	272		962	N/A	N/A	N/A
HC62209135	TRAY ARTHROGRAM(DISP)	272		373	N/A	N/A	N/A
HC62209168	STAPLE STONE/TABLE	272		355	N/A	N/A	N/A
HC62209374	POSITIONER FLUIDIZED MED Z-FLO	271		490	N/A	N/A	N/A
HC62209408	BRUSH CYTOLOGY NDLTIP TRACKING    E	272		192	N/A	N/A	N/A
HC62209572	TRACTION CERVICAL UNIT	270		406	N/A	N/A	N/A
HC62209606	TRACTION RUSSELLS UNIT	270		501	N/A	N/A	N/A
HC62209630	SLING PELVIC CANVAS	270		330	N/A	N/A	N/A
HC62209770	TRANSCUTANEOUS MNTR SUPPLIES	272		224	N/A	N/A	N/A
HC62209804	KIT CATH RT HEART FLUSH DEVICE	272		61	N/A	N/A	N/A
HC62210133	TUBE TRACH PEDS/NEO CUFFED	272	A7521	624	N/A	N/A	N/A
HC62210315	BALLOON BIOFEEDBACK	272	C1726	770	N/A	N/A	N/A
HC62210349	BRA SURGICAL POST OP	270		59	N/A	N/A	N/A
HC62210562	CATH SELECT NEURO                 A	272	C1887	420	N/A	N/A	N/A
HC62210596	CATH THROMBECT DELIV INCL NEURO   M	272	C1887	2,100	N/A	N/A	N/A
HC62210778	FORCEPS BILIARY BX (SPYBITE)	272		1,733	N/A	N/A	N/A
HC62210802	SET PERITONEAL DIALYSIS	272		312	N/A	N/A	N/A
HC62210836	POSITIONER FLUIDIZED FULL BODY	271		420	N/A	N/A	N/A
HC62210984	PACK PERFUSION - ADULT	272		3,203	N/A	N/A	N/A
HC62211016	CANNULA ARTERIAL PEDS             P	272		1,226	N/A	N/A	N/A
HC62211040	CANNULA VENOUS FEMORAL            Q	272		1,487	N/A	N/A	N/A
HC62211214	INJECTOR UTERINE	272		277	N/A	N/A	N/A
HC62211255	SYSTEM DELIVERY SEPTAL DEFECT	272		2,114	N/A	N/A	N/A
HC62211446	AIRWAY MASK LARYNGEAL (LMA)	272		45	N/A	N/A	N/A
HC62211479	PROBE VASCULAR PARSONNET	272		243	N/A	N/A	N/A
HC62211511	BLADE SAW                         L	272		190	N/A	N/A	N/A
HC62211651	DRESSING ANTIMIC PROTECTV DISC	272		34	N/A	N/A	N/A
HC62211693	DRESSING SACRUM<324CM SQ(MEPILEX)	272		19	N/A	N/A	N/A
HC62211727	KIT POSITNR FLUIDZD FB+UTIL W-COVER	270		559	N/A	N/A	N/A
HC62211875	NEEDLE ENDOSCOPIC                 J	272		560	N/A	N/A	N/A
HC62211909	SET VACUUM CANNISTER W/GEL	272		172	N/A	N/A	N/A
HC62211933	STAPLER ENDO POWERED	272		1,093	N/A	N/A	N/A
HC62212147	TUBE FEEDING ENTERAL NG W/STYLET	272		56	N/A	N/A	N/A
HC62212170	TUBE FEEDING NG>36IN TRACKABLE STYLET	272		177	N/A	N/A	N/A
HC62212345	COLLAR CERV 2 PIECE W-THORA EXTN	274	L0174	1,143	N/A	N/A	N/A
HC62212378	INTRODUCER/SHEATH                 A	272	C1894	36	N/A	N/A	N/A
HC62212402	INTRODUCER/SHEATH                 L	272	C1894	700	N/A	N/A	N/A
HC62212543	FORCEP BIOPSY DISP                D	272		246	N/A	N/A	N/A
HC62212576	NEEDLE BIOPSY EBUS	272		401	N/A	N/A	N/A
HC62212600	CATH PTCA BALLOON NON-LASER       G	272	C1725	972	N/A	N/A	N/A
HC62212774	GUIDEWIRE(SYNCHRO/TRANSEND)       T	272	C1769	1,576	N/A	N/A	N/A
HC62212808	GUIDEWIRE                         W	272	C1769	1,995	N/A	N/A	N/A
HC62212972	BLADE SHAVER                      O	272		1,050	N/A	N/A	N/A
HC62213004	BLADE SHAVER                      R	272		1,260	N/A	N/A	N/A
HC62213178	BURR                              A	272		70	N/A	N/A	N/A
HC62213202	BURR                              H	272		564	N/A	N/A	N/A
HC62213236	BURR                              K	272		770	N/A	N/A	N/A
HC62213376	REAMER                            H	272		402	N/A	N/A	N/A
HC62213400	REAMER                            K	272		609	N/A	N/A	N/A
HC62213434	REAMER                            N	272		770	N/A	N/A	N/A
HC62213608	REAMER                            AE	272		1,967	N/A	N/A	N/A
HC62213632	CANNULA AORTIC FILTERING	272		1,487	N/A	N/A	N/A
HC62213814	DRESSING THERABOND	272		75	N/A	N/A	N/A
HC62213848	KIT CATH HEART RT	272		46	N/A	N/A	N/A
HC62214010	SET CATH CVC QUAD LUMEN	272		262	N/A	N/A	N/A
HC62214044	DEVICE PRESS BONE (HENSLER)	272		1,366	N/A	N/A	N/A
HC62214077	CANNULA TARGETNG NEEDLE(STREAMLINE)	272		556	N/A	N/A	N/A
HC62214218	CATH URETERAL                     N	272	C1758	252	N/A	N/A	N/A
HC62214259	CATH URETERAL                     R	272	C1758	366	N/A	N/A	N/A
HC62214283	CATH URETERAL                     U	272	C1758	448	N/A	N/A	N/A
HC62214457	SUTURE SET FOOT/ANKLE	272		3,325	N/A	N/A	N/A
HC62214499	RETRACTOR DISPOSABLE              E	272		350	N/A	N/A	N/A
HC62214663	KIT SEALANT FIBRIN	272		204	N/A	N/A	N/A
HC62214697	VALVE ENDOSCOPIC                  A	272		36	N/A	N/A	N/A
HC62214721	CATH PTA ANGIOPLS BALLOON NON-LSR P	272	C1725	2,450	N/A	N/A	N/A
HC62215173	BLADE SAW                         C	272		42	N/A	N/A	N/A
HC62215207	BLADE SAW                         F	272		84	N/A	N/A	N/A
HC62215231	BLADE SAW                         I	272		125	N/A	N/A	N/A
HC62215405	DEVICE SUTURE ENDOSCOPIC          K	272		1,428	N/A	N/A	N/A
HC62215439	FORCEPS BIPOLAR DISPOSABLE        K	272		1,354	N/A	N/A	N/A
HC62215603	SUTURE                            K	272		296	N/A	N/A	N/A
HC62215637	SUTURE                            N	272		376	N/A	N/A	N/A
HC62215801	NEEDLE BIOPSY                     A	272		34	N/A	N/A	N/A
HC62215835	NEEDLE BIOPSY                     D	272		98	N/A	N/A	N/A
HC62215868	NEEDLE BIOPSY                     H	272		210	N/A	N/A	N/A
HC62216007	CATH BALLOON DIL NON VASCULAR     F	272	C1726	280	N/A	N/A	N/A
HC62216031	CATH BALLOON DIL NON VASCULAR     M	272	C1726	840	N/A	N/A	N/A
HC62216064	DEVICE SUTURE ENDO                E	272		420	N/A	N/A	N/A
HC62216239	SHEARS COAGULATING HARMONIC       P	272		1,330	N/A	N/A	N/A
HC62216262	STABILIZER HEART OCTOPUS          L	272		5,250	N/A	N/A	N/A
HC62216452	PIN/WIRE FIXATION TEMPORARY       H	272		112	N/A	N/A	N/A
HC62216486	PIN/WIRE FIXATION TEMPORARY       K	272		166	N/A	N/A	N/A
HC62216650	PIN/WIRE FIXATION TEMPORARY       AB	272		643	N/A	N/A	N/A
HC62216684	PIN/WIRE FIXATION TEMPORARY       AE	272		840	N/A	N/A	N/A
HC62216718	PIN/WIRE FIXATION TEMPORARY       AH	272		1,260	N/A	N/A	N/A
HC62216866	ENDO STAPLER                      X	272		1,680	N/A	N/A	N/A
HC62216890	ENDO STAPLER                     AA	272		1,889	N/A	N/A	N/A
HC62216924	ENDO STAPLER                     AD	272		2,125	N/A	N/A	N/A
HC62217096	KIT CHEST TUBE INSERTION	272		280	N/A	N/A	N/A
HC62217120	ADVANCER SYSTM ROTALINK	272	C1894	928	N/A	N/A	N/A
HC62217294	KIT HARVESTING BONE GRAFT         N	272		980	N/A	N/A	N/A
HC62217328	RETRACTOR MIS SPINAL              C	272		2,100	N/A	N/A	N/A
HC62217351	SCRAPER MEMBRANE OPHTH	272		449	N/A	N/A	N/A
HC62217492	KIT CONCENTRATOR PLATELETS        X	272		4,200	N/A	N/A	N/A
HC62217526	DRESSING FILM IV (MEPITEL)	272	A6257	46	N/A	N/A	N/A
HC62217559	KIT TUBE TRACH PEDS/NEO NO CUFF   Q	272	A7520	1,400	N/A	N/A	N/A
HC62217690	AWL SPINAL SINGLE PATIENT USE     R	272		1,540	N/A	N/A	N/A
HC62217724	AWL SPINAL SINGLE PATIENT USE     X	272		2,380	N/A	N/A	N/A
HC62217757	TEMPLATE ORTHO/ROD SPINAL         C	272		196	N/A	N/A	N/A
HC62217922	PUSHER/CUTTER KNOT SUTURE ARTHRS  E	272		420	N/A	N/A	N/A
HC62217955	ORTHOSIS SHOULDER FIGURE 8 PREFAB	274	L3660	257	N/A	N/A	N/A
HC62218128	ELECTRODE LEEP LOOPS              C	272		42	N/A	N/A	N/A
HC62218151	CAUTERY HOOK ASSEMBLY             C	272		42	N/A	N/A	N/A
HC62218185	HEMOSTATIC GEL/GELFOAM/PAD        R	272		1,648	N/A	N/A	N/A
HC62218326	ENDO STAPLER                      D	272		280	N/A	N/A	N/A
HC62218359	ENDO STAPLER                      H	272		598	N/A	N/A	N/A
HC62218383	ENDO STAPLER                      L	272		839	N/A	N/A	N/A
HC62218557	KIT ACP AUTO COND PLASMA SERIES II	272		876	N/A	N/A	N/A
HC62218581	STAPLE CARTRG/ENDO RELOAD         P	272		1,256	N/A	N/A	N/A
HC62218755	DRILL/DRILL BITS SINGLE USE       J	272		365	N/A	N/A	N/A
HC62218789	DRILL/DRILL BITS SINGLE USE       M	272		567	N/A	N/A	N/A
HC62218953	DRILL/DRILL BITS SINGLE USE      AD	272		1,766	N/A	N/A	N/A
HC62218987	DRILL/DRILL BITS SINGLE USE      AH	272		2,335	N/A	N/A	N/A
HC62219019	RETRACTOR MIS SPINAL              O	272		6,300	N/A	N/A	N/A
HC62219159	CANNULA TIP SOFT LONG	272		1,050	N/A	N/A	N/A
HC62219183	CATH CTO-CROSSER	272	C1887	9,100	N/A	N/A	N/A
HC62219217	CATH MICROCATHETER NEUROVASC      K	272	C1887	1,478	N/A	N/A	N/A
HC62219399	KIT ABLATION VEIN LASER	272		1,632	N/A	N/A	N/A
HC62219423	KIT MONITORING NERVE(S) SPINAL    K	272		5,250	N/A	N/A	N/A
HC62219613	TUBE ET                           J	272		560	N/A	N/A	N/A
HC62219647	VALVE TRACH SPEAKING              E	274	L8501	210	N/A	N/A	N/A
HC62219670	DILATOR SPINE KOROS	272		778	N/A	N/A	N/A
HC62219811	PROGRAMMER NEUROSTIM PAT          F	271	C1787	3,294	N/A	N/A	N/A
HC62219845	DRAIN BLAKE ROUND                 H	272		224	N/A	N/A	N/A
HC62219878	CATH FOLLOWER URETH PHILLIPS	272		39	N/A	N/A	N/A
HC62220017	BLADE ENDOSCOPIC CARPAL TUNNEL	272		725	N/A	N/A	N/A
HC62220041	PROBE SPINAL DISPOSABLE           V	272		1,890	N/A	N/A	N/A
HC62220074	EXTRACTOR KATZ SURGICAL	272		368	N/A	N/A	N/A
HC62220249	EXERCISER EXPIRATORY THER/MASK PEP	272		89	N/A	N/A	N/A
HC62220272	KIT MONITORING NERVE(S) SPINAL    E	272		2,800	N/A	N/A	N/A
HC62220447	TEMPLATE ORTHO/ROD SPINAL         W	272		980	N/A	N/A	N/A
HC62220470	KIT INSERTN PICC PEDS-NO CATH	272		46	N/A	N/A	N/A
HC62220504	APPLICATOR/TIP SYRINGE ONLY       F	272		280	N/A	N/A	N/A
HC62220645	DEVICE TORQUE                     B	272		70	N/A	N/A	N/A
HC62220678	KIT ACCESSORY                     C	272		280	N/A	N/A	N/A
HC62220702	KIT ACCESSORY PROSTHESIS PENILE	272		2,730	N/A	N/A	N/A
HC62220876	BLADE INCISIONAL                  V	272		2,100	N/A	N/A	N/A
HC62220900	BLANKET HYPER/HYPOTHERMIA         R	272		1,120	N/A	N/A	N/A
HC62221072	KIT CELL SAVER                    G	272		350	N/A	N/A	N/A
HC62221106	KIT CRICOTHYROTOMY EMERGENCY      R	272		1,750	N/A	N/A	N/A
HC62221288	RESERVOIR CELL SAVER              E	272		210	N/A	N/A	N/A
HC62221312	RESERVOIR CELL SAVER              H	272		420	N/A	N/A	N/A
HC62221346	SLEEVE COMPRESSION                C	272		106	N/A	N/A	N/A
HC62221486	TROCAR ENDO                       L	272		700	N/A	N/A	N/A
HC62221510	TUBE INSUFFLATOR                  G	272		350	N/A	N/A	N/A
HC62221544	TUBE TRACH CUFFED                 F	272	A7521	280	N/A	N/A	N/A
HC62221718	NEEDLE WIRE LOCALIZATION          B	272	C1819	70	N/A	N/A	N/A
HC62221742	BOTTLE REPLACEMENT DRAINAGE	272		80	N/A	N/A	N/A
HC62221916	PROBE SPINAL DISPOSABLE           B	272		490	N/A	N/A	N/A
HC62221940	PINS BONE REFERENCE ROBOTIC(2 PK)	272		470	N/A	N/A	N/A
HC62222138	BLADE TREPHINE                    C	272		223	N/A	N/A	N/A
HC62222161	TRAY EXCHANGE TRANSFUSION	272		154	N/A	N/A	N/A
HC62222195	BARRIER/BAG DEFECT WALL VENTRAL/ABD	272		1,067	N/A	N/A	N/A
HC62222336	TUBE INSUFFLATOR                  A	272		36	N/A	N/A	N/A
HC62222369	BAG/POUCH RETRIEVAL SPECMN ENDO   F	272		456	N/A	N/A	N/A
HC62222393	GUIDE DRILL                       Q	272		1,400	N/A	N/A	N/A
HC62222567	CATH BALLOON RENAL                N	272	C1726	980	N/A	N/A	N/A
HC62222591	ELECTRODE ROLLER BALL             B	272		70	N/A	N/A	N/A
HC62222765	CAUTERY PENCIL                    E	272		210	N/A	N/A	N/A
HC62222799	DEVICE CLOSURE VASCULAR           L	272	C1760	699	N/A	N/A	N/A
HC62222823	FORCEPS BIPOLAR                   B	272		70	N/A	N/A	N/A
HC62222963	CANNULA ARTERIAL                  K	272		840	N/A	N/A	N/A
HC62222997	ELECTRODE BIPOLAR HYSTERO TWIZZEL	272		1,446	N/A	N/A	N/A
HC62223029	HANDPIECE ILLUMINATOR/SUCTION	272		946	N/A	N/A	N/A
HC62223193	MANIFOLD 3 VALVE CARDIAC	272		98	N/A	N/A	N/A
HC62223227	INTRODUCER/SHEATH                 S	272	C1894	1,590	N/A	N/A	N/A
HC62223391	SPLINT ELBOW/KNEE                 B	272		70	N/A	N/A	N/A
HC62223425	CATH EP DX <20 ELECTRODES         D	272	C1730	140	N/A	N/A	N/A
HC62223599	SNARE                             N	272		980	N/A	N/A	N/A
HC62223623	SNARE                             S	272		2,100	N/A	N/A	N/A
HC62223656	STAPLE CARTRG/ENDO RELOAD         O	272		1,120	N/A	N/A	N/A
HC62223797	PACKING NASAL                     A	272		36	N/A	N/A	N/A
HC62223821	SET DRILL BIT W/PIN(S)            F	272		280	N/A	N/A	N/A
HC62223854	SYSTEM DELIVERY LEAD              K	272	C1887	2,800	N/A	N/A	N/A
HC62224027	SNARE                             D	272		140	N/A	N/A	N/A
HC62224050	VALVE ENDOSCOPIC                  G	272		350	N/A	N/A	N/A
HC62224225	GUIDE ROD                         K	272		630	N/A	N/A	N/A
HC62224258	PICK INTRAOCULAR DISPOSABLE	272		140	N/A	N/A	N/A
HC62224423	EXTRACTOR TISSUE SPINAL	272		471	N/A	N/A	N/A
HC62224456	INTRO/SHEATH EP FIXED NON-PEEL    P	272	C1893	1,750	N/A	N/A	N/A
HC62224480	NEEDLE BIOPSY BONE                O	272		1,120	N/A	N/A	N/A
HC62224621	SUCTION IRRIGATOR ROBOTIC	272		770	N/A	N/A	N/A
HC62224654	ADAPTER CATH URETERAL/URINARY     A	272		42	N/A	N/A	N/A
HC62224696	CATH EP DIAG/ABLAT 3D/VECT RPRSD	272	C1732	140	N/A	N/A	N/A
HC62224860	SPLINT FINGER OUTRIGGER           A	272	L3925	42	N/A	N/A	N/A
HC62224894	DILATOR VESSEL                    A	272		36	N/A	N/A	N/A
HC62225065	DEVICE LIGATOR                    B	272		350	N/A	N/A	N/A
HC62225099	SEAL ENDO ROBOTIC                 D	272		140	N/A	N/A	N/A
HC62225123	GUIDE DRILL                       K	272		630	N/A	N/A	N/A
HC62225263	SPLINT RESTRICTION CMC THUMB	274	L3923	70	N/A	N/A	N/A
HC62225297	CATH EP DX 20+ ELECTRODES RPRSD   N	272	C1731	980	N/A	N/A	N/A
HC62225321	CANNULA ARTHROSCOPIC              L	272		700	N/A	N/A	N/A
HC62225461	CATH BALLOON UTZ BRONCHOSCOPC	272		106	N/A	N/A	N/A
HC62225495	TUBE SPLINTING ENDOSCOPIC	272		1,138	N/A	N/A	N/A
HC62225529	CATH UMBILICAL                    G	272		246	N/A	N/A	N/A
HC62225727	SHEARS COAGULATING HARMONIC       T	272		2,100	N/A	N/A	N/A
HC62225750	KIT DRESSING WOUND NEG PRESSURE   K	272		982	N/A	N/A	N/A
HC62225933	GUIDE VAGINAL BRACHYTHERAPY	272		420	N/A	N/A	N/A
HC62225966	TEMPLATE BRACHYTHERAPY            B	272		70	N/A	N/A	N/A
HC62225990	COUNTERSINK                       G	272		560	N/A	N/A	N/A
HC62226147	ELECTRODE RESECTOSCOPE            N	272		1,390	N/A	N/A	N/A
HC62226170	KIT DRESSING WOUND NEG PRESSURE   A	272	A6550	140	N/A	N/A	N/A
HC62226204	BLADE SHAVER                      AC	272		1,959	N/A	N/A	N/A
HC62226386	RETRACTOR DISPOSABLE              M	272		1,400	N/A	N/A	N/A
HC62226410	SET CARDIOPLEGIA                                        B	272		70	N/A	N/A	N/A
HC62226584	PIN/WIRE FIXATION TEMPORARY      AW	272		3,500	N/A	N/A	N/A
HC62226618	RETRACTOR MIS SPINAL              D	272		2,450	N/A	N/A	N/A
HC62226790	KIT/TRAY BX(ONCONTROL S/L NEEDLE) I	272	C1830	490	N/A	N/A	N/A
HC62226824	BOWL CEMENT MIXING                E	272		210	N/A	N/A	N/A
HC11200094	OBSERVATION PER HOUR - PEDS ACUTE	762	G0378	363	N/A	N/A	N/A
HC11200110	TRANSPORT EXTERNAL ADULT RN ICU ACCOMP(STATISTICAL)	222		N/A	N/A	N/A	N/A
HC11200136	TRANSPORT EXTERNAL OB HI RISK RN ACCOMP(STATISTICAL)	222		N/A	N/A	N/A	N/A
HC11500097	NEW PT LVL5-COMPREHENSIVE	510	99205	566	N/A	N/A	N/A
HC11500485	LACTATION E&M INTRMD NEW L:III	761	99203	269	N/A	N/A	N/A
HC11500527	LACTATION E&M LIMITD EST' L:II	761	99212	214	N/A	N/A	N/A
HC11500790	AM/PACU EVAL COMPLX-V	761	99215	829	N/A	N/A	N/A
HC11500832	PEDS ESTAB PT ASSESS MOD(15')	761	99213	359	N/A	N/A	N/A
HC11501038	SERVICE PHASE I CLINICAL TRIAL	510	S9988	N/A	N/A	N/A	N/A
HC12200002	IV INFUSION THERAPY 1ST HOUR	260	96365	1,075	N/A	N/A	N/A
HC12200036	IV INF HYDRATION EA ADD'L HR	260	96361	446	N/A	N/A	N/A
HC12200184	INF CNTR-NEW PT EVAL COMPLEX	510	99205	630	N/A	N/A	N/A
HC12200218	INF CNTR-ESTBL'D PT EVAL BRIEF	510	99211	207	N/A	N/A	N/A
HC12200242	DRAW BLOOD VEN PICC/PERIPH CATH	300	36592	665	N/A	N/A	N/A
HC12200424	IV INJECTION BEBTELOVIMAB	771	M0222	1,045	N/A	N/A	N/A
HC12400024	CHEMO INF SEQ/NEW RX 1ST HR	335	96417	975	N/A	N/A	N/A
HC12400057	INITIATE PROLONG CHEMO INFUSION VIA PUMP	335	96416	1,992	N/A	N/A	N/A
HC12600078	ADMIN VACCINE COVID-19 30MCG/0.3ML 2ND DOSE {PFIZER-BIONTECH}	771	0002A	128	N/A	N/A	N/A
HC12600102	ADMIN VACCINE COVID-19 30MCG/0.3ML 3RD DOSE {PFIZER-BIONTECH}	771	0003A	139	N/A	N/A	N/A
HC12600276	ADMIN VACCINE COVID-19 10MCG TRS-SUCR PEDS DOSE BOOSTER {PFIZER}	771	0074A	125	N/A	N/A	N/A
HC12600318	ADMIN VACCINE COVID-19 25MCG/0.25ML IM PEDS DOSE 2ND {MODERNA}	771	0112A	115	N/A	N/A	N/A
HC12600342	ADMIN VACCINE COVID-19 50 MCG/0.5 ML 2ND {MODERNA}	771	0092A	125	N/A	N/A	N/A
HC13500012	GENETIC CNSL RISK REDCTN 15MIN	942	99401	139	N/A	N/A	N/A
HC13500046	GENETIC CNSL RISK REDCTN 60MIN	942	99404	431	N/A	N/A	N/A
HC14500045	PREGNANCY DIAB MGT 15MIN	942	99211	158	N/A	N/A	N/A
HC21000203	CAUTERIZE W/CHEM; GRAN TISSUE	361	17250	1,529	N/A	N/A	N/A
HC21000237	DEBRID/REMVL OPEN FX MUSCLE	361	11011	3,497	N/A	N/A	N/A
HC21000468	I&D ABSCESS SIMPLE SNGL	361	10060	2,412	N/A	N/A	N/A
HC21000492	I&D POST OP WOUND INF COMP'	361	10180	9,000	N/A	N/A	N/A
HC21000674	APPLY MULTILAY COMPRS BK RT	361	29581	1,140	N/A	N/A	N/A
HC21000708	DBRD SKIN&SUBQ EA ADD 20SQCM/<	361	11045	2,986	N/A	N/A	N/A
HC21000732	LAC REPAIR TO 2.5 CM(SMALL)	361	12001	1,021	N/A	N/A	N/A
HC21000930	APPLY MULTILAY COMPRS UPREX RT	361	29584	1,158	N/A	N/A	N/A
HC21000963	APPY SKIN SUB T A L 1ST 100SQ~LC	361	C5273	7,859	N/A	N/A	N/A
HC21000997	APPY SKIN SUB HEAD/HND/FT EA+25SQ~LC	361	C5276	2,704	N/A	N/A	N/A
HC22000087	OST EST PT EVAL LVL4-(25MIN)	761	99214	440	N/A	N/A	N/A
HC23000029	ASP & INJ GANGLION CYST	361	20612	1,575	N/A	N/A	N/A
HC23000334	INJ ANES/STEROID NERVE OCCIPITAL GREAT	361	64405	1,814	N/A	N/A	N/A
HC23000383	INJ ANES/STEROID NERVE AXILLARY RT	361	64417	2,122	N/A	N/A	N/A
HC23000706	INJ FORAMN EPI C/T ADD+W/S&I-BI	361	64480	7,776	N/A	N/A	N/A
HC23000730	INJ FORAMN EPI LMBR INTLW/S&I-B	361	64483	13,323	N/A	N/A	N/A
HC23000763	INJ FORAMN EPI LMBR ADD+S&I-BI	361	64484	9,472	N/A	N/A	N/A
HC23000987	INJ DX/THER LUMBAR/SACRAL W/O IMAG	361	62322	5,896	N/A	N/A	N/A
HC23001019	INJ(S);SNGL TNDON ORIGN/INSERT	361	20551	1,569	N/A	N/A	N/A
HC23001043	INJ(S);TRIGGER POINT 1-2MUSCLES	361	20552	2,042	N/A	N/A	N/A
HC23001241	DESTR C/T FAC JOINT +LVL W/IMG-L	361	64634	5,609	N/A	N/A	N/A
HC23001274	DESTR L/S FAC JOINT SNGL W/IMG-R	361	64635	7,769	N/A	N/A	N/A
HC23001464	INJ  L/S F W/IMAGE 2ND LVL LT	361	64494	3,692	N/A	N/A	N/A
HC23001498	INJ  L/S F /IMAGE 3RD+& LVL LT	361	64495	3,594	N/A	N/A	N/A
HC23001522	INJ ANES/STEROID NERVE TRIGEML BRNCH EA LT	361	64400	1,541	N/A	N/A	N/A
HC23001670	INJ ANES/STEROID ILIOINGNL/ILIOHYPOGAS RT	361	64425	2,233	N/A	N/A	N/A
HC23001704	EXAM CSF PUMP (MISC PROC)	361	64999	1,710	N/A	N/A	N/A
HC23001738	N BLOCK INJ PLANTAR DIGIT (MOTONS) RT	361	64455	1,915	N/A	N/A	N/A
HC23001902	INJ ANES/STEROID NERVE SI JOINT INNRV W/IMAGE RT	361	64451	2,544	N/A	N/A	N/A
HC23001936	INJ ANES/STEROID NERVE GENICULAR IMAGE GUIDE LT	361	64454	2,852	N/A	N/A	N/A
HC24000135	HBO FIRST 15MIN COMPLEX/C	413		729	N/A	N/A	N/A
HC25000019	ED LEVEL II - LIMITED	450	99282	1,340	N/A	N/A	N/A
HC25000191	INSERT NEEDLE INTRAOSSEOUS INF	450	36680	1,806	N/A	N/A	N/A
HC25000225	TRACHEOSTOMY	450	31603	2,429	N/A	N/A	N/A
HC25000258	BURNS LOCAL TREATMENT SM 9%	450	16020	674	N/A	N/A	N/A
HC25000415	LARYNGOSCOPY FIBEROPTIC DX	450		950	N/A	N/A	N/A
HC25000449	MANIPULATION MINOR JOINT	450		1,019	N/A	N/A	N/A
HC25000472	FRACTURE TX  RIBS	450		664	N/A	N/A	N/A
HC25000837	ASP/INJ SMALL JOINT-BILAT	450	20600	1,402	N/A	N/A	N/A
HC25000860	ASP/INJ MED JOINT-BILAT	450	20605	1,762	N/A	N/A	N/A
HC25001066	BLOOD PATCH (INJ EPIDURAL)	450	62273	3,071	N/A	N/A	N/A
HC25001090	INSERT CT(OPEN) W/DRAIN SYSTEM RT	450	32551	2,378	N/A	N/A	N/A
HC25001330	M: ED MISC PROCEDURE	450		1,246	N/A	N/A	N/A
HC25001363	EKG EMERGENCY (STATISTICAL)	450		N/A	N/A	N/A	N/A
HC25001397	I&D POSTOP WOUND	450		638	N/A	N/A	N/A
HC25001587	MOD CS DIFF PHYS/QHP 5/>YR INIT'L 15MIN	372	99156	378	N/A	N/A	N/A
HC25002692	TRAUMA ACT' III W/O CC SERVICE	682		15,170	N/A	N/A	N/A
HC25002726	TRAUMA ACT' III W/O P-H ALERT	450		8,516	N/A	N/A	N/A
HC25002932	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT 2.6-7.5CM	450	12002	726	N/A	N/A	N/A
HC25002965	LAC REPAIR SIMPLE S/N/A/GEN/T/EXT 20.1-30.0CM	450	12006	1,100	N/A	N/A	N/A
HC25003138	LAC REPAIR INTMD N/H/F/GEN 2.5CM/<	450	12041	1,390	N/A	N/A	N/A
HC25003161	LAC REPAIR INTMD N/H/F/GEN 12.6-20	450	12045	1,760	N/A	N/A	N/A
HC25003195	LAC REPAIR INTMD F/E/E/N/L&/MM 2.5CM/<	450	12051	1,445	N/A	N/A	N/A
HC25003336	LAC REPAIR CMPLX E/N/E/L 1.1-2.5 CM	450	13151	1,745	N/A	N/A	N/A
HC25003369	REMOVE FB MUSCLE/TNDON SHEATH DEEP/COMP	450	20525	3,459	N/A	N/A	N/A
HC25003393	INJ(S);SGL TNDN SHEATH/LIGMNT/APONEUR-BIL	450	20550	1,387	N/A	N/A	N/A
HC25003534	CLOSED TX HUMRL FX W/MAN W/WO SKLTL TRAC-BIL	450	23605	3,828	N/A	N/A	N/A
HC25003567	CLOSED TX SHOULDR DSLC W/MAN W/O ANES-BIL	450	23650	1,738	N/A	N/A	N/A
HC25003591	REMOVE FB UPPER ARM/ELBOW SQ-BIL	450	24200	5,781	N/A	N/A	N/A
HC25003765	CLOSED TX RADIAL SHAFT FX W/MANIP RT	450	25505	3,684	N/A	N/A	N/A
HC25003799	CLOSED TX ULNA SHAFT FX W/MANIP-BIL	450	25535	1,698	N/A	N/A	N/A
HC25003963	CLOSED TX WRIST DSLOC 1/> BONES W/MAN RT	450	25660	1,074	N/A	N/A	N/A
HC25003997	CLOSED TX DISTL RADIOULNAR DISLOC W/M RT	450	25675	1,074	N/A	N/A	N/A
HC25004029	DRAIN ABSCESS FINGER COMPLEX	450	26011	2,200	N/A	N/A	N/A
HC25004169	CLOSED TX FINGER/THUMB DISTAL FX W/MANIP EA	450	26755	907	N/A	N/A	N/A
HC25004193	CLOSED TX HIP DISLOC TRAUMIC RT	450	27250	913	N/A	N/A	N/A
HC25004227	CLOSED TX HIP DISLOC POST ARTHROPLASTY RT	450	27265	1,105	N/A	N/A	N/A
HC25004391	CLOSED TX TIBIAL SHAFT FX W/MANIP W/W-O FIBFX/TRAC LT	450	27752	4,009	N/A	N/A	N/A
HC25004425	CLOSED TX MEDIAL MALLEO(ANKLE)FX W/MANIP W/W-O TRAC LT	450	27762	3,990	N/A	N/A	N/A
HC25004599	REMOVE FB FOOT; SUBC BIL	450	28190	3,269	N/A	N/A	N/A
HC25004623	REMOVE FB FOOT; DEEP BIL	450	28192	7,843	N/A	N/A	N/A
HC25004797	CLOSED TX TARSAL DISLOC; NO ANES BIL	450	28540	1,717	N/A	N/A	N/A
HC25004821	CLOSED TX TALOTARSAL JNT DISLOC; NO ANES BIL	450	28570	1,275	N/A	N/A	N/A
HC25004854	CLOSED TX INTERPHALANGEAL JNT DISLOC; NO ANES LT	450	28660	860	N/A	N/A	N/A
HC25004995	APPLY CAST LONG LEG RT	450	29345	1,036	N/A	N/A	N/A
HC25005026	APPLY CAST SHORT LEG RT	450	29405	937	N/A	N/A	N/A
HC25005059	ADDING WALKER HEEL PREV CAST RT	450	29440	546	N/A	N/A	N/A
HC25005224	REMOVE FB VESTIBULE MOUTH; SIMPLE	450	40804	1,981	N/A	N/A	N/A
HC25005257	DRAIN LESION DENTOALVEOLAR (GUM)	450	41800	551	N/A	N/A	N/A
HC25005422	INJ ANES/STEROID NERVE TRIGEML BRNCH EA BI	450	64400	1,363	N/A	N/A	N/A
HC25005455	INJ ANES/STEROID NERVE/BRNCH PERIPH BIL	450	64450	3,300	N/A	N/A	N/A
HC25005489	REMOVE FB EXTRNL EYE; CONJUNCT SUPERF BIL	450	65205	792	N/A	N/A	N/A
HC25005620	DRAIN EXTERNAL EAR LESION COMPLEX LT	450	69005	2,420	N/A	N/A	N/A
HC25005653	THROMBOLYSIS CEREBRAL IV INFUSION	450	37195	1,389	N/A	N/A	N/A
HC25005687	ASP/INJ JOINT/BURSA MAJOR W/US-LT	450	20611	1,194	N/A	N/A	N/A
HC25005828	LARYNGOSCOPY DIAGNOSTIC	450	31575	621	N/A	N/A	N/A
HC25005851	DECLOT IVAD W/THROMBOLYTIC	450	36593	889	N/A	N/A	N/A
HC25005885	LYSIS & STRETCHING ADHESIONS PREPUTIAL	450	54450	825	N/A	N/A	N/A
HC25006065	CLOSED TX TARSOMETATARSAL JNT DISLOC; NO ANES BIL	450	28600	1,275	N/A	N/A	N/A
HC25006099	CLOSED TX INTERPHALANGEAL JNT DISLOC; NO ANES RT	450	28660	781	N/A	N/A	N/A
HC25090036	P: THORACENTESIS PNCT(W/O IMAGE)-BI+ 2 TRAYS			N/A	N/A	N/A	N/A
HC25090069	P: INSRTCTW/H20 SEAL B+2PLRVC2CTUBES			N/A	N/A	N/A	N/A
HC25090093	P: PERICARDIOCENTESIS INIT+TRAY			N/A	N/A	N/A	N/A
HC25090234	P: INSRT BLADDR CATH-NON INDWLL+CATH			N/A	N/A	N/A	N/A
HC25090267	P: LUMBAR PUNCTURE DIAGNOSTIC+TRAY			N/A	N/A	N/A	N/A
HC25090291	P: IV INF HYDRATION 1ST HR			N/A	N/A	N/A	N/A
HC25090465	P: LAC RPR TO 2.5 CM(SM)+STAPLER SKN			N/A	N/A	N/A	N/A
HC25090499	P: LAC RPR TO 2.5 CM(SM)+DERMABOND			N/A	N/A	N/A	N/A
HC26000075	FETAL CONTRACT/NIPPLE STIM	720	59020	1,946	N/A	N/A	N/A
HC26000109	INSERTION CERVICAL DILATOR	361	59200	2,003	N/A	N/A	N/A
HC27000082	ANOSCOPY W/HOT BIOPSY	750	46610	5,713	N/A	N/A	N/A
HC27000140	BREATH HYDROGEN TEST	300	91065	1,693	N/A	N/A	N/A
HC27000181	COLONOSCOPY DIAGNOSTIC DC'D	750	45378	1,380	N/A	N/A	N/A
HC27000355	EGD COMPLETE DX W/ BRUSH/SPEC ~FO	750	43235	4,113	N/A	N/A	N/A
HC27000405	EGD W/BANDING  ESOPH/GASTRIC ~FO	750	43244	4,797	N/A	N/A	N/A
HC27000439	EGD W/DIL OVER GUIDEWIRE ~FO	750	43248	4,579	N/A	N/A	N/A
HC27000611	ENTEROSCOPY W/BIOPSY	750	44361	6,496	N/A	N/A	N/A
HC27000645	ENTEROSCOPY W/FRN BDY(S) REMOVAL	750	44363	6,057	N/A	N/A	N/A
HC27000884	ESOPH MOTILTY/MANO STDY/I&R;2D	750	91010	4,900	N/A	N/A	N/A
HC27000918	ESOPHAGEAL REFLUX W/PH ELECTR	750	91035	8,898	N/A	N/A	N/A
HC27001155	SIGMOIDOSCOPY FLEX W/FB(S) REMOV	750	45332	4,023	N/A	N/A	N/A
HC27001189	M: UNLISTED PROCEDURE  ESOPH	750	43499	2,955	N/A	N/A	N/A
HC27001213	NURSE ASSIST EA HR (STATISTIC)	750		N/A	N/A	N/A	N/A
HC27001387	ESOPHSCPY W/DILAT ESOPH RETROGR ~FO	750	43213	5,099	N/A	N/A	N/A
HC27001411	EGD HEAT ESO SPHINC/GASTRIC CARDIA~FO	750	43257	6,224	N/A	N/A	N/A
HC27001445	EGD W/EUS ESOPH/STOMCH/DUOD ~FO	750	43237	4,976	N/A	N/A	N/A
HC27001619	COLONOSCOPY STOMA W/ABLAT LESN GUIDEWIRE	750	44401	4,170	N/A	N/A	N/A
HC27001643	COLONOSCOPY STOMA W/INJ SUBMUCOSL	750	44404	3,759	N/A	N/A	N/A
HC27001817	EGD W/EUS FNA/BX ESOPH/STOMCH/DUOD~FO	750	43238	5,271	N/A	N/A	N/A
HC27001841	SIGMOIDOSCOPY FLEX W/EUS&FNA/BX	750	45342	4,507	N/A	N/A	N/A
HC27001874	SIGMOIDOSCOPY FLEX W/EUS	750	45341	4,360	N/A	N/A	N/A
HC28000032	CR REHAB CARDIAC W/O ECG SESSION (II)	943	93797	500	N/A	N/A	N/A
HC28000065	CR EST PT EVAL LVL3-(15MIN)	510	99213	350	N/A	N/A	N/A
HC28000107	CR NEW PT EVAL LVL2-(20MIN)	510	99202	277	N/A	N/A	N/A
HC29000585	PREVENTATIVE MED COUNSELING 60MIN	770	99404	586	N/A	N/A	N/A
HC29000627	IPPE EXAM INITIAL PREVENTIVE	770	G0402	276	N/A	N/A	N/A
HC31000102	PT-ASSESS ASSIST TECH 15MIN/CM	420	97755	170	N/A	N/A	N/A
HC31000144	PT-COMMTY WK/REINTEGRT 15M/M	420	97537	228	N/A	N/A	N/A
HC31000375	PT-IONTOPHORESIS 15MIN/MW	420	97033	219	N/A	N/A	N/A
HC31000409	PT-NEUROMUSC RE-ED 15MIN/M	420	97112	230	N/A	N/A	N/A
HC31000433	PT-PARAFFIN BATH /CMW	420	97018	157	N/A	N/A	N/A
HC31000755	PT-WORK HARDENING INIT 2HR/CMW	420	97545	695	N/A	N/A	N/A
HC31000789	PT-WOUND NON-SEL DEB 30MIN/CMW	420	97602	572	N/A	N/A	N/A
HC31000813	PT-WOUND VAC 15MIN<50 SQ CM/M	420	97605	287	N/A	N/A	N/A
HC31000995	PT-PHYS MED TX ANY ADDL 15MIN/CW	420		203	N/A	N/A	N/A
HC31001027	PT-GAIT TRAINING 30MIN/CW	420		352	N/A	N/A	N/A
HC31001191	PT- TM CONF INTERDISPLNS 3MNM WPT PRES 30MIN	420	G0175	325	N/A	N/A	N/A
HC31001266	PT-ELEC STIM/TENS/MCW	420	G0283	413	N/A	N/A	N/A
HC31001530	PT-PHYS PERFORM TEST ADD'15M/W	420		184	N/A	N/A	N/A
HC31001563	PT-GROUP EDUCATION MIN 1HR/W	420		263	N/A	N/A	N/A
HC31001597	PT-CONTRAST BATH AD15MIN/CW	420		147	N/A	N/A	N/A
HC31001761	PT-CASE CONF 30MIN/C	420		315	N/A	N/A	N/A
HC31001795	PT-APPLICATION CAST LONG LEG	420	29345	1,370	N/A	N/A	N/A
HC31001829	PT-THER PROC GRP 120MIN/MC	423	97150	431	N/A	N/A	N/A
HC31002017	PT - STRAPPING; ANKLE AND/OR FOOT	420	29540	587	N/A	N/A	N/A
HC31002066	PT-EVAL MOD COMPLEXITY 30MF2F 60MIN	424	97162	818	N/A	N/A	N/A
HC31010085	PT-RE-EVAL EST POC[15MIN]	424	97164	219	N/A	N/A	N/A
HC31010119	PT-WHEELCHAIR MGT 15MIN	420	97542	211	N/A	N/A	N/A
HC31010143	PT-MANUAL THERAPY 15MIN	420	97140	222	N/A	N/A	N/A
HC31010341	PT- TM CONF INTERDISCPLN NO PT/FAM  WMD 60MIN	420	99367	375	N/A	N/A	N/A
HC31010374	PT- TM CONF INTERDISPLNS 3MNM WPT PRES 45MIN	420	G0175	550	N/A	N/A	N/A
HC31090012	P: PT-EVAL 45 MIN/C			N/A	N/A	N/A	N/A
HC31090152	PT-ONLINE ASSESS & MANAGMNT EST PT 11-20MIN	420	98971	157	N/A	N/A	N/A
HC32000028	OT-ASSESS ASSIST TECH 15MIN/CM	430	97755	170	N/A	N/A	N/A
HC32000051	OT-COMPUT DYNAMIC POSTURE SOT 6 CONDITIONS	430	92548	1,045	N/A	N/A	N/A
HC32000309	OT-IONTOPHORESIS 15MIN/MW	430	97033	219	N/A	N/A	N/A
HC32000333	OT-NEUROMUSC RE-ED 15MIN/M	430	97112	230	N/A	N/A	N/A
HC32000507	OT-SWALLOWING THERAPY  30 MIN	430	92526	658	N/A	N/A	N/A
HC32000531	OT-SWALLOWING THERAPY  90 MIN	430	92526	1,621	N/A	N/A	N/A
HC32000564	OT-TRACTION/MECHANICAL/CMW	430	97012	200	N/A	N/A	N/A
HC32000788	OT-WOUND VAC 60MIN<50 SQ CM/M	430	97605	766	N/A	N/A	N/A
HC32000812	OT-WOUND VAC 45MIN>50 SQ CM/M	430	97606	706	N/A	N/A	N/A
HC32000846	OT-RE-EVAL ADDL 15MIN/CW	434		206	N/A	N/A	N/A
HC32001018	OT-MANUAL THER JOINT MOB/W	430		254	N/A	N/A	N/A
HC32001042	OT-PROSTHETIC TRNG 30MIN/CW	430		356	N/A	N/A	N/A
HC32001265	OT-DBRD OPN WND EA+20SQCM OR <	430	97598	1,160	N/A	N/A	N/A
HC32001299	OT-THER PROC GRP 1ST 30MIN/MW	430	97150	190	N/A	N/A	N/A
HC32001471	OT-DEVEL TEST PER STANDARD INSTRUMENT(SCREENING)	430	96110	248	N/A	N/A	N/A
HC32001521	OT-THER PROC GRP 90MIN/MC	433	97150	422	N/A	N/A	N/A
HC32001588	OT-DRIVING TRAINING 60MIN/W	430	97799	343	N/A	N/A	N/A
HC32001737	OT-EVAL HIGH COMPLEXITY 45MF2F 150MIN	434	97167	1,620	N/A	N/A	N/A
HC32001760	OT-DYSPHAGIA/SWALLOW TX 75MIN/M	430	92526	1,220	N/A	N/A	N/A
HC32001802	OT-ENDOSCOPIC EVAL LARYNGEAL	434	92614	1,428	N/A	N/A	N/A
HC32010019	OT-SELF/HOME MGMT/ADL 15MIN	430	97535	228	N/A	N/A	N/A
HC32010043	OT-FUNCTIONAL ACTIVITY 15MIN	430	97530	228	N/A	N/A	N/A
HC32010217	OT-COMPUT DYNAMIC POSTURE SOT 6 CNDTNS; &MCT&ADT	430	92549	1,284	N/A	N/A	N/A
HC32010274	OT-PROSTHETIC MGMT & TRNG INITIAL ENC 15MIN	430	97761	209	N/A	N/A	N/A
HC32010332	OT-ONLINE ASSESS & MANAGMNT EST PT 11-20MIN	430	98971	157	N/A	N/A	N/A
HC32010472	OT ORTHOTIC CUSTOMIZATION EA 15MIN (ROLL 2L CODES)	439	S1002	140	N/A	N/A	N/A
HC32090029	P: OT-EVAL 75MIN/C			N/A	N/A	N/A	N/A
HC32090052	P: OT-EVAL 150MIN/C			N/A	N/A	N/A	N/A
HC32090193	P: ORTH HFO W/O JOINTS CUSTOM (90MINUOS)			N/A	N/A	N/A	N/A
HC32090227	P: ORTH HO W/O JOINTS CUSTOM (90MINUOS)			N/A	N/A	N/A	N/A
HC32090250	P: ORTH FO W/O JOINTS CUSTOM (90MINUOS)			N/A	N/A	N/A	N/A
HC33000274	ST-SPEECH THERAPY GRP 30MIN/MCW	443	92508	279	N/A	N/A	N/A
HC33000308	ST-SPEECH THERAPY GRP120MIN/MCW	443	92508	771	N/A	N/A	N/A
HC33000472	ST-CASE CONFERENCE 30MIN/C	440		242	N/A	N/A	N/A
HC33000548	ST-SPEECH THERAPY 15 MIN/MW	440	92507	331	N/A	N/A	N/A
HC33000571	ST-EVAL SWALLOW CINE/FLUORO 45M	444	92611	1,294	N/A	N/A	N/A
HC33000803	ST-SPEECH SCREENING/IP	440	V5362	172	N/A	N/A	N/A
HC33000837	ST- TM CONF INTERDISCPLN NO PT/FAM  WMD 30MIN	440	99367	271	N/A	N/A	N/A
HC33000860	ST-EVAL SPEECH CMPNT 120MIN	444	92522	1,438	N/A	N/A	N/A
HC33001082	ST EVAL BEHAVRAL QUAL VOICE 30MIN/M	444	92524	356	N/A	N/A	N/A
HC33001124	ST EVAL BEHAVRAL QUAL VOICE 120MIN/M	444	92524	989	N/A	N/A	N/A
HC33010125	ST-DEV COGNITIVE SKILLS ADDL 15MIN	440	97130	212	N/A	N/A	N/A
HC33010208	ST-ONLINE ASSESS & MANAGMNT EST PT 11-20MIN	440	98971	157	N/A	N/A	N/A
HC34000042	COMPREHENSIV AUDIOMETRY	471	92557	807	N/A	N/A	N/A
HC34000083	VISUAL REINFORCE AUDIO (VRA)	471	92579	435	N/A	N/A	N/A
HC34000117	AUD-INFANT HEARING SCREEN AEP BBS AUTO REPEAT OP	471	92650	612	N/A	N/A	N/A
HC34000273	SENSORINEURAL ACUITY TEST	471	92575	130	N/A	N/A	N/A
HC34000307	ELECTROACOUSTIC EVAL FOR HEARING AID; BIAURAL	471	92595	208	N/A	N/A	N/A
HC34000331	COCHLEAR IMPLT DX ANALYS W/PROGRAM >7	471	92603	389	N/A	N/A	N/A
HC35000207	REC TM CONF INTERDISCPLN NO PT/FAM  WQHCP 30MIN	941	99368	238	N/A	N/A	N/A
HC35000249	REC-DEV COGNITIVE SKILLS INITL 15MIN	941	97129	212	N/A	N/A	N/A
HC35500198	MT-BEHAVIOR TX FAMW/PT 1ST 30MIN	916	96167	110	N/A	N/A	N/A
HC35500222	MT-BEHAV TX FAM W/O PT ADD 15	916	96171	55	N/A	N/A	N/A
HC36000149	MANIP CHEST(INFANT) INIT DEMO/EVAL	410	94667	896	N/A	N/A	N/A
HC36000172	DEMO&/OR EVAL OF INH TX	410	94664	854	N/A	N/A	N/A
HC36000222	INTUBATION	361	31500	2,777	N/A	N/A	N/A
HC36000636_06469300202	NONCDM CHARGE RECORD PHARMACY	250	J3490	15,723	N/A	N/A	N/A
HC36000677	AIRWAY RESISTANCE OSCILLOMETRY	410	94728	1,224	N/A	N/A	N/A
HC36000701	NITRIC OXIDE PER DIEM/ 12 HRS	636	J3490	4,353	N/A	N/A	N/A
HC36000909	BRONCH THERAPEUTIC SUBSEQ (PER DOS)	361	31646	5,223	N/A	N/A	N/A
HC36000933	BRONCH W/LUNG BX; EA ADD'L+	361	31632	3,471	N/A	N/A	N/A
HC36001147	TRANSENDOSCOPIC EBUS DURING BRONCH DX OR TX FOR PERIPH NODE(S)+	361	31654	3,000	N/A	N/A	N/A
HC36001170	PERC BX CORE LUNG/MEDIASTINUM W/ IMAG IF OCCURS	361	32408	7,454	N/A	N/A	N/A
HC36500015	SMOKING CESSATION > 10 MIN	942	99407	125	N/A	N/A	N/A
HC36800134	BRONCHIAL PROVOCATION EVAL	460	94070	2,642	N/A	N/A	N/A
HC36800209	HIGH ALTITUDE SIM' TEST- HAST	460	94452	1,857	N/A	N/A	N/A
HC36800233	M V V (MAX VOL VENT)	460	94200	629	N/A	N/A	N/A
HC36800498	BRONCH W/NDL ASP BX(S) EA ADDL+	361	31633	3,436	N/A	N/A	N/A
HC36800522	PULM REHAB PER SESSION (90MIN) W/O POX2	948	94625	739	N/A	N/A	N/A
HC36800696	HGB QUANT TRANSCUTANEOUS DAILY	300	88738	280	N/A	N/A	N/A
HC36800720	AIRWAY RESISTANCE OSCILLOMETRY	460	94728	1,224	N/A	N/A	N/A
HC37000015	MNT REASSESMENT EA 15 MIN	942	97803	215	N/A	N/A	N/A
HC37000049	MNT REASSESS EA INDIV 15MIN            1ST REF	942	97803	215	N/A	N/A	N/A
HC37000072	MNT INIT ASSESS EA 15MIN-IP(ST	942		N/A	N/A	N/A	N/A
HC37090065	P: MNT RE-ASSESS 45 MIN-OP			N/A	N/A	N/A	N/A
HC37090099	P: MNT INITIAL ASSESS 30 MIN-IP (ST)			N/A	N/A	N/A	N/A
HC37090123	P: MNT INITIAL ASSESS 75 MIN-IP (ST)			N/A	N/A	N/A	N/A
HC38000113	REMV/BIVALVE SHRT CAST ARM/LEG	700	29700	802	N/A	N/A	N/A
HC38000147	APPLY SPLINT LONG LEG	700	29505	1,186	N/A	N/A	N/A
HC38000329	APPLY LONG LEG CAST BRACE	700	29358	854	N/A	N/A	N/A
HC38000352	ADDING WALKER HEEL  PREV CAST	700	29440	575	N/A	N/A	N/A
HC38420089	ECMO INITIATION VENO-VENOUS	489	33946	12,209	N/A	N/A	N/A
HC38420113	ECMO DAILY MNGMT EA DAY VENO-ART	489	33949	9,361	N/A	N/A	N/A
HC38420147	ECMO INSERT PERIPH CANNULA PERC W/FLUORO	489	33952	16,584	N/A	N/A	N/A
HC38420287	ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS	489	33985	20,125	N/A	N/A	N/A
HC38420311	INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS	489	33988	30,521	N/A	N/A	N/A
HC38420345	ASSEMBLY & OPER PUMP OXYGEN; 45MIN	481	99191	3,177	N/A	N/A	N/A
HC39000286	PSYCH TX W/PATIENT 60MIN	914	90837	709	N/A	N/A	N/A
HC39000518	PSY-TEAM CONF W/PT &3D 30MINOR>	914	G0175	243	N/A	N/A	N/A
HC39000963	PSY TX W/PATIENT 60MIN W/E&M+	914	90838	694	N/A	N/A	N/A
HC39001003	PHARMACOLOGIC MGMT W/PSYTX+	900	90863	129	N/A	N/A	N/A
HC39001037	TMS SUBSEQ DELIV MGMNT SESS	900	90868	1,214	N/A	N/A	N/A
HC39001276	NEUROPSYCH TEST EVAL INTRG INTERP  CLIN DES FEEDBACK; EA ADDL HR+	918	96133	599	N/A	N/A	N/A
HC39001300	PSYCH/NEUROPSYCH TEST ADMIN SNGLE AUTO INSTRU VIA ELECTRONIC AUTO RESULT ON	918	96146	186	N/A	N/A	N/A
HC39001334	BEHAVIOR ADAPT TX FAMILY GUIDNC QHCP W GUARDIANS EA 15MIN	918	97156	139	N/A	N/A	N/A
HC39001573	PSY-BEHAVIOR TX FAMW/PT 1ST 30MIN	916	96167	110	N/A	N/A	N/A
HC39001607	PSY-BEHAV TX FAM W/O PT ADD 15	916	96171	55	N/A	N/A	N/A
HC41000027	SLEEP STUDY ATTENDED DISCNT'D	920	95807	1,791	N/A	N/A	N/A
HC41500034	CENTRAL MOTOR EVOKED LOW LIMBS	922	95929	2,631	N/A	N/A	N/A
HC41500067	DBS CORTICAL MAP INITIAL HR	740	95961	2,609	N/A	N/A	N/A
HC41500299	INFANT HEARING SCREEN AEP BBS AUTO INITIAL OP	471	92650	966	N/A	N/A	N/A
HC41500364	NYSTAGMUS MIN 4POSITIONS W/REC	471	92542	682	N/A	N/A	N/A
HC41500398	OSCILLAT TRACKING TEST W/REC	471	92545	585	N/A	N/A	N/A
HC41500539	EMG FACIAL UNILAT	922	95867	1,112	N/A	N/A	N/A
HC41500562	STUDIES NERVE CONDUCTN 1-2 STUDIES	922	95907	1,137	N/A	N/A	N/A
HC41500596	STUDIES NERVE CONDUCTN 7-8 STUDIES	922	95910	2,291	N/A	N/A	N/A
HC41500786	EEG W/O VID MONITOR INTERMIT 2-12HR	740	95706	2,166	N/A	N/A	N/A
HC41500810	EEG W/O VID MONITOR INTERMT EA 12-26HR	740	95709	2,857	N/A	N/A	N/A
HC42000059	CARDIOVERSION EXTERNAL	480	92960	6,104	N/A	N/A	N/A
HC42000083	ECHO CONGENITAL COMPLETE	483	93303	4,679	N/A	N/A	N/A
HC42000257	ECHO 2D STRESS TREADMILL	483	93350	4,679	N/A	N/A	N/A
HC42000315	ECG EXT HOLTER W/CONNECT UP TO 48HRS; RECORD	731	93225	1,539	N/A	N/A	N/A
HC42000356	INTERROGATION T-ICD	480	93289	675	N/A	N/A	N/A
HC42000497	SIGNAL AVERAGE ECG	730	93278	971	N/A	N/A	N/A
HC42000521	TEE MONITORING COMPLETE	483	93318	4,723	N/A	N/A	N/A
HC42000570	WCH NEW PT LVL4-DETAILED	510	99204	415	N/A	N/A	N/A
HC42000786	ECHO 2D RX STRESS; CONT EKG	483	93351	5,704	N/A	N/A	N/A
HC42000810	TEE GUIDE TRANSCATH INTVNTN INCL US	483	93355	4,614	N/A	N/A	N/A
HC42090076	P: STRESS NUCLEAR PHARMACOLOGI			N/A	N/A	N/A	N/A
HC42090100	P:STRESS ECHO TREADMILL			N/A	N/A	N/A	N/A
HC42090167	P: ECHO LMT/FOL-UP W/DOPP FLO  W/WO CONTR			N/A	N/A	N/A	N/A
HC43000512	CONSULTATION 15MIN (STATISTIC)	401		N/A	N/A	N/A	N/A
HC43000553	PUNC ASP CYST BREAST EA ADD+RT	361	19001	2,246	N/A	N/A	N/A
HC43000611	PUNC ASP CYST BREAST EA ADD+LT	361	19001	2,246	N/A	N/A	N/A
HC43001015	US BREAST; LIMITED RT	402	76642	724	N/A	N/A	N/A
HC43001049	TOMO BRST DX 3-D; UNILAT RT+	401	77061	111	N/A	N/A	N/A
HC43001072	BREAST PROCEDURE UNSPECIFIED	361	19499	8,818	N/A	N/A	N/A
HC43500008	DEXA BONE DENS-APPEND SKELETAL	320	77081	831	N/A	N/A	N/A
HC43500032	DEXA VERTEBRAL FX ASSESSMENT	320	77086	873	N/A	N/A	N/A
HC44000149	ANKLE COMP MIN 3 VWS LT	320	73610	941	N/A	N/A	N/A
HC44000206	XR COLON DOUBLE CONTRAST INC SCOUT DELAYED	320	74280	2,241	N/A	N/A	N/A
HC44000230	BONE SURVEY COMPLETE	320	77075	2,501	N/A	N/A	N/A
HC44000412	CHEST SINGLE VIEW	324	71045	658	N/A	N/A	N/A
HC44000487	CHOLECYSTOGRAM ORAL (GB)	320	74290	960	N/A	N/A	N/A
HC44000529	CLAVICLE RT	320	73000	673	N/A	N/A	N/A
HC44000701	EYE FOR FOREIGN BODY BILAT	320	70030	891	N/A	N/A	N/A
HC44000735	FACIAL BONES COMP MIN 3 VWS	320	70150	1,195	N/A	N/A	N/A
HC44000925	FOOT COMP MIN 3 VWS LT	320	73630	910	N/A	N/A	N/A
HC44000958	FOREARM LT	320	73090	745	N/A	N/A	N/A
HC44001238	INFANT LOW EXTREM MIN 2VWS RT	320	73592	793	N/A	N/A	N/A
HC44001261	INFANT UP EXTREM MIN 2VWS RT	320	73092	691	N/A	N/A	N/A
HC44001295	INTRODUCE TUBE GASTROINTESTINAL LONG	361	44500	2,664	N/A	N/A	N/A
HC44001436	KNEE 3 VIEWS LT	320	73562	959	N/A	N/A	N/A
HC44001469	KNEE 4 OR MORE VWS LT	320	73564	1,146	N/A	N/A	N/A
HC44001493	KNEE ARTHROGRAM LT	322	73580	1,918	N/A	N/A	N/A
HC44001667	NECK  SOFT TISSUE	320	70360	607	N/A	N/A	N/A
HC44001691	ORBITS COMPLETE MIN 4 VWS	320	70200	1,068	N/A	N/A	N/A
HC44001865	SALIVARY GLAND FOR CALCULUS	320	70380	481	N/A	N/A	N/A
HC44001899	SCAPULA RT	320	73010	713	N/A	N/A	N/A
HC44002079	XR SMALL BOWEL W/DOUBLE CONTRAST INC SCOUT SERIAL	320	74251	2,144	N/A	N/A	N/A
HC44002111	STERNOCLAVICULAR MIN 3 VWS	320	71130	797	N/A	N/A	N/A
HC44002152	XR SWALLOW FUNC W/CINE/VIDEO INC SCOUT&DELAYES	320	74230	1,441	N/A	N/A	N/A
HC44002301	TMJ BILAT	320	70330	1,009	N/A	N/A	N/A
HC44002335	TOE (S) BILAT	320	73660	1,141	N/A	N/A	N/A
HC44002376	TOMOGRAM SINGLE PLANE	320	76100	1,187	N/A	N/A	N/A
HC44002616	XR UGI W/SNGLE CONTRAST INC SCOUT DELAYED	320	74240	1,557	N/A	N/A	N/A
HC44002673	PHYSICIAN READING(STATISTICAL)	320		N/A	N/A	N/A	N/A
HC44002848	MYELOGRAPHY INJ W/S&I; THORACIC	361	62303	9,422	N/A	N/A	N/A
HC44002871	SPINE ENTIRE SKULL-SACRUM 1 VIEW	320	72081	762	N/A	N/A	N/A
HC44002905	SPINE ENTIRE SKULL-SACRUM 6/> VIEWS	320	72084	1,852	N/A	N/A	N/A
HC44003069	ABDOMEN 3/> VIEWS	324	74021	1,057	N/A	N/A	N/A
HC44003093	EVAL MED PHYSICS DOSE RADIATION EXPOSE W/REPORT	320	76145	444	N/A	N/A	N/A
HC44089910	CDSM MEDICALIS	329	G1003	0	N/A	N/A	N/A
HC44200111	US DUPLEX ABD/PEL FLOW LTD	921	93976	1,919	N/A	N/A	N/A
HC44200145	US DUPLEX ART LOW EXT COMP BIL	921	93925	3,500	N/A	N/A	N/A
HC44200178	US DUPLEX ART UP EXT UNILAT/LTD	921	93931	1,900	N/A	N/A	N/A
HC44200350	US HYSTEROSONOGRAPHY	402	76831	1,806	N/A	N/A	N/A
HC44200384	US KIDNEY TRANSPLANT W/DOPLER	402	76776	2,073	N/A	N/A	N/A
HC44200574	US SPINAL CANAL & CONTENT	402	76800	1,716	N/A	N/A	N/A
HC44200608	TRANSCRANIAL DOPPLER STUDY COMP	921	93886	3,289	N/A	N/A	N/A
HC44200632	US TRANSRECTAL	402	76872	1,676	N/A	N/A	N/A
HC44200822	US EXTREMITY NON VASC LTD-RT	402	76882	840	N/A	N/A	N/A
HC44200855	ART STDY SNG U/L 1-2 LVL LTD-L	921	93922	1,193	N/A	N/A	N/A
HC44200889	ECHO VELOCIMETRY FETAL UMBILIC	402	76820	938	N/A	N/A	N/A
HC44500031	ANGIO ADRENAL BILAT	323	75733	12,702	N/A	N/A	N/A
HC44500171	ANGIO EA ADD'L VESSEL +	323	75774	7,392	N/A	N/A	N/A
HC44500478	AORTOGRAM THOR W/ SERIAL(ARCH)	323	75605	8,873	N/A	N/A	N/A
HC44500551	PERC DILATATION INTRACRANIAL VASOSPASM EA ADD VES SAME TERRITORY+	361	61641	13,809	N/A	N/A	N/A
HC44500882	INJ ART OCCLUS AVM SPINAL	361	62294	5,407	N/A	N/A	N/A
HC44500916	INJ PERC EXT PSEUDOANEUR LT	361	36002	2,171	N/A	N/A	N/A
HC44500940	INJ SCLEROTHERAPY MULT VEINS-RT	361	36471	2,487	N/A	N/A	N/A
HC44501484	TLA AORTA W/S&I:INITIAL	323	37246	15,680	N/A	N/A	N/A
HC44501740	REM & REPLAC EXT URET CATH(IMG S&I) LT	361	50387	8,662	N/A	N/A	N/A
HC44501773	REM & REPLAC URETERAL STENT LT	361	50382	12,127	N/A	N/A	N/A
HC44501955	THROMBECTOMY ART 2ND RT(NONCOR/CRNL)	361	37186	12,936	N/A	N/A	N/A
HC44502003	THROMBECTOMY VEIN REPEAT LT	361	37188	13,828	N/A	N/A	N/A
HC44502268	VENOGRAM HEPATIC W/O HEMO EVAL	320	75891	6,231	N/A	N/A	N/A
HC44502292	VENOGRAM RENAL RT	320	75831	7,097	N/A	N/A	N/A
HC44502334	ENDOVENOUS ABLAT LASER WS&I; ADDL VEIN+	361	36479	9,257	N/A	N/A	N/A
HC44502748	REVASC ILIAC W/TLA & STENT-RT	323	37221	25,754	N/A	N/A	N/A
HC44502771	REVASC ILIAC EA+VES W/TLA-RT	323	37222	16,447	N/A	N/A	N/A
HC44502805	REVAS ILIAC EA+VES W/TLA&STENT-R	323	37223	21,216	N/A	N/A	N/A
HC44502946	REVAS FEMPOP TLA&STENT&ATHER-B	323	37227	78,782	N/A	N/A	N/A
HC44502979	REVAS TIB/PERO W/TLA 1ST VES-BI	323	37228	32,160	N/A	N/A	N/A
HC44503001	REVAS TIB/PERO W/TLA & ATHER-BI	323	37229	51,158	N/A	N/A	N/A
HC44503175	REVAS TIB/PER EA+TLA&ATH&STN-L	323	37235	25,788	N/A	N/A	N/A
HC44503209	ATHER' TRLUML RENAL ART&S&I-LT	323	0234T	26,781	N/A	N/A	N/A
HC44503514	ENDOVENOUS ABLAT RADIO FREQ WS&I; INITIAL VEIN	361	36475	16,245	N/A	N/A	N/A
HC44503555	SEL CATH&RENAL ANGIO1STW/S&I-R	361	36251	11,569	N/A	N/A	N/A
HC44503589	SEL CATH&RENAL ANGIO2NDW/S&I-R	361	36253	13,105	N/A	N/A	N/A
HC44503746	THROMBOLYSIS NONCOR+S&I SUB DAY	323	37213	15,033	N/A	N/A	N/A
HC44503779	PLACE CATH THOR AORTA&ANGIO W/S&I	323	36221	12,018	N/A	N/A	N/A
HC44503803	SEL CATH CC/INOM &ANGIO IC W/S&I LT	323	36223	19,524	N/A	N/A	N/A
HC44504041	EMBOLIZE TUMOR/ORGAN/INFARCT W/S&I	361	37243	56,381	N/A	N/A	N/A
HC44504074	REVAS OTHR PERIPH +ART W/STNT W-S&I	361	37237	12,764	N/A	N/A	N/A
HC44504249	VERTEBROPLASTY 1BODY/GUIDE;CERVICOTHORACIC	361	22510	14,028	N/A	N/A	N/A
HC44504272	VERTEBRAL AUGMNT 1BODY W/GUIDE;THORACIC	361	22513	26,212	N/A	N/A	N/A
HC44504447	REMOV CALC DUCT(S)BIL&/GB PERC(DESTRCT S&I)+	361	47544	7,499	N/A	N/A	N/A
HC44504470	IVUS VESSEL ADD'L NONCORON W/EXAM++	402	37253	4,843	N/A	N/A	N/A
HC44504504	PERC PLCMT TISS SOFT DEV 1ST LESN	361	10035	4,335	N/A	N/A	N/A
HC44504645	EMBOLIZATION/OCCLUSION URETERAL  LT	361	50705	7,724	N/A	N/A	N/A
HC44504678	DILAT BALLOON STRICTURE URETERAL  RT	361	50706	7,294	N/A	N/A	N/A
HC44504702	ENDOVENOUS ABLAT MECHANOCHEM WS&I; ADDL VEIN+	361	36474	5,163	N/A	N/A	N/A
HC44504876	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:INTL RIGHT	361	37248	14,005	N/A	N/A	N/A
HC44504900	TRANSLUMINAL BALO ANGIOP VEIN W/S&I:ADDL + RT	361	37249	8,490	N/A	N/A	N/A
HC44700144	COMP EP EVAL W/ INDUC ARRHYTHM	481	93620	27,500	N/A	N/A	N/A
HC44700177	ENDOMYOCARDIAL BIOPSY	481	93505	5,080	N/A	N/A	N/A
HC44700201	EP EVAL T-ICD W/PROGRAMMING	481	93642	8,037	N/A	N/A	N/A
HC44700417	INSERT/EXTRAC/RET/REPOS S TV LEAD	481	33216	14,050	N/A	N/A	N/A
HC44700441	INSERT/REPLC SYSTM T-ICD SNGL W/LD	481	33249	34,902	N/A	N/A	N/A
HC44700474	INSRT PACER ONLY;W/EXIST DUAL LEAD	481	33213	16,475	N/A	N/A	N/A
HC44700664	MAP TACHYCARDIA SITES NON 3D+	481	93609	10,072	N/A	N/A	N/A
HC44700706	PERC BALLOON VALVPLSTY PULM	481	92990	28,589	N/A	N/A	N/A
HC44700797	PERICARDIOCENTESIS INCL IMAGING	361	33016	4,153	N/A	N/A	N/A
HC44701100	RIGHT HEART CATH; MSRMT  CO	481	93451	15,040	N/A	N/A	N/A
HC44701167	THROMBOLYSIS CORONARY IV INFUSION	481	92977	2,783	N/A	N/A	N/A
HC44701399	PLCMT CORON CATH;LT HRT&GRAFTS	481	93459	32,804	N/A	N/A	N/A
HC44701423	PUNCTURE TRANSEPTL (LT HC) +	481	93462	8,145	N/A	N/A	N/A
HC44701456	INJ PRO HRT CATH &IMG; LT VENT / ATRIUM+	481	93565	5,599	N/A	N/A	N/A
HC44701647	REMV&REPLC SYSTM ICD LEAD DUAL	481	33263	26,785	N/A	N/A	N/A
HC44701670	INSERT IMPLANTED MONITOR DEVIC	481	33999	6,657	N/A	N/A	N/A
HC44701720	PERC COR ANGIOPLST; SNGL CA/BRCH-LD	481	92920	23,521	N/A	N/A	N/A
HC44701894	PERC COR ANGIOP/ATHRECT; ADDL CA/BR-RC+	481	92925	17,742	N/A	N/A	N/A
HC44701928	PERC COR STENT(S)/ANGIOP; SNGL CA/BR-LD	481	92928	27,128	N/A	N/A	N/A
HC44702090	PERC COR ATHR+STENT/ANGIOP; ADDL-RC+	481	92934	18,933	N/A	N/A	N/A
HC44702124	PERC CABG REVAS ATHR/STENT/ANG; SNGL-LD	481	92937	27,918	N/A	N/A	N/A
HC44702298	PERC COR CHRON REVAS ATHR/STNT/A;SNGL-RC	481	92943	32,524	N/A	N/A	N/A
HC44702322	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-LD+	481	92944	19,137	N/A	N/A	N/A
HC44702355	PERC COR CHRON REVAS ATHR/STNT/A;ADDL-RI+	481	92944	19,137	N/A	N/A	N/A
HC44702496	PERC COR ATHR+STENT(DES)ANGIOP; SNGL-RC	481	92933	32,208	N/A	N/A	N/A
HC44702520	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-LD+	481	92934	18,933	N/A	N/A	N/A
HC44702553	PERC COR ATHR+STENT(DES)ANGIOP; ADDL-RI+	481	92934	18,933	N/A	N/A	N/A
HC44702728	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-LD	481	92943	32,524	N/A	N/A	N/A
HC44702751	PERC COR CHRONC REVAS ATHR/DES/A;SNGL-RI	481	92943	32,524	N/A	N/A	N/A
HC44702926	REPAIR VISC AORTA FEVAR(PROX&DIST);3 PROSTH	360	34847	52,945	N/A	N/A	N/A
HC44702959	REM PERC VAD DEVICE-SEP SETTING ARTERIAL/AV; LEFT HEART	361	33992	7,225	N/A	N/A	N/A
HC44703122	TEVAR; PLCMT PROX EXT PROTH; INITIAL	360	33883	37,077	N/A	N/A	N/A
HC44703155	OPEN ILIAC FOR ENDOGRAFT OR OCCLUSION  UNI	360	34820	19,462	N/A	N/A	N/A
HC44703189	OPEN REPAIR INFRARENAL AAA; FAILED ENDOGRAFT; AORTO-BIFEM PRO	360	34832	55,081	N/A	N/A	N/A
HC44703338	EV REPAIR INFRARENAL AORTA&/ILIAC GRFT AORTO-UNI-ILIAC ~RUPT	360	34704	49,602	N/A	N/A	N/A
HC44703361	EV REPAIR ILIAC GRFT ILIO-ILIAC AORTC BI DIST UNILAT NONRUPT	360	34707	25,572	N/A	N/A	N/A
HC44703395	PLACMNT DELAY DISTL/PROX EXTSN INFRARENL AA ILIAC:INT'L VSSL	360	34710	19,658	N/A	N/A	N/A
HC44703569	EV REPAIR AORTOILIAC DEPLOY GRAFT ILIAC CATH UNILAT RUPT/NON-RUPT+	360	34717	9,571	N/A	N/A	N/A
HC44703593	TMVR MITRACLIP ADD'L PROTH+	481	33419	8,630	N/A	N/A	N/A
HC44703817	EV REPAIR STENT PLACE COARCT AORTA NOT CROSSING MAJOR SIDE BRANCHES	360	33895	47,208	N/A	N/A	N/A
HC44703874	INJ PRO HRT CATH &IMAG; SELCT PULM ARTRL ANGIO UNILAT+	481	93569	4,268	N/A	N/A	N/A
HC44703908	INJ PRO HRT CATH &IMAG; SELCT PULM MAPCAS AORTA EA+	481	93575	10,496	N/A	N/A	N/A
HC44900074	CT CHEST DX HI RESOLUTION W/ CNTRST	352	71260	6,048	N/A	N/A	N/A
HC44900108	CT CHEST DX W&W/O CONTRAST	352	71270	7,041	N/A	N/A	N/A
HC44900132	CT C-SPINE W&W/O  CONTRAST	352	72127	7,279	N/A	N/A	N/A
HC44900280	CT LOW EXT W/CONTRAST RT	352	73701	5,432	N/A	N/A	N/A
HC44900314	CT LOW EXT W/O CONTRAST RT	352	73700	4,962	N/A	N/A	N/A
HC44900348	CT L-SPINE W/O CONTRAST	352	72131	6,469	N/A	N/A	N/A
HC44900512	CT T-SPINE W/ CONTRAST	352	72129	7,289	N/A	N/A	N/A
HC44900546	CT UPPER EXT W&W/O CONTRAST LT	352	73202	6,469	N/A	N/A	N/A
HC44900710	CTA UPPER EXT W/CONTRAST-BILAT	352	73206	13,867	N/A	N/A	N/A
HC44900744	CT HEART W/CORO CALC W/O CON	350	75571	1,642	N/A	N/A	N/A
HC44900843	CT BODY SCAN LTD ABD/PELVIS	350		783	N/A	N/A	N/A
HC44900991	CT ABD & PELVIS W/O&W CONTRAST	352	74178	10,546	N/A	N/A	N/A
HC44901031	CT CEREBRAL PERF ANALYSIS	350	0042T	6,681	N/A	N/A	N/A
HC44901064	CT BREAST 3D RENDER UNILAT W/CONTRAST	352	0634T	2,993	N/A	N/A	N/A
HC45200144	NM BRAIN IMAG MIN'4 STATIC VWS	341	78605	3,444	N/A	N/A	N/A
HC45200185	NM CARDIAC BP 1ST PASS(EF)SNGL	341	78481	3,492	N/A	N/A	N/A
HC45200375	NM INTRACAV RADIOAC COLLOID TX	342	79200	2,492	N/A	N/A	N/A
HC45200409	NM KIDNEY IMAGING W/VASC FLOW	341	78701	3,084	N/A	N/A	N/A
HC45200730	NM RED CELL SURVIVAL	341	78130	2,843	N/A	N/A	N/A
HC45200797	NM SHUNT EVALUATION	341	78645	3,225	N/A	N/A	N/A
HC45200839	NM THYROID CA METS BODY SCAN	341	78018	4,384	N/A	N/A	N/A
HC45201167	RADIOLABEL MONONCLON ANTIBODY	342	79403	3,045	N/A	N/A	N/A
HC45201217	MIBI SPECT MULTI STUDY W/WM&EF	341	78452	8,597	N/A	N/A	N/A
HC45201241	PULM VENTILATION IMAGING	341	78579	2,662	N/A	N/A	N/A
HC45201415	NM MYOCARDIAL SYMPATHETIC INNERV IMAGE	341	0331T	2,478	N/A	N/A	N/A
HC45400025	MR ABDOMEN W/O CONTRAST	610	74181	7,134	N/A	N/A	N/A
HC45400199	MR LOW EXT(NON JNT)W/CONT BIL	610	73719	13,239	N/A	N/A	N/A
HC45400223	MR LO EXT(NON JNT)W&W/O CON BI	610	73720	18,773	N/A	N/A	N/A

Section: Discounted Cash Pricing Policy
Policy Line
Payment discount rates
a. California Residents
       i. Inpatient – 150% of the Medicare Inpatient Prospective System (IPPS) rates
      ii. Outpatient Surgery – 150% of Medicare Outpatient Prospective Payment Services (OPPS) rates per CPT/HCPC code services
     iii. Outpatient non-surgical – 150% of Medicare Outpatient Prospective Payment Services (OPPS) rates per CPT/HCPC code services iv. Robotic assisted procedure (S2900) – additional charge of $2,800 applies to outpatient surgeries only; no additional mark-up on inpatient surgeries.
      v. If the CPT/HCPC code cannot be determined, then OP pricing will be determined as follows:
                 1. 1 st hour in the OR : $1,200. Subsequent 15 minutes: $300 each.
                2. Implants: acquisition cost plus 10% markup.
vi. All monies are due prior to services being rendered for pre-scheduled services. If immediate care is required, then the following deposits are due and the balance will be paid after services are rendered:
               1. $5,000 for IP
               2. $2,500 for OP
b. Non-California residents
      i. Inpatient – 180% of the Medicare Inpatient Prospective System (IPPS) rates
     ii. Outpatient Surgery – 180% of Medicare Outpatient Prospective Payment Services (OPPS) rates per CPT/HCPC code services
    iii. Outpatient non-surgical – 180% of Medicare Outpatient Prospective Payment Services (OPPS) rates per CPT/HCPC code services
    iv. Robotic assisted procedure (S2900) – additional charge of $2,800 applies to outpatient surgeries only; no additional mark-up on inpatient surgeries.
     v. If the CPT/HCPC code cannot be determined, then OP pricing will be determined as follows:
             1. 1 st hour in the OR : $1,400. Subsequent 15 minutes: $350 each.
             2. Implants: acquisition cost plus 10% markup.
vi. All monies are due prior to services being rendered for pre-scheduled services. If immediate care is required, then the following deposits are due and the balance will be paid after services are rendered:
             1. $6,000 IP
             2. $3,000 OP

Section: Inpatient De-identified Minimum Negotiated Charge
MS-DRG	Description	De-Identified Minimum Negotiated Charge
003	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major	111412.0
023	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Chemothera	51698.0
024	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc	36228.0
025	Craniotomy And Endovascular Intracranial Procedures With Mcc	9658.0
026	Craniotomy And Endovascular Intracranial Procedures With Cc	28326.0
035	Carotid Artery Stent Procedures With Cc	22196.0
036	Carotid Artery Stent Procedures Without Cc/Mcc	16215.0
041	Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator	59991.0
054	Nervous System Neoplasms With Mcc	12970.0
056	Degenerative Nervous System Disorders With Mcc	15396.0
057	Degenerative Nervous System Disorders Without Mcc	9400.0
062	Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc	18386.0
064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	11236.0
065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	6312.0
066	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	8646.0
069	Transient Ischemia Without Thrombolytic	7150.0
071	Nonspecific Cerebrovascular Disorders With Cc	9926.0
073	Cranial And Peripheral Nerve Disorders With Mcc	8406.0
074	Cranial And Peripheral Nerve Disorders Without Mcc	7890.0
082	Traumatic Stupor And Coma >1 Hour With Mcc	9894.0
083	Traumatic Stupor And Coma >1 Hour With Cc	12655.0
084	Traumatic Stupor And Coma >1 Hour Without Cc/Mcc	6994.0
086	Traumatic Stupor And Coma <1 Hour With Cc	12891.0
091	Other Disorders Of Nervous System With Mcc	11540.0
092	Other Disorders Of Nervous System With Cc	7101.0
100	Seizures With Mcc	8995.0
101	Seizures Without Mcc	4734.0
103	Headaches Without Mcc	7509.0
142	Major Head And Neck Procedures Without Cc/Mcc	17798.0
144	Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc	1578.0
149	Dysequilibrium	7063.0
152	Otitis Media And Uri With Mcc	30731.0
153	Otitis Media And Uri Without Mcc	17717.0
158	Dental And Oral Diseases With Cc	7031.0
163	Major Chest Procedures With Mcc	45766.0
164	Major Chest Procedures With Cc	19518.0
166	Other Respiratory System O.R. Procedures With Mcc	18070.0
168	Other Respiratory System O.R. Procedures Without Cc/Mcc	12693.0
175	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	35839.0
176	Pulmonary Embolism Without Mcc	8598.0
177	Respiratory Infections And Inflammations With Mcc	7101.0
178	Respiratory Infections And Inflammations With Cc	10874.0
179	Respiratory Infections And Inflammations Without Cc/Mcc	9745.0
189	Pulmonary Edema And Respiratory Failure	8300.0
190	Chronic Obstructive Pulmonary Disease With Mcc	4734.0
191	Chronic Obstructive Pulmonary Disease With Cc	7511.0
193	Simple Pneumonia And Pleurisy With Mcc	9025.0
194	Simple Pneumonia And Pleurisy With Cc	9009.0
199	Pneumothorax With Mcc	45122.0
202	Bronchitis And Asthma With Cc/Mcc	6484.0
206	Other Respiratory System Diagnoses Without Mcc	22923.0
207	Respiratory System Diagnosis With Ventilator Support >96 Hours	57739.0
208	Respiratory System Diagnosis With Ventilator Support <=96 Hours	17575.0
216	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	61170.0
219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	17548.0
220	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc	101912.0
233	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	61116.0
234	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	92700.0
239	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	24339.0
242	Permanent Cardiac Pacemaker Implant With Mcc	33529.0
243	Permanent Cardiac Pacemaker Implant With Cc	23064.0
246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	7196.0
247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	4040.0
252	Other Vascular Procedures With Mcc	30286.0
253	Other Vascular Procedures With Cc	24426.0
264	Other Circulatory System O.R. Procedures	30057.0
266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	30981.0
269	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	41169.0
270	Other Major Cardiovascular Procedures With Mcc	27738.0
271	Other Major Cardiovascular Procedures With Cc	33698.0
272	Other Major Cardiovascular Procedures Without Cc/Mcc	24563.0
273	Percutaneous And Other Intracardiac Procedures With Mcc	1578.0
274	Percutaneous And Other Intracardiac Procedures Without Mcc	1578.0
280	Acute Myocardial Infarction, Discharged Alive With Mcc	11426.0
281	Acute Myocardial Infarction, Discharged Alive With Cc	8923.0
282	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	18389.0
283	Acute Myocardial Infarction, Expired With Mcc	18757.0
286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	16972.0
287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	12364.0
291	Heart Failure And Shock With Mcc	5618.0
299	Peripheral Vascular Disorders With Mcc	9957.0
300	Peripheral Vascular Disorders With Cc	9957.0
304	Hypertension With Mcc	6819.0
305	Hypertension Without Mcc	6315.0
308	Cardiac Arrhythmia And Conduction Disorders With Mcc	6312.0
309	Cardiac Arrhythmia And Conduction Disorders With Cc	6331.0
312	Syncope And Collapse	5523.0
313	Chest Pain	1578.0
314	Other Circulatory System Diagnoses With Mcc	8356.0
315	Other Circulatory System Diagnoses With Cc	9393.0
326	Stomach, Esophageal And Duodenal Procedures With Mcc	49479.0
329	Major Small And Large Bowel Procedures With Mcc	30670.0
330	Major Small And Large Bowel Procedures With Cc	4734.0
331	Major Small And Large Bowel Procedures Without Cc/Mcc	21982.0
339	Appendectomy With Complicated Principal Diagnosis With Cc	41781.0
343	Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc	24419.0
357	Other Digestive System O.R. Procedures With Cc	21011.0
368	Major Esophageal Disorders With Mcc	11675.0
371	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	16159.0
372	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	23234.0
374	Digestive Malignancy With Mcc	12492.0
375	Digestive Malignancy With Cc	11401.0
377	Gastrointestinal Hemorrhage With Mcc	5523.0
378	Gastrointestinal Hemorrhage With Cc	4734.0
379	Gastrointestinal Hemorrhage Without Cc/Mcc	16262.0
386	Inflammatory Bowel Disease With Cc	22590.0
388	Gastrointestinal Obstruction With Mcc	14323.0
389	Gastrointestinal Obstruction With Cc	3156.0
390	Gastrointestinal Obstruction Without Cc/Mcc	5328.0
391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	9055.0
392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	3163.0
393	Other Digestive System Diagnoses With Mcc	11431.0
394	Other Digestive System Diagnoses With Cc	7980.0
395	Other Digestive System Diagnoses Without Cc/Mcc	5303.0
417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	12814.0
418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	15088.0
419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	11770.0
423	Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc	38311.0
432	Cirrhosis And Alcoholic Hepatitis With Mcc	10844.0
433	Cirrhosis And Alcoholic Hepatitis With Cc	7435.0
435	Malignancy Of Hepatobiliary System Or Pancreas With Mcc	16350.0
438	Disorders Of Pancreas Except Malignancy With Mcc	11383.0
439	Disorders Of Pancreas Except Malignancy With Cc	7644.0
440	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	7787.0
441	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc	10415.0
443	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc	16726.0
444	Disorders Of The Biliary Tract With Mcc	13247.0
445	Disorders Of The Biliary Tract With Cc	10281.0
446	Disorders Of The Biliary Tract Without Cc/Mcc	20827.0
453	Combined Anterior And Posterior Spinal Fusion With Mcc	234894.0
454	Combined Anterior And Posterior Spinal Fusion With Cc	7890.0
455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	6312.0
460	Spinal Fusion Except Cervical Without Mcc	3156.0
464	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit	56622.0
467	Revision Of Hip Or Knee Replacement With Cc	16983.0
468	Revision Of Hip Or Knee Replacement Without Cc/Mcc	26341.0
470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	1578.0
471	Cervical Spinal Fusion With Mcc	43566.0
472	Cervical Spinal Fusion With Cc	6312.0
473	Cervical Spinal Fusion Without Cc/Mcc	19561.0
475	Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc	2055.0
480	Hip And Femur Procedures Except Major Joint With Mcc	27954.0
481	Hip And Femur Procedures Except Major Joint With Cc	18358.0
483	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	21810.0
493	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc	18334.0
494	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc	16926.0
511	Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc	18155.0
513	Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc	12348.0
519	Back And Neck Procedures Except Spinal Fusion With Cc	16516.0
520	Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc	35404.0
522	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	20229.0
543	Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc	11032.0
546	Connective Tissue Disorders With Cc	11728.0
551	Medical Back Problems With Mcc	15387.0
552	Medical Back Problems Without Mcc	6724.0
560	Aftercare, Musculoskeletal System And Connective Tissue With Cc	9624.0
563	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc	5998.0
565	Other Musculoskeletal System And Connective Tissue Diagnoses With Cc	7565.0
580	Other Skin, Subcutaneous Tissue And Breast Procedures With Cc	11794.0
581	Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc	26607.0
585	Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc	47239.0
602	Cellulitis With Mcc	10067.0
603	Cellulitis Without Mcc	6437.0
605	Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc	5749.0
607	Minor Skin Disorders Without Mcc	6320.0
617	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc	16961.0
622	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc	13680.0
627	Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc	6624.0
637	Diabetes With Mcc	9338.0
638	Diabetes With Cc	5030.0
639	Diabetes Without Cc/Mcc	6054.0
640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	7890.0
641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	7322.0
660	Kidney And Ureter Procedures For Non-Neoplasm With Cc	13956.0
661	Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc	6827.0
673	Other Kidney And Urinary Tract Procedures With Mcc	15216.0
674	Other Kidney And Urinary Tract Procedures With Cc	21832.0
682	Renal Failure With Mcc	6312.0
683	Renal Failure With Cc	6715.0
689	Kidney And Urinary Tract Infections With Mcc	10894.0
690	Kidney And Urinary Tract Infections Without Mcc	6542.0
698	Other Kidney And Urinary Tract Diagnoses With Mcc	9790.0
699	Other Kidney And Urinary Tract Diagnoses With Cc	6758.0
713	Transurethral Prostatectomy With Cc/Mcc	38023.0
742	Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc	12778.0
743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	5032.0
750	Other Female Reproductive System O.R. Procedures Without Cc/Mcc	18357.0
759	Infections, Female Reproductive System Without Cc/Mcc	7233.0
761	Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc	4550.0
770	Abortion With D&C, Aspiration Curettage Or Hysterotomy	5133.0
776	Postpartum And Post Abortion Diagnoses Without O.R. Procedures	4248.0
808	Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders 	11046.0
811	Red Blood Cell Disorders With Mcc	9160.0
812	Red Blood Cell Disorders Without Mcc	5427.0
831	Other Antepartum Diagnoses Without O.R. Procedures With Mcc	30489.0
835	Acute Leukemia Without Major O.R. Procedures With Cc	33476.0
839	Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc	8281.0
840	Lymphoma And Non-Acute Leukemia With Mcc	29586.0
843	Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc	12719.0
846	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc	24555.0
847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	6312.0
853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	26732.0
854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	17166.0
857	Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc	8307.0
862	Postoperative And Post-Traumatic Infections With Mcc	13139.0
870	Septicemia Or Severe Sepsis With Mv >96 Hours	21083.0
871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	7964.0
872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	4734.0
884	Organic Disturbances And Intellectual Disability	14453.0
897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	4872.0
907	Other O.R. Procedures For Injuries With Mcc	36185.0
908	Other O.R. Procedures For Injuries With Cc	18854.0
917	Poisoning And Toxic Effects Of Drugs With Mcc	39064.0
919	Complications Of Treatment With Mcc	11196.0
920	Complications Of Treatment With Cc	9842.0
945	Rehabilitation With Cc/Mcc	17607.0
948	Signs And Symptoms Without Mcc	4124.0
949	Aftercare With Cc/Mcc	10743.0
956	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	68223.0
974	Hiv With Major Related Condition With Mcc	28037.0
981	Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc	16562.0

Section: Inpatient De-identified Maximum Negotiated Charge
MS-DRG	Description	De-Identified Maximum Negotiated Charge
003	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major	111412.0
023	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Chemothera	55187.0
024	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc	36228.0
025	Craniotomy And Endovascular Intracranial Procedures With Mcc	116500.0
026	Craniotomy And Endovascular Intracranial Procedures With Cc	72337.0
035	Carotid Artery Stent Procedures With Cc	22196.0
036	Carotid Artery Stent Procedures Without Cc/Mcc	16215.0
041	Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator	59991.0
054	Nervous System Neoplasms With Mcc	35588.0
056	Degenerative Nervous System Disorders With Mcc	69760.0
057	Degenerative Nervous System Disorders Without Mcc	55821.0
062	Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc	45869.0
064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	50598.0
065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	32513.0
066	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	10815.0
069	Transient Ischemia Without Thrombolytic	8268.0
071	Nonspecific Cerebrovascular Disorders With Cc	10223.0
073	Cranial And Peripheral Nerve Disorders With Mcc	38469.0
074	Cranial And Peripheral Nerve Disorders Without Mcc	26264.0
082	Traumatic Stupor And Coma >1 Hour With Mcc	23137.0
083	Traumatic Stupor And Coma >1 Hour With Cc	15806.0
084	Traumatic Stupor And Coma >1 Hour Without Cc/Mcc	7125.0
086	Traumatic Stupor And Coma <1 Hour With Cc	12891.0
091	Other Disorders Of Nervous System With Mcc	11540.0
092	Other Disorders Of Nervous System With Cc	25512.0
100	Seizures With Mcc	36077.0
101	Seizures Without Mcc	7990.0
103	Headaches Without Mcc	21360.0
142	Major Head And Neck Procedures Without Cc/Mcc	38838.0
144	Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc	1578.0
149	Dysequilibrium	7733.0
152	Otitis Media And Uri With Mcc	30731.0
153	Otitis Media And Uri Without Mcc	17717.0
158	Dental And Oral Diseases With Cc	7031.0
163	Major Chest Procedures With Mcc	124280.0
164	Major Chest Procedures With Cc	66267.0
166	Other Respiratory System O.R. Procedures With Mcc	32424.0
168	Other Respiratory System O.R. Procedures Without Cc/Mcc	12693.0
175	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	35839.0
176	Pulmonary Embolism Without Mcc	8598.0
177	Respiratory Infections And Inflammations With Mcc	45669.0
178	Respiratory Infections And Inflammations With Cc	12063.0
179	Respiratory Infections And Inflammations Without Cc/Mcc	9745.0
189	Pulmonary Edema And Respiratory Failure	15527.0
190	Chronic Obstructive Pulmonary Disease With Mcc	41732.0
191	Chronic Obstructive Pulmonary Disease With Cc	8744.0
193	Simple Pneumonia And Pleurisy With Mcc	13057.0
194	Simple Pneumonia And Pleurisy With Cc	9009.0
199	Pneumothorax With Mcc	45122.0
202	Bronchitis And Asthma With Cc/Mcc	9391.0
206	Other Respiratory System Diagnoses Without Mcc	22923.0
207	Respiratory System Diagnosis With Ventilator Support >96 Hours	57739.0
208	Respiratory System Diagnosis With Ventilator Support <=96 Hours	22239.0
216	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	61170.0
219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	208556.0
220	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc	139454.0
233	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	61116.0
234	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	92700.0
239	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	24339.0
242	Permanent Cardiac Pacemaker Implant With Mcc	33529.0
243	Permanent Cardiac Pacemaker Implant With Cc	23064.0
246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	31222.0
247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	48994.0
252	Other Vascular Procedures With Mcc	30286.0
253	Other Vascular Procedures With Cc	68609.0
264	Other Circulatory System O.R. Procedures	30057.0
266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	63687.0
269	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	41169.0
270	Other Major Cardiovascular Procedures With Mcc	131179.0
271	Other Major Cardiovascular Procedures With Cc	33698.0
272	Other Major Cardiovascular Procedures Without Cc/Mcc	24563.0
273	Percutaneous And Other Intracardiac Procedures With Mcc	1578.0
274	Percutaneous And Other Intracardiac Procedures Without Mcc	86198.0
280	Acute Myocardial Infarction, Discharged Alive With Mcc	38433.0
281	Acute Myocardial Infarction, Discharged Alive With Cc	9423.0
282	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	18389.0
283	Acute Myocardial Infarction, Expired With Mcc	18757.0
286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	20280.0
287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	12364.0
291	Heart Failure And Shock With Mcc	32837.0
299	Peripheral Vascular Disorders With Mcc	14592.0
300	Peripheral Vascular Disorders With Cc	9957.0
304	Hypertension With Mcc	10455.0
305	Hypertension Without Mcc	15511.0
308	Cardiac Arrhythmia And Conduction Disorders With Mcc	30087.0
309	Cardiac Arrhythmia And Conduction Disorders With Cc	18925.0
312	Syncope And Collapse	21879.0
313	Chest Pain	18561.0
314	Other Circulatory System Diagnoses With Mcc	22247.0
315	Other Circulatory System Diagnoses With Cc	9393.0
326	Stomach, Esophageal And Duodenal Procedures With Mcc	49479.0
329	Major Small And Large Bowel Procedures With Mcc	45100.0
330	Major Small And Large Bowel Procedures With Cc	63001.0
331	Major Small And Large Bowel Procedures Without Cc/Mcc	43844.0
339	Appendectomy With Complicated Principal Diagnosis With Cc	41781.0
343	Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc	28036.0
357	Other Digestive System O.R. Procedures With Cc	21011.0
368	Major Esophageal Disorders With Mcc	11675.0
371	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	16159.0
372	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	23234.0
374	Digestive Malignancy With Mcc	51144.0
375	Digestive Malignancy With Cc	11401.0
377	Gastrointestinal Hemorrhage With Mcc	16906.0
378	Gastrointestinal Hemorrhage With Cc	25273.0
379	Gastrointestinal Hemorrhage Without Cc/Mcc	16262.0
386	Inflammatory Bowel Disease With Cc	22590.0
388	Gastrointestinal Obstruction With Mcc	37651.0
389	Gastrointestinal Obstruction With Cc	8398.0
390	Gastrointestinal Obstruction Without Cc/Mcc	5328.0
391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	25005.0
392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	20208.0
393	Other Digestive System Diagnoses With Mcc	15646.0
394	Other Digestive System Diagnoses With Cc	24195.0
395	Other Digestive System Diagnoses Without Cc/Mcc	5547.0
417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	61007.0
418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	42618.0
419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	33484.0
423	Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc	38311.0
432	Cirrhosis And Alcoholic Hepatitis With Mcc	48447.0
433	Cirrhosis And Alcoholic Hepatitis With Cc	11136.0
435	Malignancy Of Hepatobiliary System Or Pancreas With Mcc	34071.0
438	Disorders Of Pancreas Except Malignancy With Mcc	15044.0
439	Disorders Of Pancreas Except Malignancy With Cc	22317.0
440	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	14508.0
441	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc	10611.0
443	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc	16726.0
444	Disorders Of The Biliary Tract With Mcc	42713.0
445	Disorders Of The Biliary Tract With Cc	28214.0
446	Disorders Of The Biliary Tract Without Cc/Mcc	20827.0
453	Combined Anterior And Posterior Spinal Fusion With Mcc	234894.0
454	Combined Anterior And Posterior Spinal Fusion With Cc	156280.0
455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	122850.0
460	Spinal Fusion Except Cervical Without Mcc	96628.0
464	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit	56622.0
467	Revision Of Hip Or Knee Replacement With Cc	74471.0
468	Revision Of Hip Or Knee Replacement Without Cc/Mcc	26341.0
470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	49056.0
471	Cervical Spinal Fusion With Mcc	43566.0
472	Cervical Spinal Fusion With Cc	78796.0
473	Cervical Spinal Fusion Without Cc/Mcc	65046.0
475	Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc	2055.0
480	Hip And Femur Procedures Except Major Joint With Mcc	27954.0
481	Hip And Femur Procedures Except Major Joint With Cc	22204.0
483	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	21948.0
493	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc	21559.0
494	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc	48463.0
511	Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc	50777.0
513	Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc	12348.0
519	Back And Neck Procedures Except Spinal Fusion With Cc	51298.0
520	Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc	37969.0
522	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	20229.0
543	Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc	11032.0
546	Connective Tissue Disorders With Cc	11728.0
551	Medical Back Problems With Mcc	20129.0
552	Medical Back Problems Without Mcc	28287.0
560	Aftercare, Musculoskeletal System And Connective Tissue With Cc	26212.0
563	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc	7640.0
565	Other Musculoskeletal System And Connective Tissue Diagnoses With Cc	7565.0
580	Other Skin, Subcutaneous Tissue And Breast Procedures With Cc	44547.0
581	Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc	36216.0
585	Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc	47239.0
602	Cellulitis With Mcc	10067.0
603	Cellulitis Without Mcc	22625.0
605	Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc	8706.0
607	Minor Skin Disorders Without Mcc	6320.0
617	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc	16961.0
622	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc	13680.0
627	Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc	32737.0
637	Diabetes With Mcc	35811.0
638	Diabetes With Cc	22476.0
639	Diabetes Without Cc/Mcc	6333.0
640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	32465.0
641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	8345.0
660	Kidney And Ureter Procedures For Non-Neoplasm With Cc	13956.0
661	Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc	6827.0
673	Other Kidney And Urinary Tract Procedures With Mcc	65794.0
674	Other Kidney And Urinary Tract Procedures With Cc	60822.0
682	Renal Failure With Mcc	38143.0
683	Renal Failure With Cc	9395.0
689	Kidney And Urinary Tract Infections With Mcc	10894.0
690	Kidney And Urinary Tract Infections Without Mcc	20414.0
698	Other Kidney And Urinary Tract Diagnoses With Mcc	41117.0
699	Other Kidney And Urinary Tract Diagnoses With Cc	7066.0
713	Transurethral Prostatectomy With Cc/Mcc	38023.0
742	Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc	46238.0
743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	34200.0
750	Other Female Reproductive System O.R. Procedures Without Cc/Mcc	18357.0
759	Infections, Female Reproductive System Without Cc/Mcc	7233.0
761	Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc	4550.0
770	Abortion With D&C, Aspiration Curettage Or Hysterotomy	5133.0
776	Postpartum And Post Abortion Diagnoses Without O.R. Procedures	5538.0
808	Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders 	20504.0
811	Red Blood Cell Disorders With Mcc	31731.0
812	Red Blood Cell Disorders Without Mcc	20495.0
831	Other Antepartum Diagnoses Without O.R. Procedures With Mcc	30489.0
835	Acute Leukemia Without Major O.R. Procedures With Cc	33476.0
839	Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc	8281.0
840	Lymphoma And Non-Acute Leukemia With Mcc	29586.0
843	Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc	12719.0
846	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc	25714.0
847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	12344.0
853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	125750.0
854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	52743.0
857	Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc	8307.0
862	Postoperative And Post-Traumatic Infections With Mcc	46931.0
870	Septicemia Or Severe Sepsis With Mv >96 Hours	58996.0
871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	50218.0
872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	26376.0
884	Organic Disturbances And Intellectual Disability	14453.0
897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	5782.0
907	Other O.R. Procedures For Injuries With Mcc	76566.0
908	Other O.R. Procedures For Injuries With Cc	52766.0
917	Poisoning And Toxic Effects Of Drugs With Mcc	39064.0
919	Complications Of Treatment With Mcc	46020.0
920	Complications Of Treatment With Cc	9842.0
945	Rehabilitation With Cc/Mcc	69760.0
948	Signs And Symptoms Without Mcc	20440.0
949	Aftercare With Cc/Mcc	10743.0
956	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	68223.0
974	Hiv With Major Related Condition With Mcc	28037.0
981	Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc	40049.0

Section: Inpatient Payer Specific Charge 1
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
LA CARE MEDI-CAL/HEALTHY FAMILY	003	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major	111412.0
LA CARE MEDI-CAL/HEALTHY FAMILY	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	28111.0
LA CARE MEDI-CAL/HEALTHY FAMILY	056	Degenerative Nervous System Disorders With Mcc	15396.0
LA CARE MEDI-CAL/HEALTHY FAMILY	057	Degenerative Nervous System Disorders Without Mcc	9400.0
LA CARE MEDI-CAL/HEALTHY FAMILY	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	14515.0
LA CARE MEDI-CAL/HEALTHY FAMILY	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	10815.0
LA CARE MEDI-CAL/HEALTHY FAMILY	066	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	10815.0
LA CARE MEDI-CAL/HEALTHY FAMILY	069	Transient Ischemia Without Thrombolytic	8268.0
LA CARE MEDI-CAL/HEALTHY FAMILY	071	Nonspecific Cerebrovascular Disorders With Cc	9926.0
LA CARE MEDI-CAL/HEALTHY FAMILY	073	Cranial And Peripheral Nerve Disorders With Mcc	10904.0
LA CARE MEDI-CAL/HEALTHY FAMILY	074	Cranial And Peripheral Nerve Disorders Without Mcc	7890.0
LA CARE MEDI-CAL/HEALTHY FAMILY	082	Traumatic Stupor And Coma >1 Hour With Mcc	9894.0
LA CARE MEDI-CAL/HEALTHY FAMILY	084	Traumatic Stupor And Coma >1 Hour Without Cc/Mcc	7125.0
LA CARE MEDI-CAL/HEALTHY FAMILY	092	Other Disorders Of Nervous System With Cc	9926.0
LA CARE MEDI-CAL/HEALTHY FAMILY	100	Seizures With Mcc	8995.0
LA CARE MEDI-CAL/HEALTHY FAMILY	101	Seizures Without Mcc	7990.0
LA CARE MEDI-CAL/HEALTHY FAMILY	103	Headaches Without Mcc	7509.0
LA CARE MEDI-CAL/HEALTHY FAMILY	142	Major Head And Neck Procedures Without Cc/Mcc	17798.0
LA CARE MEDI-CAL/HEALTHY FAMILY	149	Dysequilibrium	7063.0
LA CARE MEDI-CAL/HEALTHY FAMILY	158	Dental And Oral Diseases With Cc	7031.0
LA CARE MEDI-CAL/HEALTHY FAMILY	164	Major Chest Procedures With Cc	19518.0
LA CARE MEDI-CAL/HEALTHY FAMILY	166	Other Respiratory System O.R. Procedures With Mcc	18070.0
LA CARE MEDI-CAL/HEALTHY FAMILY	177	Respiratory Infections And Inflammations With Mcc	17575.0
LA CARE MEDI-CAL/HEALTHY FAMILY	179	Respiratory Infections And Inflammations Without Cc/Mcc	9745.0
LA CARE MEDI-CAL/HEALTHY FAMILY	189	Pulmonary Edema And Respiratory Failure	8300.0
LA CARE MEDI-CAL/HEALTHY FAMILY	190	Chronic Obstructive Pulmonary Disease With Mcc	11687.0
LA CARE MEDI-CAL/HEALTHY FAMILY	191	Chronic Obstructive Pulmonary Disease With Cc	7511.0
LA CARE MEDI-CAL/HEALTHY FAMILY	193	Simple Pneumonia And Pleurisy With Mcc	9025.0
LA CARE MEDI-CAL/HEALTHY FAMILY	202	Bronchitis And Asthma With Cc/Mcc	6484.0
LA CARE MEDI-CAL/HEALTHY FAMILY	207	Respiratory System Diagnosis With Ventilator Support >96 Hours	57739.0
LA CARE MEDI-CAL/HEALTHY FAMILY	208	Respiratory System Diagnosis With Ventilator Support <=96 Hours	17575.0
LA CARE MEDI-CAL/HEALTHY FAMILY	216	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	61170.0
LA CARE MEDI-CAL/HEALTHY FAMILY	219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	71923.0
LA CARE MEDI-CAL/HEALTHY FAMILY	239	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	24339.0
LA CARE MEDI-CAL/HEALTHY FAMILY	246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	31222.0
LA CARE MEDI-CAL/HEALTHY FAMILY	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	24848.0
LA CARE MEDI-CAL/HEALTHY FAMILY	270	Other Major Cardiovascular Procedures With Mcc	27738.0
LA CARE MEDI-CAL/HEALTHY FAMILY	280	Acute Myocardial Infarction, Discharged Alive With Mcc	12424.0
LA CARE MEDI-CAL/HEALTHY FAMILY	286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	16972.0
LA CARE MEDI-CAL/HEALTHY FAMILY	287	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	12364.0
LA CARE MEDI-CAL/HEALTHY FAMILY	291	Heart Failure And Shock With Mcc	10770.0
LA CARE MEDI-CAL/HEALTHY FAMILY	299	Peripheral Vascular Disorders With Mcc	9957.0
LA CARE MEDI-CAL/HEALTHY FAMILY	300	Peripheral Vascular Disorders With Cc	9957.0
LA CARE MEDI-CAL/HEALTHY FAMILY	304	Hypertension With Mcc	9615.0
LA CARE MEDI-CAL/HEALTHY FAMILY	305	Hypertension Without Mcc	6315.0
LA CARE MEDI-CAL/HEALTHY FAMILY	308	Cardiac Arrhythmia And Conduction Disorders With Mcc	9918.0
LA CARE MEDI-CAL/HEALTHY FAMILY	309	Cardiac Arrhythmia And Conduction Disorders With Cc	6623.0
LA CARE MEDI-CAL/HEALTHY FAMILY	312	Syncope And Collapse	7275.0
LA CARE MEDI-CAL/HEALTHY FAMILY	313	Chest Pain	6426.0
LA CARE MEDI-CAL/HEALTHY FAMILY	314	Other Circulatory System Diagnoses With Mcc	22247.0
LA CARE MEDI-CAL/HEALTHY FAMILY	329	Major Small And Large Bowel Procedures With Mcc	30670.0
LA CARE MEDI-CAL/HEALTHY FAMILY	330	Major Small And Large Bowel Procedures With Cc	20884.0
LA CARE MEDI-CAL/HEALTHY FAMILY	368	Major Esophageal Disorders With Mcc	11675.0
LA CARE MEDI-CAL/HEALTHY FAMILY	374	Digestive Malignancy With Mcc	12726.0
LA CARE MEDI-CAL/HEALTHY FAMILY	377	Gastrointestinal Hemorrhage With Mcc	12367.0
LA CARE MEDI-CAL/HEALTHY FAMILY	378	Gastrointestinal Hemorrhage With Cc	11774.0
LA CARE MEDI-CAL/HEALTHY FAMILY	391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	9055.0
LA CARE MEDI-CAL/HEALTHY FAMILY	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	6255.0
LA CARE MEDI-CAL/HEALTHY FAMILY	393	Other Digestive System Diagnoses With Mcc	11431.0
LA CARE MEDI-CAL/HEALTHY FAMILY	394	Other Digestive System Diagnoses With Cc	7980.0
LA CARE MEDI-CAL/HEALTHY FAMILY	395	Other Digestive System Diagnoses Without Cc/Mcc	5547.0
LA CARE MEDI-CAL/HEALTHY FAMILY	417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	19767.0
LA CARE MEDI-CAL/HEALTHY FAMILY	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	15371.0
LA CARE MEDI-CAL/HEALTHY FAMILY	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	13681.0
LA CARE MEDI-CAL/HEALTHY FAMILY	432	Cirrhosis And Alcoholic Hepatitis With Mcc	11345.0
LA CARE MEDI-CAL/HEALTHY FAMILY	433	Cirrhosis And Alcoholic Hepatitis With Cc	7435.0
LA CARE MEDI-CAL/HEALTHY FAMILY	438	Disorders Of Pancreas Except Malignancy With Mcc	11909.0
LA CARE MEDI-CAL/HEALTHY FAMILY	439	Disorders Of Pancreas Except Malignancy With Cc	7787.0
LA CARE MEDI-CAL/HEALTHY FAMILY	440	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	7787.0
LA CARE MEDI-CAL/HEALTHY FAMILY	441	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc	10611.0
LA CARE MEDI-CAL/HEALTHY FAMILY	444	Disorders Of The Biliary Tract With Mcc	13247.0
LA CARE MEDI-CAL/HEALTHY FAMILY	460	Spinal Fusion Except Cervical Without Mcc	31919.0
LA CARE MEDI-CAL/HEALTHY FAMILY	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	17177.0
LA CARE MEDI-CAL/HEALTHY FAMILY	472	Cervical Spinal Fusion With Cc	23790.0
LA CARE MEDI-CAL/HEALTHY FAMILY	473	Cervical Spinal Fusion Without Cc/Mcc	19561.0
LA CARE MEDI-CAL/HEALTHY FAMILY	493	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc	18334.0
LA CARE MEDI-CAL/HEALTHY FAMILY	513	Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc	12348.0
LA CARE MEDI-CAL/HEALTHY FAMILY	519	Back And Neck Procedures Except Spinal Fusion With Cc	16516.0
LA CARE MEDI-CAL/HEALTHY FAMILY	546	Connective Tissue Disorders With Cc	11728.0
LA CARE MEDI-CAL/HEALTHY FAMILY	551	Medical Back Problems With Mcc	20129.0
LA CARE MEDI-CAL/HEALTHY FAMILY	552	Medical Back Problems Without Mcc	6724.0
LA CARE MEDI-CAL/HEALTHY FAMILY	563	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc	7640.0
LA CARE MEDI-CAL/HEALTHY FAMILY	580	Other Skin, Subcutaneous Tissue And Breast Procedures With Cc	11794.0
LA CARE MEDI-CAL/HEALTHY FAMILY	602	Cellulitis With Mcc	10067.0
LA CARE MEDI-CAL/HEALTHY FAMILY	603	Cellulitis Without Mcc	6734.0
LA CARE MEDI-CAL/HEALTHY FAMILY	605	Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc	5749.0
LA CARE MEDI-CAL/HEALTHY FAMILY	607	Minor Skin Disorders Without Mcc	6320.0
LA CARE MEDI-CAL/HEALTHY FAMILY	617	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc	16961.0
LA CARE MEDI-CAL/HEALTHY FAMILY	637	Diabetes With Mcc	9338.0
LA CARE MEDI-CAL/HEALTHY FAMILY	638	Diabetes With Cc	6333.0
LA CARE MEDI-CAL/HEALTHY FAMILY	639	Diabetes Without Cc/Mcc	6333.0
LA CARE MEDI-CAL/HEALTHY FAMILY	641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	8269.0
LA CARE MEDI-CAL/HEALTHY FAMILY	673	Other Kidney And Urinary Tract Procedures With Mcc	15216.0
LA CARE MEDI-CAL/HEALTHY FAMILY	682	Renal Failure With Mcc	10655.0
LA CARE MEDI-CAL/HEALTHY FAMILY	683	Renal Failure With Cc	6841.0
LA CARE MEDI-CAL/HEALTHY FAMILY	690	Kidney And Urinary Tract Infections Without Mcc	6665.0
LA CARE MEDI-CAL/HEALTHY FAMILY	698	Other Kidney And Urinary Tract Diagnoses With Mcc	10346.0
LA CARE MEDI-CAL/HEALTHY FAMILY	699	Other Kidney And Urinary Tract Diagnoses With Cc	7066.0
LA CARE MEDI-CAL/HEALTHY FAMILY	742	Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc	12778.0
LA CARE MEDI-CAL/HEALTHY FAMILY	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	10116.0
LA CARE MEDI-CAL/HEALTHY FAMILY	759	Infections, Female Reproductive System Without Cc/Mcc	7233.0
LA CARE MEDI-CAL/HEALTHY FAMILY	776	Postpartum And Post Abortion Diagnoses Without O.R. Procedures	5538.0
LA CARE MEDI-CAL/HEALTHY FAMILY	808	Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders 	13319.0
LA CARE MEDI-CAL/HEALTHY FAMILY	811	Red Blood Cell Disorders With Mcc	9160.0
LA CARE MEDI-CAL/HEALTHY FAMILY	812	Red Blood Cell Disorders Without Mcc	5677.0
LA CARE MEDI-CAL/HEALTHY FAMILY	843	Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc	12719.0
LA CARE MEDI-CAL/HEALTHY FAMILY	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	27966.0
LA CARE MEDI-CAL/HEALTHY FAMILY	854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	17166.0
LA CARE MEDI-CAL/HEALTHY FAMILY	857	Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc	8307.0
LA CARE MEDI-CAL/HEALTHY FAMILY	862	Postoperative And Post-Traumatic Infections With Mcc	13139.0
LA CARE MEDI-CAL/HEALTHY FAMILY	870	Septicemia Or Severe Sepsis With Mv >96 Hours	21478.0
LA CARE MEDI-CAL/HEALTHY FAMILY	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	12333.0
LA CARE MEDI-CAL/HEALTHY FAMILY	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8389.0
LA CARE MEDI-CAL/HEALTHY FAMILY	897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	5782.0
LA CARE MEDI-CAL/HEALTHY FAMILY	919	Complications Of Treatment With Mcc	11196.0
LA CARE MEDI-CAL/HEALTHY FAMILY	945	Rehabilitation With Cc/Mcc	17607.0
LA CARE MEDI-CAL/HEALTHY FAMILY	974	Hiv With Major Related Condition With Mcc	28037.0

Section: Inpatient Payer Specific Charge 2
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	023	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Chemothera	51698.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	024	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc	36228.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	41164.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	026	Craniotomy And Endovascular Intracranial Procedures With Cc	28326.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	035	Carotid Artery Stent Procedures With Cc	22196.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	054	Nervous System Neoplasms With Mcc	12970.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	057	Degenerative Nervous System Disorders Without Mcc	11882.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	062	Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc	18386.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	18368.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	9722.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	069	Transient Ischemia Without Thrombolytic	7595.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	074	Cranial And Peripheral Nerve Disorders Without Mcc	9788.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	083	Traumatic Stupor And Coma >1 Hour With Cc	12655.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	086	Traumatic Stupor And Coma <1 Hour With Cc	12891.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	092	Other Disorders Of Nervous System With Cc	9444.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	100	Seizures With Mcc	18954.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	149	Dysequilibrium	7733.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	163	Major Chest Procedures With Mcc	45766.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	164	Major Chest Procedures With Cc	24542.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	168	Other Respiratory System O.R. Procedures Without Cc/Mcc	12693.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	177	Respiratory Infections And Inflammations With Mcc	17536.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	178	Respiratory Infections And Inflammations With Cc	11534.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	189	Pulmonary Edema And Respiratory Failure	11654.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	190	Chronic Obstructive Pulmonary Disease With Mcc	10897.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	191	Chronic Obstructive Pulmonary Disease With Cc	8744.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	193	Simple Pneumonia And Pleurisy With Mcc	13039.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	72909.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	242	Permanent Cardiac Pacemaker Implant With Mcc	33529.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	243	Permanent Cardiac Pacemaker Implant With Cc	23064.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	28581.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	18466.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	252	Other Vascular Procedures With Mcc	30286.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	253	Other Vascular Procedures With Cc	24426.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	264	Other Circulatory System O.R. Procedures	30057.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	63583.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	269	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	41169.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	270	Other Major Cardiovascular Procedures With Mcc	47391.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	271	Other Major Cardiovascular Procedures With Cc	33698.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	272	Other Major Cardiovascular Procedures Without Cc/Mcc	24563.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	274	Percutaneous And Other Intracardiac Procedures Without Mcc	29929.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	280	Acute Myocardial Infarction, Discharged Alive With Mcc	15176.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	281	Acute Myocardial Infarction, Discharged Alive With Cc	8923.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	283	Acute Myocardial Infarction, Expired With Mcc	18757.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	20280.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	291	Heart Failure And Shock With Mcc	12075.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	299	Peripheral Vascular Disorders With Mcc	14592.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	308	Cardiac Arrhythmia And Conduction Disorders With Mcc	11526.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	309	Cardiac Arrhythmia And Conduction Disorders With Cc	7311.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	312	Syncope And Collapse	8144.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	313	Chest Pain	6985.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	314	Other Circulatory System Diagnoses With Mcc	19581.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	315	Other Circulatory System Diagnoses With Cc	9393.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	326	Stomach, Esophageal And Duodenal Procedures With Mcc	49479.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	329	Major Small And Large Bowel Procedures With Mcc	45100.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	330	Major Small And Large Bowel Procedures With Cc	23493.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	357	Other Digestive System O.R. Procedures With Cc	21011.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	371	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	16159.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	374	Digestive Malignancy With Mcc	19347.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	375	Digestive Malignancy With Cc	11401.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	377	Gastrointestinal Hemorrhage With Mcc	16906.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	378	Gastrointestinal Hemorrhage With Cc	9529.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	388	Gastrointestinal Obstruction With Mcc	14323.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	389	Gastrointestinal Obstruction With Cc	8398.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	11783.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	7470.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	393	Other Digestive System Diagnoses With Mcc	15646.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	22854.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	16015.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	12507.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	423	Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc	38311.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	432	Cirrhosis And Alcoholic Hepatitis With Mcc	18600.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	435	Malignancy Of Hepatobiliary System Or Pancreas With Mcc	16350.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	438	Disorders Of Pancreas Except Malignancy With Mcc	15044.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	439	Disorders Of Pancreas Except Malignancy With Cc	8158.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	445	Disorders Of The Biliary Tract With Cc	10281.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	454	Combined Anterior And Posterior Spinal Fusion With Cc	55293.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	460	Spinal Fusion Except Cervical Without Mcc	35831.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	467	Revision Of Hip Or Knee Replacement With Cc	32780.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	468	Revision Of Hip Or Knee Replacement Without Cc/Mcc	26341.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	17577.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	472	Cervical Spinal Fusion With Cc	27918.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	473	Cervical Spinal Fusion Without Cc/Mcc	23972.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	480	Hip And Femur Procedures Except Major Joint With Mcc	27954.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	481	Hip And Femur Procedures Except Major Joint With Cc	19526.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	483	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	21948.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	493	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc	21559.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	511	Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc	18155.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	522	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	20229.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	543	Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc	11032.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	551	Medical Back Problems With Mcc	15387.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	552	Medical Back Problems Without Mcc	9125.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	580	Other Skin, Subcutaneous Tissue And Breast Procedures With Cc	16108.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	603	Cellulitis Without Mcc	8642.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	605	Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc	8706.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	637	Diabetes With Mcc	13333.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	638	Diabetes With Cc	8801.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	11803.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	7322.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	660	Kidney And Ureter Procedures For Non-Neoplasm With Cc	13956.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	674	Other Kidney And Urinary Tract Procedures With Cc	21832.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	682	Renal Failure With Mcc	14036.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	683	Renal Failure With Cc	8551.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	689	Kidney And Urinary Tract Infections With Mcc	10894.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	690	Kidney And Urinary Tract Infections Without Mcc	7953.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	698	Other Kidney And Urinary Tract Diagnoses With Mcc	15094.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	10930.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	808	Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders 	20504.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	811	Red Blood Cell Disorders With Mcc	13027.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	840	Lymphoma And Non-Acute Leukemia With Mcc	29586.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	846	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc	24555.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	12344.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	45570.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	19706.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	862	Postoperative And Post-Traumatic Infections With Mcc	18050.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	870	Septicemia Or Severe Sepsis With Mv >96 Hours	58996.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	17522.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	9866.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	907	Other O.R. Procedures For Injuries With Mcc	36185.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	908	Other O.R. Procedures For Injuries With Cc	18854.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	920	Complications Of Treatment With Cc	9842.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	981	Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc	40049.0

Section: Inpatient Payer Specific Charge 3
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
KAISER SENIOR NON-CONTRACTED	023	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Chemothera	55187.0
KAISER SENIOR NON-CONTRACTED	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	9635.0
KAISER SENIOR NON-CONTRACTED	082	Traumatic Stupor And Coma >1 Hour With Mcc	23137.0
KAISER SENIOR NON-CONTRACTED	552	Medical Back Problems Without Mcc	8993.0
KAISER SENIOR NON-CONTRACTED	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	17347.0

Section: Inpatient Payer Specific Charge 4
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN SENIOR	023	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Chemothera	52937.0
MONARCH HEALTH PLAN SENIOR	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	41466.0
MONARCH HEALTH PLAN SENIOR	036	Carotid Artery Stent Procedures Without Cc/Mcc	16215.0
MONARCH HEALTH PLAN SENIOR	057	Degenerative Nervous System Disorders Without Mcc	11788.0
MONARCH HEALTH PLAN SENIOR	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	16981.0
MONARCH HEALTH PLAN SENIOR	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	9569.0
MONARCH HEALTH PLAN SENIOR	069	Transient Ischemia Without Thrombolytic	7219.0
MONARCH HEALTH PLAN SENIOR	164	Major Chest Procedures With Cc	23139.0
MONARCH HEALTH PLAN SENIOR	166	Other Respiratory System O.R. Procedures With Mcc	32424.0
MONARCH HEALTH PLAN SENIOR	177	Respiratory Infections And Inflammations With Mcc	16563.0
MONARCH HEALTH PLAN SENIOR	178	Respiratory Infections And Inflammations With Cc	10874.0
MONARCH HEALTH PLAN SENIOR	189	Pulmonary Edema And Respiratory Failure	11030.0
MONARCH HEALTH PLAN SENIOR	190	Chronic Obstructive Pulmonary Disease With Mcc	10383.0
MONARCH HEALTH PLAN SENIOR	208	Respiratory System Diagnosis With Ventilator Support <=96 Hours	22239.0
MONARCH HEALTH PLAN SENIOR	219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	69180.0
MONARCH HEALTH PLAN SENIOR	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	17276.0
MONARCH HEALTH PLAN SENIOR	266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	60410.0
MONARCH HEALTH PLAN SENIOR	274	Percutaneous And Other Intracardiac Procedures Without Mcc	28377.0
MONARCH HEALTH PLAN SENIOR	291	Heart Failure And Shock With Mcc	11513.0
MONARCH HEALTH PLAN SENIOR	312	Syncope And Collapse	7750.0
MONARCH HEALTH PLAN SENIOR	329	Major Small And Large Bowel Procedures With Mcc	42806.0
MONARCH HEALTH PLAN SENIOR	330	Major Small And Large Bowel Procedures With Cc	22235.0
MONARCH HEALTH PLAN SENIOR	377	Gastrointestinal Hemorrhage With Mcc	16126.0
MONARCH HEALTH PLAN SENIOR	378	Gastrointestinal Hemorrhage With Cc	8969.0
MONARCH HEALTH PLAN SENIOR	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	7171.0
MONARCH HEALTH PLAN SENIOR	460	Spinal Fusion Except Cervical Without Mcc	34060.0
MONARCH HEALTH PLAN SENIOR	467	Revision Of Hip Or Knee Replacement With Cc	29369.0
MONARCH HEALTH PLAN SENIOR	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	16624.0
MONARCH HEALTH PLAN SENIOR	471	Cervical Spinal Fusion With Mcc	43566.0
MONARCH HEALTH PLAN SENIOR	472	Cervical Spinal Fusion With Cc	28444.0
MONARCH HEALTH PLAN SENIOR	481	Hip And Femur Procedures Except Major Joint With Cc	18358.0
MONARCH HEALTH PLAN SENIOR	552	Medical Back Problems Without Mcc	8835.0
MONARCH HEALTH PLAN SENIOR	640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	13762.0
MONARCH HEALTH PLAN SENIOR	682	Renal Failure With Mcc	13084.0
MONARCH HEALTH PLAN SENIOR	690	Kidney And Urinary Tract Infections Without Mcc	7274.0
MONARCH HEALTH PLAN SENIOR	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	43084.0
MONARCH HEALTH PLAN SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	16632.0
MONARCH HEALTH PLAN SENIOR	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	9331.0
MONARCH HEALTH PLAN SENIOR	948	Signs And Symptoms Without Mcc	7257.0

Section: Inpatient Payer Specific Charge 5
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE CROSS NON-MCS	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	116500.0
BLUE CROSS NON-MCS	041	Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator	59991.0
BLUE CROSS NON-MCS	054	Nervous System Neoplasms With Mcc	35588.0
BLUE CROSS NON-MCS	056	Degenerative Nervous System Disorders With Mcc	69760.0
BLUE CROSS NON-MCS	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	50598.0
BLUE CROSS NON-MCS	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	26079.0
BLUE CROSS NON-MCS	073	Cranial And Peripheral Nerve Disorders With Mcc	38469.0
BLUE CROSS NON-MCS	074	Cranial And Peripheral Nerve Disorders Without Mcc	26264.0
BLUE CROSS NON-MCS	092	Other Disorders Of Nervous System With Cc	25512.0
BLUE CROSS NON-MCS	103	Headaches Without Mcc	21360.0
BLUE CROSS NON-MCS	152	Otitis Media And Uri With Mcc	30731.0
BLUE CROSS NON-MCS	153	Otitis Media And Uri Without Mcc	17717.0
BLUE CROSS NON-MCS	163	Major Chest Procedures With Mcc	124280.0
BLUE CROSS NON-MCS	164	Major Chest Procedures With Cc	66267.0
BLUE CROSS NON-MCS	175	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	35839.0
BLUE CROSS NON-MCS	177	Respiratory Infections And Inflammations With Mcc	45669.0
BLUE CROSS NON-MCS	199	Pneumothorax With Mcc	45122.0
BLUE CROSS NON-MCS	206	Other Respiratory System Diagnoses Without Mcc	22923.0
BLUE CROSS NON-MCS	219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	208556.0
BLUE CROSS NON-MCS	220	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc	139454.0
BLUE CROSS NON-MCS	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	48994.0
BLUE CROSS NON-MCS	253	Other Vascular Procedures With Cc	68609.0
BLUE CROSS NON-MCS	270	Other Major Cardiovascular Procedures With Mcc	131179.0
BLUE CROSS NON-MCS	274	Percutaneous And Other Intracardiac Procedures Without Mcc	86198.0
BLUE CROSS NON-MCS	282	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	18389.0
BLUE CROSS NON-MCS	291	Heart Failure And Shock With Mcc	32837.0
BLUE CROSS NON-MCS	308	Cardiac Arrhythmia And Conduction Disorders With Mcc	30087.0
BLUE CROSS NON-MCS	309	Cardiac Arrhythmia And Conduction Disorders With Cc	18925.0
BLUE CROSS NON-MCS	312	Syncope And Collapse	21879.0
BLUE CROSS NON-MCS	313	Chest Pain	18561.0
BLUE CROSS NON-MCS	330	Major Small And Large Bowel Procedures With Cc	63001.0
BLUE CROSS NON-MCS	331	Major Small And Large Bowel Procedures Without Cc/Mcc	43844.0
BLUE CROSS NON-MCS	339	Appendectomy With Complicated Principal Diagnosis With Cc	41781.0
BLUE CROSS NON-MCS	343	Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc	28036.0
BLUE CROSS NON-MCS	374	Digestive Malignancy With Mcc	51144.0
BLUE CROSS NON-MCS	378	Gastrointestinal Hemorrhage With Cc	25273.0
BLUE CROSS NON-MCS	379	Gastrointestinal Hemorrhage Without Cc/Mcc	16262.0
BLUE CROSS NON-MCS	388	Gastrointestinal Obstruction With Mcc	37651.0
BLUE CROSS NON-MCS	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	20208.0
BLUE CROSS NON-MCS	394	Other Digestive System Diagnoses With Cc	24195.0
BLUE CROSS NON-MCS	417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	61007.0
BLUE CROSS NON-MCS	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	42618.0
BLUE CROSS NON-MCS	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	33484.0
BLUE CROSS NON-MCS	432	Cirrhosis And Alcoholic Hepatitis With Mcc	48447.0
BLUE CROSS NON-MCS	439	Disorders Of Pancreas Except Malignancy With Cc	22317.0
BLUE CROSS NON-MCS	443	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc	16726.0
BLUE CROSS NON-MCS	444	Disorders Of The Biliary Tract With Mcc	42713.0
BLUE CROSS NON-MCS	445	Disorders Of The Biliary Tract With Cc	28214.0
BLUE CROSS NON-MCS	446	Disorders Of The Biliary Tract Without Cc/Mcc	20827.0
BLUE CROSS NON-MCS	453	Combined Anterior And Posterior Spinal Fusion With Mcc	234894.0
BLUE CROSS NON-MCS	454	Combined Anterior And Posterior Spinal Fusion With Cc	156280.0
BLUE CROSS NON-MCS	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	122850.0
BLUE CROSS NON-MCS	460	Spinal Fusion Except Cervical Without Mcc	96628.0
BLUE CROSS NON-MCS	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	49056.0
BLUE CROSS NON-MCS	472	Cervical Spinal Fusion With Cc	78796.0
BLUE CROSS NON-MCS	473	Cervical Spinal Fusion Without Cc/Mcc	65046.0
BLUE CROSS NON-MCS	494	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc	48463.0
BLUE CROSS NON-MCS	511	Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc	50777.0
BLUE CROSS NON-MCS	519	Back And Neck Procedures Except Spinal Fusion With Cc	51298.0
BLUE CROSS NON-MCS	520	Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc	37969.0
BLUE CROSS NON-MCS	552	Medical Back Problems Without Mcc	24645.0
BLUE CROSS NON-MCS	580	Other Skin, Subcutaneous Tissue And Breast Procedures With Cc	44547.0
BLUE CROSS NON-MCS	581	Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc	36216.0
BLUE CROSS NON-MCS	585	Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc	47239.0
BLUE CROSS NON-MCS	603	Cellulitis Without Mcc	22625.0
BLUE CROSS NON-MCS	627	Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc	32737.0
BLUE CROSS NON-MCS	637	Diabetes With Mcc	35811.0
BLUE CROSS NON-MCS	638	Diabetes With Cc	22476.0
BLUE CROSS NON-MCS	640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	32465.0
BLUE CROSS NON-MCS	674	Other Kidney And Urinary Tract Procedures With Cc	60822.0
BLUE CROSS NON-MCS	682	Renal Failure With Mcc	38143.0
BLUE CROSS NON-MCS	690	Kidney And Urinary Tract Infections Without Mcc	20414.0
BLUE CROSS NON-MCS	698	Other Kidney And Urinary Tract Diagnoses With Mcc	41117.0
BLUE CROSS NON-MCS	713	Transurethral Prostatectomy With Cc/Mcc	38023.0
BLUE CROSS NON-MCS	742	Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc	46238.0
BLUE CROSS NON-MCS	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	30035.0
BLUE CROSS NON-MCS	831	Other Antepartum Diagnoses Without O.R. Procedures With Mcc	30489.0
BLUE CROSS NON-MCS	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	125750.0
BLUE CROSS NON-MCS	854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	52743.0
BLUE CROSS NON-MCS	862	Postoperative And Post-Traumatic Infections With Mcc	46931.0
BLUE CROSS NON-MCS	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	50218.0
BLUE CROSS NON-MCS	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	26376.0
BLUE CROSS NON-MCS	897	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	4872.0
BLUE CROSS NON-MCS	907	Other O.R. Procedures For Injuries With Mcc	76566.0
BLUE CROSS NON-MCS	908	Other O.R. Procedures For Injuries With Cc	52766.0
BLUE CROSS NON-MCS	917	Poisoning And Toxic Effects Of Drugs With Mcc	39064.0
BLUE CROSS NON-MCS	919	Complications Of Treatment With Mcc	46020.0
BLUE CROSS NON-MCS	945	Rehabilitation With Cc/Mcc	69760.0
BLUE CROSS NON-MCS	948	Signs And Symptoms Without Mcc	20440.0

Section: Inpatient Payer Specific Charge 6
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
DIGNITY HEALTH MEDI-CAL	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	34481.0
DIGNITY HEALTH MEDI-CAL	177	Respiratory Infections And Inflammations With Mcc	12603.0
DIGNITY HEALTH MEDI-CAL	313	Chest Pain	3214.0
DIGNITY HEALTH MEDI-CAL	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	3163.0
DIGNITY HEALTH MEDI-CAL	481	Hip And Femur Procedures Except Major Joint With Cc	22204.0
DIGNITY HEALTH MEDI-CAL	565	Other Musculoskeletal System And Connective Tissue Diagnoses With Cc	7565.0
DIGNITY HEALTH MEDI-CAL	627	Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc	6624.0
DIGNITY HEALTH MEDI-CAL	637	Diabetes With Mcc	9657.0
DIGNITY HEALTH MEDI-CAL	638	Diabetes With Cc	5030.0
DIGNITY HEALTH MEDI-CAL	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	5032.0
DIGNITY HEALTH MEDI-CAL	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	37907.0
DIGNITY HEALTH MEDI-CAL	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	7964.0

Section: Inpatient Payer Specific Charge 7
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTHCARE PARTNERS COMMERCIAL	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	90805.0
HEALTHCARE PARTNERS COMMERCIAL	026	Craniotomy And Endovascular Intracranial Procedures With Cc	58534.0
HEALTHCARE PARTNERS COMMERCIAL	057	Degenerative Nervous System Disorders Without Mcc	26160.0
HEALTHCARE PARTNERS COMMERCIAL	100	Seizures With Mcc	36077.0
HEALTHCARE PARTNERS COMMERCIAL	220	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc	101912.0
HEALTHCARE PARTNERS COMMERCIAL	291	Heart Failure And Shock With Mcc	24788.0
HEALTHCARE PARTNERS COMMERCIAL	330	Major Small And Large Bowel Procedures With Cc	48853.0
HEALTHCARE PARTNERS COMMERCIAL	331	Major Small And Large Bowel Procedures Without Cc/Mcc	34821.0
HEALTHCARE PARTNERS COMMERCIAL	378	Gastrointestinal Hemorrhage With Cc	19816.0
HEALTHCARE PARTNERS COMMERCIAL	391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	25005.0
HEALTHCARE PARTNERS COMMERCIAL	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	15327.0
HEALTHCARE PARTNERS COMMERCIAL	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	32606.0
HEALTHCARE PARTNERS COMMERCIAL	432	Cirrhosis And Alcoholic Hepatitis With Mcc	36237.0
HEALTHCARE PARTNERS COMMERCIAL	435	Malignancy Of Hepatobiliary System Or Pancreas With Mcc	34071.0
HEALTHCARE PARTNERS COMMERCIAL	464	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit	56622.0
HEALTHCARE PARTNERS COMMERCIAL	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	36223.0
HEALTHCARE PARTNERS COMMERCIAL	472	Cervical Spinal Fusion With Cc	57860.0
HEALTHCARE PARTNERS COMMERCIAL	627	Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc	22889.0
HEALTHCARE PARTNERS COMMERCIAL	638	Diabetes With Cc	18373.0
HEALTHCARE PARTNERS COMMERCIAL	673	Other Kidney And Urinary Tract Procedures With Mcc	65794.0
HEALTHCARE PARTNERS COMMERCIAL	742	Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc	33024.0
HEALTHCARE PARTNERS COMMERCIAL	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	22124.0
HEALTHCARE PARTNERS COMMERCIAL	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	94972.0
HEALTHCARE PARTNERS COMMERCIAL	854	Infectious And Parasitic Diseases With O.R. Procedures With Cc	40658.0
HEALTHCARE PARTNERS COMMERCIAL	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	35999.0
HEALTHCARE PARTNERS COMMERCIAL	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	20151.0

Section: Inpatient Payer Specific Charge 8
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION VALUATION	025	Craniotomy And Endovascular Intracranial Procedures With Mcc	9658.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	057	Degenerative Nervous System Disorders Without Mcc	22092.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	11236.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	092	Other Disorders Of Nervous System With Cc	7101.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	101	Seizures Without Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	144	Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	177	Respiratory Infections And Inflammations With Mcc	7101.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	190	Chronic Obstructive Pulmonary Disease With Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	193	Simple Pneumonia And Pleurisy With Mcc	10352.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	17548.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	7196.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	4040.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	273	Percutaneous And Other Intracardiac Procedures With Mcc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	274	Percutaneous And Other Intracardiac Procedures Without Mcc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	280	Acute Myocardial Infarction, Discharged Alive With Mcc	11426.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	291	Heart Failure And Shock With Mcc	5618.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	308	Cardiac Arrhythmia And Conduction Disorders With Mcc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	312	Syncope And Collapse	5523.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	313	Chest Pain	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	330	Major Small And Large Bowel Procedures With Cc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	377	Gastrointestinal Hemorrhage With Mcc	5523.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	378	Gastrointestinal Hemorrhage With Cc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	389	Gastrointestinal Obstruction With Cc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	417	Laparoscopic Cholecystectomy Without C.D.E. With Mcc	12814.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	454	Combined Anterior And Posterior Spinal Fusion With Cc	7890.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	460	Spinal Fusion Except Cervical Without Mcc	3156.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	1578.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	472	Cervical Spinal Fusion With Cc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	7890.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	682	Renal Failure With Mcc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	808	Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders 	11046.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	6312.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	33518.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	10352.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	4734.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	981	Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc	35600.0

Section: Inpatient Payer Specific Charge 9
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
AETNA HMO	026	Craniotomy And Endovascular Intracranial Procedures With Cc	72337.0
AETNA HMO	057	Degenerative Nervous System Disorders Without Mcc	31138.0
AETNA HMO	062	Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc	45869.0
AETNA HMO	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	47180.0
AETNA HMO	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	45685.0
AETNA HMO	280	Acute Myocardial Infarction, Discharged Alive With Mcc	38433.0
AETNA HMO	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	18843.0
AETNA HMO	440	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	14508.0
AETNA HMO	454	Combined Anterior And Posterior Spinal Fusion With Cc	145725.0
AETNA HMO	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	114553.0
AETNA HMO	460	Spinal Fusion Except Cervical Without Mcc	90102.0
AETNA HMO	520	Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc	35404.0
AETNA HMO	560	Aftercare, Musculoskeletal System And Connective Tissue With Cc	26212.0
AETNA HMO	581	Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc	33770.0
AETNA HMO	627	Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc	30526.0
AETNA HMO	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	28007.0
AETNA HMO	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	46826.0
AETNA HMO	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	24595.0

Section: Inpatient Payer Specific Charge 10
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE CROSS SENIOR	057	Degenerative Nervous System Disorders Without Mcc	13478.0
BLUE CROSS SENIOR	266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	63687.0
BLUE CROSS SENIOR	312	Syncope And Collapse	8037.0
BLUE CROSS SENIOR	394	Other Digestive System Diagnoses With Cc	9080.0
BLUE CROSS SENIOR	454	Combined Anterior And Posterior Spinal Fusion With Cc	58429.0
BLUE CROSS SENIOR	460	Spinal Fusion Except Cervical Without Mcc	35835.0
BLUE CROSS SENIOR	467	Revision Of Hip Or Knee Replacement With Cc	32561.0
BLUE CROSS SENIOR	483	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	21810.0
BLUE CROSS SENIOR	552	Medical Back Problems Without Mcc	9037.0
BLUE CROSS SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	17391.0
BLUE CROSS SENIOR	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	10541.0

Section: Inpatient Payer Specific Charge 11
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD HMO	057	Degenerative Nervous System Disorders Without Mcc	24132.0
BLUE SHIELD HMO	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	22891.0

Section: Inpatient Payer Specific Charge 12
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD PPO	057	Degenerative Nervous System Disorders Without Mcc	25674.0
BLUE SHIELD PPO	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	39753.0
BLUE SHIELD PPO	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	21791.0
BLUE SHIELD PPO	103	Headaches Without Mcc	16953.0
BLUE SHIELD PPO	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	43144.0
BLUE SHIELD PPO	305	Hypertension Without Mcc	15511.0
BLUE SHIELD PPO	312	Syncope And Collapse	17315.0
BLUE SHIELD PPO	343	Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc	24419.0
BLUE SHIELD PPO	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	16147.0
BLUE SHIELD PPO	439	Disorders Of Pancreas Except Malignancy With Cc	17964.0
BLUE SHIELD PPO	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	102061.0
BLUE SHIELD PPO	467	Revision Of Hip Or Knee Replacement With Cc	74471.0
BLUE SHIELD PPO	473	Cervical Spinal Fusion Without Cc/Mcc	53273.0
BLUE SHIELD PPO	581	Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc	26607.0
BLUE SHIELD PPO	627	Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc	24209.0
BLUE SHIELD PPO	638	Diabetes With Cc	18746.0
BLUE SHIELD PPO	742	Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc	35824.0
BLUE SHIELD PPO	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	24353.0
BLUE SHIELD PPO	812	Red Blood Cell Disorders Without Mcc	18462.0
BLUE SHIELD PPO	862	Postoperative And Post-Traumatic Infections With Mcc	39240.0
BLUE SHIELD PPO	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	39573.0
BLUE SHIELD PPO	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	22037.0

Section: Inpatient Payer Specific Charge 13
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
CIGNA	057	Degenerative Nervous System Disorders Without Mcc	55821.0
CIGNA	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	45007.0
CIGNA	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	23197.0
CIGNA	142	Major Head And Neck Procedures Without Cc/Mcc	38838.0
CIGNA	220	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc	124045.0
CIGNA	372	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	23234.0
CIGNA	386	Inflammatory Bowel Disease With Cc	22590.0
CIGNA	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	17975.0
CIGNA	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	37909.0
CIGNA	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	29784.0
CIGNA	455	Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc	109277.0
CIGNA	460	Spinal Fusion Except Cervical Without Mcc	85951.0
CIGNA	742	Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc	41129.0
CIGNA	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	26717.0
CIGNA	811	Red Blood Cell Disorders With Mcc	31731.0
CIGNA	812	Red Blood Cell Disorders Without Mcc	20495.0
CIGNA	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	44669.0
CIGNA	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	23462.0

Section: Inpatient Payer Specific Charge 14
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTH NET SELECT HEALTH MEDI-CAL	057	Degenerative Nervous System Disorders Without Mcc	11540.0
HEALTH NET SELECT HEALTH MEDI-CAL	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	10616.0
HEALTH NET SELECT HEALTH MEDI-CAL	066	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	8646.0
HEALTH NET SELECT HEALTH MEDI-CAL	069	Transient Ischemia Without Thrombolytic	7150.0
HEALTH NET SELECT HEALTH MEDI-CAL	202	Bronchitis And Asthma With Cc/Mcc	7692.0
HEALTH NET SELECT HEALTH MEDI-CAL	219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	91251.0
HEALTH NET SELECT HEALTH MEDI-CAL	286	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	19533.0
HEALTH NET SELECT HEALTH MEDI-CAL	291	Heart Failure And Shock With Mcc	7598.0
HEALTH NET SELECT HEALTH MEDI-CAL	304	Hypertension With Mcc	6819.0
HEALTH NET SELECT HEALTH MEDI-CAL	312	Syncope And Collapse	7141.0
HEALTH NET SELECT HEALTH MEDI-CAL	314	Other Circulatory System Diagnoses With Mcc	17051.0
HEALTH NET SELECT HEALTH MEDI-CAL	374	Digestive Malignancy With Mcc	12492.0
HEALTH NET SELECT HEALTH MEDI-CAL	390	Gastrointestinal Obstruction Without Cc/Mcc	5328.0
HEALTH NET SELECT HEALTH MEDI-CAL	391	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	10975.0
HEALTH NET SELECT HEALTH MEDI-CAL	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	5690.0
HEALTH NET SELECT HEALTH MEDI-CAL	418	Laparoscopic Cholecystectomy Without C.D.E. With Cc	15088.0
HEALTH NET SELECT HEALTH MEDI-CAL	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	11770.0
HEALTH NET SELECT HEALTH MEDI-CAL	433	Cirrhosis And Alcoholic Hepatitis With Cc	11136.0
HEALTH NET SELECT HEALTH MEDI-CAL	438	Disorders Of Pancreas Except Malignancy With Mcc	11690.0
HEALTH NET SELECT HEALTH MEDI-CAL	439	Disorders Of Pancreas Except Malignancy With Cc	7644.0
HEALTH NET SELECT HEALTH MEDI-CAL	441	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc	10415.0
HEALTH NET SELECT HEALTH MEDI-CAL	460	Spinal Fusion Except Cervical Without Mcc	31332.0
HEALTH NET SELECT HEALTH MEDI-CAL	467	Revision Of Hip Or Knee Replacement With Cc	16983.0
HEALTH NET SELECT HEALTH MEDI-CAL	494	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc	16926.0
HEALTH NET SELECT HEALTH MEDI-CAL	560	Aftercare, Musculoskeletal System And Connective Tissue With Cc	9624.0
HEALTH NET SELECT HEALTH MEDI-CAL	603	Cellulitis Without Mcc	6611.0
HEALTH NET SELECT HEALTH MEDI-CAL	622	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc	13680.0
HEALTH NET SELECT HEALTH MEDI-CAL	637	Diabetes With Mcc	9373.0
HEALTH NET SELECT HEALTH MEDI-CAL	638	Diabetes With Cc	6217.0
HEALTH NET SELECT HEALTH MEDI-CAL	641	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc	8345.0
HEALTH NET SELECT HEALTH MEDI-CAL	661	Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc	6827.0
HEALTH NET SELECT HEALTH MEDI-CAL	683	Renal Failure With Cc	6715.0
HEALTH NET SELECT HEALTH MEDI-CAL	690	Kidney And Urinary Tract Infections Without Mcc	6542.0
HEALTH NET SELECT HEALTH MEDI-CAL	698	Other Kidney And Urinary Tract Diagnoses With Mcc	13134.0
HEALTH NET SELECT HEALTH MEDI-CAL	699	Other Kidney And Urinary Tract Diagnoses With Cc	6758.0
HEALTH NET SELECT HEALTH MEDI-CAL	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	9930.0
HEALTH NET SELECT HEALTH MEDI-CAL	761	Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc	4550.0
HEALTH NET SELECT HEALTH MEDI-CAL	770	Abortion With D&C, Aspiration Curettage Or Hysterotomy	5133.0
HEALTH NET SELECT HEALTH MEDI-CAL	776	Postpartum And Post Abortion Diagnoses Without O.R. Procedures	4248.0
HEALTH NET SELECT HEALTH MEDI-CAL	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	50289.0
HEALTH NET SELECT HEALTH MEDI-CAL	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	12107.0
HEALTH NET SELECT HEALTH MEDI-CAL	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8235.0
HEALTH NET SELECT HEALTH MEDI-CAL	949	Aftercare With Cc/Mcc	10743.0
HEALTH NET SELECT HEALTH MEDI-CAL	981	Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc	16562.0

Section: Inpatient Payer Specific Charge 15
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
EASY CHOICE SENIOR	064	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	20393.0
EASY CHOICE SENIOR	071	Nonspecific Cerebrovascular Disorders With Cc	10223.0
EASY CHOICE SENIOR	178	Respiratory Infections And Inflammations With Cc	12063.0
EASY CHOICE SENIOR	194	Simple Pneumonia And Pleurisy With Cc	9009.0
EASY CHOICE SENIOR	247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc	19220.0
EASY CHOICE SENIOR	291	Heart Failure And Shock With Mcc	12690.0
EASY CHOICE SENIOR	378	Gastrointestinal Hemorrhage With Cc	10069.0
EASY CHOICE SENIOR	432	Cirrhosis And Alcoholic Hepatitis With Mcc	18406.0
EASY CHOICE SENIOR	552	Medical Back Problems Without Mcc	9627.0
EASY CHOICE SENIOR	640	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc	12419.0
EASY CHOICE SENIOR	698	Other Kidney And Urinary Tract Diagnoses With Mcc	15803.0
EASY CHOICE SENIOR	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	47757.0
EASY CHOICE SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	18583.0
EASY CHOICE SENIOR	884	Organic Disturbances And Intellectual Disability	14453.0
EASY CHOICE SENIOR	948	Signs And Symptoms Without Mcc	8034.0

Section: Inpatient Payer Specific Charge 16
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTH NET MEDI-CAL	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	10616.0
HEALTH NET MEDI-CAL	084	Traumatic Stupor And Coma >1 Hour Without Cc/Mcc	6994.0
HEALTH NET MEDI-CAL	091	Other Disorders Of Nervous System With Mcc	11540.0
HEALTH NET MEDI-CAL	100	Seizures With Mcc	20690.0
HEALTH NET MEDI-CAL	101	Seizures Without Mcc	6857.0
HEALTH NET MEDI-CAL	177	Respiratory Infections And Inflammations With Mcc	14616.0
HEALTH NET MEDI-CAL	202	Bronchitis And Asthma With Cc/Mcc	6550.0
HEALTH NET MEDI-CAL	233	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	61116.0
HEALTH NET MEDI-CAL	246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	31147.0
HEALTH NET MEDI-CAL	291	Heart Failure And Shock With Mcc	7598.0
HEALTH NET MEDI-CAL	314	Other Circulatory System Diagnoses With Mcc	8356.0
HEALTH NET MEDI-CAL	377	Gastrointestinal Hemorrhage With Mcc	10975.0
HEALTH NET MEDI-CAL	378	Gastrointestinal Hemorrhage With Cc	8181.0
HEALTH NET MEDI-CAL	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	5709.0
HEALTH NET MEDI-CAL	432	Cirrhosis And Alcoholic Hepatitis With Mcc	11136.0
HEALTH NET MEDI-CAL	603	Cellulitis Without Mcc	6611.0
HEALTH NET MEDI-CAL	605	Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc	6062.0
HEALTH NET MEDI-CAL	638	Diabetes With Cc	6217.0
HEALTH NET MEDI-CAL	690	Kidney And Urinary Tract Infections Without Mcc	6542.0
HEALTH NET MEDI-CAL	698	Other Kidney And Urinary Tract Diagnoses With Mcc	9790.0
HEALTH NET MEDI-CAL	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	50289.0
HEALTH NET MEDI-CAL	870	Septicemia Or Severe Sepsis With Mv >96 Hours	21083.0
HEALTH NET MEDI-CAL	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	21083.0
HEALTH NET MEDI-CAL	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8235.0
HEALTH NET MEDI-CAL	956	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	68223.0

Section: Inpatient Payer Specific Charge 17
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTH NET SENIOR	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	10416.0
HEALTH NET SENIOR	177	Respiratory Infections And Inflammations With Mcc	17970.0
HEALTH NET SENIOR	291	Heart Failure And Shock With Mcc	12116.0
HEALTH NET SENIOR	314	Other Circulatory System Diagnoses With Mcc	19812.0
HEALTH NET SENIOR	698	Other Kidney And Urinary Tract Diagnoses With Mcc	15575.0
HEALTH NET SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	17771.0
HEALTH NET SENIOR	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	9885.0

Section: Inpatient Payer Specific Charge 18
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HERITAGE PROVIDER NETWORK SENIOR	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	9679.0
HERITAGE PROVIDER NETWORK SENIOR	176	Pulmonary Embolism Without Mcc	8598.0
HERITAGE PROVIDER NETWORK SENIOR	291	Heart Failure And Shock With Mcc	12152.0
HERITAGE PROVIDER NETWORK SENIOR	304	Hypertension With Mcc	10455.0
HERITAGE PROVIDER NETWORK SENIOR	313	Chest Pain	7517.0
HERITAGE PROVIDER NETWORK SENIOR	329	Major Small And Large Bowel Procedures With Mcc	44358.0
HERITAGE PROVIDER NETWORK SENIOR	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	7999.0
HERITAGE PROVIDER NETWORK SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	19517.0

Section: Inpatient Payer Specific Charge 19
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE ALL PAYER	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	32513.0
UNITED HEALTHCARE ALL PAYER	552	Medical Back Problems Without Mcc	28287.0
UNITED HEALTHCARE ALL PAYER	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	9693.0

Section: Inpatient Payer Specific Charge 20
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
UNIVERSAL CARE SENIOR	065	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	10472.0
UNIVERSAL CARE SENIOR	177	Respiratory Infections And Inflammations With Mcc	18136.0
UNIVERSAL CARE SENIOR	190	Chronic Obstructive Pulmonary Disease With Mcc	11513.0
UNIVERSAL CARE SENIOR	281	Acute Myocardial Infarction, Discharged Alive With Cc	9423.0
UNIVERSAL CARE SENIOR	291	Heart Failure And Shock With Mcc	12771.0
UNIVERSAL CARE SENIOR	312	Syncope And Collapse	8581.0
UNIVERSAL CARE SENIOR	313	Chest Pain	7403.0
UNIVERSAL CARE SENIOR	378	Gastrointestinal Hemorrhage With Cc	10404.0
UNIVERSAL CARE SENIOR	846	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc	25714.0
UNIVERSAL CARE SENIOR	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	47941.0
UNIVERSAL CARE SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	18445.0

Section: Inpatient Payer Specific Charge 21
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	073	Cranial And Peripheral Nerve Disorders With Mcc	8406.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	101	Seizures Without Mcc	7443.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	177	Respiratory Infections And Inflammations With Mcc	17313.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	190	Chronic Obstructive Pulmonary Disease With Mcc	9951.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	219	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc	89723.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	291	Heart Failure And Shock With Mcc	11475.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	377	Gastrointestinal Hemorrhage With Mcc	12688.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	7354.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	12775.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	563	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc	5998.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	603	Cellulitis Without Mcc	7175.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	638	Diabetes With Cc	6748.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	12480.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	812	Red Blood Cell Disorders Without Mcc	7058.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	29796.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	13141.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8938.0

Section: Inpatient Payer Specific Charge 22
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
LAKEWOOD IPA	083	Traumatic Stupor And Coma >1 Hour With Cc	15806.0
LAKEWOOD IPA	266	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	30981.0
LAKEWOOD IPA	389	Gastrointestinal Obstruction With Cc	4650.0
LAKEWOOD IPA	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	24250.0
LAKEWOOD IPA	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	11942.0

Section: Inpatient Payer Specific Charge 23
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE CROSS MEDI-CAL	177	Respiratory Infections And Inflammations With Mcc	14233.0
BLUE CROSS MEDI-CAL	190	Chronic Obstructive Pulmonary Disease With Mcc	11171.0
BLUE CROSS MEDI-CAL	291	Heart Failure And Shock With Mcc	10295.0
BLUE CROSS MEDI-CAL	309	Cardiac Arrhythmia And Conduction Disorders With Cc	6331.0
BLUE CROSS MEDI-CAL	313	Chest Pain	6103.0
BLUE CROSS MEDI-CAL	378	Gastrointestinal Hemorrhage With Cc	7966.0
BLUE CROSS MEDI-CAL	389	Gastrointestinal Obstruction With Cc	6767.0
BLUE CROSS MEDI-CAL	392	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	6688.0
BLUE CROSS MEDI-CAL	395	Other Digestive System Diagnoses Without Cc/Mcc	5303.0
BLUE CROSS MEDI-CAL	419	Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc	14693.0
BLUE CROSS MEDI-CAL	432	Cirrhosis And Alcoholic Hepatitis With Mcc	10844.0
BLUE CROSS MEDI-CAL	438	Disorders Of Pancreas Except Malignancy With Mcc	11383.0
BLUE CROSS MEDI-CAL	439	Disorders Of Pancreas Except Malignancy With Cc	11383.0
BLUE CROSS MEDI-CAL	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	23222.0
BLUE CROSS MEDI-CAL	603	Cellulitis Without Mcc	6437.0
BLUE CROSS MEDI-CAL	638	Diabetes With Cc	6054.0
BLUE CROSS MEDI-CAL	639	Diabetes Without Cc/Mcc	6054.0
BLUE CROSS MEDI-CAL	683	Renal Failure With Cc	9395.0
BLUE CROSS MEDI-CAL	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	9924.0
BLUE CROSS MEDI-CAL	812	Red Blood Cell Disorders Without Mcc	5427.0
BLUE CROSS MEDI-CAL	835	Acute Leukemia Without Major O.R. Procedures With Cc	33476.0
BLUE CROSS MEDI-CAL	839	Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc	8281.0
BLUE CROSS MEDI-CAL	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	26732.0
BLUE CROSS MEDI-CAL	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	16160.0
BLUE CROSS MEDI-CAL	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8019.0
BLUE CROSS MEDI-CAL	948	Signs And Symptoms Without Mcc	4124.0

Section: Inpatient Payer Specific Charge 24
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD SENIOR	177	Respiratory Infections And Inflammations With Mcc	17228.0
BLUE SHIELD SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	17347.0

Section: Inpatient Payer Specific Charge 25
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE CROSS VIVITY - NON CITY	189	Pulmonary Edema And Respiratory Failure	15527.0
BLUE CROSS VIVITY - NON CITY	331	Major Small And Large Bowel Procedures Without Cc/Mcc	21982.0
BLUE CROSS VIVITY - NON CITY	439	Disorders Of Pancreas Except Malignancy With Cc	11189.0
BLUE CROSS VIVITY - NON CITY	638	Diabetes With Cc	11269.0
BLUE CROSS VIVITY - NON CITY	750	Other Female Reproductive System O.R. Procedures Without Cc/Mcc	18357.0
BLUE CROSS VIVITY - NON CITY	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	25177.0

Section: Inpatient Payer Specific Charge 26
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
TRICARE VETERANS CHOICE	190	Chronic Obstructive Pulmonary Disease With Mcc	41732.0
TRICARE VETERANS CHOICE	246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	18869.0
TRICARE VETERANS CHOICE	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	14748.0

Section: Inpatient Payer Specific Charge 27
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE SENIOR	193	Simple Pneumonia And Pleurisy With Mcc	13057.0
UNITED HEALTHCARE SENIOR	246	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents	28462.0
UNITED HEALTHCARE SENIOR	274	Percutaneous And Other Intracardiac Procedures Without Mcc	29871.0
UNITED HEALTHCARE SENIOR	291	Heart Failure And Shock With Mcc	11933.0
UNITED HEALTHCARE SENIOR	312	Syncope And Collapse	8027.0
UNITED HEALTHCARE SENIOR	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	5844.0
UNITED HEALTHCARE SENIOR	683	Renal Failure With Cc	9016.0
UNITED HEALTHCARE SENIOR	690	Kidney And Urinary Tract Infections Without Mcc	7788.0
UNITED HEALTHCARE SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	18092.0

Section: Inpatient Payer Specific Charge 28
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
LA CARE HMO/SENIOR	202	Bronchitis And Asthma With Cc/Mcc	9391.0
LA CARE HMO/SENIOR	291	Heart Failure And Shock With Mcc	12075.0
LA CARE HMO/SENIOR	313	Chest Pain	7019.0
LA CARE HMO/SENIOR	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	11156.0
LA CARE HMO/SENIOR	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	46020.0

Section: Inpatient Payer Specific Charge 29
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE PREFERRED	234	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	92700.0
UNITED HEALTHCARE PREFERRED	470	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	16141.0
UNITED HEALTHCARE PREFERRED	853	Infectious And Parasitic Diseases With O.R. Procedures With Mcc	86997.0
UNITED HEALTHCARE PREFERRED	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	34787.0

Section: Inpatient Payer Specific Charge 30
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
EDINGER VALUATION	274	Percutaneous And Other Intracardiac Procedures Without Mcc	2313.0

Section: Inpatient Payer Specific Charge 31
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
CENTRAL HEALTH SENIOR	291	Heart Failure And Shock With Mcc	13283.0

Section: Inpatient Payer Specific Charge 32
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
CITIZENS CHOICE	291	Heart Failure And Shock With Mcc	12834.0
CITIZENS CHOICE	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	17479.0
CITIZENS CHOICE	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	9823.0

Section: Inpatient Payer Specific Charge 33
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
LA CARE CAL MEDICONNECT	291	Heart Failure And Shock With Mcc	13052.0
LA CARE CAL MEDICONNECT	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	18894.0

Section: Inpatient Payer Specific Charge 34
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
MOLINA MEDI-CAL/HEALTHY FAMILY	291	Heart Failure And Shock With Mcc	10770.0
MOLINA MEDI-CAL/HEALTHY FAMILY	378	Gastrointestinal Hemorrhage With Cc	8334.0
MOLINA MEDI-CAL/HEALTHY FAMILY	638	Diabetes With Cc	6333.0
MOLINA MEDI-CAL/HEALTHY FAMILY	847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	9561.0
MOLINA MEDI-CAL/HEALTHY FAMILY	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	12333.0
MOLINA MEDI-CAL/HEALTHY FAMILY	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8389.0

Section: Inpatient Payer Specific Charge 35
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
ST. FRANCIS MEDICAL CENTER SENIOR	291	Heart Failure And Shock With Mcc	11748.0
ST. FRANCIS MEDICAL CENTER SENIOR	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	17238.0

Section: Inpatient Payer Specific Charge 36
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD COVERED CALIFORNIA	432	Cirrhosis And Alcoholic Hepatitis With Mcc	30542.0
BLUE SHIELD COVERED CALIFORNIA	560	Aftercare, Musculoskeletal System And Connective Tissue With Cc	17479.0
BLUE SHIELD COVERED CALIFORNIA	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	19237.0
BLUE SHIELD COVERED CALIFORNIA	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	31261.0

Section: Inpatient Payer Specific Charge 37
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
VALLEY PRESBYTERIAN MEDI-CAL	475	Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc	2055.0

Section: Inpatient Payer Specific Charge 38
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HERITAGE PROVIDER NETWORK HMO	638	Diabetes With Cc	10840.0
HERITAGE PROVIDER NETWORK HMO	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	10469.0

Section: Inpatient Payer Specific Charge 39
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
BLUE SHIELD TRIO	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	20030.0
BLUE SHIELD TRIO	872	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	18125.0

Section: Inpatient Payer Specific Charge 40
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
HEALTH NET HMO & PPO	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	34200.0

Section: Inpatient Payer Specific Charge 41
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN COMMERCIAL	743	Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	21397.0
MONARCH HEALTH PLAN COMMERCIAL	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	35168.0

Section: Inpatient Payer Specific Charge 42
Payer	MS-DRG	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION-GNP	847	Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc	9641.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	9641.0

Section: Outpatient De-identified Minimum Negotiated Charge
APC	Description	De-Identified Minimum Negotiated Charge
1503	New Technology - Level 3 ($101 - $200)	273.0
5012	Clinic Visits and Related Services	336.0
5021	Level 1 Type A ED Visits	20.0
5022	Level 2 Type A ED Visits	40.0
5023	Level 3 Type A ED Visits	94.0
5024	Level 4 Type A ED Visits	201.0
5025	Level 5 Type A ED Visits	149.0
5051	Level 1 Skin Procedures	62.0
5052	Level 2 Skin Procedures	112.0
5053	Level 3 Skin Procedures	419.0
5054	Level 4 Skin Procedures	2274.0
5061	Hyperbaric Oxygen	361.0
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	153.0
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	91.0
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	268.0
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	1459.0
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	120.0
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	159.0
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	52137.0
5101	Level 1 Strapping and Cast Application	64.0
5102	Level 2 Strapping and Cast Application	20.0
5111	Level 1 Musculoskeletal Procedures	16.0
5112	Level 2 Musculoskeletal Procedures	334.0
5113	Level 3 Musculoskeletal Procedures	115.0
5114	Level 4 Musculoskeletal Procedures	1682.0
5115	Level 5 Musculoskeletal Procedures	268.0
5151	Level 1 Airway Endoscopy	21.0
5153	Level 3 Airway Endoscopy	2748.0
5154	Level 4 Airway Endoscopy	1675.0
5155	Level 5 Airway Endoscopy	115.0
5161	Level 1 ENT Procedures	310.0
5162	Level 2 ENT Procedures	182.0
5163	Level 3 ENT Procedures	3072.0
5164	Level 4 ENT Procedures	3771.0
5165	Level 5 ENT Procedures	487.0
5181	Level 1 Vascular Procedures	745.0
5182	Level 2 Vascular Procedures	374.0
5183	Level 3 Vascular Procedures	1462.0
5184	Level 4 Vascular Procedures	1223.0
5191	Level 1 Endovascular Procedures	1875.0
5192	Level 2 Endovascular Procedures	2231.0
5193	Level 3 Endovascular Procedures	4301.0
5194	Level 4 Endovascular Procedures	19208.0
5213	Level 3 Electrophysiologic Procedures	2231.0
5223	Level 3 Pacemaker and Similar Procedures	12431.0
5241	Level 1 Blood Product Exchange and Related Services	204.0
5301	Level 1 Upper GI Procedures	67.0
5302	Level 2 Upper GI Procedures	1030.0
5303	Level 3 Upper GI Procedures	3671.0
5311	Level 1 Lower GI Procedures	163.0
5312	Level 2 Lower GI Procedures	1030.0
5313	Level 3 Lower GI Procedures	115.0
5331	Complex GI Procedures	1030.0
5341	Abdominal/Peritoneal/Biliary and Related Procedures	1675.0
5361	Level 1 Laparoscopy and Related Services	111.0
5362	Level 2 Laparoscopy and Related Services	106.0
5371	Level 1 Urology and Related Services	32.0
5372	Level 2 Urology and Related Services	163.0
5373	Level 3 Urology and Related Services	255.0
5374	Level 4 Urology and Related Services	815.0
5375	Level 5 Urology and Related Services	572.0
5401	Dialysis	2320.0
5412	Level 2 Gynecologic Procedures	219.0
5414	Level 4 Gynecologic Procedures	132.0
5415	Level 5 Gynecologic Procedures	487.0
5416	Level 6 Gynecologic Procedures	80.0
5431	Level 1 Nerve Procedures	1548.0
5441	Level 1 Nerve Injections	295.0
5442	Level 2 Nerve Injections	449.0
5465	Level 5 Neurostimulator and Related Procedures	102846.0
5491	Level 1 Intraocular Procedures	961.0
5492	Level 2 Intraocular Procedures	1396.0
5503	Level 3 Extraocular, Repair, and Plastic Eye Procedures	976.0
5504	Level 4 Extraocular, Repair, and Plastic Eye Procedures	6005.0
5521	Level 1 Imaging without Contrast	27.0
5522	Level 2 Imaging without Contrast	86.0
5523	Level 3 Imaging without Contrast	149.0
5524	Level 4 Imaging without Contrast	84.0
5571	Level 1 Imaging with Contrast	155.0
5572	Level 2 Imaging with Contrast	419.0
5573	Level 3 Imaging with Contrast	454.0
5591	Level 1 Nuclear Medicine and Related Services	274.0
5592	Level 2 Nuclear Medicine and Related Services	321.0
5593	Level 3 Nuclear Medicine and Related Services	684.0
5594	Level 4 Nuclear Medicine and Related Services	891.0
5612	Level 2 Therapeutic Radiation Treatment Preparation	1735.0
5613	Level 3 Therapeutic Radiation Treatment Preparation	4873.0
5622	Level 2 Radiation Therapy	1019.0
5623	Level 3 Radiation Therapy	4742.0
5626	Level 6 Radiation Therapy	9042.0
5627	Level 7 Radiation Therapy	13773.0
5661	Therapeutic Nuclear Medicine	751.0
5671	Level 1 Pathology	59.0
5672	Level 2 Pathology	76.0
5673	Level 3 Pathology	45.0
5674	Level 4 Pathology	217.0
5691	Level 1 Drug Administration	23.0
5692	Level 2 Drug Administration	21.0
5693	Level 3 Drug Administration	52.0
5694	Level 4 Drug Administration	188.0
5721	Level 1 Diagnostic Tests and Related Services	22.0
5722	Level 2 Diagnostic Tests and Related Services	107.0
5723	Level 3 Diagnostic Tests and Related Services	78.0
5724	Level 4 Diagnostic Tests and Related Services	476.0
5731	Level 1 Minor Procedures	13.0
5732	Level 2 Minor Procedures	22.0
5733	Level 3 Minor Procedures	14.0
5734	Level 4 Minor Procedures	24.0
5742	Level 2 Electronic Analysis of Devices	157.0
5743	Level 3 Electronic Analysis of Devices	261.0
5771	Cardiac Rehabilitation	100.0
5781	Resuscitation and Cardioversion	672.0
5791	Pulmonary Treatment	11.0
5801	Ventilation Initiation and Management	1156.0
5823	Level 3 Health and Behavior Services	27.0
9397	Covid-19 Vaccine Admin Dose 1 of 2	47.0
9398	Covid-19 Vaccine Admin Dose 2 of 2, Single Dose Product or Additional Dose	47.0
N700	Non-OPPS Clinic Services	8.0
N800	Clinical Diagnostic Lab Services	7.0
N801	Therapy Services	56.0
N804	Mammography Services	59.0
N805	Durable Medical Equipment	872.0
N809	Other Medicine	2.0
N900	Non-covered Services	6.0
N902	Packaged Services	1.0
N905	Not Recognized by OPPS	37.0

Section: Outpatient De-identified Maximum Negotiated Charge
APC	Description	De-Identified Maximum Negotiated Charge
1503	New Technology - Level 3 ($101 - $200)	515.0
5012	Clinic Visits and Related Services	336.0
5021	Level 1 Type A ED Visits	667.0
5022	Level 2 Type A ED Visits	1341.0
5023	Level 3 Type A ED Visits	2580.0
5024	Level 4 Type A ED Visits	6076.0
5025	Level 5 Type A ED Visits	10311.0
5051	Level 1 Skin Procedures	2088.0
5052	Level 2 Skin Procedures	3375.0
5053	Level 3 Skin Procedures	3026.0
5054	Level 4 Skin Procedures	5984.0
5061	Hyperbaric Oxygen	29034.0
5071	Level 1 Excision/ Biopsy/ Incision and Drainage	3293.0
5072	Level 2 Excision/ Biopsy/ Incision and Drainage	8080.0
5073	Level 3 Excision/ Biopsy/ Incision and Drainage	12197.0
5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	12197.0
5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	19336.0
5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	31153.0
5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	52137.0
5101	Level 1 Strapping and Cast Application	508.0
5102	Level 2 Strapping and Cast Application	933.0
5111	Level 1 Musculoskeletal Procedures	1074.0
5112	Level 2 Musculoskeletal Procedures	10553.0
5113	Level 3 Musculoskeletal Procedures	12197.0
5114	Level 4 Musculoskeletal Procedures	21884.0
5115	Level 5 Musculoskeletal Procedures	44657.0
5151	Level 1 Airway Endoscopy	1935.0
5153	Level 3 Airway Endoscopy	6452.0
5154	Level 4 Airway Endoscopy	12197.0
5155	Level 5 Airway Endoscopy	20346.0
5161	Level 1 ENT Procedures	4437.0
5162	Level 2 ENT Procedures	2002.0
5163	Level 3 ENT Procedures	4726.0
5164	Level 4 ENT Procedures	10119.0
5165	Level 5 ENT Procedures	17769.0
5181	Level 1 Vascular Procedures	6267.0
5182	Level 2 Vascular Procedures	6267.0
5183	Level 3 Vascular Procedures	16455.0
5184	Level 4 Vascular Procedures	28054.0
5191	Level 1 Endovascular Procedures	18709.0
5192	Level 2 Endovascular Procedures	5929.0
5193	Level 3 Endovascular Procedures	35099.0
5194	Level 4 Endovascular Procedures	56112.0
5213	Level 3 Electrophysiologic Procedures	74973.0
5223	Level 3 Pacemaker and Similar Procedures	13678.0
5241	Level 1 Blood Product Exchange and Related Services	2803.0
5301	Level 1 Upper GI Procedures	6267.0
5302	Level 2 Upper GI Procedures	8387.0
5303	Level 3 Upper GI Procedures	10728.0
5311	Level 1 Lower GI Procedures	3739.0
5312	Level 2 Lower GI Procedures	5944.0
5313	Level 3 Lower GI Procedures	13466.0
5331	Complex GI Procedures	17587.0
5341	Abdominal/Peritoneal/Biliary and Related Procedures	11116.0
5361	Level 1 Laparoscopy and Related Services	17679.0
5362	Level 2 Laparoscopy and Related Services	31119.0
5371	Level 1 Urology and Related Services	683.0
5372	Level 2 Urology and Related Services	2010.0
5373	Level 3 Urology and Related Services	4431.0
5374	Level 4 Urology and Related Services	17506.0
5375	Level 5 Urology and Related Services	15415.0
5401	Dialysis	3027.0
5412	Level 2 Gynecologic Procedures	219.0
5414	Level 4 Gynecologic Procedures	13466.0
5415	Level 5 Gynecologic Procedures	15406.0
5416	Level 6 Gynecologic Procedures	4058.0
5431	Level 1 Nerve Procedures	1550.0
5441	Level 1 Nerve Injections	2141.0
5442	Level 2 Nerve Injections	6267.0
5465	Level 5 Neurostimulator and Related Procedures	102846.0
5491	Level 1 Intraocular Procedures	2683.0
5492	Level 2 Intraocular Procedures	9691.0
5503	Level 3 Extraocular, Repair, and Plastic Eye Procedures	2392.0
5504	Level 4 Extraocular, Repair, and Plastic Eye Procedures	6005.0
5521	Level 1 Imaging without Contrast	1384.0
5522	Level 2 Imaging without Contrast	4671.0
5523	Level 3 Imaging without Contrast	2175.0
5524	Level 4 Imaging without Contrast	2159.0
5571	Level 1 Imaging with Contrast	5548.0
5572	Level 2 Imaging with Contrast	10838.0
5573	Level 3 Imaging with Contrast	11045.0
5591	Level 1 Nuclear Medicine and Related Services	2170.0
5592	Level 2 Nuclear Medicine and Related Services	3295.0
5593	Level 3 Nuclear Medicine and Related Services	9406.0
5594	Level 4 Nuclear Medicine and Related Services	12292.0
5612	Level 2 Therapeutic Radiation Treatment Preparation	31682.0
5613	Level 3 Therapeutic Radiation Treatment Preparation	54286.0
5622	Level 2 Radiation Therapy	18501.0
5623	Level 3 Radiation Therapy	88002.0
5626	Level 6 Radiation Therapy	32459.0
5627	Level 7 Radiation Therapy	13773.0
5661	Therapeutic Nuclear Medicine	101564.0
5671	Level 1 Pathology	369.0
5672	Level 2 Pathology	1625.0
5673	Level 3 Pathology	1971.0
5674	Level 4 Pathology	2219.0
5691	Level 1 Drug Administration	3060.0
5692	Level 2 Drug Administration	5827.0
5693	Level 3 Drug Administration	73953.0
5694	Level 4 Drug Administration	23017.0
5721	Level 1 Diagnostic Tests and Related Services	488.0
5722	Level 2 Diagnostic Tests and Related Services	2025.0
5723	Level 3 Diagnostic Tests and Related Services	3991.0
5724	Level 4 Diagnostic Tests and Related Services	6982.0
5731	Level 1 Minor Procedures	1083.0
5732	Level 2 Minor Procedures	568.0
5733	Level 3 Minor Procedures	1761.0
5734	Level 4 Minor Procedures	1206.0
5742	Level 2 Electronic Analysis of Devices	528.0
5743	Level 3 Electronic Analysis of Devices	4333.0
5771	Cardiac Rehabilitation	4462.0
5781	Resuscitation and Cardioversion	8703.0
5791	Pulmonary Treatment	1409.0
5801	Ventilation Initiation and Management	1156.0
5823	Level 3 Health and Behavior Services	374.0
9397	Covid-19 Vaccine Admin Dose 1 of 2	47.0
9398	Covid-19 Vaccine Admin Dose 2 of 2, Single Dose Product or Additional Dose	47.0
N700	Non-OPPS Clinic Services	314.0
N800	Clinical Diagnostic Lab Services	904.0
N801	Therapy Services	2101.0
N804	Mammography Services	1167.0
N805	Durable Medical Equipment	872.0
N809	Other Medicine	38.0
N900	Non-covered Services	76.0
N902	Packaged Services	2512.0
N905	Not Recognized by OPPS	724.0

Section: Outpatient Payer Specific Charge 1
Payer	APC	Description	Payer Specific Negotiated Charge
AETNA HMO	1503	New Technology - Level 3 ($101 - $200)	273.0
AETNA HMO	5021	Level 1 Type A ED Visits	667.0
AETNA HMO	5022	Level 2 Type A ED Visits	1340.0
AETNA HMO	5023	Level 3 Type A ED Visits	2337.0
AETNA HMO	5024	Level 4 Type A ED Visits	3025.0
AETNA HMO	5025	Level 5 Type A ED Visits	3028.0
AETNA HMO	5051	Level 1 Skin Procedures	2078.0
AETNA HMO	5052	Level 2 Skin Procedures	3025.0
AETNA HMO	5053	Level 3 Skin Procedures	3026.0
AETNA HMO	5061	Hyperbaric Oxygen	18393.0
AETNA HMO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1971.0
AETNA HMO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2649.0
AETNA HMO	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	2053.0
AETNA HMO	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	3063.0
AETNA HMO	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	120.0
AETNA HMO	5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	4381.0
AETNA HMO	5101	Level 1 Strapping and Cast Application	508.0
AETNA HMO	5102	Level 2 Strapping and Cast Application	394.0
AETNA HMO	5111	Level 1 Musculoskeletal Procedures	1074.0
AETNA HMO	5112	Level 2 Musculoskeletal Procedures	3025.0
AETNA HMO	5113	Level 3 Musculoskeletal Procedures	3050.0
AETNA HMO	5114	Level 4 Musculoskeletal Procedures	5296.0
AETNA HMO	5115	Level 5 Musculoskeletal Procedures	3091.0
AETNA HMO	5153	Level 3 Airway Endoscopy	3662.0
AETNA HMO	5155	Level 5 Airway Endoscopy	7730.0
AETNA HMO	5161	Level 1 ENT Procedures	1061.0
AETNA HMO	5162	Level 2 ENT Procedures	2002.0
AETNA HMO	5164	Level 4 ENT Procedures	3771.0
AETNA HMO	5165	Level 5 ENT Procedures	5786.0
AETNA HMO	5181	Level 1 Vascular Procedures	1971.0
AETNA HMO	5182	Level 2 Vascular Procedures	1976.0
AETNA HMO	5183	Level 3 Vascular Procedures	3075.0
AETNA HMO	5191	Level 1 Endovascular Procedures	11644.0
AETNA HMO	5193	Level 3 Endovascular Procedures	6663.0
AETNA HMO	5213	Level 3 Electrophysiologic Procedures	6002.0
AETNA HMO	5241	Level 1 Blood Product Exchange and Related Services	1973.0
AETNA HMO	5301	Level 1 Upper GI Procedures	2679.0
AETNA HMO	5302	Level 2 Upper GI Procedures	2685.0
AETNA HMO	5312	Level 2 Lower GI Procedures	3522.0
AETNA HMO	5313	Level 3 Lower GI Procedures	3090.0
AETNA HMO	5341	Abdominal/Peritoneal/Biliary and Related Procedures	2658.0
AETNA HMO	5361	Level 1 Laparoscopy and Related Services	3091.0
AETNA HMO	5362	Level 2 Laparoscopy and Related Services	4359.0
AETNA HMO	5374	Level 4 Urology and Related Services	2682.0
AETNA HMO	5375	Level 5 Urology and Related Services	572.0
AETNA HMO	5401	Dialysis	3027.0
AETNA HMO	5414	Level 4 Gynecologic Procedures	3053.0
AETNA HMO	5415	Level 5 Gynecologic Procedures	1524.0
AETNA HMO	5441	Level 1 Nerve Injections	1996.0
AETNA HMO	5442	Level 2 Nerve Injections	3766.0
AETNA HMO	5521	Level 1 Imaging without Contrast	904.0
AETNA HMO	5522	Level 2 Imaging without Contrast	569.0
AETNA HMO	5523	Level 3 Imaging without Contrast	1453.0
AETNA HMO	5524	Level 4 Imaging without Contrast	1307.0
AETNA HMO	5571	Level 1 Imaging with Contrast	1687.0
AETNA HMO	5572	Level 2 Imaging with Contrast	973.0
AETNA HMO	5573	Level 3 Imaging with Contrast	3096.0
AETNA HMO	5591	Level 1 Nuclear Medicine and Related Services	2170.0
AETNA HMO	5592	Level 2 Nuclear Medicine and Related Services	2483.0
AETNA HMO	5593	Level 3 Nuclear Medicine and Related Services	5431.0
AETNA HMO	5594	Level 4 Nuclear Medicine and Related Services	1884.0
AETNA HMO	5612	Level 2 Therapeutic Radiation Treatment Preparation	31682.0
AETNA HMO	5613	Level 3 Therapeutic Radiation Treatment Preparation	37340.0
AETNA HMO	5622	Level 2 Radiation Therapy	18104.0
AETNA HMO	5623	Level 3 Radiation Therapy	38514.0
AETNA HMO	5671	Level 1 Pathology	369.0
AETNA HMO	5672	Level 2 Pathology	1625.0
AETNA HMO	5673	Level 3 Pathology	1971.0
AETNA HMO	5692	Level 2 Drug Administration	1185.0
AETNA HMO	5693	Level 3 Drug Administration	777.0
AETNA HMO	5694	Level 4 Drug Administration	6199.0
AETNA HMO	5721	Level 1 Diagnostic Tests and Related Services	141.0
AETNA HMO	5722	Level 2 Diagnostic Tests and Related Services	1169.0
AETNA HMO	5723	Level 3 Diagnostic Tests and Related Services	1971.0
AETNA HMO	5724	Level 4 Diagnostic Tests and Related Services	3553.0
AETNA HMO	5731	Level 1 Minor Procedures	369.0
AETNA HMO	5733	Level 3 Minor Procedures	339.0
AETNA HMO	5734	Level 4 Minor Procedures	852.0
AETNA HMO	5743	Level 3 Electronic Analysis of Devices	4333.0
AETNA HMO	5771	Cardiac Rehabilitation	1668.0
AETNA HMO	5781	Resuscitation and Cardioversion	5062.0
AETNA HMO	5791	Pulmonary Treatment	302.0
AETNA HMO	5823	Level 3 Health and Behavior Services	178.0
AETNA HMO	N700	Non-OPPS Clinic Services	108.0
AETNA HMO	N800	Clinical Diagnostic Lab Services	92.0
AETNA HMO	N801	Therapy Services	874.0
AETNA HMO	N804	Mammography Services	691.0
AETNA HMO	N809	Other Medicine	29.0
AETNA HMO	N900	Non-covered Services	40.0
AETNA HMO	N902	Packaged Services	6.0
AETNA HMO	N905	Not Recognized by OPPS	344.0

Section: Outpatient Payer Specific Charge 2
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS NON-MCS	1503	New Technology - Level 3 ($101 - $200)	515.0
BLUE CROSS NON-MCS	5012	Clinic Visits and Related Services	336.0
BLUE CROSS NON-MCS	5021	Level 1 Type A ED Visits	253.0
BLUE CROSS NON-MCS	5022	Level 2 Type A ED Visits	459.0
BLUE CROSS NON-MCS	5023	Level 3 Type A ED Visits	809.0
BLUE CROSS NON-MCS	5024	Level 4 Type A ED Visits	1554.0
BLUE CROSS NON-MCS	5025	Level 5 Type A ED Visits	2205.0
BLUE CROSS NON-MCS	5051	Level 1 Skin Procedures	618.0
BLUE CROSS NON-MCS	5052	Level 2 Skin Procedures	1208.0
BLUE CROSS NON-MCS	5053	Level 3 Skin Procedures	2871.0
BLUE CROSS NON-MCS	5054	Level 4 Skin Procedures	5984.0
BLUE CROSS NON-MCS	5061	Hyperbaric Oxygen	8125.0
BLUE CROSS NON-MCS	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	2422.0
BLUE CROSS NON-MCS	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	5164.0
BLUE CROSS NON-MCS	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	8284.0
BLUE CROSS NON-MCS	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	11033.0
BLUE CROSS NON-MCS	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	19336.0
BLUE CROSS NON-MCS	5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	31153.0
BLUE CROSS NON-MCS	5094	Level 4 Breast/Lymphatic Surgery and Related Procedures	52137.0
BLUE CROSS NON-MCS	5101	Level 1 Strapping and Cast Application	406.0
BLUE CROSS NON-MCS	5102	Level 2 Strapping and Cast Application	843.0
BLUE CROSS NON-MCS	5111	Level 1 Musculoskeletal Procedures	720.0
BLUE CROSS NON-MCS	5112	Level 2 Musculoskeletal Procedures	4866.0
BLUE CROSS NON-MCS	5113	Level 3 Musculoskeletal Procedures	9894.0
BLUE CROSS NON-MCS	5114	Level 4 Musculoskeletal Procedures	21884.0
BLUE CROSS NON-MCS	5115	Level 5 Musculoskeletal Procedures	43347.0
BLUE CROSS NON-MCS	5151	Level 1 Airway Endoscopy	575.0
BLUE CROSS NON-MCS	5153	Level 3 Airway Endoscopy	5227.0
BLUE CROSS NON-MCS	5154	Level 4 Airway Endoscopy	10823.0
BLUE CROSS NON-MCS	5155	Level 5 Airway Endoscopy	20346.0
BLUE CROSS NON-MCS	5163	Level 3 ENT Procedures	4726.0
BLUE CROSS NON-MCS	5164	Level 4 ENT Procedures	9558.0
BLUE CROSS NON-MCS	5165	Level 5 ENT Procedures	17769.0
BLUE CROSS NON-MCS	5181	Level 1 Vascular Procedures	2264.0
BLUE CROSS NON-MCS	5182	Level 2 Vascular Procedures	4913.0
BLUE CROSS NON-MCS	5183	Level 3 Vascular Procedures	10002.0
BLUE CROSS NON-MCS	5184	Level 4 Vascular Procedures	16661.0
BLUE CROSS NON-MCS	5191	Level 1 Endovascular Procedures	10141.0
BLUE CROSS NON-MCS	5193	Level 3 Endovascular Procedures	35099.0
BLUE CROSS NON-MCS	5194	Level 4 Endovascular Procedures	56112.0
BLUE CROSS NON-MCS	5213	Level 3 Electrophysiologic Procedures	74973.0
BLUE CROSS NON-MCS	5241	Level 1 Blood Product Exchange and Related Services	2803.0
BLUE CROSS NON-MCS	5301	Level 1 Upper GI Procedures	3063.0
BLUE CROSS NON-MCS	5302	Level 2 Upper GI Procedures	5675.0
BLUE CROSS NON-MCS	5303	Level 3 Upper GI Procedures	10728.0
BLUE CROSS NON-MCS	5311	Level 1 Lower GI Procedures	2922.0
BLUE CROSS NON-MCS	5312	Level 2 Lower GI Procedures	5023.0
BLUE CROSS NON-MCS	5313	Level 3 Lower GI Procedures	8535.0
BLUE CROSS NON-MCS	5331	Complex GI Procedures	17587.0
BLUE CROSS NON-MCS	5341	Abdominal/Peritoneal/Biliary and Related Procedures	11116.0
BLUE CROSS NON-MCS	5361	Level 1 Laparoscopy and Related Services	17679.0
BLUE CROSS NON-MCS	5362	Level 2 Laparoscopy and Related Services	31119.0
BLUE CROSS NON-MCS	5372	Level 2 Urology and Related Services	2010.0
BLUE CROSS NON-MCS	5373	Level 3 Urology and Related Services	3569.0
BLUE CROSS NON-MCS	5374	Level 4 Urology and Related Services	10742.0
BLUE CROSS NON-MCS	5375	Level 5 Urology and Related Services	15415.0
BLUE CROSS NON-MCS	5414	Level 4 Gynecologic Procedures	9167.0
BLUE CROSS NON-MCS	5415	Level 5 Gynecologic Procedures	15406.0
BLUE CROSS NON-MCS	5416	Level 6 Gynecologic Procedures	80.0
BLUE CROSS NON-MCS	5441	Level 1 Nerve Injections	913.0
BLUE CROSS NON-MCS	5442	Level 2 Nerve Injections	5023.0
BLUE CROSS NON-MCS	5465	Level 5 Neurostimulator and Related Procedures	102846.0
BLUE CROSS NON-MCS	5521	Level 1 Imaging without Contrast	283.0
BLUE CROSS NON-MCS	5522	Level 2 Imaging without Contrast	380.0
BLUE CROSS NON-MCS	5523	Level 3 Imaging without Contrast	804.0
BLUE CROSS NON-MCS	5524	Level 4 Imaging without Contrast	1688.0
BLUE CROSS NON-MCS	5571	Level 1 Imaging with Contrast	624.0
BLUE CROSS NON-MCS	5572	Level 2 Imaging with Contrast	1287.0
BLUE CROSS NON-MCS	5573	Level 3 Imaging with Contrast	4624.0
BLUE CROSS NON-MCS	5591	Level 1 Nuclear Medicine and Related Services	1317.0
BLUE CROSS NON-MCS	5592	Level 2 Nuclear Medicine and Related Services	1710.0
BLUE CROSS NON-MCS	5593	Level 3 Nuclear Medicine and Related Services	4566.0
BLUE CROSS NON-MCS	5594	Level 4 Nuclear Medicine and Related Services	5171.0
BLUE CROSS NON-MCS	5612	Level 2 Therapeutic Radiation Treatment Preparation	9832.0
BLUE CROSS NON-MCS	5613	Level 3 Therapeutic Radiation Treatment Preparation	18737.0
BLUE CROSS NON-MCS	5622	Level 2 Radiation Therapy	4909.0
BLUE CROSS NON-MCS	5623	Level 3 Radiation Therapy	25973.0
BLUE CROSS NON-MCS	5627	Level 7 Radiation Therapy	13773.0
BLUE CROSS NON-MCS	5661	Therapeutic Nuclear Medicine	101564.0
BLUE CROSS NON-MCS	5671	Level 1 Pathology	174.0
BLUE CROSS NON-MCS	5672	Level 2 Pathology	283.0
BLUE CROSS NON-MCS	5673	Level 3 Pathology	342.0
BLUE CROSS NON-MCS	5674	Level 4 Pathology	2219.0
BLUE CROSS NON-MCS	5691	Level 1 Drug Administration	3060.0
BLUE CROSS NON-MCS	5692	Level 2 Drug Administration	1462.0
BLUE CROSS NON-MCS	5693	Level 3 Drug Administration	994.0
BLUE CROSS NON-MCS	5694	Level 4 Drug Administration	9526.0
BLUE CROSS NON-MCS	5721	Level 1 Diagnostic Tests and Related Services	297.0
BLUE CROSS NON-MCS	5722	Level 2 Diagnostic Tests and Related Services	925.0
BLUE CROSS NON-MCS	5723	Level 3 Diagnostic Tests and Related Services	2141.0
BLUE CROSS NON-MCS	5724	Level 4 Diagnostic Tests and Related Services	3214.0
BLUE CROSS NON-MCS	5731	Level 1 Minor Procedures	207.0
BLUE CROSS NON-MCS	5732	Level 2 Minor Procedures	118.0
BLUE CROSS NON-MCS	5733	Level 3 Minor Procedures	194.0
BLUE CROSS NON-MCS	5734	Level 4 Minor Procedures	394.0
BLUE CROSS NON-MCS	5743	Level 3 Electronic Analysis of Devices	1602.0
BLUE CROSS NON-MCS	5771	Cardiac Rehabilitation	2839.0
BLUE CROSS NON-MCS	5781	Resuscitation and Cardioversion	1998.0
BLUE CROSS NON-MCS	5791	Pulmonary Treatment	458.0
BLUE CROSS NON-MCS	5823	Level 3 Health and Behavior Services	374.0
BLUE CROSS NON-MCS	N700	Non-OPPS Clinic Services	166.0
BLUE CROSS NON-MCS	N800	Clinical Diagnostic Lab Services	60.0
BLUE CROSS NON-MCS	N801	Therapy Services	944.0
BLUE CROSS NON-MCS	N804	Mammography Services	330.0
BLUE CROSS NON-MCS	N805	Durable Medical Equipment	872.0
BLUE CROSS NON-MCS	N809	Other Medicine	13.0
BLUE CROSS NON-MCS	N905	Not Recognized by OPPS	151.0

Section: Outpatient Payer Specific Charge 3
Payer	APC	Description	Payer Specific Negotiated Charge
AVANTI HEALTH SYSTEMS	5021	Level 1 Type A ED Visits	31.0
AVANTI HEALTH SYSTEMS	5022	Level 2 Type A ED Visits	62.0
AVANTI HEALTH SYSTEMS	5023	Level 3 Type A ED Visits	143.0
AVANTI HEALTH SYSTEMS	5024	Level 4 Type A ED Visits	286.0
AVANTI HEALTH SYSTEMS	5025	Level 5 Type A ED Visits	460.0
AVANTI HEALTH SYSTEMS	5051	Level 1 Skin Procedures	92.0
AVANTI HEALTH SYSTEMS	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	130.0
AVANTI HEALTH SYSTEMS	5102	Level 2 Strapping and Cast Application	33.0
AVANTI HEALTH SYSTEMS	5112	Level 2 Musculoskeletal Procedures	567.0
AVANTI HEALTH SYSTEMS	5151	Level 1 Airway Endoscopy	58.0
AVANTI HEALTH SYSTEMS	5522	Level 2 Imaging without Contrast	173.0
AVANTI HEALTH SYSTEMS	5731	Level 1 Minor Procedures	49.0
AVANTI HEALTH SYSTEMS	5733	Level 3 Minor Procedures	33.0
AVANTI HEALTH SYSTEMS	N800	Clinical Diagnostic Lab Services	43.0

Section: Outpatient Payer Specific Charge 4
Payer	APC	Description	Payer Specific Negotiated Charge
BEVERLY HOSPITAL MEDI-CAL	5021	Level 1 Type A ED Visits	53.0
BEVERLY HOSPITAL MEDI-CAL	5022	Level 2 Type A ED Visits	106.0
BEVERLY HOSPITAL MEDI-CAL	5023	Level 3 Type A ED Visits	247.0
BEVERLY HOSPITAL MEDI-CAL	5024	Level 4 Type A ED Visits	581.0
BEVERLY HOSPITAL MEDI-CAL	5025	Level 5 Type A ED Visits	856.0
BEVERLY HOSPITAL MEDI-CAL	5731	Level 1 Minor Procedures	84.0
BEVERLY HOSPITAL MEDI-CAL	5733	Level 3 Minor Procedures	60.0
BEVERLY HOSPITAL MEDI-CAL	N700	Non-OPPS Clinic Services	18.0

Section: Outpatient Payer Specific Charge 5
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS MEDI-CAL	5021	Level 1 Type A ED Visits	30.0
BLUE CROSS MEDI-CAL	5022	Level 2 Type A ED Visits	61.0
BLUE CROSS MEDI-CAL	5023	Level 3 Type A ED Visits	142.0
BLUE CROSS MEDI-CAL	5024	Level 4 Type A ED Visits	294.0
BLUE CROSS MEDI-CAL	5025	Level 5 Type A ED Visits	462.0
BLUE CROSS MEDI-CAL	5051	Level 1 Skin Procedures	90.0
BLUE CROSS MEDI-CAL	5052	Level 2 Skin Procedures	277.0
BLUE CROSS MEDI-CAL	5061	Hyperbaric Oxygen	1366.0
BLUE CROSS MEDI-CAL	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	199.0
BLUE CROSS MEDI-CAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	138.0
BLUE CROSS MEDI-CAL	5101	Level 1 Strapping and Cast Application	77.0
BLUE CROSS MEDI-CAL	5102	Level 2 Strapping and Cast Application	66.0
BLUE CROSS MEDI-CAL	5111	Level 1 Musculoskeletal Procedures	76.0
BLUE CROSS MEDI-CAL	5151	Level 1 Airway Endoscopy	34.0
BLUE CROSS MEDI-CAL	5241	Level 1 Blood Product Exchange and Related Services	204.0
BLUE CROSS MEDI-CAL	5301	Level 1 Upper GI Procedures	378.0
BLUE CROSS MEDI-CAL	5311	Level 1 Lower GI Procedures	231.0
BLUE CROSS MEDI-CAL	5373	Level 3 Urology and Related Services	744.0
BLUE CROSS MEDI-CAL	5442	Level 2 Nerve Injections	453.0
BLUE CROSS MEDI-CAL	5491	Level 1 Intraocular Procedures	1242.0
BLUE CROSS MEDI-CAL	5521	Level 1 Imaging without Contrast	76.0
BLUE CROSS MEDI-CAL	5522	Level 2 Imaging without Contrast	277.0
BLUE CROSS MEDI-CAL	5524	Level 4 Imaging without Contrast	84.0
BLUE CROSS MEDI-CAL	5573	Level 3 Imaging with Contrast	1937.0
BLUE CROSS MEDI-CAL	5623	Level 3 Radiation Therapy	4942.0
BLUE CROSS MEDI-CAL	5692	Level 2 Drug Administration	55.0
BLUE CROSS MEDI-CAL	5693	Level 3 Drug Administration	52.0
BLUE CROSS MEDI-CAL	5694	Level 4 Drug Administration	188.0
BLUE CROSS MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	240.0
BLUE CROSS MEDI-CAL	5723	Level 3 Diagnostic Tests and Related Services	220.0
BLUE CROSS MEDI-CAL	5731	Level 1 Minor Procedures	15.0
BLUE CROSS MEDI-CAL	5733	Level 3 Minor Procedures	41.0
BLUE CROSS MEDI-CAL	5734	Level 4 Minor Procedures	35.0
BLUE CROSS MEDI-CAL	5791	Pulmonary Treatment	74.0
BLUE CROSS MEDI-CAL	N700	Non-OPPS Clinic Services	11.0
BLUE CROSS MEDI-CAL	N800	Clinical Diagnostic Lab Services	48.0
BLUE CROSS MEDI-CAL	N809	Other Medicine	3.0
BLUE CROSS MEDI-CAL	N902	Packaged Services	84.0

Section: Outpatient Payer Specific Charge 6
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS SELECT HMO	5021	Level 1 Type A ED Visits	165.0
BLUE CROSS SELECT HMO	5022	Level 2 Type A ED Visits	298.0
BLUE CROSS SELECT HMO	5023	Level 3 Type A ED Visits	526.0
BLUE CROSS SELECT HMO	5024	Level 4 Type A ED Visits	826.0
BLUE CROSS SELECT HMO	5025	Level 5 Type A ED Visits	1303.0
BLUE CROSS SELECT HMO	5052	Level 2 Skin Procedures	1311.0
BLUE CROSS SELECT HMO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	3276.0
BLUE CROSS SELECT HMO	5102	Level 2 Strapping and Cast Application	468.0
BLUE CROSS SELECT HMO	5111	Level 1 Musculoskeletal Procedures	468.0
BLUE CROSS SELECT HMO	5115	Level 5 Musculoskeletal Procedures	28176.0
BLUE CROSS SELECT HMO	5163	Level 3 ENT Procedures	3072.0
BLUE CROSS SELECT HMO	5183	Level 3 Vascular Procedures	6501.0
BLUE CROSS SELECT HMO	5241	Level 1 Blood Product Exchange and Related Services	2563.0
BLUE CROSS SELECT HMO	5361	Level 1 Laparoscopy and Related Services	11491.0
BLUE CROSS SELECT HMO	5414	Level 4 Gynecologic Procedures	5958.0
BLUE CROSS SELECT HMO	5521	Level 1 Imaging without Contrast	184.0
BLUE CROSS SELECT HMO	5522	Level 2 Imaging without Contrast	247.0
BLUE CROSS SELECT HMO	5613	Level 3 Therapeutic Radiation Treatment Preparation	11745.0
BLUE CROSS SELECT HMO	5692	Level 2 Drug Administration	489.0
BLUE CROSS SELECT HMO	5693	Level 3 Drug Administration	646.0
BLUE CROSS SELECT HMO	5694	Level 4 Drug Administration	2284.0
BLUE CROSS SELECT HMO	5731	Level 1 Minor Procedures	135.0
BLUE CROSS SELECT HMO	5771	Cardiac Rehabilitation	2636.0
BLUE CROSS SELECT HMO	N700	Non-OPPS Clinic Services	108.0
BLUE CROSS SELECT HMO	N800	Clinical Diagnostic Lab Services	219.0
BLUE CROSS SELECT HMO	N804	Mammography Services	215.0

Section: Outpatient Payer Specific Charge 7
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS VIVITY - NON CITY	5021	Level 1 Type A ED Visits	108.0
BLUE CROSS VIVITY - NON CITY	5022	Level 2 Type A ED Visits	196.0
BLUE CROSS VIVITY - NON CITY	5023	Level 3 Type A ED Visits	346.0
BLUE CROSS VIVITY - NON CITY	5024	Level 4 Type A ED Visits	664.0
BLUE CROSS VIVITY - NON CITY	5025	Level 5 Type A ED Visits	950.0
BLUE CROSS VIVITY - NON CITY	5051	Level 1 Skin Procedures	268.0
BLUE CROSS VIVITY - NON CITY	5052	Level 2 Skin Procedures	516.0
BLUE CROSS VIVITY - NON CITY	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1088.0
BLUE CROSS VIVITY - NON CITY	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2260.0
BLUE CROSS VIVITY - NON CITY	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	3543.0
BLUE CROSS VIVITY - NON CITY	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	4718.0
BLUE CROSS VIVITY - NON CITY	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	8275.0
BLUE CROSS VIVITY - NON CITY	5101	Level 1 Strapping and Cast Application	325.0
BLUE CROSS VIVITY - NON CITY	5102	Level 2 Strapping and Cast Application	360.0
BLUE CROSS VIVITY - NON CITY	5111	Level 1 Musculoskeletal Procedures	308.0
BLUE CROSS VIVITY - NON CITY	5112	Level 2 Musculoskeletal Procedures	2081.0
BLUE CROSS VIVITY - NON CITY	5113	Level 3 Musculoskeletal Procedures	4231.0
BLUE CROSS VIVITY - NON CITY	5114	Level 4 Musculoskeletal Procedures	9358.0
BLUE CROSS VIVITY - NON CITY	5115	Level 5 Musculoskeletal Procedures	18593.0
BLUE CROSS VIVITY - NON CITY	5155	Level 5 Airway Endoscopy	8701.0
BLUE CROSS VIVITY - NON CITY	5183	Level 3 Vascular Procedures	4277.0
BLUE CROSS VIVITY - NON CITY	5191	Level 1 Endovascular Procedures	4333.0
BLUE CROSS VIVITY - NON CITY	5213	Level 3 Electrophysiologic Procedures	32061.0
BLUE CROSS VIVITY - NON CITY	5241	Level 1 Blood Product Exchange and Related Services	1074.0
BLUE CROSS VIVITY - NON CITY	5301	Level 1 Upper GI Procedures	3089.0
BLUE CROSS VIVITY - NON CITY	5302	Level 2 Upper GI Procedures	2427.0
BLUE CROSS VIVITY - NON CITY	5311	Level 1 Lower GI Procedures	1466.0
BLUE CROSS VIVITY - NON CITY	5341	Abdominal/Peritoneal/Biliary and Related Procedures	2503.0
BLUE CROSS VIVITY - NON CITY	5361	Level 1 Laparoscopy and Related Services	7560.0
BLUE CROSS VIVITY - NON CITY	5362	Level 2 Laparoscopy and Related Services	13307.0
BLUE CROSS VIVITY - NON CITY	5373	Level 3 Urology and Related Services	2681.0
BLUE CROSS VIVITY - NON CITY	5375	Level 5 Urology and Related Services	6592.0
BLUE CROSS VIVITY - NON CITY	5414	Level 4 Gynecologic Procedures	3920.0
BLUE CROSS VIVITY - NON CITY	5521	Level 1 Imaging without Contrast	121.0
BLUE CROSS VIVITY - NON CITY	5522	Level 2 Imaging without Contrast	163.0
BLUE CROSS VIVITY - NON CITY	5573	Level 3 Imaging with Contrast	3432.0
BLUE CROSS VIVITY - NON CITY	5612	Level 2 Therapeutic Radiation Treatment Preparation	3427.0
BLUE CROSS VIVITY - NON CITY	5613	Level 3 Therapeutic Radiation Treatment Preparation	6966.0
BLUE CROSS VIVITY - NON CITY	5623	Level 3 Radiation Therapy	12728.0
BLUE CROSS VIVITY - NON CITY	5673	Level 3 Pathology	133.0
BLUE CROSS VIVITY - NON CITY	5692	Level 2 Drug Administration	938.0
BLUE CROSS VIVITY - NON CITY	5693	Level 3 Drug Administration	425.0
BLUE CROSS VIVITY - NON CITY	5694	Level 4 Drug Administration	11452.0
BLUE CROSS VIVITY - NON CITY	5721	Level 1 Diagnostic Tests and Related Services	209.0
BLUE CROSS VIVITY - NON CITY	5722	Level 2 Diagnostic Tests and Related Services	395.0
BLUE CROSS VIVITY - NON CITY	5731	Level 1 Minor Procedures	114.0
BLUE CROSS VIVITY - NON CITY	5733	Level 3 Minor Procedures	83.0
BLUE CROSS VIVITY - NON CITY	N700	Non-OPPS Clinic Services	106.0
BLUE CROSS VIVITY - NON CITY	N800	Clinical Diagnostic Lab Services	215.0
BLUE CROSS VIVITY - NON CITY	N809	Other Medicine	18.0

Section: Outpatient Payer Specific Charge 8
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD COVERED CALIFORNIA	5021	Level 1 Type A ED Visits	335.0
BLUE SHIELD COVERED CALIFORNIA	5022	Level 2 Type A ED Visits	673.0
BLUE SHIELD COVERED CALIFORNIA	5023	Level 3 Type A ED Visits	1460.0
BLUE SHIELD COVERED CALIFORNIA	5024	Level 4 Type A ED Visits	3082.0
BLUE SHIELD COVERED CALIFORNIA	5025	Level 5 Type A ED Visits	4853.0
BLUE SHIELD COVERED CALIFORNIA	5051	Level 1 Skin Procedures	1031.0
BLUE SHIELD COVERED CALIFORNIA	5052	Level 2 Skin Procedures	2482.0
BLUE SHIELD COVERED CALIFORNIA	5053	Level 3 Skin Procedures	2958.0
BLUE SHIELD COVERED CALIFORNIA	5061	Hyperbaric Oxygen	13372.0
BLUE SHIELD COVERED CALIFORNIA	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1536.0
BLUE SHIELD COVERED CALIFORNIA	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	6655.0
BLUE SHIELD COVERED CALIFORNIA	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	3867.0
BLUE SHIELD COVERED CALIFORNIA	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	9405.0
BLUE SHIELD COVERED CALIFORNIA	5102	Level 2 Strapping and Cast Application	843.0
BLUE SHIELD COVERED CALIFORNIA	5112	Level 2 Musculoskeletal Procedures	6772.0
BLUE SHIELD COVERED CALIFORNIA	5113	Level 3 Musculoskeletal Procedures	3998.0
BLUE SHIELD COVERED CALIFORNIA	5114	Level 4 Musculoskeletal Procedures	7606.0
BLUE SHIELD COVERED CALIFORNIA	5115	Level 5 Musculoskeletal Procedures	12770.0
BLUE SHIELD COVERED CALIFORNIA	5154	Level 4 Airway Endoscopy	3391.0
BLUE SHIELD COVERED CALIFORNIA	5155	Level 5 Airway Endoscopy	9405.0
BLUE SHIELD COVERED CALIFORNIA	5161	Level 1 ENT Procedures	310.0
BLUE SHIELD COVERED CALIFORNIA	5164	Level 4 ENT Procedures	6655.0
BLUE SHIELD COVERED CALIFORNIA	5182	Level 2 Vascular Procedures	4973.0
BLUE SHIELD COVERED CALIFORNIA	5183	Level 3 Vascular Procedures	9149.0
BLUE SHIELD COVERED CALIFORNIA	5191	Level 1 Endovascular Procedures	14846.0
BLUE SHIELD COVERED CALIFORNIA	5241	Level 1 Blood Product Exchange and Related Services	1536.0
BLUE SHIELD COVERED CALIFORNIA	5301	Level 1 Upper GI Procedures	4718.0
BLUE SHIELD COVERED CALIFORNIA	5302	Level 2 Upper GI Procedures	3432.0
BLUE SHIELD COVERED CALIFORNIA	5313	Level 3 Lower GI Procedures	3998.0
BLUE SHIELD COVERED CALIFORNIA	5361	Level 1 Laparoscopy and Related Services	5729.0
BLUE SHIELD COVERED CALIFORNIA	5362	Level 2 Laparoscopy and Related Services	10692.0
BLUE SHIELD COVERED CALIFORNIA	5414	Level 4 Gynecologic Procedures	2682.0
BLUE SHIELD COVERED CALIFORNIA	5415	Level 5 Gynecologic Procedures	7606.0
BLUE SHIELD COVERED CALIFORNIA	5441	Level 1 Nerve Injections	1536.0
BLUE SHIELD COVERED CALIFORNIA	5442	Level 2 Nerve Injections	4973.0
BLUE SHIELD COVERED CALIFORNIA	5521	Level 1 Imaging without Contrast	1100.0
BLUE SHIELD COVERED CALIFORNIA	5522	Level 2 Imaging without Contrast	311.0
BLUE SHIELD COVERED CALIFORNIA	5523	Level 3 Imaging without Contrast	1581.0
BLUE SHIELD COVERED CALIFORNIA	5524	Level 4 Imaging without Contrast	1749.0
BLUE SHIELD COVERED CALIFORNIA	5571	Level 1 Imaging with Contrast	4823.0
BLUE SHIELD COVERED CALIFORNIA	5572	Level 2 Imaging with Contrast	4480.0
BLUE SHIELD COVERED CALIFORNIA	5591	Level 1 Nuclear Medicine and Related Services	1684.0
BLUE SHIELD COVERED CALIFORNIA	5592	Level 2 Nuclear Medicine and Related Services	2119.0
BLUE SHIELD COVERED CALIFORNIA	5593	Level 3 Nuclear Medicine and Related Services	4290.0
BLUE SHIELD COVERED CALIFORNIA	5594	Level 4 Nuclear Medicine and Related Services	9959.0
BLUE SHIELD COVERED CALIFORNIA	5612	Level 2 Therapeutic Radiation Treatment Preparation	17175.0
BLUE SHIELD COVERED CALIFORNIA	5613	Level 3 Therapeutic Radiation Treatment Preparation	39252.0
BLUE SHIELD COVERED CALIFORNIA	5623	Level 3 Radiation Therapy	67831.0
BLUE SHIELD COVERED CALIFORNIA	5626	Level 6 Radiation Therapy	32459.0
BLUE SHIELD COVERED CALIFORNIA	5672	Level 2 Pathology	985.0
BLUE SHIELD COVERED CALIFORNIA	5673	Level 3 Pathology	481.0
BLUE SHIELD COVERED CALIFORNIA	5692	Level 2 Drug Administration	1278.0
BLUE SHIELD COVERED CALIFORNIA	5693	Level 3 Drug Administration	1580.0
BLUE SHIELD COVERED CALIFORNIA	5694	Level 4 Drug Administration	7791.0
BLUE SHIELD COVERED CALIFORNIA	5721	Level 1 Diagnostic Tests and Related Services	189.0
BLUE SHIELD COVERED CALIFORNIA	5722	Level 2 Diagnostic Tests and Related Services	1287.0
BLUE SHIELD COVERED CALIFORNIA	5723	Level 3 Diagnostic Tests and Related Services	2842.0
BLUE SHIELD COVERED CALIFORNIA	5724	Level 4 Diagnostic Tests and Related Services	4756.0
BLUE SHIELD COVERED CALIFORNIA	5731	Level 1 Minor Procedures	390.0
BLUE SHIELD COVERED CALIFORNIA	5732	Level 2 Minor Procedures	538.0
BLUE SHIELD COVERED CALIFORNIA	5733	Level 3 Minor Procedures	222.0
BLUE SHIELD COVERED CALIFORNIA	5734	Level 4 Minor Procedures	539.0
BLUE SHIELD COVERED CALIFORNIA	5771	Cardiac Rehabilitation	1176.0
BLUE SHIELD COVERED CALIFORNIA	5791	Pulmonary Treatment	159.0
BLUE SHIELD COVERED CALIFORNIA	N700	Non-OPPS Clinic Services	92.0
BLUE SHIELD COVERED CALIFORNIA	N800	Clinical Diagnostic Lab Services	159.0
BLUE SHIELD COVERED CALIFORNIA	N801	Therapy Services	635.0
BLUE SHIELD COVERED CALIFORNIA	N804	Mammography Services	825.0
BLUE SHIELD COVERED CALIFORNIA	N809	Other Medicine	31.0
BLUE SHIELD COVERED CALIFORNIA	N900	Non-covered Services	43.0
BLUE SHIELD COVERED CALIFORNIA	N902	Packaged Services	4.0
BLUE SHIELD COVERED CALIFORNIA	N905	Not Recognized by OPPS	364.0

Section: Outpatient Payer Specific Charge 9
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD HMO	5021	Level 1 Type A ED Visits	347.0
BLUE SHIELD HMO	5022	Level 2 Type A ED Visits	697.0
BLUE SHIELD HMO	5023	Level 3 Type A ED Visits	1220.0
BLUE SHIELD HMO	5024	Level 4 Type A ED Visits	2943.0
BLUE SHIELD HMO	5025	Level 5 Type A ED Visits	4678.0
BLUE SHIELD HMO	5052	Level 2 Skin Procedures	3063.0
BLUE SHIELD HMO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1489.0
BLUE SHIELD HMO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	6452.0
BLUE SHIELD HMO	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	268.0
BLUE SHIELD HMO	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	3292.0
BLUE SHIELD HMO	5111	Level 1 Musculoskeletal Procedures	844.0
BLUE SHIELD HMO	5113	Level 3 Musculoskeletal Procedures	132.0
BLUE SHIELD HMO	5114	Level 4 Musculoskeletal Procedures	3889.0
BLUE SHIELD HMO	5115	Level 5 Musculoskeletal Procedures	268.0
BLUE SHIELD HMO	5153	Level 3 Airway Endoscopy	6452.0
BLUE SHIELD HMO	5155	Level 5 Airway Endoscopy	5249.0
BLUE SHIELD HMO	5183	Level 3 Vascular Procedures	10366.0
BLUE SHIELD HMO	5241	Level 1 Blood Product Exchange and Related Services	1489.0
BLUE SHIELD HMO	5301	Level 1 Upper GI Procedures	4821.0
BLUE SHIELD HMO	5302	Level 2 Upper GI Procedures	6452.0
BLUE SHIELD HMO	5311	Level 1 Lower GI Procedures	3597.0
BLUE SHIELD HMO	5313	Level 3 Lower GI Procedures	7374.0
BLUE SHIELD HMO	5361	Level 1 Laparoscopy and Related Services	326.0
BLUE SHIELD HMO	5373	Level 3 Urology and Related Services	2941.0
BLUE SHIELD HMO	5374	Level 4 Urology and Related Services	3698.0
BLUE SHIELD HMO	5414	Level 4 Gynecologic Procedures	132.0
BLUE SHIELD HMO	5415	Level 5 Gynecologic Procedures	2476.0
BLUE SHIELD HMO	5441	Level 1 Nerve Injections	1489.0
BLUE SHIELD HMO	5442	Level 2 Nerve Injections	4821.0
BLUE SHIELD HMO	5521	Level 1 Imaging without Contrast	585.0
BLUE SHIELD HMO	5612	Level 2 Therapeutic Radiation Treatment Preparation	7817.0
BLUE SHIELD HMO	5613	Level 3 Therapeutic Radiation Treatment Preparation	54286.0
BLUE SHIELD HMO	5693	Level 3 Drug Administration	944.0
BLUE SHIELD HMO	5722	Level 2 Diagnostic Tests and Related Services	370.0
BLUE SHIELD HMO	5723	Level 3 Diagnostic Tests and Related Services	1229.0
BLUE SHIELD HMO	5731	Level 1 Minor Procedures	404.0
BLUE SHIELD HMO	5733	Level 3 Minor Procedures	581.0
BLUE SHIELD HMO	5734	Level 4 Minor Procedures	450.0
BLUE SHIELD HMO	5791	Pulmonary Treatment	789.0
BLUE SHIELD HMO	N700	Non-OPPS Clinic Services	113.0
BLUE SHIELD HMO	N800	Clinical Diagnostic Lab Services	504.0
BLUE SHIELD HMO	N809	Other Medicine	32.0
BLUE SHIELD HMO	N900	Non-covered Services	44.0
BLUE SHIELD HMO	N902	Packaged Services	33.0

Section: Outpatient Payer Specific Charge 10
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD PPO	5021	Level 1 Type A ED Visits	418.0
BLUE SHIELD PPO	5022	Level 2 Type A ED Visits	840.0
BLUE SHIELD PPO	5023	Level 3 Type A ED Visits	1465.0
BLUE SHIELD PPO	5024	Level 4 Type A ED Visits	3587.0
BLUE SHIELD PPO	5025	Level 5 Type A ED Visits	7191.0
BLUE SHIELD PPO	5051	Level 1 Skin Procedures	1311.0
BLUE SHIELD PPO	5052	Level 2 Skin Procedures	3063.0
BLUE SHIELD PPO	5053	Level 3 Skin Procedures	2505.0
BLUE SHIELD PPO	5061	Hyperbaric Oxygen	27299.0
BLUE SHIELD PPO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1935.0
BLUE SHIELD PPO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	7794.0
BLUE SHIELD PPO	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	1935.0
BLUE SHIELD PPO	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	8986.0
BLUE SHIELD PPO	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	11852.0
BLUE SHIELD PPO	5093	Level 3 Breast/Lymphatic Surgery and Related Procedures	159.0
BLUE SHIELD PPO	5102	Level 2 Strapping and Cast Application	933.0
BLUE SHIELD PPO	5111	Level 1 Musculoskeletal Procedures	918.0
BLUE SHIELD PPO	5112	Level 2 Musculoskeletal Procedures	6316.0
BLUE SHIELD PPO	5113	Level 3 Musculoskeletal Procedures	9585.0
BLUE SHIELD PPO	5114	Level 4 Musculoskeletal Procedures	6267.0
BLUE SHIELD PPO	5115	Level 5 Musculoskeletal Procedures	13274.0
BLUE SHIELD PPO	5151	Level 1 Airway Endoscopy	1935.0
BLUE SHIELD PPO	5155	Level 5 Airway Endoscopy	9585.0
BLUE SHIELD PPO	5161	Level 1 ENT Procedures	4437.0
BLUE SHIELD PPO	5164	Level 4 ENT Procedures	10119.0
BLUE SHIELD PPO	5165	Level 5 ENT Procedures	487.0
BLUE SHIELD PPO	5181	Level 1 Vascular Procedures	6267.0
BLUE SHIELD PPO	5182	Level 2 Vascular Procedures	6267.0
BLUE SHIELD PPO	5183	Level 3 Vascular Procedures	13474.0
BLUE SHIELD PPO	5184	Level 4 Vascular Procedures	6267.0
BLUE SHIELD PPO	5191	Level 1 Endovascular Procedures	18709.0
BLUE SHIELD PPO	5213	Level 3 Electrophysiologic Procedures	18709.0
BLUE SHIELD PPO	5241	Level 1 Blood Product Exchange and Related Services	1935.0
BLUE SHIELD PPO	5301	Level 1 Upper GI Procedures	6267.0
BLUE SHIELD PPO	5302	Level 2 Upper GI Procedures	8387.0
BLUE SHIELD PPO	5311	Level 1 Lower GI Procedures	3739.0
BLUE SHIELD PPO	5313	Level 3 Lower GI Procedures	8986.0
BLUE SHIELD PPO	5341	Abdominal/Peritoneal/Biliary and Related Procedures	3606.0
BLUE SHIELD PPO	5361	Level 1 Laparoscopy and Related Services	9585.0
BLUE SHIELD PPO	5362	Level 2 Laparoscopy and Related Services	159.0
BLUE SHIELD PPO	5373	Level 3 Urology and Related Services	2954.0
BLUE SHIELD PPO	5374	Level 4 Urology and Related Services	4666.0
BLUE SHIELD PPO	5375	Level 5 Urology and Related Services	11852.0
BLUE SHIELD PPO	5414	Level 4 Gynecologic Procedures	6267.0
BLUE SHIELD PPO	5415	Level 5 Gynecologic Procedures	487.0
BLUE SHIELD PPO	5441	Level 1 Nerve Injections	1935.0
BLUE SHIELD PPO	5442	Level 2 Nerve Injections	6267.0
BLUE SHIELD PPO	5504	Level 4 Extraocular, Repair, and Plastic Eye Procedures	6005.0
BLUE SHIELD PPO	5521	Level 1 Imaging without Contrast	685.0
BLUE SHIELD PPO	5522	Level 2 Imaging without Contrast	556.0
BLUE SHIELD PPO	5523	Level 3 Imaging without Contrast	2175.0
BLUE SHIELD PPO	5524	Level 4 Imaging without Contrast	2159.0
BLUE SHIELD PPO	5571	Level 1 Imaging with Contrast	5548.0
BLUE SHIELD PPO	5572	Level 2 Imaging with Contrast	5590.0
BLUE SHIELD PPO	5573	Level 3 Imaging with Contrast	6267.0
BLUE SHIELD PPO	5591	Level 1 Nuclear Medicine and Related Services	2118.0
BLUE SHIELD PPO	5592	Level 2 Nuclear Medicine and Related Services	3295.0
BLUE SHIELD PPO	5593	Level 3 Nuclear Medicine and Related Services	9406.0
BLUE SHIELD PPO	5594	Level 4 Nuclear Medicine and Related Services	12292.0
BLUE SHIELD PPO	5612	Level 2 Therapeutic Radiation Treatment Preparation	21915.0
BLUE SHIELD PPO	5613	Level 3 Therapeutic Radiation Treatment Preparation	36847.0
BLUE SHIELD PPO	5622	Level 2 Radiation Therapy	18501.0
BLUE SHIELD PPO	5623	Level 3 Radiation Therapy	88002.0
BLUE SHIELD PPO	5661	Therapeutic Nuclear Medicine	7083.0
BLUE SHIELD PPO	5672	Level 2 Pathology	1548.0
BLUE SHIELD PPO	5673	Level 3 Pathology	475.0
BLUE SHIELD PPO	5692	Level 2 Drug Administration	1559.0
BLUE SHIELD PPO	5693	Level 3 Drug Administration	3622.0
BLUE SHIELD PPO	5694	Level 4 Drug Administration	7101.0
BLUE SHIELD PPO	5721	Level 1 Diagnostic Tests and Related Services	233.0
BLUE SHIELD PPO	5722	Level 2 Diagnostic Tests and Related Services	1239.0
BLUE SHIELD PPO	5723	Level 3 Diagnostic Tests and Related Services	3991.0
BLUE SHIELD PPO	5724	Level 4 Diagnostic Tests and Related Services	5870.0
BLUE SHIELD PPO	5731	Level 1 Minor Procedures	487.0
BLUE SHIELD PPO	5732	Level 2 Minor Procedures	303.0
BLUE SHIELD PPO	5733	Level 3 Minor Procedures	250.0
BLUE SHIELD PPO	5734	Level 4 Minor Procedures	688.0
BLUE SHIELD PPO	5743	Level 3 Electronic Analysis of Devices	331.0
BLUE SHIELD PPO	5771	Cardiac Rehabilitation	2200.0
BLUE SHIELD PPO	5781	Resuscitation and Cardioversion	8703.0
BLUE SHIELD PPO	5791	Pulmonary Treatment	159.0
BLUE SHIELD PPO	5823	Level 3 Health and Behavior Services	234.0
BLUE SHIELD PPO	N700	Non-OPPS Clinic Services	113.0
BLUE SHIELD PPO	N800	Clinical Diagnostic Lab Services	127.0
BLUE SHIELD PPO	N801	Therapy Services	726.0
BLUE SHIELD PPO	N804	Mammography Services	1018.0
BLUE SHIELD PPO	N809	Other Medicine	38.0
BLUE SHIELD PPO	N900	Non-covered Services	53.0
BLUE SHIELD PPO	N902	Packaged Services	32.0
BLUE SHIELD PPO	N905	Not Recognized by OPPS	454.0

Section: Outpatient Payer Specific Charge 11
Payer	APC	Description	Payer Specific Negotiated Charge
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5021	Level 1 Type A ED Visits	34.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5022	Level 2 Type A ED Visits	68.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5023	Level 3 Type A ED Visits	160.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5024	Level 4 Type A ED Visits	321.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5025	Level 5 Type A ED Visits	565.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5051	Level 1 Skin Procedures	103.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5052	Level 2 Skin Procedures	191.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	144.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5102	Level 2 Strapping and Cast Application	64.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5111	Level 1 Musculoskeletal Procedures	67.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5112	Level 2 Musculoskeletal Procedures	544.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5113	Level 3 Musculoskeletal Procedures	1456.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5151	Level 1 Airway Endoscopy	38.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5191	Level 1 Endovascular Procedures	1875.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5301	Level 1 Upper GI Procedures	1468.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5311	Level 1 Lower GI Procedures	569.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5361	Level 1 Laparoscopy and Related Services	1567.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5374	Level 4 Urology and Related Services	1106.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5491	Level 1 Intraocular Procedures	1277.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5521	Level 1 Imaging without Contrast	53.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5522	Level 2 Imaging without Contrast	158.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5593	Level 3 Nuclear Medicine and Related Services	2788.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5692	Level 2 Drug Administration	29.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5723	Level 3 Diagnostic Tests and Related Services	78.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5731	Level 1 Minor Procedures	35.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5733	Level 3 Minor Procedures	24.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5734	Level 4 Minor Procedures	27.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	5791	Pulmonary Treatment	43.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	N700	Non-OPPS Clinic Services	12.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	N800	Clinical Diagnostic Lab Services	66.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	N801	Therapy Services	102.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	N809	Other Medicine	3.0
CARE FIRST MEDI-CAL/HEALTHY FAMILIES	N902	Packaged Services	94.0

Section: Outpatient Payer Specific Charge 12
Payer	APC	Description	Payer Specific Negotiated Charge
CIGNA	5021	Level 1 Type A ED Visits	310.0
CIGNA	5022	Level 2 Type A ED Visits	623.0
CIGNA	5023	Level 3 Type A ED Visits	1059.0
CIGNA	5024	Level 4 Type A ED Visits	2785.0
CIGNA	5025	Level 5 Type A ED Visits	3959.0
CIGNA	5051	Level 1 Skin Procedures	1024.0
CIGNA	5052	Level 2 Skin Procedures	2877.0
CIGNA	5061	Hyperbaric Oxygen	2231.0
CIGNA	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	2141.0
CIGNA	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	3238.0
CIGNA	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	3238.0
CIGNA	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	3238.0
CIGNA	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	18514.0
CIGNA	5102	Level 2 Strapping and Cast Application	489.0
CIGNA	5111	Level 1 Musculoskeletal Procedures	83.0
CIGNA	5112	Level 2 Musculoskeletal Procedures	3959.0
CIGNA	5113	Level 3 Musculoskeletal Procedures	3956.0
CIGNA	5114	Level 4 Musculoskeletal Procedures	3956.0
CIGNA	5115	Level 5 Musculoskeletal Procedures	8678.0
CIGNA	5154	Level 4 Airway Endoscopy	2877.0
CIGNA	5155	Level 5 Airway Endoscopy	6101.0
CIGNA	5164	Level 4 ENT Procedures	3956.0
CIGNA	5165	Level 5 ENT Procedures	4482.0
CIGNA	5182	Level 2 Vascular Procedures	2141.0
CIGNA	5183	Level 3 Vascular Procedures	3238.0
CIGNA	5184	Level 4 Vascular Procedures	3956.0
CIGNA	5191	Level 1 Endovascular Procedures	14033.0
CIGNA	5301	Level 1 Upper GI Procedures	2877.0
CIGNA	5302	Level 2 Upper GI Procedures	2877.0
CIGNA	5312	Level 2 Lower GI Procedures	2877.0
CIGNA	5313	Level 3 Lower GI Procedures	3238.0
CIGNA	5341	Abdominal/Peritoneal/Biliary and Related Procedures	3956.0
CIGNA	5361	Level 1 Laparoscopy and Related Services	3956.0
CIGNA	5362	Level 2 Laparoscopy and Related Services	4482.0
CIGNA	5373	Level 3 Urology and Related Services	2877.0
CIGNA	5374	Level 4 Urology and Related Services	3058.0
CIGNA	5375	Level 5 Urology and Related Services	3956.0
CIGNA	5414	Level 4 Gynecologic Procedures	2877.0
CIGNA	5415	Level 5 Gynecologic Procedures	4664.0
CIGNA	5441	Level 1 Nerve Injections	2141.0
CIGNA	5442	Level 2 Nerve Injections	3212.0
CIGNA	5521	Level 1 Imaging without Contrast	667.0
CIGNA	5522	Level 2 Imaging without Contrast	449.0
CIGNA	5523	Level 3 Imaging without Contrast	949.0
CIGNA	5524	Level 4 Imaging without Contrast	1268.0
CIGNA	5571	Level 1 Imaging with Contrast	1070.0
CIGNA	5572	Level 2 Imaging with Contrast	1567.0
CIGNA	5591	Level 1 Nuclear Medicine and Related Services	1693.0
CIGNA	5592	Level 2 Nuclear Medicine and Related Services	2626.0
CIGNA	5593	Level 3 Nuclear Medicine and Related Services	7408.0
CIGNA	5594	Level 4 Nuclear Medicine and Related Services	6299.0
CIGNA	5612	Level 2 Therapeutic Radiation Treatment Preparation	4280.0
CIGNA	5622	Level 2 Radiation Therapy	2642.0
CIGNA	5623	Level 3 Radiation Therapy	4742.0
CIGNA	5672	Level 2 Pathology	248.0
CIGNA	5673	Level 3 Pathology	619.0
CIGNA	5692	Level 2 Drug Administration	258.0
CIGNA	5693	Level 3 Drug Administration	562.0
CIGNA	5694	Level 4 Drug Administration	16246.0
CIGNA	5721	Level 1 Diagnostic Tests and Related Services	137.0
CIGNA	5722	Level 2 Diagnostic Tests and Related Services	1132.0
CIGNA	5723	Level 3 Diagnostic Tests and Related Services	3540.0
CIGNA	5724	Level 4 Diagnostic Tests and Related Services	4818.0
CIGNA	5731	Level 1 Minor Procedures	240.0
CIGNA	5733	Level 3 Minor Procedures	334.0
CIGNA	5734	Level 4 Minor Procedures	347.0
CIGNA	5771	Cardiac Rehabilitation	1310.0
CIGNA	5791	Pulmonary Treatment	297.0
CIGNA	5823	Level 3 Health and Behavior Services	172.0
CIGNA	N700	Non-OPPS Clinic Services	105.0
CIGNA	N800	Clinical Diagnostic Lab Services	71.0
CIGNA	N801	Therapy Services	594.0
CIGNA	N804	Mammography Services	485.0
CIGNA	N809	Other Medicine	28.0
CIGNA	N900	Non-covered Services	39.0
CIGNA	N902	Packaged Services	10.0
CIGNA	N905	Not Recognized by OPPS	334.0

Section: Outpatient Payer Specific Charge 13
Payer	APC	Description	Payer Specific Negotiated Charge
DIGNITY HEALTH MEDI-CAL	5021	Level 1 Type A ED Visits	20.0
DIGNITY HEALTH MEDI-CAL	5022	Level 2 Type A ED Visits	40.0
DIGNITY HEALTH MEDI-CAL	5023	Level 3 Type A ED Visits	94.0
DIGNITY HEALTH MEDI-CAL	5024	Level 4 Type A ED Visits	201.0
DIGNITY HEALTH MEDI-CAL	5025	Level 5 Type A ED Visits	339.0
DIGNITY HEALTH MEDI-CAL	5051	Level 1 Skin Procedures	62.0
DIGNITY HEALTH MEDI-CAL	5052	Level 2 Skin Procedures	112.0
DIGNITY HEALTH MEDI-CAL	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	153.0
DIGNITY HEALTH MEDI-CAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	91.0
DIGNITY HEALTH MEDI-CAL	5102	Level 2 Strapping and Cast Application	38.0
DIGNITY HEALTH MEDI-CAL	5111	Level 1 Musculoskeletal Procedures	59.0
DIGNITY HEALTH MEDI-CAL	5112	Level 2 Musculoskeletal Procedures	334.0
DIGNITY HEALTH MEDI-CAL	5151	Level 1 Airway Endoscopy	21.0
DIGNITY HEALTH MEDI-CAL	5311	Level 1 Lower GI Procedures	163.0
DIGNITY HEALTH MEDI-CAL	5374	Level 4 Urology and Related Services	815.0
DIGNITY HEALTH MEDI-CAL	5521	Level 1 Imaging without Contrast	27.0
DIGNITY HEALTH MEDI-CAL	5522	Level 2 Imaging without Contrast	187.0
DIGNITY HEALTH MEDI-CAL	5573	Level 3 Imaging with Contrast	1089.0
DIGNITY HEALTH MEDI-CAL	5593	Level 3 Nuclear Medicine and Related Services	1517.0
DIGNITY HEALTH MEDI-CAL	5692	Level 2 Drug Administration	41.0
DIGNITY HEALTH MEDI-CAL	5723	Level 3 Diagnostic Tests and Related Services	242.0
DIGNITY HEALTH MEDI-CAL	5731	Level 1 Minor Procedures	32.0
DIGNITY HEALTH MEDI-CAL	5733	Level 3 Minor Procedures	14.0
DIGNITY HEALTH MEDI-CAL	5734	Level 4 Minor Procedures	52.0
DIGNITY HEALTH MEDI-CAL	5791	Pulmonary Treatment	63.0
DIGNITY HEALTH MEDI-CAL	N800	Clinical Diagnostic Lab Services	32.0

Section: Outpatient Payer Specific Charge 14
Payer	APC	Description	Payer Specific Negotiated Charge
EASY CHOICE SENIOR	5021	Level 1 Type A ED Visits	91.0
EASY CHOICE SENIOR	5022	Level 2 Type A ED Visits	165.0
EASY CHOICE SENIOR	5023	Level 3 Type A ED Visits	291.0
EASY CHOICE SENIOR	5024	Level 4 Type A ED Visits	600.0
EASY CHOICE SENIOR	5025	Level 5 Type A ED Visits	1066.0
EASY CHOICE SENIOR	5052	Level 2 Skin Procedures	434.0
EASY CHOICE SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1878.0
EASY CHOICE SENIOR	5115	Level 5 Musculoskeletal Procedures	15597.0
EASY CHOICE SENIOR	5184	Level 4 Vascular Procedures	5992.0
EASY CHOICE SENIOR	5193	Level 3 Endovascular Procedures	12617.0
EASY CHOICE SENIOR	5301	Level 1 Upper GI Procedures	1126.0
EASY CHOICE SENIOR	5401	Dialysis	2396.0
EASY CHOICE SENIOR	5491	Level 1 Intraocular Procedures	2611.0
EASY CHOICE SENIOR	5521	Level 1 Imaging without Contrast	102.0
EASY CHOICE SENIOR	5522	Level 2 Imaging without Contrast	191.0
EASY CHOICE SENIOR	5571	Level 1 Imaging with Contrast	332.0
EASY CHOICE SENIOR	5593	Level 3 Nuclear Medicine and Related Services	3111.0
EASY CHOICE SENIOR	5672	Level 2 Pathology	187.0
EASY CHOICE SENIOR	5731	Level 1 Minor Procedures	110.0
EASY CHOICE SENIOR	5733	Level 3 Minor Procedures	70.0
EASY CHOICE SENIOR	N800	Clinical Diagnostic Lab Services	30.0
EASY CHOICE SENIOR	N801	Therapy Services	802.0

Section: Outpatient Payer Specific Charge 15
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTH NET MEDI-CAL	5021	Level 1 Type A ED Visits	28.0
HEALTH NET MEDI-CAL	5022	Level 2 Type A ED Visits	57.0
HEALTH NET MEDI-CAL	5023	Level 3 Type A ED Visits	132.0
HEALTH NET MEDI-CAL	5024	Level 4 Type A ED Visits	264.0
HEALTH NET MEDI-CAL	5025	Level 5 Type A ED Visits	461.0
HEALTH NET MEDI-CAL	5051	Level 1 Skin Procedures	84.0
HEALTH NET MEDI-CAL	5052	Level 2 Skin Procedures	191.0
HEALTH NET MEDI-CAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	140.0
HEALTH NET MEDI-CAL	5102	Level 2 Strapping and Cast Application	20.0
HEALTH NET MEDI-CAL	5111	Level 1 Musculoskeletal Procedures	56.0
HEALTH NET MEDI-CAL	5112	Level 2 Musculoskeletal Procedures	455.0
HEALTH NET MEDI-CAL	5114	Level 4 Musculoskeletal Procedures	1682.0
HEALTH NET MEDI-CAL	5182	Level 2 Vascular Procedures	453.0
HEALTH NET MEDI-CAL	5241	Level 1 Blood Product Exchange and Related Services	232.0
HEALTH NET MEDI-CAL	5301	Level 1 Upper GI Procedures	338.0
HEALTH NET MEDI-CAL	5311	Level 1 Lower GI Procedures	235.0
HEALTH NET MEDI-CAL	5374	Level 4 Urology and Related Services	1123.0
HEALTH NET MEDI-CAL	5521	Level 1 Imaging without Contrast	69.0
HEALTH NET MEDI-CAL	5522	Level 2 Imaging without Contrast	234.0
HEALTH NET MEDI-CAL	5692	Level 2 Drug Administration	21.0
HEALTH NET MEDI-CAL	5693	Level 3 Drug Administration	96.0
HEALTH NET MEDI-CAL	5723	Level 3 Diagnostic Tests and Related Services	83.0
HEALTH NET MEDI-CAL	5731	Level 1 Minor Procedures	29.0
HEALTH NET MEDI-CAL	5733	Level 3 Minor Procedures	32.0
HEALTH NET MEDI-CAL	5734	Level 4 Minor Procedures	47.0
HEALTH NET MEDI-CAL	5743	Level 3 Electronic Analysis of Devices	543.0
HEALTH NET MEDI-CAL	5791	Pulmonary Treatment	80.0
HEALTH NET MEDI-CAL	N700	Non-OPPS Clinic Services	10.0
HEALTH NET MEDI-CAL	N800	Clinical Diagnostic Lab Services	48.0
HEALTH NET MEDI-CAL	N804	Mammography Services	59.0
HEALTH NET MEDI-CAL	N809	Other Medicine	3.0

Section: Outpatient Payer Specific Charge 16
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTH NET SELECT HEALTH MEDI-CAL	5021	Level 1 Type A ED Visits	47.0
HEALTH NET SELECT HEALTH MEDI-CAL	5022	Level 2 Type A ED Visits	94.0
HEALTH NET SELECT HEALTH MEDI-CAL	5023	Level 3 Type A ED Visits	219.0
HEALTH NET SELECT HEALTH MEDI-CAL	5024	Level 4 Type A ED Visits	466.0
HEALTH NET SELECT HEALTH MEDI-CAL	5025	Level 5 Type A ED Visits	764.0
HEALTH NET SELECT HEALTH MEDI-CAL	5051	Level 1 Skin Procedures	142.0
HEALTH NET SELECT HEALTH MEDI-CAL	5052	Level 2 Skin Procedures	344.0
HEALTH NET SELECT HEALTH MEDI-CAL	5053	Level 3 Skin Procedures	419.0
HEALTH NET SELECT HEALTH MEDI-CAL	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	393.0
HEALTH NET SELECT HEALTH MEDI-CAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	226.0
HEALTH NET SELECT HEALTH MEDI-CAL	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	1750.0
HEALTH NET SELECT HEALTH MEDI-CAL	5101	Level 1 Strapping and Cast Application	116.0
HEALTH NET SELECT HEALTH MEDI-CAL	5102	Level 2 Strapping and Cast Application	62.0
HEALTH NET SELECT HEALTH MEDI-CAL	5111	Level 1 Musculoskeletal Procedures	127.0
HEALTH NET SELECT HEALTH MEDI-CAL	5112	Level 2 Musculoskeletal Procedures	1338.0
HEALTH NET SELECT HEALTH MEDI-CAL	5113	Level 3 Musculoskeletal Procedures	2166.0
HEALTH NET SELECT HEALTH MEDI-CAL	5114	Level 4 Musculoskeletal Procedures	4969.0
HEALTH NET SELECT HEALTH MEDI-CAL	5115	Level 5 Musculoskeletal Procedures	5867.0
HEALTH NET SELECT HEALTH MEDI-CAL	5151	Level 1 Airway Endoscopy	52.0
HEALTH NET SELECT HEALTH MEDI-CAL	5182	Level 2 Vascular Procedures	797.0
HEALTH NET SELECT HEALTH MEDI-CAL	5183	Level 3 Vascular Procedures	1544.0
HEALTH NET SELECT HEALTH MEDI-CAL	5191	Level 1 Endovascular Procedures	2621.0
HEALTH NET SELECT HEALTH MEDI-CAL	5241	Level 1 Blood Product Exchange and Related Services	360.0
HEALTH NET SELECT HEALTH MEDI-CAL	5301	Level 1 Upper GI Procedures	732.0
HEALTH NET SELECT HEALTH MEDI-CAL	5302	Level 2 Upper GI Procedures	1227.0
HEALTH NET SELECT HEALTH MEDI-CAL	5311	Level 1 Lower GI Procedures	1221.0
HEALTH NET SELECT HEALTH MEDI-CAL	5331	Complex GI Procedures	2456.0
HEALTH NET SELECT HEALTH MEDI-CAL	5361	Level 1 Laparoscopy and Related Services	2907.0
HEALTH NET SELECT HEALTH MEDI-CAL	5371	Level 1 Urology and Related Services	33.0
HEALTH NET SELECT HEALTH MEDI-CAL	5372	Level 2 Urology and Related Services	163.0
HEALTH NET SELECT HEALTH MEDI-CAL	5373	Level 3 Urology and Related Services	255.0
HEALTH NET SELECT HEALTH MEDI-CAL	5401	Dialysis	2498.0
HEALTH NET SELECT HEALTH MEDI-CAL	5431	Level 1 Nerve Procedures	1550.0
HEALTH NET SELECT HEALTH MEDI-CAL	5442	Level 2 Nerve Injections	2025.0
HEALTH NET SELECT HEALTH MEDI-CAL	5521	Level 1 Imaging without Contrast	123.0
HEALTH NET SELECT HEALTH MEDI-CAL	5522	Level 2 Imaging without Contrast	295.0
HEALTH NET SELECT HEALTH MEDI-CAL	5523	Level 3 Imaging without Contrast	234.0
HEALTH NET SELECT HEALTH MEDI-CAL	5593	Level 3 Nuclear Medicine and Related Services	2699.0
HEALTH NET SELECT HEALTH MEDI-CAL	5612	Level 2 Therapeutic Radiation Treatment Preparation	4434.0
HEALTH NET SELECT HEALTH MEDI-CAL	5613	Level 3 Therapeutic Radiation Treatment Preparation	4873.0
HEALTH NET SELECT HEALTH MEDI-CAL	5622	Level 2 Radiation Therapy	4300.0
HEALTH NET SELECT HEALTH MEDI-CAL	5623	Level 3 Radiation Therapy	10345.0
HEALTH NET SELECT HEALTH MEDI-CAL	5692	Level 2 Drug Administration	142.0
HEALTH NET SELECT HEALTH MEDI-CAL	5693	Level 3 Drug Administration	122.0
HEALTH NET SELECT HEALTH MEDI-CAL	5694	Level 4 Drug Administration	254.0
HEALTH NET SELECT HEALTH MEDI-CAL	5724	Level 4 Diagnostic Tests and Related Services	559.0
HEALTH NET SELECT HEALTH MEDI-CAL	5731	Level 1 Minor Procedures	23.0
HEALTH NET SELECT HEALTH MEDI-CAL	5733	Level 3 Minor Procedures	34.0
HEALTH NET SELECT HEALTH MEDI-CAL	5734	Level 4 Minor Procedures	42.0
HEALTH NET SELECT HEALTH MEDI-CAL	5743	Level 3 Electronic Analysis of Devices	901.0
HEALTH NET SELECT HEALTH MEDI-CAL	5791	Pulmonary Treatment	129.0
HEALTH NET SELECT HEALTH MEDI-CAL	N700	Non-OPPS Clinic Services	39.0
HEALTH NET SELECT HEALTH MEDI-CAL	N800	Clinical Diagnostic Lab Services	62.0
HEALTH NET SELECT HEALTH MEDI-CAL	N809	Other Medicine	4.0
HEALTH NET SELECT HEALTH MEDI-CAL	N902	Packaged Services	28.0

Section: Outpatient Payer Specific Charge 17
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTHCARE PARTNERS COMMERCIAL	5021	Level 1 Type A ED Visits	180.0
HEALTHCARE PARTNERS COMMERCIAL	5022	Level 2 Type A ED Visits	325.0
HEALTHCARE PARTNERS COMMERCIAL	5023	Level 3 Type A ED Visits	573.0
HEALTHCARE PARTNERS COMMERCIAL	5024	Level 4 Type A ED Visits	1170.0
HEALTHCARE PARTNERS COMMERCIAL	5025	Level 5 Type A ED Visits	2167.0
HEALTHCARE PARTNERS COMMERCIAL	5051	Level 1 Skin Procedures	325.0
HEALTHCARE PARTNERS COMMERCIAL	5052	Level 2 Skin Procedures	1428.0
HEALTHCARE PARTNERS COMMERCIAL	5061	Hyperbaric Oxygen	5329.0
HEALTHCARE PARTNERS COMMERCIAL	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1540.0
HEALTHCARE PARTNERS COMMERCIAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	3482.0
HEALTHCARE PARTNERS COMMERCIAL	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	5878.0
HEALTHCARE PARTNERS COMMERCIAL	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	7823.0
HEALTHCARE PARTNERS COMMERCIAL	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	13696.0
HEALTHCARE PARTNERS COMMERCIAL	5102	Level 2 Strapping and Cast Application	597.0
HEALTHCARE PARTNERS COMMERCIAL	5111	Level 1 Musculoskeletal Procedures	510.0
HEALTHCARE PARTNERS COMMERCIAL	5112	Level 2 Musculoskeletal Procedures	3447.0
HEALTHCARE PARTNERS COMMERCIAL	5113	Level 3 Musculoskeletal Procedures	7008.0
HEALTHCARE PARTNERS COMMERCIAL	5114	Level 4 Musculoskeletal Procedures	15501.0
HEALTHCARE PARTNERS COMMERCIAL	5115	Level 5 Musculoskeletal Procedures	30748.0
HEALTHCARE PARTNERS COMMERCIAL	5154	Level 4 Airway Endoscopy	7666.0
HEALTHCARE PARTNERS COMMERCIAL	5164	Level 4 ENT Procedures	6770.0
HEALTHCARE PARTNERS COMMERCIAL	5165	Level 5 ENT Procedures	12586.0
HEALTHCARE PARTNERS COMMERCIAL	5182	Level 2 Vascular Procedures	3480.0
HEALTHCARE PARTNERS COMMERCIAL	5183	Level 3 Vascular Procedures	7084.0
HEALTHCARE PARTNERS COMMERCIAL	5184	Level 4 Vascular Procedures	11801.0
HEALTHCARE PARTNERS COMMERCIAL	5191	Level 1 Endovascular Procedures	7180.0
HEALTHCARE PARTNERS COMMERCIAL	5193	Level 3 Endovascular Procedures	24885.0
HEALTHCARE PARTNERS COMMERCIAL	5194	Level 4 Endovascular Procedures	39744.0
HEALTHCARE PARTNERS COMMERCIAL	5213	Level 3 Electrophysiologic Procedures	53104.0
HEALTHCARE PARTNERS COMMERCIAL	5241	Level 1 Blood Product Exchange and Related Services	2269.0
HEALTHCARE PARTNERS COMMERCIAL	5301	Level 1 Upper GI Procedures	2757.0
HEALTHCARE PARTNERS COMMERCIAL	5312	Level 2 Lower GI Procedures	3567.0
HEALTHCARE PARTNERS COMMERCIAL	5313	Level 3 Lower GI Procedures	6046.0
HEALTHCARE PARTNERS COMMERCIAL	5361	Level 1 Laparoscopy and Related Services	12522.0
HEALTHCARE PARTNERS COMMERCIAL	5362	Level 2 Laparoscopy and Related Services	22046.0
HEALTHCARE PARTNERS COMMERCIAL	5373	Level 3 Urology and Related Services	4431.0
HEALTHCARE PARTNERS COMMERCIAL	5374	Level 4 Urology and Related Services	7609.0
HEALTHCARE PARTNERS COMMERCIAL	5375	Level 5 Urology and Related Services	10918.0
HEALTHCARE PARTNERS COMMERCIAL	5414	Level 4 Gynecologic Procedures	6493.0
HEALTHCARE PARTNERS COMMERCIAL	5415	Level 5 Gynecologic Procedures	10912.0
HEALTHCARE PARTNERS COMMERCIAL	5441	Level 1 Nerve Injections	647.0
HEALTHCARE PARTNERS COMMERCIAL	5442	Level 2 Nerve Injections	4111.0
HEALTHCARE PARTNERS COMMERCIAL	5492	Level 2 Intraocular Procedures	9691.0
HEALTHCARE PARTNERS COMMERCIAL	5521	Level 1 Imaging without Contrast	200.0
HEALTHCARE PARTNERS COMMERCIAL	5522	Level 2 Imaging without Contrast	269.0
HEALTHCARE PARTNERS COMMERCIAL	5523	Level 3 Imaging without Contrast	569.0
HEALTHCARE PARTNERS COMMERCIAL	5524	Level 4 Imaging without Contrast	1196.0
HEALTHCARE PARTNERS COMMERCIAL	5571	Level 1 Imaging with Contrast	442.0
HEALTHCARE PARTNERS COMMERCIAL	5572	Level 2 Imaging with Contrast	911.0
HEALTHCARE PARTNERS COMMERCIAL	5573	Level 3 Imaging with Contrast	4681.0
HEALTHCARE PARTNERS COMMERCIAL	5591	Level 1 Nuclear Medicine and Related Services	933.0
HEALTHCARE PARTNERS COMMERCIAL	5592	Level 2 Nuclear Medicine and Related Services	1211.0
HEALTHCARE PARTNERS COMMERCIAL	5593	Level 3 Nuclear Medicine and Related Services	5357.0
HEALTHCARE PARTNERS COMMERCIAL	5594	Level 4 Nuclear Medicine and Related Services	3663.0
HEALTHCARE PARTNERS COMMERCIAL	5613	Level 3 Therapeutic Radiation Treatment Preparation	13827.0
HEALTHCARE PARTNERS COMMERCIAL	5623	Level 3 Radiation Therapy	20054.0
HEALTHCARE PARTNERS COMMERCIAL	5661	Therapeutic Nuclear Medicine	4666.0
HEALTHCARE PARTNERS COMMERCIAL	5672	Level 2 Pathology	372.0
HEALTHCARE PARTNERS COMMERCIAL	5673	Level 3 Pathology	806.0
HEALTHCARE PARTNERS COMMERCIAL	5692	Level 2 Drug Administration	3426.0
HEALTHCARE PARTNERS COMMERCIAL	5693	Level 3 Drug Administration	506.0
HEALTHCARE PARTNERS COMMERCIAL	5694	Level 4 Drug Administration	1398.0
HEALTHCARE PARTNERS COMMERCIAL	5721	Level 1 Diagnostic Tests and Related Services	346.0
HEALTHCARE PARTNERS COMMERCIAL	5722	Level 2 Diagnostic Tests and Related Services	655.0
HEALTHCARE PARTNERS COMMERCIAL	5723	Level 3 Diagnostic Tests and Related Services	1863.0
HEALTHCARE PARTNERS COMMERCIAL	5724	Level 4 Diagnostic Tests and Related Services	2277.0
HEALTHCARE PARTNERS COMMERCIAL	5731	Level 1 Minor Procedures	356.0
HEALTHCARE PARTNERS COMMERCIAL	5732	Level 2 Minor Procedures	84.0
HEALTHCARE PARTNERS COMMERCIAL	5733	Level 3 Minor Procedures	138.0
HEALTHCARE PARTNERS COMMERCIAL	5734	Level 4 Minor Procedures	279.0
HEALTHCARE PARTNERS COMMERCIAL	5771	Cardiac Rehabilitation	1436.0
HEALTHCARE PARTNERS COMMERCIAL	5781	Resuscitation and Cardioversion	1474.0
HEALTHCARE PARTNERS COMMERCIAL	5791	Pulmonary Treatment	465.0
HEALTHCARE PARTNERS COMMERCIAL	N700	Non-OPPS Clinic Services	53.0
HEALTHCARE PARTNERS COMMERCIAL	N800	Clinical Diagnostic Lab Services	21.0
HEALTHCARE PARTNERS COMMERCIAL	N801	Therapy Services	704.0
HEALTHCARE PARTNERS COMMERCIAL	N804	Mammography Services	291.0
HEALTHCARE PARTNERS COMMERCIAL	N905	Not Recognized by OPPS	85.0

Section: Outpatient Payer Specific Charge 18
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5021	Level 1 Type A ED Visits	87.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5022	Level 2 Type A ED Visits	157.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5023	Level 3 Type A ED Visits	277.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5024	Level 4 Type A ED Visits	565.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5025	Level 5 Type A ED Visits	1112.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5051	Level 1 Skin Procedures	157.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5052	Level 2 Skin Procedures	413.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5053	Level 3 Skin Procedures	884.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5054	Level 4 Skin Procedures	2274.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5061	Hyperbaric Oxygen	2572.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	756.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1688.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	2842.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	6616.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5092	Level 2 Breast/Lymphatic Surgery and Related Procedures	6616.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5113	Level 3 Musculoskeletal Procedures	3386.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5114	Level 4 Musculoskeletal Procedures	7488.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5115	Level 5 Musculoskeletal Procedures	14854.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5153	Level 3 Airway Endoscopy	2748.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5154	Level 4 Airway Endoscopy	3703.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5165	Level 5 ENT Procedures	6080.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5181	Level 1 Vascular Procedures	745.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5182	Level 2 Vascular Procedures	1681.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5183	Level 3 Vascular Procedures	3426.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5184	Level 4 Vascular Procedures	5705.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5191	Level 1 Endovascular Procedures	3471.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5192	Level 2 Endovascular Procedures	5929.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5193	Level 3 Endovascular Procedures	12012.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5213	Level 3 Electrophysiologic Procedures	25654.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5223	Level 3 Pacemaker and Similar Procedures	12431.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5241	Level 1 Blood Product Exchange and Related Services	859.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5301	Level 1 Upper GI Procedures	1072.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5302	Level 2 Upper GI Procedures	1942.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5303	Level 3 Upper GI Procedures	3671.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5311	Level 1 Lower GI Procedures	1186.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5312	Level 2 Lower GI Procedures	1984.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5313	Level 3 Lower GI Procedures	2921.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5331	Complex GI Procedures	6018.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5341	Abdominal/Peritoneal/Biliary and Related Procedures	3804.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5361	Level 1 Laparoscopy and Related Services	6057.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5362	Level 2 Laparoscopy and Related Services	10648.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5373	Level 3 Urology and Related Services	2141.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5375	Level 5 Urology and Related Services	5278.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5401	Dialysis	2539.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5414	Level 4 Gynecologic Procedures	3137.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5415	Level 5 Gynecologic Procedures	5272.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5416	Level 6 Gynecologic Procedures	4058.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5441	Level 1 Nerve Injections	312.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5442	Level 2 Nerve Injections	759.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5492	Level 2 Intraocular Procedures	4686.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5521	Level 1 Imaging without Contrast	97.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5522	Level 2 Imaging without Contrast	130.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5523	Level 3 Imaging without Contrast	275.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5524	Level 4 Imaging without Contrast	578.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5571	Level 1 Imaging with Contrast	214.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5572	Level 2 Imaging with Contrast	440.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5573	Level 3 Imaging with Contrast	2279.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5591	Level 1 Nuclear Medicine and Related Services	451.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5592	Level 2 Nuclear Medicine and Related Services	585.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5593	Level 3 Nuclear Medicine and Related Services	2745.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5594	Level 4 Nuclear Medicine and Related Services	1769.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5612	Level 2 Therapeutic Radiation Treatment Preparation	3577.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5613	Level 3 Therapeutic Radiation Treatment Preparation	7430.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5623	Level 3 Radiation Therapy	6790.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5661	Therapeutic Nuclear Medicine	28983.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5672	Level 2 Pathology	148.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5673	Level 3 Pathology	348.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5674	Level 4 Pathology	771.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5692	Level 2 Drug Administration	74.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5693	Level 3 Drug Administration	418.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5694	Level 4 Drug Administration	10932.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5721	Level 1 Diagnostic Tests and Related Services	167.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5722	Level 2 Diagnostic Tests and Related Services	316.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5723	Level 3 Diagnostic Tests and Related Services	584.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5724	Level 4 Diagnostic Tests and Related Services	1100.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5731	Level 1 Minor Procedures	105.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5732	Level 2 Minor Procedures	40.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5733	Level 3 Minor Procedures	67.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5734	Level 4 Minor Procedures	135.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5771	Cardiac Rehabilitation	902.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	5781	Resuscitation and Cardioversion	672.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	9397	Covid-19 Vaccine Admin Dose 1 of 2	47.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	9398	Covid-19 Vaccine Admin Dose 2 of 2, Single Dose Product or Additional Dose	47.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	N700	Non-OPPS Clinic Services	23.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	N800	Clinical Diagnostic Lab Services	28.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	N801	Therapy Services	486.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	N804	Mammography Services	141.0
HEALTHCARE PARTNERS SENIOR/DUAL ELIGIBLE	N905	Not Recognized by OPPS	37.0

Section: Outpatient Payer Specific Charge 19
Payer	APC	Description	Payer Specific Negotiated Charge
KAISER COMMERCIAL NON-CONTRACTED	5021	Level 1 Type A ED Visits	600.0
KAISER COMMERCIAL NON-CONTRACTED	5022	Level 2 Type A ED Visits	1206.0
KAISER COMMERCIAL NON-CONTRACTED	5023	Level 3 Type A ED Visits	2022.0
KAISER COMMERCIAL NON-CONTRACTED	5024	Level 4 Type A ED Visits	5347.0
KAISER COMMERCIAL NON-CONTRACTED	5025	Level 5 Type A ED Visits	10311.0
KAISER COMMERCIAL NON-CONTRACTED	5051	Level 1 Skin Procedures	1871.0
KAISER COMMERCIAL NON-CONTRACTED	5052	Level 2 Skin Procedures	3375.0
KAISER COMMERCIAL NON-CONTRACTED	5112	Level 2 Musculoskeletal Procedures	10553.0
KAISER COMMERCIAL NON-CONTRACTED	5521	Level 1 Imaging without Contrast	1267.0
KAISER COMMERCIAL NON-CONTRACTED	5522	Level 2 Imaging without Contrast	4671.0
KAISER COMMERCIAL NON-CONTRACTED	5572	Level 2 Imaging with Contrast	10838.0
KAISER COMMERCIAL NON-CONTRACTED	5692	Level 2 Drug Administration	1156.0
KAISER COMMERCIAL NON-CONTRACTED	5693	Level 3 Drug Administration	34460.0
KAISER COMMERCIAL NON-CONTRACTED	5731	Level 1 Minor Procedures	1083.0
KAISER COMMERCIAL NON-CONTRACTED	5733	Level 3 Minor Procedures	1761.0
KAISER COMMERCIAL NON-CONTRACTED	5791	Pulmonary Treatment	1409.0
KAISER COMMERCIAL NON-CONTRACTED	N800	Clinical Diagnostic Lab Services	904.0
KAISER COMMERCIAL NON-CONTRACTED	N801	Therapy Services	2101.0
KAISER COMMERCIAL NON-CONTRACTED	N804	Mammography Services	1167.0
KAISER COMMERCIAL NON-CONTRACTED	N900	Non-covered Services	76.0

Section: Outpatient Payer Specific Charge 20
Payer	APC	Description	Payer Specific Negotiated Charge
KAISER SENIOR NON-CONTRACTED	5021	Level 1 Type A ED Visits	87.0
KAISER SENIOR NON-CONTRACTED	5022	Level 2 Type A ED Visits	157.0
KAISER SENIOR NON-CONTRACTED	5023	Level 3 Type A ED Visits	277.0
KAISER SENIOR NON-CONTRACTED	5024	Level 4 Type A ED Visits	565.0
KAISER SENIOR NON-CONTRACTED	5025	Level 5 Type A ED Visits	1118.0
KAISER SENIOR NON-CONTRACTED	5733	Level 3 Minor Procedures	69.0

Section: Outpatient Payer Specific Charge 21
Payer	APC	Description	Payer Specific Negotiated Charge
LA CARE MEDI-CAL/HEALTHY FAMILY	5021	Level 1 Type A ED Visits	45.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5022	Level 2 Type A ED Visits	91.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5023	Level 3 Type A ED Visits	212.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5024	Level 4 Type A ED Visits	426.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5025	Level 5 Type A ED Visits	742.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5051	Level 1 Skin Procedures	137.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5052	Level 2 Skin Procedures	366.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5053	Level 3 Skin Procedures	517.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	345.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	461.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	1582.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5101	Level 1 Strapping and Cast Application	64.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5102	Level 2 Strapping and Cast Application	103.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5111	Level 1 Musculoskeletal Procedures	99.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5112	Level 2 Musculoskeletal Procedures	774.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5113	Level 3 Musculoskeletal Procedures	2273.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5114	Level 4 Musculoskeletal Procedures	3453.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5115	Level 5 Musculoskeletal Procedures	5711.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5151	Level 1 Airway Endoscopy	51.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5162	Level 2 ENT Procedures	182.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5165	Level 5 ENT Procedures	2508.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5182	Level 2 Vascular Procedures	730.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5183	Level 3 Vascular Procedures	1462.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5191	Level 1 Endovascular Procedures	2893.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5193	Level 3 Endovascular Procedures	5574.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5241	Level 1 Blood Product Exchange and Related Services	408.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5301	Level 1 Upper GI Procedures	457.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5302	Level 2 Upper GI Procedures	1264.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5311	Level 1 Lower GI Procedures	346.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5313	Level 3 Lower GI Procedures	2238.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5341	Abdominal/Peritoneal/Biliary and Related Procedures	3292.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5361	Level 1 Laparoscopy and Related Services	2530.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5371	Level 1 Urology and Related Services	32.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5372	Level 2 Urology and Related Services	177.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5373	Level 3 Urology and Related Services	618.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5374	Level 4 Urology and Related Services	1651.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5401	Dialysis	2320.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5412	Level 2 Gynecologic Procedures	219.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5414	Level 4 Gynecologic Procedures	1512.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5431	Level 1 Nerve Procedures	1548.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5441	Level 1 Nerve Injections	295.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5442	Level 2 Nerve Injections	577.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5491	Level 1 Intraocular Procedures	1892.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5492	Level 2 Intraocular Procedures	2242.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5521	Level 1 Imaging without Contrast	130.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5522	Level 2 Imaging without Contrast	304.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5523	Level 3 Imaging without Contrast	927.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5571	Level 1 Imaging with Contrast	515.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5572	Level 2 Imaging with Contrast	674.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5573	Level 3 Imaging with Contrast	2467.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5593	Level 3 Nuclear Medicine and Related Services	3496.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5692	Level 2 Drug Administration	24.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5693	Level 3 Drug Administration	237.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5694	Level 4 Drug Administration	338.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5721	Level 1 Diagnostic Tests and Related Services	35.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5722	Level 2 Diagnostic Tests and Related Services	283.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5723	Level 3 Diagnostic Tests and Related Services	329.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5724	Level 4 Diagnostic Tests and Related Services	547.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5731	Level 1 Minor Procedures	22.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5733	Level 3 Minor Procedures	50.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5734	Level 4 Minor Procedures	24.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5743	Level 3 Electronic Analysis of Devices	667.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5781	Resuscitation and Cardioversion	917.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5791	Pulmonary Treatment	132.0
LA CARE MEDI-CAL/HEALTHY FAMILY	5801	Ventilation Initiation and Management	1156.0
LA CARE MEDI-CAL/HEALTHY FAMILY	N700	Non-OPPS Clinic Services	16.0
LA CARE MEDI-CAL/HEALTHY FAMILY	N800	Clinical Diagnostic Lab Services	79.0
LA CARE MEDI-CAL/HEALTHY FAMILY	N801	Therapy Services	191.0
LA CARE MEDI-CAL/HEALTHY FAMILY	N804	Mammography Services	94.0
LA CARE MEDI-CAL/HEALTHY FAMILY	N809	Other Medicine	4.0

Section: Outpatient Payer Specific Charge 22
Payer	APC	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5021	Level 1 Type A ED Visits	98.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5022	Level 2 Type A ED Visits	198.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5023	Level 3 Type A ED Visits	394.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5024	Level 4 Type A ED Visits	691.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5025	Level 5 Type A ED Visits	986.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5051	Level 1 Skin Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5052	Level 2 Skin Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5053	Level 3 Skin Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5113	Level 3 Musculoskeletal Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5114	Level 4 Musculoskeletal Procedures	3105.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5115	Level 5 Musculoskeletal Procedures	6133.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5154	Level 4 Airway Endoscopy	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5155	Level 5 Airway Endoscopy	2762.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5165	Level 5 ENT Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5182	Level 2 Vascular Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5183	Level 3 Vascular Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5184	Level 4 Vascular Procedures	2273.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5191	Level 1 Endovascular Procedures	2231.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5192	Level 2 Endovascular Procedures	2231.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5193	Level 3 Endovascular Procedures	4301.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5213	Level 3 Electrophysiologic Procedures	2231.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5241	Level 1 Blood Product Exchange and Related Services	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5301	Level 1 Upper GI Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5302	Level 2 Upper GI Procedures	1030.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5311	Level 1 Lower GI Procedures	1030.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5312	Level 2 Lower GI Procedures	1030.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5313	Level 3 Lower GI Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5331	Complex GI Procedures	1030.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5341	Abdominal/Peritoneal/Biliary and Related Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5361	Level 1 Laparoscopy and Related Services	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5371	Level 1 Urology and Related Services	683.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5372	Level 2 Urology and Related Services	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5373	Level 3 Urology and Related Services	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5374	Level 4 Urology and Related Services	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5375	Level 5 Urology and Related Services	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5414	Level 4 Gynecologic Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5441	Level 1 Nerve Injections	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5442	Level 2 Nerve Injections	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5492	Level 2 Intraocular Procedures	1675.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5521	Level 1 Imaging without Contrast	1360.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5522	Level 2 Imaging without Contrast	1061.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5523	Level 3 Imaging without Contrast	1489.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5524	Level 4 Imaging without Contrast	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5573	Level 3 Imaging with Contrast	986.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5593	Level 3 Nuclear Medicine and Related Services	986.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5594	Level 4 Nuclear Medicine and Related Services	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5612	Level 2 Therapeutic Radiation Treatment Preparation	1735.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5613	Level 3 Therapeutic Radiation Treatment Preparation	6782.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5622	Level 2 Radiation Therapy	15220.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5623	Level 3 Radiation Therapy	13563.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5626	Level 6 Radiation Therapy	9042.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5672	Level 2 Pathology	1109.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5673	Level 3 Pathology	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5691	Level 1 Drug Administration	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5692	Level 2 Drug Administration	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5693	Level 3 Drug Administration	642.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5694	Level 4 Drug Administration	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5722	Level 2 Diagnostic Tests and Related Services	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5724	Level 4 Diagnostic Tests and Related Services	1507.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5731	Level 1 Minor Procedures	106.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5733	Level 3 Minor Procedures	300.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5734	Level 4 Minor Procedures	840.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	5771	Cardiac Rehabilitation	1317.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	N700	Non-OPPS Clinic Services	95.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	N800	Clinical Diagnostic Lab Services	568.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	N801	Therapy Services	869.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	N809	Other Medicine	26.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	N902	Packaged Services	3.0
MEMORIALCARE MEDICAL FOUNDATION VALUATION	N905	Not Recognized by OPPS	304.0

Section: Outpatient Payer Specific Charge 23
Payer	APC	Description	Payer Specific Negotiated Charge
MOLINA MEDI-CAL/HEALTHY FAMILY	5021	Level 1 Type A ED Visits	26.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5022	Level 2 Type A ED Visits	52.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5023	Level 3 Type A ED Visits	121.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5024	Level 4 Type A ED Visits	239.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5025	Level 5 Type A ED Visits	396.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5051	Level 1 Skin Procedures	77.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5052	Level 2 Skin Procedures	140.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	269.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5102	Level 2 Strapping and Cast Application	38.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5111	Level 1 Musculoskeletal Procedures	16.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5112	Level 2 Musculoskeletal Procedures	420.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5311	Level 1 Lower GI Procedures	871.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5442	Level 2 Nerve Injections	449.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5491	Level 1 Intraocular Procedures	961.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5492	Level 2 Intraocular Procedures	1396.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5503	Level 3 Extraocular, Repair, and Plastic Eye Procedures	976.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5521	Level 1 Imaging without Contrast	42.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5692	Level 2 Drug Administration	25.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5693	Level 3 Drug Administration	208.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5731	Level 1 Minor Procedures	13.0
MOLINA MEDI-CAL/HEALTHY FAMILY	5733	Level 3 Minor Procedures	18.0
MOLINA MEDI-CAL/HEALTHY FAMILY	N700	Non-OPPS Clinic Services	9.0
MOLINA MEDI-CAL/HEALTHY FAMILY	N800	Clinical Diagnostic Lab Services	41.0
MOLINA MEDI-CAL/HEALTHY FAMILY	N809	Other Medicine	2.0

Section: Outpatient Payer Specific Charge 24
Payer	APC	Description	Payer Specific Negotiated Charge
ST. FRANCIS MEDICAL CENTER MEDI-CAL	5021	Level 1 Type A ED Visits	22.0
ST. FRANCIS MEDICAL CENTER MEDI-CAL	5022	Level 2 Type A ED Visits	44.0
ST. FRANCIS MEDICAL CENTER MEDI-CAL	5023	Level 3 Type A ED Visits	103.0
ST. FRANCIS MEDICAL CENTER MEDI-CAL	5024	Level 4 Type A ED Visits	207.0
ST. FRANCIS MEDICAL CENTER MEDI-CAL	5025	Level 5 Type A ED Visits	375.0
ST. FRANCIS MEDICAL CENTER MEDI-CAL	5051	Level 1 Skin Procedures	66.0
ST. FRANCIS MEDICAL CENTER MEDI-CAL	5521	Level 1 Imaging without Contrast	34.0
ST. FRANCIS MEDICAL CENTER MEDI-CAL	5731	Level 1 Minor Procedures	35.0
ST. FRANCIS MEDICAL CENTER MEDI-CAL	5733	Level 3 Minor Procedures	56.0
ST. FRANCIS MEDICAL CENTER MEDI-CAL	N800	Clinical Diagnostic Lab Services	19.0

Section: Outpatient Payer Specific Charge 25
Payer	APC	Description	Payer Specific Negotiated Charge
TRICARE WEST	5021	Level 1 Type A ED Visits	67.0
TRICARE WEST	5022	Level 2 Type A ED Visits	134.0
TRICARE WEST	5023	Level 3 Type A ED Visits	318.0
TRICARE WEST	5024	Level 4 Type A ED Visits	663.0
TRICARE WEST	5025	Level 5 Type A ED Visits	1465.0
TRICARE WEST	5051	Level 1 Skin Procedures	205.0
TRICARE WEST	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1084.0
TRICARE WEST	5114	Level 4 Musculoskeletal Procedures	5806.0
TRICARE WEST	5115	Level 5 Musculoskeletal Procedures	7691.0
TRICARE WEST	5301	Level 1 Upper GI Procedures	792.0
TRICARE WEST	5361	Level 1 Laparoscopy and Related Services	3489.0
TRICARE WEST	5414	Level 4 Gynecologic Procedures	2316.0
TRICARE WEST	5442	Level 2 Nerve Injections	1158.0
TRICARE WEST	5521	Level 1 Imaging without Contrast	185.0
TRICARE WEST	5522	Level 2 Imaging without Contrast	196.0
TRICARE WEST	5523	Level 3 Imaging without Contrast	658.0
TRICARE WEST	5524	Level 4 Imaging without Contrast	240.0
TRICARE WEST	5571	Level 1 Imaging with Contrast	503.0
TRICARE WEST	5572	Level 2 Imaging with Contrast	1172.0
TRICARE WEST	5693	Level 3 Drug Administration	536.0
TRICARE WEST	5694	Level 4 Drug Administration	9988.0
TRICARE WEST	5721	Level 1 Diagnostic Tests and Related Services	31.0
TRICARE WEST	5722	Level 2 Diagnostic Tests and Related Services	251.0
TRICARE WEST	5723	Level 3 Diagnostic Tests and Related Services	856.0
TRICARE WEST	5724	Level 4 Diagnostic Tests and Related Services	816.0
TRICARE WEST	5731	Level 1 Minor Procedures	33.0
TRICARE WEST	5733	Level 3 Minor Procedures	197.0
TRICARE WEST	5791	Pulmonary Treatment	34.0
TRICARE WEST	N700	Non-OPPS Clinic Services	23.0
TRICARE WEST	N800	Clinical Diagnostic Lab Services	12.0
TRICARE WEST	N801	Therapy Services	306.0
TRICARE WEST	N804	Mammography Services	138.0
TRICARE WEST	N809	Other Medicine	6.0

Section: Outpatient Payer Specific Charge 26
Payer	APC	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE ALL PAYER	5021	Level 1 Type A ED Visits	667.0
UNITED HEALTHCARE ALL PAYER	5022	Level 2 Type A ED Visits	1340.0
UNITED HEALTHCARE ALL PAYER	5023	Level 3 Type A ED Visits	2343.0
UNITED HEALTHCARE ALL PAYER	5024	Level 4 Type A ED Visits	6076.0
UNITED HEALTHCARE ALL PAYER	5025	Level 5 Type A ED Visits	6597.0
UNITED HEALTHCARE ALL PAYER	5051	Level 1 Skin Procedures	2088.0
UNITED HEALTHCARE ALL PAYER	5052	Level 2 Skin Procedures	2570.0
UNITED HEALTHCARE ALL PAYER	5061	Hyperbaric Oxygen	29034.0
UNITED HEALTHCARE ALL PAYER	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	3293.0
UNITED HEALTHCARE ALL PAYER	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	5301.0
UNITED HEALTHCARE ALL PAYER	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	12197.0
UNITED HEALTHCARE ALL PAYER	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	12197.0
UNITED HEALTHCARE ALL PAYER	5112	Level 2 Musculoskeletal Procedures	6597.0
UNITED HEALTHCARE ALL PAYER	5113	Level 3 Musculoskeletal Procedures	12197.0
UNITED HEALTHCARE ALL PAYER	5114	Level 4 Musculoskeletal Procedures	21212.0
UNITED HEALTHCARE ALL PAYER	5115	Level 5 Musculoskeletal Procedures	44657.0
UNITED HEALTHCARE ALL PAYER	5151	Level 1 Airway Endoscopy	913.0
UNITED HEALTHCARE ALL PAYER	5154	Level 4 Airway Endoscopy	12197.0
UNITED HEALTHCARE ALL PAYER	5155	Level 5 Airway Endoscopy	12133.0
UNITED HEALTHCARE ALL PAYER	5164	Level 4 ENT Procedures	6154.0
UNITED HEALTHCARE ALL PAYER	5182	Level 2 Vascular Procedures	5301.0
UNITED HEALTHCARE ALL PAYER	5183	Level 3 Vascular Procedures	16455.0
UNITED HEALTHCARE ALL PAYER	5213	Level 3 Electrophysiologic Procedures	50810.0
UNITED HEALTHCARE ALL PAYER	5241	Level 1 Blood Product Exchange and Related Services	1716.0
UNITED HEALTHCARE ALL PAYER	5301	Level 1 Upper GI Procedures	5301.0
UNITED HEALTHCARE ALL PAYER	5302	Level 2 Upper GI Procedures	5301.0
UNITED HEALTHCARE ALL PAYER	5311	Level 1 Lower GI Procedures	1702.0
UNITED HEALTHCARE ALL PAYER	5313	Level 3 Lower GI Procedures	9277.0
UNITED HEALTHCARE ALL PAYER	5361	Level 1 Laparoscopy and Related Services	149.0
UNITED HEALTHCARE ALL PAYER	5362	Level 2 Laparoscopy and Related Services	22980.0
UNITED HEALTHCARE ALL PAYER	5414	Level 4 Gynecologic Procedures	6154.0
UNITED HEALTHCARE ALL PAYER	5415	Level 5 Gynecologic Procedures	14326.0
UNITED HEALTHCARE ALL PAYER	5441	Level 1 Nerve Injections	1716.0
UNITED HEALTHCARE ALL PAYER	5442	Level 2 Nerve Injections	4429.0
UNITED HEALTHCARE ALL PAYER	5521	Level 1 Imaging without Contrast	309.0
UNITED HEALTHCARE ALL PAYER	5522	Level 2 Imaging without Contrast	129.0
UNITED HEALTHCARE ALL PAYER	5523	Level 3 Imaging without Contrast	268.0
UNITED HEALTHCARE ALL PAYER	5524	Level 4 Imaging without Contrast	1728.0
UNITED HEALTHCARE ALL PAYER	5571	Level 1 Imaging with Contrast	210.0
UNITED HEALTHCARE ALL PAYER	5572	Level 2 Imaging with Contrast	439.0
UNITED HEALTHCARE ALL PAYER	5573	Level 3 Imaging with Contrast	5996.0
UNITED HEALTHCARE ALL PAYER	5591	Level 1 Nuclear Medicine and Related Services	423.0
UNITED HEALTHCARE ALL PAYER	5592	Level 2 Nuclear Medicine and Related Services	543.0
UNITED HEALTHCARE ALL PAYER	5593	Level 3 Nuclear Medicine and Related Services	1886.0
UNITED HEALTHCARE ALL PAYER	5594	Level 4 Nuclear Medicine and Related Services	1660.0
UNITED HEALTHCARE ALL PAYER	5612	Level 2 Therapeutic Radiation Treatment Preparation	1922.0
UNITED HEALTHCARE ALL PAYER	5613	Level 3 Therapeutic Radiation Treatment Preparation	16337.0
UNITED HEALTHCARE ALL PAYER	5623	Level 3 Radiation Therapy	30752.0
UNITED HEALTHCARE ALL PAYER	5672	Level 2 Pathology	402.0
UNITED HEALTHCARE ALL PAYER	5673	Level 3 Pathology	412.0
UNITED HEALTHCARE ALL PAYER	5692	Level 2 Drug Administration	5827.0
UNITED HEALTHCARE ALL PAYER	5693	Level 3 Drug Administration	630.0
UNITED HEALTHCARE ALL PAYER	5694	Level 4 Drug Administration	9464.0
UNITED HEALTHCARE ALL PAYER	5721	Level 1 Diagnostic Tests and Related Services	297.0
UNITED HEALTHCARE ALL PAYER	5722	Level 2 Diagnostic Tests and Related Services	1224.0
UNITED HEALTHCARE ALL PAYER	5724	Level 4 Diagnostic Tests and Related Services	6982.0
UNITED HEALTHCARE ALL PAYER	5731	Level 1 Minor Procedures	111.0
UNITED HEALTHCARE ALL PAYER	5732	Level 2 Minor Procedures	30.0
UNITED HEALTHCARE ALL PAYER	5733	Level 3 Minor Procedures	603.0
UNITED HEALTHCARE ALL PAYER	5734	Level 4 Minor Procedures	336.0
UNITED HEALTHCARE ALL PAYER	5771	Cardiac Rehabilitation	4462.0
UNITED HEALTHCARE ALL PAYER	N700	Non-OPPS Clinic Services	227.0
UNITED HEALTHCARE ALL PAYER	N800	Clinical Diagnostic Lab Services	18.0
UNITED HEALTHCARE ALL PAYER	N801	Therapy Services	1275.0
UNITED HEALTHCARE ALL PAYER	N804	Mammography Services	144.0
UNITED HEALTHCARE ALL PAYER	N900	Non-covered Services	6.0
UNITED HEALTHCARE ALL PAYER	N905	Not Recognized by OPPS	724.0

Section: Outpatient Payer Specific Charge 27
Payer	APC	Description	Payer Specific Negotiated Charge
VALLEY PRESBYTERIAN MEDI-CAL	5021	Level 1 Type A ED Visits	29.0
VALLEY PRESBYTERIAN MEDI-CAL	5022	Level 2 Type A ED Visits	58.0
VALLEY PRESBYTERIAN MEDI-CAL	5023	Level 3 Type A ED Visits	136.0
VALLEY PRESBYTERIAN MEDI-CAL	5024	Level 4 Type A ED Visits	271.0
VALLEY PRESBYTERIAN MEDI-CAL	5025	Level 5 Type A ED Visits	426.0
VALLEY PRESBYTERIAN MEDI-CAL	5051	Level 1 Skin Procedures	88.0
VALLEY PRESBYTERIAN MEDI-CAL	5052	Level 2 Skin Procedures	180.0
VALLEY PRESBYTERIAN MEDI-CAL	5113	Level 3 Musculoskeletal Procedures	1560.0
VALLEY PRESBYTERIAN MEDI-CAL	5114	Level 4 Musculoskeletal Procedures	2128.0
VALLEY PRESBYTERIAN MEDI-CAL	5311	Level 1 Lower GI Procedures	249.0
VALLEY PRESBYTERIAN MEDI-CAL	5521	Level 1 Imaging without Contrast	88.0
VALLEY PRESBYTERIAN MEDI-CAL	5573	Level 3 Imaging with Contrast	1651.0
VALLEY PRESBYTERIAN MEDI-CAL	5731	Level 1 Minor Procedures	46.0

Section: Outpatient Payer Specific Charge 28
Payer	APC	Description	Payer Specific Negotiated Charge
AETNA WHOLE HEALTH HMO	5022	Level 2 Type A ED Visits	1340.0
AETNA WHOLE HEALTH HMO	5023	Level 3 Type A ED Visits	1879.0
AETNA WHOLE HEALTH HMO	5024	Level 4 Type A ED Visits	1879.0
AETNA WHOLE HEALTH HMO	5025	Level 5 Type A ED Visits	1879.0
AETNA WHOLE HEALTH HMO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2266.0
AETNA WHOLE HEALTH HMO	5414	Level 4 Gynecologic Procedures	760.0
AETNA WHOLE HEALTH HMO	5521	Level 1 Imaging without Contrast	268.0
AETNA WHOLE HEALTH HMO	5572	Level 2 Imaging with Contrast	607.0
AETNA WHOLE HEALTH HMO	5692	Level 2 Drug Administration	780.0
AETNA WHOLE HEALTH HMO	5693	Level 3 Drug Administration	489.0
AETNA WHOLE HEALTH HMO	5694	Level 4 Drug Administration	9358.0
AETNA WHOLE HEALTH HMO	5731	Level 1 Minor Procedures	244.0
AETNA WHOLE HEALTH HMO	5734	Level 4 Minor Procedures	512.0
AETNA WHOLE HEALTH HMO	N700	Non-OPPS Clinic Services	71.0
AETNA WHOLE HEALTH HMO	N800	Clinical Diagnostic Lab Services	258.0
AETNA WHOLE HEALTH HMO	N804	Mammography Services	450.0

Section: Outpatient Payer Specific Charge 29
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS EXCHANGE	5022	Level 2 Type A ED Visits	298.0
BLUE CROSS EXCHANGE	5023	Level 3 Type A ED Visits	526.0
BLUE CROSS EXCHANGE	5024	Level 4 Type A ED Visits	1073.0
BLUE CROSS EXCHANGE	5025	Level 5 Type A ED Visits	1834.0
BLUE CROSS EXCHANGE	5052	Level 2 Skin Procedures	815.0
BLUE CROSS EXCHANGE	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1413.0
BLUE CROSS EXCHANGE	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	3206.0
BLUE CROSS EXCHANGE	5114	Level 4 Musculoskeletal Procedures	14225.0
BLUE CROSS EXCHANGE	5373	Level 3 Urology and Related Services	2942.0
BLUE CROSS EXCHANGE	5374	Level 4 Urology and Related Services	6982.0
BLUE CROSS EXCHANGE	5414	Level 4 Gynecologic Procedures	914.0
BLUE CROSS EXCHANGE	5521	Level 1 Imaging without Contrast	406.0
BLUE CROSS EXCHANGE	5693	Level 3 Drug Administration	816.0
BLUE CROSS EXCHANGE	5694	Level 4 Drug Administration	6912.0
BLUE CROSS EXCHANGE	5731	Level 1 Minor Procedures	135.0
BLUE CROSS EXCHANGE	5733	Level 3 Minor Procedures	126.0
BLUE CROSS EXCHANGE	N700	Non-OPPS Clinic Services	108.0
BLUE CROSS EXCHANGE	N804	Mammography Services	215.0

Section: Outpatient Payer Specific Charge 30
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD TRIO	5022	Level 2 Type A ED Visits	609.0
BLUE SHIELD TRIO	5023	Level 3 Type A ED Visits	1049.0
BLUE SHIELD TRIO	5024	Level 4 Type A ED Visits	2757.0
BLUE SHIELD TRIO	5025	Level 5 Type A ED Visits	4386.0
BLUE SHIELD TRIO	5051	Level 1 Skin Procedures	963.0
BLUE SHIELD TRIO	5052	Level 2 Skin Procedures	2677.0
BLUE SHIELD TRIO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1303.0
BLUE SHIELD TRIO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	5644.0
BLUE SHIELD TRIO	5112	Level 2 Musculoskeletal Procedures	5006.0
BLUE SHIELD TRIO	5113	Level 3 Musculoskeletal Procedures	115.0
BLUE SHIELD TRIO	5114	Level 4 Musculoskeletal Procedures	4699.0
BLUE SHIELD TRIO	5115	Level 5 Musculoskeletal Procedures	7385.0
BLUE SHIELD TRIO	5155	Level 5 Airway Endoscopy	115.0
BLUE SHIELD TRIO	5165	Level 5 ENT Procedures	12591.0
BLUE SHIELD TRIO	5183	Level 3 Vascular Procedures	9068.0
BLUE SHIELD TRIO	5191	Level 1 Endovascular Procedures	12591.0
BLUE SHIELD TRIO	5312	Level 2 Lower GI Procedures	2522.0
BLUE SHIELD TRIO	5313	Level 3 Lower GI Procedures	115.0
BLUE SHIELD TRIO	5341	Abdominal/Peritoneal/Biliary and Related Procedures	2522.0
BLUE SHIELD TRIO	5361	Level 1 Laparoscopy and Related Services	3638.0
BLUE SHIELD TRIO	5374	Level 4 Urology and Related Services	2999.0
BLUE SHIELD TRIO	5375	Level 5 Urology and Related Services	4046.0
BLUE SHIELD TRIO	5414	Level 4 Gynecologic Procedures	3402.0
BLUE SHIELD TRIO	5692	Level 2 Drug Administration	182.0
BLUE SHIELD TRIO	5693	Level 3 Drug Administration	825.0
BLUE SHIELD TRIO	5731	Level 1 Minor Procedures	353.0
BLUE SHIELD TRIO	N700	Non-OPPS Clinic Services	99.0
BLUE SHIELD TRIO	N800	Clinical Diagnostic Lab Services	482.0
BLUE SHIELD TRIO	N801	Therapy Services	1595.0
BLUE SHIELD TRIO	N809	Other Medicine	28.0

Section: Outpatient Payer Specific Charge 31
Payer	APC	Description	Payer Specific Negotiated Charge
CAREMORE SENIOR	5022	Level 2 Type A ED Visits	157.0
CAREMORE SENIOR	5023	Level 3 Type A ED Visits	277.0
CAREMORE SENIOR	5024	Level 4 Type A ED Visits	565.0
CAREMORE SENIOR	5025	Level 5 Type A ED Visits	1124.0
CAREMORE SENIOR	5052	Level 2 Skin Procedures	413.0
CAREMORE SENIOR	5061	Hyperbaric Oxygen	2994.0
CAREMORE SENIOR	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	744.0
CAREMORE SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1682.0
CAREMORE SENIOR	5115	Level 5 Musculoskeletal Procedures	14858.0
CAREMORE SENIOR	5165	Level 5 ENT Procedures	6084.0
CAREMORE SENIOR	5182	Level 2 Vascular Procedures	1681.0
CAREMORE SENIOR	5183	Level 3 Vascular Procedures	3426.0
CAREMORE SENIOR	5184	Level 4 Vascular Procedures	5705.0
CAREMORE SENIOR	5191	Level 1 Endovascular Procedures	3480.0
CAREMORE SENIOR	5192	Level 2 Endovascular Procedures	5929.0
CAREMORE SENIOR	5193	Level 3 Endovascular Procedures	12012.0
CAREMORE SENIOR	5194	Level 4 Endovascular Procedures	19208.0
CAREMORE SENIOR	5241	Level 1 Blood Product Exchange and Related Services	959.0
CAREMORE SENIOR	5301	Level 1 Upper GI Procedures	1072.0
CAREMORE SENIOR	5302	Level 2 Upper GI Procedures	1944.0
CAREMORE SENIOR	5312	Level 2 Lower GI Procedures	1267.0
CAREMORE SENIOR	5313	Level 3 Lower GI Procedures	2925.0
CAREMORE SENIOR	5361	Level 1 Laparoscopy and Related Services	6057.0
CAREMORE SENIOR	5401	Dialysis	2356.0
CAREMORE SENIOR	5521	Level 1 Imaging without Contrast	97.0
CAREMORE SENIOR	5522	Level 2 Imaging without Contrast	130.0
CAREMORE SENIOR	5523	Level 3 Imaging without Contrast	275.0
CAREMORE SENIOR	5571	Level 1 Imaging with Contrast	214.0
CAREMORE SENIOR	5572	Level 2 Imaging with Contrast	440.0
CAREMORE SENIOR	5573	Level 3 Imaging with Contrast	2189.0
CAREMORE SENIOR	5591	Level 1 Nuclear Medicine and Related Services	451.0
CAREMORE SENIOR	5593	Level 3 Nuclear Medicine and Related Services	2952.0
CAREMORE SENIOR	5594	Level 4 Nuclear Medicine and Related Services	1769.0
CAREMORE SENIOR	5672	Level 2 Pathology	178.0
CAREMORE SENIOR	5693	Level 3 Drug Administration	268.0
CAREMORE SENIOR	5722	Level 2 Diagnostic Tests and Related Services	316.0
CAREMORE SENIOR	5731	Level 1 Minor Procedures	105.0
CAREMORE SENIOR	5733	Level 3 Minor Procedures	67.0
CAREMORE SENIOR	5734	Level 4 Minor Procedures	157.0
CAREMORE SENIOR	N800	Clinical Diagnostic Lab Services	46.0
CAREMORE SENIOR	N801	Therapy Services	365.0
CAREMORE SENIOR	N804	Mammography Services	141.0

Section: Outpatient Payer Specific Charge 32
Payer	APC	Description	Payer Specific Negotiated Charge
CITIZENS CHOICE	5022	Level 2 Type A ED Visits	157.0
CITIZENS CHOICE	5023	Level 3 Type A ED Visits	277.0
CITIZENS CHOICE	5024	Level 4 Type A ED Visits	578.0
CITIZENS CHOICE	5025	Level 5 Type A ED Visits	1112.0
CITIZENS CHOICE	5051	Level 1 Skin Procedures	215.0
CITIZENS CHOICE	5052	Level 2 Skin Procedures	413.0
CITIZENS CHOICE	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1767.0
CITIZENS CHOICE	5183	Level 3 Vascular Procedures	3424.0
CITIZENS CHOICE	5241	Level 1 Blood Product Exchange and Related Services	859.0
CITIZENS CHOICE	5491	Level 1 Intraocular Procedures	2483.0
CITIZENS CHOICE	5522	Level 2 Imaging without Contrast	130.0
CITIZENS CHOICE	5693	Level 3 Drug Administration	721.0
CITIZENS CHOICE	5723	Level 3 Diagnostic Tests and Related Services	584.0
CITIZENS CHOICE	5731	Level 1 Minor Procedures	130.0
CITIZENS CHOICE	N700	Non-OPPS Clinic Services	314.0
CITIZENS CHOICE	N801	Therapy Services	364.0
CITIZENS CHOICE	N804	Mammography Services	141.0

Section: Outpatient Payer Specific Charge 33
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTH NET HMO & PPO	5022	Level 2 Type A ED Visits	867.0
HEALTH NET HMO & PPO	5023	Level 3 Type A ED Visits	1763.0
HEALTH NET HMO & PPO	5024	Level 4 Type A ED Visits	4797.0
HEALTH NET HMO & PPO	5025	Level 5 Type A ED Visits	6869.0
HEALTH NET HMO & PPO	5051	Level 1 Skin Procedures	752.0
HEALTH NET HMO & PPO	5052	Level 2 Skin Procedures	1077.0
HEALTH NET HMO & PPO	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	2693.0
HEALTH NET HMO & PPO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	8080.0
HEALTH NET HMO & PPO	5111	Level 1 Musculoskeletal Procedures	870.0
HEALTH NET HMO & PPO	5114	Level 4 Musculoskeletal Procedures	18020.0
HEALTH NET HMO & PPO	5115	Level 5 Musculoskeletal Procedures	34214.0
HEALTH NET HMO & PPO	5184	Level 4 Vascular Procedures	28054.0
HEALTH NET HMO & PPO	5241	Level 1 Blood Product Exchange and Related Services	2693.0
HEALTH NET HMO & PPO	5301	Level 1 Upper GI Procedures	4576.0
HEALTH NET HMO & PPO	5311	Level 1 Lower GI Procedures	3578.0
HEALTH NET HMO & PPO	5312	Level 2 Lower GI Procedures	5944.0
HEALTH NET HMO & PPO	5313	Level 3 Lower GI Procedures	13466.0
HEALTH NET HMO & PPO	5361	Level 1 Laparoscopy and Related Services	505.0
HEALTH NET HMO & PPO	5362	Level 2 Laparoscopy and Related Services	106.0
HEALTH NET HMO & PPO	5374	Level 4 Urology and Related Services	17506.0
HEALTH NET HMO & PPO	5414	Level 4 Gynecologic Procedures	13466.0
HEALTH NET HMO & PPO	5442	Level 2 Nerve Injections	2693.0
HEALTH NET HMO & PPO	5521	Level 1 Imaging without Contrast	726.0
HEALTH NET HMO & PPO	5522	Level 2 Imaging without Contrast	468.0
HEALTH NET HMO & PPO	5523	Level 3 Imaging without Contrast	1928.0
HEALTH NET HMO & PPO	5571	Level 1 Imaging with Contrast	2431.0
HEALTH NET HMO & PPO	5572	Level 2 Imaging with Contrast	3744.0
HEALTH NET HMO & PPO	5592	Level 2 Nuclear Medicine and Related Services	2088.0
HEALTH NET HMO & PPO	5613	Level 3 Therapeutic Radiation Treatment Preparation	7371.0
HEALTH NET HMO & PPO	5672	Level 2 Pathology	1542.0
HEALTH NET HMO & PPO	5692	Level 2 Drug Administration	820.0
HEALTH NET HMO & PPO	5693	Level 3 Drug Administration	708.0
HEALTH NET HMO & PPO	5694	Level 4 Drug Administration	10980.0
HEALTH NET HMO & PPO	5721	Level 1 Diagnostic Tests and Related Services	118.0
HEALTH NET HMO & PPO	5722	Level 2 Diagnostic Tests and Related Services	1193.0
HEALTH NET HMO & PPO	5723	Level 3 Diagnostic Tests and Related Services	2674.0
HEALTH NET HMO & PPO	5724	Level 4 Diagnostic Tests and Related Services	3139.0
HEALTH NET HMO & PPO	5731	Level 1 Minor Procedures	326.0
HEALTH NET HMO & PPO	5733	Level 3 Minor Procedures	786.0
HEALTH NET HMO & PPO	5734	Level 4 Minor Procedures	773.0
HEALTH NET HMO & PPO	5771	Cardiac Rehabilitation	1474.0
HEALTH NET HMO & PPO	5791	Pulmonary Treatment	333.0
HEALTH NET HMO & PPO	N700	Non-OPPS Clinic Services	95.0
HEALTH NET HMO & PPO	N800	Clinical Diagnostic Lab Services	243.0
HEALTH NET HMO & PPO	N801	Therapy Services	746.0
HEALTH NET HMO & PPO	N804	Mammography Services	545.0
HEALTH NET HMO & PPO	N809	Other Medicine	26.0
HEALTH NET HMO & PPO	N900	Non-covered Services	36.0
HEALTH NET HMO & PPO	N902	Packaged Services	1.0

Section: Outpatient Payer Specific Charge 34
Payer	APC	Description	Payer Specific Negotiated Charge
HERITAGE PROVIDER NETWORK HMO	5022	Level 2 Type A ED Visits	831.0
HERITAGE PROVIDER NETWORK HMO	5023	Level 3 Type A ED Visits	1819.0
HERITAGE PROVIDER NETWORK HMO	5024	Level 4 Type A ED Visits	3792.0
HERITAGE PROVIDER NETWORK HMO	5025	Level 5 Type A ED Visits	5302.0
HERITAGE PROVIDER NETWORK HMO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1091.0
HERITAGE PROVIDER NETWORK HMO	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	1459.0
HERITAGE PROVIDER NETWORK HMO	5102	Level 2 Strapping and Cast Application	323.0
HERITAGE PROVIDER NETWORK HMO	5111	Level 1 Musculoskeletal Procedures	449.0
HERITAGE PROVIDER NETWORK HMO	5301	Level 1 Upper GI Procedures	3555.0
HERITAGE PROVIDER NETWORK HMO	5302	Level 2 Upper GI Procedures	2188.0
HERITAGE PROVIDER NETWORK HMO	5312	Level 2 Lower GI Procedures	1459.0
HERITAGE PROVIDER NETWORK HMO	5313	Level 3 Lower GI Procedures	1669.0
HERITAGE PROVIDER NETWORK HMO	5414	Level 4 Gynecologic Procedures	1459.0
HERITAGE PROVIDER NETWORK HMO	5521	Level 1 Imaging without Contrast	463.0
HERITAGE PROVIDER NETWORK HMO	5522	Level 2 Imaging without Contrast	1137.0
HERITAGE PROVIDER NETWORK HMO	5524	Level 4 Imaging without Contrast	1420.0
HERITAGE PROVIDER NETWORK HMO	5571	Level 1 Imaging with Contrast	1989.0
HERITAGE PROVIDER NETWORK HMO	5573	Level 3 Imaging with Contrast	11045.0
HERITAGE PROVIDER NETWORK HMO	5592	Level 2 Nuclear Medicine and Related Services	2657.0
HERITAGE PROVIDER NETWORK HMO	5721	Level 1 Diagnostic Tests and Related Services	153.0
HERITAGE PROVIDER NETWORK HMO	5722	Level 2 Diagnostic Tests and Related Services	608.0
HERITAGE PROVIDER NETWORK HMO	5723	Level 3 Diagnostic Tests and Related Services	2226.0
HERITAGE PROVIDER NETWORK HMO	5732	Level 2 Minor Procedures	125.0
HERITAGE PROVIDER NETWORK HMO	5733	Level 3 Minor Procedures	1031.0
HERITAGE PROVIDER NETWORK HMO	5734	Level 4 Minor Procedures	1206.0
HERITAGE PROVIDER NETWORK HMO	5791	Pulmonary Treatment	160.0
HERITAGE PROVIDER NETWORK HMO	N800	Clinical Diagnostic Lab Services	68.0
HERITAGE PROVIDER NETWORK HMO	N801	Therapy Services	472.0

Section: Outpatient Payer Specific Charge 35
Payer	APC	Description	Payer Specific Negotiated Charge
KAISER MEDI-CAL NON-CONTRACTED	5022	Level 2 Type A ED Visits	48.0
KAISER MEDI-CAL NON-CONTRACTED	5023	Level 3 Type A ED Visits	113.0
KAISER MEDI-CAL NON-CONTRACTED	5024	Level 4 Type A ED Visits	223.0
KAISER MEDI-CAL NON-CONTRACTED	5025	Level 5 Type A ED Visits	446.0
KAISER MEDI-CAL NON-CONTRACTED	5051	Level 1 Skin Procedures	72.0
KAISER MEDI-CAL NON-CONTRACTED	5521	Level 1 Imaging without Contrast	100.0
KAISER MEDI-CAL NON-CONTRACTED	5692	Level 2 Drug Administration	48.0
KAISER MEDI-CAL NON-CONTRACTED	5731	Level 1 Minor Procedures	38.0
KAISER MEDI-CAL NON-CONTRACTED	5733	Level 3 Minor Procedures	94.0
KAISER MEDI-CAL NON-CONTRACTED	5734	Level 4 Minor Procedures	76.0
KAISER MEDI-CAL NON-CONTRACTED	N700	Non-OPPS Clinic Services	8.0
KAISER MEDI-CAL NON-CONTRACTED	N800	Clinical Diagnostic Lab Services	61.0

Section: Outpatient Payer Specific Charge 36
Payer	APC	Description	Payer Specific Negotiated Charge
KARING PHYSICIANS IPA	5022	Level 2 Type A ED Visits	128.0
KARING PHYSICIANS IPA	5023	Level 3 Type A ED Visits	297.0
KARING PHYSICIANS IPA	5024	Level 4 Type A ED Visits	583.0
KARING PHYSICIANS IPA	5025	Level 5 Type A ED Visits	852.0
KARING PHYSICIANS IPA	5111	Level 1 Musculoskeletal Procedures	169.0
KARING PHYSICIANS IPA	5521	Level 1 Imaging without Contrast	107.0
KARING PHYSICIANS IPA	5522	Level 2 Imaging without Contrast	231.0
KARING PHYSICIANS IPA	5523	Level 3 Imaging without Contrast	640.0
KARING PHYSICIANS IPA	5524	Level 4 Imaging without Contrast	315.0
KARING PHYSICIANS IPA	5721	Level 1 Diagnostic Tests and Related Services	52.0
KARING PHYSICIANS IPA	5722	Level 2 Diagnostic Tests and Related Services	334.0
KARING PHYSICIANS IPA	5724	Level 4 Diagnostic Tests and Related Services	763.0
KARING PHYSICIANS IPA	5731	Level 1 Minor Procedures	31.0
KARING PHYSICIANS IPA	5733	Level 3 Minor Procedures	70.0
KARING PHYSICIANS IPA	5791	Pulmonary Treatment	40.0
KARING PHYSICIANS IPA	N700	Non-OPPS Clinic Services	22.0
KARING PHYSICIANS IPA	N800	Clinical Diagnostic Lab Services	47.0
KARING PHYSICIANS IPA	N809	Other Medicine	6.0

Section: Outpatient Payer Specific Charge 37
Payer	APC	Description	Payer Specific Negotiated Charge
LA CARE CAL MEDICONNECT	5022	Level 2 Type A ED Visits	170.0
LA CARE CAL MEDICONNECT	5023	Level 3 Type A ED Visits	299.0
LA CARE CAL MEDICONNECT	5024	Level 4 Type A ED Visits	610.0
LA CARE CAL MEDICONNECT	5025	Level 5 Type A ED Visits	1235.0
LA CARE CAL MEDICONNECT	5051	Level 1 Skin Procedures	232.0
LA CARE CAL MEDICONNECT	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	803.0
LA CARE CAL MEDICONNECT	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1819.0
LA CARE CAL MEDICONNECT	5115	Level 5 Musculoskeletal Procedures	16042.0
LA CARE CAL MEDICONNECT	5301	Level 1 Upper GI Procedures	1045.0
LA CARE CAL MEDICONNECT	5312	Level 2 Lower GI Procedures	1604.0
LA CARE CAL MEDICONNECT	5374	Level 4 Urology and Related Services	3974.0
LA CARE CAL MEDICONNECT	5491	Level 1 Intraocular Procedures	2683.0
LA CARE CAL MEDICONNECT	5521	Level 1 Imaging without Contrast	258.0
LA CARE CAL MEDICONNECT	5731	Level 1 Minor Procedures	113.0

Section: Outpatient Payer Specific Charge 38
Payer	APC	Description	Payer Specific Negotiated Charge
LA CARE HMO/SENIOR	5022	Level 2 Type A ED Visits	157.0
LA CARE HMO/SENIOR	5023	Level 3 Type A ED Visits	277.0
LA CARE HMO/SENIOR	5024	Level 4 Type A ED Visits	435.0
LA CARE HMO/SENIOR	5025	Level 5 Type A ED Visits	754.0
LA CARE HMO/SENIOR	5052	Level 2 Skin Procedures	413.0
LA CARE HMO/SENIOR	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	850.0
LA CARE HMO/SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1688.0
LA CARE HMO/SENIOR	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	1665.0
LA CARE HMO/SENIOR	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	3775.0
LA CARE HMO/SENIOR	5112	Level 2 Musculoskeletal Procedures	1665.0
LA CARE HMO/SENIOR	5113	Level 3 Musculoskeletal Procedures	3386.0
LA CARE HMO/SENIOR	5114	Level 4 Musculoskeletal Procedures	7488.0
LA CARE HMO/SENIOR	5115	Level 5 Musculoskeletal Procedures	14854.0
LA CARE HMO/SENIOR	5182	Level 2 Vascular Procedures	1685.0
LA CARE HMO/SENIOR	5183	Level 3 Vascular Procedures	3426.0
LA CARE HMO/SENIOR	5184	Level 4 Vascular Procedures	5705.0
LA CARE HMO/SENIOR	5213	Level 3 Electrophysiologic Procedures	25654.0
LA CARE HMO/SENIOR	5241	Level 1 Blood Product Exchange and Related Services	859.0
LA CARE HMO/SENIOR	5301	Level 1 Upper GI Procedures	967.0
LA CARE HMO/SENIOR	5311	Level 1 Lower GI Procedures	949.0
LA CARE HMO/SENIOR	5312	Level 2 Lower GI Procedures	1240.0
LA CARE HMO/SENIOR	5313	Level 3 Lower GI Procedures	2921.0
LA CARE HMO/SENIOR	5361	Level 1 Laparoscopy and Related Services	6049.0
LA CARE HMO/SENIOR	5373	Level 3 Urology and Related Services	2143.0
LA CARE HMO/SENIOR	5374	Level 4 Urology and Related Services	3676.0
LA CARE HMO/SENIOR	5414	Level 4 Gynecologic Procedures	3137.0
LA CARE HMO/SENIOR	5491	Level 1 Intraocular Procedures	2490.0
LA CARE HMO/SENIOR	5492	Level 2 Intraocular Procedures	4682.0
LA CARE HMO/SENIOR	5503	Level 3 Extraocular, Repair, and Plastic Eye Procedures	2392.0
LA CARE HMO/SENIOR	5521	Level 1 Imaging without Contrast	97.0
LA CARE HMO/SENIOR	5522	Level 2 Imaging without Contrast	130.0
LA CARE HMO/SENIOR	5523	Level 3 Imaging without Contrast	275.0
LA CARE HMO/SENIOR	5693	Level 3 Drug Administration	245.0
LA CARE HMO/SENIOR	5723	Level 3 Diagnostic Tests and Related Services	584.0
LA CARE HMO/SENIOR	5731	Level 1 Minor Procedures	105.0
LA CARE HMO/SENIOR	5733	Level 3 Minor Procedures	172.0
LA CARE HMO/SENIOR	N800	Clinical Diagnostic Lab Services	143.0

Section: Outpatient Payer Specific Charge 39
Payer	APC	Description	Payer Specific Negotiated Charge
LAKEWOOD IPA	5022	Level 2 Type A ED Visits	113.0
LAKEWOOD IPA	5023	Level 3 Type A ED Visits	254.0
LAKEWOOD IPA	5024	Level 4 Type A ED Visits	515.0
LAKEWOOD IPA	5025	Level 5 Type A ED Visits	1411.0
LAKEWOOD IPA	5052	Level 2 Skin Procedures	291.0
LAKEWOOD IPA	5061	Hyperbaric Oxygen	361.0
LAKEWOOD IPA	5115	Level 5 Musculoskeletal Procedures	6244.0
LAKEWOOD IPA	5183	Level 3 Vascular Procedures	1808.0
LAKEWOOD IPA	5521	Level 1 Imaging without Contrast	82.0
LAKEWOOD IPA	5522	Level 2 Imaging without Contrast	206.0
LAKEWOOD IPA	5523	Level 3 Imaging without Contrast	555.0
LAKEWOOD IPA	5524	Level 4 Imaging without Contrast	489.0
LAKEWOOD IPA	5571	Level 1 Imaging with Contrast	344.0
LAKEWOOD IPA	5572	Level 2 Imaging with Contrast	1097.0
LAKEWOOD IPA	5594	Level 4 Nuclear Medicine and Related Services	1411.0
LAKEWOOD IPA	5672	Level 2 Pathology	256.0
LAKEWOOD IPA	5693	Level 3 Drug Administration	96.0
LAKEWOOD IPA	5694	Level 4 Drug Administration	3898.0
LAKEWOOD IPA	5721	Level 1 Diagnostic Tests and Related Services	23.0
LAKEWOOD IPA	5722	Level 2 Diagnostic Tests and Related Services	252.0
LAKEWOOD IPA	5723	Level 3 Diagnostic Tests and Related Services	556.0
LAKEWOOD IPA	5731	Level 1 Minor Procedures	27.0
LAKEWOOD IPA	5733	Level 3 Minor Procedures	130.0
LAKEWOOD IPA	5734	Level 4 Minor Procedures	191.0
LAKEWOOD IPA	5771	Cardiac Rehabilitation	264.0
LAKEWOOD IPA	N700	Non-OPPS Clinic Services	40.0
LAKEWOOD IPA	N800	Clinical Diagnostic Lab Services	7.0
LAKEWOOD IPA	N801	Therapy Services	173.0
LAKEWOOD IPA	N804	Mammography Services	116.0

Section: Outpatient Payer Specific Charge 40
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN COMMERCIAL	5022	Level 2 Type A ED Visits	314.0
MONARCH HEALTH PLAN COMMERCIAL	5023	Level 3 Type A ED Visits	554.0
MONARCH HEALTH PLAN COMMERCIAL	5024	Level 4 Type A ED Visits	1098.0
MONARCH HEALTH PLAN COMMERCIAL	5025	Level 5 Type A ED Visits	1510.0
MONARCH HEALTH PLAN COMMERCIAL	5051	Level 1 Skin Procedures	314.0
MONARCH HEALTH PLAN COMMERCIAL	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1489.0
MONARCH HEALTH PLAN COMMERCIAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	3581.0
MONARCH HEALTH PLAN COMMERCIAL	5111	Level 1 Musculoskeletal Procedures	493.0
MONARCH HEALTH PLAN COMMERCIAL	5183	Level 3 Vascular Procedures	6852.0
MONARCH HEALTH PLAN COMMERCIAL	5193	Level 3 Endovascular Procedures	24049.0
MONARCH HEALTH PLAN COMMERCIAL	5213	Level 3 Electrophysiologic Procedures	51359.0
MONARCH HEALTH PLAN COMMERCIAL	5241	Level 1 Blood Product Exchange and Related Services	2257.0
MONARCH HEALTH PLAN COMMERCIAL	5301	Level 1 Upper GI Procedures	1960.0
MONARCH HEALTH PLAN COMMERCIAL	5302	Level 2 Upper GI Procedures	3887.0
MONARCH HEALTH PLAN COMMERCIAL	5442	Level 2 Nerve Injections	1520.0
MONARCH HEALTH PLAN COMMERCIAL	5521	Level 1 Imaging without Contrast	194.0
MONARCH HEALTH PLAN COMMERCIAL	5522	Level 2 Imaging without Contrast	261.0
MONARCH HEALTH PLAN COMMERCIAL	5693	Level 3 Drug Administration	873.0
MONARCH HEALTH PLAN COMMERCIAL	5694	Level 4 Drug Administration	23017.0
MONARCH HEALTH PLAN COMMERCIAL	5722	Level 2 Diagnostic Tests and Related Services	633.0
MONARCH HEALTH PLAN COMMERCIAL	5731	Level 1 Minor Procedures	396.0
MONARCH HEALTH PLAN COMMERCIAL	5733	Level 3 Minor Procedures	133.0
MONARCH HEALTH PLAN COMMERCIAL	N800	Clinical Diagnostic Lab Services	72.0

Section: Outpatient Payer Specific Charge 41
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN SENIOR	5022	Level 2 Type A ED Visits	157.0
MONARCH HEALTH PLAN SENIOR	5023	Level 3 Type A ED Visits	277.0
MONARCH HEALTH PLAN SENIOR	5024	Level 4 Type A ED Visits	532.0
MONARCH HEALTH PLAN SENIOR	5025	Level 5 Type A ED Visits	1065.0
MONARCH HEALTH PLAN SENIOR	5051	Level 1 Skin Procedures	215.0
MONARCH HEALTH PLAN SENIOR	5052	Level 2 Skin Procedures	413.0
MONARCH HEALTH PLAN SENIOR	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	850.0
MONARCH HEALTH PLAN SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1788.0
MONARCH HEALTH PLAN SENIOR	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	2835.0
MONARCH HEALTH PLAN SENIOR	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	3885.0
MONARCH HEALTH PLAN SENIOR	5112	Level 2 Musculoskeletal Procedures	1665.0
MONARCH HEALTH PLAN SENIOR	5114	Level 4 Musculoskeletal Procedures	7488.0
MONARCH HEALTH PLAN SENIOR	5115	Level 5 Musculoskeletal Procedures	14854.0
MONARCH HEALTH PLAN SENIOR	5155	Level 5 Airway Endoscopy	6962.0
MONARCH HEALTH PLAN SENIOR	5181	Level 1 Vascular Procedures	747.0
MONARCH HEALTH PLAN SENIOR	5183	Level 3 Vascular Procedures	3426.0
MONARCH HEALTH PLAN SENIOR	5191	Level 1 Endovascular Procedures	3471.0
MONARCH HEALTH PLAN SENIOR	5193	Level 3 Endovascular Procedures	12008.0
MONARCH HEALTH PLAN SENIOR	5213	Level 3 Electrophysiologic Procedures	25658.0
MONARCH HEALTH PLAN SENIOR	5241	Level 1 Blood Product Exchange and Related Services	667.0
MONARCH HEALTH PLAN SENIOR	5301	Level 1 Upper GI Procedures	1545.0
MONARCH HEALTH PLAN SENIOR	5311	Level 1 Lower GI Procedures	2108.0
MONARCH HEALTH PLAN SENIOR	5313	Level 3 Lower GI Procedures	1460.0
MONARCH HEALTH PLAN SENIOR	5373	Level 3 Urology and Related Services	2141.0
MONARCH HEALTH PLAN SENIOR	5375	Level 5 Urology and Related Services	6784.0
MONARCH HEALTH PLAN SENIOR	5414	Level 4 Gynecologic Procedures	3137.0
MONARCH HEALTH PLAN SENIOR	5415	Level 5 Gynecologic Procedures	5276.0
MONARCH HEALTH PLAN SENIOR	5522	Level 2 Imaging without Contrast	130.0
MONARCH HEALTH PLAN SENIOR	5573	Level 3 Imaging with Contrast	2237.0
MONARCH HEALTH PLAN SENIOR	5593	Level 3 Nuclear Medicine and Related Services	2738.0
MONARCH HEALTH PLAN SENIOR	5692	Level 2 Drug Administration	1944.0
MONARCH HEALTH PLAN SENIOR	5693	Level 3 Drug Administration	268.0
MONARCH HEALTH PLAN SENIOR	5694	Level 4 Drug Administration	808.0
MONARCH HEALTH PLAN SENIOR	5733	Level 3 Minor Procedures	67.0
MONARCH HEALTH PLAN SENIOR	N800	Clinical Diagnostic Lab Services	28.0

Section: Outpatient Payer Specific Charge 42
Payer	APC	Description	Payer Specific Negotiated Charge
MULTIPLAN COMPLEMENTARY NETWORK	5022	Level 2 Type A ED Visits	855.0
MULTIPLAN COMPLEMENTARY NETWORK	5023	Level 3 Type A ED Visits	1607.0
MULTIPLAN COMPLEMENTARY NETWORK	5024	Level 4 Type A ED Visits	2691.0
MULTIPLAN COMPLEMENTARY NETWORK	5025	Level 5 Type A ED Visits	767.0
MULTIPLAN COMPLEMENTARY NETWORK	5521	Level 1 Imaging without Contrast	1384.0
MULTIPLAN COMPLEMENTARY NETWORK	5731	Level 1 Minor Procedures	767.0
MULTIPLAN COMPLEMENTARY NETWORK	5733	Level 3 Minor Procedures	1643.0
MULTIPLAN COMPLEMENTARY NETWORK	N800	Clinical Diagnostic Lab Services	641.0
MULTIPLAN COMPLEMENTARY NETWORK	N804	Mammography Services	827.0

Section: Outpatient Payer Specific Charge 43
Payer	APC	Description	Payer Specific Negotiated Charge
OMNICARE MEDI-CAL	5022	Level 2 Type A ED Visits	340.0
OMNICARE MEDI-CAL	5023	Level 3 Type A ED Visits	769.0
OMNICARE MEDI-CAL	5024	Level 4 Type A ED Visits	1474.0
OMNICARE MEDI-CAL	5521	Level 1 Imaging without Contrast	320.0
OMNICARE MEDI-CAL	5522	Level 2 Imaging without Contrast	372.0
OMNICARE MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	137.0
OMNICARE MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	1314.0
OMNICARE MEDI-CAL	5724	Level 4 Diagnostic Tests and Related Services	2067.0
OMNICARE MEDI-CAL	5731	Level 1 Minor Procedures	270.0
OMNICARE MEDI-CAL	5733	Level 3 Minor Procedures	668.0
OMNICARE MEDI-CAL	5734	Level 4 Minor Procedures	695.0
OMNICARE MEDI-CAL	5791	Pulmonary Treatment	433.0
OMNICARE MEDI-CAL	N700	Non-OPPS Clinic Services	59.0
OMNICARE MEDI-CAL	N800	Clinical Diagnostic Lab Services	217.0
OMNICARE MEDI-CAL	N809	Other Medicine	16.0

Section: Outpatient Payer Specific Charge 44
Payer	APC	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE NON-PREFERRED	5022	Level 2 Type A ED Visits	1341.0
UNITED HEALTHCARE NON-PREFERRED	5023	Level 3 Type A ED Visits	2228.0
UNITED HEALTHCARE NON-PREFERRED	5024	Level 4 Type A ED Visits	524.0
UNITED HEALTHCARE NON-PREFERRED	5025	Level 5 Type A ED Visits	149.0
UNITED HEALTHCARE NON-PREFERRED	5111	Level 1 Musculoskeletal Procedures	815.0
UNITED HEALTHCARE NON-PREFERRED	5301	Level 1 Upper GI Procedures	67.0
UNITED HEALTHCARE NON-PREFERRED	5361	Level 1 Laparoscopy and Related Services	111.0
UNITED HEALTHCARE NON-PREFERRED	5692	Level 2 Drug Administration	231.0
UNITED HEALTHCARE NON-PREFERRED	5693	Level 3 Drug Administration	149.0
UNITED HEALTHCARE NON-PREFERRED	5731	Level 1 Minor Procedures	141.0
UNITED HEALTHCARE NON-PREFERRED	5733	Level 3 Minor Procedures	149.0
UNITED HEALTHCARE NON-PREFERRED	N700	Non-OPPS Clinic Services	227.0
UNITED HEALTHCARE NON-PREFERRED	N800	Clinical Diagnostic Lab Services	128.0
UNITED HEALTHCARE NON-PREFERRED	N804	Mammography Services	144.0
UNITED HEALTHCARE NON-PREFERRED	N900	Non-covered Services	6.0

Section: Outpatient Payer Specific Charge 45
Payer	APC	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE PREFERRED	5022	Level 2 Type A ED Visits	1340.0
UNITED HEALTHCARE PREFERRED	5023	Level 3 Type A ED Visits	1355.0
UNITED HEALTHCARE PREFERRED	5024	Level 4 Type A ED Visits	3782.0
UNITED HEALTHCARE PREFERRED	5025	Level 5 Type A ED Visits	3782.0
UNITED HEALTHCARE PREFERRED	5051	Level 1 Skin Procedures	1036.0
UNITED HEALTHCARE PREFERRED	5052	Level 2 Skin Procedures	1355.0
UNITED HEALTHCARE PREFERRED	5061	Hyperbaric Oxygen	25704.0
UNITED HEALTHCARE PREFERRED	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	1933.0
UNITED HEALTHCARE PREFERRED	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	3097.0
UNITED HEALTHCARE PREFERRED	5073	Level 3 Excision/ Biopsy/ Incision and Drainage	6995.0
UNITED HEALTHCARE PREFERRED	5111	Level 1 Musculoskeletal Procedures	716.0
UNITED HEALTHCARE PREFERRED	5114	Level 4 Musculoskeletal Procedures	12799.0
UNITED HEALTHCARE PREFERRED	5115	Level 5 Musculoskeletal Procedures	28220.0
UNITED HEALTHCARE PREFERRED	5155	Level 5 Airway Endoscopy	15675.0
UNITED HEALTHCARE PREFERRED	5165	Level 5 ENT Procedures	11839.0
UNITED HEALTHCARE PREFERRED	5184	Level 4 Vascular Procedures	12441.0
UNITED HEALTHCARE PREFERRED	5191	Level 1 Endovascular Procedures	11839.0
UNITED HEALTHCARE PREFERRED	5213	Level 3 Electrophysiologic Procedures	28009.0
UNITED HEALTHCARE PREFERRED	5301	Level 1 Upper GI Procedures	3097.0
UNITED HEALTHCARE PREFERRED	5302	Level 2 Upper GI Procedures	3871.0
UNITED HEALTHCARE PREFERRED	5311	Level 1 Lower GI Procedures	2515.0
UNITED HEALTHCARE PREFERRED	5313	Level 3 Lower GI Procedures	7962.0
UNITED HEALTHCARE PREFERRED	5331	Complex GI Procedures	13263.0
UNITED HEALTHCARE PREFERRED	5361	Level 1 Laparoscopy and Related Services	12441.0
UNITED HEALTHCARE PREFERRED	5362	Level 2 Laparoscopy and Related Services	111.0
UNITED HEALTHCARE PREFERRED	5375	Level 5 Urology and Related Services	11839.0
UNITED HEALTHCARE PREFERRED	5414	Level 4 Gynecologic Procedures	6995.0
UNITED HEALTHCARE PREFERRED	5415	Level 5 Gynecologic Procedures	11420.0
UNITED HEALTHCARE PREFERRED	5442	Level 2 Nerve Injections	2900.0
UNITED HEALTHCARE PREFERRED	5521	Level 1 Imaging without Contrast	309.0
UNITED HEALTHCARE PREFERRED	5522	Level 2 Imaging without Contrast	129.0
UNITED HEALTHCARE PREFERRED	5523	Level 3 Imaging without Contrast	149.0
UNITED HEALTHCARE PREFERRED	5524	Level 4 Imaging without Contrast	1110.0
UNITED HEALTHCARE PREFERRED	5571	Level 1 Imaging with Contrast	210.0
UNITED HEALTHCARE PREFERRED	5572	Level 2 Imaging with Contrast	439.0
UNITED HEALTHCARE PREFERRED	5573	Level 3 Imaging with Contrast	1095.0
UNITED HEALTHCARE PREFERRED	5591	Level 1 Nuclear Medicine and Related Services	423.0
UNITED HEALTHCARE PREFERRED	5623	Level 3 Radiation Therapy	10660.0
UNITED HEALTHCARE PREFERRED	5672	Level 2 Pathology	300.0
UNITED HEALTHCARE PREFERRED	5692	Level 2 Drug Administration	307.0
UNITED HEALTHCARE PREFERRED	5693	Level 3 Drug Administration	453.0
UNITED HEALTHCARE PREFERRED	5694	Level 4 Drug Administration	9304.0
UNITED HEALTHCARE PREFERRED	5721	Level 1 Diagnostic Tests and Related Services	298.0
UNITED HEALTHCARE PREFERRED	5722	Level 2 Diagnostic Tests and Related Services	808.0
UNITED HEALTHCARE PREFERRED	5723	Level 3 Diagnostic Tests and Related Services	716.0
UNITED HEALTHCARE PREFERRED	5724	Level 4 Diagnostic Tests and Related Services	3849.0
UNITED HEALTHCARE PREFERRED	5731	Level 1 Minor Procedures	111.0
UNITED HEALTHCARE PREFERRED	5733	Level 3 Minor Procedures	300.0
UNITED HEALTHCARE PREFERRED	5734	Level 4 Minor Procedures	355.0
UNITED HEALTHCARE PREFERRED	5771	Cardiac Rehabilitation	1470.0
UNITED HEALTHCARE PREFERRED	N700	Non-OPPS Clinic Services	174.0
UNITED HEALTHCARE PREFERRED	N800	Clinical Diagnostic Lab Services	22.0
UNITED HEALTHCARE PREFERRED	N801	Therapy Services	420.0
UNITED HEALTHCARE PREFERRED	N804	Mammography Services	144.0
UNITED HEALTHCARE PREFERRED	N900	Non-covered Services	6.0
UNITED HEALTHCARE PREFERRED	N905	Not Recognized by OPPS	543.0

Section: Outpatient Payer Specific Charge 46
Payer	APC	Description	Payer Specific Negotiated Charge
UNITED HEALTHCARE SENIOR	5022	Level 2 Type A ED Visits	157.0
UNITED HEALTHCARE SENIOR	5023	Level 3 Type A ED Visits	277.0
UNITED HEALTHCARE SENIOR	5024	Level 4 Type A ED Visits	565.0
UNITED HEALTHCARE SENIOR	5025	Level 5 Type A ED Visits	1042.0
UNITED HEALTHCARE SENIOR	5051	Level 1 Skin Procedures	215.0
UNITED HEALTHCARE SENIOR	5052	Level 2 Skin Procedures	413.0
UNITED HEALTHCARE SENIOR	5054	Level 4 Skin Procedures	4095.0
UNITED HEALTHCARE SENIOR	5061	Hyperbaric Oxygen	3422.0
UNITED HEALTHCARE SENIOR	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	797.0
UNITED HEALTHCARE SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1788.0
UNITED HEALTHCARE SENIOR	5114	Level 4 Musculoskeletal Procedures	7488.0
UNITED HEALTHCARE SENIOR	5115	Level 5 Musculoskeletal Procedures	14854.0
UNITED HEALTHCARE SENIOR	5183	Level 3 Vascular Procedures	3422.0
UNITED HEALTHCARE SENIOR	5191	Level 1 Endovascular Procedures	3467.0
UNITED HEALTHCARE SENIOR	5213	Level 3 Electrophysiologic Procedures	25658.0
UNITED HEALTHCARE SENIOR	5241	Level 1 Blood Product Exchange and Related Services	971.0
UNITED HEALTHCARE SENIOR	5301	Level 1 Upper GI Procedures	1259.0
UNITED HEALTHCARE SENIOR	5302	Level 2 Upper GI Procedures	1942.0
UNITED HEALTHCARE SENIOR	5361	Level 1 Laparoscopy and Related Services	6049.0
UNITED HEALTHCARE SENIOR	5415	Level 5 Gynecologic Procedures	5272.0
UNITED HEALTHCARE SENIOR	5441	Level 1 Nerve Injections	312.0
UNITED HEALTHCARE SENIOR	5521	Level 1 Imaging without Contrast	160.0
UNITED HEALTHCARE SENIOR	5522	Level 2 Imaging without Contrast	130.0
UNITED HEALTHCARE SENIOR	5523	Level 3 Imaging without Contrast	275.0
UNITED HEALTHCARE SENIOR	5524	Level 4 Imaging without Contrast	578.0
UNITED HEALTHCARE SENIOR	5571	Level 1 Imaging with Contrast	214.0
UNITED HEALTHCARE SENIOR	5572	Level 2 Imaging with Contrast	440.0
UNITED HEALTHCARE SENIOR	5573	Level 3 Imaging with Contrast	1303.0
UNITED HEALTHCARE SENIOR	5591	Level 1 Nuclear Medicine and Related Services	451.0
UNITED HEALTHCARE SENIOR	5593	Level 3 Nuclear Medicine and Related Services	2226.0
UNITED HEALTHCARE SENIOR	5594	Level 4 Nuclear Medicine and Related Services	1769.0
UNITED HEALTHCARE SENIOR	5613	Level 3 Therapeutic Radiation Treatment Preparation	7101.0
UNITED HEALTHCARE SENIOR	5672	Level 2 Pathology	178.0
UNITED HEALTHCARE SENIOR	5692	Level 2 Drug Administration	1409.0
UNITED HEALTHCARE SENIOR	5693	Level 3 Drug Administration	73953.0
UNITED HEALTHCARE SENIOR	5694	Level 4 Drug Administration	1723.0
UNITED HEALTHCARE SENIOR	5722	Level 2 Diagnostic Tests and Related Services	316.0
UNITED HEALTHCARE SENIOR	5724	Level 4 Diagnostic Tests and Related Services	1100.0
UNITED HEALTHCARE SENIOR	5731	Level 1 Minor Procedures	105.0
UNITED HEALTHCARE SENIOR	5733	Level 3 Minor Procedures	67.0
UNITED HEALTHCARE SENIOR	5734	Level 4 Minor Procedures	135.0
UNITED HEALTHCARE SENIOR	5771	Cardiac Rehabilitation	1457.0
UNITED HEALTHCARE SENIOR	5781	Resuscitation and Cardioversion	672.0
UNITED HEALTHCARE SENIOR	N800	Clinical Diagnostic Lab Services	38.0
UNITED HEALTHCARE SENIOR	N801	Therapy Services	530.0
UNITED HEALTHCARE SENIOR	N804	Mammography Services	141.0

Section: Outpatient Payer Specific Charge 47
Payer	APC	Description	Payer Specific Negotiated Charge
UNIVERSAL CARE SENIOR	5022	Level 2 Type A ED Visits	173.0
UNIVERSAL CARE SENIOR	5023	Level 3 Type A ED Visits	304.0
UNIVERSAL CARE SENIOR	5024	Level 4 Type A ED Visits	483.0
UNIVERSAL CARE SENIOR	5025	Level 5 Type A ED Visits	1208.0
UNIVERSAL CARE SENIOR	5052	Level 2 Skin Procedures	455.0
UNIVERSAL CARE SENIOR	5115	Level 5 Musculoskeletal Procedures	16339.0
UNIVERSAL CARE SENIOR	5183	Level 3 Vascular Procedures	3767.0
UNIVERSAL CARE SENIOR	5223	Level 3 Pacemaker and Similar Procedures	13678.0
UNIVERSAL CARE SENIOR	5301	Level 1 Upper GI Procedures	2197.0
UNIVERSAL CARE SENIOR	5401	Dialysis	2621.0
UNIVERSAL CARE SENIOR	5521	Level 1 Imaging without Contrast	121.0
UNIVERSAL CARE SENIOR	5522	Level 2 Imaging without Contrast	143.0
UNIVERSAL CARE SENIOR	5523	Level 3 Imaging without Contrast	303.0
UNIVERSAL CARE SENIOR	5524	Level 4 Imaging without Contrast	635.0
UNIVERSAL CARE SENIOR	5571	Level 1 Imaging with Contrast	235.0
UNIVERSAL CARE SENIOR	5593	Level 3 Nuclear Medicine and Related Services	1719.0
UNIVERSAL CARE SENIOR	5722	Level 2 Diagnostic Tests and Related Services	348.0
UNIVERSAL CARE SENIOR	5724	Level 4 Diagnostic Tests and Related Services	1210.0
UNIVERSAL CARE SENIOR	5731	Level 1 Minor Procedures	115.0
UNIVERSAL CARE SENIOR	5733	Level 3 Minor Procedures	73.0
UNIVERSAL CARE SENIOR	N800	Clinical Diagnostic Lab Services	31.0
UNIVERSAL CARE SENIOR	N801	Therapy Services	515.0
UNIVERSAL CARE SENIOR	N804	Mammography Services	155.0

Section: Outpatient Payer Specific Charge 48
Payer	APC	Description	Payer Specific Negotiated Charge
AETNA PPO	5023	Level 3 Type A ED Visits	2580.0
AETNA PPO	5024	Level 4 Type A ED Visits	3185.0
AETNA PPO	5025	Level 5 Type A ED Visits	3191.0
AETNA PPO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2833.0
AETNA PPO	5102	Level 2 Strapping and Cast Application	369.0
AETNA PPO	5361	Level 1 Laparoscopy and Related Services	7807.0
AETNA PPO	5521	Level 1 Imaging without Contrast	251.0
AETNA PPO	5522	Level 2 Imaging without Contrast	547.0
AETNA PPO	5523	Level 3 Imaging without Contrast	2111.0
AETNA PPO	5571	Level 1 Imaging with Contrast	1696.0
AETNA PPO	5572	Level 2 Imaging with Contrast	1041.0
AETNA PPO	5672	Level 2 Pathology	867.0
AETNA PPO	5692	Level 2 Drug Administration	5088.0
AETNA PPO	5722	Level 2 Diagnostic Tests and Related Services	2025.0
AETNA PPO	5731	Level 1 Minor Procedures	369.0
AETNA PPO	5733	Level 3 Minor Procedures	339.0
AETNA PPO	5734	Level 4 Minor Procedures	788.0
AETNA PPO	N700	Non-OPPS Clinic Services	108.0
AETNA PPO	N800	Clinical Diagnostic Lab Services	287.0
AETNA PPO	N801	Therapy Services	891.0
AETNA PPO	N804	Mammography Services	691.0
AETNA PPO	N809	Other Medicine	29.0
AETNA PPO	N900	Non-covered Services	40.0
AETNA PPO	N905	Not Recognized by OPPS	344.0

Section: Outpatient Payer Specific Charge 49
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS MCS	5023	Level 3 Type A ED Visits	970.0
BLUE CROSS MCS	5024	Level 4 Type A ED Visits	2389.0
BLUE CROSS MCS	5025	Level 5 Type A ED Visits	3277.0
BLUE CROSS MCS	5521	Level 1 Imaging without Contrast	339.0
BLUE CROSS MCS	5522	Level 2 Imaging without Contrast	456.0
BLUE CROSS MCS	5731	Level 1 Minor Procedures	159.0
BLUE CROSS MCS	N700	Non-OPPS Clinic Services	200.0
BLUE CROSS MCS	N804	Mammography Services	396.0

Section: Outpatient Payer Specific Charge 50
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS SENIOR	5023	Level 3 Type A ED Visits	277.0
BLUE CROSS SENIOR	5024	Level 4 Type A ED Visits	565.0
BLUE CROSS SENIOR	5025	Level 5 Type A ED Visits	1041.0
BLUE CROSS SENIOR	5051	Level 1 Skin Procedures	215.0
BLUE CROSS SENIOR	5052	Level 2 Skin Procedures	413.0
BLUE CROSS SENIOR	5061	Hyperbaric Oxygen	3638.0
BLUE CROSS SENIOR	5071	Level 1 Excision/ Biopsy/ Incision and Drainage	850.0
BLUE CROSS SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1788.0
BLUE CROSS SENIOR	5091	Level 1 Breast/Lymphatic Surgery and Related Procedures	3775.0
BLUE CROSS SENIOR	5114	Level 4 Musculoskeletal Procedures	7496.0
BLUE CROSS SENIOR	5115	Level 5 Musculoskeletal Procedures	14854.0
BLUE CROSS SENIOR	5183	Level 3 Vascular Procedures	3422.0
BLUE CROSS SENIOR	5223	Level 3 Pacemaker and Similar Procedures	12431.0
BLUE CROSS SENIOR	5241	Level 1 Blood Product Exchange and Related Services	986.0
BLUE CROSS SENIOR	5301	Level 1 Upper GI Procedures	1072.0
BLUE CROSS SENIOR	5312	Level 2 Lower GI Procedures	1244.0
BLUE CROSS SENIOR	5375	Level 5 Urology and Related Services	6029.0
BLUE CROSS SENIOR	5521	Level 1 Imaging without Contrast	203.0
BLUE CROSS SENIOR	5522	Level 2 Imaging without Contrast	130.0
BLUE CROSS SENIOR	5523	Level 3 Imaging without Contrast	275.0
BLUE CROSS SENIOR	5524	Level 4 Imaging without Contrast	578.0
BLUE CROSS SENIOR	5571	Level 1 Imaging with Contrast	214.0
BLUE CROSS SENIOR	5572	Level 2 Imaging with Contrast	440.0
BLUE CROSS SENIOR	5591	Level 1 Nuclear Medicine and Related Services	451.0
BLUE CROSS SENIOR	5592	Level 2 Nuclear Medicine and Related Services	585.0
BLUE CROSS SENIOR	5594	Level 4 Nuclear Medicine and Related Services	1769.0
BLUE CROSS SENIOR	5612	Level 2 Therapeutic Radiation Treatment Preparation	3089.0
BLUE CROSS SENIOR	5613	Level 3 Therapeutic Radiation Treatment Preparation	6944.0
BLUE CROSS SENIOR	5622	Level 2 Radiation Therapy	1019.0
BLUE CROSS SENIOR	5623	Level 3 Radiation Therapy	11482.0
BLUE CROSS SENIOR	5626	Level 6 Radiation Therapy	9450.0
BLUE CROSS SENIOR	5672	Level 2 Pathology	148.0
BLUE CROSS SENIOR	5692	Level 2 Drug Administration	1425.0
BLUE CROSS SENIOR	5693	Level 3 Drug Administration	292.0
BLUE CROSS SENIOR	5694	Level 4 Drug Administration	1080.0
BLUE CROSS SENIOR	5721	Level 1 Diagnostic Tests and Related Services	167.0
BLUE CROSS SENIOR	5722	Level 2 Diagnostic Tests and Related Services	316.0
BLUE CROSS SENIOR	5724	Level 4 Diagnostic Tests and Related Services	1100.0
BLUE CROSS SENIOR	5731	Level 1 Minor Procedures	105.0
BLUE CROSS SENIOR	5732	Level 2 Minor Procedures	568.0
BLUE CROSS SENIOR	5733	Level 3 Minor Procedures	67.0
BLUE CROSS SENIOR	5734	Level 4 Minor Procedures	135.0
BLUE CROSS SENIOR	5771	Cardiac Rehabilitation	1110.0
BLUE CROSS SENIOR	N800	Clinical Diagnostic Lab Services	38.0
BLUE CROSS SENIOR	N801	Therapy Services	450.0
BLUE CROSS SENIOR	N804	Mammography Services	141.0

Section: Outpatient Payer Specific Charge 51
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE CROSS VIVITY - CITY	5023	Level 3 Type A ED Visits	307.0
BLUE CROSS VIVITY - CITY	5024	Level 4 Type A ED Visits	860.0
BLUE CROSS VIVITY - CITY	5025	Level 5 Type A ED Visits	1105.0
BLUE CROSS VIVITY - CITY	5052	Level 2 Skin Procedures	458.0
BLUE CROSS VIVITY - CITY	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2007.0
BLUE CROSS VIVITY - CITY	5694	Level 4 Drug Administration	11509.0
BLUE CROSS VIVITY - CITY	5731	Level 1 Minor Procedures	101.0
BLUE CROSS VIVITY - CITY	N800	Clinical Diagnostic Lab Services	15.0

Section: Outpatient Payer Specific Charge 52
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD SENIOR	5023	Level 3 Type A ED Visits	277.0
BLUE SHIELD SENIOR	5024	Level 4 Type A ED Visits	435.0
BLUE SHIELD SENIOR	5025	Level 5 Type A ED Visits	1161.0
BLUE SHIELD SENIOR	5052	Level 2 Skin Procedures	413.0
BLUE SHIELD SENIOR	5115	Level 5 Musculoskeletal Procedures	14854.0
BLUE SHIELD SENIOR	5301	Level 1 Upper GI Procedures	1124.0
BLUE SHIELD SENIOR	5302	Level 2 Upper GI Procedures	1942.0
BLUE SHIELD SENIOR	5312	Level 2 Lower GI Procedures	1244.0
BLUE SHIELD SENIOR	5521	Level 1 Imaging without Contrast	160.0
BLUE SHIELD SENIOR	5692	Level 2 Drug Administration	74.0
BLUE SHIELD SENIOR	5731	Level 1 Minor Procedures	105.0
BLUE SHIELD SENIOR	5733	Level 3 Minor Procedures	209.0
BLUE SHIELD SENIOR	5734	Level 4 Minor Procedures	135.0
BLUE SHIELD SENIOR	N801	Therapy Services	671.0
BLUE SHIELD SENIOR	N804	Mammography Services	141.0

Section: Outpatient Payer Specific Charge 53
Payer	APC	Description	Payer Specific Negotiated Charge
BLUE SHIELD TANDEM PPO	5023	Level 3 Type A ED Visits	1514.0
BLUE SHIELD TANDEM PPO	5024	Level 4 Type A ED Visits	3164.0
BLUE SHIELD TANDEM PPO	5025	Level 5 Type A ED Visits	5442.0
BLUE SHIELD TANDEM PPO	5521	Level 1 Imaging without Contrast	676.0
BLUE SHIELD TANDEM PPO	5572	Level 2 Imaging with Contrast	6767.0
BLUE SHIELD TANDEM PPO	5694	Level 4 Drug Administration	4079.0
BLUE SHIELD TANDEM PPO	5731	Level 1 Minor Procedures	594.0
BLUE SHIELD TANDEM PPO	5734	Level 4 Minor Procedures	522.0
BLUE SHIELD TANDEM PPO	N700	Non-OPPS Clinic Services	94.0
BLUE SHIELD TANDEM PPO	N804	Mammography Services	846.0

Section: Outpatient Payer Specific Charge 54
Payer	APC	Description	Payer Specific Negotiated Charge
CENTRAL HEALTH SENIOR	5023	Level 3 Type A ED Visits	304.0
CENTRAL HEALTH SENIOR	5025	Level 5 Type A ED Visits	1353.0
CENTRAL HEALTH SENIOR	N700	Non-OPPS Clinic Services	79.0

Section: Outpatient Payer Specific Charge 55
Payer	APC	Description	Payer Specific Negotiated Charge
COMMUNITY FAMILY CARE MEDI-CAL	5023	Level 3 Type A ED Visits	373.0
COMMUNITY FAMILY CARE MEDI-CAL	5521	Level 1 Imaging without Contrast	196.0
COMMUNITY FAMILY CARE MEDI-CAL	5522	Level 2 Imaging without Contrast	257.0
COMMUNITY FAMILY CARE MEDI-CAL	5523	Level 3 Imaging without Contrast	1144.0
COMMUNITY FAMILY CARE MEDI-CAL	5524	Level 4 Imaging without Contrast	556.0
COMMUNITY FAMILY CARE MEDI-CAL	5571	Level 1 Imaging with Contrast	986.0
COMMUNITY FAMILY CARE MEDI-CAL	5591	Level 1 Nuclear Medicine and Related Services	781.0
COMMUNITY FAMILY CARE MEDI-CAL	5592	Level 2 Nuclear Medicine and Related Services	915.0
COMMUNITY FAMILY CARE MEDI-CAL	5593	Level 3 Nuclear Medicine and Related Services	1174.0
COMMUNITY FAMILY CARE MEDI-CAL	5673	Level 3 Pathology	222.0
COMMUNITY FAMILY CARE MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	92.0
COMMUNITY FAMILY CARE MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	589.0
COMMUNITY FAMILY CARE MEDI-CAL	5724	Level 4 Diagnostic Tests and Related Services	1350.0
COMMUNITY FAMILY CARE MEDI-CAL	5731	Level 1 Minor Procedures	55.0
COMMUNITY FAMILY CARE MEDI-CAL	5733	Level 3 Minor Procedures	153.0
COMMUNITY FAMILY CARE MEDI-CAL	5771	Cardiac Rehabilitation	636.0
COMMUNITY FAMILY CARE MEDI-CAL	5791	Pulmonary Treatment	71.0
COMMUNITY FAMILY CARE MEDI-CAL	N700	Non-OPPS Clinic Services	40.0
COMMUNITY FAMILY CARE MEDI-CAL	N800	Clinical Diagnostic Lab Services	55.0
COMMUNITY FAMILY CARE MEDI-CAL	N809	Other Medicine	11.0

Section: Outpatient Payer Specific Charge 56
Payer	APC	Description	Payer Specific Negotiated Charge
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5023	Level 3 Type A ED Visits	500.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5024	Level 4 Type A ED Visits	857.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5025	Level 5 Type A ED Visits	2038.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5521	Level 1 Imaging without Contrast	145.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5522	Level 2 Imaging without Contrast	237.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5591	Level 1 Nuclear Medicine and Related Services	747.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	87.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5723	Level 3 Diagnostic Tests and Related Services	710.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5731	Level 1 Minor Procedures	52.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5733	Level 3 Minor Procedures	117.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	5791	Pulmonary Treatment	113.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	N700	Non-OPPS Clinic Services	38.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	N800	Clinical Diagnostic Lab Services	68.0
EXCEPTIONAL CARE MEDICAL GROUP MEDI-CAL	N809	Other Medicine	10.0

Section: Outpatient Payer Specific Charge 57
Payer	APC	Description	Payer Specific Negotiated Charge
FIRST HEALTH PPO	5023	Level 3 Type A ED Visits	1123.0
FIRST HEALTH PPO	5024	Level 4 Type A ED Visits	1957.0
FIRST HEALTH PPO	5521	Level 1 Imaging without Contrast	1105.0
FIRST HEALTH PPO	5693	Level 3 Drug Administration	19499.0
FIRST HEALTH PPO	5731	Level 1 Minor Procedures	150.0
FIRST HEALTH PPO	N800	Clinical Diagnostic Lab Services	43.0
FIRST HEALTH PPO	N804	Mammography Services	661.0

Section: Outpatient Payer Specific Charge 58
Payer	APC	Description	Payer Specific Negotiated Charge
GLOBAL CARE MEDI-CAL	5023	Level 3 Type A ED Visits	344.0
GLOBAL CARE MEDI-CAL	5521	Level 1 Imaging without Contrast	297.0
GLOBAL CARE MEDI-CAL	5522	Level 2 Imaging without Contrast	467.0
GLOBAL CARE MEDI-CAL	5524	Level 4 Imaging without Contrast	341.0
GLOBAL CARE MEDI-CAL	5571	Level 1 Imaging with Contrast	267.0
GLOBAL CARE MEDI-CAL	5572	Level 2 Imaging with Contrast	1175.0
GLOBAL CARE MEDI-CAL	5593	Level 3 Nuclear Medicine and Related Services	758.0
GLOBAL CARE MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	129.0
GLOBAL CARE MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	463.0
GLOBAL CARE MEDI-CAL	5731	Level 1 Minor Procedures	36.0
GLOBAL CARE MEDI-CAL	5733	Level 3 Minor Procedures	218.0
GLOBAL CARE MEDI-CAL	5734	Level 4 Minor Procedures	294.0
GLOBAL CARE MEDI-CAL	5771	Cardiac Rehabilitation	349.0
GLOBAL CARE MEDI-CAL	5791	Pulmonary Treatment	88.0
GLOBAL CARE MEDI-CAL	N700	Non-OPPS Clinic Services	26.0
GLOBAL CARE MEDI-CAL	N800	Clinical Diagnostic Lab Services	143.0
GLOBAL CARE MEDI-CAL	N801	Therapy Services	222.0
GLOBAL CARE MEDI-CAL	N809	Other Medicine	7.0

Section: Outpatient Payer Specific Charge 59
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTH NET ENHANCED PPO	5023	Level 3 Type A ED Visits	1498.0
HEALTH NET ENHANCED PPO	5024	Level 4 Type A ED Visits	2967.0
HEALTH NET ENHANCED PPO	5025	Level 5 Type A ED Visits	5072.0
HEALTH NET ENHANCED PPO	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	5656.0
HEALTH NET ENHANCED PPO	5521	Level 1 Imaging without Contrast	569.0
HEALTH NET ENHANCED PPO	5522	Level 2 Imaging without Contrast	610.0
HEALTH NET ENHANCED PPO	5524	Level 4 Imaging without Contrast	2014.0
HEALTH NET ENHANCED PPO	5572	Level 2 Imaging with Contrast	3497.0
HEALTH NET ENHANCED PPO	5594	Level 4 Nuclear Medicine and Related Services	4596.0
HEALTH NET ENHANCED PPO	5692	Level 2 Drug Administration	601.0
HEALTH NET ENHANCED PPO	5693	Level 3 Drug Administration	1403.0
HEALTH NET ENHANCED PPO	5694	Level 4 Drug Administration	1212.0
HEALTH NET ENHANCED PPO	5721	Level 1 Diagnostic Tests and Related Services	488.0
HEALTH NET ENHANCED PPO	5722	Level 2 Diagnostic Tests and Related Services	1251.0
HEALTH NET ENHANCED PPO	5731	Level 1 Minor Procedures	228.0
HEALTH NET ENHANCED PPO	5733	Level 3 Minor Procedures	165.0
HEALTH NET ENHANCED PPO	5734	Level 4 Minor Procedures	503.0
HEALTH NET ENHANCED PPO	5771	Cardiac Rehabilitation	1619.0
HEALTH NET ENHANCED PPO	N700	Non-OPPS Clinic Services	67.0
HEALTH NET ENHANCED PPO	N800	Clinical Diagnostic Lab Services	284.0
HEALTH NET ENHANCED PPO	N801	Therapy Services	522.0
HEALTH NET ENHANCED PPO	N804	Mammography Services	381.0
HEALTH NET ENHANCED PPO	N900	Non-covered Services	25.0

Section: Outpatient Payer Specific Charge 60
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTH NET SENIOR	5023	Level 3 Type A ED Visits	277.0
HEALTH NET SENIOR	5024	Level 4 Type A ED Visits	565.0
HEALTH NET SENIOR	5025	Level 5 Type A ED Visits	1042.0
HEALTH NET SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1726.0
HEALTH NET SENIOR	5241	Level 1 Blood Product Exchange and Related Services	763.0
HEALTH NET SENIOR	5693	Level 3 Drug Administration	245.0
HEALTH NET SENIOR	5694	Level 4 Drug Administration	503.0
HEALTH NET SENIOR	5731	Level 1 Minor Procedures	123.0
HEALTH NET SENIOR	N700	Non-OPPS Clinic Services	124.0

Section: Outpatient Payer Specific Charge 61
Payer	APC	Description	Payer Specific Negotiated Charge
HERITAGE PROVIDER NETWORK SENIOR	5023	Level 3 Type A ED Visits	332.0
HERITAGE PROVIDER NETWORK SENIOR	5024	Level 4 Type A ED Visits	522.0
HERITAGE PROVIDER NETWORK SENIOR	5025	Level 5 Type A ED Visits	1189.0
HERITAGE PROVIDER NETWORK SENIOR	5061	Hyperbaric Oxygen	3422.0
HERITAGE PROVIDER NETWORK SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1682.0
HERITAGE PROVIDER NETWORK SENIOR	5183	Level 3 Vascular Procedures	3422.0
HERITAGE PROVIDER NETWORK SENIOR	5301	Level 1 Upper GI Procedures	2311.0
HERITAGE PROVIDER NETWORK SENIOR	5302	Level 2 Upper GI Procedures	1942.0
HERITAGE PROVIDER NETWORK SENIOR	5521	Level 1 Imaging without Contrast	97.0
HERITAGE PROVIDER NETWORK SENIOR	5571	Level 1 Imaging with Contrast	214.0
HERITAGE PROVIDER NETWORK SENIOR	5593	Level 3 Nuclear Medicine and Related Services	3282.0
HERITAGE PROVIDER NETWORK SENIOR	5672	Level 2 Pathology	97.0
HERITAGE PROVIDER NETWORK SENIOR	5723	Level 3 Diagnostic Tests and Related Services	900.0
HERITAGE PROVIDER NETWORK SENIOR	5731	Level 1 Minor Procedures	105.0
HERITAGE PROVIDER NETWORK SENIOR	5732	Level 2 Minor Procedures	40.0
HERITAGE PROVIDER NETWORK SENIOR	5733	Level 3 Minor Procedures	67.0
HERITAGE PROVIDER NETWORK SENIOR	5734	Level 4 Minor Procedures	138.0
HERITAGE PROVIDER NETWORK SENIOR	N800	Clinical Diagnostic Lab Services	29.0
HERITAGE PROVIDER NETWORK SENIOR	N801	Therapy Services	364.0

Section: Outpatient Payer Specific Charge 62
Payer	APC	Description	Payer Specific Negotiated Charge
HUMANA CHOICECARE	5023	Level 3 Type A ED Visits	1899.0
HUMANA CHOICECARE	N801	Therapy Services	1843.0
HUMANA CHOICECARE	N804	Mammography Services	874.0

Section: Outpatient Payer Specific Charge 63
Payer	APC	Description	Payer Specific Negotiated Charge
HUMANA SENIOR	5023	Level 3 Type A ED Visits	277.0
HUMANA SENIOR	5024	Level 4 Type A ED Visits	565.0
HUMANA SENIOR	5025	Level 5 Type A ED Visits	906.0
HUMANA SENIOR	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	1690.0
HUMANA SENIOR	5521	Level 1 Imaging without Contrast	122.0
HUMANA SENIOR	5522	Level 2 Imaging without Contrast	130.0
HUMANA SENIOR	5693	Level 3 Drug Administration	2564.0
HUMANA SENIOR	5731	Level 1 Minor Procedures	105.0
HUMANA SENIOR	N801	Therapy Services	654.0
HUMANA SENIOR	N804	Mammography Services	141.0

Section: Outpatient Payer Specific Charge 64
Payer	APC	Description	Payer Specific Negotiated Charge
MOLINA EXCHANGE	5023	Level 3 Type A ED Visits	448.0
MOLINA EXCHANGE	5024	Level 4 Type A ED Visits	705.0
MOLINA EXCHANGE	5025	Level 5 Type A ED Visits	1642.0
MOLINA EXCHANGE	5731	Level 1 Minor Procedures	169.0

Section: Outpatient Payer Specific Charge 65
Payer	APC	Description	Payer Specific Negotiated Charge
MOLINA SENIOR	5023	Level 3 Type A ED Visits	285.0
MOLINA SENIOR	5025	Level 5 Type A ED Visits	1261.0
MOLINA SENIOR	5734	Level 4 Minor Procedures	139.0

Section: Outpatient Payer Specific Charge 66
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN COVERED CALIFORNIA	5023	Level 3 Type A ED Visits	465.0
MONARCH HEALTH PLAN COVERED CALIFORNIA	5024	Level 4 Type A ED Visits	950.0
MONARCH HEALTH PLAN COVERED CALIFORNIA	5025	Level 5 Type A ED Visits	1391.0
MONARCH HEALTH PLAN COVERED CALIFORNIA	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	2829.0

Section: Outpatient Payer Specific Charge 67
Payer	APC	Description	Payer Specific Negotiated Charge
MULTIPLAN PRIMARY NETWORK	5023	Level 3 Type A ED Visits	1685.0
MULTIPLAN PRIMARY NETWORK	5024	Level 4 Type A ED Visits	3578.0
MULTIPLAN PRIMARY NETWORK	5521	Level 1 Imaging without Contrast	1098.0
MULTIPLAN PRIMARY NETWORK	5731	Level 1 Minor Procedures	720.0
MULTIPLAN PRIMARY NETWORK	N804	Mammography Services	776.0

Section: Outpatient Payer Specific Charge 68
Payer	APC	Description	Payer Specific Negotiated Charge
NOBLE IPA MEDI-CAL	5023	Level 3 Type A ED Visits	352.0
NOBLE IPA MEDI-CAL	5024	Level 4 Type A ED Visits	1180.0
NOBLE IPA MEDI-CAL	5025	Level 5 Type A ED Visits	1085.0
NOBLE IPA MEDI-CAL	5521	Level 1 Imaging without Contrast	127.0
NOBLE IPA MEDI-CAL	5522	Level 2 Imaging without Contrast	167.0
NOBLE IPA MEDI-CAL	5523	Level 3 Imaging without Contrast	747.0
NOBLE IPA MEDI-CAL	5524	Level 4 Imaging without Contrast	659.0
NOBLE IPA MEDI-CAL	5571	Level 1 Imaging with Contrast	517.0
NOBLE IPA MEDI-CAL	5572	Level 2 Imaging with Contrast	1969.0
NOBLE IPA MEDI-CAL	5591	Level 1 Nuclear Medicine and Related Services	525.0
NOBLE IPA MEDI-CAL	5673	Level 3 Pathology	127.0
NOBLE IPA MEDI-CAL	5692	Level 2 Drug Administration	41.0
NOBLE IPA MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	62.0
NOBLE IPA MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	396.0
NOBLE IPA MEDI-CAL	5723	Level 3 Diagnostic Tests and Related Services	655.0
NOBLE IPA MEDI-CAL	5724	Level 4 Diagnostic Tests and Related Services	904.0
NOBLE IPA MEDI-CAL	5731	Level 1 Minor Procedures	37.0
NOBLE IPA MEDI-CAL	5732	Level 2 Minor Procedures	42.0
NOBLE IPA MEDI-CAL	5733	Level 3 Minor Procedures	87.0
NOBLE IPA MEDI-CAL	5734	Level 4 Minor Procedures	177.0
NOBLE IPA MEDI-CAL	5742	Level 2 Electronic Analysis of Devices	528.0
NOBLE IPA MEDI-CAL	5791	Pulmonary Treatment	49.0
NOBLE IPA MEDI-CAL	N700	Non-OPPS Clinic Services	27.0
NOBLE IPA MEDI-CAL	N800	Clinical Diagnostic Lab Services	75.0
NOBLE IPA MEDI-CAL	N801	Therapy Services	71.0
NOBLE IPA MEDI-CAL	N809	Other Medicine	7.0

Section: Outpatient Payer Specific Charge 69
Payer	APC	Description	Payer Specific Negotiated Charge
PREFERRED IPA SENIOR	5023	Level 3 Type A ED Visits	350.0
PREFERRED IPA SENIOR	5024	Level 4 Type A ED Visits	532.0
PREFERRED IPA SENIOR	5025	Level 5 Type A ED Visits	854.0
PREFERRED IPA SENIOR	5061	Hyperbaric Oxygen	2139.0
PREFERRED IPA SENIOR	5521	Level 1 Imaging without Contrast	97.0
PREFERRED IPA SENIOR	5522	Level 2 Imaging without Contrast	130.0
PREFERRED IPA SENIOR	5722	Level 2 Diagnostic Tests and Related Services	316.0
PREFERRED IPA SENIOR	5731	Level 1 Minor Procedures	156.0
PREFERRED IPA SENIOR	N800	Clinical Diagnostic Lab Services	28.0
PREFERRED IPA SENIOR	N801	Therapy Services	579.0

Section: Outpatient Payer Specific Charge 70
Payer	APC	Description	Payer Specific Negotiated Charge
ST. FRANCIS MEDICAL CENTER SENIOR	5023	Level 3 Type A ED Visits	277.0
ST. FRANCIS MEDICAL CENTER SENIOR	5024	Level 4 Type A ED Visits	584.0
ST. FRANCIS MEDICAL CENTER SENIOR	5025	Level 5 Type A ED Visits	1184.0
ST. FRANCIS MEDICAL CENTER SENIOR	5521	Level 1 Imaging without Contrast	101.0

Section: Outpatient Payer Specific Charge 71
Payer	APC	Description	Payer Specific Negotiated Charge
TORRANCE HOSPITAL IPA	5023	Level 3 Type A ED Visits	487.0
TORRANCE HOSPITAL IPA	5024	Level 4 Type A ED Visits	1067.0
TORRANCE HOSPITAL IPA	5025	Level 5 Type A ED Visits	2419.0
TORRANCE HOSPITAL IPA	5061	Hyperbaric Oxygen	5372.0
TORRANCE HOSPITAL IPA	5102	Level 2 Strapping and Cast Application	124.0
TORRANCE HOSPITAL IPA	5111	Level 1 Musculoskeletal Procedures	98.0
TORRANCE HOSPITAL IPA	5521	Level 1 Imaging without Contrast	154.0
TORRANCE HOSPITAL IPA	5522	Level 2 Imaging without Contrast	206.0
TORRANCE HOSPITAL IPA	5721	Level 1 Diagnostic Tests and Related Services	47.0
TORRANCE HOSPITAL IPA	5722	Level 2 Diagnostic Tests and Related Services	554.0
TORRANCE HOSPITAL IPA	5724	Level 4 Diagnostic Tests and Related Services	1330.0
TORRANCE HOSPITAL IPA	5733	Level 3 Minor Procedures	76.0
TORRANCE HOSPITAL IPA	5734	Level 4 Minor Procedures	46.0
TORRANCE HOSPITAL IPA	5791	Pulmonary Treatment	34.0
TORRANCE HOSPITAL IPA	N700	Non-OPPS Clinic Services	88.0
TORRANCE HOSPITAL IPA	N800	Clinical Diagnostic Lab Services	15.0
TORRANCE HOSPITAL IPA	N902	Packaged Services	20.0

Section: Outpatient Payer Specific Charge 72
Payer	APC	Description	Payer Specific Negotiated Charge
TRICARE VETERANS CHOICE	5023	Level 3 Type A ED Visits	396.0
TRICARE VETERANS CHOICE	5024	Level 4 Type A ED Visits	825.0
TRICARE VETERANS CHOICE	5025	Level 5 Type A ED Visits	4421.0
TRICARE VETERANS CHOICE	5061	Hyperbaric Oxygen	3179.0
TRICARE VETERANS CHOICE	5114	Level 4 Musculoskeletal Procedures	8932.0
TRICARE VETERANS CHOICE	5115	Level 5 Musculoskeletal Procedures	8959.0
TRICARE VETERANS CHOICE	5213	Level 3 Electrophysiologic Procedures	20787.0
TRICARE VETERANS CHOICE	5521	Level 1 Imaging without Contrast	228.0
TRICARE VETERANS CHOICE	5522	Level 2 Imaging without Contrast	636.0
TRICARE VETERANS CHOICE	5571	Level 1 Imaging with Contrast	990.0
TRICARE VETERANS CHOICE	5572	Level 2 Imaging with Contrast	1305.0
TRICARE VETERANS CHOICE	5672	Level 2 Pathology	700.0
TRICARE VETERANS CHOICE	5693	Level 3 Drug Administration	121.0
TRICARE VETERANS CHOICE	5722	Level 2 Diagnostic Tests and Related Services	514.0
TRICARE VETERANS CHOICE	5731	Level 1 Minor Procedures	85.0
TRICARE VETERANS CHOICE	5733	Level 3 Minor Procedures	270.0
TRICARE VETERANS CHOICE	5771	Cardiac Rehabilitation	310.0
TRICARE VETERANS CHOICE	N700	Non-OPPS Clinic Services	59.0

Section: Outpatient Payer Specific Charge 73
Payer	APC	Description	Payer Specific Negotiated Charge
CARE FIRST COMMERCIAL	5024	Level 4 Type A ED Visits	3188.0
CARE FIRST COMMERCIAL	5731	Level 1 Minor Procedures	501.0

Section: Outpatient Payer Specific Charge 74
Payer	APC	Description	Payer Specific Negotiated Charge
CARE FIRST SENIOR	5024	Level 4 Type A ED Visits	593.0
CARE FIRST SENIOR	5025	Level 5 Type A ED Visits	1142.0

Section: Outpatient Payer Specific Charge 75
Payer	APC	Description	Payer Specific Negotiated Charge
CIGNA SELECT	5024	Level 4 Type A ED Visits	2101.0
CIGNA SELECT	5025	Level 5 Type A ED Visits	2625.0
CIGNA SELECT	5731	Level 1 Minor Procedures	225.0

Section: Outpatient Payer Specific Charge 76
Payer	APC	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION-GNP	5024	Level 4 Type A ED Visits	491.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5025	Level 5 Type A ED Visits	491.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5051	Level 1 Skin Procedures	609.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	5052	Level 2 Skin Procedures	2769.0
MEMORIALCARE MEDICAL FOUNDATION-GNP	N700	Non-OPPS Clinic Services	46.0

Section: Outpatient Payer Specific Charge 77
Payer	APC	Description	Payer Specific Negotiated Charge
SELECT HEALTH COMMERCIAL	5024	Level 4 Type A ED Visits	285.0
SELECT HEALTH COMMERCIAL	5102	Level 2 Strapping and Cast Application	119.0
SELECT HEALTH COMMERCIAL	5521	Level 1 Imaging without Contrast	79.0
SELECT HEALTH COMMERCIAL	5522	Level 2 Imaging without Contrast	205.0
SELECT HEALTH COMMERCIAL	5523	Level 3 Imaging without Contrast	550.0
SELECT HEALTH COMMERCIAL	5524	Level 4 Imaging without Contrast	220.0
SELECT HEALTH COMMERCIAL	5571	Level 1 Imaging with Contrast	636.0
SELECT HEALTH COMMERCIAL	5572	Level 2 Imaging with Contrast	973.0
SELECT HEALTH COMMERCIAL	5591	Level 1 Nuclear Medicine and Related Services	397.0
SELECT HEALTH COMMERCIAL	5592	Level 2 Nuclear Medicine and Related Services	394.0
SELECT HEALTH COMMERCIAL	5594	Level 4 Nuclear Medicine and Related Services	1300.0
SELECT HEALTH COMMERCIAL	5672	Level 2 Pathology	149.0
SELECT HEALTH COMMERCIAL	5692	Level 2 Drug Administration	462.0
SELECT HEALTH COMMERCIAL	5693	Level 3 Drug Administration	181.0
SELECT HEALTH COMMERCIAL	5694	Level 4 Drug Administration	1061.0
SELECT HEALTH COMMERCIAL	5721	Level 1 Diagnostic Tests and Related Services	24.0
SELECT HEALTH COMMERCIAL	5722	Level 2 Diagnostic Tests and Related Services	107.0
SELECT HEALTH COMMERCIAL	5724	Level 4 Diagnostic Tests and Related Services	622.0
SELECT HEALTH COMMERCIAL	5731	Level 1 Minor Procedures	18.0
SELECT HEALTH COMMERCIAL	5733	Level 3 Minor Procedures	56.0
SELECT HEALTH COMMERCIAL	5734	Level 4 Minor Procedures	155.0
SELECT HEALTH COMMERCIAL	5791	Pulmonary Treatment	15.0
SELECT HEALTH COMMERCIAL	N700	Non-OPPS Clinic Services	18.0
SELECT HEALTH COMMERCIAL	N800	Clinical Diagnostic Lab Services	33.0
SELECT HEALTH COMMERCIAL	N801	Therapy Services	240.0
SELECT HEALTH COMMERCIAL	N804	Mammography Services	107.0
SELECT HEALTH COMMERCIAL	N809	Other Medicine	5.0
SELECT HEALTH COMMERCIAL	N900	Non-covered Services	7.0

Section: Outpatient Payer Specific Charge 78
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN-OTHER ANCILLARY	5025	Level 5 Type A ED Visits	624.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5061	Hyperbaric Oxygen	2994.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5612	Level 2 Therapeutic Radiation Treatment Preparation	4133.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5613	Level 3 Therapeutic Radiation Treatment Preparation	7276.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5623	Level 3 Radiation Therapy	9739.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5626	Level 6 Radiation Therapy	10663.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5671	Level 1 Pathology	59.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5672	Level 2 Pathology	178.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5673	Level 3 Pathology	348.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5721	Level 1 Diagnostic Tests and Related Services	167.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5722	Level 2 Diagnostic Tests and Related Services	316.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5723	Level 3 Diagnostic Tests and Related Services	900.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5731	Level 1 Minor Procedures	105.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5732	Level 2 Minor Procedures	40.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5733	Level 3 Minor Procedures	67.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5734	Level 4 Minor Procedures	135.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5771	Cardiac Rehabilitation	833.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5781	Resuscitation and Cardioversion	672.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	5791	Pulmonary Treatment	225.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	N800	Clinical Diagnostic Lab Services	22.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	N801	Therapy Services	450.0
MONARCH HEALTH PLAN-OTHER ANCILLARY	N902	Packaged Services	2512.0

Section: Outpatient Payer Specific Charge 79
Payer	APC	Description	Payer Specific Negotiated Charge
ONECARE SENIOR	5025	Level 5 Type A ED Visits	767.0

Section: Outpatient Payer Specific Charge 80
Payer	APC	Description	Payer Specific Negotiated Charge
PIONEER IPA COMMERCIAL/SENIOR	5025	Level 5 Type A ED Visits	905.0
PIONEER IPA COMMERCIAL/SENIOR	5521	Level 1 Imaging without Contrast	89.0
PIONEER IPA COMMERCIAL/SENIOR	5522	Level 2 Imaging without Contrast	119.0
PIONEER IPA COMMERCIAL/SENIOR	5591	Level 1 Nuclear Medicine and Related Services	447.0
PIONEER IPA COMMERCIAL/SENIOR	5721	Level 1 Diagnostic Tests and Related Services	30.0
PIONEER IPA COMMERCIAL/SENIOR	5722	Level 2 Diagnostic Tests and Related Services	478.0
PIONEER IPA COMMERCIAL/SENIOR	N800	Clinical Diagnostic Lab Services	12.0

Section: Outpatient Payer Specific Charge 81
Payer	APC	Description	Payer Specific Negotiated Charge
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5061	Hyperbaric Oxygen	1908.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5102	Level 2 Strapping and Cast Application	92.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5184	Level 4 Vascular Procedures	6692.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5521	Level 1 Imaging without Contrast	164.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5522	Level 2 Imaging without Contrast	110.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5523	Level 3 Imaging without Contrast	580.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5524	Level 4 Imaging without Contrast	516.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5571	Level 1 Imaging with Contrast	693.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5572	Level 2 Imaging with Contrast	1032.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5591	Level 1 Nuclear Medicine and Related Services	411.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5592	Level 2 Nuclear Medicine and Related Services	469.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5593	Level 3 Nuclear Medicine and Related Services	1236.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5594	Level 4 Nuclear Medicine and Related Services	1491.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5672	Level 2 Pathology	434.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5694	Level 4 Drug Administration	2863.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5721	Level 1 Diagnostic Tests and Related Services	27.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5722	Level 2 Diagnostic Tests and Related Services	370.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5724	Level 4 Diagnostic Tests and Related Services	708.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5731	Level 1 Minor Procedures	29.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5733	Level 3 Minor Procedures	180.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5734	Level 4 Minor Procedures	293.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5771	Cardiac Rehabilitation	279.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	5791	Pulmonary Treatment	17.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	N700	Non-OPPS Clinic Services	21.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	N800	Clinical Diagnostic Lab Services	21.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	N801	Therapy Services	183.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	N804	Mammography Services	123.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	N809	Other Medicine	6.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	N900	Non-covered Services	8.0
APPLECARE ANCILLARY COMMERCIAL/SENIOR	N905	Not Recognized by OPPS	69.0

Section: Outpatient Payer Specific Charge 82
Payer	APC	Description	Payer Specific Negotiated Charge
EDINGER MEDICAL GROUP IPA-GNP	5061	Hyperbaric Oxygen	2467.0
EDINGER MEDICAL GROUP IPA-GNP	5102	Level 2 Strapping and Cast Application	36.0
EDINGER MEDICAL GROUP IPA-GNP	5521	Level 1 Imaging without Contrast	69.0
EDINGER MEDICAL GROUP IPA-GNP	5522	Level 2 Imaging without Contrast	89.0
EDINGER MEDICAL GROUP IPA-GNP	5523	Level 3 Imaging without Contrast	474.0
EDINGER MEDICAL GROUP IPA-GNP	5524	Level 4 Imaging without Contrast	126.0
EDINGER MEDICAL GROUP IPA-GNP	5571	Level 1 Imaging with Contrast	582.0
EDINGER MEDICAL GROUP IPA-GNP	5572	Level 2 Imaging with Contrast	746.0
EDINGER MEDICAL GROUP IPA-GNP	5591	Level 1 Nuclear Medicine and Related Services	332.0
EDINGER MEDICAL GROUP IPA-GNP	5594	Level 4 Nuclear Medicine and Related Services	1176.0
EDINGER MEDICAL GROUP IPA-GNP	5672	Level 2 Pathology	416.0
EDINGER MEDICAL GROUP IPA-GNP	5693	Level 3 Drug Administration	87.0
EDINGER MEDICAL GROUP IPA-GNP	5694	Level 4 Drug Administration	701.0
EDINGER MEDICAL GROUP IPA-GNP	5721	Level 1 Diagnostic Tests and Related Services	22.0
EDINGER MEDICAL GROUP IPA-GNP	5722	Level 2 Diagnostic Tests and Related Services	237.0
EDINGER MEDICAL GROUP IPA-GNP	5724	Level 4 Diagnostic Tests and Related Services	575.0
EDINGER MEDICAL GROUP IPA-GNP	5731	Level 1 Minor Procedures	23.0
EDINGER MEDICAL GROUP IPA-GNP	5733	Level 3 Minor Procedures	52.0
EDINGER MEDICAL GROUP IPA-GNP	5734	Level 4 Minor Procedures	145.0
EDINGER MEDICAL GROUP IPA-GNP	5791	Pulmonary Treatment	11.0
EDINGER MEDICAL GROUP IPA-GNP	N700	Non-OPPS Clinic Services	34.0
EDINGER MEDICAL GROUP IPA-GNP	N800	Clinical Diagnostic Lab Services	12.0
EDINGER MEDICAL GROUP IPA-GNP	N801	Therapy Services	285.0
EDINGER MEDICAL GROUP IPA-GNP	N804	Mammography Services	99.0
EDINGER MEDICAL GROUP IPA-GNP	N900	Non-covered Services	7.0
EDINGER MEDICAL GROUP IPA-GNP	N905	Not Recognized by OPPS	56.0

Section: Outpatient Payer Specific Charge 83
Payer	APC	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5061	Hyperbaric Oxygen	2200.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5102	Level 2 Strapping and Cast Application	83.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5184	Level 4 Vascular Procedures	1223.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5521	Level 1 Imaging without Contrast	80.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5522	Level 2 Imaging without Contrast	102.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5523	Level 3 Imaging without Contrast	579.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5524	Level 4 Imaging without Contrast	496.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5571	Level 1 Imaging with Contrast	667.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5572	Level 2 Imaging with Contrast	1077.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5573	Level 3 Imaging with Contrast	964.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5591	Level 1 Nuclear Medicine and Related Services	395.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5592	Level 2 Nuclear Medicine and Related Services	463.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5593	Level 3 Nuclear Medicine and Related Services	896.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5594	Level 4 Nuclear Medicine and Related Services	1433.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5613	Level 3 Therapeutic Radiation Treatment Preparation	9043.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5661	Therapeutic Nuclear Medicine	1132.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5672	Level 2 Pathology	264.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5673	Level 3 Pathology	295.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5674	Level 4 Pathology	217.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5691	Level 1 Drug Administration	209.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5692	Level 2 Drug Administration	162.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5693	Level 3 Drug Administration	107.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5694	Level 4 Drug Administration	2897.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5721	Level 1 Diagnostic Tests and Related Services	99.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5722	Level 2 Diagnostic Tests and Related Services	356.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5723	Level 3 Diagnostic Tests and Related Services	493.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5724	Level 4 Diagnostic Tests and Related Services	686.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5731	Level 1 Minor Procedures	20.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5732	Level 2 Minor Procedures	22.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5733	Level 3 Minor Procedures	124.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5734	Level 4 Minor Procedures	159.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5771	Cardiac Rehabilitation	238.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	5791	Pulmonary Treatment	17.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N700	Non-OPPS Clinic Services	20.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N800	Clinical Diagnostic Lab Services	62.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N801	Therapy Services	178.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N804	Mammography Services	118.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N809	Other Medicine	5.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N902	Packaged Services	48.0
MEMORIALCARE MEDICAL FOUNDATION-ANCILLARY	N905	Not Recognized by OPPS	66.0

Section: Outpatient Payer Specific Charge 84
Payer	APC	Description	Payer Specific Negotiated Charge
PREFERRED IPA MEDI-CAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	326.0
PREFERRED IPA MEDI-CAL	5311	Level 1 Lower GI Procedures	548.0
PREFERRED IPA MEDI-CAL	5521	Level 1 Imaging without Contrast	142.0
PREFERRED IPA MEDI-CAL	5522	Level 2 Imaging without Contrast	170.0
PREFERRED IPA MEDI-CAL	5523	Level 3 Imaging without Contrast	784.0
PREFERRED IPA MEDI-CAL	5524	Level 4 Imaging without Contrast	229.0
PREFERRED IPA MEDI-CAL	5571	Level 1 Imaging with Contrast	155.0
PREFERRED IPA MEDI-CAL	5572	Level 2 Imaging with Contrast	1204.0
PREFERRED IPA MEDI-CAL	5592	Level 2 Nuclear Medicine and Related Services	617.0
PREFERRED IPA MEDI-CAL	5673	Level 3 Pathology	139.0
PREFERRED IPA MEDI-CAL	5692	Level 2 Drug Administration	56.0
PREFERRED IPA MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	63.0
PREFERRED IPA MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	482.0
PREFERRED IPA MEDI-CAL	5723	Level 3 Diagnostic Tests and Related Services	668.0
PREFERRED IPA MEDI-CAL	5731	Level 1 Minor Procedures	38.0
PREFERRED IPA MEDI-CAL	5733	Level 3 Minor Procedures	167.0
PREFERRED IPA MEDI-CAL	5734	Level 4 Minor Procedures	267.0
PREFERRED IPA MEDI-CAL	5791	Pulmonary Treatment	50.0
PREFERRED IPA MEDI-CAL	N700	Non-OPPS Clinic Services	27.0
PREFERRED IPA MEDI-CAL	N800	Clinical Diagnostic Lab Services	57.0
PREFERRED IPA MEDI-CAL	N801	Therapy Services	182.0
PREFERRED IPA MEDI-CAL	N809	Other Medicine	7.0
PREFERRED IPA MEDI-CAL	N905	Not Recognized by OPPS	90.0

Section: Outpatient Payer Specific Charge 85
Payer	APC	Description	Payer Specific Negotiated Charge
SELECT HEALTH MEDI-CAL	5072	Level 2 Excision/ Biopsy/ Incision and Drainage	559.0
SELECT HEALTH MEDI-CAL	5102	Level 2 Strapping and Cast Application	100.0
SELECT HEALTH MEDI-CAL	5111	Level 1 Musculoskeletal Procedures	130.0
SELECT HEALTH MEDI-CAL	5151	Level 1 Airway Endoscopy	44.0
SELECT HEALTH MEDI-CAL	5182	Level 2 Vascular Procedures	374.0
SELECT HEALTH MEDI-CAL	5184	Level 4 Vascular Procedures	1332.0
SELECT HEALTH MEDI-CAL	5311	Level 1 Lower GI Procedures	289.0
SELECT HEALTH MEDI-CAL	5521	Level 1 Imaging without Contrast	69.0
SELECT HEALTH MEDI-CAL	5522	Level 2 Imaging without Contrast	156.0
SELECT HEALTH MEDI-CAL	5523	Level 3 Imaging without Contrast	391.0
SELECT HEALTH MEDI-CAL	5524	Level 4 Imaging without Contrast	174.0
SELECT HEALTH MEDI-CAL	5571	Level 1 Imaging with Contrast	417.0
SELECT HEALTH MEDI-CAL	5572	Level 2 Imaging with Contrast	729.0
SELECT HEALTH MEDI-CAL	5573	Level 3 Imaging with Contrast	454.0
SELECT HEALTH MEDI-CAL	5591	Level 1 Nuclear Medicine and Related Services	274.0
SELECT HEALTH MEDI-CAL	5592	Level 2 Nuclear Medicine and Related Services	321.0
SELECT HEALTH MEDI-CAL	5593	Level 3 Nuclear Medicine and Related Services	814.0
SELECT HEALTH MEDI-CAL	5594	Level 4 Nuclear Medicine and Related Services	994.0
SELECT HEALTH MEDI-CAL	5612	Level 2 Therapeutic Radiation Treatment Preparation	2378.0
SELECT HEALTH MEDI-CAL	5613	Level 3 Therapeutic Radiation Treatment Preparation	5089.0
SELECT HEALTH MEDI-CAL	5622	Level 2 Radiation Therapy	3515.0
SELECT HEALTH MEDI-CAL	5623	Level 3 Radiation Therapy	9297.0
SELECT HEALTH MEDI-CAL	5672	Level 2 Pathology	76.0
SELECT HEALTH MEDI-CAL	5673	Level 3 Pathology	45.0
SELECT HEALTH MEDI-CAL	5691	Level 1 Drug Administration	23.0
SELECT HEALTH MEDI-CAL	5692	Level 2 Drug Administration	54.0
SELECT HEALTH MEDI-CAL	5693	Level 3 Drug Administration	100.0
SELECT HEALTH MEDI-CAL	5694	Level 4 Drug Administration	361.0
SELECT HEALTH MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	32.0
SELECT HEALTH MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	207.0
SELECT HEALTH MEDI-CAL	5723	Level 3 Diagnostic Tests and Related Services	342.0
SELECT HEALTH MEDI-CAL	5724	Level 4 Diagnostic Tests and Related Services	476.0
SELECT HEALTH MEDI-CAL	5731	Level 1 Minor Procedures	19.0
SELECT HEALTH MEDI-CAL	5732	Level 2 Minor Procedures	22.0
SELECT HEALTH MEDI-CAL	5733	Level 3 Minor Procedures	43.0
SELECT HEALTH MEDI-CAL	5734	Level 4 Minor Procedures	117.0
SELECT HEALTH MEDI-CAL	5742	Level 2 Electronic Analysis of Devices	157.0
SELECT HEALTH MEDI-CAL	5771	Cardiac Rehabilitation	186.0
SELECT HEALTH MEDI-CAL	5791	Pulmonary Treatment	40.0
SELECT HEALTH MEDI-CAL	5823	Level 3 Health and Behavior Services	27.0
SELECT HEALTH MEDI-CAL	N700	Non-OPPS Clinic Services	14.0
SELECT HEALTH MEDI-CAL	N800	Clinical Diagnostic Lab Services	43.0
SELECT HEALTH MEDI-CAL	N801	Therapy Services	123.0
SELECT HEALTH MEDI-CAL	N804	Mammography Services	82.0
SELECT HEALTH MEDI-CAL	N809	Other Medicine	4.0
SELECT HEALTH MEDI-CAL	N902	Packaged Services	31.0
SELECT HEALTH MEDI-CAL	N905	Not Recognized by OPPS	46.0

Section: Outpatient Payer Specific Charge 86
Payer	APC	Description	Payer Specific Negotiated Charge
HERITAGE PROVIDER NETWORK MEDI-CAL	5102	Level 2 Strapping and Cast Application	111.0
HERITAGE PROVIDER NETWORK MEDI-CAL	5111	Level 1 Musculoskeletal Procedures	167.0
HERITAGE PROVIDER NETWORK MEDI-CAL	5151	Level 1 Airway Endoscopy	133.0
HERITAGE PROVIDER NETWORK MEDI-CAL	5521	Level 1 Imaging without Contrast	158.0
HERITAGE PROVIDER NETWORK MEDI-CAL	5522	Level 2 Imaging without Contrast	227.0
HERITAGE PROVIDER NETWORK MEDI-CAL	5524	Level 4 Imaging without Contrast	398.0
HERITAGE PROVIDER NETWORK MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	82.0
HERITAGE PROVIDER NETWORK MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	126.0
HERITAGE PROVIDER NETWORK MEDI-CAL	5791	Pulmonary Treatment	67.0
HERITAGE PROVIDER NETWORK MEDI-CAL	N700	Non-OPPS Clinic Services	36.0
HERITAGE PROVIDER NETWORK MEDI-CAL	N800	Clinical Diagnostic Lab Services	62.0
HERITAGE PROVIDER NETWORK MEDI-CAL	N809	Other Medicine	10.0

Section: Outpatient Payer Specific Charge 87
Payer	APC	Description	Payer Specific Negotiated Charge
CALOPTIMA MEDI-CAL	5111	Level 1 Musculoskeletal Procedures	461.0
CALOPTIMA MEDI-CAL	5442	Level 2 Nerve Injections	1330.0
CALOPTIMA MEDI-CAL	5524	Level 4 Imaging without Contrast	690.0
CALOPTIMA MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	138.0
CALOPTIMA MEDI-CAL	5733	Level 3 Minor Procedures	225.0
CALOPTIMA MEDI-CAL	5743	Level 3 Electronic Analysis of Devices	261.0
CALOPTIMA MEDI-CAL	N700	Non-OPPS Clinic Services	60.0
CALOPTIMA MEDI-CAL	N800	Clinical Diagnostic Lab Services	42.0
CALOPTIMA MEDI-CAL	N809	Other Medicine	16.0

Section: Outpatient Payer Specific Charge 88
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTHCARE LA MEDI-CAL	5191	Level 1 Endovascular Procedures	4217.0
HEALTHCARE LA MEDI-CAL	5521	Level 1 Imaging without Contrast	140.0
HEALTHCARE LA MEDI-CAL	5522	Level 2 Imaging without Contrast	291.0
HEALTHCARE LA MEDI-CAL	5523	Level 3 Imaging without Contrast	577.0
HEALTHCARE LA MEDI-CAL	5524	Level 4 Imaging without Contrast	326.0
HEALTHCARE LA MEDI-CAL	5571	Level 1 Imaging with Contrast	961.0
HEALTHCARE LA MEDI-CAL	5572	Level 2 Imaging with Contrast	1412.0
HEALTHCARE LA MEDI-CAL	5573	Level 3 Imaging with Contrast	892.0
HEALTHCARE LA MEDI-CAL	5591	Level 1 Nuclear Medicine and Related Services	557.0
HEALTHCARE LA MEDI-CAL	5592	Level 2 Nuclear Medicine and Related Services	948.0
HEALTHCARE LA MEDI-CAL	5593	Level 3 Nuclear Medicine and Related Services	684.0
HEALTHCARE LA MEDI-CAL	5661	Therapeutic Nuclear Medicine	751.0
HEALTHCARE LA MEDI-CAL	5673	Level 3 Pathology	99.0
HEALTHCARE LA MEDI-CAL	5692	Level 2 Drug Administration	44.0
HEALTHCARE LA MEDI-CAL	5693	Level 3 Drug Administration	419.0
HEALTHCARE LA MEDI-CAL	5694	Level 4 Drug Administration	3033.0
HEALTHCARE LA MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	61.0
HEALTHCARE LA MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	420.0
HEALTHCARE LA MEDI-CAL	5723	Level 3 Diagnostic Tests and Related Services	638.0
HEALTHCARE LA MEDI-CAL	5724	Level 4 Diagnostic Tests and Related Services	959.0
HEALTHCARE LA MEDI-CAL	5731	Level 1 Minor Procedures	39.0
HEALTHCARE LA MEDI-CAL	5732	Level 2 Minor Procedures	44.0
HEALTHCARE LA MEDI-CAL	5733	Level 3 Minor Procedures	88.0
HEALTHCARE LA MEDI-CAL	5734	Level 4 Minor Procedures	152.0
HEALTHCARE LA MEDI-CAL	5771	Cardiac Rehabilitation	291.0
HEALTHCARE LA MEDI-CAL	5791	Pulmonary Treatment	84.0
HEALTHCARE LA MEDI-CAL	5823	Level 3 Health and Behavior Services	54.0
HEALTHCARE LA MEDI-CAL	N700	Non-OPPS Clinic Services	28.0
HEALTHCARE LA MEDI-CAL	N800	Clinical Diagnostic Lab Services	69.0
HEALTHCARE LA MEDI-CAL	N801	Therapy Services	128.0
HEALTHCARE LA MEDI-CAL	N804	Mammography Services	167.0
HEALTHCARE LA MEDI-CAL	N809	Other Medicine	8.0
HEALTHCARE LA MEDI-CAL	N902	Packaged Services	124.0
HEALTHCARE LA MEDI-CAL	N905	Not Recognized by OPPS	47.0

Section: Outpatient Payer Specific Charge 89
Payer	APC	Description	Payer Specific Negotiated Charge
SYNERMED COMMERCIAL	5241	Level 1 Blood Product Exchange and Related Services	1325.0
SYNERMED COMMERCIAL	5521	Level 1 Imaging without Contrast	116.0
SYNERMED COMMERCIAL	5522	Level 2 Imaging without Contrast	156.0
SYNERMED COMMERCIAL	5524	Level 4 Imaging without Contrast	693.0
SYNERMED COMMERCIAL	5721	Level 1 Diagnostic Tests and Related Services	200.0
SYNERMED COMMERCIAL	5722	Level 2 Diagnostic Tests and Related Services	380.0
SYNERMED COMMERCIAL	5724	Level 4 Diagnostic Tests and Related Services	1320.0
SYNERMED COMMERCIAL	5733	Level 3 Minor Procedures	80.0
SYNERMED COMMERCIAL	N700	Non-OPPS Clinic Services	136.0
SYNERMED COMMERCIAL	N800	Clinical Diagnostic Lab Services	9.0

Section: Outpatient Payer Specific Charge 90
Payer	APC	Description	Payer Specific Negotiated Charge
EDINGER VALUATION	5302	Level 2 Upper GI Procedures	1510.0
EDINGER VALUATION	5694	Level 4 Drug Administration	1960.0
EDINGER VALUATION	N700	Non-OPPS Clinic Services	95.0
EDINGER VALUATION	N809	Other Medicine	26.0

Section: Outpatient Payer Specific Charge 91
Payer	APC	Description	Payer Specific Negotiated Charge
APPLECARE ANCILLARY MEDI-CAL	5521	Level 1 Imaging without Contrast	88.0
APPLECARE ANCILLARY MEDI-CAL	5522	Level 2 Imaging without Contrast	181.0
APPLECARE ANCILLARY MEDI-CAL	5523	Level 3 Imaging without Contrast	497.0
APPLECARE ANCILLARY MEDI-CAL	5524	Level 4 Imaging without Contrast	435.0
APPLECARE ANCILLARY MEDI-CAL	5571	Level 1 Imaging with Contrast	543.0
APPLECARE ANCILLARY MEDI-CAL	5572	Level 2 Imaging with Contrast	877.0
APPLECARE ANCILLARY MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	38.0
APPLECARE ANCILLARY MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	324.0
APPLECARE ANCILLARY MEDI-CAL	5731	Level 1 Minor Procedures	24.0
APPLECARE ANCILLARY MEDI-CAL	5733	Level 3 Minor Procedures	201.0
APPLECARE ANCILLARY MEDI-CAL	5734	Level 4 Minor Procedures	198.0
APPLECARE ANCILLARY MEDI-CAL	5771	Cardiac Rehabilitation	329.0
APPLECARE ANCILLARY MEDI-CAL	N700	Non-OPPS Clinic Services	18.0
APPLECARE ANCILLARY MEDI-CAL	N800	Clinical Diagnostic Lab Services	104.0
APPLECARE ANCILLARY MEDI-CAL	N801	Therapy Services	120.0
APPLECARE ANCILLARY MEDI-CAL	N804	Mammography Services	104.0
APPLECARE ANCILLARY MEDI-CAL	N809	Other Medicine	5.0

Section: Outpatient Payer Specific Charge 92
Payer	APC	Description	Payer Specific Negotiated Charge
ASIAN COMMUNITY MEDICAL GROUP	5521	Level 1 Imaging without Contrast	166.0
ASIAN COMMUNITY MEDICAL GROUP	5722	Level 2 Diagnostic Tests and Related Services	422.0
ASIAN COMMUNITY MEDICAL GROUP	5724	Level 4 Diagnostic Tests and Related Services	971.0
ASIAN COMMUNITY MEDICAL GROUP	5731	Level 1 Minor Procedures	39.0
ASIAN COMMUNITY MEDICAL GROUP	N700	Non-OPPS Clinic Services	28.0
ASIAN COMMUNITY MEDICAL GROUP	N800	Clinical Diagnostic Lab Services	87.0
ASIAN COMMUNITY MEDICAL GROUP	N804	Mammography Services	167.0
ASIAN COMMUNITY MEDICAL GROUP	N809	Other Medicine	8.0

Section: Outpatient Payer Specific Charge 93
Payer	APC	Description	Payer Specific Negotiated Charge
CALCARE IPA MEDI-CAL	5521	Level 1 Imaging without Contrast	311.0
CALCARE IPA MEDI-CAL	5522	Level 2 Imaging without Contrast	165.0
CALCARE IPA MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	53.0
CALCARE IPA MEDI-CAL	5724	Level 4 Diagnostic Tests and Related Services	774.0
CALCARE IPA MEDI-CAL	5731	Level 1 Minor Procedures	67.0
CALCARE IPA MEDI-CAL	N700	Non-OPPS Clinic Services	23.0
CALCARE IPA MEDI-CAL	N800	Clinical Diagnostic Lab Services	145.0
CALCARE IPA MEDI-CAL	N809	Other Medicine	6.0

Section: Outpatient Payer Specific Charge 94
Payer	APC	Description	Payer Specific Negotiated Charge
CALOPTIMA MEDI-CAL-CHOC	5521	Level 1 Imaging without Contrast	179.0
CALOPTIMA MEDI-CAL-CHOC	N700	Non-OPPS Clinic Services	42.0
CALOPTIMA MEDI-CAL-CHOC	N809	Other Medicine	10.0

Section: Outpatient Payer Specific Charge 95
Payer	APC	Description	Payer Specific Negotiated Charge
CENTIVO	5521	Level 1 Imaging without Contrast	496.0
CENTIVO	N700	Non-OPPS Clinic Services	79.0

Section: Outpatient Payer Specific Charge 96
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTHCARE LA HMO	5521	Level 1 Imaging without Contrast	116.0
HEALTHCARE LA HMO	5522	Level 2 Imaging without Contrast	156.0
HEALTHCARE LA HMO	5572	Level 2 Imaging with Contrast	528.0
HEALTHCARE LA HMO	5692	Level 2 Drug Administration	89.0
HEALTHCARE LA HMO	5722	Level 2 Diagnostic Tests and Related Services	380.0
HEALTHCARE LA HMO	5733	Level 3 Minor Procedures	80.0
HEALTHCARE LA HMO	5734	Level 4 Minor Procedures	183.0
HEALTHCARE LA HMO	5771	Cardiac Rehabilitation	666.0
HEALTHCARE LA HMO	N700	Non-OPPS Clinic Services	79.0
HEALTHCARE LA HMO	N800	Clinical Diagnostic Lab Services	73.0
HEALTHCARE LA HMO	N801	Therapy Services	408.0

Section: Outpatient Payer Specific Charge 97
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTHCARE LA SENIOR	5521	Level 1 Imaging without Contrast	97.0
HEALTHCARE LA SENIOR	5522	Level 2 Imaging without Contrast	130.0
HEALTHCARE LA SENIOR	5523	Level 3 Imaging without Contrast	275.0
HEALTHCARE LA SENIOR	5524	Level 4 Imaging without Contrast	578.0
HEALTHCARE LA SENIOR	5572	Level 2 Imaging with Contrast	440.0
HEALTHCARE LA SENIOR	5692	Level 2 Drug Administration	909.0
HEALTHCARE LA SENIOR	5722	Level 2 Diagnostic Tests and Related Services	316.0
HEALTHCARE LA SENIOR	5724	Level 4 Diagnostic Tests and Related Services	1100.0
HEALTHCARE LA SENIOR	5731	Level 1 Minor Procedures	134.0
HEALTHCARE LA SENIOR	5733	Level 3 Minor Procedures	67.0
HEALTHCARE LA SENIOR	5734	Level 4 Minor Procedures	161.0
HEALTHCARE LA SENIOR	N700	Non-OPPS Clinic Services	79.0
HEALTHCARE LA SENIOR	N800	Clinical Diagnostic Lab Services	16.0
HEALTHCARE LA SENIOR	N801	Therapy Services	650.0
HEALTHCARE LA SENIOR	N804	Mammography Services	141.0

Section: Outpatient Payer Specific Charge 98
Payer	APC	Description	Payer Specific Negotiated Charge
HEALTHY NEW LIFE MEDI-CAL	5521	Level 1 Imaging without Contrast	173.0
HEALTHY NEW LIFE MEDI-CAL	5522	Level 2 Imaging without Contrast	212.0
HEALTHY NEW LIFE MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	78.0
HEALTHY NEW LIFE MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	715.0
HEALTHY NEW LIFE MEDI-CAL	5731	Level 1 Minor Procedures	47.0
HEALTHY NEW LIFE MEDI-CAL	5791	Pulmonary Treatment	105.0
HEALTHY NEW LIFE MEDI-CAL	N700	Non-OPPS Clinic Services	34.0
HEALTHY NEW LIFE MEDI-CAL	N800	Clinical Diagnostic Lab Services	61.0
HEALTHY NEW LIFE MEDI-CAL	N809	Other Medicine	9.0

Section: Outpatient Payer Specific Charge 99
Payer	APC	Description	Payer Specific Negotiated Charge
MEMORIALCARE MEDICAL FOUNDATION-CAPITATED	5521	Level 1 Imaging without Contrast	93.0
MEMORIALCARE MEDICAL FOUNDATION-CAPITATED	5522	Level 2 Imaging without Contrast	86.0
MEMORIALCARE MEDICAL FOUNDATION-CAPITATED	5572	Level 2 Imaging with Contrast	419.0
MEMORIALCARE MEDICAL FOUNDATION-CAPITATED	N804	Mammography Services	62.0

Section: Outpatient Payer Specific Charge 100
Payer	APC	Description	Payer Specific Negotiated Charge
MONARCH HEALTH PLAN-RAD ANCILLARY	5521	Level 1 Imaging without Contrast	200.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5522	Level 2 Imaging without Contrast	129.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5523	Level 3 Imaging without Contrast	732.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5524	Level 4 Imaging without Contrast	628.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5571	Level 1 Imaging with Contrast	517.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5572	Level 2 Imaging with Contrast	1204.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5591	Level 1 Nuclear Medicine and Related Services	500.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5592	Level 2 Nuclear Medicine and Related Services	588.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5594	Level 4 Nuclear Medicine and Related Services	1813.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5672	Level 2 Pathology	92.0
MONARCH HEALTH PLAN-RAD ANCILLARY	5734	Level 4 Minor Procedures	182.0
MONARCH HEALTH PLAN-RAD ANCILLARY	N804	Mammography Services	150.0

Section: Outpatient Payer Specific Charge 101
Payer	APC	Description	Payer Specific Negotiated Charge
PIONEER IPA MEDI-CAL	5521	Level 1 Imaging without Contrast	209.0
PIONEER IPA MEDI-CAL	5522	Level 2 Imaging without Contrast	295.0
PIONEER IPA MEDI-CAL	5692	Level 2 Drug Administration	73.0
PIONEER IPA MEDI-CAL	5693	Level 3 Drug Administration	1077.0
PIONEER IPA MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	109.0
PIONEER IPA MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	700.0
PIONEER IPA MEDI-CAL	5723	Level 3 Diagnostic Tests and Related Services	1159.0
PIONEER IPA MEDI-CAL	5731	Level 1 Minor Procedures	65.0
PIONEER IPA MEDI-CAL	5733	Level 3 Minor Procedures	530.0
PIONEER IPA MEDI-CAL	5791	Pulmonary Treatment	87.0
PIONEER IPA MEDI-CAL	N700	Non-OPPS Clinic Services	47.0
PIONEER IPA MEDI-CAL	N800	Clinical Diagnostic Lab Services	128.0
PIONEER IPA MEDI-CAL	N809	Other Medicine	13.0

Section: Outpatient Payer Specific Charge 102
Payer	APC	Description	Payer Specific Negotiated Charge
SELECT HEALTH SENIOR	5521	Level 1 Imaging without Contrast	112.0
SELECT HEALTH SENIOR	5522	Level 2 Imaging without Contrast	92.0
SELECT HEALTH SENIOR	5523	Level 3 Imaging without Contrast	360.0
SELECT HEALTH SENIOR	5571	Level 1 Imaging with Contrast	252.0
SELECT HEALTH SENIOR	5572	Level 2 Imaging with Contrast	779.0
SELECT HEALTH SENIOR	5594	Level 4 Nuclear Medicine and Related Services	891.0
SELECT HEALTH SENIOR	5693	Level 3 Drug Administration	212.0
SELECT HEALTH SENIOR	5694	Level 4 Drug Administration	245.0
SELECT HEALTH SENIOR	5722	Level 2 Diagnostic Tests and Related Services	221.0
SELECT HEALTH SENIOR	5731	Level 1 Minor Procedures	17.0
SELECT HEALTH SENIOR	5733	Level 3 Minor Procedures	88.0
SELECT HEALTH SENIOR	5734	Level 4 Minor Procedures	88.0
SELECT HEALTH SENIOR	5771	Cardiac Rehabilitation	100.0
SELECT HEALTH SENIOR	N700	Non-OPPS Clinic Services	12.0
SELECT HEALTH SENIOR	N801	Therapy Services	56.0
SELECT HEALTH SENIOR	N804	Mammography Services	74.0
SELECT HEALTH SENIOR	N809	Other Medicine	3.0

Section: Outpatient Payer Specific Charge 103
Payer	APC	Description	Payer Specific Negotiated Charge
SOUTH ATLANTIC MEDI-CAL	5521	Level 1 Imaging without Contrast	149.0
SOUTH ATLANTIC MEDI-CAL	5522	Level 2 Imaging without Contrast	311.0
SOUTH ATLANTIC MEDI-CAL	5673	Level 3 Pathology	60.0
SOUTH ATLANTIC MEDI-CAL	5692	Level 2 Drug Administration	44.0
SOUTH ATLANTIC MEDI-CAL	5721	Level 1 Diagnostic Tests and Related Services	65.0
SOUTH ATLANTIC MEDI-CAL	5722	Level 2 Diagnostic Tests and Related Services	499.0
SOUTH ATLANTIC MEDI-CAL	5724	Level 4 Diagnostic Tests and Related Services	963.0
SOUTH ATLANTIC MEDI-CAL	5731	Level 1 Minor Procedures	83.0
SOUTH ATLANTIC MEDI-CAL	5733	Level 3 Minor Procedures	92.0
SOUTH ATLANTIC MEDI-CAL	5791	Pulmonary Treatment	88.0
SOUTH ATLANTIC MEDI-CAL	N700	Non-OPPS Clinic Services	28.0
SOUTH ATLANTIC MEDI-CAL	N800	Clinical Diagnostic Lab Services	76.0
SOUTH ATLANTIC MEDI-CAL	N801	Therapy Services	75.0
SOUTH ATLANTIC MEDI-CAL	N809	Other Medicine	8.0

Section: Outpatient Payer Specific Charge 104
Payer	APC	Description	Payer Specific Negotiated Charge
GLOBAL CARE HMO	5771	Cardiac Rehabilitation	833.0
GLOBAL CARE HMO	N700	Non-OPPS Clinic Services	79.0